4451
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Charitos IA, Ballini A, Bottalico L, Cantore S, Passarelli PC, Inchingolo F, D'Addona A, Santacroce L. Special features of SARS-CoV-2 in daily practice. World J Clin Cases 2020; 8:3920-3933. [PMID: 33024749 PMCID: PMC7520789 DOI: 10.12998/wjcc.v8.i18.3920] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 07/31/2020] [Accepted: 09/01/2020] [Indexed: 02/05/2023] Open
Abstract
The severe acute respiratory syndrome-coronavirus-2 (commonly known as SARS-CoV-2) is a novel coronavirus (designated as 2019-nCoV), which was isolated for the first time after the Chinese health authorities reported a cluster of pneumonia cases in Wuhan, China in December 2019. Optimal management of the Coronavirus Disease-2019 disease is evolving quickly and treatment guidelines, based on scientific evidence and experts' opinions with clinical experience, are constantly being updated. On January 30, 2020, the World Health Organization declared the SARS-CoV-2 outbreak as a "Public Health Emergency of International Concern". The total lack of immune protection brought about a severe spread of the contagion all over the world. For this reason, diagnostic tools, patient management and therapeutic approaches have been tested along the way, in the desperate race to break free from the widespread infection and its fatal respiratory complications. Current medical knowledge and research on severe and critical patients' management and experimental treatments are still evolving, but several protocols on minimizing risk of infection among the general population, patients and healthcare workers have been approved and diffused by International Health Authorities.
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Affiliation(s)
- Ioannis A Charitos
- Department of Emergency and Urgency, National Poisoning Centre, Riuniti University Hospital of Foggia, Foggia 71122, Italy
| | - Andrea Ballini
- Department of Biosciences, Biotechnologies and Biopharmaceutics, University Campus "E. Quagliariello", University of Bari “Aldo Moro”, Bari 70125, Italy
- Department of Precision Medicine, University of Campania “Luigi Vanvitelli”, Naples 80138, Italy
| | - Lucrezia Bottalico
- Interdepartmental Research Center for Pre-Latin, Latin and Oriental Rights and Culture Studies (CEDICLO), University of Bari, Bari 70121, Italy
| | - Stefania Cantore
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, Bari 70124, Italy
- Sorriso & Benessere - Ricerca e Clinica S.R.L, Bari 70129, Italy
| | - Pier Carmine Passarelli
- Department of Head, Neck and Sense Organs, Division of Oral Surgery and Implantology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Francesco Inchingolo
- Department of Interdisciplinary Medicine, Section of Dental Medicine, University of Bari “Aldo Moro”, Bari 70124, Italy
| | - Antonio D'Addona
- Department of Head and Neck and Sensory Organs, Division of Oral Surgery and Implantology, Fondazione Policlinico Universitario A. Gemelli IRCCS — Università Cattolica del Sacro Cuore, Roma 00168, Italy
| | - Luigi Santacroce
- Interdepartmental Research Center for Pre-Latin, Latin and Oriental Rights and Culture Studies (CEDICLO), University of Bari, Bari 70121, Italy
- Ionian Department, Microbiology and Virology Laboratory, Policlinico University Hospital, University of Bari “Aldo Moro”, Bari 70124, Italy
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4452
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Long FJ, Chen H, Wang YF, He LM, Chen L, Liang ZB, Chen YN, Gong XH. Research on the effect of health care integration on patients’ negative emotions and satisfaction with lung cancer nursing activities. World J Clin Cases 2020; 8:4059-4066. [PMID: 33024763 PMCID: PMC7520783 DOI: 10.12998/wjcc.v8.i18.4059] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 05/25/2020] [Accepted: 08/13/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Lung cancer is a clinical disease with multiple malignant tumors. Currently, it is difficult for patients to benefit from routine clinical nursing due to the lack of a pertinent and systematic approach.
AIM To investigate the effect of integrated nursing care on the negative emotions and satisfaction of lung cancer patients.
METHODS From January 2018 to December 2019, 92 patients with lung cancer were selected and divided into the study group and the control group; there were 46 patients in each group. The control group received routine nursing, and the study group received integrated medical care in addition to the care received by the control group. Negative emotions before and after the intervention, the self-management ability score after the intervention, family care burden after the intervention and nursing satisfaction after the intervention were measured in the two groups.
RESULTS After the intervention, the self-rating anxiety scale and self-rating depression scale scores in the study group were lower than those in the control group (P < 0.05); the scores for health knowledge, self-concept, self-responsibility and self-care skills in the study group were higher than those in the control group (P < 0.05); the scores for individual burden and responsibility burden in the study group were lower than those before the intervention (P < 0.05); and the nursing satisfaction in the study group (93.48%) was higher than that in the control group (78.26%, P < 0.05).
CONCLUSION An integrated nursing care approach for lung cancer patients can effectively relieve the patient’s negative feelings, improve their self-management ability, help to reduce the burden of family care and improve patient satisfaction with nursing activities.
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Affiliation(s)
- Feng-Jiao Long
- Department of Thoracic Oncology, the Cancer Center of the Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai 519000, Guangdong Province, China
| | - Hui Chen
- Department of Thoracic Oncology, the Cancer Center of the Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai 519000, Guangdong Province, China
| | - Yue-Feng Wang
- Department of Otolaryngology, Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai 519000, Guangdong Province, China
| | - Lan-Man He
- Department of Thoracic Oncology, the Cancer Center of the Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai 519000, Guangdong Province, China
| | - Lin Chen
- Department of Thoracic Oncology, the Cancer Center of the Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai 519000, Guangdong Province, China
| | - Zi-Bin Liang
- Department of Thoracic Oncology, the Cancer Center of the Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai 519000, Guangdong Province, China
| | - Yan-Ni Chen
- Department of Otolaryngology, Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai 519000, Guangdong Province, China
| | - Xiao-Hua Gong
- Department of Thoracic Oncology, the Cancer Center of the Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai 519000, Guangdong Province, China
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4453
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Santana FAF, de Oliveira TVL, Filho MBDS, da Silva LSC, de Brito BB, de Melo FF, Souza CL, Marques LM, Oliveira MV. Streptococcus agalactiae: Identification methods, antimicrobial susceptibility, and resistance genes in pregnant women. World J Clin Cases 2020; 8:3988-3998. [PMID: 33024755 PMCID: PMC7520794 DOI: 10.12998/wjcc.v8.i18.3988] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 07/28/2020] [Accepted: 08/21/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Group B Streptococcus (GBS) is a normal component of the gastrointestinal and genital microbiota in humans and can lead to important infections in newborns.
AIM To compare GBS isolation and identification methods as well as to assess the antibiotic susceptibility and to identify resistance genes in GBS strains from pregnant women attended in healthcare services from the city of Vitória da Conquista, in Bahia State, Brazil.
METHODS From January 2017 to February 2018, vaginorectal swabs were obtained from 186 participants and the samples were seeded onto chromogenic agar for GBS before and after inoculation in selective broth. Confirmatory identification using 3 CAMP and latex tests was performed in samples with GBS-suggestive colonies. Then, disk diffusion antibiograms were performed in GBS-positive samples, and the detection of the resistance genes ermB, ermTR, mefA, and linB in the clindamycin and/or erythromycin-resistant samples was carried out.
RESULTS Thirty-two samples (17.2%) were GBS-positive. The culture in chromogenic agar after sample incubation in selective broth was the most sensitive method (96.9%) for GBS detection. All isolates were susceptible to penicillin, ampicillin, cefotaxime, and vancomycin. Clindamycin resistance was observed in 6 samples (18.8%), while 8 samples (25%) were erythromycin-resistant. All erythromycin and/or clindamycin-resistant GBS strains had negative D-tests. Two strains (25%) presented an M phenotype and 6 isolates (75%) presented a cMLSB phenotype. The ermB gene was identified in 4 samples (44.4%), the mefA gene was also found in 4 samples (44.4%), the ermTR gene was identified in 1 isolate (11.1%), and the linB gene was not found in any isolate.
CONCLUSION This study evidenced that the screening for SGB can be performed by means of various methods, including chromogenic media, and that the chemoprophylaxis for pregnant women who cannot use penicillin must be susceptibility-guided.
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Affiliation(s)
| | - Tais Viana Ledo de Oliveira
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista 45029-094, Bahia, Brazil
| | | | | | - Breno Bittencourt de Brito
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista 45029-094, Bahia, Brazil
| | - Fabrício Freire de Melo
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista 45029-094, Bahia, Brazil
| | - Cláudio Lima Souza
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista 45029-094, Bahia, Brazil
| | - Lucas Miranda Marques
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista 45029-094, Bahia, Brazil
- Campus Soane Nazaré de Andrade, Universidade Estadual de Santa Cruz, Ilhéus 45662900, Bahia, Brazil
| | - Márcio Vasconcelos Oliveira
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista 45029-094, Bahia, Brazil
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4454
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Lemaire CC, Portilho ALC, Pinheiro LV, Vivas RA, Britto M, Montenegro M, Rodrigues LFDF, Arruda S, Lyra AC, Cavalcante LN. Sweet syndrome as a paraneoplastic manifestation of cholangiocarcinoma: A case report. World J Clin Cases 2020; 8:4122-4127. [PMID: 33024770 PMCID: PMC7520775 DOI: 10.12998/wjcc.v8.i18.4122] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Revised: 08/02/2020] [Accepted: 08/29/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Sweet’s syndrome, also known as acute febrile neutrophilic dermatosis, is a rare skin disorder that may be associated with cancer.
CASE SUMMARY A 58-year-old female presented with a cholestatic syndrome and significant weight loss three months before admission. Five months earlier, she had abruptly developed skin lesions with erythematous papules that evolved to erythematous blisters. Clinical evaluation and laboratory tests confirmed hepatic cholangiocarcinoma. Skin lesions histopathological findings showed neutrophilic dermatosis, massive edema, fibrin, necrosis, and elastosis. These results, in association with the macroscopic aspects of the findings, led to the diagnosis of paraneoplastic Sweet’s syndrome due to cholangiocarcinoma. As staging was consistent with an advanced tumor without a cure perspective, we opted to perform percutaneous biliary drainage, and subsequently, palliative care. Eventually, after a few weeks, the patient died.
CONCLUSION In conclusion, the diagnosis of the underlying disease-causing Sweet’s syndrome must be accurate, and patients need to be followed-up, as neoplasia such as cholangiocarcinoma may be a later manifestation.
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Affiliation(s)
- Camille Carneiro Lemaire
- Department of Internal Medicine, Escola Bahiana de Medicina e Saúde Pública, Salvador 40290-000, Bahia, Brazil
| | - Ana Luisa Carvalho Portilho
- Department of Internal Medicine, Escola Bahiana de Medicina e Saúde Pública, Salvador 40290-000, Bahia, Brazil
| | - Luciana V Pinheiro
- Department of Internal Medicine, Hospital Geral Roberto Santos, Salvador 41180-780, Bahia, Brazil
| | - Rafael Alves Vivas
- Department of Surgery, Hospital Geral Roberto Santos, Salvador 41180-780, Bahia, Brazil
| | - Maíra Britto
- Department of Gastroenterology and Hepatology, Hospital Geral Roberto Santos, Salvador 41180-780, Bahia, Brazil
| | - Melaine Montenegro
- Department of Internal Medicine, Hospital Geral Roberto Santos, Salvador 41180-780, Bahia, Brazil
| | | | - Sérgio Arruda
- Pathological Anatomy, Fiocruz - Bahia, Universidade Estadual da Bahia, Salvador 40000-000, Bahia, Brazil
| | - André Castro Lyra
- Department of Medicine, Division of Gastroenterology and Hepatology, Federal University of Bahia and Gastro-Hepatology Service, Salvador 40295-050, Bahia, Brazil
| | - Lourianne Nascimento Cavalcante
- Department of Medicine, Division of Gastroenterology and Hepatology, Federal University of Bahia and SED-CHD Hospital Geral Roberto Santos, Salvador 40295-050, Bahia, Brazil
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4455
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Ribeiro Jr MAF, Elias YGB, Augusto SDS, Néder PR, Costa CTK, Maurício AD, Sampaio AP, Fonseca AZ. Laparoscopic resection of primary retroperitoneal schwannoma: A case report. World J Clin Cases 2020; 8:4114-4121. [PMID: 33024769 PMCID: PMC7520759 DOI: 10.12998/wjcc.v8.i18.4114] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 07/07/2020] [Accepted: 08/29/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Schwannomas are rare, often benign, tumors deriving from Schwann cells that have low incidence in the retroperitoneal region (0.5% to 5%). Their diagnosis is hardly confirmed at early stage due to lack of specific features in signs, symptoms and imaging tests. Thus, it is necessary performing guided punch biopsy in order to identify it. Tumor removal is the treatment of choice due to its low sensitivity to radiation and chemotherapy.
CASE SUMMARY Forty-seven years old female patient who was hospitalized for elective orthopedic procedure, without complications, evolved with severe pain in the lower limbs, thigh and gluteal region associated with neurogenic claudication. Persistent pain required magnetic resonance imaging (MRI) of the lumbar spine, which showed epidural collection with dural compression and massive heterogeneous perihepatic nodular lesion. The surgical team opted for draining the collection, as well as requested an MRI of the abdomen and pelvis, whose analysis showed expansive lesion in the retroperitoneum, in close contact with the inferior vena cava and with the right renal vein. A guided puncture was performed for diagnostic clarification, which showed immunohistochemical profile compatible with schwannoma. The selected treatment comprised retroperitoneum tumor resection in association with laparoscopic cholecystectomy. The patient was discharged and remained stable after 4-mo follow-up; she remains under follow-up to check the need of cancer investigations.
CONCLUSION Schwannoma features requires surgical treatment based on laparoscopic resection, which often presents low relapse rates and optimistic prognosis.
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Affiliation(s)
- Marcelo AF Ribeiro Jr
- General Surgery and Trauma Department, Catholic University of São Paulo – PUC-Sorocaba and Moriah Hospital, São Paulo 04083-002, São Paulo CEP, Brazil
| | - Yasmin GB Elias
- Department of Surgery, Medical School, Santo Amaro University, São Paulo 04743-030, São Paulo State, Brazil
| | - Samara de S Augusto
- Department of Surgery, Medical School, Santo Amaro University, São Paulo 04743-030, São Paulo State, Brazil
| | - Paola R Néder
- Department of Surgery, Medical School, Santo Amaro University, São Paulo 04743-030, São Paulo State, Brazil
| | - Cássia TK Costa
- Department of Surgery, Medical School, Santo Amaro University, São Paulo 04743-030, São Paulo State, Brazil
| | - Andressa D Maurício
- Department of Surgery, Medical School, Santo Amaro University, São Paulo 04743-030, São Paulo State, Brazil
| | - Adriano P Sampaio
- General Surgery and Trauma Department, Moriah Hospital, São Paulo 04083-002, São Paulo State, Brazil
| | - Alexandre Z Fonseca
- General Surgery and Trauma Department, Moriah Hospital, São Paulo 04083-002, São Paulo State, Brazil
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4456
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Lei QR, Yang X, Miao CM, Wang JC, Yang Y. Relationship between granulomatous lobular mastitis and methylene tetrahydrofolate reductase gene polymorphism. World J Clin Cases 2020; 8:4017-4021. [PMID: 33024758 PMCID: PMC7520777 DOI: 10.12998/wjcc.v8.i18.4017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 08/05/2020] [Accepted: 08/14/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Variations in the methylene tetrahydrofolate reductase (MTHFR) gene have been reported as risk factors for numerous conditions, including cardiovascular disease, thrombophilia, stroke, hypertension and pregnancy-related complications. Moreover, it was reported there is an association between breast cancer and mutations in MTHFR-C677T. However, whether there is an association between MTHFR gene polymorphism and granulomatous lobular mastitis or not has been rarely investigated.
AIM To analyze the association between MTHFR gene polymorphism and granulomatous lobular mastitis.
METHODS Fifty-one patients with granulomatous lobular mastitis admitted to The First Hospital of Kunming were selected as study samples. Their hospitalization time ranged from February 2018 to February 2019. The 51 patients were included in the experimental group, and another 51 women who underwent physical examination at The First Hospital of Kunming in the same period were included in the control group. Deoxyribonucleic acid and MTFR genetic polymorphism testing were performed in each group. The association between MTHFR gene polymorphism and granulomatous lobular mastitis was observed.
RESULTS There were significant differences in genotype frequency and allele frequency of C/C and C/T between the experimental group and the control group (all P < 0.05). However, there was no significant difference in frequency of T/T genotype between the two groups (P > 0.05). In addition, there was no significant difference in genotype frequency and allele frequency of A/A, A/C and C/C between the two groups (P > 0.05).
CONCLUSION MTHFR gene C677T locus polymorphism is closely related to granulomatous lobular mastitis.
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Affiliation(s)
- Qing-Ran Lei
- Department of Breast, The First People's Hospital of Kunming, Kunming 650031, Yunnan Province, China
| | - Xin Yang
- Department of Breast, The First People's Hospital of Kunming, Kunming 650031, Yunnan Province, China
| | - Chun-Mei Miao
- Department of Breast, The First People's Hospital of Kunming, Kunming 650031, Yunnan Province, China
| | - Jin-Chang Wang
- Department of Breast, The First People's Hospital of Kunming, Kunming 650031, Yunnan Province, China
| | - Yue Yang
- Department of Breast, The First People's Hospital of Kunming, Kunming 650031, Yunnan Province, China
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4457
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Maiese A, La Russa R, Arcangeli M, Volonnino G, De Matteis A, Frati P, Fineschi V. Multidisciplinary approach to suspected sudden unexpected infant death caused by milk-aspiration: A case report. World J Clin Cases 2020; 8:4128-4134. [PMID: 33024771 PMCID: PMC7520785 DOI: 10.12998/wjcc.v8.i18.4128] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 08/02/2020] [Accepted: 08/26/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The term sudden unexpected infant death (SUID) is not always properly invoked. It refers to a broad range of conditions that sometimes defy classification. There is not only a strong emotional impact on the family, but such cases are also quite complex. Underlying causes may be multiple, not always readily apparent, and have potential repercussions, especially in terms of forensics.
CASE SUMMARY A 5-month-old male baby was pronounced dead following acute lung failure and cardiopulmonary arrest. The parents had immediately rushed their child to the hospital, stating the baby was found prone and not breathing. Total-body postmortem computed tomography (PMCT) was performed, revealing a hypodense material of indeterminate nature within the main airways and areas of ground-glass parenchymal change. At autopsy, the respiratory tract mucosa appeared edematous and was coated with a whitish stringy material. There was widespread airspace reduction due to parenchymal collapse. Alveolar sacs and bronchial openings contained abundant amorphous material admixed with white blood cells. Immunohistochemical studies were performed, targeting CD15, CD68, and alpha-lactalbumin. Ultimately, the focus was on alpha-lactalbumin (milk protein), which showed marked immunopositivity within alveolar spaces. Cytoplasmic staining of macrophages was also particularly prominent.
CONCLUSION Postmortem investigations are thus essential to identify causes of death and surrounding circumstances. PMCT is a useful tool in this setting, given the frequent dearth of autopsy findings and ambiguity as to cause of death in SUID cases. These findings, later confirmed by immunohistochemical investigations, were indicative of active pneumonia due to aspirated milk. The present account illustrates the importance a broad diagnostic approach to SUID in cases of forensic concern. PMCT is a very valuable aid in cases of forensic interest, as it can provide useful information in all those situations in which the cause of death is uncertain or there are no suggestive dynamics or lesions.
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Affiliation(s)
- Aniello Maiese
- Department of Surgical Pathology, Medical, Molecular and Critical Area, Institute of Legal Medicine, University of Pisa, Pisa 56126, Italy
| | - Raffaele La Russa
- Department of Anatomy, Histology, Forensic Medicine and Orthopedics, Sapienza University of Roma, Roma 00185, Italy
| | - Mauro Arcangeli
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila 67100, Italy
| | - Gianpietro Volonnino
- Department of Anatomy, Histology, Forensic Medicine and Orthopedics, Sapienza University of Roma, Roma 00185, Italy
| | - Alessandra De Matteis
- Department of Anatomy, Histology, Forensic Medicine and Orthopedics, Sapienza University of Roma, Roma 00185, Italy
| | - Paola Frati
- Department SAIMLAL, Sapienza University of Roma, Roma 00185, Italy
| | - Vittorio Fineschi
- Department of Anatomy, Histology, Forensic Medicine and Orthopedics, Sapienza University of Roma, Roma 00185, Italy
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4458
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Abstract
BACKGROUND Epidermolytic acanthoma (EA) is a rare benign skin lesion, usually found in the genital area of men and women, with epidermolytic hyperkeratosis as its distinguishing histologic characteristic. It is commonly misdiagnosed as condyloma accuminatum, verruca, and seborrheic keratosis. Since this lesion is benign, treatment is not necessary. However, it is often misdiagnosed, and patients are likely to undergo incorrect counseling and unnecessary treatment, causing undue burden to the patient. This study seeks to increase awareness of this rare condition to prevent future misdiagnoses.
CASE SUMMARY A 55-year-old man living with human immunodeficiency virus presented for anal cancer screening. His physical examination revealed a flesh colored papule at the anal margin. The initial differential diagnosis included molluscum contagiosum, anal condyloma, and basal cell carcinoma. The lesion was excised to obtain a definitive diagnosis and was discovered to be EA.
CONCLUSION EA is often misdiagnosed due to its similarity to other dermatologic conditions. Careful examination and pathologic evaluation should be obtained to ensure proper diagnosis.
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Affiliation(s)
- Ariana S Ginsberg
- Department of Colon and Rectal Surgery, Laser Surgery Care, New York, NY 10011, United States
| | - Archeta Rajagopalan
- Department of Colon and Rectal Surgery, Laser Surgery Care, New York, NY 10011, United States
| | - Joseph P Terlizzi
- Department of Colon and Rectal Surgery, Laser Surgery Care, New York, NY 10011, United States
- Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States
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4459
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Zhong M, Sun Y, Wang HG, Marcella C, Cui BT, Miao YL, Zhang FM. Awareness and attitude of fecal microbiota transplantation through transendoscopic enteral tubing among inflammatory bowel disease patients. World J Clin Cases 2020; 8:3786-3796. [PMID: 32953854 PMCID: PMC7479546 DOI: 10.12998/wjcc.v8.i17.3786] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 04/28/2020] [Accepted: 07/30/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Transendoscopic enteral tubing (TET) has been used in China as a novel delivery route for fecal microbiota transplantation (FMT) into the whole colon with a high degree of patient satisfaction among adults.
AIM To explore the recognition and attitudes of FMT through TET in patients with inflammatory bowel disease (IBD).
METHODS An anonymous questionnaire, evaluating their awareness and attitudes toward FMT and TET was distributed among IBD patients in two provinces of Eastern and Southwestern China. Question formats included single-choice questions, multiple-choice questions and sorting questions. Patients who had not undergone FMT were mainly investigated for their cognition and acceptance of FMT and TET. Patients who had experience of FMT, the way they underwent FMT and acceptance of TET were the main interest. Then all the patients were asked whether they would recommend FMT and TET. This study also analyzed the preference of FMT delivery in IBD patients and the patient-related factors associated with it.
RESULTS A total of 620 eligible questionnaires were included in the analysis. The survey showed that 44.6% (228/511) of patients did not know that FMT is a therapeutic option in IBD, and 80.6% (412/511) of them did not know the concept of TET. More than half (63.2%, 323/511) of the participants stated that they would agree to undergo FMT through TET. Of the patients who underwent FMT via TET [62.4% (68/109)], the majority [95.6% (65/68)] of them were satisfied with TET. Patients who had undergone FMT and TET were more likely to recommend FMT than patients who had not (94.5% vs 86.3%, P = 0.018 and 98.5% vs 87.8%, P = 0.017). Patients’ choice for the delivery way of FMT would be affected by the type of disease and whether the patient had the experience of FMT. When compared to patients without experience of FMT, Crohn’s disease and ulcerative colitis patients who had experience of FMT preferred mid-gut TET (P < 0.001) and colonic TET (P < 0.001), respectively.
CONCLUSION Patients’ experience of FMT through TET lead them to maintain a positive attitude towards FMT. The present findings highlighted the significance of patient education on FMT and TET.
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Affiliation(s)
- Min Zhong
- Medical Center for Digestive Diseases, The Second Affiliated Hospital of Nanjing Medical University, Nanjing 210011, Jiangsu Province, China
- Key Lab of Holistic Integrative Enterology, Nanjing Medical University, Nanjing 210011, Jiangsu Province, China
| | - Yang Sun
- Department of Gastroenterology, The First Affiliated Hospital of Kunming Medical University, Yunnan Institute of Digestive Disease, Kunming 650032, Yunnan, China
| | - Hong-Gang Wang
- Medical Center for Digestive Diseases, The Affiliated Huaian No. 1 People’s Hospital of Nanjing Medical University, Huaian 223300, Jiangsu Province, China
| | - Cicilia Marcella
- Medical Center for Digestive Diseases, The Second Affiliated Hospital of Nanjing Medical University, Nanjing 210011, Jiangsu Province, China
- Key Lab of Holistic Integrative Enterology, Nanjing Medical University, Nanjing 210011, Jiangsu Province, China
| | - Bo-Ta Cui
- Medical Center for Digestive Diseases, The Second Affiliated Hospital of Nanjing Medical University, Nanjing 210011, Jiangsu Province, China
- Key Lab of Holistic Integrative Enterology, Nanjing Medical University, Nanjing 210011, Jiangsu Province, China
| | - Ying-Lei Miao
- Department of Gastroenterology, The First Affiliated Hospital of Kunming Medical University, Yunnan Institute of Digestive Disease, Kunming 650032, Yunnan, China
| | - Fa-Ming Zhang
- Medical Center for Digestive Diseases, The Second Affiliated Hospital of Nanjing Medical University, Nanjing 210011, Jiangsu Province, China
- Key Lab of Holistic Integrative Enterology, Nanjing Medical University, Nanjing 210011, Jiangsu Province, China
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4460
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Yang Y, Li CQ, Chen WJ, Ma ZH, Liu G. Gastroduodenitis associated with ulcerative colitis: A case report. World J Clin Cases 2020; 8:3847-3852. [PMID: 32953863 PMCID: PMC7479559 DOI: 10.12998/wjcc.v8.i17.3847] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 06/23/2020] [Accepted: 07/30/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Ulcerative colitis (UC) is defined as a chronic inflammatory bowel disease that can occur in any part of the large bowel. In addition, UC affects only the large bowel except for backwash ileitis and pouchitis, whereas Crohn's disease (CD) affects the entire digestive tract. Inflammatory bowel disease (IBD) patients tend to be diagnosed with CD or indeterminate colitis when combined with gastric lesion. However, in recent years, some UC patients are reported to have various degrees of lesions in gastroduodenum. Here, we report a case of gastroduodenitis associated with UC (GDUC).
CASE SUMMARY A 25-year-old man with a history of Klippel-Trenaunay syndrome presented to the hospital with mucopurulent bloody stool and epigastric persistent colic pain for 2 wk. Continuous superficial ulcers and spontaneous bleeding were observed under colonoscopy. Subsequent gastroscopy revealed mucosa with diffuse edema, ulcers, errhysis, and granular and friable changes in the stomach and duodenal bulb, which were similar to the appearance of the rectum. After ruling out other possibilities according to a series of examinations, a diagnosis of GDUC was considered. The patient hesitated about intravenous corticosteroids, so he received a standardized treatment with pentasa of 3.2 g/d. After 0.5 mo of treatment, the patient’s symptoms achieved complete remission. Follow-up endoscopy and imaging findings showed no evidence of recurrence for 26 mo.
CONCLUSION The occurrence of gastrointestinal involvement in UC is rare, which may open a new window for studying the etiology and pathogenesis of UC. Physicians should consider broad differential diagnosis by endoscopic biopsy and laboratory examinations.
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Affiliation(s)
- Ye Yang
- Department of Gastroenterology, HwaMei Hospital, University of Chinese Academy of Sciences, Ningbo 315000, Zhejiang Province, China
- Ningbo Institute of Life and Health Industry, University of Chinese Academy of Sciences, Ningbo 315000, Zhejiang Province, China
- Key Laboratory of Diagnosis and Treatment of Digestive System Tumors of Zhejiang Province, Ningbo 315000, Zhejiang Province, China
- Ningbo Clinical Research Center for Digestive System Tumors, Ningbo 315000, Zhejiang Province, China
| | - Chun-Qiang Li
- Department of General Surgery, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Wu-Jie Chen
- Department of Gastroenterology, HwaMei Hospital, University of Chinese Academy of Sciences, Ningbo 315000, Zhejiang Province, China
- Ningbo Institute of Life and Health Industry, University of Chinese Academy of Sciences, Ningbo 315000, Zhejiang Province, China
- Key Laboratory of Diagnosis and Treatment of Digestive System Tumors of Zhejiang Province, Ningbo 315000, Zhejiang Province, China
- Ningbo Clinical Research Center for Digestive System Tumors, Ningbo 315000, Zhejiang Province, China
| | - Zhen-Hua Ma
- Department of Gastroenterology, HwaMei Hospital, University of Chinese Academy of Sciences, Ningbo 315000, Zhejiang Province, China
- Ningbo Institute of Life and Health Industry, University of Chinese Academy of Sciences, Ningbo 315000, Zhejiang Province, China
- Key Laboratory of Diagnosis and Treatment of Digestive System Tumors of Zhejiang Province, Ningbo 315000, Zhejiang Province, China
- Ningbo Clinical Research Center for Digestive System Tumors, Ningbo 315000, Zhejiang Province, China
| | - Gang Liu
- Department of General Surgery, Tianjin Medical University General Hospital, Tianjin 300052, China
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4461
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Abstract
BACKGROUND Osteochondral lesion of talus is a broad term used to describe an injury or abnormality of the talar articular cartilage and adjacent bone. It arises from diverse causes, and although trauma is implicated in many cases, it does not account for the etiology of every lesion. Gout is a chronic arthritic disease caused by excess levels of uric acid in blood. Intraosseous deposition of monosodium urate in the clavicle, femur, patella and calcaneus was reported previously. Gout is common disease but rare at a young age, especially during teenage years. Osteochondral lesion caused by intra-articular gouty invasion is very rare.
CASE SUMMARY We encountered a rare case of a 16-year-old male who has osteochondral lesion of the talus (OLT) with gout. He had fluctuating pain for more than 2 years. We could see intra-articular tophi with magnetic resonance image (MRI) and arthroscopy. We performed arthroscopic exploration, debridement and microfracture. Symptoms were resolved after operation, and bony coverage at the lesion was seen on postoperative images. We had checked image and uric acid levels for 18 mo.
CONCLUSION It is rare to see OLT with gouty tophi in young adults. While it is challenging, the accuracy of diagnosis can be improved through history taking, MRI and arthroscopy.
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Affiliation(s)
- Taeho Kim
- Department of Orthopaedic Surgery, CHA Bundang Medical Center, CHA University, Seongnam 13497, Gyeonggi-do, South Korea
| | - Young-Rak Choi
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, South Korea
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4462
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Ahn JS, Seo SI, Kim J, Kim T, Kang JG, Kim HS, Shin WG, Jang MK, Kim HY. Efficacy of stool multiplex polymerase chain reaction assay in adult patients with acute infectious diarrhea. World J Clin Cases 2020; 8:3708-3717. [PMID: 32953847 PMCID: PMC7479561 DOI: 10.12998/wjcc.v8.i17.3708] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 06/04/2020] [Accepted: 08/01/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Recently, stool multiplex polymerase chain reaction (PCR) tests have been developed for identifying diarrhea-causing bacterial pathogens. Furthermore, fecal calprotectin is a well-known effective marker for intestinal mucosal inflammation.
AIM To evaluate the efficacy of stool multiplex PCR and fecal calprotectin in acute infectious diarrhea.
METHODS Overall, 400 patients with acute infectious diarrhea were enrolled from Kangdong Sacred Heart Hospital (January 2016 to December 2018). Multiplex PCR detected 7 enteropathogenic bacteria including Salmonella, Campylobacter, Shigella, Escherichia coli O157:H7, Aeromonas, Vibrio, and Clostridium difficile. We reviewed clinical and laboratory findings using stool multiplex PCR.
RESULTS Stool multiplex PCR test detected considerably more bacterial pathogens than stool culture (49.2% vs 5.2%), with Campylobacter as the most common pathogen (54%). Patients with positive stool PCR showed elevated fecal calprotectin expression compared to patients with negative stool PCR (1124.5 ± 816.9 mg/kg vs 609 ± 713.2 mg/kg, P = 0.001). C-reactive protein (OR = 1.01, 95%CI: 1.001-1.027, P = 0.034) and sigmoidoscopy-detected colitis (OR = 4.76, 95%CI: 1.101-20.551, P = 0.037) were independent factors in stool PCR-based detection of bacterial pathogens. Sensitivity and specificity of calprotectin were evaluated to be 70.5% and 60.9%, respectively (adjusted cut-off value = 388 mg/kg).
CONCLUSION Stool multiplex PCR test has increased sensitivity in detecting pathogens than conventional culture, and it is correlated with calprotectin expression. Stool multiplex PCR and calprotectin may be effective in predicting clinical severity of infectious diarrhea.
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Affiliation(s)
- Jae Sung Ahn
- Department of Internal Medicine, Kangdong Sacred Heart Hospital, Seoul KS013, South Korea
| | - Seung In Seo
- Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul KS013, South Korea
- Institute for Liver and Digestive Diseases, Hallym University, Chuncheon KS013, South Korea
| | - Jinseob Kim
- Department of Epidemiology, School of Public Health, Seoul National University, Seoul KS013, South Korea
| | - Taewan Kim
- Department of Internal Medicine, Kangdong Sacred Heart Hospital, Seoul KS013, South Korea
| | - Jin Gu Kang
- Department of Internal Medicine, Kangdong Sacred Heart Hospital, Seoul KS013, South Korea
| | - Hyoung Su Kim
- Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul KS013, South Korea
- Institute for Liver and Digestive Diseases, Hallym University, Chuncheon KS013, South Korea
| | - Woon Geon Shin
- Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul KS013, South Korea
- Institute for Liver and Digestive Diseases, Hallym University, Chuncheon KS013, South Korea
| | - Myoung Kuk Jang
- Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul KS013, South Korea
- Institute for Liver and Digestive Diseases, Hallym University, Chuncheon KS013, South Korea
| | - Hak Yang Kim
- Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul KS013, South Korea
- Institute for Liver and Digestive Diseases, Hallym University, Chuncheon KS013, South Korea
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4463
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Lee AD, Harada K, Tanaka S, Yokota Y, Mima T, Enomoto A, Kogo M. Large lingual heterotopic gastrointestinal cyst in a newborn: A case report. World J Clin Cases 2020; 8:3808-3813. [PMID: 32953857 PMCID: PMC7479572 DOI: 10.12998/wjcc.v8.i17.3808] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 08/01/2020] [Accepted: 08/19/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Heterotopic gastrointestinal cysts have gastrointestinal epithelium in the cyst wall and rarely occur in the oral cavity. Most are found in the neonatal period. However, heterotopic gastrointestinal cysts that are diagnosed as a congenital tongue cyst by routine ultrasonography are extremely rare.
CASE SUMMARY A 12-day-old female presented with swelling of the anterior tongue. The obstetrician had detected significant tongue swelling on fetal ultrasonography in the 35th gestational week. The female was born by cesarean delivery at gestational week 39. She soon became dyspneic, and the cyst was aspirated. After the aspiration, her breathing recovered and she started breastfeeding. The cyst was excised under general anesthesia on the 67th day. Histopathologic examination showed that that cyst wall consisted of a lining of columnar gastrointestinal-type epithelium and pseudostratified ciliated epithelium. The patient restarted breastfeeding 3 h after surgery. The postoperative course was uneventful.
CONCLUSION Airway distress and feeding difficulty were successfully avoided by cyst aspiration, and surgical resection was performed with no perioperative complications.
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Affiliation(s)
- Atsushi-Doksa Lee
- First Department of Oral and Maxillofacial Surgery, Graduate School of Dentistry, Osaka University, Suita 565-0871, Osaka, Japan
- Department of Oral and Maxillofacial Surgery, Faculty of Medicine, Kindai University, Osaka-Sayama 589-8511, Osaka, Japan
| | - Kazuma Harada
- First Department of Oral and Maxillofacial Surgery, Graduate School of Dentistry, Osaka University, Suita 565-0871, Osaka, Japan
| | - Susumu Tanaka
- First Department of Oral and Maxillofacial Surgery, Graduate School of Dentistry, Osaka University, Suita 565-0871, Osaka, Japan
| | - Yusuke Yokota
- First Department of Oral and Maxillofacial Surgery, Graduate School of Dentistry, Osaka University, Suita 565-0871, Osaka, Japan
| | - Takashi Mima
- Department of Oral and Maxillofacial Surgery, Daini Osaka Police Hospital, Osaka 543-8922, Osaka, Japan
| | - Akifumi Enomoto
- Department of Oral and Maxillofacial Surgery, Faculty of Medicine, Kindai University, Osaka-Sayama 589-8511, Osaka, Japan
| | - Mikihiko Kogo
- First Department of Oral and Maxillofacial Surgery, Graduate School of Dentistry, Osaka University, Suita 565-0871, Osaka, Japan
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4464
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A JD, Chai JP, Wang H, Gao W, Peng Z, Zhao SY, A XR. Diagnosis and treatment of mixed infection of hepatic cystic and alveolar echinococcosis: Four case reports. World J Clin Cases 2020; 8:3911-3919. [PMID: 32953871 PMCID: PMC7479555 DOI: 10.12998/wjcc.v8.i17.3911] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 05/04/2020] [Accepted: 07/14/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Mixed infection of hepatic cystic and alveolar echinococcosis is extremely rare. This article reveals the typical imaging manifestations of cystic and alveolar echinococcosis and investigates the diagnosis and surgical experience of mixed infection of hepatic cystic and alveolar echinococcosis.
CASE SUMMARY From January 2017 to May 2019, 4 cases with rare mixed infection of hepatic cystic and alveolar echinococcosis were admitted and treated by the Division of General Surgery of Qinghai Provincial People's Hospital. Three of the patients occasionally had upper abdominal discomfort, but it did not affect their daily lives. However, hepatic echinococcosis was found in one patient by physical examination, and the patient had no discomfort. All 4 cases were Tibetans who had lived in pastoral areas of southern Qinghai for a long time. Enzyme-linked immunosorbent assay for echinococcosis was positive for all patients. Moreover, abdominal computed tomography showed typical imaging manifestations of cystic and alveolar echinococcosis including coexisting “honeycomb sign,” and “spotted calcification.” Three of the patients underwent radical resection, and 1 case underwent palliative resection. All 4 patients developed different types of surgical complications after the operation, but all of them recovered and were discharged after symptomatic treatment.
CONCLUSION There are no problems diagnosing mixed infection of hepatic cystic and alveolar echinococcosis. The difficulties involve preoperative evaluation and treatment of surgical complications.
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Affiliation(s)
- Ji-De A
- General Surgery, Provincial People's Hospital, Xining 810000, Qinghai Province, China
| | - Jin-Ping Chai
- Internal Medicine-Cardiovascular, Provincial People's Hospital, Xining 810000, Qinghai Province, China
| | - Hao Wang
- ICU, Provincial People's Hospital, Xining 810000, Qinghai Province, China
| | - Wei Gao
- General Surgery, Provincial People's Hospital, Xining 810000, Qinghai Province, China
| | - Zhe Peng
- General Surgery, Provincial People's Hospital, Xining 810000, Qinghai Province, China
| | - Shun-Yun Zhao
- General Surgery, Provincial People's Hospital, Xining 810000, Qinghai Province, China
| | - Xiang-Ren A
- Department of Clinical Laboratory, Provincial People's Hospital, Xining 810007, Qinghai Province, China
- Department of Clinical Laboratory, Qinghai Province Key Laboratory of Laboratory Medicine, Xining 810007, Qinghai Province, China
- Department of Clinical Laboratory, Qinghai Clinical Medical Research Center, Xining 810007, Qinghai Province, China
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4465
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Abstract
BACKGROUND Gallbladder sarcomatoid carcinoma is a rare and aggressive tumor, and little is known about its clinical behavior, prognosis, and optimal treatment.
CASE SUMMARY From 1997 to 2017, we collected seven cases of gallbladder sarcomatoid carcinoma at our institution. The median patient age was 68.5 years. Six (85.7%) patients were female. Overall, 85.7% (6/7) of the tumors had a maximal diameter greater than 7 cm. Late TNM stage was associated with a significantly poor prognosis. All patients with advanced-stage (III/IV) disease died from metastases or disease progression shortly after surgery. One patient with stage IIIB disease who received adjuvant chemoradiotherapy (gemcitabine and capecitabine) achieved a progression-free survival (PFS) of 12 mo and overall survival of 15 mo, which might be the longest PFS reported among patients who ultimately experienced recurrence or metastasis.
CONCLUSION Sarcomatoid carcinoma is a unique and aggressive gallbladder malignancy. Surgery is suggested as the first and only recognized treatment. There is a significant difference in prognosis between patients with early-stage and advanced-stage disease. Postoperative adjuvant therapy may bring survival benefits for locally advanced patients. Gemcitabine combined with fluorouracil and radiotherapy could be a potential strategy.
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Affiliation(s)
- Qing Qin
- Department of Medical Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
- Department of Oncology, Chengdu Shangjin Nanfu Hospital, Chengdu 611730, Sichuan Province, China
| | - Ming Liu
- Department of Medical Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Xin Wang
- Department of Abdominal Oncology, Department of Radiation Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
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4466
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Georgiev T, Angelov AK. Complexities of diagnosis and management of COVID-19 in autoimmune diseases: Potential benefits and detriments of immunosuppression. World J Clin Cases 2020; 8:3669-3678. [PMID: 32953843 PMCID: PMC7479565 DOI: 10.12998/wjcc.v8.i17.3669] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 06/12/2020] [Accepted: 08/26/2020] [Indexed: 02/05/2023] Open
Abstract
Recent advances in our understanding of coronavirus disease 2019 (COVID-19) and the associated acute respiratory distress syndrome might approximate the cytokine release syndrome of severe immune-mediated disease. Importantly, this presumption provides the rationale for utilization of therapy, until recently reserved mostly for autoimmune diseases (ADs), in the management of COVID-19 hyperinflammation condition and has led to an extensive discussion for the potential benefits and detriments of immunosuppression. Our paper intends to examine the available recommendations, complexities in diagnosis and management when dealing with patients with ADs amidst the COVID-19 crisis. Mimicking a flare of an underlying AD, overlapping pathological lung patterns, probability of higher rates of false-positive antibody test, and lack of concrete data are only a part of the detrimental and specific characteristics of COVID-19 outbreak among the population with ADs. The administration of pharmaceutical therapy should not undermine the physical and psychological status of the patient with the maximum utilization of telemedicine. Researchers and clinicians should be vigilant for upcoming research for insight and perspective to fine-tune the clinical guidelines and practice and to weigh the potential benefits and detrimental effects of the applied immunomodulating therapy.
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Affiliation(s)
- Tsvetoslav Georgiev
- Clinic of Rheumatology, University Hospital "St. Marina", First Department of Internal Medicine, Medical University - Varna, Varna 9010, Bulgaria
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4467
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Wang XF, Meng Y, Liu H, Hong Y, Wang BY. Surgical strategy used in multilevel cervical disc replacement and cervical hybrid surgery: Four case reports. World J Clin Cases 2020; 8:3890-3902. [PMID: 32953869 PMCID: PMC7479569 DOI: 10.12998/wjcc.v8.i17.3890] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 07/18/2020] [Accepted: 07/30/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Multilevel artificial cervical disc replacement and anterior hybrid surgery have been introduced as reliable treatments for multilevel cervical degenerative disc disease. Surgical techniques are important for resolving patients’ symptoms and maintaining the normal functioning of cervical implants. However, the use of inappropriate surgical strategies could lead to complications such as implant migration and neurological deficit. In this paper, we summarize our surgical strategies used in multilevel cervical disc replacement and hybrid surgery into five major notes.
CASE SUMMARY We share the key notes and our surgical procedures in the form of four typical case presentations. All patients were diagnosed with cervical degenerative disc disease with myelopathy or radiculopathy and needed multilevel cervical spine surgery. The first case demonstrated that index levels indicating the presence of highly serious spinal cord compression required a prioritized decompression. The second case demonstrated that the disc replacement should be performed before fusion in cervical hybrid surgery. The third and forth cases demonstrated that a top-down implantation sequence was needed in continuous two-level cervical disc replacement. The symptoms of all patients were significantly relieved after surgery.
CONCLUSION We hope that our surgical strategies can help improve the performance and outcomes of multilevel cervical spine surgery.
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Affiliation(s)
- Xiao-Fei Wang
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Yang Meng
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Hao Liu
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Ying Hong
- Department of Operation Room, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Bei-Yu Wang
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
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4468
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Moussaddaq AS, Brochard C, Palard-Novello X, Garin E, Wallenhorst T, Le Balc’h E, Merlini L’heritier A, Grainville T, Siproudhis L, Lièvre A. Incidental anal 18fluorodeoxyglucose uptake: Should we further examine the patient? World J Clin Cases 2020; 8:3679-3690. [PMID: 32953844 PMCID: PMC7479548 DOI: 10.12998/wjcc.v8.i17.3679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 05/15/2020] [Accepted: 08/01/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND There are no studies on incidental anal 18F-fluorodeoxyglucose (18FDG) uptake.
AIM To assess the rate and aetiologies of incidental anal 18FDG uptake and to evaluate the correlation between 18FDG positron-emission tomography/computed tomography (PET/CT) parameters and the diagnosis of an anorectal disease.
METHODS The data from patients with incidental anal 18FDG uptake were retrospectively analysed. Patients who underwent anorectal examinations were identified and compared to those who did not undergo examinations. Patients who were offered treatment were then identified and compared to those who did not receive treatment.
RESULTS Among the 43020 18FDG PET/CT scans performed, 197 18FDG PET/CT scans of 146 patients (0.45%) reported incidental anal uptake. Among the 134 patients included, 48 (35.8%) patients underwent anorectal examinations, and anorectal diseases were diagnosed in 33 (69.0%) of these patients and treated in 18/48 (37.5%) patients. Among the examined patients, those with a pathology requiring treatment had significantly smaller metabolic volumes (MV) 30 and MV41 values and higher maximal and mean standardized uptake value measurements than those who did not require treatment.
CONCLUSION Incidental anal 18FDG uptake is rare, but a reliable anorectal diagnosis is commonly obtained when an anorectal examination is performed. The diagnosis of an anorectal disease induces treatment in more than one-third of the patients. These data should encourage practitioners to explore incidental anal 18FDG uptake systematically.
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Affiliation(s)
- Anne-Sophie Moussaddaq
- Department of Gastroenterology, University Hospital of Rennes, Pontchaillou, Rennes 35000, France
| | - Charlène Brochard
- Department of Gastroenterology, University Hospital of Rennes, Pontchaillou, Rennes 35000, France
- Inphy CIC 1414 University Hospital of Rennes, Pontchaillou, Rennes 35000, France
| | - Xavier Palard-Novello
- Department of Nuclear Medicine, Cancer Institute Eugène Marquis, Rennes 35000, France
| | - Etienne Garin
- Department of Nuclear Medicine, Cancer Institute Eugène Marquis, Rennes 35000, France
- Laboratoire Traitement du Signal et de l'Image-UMR1099, University of Rennes, Inserm, Rennes 35000, France
| | - Timothée Wallenhorst
- Department of Gastroenterology, University Hospital of Rennes, Pontchaillou, Rennes 35000, France
| | - Eric Le Balc’h
- Department of Gastroenterology, University Hospital of Rennes, Pontchaillou, Rennes 35000, France
| | | | - Thomas Grainville
- Department of Gastroenterology, University Hospital of Rennes, Pontchaillou, Rennes 35000, France
| | - Laurent Siproudhis
- Department of Gastroenterology, University Hospital of Rennes, Pontchaillou, Rennes 35000, France
- Inphy CIC 1414 University Hospital of Rennes, Pontchaillou, Rennes 35000, France
| | - Astrid Lièvre
- Department of Gastroenterology, University Hospital of Rennes, Pontchaillou, Rennes 35000, France
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4469
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Ma JJ, Zhang B. Diagnosis of an actively bleeding brachial artery hematoma by contrast-enhanced ultrasound: A case report. World J Clin Cases 2020; 8:3835-3840. [PMID: 32953861 PMCID: PMC7479570 DOI: 10.12998/wjcc.v8.i17.3835] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 07/16/2020] [Accepted: 07/30/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Active bleeding due to arterial injury following the acupuncture can sometimes represent a life-threatening complication. Only few reports of an actively bleeding hematoma diagnosed by contrast-enhanced ultrasound, which enables the depiction of vascular, have been reported.
CASE SUMMARY Here, we report the case of a 75-year-old woman, who presented with sudden swelling, ecchymosis, and pain in the upper left limb. She underwent an acupuncture treatment of traditional Chinese medicine followed by a deep shoulder massage 2 d before admission to hospital. A few hours after the massage, her left upper arm was red, swollen and progressively aggravated. Ultrasonography showed a large hematoma (11.2 cm × 3.5 cm × 3.4 cm) beside the left brachial artery. Color Doppler ultrasound revealed that blood flow signals of the arteries branched into the hematoma. The contrast-enhanced ultrasound showed microbubbles from the brachial artery passing into the hematoma, diffused within the hematoma with the local surge of red blood cells, and disappearing after approximately 17 s. The microbubbles were likely due to bleeding from the arteries. After pressure bandaging treatment, the hematoma became smaller (3.1 cm × 1.7 cm) and organized according to ultrasonography performed 20 d later.
CONCLUSION This case highlights the ultimate importance of contrast-enhanced ultrasound for the diagnosis of an actively bleeding hematoma.
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Affiliation(s)
- Jiao-Jiao Ma
- Department of Ultrasound, China-Japan Friendship Hospital, Beijing 100029, China
| | - Bo Zhang
- Department of Ultrasound, China-Japan Friendship Hospital, Beijing 100029, China
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4470
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Zeng J, Xie MH, Yang J, Chao SW, Xu EL. Clinical efficacy of tocilizumab treatment in severe and critical COVID-19 patients. World J Clin Cases 2020; 8:3763-3773. [PMID: 32953852 PMCID: PMC7479568 DOI: 10.12998/wjcc.v8.i17.3763] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 06/08/2020] [Accepted: 08/05/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The main pathophysiological basis of coronavirus disease 2019 (COVID-19) causing respiratory failure is a cytokine storm and interleukin-6 (IL-6) is an important component of the COVID-19 cytokine storm. As a specific antagonist of IL-6, tocilizumab may block the cytokine storm of COVID-19. The Diagnosis and Treatment Guidelines of New Coronavirus Pneumonia (7th Edition) includes tocilizumab as a recommended drug for immunotherapy in severe and critical COVID-19 patients. However, the specific clinical efficacy of tocilizumab in the treatment of COVID-19 patients is worth studying.
AIM To determine the clinical efficacy of tocilizumab in inhibiting the cytokine storm in COVID-19.
METHODS In total, 19 severe and critical COVID-19 patients were enrolled in this study, and were treated with tocilizumab in Optical Valley Campus of Hubei Maternal and Child Health Care Hospital from February 20 to March 31, 2020. The imaging manifestations and clinical data before and after treatment were analyzed retrospectively, including routine peripheral venous blood tests, routine blood biochemical tests, coagulation test, C-reactive protein (CRP), IL-6, and arterial blood gas analysis.
RESULTS Of the 19 patients in this group, 13 (68.4%) had significantly improved symptoms of COVID-19 (5 patients were discharged directly and 8 patients were transferred after improvement) following treatment. One case was invalid, 1 case was exacerbated, and 4 deaths (21.1%) were observed (all critical cases). The lymphocyte count, CRP, lactic acid, oxygenation index, fibrinogen (FIB) and IL-6 levels were significantly different in the improved group.
CONCLUSION Tocilizumab treatment is effective against IL-6 in COVID-19 patients, but it does not completely inhibit the inflammation and cytokine storm in all patients with COVID-19.In the clinical treatment of COVID-19 patients, attention should be paid to the timing of drug administration and other adjuvant treatments.
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Affiliation(s)
- Jia Zeng
- Department of Aviation Disease, Naval Medical Center of PLA, Shanghai 200052, China
- No. 1 Department of Infection, Optical Valley Campus of Hubei Maternal and Child Health Care Hospital, Wuhan 430073, Hubei Province, China
| | - Ming-Hui Xie
- No. 1 Department of Infection, Optical Valley Campus of Hubei Maternal and Child Health Care Hospital, Wuhan 430073, Hubei Province, China
- Department of Interventional Therapy, First Affiliated Hospital, the Second Military Medical University, Shanghai 200433, China
| | - Jing Yang
- No. 1 Department of Infection, Optical Valley Campus of Hubei Maternal and Child Health Care Hospital, Wuhan 430073, Hubei Province, China
- Department of Nephrology, Naval Medical Center of PLA, Shanghai 200052, China
| | - Sheng-Wu Chao
- No. 1 Department of Infection, Optical Valley Campus of Hubei Maternal and Child Health Care Hospital, Wuhan 430073, Hubei Province, China
- Department of Cardiovascular Medicine, Naval Medical Center of PLA, Shanghai 200052, China
| | - Er-Li Xu
- Department of Aviation Disease, Naval Medical Center of PLA, Shanghai 200052, China
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4471
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Altokhais TI. Portal gas in neonates; is it always surgical? A case report. World J Clin Cases 2020; 8:3804-3807. [PMID: 32953856 PMCID: PMC7479558 DOI: 10.12998/wjcc.v8.i17.3804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 07/29/2020] [Accepted: 08/13/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Hepatic portal venous gas in infants is frequently due to late presentation of necrotizing enterocolitis which is considered a relative indicator for surgical intervention.
CASE SUMMARY A preterm baby underwent an umbilical catheter placement and discovered in abdominal radiograph to have air in the portal venous system due to malpositioning of the umbilical catheter.
CONCLUSION Hepatic portal venous gas in infants without signs of necrotizing enterocolitis could result from malposition of umbilical venous catheter, and in that case, should be managed medically, with no need for surgical intervention.
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Affiliation(s)
- Tariq Ibrahim Altokhais
- Division of Pediatric Surgery, Department of Surgery, College of Medicine, King Saud University, Riyadh 4545, Saudi Arabia
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4472
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Kim DH, Park JH, Cho JK, Yang JW, Kim TH, Jeong SH, Kim YH, Lee YJ, Hong SC, Jung EJ, Ju YT, Jeong CY, Kim JY. Traumatic neuroma of remnant cystic duct mimicking duodenal subepithelial tumor: A case report. World J Clin Cases 2020; 8:3821-3827. [PMID: 32953859 PMCID: PMC7479553 DOI: 10.12998/wjcc.v8.i17.3821] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 06/22/2020] [Accepted: 08/21/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Gastrointestinal subepithelial tumors (GSTs), incidentally detected during upper gastrointestinal (GI) endoscopy, may be lesions derived from the GI wall or may be caused by compression from external organs. In general, traumatic neuroma is a benign nerve tumor that results from postoperative nerve injury, occurring in the bile duct as one of the complications after cholecystectomy. This is the first case report demonstrating that neuroma of the cystic duct can be incorrectly perceived as a duodenal subepithelial tumor by compressing the duodenal wall.
CASE SUMMARY We report the case of a 72-year-old man with traumatic neuroma of the cystic duct after cholecystectomy. This tumor was mistaken for a duodenal subepithelial tumor on preoperative upper GI endoscopy and endoscopic ultrasonography due to external compression of the GI wall. The patient had no symptoms, and his laboratory test results were normal. However, in a series of follow-up endoscopies, the tumor was found to have grown in size, so it was surgically resected. The lesion was completely removed by laparoscopic endoscopic cooperative surgery. The patient was discharged on postoperative day 7 without complications.
CONCLUSION Traumatic neuroma of the cystic duct can be mistaken for GSTs in GI endoscopy.
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Affiliation(s)
- Dong-Hwan Kim
- Department of Surgery, Gyeongsang National University College of Medicine, Gyeongsang National University Hospital, Jinju 52727, South Korea
| | - Ji-Ho Park
- Department of Surgery, Gyeongsang National University College of Medicine, Gyeongsang National University Hospital, Jinju 52727, South Korea
| | - Jin-Kyu Cho
- Department of Surgery, Gyeongsang National University College of Medicine, Gyeongsang National University Hospital, Jinju 52727, South Korea
| | - Jung-Wook Yang
- Department of Pathology, Gyeongsang National University College of Medicine, Gyeongsang National University Hospital, Jinju 52727, South Korea
| | - Tae-Han Kim
- Department of Surgery, Gyeongsang National University College of Medicine, Gyeongsang National University Hospital, Jinju 52727, South Korea
| | - Sang-Ho Jeong
- Department of Surgery, Gyeongsang National University College of Medicine, Gyeongsang National University Hospital, Jinju 52727, South Korea
| | - Young-Hye Kim
- Department of Surgery, Gyeongsang National University College of Medicine, Gyeongsang National University Hospital, Jinju 52727, South Korea
| | - Young-Joon Lee
- Department of Surgery, Gyeongsang National University College of Medicine, Gyeongsang National University Hospital, Jinju 52727, South Korea
| | - Soon-Chan Hong
- Department of Surgery, Gyeongsang National University College of Medicine, Gyeongsang National University Hospital, Jinju 52727, South Korea
| | - Eun-Jung Jung
- Department of Surgery, Gyeongsang National University College of Medicine, Gyeongsang National University Hospital, Jinju 52727, South Korea
| | - Young-Tae Ju
- Department of Surgery, Gyeongsang National University College of Medicine, Gyeongsang National University Hospital, Jinju 52727, South Korea
| | - Chi-Young Jeong
- Department of Surgery, Gyeongsang National University College of Medicine, Gyeongsang National University Hospital, Jinju 52727, South Korea
| | - Ju-Yeon Kim
- Department of Surgery, Gyeongsang National University College of Medicine, Gyeongsang National University Hospital, Jinju 52727, South Korea
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4473
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Jeon YH, Kim DW, Lee SJ, Park YJ, Kim HJ, Han M, Kim IY, Lee DW, Song SH, Lee SB, Seong EY. Autoimmune hepatitis in a patient with immunoglobulin A nephropathy: A case report. World J Clin Cases 2020; 8:3828-3834. [PMID: 32953860 PMCID: PMC7479551 DOI: 10.12998/wjcc.v8.i17.3828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 08/05/2020] [Accepted: 08/19/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Immunoglobulin A nephropathy (IgAN) is the most commonly encountered glomerular disease in Asian countries. It has a broad clinical presentation, and it is frequently associated with other conditions. Chronic liver disease is well recognized as the leading cause of secondary IgAN. However, cases of IgAN associated with autoimmune hepatitis (AIH) have seldom been reported.
CASE SUMMARY A 63-year-old Korean woman was admitted to Pusan National University Hospital for an evaluation of abdominal pain and elevated liver enzymes. Two weeks prior, she had presented to our hospital with proteinuria of approximately 1350 mg/d and hematuria and was diagnosed with IgAN. Autoimmune profiles were highly positive for antinuclear antibodies, and symptoms related to portal hypertension including ascites and peripheral edema were present. A diagnosis of AIH was made according to the simplified scoring system of the International Autoimmune Hepatitis Group. Despite immunosuppression with prednisolone and azathioprine, rapid deterioration of liver function led to end-stage liver disease. After a living-donor liver transplantation, liver function gradually improved, and she had maintained stable liver and kidney function at the six months follow-up.
CONCLUSION Cases of secondary IgAN with chronic liver disease have been frequently reported in the literature but are rarely associated with AIH. We encountered an IgAN patient with concurrent progressive liver failure due to AIH.
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Affiliation(s)
- You Hyun Jeon
- Department of Internal Medicine, Pusan National University School of Medicine, Busan 49241, South Korea
| | - Da Woon Kim
- Department of Internal Medicine, Pusan National University School of Medicine, Busan 49241, South Korea
| | - So Jeong Lee
- Department of Pathology, Pusan National University Hospital, Busan 49241, South Korea
| | - Young Joo Park
- Division of Gastroenterology, Department of Internal Medicine, Biomedical Research Institute, Pusan National University Hospital, Busan 49241, South Korea
| | - Hyo Jin Kim
- Division of Nephrology, Department of Internal Medicine, Biomedical Research Institute, Pusan National University Hospital, Busan 49241, South Korea
| | - Miyeun Han
- Division of Nephrology, Department of Internal Medicine, Biomedical Research Institute, Pusan National University Hospital, Busan 49241, South Korea
| | - Il Young Kim
- Division of Nephrology, Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan 626-770, South Korea
| | - Dong Won Lee
- Division of Nephrology, Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan 626-770, South Korea
| | - Sang Heon Song
- Division of Nephrology, Department of Internal Medicine, Biomedical Research Institute, Pusan National University Hospital, Busan 49241, South Korea
| | - Soo Bong Lee
- Division of Nephrology, Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan 626-770, South Korea
| | - Eun Young Seong
- Division of Nephrology, Department of Internal Medicine, Biomedical Research Institute, Pusan National University Hospital, Busan 49241, South Korea
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4474
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He TP, Wang DL, Zhao J, Jiang XY, He J, Feng JK, Yuan Y. Diagnosis and treatment of an elderly patient with 2019-nCoV pneumonia and acute exacerbation of chronic obstructive pulmonary disease in Gansu Province: A case report. World J Clin Cases 2020; 8:3903-3910. [PMID: 32953870 PMCID: PMC7479549 DOI: 10.12998/wjcc.v8.i17.3903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Revised: 07/09/2020] [Accepted: 07/30/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND In December 2019, the first patient with 2019-novel coronavirus (2019-nCoV) was reported in Wuhan, China, and the disease spread rapidly across the country and surrounding countries within 2 mo. As of February 29, 2020, a total of 91 confirmed cases had been reported in Gansu Province. This case report of the diagnosis and treatment of an elderly patient with 2019-nCoV pneumonia complicated by acute exacerbation of chronic obstructive pulmonary disease in Gansu Province aims to provide a better reference for the treatment of patients in the future.
CASE SUMMARY The patient, a 94-year-old female, lived in Maiji District of Tianshui, Gansu Province, China. On January 30, 2020, she was admitted to the Fourth People’s Hospital of Tianshui after 9 d of close contact with a patient with 2019-nCoV pneumonia. She was subsequently admitted to Gansu Provincial Hospital of Traditional Chinese Medicine for isolation and transferred to Tianshui Gansu Provincial Hospital of Infectious Diseases on February 3, 2020 for treatment. Upon initial examination, her body temperature was 36.7 °C , pulse was 80, breathing was 20, and blood pressure was 130/80 mmHg. She was conscious with normal development and normal nutrition. The pharynx was not red, and bilateral tonsils were not red and swollen. The lungs sounded slightly coarse with no dry or wet rales. The first symptoms were cough and fatigue on 2 February. The patient was hospitalized for 12 d. After active treatment, she was discharged on February 14 with a good prognosis.
CONCLUSION A history of exposure to the affected area or patient is a major cause of 2019-nCoV infection, and population clustering is a high risk factor for transmission. Patients may not necessarily have respiratory system symptoms as the only clinical manifestation but may also have concomitant or first onset digestive symptoms. Attention should be paid to the prevention and treatment of multiple organ dysfunction syndrome. Nucleic acid testing is extremely important and needs to be repeated several times. Laboratory and auxiliary examination indicators during the first week of admission are extremely important. It is feasible to carry out dynamic and continuous index monitoring, which can predict and guide the prevention and treatment of multiple organ dysfunction and the prognosis of the disease.
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Affiliation(s)
- Tian-Peng He
- First Department of Critical Care Medicine, Gansu Provincial Hospital, Lanzhou 730000, Gansu Province, China
| | - Dong-Liang Wang
- First Department of Critical Care Medicine, Gansu Provincial Hospital, Lanzhou 730000, Gansu Province, China
| | - Jing Zhao
- First Department of Critical Care Medicine, Gansu Provincial Hospital, Lanzhou 730000, Gansu Province, China
| | - Xiao-Ying Jiang
- First Department of Critical Care Medicine, Gansu Provincial Hospital, Lanzhou 730000, Gansu Province, China
| | - Jin He
- Department of Medical, Gansu Provincial Hospital, Lanzhou 730000, Gansu Province, China
| | - Jian-Ke Feng
- Department of Medical, Infectious Diseases of Gansu Provincial Hospital, Tianshui 741024, Gansu Province, China
| | - Yuan Yuan
- First Department of Critical Care Medicine, Gansu Provincial Hospital, Lanzhou 730000, Gansu Province, China
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4475
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Hu XM, Yuan K, Chen H, Chen C, Fang YL, Zhu JF, Liang L, Wang CL. Novel deletion mutation in Bruton’s tyrosine kinase results in X-linked agammaglobulinemia: A case report. World J Clin Cases 2020; 8:3859-3866. [PMID: 32953865 PMCID: PMC7479573 DOI: 10.12998/wjcc.v8.i17.3859] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 07/08/2020] [Accepted: 07/18/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND X-linked agammaglobulinemia is a primary immunodeficiency disease caused by gene mutations of Bruton’s tyrosine kinase (BTK). We found a new mutation point and summarized the correlation analysis and performed a literature review.
CASE SUMMARY The proband was a 5-year-old boy. He was admitted to our hospital due to a recurrent cough and a fever that had persisted for a month. He had a history of multiple respiratory infections and sinusitis. There was no immunodeficiency or recurrent infection history among his family members. Agammaglobulinemia was characterized as follows: Immunoglobulin (Ig) A, 90.0 mg/dL (90-450 mg/dL); IgG, 20.0 mg/dL (800-1800 mg/dL); and IgM, 18.0 mg/dL (60-280 mg/dL). Notably, the assessment of IgG subtypes revealed the following very low levels: Subtype 1, 0.26 g/L (3.62-12.28 g/L); subtype 2, 0.10 g/L (0.57-2.9 g/L); subtype 3, 0.009 g/L (0.129-0.789 g/L); and subtype 4, 0.003 g/L (0.013-1.446 g/L). Cellular immunological test results were as follows: CD3, 74.6% (50%-84.0%); CD4, 47.3% (27.0%-51.0%); and CD8, 24.9% (15.0%-44.0%). A de novo hemizygous deletion in BTK was detected: c.902_c.904delAAG/p.E301del. Transcript levels of the mutant BTK were similar to those of the wild-type gene, though overexpression resulted in markedly reduced levels of mutant BTK (9.49% ± 1.58%), relative to the wild-type BTK (75.8% ± 2.98%, P < 0.01).
CONCLUSION This case of X-linked agammaglobulinemia was attributed to a de novo hemizygous deletion mutation in BTK (c.902_c.904delAAG/p.E301del). The mutation resulted in markedly reduced BTK protein stability in vitro.
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Affiliation(s)
- Xiao-Mei Hu
- Department of Pediatrics, The First Affiliated Hospital of Zhejiang University, Hangzhou 310003, Zhejiang Province, China
| | - Ke Yuan
- Department of Pediatrics, The First Affiliated Hospital of Zhejiang University, Hangzhou 310003, Zhejiang Province, China
| | - Hong Chen
- Department of Pediatrics, The First Affiliated Hospital of Zhejiang University, Hangzhou 310003, Zhejiang Province, China
| | - Chun Chen
- Department of Pediatrics, The First Affiliated Hospital of Zhejiang University, Hangzhou 310003, Zhejiang Province, China
| | - Yan-Lan Fang
- Department of Pediatrics, The First Affiliated Hospital of Zhejiang University, Hangzhou 310003, Zhejiang Province, China
| | - Jian-Fang Zhu
- Department of Pediatrics, The First Affiliated Hospital of Zhejiang University, Hangzhou 310003, Zhejiang Province, China
| | - Li Liang
- Department of Pediatrics, The First Affiliated Hospital of Zhejiang University, Hangzhou 310003, Zhejiang Province, China
| | - Chun-Lin Wang
- Department of Pediatrics, The First Affiliated Hospital of Zhejiang University, Hangzhou 310003, Zhejiang Province, China
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4476
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Li CG, Zhou ZP, Jia YZ, Tan XL, Song YY. Radioactive 125I seed implantation for locally advanced pancreatic cancer: A retrospective analysis of 50 cases. World J Clin Cases 2020; 8:3743-3750. [PMID: 32953850 PMCID: PMC7479562 DOI: 10.12998/wjcc.v8.i17.3743] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 05/25/2020] [Accepted: 08/12/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Pancreatic cancer is one of the common malignant tumors of the digestive system, and radical resection is the first choice of treatment for pancreatic cancer. If patients with locally advanced pancreatic cancer cannot be treated in time and effectively, their disease often develops rapidly and their survival period is very short.
AIM To evaluate the therapeutic effect of 125I seed implantation in patients with locally advanced pancreatic cancer.
METHODS The demographics and perioperative outcomes of a consecutive series of patients who underwent 125I seed implantation to treat locally advanced pancreatic cancer between January 1, 2017 and June 30, 2019 were retrospectively analyzed. According to the results of preoperative computed tomography or magnetic resonance imaging, the treatment planning system was used to determine the area and number of 125I seeds implanted. During the operation, 125I seeds were implanted into the tumor under the guidance of intraoperative ultrasound, with a spacing of 1.5 cm and a row spacing of 1.5 cm. For patients with obstructive jaundice and digestive tract obstruction, choledochojejunostomy and gastroenterostomy were performed simultaneously. After operation, the patients were divided into a non-chemotherapy group and a chemotherapy group that received gemcitabine combined with albumin-bound paclitaxel treatment.
RESULTS Among the 50 patients, there were 29 males and 21 females, with a mean age of 56.9 ± 9.8 years. The main reason for the failure of radical resection was superior mesenteric artery invasion (37, 74%), followed by superior mesenteric vein invasion (33, 66%). Twenty-one (62%) patients underwent palliative surgery and postoperative pain relief occurred in 40 (80%) patients. The estimated blood loss in operation was 107.4 ± 115.3 mL and none of the patient received blood transfusion. The postoperative hospital stay was 7.5 ± 4.2 d; one patient had biliary fistula and three had pancreatic fistula, all of whom recovered after conservative treatment. After operation, 26 patients received chemotherapy and 24 did not. The 1-year survival rate was significantly higher in patients who received chemotherapy than in those who did not (60.7% vs 35.9%, P = 0.034). The mean overall survival of patients of the chemotherapy group and non-chemotherapy group was 14 and 11 mo, respectively (χ2 = 3.970, P = 0.046).
CONCLUSION Radioactive 125I seed implantation combined with postoperative chemotherapy can prolong the survival time, relieve pain, and improve the quality of life of patients with locally advanced pancreatic cancer.
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Affiliation(s)
- Cheng-Gang Li
- Second Department of Hepatobiliary Surgery, Chinese PLA General Hospital, Beijing 100853, China
| | - Zhi-Peng Zhou
- Second Department of Hepatobiliary Surgery, Chinese PLA General Hospital, Beijing 100853, China
| | - Yu-Ze Jia
- Second Department of Hepatobiliary Surgery, Chinese PLA General Hospital, Beijing 100853, China
| | - Xiang-Long Tan
- Second Department of Hepatobiliary Surgery, Chinese PLA General Hospital, Beijing 100853, China
| | - Yu-Yao Song
- Second Department of Hepatobiliary Surgery, Chinese PLA General Hospital, Beijing 100853, China
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4477
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Lin YY, Sun Y, Jiang Y, Song BZ, Ke LJ. Multidisciplinary treatment of life-threatening hemoptysis and paraplegia of choriocarcinoma with pulmonary, hepatic and spinal metastases: A case report. World J Clin Cases 2020; 8:3867-3874. [PMID: 32953866 PMCID: PMC7479556 DOI: 10.12998/wjcc.v8.i17.3867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 08/02/2020] [Accepted: 08/14/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Although choriocarcinoma is thought to be a malignancy curable by chemotherapy, there remain difficult and challenging problems in cases with high prognostic scores or extensive metastases, for which the treatment is limited. Particularly, chemotherapy in combination with other treatments offers promising therapeutic potential for these cases.
CASE SUMMARY We present the case of a 40-year-old female patient who suffered from life-threatening hemoptysis and paraplegia due to choriocarcinoma with pulmonary, hepatic and spinal metastases. The patient successfully recovered after multidisciplinary treatment consisting of 21 cycles of intravenous chemotherapy, radiofrequency ablation of multiple hepatic metastases, intensity-modulated radiation therapy for spinal metastases and routine physiotherapy. To our knowledge, it is the first reported case of recovery from pulmonary, hepatic and spinal metastases of choriocarcinoma with no specific primary site. Moreover, this is the first reported clinical attempt on 5-d actinomycin D as primary chemotherapy in ultrahigh-risk gestational trophoblastic neoplasia.
CONCLUSION The case supports the opinion that the individualized treatment of choriocarcinoma by a multidisciplinary approach can accomplish optimal therapeutic effects.
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Affiliation(s)
- Yuan-Yuan Lin
- Department of Gynecology, Fujian Cancer Hospital, Affiliated Cancer Hospital of Fujian Medical University, Fuzhou 350014, Fujian Province, China
- Department of Gynecology, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou 350001, Fujian Province, China
| | - Yang Sun
- Department of Gynecology, Fujian Cancer Hospital, Affiliated Cancer Hospital of Fujian Medical University, Fuzhou 350014, Fujian Province, China
| | - Yu Jiang
- Department of Gynecology, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou 350001, Fujian Province, China
| | - Bao-Zhi Song
- Department of Gynecology, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou 350001, Fujian Province, China
| | - Li-Juan Ke
- Department of Gynecology, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou 350001, Fujian Province, China
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4478
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Gao HL, Wang WQ, Xu HX, Wu CT, Li H, Ni QX, Yu XJ, Liu L. Active surveillance in metastatic pancreatic neuroendocrine tumors: A 20-year single-institutional experience. World J Clin Cases 2020; 8:3751-3762. [PMID: 32953851 PMCID: PMC7479574 DOI: 10.12998/wjcc.v8.i17.3751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Revised: 05/09/2020] [Accepted: 08/09/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Pancreatic neuroendocrine tumors (PanNETs) are heterogeneous and indolent; systemic therapy is not essential for every patient with metastatic PanNET. The National Comprehensive Cancer Network guidelines state that delaying treatment is an option for PanNET with distant metastasis, if the patient has stable disease. However, specific factors that influence surveillance were not mentioned. In addition, data regarding the period of active surveillance in patients with metastatic PanNET are lacking.
AIM To specifically determine factors influencing active surveillance in patients with liver metastatic nonfunctioning PanNETs (NF-PanNETs).
METHODS Seventy-six patients with liver metastatic NF-PanNETs who received active surveillance from a high-volume institution were enrolled. Time to disease progression (TTP) and time to initiation of systemic therapy were determined.
RESULTS Thirty-one (40.8%) patients had recurrent liver disease after R0 resection; 45 (59.2%) were diagnosed with liver metastasis. The median follow-up period was 42 mo and 90.7% patients were observed to have disease progression. The median TTP (mTTP) was 10 mo. Multivariate analysis showed that the largest axis of the liver metastasis > 5 mm (P = 0.04), non-resection of the primary tumor (P = 0.024), and T3-4 stage (P = 0.028) were associated with a shorter TTP. The mTTP in patients with no risk factors was 24 mo, which was significantly longer than that in patients with one (10 mo) or more (6 mo) risk factors (P < 0.001). A nomogram with three risk factors showed reasonable calibration, with a C-index of 0.603 (95% confidence interval: 0.47-0.74).
CONCLUSION Active surveillance may only be safe for metastatic NF-PanNET patients with favorable risk factors, and other patients progressed rapidly without treatment. Further studies with a larger sample size and a control group are needed.
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Affiliation(s)
- He-Li Gao
- Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
- Shanghai Pancreatic Cancer Institute, Shanghai 200032, China
- Pancreatic Cancer Institute, Fudan University, Shanghai 200032, China
| | - Wen-Quan Wang
- Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
- Shanghai Pancreatic Cancer Institute, Shanghai 200032, China
- Pancreatic Cancer Institute, Fudan University, Shanghai 200032, China
| | - Hua-Xiang Xu
- Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
- Shanghai Pancreatic Cancer Institute, Shanghai 200032, China
- Pancreatic Cancer Institute, Fudan University, Shanghai 200032, China
| | - Chun-Tao Wu
- Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
- Shanghai Pancreatic Cancer Institute, Shanghai 200032, China
- Pancreatic Cancer Institute, Fudan University, Shanghai 200032, China
| | - Hao Li
- Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
- Shanghai Pancreatic Cancer Institute, Shanghai 200032, China
- Pancreatic Cancer Institute, Fudan University, Shanghai 200032, China
| | - Quan-Xing Ni
- Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
- Shanghai Pancreatic Cancer Institute, Shanghai 200032, China
- Pancreatic Cancer Institute, Fudan University, Shanghai 200032, China
| | - Xian-Jun Yu
- Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
- Shanghai Pancreatic Cancer Institute, Shanghai 200032, China
- Pancreatic Cancer Institute, Fudan University, Shanghai 200032, China
| | - Liang Liu
- Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
- Shanghai Pancreatic Cancer Institute, Shanghai 200032, China
- Pancreatic Cancer Institute, Fudan University, Shanghai 200032, China
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4479
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Machluf Y, Chaiter Y, Tal O. Gender medicine: Lessons from COVID-19 and other medical conditions for designing health policy. World J Clin Cases 2020; 8:3645-3668. [PMID: 32953842 PMCID: PMC7479575 DOI: 10.12998/wjcc.v8.i17.3645] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 05/29/2020] [Accepted: 08/12/2020] [Indexed: 02/05/2023] Open
Abstract
Gender-specific differences in the prevalence, incidence, comorbidities, prognosis, severity, risk factors, drug-related aspects and outcomes of various medical conditions are well documented. We present a literature review on the extent to which research in this field has developed over the years, and reveal gaps in gender-sensitive awareness between the clinical portrayal and the translation into gender-specific treatment regimens, guidelines and into gender-oriented preventive strategies and health policies. Subsequently, through the lens of gender, we describe these domains in detail for four selected medical conditions: Asthma, obesity and overweight, chronic kidney disease and coronavirus disease 2019. As some of the key gender differences become more apparent during adolescence, we focus on this developmental stage. Finally, we propose a model which is based on three influential issues: (1) Investigating gender-specific medical profiles of related health conditions, rather than a single disease; (2) The dynamics of gender disparities across developmental stages; and (3) An integrative approach which takes into account additional risk factors (ethnicity, socio-demographic variables, minorities, lifestyle habits etc.). Increasing the awareness of gender-specific medicine in daily practice and in tailored guidelines, already among adolescents, may reduce inequities, facilitate the prediction of future trends and properly address the characteristics and needs of certain subpopulations within each gender.
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Affiliation(s)
- Yossy Machluf
- Shamir Research Institute, University of Haifa, Kazerin 1290000, Israel
| | - Yoram Chaiter
- The Israeli Center for Emerging Technologies in Hospitals and Hospital-based Health Technology Assessment, Shamir (Assaf Harofeh) Medical Center, Zerifin 7030100, Israel
| | - Orna Tal
- The Israeli Center for Emerging Technologies in Hospitals and Hospital-based Health Technology Assessment, Shamir (Assaf Harofeh) Medical Center, Zerifin 7030100, Israel
- Shamir (Assaf Harofeh) Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Zerifin 7030100, Israel
- Department of Management, Program of Public Health and Health System Administration, Bar Ilan University, Ramat Gan 5290002, Israel
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4480
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Liu J, Xin WQ, Liu LT, Chen CF, Wu L, Hu XP. Majocchi's granuloma caused by Trichophyton rubrum after facial injection with hyaluronic acid: A case report. World J Clin Cases 2020; 8:3853-3858. [PMID: 32953864 PMCID: PMC7479567 DOI: 10.12998/wjcc.v8.i17.3853] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 07/02/2020] [Accepted: 07/30/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Facial cosmetic procedures become popular for people with a desire to have a younger appearance, and cosmetic technology has developed rapidly over the past several decades. However, increasing complications related to cosmetic injections have been reported, and infection is one of the most serious problems and can cause anxiety and facial injury. We here report a case of Majocchi's granuloma (MG) caused by Trichophyton rubrum after facial injection of hyaluronic acid.
CASE SUMMARY A 37-year-old woman presented to our hospital with a history of red papules, nodules, and abscesses on her left zygomatic arch for 2 mo. She had received a cosmetic injection of hyaluronic acid on the left side of her face prior to the appearance of the lesions. MG caused by Trichophyton rubrum after facial injection of hyaluronic acid was diagnosed based on morphology and molecular biological identification. In vitro antifungal susceptibility testing was conducted according to the Clinical and Laboratory Standards Institute M38-A2 method. Minimal inhibitory concentrations were used to evaluate the antifungal susceptibility. The antifungal agents and their minimal inhibitory concentrations for the strain were terbinafine (< 0.5 μg/mL), itraconazole (0.06 μg/mL), amphotericin B (0.25 μg/mL), fluconazole (32 μg/mL), voriconazole (0.125 μg/mL), posaconazole (0.125 μg/mL), and isavuconazole (0.06 μg/mL). We initially administered 250 mg/d oral terbinafine for 2 mo, but the patient still had painful papules, nodules and abscesses on her face. Then, we adjusted the treatment to itraconazole 400 mg/d for 8 wk based on the in vitro antifungal susceptibility testing results. The skin lesions improved significantly, and there was no recurrence during follow-up.
CONCLUSION This case revealed that facial injection of hyaluronic acid may cause serious MG. Antifungal susceptibility testing should be considered in the treatment of MG caused by Trichophyton rubrum.
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Affiliation(s)
- Jie Liu
- Department of Dermatology, Skin Research Institute of Peking University Shenzhen Hospital, Peking University Shenzhen Hospital, Shenzhen 518036, Guangdong Province, China
| | - Wen-Qiang Xin
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Lan-Ting Liu
- Department of Dermatology, Skin Research Institute of Peking University Shenzhen Hospital, Peking University Shenzhen Hospital, Shenzhen 518036, Guangdong Province, China
| | - Chao-Feng Chen
- Department of Dermatology, Skin Research Institute of Peking University Shenzhen Hospital, Peking University Shenzhen Hospital, Shenzhen 518036, Guangdong Province, China
| | - Lin Wu
- Department of Dermatology, Skin Research Institute of Peking University Shenzhen Hospital, Peking University Shenzhen Hospital, Shenzhen 518036, Guangdong Province, China
| | - Xiao-Ping Hu
- Department of Dermatology, Skin Research Institute of Peking University Shenzhen Hospital, Peking University Shenzhen Hospital, Shenzhen 518036, Guangdong Province, China
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4481
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Cai Y, Zheng Q, Yao DJ. Phosphatidylinositol-3,4,5-trisphosphate dependent Rac exchange factor 1 is a diagnostic and prognostic biomarker for hepatocellular carcinoma. World J Clin Cases 2020; 8:3774-3785. [PMID: 32953853 PMCID: PMC7479560 DOI: 10.12998/wjcc.v8.i17.3774] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 06/15/2020] [Accepted: 08/03/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Phosphatidylinositol-3,4,5-trisphosphate dependent Rac exchange factor 1 (P-Rex1) was reported to be a risk factor in several cancers, including breast cancer, lung cancer, and melanoma, but its expression and role in hepatocellular carcinoma (HCC) have not yet been fully studied.
AIM To explore the expression of P-Rex1 in HCC, and further evaluate its potential application in the diagnosis and prognosis of HCC, especially in hepatitis B virus (HBV)-related patients.
METHODS P-Rex1 expression in HCC was evaluated by real-time-quantitative polymerase chain reaction. The expression of P-Rex1 was subjected to correlation analysis with clinical features, such as lymph node invasion, distant metastasis, HBV infection, patient's age and gender. Receiver operating characteristic analysis was used to examine the potential role of P-Rex1 as a diagnostic biomarker in HCC. Kaplan-Meier analysis was used to determine the association between P-Rex1 expression and overall survival, progression-free survival and relapse-free survival. Bioinformatic analysis was used to validate the clinical findings.
RESULTS P-Rex1 expression was significantly increased in HCC tumors than adjacent tissues. The expression of P-Rex1 was higher in HCC patients with lymph node invasion, distant metastasis, HBV infection and positive alpha-fetoprotein, respectively. The receiver operating characteristic analysis showed that P-Rex1 was a diagnostic biomarker with a higher area under the curve value, especially in patients with HBV infection. Survival analysis showed that patients with higher P-Rex1 expression had a favorable survival rate, even in early-stage patients.
CONCLUSION P-Rex1 expression was highly increased in HCC, and the expression level of P-Rex1 was positively correlated with tumor progression. P-Rex1 has a higher efficiency in the diagnosis of HBV-related HCC, and could also be used as a favorable prognostic factor for HCC patients.
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Affiliation(s)
- Yi Cai
- Department of Oncology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu 610000, Sichuan Province, China
| | - Qiao Zheng
- Department of Oncology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu 610000, Sichuan Province, China
| | - De-Jiao Yao
- Department of Oncology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu 610000, Sichuan Province, China
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4482
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Yao TT, Pan J, Qian JD, Cheng H, Wang Y, Wang GQ. Shear wave elastography may be sensitive and more precise than transient elastography in predicting significant fibrosis. World J Clin Cases 2020; 8:3730-3742. [PMID: 32953849 PMCID: PMC7479564 DOI: 10.12998/wjcc.v8.i17.3730] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 03/27/2020] [Accepted: 07/14/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Noninvasive measurements including transient elastography (TE) and two-dimensional shear wave elastography (SWE) have been used clinically instead of liver biopsy for regular assessment of liver fibrosis in chronic hepatitis B (CHB) patients.
AIM To investigate the diagnostic efficiency of SWE compared to TE by assessing independent influencing factors and performance for diagnosing significant fibrosis based on our cohort of treatment-naive CHB patients.
METHODS Fifty-four treatment-naive CHB patients who underwent liver biopsy to determine whether to initiate antiviral therapy were enrolled. SWE, TE, serum tests and liver biopsy were performed for all participants. The fibrosis-4 and aspartate aminotransferase to platelet ratio index scores were also calculated. Potential independent influencing factors on SWE and TE values were analyzed. Based on liver pathology results, the agreement and correlation were determined, and a comparison of the two methods was performed.
RESULTS There were 27 cases (50%) of mild fibrosis (F0-F2) and 27 (50%) cases of significant fibrosis (F3-F6); fibrosis was assessed with the Ishak scoring system. Multivariate linear regression analyses revealed that the fibrosis stage was the only factor that affected the SWE values (P < 0.001), whereas the total bilirubin level (P = 0.013) and fibrosis stage (P = 0.037) were independent factors that affected TE values. Orthogonal partial least squares discriminant analysis showed that the number of independent factors (VIP > 1) was higher for TE than SWE. Bland-Altman analysis showed satisfactory agreement between liver stiffness measurements (LSMs) of SWE and TE. Both SWE and TE could significantly discriminate significant fibrosis from mild fibrosis (P < 0.001). SWE exhibited a higher correlation with LSMs of liver fibrosis than TE (r = 0.65 and 0.50, P < 0.001). The diagnostic performance of SWE was better than that of TE for significant fibrosis (F > 2). The areas under the receiver operating characteristic curves of SWE and TE were 0.786 and 0.714, respectively. The optimal LSM cutoff values of SWE and TE were 9.05 kPa and 8.15 kPa, respectively.
CONCLUSION Compared to the TE value, the SWE value was less affected by other factors. SWE may be more sensitive and precise than TE in predicting significant fibrosis (> F2) in CHB patients.
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Affiliation(s)
- Tian-Tian Yao
- Department of Infectious Diseases, Peking University First Hospital, Beijing 100034, China
| | - Jing Pan
- Department of Infectious Diseases, Peking University First Hospital, Beijing 100034, China
| | - Jian-Dan Qian
- Department of Infectious Diseases, Peking University First Hospital, Beijing 100034, China
| | - Hao Cheng
- Department of Infectious Diseases, Peking University First Hospital, Beijing 100034, China
| | - Yan Wang
- Department of Infectious Diseases, Peking University First Hospital, Beijing 100034, China
| | - Gui-Qiang Wang
- Department of Infectious Diseases, Peking University First Hospital, Beijing 100034, China
- Peking University International Hospital, Beijing 102206, China
- the Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Zhejiang University, Hangzhou 310058, Zhejiang Province, China
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4483
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Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection can give rise to different clinical manifestations that are directly related to viral tissue damage or indirectly induced by the antiviral immune response. Hyper-activation of the immune system in an attempt to eradicate the infection may trigger autoimmunity. Several immune-mediated disorders have been described in SARS-CoV-2-infected individuals. These include cutaneous rashes and vasculitis, autoimmune cytopenia, anti-phospholipid syndrome, central or peripheral neuropathy, myositis and myocarditis. On the other hand, rheumatic patients were reported to have similar coronavirus disease 2019 (COVID-19) incidence, morbidity and mortality rates compared to general population. This opinion review will summarize the crucial immunologic steps which occur during SARS-CoV-2-infection that may link autoimmunity to COVID-19 and provides an opportunity for further discussion regarding this association.
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Affiliation(s)
- Rossella Talotta
- Department of Clinical and Experimental Medicine, Rheumatology Unit, AOU “Gaetano Martino”, University of Messina, Messina 98100, Italy
| | - Erle Robertson
- Department of Otorhinolaryngology-Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19014, United States
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4484
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Saponjski J, Macut D, Sobic-Saranovic D, Ognjanovic S, Bozic Antic I, Pavlovic D, Artiko V. Somatostatin receptor scintigraphy in the follow up of neuroendocrine neoplasms of appendix. World J Clin Cases 2020; 8:3697-3707. [PMID: 32953846 PMCID: PMC7479554 DOI: 10.12998/wjcc.v8.i17.3697] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 08/10/2020] [Accepted: 08/12/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Neuroendocrine tumors of appendix (ANETs) known as carcinoids, are rare endocrine neoplasms originated from enterochromaffin cells of gastrointestinal tract. ANETs are the third most frequent (16.7%) gastrointestinal neuroendocrine tumors, with the incidence of 0.08-0.2 cases/100000 during one year. Incidental ANETs occur in 0.2%-0.7% of emergency surgical resections because of suspected appendicitis which is usually the first manifestation of ANET. Although there are a lot of papers about application of somatostatin receptor scintigraphy in gastrointestinal neuroendocrine tumors, there are very rare sporadic cases described about ANETs particularly.
AIM To establish the role of somatostatin receptor scintigraphy (SRS) in the management of patients with neuroendocrine tumors of appendix (ANET).
METHODS The total of 35 patients was investigated, 23 females and 12 males, average age (43.7 ± 17.3 years). All patients had histological diagnosis of ANET (34 carcinoids of appendix and one tubular carcinoid). Majority of tumors have been found incidentally during surgery of: Acute appendicitis (n = 15), perforated appendicitis (n = 2), ileus (n = 3), hysterectomy (n = 3), ruptured ovarian cyst (n = 2), caecal volvulus (n = 1), while 9 patients had diagnosis of appendiceal tumor before the surgery. Seventeen patients had tumor grade (G) G1, 12 G2 and 6 G3. The right hemicolectomy was performed in 13, while the rest of the patients had appendectomy only. SRS was done early (2 h) and late (24 h) after i.v. application of 740 MBq technetium-99m ethylenediamine-N, N'-diacetic acid Hydrazinonicotinyl-Tyr3-Octreotide (technetium-99m-Tektrotyd, Polatom, Poland). SRS was performed for restaging in all the patients after surgery.
RESULTS There were 12 true positive (TP), 19 true negative, 3 false positive and 1 false negative SRS result. Sensitivity of the method was 92.31%, specificity was 86.36%, positive predictive value was 80.00%, negative predictive value was 95.00% and accuracy 88.57%. Receiver operating characteristics analysis showed that SRS scintigraphy is a good test for detection TP cases [area under the curve of 0.850, 95% confidence interval (CI): 0.710-0.990, P < 001]. Single photon emission computed tomography contributed diagnosis in 7 TP findings. In 10 patients Krenning score was 4 and in 2 was 3. In 8 patients SRS significantly changed the management of the patients (in two surgery was repeated, in 4 somatostatin analogues and in two peptide receptor radionuclide therapy). Median progression-free survival in SRS positive patients was 52 months (95%CI: 39.7-117.3 mo) while in SRS negative patients it was 60 months (95%CI: 42.8-77.1 mo), without statistically significant difference between the two groups (P = 0.434).
CONCLUSION In conclusion, our results confirmed the value of SRS in the follow-up of the patients with ANET after surgery, if recurrences or metastases are suspected.
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Affiliation(s)
- Jelena Saponjski
- Center for Nuclear Medicine, Clinical Center of Serbia, Belgrade 11000, Serbia
| | - Djuro Macut
- Clinic for Endocrinology, Diabetes and Metabolic Diseases, Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Belgrade 11000, Serbia
| | - Dragana Sobic-Saranovic
- Center for Nuclear Medicine Clinical Center of Serbia, Faculty of Medicine University of Belgrade, Belgrade 11000, Serbia
| | - Sanja Ognjanovic
- Clinic for Endocrinology, Diabetes and Metabolic Diseases, Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Belgrade 11000, Serbia
| | - Ivana Bozic Antic
- Clinic for Endocrinology, Diabetes and Metabolic Diseases, Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Belgrade 11000, Serbia
| | | | - Vera Artiko
- Center for Nuclear Medicine Clinical Center of Serbia, Faculty of Medicine University of Belgrade, Belgrade 11000, Serbia
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4485
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Santini M, Zupetic I, Viskovic K, Krznaric J, Kutlesa M, Krajinovic V, Polak VL, Savic V, Tabain I, Barbic L, Bogdanic M, Stevanovic V, Mrzljak A, Vilibic-Cavlek T. Cauda equina arachnoiditis – a rare manifestation of West Nile virus neuroinvasive disease: A case report. World J Clin Cases 2020; 8:3797-3803. [PMID: 32953855 PMCID: PMC7479571 DOI: 10.12998/wjcc.v8.i17.3797] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 05/10/2020] [Accepted: 08/13/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Data regarding the neuroradiology features of the West Nile virus neuroinvasive disease (WNV NID) is rather scarce. To contribute to the knowledge of the WNV NID, we present a patient with a combination of encephalitis and acute flaccid paresis, with cauda equina arachnoiditis as the main magnetic resonance (MR) finding.
CASE SUMMARY A 72-year-old female patient was admitted due to fever, headache and gait instability. During the first several days she developed somnolence, aphasia, urinary incontinence, constipation, and asymmetric lower extremities weakness. Cerebrospinal fluid analysis indicated encephalitis. Native brain computed tomography and MR were unremarkable, while spinal MR demonstrated cauda equina enhancement without cord lesions. Virology testing revealed WNV IgM and IgG antibodies in serum and cerebrospinal fluid, which confirmed acute WNV NID. The treatment was supportive. After two months only a slight improvement was noticed but cognitive impairment, loss of sphincter control and asymmetric inferior extremities weakness remained. The patient died after a month on chronic rehabilitation.
CONCLUSION Cauda equina arachnoiditis is a rare, but possible neuroradiological feature in acute flaccid paresis form of WNV NID.
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Affiliation(s)
- Marija Santini
- Department for Intensive Care Medicine and Neuroinfectology, University Hospital for Infectious Diseases “Dr Fran Mihaljevic”, Zagreb 10000, Croatia
| | - Ivana Zupetic
- Department of Radiology, University Clinical Hospital Center, Clinic for Traumatology, Zagreb 10000, Croatia
| | - Klaudija Viskovic
- Department of Radiology and Ultrasound, University Hospital for Infectious Diseases “Dr Fran Mihaljevic”, Zagreb 10000, Croatia
| | - Juraj Krznaric
- Department for Intensive Care Medicine and Neuroinfectology, University Hospital for Infectious Diseases “Dr Fran Mihaljevic”, Zagreb 10000, Croatia
| | - Marko Kutlesa
- Department for Intensive Care Medicine and Neuroinfectology, University Hospital for Infectious Diseases “Dr Fran Mihaljevic”, Zagreb 10000, Croatia
| | - Vladimir Krajinovic
- Department for Intensive Care Medicine and Neuroinfectology, University Hospital for Infectious Diseases “Dr Fran Mihaljevic”, Zagreb 10000, Croatia
| | - Vlatka Lovrakovic Polak
- Department of Infectious Diseases, General County Hospital Karlovac, Karlovac 47000, Croatia
| | - Vladimir Savic
- Department of Poultry Center, Laboratory for Virology and Serology, Croatian Veterinary Institute, Zagreb 10000, Croatia
| | - Irena Tabain
- Department of Virology, Croatian Institute of Public Health, Zagreb 10000, Croatia
| | - Ljubo Barbic
- Department of Microbiology and Infectious Diseases with Clinic, Faculty of Veterinary Medicine, University of Zagreb, Zagreb 10000, Croatia
| | - Maja Bogdanic
- Department of Virology, Croatian Institute of Public Health, Zagreb 10000, Croatia
| | - Vladimir Stevanovic
- Department of Microbiology and Infectious Diseases with Clinic, Faculty of Veterinary Medicine, University of Zagreb, Zagreb 10000, Croatia
| | - Anna Mrzljak
- Department of Medicine, University Hospital Merkur, Zagreb 10000, Croatia
- School of Medicine, University of Zagreb, Zagreb 10000, Croatia
| | - Tatjana Vilibic-Cavlek
- Department of Virology, Croatian Institute of Public Health, Zagreb 10000, Croatia
- School of Medicine, University of Zagreb, Zagreb 10000, Croatia
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4486
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Zhang T, Xue S, Wang ZM, Duan XM, Wang DX. Diagnostic value of ultrasound in the spontaneous rupture of renal angiomyolipoma during pregnancy: A case report. World J Clin Cases 2020; 8:3875-3880. [PMID: 32953867 PMCID: PMC7479563 DOI: 10.12998/wjcc.v8.i17.3875] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 06/27/2020] [Accepted: 08/05/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Spontaneous rupture and hemorrhage of renal angiomyolipoma (RAML) is a life-threatening clinical emergency. When it occurs during pregnancy, it is compared to a “bomb explosion,” which makes the diagnosis and treatment more challenging. An ultrasound examination is a quick and safe examination with the benefit of no radiation exposure, which is always preferred for pregnant women. Currently, cases of spontaneous rupture and hemorrhage of RAML during pregnancy are rare, as is the diagnostic value and characteristics of ultrasound. The lack of understanding of the condition among ultrasound doctors makes it prone to misdiagnosis. In this study, we present the case of a pregnant woman who was preliminarily diagnosed with spontaneous rupture and hemorrhage of the left RAML using ultrasound and discuss the ultrasound characteristics.
CASE SUMMARY A 38-year-old woman in her 19th wk of pregnancy (G2P1) was referred to our clinic for a sudden, persistent pain on the left side of the waist. She had not undergone any previous related abdominal examination. Ultrasound of the urinary system revealed a giant nonhomogenous lump in the left kidney area. The diagnosis was considered spontaneous rupture and hemorrhage of the left RAML in pregnancy via ultrasound. Her left-side waist pain continued to be intense. Subsequently, she underwent computed tomography, which led to the same diagnosis. Based on many factors, the patient underwent left nephrectomy after the induction of labor. The pathological result was the rupture and hemorrhage of a vascular leiomyoma lipoma.
CONCLUSION Ultrasound examination plays an important role in the diagnosis of the spontaneous rupture and hemorrhage of RAML during pregnancy.
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Affiliation(s)
- Tong Zhang
- Department of Ultrasound, The First Hospital of Jilin University, Changchun 130000, Jilin Province, China
| | - Shuai Xue
- Department of Thyroid Surgery, The First Hospital of Jilin University, Changchun 130000, Jilin Province, China
| | - Zheng-Min Wang
- Department of Thyroid Surgery, The First Hospital of Jilin University, Changchun 130000, Jilin Province, China
| | - Xiu-Mei Duan
- Department of Pathology, The First Hospital of Jilin University, Changchun 130000, Jilin Province, China
| | - Dong-Xuan Wang
- Department of Ultrasound, The First Hospital of Jilin University, Changchun 130000, Jilin Province, China
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4487
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D'Urbano F, Fabbri N, Koleva Radica M, Rossin E, Carcoforo P. Emergency surgery in COVID-19 outbreak: Has anything changed? Single center experience. World J Clin Cases 2020; 8:3691-3696. [PMID: 32953845 PMCID: PMC7479566 DOI: 10.12998/wjcc.v8.i17.3691] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 07/22/2020] [Accepted: 08/27/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The current coronavirus disease 19 (COVID-19) pandemic is changing the organization of health care and has had a direct impact on the management of surgical patients.At the General Surgery Department of Sant’Anna University Hospital in Ferrara, Italy, surgical activities were progressively reduced during the peak of the COVID-19 outbreak in Italy. During this period, only one operating room was available for elective cancer surgeries and another for emergency surgeries. Moreover, the number of beds for surgical patients had to be reduced to provide beds and personnel for the new COVID-19 wards.
AIM To compare 2 different period (from March 9 to April 9 2019 and from March 9 to April 9 2020), searching differences in terms of number and type of interventions in emergency surgery of a main University Hospital in Ferrara, a city in Emilia Romagna region, North of Italy.
METHODS This retrospective study was carried out at the General Surgery Department of Sant’Anna University Hospital in Ferrara, Italy. We examined the number of emergency surgeries performed and patient outcomes during the peak of the COVID-19 outbreak in Italy and subsequent total lockdown. We then drew a comparison with the number of surgeries performed and their outcomes during the same period in 2019. The study examined all adult patients who underwent emergency surgery from March 9 to April 9, 2019 (n = 46), and those who underwent surgery during the first month of the lockdown, from March 9 to April 9, 2020 (n = 27). Analyses were adjusted for age, gender, American Society of Anesthesiologists classification scores and types of surgery.
RESULTS A total of 27 patients underwent emergency surgery at Sant’Anna University Hospital in Ferrara during the first month of the lockdown. This represents a 41.3% reduction in the number of patients who were hospitalized and underwent emergency surgery compared to the same period in 2019. The complication rate during the pandemic period was substantially higher than it was during the analogous period in 2019: 15 out of 27 cases from March 9 to April 9, 2020 (55) vs 17 out of 46 cases from March 9 to April 9, 2019 (36.9). Of the 27 patients who underwent emergency surgery during the pandemic, 10 were screened for COVID-19 using both thorax high resolution computerized tomography and a naso-pharyngeal swab, while 9 only underwent thorax high resolution computerized tomography. Only 1 patient tested positive for SARS-CoV-2 and died following surgery.
CONCLUSION There was a significant reduction in emergency surgeries at our center during the COVID-19 pandemic, and it is plausible that there were analogous reductions at other centers across Italy.
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Affiliation(s)
- Francesco D'Urbano
- Department of Morphology, Experimental Medicine and Surgery, Section of General Surgery, University of Ferrara, Ferrara 44100, Italy
| | - Nicolò Fabbri
- Unit of General Surgery, Azienda Unità Sanitaria Locale di Ferrara, Ferrara 44100, Italy
| | - Margherita Koleva Radica
- Department of Morphology, Experimental Medicine and Surgery, Section of General Surgery, University of Ferrara, Ferrara 44100, Italy
| | - Eleonora Rossin
- Department of Morphology, Experimental Medicine and Surgery, Section of General Surgery, University of Ferrara, Ferrara 44100, Italy
| | - Paolo Carcoforo
- Department of Morphology, Experimental Medicine and Surgery, Section of General Surgery, University of Ferrara, Ferrara 44100, Italy
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4488
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Han SY, Kim DU, Seol YM, Kim S, Lee NK, Hong SB, Seo HI. Comparison of gemcitabine plus nab-paclitaxel and FOLFIRINOX in metastatic pancreatic cancer. World J Clin Cases 2020; 8:3718-3729. [PMID: 32953848 PMCID: PMC7479547 DOI: 10.12998/wjcc.v8.i17.3718] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 07/28/2020] [Accepted: 08/12/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Gemcitabine plus nab-paclitaxel (GA) and modified FOLFIRINOX (FFX) have been widely used as standard first-line treatment in pancreatic cancer. However, it is unclear which regimen is more efficacious.
AIM To evaluate a retrospective analysis comparing the efficacy and safety of FFX and GA as first-line chemotherapeutic regimens in patients with metastatic pancreatic cancer.
METHODS We retrospectively analyzed and compared outcomes in 101 patients who presented with pancreatic cancer and were treated with either GA (n = 54) or FFX (n = 47). Moreover, we performed subgroup analysis based on the neutrophil/lymphocyte ratio (NLR) and Eastern Cooperative Oncology Group (ECOG) performance status.
RESULTS There were no significant differences between two groups in baseline characteristics, except for the ECOG performance status. The median progression-free survival (PFS) (6.43 mo vs 4.90 mo, P = 0.058) was comparable between two groups; however, median overall survival (OS) (10.17 mo vs 6.93 mo, P = 0.008) was longer in patients who received GA regimen. In patients with ECOG 0 (PFS: 8.93 mo vs 5.43 mo, P = 0.002; OS: 16.10 mo vs 6.97 mo, P = 0.000) and those with NLR < 3 (PFS: 8.10 mo vs 6.57 mo, P = 0.008; OS: 12.87 mo vs 9.93 mo, P = 0.002), GA regimen showed higher efficacy.
CONCLUSION GA regimen may be recommended to the patients with NLR < 3 or ECOG 0 status although GA and FFX showed comparable efficacy outcomes in patients with metastatic pancreatic cancer.
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Affiliation(s)
- Sung Yong Han
- Department of Internal Medicine and Biomedical Research Institute, Division of Gastroenterology, Pusan National University Hospital, Busan 49241, South Korea
| | - Dong Uk Kim
- Department of Internal Medicine and Biomedical Research Institute, Division of Gastroenterology, Pusan National University Hospital, Busan 49241, South Korea
| | - Young Mi Seol
- Department of Hematology-Oncology, Biomedical Research Institute, Pusan National University Hospital, Busan 49241, South Korea
| | - Suk Kim
- Department of Radiology, Biomedical Research Institute, Pusan National University Hospital, Busan 49241, South Korea
| | - Nam Kyung Lee
- Department of Radiology, Biomedical Research Institute, Pusan National University Hospital, Busan 49241, South Korea
| | - Seung Baek Hong
- Department of Radiology, Biomedical Research Institute, Pusan National University Hospital, Busan 49241, South Korea
| | - Hyung-Il Seo
- Department of Surgery, Biomedical Research Institute, Pusan National University Hospital, Busan 49241, South Korea
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4489
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Zhai SS, Yu H, Gu TT, Li YX, Lei Y, Zhang HY, Zhen TH, Gao YG. Lung adenocarcinoma harboring rare epidermal growth factor receptor L858R and V834L mutations treated with icotinib: A case report. World J Clin Cases 2020; 8:3841-3846. [PMID: 32953862 PMCID: PMC7479576 DOI: 10.12998/wjcc.v8.i17.3841] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 06/02/2020] [Accepted: 07/30/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Epidermal growth factor receptor (EGFR) tyrosine-kinase inhibitors are widely used for the treatment of non-small-cell lung cancer with EGFR mutations. However, patients with rare, even compound EGFR mutations have different responses to EGFR-tyrosine-kinase inhibitors, which bring uncertainty to clinical treatment.
CASE SUMMARY A 45-year-old female patient presented with a 3-mo history of cough and white sputum without chest pain. Chest computed tomography revealed lung space-occupying lesions and multiple lymphadenectasis. Bronchoscopy and pathology suggested lung adenocarcinoma. Compound variation of EGFR gene (exon 21 L858R/V834L) was detected in both tissue and circulating tumor deoxyribonucleic acid samples. As a result of next-generation sequencing and her family’s wishes, the patient was given oral treatment with icotinib hydrochloride (125 mg/d, tid) from March 21, 2019 and has achieved stable disease for the last 1 year.
CONCLUSION Non-small cell lung adenocarcinoma with EGFR L858R/V834L was treated successfully with icotinib, and it may be a new medication treatment option.
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Affiliation(s)
- Shu-Sen Zhai
- Oncology Section, PLA Strategic Support Force Characteristic Medical Center, Beijing 100101, China
| | - Hui Yu
- Cancer Research Institute, YuceBio, Shenzhen 518000, Guangdong Province, China
| | - Tian-Tian Gu
- Cancer Research Institute, YuceBio, Shenzhen 518000, Guangdong Province, China
| | - Yan-Xia Li
- Cancer Research Institute, YuceBio, Shenzhen 518000, Guangdong Province, China
| | - Yan Lei
- Oncology Section, PLA Strategic Support Force Characteristic Medical Center, Beijing 100101, China
| | - Hai-Yan Zhang
- Oncology Section, PLA Strategic Support Force Characteristic Medical Center, Beijing 100101, China
| | - Tong-Huan Zhen
- Oncology Section, PLA Strategic Support Force Characteristic Medical Center, Beijing 100101, China
| | - Yun-Ge Gao
- Oncology Section, PLA Strategic Support Force Characteristic Medical Center, Beijing 100101, China
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4490
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Kim YJ, Lee JH. Disseminated osteomyelitis after urinary tract infection in immunocompetent adult: A case report. World J Clin Cases 2020; 8:3542-3547. [PMID: 32913861 PMCID: PMC7457109 DOI: 10.12998/wjcc.v8.i16.3542] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 06/26/2020] [Accepted: 08/05/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Urinary tract infection (UTI) is one of the most common bacterial infections. Acute pyelonephritis or upper urinary tract infection is often accompanied by bacteremia; however, bacteremia resolves in most cases without complication. Rarely, complications due to bacteremia occur. One of these is osteomyelitis. It mainly affects the lumbar vertebral bodies, and rarely affects other site.
CASE SUMMARY An 80-year-old woman presented to the hospital with a two-month history of pain in both legs. Two months ago, she was admitted to the hospital for fever, flank pain, and urinary frequency and was diagnosed with bacteremic UTI. During hospitalization, she complained of pain in both legs; however, the pain resolved shortly after, and no abnormalities were observed on physical examination. Therefore, she was placed on 2-wk antibiotic therapy for UTI without further evaluation for leg pain. However, pain recurred after discharge and persisted; therefore, an imaging test was performed. Bone scan and magnetic resonance imaging suggested osseous infection in both femurs, tibiae and patellae. Surgical treatment was performed, and tissue- and bone cultures revealed Escherichia coli, a previously observed pathogen, which demonstrated same antibiotic sensitivities, as noted in previous UTI. She was diagnosed with disseminated osteomyelitis, as a complication of UTI, and was placed on an 8-wk antibiotic therapy.
CONCLUSION Indication for osteomyelitis should be high regardless of bone pain at sites other than lumbar spine after or during UTI.
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Affiliation(s)
- Young Jun Kim
- Department of Internal Medicine, Institute of Wonkwang Medical Science, Wonkwang University College of Medicine, Iksan 54538, South Korea
| | - Jae Hoon Lee
- Department of Internal Medicine, Institute of Wonkwang Medical Science, Wonkwang University College of Medicine, Iksan 54538, South Korea
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4491
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Zhou GYJ, Hu JL, Wang S, Ge N, Liu X, Wang GX, Sun SY, Guo JT. Delayed perforation after endoscopic resection of a colonic laterally spreading tumor: A case report and literature review. World J Clin Cases 2020; 8:3608-3615. [PMID: 32913871 PMCID: PMC7457092 DOI: 10.12998/wjcc.v8.i16.3608] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 04/29/2020] [Accepted: 07/14/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) have been widely used for the treatment of early gastrointestinal cancer. Endoscopic piecemeal mucosal resection (EPMR) is derived from the combination of EMR and ESD. Delayed perforation with peritonitis after colonic EPMR is a rare but severe complication, sometimes requiring surgery. There are some associated risk factors, including patient- (location, diameter, and presence of fibrosis) and procedure-related factors. Early recognition and timely treatment are crucial for its management.
CASE SUMMARY We report a case in which delayed perforation with peritonitis was treated using endoscopic closure. A 54-year-old man was diagnosed with a 30-mm-diameter laterally spreading tumor in the colonic hepatic curvature. Fifteen hours after endoscopic resection, peritonitis caused by delayed perforation occurred and gradually aggravated. Conservative treatment was ineffective and no obvious perforation was observed. After timely endoscopic closure, the patient was discharged on postoperative day 4.
CONCLUSION In occasion of localized peritonitis aggravating without macroscopic perforation, endoscopic closure is an effective treatment for delayed perforation with stable vital signs in the early stage.
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Affiliation(s)
- Ge-Yu-Jia Zhou
- Department of Gastroenterology, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
| | - Jin-Long Hu
- Department of Gastroenterology, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
| | - Sheng Wang
- Department of Gastroenterology, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
| | - Nan Ge
- Department of Gastroenterology, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
| | - Xiang Liu
- Department of Gastroenterology, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
| | - Guo-Xin Wang
- Department of Gastroenterology, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
| | - Si-Yu Sun
- Department of Gastroenterology, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
| | - Jin-Tao Guo
- Department of Gastroenterology, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
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4492
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Zhang CL, Li CL, Chen HQ, Sun Q, Liu ZH. First branchial cleft cyst accompanied by external auditory canal atresia and middle ear malformation: A case report. World J Clin Cases 2020; 8:3616-3620. [PMID: 32913872 PMCID: PMC7457106 DOI: 10.12998/wjcc.v8.i16.3616] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Revised: 05/06/2020] [Accepted: 07/16/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND We report a rare case of first branchial cleft anomaly (FBCA) accompanied by bony atresia of the external auditory canal, middle ear malformation, and location malformation of the facial nerve according to the intraoperative findings.
CASE SUMMARY A 19-year-old male patient presented to our department with a mass behind the right earlobe and recurrent postauricular swelling and pain since childhood, he also had severe hearing loss in the right ear since birth. The patient underwent surgery including mass removal, mastoidectomy, and simultaneous meatoplasty and ossiculoplasty under microscopy. No facial palsy or recurrence was noted during postoperative follow-up.
CONCLUSION FBCAs are rare, and to our knowledge, this is the first report of FBCA accompanied by external auditory canal bony atresia, middle ear malformation, and location malformation of the facial nerve. An effective postauricular approach under microscopy facilitated complete lesion removal and simultaneous otologic reconstruction.
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Affiliation(s)
- Chun-Lin Zhang
- Department of Otorhinolaryngology, Head and Neck Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi 563000, Guizhou Province, China
| | - Chun-Lei Li
- Department of Otorhinolaryngology, Head and Neck Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi 563000, Guizhou Province, China
| | - Hang-Qi Chen
- Department of Otorhinolaryngology, Head and Neck Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi 563000, Guizhou Province, China
- Postgraduate College of Zunyi Medical University, Zunyi 563000, Guizhou Province, China
| | - Qiang Sun
- Department of Otorhinolaryngology, Head and Neck Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi 563000, Guizhou Province, China
- Postgraduate College of Zunyi Medical University, Zunyi 563000, Guizhou Province, China
| | - Zhao-Hui Liu
- Department of Otorhinolaryngology, Head and Neck Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi 563000, Guizhou Province, China
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4493
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Luo M, Mu R, Liu JF, Bai FH. Novel computerized psychometric tests as primary screening tools for the diagnosis of minimal hepatic encephalopathy. World J Clin Cases 2020; 8:3377-3389. [PMID: 32913845 PMCID: PMC7457114 DOI: 10.12998/wjcc.v8.i16.3377] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 05/05/2020] [Accepted: 07/14/2020] [Indexed: 02/06/2023] Open
Abstract
Minimal hepatic encephalopathy (MHE) is a critical neurocognitive complication of decompensated liver cirrhosis and portosystemic shunting, which results in a wide range of cognitive deficits including impairments in working attention, psychomotor speed, and executive function. Current guidelines have recommended paper-and-pencil psychometric tests for the diagnosis of MHE. Most high-risk cirrhotic patients are required to be examined; however, paper-and-pencil psychometric tests are neither convenient nor rapid to perform in the clinic. Recently, novel computerized psychometric tests, including the inhibitory control test, EncephalApp Stroop App, and critical flicker frequency, have been proven to be rapid, effective, and convenient methods for screening MHE in clinical practice and for identifying high-risk cirrhotic patients for further validation using rigid neuropsychometric examinations. However, diagnostic accuracy of these tests is influenced by educational background, age, and cultural differences. This review summarizes clinical evidence of the application of novel computerized psychometric tests for screening MHE.
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Affiliation(s)
- Ming Luo
- Department of Gastroenterology, People’s Hospital of Ningxia Hui Autonomous Region, Yinchuan 750021, Ningxia Hui Autonomous Region, China
| | - Rui Mu
- Department of Gastroenterology, People’s Hospital of Ningxia Hui Autonomous Region, Yinchuan 750021, Ningxia Hui Autonomous Region, China
| | - Jian-Fang Liu
- Department of Gastroenterology, People’s Hospital of Ningxia Hui Autonomous Region, Yinchuan 750021, Ningxia Hui Autonomous Region, China
| | - Fei-Hu Bai
- Department of Gastroenterology, People’s Hospital of Ningxia Hui Autonomous Region, Yinchuan 750021, Ningxia Hui Autonomous Region, China
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4494
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Li LL, Lu YQ, Li T. Acute generalized exanthematous pustulosis with airway mucosa involvement: A case report. World J Clin Cases 2020; 8:3578-3582. [PMID: 32913867 PMCID: PMC7457104 DOI: 10.12998/wjcc.v8.i16.3578] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 06/26/2020] [Accepted: 07/14/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Acute generalized exanthematous pustulosis (AGEP) is a severe cutaneous adverse reaction characterized by sterile pustules on erythematous skin associated with fever and leukocytosis. The annual incidence of AGEP is estimated to be 1-5 cases per million. Cases of AGEP with oral mucosa involvement have been reported. However, reports of AGEP involving airway mucosa are limited.
CASE SUMMARY We report a 42-year-old woman with serious AGEP involving the airway mucosa. The patient initially developed fever and a small rash on her forehead and face. Over the next 2 d, she developed a diffuse, pustular rash over her trunk and legs. In addition, she complained of a cough with white foam-like sputum, chest tightness and dyspnea. Four days later, due to dyspnea, her mental status started to gradually deteriorate. She became more and more drowsy. Biopsies of the skin and airway mucosa suggested the diagnosis of AGEP. According to the European study of severe cutaneous adverse reactions group’s scoring system, the patient scored +6 indicating a probable diagnosis of AGEP. She received intravenous methylprednisolone 120 mg/12 h for 3 d, and was eventually discharged in good condition. This patient had already experienced respiratory failure and airway mucosa involvement on admission; however, the clinicians had an insufficient understanding of AGEP. Glucocorticoid was administered for more than 10 d following onset of the disease, and her overall prognosis was satisfactory.
CONCLUSION This case represents a rare clinical feature of AGEP and an important finding for clinicians.
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Affiliation(s)
- Lu-Lu Li
- Department of Emergency Medicine, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
| | - Yuan-Qiang Lu
- Department of Emergency Medicine, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
| | - Tong Li
- Department of Emergency Medicine, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
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4495
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Du Y, Lv GZ, Yu S, Wang D, Tan Q. Long-term medical treatment of patients with severe burns at exposed sites. World J Clin Cases 2020; 8:3515-3526. [PMID: 32913858 PMCID: PMC7457097 DOI: 10.12998/wjcc.v8.i16.3515] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Revised: 05/18/2020] [Accepted: 07/14/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Body parts such as the face and hands are highly exposed during daily life and burns may accumulate in these areas. In addition, residual wounds, scar hyperplasia and contracture often exist in the late stage of a deep burn in these areas, which may affect patients’ appearance, movements, and mental health. However, inadequate attention has been paid to this issue which can result in problems, such as difficulty in healing, possibility of carcinoma, chronic pain and a heavy mental burden.
AIM To investigate the long-term medical treatment of patients with severe burns at exposed sites following a mass burn casualty event.
METHODS A retrospective analysis of 13 patients with severe burns at exposed sites was performed to determine their respective long-term medical treatment. A combined wound dressing scheme consisting of traditional Chinese and Western medicine was introduced to repair residual wounds. Active and passive functional exercises with massage, Chinese herbal baths and compression fixation were proposed to ameliorate the condition of the hands. A combination of physical, chemical and photoelectrical measures was adopted for anti-scar treatment. A psychological intervention and recovery guide was provided which corresponded to the patients’ psychological status.
RESULTS Compared to patients who did not simultaneously receive the same treatment, patients who underwent systematic treatment recovered with a lower wound infection rate (P < 0.05), a shorter healing time (13.6 ± 3.2 d) compared with (19.1 ± 3.5 d) and more bearable pain during wound dressing at three days, one week and two weeks after a Chinese herbal bath (P < 0.05). Satisfactory results were achieved with regard to restored function of patients’ joints and blood supply to nerve endings, closure of the eyelids and the size of mouth opening tended to be normal, and only 7.1% of patients were diagnosed with severe scar hyperplasia and contracture deformity compared with 30.7% in the control group. In addition, the color, thickness, vascular distribution and softness score of the scars improved (P < 0.01), and the effects of the psychological intervention was remarkable as shown by the Self-Rating Anxiety Scale and Self-Rating Depression Scale.
CONCLUSION A better prognosis can be achieved in patients in the late stage of a burn with active residual wound repair, limb functional exercise, anti-scar and psychological rehabilitation.
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Affiliation(s)
- Yong Du
- Department of Burns and Plastic Surgery, Affiliated Hospital of Jiangnan University, Wuxi 214000, Jiangsu Province, China
- Department of Burns and Plastic Surgery, The Drum Tower Clinical College of Nanjing Medical University, Nanjing 210008, Jiangsu Province, China
| | - Guo-Zhong Lv
- Department of Burns and Plastic Surgery, Affiliated Hospital of Jiangnan University, Wuxi 214000, Jiangsu Province, China
| | - Shun Yu
- Department of Burns and Plastic Surgery, Affiliated Hospital of Jiangnan University, Wuxi 214000, Jiangsu Province, China
| | - Dan Wang
- Department of Burns and Plastic Surgery, Affiliated Hospital of Jiangnan University, Wuxi 214000, Jiangsu Province, China
| | - Qian Tan
- Department of Burns and Plastic Surgery, The Drum Tower Clinical College of Nanjing Medical University, Nanjing 210008, Jiangsu Province, China
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4496
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Zhao XY, Wang X, Li CQ, Zhang Q, He AQ, Liu G. Intestinal obstruction in pregnancy with reverse rotation of the midgut: A case report. World J Clin Cases 2020; 8:3553-3559. [PMID: 32913863 PMCID: PMC7457094 DOI: 10.12998/wjcc.v8.i16.3553] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 05/30/2020] [Accepted: 07/16/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Reverse rotation of the midgut is a rare type of intestinal malrotation. Volvulus of the right colon or entire midgut, stenosis of the transverse colon and obstruction of the duodenojejunal junction are common complications of reverse rotation. In this study, we report the first case of intestinal obstruction associated with reverse rotation in pregnancy.
CASE SUMMARY A 31-year-old woman at 36+2 wk gestation presented to the emergency department with progressive abdominal cramping, nausea and bilious vomiting. Abdominal ultrasound scanning showed dilatation of the bowel. Computed tomography scanning revealed features of reverse rotation of the midgut with intestinal volvulus. After consultation with the obstetrician, the pregnancy was terminated and exploratory abdominal surgery was performed. Intra-operatively, it was found that the mesentery of the colon and small intestine was insufficiently attached. The right colon and the small intestinal mesentery was twisted, and intestinal necrosis was observed. The duodenum and duodenojejunal junction were curved in front of the transverse colon, and the transverse colon passed through the tunnel behind the mesenteric root. Intestinal reverse rotation with volvulus was confirmed. The necrotic intestine was resected and small intestine mesenteric reconstruction was performed. The patient recovered after surgery. After leaving the hospital, the patient and her daughter remained well during an 8-month follow-up period.
CONCLUSION We report the diagnosis, treatment and etiology of a pregnant patient with intestinal obstruction due to reverse rotation of the midgut. For similar cases, appropriate diagnosis and treatment should be carried out according to the condition of the fetus and pregnant woman.
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Affiliation(s)
- Xin-Yu Zhao
- Department of General Surgery, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Xin Wang
- Department of General Surgery, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Chun-Qiang Li
- Department of General Surgery, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Qi Zhang
- Department of General Surgery, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - An-Qi He
- Department of General Surgery, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Gang Liu
- Department of General Surgery, Tianjin Medical University General Hospital, Tianjin 300052, China
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4497
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Han XY, Wang YY, Wei HQ, Yang GZ, Wang J, Jia YZ, Ao WQ. Multifocal neuroendocrine cell hyperplasia accompanied by tumorlet formation and pulmonary sclerosing pneumocytoma: A case report. World J Clin Cases 2020; 8:3583-3590. [PMID: 32913868 PMCID: PMC7457093 DOI: 10.12998/wjcc.v8.i16.3583] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 07/06/2020] [Accepted: 07/16/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Pulmonary tumorlets are nodular hyperplastic neuroendocrine cells (NECs) that extend beyond the basement membrane. They often coexist with other lung diseases such as fibrosis and bronchiectasis, but rarely accompanied by pulmonary sclerosing pneumocytoma (PSP), which has not been reported in the literature.
CASE SUMMARY A 54-year-old woman was admitted to the hospital because she had symptoms of bloody sputum for more than 4 mo and hemoptysis for 1 wk. Computed tomography images showed atrophy accompanied by infections in the middle lobe of her right lung. Moreover, numerous nodules were identified in the middle lobe of the right lung. The patient underwent thoracoscopic pneumonectomy of the middle lobe of the right lung, and the resected mass was pathologically confirmed to have bronchiectasis, multifocal NEC hyperplasia accompanied by tumorlet, and PSP.
CONCLUSION Our report presents a rare clinical case of bronchiectasis complicated with multifocal NEC hyperplasia, tumorlet, and PSP.
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Affiliation(s)
- Xiao-Yu Han
- Department of Pathology, Tongde Hospital of Zhejiang Province, Hangzhou 310012, Zhejiang Province, China
| | - Yuan-Yuan Wang
- Department of Pathology, Tongde Hospital of Zhejiang Province, Hangzhou 310012, Zhejiang Province, China
| | - Hong-Quan Wei
- Department of Pathology, Tongde Hospital of Zhejiang Province, Hangzhou 310012, Zhejiang Province, China
| | - Guang-Zhao Yang
- Department of Radiology, Tongde Hospital of Zhejiang Province, Hangzhou 310012, Zhejiang Province, China
| | - Jian Wang
- Department of Radiology, Tongde Hospital of Zhejiang Province, Hangzhou 310012, Zhejiang Province, China
| | - Yu-Zhu Jia
- Department of Radiology, Tongde Hospital of Zhejiang Province, Hangzhou 310012, Zhejiang Province, China
| | - Wei-Qun Ao
- Department of Radiology, Tongde Hospital of Zhejiang Province, Hangzhou 310012, Zhejiang Province, China
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4498
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Wu HY, Cao YW, Chang FJ, Liang L. Spontaneous multivessel coronary artery spasm diagnosed with intravascular ultrasound imaging: A case report. World J Clin Cases 2020; 8:3601-3607. [PMID: 32913870 PMCID: PMC7457112 DOI: 10.12998/wjcc.v8.i16.3601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 05/27/2020] [Accepted: 07/16/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Coronary artery spasm is a major cause of myocardial ischemia. Although coronary artery spasm has been known for a long time, its mechanism has not yet been identified. Many clinicians, especially young clinicians pay less attention to coronary artery spasm, which may lead to some patients not being appropriately diagnosed and treated in time. We report a patient with spontaneous multivessel coronary artery spasm for more than 30 years diagnosed with intravascular ultrasound (IVUS) imaging.
CASE SUMMARY A 66-year-old Chinese male patient had chest squeezing at rest for more than 30 years. He had a history of cigarette smoking for more than 40 years and hypertension for 10 years. Before presenting at our institution, the patient had undergone coronary angiography 4 times and percutaneous transluminal coronary angioplasty procedures twice at other hospitals without a diagnosis of coronary artery spasm. However, his chest symptoms worsened. Spontaneous multivessel coronary artery spasm occurred during IVUS without provocation testing, and the IVUS image was recorded. Thus, the diagnosis of multifocal spontaneous coronary artery spasm was confirmed. The patient was placed on oral diltiazem, isosorbide mononitrate, and nicorandil to suppress coronary artery spasms. All medications were given at the maximum dosages tolerated by the patient. He was discharged after 5 d without complications. During the six-month follow-up period, the patient was symptom-free.
CONCLUSION Coronary artery spasm is still prevalent in Eastern countries. It is essential for clinicians to be aware of coronary artery spasm, which may be hard to detect and can be lethal, in order to diagnose and treat patients appropriately.
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Affiliation(s)
- Hao-Yu Wu
- Department of Cardiology, Shaanxi Provincial People's Hospital, Xi'an 710068, Shaanxi Province, China
| | - Yi-Wei Cao
- Department of Cardiology, Shaanxi Provincial People's Hospital, Xi'an 710068, Shaanxi Province, China
| | - Feng-Jun Chang
- Department of Cardiology, Shaanxi Provincial People's Hospital, Xi'an 710068, Shaanxi Province, China
| | - Lei Liang
- Department of Cardiology, Shaanxi Provincial People's Hospital, Xi'an 710068, Shaanxi Province, China
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4499
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Chela HK, Pasha SB, Basar O, Daglilar E, Tahan V. Liver in the limelight in the corona (COVID-19) time. World J Clin Cases 2020; 8:3405-3410. [PMID: 32913847 PMCID: PMC7457103 DOI: 10.12998/wjcc.v8.i16.3405] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 07/08/2020] [Accepted: 08/05/2020] [Indexed: 02/05/2023] Open
Abstract
The novel coronavirus, severe acute respiratory syndrome-corona virus-2 (SARS-CoV-2), is a topic of great interest currently in the medical field due to the significant morbidity and mortality associated with it. There is immense curiosity about this virus as knowledge about it is limited from pathogenesis, host related factors and the variable effect it has on different patient populations. Though it has claimed fame due to its ability to compromise the respiratory system, it possess the capability to infect other organs as well including the liver. It is important for clinicians to recognize that the virus can result in multi-organ dysfunction as well. Presentation with gastrointestinal symptoms and involvement of the liver can be subtle and can be misdiagnosed. Those with pre-existing liver disease may be more susceptible as well as those who are immunosuppressed or have other co-morbidities. This review article provides a brief overview of some of the information that is available so far with regards to how the liver is impacted by the coronavirus.
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Affiliation(s)
- Harleen Kaur Chela
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, University of Missouri, Columbia, MO 65212, United States
| | - Syed Bilal Pasha
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, University of Missouri, Columbia, MO 65212, United States
| | - Omer Basar
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, University of Missouri, Columbia, MO 65212, United States
| | - Ebubekir Daglilar
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, University of Missouri, Columbia, MO 65212, United States
| | - Veysel Tahan
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, University of Missouri, Columbia, MO 65212, United States
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4500
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Wang JG, Sun JL, Shen J. Factors affecting failed trial of labor and countermeasures: A retrospective analysis. World J Clin Cases 2020; 8:3483-3492. [PMID: 32913855 PMCID: PMC7457101 DOI: 10.12998/wjcc.v8.i16.3483] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 05/04/2020] [Accepted: 07/14/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Vaginal delivery is the ideal mode of delivery for the termination of a pregnancy. However, the cesarean section rate in China is much higher than the published by the World Health Organization in the Lancet in 2010.
AIM To retrospectively analyze the factors related to failed trial of labor and the clinical indications for cesarean section conversion, explore how to promote the trial of labor success rate, and determine the feasibility of reducing the rate of conversion to cesarean section.
METHODS A retrospective analysis was performed on 9240 maternal women who met vaginal delivery conditions and required a trial of labor from January 2016 to December 2018 at our hospital. Among them, 8164 pregnant women who had a successful trial of labor were used as a control group, and 1076 pregnant women who had a failed trial of labor and converted to an emergency cesarean section were used as an observation group. The patients’ clinical data during hospitalization were collected for comparative analysis, the related factors of the failed trial of labor were discussed, and reasonable prevention and resolution strategies were proposed to increase the success rate of trial of labor.
RESULTS The analysis revealed that advanced age (≥ 35 years old), macrosomia (≥ 4000 g), delayed pregnancy (≥ 41 wk), use of uterine contraction drugs, primipara, and fever during labor were associated with conversion to an emergency cesarean section in the failed trial of labor. Multivariate regression analysis showed that age, gestational age, primipara, use of uterine contraction drugs, fever during birth, and newborn weight led to a higher probability of conversion to an emergency cesarean section in the failed trial of labor. The analysis indicated that the following clinical indications were associated with the conversion to cesarean section in the failed trial of labor: Fetal distress (44.3%), social factors (12.8%), malpresentation (face presentation, persistent occipitoposterior position, and persistent occipitotransverse position) (9.4%), and cephalopelvic disproportion (8.9%).
CONCLUSION The conversion to emergency cesarean section in failed trial of labor is affected by many factors. Medical staff should take appropriate preventive measures for the main factors, increase the trial of labor success rate, improve the quality of delivery, ensure the safety of mother and child during the perinatal period, and improve the relationship between doctors and patients.
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Affiliation(s)
- Jin-Guang Wang
- Department of Obstetrics and Gynecology, General Hospital of Northern Theater Command (Heping Campus), Shenyang 110000, Liaoning Province, China
| | - Jing-Li Sun
- Department of Obstetrics and Gynecology, General Hospital of Northern Theater Command (Heping Campus), Shenyang 110000, Liaoning Province, China
| | - Jian Shen
- Department of Obstetrics and Gynecology, General Hospital of Northern Theater Command (Heping Campus), Shenyang 110000, Liaoning Province, China
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