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Permanent URI for this communityhttps://hdl.handle.net/20.500.12503/30801
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Browsing Abstracts by Author "Ali, Arsalan"
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Item A Case Series of Atypical Back Pain in Pediatric Athletes(2022) Ali, Arsalan; Jacobs, Benjamin; Gandhi, Artee; Brooks, MeredithBackground: Baastrup's disease is a rare, often misdiagnosed, cause of back pain in children. It is characterized by degenerative changes of both spinous processes and interspinous soft tissues between two adjacent vertebrae. Repetitive spinal movements in the sagittal plane predispose to injury of the posterior elements of the spine. Chronic flexion and extension strain the interspinous ligament causing the neighboring spinous processes to adjoin. Pain is aggravated by extension and palpation and is alleviated with flexion. Some children with Baastrup's do not experience pain but present with swelling along the spinous processes. Moreover, increased interspinous spaces and bone remodeling may also be seen. Diagnosis is dependent on distinctive radiologic findings and characteristic exam features. This is the first report of children undergoing interventional modalities for the treatment of Baastrup's disease. Case Information: The first case study is a 16-year-old active gymnast who initially presented to the clinic in 2014 with complaints of a sore back that worsened with extension and arching. On physical exam, there were trigger points along her thoracic spinous processes. Diagnostic imaging revealed early suspicion for spinous process abnormality at the thoracolumbar junction region vertebra, particularly T12. A conservative treatment approach was initially taken however her symptoms did not resolve. The patient ultimately underwent bilateral T11, T12, L1 medial branch blocks. The second case is an 18-year-old female cheerleader and gymnast who initially presented to the clinic in 2016 complaining of one year duration of back pain that started after doing tumbling exercises in gymnastics. After multiple visits and imaging modalities, a working diagnosis of Baastrup's disease was suspected. The patient was treated with four trigger point injections in her interspinous ligament that were done at different times. Conclusion: While the current treatment for pain associated with Baastrup's is directed towards physical therapy, massage therapy, nonsteroidal anti-inflammatory medications, muscle relaxants and rest from activity, this is the first report of children undergoing interventional modalities for the treatment of back pain associated with Baastrup's disease. The epidemiology of the disease is very rare in the pediatric population, however, certain active groups such as gymnasts can be at an increased risk due to repeated spinal extension and flexion movements.Item Case Report: Patient with 3 Gastric Cancers Simultaneously (Adenocarcionma, NET, GIST)(2022) Jacobs, Benjamin; Ali, Arsalan; Logarajah, Shankar; Jeyarajah, RohanBackground: Cancer is the second leading cause of death in the world second only to heart disease. The top three cancers by incidence for men are Lung, Prostate, and Colorectal. For women, the top three cancers by incidence are Breast, Colorectal, and Lung. Although gastric cancer does not crack the top three for men or women by incidence, gastric cancer is the second most common cause of cancer death worldwide. Of the different types of gastric cancer, adenocarcinoma of the stomach comprises nearly 95% of all forms of gastric cancer. The other less common types of gastric cancer include primary gastric lymphoma, gastrointestinal stromal tumor (GIST), and neuroendocrine (carcinoid) tumors. Diagnosis of the specific type of gastric cancer comes from the analysis of the removed specimen under the microscope. Multiple gastric cancers in a single patient are extremely rare and few cases have been reported. We report a case of a patient with three distinct types of gastric cancer in one pathology specimen. Case Information: The patient is a 77-year-old female who underwent total gastrectomy and distal esophagectomy in 2011 for concerning imaging and EGD studies consistent with cancerous lesions in her stomach. Upon examination under the microscope, the pathology report revealed three distinct cancers: 1) Mucinous adenocarcinoma 2) Well-differentiated neuroendocrine and 3) Gastrointestinal stromal tumor. After surgery, this patient underwent adjuvant chemoradiation and has been in remission and cancer-free going on 10 years. Conclusions: We present an extremely rare and peculiar case of a 77-year-old female who is 10 years post-op total gastrectomy and distal esophagectomy revealing three separate, coexisting, gastric cancers. Coexisting gastric cancers are very uncommon; however, physicians shouldn't rule out the possibility of their patients' having more than one type of cancer in the pathology specimen report. Understanding the different types of gastric cancer can alter therapy and change the plan moving forward (post-op) to recheck scans for lesions elsewhere in the body and undergo genetic testing for inherited mutations.