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Tunio S, Strychowsky JE, Dzioba A, You P, Madou E, Chen BA. The Use of Ipratropium Bromide for the Treatment of Pediatric Sialorrhea: A Retrospective Clinical Case Series. Ann Otol Rhinol Laryngol 2024; 133:560-565. [PMID: 38433339 PMCID: PMC11107125 DOI: 10.1177/00034894241235523] [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] [Subscribe] [Scholar Register] [Indexed: 03/05/2024]
Abstract
OBJECTIVE This retrospective review documents the experience of ipratropium bromide use among pediatric patients with sialorrhea at our multidisciplinary sialorrhea clinic at Children's Hospital at London Health Sciences Centre (LHSC). METHODS A retrospective chart review of patients diagnosed with sialorrhea at our multidisciplinary clinic between January 2015 and June 2021 was completed. Data on patient demographics, comorbidities, clinical presentation, previous interventions, quality of life, and medication adverse side effects was collected. Drooling Frequency and Severity Scale (DFSS) scores were reviewed to compare sialorrhea management pre- and post-treatment with topical 0.03% ipratropium bromide nasal solution. A descriptive analysis and Wilcoxon signed rank tests were conducted to compare pre- versus post-treatment DFSS scores. RESULTS A total of 12 patients presented for follow-up and were included in the final analysis. At the pre-treatment visit, the median DFSS score was 4 for frequency and 5 for severity. Post-treatment, median DFSS score was 3 for frequency and 4.5 for severity, (P = .020 and .129, respectively). Minimal adverse effects were encountered. CONCLUSIONS Ipratropium bromide provided a statistically significant benefit for drooling frequency in the patients studied and may present an additional topical medical option for pediatric sialorrhea with limited adverse effects.
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Affiliation(s)
- Suhaima Tunio
- Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | - Julie E. Strychowsky
- Department of Otolaryngology-Head & Neck Surgery, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | - Agnieszka Dzioba
- Department of Otolaryngology-Head & Neck Surgery, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | - Peng You
- Department of Otolaryngology-Head & Neck Surgery, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | - Edward Madou
- Department of Otolaryngology-Head & Neck Surgery, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | - Breanna A. Chen
- Department of Paediatrics, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
- Children’s Health Research Institute, Lawson Health Research Institute, London, ON, Canada
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Ishizuka K, Yamashita S, Mine Y, Yamamoto Y, Kojima H, Someko H, Miyagami T. How case reports can be used to improve diagnosis. Diagnosis (Berl) 2024; 11:198-199. [PMID: 38234286 DOI: 10.1515/dx-2023-0181] [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: 12/15/2023] [Accepted: 01/08/2024] [Indexed: 01/19/2024]
Affiliation(s)
- Kosuke Ishizuka
- Department of General Medicine, Yokohama City University School of Medicine, Yokohama, Kanagawa, Japan
| | - Shun Yamashita
- Department of General Medicine, Saga University Hospital, Saga, Japan
- Education and Research Center for Community Medicine, Faculty of Medicine, Saga University, Saga, Japan
| | - Yuichiro Mine
- Department of General Medicine, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | - Yukichika Yamamoto
- Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
- Department of General Internal Medicine, Iizuka Hospital, Iizuka, Fukuoka, Japan
| | - Hiroki Kojima
- Department of Infectious Disease, Kyorin University School of Medicine, Tokyo, Japan
| | - Hidehiro Someko
- Department of General Internal Medicine, Asahi General Hospital, Asahi, Japan
| | - Taiju Miyagami
- Department of General Medicine, Faculty of Medicine, Juntendo University, Tokyo, Japan
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Mohebbi A, Motamedaria P, Naderi M, Hassanpour M, Salavatiha Z, Makouei M, Ataei-Pirkooh A. Understanding Creutzfeldt-Jakob disease in Iran: a systematic review of case reports. J Int Med Res 2024; 52:3000605241247706. [PMID: 38717041 PMCID: PMC11080748 DOI: 10.1177/03000605241247706] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 03/31/2024] [Indexed: 05/12/2024] Open
Abstract
OBJECTIVE To systematically review the reported cases of Creutzfeldt-Jakob disease (CJD) in Iran. METHODS A comprehensive literature review of CJD cases in Iran was undertaken using the PubMed®, Scopus® and Google Scholar databases. In addition, the Iranian database MagIran was searched for Persian language reports. Case selection used the following criteria: (i) patients of Iranian origin; (ii) publication in peer-reviewed journals or reputable medical databases; (iii) a definitive diagnosis of CJD based on established diagnostic criteria. RESULTS Thirteen cases from twelve reports were included in this systematic review. The majority of the cases were female (11 of 13; 84.6%). The mean ± SD age of patients at hospital admission was 59.38 ± 7.44 years. The findings of the case review suggested that the prevalence of CJD in Iran is not fully established. CJD may be misdiagnosed alongside other clinical signs. The most prevalent early indications of the disease were psychiatric and neurological in nature. A considerable delay in diagnosis was observed in some cases and there was a shortage of brain autopsy records. CONCLUSION Efforts to improve diagnostic capabilities, promote awareness and establish monitoring systems are necessary for managing the challenges of providing an early diagnosis of CJD in Iran.
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Affiliation(s)
- Alireza Mohebbi
- Department of Virology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Parastoo Motamedaria
- Department of Virology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Malihe Naderi
- Department of Microbiology and Microbial Biotechnology, Faculty of Life Sciences and Biotechnology, Shahid Beheshti University, Tehran, Iran
| | - Mina Hassanpour
- Department of Microbiology, Golestan University of Medical Sciences, Gorgan, Iran
| | - Zahra Salavatiha
- Department of Virology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Mahsa Makouei
- School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Angila Ataei-Pirkooh
- Department of Virology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
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Ando T, Sasaki T, Naito M. Lethal disseminated intravascular coagulation induced by primary and metastatic neuroendocrine prostate cancer. IJU Case Rep 2024; 7:238-242. [PMID: 38686071 PMCID: PMC11056258 DOI: 10.1002/iju5.12712] [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: 12/20/2023] [Accepted: 02/14/2024] [Indexed: 05/02/2024] Open
Abstract
Introduction Neuroendocrine prostate cancer has a poor prognosis. Although disseminated intravascular coagulation associated with malignancy can be lethal, it very rarely occurs among patients with primary neuroendocrine prostate cancer. Case presentation An 80-year-old man presented to our hospital with bloody sputum. Blood examination indicated disseminated intravascular coagulation. Serum levels of prostate-specific antigen and neuron-specific enolase were 44.274 and 176 ng/mL, respectively. Core needle biopsies of an irregular mass in the prostate and a metastatic tumor in the left iliac bone showed similar neuroendocrine carcinoma cells. Hence, the patient was diagnosed with disseminated intravascular coagulation associated with primary and metastatic neuroendocrine prostate cancer. Unfortunately, he passed away 3 weeks after the biopsies. Conclusion Given the difficulty of effectively treating metastatic neuroendocrine prostate cancer among patients in poor physical condition due to disease progression, identifying a new well-tolerated treatment modality is imperative.
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Affiliation(s)
- Takashi Ando
- Department of UrologyJA Niigata Kouseiren Murakami General HospitalMurakamishiNiigataJapan
| | - Taro Sasaki
- Department of Orthopedic SurgeryJA Niigata Kouseiren Murakami General HospitalMurakamishiNiigataJapan
| | - Makoto Naito
- Department of PathologyNiigata Medical CenterNiigatashiNiigataJapan
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Meneses WEF, Lima DO Rego PHC, Junior VNF, Palmeira HT, Aragao DHP, Teixeira AC, DE Aquino PL, Pinheiro PMA, Silva JPT, DE Menezes FJC, DA Silva MJ, Fernandes GGS. First Case Report of Bilateral Parotid Lymphoepithelial Carcinoma. Cancer Diagn Progn 2024; 4:384-389. [PMID: 38707721 PMCID: PMC11062164 DOI: 10.21873/cdp.10336] [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] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 01/15/2024] [Indexed: 05/07/2024]
Abstract
Background/Aim The parotid is the largest salivary gland and is located anteriorly to the sternocleidomastoid muscle and laterally to the ramus of the mandible. Neoplasms in this gland are relatively rare, with 80% being benign and 20% malignant, primarily represented by mucoepidermoid carcinoma. In the head and neck region, lymphoepithelial carcinoma (LEC) accounts for 0.4% of malignant salivary gland tumors. Case Report A 35-year-old man with no previous comorbidities was admitted to a Head and Neck Surgery Specialty Service for a painless right cervical mass of uncertain growth. Extensive diagnostic investigation revealed involvement of the contralateral parotid, associated with systemic lymph node enlargement. Thus, adjuvant radiotherapy was decided by the treating team. Conclusion This case confirms the heterogeneous features and distinctive behavior that the disease can present, as seen with bilateral parotid LEC.
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Affiliation(s)
| | | | | | - Herbert Tavares Palmeira
- Department of Clinical Oncology, Santa Casa da Misericórdia de Fortaleza Hospital, Fortaleza, Brazil
| | | | - Andre Costa Teixeira
- Department of Pathology, Argos Pathology, Fortaleza, Brazil
- Department of Medicine, Christus University Center, Fortaleza, Brazil
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Zhang M, Xiao Y, Chang G, Liu H, Long X. Perineal Benign Symmetric Lipomatosis in a Female Patient: A Case Report. Am J Case Rep 2024; 25:e943803. [PMID: 38685699 PMCID: PMC11068072 DOI: 10.12659/ajcr.943803] [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] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 03/18/2024] [Accepted: 03/05/2024] [Indexed: 05/02/2024]
Abstract
BACKGROUND Benign symmetric lipomatosis (BSL), also known as Madelung's disease, is a rare disease generally characterized by fat deposits painlessly and symmetrically distributed in the body. In former studies, the incidence of BSL is highest in male patients and more frequent in the Mediterranean area. Asian females seem to be rarely affected. BSL often occurs in the neck or upper-back of patients, and is related to various metabolic disorders. Unusual clinical appearances may add difficulties in diagnosis. CASE REPORT In this report, we present a case of BSL in a 33-year-old woman's perineal region, with no clear BSL risk factors (sex, medical history, sites, and comorbidities), which increased the difficulties in diagnosis. The patient's quality of life was seriously affected by the continuous growth of fat tissue. Based on MRI and B-ultrasonic examinations, she underwent excision at our outpatient facility. Combined with the patient's clinical appearance, imaging results, and pathological tests, we could finally determine the diagnosis of BSL. After 18 months of follow-up, this patient recovered well with no recurrence. CONCLUSIONS Difficulties in diagnosis can seriously affect doctors' treatment approaches. BSL rarely occurs in the lower body, and our patient showed no clear risk factors. Therefore, imaging and pathological examinations can be essential tools for dermatological and plastic surgeons to diagnose and treat rare BSL.
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Affiliation(s)
| | | | | | | | - Xiao Long
- Corresponding Author: Xiao Long, e-mail:
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Chen MY, Chen TL. A Rare Autochthonous Case of Hepatic Hydatid Cyst in the Non-Endemic Region of Taiwan. Am J Case Rep 2024; 25:e943687. [PMID: 38676296 PMCID: PMC11060492 DOI: 10.12659/ajcr.943687] [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] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 03/16/2024] [Accepted: 03/07/2024] [Indexed: 04/28/2024]
Abstract
BACKGROUND Hepatic hydatid cyst disease, caused by the parasite Echinococcus granulosus, is endemic in certain rural areas of the world, but not in most of East Asia outside Mainland China. In Taiwan, only one autochthonous case has been reported over the past 40 years. We present the case of an urban 91-year-old female patient without international travel history for more than 40 years. CASE REPORT The 91-year-old woman who used a wheelchair came to the Emergency Department reporting melena for 2 days and 1 episode of coffee-grounds vomitus. Epigastric tenderness was present. An incidental finding of elevated liver enzymes along with the clinical picture prompted further survey. Computed tomography revealed a 14×10×12 cm homogeneous cystic lesion in the right hepatic lobe with a partially calcified wall. On sonograms, a similar lesion was found, and the pathognomic "water-lily" sign was visualized along with the isoechoic-to-hypoechoic internal septa, fulfilling the diagnosis despite the patient's refusal to undergo magnetic resonance imaging studies and invasive definite diagnostic procedures. Although anthelmintic chemotherapy and invasive therapeutic measures were also refused, her symptoms improved and was not recurrent under supportive measures. However, the cyst was still present 12 months after discharge. CONCLUSIONS The case highlights that in areas with few cases of hepatic hydatid disease, the accurate diagnosis could be missed in patients without a significant epidemiological history. However, once imaging findings, especially those that are pathognomic, are appropriately interpreted on at least 2 imaging modalities, such cases could be diagnosed without further definitive studies.
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Affiliation(s)
- Mao-Yuan Chen
- Department of Medicine, Taipei Veterans General Hospital, Taipei City, ROC (Taiwan)
| | - Tsung-Lin Chen
- Division of Gastroenterology, West Garden Hospital, Taipei City, ROC (Taiwan)
- Eonway Health Management Center, Taipei City, ROC (Taiwan)
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8
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Gao P, Shen Y, Wu P, Lv W. Ascorbic acid-induced warfarin resistance after breast cancer surgery: a case report and literature review. Front Pharmacol 2024; 15:1390996. [PMID: 38738175 PMCID: PMC11082382 DOI: 10.3389/fphar.2024.1390996] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Accepted: 04/12/2024] [Indexed: 05/14/2024] Open
Abstract
Warfarin is an anticoagulant that requires INR-based dosage adjustment. Ascorbic acid may impair warfarin effectiveness according to limited literature. We report a rare case of a 63-year-old woman with an aortic valve replacement history who developed warfarin resistance after taking ascorbic acid for anemia following breast cancer surgery. Despite increasing the warfarin dose from 6 mg to 10 mg daily, her INR remained below the therapeutic range. After ruling out other causes of warfarin resistance, we discontinued ascorbic acid and observed a rapid increase in INR to target values. The temporal relationship and the absence of other confounding factors confirmed the causality of ascorbic acid in this case. We recommend that patients concomitantly taking vitamin C and warfarin should monitor their INR values closely and discontinue ascorbic acid as soon as possible if they exhibit signs of warfarin resistance.
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Affiliation(s)
- Pingfa Gao
- Department of Thyroid and Breast Surgery, Chongming Hospital Affiliated to Shanghai University of Medicine and Health Sciences, Shanghai, China
| | - Yang Shen
- Shanghai University of Medicine and Health Sciences, Shanghai, China
| | - Ping Wu
- Department of Breast Surgery, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wenjie Lv
- Department of Thyroid and Breast Surgery, Chongming Hospital Affiliated to Shanghai University of Medicine and Health Sciences, Shanghai, China
- Department of Breast Surgery, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Elendu C, Amaechi DC, Jingwa KA, Elendu TC. Comparative analysis of different therapeutic approaches in the management of protein-energy malnutrition: Case reports from a clinical setting. Medicine (Baltimore) 2024; 103:e37890. [PMID: 38669421 PMCID: PMC11049791 DOI: 10.1097/md.0000000000037890] [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: 12/27/2023] [Accepted: 03/22/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND Severe protein-energy malnutrition (PEM) presents a significant clinical challenge, often compounded by comorbidities such as type 2 diabetes. This case report aims to elucidate the intricacies of managing severe PEM in conjunction with type 2 diabetes, emphasizing the importance of personalized interventions and multidisciplinary collaboration in achieving optimal outcomes. By addressing the unique challenges this complex clinical scenario poses, this report contributes valuable insights to the medical literature and guides clinicians in effectively managing similar cases. METHODS The patient, pseudonymously identified as Emma Thompson, underwent a comprehensive diagnostic evaluation to assess her symptoms' severity and underlying causes. This included a thorough physical examination, laboratory testing, imaging studies, and collaboration with specialists to formulate a tailored treatment plan. Interventions were meticulously administered, with dosages, strengths, and durations adjusted based on ongoing assessments and patient response. RESULTS Implementing multidisciplinary therapeutic interventions significantly improved the patient's nutritional status, glycemic control, and overall well-being. Objective measures such as BMI, serum albumin levels, and physical functioning showed marked improvement throughout treatment. Patient-reported outcomes indicated enhanced quality of life, reduced fatigue, and increased energy levels, underscoring the comprehensive success of the integrated therapeutic approach. CONCLUSION This case report highlights the efficacy of a holistic, patient-centered approach in managing severe PEM and comorbid type 2 diabetes. Optimal outcomes were achieved by addressing the complex interplay of medical conditions through tailored interventions and multidisciplinary collaboration. The lessons from this case underscore the importance of individualized care, ongoing assessment, and long-term follow-up in enhancing patient well-being and guiding future clinical practice.
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Affiliation(s)
- Chukwuka Elendu
- Internal Medicine, Federal University Teaching Hospital, Owerri, Nigeria
| | | | - Klein A. Jingwa
- Internal Medicine, Kazan State Medical University, Kazan, Russia
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10
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Elendu C, Amaechi DC, Davidson G, Jingwa KA, Elendu TC. Lymphoma of the central nervous system originating from the septum pellucidum region: Two case reports with literature review. Medicine (Baltimore) 2024; 103:e37892. [PMID: 38669431 PMCID: PMC11049786 DOI: 10.1097/md.0000000000037892] [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: 12/27/2023] [Accepted: 03/22/2024] [Indexed: 04/28/2024] Open
Abstract
RATIONALE Central nervous system lymphoma (CNSL) originating from the septum pellucidum is exceptionally rare, presenting unique diagnostic and therapeutic complexities. This case report aims to elucidate the diagnostic challenges, treatment strategies, and outcomes of this rare manifestation. By documenting this case, we seek to enhance understanding within the medical community and contribute valuable insights to the management of CNSL, particularly in atypical locations. PATIENT CONCERNS A 45-year-old female presented with persistent headaches, blurred vision, and motor weakness, prompting a thorough neurological evaluation. Imaging revealed an enhancing mass in the septum pellucidum, leading to the diagnosis of CNSL. The patient's concerns encompassed not only the physical symptoms but also the emotional impact of her diagnosis and treatment journey. DIAGNOSES Diagnostic confirmation of CNSL involved cerebrospinal fluid analysis and imaging findings, highlighting the challenge of distinguishing lymphoma from other intracranial pathologies. The case underscores the importance of comprehensive diagnostic evaluation in rare CNSL presentations. INTERVENTIONS Multidisciplinary management included high-dose methotrexate-based chemotherapy and corticosteroids, with consideration for neurosurgical intervention. Psychosocial support and self-care strategies were integrated into the treatment plan to address holistic patient needs. OUTCOMES Monitoring revealed a positive treatment response, with a reduction observed in the septum pellucidum mass. Regular assessments ensured adherence to interventions and management of treatment-related side effects, contributing to favorable outcomes and improved quality of life for the patient. LESSONS This case emphasizes the significance of meticulous diagnostic evaluation and personalized treatment approaches in managing rare CNSL presentations. Collaboration among specialists and comprehensive patient support is paramount in optimizing outcomes and addressing the multifaceted challenges posed by CNSL in unique anatomical locations.
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Niedrig DF, Pyra M, Lussmann R, Serra A, Russmann S. Rosuvastatin-induced rhabdomyolysis: case report and call for proactive multifactorial risk assessment and preventive management of statin therapy in high-risk patients. Eur J Hosp Pharm 2024; 31:281-284. [PMID: 37451842 PMCID: PMC11042465 DOI: 10.1136/ejhpharm-2023-003765] [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] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 07/04/2023] [Indexed: 07/18/2023] Open
Abstract
Cholesterol-lowering statins are frequently prescribed for primary and secondary prevention of ischaemic vascular events. Whereas most patients tolerate statins without problems, statin-associated myopathy is well documented, as are several risk factors. We present a case report of an 80-90-year-old man with coronary artery disease who rapidly developed severe rhabdomyolysis during treatment with rosuvastatin while in intensive care. He had several concomitant risk factors for statin-induced myopathy including high dosage, old age, renal and hepatic impairment, and a pharmacogenetic SLCO1B1*1 a/*5 variant. Single known risk factors have a low predictive value for statin-induced myopathy and may therefore be underestimated in clinical practice. However, adverse drug reactions frequently involve the joint action of a multitude of environmental and genetic component causes, and statin-induced myopathy should be regarded as a multicausal event. We therefore advocate a proactive multifactorial risk assessment to guide and individualise statin therapy in high-risk patients.
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Affiliation(s)
- David Franklin Niedrig
- Clinical Servcies, Hirslanden AG, Glattpark, Switzerland
- drugsafety.ch, Kusnacht, Switzerland
| | - Martin Pyra
- 24h Accident & Emergency Unit Zurich, Hirslanden Hospital Hirslanden, Zürich, Switzerland
| | - Roger Lussmann
- Institute of Physicians for Anaesthesia and Intensive Care, Hirslanden Klinik Hirslanden, Zürich, Switzerland
| | - Andreas Serra
- Centre for Nephrology and Dialysis, Hirslanden Hospital Hirslanden, Zürich, Switzerland
- University of Zurich Institute of Epidemiology Biostatistics and Prevention, Zürich, Switzerland
| | - Stefan Russmann
- drugsafety.ch, Kusnacht, Switzerland
- Hirslanden Hospital Hirslanden, Zürich, Switzerland
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Hsiao YS, Shen SC, Hsiao SC. Recurrent Marginal Zone Lymphoma with Bone Marrow Involvement Detected by ¹⁸F-FDG PET/CT and Biopsy: A Diagnostic Challenge. Am J Case Rep 2024; 25:e943275. [PMID: 38644602 PMCID: PMC11056210 DOI: 10.12659/ajcr.943275] [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] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 03/12/2024] [Accepted: 03/01/2024] [Indexed: 04/23/2024]
Abstract
BACKGROUND Marginal zone lymphoma is a low-grade, B-cell, non-Hodgkin lymphoma. Bone marrow involvement (BMI) of leukemia or lymphoma can usually be displayed in fluorine-18-fluorodeoxyglucose positron emission tomography/computed tomography (¹⁸F-FDG PET/CT) with high standardized uptake values (SUV), while diffuse homogeneous ¹⁸F-FDG bone marrow uptake (BMU) in PET/CT primarily reflects hyperplastic bone marrow status. This report is of a 74-year-old man presenting with anemia and a diagnosis of recurrent marginal zone lymphoma with bone marrow involvement identified with 18F-FDG PET/CT imaging and biopsy. CASE REPORT A 64-year-old man with severe anemia and body weight loss of 7 kg in 1 month was diagnosed with marginal zone lymphoma, stage III, in July 2011. He went into complete remission in April 2012 after 6 cycles of chemotherapy, with Hb restored. Anemia and diffuse homogeneous ¹⁸F-FDG BMU in PET/CT were then noted during a routine check-up in October 2021, and recurrent disease was established through positive biopsy of subcutaneous nodules and bone marrow. Subsequent complete remission after 6 cycles of combination therapy was validated with pathologically negative BMI, the resolution of the slightly enhanced ¹⁸F-FDG BMU in PET/CT, and restored hemoglobin. CONCLUSIONS This report has highlighted the importance of follow-up for patients with lymphoma and supports the diagnostic role of ¹⁸F-FDG PET/CT imaging and the pathological verification in identifying malignant involvement in bone marrow.
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Affiliation(s)
- Yeong-Shin Hsiao
- Department of Internal Medicine, St. Marien- and St. Anna Foundation Hospital, Ludwigshafen, Germany
| | - Shu-Chane Shen
- Department of Nuclear Medicine, St. Martin de Porres Hospital, Chiayi, Taiwan
| | - Shih-Chuan Hsiao
- Department of Hematology and Oncology, St. Martin de Porres Hospital, Chiayi, Taiwan
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13
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O'Hagan R, Ngandjui J, Ungar B, Ungar J, Gulati N. A Survey of Demographics and Treatments in Melanoma Case Reports: Retrospective Bibliometric Analysis. JMIR Dermatol 2024; 7:e56684. [PMID: 38648085 DOI: 10.2196/56684] [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] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 03/22/2024] [Accepted: 04/10/2024] [Indexed: 04/25/2024] Open
Abstract
Melanoma case reports show variations in treatment by age and sex.
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Affiliation(s)
- Ross O'Hagan
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
- Department of Medical Education, Garnet Health, Middletown, NY, United States
| | - Jessie Ngandjui
- Department of Medical Education, Garnet Health, Middletown, NY, United States
| | - Benjamin Ungar
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Jonathan Ungar
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Nicholas Gulati
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
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Deng X, Guo X, Chen X, Zeng X, Guo J, Bai X, Zhang P, Wang Y. ACE Gene Mutations (rs577350502) in Early-Onset and Recurrent Myocardial Infarction: A Case Report and Review. Pharmgenomics Pers Med 2024; 17:163-169. [PMID: 38659693 PMCID: PMC11042475 DOI: 10.2147/pgpm.s455740] [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] [Accepted: 04/04/2024] [Indexed: 04/26/2024] Open
Abstract
Background Acute myocardial infarction (AMI) is a severe acute coronary syndrome, demonstrating a trend toward affecting younger individuals in recent years. The association between early-onset myocardial infarction and single nucleotide polymorphism necessitates further exploration and evaluation. Case description We present a case of a patient experiencing early-onset and recurrent myocardial infarction. The patient underwent stent implantation for myocardial infarction at the age of 53 and subsequently encountered two more myocardial infarctions within a span of 16 years. Following interventional therapy, genetic testing was conducted to assess the efficacy of subsequent anti-heart failure medications, with the aim to preemptively address heart failure risks. Genetic testing revealed a mutation in the angiotensin-converting enzyme (ACE) gene (rs577350502, g.63488533C>A), characterized by an intron-deletion single nucleotide variant. Conclusion While this variant has not been previously reported to be associated with any specific disease, we hypothesize that it may contribute to the susceptibility and risk of myocardial infarction and coronary heart disease in the patient under consideration. This observation underscores the significance of investigating the insertion/deletion polymorphisms of the ACE gene in the context of AMI and emphasizes the necessity for further validation of this variant and other genetic markers associated with AMI in related diseases.
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Affiliation(s)
- Xiaoxi Deng
- Department of Pathology, Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing, 100102, People's Republic of China
| | - Xiaofei Guo
- Department of Pathology, Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing, 100102, People's Republic of China
| | - Xiaojie Chen
- Department of Emergency, Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing, 100102, People's Republic of China
| | - Xinyu Zeng
- Department of Pathology, Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing, 100102, People's Republic of China
| | - Jiamin Guo
- Department of Pathology, Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing, 100102, People's Republic of China
| | - Xin Bai
- Department of Pathology, Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing, 100102, People's Republic of China
| | - Ping Zhang
- Department of Pathology, Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing, 100102, People's Republic of China
| | - Yuan Wang
- Department of Pathology, Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing, 100102, People's Republic of China
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15
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Alsharif MB. Successful Healing of Periapical Pathology with Partial Pulpotomy in a Mature Permanent Molar: A Case Report. Am J Case Rep 2024; 25:e942937. [PMID: 38641871 PMCID: PMC11055469 DOI: 10.12659/ajcr.942937] [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] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Revised: 03/06/2024] [Accepted: 02/23/2024] [Indexed: 04/21/2024]
Abstract
BACKGROUND Vital pulp therapy approaches are preferred over non-surgical root canal treatment, giving the advantage of preserving the vitality of the dental pulp and thus maintaining its benefits. Such approaches can be performed in teeth having normal apical area; however, performing vital pulp therapy approaches in teeth associated with periapical pathology remains controversial. CASE REPORT We present a case of a mature mandibular right first permanent molar tooth in a medically fit 10-year-old female diagnosed as asymptomatic irreversible pulpitis with asymptomatic apical periodontitis with periapical radiolucency having a periapical index (PAI) score of 4. Partial pulpotomy was performed instead of non-surgical root canal treatment due to uncooperativeness of the patient. Biodentine was used as a pulp capping material. The tooth was restored with resin composite permanent restoration. Six months after the procedure, an intraoral periapical radiograph revealed normal bone features with complete periapical pathology healing and development of intact lamina dura around the mesial and distal roots. The tooth responded normal to electric pulp testing (EPT), cold, percussion, and palpation tests. CONCLUSIONS Periapical pathology involvement having large periapical radiolucency exhibiting PAI score 4 in inflamed dental pulp tooth diagnosed as irreversible pulpitis does not necessitate non-surgical root canal treatment. Partial pulpotomy should be considered as an alternative treatment to promote the return dental pulp and periapical tissue to a healthy condition. Considering a similar approach in older patients would be interesting to gain a more comprehensive understanding of its potential as a treatment method.
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16
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Wang LJ, Zou HM, Hou F, Wang GX, Gao CP. Aggressive vertebral hemangiomas contain no adipose tissue resulting in thoracic spine kyphosis: A case report. Medicine (Baltimore) 2024; 103:e37885. [PMID: 38640290 PMCID: PMC11029966 DOI: 10.1097/md.0000000000037885] [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: 12/20/2023] [Revised: 03/15/2024] [Accepted: 03/22/2024] [Indexed: 04/21/2024] Open
Abstract
RATIONALE Aggressive vertebral hemangiomas (AVHs) destroy continuous vertebral bodies and intervertebral discs and resulting in spinal kyphosis is extremely rare. The very aggressive behavior was attributable to its significant vascular component and contained no adipose tissue. PATIENT CONCERNS We report a case of thoracic spine kyphosis of AVHs with multiple vertebral bodies and intervertebral disc destruction in a 45-year-old woman. DIAGNOSES Based on the imaging studies, the patient underwent surgical removal of this lesion and spinal reconstruction. Histopathology consistent with vertebral hemangioma and contained no adipose. INTERVENTIONS The patient underwent surgical removal of the lesion and spinal reconstruction. After subperiosteal dissection of the paraspinal muscles and exposure of the laminae, the laminae of the T5-7 vertebrae were removed and exposing the lesion. The lesion was soft and showed cystic changes, completely curetted and autogenous bone was implanted. Vertebroplasty was performed through T3-T9 pedicles bilaterally. Pedicle screw fixation was performed for segmental fixation and fusion. OUTCOMES After 9 days of operation, the incision healed cleanly and free of pain. She was discharged in good general condition. The patient remained asymptomatic after follow-up 6 months of postoperative. LESSONS AVHs destroy multiple vertebral bodies and intervertebral discs and resulting in spinal kyphosis is extremely rare.
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Affiliation(s)
- Liang-Jie Wang
- Department of Radiology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Hong-Mei Zou
- Department of Radiology, The Affiliated Qingdao Third People's Hospital, Qingdao University, Qingdao, China
| | - Feng Hou
- Department of Pathology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Guan-Xi Wang
- Department of Radiology, Songshan Hospital of Qingdao University Medical College University, Qingdao, China
| | - Chuan-Ping Gao
- Department of Radiology, The Affiliated Hospital of Qingdao University, Qingdao, China
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17
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Micheels P, Porcello A, Bezzola T, Perrenoud D, Christen MO, Applegate LA, Laurent A. Comprehensive Evaluation of Injectability Attributes in OxiFree™ Dermal Fillers: MaiLi ® Product Variants and Clinical Case Reports. Gels 2024; 10:276. [PMID: 38667695 PMCID: PMC11049332 DOI: 10.3390/gels10040276] [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: 03/18/2024] [Revised: 04/08/2024] [Accepted: 04/16/2024] [Indexed: 04/28/2024] Open
Abstract
Dermal filler injectability is a critical factor for commercial product adoption by medical aesthetic professionals and for successful clinical administration. We have previously reported (in vitro and ex vivo) cross-linked hyaluronic acid (HA)-based dermal filler benchmarking in terms of manual and automated injectability requirements. To further enhance the function-oriented product characterization workflows and the clinical relevance of dermal filler injectability assessments, the aim of this study was to perform in vivo evaluations. Therefore, several variants of the MaiLi® product range (OxiFree™ technology) were characterized in vitro and in vivo in terms of injectability attributes, with a focus on hydrogel system homogeneity and ease of injection. Firstly, standardized in vitro assays were performed in SimSkin® cutaneous equivalents, with variations of the clinical injector, injection site, and injection technique. Then, automated injections in SimSkin® cutaneous equivalents were comparatively performed in a texture analysis setup to obtain fine-granulometry injection force profile results. Finally, five female participants were recruited for the in vivo arm of the study (case reports), with variations of the clinical injector, injection site, and injection technique. Generally, the obtained quantitative force values and injection force profiles were critically appraised from a translational viewpoint, based on discussions around the OxiFree™ manufacturing technology and on in-use specialized clinician feedback. Overall, the present study outlined a notable level of homogeneity across the MaiLi® product range in terms of injectability attributes, as well as consistently high ease of administration by medical aesthetic clinicians.
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Affiliation(s)
| | - Alexandre Porcello
- Development Department, Abcello Sàrl, CH-1432 Belmont-sur-Yverdon, Switzerland;
| | | | | | | | - Lee Ann Applegate
- Regenerative Therapy Unit, Lausanne University Hospital, University of Lausanne, CH-1066 Epalinges, Switzerland;
- Center for Applied Biotechnology and Molecular Medicine, University of Zurich, CH-8057 Zurich, Switzerland
- Oxford OSCAR Suzhou Center, Oxford University, Suzhou 215123, China
| | - Alexis Laurent
- Regenerative Therapy Unit, Lausanne University Hospital, University of Lausanne, CH-1066 Epalinges, Switzerland;
- Manufacturing Department, TEC-PHARMA SA, CH-1038 Bercher, Switzerland
- Manufacturing Department, LAM Biotechnologies SA, CH-1066 Epalinges, Switzerland
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18
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Wang S, Bi Y, Chen Y. Bilateral Bow Hunter Syndrome Associated with Loss of Cervical Physiological Curvature. Am J Case Rep 2024; 25:e942609. [PMID: 38605499 PMCID: PMC11020505 DOI: 10.12659/ajcr.942609] [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] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 02/28/2024] [Accepted: 02/08/2024] [Indexed: 04/13/2024]
Abstract
BACKGROUND Bow hunter syndrome is a rare disease that is often overlooked. It presents with complex and variable clinical symptoms and causes, making diagnosis and treatment challenging. This case report focuses on a young patient with bilateral bow hunter syndrome, possibly caused by the loss of cervical physiological curvature. The aim is to enhance understanding and awareness of the disease. It is important to consider the possibility of bow hunter syndrome in young patients with long-term poor neck posture and symptoms such as dizziness, nausea, vomiting, and neck rotation-related symptoms. In such cases, thorough examination of posterior circulation hemodynamics and vascular morphology is recommended. CASE REPORT A 25-year-old woman was admitted to the hospital mainly because of "dizziness for 10 hours." The dizziness was aggravated when the right side of the neck was turned and the body position changed. This was accompanied by visual rotation, nausea, and vomiting. Bow hunter syndrome was diagnosed based on the clinical symptoms and hemodynamic examination of the posterior circulation. The patient was given a cervical collar to limit excessive twisting of the neck and instructed to avoid large-angle deflection of the neck after discharge. During the 3-month follow-up, no characteristic symptoms (such as dizziness) reappeared. CONCLUSIONS Bow hunter syndrome is a rare clinical posterior circulation compression syndrome with complex etiology. This case suggests that the simple disappearance of cervical curvature may be related to the occurrence of bow hunter syndrome. The dynamic monitoring of blood flow by color Doppler ultrasound and transcranial Doppler in different head positions provides clear clues to suspected bow hunter syndrome. With the help of computed tomography angiography, the diagnosis of bow hunter syndrome may be obtained by noninvasive examination.
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19
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Zhang H, Yang L. Adverse reactions of piperacillin: A literature review of case reports. Open Med (Wars) 2024; 19:20240931. [PMID: 38623456 PMCID: PMC11017182 DOI: 10.1515/med-2024-0931] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 01/26/2024] [Accepted: 02/16/2024] [Indexed: 04/17/2024] Open
Abstract
Aim This study aimed to summarize case reports of adverse drug reactions (ADRs) caused by piperacillin and explore their effects on human organs in real-world settings. Method Case reports of piperacillin ADRs were collected by searching databases such as PubMed, Embase, Web of Science, CNKI, WanFang, and VIP from inception to December 2022. Results A total of 170 patients were ultimately included. The results revealed that ADRs caused by piperacillin were primarily associated with the entire body, followed by the blood system, skin and soft tissues, and the nervous system. The most frequently reported cases included anaphylactic shock, drug fever, rash, and thrombocytopenia. The most severe ADRs were identified as anaphylactic shock and bullous epidermal necrolysis. Furthermore, a comparison was made between systemic adverse reactions caused by piperacillin as a single drug and two composite preparations of piperacillin/β-lactamase inhibitor. ADRs not mentioned in the instructions included convulsions or hallucinations and Kounis syndrome (KS). Conclusion This review suggests that the most severe ADRs associated with piperacillin are toxic epidermal necrolysis and anaphylactic shock. Rare ADRs caused by piperacillin, such as myoclonic jerks, hallucinations, and KS, were identified. The most common symptom with domestic preparations of piperacillin/sulbactam and piperacillin sodium was dyspnea.
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Affiliation(s)
- Hongru Zhang
- Department of Pharmacy, ZhangJiakou First Hospital, Zhangjiakou City, Hebei Province 075000, China
| | - Liping Yang
- Department of Pharmacy, Beijing Hospital, Beijing, China
- National Center of Gerontology, Beijing, China
- Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
- Beijing Key Laboratory of Assessment of Clinical Drugs Risk and Individual Application (Beijing Hospital), Beijing100730, China
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20
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Hájek M, Chmelař D, Tlapák J, Rybárová V, Ondra P, Halouzka V. Accidental Aluminum Phosphide Intoxication Successfully Treated with Hyperbaric Oxygen Therapy: A Case Report. Toxics 2024; 12:272. [PMID: 38668495 PMCID: PMC11053606 DOI: 10.3390/toxics12040272] [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] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 03/25/2024] [Accepted: 04/02/2024] [Indexed: 04/29/2024]
Abstract
The most common pesticide agents are organophosphates and phosphides, aluminum phosphide (ALP) in particular. ALP is a major cause of suicidal poisoning in many countries. In other countries, the problem of accidental, mainly occupational-related, poisoning is also real and actual. Almost two thirds of individuals in poisoning cases have died. This case report describes a case of a patient with accidental ALP intoxication. The origin of the poisoning was the fumigation of stored grain in an agricultural building adjacent to the building in which patient was temporarily housed, while both buildings were connected by an underground corridor, through which the released poison gas penetrated. The case was originally presented by the rescuers as well as healthcare professionals of the local hospital as carbon monoxide intoxication, which has a similar symptomatology as ALP intoxication. The patient was treated comprehensively, including using the HBOT method, which is very unique in the case of phosphine intoxication in human medicine, with an excellent final clinical outcome. This was the first described case of HBOT for ALP intoxication in clinical medicine, although the HBOT indication itself became a coincidence in this case. Further studies must be undertaken to demonstrate the effectiveness of HBOT in treating patients with ALP poisoning.
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Affiliation(s)
- Michal Hájek
- Centre of Hyperbaric Medicine, Ostrava City Hospital, 72880 Ostrava, Czech Republic;
- Institute of Laboratory Medicine, Institute of Microbiology, Faculty of Medicine, University of Ostrava, 70300 Ostrava, Czech Republic
- Centre for Hyperbaric Medicine of Faculty of Medicine University of Ostrava and Ostrava City Hospital, 70300 Ostrava, Czech Republic
| | - Dittmar Chmelař
- Institute of Laboratory Medicine, Institute of Microbiology, Faculty of Medicine, University of Ostrava, 70300 Ostrava, Czech Republic
- Centre for Hyperbaric Medicine of Faculty of Medicine University of Ostrava and Ostrava City Hospital, 70300 Ostrava, Czech Republic
| | - Jakub Tlapák
- The Institute of Aviation Medicine, 16000 Prague, Czech Republic
- Faculty of Biomedical Engineering, Czech Technical University in Prague, 16000 Prague, Czech Republic
| | - Veronika Rybárová
- Department of Forensic Medicine and Medicolegal Expertises, Jessenius Faculty of Medicine, Comenius University, University Hospital, 036 01 Martin, Slovakia
| | - Peter Ondra
- Department of Forensic Medicine and Medical Law, University Hospital Olomouc and Faculty of Medicine and Dentistry, Palacky University Olomouc, 77900 Olomouc, Czech Republic
| | - Vladimír Halouzka
- Department of Forensic Medicine and Medical Law, University Hospital Olomouc and Faculty of Medicine and Dentistry, Palacky University Olomouc, 77900 Olomouc, Czech Republic
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21
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Ghosh SR, Pecorari IL, Funari A, Ledet AJ, Lally A, Karandish A, Agarwal V. Primary Pituitary Abscess: Two Case Reports. J Neurol Surg Rep 2024; 85:e53-e58. [PMID: 38665392 PMCID: PMC11045293 DOI: 10.1055/a-2297-3909] [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: 09/28/2022] [Accepted: 10/21/2023] [Indexed: 04/28/2024] Open
Abstract
Introduction Pituitary abscess is a rare disorder that represents a small fraction of all pituitary lesions. In this report, we present two additional cases with unique features to promote awareness and prompt surgical intervention. Case Presentations A 42-year-old male presented with headache, photophobia, subjective fever, dizziness, imbalance, nausea, and vomiting. A pituitary hormone panel confirmed hypothyroidism and suggested central hypogonadism and secondary adrenal insufficiency. Magnetic resonance imaging (MRI) showed a large sellar mass measuring 2.5 cm × 1.8 cm × 1.6 cm (CC × XT × AP). A 76-year-old woman presented with several months of headaches and unsteady gait in the setting of a known previously asymptomatic sellar lesion, measuring 1.8 cm × 1.2 cm × 1.5 cm (XT × CC × AP). Repeat MRI demonstrated possible hemorrhage within the lesion. In both cases, a preliminary diagnosis of pituitary macroadenoma was made, but transsphenoidal surgery revealed an encapsulated abscess; cultures obtained from the abscesses stained for gram-positive bacteria. Conclusion Pituitary abscess is a rare, potentially life-threatening disorder that may be easily mistaken for other sellar lesions. In this review, we contribute two additional cases of pituitary abscesses to increase awareness and emphasize the importance of proper diagnosis and management.
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Affiliation(s)
- Sayak R. Ghosh
- Department of Neurological Surgery, Albert Einstein College of Medicine, Bronx, New York, United States
| | - Isabella L. Pecorari
- Department of Neurological Surgery, Albert Einstein College of Medicine, Bronx, New York, United States
| | - Abigail Funari
- Department of Neurological Surgery, Albert Einstein College of Medicine, Bronx, New York, United States
| | - Alexander J. Ledet
- Department of Neurological Surgery, Albert Einstein College of Medicine, Bronx, New York, United States
| | - Anne Lally
- Department of Neurological Surgery, Albert Einstein College of Medicine, Bronx, New York, United States
| | - Alireza Karandish
- Department of Neurological Surgery, Albert Einstein College of Medicine, Bronx, New York, United States
| | - Vijay Agarwal
- Department of Neurological Surgery, Albert Einstein College of Medicine, Bronx, New York, United States
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22
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Wang W, Maciel CB, Blatt J, Chang PM, Peek GJ, Machado DS. After the storm: Extracorporeal membrane oxygenation after hemicraniectomy in a child. Perfusion 2024; 39:624-626. [PMID: 36600179 DOI: 10.1177/02676591221151037] [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] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Ventricular arrhythmias following neurological injury have been attributed to sympathetic surge in subarachnoid hemorrhage and traumatic brain injury. Despite associated risks of bleeding and thrombosis, veno-arterial extracorporeal membrane oxygenation (ECMO) in critically ill, clinically unstable postoperative neurosurgical patients can be lifesaving. In the context of neurological injury and the neurosurgical population, the literature available regarding ECMO utilization is limited, especially in children. We report a case of successful ECMO utilization in a child with malignant ventricular tachycardia after decompressive craniectomy for refractory intracranial hypertension following evacuation of extensive subdural empyema.
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Affiliation(s)
- Wei Wang
- Department of Pediatrics, Division of Pediatric Critical Care, University of Florida, Gainesville, FL, USA
| | - Carolina B Maciel
- Department of Neurosurgery, Division of Pediatric Neurosurgery, University of Florida, Gainesville, FL, USA
- Department of Neurology, Division of Neurocritical Care, University of Florida, Gainesville, FL, USA
| | - Jason Blatt
- Department of Neurosurgery, Division of Pediatric Neurosurgery, University of Florida, Gainesville, FL, USA
| | - Philip M Chang
- Congenital Heart Center, Department of Pediatrics, Division of Pediatric Cardiology, University of Florida, Gainesville, FL, USA
| | - Giles J Peek
- Congenital Heart Center, Department of Cardiothoracic Surgery, University of Florida, Gainesville, FL, USA
| | - Desiree S Machado
- Department of Pediatrics, Division of Pediatric Critical Care, University of Florida, Gainesville, FL, USA
- Department of Pediatrics, Division of Cardiology and Pediatric Cardiac Critical Care, Jackson Memorial Hospital, University of Miami, Miami, FL, USA
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23
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Leandro DLF, D'Agostino F, Lopes CT, Lopes JDL. Development and validation of a case study to aid in the diagnostic reasoning of nursing students and nurses. Int J Nurs Knowl 2024; 35:107-116. [PMID: 36815244 DOI: 10.1111/2047-3095.12415] [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] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 02/05/2023] [Indexed: 02/24/2023]
Abstract
PURPOSE The aim of this study is to develop and validate a case study to aid in the diagnostic reasoning of nursing students and nurses. METHODS It is a validation study using a case study based on Lunney's method including (1) content validation of the case study by nurse experts through the Delphi technique, (2) identification of nursing diagnoses (NDs) in the case, (3) evaluation of diagnostic accuracy, and (4) establishment of a priority diagnosis by nurse experts. FINDINGS The case study was developed from the findings of a narrative literature review on the cues of the NDs with a prevalence > 50% in patients with peripheral arterial occlusive disease. Two rounds of expert evaluation were required to validate the case study. The experts identified 18 NDs with different degrees of accuracy. The highly accurate diagnoses most frequently identified by the experts were: Ineffective peripheral tissue perfusion (100%), impaired walking (83%), impaired comfort (50%), and chronic pain (50%). The diagnosis considered a priority by all experts was ineffective peripheral tissue perfusion. CONCLUSIONS The case study was developed and had its content validated. High-accuracy diagnoses were identified, and a priority was determined. IMPLICATIONS FOR NURSING PRACTICE The validated case study may be used by students and nurses to facilitate the development of diagnostic reasoning and critical thinking in practice, teaching or research.
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Affiliation(s)
| | - Fabio D'Agostino
- Faculty of Medcine and Surgery, Saint Camillus International University of Health and Medical Sciences Rome, Rome, Italy
| | - Camila Takao Lopes
- Escola Paulista de Enfermagem, Universidade Federal de São Paulo, São Paulo, Brazil
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24
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Chadli S, Oudrhiri MY, Maamar M, Boutarbouch M, Khibri H, Haidouri S, Messaoud O, El-Aoufir O, Melhaoui A, Ammouri W, Ouahabi A, Harmouche H, Adnaoui M, Mezalek ZT. Sphenoid plasmacytoma as initial presentation of multiple myeloma-case report. J Surg Case Rep 2024; 2024:rjae199. [PMID: 38572279 PMCID: PMC10987209 DOI: 10.1093/jscr/rjae199] [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: 02/22/2024] [Accepted: 03/12/2024] [Indexed: 04/05/2024] Open
Abstract
Plasmacytoma is a rare plasma cell neoplasm. Whether solitary or associated with multiple myeloma (MM), it rarely involves the skull base, particularly the sphenoid bone. We present a unique case of sphenoid bone plasmacytoma secondary to MM, highlighting diagnostic and therapeutic challenges. A 56-year-old female presented with headaches, vomiting, epistaxis, and cranial nerve deficits. Cerebral imaging revealed a 65-mm tumor infiltrating the sphenoid bone and adjacent structures. Subtotal resection was performed using an endoscopic nasal approach. Histopathology revealed plasmacytoma, and diagnostic workup confirmed MM. By the end of biological exploration, relapse of the sphenoid plasmacytoma was observed, and the patient was successfully treated with radiotherapy, immunochemotherapy, and autologous stem cell transplantation. After 18-month follow-up, sustained complete remission was confirmed. Although rare, the diagnosis of plasmacytoma should be considered in cases of skull base tumors. This localization is highly predictive of MM, warranting comprehensive investigations to initiate prompt and adequate management.
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Affiliation(s)
- Sarra Chadli
- Internal Medicine, Ibn Sina University Hospital, Mohammed V University, 10100 Rabat, Morocco
| | - Mohammed Y Oudrhiri
- Neurosurgery HSR, Ibn Sina University Hospital, Mohammed V University, 10100 Rabat, Morocco
| | - Mouna Maamar
- Internal Medicine, Ibn Sina University Hospital, Mohammed V University, 10100 Rabat, Morocco
| | - Mahjouba Boutarbouch
- Neurosurgery HSR, Ibn Sina University Hospital, Mohammed V University, 10100 Rabat, Morocco
| | - Hajar Khibri
- Internal Medicine, Ibn Sina University Hospital, Mohammed V University, 10100 Rabat, Morocco
| | - Soukaina Haidouri
- Clinical Hematology, Ibn Sina University Hospital, Mohammed V University, 10100 Rabat, Morocco
| | - Ola Messaoud
- Radiology, Ibn Sina University Hospital, Mohammed V University, 10100 Rabat, Morocco
| | - Omar El-Aoufir
- Radiology, Ibn Sina University Hospital, Mohammed V University, 10100 Rabat, Morocco
| | - Adyl Melhaoui
- Neurosurgery HSR, Ibn Sina University Hospital, Mohammed V University, 10100 Rabat, Morocco
| | - Wafaa Ammouri
- Internal Medicine, Ibn Sina University Hospital, Mohammed V University, 10100 Rabat, Morocco
| | - Abdessamad Ouahabi
- Neurosurgery HSR, Ibn Sina University Hospital, Mohammed V University, 10100 Rabat, Morocco
| | - Hicham Harmouche
- Internal Medicine, Ibn Sina University Hospital, Mohammed V University, 10100 Rabat, Morocco
| | - Mohammed Adnaoui
- Internal Medicine, Ibn Sina University Hospital, Mohammed V University, 10100 Rabat, Morocco
| | - Zoubida Tazi Mezalek
- Internal Medicine, Ibn Sina University Hospital, Mohammed V University, 10100 Rabat, Morocco
- Clinical Hematology, Ibn Sina University Hospital, Mohammed V University, 10100 Rabat, Morocco
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25
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Romero-Guerra AL, Salas-Cosio MDJ, Bautista-Martínez BA, Castillo-Rodríguez SA, Landa Juárez S, Hernández-Piñon Z, Saldaña Sánchez IDR, Núñez-Enríquez JC. Priapism and chronic myeloid leukemia in an adolescent. Rare debut presentation. A case report. ARCH ARGENT PEDIATR 2024; 122:e202310068. [PMID: 37871128 DOI: 10.5546/aap.2023-10068.eng] [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] [Subscribe] [Scholar Register] [Indexed: 10/25/2023]
Abstract
Priapism is a painful and persistent erection, with or without sexual stimulation. A rare cause of such abnormality is chronic myeloid leukemia. Few cases of priapism as an initial manifestation of this type of leukemia have been reported in adolescent patients. Here we describe the case of a 16-year-old patient who presented with priapism as the initial manifestation of chronic myeloid leukemia. No cavernosal aspiration was performed. A specific hematological treatment was started and, given the persistence of priapism, the patient required 2 corpora cavernosa shunt procedures; despite this treatment, there is a high probability of sequelae.
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Affiliation(s)
- Ana L Romero-Guerra
- Department of Schoolchildren and Adolescents; Hospital de Pediatría Centro Médico Nacional Siglo XXI, Instituto Mexicano Del Seguro Social, Federal District, Mexico
| | - Miguel de J Salas-Cosio
- Department of Schoolchildren and Adolescents; Hospital de Pediatría Centro Médico Nacional Siglo XXI, Instituto Mexicano Del Seguro Social, Federal District, Mexico
| | - Benito A Bautista-Martínez
- Department of Pediatric Hematology; Hospital de Pediatría Centro Médico Nacional Siglo XXI, Instituto Mexicano Del Seguro Social, Federal District, Mexico
| | - Sebastián A Castillo-Rodríguez
- Department of Pediatric Imaging Studies; Hospital de Pediatría Centro Médico Nacional Siglo XXI, Instituto Mexicano Del Seguro Social, Federal District, Mexico
| | - Sergio Landa Juárez
- Department of Pediatric Urology; Hospital de Pediatría Centro Médico Nacional Siglo XXI, Instituto Mexicano Del Seguro Social, Federal District, Mexico
| | - Zayra Hernández-Piñon
- Department of Pediatric Hematology; Hospital de Pediatría Centro Médico Nacional Siglo XXI, Instituto Mexicano Del Seguro Social, Federal District, Mexico
| | - Iris Del R Saldaña Sánchez
- Department of Pediatric Urology; Hospital de Pediatría Centro Médico Nacional Siglo XXI, Instituto Mexicano Del Seguro Social, Federal District, Mexico
| | - Juan C Núñez-Enríquez
- Division of Research; Hospital de Pediatría Centro Médico Nacional Siglo XXI, Instituto Mexicano Del Seguro Social, Federal District, Mexico
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Sah BK, Fatima Z, Sah RK, Syed B, Garg T, Chowdhury S, Ghosh B, Kunwar B, Shree A, Sah VK, Raut A. Guillain-Barre syndrome following COVID-19 vaccination: a study of 70 case reports. Ann Med Surg (Lond) 2024; 86:2067-2080. [PMID: 38576928 PMCID: PMC10990410 DOI: 10.1097/ms9.0000000000001915] [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: 05/11/2023] [Accepted: 02/25/2024] [Indexed: 04/06/2024] Open
Abstract
Background and objective Guillain-Barre syndrome (GBS) has been found to have some interesting association with vaccinations. This paper mainly focuses on exploring different associations between COVID-19 vaccination and GBS. Methods Electronic databases such as PubMed, Google Scholar, Cochrane, and Embase were searched using MESH terms for case reports published till 1 August 2023 from which 70 case reports were documented involving 103 individuals from 23 different countries. Result and discussion The case reports were from a wide range of individuals aged from 13 to 87 years with an average age of 53±20 interquartile range years along with male predominance. The average time between receiving the vaccine and the onset of symptoms was 13.08±2.14 days. Prominent clinical features included back pain, facial diplegia, weakness, and paraesthesia whereas the main diagnostic studies were cerebrospinal fluid (CSF) analysis and electromagnetic studies. The principal diagnostic clue was albumin-cytological dissociation in CSF while being negative for anti-ganglioside antibodies or SARS-CoV-2. Available treatment options consisted of intravenous immunoglobulin and Plasmapheresis. Patients with comorbidities such as diabetes mellitus, hypertension, dyslipidemia, permanent atrial fibrillation, hypothyroidism, Hashimoto's thyroiditis, Chronic Obstructive Pulmonary Disease, asthma, osteoporosis, migraine, rheumatoid arthritis, osteoarthritis, ulcerative colitis, coeliac disease, seizures, bipolar disorder, endometriosis, multiple sclerosis, bell's palsy, squamous cell carcinoma, prostate cancer were included in our study. Conclusion Overall, this review evaluated innovative and clinically relevant associations between COVID-19 vaccination and GBS. Understanding of this uncommon potential side effect of COVID-19 vaccination is crucial for prompt diagnosis and appropriate treatment. Importantly, GBS should not be considered a contraindication to vaccination. This underscores the importance of ongoing research to enhance the safety and efficacy of COVID-19 vaccination efforts.
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Affiliation(s)
| | - Zahra Fatima
- Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | | | - Bushra Syed
- Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | - Tulika Garg
- Government Medical College and Hospital, Chandigarh
| | | | - Bikona Ghosh
- Government Medical College and Hospital, Chandigarh
| | | | - Anagha Shree
- SGT Medical college and research institute, Gurgaon, India
| | - Vivek Kumar Sah
- Universal College of Medical Sciences and Teaching Hospital, Bhairahawa
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Hassan A, Habbash Z, Aljawad M, Alnemer F, Alzayer A, AlZaher A. Warfarin Woes: A Rare Case of Hemoperitoneum with Intramural Small Bowel Hematoma. Am J Case Rep 2024; 25:e943519. [PMID: 38556771 PMCID: PMC11000204 DOI: 10.12659/ajcr.943519] [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] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 02/13/2024] [Accepted: 02/09/2024] [Indexed: 04/02/2024]
Abstract
BACKGROUND Small bowel hematoma is a rare yet clinically significant condition characterized by the accumulation of blood within the mucosa and submucosa layers of the small intestine wall. It can lead to complications such as bowel obstruction, ischemia, perforation, and even hemorrhagic shock. The etiology of intramural small bowel hematoma is diverse, encompassing factors such as anticoagulant therapy, coagulopathies, vascular disorders, trauma, and underlying systemic conditions. CASE REPORT We present the case of a 67-year-old man with a history of aortic valve replacement who presented with intense abdominal pain. Physical examination revealed generalized abdominal tenderness and black stools upon rectal examination. Laboratory tests indicated coagulopathy with a prolonged thrombin time. A computed tomography scan confirmed the presence of an intramural small bowel hematoma and hemoperitoneum. The patient's condition significantly improved within 48 h under conservative management, including nasogastric tube insertion, continuous monitoring of gastric aspirate, nil per os status, intravenous fluids, and analgesics. Warfarin was temporarily stopped, and fresh frozen plasma was administered for anticoagulation reversal. Heparin infusion was initiated once the INR became within the therapeutic level. CONCLUSIONS The occurrence of spontaneous intramural small bowel hematoma, although rare, demands rapid diagnosis and prompt, well-coordinated management. This case underscores the pivotal role of multidisciplinary collaboration in providing a comprehensive assessment and a tailored approach to treatment. While conservative measures, including careful monitoring and supportive care, have demonstrated favorable outcomes, the consideration of surgical intervention remains crucial, particularly in severe cases.
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Affiliation(s)
- Ali Hassan
- Department of Radiology, Salmaniya Medical Complex, Manama, Bahrain
| | - Zainab Habbash
- Department of Radiology, Salmaniya Medical Complex, Manama, Bahrain
| | - Mahdi Aljawad
- Department of Radiology, Maternity and Children Hospital, Dammam, Saudi Arabia
| | - Faris Alnemer
- Department of Radiology, Eastern Health Cluster, Dammam, Saudi Arabia
| | - Ali Alzayer
- Department of Radiology, Eastern Health Cluster, Dammam, Saudi Arabia
| | - Aqil AlZaher
- Department of Radiology, Qatif Central Hospital, Qatif, Saudi Arabia
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Lin KC, Chen TA, Lin MH, Chen YC, Chen TJ. Integration and Assessment of ChatGPT in Medical Case Reporting: A Multifaceted Approach. Eur J Investig Health Psychol Educ 2024; 14:888-901. [PMID: 38667812 PMCID: PMC11049282 DOI: 10.3390/ejihpe14040057] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Revised: 03/18/2024] [Accepted: 03/19/2024] [Indexed: 04/28/2024] Open
Abstract
ChatGPT, a large language model, has gained significance in medical writing, particularly in case reports that document the course of an illness. This article explores the integration of ChatGPT and how ChatGPT shapes the process, product, and politics of medical writing in the real world. We conducted a bibliometric analysis on case reports utilizing ChatGPT and indexed in PubMed, encompassing publication information. Furthermore, an in-depth analysis was conducted to categorize the applications and limitations of ChatGPT and the publication trend of application categories. A total of 66 case reports utilizing ChatGPT were identified, with a predominant preference for the online version and English input by the authors. The prevalent application categories were information retrieval and content generation. Notably, this trend remained consistent across different months. Within the subset of 32 articles addressing ChatGPT limitations in case report writing, concerns related to inaccuracies and a lack of clinical context were prominently emphasized. This pointed out the important role of clinical thinking and professional expertise, representing the foundational tenets of medical education, while also accentuating the distinction between physicians and generative artificial intelligence.
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Affiliation(s)
- Kuan-Chen Lin
- Department of Family Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shih-Pai Road, Taipei 11217, Taiwan; (K.-C.L.); (T.-A.C.); (M.-H.L.)
| | - Tsung-An Chen
- Department of Family Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shih-Pai Road, Taipei 11217, Taiwan; (K.-C.L.); (T.-A.C.); (M.-H.L.)
| | - Ming-Hwai Lin
- Department of Family Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shih-Pai Road, Taipei 11217, Taiwan; (K.-C.L.); (T.-A.C.); (M.-H.L.)
- School of Medicine, National Yang Ming Chiao Tung University, Taipei 30010, Taiwan
| | - Yu-Chun Chen
- Department of Family Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shih-Pai Road, Taipei 11217, Taiwan; (K.-C.L.); (T.-A.C.); (M.-H.L.)
- School of Medicine, National Yang Ming Chiao Tung University, Taipei 30010, Taiwan
- Institute of Hospital and Health Care Administration, School of Medicine, National Yang Ming Chiao Tung University, Taipei 30010, Taiwan
- Big Data Center, Taipei Veterans General Hospital, Taipei 11217, Taiwan
| | - Tzeng-Ji Chen
- Department of Family Medicine, Taipei Veterans General Hospital Hsinchu Branch, No. 81, Sec. 1, Zhongfeng Road, Zhudong Township, Hsinchu 310403, Taiwan
- Department of Post-Baccalaureate Medicine, National Chung Hsing University, No. 145, Xingda Road, South District, Taichung 402202, Taiwan
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Halicek MT, Scott C, Zimmermann T, Watson B. Primary Mucinous Carcinoma of the Thyroid: A Case Report, Literature Review, and Immunohistochemistry Summary. HCA Healthc J Med 2024; 5:39-43. [PMID: 38560396 PMCID: PMC10939087 DOI: 10.36518/2689-0216.1570] [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] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
Introduction Primary mucinous carcinoma of the thyroid is an exceedingly rare malignancy that is histologically similar to mucinous carcinoma of other sites. Accurate diagnosis is a challenging yet crucial component of clinical management for both patients and our understanding of this rare disease. Case Presentation We report the case of a 69-year-old male patient with primary mucinous carcinoma of the thyroid. Microscopic examination of a biopsy specimen showed fibrous tissue, which was extensively and irregularly infiltrated by a cytologically malignant epithelial neoplasm showing glandular differentiation with mucin production. Immunohistochemistry demonstrated that tumor cells were positive for TTF1, thyroglobulin, CK7, and PAX8. Co-expression of TTF1 and PAX8 is most commonly seen in thyroid tumors. These findings support our diagnosis of mucinous carcinoma of thyroid origin, which is rare and highly aggressive. Conclusion In this report, we present the only documented case of primary mucinous carcinoma of the thyroid reported in the United States in the last decade. The diagnosis of primary mucinous carcinoma of the thyroid can be challenging. Therefore, we discuss and detail the clinicopathologic tumor profile and provide more current, detailed histological criteria to assist in the diagnosis of this rare disease.
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Affiliation(s)
- Martin T Halicek
- Emory University Hospital, Atlanta, GA
- Grand Strand Medical Center, Myrtle Beach SC
| | - Caleb Scott
- Grand Strand Medical Center, Myrtle Beach SC
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Scheufele CJ, Hodges L, Hasan A, Workman AE, Malouf P, Weis SE. Bowel-Associated Dermatosis-Arthritis Syndrome: A Case Report. HCA Healthc J Med 2024; 5:27-34. [PMID: 38560393 PMCID: PMC10939089 DOI: 10.36518/2689-0216.1468] [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] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
Introduction Gastric bypass surgery is an effective surgical intervention for morbid obesity. However, it is not without risk. Gastric bypass surgery may produce malabsorptive or surgical complications, which can result in nutritional deficiencies as well as syndromes related to bacterial overgrowth in the blind loops of the bowel. Case Presentation Severe nutritional deficiencies may occur due to patient noncompliance with the prescribed regimen, or arise secondary to malabsorptive or mechanical surgical complications. We describe a case of a 37-year-old female who underwent gastric bypass surgery and experienced a recalcitrant eczematous eruption with sporadic subcutaneous, purulent nodules which completely resolved after the reversal of her bariatric procedure. Conclusion Since 2001, the number of morbidly obese patients who have undergone bariatric surgery has been increasing. As a result, clinicians can expect to more frequently encounter complications that can result from these procedures.
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Affiliation(s)
| | - Leisa Hodges
- McGuiness Dermatology and Plastic Surgery, Dallas, TX
| | - Aya Hasan
- University of North Texas Health Science Center, Fort Worth, TX
| | | | | | - Stephen E Weis
- Medical City Fort Worth, Fort Worth, TX
- University of North Texas Health Science Center, Fort Worth, TX
- John Peter Smith Hospital, Fort Worth, TX
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Yuan X, Sun Y, Chen H, Lan Q, Wu W, Yao Y. Iatrogenic aortic dissection in patients undergoing coronary artery bypass grafting surgery: A systemic review of published literatures. Medicine (Baltimore) 2024; 103:e37472. [PMID: 38518053 PMCID: PMC10956975 DOI: 10.1097/md.0000000000037472] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 02/12/2024] [Indexed: 03/24/2024] Open
Abstract
BACKGROUND Iatrogenic aortic dissection (IAD) is a rare but highly lethal complication that may occur following coronary artery bypass grafting (CABG) surgery. Aortic dissection (AD) is often asymptomatic, making early detection difficult. We aimed to optimize preoperative evaluation strategies of CABG surgery for minimizing the incidence of IAD and assess early recognition and management of IAD for improving outcomes. METHODS Electronic databases were searched to identify all case reports of patients undergoing CABG surgery who developed IAD. Clinical characteristics, operative information, perioperative management, and patient outcomes were compiled and analyzed. RESULTS Nineteen case reports involving 27 patients aged 50 to 81 were included. Patients were from Europe (n = 23) and Asia (n = 4), mostly men (n = 25). The aorta was described as normal, abnormal, and unmentioned (n = 8, 5, and 14, respectively). Sixteen patients had a bypass with more than 3 grafts. Most patients (n = 25) experienced type A dissection. There were intraoperative (n = 12) and postoperative (n = 15) cases. Surgery (n = 19) was the most common treatment, with 9 patients selecting deep hypothermic circulatory arrest. Eighteen patients were restored to health, while 9 patients died (3 died before treatment). CONCLUSIONS Our study focused on patients with IAD and developed a recommended management protocol for patients undergoing CABG surgery.
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Affiliation(s)
- Xi Yuan
- Department of Anesthesiology, Xichang People’s Hospital, Xichang, China
- Department of Anesthesiology, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Fuwai Hospital, Peking Union Medical College, Beijing, China
| | - Yanting Sun
- Department of Anesthesiology, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Fuwai Hospital, Peking Union Medical College, Beijing, China
- Department of Anesthesiology, Baoji High-Tech Hospital, Shaanxi, China
| | - Huaqiu Chen
- Department of Laboratory, Xichang People’s Hospital, Xichang, China
| | - Qiqing Lan
- Department of Anesthesiology, Xichang People’s Hospital, Xichang, China
| | - Wen Wu
- Department of Anesthesiology, Xichang People’s Hospital, Xichang, China
| | - Yuntai Yao
- Department of Anesthesiology, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Fuwai Hospital, Peking Union Medical College, Beijing, China
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Nishizawa T, Ishizuka K, Otsuka Y, Nakanishi T, Kawashima A, Miyagami T, Yamashita S. Writing Case Reports Can Improve Seven Components in Clinical Reasoning. Int Med Case Rep J 2024; 17:195-200. [PMID: 38533427 PMCID: PMC10963171 DOI: 10.2147/imcrj.s449310] [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] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 03/17/2024] [Indexed: 03/28/2024] Open
Abstract
Case reports provide scientific knowledge and opportunities for new clinical research. However, it is estimated that less than 5% of cases presented by Japanese generalists at academic conferences are published due to various barriers such as the complex process of writing articles, conducting literature searches, the significant time required, the reluctance to write in English, and the challenge of selecting appropriate journals for publication. Therefore, the purpose of this opinion paper is to provide clinicians with practical tips for writing case reports that promote diagnostic excellence. In recent years, clinical practitioners have been striving for diagnostic excellence and optimal methods to accurately and comprehensively understand the patient's condition. To write a case report, it is essential to be mindful of the elements of diagnostic excellence and consider the quality of the diagnostic reasoning process. We (the authors) are seven academic generalists who are members of the Japanese Society of Hospital General Medicine (JSHGM) - Junior Doctors Association, with a median of 7 years after graduation and extensive experience publishing case reports in international peer-reviewed journals. We conducted a narrative review and discussed ways to write case reports to promote diagnostic excellence, leveraging our unique perspectives as academic generalists. Our review did not identify any reports addressing the critical points in writing case reports that embody diagnostic excellence. Therefore, this report proposes a methodology that describes the process involved in writing diagnostic excellence-promoting case reports and provides an overview of the lessons learned. Based on our review and discussion, we explain the essential points for promoting diagnostic excellence through case reports categorized into seven components of clinical reasoning. These strategies are useful in daily clinical practice and instrumental in promoting diagnostic excellence through case reports.
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Affiliation(s)
- Toshinori Nishizawa
- Department of General Internal Medicine, St Luke's International Hospital, Tokyo, Japan
- Department of Global Health Promotion, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kosuke Ishizuka
- Department of General Medicine, Yokohama City University School of Medicine, Kanagawa, Japan
| | - Yuki Otsuka
- Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Toshiyuki Nakanishi
- Department of Emergency and General Medicine, Nerima Hikarigaoka Hospital, Tokyo, Japan
| | - Akira Kawashima
- Department of General Internal Medicine, National Center for Global Health and Medicine, Tokyo, Japan
| | - Taiju Miyagami
- Department of General Medicine, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | - Shun Yamashita
- Department of General Medicine, Saga University Hospital, Saga, Japan
- Education and Research Center for Community Medicine, Faculty of Medicine, Saga University, Saga, Japan
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Elshenawy M, Aldahoul SK, El-Sibai AM, Hamad A, Arabi TZ, Rab SA, Badran A, Alzaid T, Sabbah BN, Atallah JP. Rare Case of Recurrent Adamantinoma of the Tibia: Limited Efficacy of Pazopanib as a Standalone Treatment. Am J Case Rep 2024; 25:e941248. [PMID: 38486378 PMCID: PMC10949342 DOI: 10.12659/ajcr.941248] [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] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 01/26/2024] [Accepted: 12/13/2023] [Indexed: 03/19/2024]
Abstract
BACKGROUND Adamantinoma is a rare low-grade malignant bone tumor, usually found in the tibial diaphysis and metaphysis, with histological similarities to mandibular ameloblastoma. The most effective treatment of recurrent adamantinoma is not yet clear. This report is of a 22-year-old woman with recurrent tibial adamantinoma treated with the tyrosine kinase inhibitor pazopanib. CASE REPORT We report the case of a 22-year-old woman who was referred to our center for a suspicious bone lesion in the right tibia. Bone biopsy findings were consistent with an adamantinoma. En bloc resection was completed successfully, with no postoperative complications. Five years later, a positive emission tomography scan revealed mildly increased tracer uptake near the area of the previous lesion and in the right inguinal lymph node. Biopsies of the lesion and inguinal lymph node confirmed recurrence of the adamantinoma. Due to abdominal and pelvic metastasis, the patient underwent surgical debulking, along with an appendectomy, right salpingo-oophorectomy, intraoperative radiation therapy, and hyperthermic intraperitoneal chemotherapy. Subsequently, the patient was placed on pazopanib for 4 months; however, her tumor continued to worsen after 4 months of chemotherapy. Currently, the patient is receiving gemcitabine and docetaxel as second-line medical therapy. CONCLUSIONS This report showed that pazopanib as standalone treatment does not appear to have promising role on patient outcomes. To the best of our knowledge, this is the second report of pazopanib in the treatment of adamantinoma.
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Affiliation(s)
- Mahmoud Elshenawy
- Department of Medical Oncology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
- Department of Clinical Oncology and Nuclear Medicine, Faculty of Medicine, Menoufia University, Shebin El Kom, Egypt
| | | | | | - Alaa Hamad
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | | | | | - Ahmed Badran
- Department of Medical Oncology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
- Department of Clinical Oncology and Nuclear Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Tariq Alzaid
- Department of Pathology and Laboratory Medicine, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | | | - Jean Paul Atallah
- Department of Medical Oncology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
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Martínez-García JJ, Ordorica-Sandoval SF, Rivera-Sainz E, Beltrán-Salas MA, León-Sicairos N, Canizalez-Roman A. Bovine Aortic Arch with an Aberrant Left Vertebral Artery in a 3-Year-Old Boy with VACTERL Association: A Case Report. Am J Case Rep 2024; 25:e942974. [PMID: 38526305 PMCID: PMC10946695 DOI: 10.12659/ajcr.942974] [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] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 02/07/2024] [Accepted: 01/24/2024] [Indexed: 03/26/2024]
Abstract
BACKGROUND The VACTEREL association is an acronym that includes vertebral malformations (V), anal atresia (A), cardiac defects (C), tracheoesophageal fistula (TE), renal defects (R), and limb malformations (L). The aortic arch is the section between the ascending aorta and the descending aorta, where some variants have been described, such as the right aortic arch and bovine aortic arch, among others. A rare presentation in the Natsis classification is the "type X" where a bovine aortic arch and anomalous origin of the left vertebral artery are present. Several structural cardiac malformations have been described in the VACTEREL association. Still, there is no bovine arch or an anomalous left vertebral artery. CASE REPORT Our patient was a 3-year-old boy with a diagnosis of VACTEREL association (type III esophageal atresia, congenital hip dislocation, scoliosis, bilateral clubfoot, and grade IV biliary ureteral reflux). Echocardiographic findings showed changes in the aortic arch, and angiotomography and magnetic resonance angiography showed a bovine aortic arch and an anomalous left vertebral artery. At the time of diagnosis, there were no clinical manifestations or complications due to the anomalous origin of the left vertebral artery. CONCLUSIONS This is the first description of a bovine type X arch according to the Natsis classification in a VACTEREL association. In general, knowledge of the anatomical variants of the aortic arch and the origin and course of the vertebral arteries is of great clinical and interventional importance, mainly because of the risk of cerebral ischemia.
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Affiliation(s)
- Jesús J. Martínez-García
- Pediatric Intensive Care Unit, Pediatric Hospital of Sinaloa, Culiacán, Sinaloa, México
- School of Medicine, Autonomous University of Sinaloa, Culiacán, Sinaloa, México
| | | | - Erick Rivera-Sainz
- Department of Cardiology, General Hospital ISSSTE, Culiacán, Sinaloa, México
| | | | - Nidia León-Sicairos
- School of Medicine, Autonomous University of Sinaloa, Culiacán, Sinaloa, México
- Department of Research, Pediatric Hospital of Sinaloa, Culiacán, Sinaloa, México
| | - Adrian Canizalez-Roman
- School of Medicine, Autonomous University of Sinaloa, Culiacán, Sinaloa, México
- Secretariat of Health, The Women’s Hospital, Culiacán, Sinaloa, México
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Xu L, Fu G. Cerebral venous thrombosis presented with symmetrical crescent-shaped intracranial hemorrhage in alcoholic liver disease: Case reports. Medicine (Baltimore) 2024; 103:e37441. [PMID: 38457541 PMCID: PMC10919519 DOI: 10.1097/md.0000000000037441] [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: 11/29/2023] [Accepted: 02/09/2024] [Indexed: 03/10/2024] Open
Abstract
RATIONALE Cerebral venous thrombosis (CVT) is a relatively uncommon but fatal disease. It can be caused by a variety of hereditary or acquired thrombotic diseases. Initial presentation with intracranial hemorrhage (ICH) in CVT is rare but can further complicate the therapeutic measures and prognosis. Cases of CVT presented with ICH in patients with alcoholic liver disease (ALD) have not been described in the literature, and it might be related with hemostatic abnormalities in ALD patients. PATIENT CONCERNS We report 2 cases of men admitted to our hospital who were diagnosed with CVT but initially presented with symmetrical crescent-shaped ICH; both of them were ALD patients. DIAGNOSES Cerebral imaging revealed extended CVT in both cases. The first case was a 64-year-old man with ALD deteriorated with unconsciousness and convulsions; computed tomography showed symmetrical crescent-shaped ICH in the right temporal lobe, and magnetic resonance venography revealed CVT. Another 50-year-old man with ALD complained about dizziness and weakness of his right limbs; computed tomography revealed symmetrical crescent-shaped ICH in bilateral parietal and occipital lobes, and magnetic resonance venography revealed CVT. INTERVENTIONS The first patient was referred to the endovascular thrombectomy. Both of them were treated with anticoagulation treatment. OUTCOMES Favorable outcomes were observed in both patients. LESSONS Symmetrical or multiple crescent-shaped ICH requires a high suspicion in the diagnosis of CVT; even with hemorrhage, it is still important to initiate anticoagulation therapy promptly. The crescent-shaped ICH might be a new sign for CVT, and further studies are needed in the underlying mechanisms of ALD and potential thrombophilia.
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Affiliation(s)
- Lingjia Xu
- Department of Neurology, Shaoxing Second Hospital, The Second Affiliated Hospital of Shaoxing University Medical College, Shaoxing, Zhejiang, China
| | - Guoping Fu
- Department of Neurology, Shaoxing Second Hospital, The Second Affiliated Hospital of Shaoxing University Medical College, Shaoxing, Zhejiang, China
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Shao L, Yang Z, Yan H, Xu R. Uterine rupture in patients with a history of hysteroscopy procedures: Case series and review of literature. Medicine (Baltimore) 2024; 103:e37428. [PMID: 38457539 PMCID: PMC10919467 DOI: 10.1097/md.0000000000037428] [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: 11/12/2023] [Revised: 02/01/2024] [Accepted: 02/07/2024] [Indexed: 03/10/2024] Open
Abstract
RATIONALE Uterine rupture during pregnancy poses significant risks to both the fetus and the mother, resulting in high mortality and morbidity rates. While awareness of uterine rupture prevention after a cesarean section has increased, insufficient attention has been given to cases caused by pregnancy following hysteroscopy surgery. PATIENT CONCERNS We report 2 cases here, both of whom had a history of hysteroscopy surgery and presented with severe abdominal pain during pregnancy. DIAGNOSES Both patients had small uterine ruptures, with no significant abnormalities detected on ultrasonography. The diagnosis was confirmed by a CT scan, which showed hemoperitoneum. INTERVENTIONS We performed emergency surgeries for the 2 cases. OUTCOMES We repaired the uterus in 2 patients during the operation. Both patients recovered well. The children survived. No abnormalities were detected during their follow-up visits. LESSONS Attention should be paid to the cases of pregnancy after hysteroscopy.
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Affiliation(s)
- Liping Shao
- Department of Obstetrics and Gynecology, Changzhou Cancer Hospital Changzhou Fourth People’s Hospital, Changzhou, Jiangsu, China
| | - Zhilong Yang
- Department of General Surgery, Nanjing Lishui People’s Hospital, Nanjing, Jiangsu, China
| | - Huifang Yan
- Department of Obstetrics and Gynecology, Nanjing Lishui People’s Hospital, Nanjing, Jiangsu, China
| | - Rong Xu
- Department of Obstetrics and Gynecology, Nanjing Lishui People’s Hospital, Nanjing, Jiangsu, China
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Papaetis GS, Dionysiou EA, Charalambous IS, Doukanaris PT. Extended-Spectrum Beta-Lactamase Escherichia coli Diabetic Foot Osteomyelitis Causing Sausage Toe Deformity: Successful Therapy with Ertapenem in the Outpatient Setting. Am J Case Rep 2024; 25:e943092. [PMID: 38503690 PMCID: PMC10942098 DOI: 10.12659/ajcr.943092] [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] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Revised: 01/23/2024] [Accepted: 01/12/2024] [Indexed: 03/21/2024]
Abstract
BACKGROUND Diabetic foot osteomyelitis is a high-morbidity and debilitating complication of diabetic foot ulcers that contributes to significantly worse quality of life in the affected population and higher cost of healthcare services. One of the clinical presentations of diabetic foot osteomyelitis is the 'sausage' toe deformity, which affects the phalanges (local soft tissue infection and underlying bony changes). This deformity is highly suggestive of the presence of osteomyelitis. Unfortunately, during recent years, the emergence of antibiotic-resistant bacteria have created great difficulties in choosing appropriate empirical antibiotics for the treatment of diabetic foot infections. Multidrug-resistant pathogens have been strongly related to higher morbidity and mortality compared with infections caused by their antibiotic-susceptible counterparts. CASE REPORT We describe a case of a 74-year-old woman with long-standing insulin-treated type 2 diabetes, who experienced extended-spectrum beta-lactamase-producing Escherichia coli infection that caused diabetic foot osteomyelitis with 'sausage' deformity in her second right toe. She was successfully treated with surgical debridement combined with the administration of ertapenem in the outpatient setting, completing, in total, a 6-week course of antibiotic therapy. CONCLUSIONS 'Sausage' toe deformity is one of the clinical presentations of diabetic foot osteomyelitis, and should be an alarming sign in everyday clinical practice. Ertapenem is an excellent option for the treatment of diabetic foot infections caused by extended-spectrum beta-lactamase E. coli in the outpatient setting. Early diagnosis and proper therapeutic approach are of great importance to reduce the risk of amputations, overall mortality, total cost, and the surge of antimicrobial resistance in the community.
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Affiliation(s)
- Georgios S. Papaetis
- Internal Medicine and Diabetes Clinic, K.M.P. THERAPIS Paphos Medical Center, Paphos, Cyprus
- Department of Internal Medicine, CDA College, Paphos, Cyprus
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Palazzo P, Piechowiak EI, Heldner MR. Successful Thrombectomy of the Posterior Cerebral Artery P2 Segment in a 61-Year-Old Man with Acute Ischaemic Stroke: A Case Report. Am J Case Rep 2024; 25:e941441. [PMID: 38439524 PMCID: PMC10926235 DOI: 10.12659/ajcr.941441] [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] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Revised: 02/04/2024] [Accepted: 12/01/2023] [Indexed: 03/06/2024]
Abstract
BACKGROUND Acute ischemic stroke in the posterior cerebral artery (PCA) territory can lead to persistent disabling deficits. The PCA is divided into 4 segments. The P2 segment begins at the posterior communicating artery and curves around the midbrain and above the tentorium cerebelli. This report is of a 61-year-old man with acute ischemic stroke involving the left hippocampus treated with direct thrombectomy of the P2 segment of the PCA. CASE REPORT A 61-year-old white man presented with transient amnesia, aphasia, right-sided hemianopia, dizziness, and persistent acute memory deficits. Magnetic resonance imaging (MRI) showed a left hippocampal acute ischemic stroke with left PCA occlusion in the P2 segment. Despite a low National Institutes of Health Stroke Scale (NIHSS) score and the already-formed lesion in the hippocampus, successful stent retriever thrombectomy was performed due to a considerable perfusion-diffusion mismatch and a persistent potentially disabling neurocognitive deficit. Due to partial thrombus dislocation, occlusion of the common origin of the right posterior inferior cerebellar artery (PICA) and anterior inferior cerebellar artery (AICA) occurred and was immediately treated by thrombectomy to prevent severe cerebellar infarction. His clinical symptoms completely resolved and a neuropsychological exam showed no residual deficits. CONCLUSIONS Thrombectomy of the P2 segment of the PCA is feasible and can be considered to treat patients with acute occlusion at risk for persistent disabling deficits, based on clinical estimation of the impact of such deficits and the presence of potentially salvageable brain tissue. Potential procedural complications should be sought out and immediately treated, if technically feasible.
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Affiliation(s)
- Paola Palazzo
- Department of Clinical Neurosciences, Lausanne University Hospital, Lausanne, Switzerland
| | - Eike I. Piechowiak
- Institute of Diagnostic and Interventional Neuroradiology, University Hospital and University of Bern, Bern, Switzerland
| | - Mirjam R. Heldner
- Department of Neurology, Inselspital, University Hospital and University of Bern, Bern, Switzerland
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Watjer RM, Eekhof JAH, Quint KD, Numans ME, Bonten TN. Severe drug eruption from oral terbinafine for mild onychomycosis-A case report from family practice and literature review: "Just an innocent little pill?". SAGE Open Med Case Rep 2024; 12:2050313X241235823. [PMID: 38444697 PMCID: PMC10913523 DOI: 10.1177/2050313x241235823] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 02/11/2024] [Indexed: 03/07/2024] Open
Abstract
Onychomycosis is the most prevalent nail disease and is frequently encountered in clinical practice. Despite having multiple therapeutic options, of which systemic antifungals are the most effective, treatment is not always mandatory in all patients. Especially when considering systemic treatment, the risk of adverse reactions may outweigh the potential benefits of treatment. In this case report, we present a clinical case of a 49-year-old male patient with a blank past medical history who experienced a severe drug eruption from terbinafine prescribed for mild onychomycosis that required discontinuation of terbinafine, additional evaluation, and treatment of this adverse reaction.
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Affiliation(s)
- Roeland M Watjer
- Department of Public Health and Primary Care, Leiden University Medical Center (LUMC), Leiden, The Netherlands
| | - Just AH Eekhof
- Department of Public Health and Primary Care, Leiden University Medical Center (LUMC), Leiden, The Netherlands
| | - Koen D Quint
- Department of Dermatology, Leiden University Medical Center (LUMC), Leiden, The Netherlands
- Department of Dermatology, Roosevelt Clinic, Leiden, The Netherlands
| | - Mattijs E Numans
- Department of Public Health and Primary Care, Leiden University Medical Center (LUMC), Leiden, The Netherlands
| | - Tobias N Bonten
- Department of Public Health and Primary Care, Leiden University Medical Center (LUMC), Leiden, The Netherlands
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de Paula J, da Silva LAB, Wayar MAS, Campagnoli EB, Dos Santos FA. Epithelial cyst following subepithelial connective tissue graft: A case report. Clin Adv Periodontics 2024. [PMID: 38430209 DOI: 10.1002/cap.10284] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 01/25/2024] [Accepted: 02/15/2024] [Indexed: 03/03/2024]
Abstract
BACKGROUND Various surgical approaches have been employed to manage gingival recession, including subepithelial connective tissue grafting, which has yielded favorable outcomes. METHODS AND RESULTS We present the case of a 17-year-old patient who developed gingival recession on tooth #6 following an esthetic crown lengthening procedure. The recession was treated with a subepithelial connective tissue graft; however, this case details the occurrence of two epithelial cysts adjacent to the region subjected to the surgical procedure, 6 months after surgery. The treatment involved periodontal surgical intervention, during which the lesions were completely excised and the associated osseous defect was filled using an inorganic bovine bone matrix along with a collagen membrane. The healing progressed without any complications. Histopathological analysis revealed the presence of cystic lesions, which were characterized by a cystic cavity lined with stratified orthokeratinized epithelium with cuboidal cells in some areas surrounded by fibrous connective tissue. The patient's progress was monitored through tomography performed 6 months, 1 year, and 5 years post-procedure, all of which demonstrated the absence of any signs of lesion recurrence. CONCLUSION This case study emphasizes the effectiveness and predictability of subepithelial connective tissue grafting in the treatment of gingival recession. However, dental professionals should be cautious about the potential risk of gingival recession following esthetic crown lengthening procedures and recognize the potential complications associated with subepithelial connective tissue grafting, such as the observed development of epithelial cysts in this specific case. KEY POINTS Why is this case new information? We present a case of an epithelial cyst following a subepithelial connective tissue graft, which resulted in buccal cortical bone resorption. The treatment involved excisional biopsy and the use of an inorganic bovine bone matrix with a collagen membrane. What are the keys to the successful management of this case? Successful treatment included periodontal surgery, bone defect filling using an inorganic bovine bone matrix and a collagen membrane, and regular monitoring with CT scans at 6 months, 1 year, and 5 years post-surgery; all showed no recurrence. Success factors included careful surgery, appropriate biomaterial usage, and ongoing follow-up. What are the primary limitations to success in this case? The limitations involve potential complications from subepithelial connective tissue grafting such as cyst development. This report stresses the importance of meticulous patient selection and periodontal phenotype evaluation to minimize risks. Continuous follow-up is critical to detect recurrence and other issues.
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Affiliation(s)
- Julien de Paula
- Department of Dentistry, Universidade Estadual de Ponta Grossa, Ponta Grossa, Brazil
| | - Luise A B da Silva
- Department of Dentistry, Universidade Estadual de Ponta Grossa, Ponta Grossa, Brazil
| | - Mariane A S Wayar
- Department of Dentistry, Universidade Estadual de Ponta Grossa, Ponta Grossa, Brazil
| | - Eduardo B Campagnoli
- Department of Dentistry, Universidade Estadual de Ponta Grossa, Ponta Grossa, Brazil
| | - Fábio A Dos Santos
- Department of Dentistry, Universidade Estadual de Ponta Grossa, Ponta Grossa, Brazil
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Ko MJ, Song KM, Yoon HY. Clinical evaluation and surgical intervention for diaphragmatic eventration mimicking peritoneopericardial hernia in a cat. J Vet Sci 2024; 25:e19. [PMID: 38568821 PMCID: PMC10990918 DOI: 10.4142/jvs.23277] [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] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Revised: 12/30/2023] [Accepted: 01/10/2024] [Indexed: 04/05/2024] Open
Abstract
A 2-year-old spayed female British Shorthair cat presented with an increased frequency and duration of cough since infant period. Based on radiographic, ultrasonographic, and computed tomography findings, peritoneopericardial diaphragmatic hernia was considered so that repair surgery was planned. During celiotomy, lax diaphragm was identified instead of defect. Transabdominal diaphragmatic plication was performed to resolve lax diaphragm and to prevent recurrence by overlapping relatively normal part of diaphragm. Diagnosed with diaphragmatic eventration postoperatively, the cat showed improvement in clinical signs and imaging results. Transabdominal diaphragmatic plication is a suitable treatment; the patient maintained normally during a 14-month follow-up period.
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Affiliation(s)
- Min-Jung Ko
- Department of Veterinary Surgery, College of Veterinary Medicine, Konkuk University, Seoul 05029, Korea
| | | | - Hun-Young Yoon
- Department of Veterinary Surgery, College of Veterinary Medicine, Konkuk University, Seoul 05029, Korea
- KU Center for Animal Blood Medical Science, Konkuk University, Seoul 05030, Korea.
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Khanal P, Khanal P, Paudel S, Pokhrel A, Chapagain S. Paraneoplastic movement disorder due to suspected metastatic Leiomyosarcoma of tongue: A case report. Clin Case Rep 2024; 12:e8648. [PMID: 38464567 PMCID: PMC10920308 DOI: 10.1002/ccr3.8648] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Revised: 02/19/2024] [Accepted: 02/22/2024] [Indexed: 03/12/2024] Open
Abstract
Paraneoplastic movement disorders, though rare, can be the initial symptoms of malignancies like leiomyosarcoma, as in our case. Clinicians should keep malignancies in their differential diagnosis in cases of unexplained movement abnormalities.
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Affiliation(s)
- Pradeep Khanal
- Department of Internal MedicineTrinity Health Ann Arbor HospitalYpsilantiMichiganUSA
| | | | - Sandip Paudel
- Institute of MedicineTribhuvan UniversityKathmanduNepal
| | - Ashbita Pokhrel
- Department of Anatomic and Clinical PathologyWilliam Beaumont HospitalRoyal OakMichiganUSA
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Vásquez Montoya JD, Velez JM, Naranjo Vanegas M, Montes Jimenez N. Optic nerve haemangioblastoma in association with von Hippel-Lindau syndrome: case report and literature review. BJR Case Rep 2024; 10:uaae007. [PMID: 38486681 PMCID: PMC10937900 DOI: 10.1093/bjrcr/uaae007] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 07/18/2023] [Accepted: 02/07/2024] [Indexed: 03/17/2024] Open
Abstract
Optic nerve haemangioblastoma (ONH) is an uncommon, benign, non-meningothelial, mesenchymal tumour of unclear origin. Most are associated with von Hippel-Lindau (VHL) syndrome (71%), and only 40 cases have been reported in the medical literature. Most of the patients develop non-specific visual symptoms, including decreased visual acuity and/or loss of visual fields, exophthalmos, trigeminal neuralgia, and retroorbital pain. Optic nerve sheath meningioma and optic nerve glioma are among the differential diagnoses that may be considered in this location. Contrast-enhanced MRI is considered an optimal diagnostic tool, which helps to determine some characteristics that guide towards an adequate diagnosis and treatment. We present a 42-year-old patient with a history of VHL syndrome in whom a cerebellar lesion and optic nerve lesions were evidenced, and we did a review of the literature and case analysis.
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Affiliation(s)
| | - Jorge Mario Velez
- Medical imagine & AI in health SURA, Bioscience Center, Ayudas Diagnósticas SURA, Medellín 050015, Colombia
| | - Melisa Naranjo Vanegas
- Medical imagine & AI in health SURA, Bioscience Center, Ayudas Diagnósticas SURA, Medellín 050015, Colombia
| | - Natalia Montes Jimenez
- Medical imagine & AI in health SURA, Bioscience Center, Ayudas Diagnósticas SURA, Medellín 050015, Colombia
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Aulakh G, Lewis R, Singh A, Marian V. A 40-Year-Old Man with a 7-Year History of Polyarthritis and a Late Diagnosis of Whipple Disease: A Journey to Resolve the Mystery. Am J Case Rep 2024; 25:e942896. [PMID: 38402412 PMCID: PMC10903923 DOI: 10.12659/ajcr.942896] [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] [Subscribe] [Scholar Register] [Indexed: 02/26/2024]
Abstract
BACKGROUND Whipple disease (WD) is rare, with an incidence of only a few patients per million. It is caused by infection with the gram-positive bacterium Tropheryma whipplei, and presents with symptoms that include joint pain, fever, diarrhea, and weight loss. This report is of a 40-year-old man with a 7-year history of polyarthritis and a late diagnosis of Whipple disease. The atypical nature of his symptoms led to misdirection and misdiagnosis for years. CASE REPORT A middle-aged white man with seronegative migratory polyarticular arthritis underwent 7 years of treatment with steroids, disease-modifying anti-rheumatic drugs (DMARDs), and a TNF (tumor necrosis factor)-alpha inhibitor, all without any clinical improvement. Throughout this period, he had persistent loose stools and iron-deficiency anemia. Extensive diagnostic investigations for various possibilities yielded negative results. However, after 7 years, he began displaying clinical signs of malabsorption. This prompted further evaluation, including an upper-gastrointestinal endoscopy and biopsy, which revealed the presence of PAS (periodic acid-Schiff)-positive Treponema whipplei, which led to the diagnosis of WD. Following initiation of appropriate treatment, the patient experienced complete resolution of symptoms. Retrospectively, all the pieces of this puzzle fell into place, providing a comprehensive understanding of the prolonged medical challenge the patient faced. CONCLUSIONS This case illuminates the diagnostic challenge faced when dealing with migratory polyarticular inflammatory arthritis and fever. This report has highlighted that Whipple disease can be associated with multiple symptoms and signs, which can result in a delay in diagnosis. However, once the diagnosis is confirmed, antibiotic treatment is effective.
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Affiliation(s)
- Gagan Aulakh
- Department of Internal Medicine, Jersey City Medical Center, Jersey City, NJ, USA
| | - Rebekah Lewis
- Department of Internal Medicine, Jersey City Medical Center, Jersey City, NJ, USA
| | - Arshdeep Singh
- Department of Internal Medicine, Government Medical College, Medical Enclave, Amritsar, India
| | - Valentin Marian
- Department of Internal Medicine, Jersey City Medical Center, Jersey City, NJ, USA
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Azuara-Antonio O, Isidoro Ortiz M, Jiménez-Oliver KD, Castillo-Cabrera M, Méndez-Salinas AK, Hernández-Ramírez L. Utilization of dapsone and hemoglobin in the epithelial skin regeneration therapy of cutaneous loxoscelism: A case report and integrative literature review. SAO PAULO MED J 2024; 142:e2023151. [PMID: 38422241 PMCID: PMC10885633 DOI: 10.1590/1516-3180.2023.0151.04012023] [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: 05/31/2023] [Revised: 06/28/2023] [Accepted: 01/04/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND Loxosceles spp are arthropods found worldwide. Its bite may produce cutaneous loxoscelism (necrotic or edematous) or cutaneous-visceral loxoscelism. Depending on their severity and location, cutaneous forms are managed with local cold application and systemic administration of antihistamines, corticosteroids, antibiotics, polymorphonuclear inhibitors, and analgesics. OBJECTIVE This study aimed to report a case of cutaneous loxoscelism and to identify the main dermatological manifestations associated with the Loxosceles spp bite. DESIGN AND SETTING This case report and literature review was conducted in a Mexican university. METHODS A detailed report on the medical management of a patient with cutaneous loxoscelism treated at the emergency department of a public hospital was published. Scopus, PubMed, Web of Science, and Google Scholar databases were searched to identify articles reporting cutaneous loxoscelism. The following keywords were used during the database search: "loxoscelism" OR "spider bite," OR "loxosceles" OR "loxosceles species" OR "loxosceles venom" OR "loxoscelism case report" AND "cutaneous" OR "dermonecrotic arachnidism." RESULTS A 62-year-old female patient with cutaneous loxoscelism was treated with systemic dapsone and local heparin spray. Eighteen studies with 22 clinical cases were included in this systematic review. Of the 22 patients, 12 (54.5%) were men. L. rufescens was the predominant spider species. CONCLUSIONS The administration of dapsone and heparin for the management of cutaneous loxoscelism demonstrated success in this case, with no sequelae observed. In general, the literature review indicated favorable outcomes in patients treated with antimicrobials and corticosteroids, with continuous healing of skin lesions. SYSTEMATIC REVIEW REGISTRATION PROSPERO ID CRD42023422424 (https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023422424).
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Affiliation(s)
- Omar Azuara-Antonio
- MD. Physician, Medical staff, emergency department, general hospital de Pachuca. Pachuca, Hidalgo, Mexico; Subject teacher, Academic Field of Medicine, Institute of Health Sciences, Universidad Autónoma del Estado de Hidalgo, Pachuca, Hidalgo, Mexico
| | - Mario Isidoro Ortiz
- MD, PhD. Professor, Department of Medicine, School of Health Sciences, Universidad Autónoma del Estado de Hidalgo. Pachuca, Hidalgo, Mexico
| | - Karla Daniela Jiménez-Oliver
- Medical student. Department of Medicine, School of Health Sciences, Universidad Autónoma del Estado de Hidalgo. Pachuca, Hidalgo, Mexico
| | - Marco Castillo-Cabrera
- MD. Physician, Medical staff, emergency department, general hospital de Pachuca. Pachuca, Hidalgo, Mexico
| | - Ana Karen Méndez-Salinas
- MD. Physician, Medical staff, emergency department, general hospital de Pachuca. Pachuca, Hidalgo, Mexico
| | - Luz Hernández-Ramírez
- MD. Physician, Medical staff, emergency department, general hospital de Pachuca. Pachuca, Hidalgo, Mexico
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Malek FA, Funk P. Identifying in-market application of Pelargonium root extract EPs 7630 for the treatment of COVID-19: analysis of pharmacovigilance data. Front Pharmacol 2024; 15:1335309. [PMID: 38464728 PMCID: PMC10920291 DOI: 10.3389/fphar.2024.1335309] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 02/01/2024] [Indexed: 03/12/2024] Open
Abstract
Introduction: Phytopharmaceutical products are successfully used for acute respiratory infections and may therefore be promising candidates for adjuvant symptomatic treatment of COVID-19. In vitro and clinical studies suggest that the proprietary Pelargonium sidoides DC. root extract EPs 7630 has antiviral and immunomodulatory properties, and effects on SARS-CoV-2 propagation have been shown in vitro. Medicinal products containing the extract have been approved for the symptomatic treatment of acute viral respiratory tract infections. Methods: We present a retrospective review of case reports submitted spontaneously to the pharmacovigilance database of the manufacturer of EPs 7630 and containing information on the off-label use of the extract for the treatment and prophylaxis of COVID-19 and of post-COVID-19 syndrome. Eligible case reports were identified by automated database searches. Results: Forty-four case reports filed between December 2019 and February 2023 were eligible for analysis. More than ¾ described the use of EPs 7630 for treatment of COVID-19 while the remaining reports referred to the treatment of post-COVID-19 syndrome or to COVID-19 prophylaxis. 15/22 cases which reported on treatment duration indicated an intake of EPs 7630 for up to 7 days. Five case reports indicated the use of EPs 7630 as COVID-19 monotherapy while 14 indicated a combination treatment with other drugs. All 28 cases that reported on treatment outcome characterized the patients as improved. Thirty case reports (68%) did not indicate any complications. The most frequent suspected adverse reactions were gastrointestinal complaints and hypersensitivity reactions, both of which may occur as known adverse effects of EPs 7630. No unexpected adverse reactions were observed. Conclusion: Reported cases confirm that there was a certain off-label use of EPs 7630 for COVID-19 in the market. Even though no formal conclusions about the efficacy of EPs 7630 in COVID-19 can be drawn, a beneficial effect would be explainable by the pharmacological profile of the extract. Further assessment of the effects of EPs 7630 in COVID-19-related indications therefore appears to be both justified and promising, particularly as the available case reports did not give rise to any safety concerns also in this patient group.
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Affiliation(s)
| | - Petra Funk
- Research and Development, Dr. Willmar Schwabe GmbH & Co. KG, Karlsruhe, Germany
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Guan Y, Ma Q, Zhang Y, Zhao J, Guo X. Thyroid Metastases from Breast Cancer Case Report and Literature Review. Curr Cancer Drug Targets 2024; 24:CCDT-EPUB-138712. [PMID: 38409692 DOI: 10.2174/0115680096274465240129055950] [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: 10/30/2023] [Revised: 01/08/2024] [Accepted: 01/19/2024] [Indexed: 02/28/2024]
Abstract
BACKGROUND Thyroid metastasis arising from primary breast cancer is a rare phenomenon, with only a handful of cases documented in both national and international literature. The management approach and prognosis of this occurrence have sparked debates and uncertainties. CASE PRESENTATION Herein, we report the case of a 55-year-old woman with breast cancer. She previously underwent extensive excision of the breast lesion with adjuvant chemotherapy and endocrine therapy. After 9 years, she presented with neck discomfort and examination suggested right thyroid metastasis and lymph node metastasis in the neck. Imaging showed pulmonary and bone metastases. Furthermore, the patient received endocrine therapy. After 7 months of follow- up, the patient survived without any new distant metastases. Thyroid metastases originating from breast cancer often unfold with a subtle, intricate nature, making early detection challenging. They tend to emerge inconspicuously, intertwining with widespread systemic metastases, hinting at a less favorable prognosis. CONCLUSION Given the unusual clinical indicators, identifying heterochronic thyroid metastases in patients with tumors poses a distinct challenge, requiring clinicians to navigate the follow-up process with heightened sensitivity. The key lies in timely detection and early intervention, factors that can significantly enhance the overall quality of life for patients.
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Affiliation(s)
- Yumei Guan
- Breast Disease Diagnosis and Treatment Center, Affiliated Cancer Hospital of Qinghai University, Xining, China
| | - Qinjun Ma
- Pathology Department, Affiliated Cancer Hospital of Qinghai University, Xining, China
| | - Yiqing Zhang
- Pathology Department, Affiliated Cancer Hospital of Qinghai University, Xining, China
| | - Jiuda Zhao
- Breast Disease Diagnosis and Treatment Center, Affiliated Cancer Hospital of Qinghai University, Xining, China
| | - Xinjian Guo
- Pathology Department, Affiliated Cancer Hospital of Qinghai University, Xining, China
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Kong L, Jean-Louis F, Lamont DL. Successful Antiviral Treatment for Chronic Adenoiditis Caused by Herpes Virus in a Pediatric Patient: A Case Report. Am J Case Rep 2024; 25:e942418. [PMID: 38366584 PMCID: PMC10883657 DOI: 10.12659/ajcr.942418] [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] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 01/09/2024] [Accepted: 01/01/2024] [Indexed: 02/18/2024]
Abstract
BACKGROUND The adenoids are lymphatic tissue located in the nasopharynx and play a role in upper-airway immunity. Inflammation of the adenoids is called adenoiditis, which can cause a variety of symptoms. This is a common condition and is due to acute viral or bacterial infection. Most patients experience mild symptoms of upper-respiratory tract infection with a self-limiting course. CASE REPORT A 5-year-old female patient was brought into the clinic by her parents with concerns regarding hearing and sleep. Clinical assessment was consistent with persistent otitis media with effusion and sleep-disordered breathing. She was scheduled for surgery, including nasendoscopy, adenoidectomy, and bilateral grommet insertion. During surgery, direct visualization of the postnasal space showed complete obstruction by hypertrophic, inflamed adenoids covered in a thick, white film. A biopsy was taken, which detected herpes virus cytopathic effect. A diagnostic workup excluded a neoplastic process and other bacterial or fungal infections. A trial of oral antiviral medication was successful and follow-up nasendoscopy showed resolution of adenoid hypertrophy. CONCLUSIONS Direct visualization of the postnasal space, with a transoral mirror or 120-degree endoscope, prior to adenoidectomy can aid diagnosis. Adenoiditis may be caused by a wide range of organisms, including herpes virus. Active mucopurulent discharge should raise concern for infection by bacteria, fungi, or virus. Previous research on viral infection of the adenoids have been in asymptomatic patients with presumed latent infection and undergoing elective adenoidectomy. To our knowledge, this is the first paper to report on successful treatment with antiviral medication alone.
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Affiliation(s)
- Leon Kong
- Department of Otolaryngology, Waikato Hospital, Hamilton, New Zealand
| | | | - Duncan L. Lamont
- Department of Anatomical Pathology and Cytology, Waikato Hospital, Hamilton, New Zealand
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Jie Y, Li J, Man CF, Fan Y. Ovarian cancer with intestinal wall invasion and hyperamylasemia: a case report. Front Oncol 2024; 14:1299226. [PMID: 38406808 PMCID: PMC10884171 DOI: 10.3389/fonc.2024.1299226] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 01/25/2024] [Indexed: 02/27/2024] Open
Abstract
Numerous studies have suggested a robust association between amylase and ovarian cancer. however, few amylase-producing ovarian cancers have been reported because amylase is a rare product of ovarian cancer. A case of an elderly female patient with an upper abdominal unfitness, intestinal wall along with uterine adnexal invasion, and high serum and urinary amylase is summarized in this article. The patient was initially suspected of having a gastrointestinal tumor. Initial laboratory findings showed markedly significantly raised serum and urinary amylase levels. Imaging showed invasion of the intestinal wall and uterine adnexa, and histology of the specimen taken through the abdominal wall lump and electron colonoscopy showed ovarian cancer. The patient's blood amylase levels decreased to normal after 4 cycles of neoadjuvant chemotherapy with paclitaxel and carboplatin. Following this, she underwent interval debulking surgery, which included total hysterectomy, bilateral adnexectomy, great omentectomy, appendectomy, resection of pelvic and abdominal lesions, and partial rectal resection. Postoperative pathology and immunohistochemistry staining confirmed a diagnosis of high-grade serous ovarian cancer. This case suggests that in female patients, hyperamylasemia may indicate the presence of ovarian cancer. It is necessary to perform a multisite, multipoint histologic examination to identify the tumor's origin in patients with multiple sites of invasion.
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Affiliation(s)
| | | | | | - Yu Fan
- Cancer Institute, The Affiliated People’s Hospital of Jiangsu University, Zhenjiang, Jiangsu, China
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Carlone G, Dubuis JB, Sgardello SD, Gussago S, Fournier I. Successful Conservative Management of Hepatic Portal Venous Gas Following Percutaneous Endoscopic Gastrostomy: A Case Report. Am J Case Rep 2024; 25:e942721. [PMID: 38327038 PMCID: PMC10862080 DOI: 10.12659/ajcr.942721] [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] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 12/29/2023] [Accepted: 12/14/2023] [Indexed: 02/09/2024]
Abstract
BACKGROUND Hepatic portal venous gas (HPVG) is a rare radiologic finding mostly associated with life-threatening diseases like bowel necrosis, but can also be benign; its overall mortality rate is 39-75%. In rare cases HPVG is associated with endoscopic procedures such as percutaneous endoscopic gastrostomy (PEG) placement. However, due to the rarity of this condition, there is no recommendation about its management. The aim of this case report was to describe a successful conservative management of HPVG without antibiotic administration based on the clinical presentation. CASE REPORT A 78-year-old male patient known for a history of esophageal cancer treated with radio- and chemotherapy, complicated by a post-radiation esophageal stenosis requiring a PEG tube placement 1 month prior was admitted to our Emergency Department for vomiting and abdominal pain. A contrast-enhanced abdominal CT scan showed small-bowel dilatation without obstruction, as well as gastric wall pneumatosis and HPVG. We opted for a conservative approach. The PEG was put to suction for 2 days. The clinical evolution was favorable, with resolution of abdominal pain and a restored transit on day 2. A follow-up CT scan at day 5 showed resolution of HPVG. Nutrition through the PEG was restored at day 6 without complication. CONCLUSIONS HPVG can be a benign finding after a PEG tube placement. Conservative management without antibiotics can be used in oligosymptomatic and hemodynamically stable patients after life-threatening associated diseases like bowel necrosis have been ruled out.
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Affiliation(s)
- Giovanni Carlone
- Department of General and Visceral Surgery, Sion Hospital, Sion, Switzerland
| | - Jean-Baptiste Dubuis
- Department of General and Visceral Surgery, Sion Hospital, Sion, Switzerland
- Department of Visceral Surgery, Geneva University Hospitals, Geneva, Switzerland
| | | | - Stefano Gussago
- Department of General and Visceral Surgery, Sion Hospital, Sion, Switzerland
- Department of Visceral Surgery, Geneva University Hospitals, Geneva, Switzerland
| | - Ian Fournier
- Department of General and Visceral Surgery, Sion Hospital, Sion, Switzerland
- Department of Visceral Surgery, Geneva University Hospitals, Geneva, Switzerland
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