Ectopic recurrence following treatment of arteriovenous malformations in an adult: A case report and review of literature

BACKGROUND

Digital subtraction angiography (DSA), the gold standard for the diagnosis of intracranial arteriovenous malformations (AVMs), can show clean nidus resection, leading to a perceived cure. Most cases of intracranial AVM recurrence have been reported in pediatric patients. The conventional understanding indicates that AVMs arise when abnormal blood vessels develop between the fourth and eighth weeks of embryonic development, which coincides with the typical period of blood vessel formation in the brain. As such, recurrent ectopic AVM are rare in adults.

CASE SUMMARY

Herein, we present the case of a 31-year-old adult with a history of an intracranial AVM originally diagnosed with a symptomatic de novo cerebellar AVM formation. Recurrence was observed five years following angiographically-confirmed excision of the initial AVM. DSA performed prior to initial AVM resection indicated no cerebellar abnormalities. Moreover, the recurrent arteries exhibited differences in arteries and draining veins. In addition to reporting this case, we analyzed six previously-reported adult patients with similar ectopic recurrent AVMs. These cases are summarized to review and explore the potential causes of ectopic AVM recurrence in adults, which increase the likelihood of acquired AVM.

CONCLUSION

The clinical course of the reported patients demonstrated the possibility of ectopic AVM recurrence in adults. The median time between the diagnosis of the initial AVM and the occurrence of ectopic recurrent AVM in adults was 11 years (range: 5–20 years). Magnetic resonance imaging follow-up for more than 10 years may be required in adult AVM-treated patients.

Cystic ductal adenocarcinoma of pancreas complicated with neuroendocrine tumor: A case report and review of literature

BACKGROUND

Difficulties in making an accurate preoperative diagnosis of cystic pancreatic lesions pose a challenge for radiologists. It would be helpful to report rare cases and review the literature.

CASE SUMMARY

In the present report, a case of a patient with a pancreatic cystic lesion initially misdiagnosed as a pseudocyst by radiologist was documented, which was later pathologically confirmed as pancreatic ductal adenocarcinoma with neuroendocrine tumor. However, subsequent literature review yielded no previous reports of pancreatic ductal adenocarcinoma with neuroendocrine tumors and cystic lesions. Therefore, literature on the imaging diagnosis of pancreatic cystic lesions was instead reviewed and discussed.

CONCLUSION

Careful evaluation of the characteristics revealed by multimodal imaging techniques, medical history, laboratory examination data and follow-up observations, is critical to the diagnosis and treatment of pancreatic cystic disease. We provide valuable insights into the diagnosis of pancreatic cystic disease through a rare case report and literature review.

Successful management of infection and macrophage activation syndrome patient using low-dose etoposide: A case report

BACKGROUND

Macrophage activation syndrome (MAS), a sub-type of hemophagocytic lymphohistiocytosis (HLH) secondary to autoimmune rheumatic diseases, is a critical and potentially fatal condition characterized by an excessive inflammatory response. Despite the established efficacy of the HLH-2004 guideline in diagnosing and treating HLH over the years, ongoing discussion persists regarding its application, especially for HLH secondary to complicated conditions, such as autoimmune rheumatic diseases combined with severe infection. Etoposide (VP-16), a topoisomerase II inhibitor that effectively induces DNA damage and subsequent apoptosis in hyperactivated immune cells, has been widely used for the treatment of HLH. However, its suppressive effect on immune system may also cause potential exacerbation of infection in autoimmune rheumatic disease-induced HLH patients complicated with severe infection. Therefore, the use of VP-16 in such cases was inconclusive.

CASE SUMMARY

In this case study, we propose a potentially effective strategy for managing a patient diagnosed with secondary HLH complicated with systemic lupus erythematosus (SLE) and chronic coronavirus disease 2019 infection. Our approach involves early administration of low-dose VP-16 (100 mg twice a week, 300 mg in total), combined with methylprednisolone, cyclophosphamide, and cyclosporine A. The administration of etoposide effectively led to improvements in various indices of HLH.

CONCLUSION

Low dose etoposide proves to be an effective approach in alleviating HLH while mitigating the risk of infection.

High-resolution magnetic resonance imaging in the diagnosis and management of vertebral artery dissection: A case report

BACKGROUND

Vertebral artery dissection (VAD) is a rare but life-threatening condition characterized by tearing of the intimal layer of the vertebral artery, leading to stenosis, occlusion or rupture. The clinical presentation of VAD can be heterogeneous, with common symptoms including headache, dizziness and balance problems. Timely diagnosis and treatment are crucial for favorable outcomes; however, VAD is often missed due to its variable clinical presentation and lack of robust diagnostic guidelines. High-resolution magnetic resonance imaging (HRMRI) has emerged as a reliable diagnostic tool for VAD, providing detailed visualization of vessel wall abnormalities.

CASE SUMMARY

A young male patient presented with an acute onset of severe headache, vomiting, and seizures, followed by altered consciousness. Imaging studies revealed bilateral VAD, basilar artery thrombosis, multiple brainstem and cerebellar infarcts, and subarachnoid hemorrhage. Digital subtraction angiography (DSA) revealed vertebral artery stenosis but failed to detect the dissection, potentially because intramural thrombosis obscured the VAD. In contrast, HRMRI confirmed the diagnosis by revealing specific signs of dissection. The patient was managed conservatively with antiplatelet therapy and other supportive measures, such as blood pressure control and pain management. After 5 mo of rehabilitation, the patient showed significant improvement in swallowing and limb strength.

CONCLUSION

HR-MRI can provide precise evidence for the identification of VAD.

High complex anal fistula managed by the modified transanal opening of the intersphincteric space via the inter-sphincteric approach: A case report

BACKGROUND

High complex anal fistulas are epithelialized tunnels, with the main fistula piercing above the deep external sphincter and the internal opening approaching the dentate line. Conventional surgical procedures for high complex anal fistulas remove most of the external sphincter and damage the anorectal ring. Postoperative loss of anal function can cause physical and mental damage. Transanal opening of the intersphincteric space (TROPIS) is an effective procedure that completely preserves the external anal sphincter. However, its clinical application is limited by challenges in the localization of the internal opening of a fistula and the high risk of complications. On the basis of our clinical experience, we modified the TROPIS procedure for the treatment of treating high complex anal fistulas.

CASE SUMMARY

A patient with a high complex anal fistula located above the anorectal ring underwent modified TROPIS, which involved sepsis drainage and identification of the internal opening in the intersphincteric space. The patient with the high complex anal fistula recovered well postoperatively, without any postoperative complications or anal dysfunction. Anal function returned to normal after 17 months of follow-up.

CONCLUSION

The modified TROPIS procedure is the most minimally invasive surgery for anal fistulas that minimally impairs anal function. It allows the complete removal of infected anal glands and reduces the risk of postoperative complications. Modified TROPIS via the intersphincteric approach is an alternative sphincter-preserving treatment for high complex anal fistulas.

Quantitative magnetic resonance imaging in prostate cancer: A review of current technology

Prostate cancer (PCa) imaging forms an important part of PCa clinical management. Magnetic resonance imaging is the modality of choice for prostate imaging. Most of the current imaging assessment is qualitative i.e., based on visual inspection and thus subjected to inter-observer disagreement. Quantitative imaging is better than qualitative assessment as it is more objective, and standardized, thus improving interobserver agreement. Apart from detecting PCa, few quantitative parameters may have potential to predict disease aggressiveness, and thus can be used for prognosis and deciding the course of management. There are various magnetic resonance imaging-based quantitative parameters and few of them are already part of PIRADS v.2.1. However, there are many other parameters that are under study and need further validation by rigorous multicenter studies before recommending them for routine clinical practice. This review intends to discuss the existing quantitative methods, recent developments, and novel techniques in detail.

Breast cancer imaging-clinical experience with two-dimensional-shear wave elastography: A retrospective study

BACKGROUND

Breast cancer morbidity has been increasing worldwide, but treatments are improving. The therapeutic response depends on the stage at which the disease is diagnosed. Therefore, early diagnosis has never been more essential for successful treatment and a reduction in mortality rates. Radiology plays a pivotal role in cancer detection, and advances in ultrasound (US) palpation have shown promising results for breast cancer imaging. The addition of two-dimensional-shear wave elastography (2D-SWE) US in the routine breast imaging exam can increase early cancer detection and promote better surveillance.

AIM

To evaluate the clinical applications of 2D-SWE US in breast cancer detection and its combination with other imaging modalities.

METHODS

The 200 consecutive female patients aged 50-80 were examined to evaluate palpable breast lesions. All patients underwent mammography, bright mode (B-mode) US, and 2D-SWE followed by US-guided biopsy in two consecutive sessions.

RESULTS

Combining B-mode and shear wave US imaging with X-ray mammography revealed 100% of the suspicious lesions, resulting in greater sensitivity, specificity, and negative predictive value. The result improves compared to either B-mode or 2D-SWE alone (P = 0.02).

CONCLUSION

Combining 2D-SWE with conventional US and X-ray techniques improves the chance of early cancer detection. Including 2D-SWE in regular breast imaging routines can reduce the need for biopsies and improve the chance of early cancer detection and survivability with the proper line of therapy.

Cryoablation for intrapulmonary bronchial cyst: A case report

BACKGROUND

Bronchial cysts are congenital malformations usually located in the mediastinum, and intrapulmonary localization is very rare. Cryoablation is a novel therapeutic approach that promotes tumor necrosis and stimulates anti-tumor immune responses.

CASE SUMMARY

This article reports a case of a 68-year-old male patient who was diagnosed with an intrapulmonary bronchogenic cyst by computed tomography examination and pathology, and the patient subsequently underwent cryoablation therapy and achieved complete response with after 3 months of follow-up.

CONCLUSION

Intrapulmonary bronchogenic cysts are very rare, cryoablation therapy is feasible, safe, and effective for intrapulmonary bronchial cysts.

Yttrium-90 radioembolization treatment strategies for management of hepatocellular carcinoma

As the third leading cause of cancer-related deaths worldwide, hepatocellular carcinoma (HCC) represents a significant global health challenge. This paper provides an introduction and comprehensive review of transarterial radioembolization (TARE) with Yttrium-90 (Y90), a widely performed transcatheter procedure for HCC patients who are not suitable candidates for surgery. TARE involves the targeted delivery of radioactive microspheres to liver tumors, offering a promising treatment option for managing HCC across various stages of the disease. By evaluating Y90 TARE outcomes across early, intermediate, and advanced stages of HCC, the review aims to present a thorough understanding of its efficacy and safety. Additionally, this paper highlights future research directions focusing on the potential of combination therapies with systemic and immunotherapies, as well as personalized treatments. The exploration of these innovative approaches aims to improve treatment outcomes, reduce adverse events, and provide new therapeutic opportunities for HCC patients. The review underscores the importance of ongoing research and clinical trials to optimize TARE further and integrate it into comprehensive HCC treatment paradigms.

Hypoparathyroidism with situs inversus totalis: A case report

BACKGROUND

Hypoparathyroidism (HP) is a rare endocrine disorder, while situs inversus totalis (SIT) is a rare condition in which the internal organs are positioned in a mirrored pattern compared to their usual positions. This case illustrates some potential shared mechanisms between HP and SIT, highlighting the importance of accurate identification and prompt first emergency, offering insights for future research.

CASE SUMMARY

This report discusses a case of a middle-aged patient with adolescent-onset HP with concurrent SIT. The patient experienced recurrent episodes of increased neuromuscular excitability (manifesting as spasms in the hands and feet and laryngospasms) and even periods of unconsciousness. Initially, these symptoms led to a misdiagnosis of epilepsy. Nevertheless, upon thorough examination and treatment in the general medicine ward, the correct diagnosis was established. Corresponding treatment resulted in improved management of the patient’s symptoms.

CONCLUSION

Co-occurrence of HP and SIT may be associated with genetic mutations, chromosomal anomalies, or hereditary factors, as may other similar conditions.

Asymmetric outcomes in bilateral maxillary impacted tooth extractions: A case report

BACKGROUND

The extraction of maxillary impacted teeth is a common procedure in oral surgery, frequently complicated by oroantral communications. For less-experienced clinicians, accurately assessing the difficulty and associated risks of maxillary third molar extractions remain a significant challenge.

CASE SUMMARY

We present a case involving disparate outcomes following bilateral extraction of maxillary third molars. Using cone-beam computed tomography and three-dimensional software, we conducted a digital assessment of the factors contributing to extraction difficulty and risk, controlling for potential confounders. Key variables analyzed included alveolar bone volume, bone quality, crown-root angulation, and maxillary sinus mucosal thickness. Additionally, we introduce the novel concept of "tegmen bone" to quantitatively evaluate the bone mass between the teeth and the maxillary sinus. This unique case, with differing outcomes on opposite sides of the same patient, provided an opportunity to minimize extraneous variables and focus on the local anatomical factors influencing the procedures, thereby improving the precision of our analysis.

CONCLUSION

This case highlights the potential utility of predictive analysis in guiding the management of complex tooth extractions.

Mesenteric venous thrombosis in a young adult: A case report and review of the literature

BACKGROUND

Acute mesenteric vein thrombosis (MVT) accounts for only 2%–10% of all cases of acute mesenteric ischaemia, with an incidence rate of ~0.1% in Europe and the United States. It represents < 10% of mesenteric infarction cases and is seen predominantly in older adults. In younger individuals, MVT is uncommon, with 36% of cases having unidentified mechanisms and causes.

CASE SUMMARY

A 27-year-old man presented to the emergency department on February 29, 2024, with a chief complaint of intermittent abdominal pain for 3 day. He was previously in good health. As the abdominal pain was not alleviated by conventional treatment, an abdominal computed tomography (CT) scan was performed, which showed increased density in the portal and mesenteric veins. Further imaging, including portal vein ultrasound, mesenteric CT angiography, and enhanced abdominal CT, revealed widespread thrombosis of the portal vein system (including the main portal vein, left and right branches, proximal mesenteric vein, and splenic vein). After 10 day of thrombectomy and anticoagulation therapy, the patient’s abdominal pain had improved significantly. Follow-up assessments indicated that portal venous blood flow had largely returned to normal. He was discharged on March 9, 2024. During a follow-up exam 2 months later, repeat abdominal enhanced CT showed that the previously detected thrombi were no longer visible.

CONCLUSION

Clinicians should remain vigilant for acute MVT in young patients presenting with abdominal pain, to prevent misdiagnosis of this fatal condition.

Exertional heat stroke with pronounced presentation of microangiopathic hemolytic anemia: A case report

BACKGROUND

Exertional heat stroke (EHS) is a critical condition arising from prolonged physical exertion in high temperatures that typically presents with normal hemoglobin levels. However, atypical presentations can also occur, leading to significant complications such as hemolytic anemia and organ dysfunction.

CASE SUMMARY

This case report describes a male patient who experienced moderate-to-severe anemia that was difficult to correct, with a confirmed diagnosis of microangiopathic hemolytic anemia accompanying multiple organ dysfunction syndrome, indicative of critical EHS. Despite intensive resuscitation efforts, the patient’s condition deteriorated, necessitating admission to the intensive care unit for advanced management.

CONCLUSION

This case highlights the importance of recognizing atypical presentations of EHS, particularly that with significant hemolytic anemia and concurrent organ failure. Clinicians should maintain a high level of suspicion for these complications in patients displaying symptoms of heat-related illness, especially when caused by strenuous activity, as early diagnosis and intervention are crucial to improve patient outcomes.

Portal venous gas complication following coronary angiography: A case report

BACKGROUND

Portal vein gas (PVG) is an abnormal accumulation of gas within the portal and intrahepatic portal veins. It is associated with various abdominal diseases, ranging from benign conditions to life-threatening ones that require immediate surgical intervention. Coronary angiography is the standard diagnostic procedure for coronary artery disease. There were no prior reports are available of PVG as a complication of coronary angiography.

CASE SUMMARY

In the specific case described here, the patient did not show signs of peritoneal irritation; however, computed tomography scans findings revealed pneumatosis in the wall of the small intestine, hepatic portal vein, and mesenteric vein, along with acute enteritis (etiology pending classification). A cesarean section was not performed, and the patient received treatment with fasting, rehydration, and anti-infection therapy. Subsequently, the patient's symptoms of abdominal distension and pain improved, and follow-up computed tomography scans indicated resolution of the portal system pneumatosis and intestinal wall edema, resulting in a favorable clinical outcome.

CONCLUSION

Portal venous gas complication following coronary angiography was a complication of coronary angiography.

Epstein-Barr virus positive post-transplant lymphoproliferative disorder with significantly decreased T-cell chimerism early after transplantation: A case report

BACKGROUND

Post-transplant lymphoproliferative disorder (PTLD) is a rare but highly fatal complication occurring after allogeneic hematopoietic cell transplantation (allo-HCT) or solid organ transplantation (SOT). Unlike SOT, PTLD after allo-HCT usually originates from the donor and is rarely accompanied by a loss of donor chimerism.

CASE SUMMARY

We report a case of Epstein-Barr virus positive PTLD manifesting as diffuse large B-cell lymphoma (DLBCL) with significantly decreased T-cell chimerism early after allo-HCT. A 30-year-old patient with acute myeloid leukemia underwent unrelated allo-HCT after first complete remission. Nearly 3 mo after transplantation, the patient developed cervical lymph node enlargement and gastric lesions, both of which were pathologically suggestive of DLBCL. Meanwhile, the patient experienced a significant and persistent decrease in T-cell chimerism. A partial remission was achieved after chemotherapy with single agent rituximab and subsequent R-CHOP combined chemotherapy.

CONCLUSION

The loss of T-cell chimerism and the concomitant T-cell insufficiency may be the cause of PTLD in this patient.

Nomogram for predicting short-term response to anti-vascular endothelial growth factor treatment in neovascular age-related macular degeneration: An observational study

BACKGROUND

Anti-vascular endothelial growth factor (anti-VEGF) therapy is critical for managing neovascular age-related macular degeneration (nAMD), but understanding factors influencing treatment efficacy is essential for optimizing patient outcomes.

AIM

To identify the risk factors affecting anti-VEGF treatment efficacy in nAMD and develop a predictive model for short-term response.

METHODS

In this study, 65 eyes of exudative AMD patients after anti-VEGF treatment for ≥ 1 mo were observed using optical coherence tomography angiography. Patients were classified into non-responders (n = 22) and responders (n = 43). Logistic regression was used to determine independent risk factors for treatment response. A predictive model was created using the Akaike Information Criterion, and its performance was assessed with the area under the receiver operating characteristic curve, calibration curves, and decision curve analysis (DCA) with 500 bootstrap re-samples.

RESULTS

Multivariable logistic regression analysis identified the number of junction voxels [odds ratio = 0.997, 95% confidence interval (CI): 0.993-0.999, P = 0.010] as an independent predictor of positive anti-VEGF treatment outcomes. The predictive model incorporating the fractal dimension, number of junction voxels, and longest shortest path, achieved an area under the curve of 0.753 (95%CI: 0.622-0.873). Calibration curves confirmed a high agreement between predicted and actual outcomes, and DCA validated the model's clinical utility.

CONCLUSION

The predictive model effectively forecasts 1-mo therapeutic outcomes for nAMD patients undergoing anti-VEGF therapy, enhancing personalized treatment planning.

Pneumocystis pneumonia in stage IIIA lung adenocarcinoma with immune-related acute kidney injury and thoracic radiotherapy: A case report

BACKGROUND

Immune checkpoint inhibitors (ICIs) are therapeutic agents for advanced and metastatic non-small cell lung cancer (NSCLC) with high clinical antitumor efficacy. However, immune-related adverse events occur in 20% of these patients and often requiring treatment with immunosuppressive agents, such as corticosteroids. Consequently, this may increase the risk of patients to opportunistic infections. Pneumocystis jirovecii pneumonia (PJP), a rare but serious opportunistic infection typically observed in patients with human immunodeficiency virus, can also occur in cancer patients undergoing long-term glucocorticoid treatment.

CASE SUMMARY

We report a case of a 56-year-old male with squamous NSCLC treated with triplimab combined with paclitaxel, carboplatin, and radical thoracic radiation therapy. Following this regimen, he developed acute kidney injury (AKI) with elevated creatinine levels. After concurrent radical chemoradiotherapy ended, he developed a grade 3 immune-related AKI. High-dose corticosteroids were administered to treat AKI, and renal function gradually recovered. Corticosteroids were reduced to a dose of 10 mg prednisone equivalent daily eight weeks later; however, he developed severe pneumonia with spontaneous pneumothorax. Next-generation sequencing of the bronchoscopic lavage revealed PJP co-infection with herpes simplex virus 1 and cytomegalovirus. The inflammation was more severe in areas exposed to radiation. Piperacillin-tazobactam, acyclovir, sulfamethoxazole, and trimethoprim were used to control the infection. The patient recovered, and immunotherapy was terminated.

CONCLUSION

PJP is rare but can occur in patients with ICI adverse events and should be differentiated from tumor progression or immune-related adverse events. Thoracic radiation may increase risk, necessitating careful monitoring and prevention.

Behcet's disease-related panuveitis following COVID-19 vaccination: A case report

BACKGROUND

Behcet's disease (BD) is an inflammatory disorder known for various symptoms, including oral and genital ulcers and ocular inflammation. Panuveitis, a severe eye condition, is rare as the first sign of BD.

CASE SUMMARY

We present an unusual case of a 30-year-old man who developed panuveitis after receiving the mRNA-based coronavirus disease 2019 (COVID-19) vaccine (Moderna). Laboratory tests ruled out infections, but he had a positive HLA-B51 result and a history of genital ulcer and oral ulcers, leading to a BD diagnosis. Treatment with corticosteroids improved his condition. Interestingly, he had another episode of panuveitis after the second mRNA vaccine dose, which also responded to corticosteroids.

CONCLUSION

This case highlights the rare onset of BD following mRNA COVID-19 vaccination, suggesting a potential link between these vaccines and BD's eye symptoms, emphasizing the importance of quick treatment in similar cases.

Innovative approaches beyond periprocedural hydration for preventing contrast-induced acute kidney injury

Contrast-induced acute kidney injury (CI-AKI) is a major concern in clinical practice, particularly among high-risk patients with preexisting renal and cardiovascular conditions. Although periprocedural hydration has long been the primary approach for CI-AKI prevention, recent advancements have led to the development of novel approaches such as RenalGuard and contrast removal systems. This editorial explores these emerging approaches and highlights their potential for enhancing CI-AKI prevention. By incorporating the latest evidence into clinical practice, health-care professionals can more effectively maintain renal function and improve outcomes for patients undergoing contrast-enhanced procedures.

Secondary rectal linitis plastica caused by prostatic adenocarcinoma - magnetic resonance imaging findings and dissemination pathways: A case report

BACKGROUND

Secondary rectal linitis plastica (RLP) from prostatic adenocarcinoma is a rare and poorly understood form of metastatic spread, characterized by a desmoplastic response and concentric rectal wall infiltration with mucosal preservation. This complicates endoscopic diagnosis and can mimic gastrointestinal malignancies. This case series underscores the critical role of magnetic resonance imaging (MRI) in identifying the distinct imaging features of RLP and highlights the importance of considering this condition in the differential diagnosis of patients with a history of prostate cancer.

CASE SUMMARY

Three patients with secondary RLP due to prostatic adenocarcinoma presented with varied clinical features. The first patient, a 76-year-old man with advanced prostate cancer, had rectal pain and incontinence. MRI showed diffuse prostatic invasion and significant rectal wall thickening with a characteristic "target sign" pattern. The second, a 57-year-old asymptomatic man with elevated prostate-specific antigen levels and a history of prostate cancer exhibited rectoprostatic angle involvement and rectal wall thickening on MRI, with positron emission tomography/computed tomography PSMA confirming the prostatic origin of the metastatic spread. The third patient, an 80-year-old post-radical prostatectomy, presented with refractory constipation. MRI revealed a neoplastic mass infiltrating the rectal wall. In all cases, MRI consistently showed stratified thickening, concentric signal changes, restricted diffusion, and contrast enhancement, which were essential for diagnosing secondary RLP. Biopsies confirmed the prostatic origin of the neoplastic involvement in the rectum.

CONCLUSION

Recognizing MRI findings of secondary RLP is essential for accurate diagnosis and management in prostate cancer patients.

Radiological findings of February 2023 twin earthquakes-related spine injuries

BACKGROUND

The February 6, 2023, twin earthquakes in Türkiye caused significant structural damage and a high number of injuries, particularly affecting the spine, which underscores the importance of understanding the distribution and nature of vertebral injuries in disaster victims.

AIM

To investigate the distribution of radiological findings of vertebral injuries in patients referred to a major tertiary center during the February 6, 2023 twin earthquakes in Türkiye.

METHODS

With the approval of the institutional ethics committee, 1216 examinations of 238 patients transferred from the region to a tertiary major hospital after the twin earthquakes of February 6, 2023, were retrospectively analyzed for spine injuries.

RESULTS

Spine computed tomography (CT) scans were performed in 192 of 238 patients with a suspected spinal injury, 42 of whom also had an magnetic resonance imaging (MRI). In 86 of 192 patients (44.79%; M:F = 33:53) a spinal fracture was detected on CT and in 33 of 42 patients (78.57%; M:F = 20:13) a spinal injury was found on MRI. Of the 86 patients in whom vertebral injury was detected, fractures were detected in the Denis-B group in 33, Denis-C in 4, Denis-D in 20 and Denis-E in 11 patients. Among the vertebral bodies: 40 "compression fractures", 17 "burst fractures", 5 "translational dislocation fractures", 5 "flexion-distraction fractures" and 58 "prolonged forced fetal posture fractures" were detected. In addition, isolated transverse or spinous process fractures were found in eighteen vertebrae.

CONCLUSION

Our study highlights the prevalence and diverse spectrum of spinal injuries following the February 6, 2023 twin earthquakes in Turkey underscoring the urgent need for effective management strategies in similar disaster scenarios, and emphasizing the "prolonged forced fetal posture" damage we encountered in earthquake victims who remained under the collapse for a long time.

Retinal microcirculation changes in prediabetic patients with short-term increased blood glucose using optical coherence tomography angiography

BACKGROUND

Retinal microcirculation alterations are early indicators of diabetic microvascular complications. Optical coherence tomography angiography (OCTA) is a noninvasive method to assess these changes. This study analyzes changes in retinal microcirculation in prediabetic patients during short-term increases in blood glucose using OCTA.

AIM

To investigate the changes in retinal microcirculation in prediabetic patients experiencing short-term increases in blood glucose levels using OCTA.

METHODS

Fifty volunteers were divided into three groups: Group 1 [impaired fasting glucose (IFG) or impaired glucose tolerance (IGT)], Group 2 (both IFG and IGT), and a control group. Retinal microcirculation parameters, including vessel density (VD), perfusion density (PD), and foveal avascular zone (FAZ) metrics, were measured using OCTA. Correlations between these parameters and blood glucose levels were analyzed in both the fasting and postprandial states.

RESULTS

One hour after glucose intake, the central VD (P = 0.023), central PD (P = 0.026), and parafoveal PD (P < 0.001) were significantly greater in the control group than in the fasting group. In Group 1, parafoveal PD (P < 0.001) and FAZ circularity (P = 0.023) also increased one hour after glucose intake. However, no significant changes were observed in the retinal microcirculation parameters of Group 2 before or after glucose intake (P > 0.05). Compared with the control group, Group 1 had a larger FAZ area (P = 0.032) and perimeter (P = 0.018), whereas Group 2 had no significant differences in retinal microcirculation parameters compared with the control group (P > 0.05). Compared with Group 1, Group 2 had greater central VD (P = 0.013) and PD (P = 0.008) and a smaller FAZ area (P = 0.012) and perimeter (P = 0.010). One hour after glucose intake, Group 1 had a larger FAZ area (P = 0.044) and perimeter (P = 0.038) than did the control group, whereas Group 2 showed no significant differences in retinal microcirculation parameters compared with the control group (P > 0.05). Group 2 had greater central VD (P = 0.042) and PD (P = 0.022) and a smaller FAZ area (P = 0.015) and perimeter (P = 0.016) than Group 1. At fasting, central PD was significantly positively correlated with blood glucose levels (P = 0.044), whereas no significant correlations were found between blood glucose levels and OCTA parameters one hour after glucose intake.

CONCLUSION

A short-term increase in blood glucose has a more pronounced effect on retinal microcirculation in prediabetic patients with either IFG or IGT.

Intentionally unilateral prostatic artery embolization: Patient selection, technique and potential benefits

BACKGROUND

Prostatic artery embolization (PAE) is a promising but also technically demanding interventional radiologic treatment for symptomatic benign prostatic hyperplasia. Many technical challenges in PAE are associated with the complex anatomy of prostatic arteries (PAs) and with the systematic attempts to catheterize the PAs of both pelvic sides. Long procedure times and high radiation doses are often the result of these attempts and are considered significant disadvantages of PAE. The authors hypothesized that, in selected patients, these disadvantages could be mitigated by intentionally embolizing PAs of only one pelvic side.

AIM

To describe the authors' approach for intentionally unilateral PAE (IU-PAE) and its potential benefits.

METHODS

This was a single-center retrospective study of patients treated with IU-PAE during a period of 2 years. IU-PAE was applied in patients with opacification of more than half of the contralateral prostatic lobe after angiography of the ipsilateral PA (subgroup A), or with markedly asymmetric prostatic enlargement, with the dominant prostatic lobe occupying at least two thirds of the entire gland (subgroup B). All patients treated with IU-PAE also fulfilled at least one of the following criteria: Severe tortuosity or severe atheromatosis of the pelvic arteries, non-visualization, or visualization of a tiny (< 1 mm) contralateral PA on preprocedural computed tomographic angiography. Intraprocedural contrast-enhanced ultrasonography (iCEUS) was applied to monitor prostatic infarction. IU-PAE patients were compared to a control group treated with bilateral PAE.

RESULTS

IU-PAE was performed in a total 13 patients (subgroup A, n = 7; subgroup B, n = 6). Dose-area product, fluoroscopy time and operation time in the IU-PAE group (9767.8 μGy∙m2, 30.3 minutes, 64.0 minutes, respectively) were significantly shorter (45.4%, 35.9%, 45.8% respectively, P < 0.01) compared to the control group. Clinical and imaging outcomes did not differ significantly between the IU-PAE group and the control group. In the 2 clinical failures of IU-PAE (both in subgroup A), the extent of prostatic infarction (demonstrated by iCEUS) was significantly smaller compared to the rest of the IU-PAE group.

CONCLUSION

In selected patients, IU-PAE is associated with comparable outcomes, but with lower radiation exposure and a shorter procedure compared to bilateral PAE. iCEUS could facilitate patient selection for IU-PAE.

Myelin oligodendrocyte glycoprotein-associated transverse myelitis after SARS-CoV-2 infection: A case report

BACKGROUND

Cases of myelin oligodendrocyte glycoprotein (MOG) antibody-related disease have a history of coronavirus disease 2019 infection or its vaccination before disease onset. Severe acute respiratory syndrome virus 2 (SARS-CoV-2) infection has been considered to be a trigger of central nervous system autoimmune diseases.

CASE SUMMARY

Here we report a 20-year male with MOG-associated transverse myelitis after a SARS-CoV-2 infection. The patient received a near-complete recovery after standard immunological treatments.

CONCLUSION

Attention should be paid to the evaluation of typical or atypical neurological symptoms that may be triggered by SARS-CoV-2 infection.

Acquired factor XIII deficiency presenting with multiple intracranial hemorrhages and right hip hematoma: A case report

BACKGROUND

Factor XIII (FXIII) deficiency is a rare yet profound coagulopathy. FXIII plays a pivotal role in hemostasis, and deficiencies in this factor can precipitate unchecked or spontaneous hemorrhaging. Immunological assays for detecting FXIII inhibitors are indispensable for diagnosing acquired FXIII deficiency; however, the availability of suitable testing facilities is limited, resulting in prolonged turnaround times for these assays.

CASE SUMMARY

In this case study, a 53-year-old male devoid of significant medical history presented with recurrent intracranial hemorrhages and a hematoma in the right hip. Subsequent genetic analysis revealed a homozygous mutation in the ACE gene, confirming the diagnosis of acquired FXIII deficiency.

CONCLUSION

This case underscores the significance of considering acquired deficiencies in clotting factors when evaluating patients with unexplained bleeding episodes.