Medical Reports最新文献

Background

Subungual exostosis, a rare and often misdiagnosed condition, presents unique challenges in clinical practice.

Case report

We present a case of a 19-year-old patient who, over three years, underwent conservative treatment with drugs and two nail removal procedures due to an initial misdiagnosis of fungal infection. Despite these interventions, symptoms persisted, prompting a reevaluation. Radiographic imaging, including anteroposterior and lateral views of the hallux, revealed a well-defined subungual exostosis. Subsequent surgical excision, meticulously performed, confirmed the diagnosis, and histological examination substantiated the presence of subungual exostosis tissue. Remarkably, one-year post-surgery, the hallux nail exhibited complete restoration to normalcy, emphasizing the efficacy of the tailored surgical approach.

Conclusion

This case highlights the diagnostic complexities surrounding subungual exostosis, emphasizing the importance of accurate diagnosis and tailored surgical intervention. The successful outcome underscores the transformative impact of precise clinical evaluation and surgical management in resolving prolonged symptoms associated with this rare intra-articular lesion.

Foreign bodies in the urinary tract constitute an emergency because of the serious complications that can develop if untreated, such as severe infections or bleeding. A 62-year-old man presented with two weeks of painful testicular swelling. The patient admitted that he had inserted an eyebrow pencil into the urethra two weeks prior that he could not remove. The physical examination found suprapubic tenderness, a palpably distended bladder, and pus seeping from the glans penis. An ultrasound examination detected a stick-shaped foreign body. The patient was catheterized and administered antibiotics and an intravenous analgetic. An open vesicolithotomy was then performed by a general surgeon. Proper handling of vesicourethral foreign bodies reduces the risks of infection and complications in the urinary tract. The surgical technique performed depends on the hospital instrument used and the shape and location of the foreign body.

This case report presents a rare occurrence of osteopetrosis combined with missing mental foramen and bilateral narrowing of inferior alveolar nerve canal. Osteopetrosis, also known as “marble bone disease”, is a rare genetic disorder characterized by abnormal bone density due to impaired osteoclast function. In this patient’s case, the missing mental foramen and narrowing of the inferior alveolar canal further complicate the condition, leading to potential neurological and dental implications. This report describes the radiographic findings, multidisciplinary treatment approach, and management of patient with complex disease progression and symptoms.

Background

We reported a patient who exhibited an abnormal increase in carbohydrate antigen 19–9 (CA19–9) concentrations for 5 years in our hospital without matched clinical symptoms. We considered whether it was a false-positive result.

Methods

To identify the potential interference, multiple platform detections, gradient dilution, polyethylene glycol (PEG) precipitation and heterophilic antibody blocking assays were respectively used to evaluate the true CA19–9 concentration.

Results

The CA19–9 concentration showed an obvious increase (189.9 U/mL) using the Architect i2000SR platform while it was within the reference ranges on the Cobas e801 and DXI800 platforms. PEG precipitation effectively corrected the false CA19–9 concentration, as did the heterophilic blocking tube (HBT).

Conclusion

The CA19–9 concentration of this patient was identified to be interfered with by the presence of heterophilic antibodies. The lesson learned from this case is that false positives should be vigilant when using immunoassays to detect markers, especially in patients without corresponding clinical symptoms. Three types of experiments against heterophilic interference, gradient dilution, PEG precipitation, and blockers, are highly operational and effective in clinical laboratories.

Caroli's disease (CD) and Caroli's syndrome (CS) are rare congenital conditions involving cystic dilation of the intrahepatic biliary system. CS and CD are thought to follow an autosomal recessive pattern(by ARPKD gene mutation), often associated with polycystic kidney disease. Clinical features include recurrent cholangitis and cholelithiasis in CD and cirrhosis with portal hypertension in CS. Diagnosis relies on clinical presentation and radiological imaging, mainly MRCP. Management includes antibiotics, ursodeoxycholic acid, and, in some cases, surgical intervention or liver transplantation. Early diagnosis is crucial as CS carries a significant risk of cholangiocarcinoma. Timely intervention can improve patient outcomes and quality of life.

Gastrointestinal stromal tumors (GISTs) are common primary mesenchymal neoplasms in the gastrointestinal tract. Although they account for less than 1 % of all GI tumors, high-risk or cancerous GISTs make up 20 % to 30 % of all cases. GISTs mostly affect people over 50 years old, with symptoms including bowel obstruction, constipation, GI bleeding, dysphagia, jaundice, and urination problems in males. KIT is highly expressed in GISTs, but tyrosine kinase inhibitors (TKI) such as imatinib, sunitinib, regorafenib, and ripretinib can target these tumors effectively. The therapy of GIST metastases in the liver is controversial, and metastatic liver disease is a significant factor in determining patient survival. Early detection and timely treatment can significantly improve the patient's prognosis and increase their chances of survival.

Quality medical care and optimal public health are the cornerstone objectives of the field of medicine and medical education. However, language barriers and the role of language in medicine, medical education, and healthcare have a significant impact. While developed countries prioritize their native language in medicine, developing countries often rely on foreign languages. Typically, discussions about this issue in developing countries revolve around pedagogical contexts. This commentary aims to explore an alternative aspect of this language discourse by examining how relying on foreign language in medicine may impact public health. This impact could encompass various aspects, including the influence on the doctor-patient relationship and the quality of healthcare provided, pedagogical considerations in doctors' learning and training, and the potential linguistic isolation of medicine from the general public. By addressing these ramifications, we can gain a deeper understanding of the role language plays in shaping public health outcomes.

Muscle phosphoglycerate mutase deficiency is a very rare muscle metabolism disorder which inheritance pattern is autosomal recessive. Exercise-induced muscle cramps and myoglobinuria are main clinical features. The skeletal muscle biopsy often shows tubular aggregates. We report a new patient with muscle phosphoglycerate mutase deficiency revealed by rhabdomyolysis episodes. Forearm exercise test revealed blunted lactate increase associated with hyperammonemia and ENMG with long Exercise Test disclosed a post-exercise decrease in CMAP amplitude, demonstrating the important contribution of both tests combined for the diagnosis of rare muscle glycogenosis.

Introduction

An increasing number of people need dialysis each year, and this is a reflection of the rising number of individuals suffering from chronic renal failure (CKD) and progressive underlying nephropathies. The current study conducted to evaluate the knowledge and attitude of physicians, nurses, and patients regarding the importance of protection of vascular access in patients undergoing hemodialysis and its prognostic role.

Method

The current cohort study was conducted in 2019–2020 in Ilam using the Waltz and Basel questionnaire. The content validity ratio of this tool was verified according to the Law she table. Using the relevant formula, the validity ratio of the questionnaire was calculated and the statements with a value greater than 0.59 were retained. The data collected were analyzed using SPSS16 software.

Results

Ten physicians, 150 nurses, and 80 patients undergoing hemodialysis were included in this study, and their knowledge and attitudes towards the importance of protecting vascular access were assessed. The results showed that with each unit increase in the knowledge and attitude of physicians, nurses, and patients, the prognosis of patient's improved by 0.555 units.

Conclusion

The present study showed that the adequate knowledge and positive attitudes of physicians, nurses, and patients regarding the importance of protecting vascular access in patients undergoing hemodialysis is improved the prognosis of patients. Therefore, it is necessary to implement educational programs to increase the knowledge of these people about vascular access protection.