1
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Soundarrajan D, Singh R, Subramaniam M, Dhanasekararaja P, Rajkumar N, Rajasekaran S. Takotsubo syndrome after bilateral simultaneous total knee arthroplasty - A case report. J Orthop 2024; 54:1-4. [PMID: 38496261 PMCID: PMC10943950 DOI: 10.1016/j.jor.2024.03.006] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 03/03/2024] [Accepted: 03/06/2024] [Indexed: 03/19/2024] Open
Abstract
Introduction Cardiac complications represents a major cause of morbidity and mortality especially after bilateral simultaneous total knee arthroplasty (BS-TKA). Takotsubo syndrome after BS-TKA has not been described in the literature. Case presentation A 60 years-old women underwent BS- TKA and she suddenly developed bradycardia and hypotension after second knee wound closure. The electrocardiography revealed ST elevation and echocardiography showed apical hypokinesia of left ventricle. Coronary angiography revealed normal epicardial coronaries and a provisional diagnosis of Takotsubo cardiomyopathy was made. Serial ECGs revealed resolution of ST elevation and normal LV function within 5 days. On one-year follow up, she was able to do all her normal activities, and 12-lead electrocardiography were back to normal. Conclusion Cardiac complications represents a major cause of morbidity and mortality especially after BS-TKA. Surgeons must be vigilant in the postoperative period for any likely precipitating factors of stress induced cardiomyopathy. Takotsubo syndrome should be considered as a differential diagnosis with features of acute coronary syndrome in elderly post-menopausal patients.
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Affiliation(s)
| | - Rithika Singh
- Ganga Hospital, 313, Mettupalayam Road, Coimbatore, 641 043, India
| | - Muthiah Subramaniam
- Consultant Cardiologist, Ganga Hospital, 313, Mettupalayam Road, Coimbatore, 641 043, India
| | | | - Natesan Rajkumar
- Ganga Hospital, 313, Mettupalayam Road, Coimbatore, 641 043, India
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Faraji N, Goli R, Mohsennezhad P, Mohammadpour Y, Parizad N, Salamat E, Pourbahram R, Bazbandi S. NSAID (nonsteroidal anti-inflammatory drugs) Induced Stevens Johnson Syndrome in a 50-year-old woman: A case study. Toxicol Rep 2024; 12:289-291. [PMID: 38469333 PMCID: PMC10925921 DOI: 10.1016/j.toxrep.2024.02.006] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 02/25/2024] [Accepted: 02/26/2024] [Indexed: 03/13/2024] Open
Abstract
Stevens-Johnson Syndrome (SJS) is a severe and rare adverse drug reaction associated with significant morbidity and mortality. Although SJS is commonly triggered by multiple drugs, non-steroidal anti-inflammatory drugs (NSAIDs), including diclofenac, have been frequently implicated. A middle-aged woman, who is 50 years old, has a prior medical record of high blood pressure, type 2 diabetes, and has recently suffered from a pulmonary embolism. She was later admitted to the intensive care unit (ICU), where she was ultimately diagnosed with Steven Johnson syndrome. Careful drug selection, close monitoring of patients with predisposing factors, and prompt identification of adverse events are crucial to prevent severe drug reactions.
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Affiliation(s)
- Navid Faraji
- Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Urmia University of Medical Sciences, Urmia, Iran
| | - Rasoul Goli
- Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Urmia University of Medical Sciences, Urmia, Iran
| | - Pariya Mohsennezhad
- Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Islamic Azad University, Urmia, Iran
| | - Yousef Mohammadpour
- Department of Medical Education, School of Medicine, Urmia University of Medical Sciences, Urmia, Iran
| | - Naser Parizad
- Patient Safety Research Center, Urmia University of Medical Sciences, Urmia, Iran
| | - Elaheh Salamat
- Department of Anesthesia and Surgical Technology, School of Allied Medicine, Urmia University of Medical Sciences, Urmia, Iran
| | - Raheleh Pourbahram
- Department of Nursing, School of Nursing and Midwifery, Islamic Azad University Chalus, Iran
| | - Samaneh Bazbandi
- Department of Anesthesiology, School of Nursing and Midwifery, Islamic Azad University Tehran Medical sciences, Tehran, Iran
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3
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Oukrid K, Ziani H, Ziani C, Bhallil S, Nasri S, Kamaoui I, Skiker I. Cerebral actinomycosis following a facio-cranial trauma: A case report. Radiol Case Rep 2024; 19:2253-2255. [PMID: 38532910 PMCID: PMC10963192 DOI: 10.1016/j.radcr.2024.02.043] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Accepted: 02/12/2024] [Indexed: 03/28/2024] Open
Abstract
Cerebral actinomycosis is a rare, chronic, but curable bacterial brain infection. We report the case of an 18-year-old male patient with a history of facio-cranial trauma, admitted in our institution with severe headaches and behavioral disorders. Magnetic resonance imaging (MRI) was performed showing the presence of contiguous multiple small round and ovoid lesions in the right frontal lobe with "the dot in circle" appearance. The diagnosis of cerebral actinomycosis was confirmed by histological study of the biopsy sample. Despite it being a rare condition, it is important to consider this diagnosis in patients with atypical post-traumatic neurological symptoms.
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Affiliation(s)
- Khaoula Oukrid
- Radiology Department, Mohammed VI University Hospital, Oujda, Morocco
- Mohammed First University Oujda, Faculty of Medicine and Pharmacy, Oujda, Oujda Morocco
| | - Hamid Ziani
- Radiology Department, Mohammed VI University Hospital, Oujda, Morocco
- Mohammed First University Oujda, Faculty of Medicine and Pharmacy, Oujda, Oujda Morocco
| | - Chaymae Ziani
- Radiology Department, Mohammed VI University Hospital, Oujda, Morocco
- Mohammed First University Oujda, Faculty of Medicine and Pharmacy, Oujda, Oujda Morocco
| | - Siham Bhallil
- Radiology Department, Mohammed VI University Hospital, Oujda, Morocco
- Mohammed First University Oujda, Faculty of Medicine and Pharmacy, Oujda, Oujda Morocco
| | - Siham Nasri
- Radiology Department, Mohammed VI University Hospital, Oujda, Morocco
- Mohammed First University Oujda, Faculty of Medicine and Pharmacy, Oujda, Oujda Morocco
| | - Imane Kamaoui
- Radiology Department, Mohammed VI University Hospital, Oujda, Morocco
- Mohammed First University Oujda, Faculty of Medicine and Pharmacy, Oujda, Oujda Morocco
| | - Imane Skiker
- Radiology Department, Mohammed VI University Hospital, Oujda, Morocco
- Mohammed First University Oujda, Faculty of Medicine and Pharmacy, Oujda, Oujda Morocco
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4
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Chataut D, Katwal S, Suwal S, Thapa A, Bhusal A. Endovascular embolization for massive hemoptysis in intralobar pulmonary sequestration with celiac artery supply: A comprehensive case report. Radiol Case Rep 2024; 19:2239-2244. [PMID: 38523721 PMCID: PMC10959639 DOI: 10.1016/j.radcr.2024.02.069] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Revised: 02/16/2024] [Accepted: 02/18/2024] [Indexed: 03/26/2024] Open
Abstract
Pulmonary sequestration (PS) is a rare congenital anomaly characterized by noncommunicative lung tissue supplied by an abnormal systemic vessel. We present a case of a 30-year-old male with intralobar PS, receiving arterial supply from the celiac artery, manifesting as massive hemoptysis. After urgent stabilization, endovascular embolization using polyvinyl alcohol particles was successfully employed. The patient's symptoms resolved, and follow-up confirmed satisfactory recovery. Our case underscores the diverse arterial origins of PS and the efficacy of endovascular embolization as a minimally invasive treatment. The complexity of PS, its diagnostic imaging, and alternative therapeutic options are discussed, emphasizing tailored approaches for optimal outcomes in managing this uncommon congenital anomaly.
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Affiliation(s)
- Dinesh Chataut
- Department of Radiology, Maharajgunj Medical Campus, Kathmandu, Nepal
| | - Shailendra Katwal
- Department of Radiology, Dadeldhura Subregional Hospital, Dadeldhura, Nepal
| | - Sundar Suwal
- Department of Radiology, Maharajgunj Medical Campus, Kathmandu, Nepal
| | - Ajit Thapa
- Department of Radiology, Maharajgunj Medical Campus, Kathmandu, Nepal
| | - Amrit Bhusal
- Department of Radiology, BP Koirala Institute of Health Science, Sunsari, Nepal
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5
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Montoya C, Polania-Sandoval C, Almeida JI. Endovascular mechanical thrombectomy of iliofemoral venous stent occlusion with the novel RevCore thrombectomy system: case reports and literature review. J Vasc Surg Cases Innov Tech 2024; 10:101432. [PMID: 38510090 PMCID: PMC10951538 DOI: 10.1016/j.jvscit.2024.101432] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 01/05/2024] [Indexed: 03/22/2024] Open
Abstract
Venous in-stent restenosis is not completely understood, and the currently available treatment is usually unsatisfactory. We describe the cases of two patients treated with the RevCore thrombectomy system (Inari Medical), designed for venous in-stent thrombosis. Case 1 involves a 62-year-old woman with post-thrombotic syndrome from iliac vein stent placement 15 years earlier. Case 2 describes a 30-year-old woman with post-thrombotic syndrome from recurrent iliac vein stent occlusion, despite therapeutic anticoagulation. Both patients had previous recanalization attempts at outside facilities that were unsuccessful. The RevCore system was safe and feasible in these initial cases, and more studies are warranted.
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Affiliation(s)
- Christopher Montoya
- Division of Vascular and Endovascular Surgery, DeWitt Daughtry Family Department of Surgery, Leonard M. Miller School of Medicine, University of Miami, Miami, FL
| | - Camilo Polania-Sandoval
- Division of Vascular and Endovascular Surgery, DeWitt Daughtry Family Department of Surgery, Leonard M. Miller School of Medicine, University of Miami, Miami, FL
| | - Jose I. Almeida
- Division of Vascular and Endovascular Surgery, DeWitt Daughtry Family Department of Surgery, Leonard M. Miller School of Medicine, University of Miami, Miami, FL
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6
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Rajab IM, Adas A, Shubietah AR, Khader MI. Successful embolization of an anterior chest wall arteriovenous malformation using combined transfemoral and transradial approaches with onyx. Radiol Case Rep 2024; 19:2151-2155. [PMID: 38515770 PMCID: PMC10950610 DOI: 10.1016/j.radcr.2024.02.046] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Revised: 02/13/2024] [Accepted: 02/14/2024] [Indexed: 03/23/2024] Open
Abstract
We present a case of successful embolization of an anterior chest wall arteriovenous malformation (AVM) in a 24-year-old male patient. This report aims to highlight the efficacy and safety of using the liquid embolic agent (onyx) as well as the combined approaches (trans-femoral and trans-radial) in managing rare complex chest wall AVMs.
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Affiliation(s)
- Islam M. Rajab
- Internal Medicine Department, Al-Israa Speciality Hospital, Tulkarm, Palestine
- Department of Radiology, An-Najah National University Hospital, Nablus, Palestine
| | - Abdelkarim Adas
- Thoracic Surgery, An-Najah National University Hospital, Nablus, Palestine
| | - Abdalhakim R.M. Shubietah
- Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
- Internal Medicine Department, An-Najah National University Hospital, Nablus, Palestine
| | - Mohammed I. Khader
- Interventional Radiology, An-Najah National University Hospital, Nablus, Palestine
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7
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Zebbakh H, Imrani K, Benbrahim F, Moatassim Billah N, Nassar I. Acute toxic hippocampal encephalopathy in heavy cannabis users: A case report. Radiol Case Rep 2024; 19:1913-1916. [PMID: 38425776 PMCID: PMC10904197 DOI: 10.1016/j.radcr.2024.01.088] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 01/26/2024] [Accepted: 01/29/2024] [Indexed: 03/02/2024] Open
Abstract
Cannabis use is increasing rapidly among young people worldwide despite the deleterious effects of this toxic substance on health. We report a case of acute hippocampal encephalopathy in a heavy cannabis user (8-10 joints/d for 6 years) who presented with a nonfebrile status epilepticus. Brain magnetic resonance imaging revealed bilateral and symmetrical high-signal abnormalities in the hippocampal regions. The damage to these regions is often severe, long-lasting, and sometimes irreversible. Therefore, every doctor (emergency doctor, resuscitator, neurologist...) is asked to request a brain MRI in case of neurological signs in a young cannabis user.
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Affiliation(s)
- Hajar Zebbakh
- Hajar Zebbakh, Radiology, Ibn Sina University Hospital, Rabat, Morocco
| | - Kaoutar Imrani
- Hajar Zebbakh, Radiology, Ibn Sina University Hospital, Rabat, Morocco
| | | | | | - Ittimade Nassar
- Hajar Zebbakh, Radiology, Ibn Sina University Hospital, Rabat, Morocco
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8
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Vi TNH, Tri TT, Duy HP, Kiet PT, Cuong NM, Tuan HX, Duc NM. Laparoscopic treatment for median arcuate ligament syndrome in children: A case report. Radiol Case Rep 2024; 19:2004-2007. [PMID: 38449485 PMCID: PMC10917635 DOI: 10.1016/j.radcr.2024.02.038] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 02/05/2024] [Accepted: 02/12/2024] [Indexed: 03/08/2024] Open
Abstract
In median arcuate ligament syndrome (MALS), the median arcuate ligament compresses the celiac trunk and surrounding nerves leading to chronic functional abdominal pain and vague gastrointestinal symptoms. MALS can be effectively treated by dividing the arcuate ligament through open surgery or laparoscopy. This is a rare vascular condition and mostly encountered in adult patients. We hereby report a case of a pediatric patient diagnosed with MALS and treated successfully by laparoscopic approach. An 11-year-old girl presented with severe abdominal cramps for 3 months, accompanied by nonbilious vomiting. Computed tomography (CT) angiography demonstrated clear images of celiac trunk compression suggesting MALS. Laparoscopic surgery to cut the ligament and decompress the celiac artery was performed. The patient was discharged on day 7 postoperative with no recurrence of symptoms after 12 months of follow-up. This report suggested the diagnostic value of CT scan, and the safety and the feasibility of laparoscopic surgical techniques to treat MALS in children.
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Affiliation(s)
- Trinh-Nguyen Ha Vi
- Department of Pediatric Surgery, University of Medicine and Pharmacy at Ho Chi Minh City, Vietnam
| | - Tran Thanh Tri
- Department of Hepato-Pancreato-Biliary Diseases and Liver Transplantation, Children's Hospital 2, Ho Chi Minh City, Vietnam
| | - Ho Phi Duy
- Department of Hepato-Pancreato-Biliary Diseases and Liver Transplantation, Children's Hospital 2, Ho Chi Minh City, Vietnam
| | - Phan Tuan Kiet
- Department of Hepato-Pancreato-Biliary Diseases and Liver Transplantation, Children's Hospital 2, Ho Chi Minh City, Vietnam
| | - Nguyen Manh Cuong
- Department of Pediatrics, Vietnam Military Medical University, Hanoi, Vietnam
| | - Ho Xuan Tuan
- Department of Medical Imaging, Da Nang University of Medical Technology and Pharmacy, Vietnam
| | - Nguyen Minh Duc
- Department of Radiology, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam
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9
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Lahmouch N, Britel D, Mouine N, Asfalou I, Lakhal Z, Benyass A. Rare case of cardiac angiosarcoma and alveolar hemorrhage in an adolescent patient initially suspected COVID19 infection: A case report and literature review. Radiol Case Rep 2024; 19:1722-1728. [PMID: 38384711 PMCID: PMC10877114 DOI: 10.1016/j.radcr.2024.01.045] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Revised: 01/11/2024] [Accepted: 01/18/2024] [Indexed: 02/23/2024] Open
Abstract
Primary cardiac tumors are a rarity, and sarcomas emerge as the prevailing form of primary malignant cardiac tumors across age groups, encompassing both children and adults. Within this category, angiosarcoma stands out, constituting around 31% of all primary malignant cardiac tumors. Primary cardiac angiosarcoma displays a notably aggressive nature, characterized by early systemic metastasis, and is accompanied by a generally unfavorable prognosis. We describe a case concerning a previously healthy teenage girl who displayed persistent constitutional symptoms and hemoptysis for 15 days. Subsequent investigation uncovered alveolar hemorrhage, ultimately linked to a cardiac angiosarcoma. The difficulty in this instance arose from the vague nature of the initial symptoms, posing a challenge to promptly and accurately diagnose the condition. This case highlights the aggressive nature of primary cardiac angiosarcoma. The vague initial symptoms underscore the need for early detection and optimized treatment to improve the generally unfavorable prognosis associated with this condition. Increased awareness and a multidisciplinary approach are crucial in addressing the diagnostic and therapeutic challenges posed by primary cardiac angiosarcoma.
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Affiliation(s)
- Nouhaila Lahmouch
- Department of Cardiology, Mohammed V University, Faculty of Medicine and Pharmacy in Rabat Morocco, Mohammed V Military Hospital, Morocco
| | - Driss Britel
- Department of Cardiology, Mohammed V University, Faculty of Medicine and Pharmacy in Rabat Morocco, Mohammed V Military Hospital, Morocco
| | - Najat Mouine
- Department of Cardiology, Mohammed V University, Faculty of Medicine and Pharmacy in Rabat Morocco, Mohammed V Military Hospital, Morocco
| | - Ilyasse Asfalou
- Department of Cardiology, Mohammed V University, Faculty of Medicine and Pharmacy in Rabat Morocco, Mohammed V Military Hospital, Morocco
| | - Zouhair Lakhal
- Department of Cardiology, Mohammed V University, Faculty of Medicine and Pharmacy in Rabat Morocco, Mohammed V Military Hospital, Morocco
| | - Aatif Benyass
- Department of Cardiology, Mohammed V University, Faculty of Medicine and Pharmacy in Rabat Morocco, Mohammed V Military Hospital, Morocco
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10
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Rais K, Darkaoui A, Mqaddem OE, Koulali H, Zazour A, Jabri R, Ismaili Z, Kharrasse G. A rare cause of acute esophageal necrosis: A case report. Radiol Case Rep 2024; 19:1740-1744. [PMID: 38384703 PMCID: PMC10877425 DOI: 10.1016/j.radcr.2024.01.074] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 01/20/2024] [Accepted: 01/23/2024] [Indexed: 02/23/2024] Open
Abstract
Acute esophageal necrosis (AEN) or black esophagus is a rare entity characterized by diffuse circumferential black pigmentation of the esophageal mucosa due to ischemic necrosis. It may be lethal, especially among elderly patients with multiple comorbidities and hemodynamic instability. Diagnosis is based on gastroscopy. Treatment consists of intravenous fluids, proton pump inhibitors, and additional therapies to treat the underlying illness. We report a rare case of a woman in her 50s with cervical cancer who presented with hematemesis and sepsis. Upper gastrointestinal endoscopy showed a black esophagus and an ulcerobudding duodenal process. Few days later, she developed abdominal distension with diffuse pain. Abdominal CT scan demonstrated perforation of gastroduodenal tumor. The treatment was based on resuscitation, proton pump inhibitors, antibiotics, and surgery of the perforated tumor. Unfortunately, the patient died 2 days later because of septic shock. The black esophagus is a fatal complication, thus diagnosis at an early stage and timely management may improve survival. This is the first case reported of AEN due to perforated duodenal tumor explained by septic shock leading to an ischemic esophageal injury.
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Affiliation(s)
- Kaouthar Rais
- Department of Hepatogastroenterology, Mohammed VI University Hospital Center, Digestive Diseases Research Laboratory, Faculty of Medicine and Pharmacy, Mohammed First University, Oujda, Morocco
| | - Anas Darkaoui
- Department of General Surgery, Mohammed VI University Hospital Center, Faculty of Medicine and Pharmacy, Mohammed First University, Oujda, Morocco
| | - Ouiam El Mqaddem
- Department of Hepatogastroenterology, Mohammed VI University Hospital Center, Digestive Diseases Research Laboratory, Faculty of Medicine and Pharmacy, Mohammed First University, Oujda, Morocco
| | - Hajar Koulali
- Department of Hepatogastroenterology, Mohammed VI University Hospital Center, Digestive Diseases Research Laboratory, Faculty of Medicine and Pharmacy, Mohammed First University, Oujda, Morocco
| | - Abdelkrim Zazour
- Department of Hepatogastroenterology, Mohammed VI University Hospital Center, Digestive Diseases Research Laboratory, Faculty of Medicine and Pharmacy, Mohammed First University, Oujda, Morocco
| | - Rachid Jabri
- Department of General Surgery, Mohammed VI University Hospital Center, Faculty of Medicine and Pharmacy, Mohammed First University, Oujda, Morocco
| | - Zahi Ismaili
- Department of Hepatogastroenterology, Mohammed VI University Hospital Center, Digestive Diseases Research Laboratory, Faculty of Medicine and Pharmacy, Mohammed First University, Oujda, Morocco
| | - Ghizlane Kharrasse
- Department of Hepatogastroenterology, Mohammed VI University Hospital Center, Digestive Diseases Research Laboratory, Faculty of Medicine and Pharmacy, Mohammed First University, Oujda, Morocco
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11
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Pokharel S, KC S, Lamichhane S, Pokharel M, Sah RP, Yadav SK, Bhusal A, Poudel S, Shah SK, Pokharel M. Asymptomatic spontaneous expulsion of a long foreign body through the gastrointestinal tract - a curious case report. Radiol Case Rep 2024; 19:1940-1944. [PMID: 38449486 PMCID: PMC10915782 DOI: 10.1016/j.radcr.2024.02.007] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 01/31/2024] [Accepted: 02/05/2024] [Indexed: 03/08/2024] Open
Abstract
Foreign body ingestion and its natural elimination are common in children. However, this is uncommon for long foreign bodies. Here, we report the spontaneous removal of an ingested pencil in an asymptomatic child. To our knowledge, this is the first case report of asymptomatic spontaneous elimination of a normally-sized ingested pencil. A 7-year-old male child presented with a history of ingestion of a pencil 4 hours back, without any complaints. Immediate abdominal radiography revealed a pencil in the stomach with an estimated length of approximately 10 cm and no signs of complications. He was conservatively treated under a semi-solid diet, presumably due to lack of available endoscopic option. Subsequently, he passed the pencil in stool within 24 hours of ingestion. He was asymptomatic and playful during the course and at discharge. Conservative management of a quickly moving long foreign body initially located below the esophagus in an asymptomatic child is possible with the help of imaging guidance, particularly in settings lacking an endoscopy. Although, this should not be considered a norm. However, this suggests that the treatment of ingested foreign bodies must be individualized. Thus, multiple factors related to the child and the foreign body must be assessed before committing to invasive procedures like laparotomy. Similarly, plain X-rays can be helpful even for radiolucent foreign bodies, for diagnosis and ruling out complications. All of these are vital in underdeveloped countries, where endoscopy and computed tomography facilities might be either lacking or unaffordable by patients.
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Affiliation(s)
- Sushan Pokharel
- Department of Pediatric Surgery Division, Department of General Surgery, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Suraj KC
- Department of Pediatric Surgery Division, Department of General Surgery, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Samiksha Lamichhane
- Department of Radiodiagnosis and Imaging, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Mohir Pokharel
- Department of General Surgery, Kathmandu Medical College and Teaching Hospital, Kathmandu, Nepal
| | - Rajesh P. Sah
- Department of Pediatric Surgery Division, Department of Surgery, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Sanjaya K. Yadav
- Department of Pediatric Surgery Division, Department of Surgery, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Amrit Bhusal
- Department of Radiodiagnosis and Imaging, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Sishir Poudel
- Department of Pediatric Surgery Division, Department of General Surgery, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Siddhartha K. Shah
- Department of Pediatric Surgery Division, Department of General Surgery, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Moneec Pokharel
- Birat Medical College and Teaching Hospital, Biratnagar, Nepal
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12
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Tuan HX, Hung ND, Quang NN, Tam NT, Anh NTH, Hoa T, Dung BT, Duc NM. Pulmonary artery penetration due to fish bone ingestion: A rare case report. Radiol Case Rep 2024; 19:1900-1906. [PMID: 38425774 PMCID: PMC10904187 DOI: 10.1016/j.radcr.2024.02.003] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 02/01/2024] [Accepted: 02/03/2024] [Indexed: 03/02/2024] Open
Abstract
Accidental fish bone ingestion is a common manifestation at emergency departments. In most cases, ingested foreign bodies usually pass uneventfully through the gastrointestinal tract and complications only present in less than 5% of all patients. In this report, we present the first documented case of pulmonary artery injury due to a fish bone in a 63-year-old male patient hospitalized with hemoptysis after accidentally swallowing a fish bone 30 days ago. This patient subsequently had surgery and endoscopy to safely remove the foreign body and then recovered well on a follow-up examination. For cases of fish bone ingestion, contrast-enhanced chest computed tomography is one of the most essential tools to assess vascular problems and associated mediastinal infections-risk factors for life-threatening and long-term recurrent inflammation. Reconstructing planes along the foreign body axis and changing windows when analyzing CT scans is necessary to avoid missing lesions and dilemmas.
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Affiliation(s)
- Ho Xuan Tuan
- Department of Medical Imaging, Da Nang University of Medical Technology and Pharmacy, Danang, Vietnam
| | - Nguyen Duy Hung
- Department of Radiology, Hanoi Medical University, Hanoi, Vietnam
- Department of Radiology, Viet Duc Hospital, Hanoi, Vietnam
| | | | - Nguyen-Thi Tam
- Department of Radiology, Hanoi Medical University, Hanoi, Vietnam
| | | | - Tran Hoa
- Department of Internal Medicine, Faculty of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Viet Nam
| | - Bui The Dung
- Department of Cardiology, University Medical Center HCMC, Ho Chi Minh City, Vietnam
| | - Nguyen Minh Duc
- Department of Radiology, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam
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13
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Setianingsih YA, Djatisoesanto W, Renaldo J. Laparoscopic removal of migratory intrauterine contraceptive device to the bladder : A Case report and literature review. Radiol Case Rep 2024; 19:1650-1653. [PMID: 38327556 PMCID: PMC10847832 DOI: 10.1016/j.radcr.2024.01.047] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 01/13/2024] [Accepted: 01/18/2024] [Indexed: 02/09/2024] Open
Abstract
The intrauterine contraceptive device (IUCD) is the most frequently used method of reversible contraception with high efficacy. Despite these benefits, rare complications, such as spontaneous migration of the device into adjacent organs, particularly the bladder, are possible. Minimally invasive surgery is a safe and effective procedure with few complications for the management of migrated IUCDs. We presented a 36-year-old multiparous woman referred by her gynecologist who had an IUCD inserted 4 years prior. She had been experiencing dysuria and lower abdomen pain for 3 months. Ultrasonography of the abdomen revealed a hyperechoic lesion on the bladder wall's left anterior-superior portion. An MRI revealed that the device was embedded in the bladder's anterior left wall. Under general anesthesia, a cystoscopy and laparoscopy exploration were subsequently scheduled. Cystoscopy was performed, but the long limb of the IUCD was embedded in the mucosal and muscular layers, preventing its removal from the bladder wall. Laparoscopic retrieval of the IUCD was performed without complications. The patient was discharged 2 days after surgery with a Foley catheter inserted in the bladder for 10 days. When the urethral catheter was removed, a cystoscopy was performed to confirm bladder wall healing. In the postoperative follow-up 1 month after IUCD removal, no abnormalities were observed. Patients with a suspected IUCD migration must undergo a comprehensive evaluation, regardless of whether they are symptomatic or asymptomatic. Before surgical retrieval, imaging such as ultrasonography and MRI were utilized to locate the migrated IUCD and consider therapeutic options. Even though cystoscopy is considered as an effective and safe minimally invasive procedure for managing a migrated IUCD to the bladder, laparoscopic removal could serve as an option once cystoscopy retrieval is failed.
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Affiliation(s)
- Yennie Ayu Setianingsih
- Department of Urology, Faculty of Medicine, University of Airlangga, Surabaya, East Java, Indonesia
- Dr Soetomo General-Academic Hospital, Surabaya, East Java, Indonesia
| | - Wahjoe Djatisoesanto
- Department of Urology, Faculty of Medicine, University of Airlangga, Surabaya, East Java, Indonesia
- Dr Soetomo General-Academic Hospital, Surabaya, East Java, Indonesia
| | - Johan Renaldo
- Department of Urology, Faculty of Medicine, University of Airlangga, Surabaya, East Java, Indonesia
- Dr Soetomo General-Academic Hospital, Surabaya, East Java, Indonesia
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14
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Litvak A, Desai K, Narins C, Mix D. Percutaneous endovascular stenting to treat left ventricular assist device outflow graft stenosis. J Vasc Surg Cases Innov Tech 2024; 10:101430. [PMID: 38375350 PMCID: PMC10875609 DOI: 10.1016/j.jvscit.2024.101430] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 01/02/2024] [Indexed: 02/21/2024] Open
Abstract
A 72-year-old woman presented with acute symptoms of congestive heart failure exacerbation and cardiogenic shock secondary to flow alarms in her HeartMate II left ventricular assist device (LVAD) placed in 2013. Her rapid deterioration required venoarterial extracorporeal membrane oxygenation placement with subsequent cardiac catheterization. A computed tomography scan corroborated 90% stenosis of the LVAD outflow graft with mural thrombus causing cardiogenic shock. A multidisciplinary team proceeded with endovascular treatment of the LVAD outflow obstruction via realignment with percutaneous angioplasty and placement of covered stent grafts. After in-hospital recovery, she was discharged to a rehabilitation facility.
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Affiliation(s)
- Aaron Litvak
- Division of Vascular Surgery, University of Rochester Medical Center, Rochester, NY
| | - Kshitij Desai
- Division of Vascular Surgery, University of Rochester Medical Center, Rochester, NY
| | - Craig Narins
- Division of Vascular Surgery, University of Rochester Medical Center, Rochester, NY
| | - Doran Mix
- Division of Vascular Surgery, University of Rochester Medical Center, Rochester, NY
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15
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Antúnez YO, Dávila Zablah YJ, Ávila JRV, Macías GSG, Montemayor MLG. Secondary breast lymphoma: A case report. Radiol Case Rep 2024; 19:1313-1318. [PMID: 38292778 PMCID: PMC10825539 DOI: 10.1016/j.radcr.2023.12.018] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Revised: 12/05/2023] [Accepted: 12/09/2023] [Indexed: 02/01/2024] Open
Abstract
Lymphoma is the most frequent hematologic malignancy that involves the breast. It represents less than 1% of all breast cancer. The most common subtype is the secondary B-cell lymphoma. Clinically, lymphomas are divided into primary and secondary breast lymphoma. We presented a case of 49-year-old female, who has diagnosed of Non-Hodgkin's Lymphoma, finalizing the treatment 2 months ago. Currently, she came for a check-up due to a palpable lump in the right breast. Mammography shows a dense, oval, and circumscribed mass. Ultrasound revealed a 3.6 cm oval, hypoechoic, lobulated mass with internal vascularity at color Doppler. Axillary nodes show cortical thickening of 7 mm, cortical blood flood, and absence of fatty hilum. The histopathology report corresponds to infiltration of the right breast and bilateral axillary nodes by Non-Hodgkin Lymphoma. This case corresponds with lymphoma recurrence manifested in breast. The diagnosis of lymphoma is an imaging challenge that simulates benign and malignant pathologies.
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Affiliation(s)
- Yazmin Olivares Antúnez
- Diagnostic Breast Imaging Center of Zambrano-Hellion Hospital, Tecnológico de Monterrey, Av. Batallón de San Patricio 112, Real San Agustín, 66260 San Pedro Garza García, Nuevo León, Mexico
| | - Yesika Janett Dávila Zablah
- Diagnostic Breast Imaging Center of Zambrano-Hellion Hospital, Tecnológico de Monterrey, Av. Batallón de San Patricio 112, Real San Agustín, 66260 San Pedro Garza García, Nuevo León, Mexico
| | - José Raúl Vázquez Ávila
- Patology, Service of San José Hospital, Tecnológico de Monterrey, Av. Ignacio Morones Prieto 3000, Sertoma, 64710 Monterrey, Nuevo León, Mexico
| | - Gabriela Sofía Gómez Macías
- Patology, Service of San José Hospital, Tecnológico de Monterrey, Av. Ignacio Morones Prieto 3000, Sertoma, 64710 Monterrey, Nuevo León, Mexico
| | - Margarita Lilia Garza Montemayor
- Diagnostic Breast Imaging Center of Zambrano-Hellion Hospital, Tecnológico de Monterrey, Av. Batallón de San Patricio 112, Real San Agustín, 66260 San Pedro Garza García, Nuevo León, Mexico
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16
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Bansal R, Shirkhoda L, O'Connell R, Houshyar R. Incidental solitary fibrous tumor involving the seminal vesicle: A case report. Radiol Case Rep 2024; 19:1654-1657. [PMID: 38327555 PMCID: PMC10847837 DOI: 10.1016/j.radcr.2024.01.046] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 01/12/2024] [Accepted: 01/18/2024] [Indexed: 02/09/2024] Open
Abstract
Solitary fibrous tumors are rare mesenchymal neoplasms that can range from slow-growing to aggressive tumors. This report presents a unique case of a young male patient with a solitary fibrous tumor involving the seminal vesicle, a rare location, and reinforces incidental discovery of these tumors on imaging and physical exams. Detection of these tumors is imperative to identify and treat malignancy. In our case, a 39-year-old previously healthy Asian male presents to the emergency department as a trauma admission post bicycle crash and is incidentally found to have a pelvic mass on computed tomography imaging of the pelvis. The patient underwent trans-anal biopsy which showed spindle epithelioid cells positive for CD34 and STAT6 markers, with a morphological and immunohistochemical profile consistent with a solitary fibrous tumor. The patient underwent surgery with a robotic-assisted laparoscopic pelvic mass resection and now follows up annually with imaging for observation.
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Affiliation(s)
- Riya Bansal
- University of California Irvine School of Medicine, Irvine, CA, 92617, USA
| | - Layla Shirkhoda
- Department of Radiology, University of California Irvine School of Medicine, Irvine, CA, 92617, USA
| | - Ryan O'Connell
- Department of Pathology, University of California Irvine School of Medicine, Irvine, CA, 92617, USA
| | - Roozbeh Houshyar
- Department of Radiology, University of California Irvine School of Medicine, Irvine, CA, 92617, USA
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17
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Costa AF, Rodríguez I. Paroxysmal hemidystonia as the initial presentation of multiple sclerosis: an illustrative video depicting hyperventilation-triggered dystonia. Acta Neurol Belg 2024; 124:645-646. [PMID: 37589817 DOI: 10.1007/s13760-023-02359-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 08/09/2023] [Indexed: 08/18/2023]
Affiliation(s)
- Aldo F Costa
- Department of Neurology, University Hospital Reina Sofía, Menéndez Pidal, S/N Av., 14004, Córdoba, Spain.
| | - Ignacio Rodríguez
- Department of Neurology, University Hospital Reina Sofía, Menéndez Pidal, S/N Av., 14004, Córdoba, Spain
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18
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Hurwitz TA, Avecillas-Chasin JM, Bogod NM, Honey CR. Ventral targeted anterior capsulotomy for treatment-resistant depression and obsessive-compulsive disorder: A treatment method with cases. J Affect Disord 2024; 350:887-894. [PMID: 38272366 DOI: 10.1016/j.jad.2024.01.176] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 01/15/2024] [Accepted: 01/18/2024] [Indexed: 01/27/2024]
Abstract
BACKGROUND Ablative surgery using bilateral anterior capsulotomy (BAC) is an option for treatment resistant depression (TRD) and obsessive-compulsive disorder (TROCD). The location and extent of the lesion within anterior limb of the internal capsule (ALIC) remains uncertain. Accumulating evidence has suggested that the lesion should be located ventrally while limiting the dorsal extent. Our center is now targeting specific fiber tracts within the lower half of the ALIC. METHOD Presurgical diffusion tensor Magnetic Resonance Imaging (MRI) was used to identify individual fibre tracts within the ventral aspect of the ALIC in the last two patients who underwent BAC at our center. One patient had TRD and the other had both TROCD and TRD. Radiofrequency-induced thermal lesions were created in the identified targets with lesion volumes between 20 and 229 mm3 (average 95 mm3). FINDINGS Both patients were responders with neither experiencing significant side effects including compromised executive functions. LIMITATIONS The generalizability of our findings is limited because the outcome is based on two subjects. CONCLUSION This work suggests that BAC can be individually tailored and more limited to the ventral aspect of the ALIC and is effective and safe for TRD and TROCD. Accumulating data also suggests that to be clinically effective the length of the capsulotomy should be about 10mm. BAC's use may increase with the growing utilization and mastery of magnetic resonance guided focused ultrasound.
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Affiliation(s)
- Trevor A Hurwitz
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada.
| | | | - Nicholas M Bogod
- Department of Medicine, Division of Neurology, University of British Columbia, Vancouver, BC, Canada.
| | - Christopher R Honey
- Department of Surgery, University of British Columbia, Vancouver, BC, Canada.
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19
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Mori K, Igarashi T, Noguchi A, Ito M, Nagaoka Y, Takeshita C, Takeda N, Watanabe T, Yoshioka I, Hirabayashi K, Fujii T. Giant retroperitoneal myolipoma mimicking liposarcoma: report of a resected case and review of the literature. Int Cancer Conf J 2024; 13:144-152. [PMID: 38524654 PMCID: PMC10957821 DOI: 10.1007/s13691-024-00655-9] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 01/01/2024] [Indexed: 03/26/2024] Open
Abstract
Myolipomas are rare tumors that are often difficult to differentiate from liposarcoma. Herein, we report a case of resected giant myolipoma preoperatively diagnosed as liposarcoma. A 63-year-old woman was suspected of having a large retroperitoneal liposarcoma on October 202X. The patient was referred to our department for tumor resection and a histological diagnosis. After consultation with the urology, obstetric and gynecology, and vascular surgery departments, tumor resection was planned, including the potential resection of other organs. Intraoperative findings revealed a large, elastic, soft tumor with a smooth surface and a capsule occupying the entire abdominal cavity. The tumor was adherent to the stomach, left colon, and uterine adnexa, and no invasion was observed. The tumor was completely resected, and organ resection was not necessary. The tumor was 40 cm in diameter and 4.0 kg in weight. Pathological examination and immunostaining confirmed a diagnosis of myolipoma. The patient's postoperative course was uneventful, and she was discharged on postoperative day 10 with no complications. Twelve months after surgery, the patient was doing well. To the best of our knowledge, we report a complete resection of the largest retroperitoneal myolipoma reported to date. Physicians should consider surgery, even for suspected large sarcomas that may be difficult to resect completely.
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Affiliation(s)
- Kosuke Mori
- Department of Surgery and Science, Faculty of Medicine, Academic Assembly, University of Toyama, 2630 Sugitani, Toyama, Toyama 930-0194 Japan
| | - Takamichi Igarashi
- Department of Surgery and Science, Faculty of Medicine, Academic Assembly, University of Toyama, 2630 Sugitani, Toyama, Toyama 930-0194 Japan
| | - Akira Noguchi
- Department of Diagnostic Pathology, Faculty of Medicine, Academic Assembly, University of Toyama, Toyama, Toyama 930-0194 Japan
| | - Miki Ito
- Department of Surgery and Science, Faculty of Medicine, Academic Assembly, University of Toyama, 2630 Sugitani, Toyama, Toyama 930-0194 Japan
| | - Yasuhiro Nagaoka
- Department of Surgery and Science, Faculty of Medicine, Academic Assembly, University of Toyama, 2630 Sugitani, Toyama, Toyama 930-0194 Japan
| | - Chitaru Takeshita
- Department of Surgery and Science, Faculty of Medicine, Academic Assembly, University of Toyama, 2630 Sugitani, Toyama, Toyama 930-0194 Japan
| | - Naoya Takeda
- Department of Surgery and Science, Faculty of Medicine, Academic Assembly, University of Toyama, 2630 Sugitani, Toyama, Toyama 930-0194 Japan
| | - Toru Watanabe
- Department of Surgery and Science, Faculty of Medicine, Academic Assembly, University of Toyama, 2630 Sugitani, Toyama, Toyama 930-0194 Japan
| | - Isaku Yoshioka
- Department of Surgery and Science, Faculty of Medicine, Academic Assembly, University of Toyama, 2630 Sugitani, Toyama, Toyama 930-0194 Japan
| | - Kenichi Hirabayashi
- Department of Diagnostic Pathology, Faculty of Medicine, Academic Assembly, University of Toyama, Toyama, Toyama 930-0194 Japan
| | - Tsutomu Fujii
- Department of Surgery and Science, Faculty of Medicine, Academic Assembly, University of Toyama, 2630 Sugitani, Toyama, Toyama 930-0194 Japan
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20
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Müller JV, Ramires ED, Schimit GTF, Kasuya FVB, Ramires LA. Penetrating injury of the common femoral vein followed by local deep vein thrombosis: A case report. Trauma Case Rep 2024; 50:100985. [PMID: 38464485 PMCID: PMC10924122 DOI: 10.1016/j.tcr.2024.100985] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/03/2024] [Indexed: 03/12/2024] Open
Abstract
This case report discusses a unique scenario in which a 19-year-old patient with a penetrating wound in the common femoral vein developed deep vein thrombosis in response to life-threatening bleeding. The report highlights our thoughts on managing an isolated truncal venous injury leading to deep vein thrombosis, emphasizing the significance of surgical exploration in vascular trauma and the feasibility of employing non-invasive imaging diagnosis in preoperative planning.
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21
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Golder WA, Golder W. [Medical practice in classical Greece : The dermatological case reports in the Hippocratic Corpus]. Dermatologie (Heidelb) 2024; 75:349-354. [PMID: 37823918 DOI: 10.1007/s00105-023-05240-4] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/18/2023] [Indexed: 10/13/2023]
Abstract
OBJECTIVES Which theoretical and practical competences do the dermatological case histories of the Hippocratic Corpus convey? MATERIALS The 431 Hippocratic case histories have been studied for reports and communication on diagnostics, therapy and prognosis of individuals and groups of patients suffering from skin diseases. RESULTS Within the seven books of the Hippocratic 'Epidemics', a total of 49 patients with dermatological symptoms are described; in 20 of these, skin disease was the leading suffering. The essential clinical signs were itching, red spots, blisters, pustules, aphthae, lichen, dandruff and hair loss. Most patients were male; one of the four women was pregnant, among the two children was a baby whose skin disease ended fatally. Eight patients were named. In addition, five waves of disease are reported, in the course of which the shape of the skin played an important role. The diagnostic workup was limited to inspection and palpation, but included the determination of the level of suffering. The follow-up checks often extended over months. Mostly, plasters and compresses with grain flour were primarily used for treatment. CONCLUSION The Hippocratic doctor observed and described a large number of skin lesions and attempted to classify them in the differential diagnosis. In addition to changes in the color and tension of the skin, numerous lesions-for which the names are still often used in modern dermatology-are also described in detail. The skin manifestations associated with fever and abdominal symptoms are counted among the epidemic diseases. The condition of the skin was often regarded as an indicator of general health. In the case reports, conservative treatment adapted to the development of the disease dominated. In desperate cases, bloodletting was chosen as a last resort.
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22
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Yildirim Budak B, Yazici Karabulut I. "Truman syndrome" induced by online education: A case report in adolescent-Onset psychosis. Clin Child Psychol Psychiatry 2024; 29:540-549. [PMID: 37850453 DOI: 10.1177/13591045231208349] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2023]
Abstract
Early-onset schizophrenia (EOS) is an important psychiatric problem characterized by the onset of psychotic symptoms before the age of 18 years. We present the case of a 14-year-old girl who had social anxiety symptoms in the premorbid period and whose psychotic symptoms increased with pandemic restrictions and online education. Our patient's distance from the peer environment and school as well as the fact that she used webcams and online education more frequently in her daily life were risk factors for EOS. In accordance with the case of Truman syndrome, she has delusions that her daily life is secretly filmed and that she is a "TV star." Anti-anxiety treatments were initiated during the pre-pandemic period. After a diagnosis of schizophrenia was made, antipsychotic treatment was initiated. A significant response was observed after paliperidone (extended release) treatment. Close follow-ups revealed decreased delusions and increased functionality. Further studies are required to elucidate whether Truman syndrome and social anxiety are different aspects of a similar spectrum. With increasing digitalization, the direction of psychiatric diseases, including EOS, and measures that can be taken for adolescent mental health in crisis, such as pandemics, should be discussed in future research.
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Affiliation(s)
- Burcu Yildirim Budak
- Department of Child and Adolescent Psychiatry, Goztepe Prof. Dr. Suleyman Yalcin City Hospital, Istanbul Medeniyet University, Turkey
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23
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Bhusal A, KC S, Yogi TN, Gupta RK, Kumar A, Khanal B, Katwal S, Neupane D, Lamichhane S, Bhagat R. Malignant rectal GIST managed with chemotherapy (Imatinib Mesylate): A case report and a comprehensive review. Radiol Case Rep 2024; 19:1424-1431. [PMID: 38292787 PMCID: PMC10827547 DOI: 10.1016/j.radcr.2023.12.046] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 12/08/2023] [Accepted: 12/23/2023] [Indexed: 02/01/2024] Open
Abstract
Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors involving the gastrointestinal tract, arising from the interstitial cells of Cajal. GIST comprises about 1% of all GI tumors. Rectal GISTs are rare and comprise of approximately 5% of all GISTs and only 0.1% of rectal tumors are found to be GISTs. Rectal GISTs may be diagnosed incidentally or present with symptoms, including defecation problems, bleeding, and/or pain. We report a case of a 46-year-old male with rectal GIST metastasized to the liver and bilateral lung parenchyma managed by Imatinib Mesylate (IM) regimen. Rectal GIST although being rare, must be considered as a differential diagnosis in a patient presenting with defecatory problems with bleeding.
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Affiliation(s)
- Amrit Bhusal
- Department of Radio-diagnostics and Imaging, BP Koirala Institute of Health Sciences (BPKIHS), Dharan, Sunsari, Nepal
| | - Suraj KC
- Department of General Surgery, BP Koirala Institute of Health Sciences (BPKIHS), Dharan, Sunsari, Nepal
| | - Tek Nath Yogi
- BP Koirala Institute of Health Sciences (BPKIHS), Dharan, Sunsari, Nepal
| | - Rakesh Kumar Gupta
- Department of General Surgery, BP Koirala Institute of Health Sciences (BPKIHS), Dharan, Sunsari, Nepal
| | - Abhijeet Kumar
- Department of General Surgery, BP Koirala Institute of Health Sciences (BPKIHS), Dharan, Sunsari, Nepal
| | - Bhawani Khanal
- Department of General Surgery, BP Koirala Institute of Health Sciences (BPKIHS), Dharan, Sunsari, Nepal
| | - Shailendra Katwal
- Department of Radiology, Dadeldhura Subregional Hospital, Dadeldhura, Nepal
| | - Durga Neupane
- Department of General Surgery, BP Koirala Institute of Health Sciences (BPKIHS), Dharan, Sunsari, Nepal
| | - Samikshya Lamichhane
- Department of Radio-diagnostics and Imaging, BP Koirala Institute of Health Sciences (BPKIHS), Dharan, Sunsari, Nepal
| | - Ranjan Bhagat
- Department of General Surgery, BP Koirala Institute of Health Sciences (BPKIHS), Dharan, Sunsari, Nepal
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24
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Miyaguchi K, Tsuzuki Y, Uemuara H, Ishizawa K, Shinomiya S, Matsumoto H, Shiomi R, Ohgo H, Nagata M, Nakamoto H, Imaeda H. Nintedanib-associated enterocolitis with intractable diarrhea: a case report. Clin J Gastroenterol 2024; 17:271-275. [PMID: 38042763 DOI: 10.1007/s12328-023-01894-8] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 11/03/2023] [Indexed: 12/04/2023]
Abstract
Revised idiopathic pulmonary fibrosis treatment guidelines were published in 2015, and nintedanib was conditionally recommended. Although diarrhea is reported to be a common major adverse event associated with nintedanib, there have been few reports on detailed endoscopic findings of nintedanib-associated enterocolitis. A 74-year-old woman was diagnosed with idiopathic pulmonary fibrosis 4 years ago in May. She was started on nintedanib (300 mg). Three months later, hepatic dysfunction was observed; therefore, the drug was temporarily discontinued and then resumed at a dose reduction of 200 mg. Five months later, the patient developed diarrhea, and the dose was reduced to 150 mg. However, no effect was noted; hence, colonoscopy was performed. Various inflammatory lesions, such as erythema and erosions, were observed continuously at the rectum, which resembled ulcerative colitis. No improvement was observed 2 months after follow-up colonoscopy, and nintedanib-related enterocolitis was suspected. The dose was further reduced to 100 mg. Since the endoscopic findings of nintedanib-associated enterocolitis are similar to those of ulcerative colitis, it is critical to consider patients with diarrhea who are taking nintedanib as having associated enterocolitis and attempt to reduce or discontinue the drug if diarrhea does not improve with antidiarrheal agents.
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Affiliation(s)
- Kazuya Miyaguchi
- Department of Gastroenterology, Saitama Medical University, Saitama, 350-0451, Japan
| | - Yoshikazu Tsuzuki
- Department of Gastroenterology, Saitama Medical University, Saitama, 350-0451, Japan
| | - Hayato Uemuara
- Department of Gastroenterology and Hepatology, Saitama Medical University, Saitama, 350-0451, Japan
| | - Keisuke Ishizawa
- Department of Pathology, Saitama Medical University, Saitama, 350-0451, Japan
| | - Shun Shinomiya
- Department of Respiratory Internal Medicine, Saitama Medical University, Saitama, 350-0451, Japan
| | - Hisashi Matsumoto
- Department of General Internal Medicine, Saitama Medical University, Saitama, 350-0451, Japan
| | - Rie Shiomi
- Department of General Internal Medicine, Saitama Medical University, Saitama, 350-0451, Japan
| | - Hideki Ohgo
- Department of Gastroenterology, Saitama Medical University, Saitama, 350-0451, Japan
| | - Makoto Nagata
- Department of Respiratory Internal Medicine, Saitama Medical University, Saitama, 350-0451, Japan
| | - Hidetomo Nakamoto
- Department of General Internal Medicine, Saitama Medical University, Saitama, 350-0451, Japan
| | - Hiroyuki Imaeda
- Department of Gastroenterology, Saitama Medical University, Saitama, 350-0451, Japan.
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25
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Kazemi A, Nourizadeh AM, Arjmand G, Haseli S, Askari E. Thymic lipofibroadenoma: A case report. Radiol Case Rep 2024; 19:1340-1343. [PMID: 38292789 PMCID: PMC10825526 DOI: 10.1016/j.radcr.2023.12.060] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Revised: 12/23/2023] [Accepted: 12/27/2023] [Indexed: 02/01/2024] Open
Abstract
Lipofibroadenoma (LFA) is an epithelial tumor. It has been seen rarely in the thymus, and only a handful of cases have been reported. LFA is usually seen in the anterior mediastinum and is defined as a coalescence of epithelial thymic, adipose, and fibrotic tissue. We present a 30-year-old female who presented due to an unrelated traffic accident. An incidental mass was found in her left anterior superior mediastinum. After performing a complete excision, a histologic examination of the excised mass revealed it to be LFA of the thymus, which is extremely rare. The follow-up period was uneventful. LFA is a slow-growing benign tumor and is very similar to fibroadenoma of the breast. The etiology and clinical findings are yet to be well-defined. It was only seen in men in the prior cases. But recent cases, including this one, have also reported female patients. The tumor is mainly observed in the anterior mediastinum, which was also the case in our patient. The gold standard of diagnosis is pathologic examination. Our examination showed strands and nests of thymic parenchyma, including Hassall corpuscles, which separated fibro adipose tissue. Thymectomy is the treatment of choice. It can be performed by either video-assisted thoracic surgery or open surgery. We performed open surgery. The most important prognostic factor for this tumor is staging.
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Affiliation(s)
- Arya Kazemi
- Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Amir Mohammad Nourizadeh
- Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ghazal Arjmand
- Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sara Haseli
- Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Elham Askari
- Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Eddouali MA, Slaihi Z, Armel B, El Hamzaoui H, Ziani H, Guenoun S, Azouzi I, Arfaoui ME, Alilou M. Nutcracker syndrome unveiled by severe Typhoid fever: A rare case report. Radiol Case Rep 2024; 19:1646-1649. [PMID: 38327558 PMCID: PMC10847834 DOI: 10.1016/j.radcr.2024.01.034] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Revised: 01/02/2024] [Accepted: 01/10/2024] [Indexed: 02/09/2024] Open
Abstract
Typhoid fever, caused by Salmonella Typhi, is a severe bacterial infection prevalent in developing countries, and can result in life-threatening complications if untreated. Nutcracker Syndrome is a rare vascular disorder involving compression of the left renal vein between the aorta and the superior mesenteric artery. It can lead to various symptoms and poses diagnostic and management challenges. We present a case study of a patient diagnosed with typhoid fever in a Unit of Critical Emergency Care. Coincidentally, the evaluation through CT-scan revealed the presence of Nutcracker Syndrome. This report underscores the incidental discovery of Nutcracker Syndrome during the assessment of a patient with typhoid fever in a critical emergency care setting.
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Affiliation(s)
| | - Zakariae Slaihi
- Unit of Critical Emergency Care Hospital IBN SINA, Rabat, Morocco
| | - Bouchra Armel
- Unit of Critical Emergency Care Hospital IBN SINA, Rabat, Morocco
| | | | - Hicham Ziani
- Department of intensive care Unit, Hospital IBN SINA, Rabat, Morocco
| | | | - Imane Azouzi
- Department of intensive care Unit, Hospital IBN SINA, Rabat, Morocco
| | - Manal El Arfaoui
- Department of intensive care Unit, Hospital IBN SINA, Rabat, Morocco
| | - Mustapha Alilou
- Department of intensive care Unit, Hospital IBN SINA, Rabat, Morocco
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Chavez TF, Singh M, Avadhani V, Leonis R. Leydig tumor in normal sized ovaries causing clitoromegaly: A case report. Gynecol Oncol Rep 2024; 52:101345. [PMID: 38435349 PMCID: PMC10907142 DOI: 10.1016/j.gore.2024.101345] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 02/14/2024] [Accepted: 02/17/2024] [Indexed: 03/05/2024] Open
Abstract
We describe an unusual presentation of a rare Leydig tumor presenting in bilateral ovaries that are otherwise normal in size for postmenopausal women. A 66-year-old woman presented with postmenopausal bleeding and during her work-up acutely developed clitoromegaly. Her diagnostic work-up revealed a 1.8 cm left ovarian complex cyst and extremely elevated testosterone levels. Management included hysterectomy and bilateral salpingo-oophorectomy. Final pathology revealed Leydig tumors in the bilateral ovaries. This case discusses a rare presentation of a rare tumor and highlights the importance of a thorough examination of the female genitalia and investigation for root cause.
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Affiliation(s)
- Thomas F Chavez
- Morehouse School of Medicine Department of Obstetrics and Gynecology, Grady Memorial Hospital, 80 Jesse Hill Jr Drive SE Atlanta, GA 30303
| | - Minita Singh
- Morehouse School of Medicine 720 Westview Dr SW Atlanta, GA 30310
| | - Vaidehi Avadhani
- Emory University School of Medicine Department of Pathology and Laboratory Medicine Grady Memorial Hospital80 Jesse Hill Jr Drive SE Atlanta, GA 30303
| | - Regina Leonis
- Morehouse School of Medicine Department of Obstetrics and Gynecology, Grady Memorial Hospital, 80 Jesse Hill Jr Drive SE Atlanta, GA 30303
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El Ghoul K, Akiki D, Nawfal N, Jaoude MA. Renal transplantation for infantile and juvenile cystinosis: Two case report and review of the literature. Transpl Immunol 2024; 83:101993. [PMID: 38224843 DOI: 10.1016/j.trim.2024.101993] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 01/12/2024] [Accepted: 01/12/2024] [Indexed: 01/17/2024]
Abstract
Cystinosis is a rare autosomal recessive lysosomal storage disorder characterized by cystine buildup in various tissues, including the kidneys. Renal involvement is the primary manifestation, leading to end-stage renal disease (ESRD) if left untreated. Kidney transplantation (KT) in patients with cystinosis has significantly improved their prognosis for the disease outcome. Detailed reports on preoperative and Long-term postoperative management in these patients remain sparse. This report discusses the outcomes of two young adult patients of Middle Eastern descent with cystinosis who underwent KT. The first patient, diagnosed with infantile nephropathic cystinosis treated by cystine-depleting therapy, was operated by KT at the age of 18. The second patient, diagnosed with juvenile cystinosis, underwent transplantation at the age of 35 after being treated with hemodialysis. Our report describes detailed pre- and postoperative managements, including laboratory results, and pharmacological interventions. Both cases highlighted the varying clinical manifestations and disease severity between infantile and juvenile cystinosis. Pre-transplant conditions included renal dysfunction, growth retardation, secondary hyperparathyroidism, anemia, and extrarenal manifestations. Following KT, both patients experienced regained renal function, resolution of extrarenal complications, and normalization of laboratory parameters. Furthermore, both patients showed excellent postoperative outcomes with no acute rejection or allograft-related complications. KT is the treatment of choice for cystinosis patients with ESRD. Long-term follow-up post-transplantation is crucial to maintain good graft function. Further studies may elucidate optimal pre- and postoperative management protocols for this rare condition.
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Affiliation(s)
- Karen El Ghoul
- Faculty of Medicine, Saint Joseph University, Beirut, Lebanon.
| | - Dany Akiki
- Postdoctoral research fellow, Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Beirut, Lebanon
| | - Nagi Nawfal
- Head of Nephrology Division, Sacred Heart Hospital, Baabda, Lebanon
| | - Maroun Abou Jaoude
- Transplantation Unit, Department of Surgery, Middle East Institute of Health, Bsalim, Lebanon; Department of Surgery, Faculty of Medicine, Balamand University, Beirut, Lebanon; Head of the department of Surgery, The View Hospital in affiliation with Cedars Sinai, Doha, Qatar
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Ishida E, Horiguchi K, Matsumoto S, Ozawa A, Sekiguchi S, Yamada E. Influence of diet and body weight in treatment-resistant acquired partial lipodystrophy after hematopoietic stem cell transplantation and its potential for metabolic improvement. Diabetol Int 2024; 15:290-296. [PMID: 38524924 PMCID: PMC10959909 DOI: 10.1007/s13340-023-00674-6] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 11/06/2023] [Indexed: 03/26/2024]
Abstract
Lipodystrophy is a rare disease characterized by various metabolic complications resulting from the complete or partial loss of adipose tissues and abnormal fat accumulation. Acquired lipodystrophy may occur due to certain drugs, autoimmunity or for unknown reasons. Recently, cases of acquired lipodystrophy after hematopoietic stem cell transplantation (HSCT) have been reported. Leptin administration, used recently to treat generalized lipodystrophy, effectively controlled metabolic complications; however, few reports demonstrated the effectiveness of leptin for acquired partial lipodystrophy. In this report, we present the case of a 17-year-old woman who developed insulin resistance, hypertriglyceridemia, and fatty liver after HSCT. Due to her thin gluteal fat and low blood adiponectin levels, her metabolic abnormalities were attributed to partial lipodystrophy. While both leptin and pemafibrate administration partially attenuated metabolic abnormalities, its effects were relatively limited, probably because the serum leptin levels were maintained, which is not likely in generalized lipodystrophy. Nevertheless, after she developed adjustment disorder and experienced weight loss, along with decreased food intake, her metabolic markers significantly improved. This case suggests the modest effect of leptin and permafibrate in partial lipodystrophy after HSCT, highlighting the importance of diet therapy in metreleptin treatment for acquired partial lipodystrophy.
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Affiliation(s)
- Emi Ishida
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Gunma University Graduate School of Medicine, 3-39-15 Showa-Machi, Maebashi, Gunma 371-8511 Japan
| | - Kazuhiko Horiguchi
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Gunma University Graduate School of Medicine, 3-39-15 Showa-Machi, Maebashi, Gunma 371-8511 Japan
| | - Shunichi Matsumoto
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Gunma University Graduate School of Medicine, 3-39-15 Showa-Machi, Maebashi, Gunma 371-8511 Japan
| | - Atsushi Ozawa
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Gunma University Graduate School of Medicine, 3-39-15 Showa-Machi, Maebashi, Gunma 371-8511 Japan
| | - Sho Sekiguchi
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Gunma University Graduate School of Medicine, 3-39-15 Showa-Machi, Maebashi, Gunma 371-8511 Japan
| | - Eijiro Yamada
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Gunma University Graduate School of Medicine, 3-39-15 Showa-Machi, Maebashi, Gunma 371-8511 Japan
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30
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Lai SY, Richardson NH, Tran M, Hanna NH, Shields MD. Adenocarcinoma Harboring EGFR-RAD51 Fusion Treated With Osimertinib: A Case Report. JTO Clin Res Rep 2024; 5:100652. [PMID: 38525318 PMCID: PMC10958474 DOI: 10.1016/j.jtocrr.2024.100652] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 02/08/2024] [Accepted: 02/15/2024] [Indexed: 03/26/2024] Open
Abstract
EGFR mutations are among the most common driver mutations in lung adenocarcinoma. Rare alterations, such as the EGFR-RAD51 fusion, respond to treatment with EGFR tyrosine kinase inhibitors but can be missed by limited genomic sequencing panels. Here, we report a case of metastatic lung adenocarcinoma in a never-smoker patient who initially did not have a targetable alteration identified on two different sequencing panels. The initial response to combination chemoimmunotherapy was short-lived. A rare EGFR-RAD51 fusion was then identified using a more in-depth sequencing panel. The patient experienced a dramatic and durable response to osimertinib. This case highlights the rarity of EGFR-RAD51 fusions, the efficacy of EGFR tyrosine kinase inhibitors, and the importance of a thorough search for targetable alterations in never-smokers with lung adenocarcinoma.
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Affiliation(s)
- Sunny Y. Lai
- Division of Hematology/Oncology, Department of Medicine, Indiana University, Indianapolis, Indiana
| | - Noah H. Richardson
- Division of Hematology/Oncology, Department of Medicine, Indiana University, Indianapolis, Indiana
| | - Mya Tran
- Division of Hematology/Oncology, Department of Medicine, Indiana University, Indianapolis, Indiana
| | - Nasser H. Hanna
- Division of Hematology/Oncology, Department of Medicine, Indiana University, Indianapolis, Indiana
| | - Misty D. Shields
- Division of Hematology/Oncology, Department of Medicine, Indiana University, Indianapolis, Indiana
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31
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Miqdadi A, Ayach S, El Houari H, Cherkaoui Jaouad MR, Rami A, Boulmane H, Çaoui M. Rare images of an intense 18F-FDG PET-scan uptake in an incidentally discovered thyroid lesion: A case report. Radiol Case Rep 2024; 19:1579-1581. [PMID: 38322235 PMCID: PMC10843994 DOI: 10.1016/j.radcr.2024.01.030] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 01/02/2024] [Accepted: 01/09/2024] [Indexed: 02/08/2024] Open
Abstract
Thyroid carcinoma is a type of cancer that starts in the cells of the thyroid gland, which plays a crucial role in regulating the body's metabolism. Thyroid cancer can manifest in various forms. We report the case of an 89 year-old patient presenting an incidental intense Fluorine-18-fluorodeoxyglucose (18F-FDG) PET-computed tomography (PET-CT) uptake within a thyroid lesion and the role of 18F-FDG PET-CT guiding the anatomopathological examination. The prevalence of FDG-avid thyroid incidentaloma ranges between 0.2% and 8.9%. Higher risks of cancer seems to be related to focal or unilateral uptake of 18F-FDG. Lesions with higher standardized uptake values or suspicious CT are more likely to be cancers. The diagnosis is clinically challenging. Nuclear and radiological images can guide practitioners.
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Affiliation(s)
- Amal Miqdadi
- Nuclear Medicine, Cheikh Khalifa International University Hospital, Faculty of Medicine, Mohammed VI University of Health Sciences, Casablanca, Morocco
| | - Saadia Ayach
- Nuclear Medicine, Cheikh Khalifa International University Hospital, Faculty of Medicine, Mohammed VI University of Health Sciences, Casablanca, Morocco
| | - Hamza El Houari
- Nuclear Medicine, Cheikh Khalifa International University Hospital, Faculty of Medicine, Mohammed VI University of Health Sciences, Casablanca, Morocco
| | - Mohamed Reda Cherkaoui Jaouad
- Department of Radiology, Cheikh Khalifa International University Hospital, Mohammed VI University of Health Sciences, Casablanca, Morocco
| | - Amal Rami
- Department of Radiology, Cheikh Khalifa International University Hospital, Mohammed VI University of Health Sciences, Casablanca, Morocco
| | - Hanane Boulmane
- Nuclear Medicine, Cheikh Khalifa International University Hospital, Faculty of Medicine, Mohammed VI University of Health Sciences, Casablanca, Morocco
| | - Malika Çaoui
- Nuclear Medicine, Cheikh Khalifa International University Hospital, Faculty of Medicine, Mohammed VI University of Health Sciences, Casablanca, Morocco
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32
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Gainer M, Richardson R. A rare duo: Pulmonary arterial sling with a pig bronchus. Radiol Case Rep 2024; 19:1568-1570. [PMID: 38317696 PMCID: PMC10839764 DOI: 10.1016/j.radcr.2024.01.005] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 12/28/2023] [Accepted: 01/01/2024] [Indexed: 02/07/2024] Open
Abstract
Pulmonary artery sling is an incomplete vascular ring, where the left pulmonary artery originates from the right pulmonary artery, leading to airway constriction. A tracheal bronchus is an anatomical variation in which an extra bronchus originates from the trachea, frequently resulting in respiratory symptoms or complications. We report a 6-week-old female patient with a pulmonary artery sling coursing around the distal trachea and a concurrent tracheal bronchus.
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Affiliation(s)
- Megan Gainer
- Department of Radiology, Creighton University, 3100 Central Ave, Phoenix, AZ 85012, USA
| | - Randy Richardson
- Department of Radiology, Creighton University, 3100 Central Ave, Phoenix, AZ 85012, USA
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Tamai N, Shinjoh M, Oikawa H, Hamada R, Morio T, Koinuma G, Takahashi T. Invasive pneumococcal disease caused by non-vaccine Streptococcus pneumoniae serotype 24B in an immunocompetent child. Radiol Case Rep 2024; 19:1642-1645. [PMID: 38327552 PMCID: PMC10847835 DOI: 10.1016/j.radcr.2024.01.048] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 01/17/2024] [Accepted: 01/18/2024] [Indexed: 02/09/2024] Open
Abstract
Invasive pneumococcal disease typically occurs in immunocompromised patients, although some vaccine strains of Streptococcus pneumoniae have been reported to cause invasive pneumococcal disease in immunocompetent vaccine recipients. In this study, we presented a case of a 16-month-old immunocompetent patient with lung abscess and empyema caused by nonvaccine S. pneumoniae serotype 24B. A consolidation occupying the right upper lobe in the chest computed tomography results, as observed at presentation, changed to thick-walled cavitary lesions at the end of a month of intravenous antibiotics, and antibiotics were continued for a total of two months. To the best of our knowledge this is the first report that focuses on the risk of invasive pneumococcal disease caused by S. pneumoniae serotype 24B in an immunocompetent child.
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Affiliation(s)
- Naotaka Tamai
- Department of Pediatrics, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
| | - Masayoshi Shinjoh
- Department of Pediatrics, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
| | - Hiroyuki Oikawa
- Pediatrics, Ariake child clinic, Ariake Garden Medical Mall 1F, 2-1-7 Ariake, Koto-ku, Tokyo 135-0063, Japan
| | - Riku Hamada
- Department of Pediatrics, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
- Department of Nephrology and Rheumatology, Tokyo Metropolitan Children's Medical Center, 2-8-29 Musashidai, Fuchu-shi, Tokyo 183-8561, Japan
| | - Tomohiro Morio
- Department of Pediatrics and Developmental Biology, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan
| | - Goro Koinuma
- Division of Pulmonology, Department of Medical Subspecialties, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo 157-8535, Japan
| | - Takao Takahashi
- Department of Pediatrics, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
- Center for developmental neurology, Shin-yurigaoka General Hospital, 255 Furusawa, Asao-ku, Kawasaki-shi, Kanagawa 215-0026, Japan
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Lu H, Yu J, Sun H, Yan S. Acute Coronary Artery Air Embolism Complicating a CT-guided percutaneous lung biopsy: A case report. Heliyon 2024; 10:e27914. [PMID: 38509877 PMCID: PMC10950704 DOI: 10.1016/j.heliyon.2024.e27914] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 03/02/2024] [Accepted: 03/08/2024] [Indexed: 03/22/2024] Open
Abstract
Systemic air embolism is a fatal complication of computed tomography-guided percutaneous lung biopsy. Here, we report a case of acute coronary artery air embolism following computed tomography (CT) guided percutaneous lung biopsy. The patient exhibited cardiac symptoms, and CT showed air density in left ventricle and aorta, indicating air embolism. Trendelenburg positioning and coronary angiography were performed during the treatment, and the patient was discharged without obvious complications.
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Affiliation(s)
- Haotian Lu
- China-Japan Friendship Hospital (Institute of Clinical Medical Sciences), Chinese Academy of Medical Sciences & Peking Union Medical College, China
| | - Jieqiong Yu
- Department of Emergency, China-Japan Friendship Hospital, China
| | - Hongliang Sun
- Department of Radiology, China-Japan Friendship Hospital, China
| | - Shengtao Yan
- Department of Emergency, China-Japan Friendship Hospital, China
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Du G, Jiang Z, Qu W, Zhang J, Zheng S, Liu Y, Zhou A, Shi H, Shou J. Downstaging guided neoadjuvant strategy shift and bladder preservation in locally advanced bladder cancer: A case report. Heliyon 2024; 10:e27685. [PMID: 38515680 PMCID: PMC10955234 DOI: 10.1016/j.heliyon.2024.e27685] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 03/02/2024] [Accepted: 03/05/2024] [Indexed: 03/23/2024] Open
Abstract
Background The study of bladder preservation for muscle-invasive bladder cancer (MIBC) mainly focuses on the T2 stage, which remains difficult in the T3 and T4 stage. Pembrolizumab has been applied as neoadjuvant therapy followed by radical cystectomy for MIBC, gaining encouraging results in the phase II study. Disitamab vedotin, an antibody-drug conjugate (ADC), also achieved promising efficacy for refractory bladder cancer. However, the neoadjuvant therapy strategy of these drugs for bladder sparing remains further exploration. Case presentation A patient with locally advanced MIBC at our institute underwent a neoadjuvant therapeutic regimen followed by transurethral resection of bladder tumor (TURBT) and concurrent chemoradiotherapy. In light of limited initial efficacy, we enacted an adaptive shift in the neoadjuvant treatment strategy, transitioning from a combination of gemcitabine, cis-platinum, and pembrolizumab to disitamab vedotin with pembrolizumab. This approach ultimately achieved bladder preservation, complete response, and a remarkable 1-year disease-free survival (DFS). Conclusion Proactive evaluation in the early stages of tumor downstaging can serve as a guiding principle for neoadjuvant strategies. This is the first successful case of neoadjuvant pembrolizumab combined with disitamab vedotin and chemotherapy in MIBC patients achieving complete response and bladder preservation.
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Affiliation(s)
- Gan Du
- Department of Urology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Zhichao Jiang
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Wang Qu
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Jin Zhang
- Department of Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Shan Zheng
- Department of Pathology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Yueping Liu
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Aiping Zhou
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Hongzhe Shi
- Department of Urology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Jianzhong Shou
- Department of Urology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
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Olivares-Antúnez Y, Dávila-Zablah YJ, Vázquez-Ávila JR, Gómez-Macías GS, Mireles-Aguilar MT, Garza-Montemayor ML. Ductal carcinoma in situ within a fibroadenoma: A case report and review of literature. World J Radiol 2024; 16:58-68. [DOI: 10.4329/wjr.v16.i3.58] [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: 12/10/2023] [Revised: 02/27/2024] [Accepted: 03/06/2024] [Indexed: 03/26/2024] Open
Abstract
BACKGROUND Fibroadenoma (FA) is the most common tumor found in young women, although it can occur in any age group. Ductal carcinoma in situ (DCIS) that is confined in a FA is rare; it is most frequently reported as an incidental finding.
CASE SUMMARY We report a case of DCIS within a FA in a 46-year-old female without cancer-related personal and family histories. The patient was diagnosed with a breast conglomerate of nodules and was followed for 1 year. In the current control image study, we found suspicious microcalcification, as a new finding, within one of the nodules. Consequently, a core biopsy of the tumor, which appeared hypoechoic, oval, and circumscribed, was performed. The pathological diagnosis was ductal carcinoma in situ within a fibroepithelial lesion. The patient underwent breast-conserving surgery and received radiotherapy as well as endocrine therapy (tamoxifen).
CONCLUSION We recommend a multidisciplinary approach for adequate treatment and follow-up.
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Affiliation(s)
- Yazmin Olivares-Antúnez
- Department of Diagnostic Breast Imaging Center, Hospital Zambrano Hellion, Tecnológico de Monterrey, Nuevo León 66260, Mexico
| | - Yesika Janett Dávila-Zablah
- Department of Diagnostic Breast Imaging Center, Hospital Zambrano Hellion, Tecnológico de Monterrey, Nuevo León 66260, Mexico
| | - José Raúl Vázquez-Ávila
- Department of Patology Service, Hospital San José, Tecnológico de Monterrey, Nuevo León 64710, Mexico
| | - Gabriela Sofía Gómez-Macías
- Department of Patology Service, Hospital San José, Tecnológico de Monterrey, Nuevo León 64710, Mexico
- Department of Faculty of Medicine, Hospital Universitario de la UANL, Nuevo León 64710, Mexico
| | - María Teresa Mireles-Aguilar
- Department of Breast Surgery Center, Hospital Zambrano Hellion, Tecnológico de Monterrey, Nuevo León 66260, Mexico
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Zhang X, Liu K, Lu X, Zheng W, Shi J, Yu S, Feng H, Yu Z. Late-onset Cholestasis with Paucity of Portal Area Secondary to HNF1β Deficiency in Adulthood: A Case Report. J Clin Transl Hepatol 2024; 12:327-331. [PMID: 38426190 PMCID: PMC10899876 DOI: 10.14218/jcth.2023.00464] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Revised: 12/29/2023] [Accepted: 01/22/2024] [Indexed: 03/02/2024] Open
Abstract
Hepatocyte nuclear factor 1β (HNF1β) is essential for biliary development, while its genetic defect triggers the dysplasia of interlobular bile ducts, leading to life-threatening hepatitis and cholestasis. To date, this disorder has mainly been documented in neonates. Here, we report a case of cholestasis in an adult patient caused by a de novo HNF1β mutation. A liver biopsy revealed remarkable shrinkage of the portal area accompanied by a decrease or absence of interlobular bile ducts, veins, and arteries in the portal area. Our case showed that an HNF1β defect could induce late-onset cholestasis with paucity of the portal area in adulthood.
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Affiliation(s)
- Xuemei Zhang
- Department of Hepatopathy, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Kun Liu
- Department of Pathology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xiaona Lu
- Department of Hepatopathy, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Wenlan Zheng
- Department of Hepatopathy, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Jia Shi
- Department of Hepatopathy, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Shihan Yu
- Department of Hepatopathy, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Hai Feng
- Institute of Infectious Disease, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Zhuo Yu
- Department of Hepatopathy, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
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Tang YJ, Zhang J, Wang J, Tian RD, Zhong WW, Yao BS, Hou BY, Chen YH, He W, He YH. Link between mutations in ACVRL1 and PLA2G4A genes and chronic intestinal ulcers: A case report and review of literature. World J Gastrointest Surg 2024; 16:932-943. [DOI: 10.4240/wjgs.v16.i3.932] [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: 11/06/2023] [Revised: 12/29/2023] [Accepted: 02/23/2024] [Indexed: 03/22/2024] Open
Abstract
BACKGROUND Genetic factors of chronic intestinal ulcers are increasingly garnering attention. We present a case of chronic intestinal ulcers and bleeding associated with mutations of the activin A receptor type II-like 1 (ACVRL1) and phospholipase A2 group IVA (PLA2G4A) genes and review the available relevant literature.
CASE SUMMARY A 20-year-old man was admitted to our center with a 6-year history of recurrent abdominal pain, diarrhea, and dark stools. At the onset 6 years ago, the patient had received treatment at a local hospital for abdominal pain persisting for 7 d, under the diagnosis of diffuse peritonitis, acute gangrenous appendicitis with perforation, adhesive intestinal obstruction, and pelvic abscess. The surgical treatment included exploratory laparotomy, appendectomy, intestinal adhesiolysis, and pelvic abscess removal. The patient’s condition improved and he was discharged. However, the recurrent episodes of abdominal pain and passage of black stools started again one year after discharge. On the basis of these features and results of subsequent colonoscopy, the clinical diagnosis was established as inflammatory bowel disease (IBD). Accordingly, aminosalicylic acid, immunotherapy, and related symptomatic treatment were administered, but the symptoms of the patient did not improve significantly. Further investigations revealed mutations in the ACVRL1 and PLA2G4A genes. ACVRL1 and PLA2G4A are involved in angiogenesis and coagulation, respectively. This suggests that the chronic intestinal ulcers and bleeding in this case may be linked to mutations in the ACVRL1 and PLA2G4A genes. Oral Kangfuxin liquid was administered to promote healing of the intestinal mucosa and effectively manage clinical symptoms.
CONCLUSION Mutations in the ACVRL1 and PLA2G4A genes may be one of the causes of chronic intestinal ulcers and bleeding in IBD. Orally administered Kangfuxin liquid may have therapeutic potential.
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Affiliation(s)
- Yong-Jing Tang
- Department of Infectious Diseases, The Affiliated Hospital of Zunyi Medical University, Zunyi 563000, Guizhou Province, China
| | - Jian Zhang
- Department of Gastroenterology, Dafang County People's Hospital, Bijie 551600, Guizhou Province, China
| | - Jie Wang
- Department of Internal Medicine, Puchang Branch, Medical Community, Suiyang County People's Hospital, Zunyi 563300, Guizhou Province, China
| | - Ren-Dong Tian
- Department of Infectious Diseases, The Affiliated Hospital of Zunyi Medical University, Zunyi 563000, Guizhou Province, China
| | - Wei-Wei Zhong
- Department of Infectious Diseases, Jingmen Central Hospital, Jingmen 448000, Hubei Province, China
| | - Ben-Sheng Yao
- Department of Infectious Diseases, Dafang County People's Hospital, Bijie 551600, Guizhou Province, China
| | - Bing-Yu Hou
- Department of Gastroenterology, Dafang County People's Hospital, Bijie 551600, Guizhou Province, China
| | - Ying-Hua Chen
- Department of Infectious Diseases, The Affiliated Hospital of Zunyi Medical University, Zunyi 563000, Guizhou Province, China
| | - Wei He
- Department of Infectious Diseases, The Affiliated Hospital of Zunyi Medical University, Zunyi 563000, Guizhou Province, China
| | - Yi-Huai He
- Department of Infectious Diseases, The Affiliated Hospital of Zunyi Medical University, Zunyi 563000, Guizhou Province, China
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Chang HC, Kang JC, Pu TW, Su RY, Chen CY, Hu JM. Mucinous neoplasm of the appendix: A case report and review of literature. World J Gastrointest Surg 2024; 16:944-954. [DOI: 10.4240/wjgs.v16.i3.944] [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: 11/29/2023] [Revised: 12/17/2023] [Accepted: 02/22/2024] [Indexed: 03/22/2024] Open
Abstract
BACKGROUND Appendiceal mucinous neoplasms (AMNs), although not classified as rare, are relatively uncommon tumors most often discovered incidentally during colorectal surgery. Accurate identification of AMNs is difficult due to non-specific symptoms, overlapping tumor markers with other conditions, and the potential for misdiagnosis. This underscores the urgent need for precision in diagnosis to prevent severe complications.
CASE SUMMARY This case report describes the unexpected discovery and treatment of a low-grade AMN (LAMN) in a 74-year-old man undergoing laparoscopic hemicolectomy for transverse colon adenocarcinoma (AC). Preoperatively, non-specific gastrointestinal symptoms and elevated tumor markers masked the presence of AMN. The tumor, presumed to be an AMN peritoneal cyst intraoperatively, was confirmed as LAMN through histopathological examination. The neoplasm exhibited mucin accumulation and a distinct immunohistochemical profile: Positive for Homeobox protein CDX-2, Cytokeratin 20, special AT-rich sequence-binding protein 2, and Mucin 2 but negative for cytokeratin 7 and Paired box gene 8. This profile aids in distinguishing appendiceal and ovarian mucinous tumors. Postoperative recovery was uncomplicated, and the patient initiated adjuvant chemotherapy for the colon AC.
CONCLUSION This case highlights the diagnostic complexity of AMNs, emphasizing the need for vigilant identification to avert potential complications, such as pseudomyxoma peritonei.
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Affiliation(s)
- Hao-Cheng Chang
- Department of Surgery, Tri-Service General Hospital, Taipei 114, Taiwan
| | - Jung-Cheng Kang
- Division of Colon and Rectal Surgery, Department of Surgery, Taiwan Adventist Hospital, Taipei 105, Taiwan
| | - Ta-Wei Pu
- Division of Colon and Rectal Surgery, Department of Surgery, Tri-Service General Hospital Songshan Branch, National Defense Medical Center, Taipei 105, Taiwan
- Division of Colon and Rectal Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan
| | - Ruei-Yu Su
- Department of Pathology, Tri-Service General Hospital, National Defense Medical Center, Taipei 105, Taiwan
- Department of Pathology and Laboratory Medicine, Taoyuan Armed Forces General Hospital, Taoyuan 325, Taiwan
| | - Chao-Yang Chen
- Division of Colon and Rectal Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan
| | - Je-Ming Hu
- Division of Colon and Rectal Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan
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Zhu HT, Chen WG, Wang JJ, Guo JN, Zhang FM, Xu GQ, Chen HT. Endoscopic ultrasound-guided lauromacrogol injection for treatment of colorectal cavernous hemangioma: Two case reports. World J Gastrointest Surg 2024; 16:966-973. [DOI: 10.4240/wjgs.v16.i3.966] [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: 12/19/2023] [Revised: 01/20/2024] [Accepted: 02/25/2024] [Indexed: 03/22/2024] Open
Abstract
BACKGROUND Colorectal cavernous hemangioma is a rare vascular malformation resulting in recurrent lower gastrointestinal hemorrhage, and can be misinterpreted as colitis. Surgical resection is currently the mainstay of treatment, with an emphasis on sphincter preservation.
CASE SUMMARY We present details of two young patients with a history of persistent hematochezia diagnosed with colorectal cavernous hemangioma by endoscopic ultrasound (EUS). Cavernous hemangioma was relieved by several EUS-guided lauromacrogol injections and the patients achieved favorable clinical prognosis.
CONCLUSION Multiple sequential EUS-guided injections of lauromacrogol is a safe, effective, cost-efficient, and minimally invasive alternative for colorectal cavernous hemangioma.
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Affiliation(s)
- Hua-Tuo Zhu
- Department of Gastroenterology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, Zhejiang Province, China
| | - Wen-Guo Chen
- Department of Gastroenterology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, Zhejiang Province, China
| | - Jing-Jie Wang
- Department of Gastroenterology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, Zhejiang Province, China
| | - Jia-Nan Guo
- Department of Gastroenterology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, Zhejiang Province, China
| | - Fen-Ming Zhang
- Department of Gastroenterology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, Zhejiang Province, China
| | - Guo-Qiang Xu
- Department of Gastroenterology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, Zhejiang Province, China
| | - Hong-Tan Chen
- Department of Gastroenterology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, Zhejiang Province, China
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Vipudhamorn W, Juthasilaparut T, Sutharat P, Sanmee S, Supatrakul E. Abdominal cocoon syndrome-a rare culprit behind small bowel ischemia and obstruction: Three case reports. World J Gastrointest Surg 2024; 16:955-965. [DOI: 10.4240/wjgs.v16.i3.955] [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: 11/26/2023] [Revised: 12/16/2023] [Accepted: 02/06/2024] [Indexed: 03/22/2024] Open
Abstract
BACKGROUND Abdominal cocoon syndrome (ACS) represents a category within sclerosing encapsulating peritonitis, characterized by the encapsulation of internal organs with a fibrous, cocoon-like membrane of unknown origin, resulting in bowel obstruction and ischemia. Diagnosing this condition before surgery poses a challenge, often requiring confirmation during laparotomy. In this context, we depict three instances of ACS: One linked to intestinal obstruction, the second exclusively manifesting as intestinal ischemia without any obstruction, and the final case involving a discrepancy between the radiologist and the surgeon.
CASE SUMMARY Three male patients, aged 53, 58, and 61 originating from Northern Thailand, arrived at our medical facility complaining of abdominal pain without any prior surgeries. Their vital signs remained stable during the assessment. The diagnosis of abdominal cocoon was confirmed through abdominal computed tomography (CT) before surgery. In the first case, the CT scan revealed capsules around the small bowel loops, showing no enhancement, along with mesenteric congestion affecting both small and large bowel loops, without a clear obstruction. The second case showed intestinal obstruction due to an encapsulated capsule on the CT scan. In the final case, a patient presented with recurring abdominal pain. Initially, the radiologist suspected enteritis as the cause after the CT scan. However, a detailed review led the surgeon to suspect encapsulating peritoneal sclerosis (ACS) and subsequently perform surgery. The surgical procedure involved complete removal of the encapsulating structure, resection of a portion of the small bowel, and end-to-end anastomosis. No complications occurred during surgery, and the patients had a smooth recovery after surgery, eventually discharged in good health. The histopathological examination of the fibrous membrane (cocoon) across all cases consistently revealed the presence of fibro-collagenous tissue, without any indications of malignancy.
CONCLUSION Individuals diagnosed with abdominal cocoons commonly manifest vague symptoms of abdominal discomfort. An elevated degree of clinical suspicion, combined with the application of appropriate radiological evaluations, markedly improves the probability of identifying the abdominal cocoon before surgical intervention. In cases of complete bowel obstruction or ischemia, the established norm is the comprehensive removal of the peritoneal sac as part of standard care. Resection with intestinal anastomosis is advised solely when ischemia and gangrene have been confirmed.
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Affiliation(s)
- Witcha Vipudhamorn
- Department of Colorectal Surgery, Chiang Mai University, Chiang Mai 50200, Thailand
| | | | - Pawit Sutharat
- Department of Colorectal Surgery, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Suwan Sanmee
- Department of Colorectal Surgery, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Ekkarin Supatrakul
- Department of Colorectal Surgery, Chiang Mai University, Chiang Mai 50200, Thailand
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Wongrat T, Sangmala S. Facial cutaneous Rosai-Dorfman disease: a case report. J Med Case Rep 2024; 18:182. [PMID: 38532442 DOI: 10.1186/s13256-024-04410-9] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 01/24/2024] [Indexed: 03/28/2024] Open
Abstract
BACKGROUND Rosai-Dorfman disease (RDD) is a form of non-Langerhans cell histiocytosis in which the activated histiocytes of the lymph nodes and other organs begin to accumulate following excessive production. Bilateral, massive, and painless lymphadenopathy are classic presentations. Systemic RDD is already known to be a rare condition, but isolated cutaneous RDD is extremely rare. We presented a rare and unusual presentations of a disease. CASE PRESENTATION A 35-year-old Thai female with a 6-month history of a small acne-like lesion that rapidly progressed to 5 cm tumor-like lesions on the face within 3 months. Tissue histology showed a dense dermal infiltration of histiocytes with emperipolesis phenomenon. Immunohistochemistry was positive for S100 protein and CD68 and negative for CD1a. Oral prednisolone (50 mg/day) was initiated with a favorable outcome at the one-month follow-up. However, prednisolone yielded a partial response at 2-month follow-up, leading to application of another modality. CONCLUSION Although cutaneous Rosai-Dorfman disease is considered benign and well medical responded disease, patients with atypical presentation and rapid growing lesion may necessitate aggressive multimodal treatment.
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Affiliation(s)
- Tanapong Wongrat
- Division of Dermatology, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Songkla, 90110, Thailand.
- Department of Internal Medicine, School of Medicine, Mae Fah Luang University, 365 Tambon Nang Lae, Amphoe Mueang Chiang Rai, Chang Wat Chiang Rai, Chiangrai, 57100, Thailand.
| | - Siripan Sangmala
- Division of Dermatology, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Songkla, 90110, Thailand
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Zhang T, Li M, Tan L, Li X. Pulmonary alveolar proteinosis induced by X-linked agammaglobulinemia: A case report. World J Clin Cases 2024; 12:1644-1648. [DOI: 10.12998/wjcc.v12.i9.1644] [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: 10/20/2023] [Revised: 01/20/2024] [Accepted: 03/01/2024] [Indexed: 03/25/2024] Open
Abstract
BACKGROUND Pulmonary alveolar proteinosis (PAP) and X-linked agammaglobulinemia (XLA) are rare diseases in children. Many theories infer that immunodeficiency can induce PAP, but these reports are almost all review articles, and there is little clinical evidence. We report the case of a child with both PAP and XLA.
CASE SUMMARY A 4-month-old boy sought medical treatment due to coughing and difficulty in breathing for > 2 wk. He had been hospitalized multiple times due to respiratory infections and diarrhea. Chest computed tomography and alveolar lavage fluid showed typical PAP-related manifestations. Genetic testing confirmed that the boy also had XLA. Following total lung alveolar lavage and intravenous immunoglobulin replacement therapy, the boy recovered and was discharged. During the follow-up period, the number of respiratory infections was significantly reduced, and PAP did not recur.
CONCLUSION XLA can induce PAP and improving immune function contributes to the prognosis of children with this type of PAP.
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Affiliation(s)
- Ting Zhang
- Department of Respiratory Medicine, Kunming Children´s Hospital, Kunming 650228, Yunnan Province, China
| | - Ming Li
- Department of Respiratory Medicine, Kunming Children´s Hospital, Kunming 650228, Yunnan Province, China
| | - Li Tan
- Department of Respiratory Medicine, Kunming Children´s Hospital, Kunming 650228, Yunnan Province, China
| | - Xin Li
- Department of Emergency, Kunming Children's Hospital, Kunming 650228, Yunnan Province, China
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Chen JX, Xu LL, Cheng JP, Xu XH. Challenging anticoagulation therapy for multiple primary malignant tumors combined with thrombosis: A case report and review of literature. World J Clin Cases 2024; 12:1704-1711. [DOI: 10.12998/wjcc.v12.i9.1704] [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: 01/24/2024] [Revised: 02/21/2024] [Accepted: 03/01/2024] [Indexed: 03/25/2024] Open
Abstract
BACKGROUND Venous thromboembolism significantly contributes to patient deterioration and mortality. Management of its etiology and anticoagulation treatment is intricate, necessitating a comprehensive consideration of various factors, including the bleeding risk, dosage, specific anticoagulant medications, and duration of therapy. Herein, a case of lower extremity thrombosis with multiple primary malignant tumors and high risk of bleeding was reviewed to summarize the shortcomings of treatment and prudent anticoagulation experience.
CASE SUMMARY An 83-year-old female patient was admitted to the hospital due to a 2-wk history of left lower extremity edema that had worsened over 2 d. Considering her medical history and relevant post-admission investigations, it was determined that the development of left lower extremity venous thrombosis and pulmonary embolism in this case could be attributed to a combination of factors, including multiple primary malignant tumors, iliac venous compression syndrome, previous novel coronavirus infection, and inadequate treatment for prior thrombotic events. However, the selection of appropriate anticoagulant medications, determination of optimal drug dosages, and establishment of an appropriate duration of anticoagulation therapy were important because of concurrent thrombocytopenia, decreased quantitative fibrinogen levels, and renal insufficiency.
CONCLUSION Anticoagulant prophylaxis should be promptly initiated in cases of high-risk thrombosis. Individualized anticoagulation therapy is required for complex thrombosis.
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Affiliation(s)
- Jia-Xin Chen
- Department of Gerontology, China Resources and Wisco General Hospital, Wuhan University of Science and Technology, Wuhan 430080, Hubei Province, China
- Medical College, Wuhan University of Science and Technology, Wuhan 430065, Hubei Province, China
| | - Ling-Ling Xu
- Department of Gerontology, China Resources and Wisco General Hospital, Wuhan University of Science and Technology, Wuhan 430080, Hubei Province, China
- Medical College, Wuhan University of Science and Technology, Wuhan 430065, Hubei Province, China
| | - Jing-Ping Cheng
- Department of Gerontology, China Resources and Wisco General Hospital, Wuhan 430080, Hubei Province, China
| | - Xun-Hua Xu
- Department of Radiology, China Resources and Wisco General Hospital, Wuhan 430080, Hubei Province, China
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Chen YY, Xu XZ, Xu XJ. Low interleukin-10 level indicates a good prognosis in Salmonella enterica serovar typhimurium-induced pediatric hemophagocytic lymphohistiocytosis: A case report. World J Clin Cases 2024; 12:1660-1668. [DOI: 10.12998/wjcc.v12.i9.1660] [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: 10/30/2023] [Revised: 01/10/2024] [Accepted: 03/05/2024] [Indexed: 03/25/2024] Open
Abstract
BACKGROUND Secondary hemophagocytic lymphohistiocytosis (sHLH) triggered by Salmonella enterica serovar Typhimurium is rare in pediatric patients. There is no consensus on how to treat S. typhimurium-triggered sHLH.
CASE SUMMARY A 9-year-old boy with intermittent fever for 3 d presented to our hospital with positive results for S. typhimurium, human rhinovirus, and Mycoplasma pneumoniae infections. At the time of admission to our institution, the patient’s T helper 1/T helper 2 cytokine levels were 326 pg/mL for interleukin 6 (IL-6), 9.1 pg/mL for IL-10, and 246.7 pg/mL for interferon-gamma (IFN-γ), for which the ratio of IL-10 to IFN-γ was 0.04. In this study, the patient received meropenem, linezolid, and cefoperazone/sulbactam in combination with high-dose methylprednisolone therapy (10 mg/kg/d for 3 d) and antishock supportive treatment twice. After careful evaluation, this patient did not receive HLH chemotherapy and recovered well.
CONCLUSION S. Typhimurium infection-triggered sHLH patient had a ratio of IL-10 to IFN-γ ≤ 1.33, an IL-10 concentration ≤ 10.0 pg/mL, and/or an IFN-γ concentration ≤ 225 pg/mL at admission. Early antimicrobial and supportive treatment was sufficient, and the HLH-94/2004 protocol was not necessary under these conditions.
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Affiliation(s)
- Yuan-Yuan Chen
- Division/Center of Pediatric Hematology Oncology, Children’s Hospital, Zhejiang University School of Medicine, Hangzhou 310003, Zhejiang Province, China
| | - Xiang-Zhi Xu
- Pediatric Intensive Care Unit, Children’s Hospital of Zhejiang University School of Medicine, Hangzhou 310003, Zhejiang Province, China
| | - Xiao-Jun Xu
- Division/Center of Pediatric Hematology Oncology, Children’s Hospital, Zhejiang University School of Medicine, Hangzhou 310003, Zhejiang Province, China
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Xu LL, Chen JX, Cheng JP, Luo N. Exogenous insulin autoimmune syndrome: A case report and review of literature. World J Clin Cases 2024; 12:1691-1697. [DOI: 10.12998/wjcc.v12.i9.1691] [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: 01/24/2024] [Revised: 02/23/2024] [Accepted: 03/06/2024] [Indexed: 03/25/2024] Open
Abstract
BACKGROUND Insulin autoimmune syndrome (IAS) is a severe manifestation of spontaneous hypoglycemia. It is characterized by elevated levels of immune-reactive insulin and highly potent insulin autoantibodies (IAAs), which are induced by endogenous insulin circulating in the bloodstream. It is distinguished by recurring instances of spontaneous hypoglycemia, the presence of IAA within the body, a substantial elevation in serum insulin levels, and an absence of prior exogenous insulin administration. Nevertheless, recent studies show that both conventional insulin and its analogs can induce IAS episodes, giving rise to the notion of non-classical IAS. Therefore, more attention should be paid to these diseases.
CASE SUMMARY In this case report, we present a rare case of non-classical IAS in an 83-year-old male patient who present with symptoms of a psychiatric disorder. Upon symptom onset, the patient exhibited Whipple's triad (including hypoglycemia, blood glucose level less than 2.8 mmol/L during onset, and rapid relief of hypoglycemic symptoms after glucose administration). Concurrently, his serum insulin level was significantly elevated, which contradicted his C-peptide levels. After a comprehensive examination, the patient was diagnosed with exogenous insulin autoimmune syndrome. Considering that the patient had type 2 diabetes mellitus and a history of exogenous insulin use before disease onset, it was presumed that non classical IAS was induced by this condition. The PubMed database was used to search for previous cases of IAS and non-classical IAS to analyze their characteristics and treatment approaches.
CONCLUSION The occurrence of non-classical IAS is associated with exogenous insulin or its analogs, as well as with sulfhydryl drugs. Symptoms can be effectively alleviated through the discontinuation of relevant medications, administration of hormones or immunosuppressants, plasma exchange, and lifestyle adjustments.
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Affiliation(s)
- Ling-Ling Xu
- Medical College, School of Medicine, Wuhan University of Science and Technology, Wuhan 430065, Hubei Province, China
| | - Jia-Xin Chen
- Medical College, School of Medicine, Wuhan University of Science and Technology, Wuhan 430065, Hubei Province, China
| | - Jing-Ping Cheng
- Department of Gerontology, CR & WISCO General Hospital Affiliated to Wuhan University of Science and Technology, Wuhan 430080, Hubei Province, China
| | - Ni Luo
- Department of Gerontology, CR & WISCO General Hospital Affiliated to Wuhan University of Science and Technology, Wuhan 430080, Hubei Province, China
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Li ZH, Lou L, Chen YX, Shi W, Zhang X, Yang J. Severe hypoxemia after radiofrequency ablation for atrial fibrillation in palliatively repaired tetralogy of Fallot: A case report. World J Cardiol 2024; 16:161-167. [DOI: 10.4330/wjc.v16.i3.161] [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: 07/30/2023] [Revised: 11/21/2023] [Accepted: 01/12/2024] [Indexed: 03/21/2024] Open
Abstract
BACKGROUND Patients with tetralogy of Fallot (TOF) often have arrhythmias, commonly being atrial fibrillation (AF). Radiofrequency ablation is an effective treatment for AF and does not usually cause severe postoperative hypoxemia, but the risk of complications may increase in patients with conditions such as TOF.
CASE SUMMARY We report a young male patient with a history of TOF repair who developed severe hypoxemia after radiofrequency ablation for AF and was ultimately confirmed to have a new right-to-left shunt. The patient subsequently underwent atrial septal occlusion and eventually recovered.
CONCLUSION Radiofrequency ablation may cause iatrogenic atrial septal injury; thus possible complications should be predicted in order to ensure successful treatment and patient safety.
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Affiliation(s)
- Zhi-Hang Li
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310000, Zhejiang Province, China
| | - Lian Lou
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310000, Zhejiang Province, China
| | - Yu-Xiao Chen
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310000, Zhejiang Province, China
| | - Wen Shi
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310000, Zhejiang Province, China
| | - Xuan Zhang
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310000, Zhejiang Province, China
| | - Jian Yang
- Department of Cardiology, The First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310003, Zhejiang Province, China
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Wang TG, Tian L, Zhang XL, Zhang L, Zhao XL, Kong DS. Gradient inflammation in the pancreatic stump after pancreaticoduodenectomy: Two case reports and review of literature. World J Clin Cases 2024; 12:1649-1659. [DOI: 10.12998/wjcc.v12.i9.1649] [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: 10/29/2023] [Revised: 12/26/2023] [Accepted: 03/07/2024] [Indexed: 03/25/2024] Open
Abstract
BACKGROUND Postoperative pancreatic fistula (POPF) contributes significantly to morbidity and mortality after pancreaticoduodenectomy (PD). However, the underlying mechanisms remain unclear. This study explored this pathology in the pancreatic stumps and elucidated the mechanisms of POPF following PD.
CASE SUMMARY Pathological analysis and 16S rRNA gene sequencing were performed on specimens obtained from two patients who underwent complete pancreatectomy for grade C POPF after PD. Gradient inflammation is present in the pancreatic stump. The apoptosis was lower than that in the normal pancreas. Moreover, neutrophil-dominated inflammatory cells are concentrated in the ductal system. Notably, neutrophils migrated through the ductal wall in acinar duct metaplasia-formed ducts. Additionally, evidence indicates that gut microbes migrate from the digestive tract. Gradient inflammation occurs in pancreatic stumps after PD.
CONCLUSION The mechanisms underlying POPF include high biochemical activity in the pancreas, mechanical injury, and digestive reflux. To prevent POPF and address pancreatic inflammation and reflux, breaking the link with anastomotic dehiscence is practical.
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Affiliation(s)
- Tie-Gong Wang
- Department of Surgery, Cangzhou Central Hospital, Cangzhou 061000, Hebei Province, China
| | - Liang Tian
- Department of Pathology, Cangzhou Central Hospital, Cangzhou 061000, Hebei Province, China
| | - Xiao-Ling Zhang
- Department of Pathology, Cangzhou Central Hospital, Cangzhou 061000, Hebei Province, China
| | - Lei Zhang
- Department of Surgery, Cangzhou Central Hospital, Cangzhou 061000, Hebei Province, China
| | - Xiu-Lei Zhao
- Department of Surgery, Cangzhou Central Hospital, Cangzhou 061000, Hebei Province, China
| | - De-Shuai Kong
- Department of Surgery, Cangzhou Central Hospital, Cangzhou 061000, Hebei Province, China
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Ni HY, Zhang Y, Huang DH, Zhou F. Multi-systemic melioidosis in a patient with type 2 diabetes in non-endemic areas: A case report and review of literature. World J Clin Cases 2024; 12:1669-1676. [DOI: 10.12998/wjcc.v12.i9.1669] [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: 11/08/2023] [Revised: 01/05/2024] [Accepted: 02/25/2024] [Indexed: 03/25/2024] Open
Abstract
BACKGROUND Melioidosis, an infectious disease caused by Burkholderia pseudomallei (B. pseudomallei), occurs endemically in Southeast Asia and Northern Australia and is a serious opportunistic infection associated with a high mortality rate.
CASE SUMMARY A 58-year-old woman presented with scattered erythema on the skin of her limbs, followed by fever and seizures. B. pseudomallei was isolated successively from the patient’s urine, blood, and pus. Magnetic resonance imaging showed abscess formation involving the right forehead and the right frontal region. Subsequently, abscess resection and drainage were performed. The patient showed no signs of relapse after 4 months of follow-up visits post-treatment.
CONCLUSION We present here a unique case of multi-systemic melioidosis that occurs in non-endemic regions in a patient who had no recent travel history. Hence, it is critical to enhance awareness of melioidosis in non-endemic regions.
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Affiliation(s)
- Huan-Yu Ni
- Department of Endocrinology, Puren Hospital, Wuhan University of Science and Technology, Wuhan 430080, Hubei Province, China
- School of Medicine, Wuhan University of Science and Technology, Wuhan 430080, Hubei Province, China
| | - Ying Zhang
- Department of Critical Care Medicine, Zhongnan Hospital of Wuhan University, Wuhan 430071, Hubei Province, China
| | - Dong-Hai Huang
- Department of Rheumatology and Immunology, Puren Hospital, Wuhan University of Science and Technology, Wuhan 430080, Hubei Province, China
| | - Feng Zhou
- Department of Endocrinology, Puren Hospital, Wuhan University of Science and Technology, Wuhan 430080, Hubei Province, China
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Shan D, Li T, Tan X, Hu YY. Low-molecular-weight heparin and preeclampsia — does the sword cut both ways? Three case reports and review of literature. World J Clin Cases 2024; 12:1634-1643. [DOI: 10.12998/wjcc.v12.i9.1634] [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: 10/20/2023] [Revised: 02/03/2024] [Accepted: 03/01/2024] [Indexed: 03/25/2024] Open
Abstract
BACKGROUND Low-molecular-weight heparins (LMWH) are the most commonly used anticoagulants during pregnancy. It is considered to be the drug of choice due to its safety in not crossing placenta. Considering the beneficial effect in the improvement of microcirculation, prophylactic application of LMWH in patients with preeclampsia became a trend. However, the bleeding risk related with LMWH in preeclampsia patients has seldomly been evaluated. This current study aimed to identify the potential risks regarding LMWH application in patients with preeclampsia.
CASE SUMMARY Herein we present a case series of three pregnant women diagnosed with preeclampsia on LMWH therapy during pregnancy. All the cases experienced catastrophic hemorrhagic events. After reviewing the twenty-one meta-analyses, the bleeding risk related with LMWH seems ignorable. Only one study analyzed the bleeding risk of LMWH and found a significantly higher risk of developing PPH in women receiving LMWH. Other studies reported minor bleeding risks, none of these were serious enough to stop LMWH treatment. Possibilities of bleeding either from uterus or from intrabdominal organs in preeclampsia patients on LMWH therapy should not be ignored. Intensive management of blood pressure even after delivery and homeostasis suture in surgery are crucial.
CONCLUSION Consideration should be given to the balance between benefits and risks of LMWH in patients with preeclampsia.
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Affiliation(s)
- Dan Shan
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu 610000, Sichuan Province, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu 610000, Sichuan, China
| | - Tao Li
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu 610000, Sichuan Province, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu 610000, Sichuan, China
| | - Xi Tan
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu 610000, Sichuan Province, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu 610000, Sichuan, China
| | - Ya-Yi Hu
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu 610000, Sichuan Province, China
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