Medical Reports最新文献_第4页

Not just a neck mass: Primary thyroid diffuse large B-cell lymphoma 不只是颈部肿块：原发性甲状腺弥漫性大b细胞淋巴瘤

Medical Reports

Pub Date : 2025-11-18 DOI: 10.1016/j.hmedic.2025.100394

Achraf Amine Sbai , Saad Bouchlarhem , Drissia Benfadil , Azeddine Lachkar , Fahd El Ayoubi El Idrissi

Primary thyroid lymphoma (PTL) is a rare thyroid malignancy, most often associated with chronic autoimmune thyroiditis. We report the case of a 40-year-old woman with a history of hypothyroidism treated with levothyroxine, who presented with a rapidly enlarging anterior neck mass accompanied by progressive dyspnea, dysphagia, and dysphonia. Physical examination revealed a large, firm goiter fixed to deep planes, with overlying inflammatory skin changes. Laboratory tests showed anemia, lymphocytosis, elevated thyroid-stimulating hormone (TSH), positive anti-thyroid peroxidase (anti-TPO) antibodies, and markedly increased lactate dehydrogenase (LDH). Imaging revealed diffuse thyroid enlargement with mediastinal extension, tracheal deviation, and invasion of the larynx. Due to worsening compressive symptoms, the patient underwent urgent decompressive surgery with intraoperative biopsy. Histopathological and immunohistochemical analysis confirmed the diagnosis of diffuse large B-cell lymphoma (DLBCL) of the thyroid. She received four cycles of R-CHOP chemoimmunotherapy, resulting in rapid clinical improvement and normalization of inflammatory and tumor markers. At 8-month follow-up, the patient remained in remission. This case highlights the importance of considering PTL in the differential diagnosis of rapidly enlarging thyroid masses, particularly in patients with autoimmune thyroid disease. Prompt diagnosis through appropriate histological assessment and early initiation of systemic therapy are critical to improving prognosis and preventing life-threatening airway compromise.

原发性甲状腺淋巴瘤（PTL）是一种罕见的甲状腺恶性肿瘤，通常与慢性自身免疫性甲状腺炎有关。我们报告一例40岁的女性甲状腺功能减退病史，她接受左甲状腺素治疗，表现为颈部前肿块迅速扩大，并伴有进行性呼吸困难、吞咽困难和发音困难。体格检查发现一个大的，坚固的甲状腺肿物固定在深平面上，上面有炎症性皮肤改变。实验室检查显示贫血，淋巴细胞增多，促甲状腺激素（TSH）升高，抗甲状腺过氧化物酶（抗tpo）抗体阳性，乳酸脱氢酶（LDH）明显升高。影像学显示弥漫性甲状腺肿大伴纵隔延伸、气管偏曲及喉部侵犯。由于压迫症状加重，患者接受了紧急减压手术并术中活检。组织病理学和免疫组织化学分析证实了甲状腺弥漫性大b细胞淋巴瘤（DLBCL）的诊断。她接受了四个周期的R-CHOP化学免疫治疗，导致临床快速改善，炎症和肿瘤标志物正常化。在8个月的随访中，患者仍处于缓解期。本病例强调了在快速增大的甲状腺肿块鉴别诊断中考虑PTL的重要性，特别是在自身免疫性甲状腺疾病患者中。通过适当的组织学评估及时诊断和早期开始全身治疗对于改善预后和防止危及生命的气道损害至关重要。

{"title":"Not just a neck mass: Primary thyroid diffuse large B-cell lymphoma","authors":"Achraf Amine Sbai , Saad Bouchlarhem , Drissia Benfadil , Azeddine Lachkar , Fahd El Ayoubi El Idrissi","doi":"10.1016/j.hmedic.2025.100394","DOIUrl":"10.1016/j.hmedic.2025.100394","url":null,"abstract":"<div><div>Primary thyroid lymphoma (PTL) is a rare thyroid malignancy, most often associated with chronic autoimmune thyroiditis. We report the case of a 40-year-old woman with a history of hypothyroidism treated with levothyroxine, who presented with a rapidly enlarging anterior neck mass accompanied by progressive dyspnea, dysphagia, and dysphonia. Physical examination revealed a large, firm goiter fixed to deep planes, with overlying inflammatory skin changes. Laboratory tests showed anemia, lymphocytosis, elevated thyroid-stimulating hormone (TSH), positive anti-thyroid peroxidase (anti-TPO) antibodies, and markedly increased lactate dehydrogenase (LDH). Imaging revealed diffuse thyroid enlargement with mediastinal extension, tracheal deviation, and invasion of the larynx. Due to worsening compressive symptoms, the patient underwent urgent decompressive surgery with intraoperative biopsy. Histopathological and immunohistochemical analysis confirmed the diagnosis of diffuse large B-cell lymphoma (DLBCL) of the thyroid. She received four cycles of R-CHOP chemoimmunotherapy, resulting in rapid clinical improvement and normalization of inflammatory and tumor markers. At 8-month follow-up, the patient remained in remission. This case highlights the importance of considering PTL in the differential diagnosis of rapidly enlarging thyroid masses, particularly in patients with autoimmune thyroid disease. Prompt diagnosis through appropriate histological assessment and early initiation of systemic therapy are critical to improving prognosis and preventing life-threatening airway compromise.</div></div>","PeriodicalId":100908,"journal":{"name":"Medical Reports","volume":"14 ","pages":"Article 100394"},"PeriodicalIF":0.0,"publicationDate":"2025-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145578916","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Challenges in diagnosis: Lesions following needle injury that mimic tenosynovial giant cell tumor 诊断上的挑战：针伤后的病变类似腱鞘巨细胞瘤

Medical Reports

Pub Date : 2025-11-18 DOI: 10.1016/j.hmedic.2025.100396

Kartavya Kumar Verma

Tenosynovial giant cell tumors (TSGCTs) are the second most common type of tumor found on hands after ganglion cysts. In contrast to the painful nature of a ganglion cyst, a TSGCT is painless. It is predominantly benign in nature. Clinically, there are mainly three types of TSGCTs: localized, diffuse, and malignant. Although this is a well-established entity, diagnosis remains challenging and encompasses a wide differential diagnosis. Our aim in reporting this case is to demonstrate how a simple needle injury can mimic this entity and lead to diagnostic dilemmas. To the best of our knowledge, no similar case has been reported in the medical literature. We present the case of 35-year-old female patient who developed localized swelling because of an iatrogenic needle prick that involved a nerve bundle and caused the patient extreme pain. Upon clinical, radiological, and histological examination, this lesion resembled a TSGCTs and led to a misdiagnosis. However, after synthesizing all relevant information, particularly the clinical history of the needle injury, the conclusive diagnosis favors a foreign body giant cell reaction accompanied by granulomatous inflammation. In this case review, we emphasize several key points that differentiate this entity from those in similar differential diagnoses. This case underscores the importance of a multidisciplinary approach to diagnosis, integrating clinical, radiological, and histomorphological features.

腱鞘巨细胞瘤（tsgct）是继神经节囊肿之后手部第二常见的肿瘤。与神经节囊肿的疼痛性不同，TSGCT是无痛的。它主要是良性的。临床上，tsgct主要有三种类型：局限性、弥漫性和恶性。虽然这是一个完善的实体，诊断仍然具有挑战性，包括广泛的鉴别诊断。我们报告这个病例的目的是为了证明一个简单的针伤是如何模仿这个实体并导致诊断困境的。据我们所知，在医学文献中没有类似的病例报告。我们提出的情况下，35岁的女性患者谁发展局部肿胀，因为医源性针刺，涉及神经束和引起患者极度疼痛。经临床、放射学和组织学检查，该病变类似于tsgct，导致误诊。然而，综合所有相关资料，特别是针伤的临床病史，最终的诊断倾向于异物巨细胞反应并伴有肉芽肿性炎症。在这种情况下回顾，我们强调几个关键点，区分这种实体从那些类似的鉴别诊断。该病例强调了多学科诊断方法的重要性，将临床、放射学和组织形态学特征结合起来。

{"title":"Challenges in diagnosis: Lesions following needle injury that mimic tenosynovial giant cell tumor","authors":"Kartavya Kumar Verma","doi":"10.1016/j.hmedic.2025.100396","DOIUrl":"10.1016/j.hmedic.2025.100396","url":null,"abstract":"<div><div>Tenosynovial giant cell tumors (TSGCTs) are the second most common type of tumor found on hands after ganglion cysts. In contrast to the painful nature of a ganglion cyst, a TSGCT is painless. It is predominantly benign in nature. Clinically, there are mainly three types of TSGCTs: localized, diffuse, and malignant. Although this is a well-established entity, diagnosis remains challenging and encompasses a wide differential diagnosis. Our aim in reporting this case is to demonstrate how a simple needle injury can mimic this entity and lead to diagnostic dilemmas. To the best of our knowledge, no similar case has been reported in the medical literature. We present the case of 35-year-old female patient who developed localized swelling because of an iatrogenic needle prick that involved a nerve bundle and caused the patient extreme pain. Upon clinical, radiological, and histological examination, this lesion resembled a TSGCTs and led to a misdiagnosis. However, after synthesizing all relevant information, particularly the clinical history of the needle injury, the conclusive diagnosis favors a foreign body giant cell reaction accompanied by granulomatous inflammation. In this case review, we emphasize several key points that differentiate this entity from those in similar differential diagnoses. This case underscores the importance of a multidisciplinary approach to diagnosis, integrating clinical, radiological, and histomorphological features.</div></div>","PeriodicalId":100908,"journal":{"name":"Medical Reports","volume":"14 ","pages":"Article 100396"},"PeriodicalIF":0.0,"publicationDate":"2025-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145578918","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Ureteric mucosal avulsion managed endoscopically via the antegrade approach: Short-term outcome – A case report 输尿管粘膜撕脱术经顺行入路内镜处理：短期结果- 1例报告

Medical Reports

Pub Date : 2025-11-14 DOI: 10.1016/j.hmedic.2025.100387

Manoj Kumar Deepak, Muthu Veeramani, Abraham Kurien

Ureteric mucosal avulsion is a rare ureteroscopy complication that requires early recognition to prevent complete avulsion. We report a 68-year-old male with a 360-degree mucosal avulsion, presenting with a unique "concertina accordion-like effect," a term not previously documented. Retrograde stenting failed due to mucosal crumpling, necessitating an antegrade approach for realignment and drainage. Postoperative recovery was uneventful, with no strictures at follow-up. This case highlights the importance of recognizing mucosal avulsion early and introduces a novel intraoperative sign to aid diagnosis and management, improving surgical decision-making and patient outcomes.

输尿管粘膜撕脱是一种罕见的输尿管镜并发症，需要及早发现以防止完全撕脱。我们报告一名68岁男性，360度粘膜撕脱，表现出独特的“手风琴样效果”，这一术语以前没有记录过。由于粘膜皱缩，逆行支架置入失败，需要顺行入路进行调整和引流。术后恢复顺利，随访时无狭窄。本病例强调了早期识别粘膜撕脱的重要性，并介绍了一种新的术中体征，以帮助诊断和管理，改善手术决策和患者预后。

引用次数: 0

Type C foodborne botulism: First clinical case report of a cluster within a family in Japan C型食源性肉毒杆菌中毒：日本首例家庭聚集性病例临床报告

Medical Reports

Pub Date : 2025-11-11 DOI: 10.1016/j.hmedic.2025.100386

Michito Sadohara , Hiroki Irie , Manami Kuwahara , Katsuyuki Sagishima , Hiromichi Tanaka , Kunihiko Matsui

Background

Foodborne botulism is a rare but potentially fatal neuroparalytic disease caused by the ingestion of food contaminated with Clostridium botulinum. Early diagnosis is challenging because its symptoms mimic those of other neuroparalytic diseases, such as Guillain–Barré and Miller–Fisher syndromes. Laboratory confirmation of botulinum toxin and antitoxin procurement can take several days. Type C botulism is extremely rare in humans, with only 15 reported cases worldwide.

Case presentation

Members of a family consumed expired, improperly stored, vacuum-packed chicken dishes. Four members (two adults and two children) ingested the food. The adults developed blurred vision, dysarthria, limb weakness, and respiratory distress within 24 h. Foodborne botulism was suspected based on a family cluster and shared meal history. Both adults required intubation and received antitoxins within 3 days. Following prolonged mechanical ventilation, the patients gradually improved and were discharged for rehabilitation after 2 months. The children, who were initially asymptomatic, received prophylactic antitoxins. Both children developed mild gastrointestinal symptoms and transient weakness and recovered fully within 10 days. Laboratory testing confirmed the presence of type C botulinum toxin in three patients.

Conclusion

This report describes the first documented cluster of human type C foodborne botulism cases in Japan. Although rare in humans, type C toxin can cause severe acute neuroparalytic syndrome when contaminated food is stored improperly. The early recognition of family clustering and prompt procurement of antitoxins are essential for effective management.

食源性肉毒杆菌中毒是一种罕见但可能致命的神经麻痹疾病，由摄入被肉毒梭菌污染的食物引起。早期诊断具有挑战性，因为它的症状类似于其他神经麻痹性疾病，如格林-巴罗综合征和米勒-费舍尔综合征。肉毒杆菌毒素和抗毒素采购的实验室确认可能需要几天时间。C型肉毒杆菌中毒在人类中极为罕见，全世界只有15例报告病例。案例介绍：某家庭成员食用了过期、储存不当、真空包装的鸡肉菜肴。四名成员（两名成人和两名儿童）摄入了这些食物。成人在24 h内出现视力模糊、构音障碍、肢体无力和呼吸窘迫。食源性肉毒杆菌中毒的怀疑是基于一个家庭群集和共同的用餐史。两名成人均在3天内插管并接受抗毒素治疗。延长机械通气时间后，病情逐渐好转，2个月后出院康复。最初无症状的儿童接受预防性抗毒素治疗。两例患儿均出现轻度胃肠道症状和一过性虚弱，10天内完全康复。实验室检测证实三名患者体内存在C型肉毒杆菌毒素。结论本报告报道了日本首例有文献记载的人类C型食源性肉毒杆菌中毒聚集性病例。虽然C型毒素在人类中很少见，但当受污染的食物储存不当时，会引起严重的急性神经麻痹综合征。早期识别家庭聚集性并及时采购抗毒素对有效管理至关重要。

{"title":"Type C foodborne botulism: First clinical case report of a cluster within a family in Japan","authors":"Michito Sadohara , Hiroki Irie , Manami Kuwahara , Katsuyuki Sagishima , Hiromichi Tanaka , Kunihiko Matsui","doi":"10.1016/j.hmedic.2025.100386","DOIUrl":"10.1016/j.hmedic.2025.100386","url":null,"abstract":"<div><h3>Background</h3><div>Foodborne botulism is a rare but potentially fatal neuroparalytic disease caused by the ingestion of food contaminated with <em>Clostridium botulinum</em>. Early diagnosis is challenging because its symptoms mimic those of other neuroparalytic diseases, such as Guillain–Barré and Miller–Fisher syndromes. Laboratory confirmation of botulinum toxin and antitoxin procurement can take several days. Type C botulism is extremely rare in humans, with only 15 reported cases worldwide.</div></div><div><h3>Case presentation</h3><div>Members of a family consumed expired, improperly stored, vacuum-packed chicken dishes. Four members (two adults and two children) ingested the food. The adults developed blurred vision, dysarthria, limb weakness, and respiratory distress within 24 h. Foodborne botulism was suspected based on a family cluster and shared meal history. Both adults required intubation and received antitoxins within 3 days. Following prolonged mechanical ventilation, the patients gradually improved and were discharged for rehabilitation after 2 months. The children, who were initially asymptomatic, received prophylactic antitoxins. Both children developed mild gastrointestinal symptoms and transient weakness and recovered fully within 10 days. Laboratory testing confirmed the presence of type C botulinum toxin in three patients.</div></div><div><h3>Conclusion</h3><div>This report describes the first documented cluster of human type C foodborne botulism cases in Japan. Although rare in humans, type C toxin can cause severe acute neuroparalytic syndrome when contaminated food is stored improperly. The early recognition of family clustering and prompt procurement of antitoxins are essential for effective management.</div></div>","PeriodicalId":100908,"journal":{"name":"Medical Reports","volume":"14 ","pages":"Article 100386"},"PeriodicalIF":0.0,"publicationDate":"2025-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145519430","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Altitude-specific neurocritical care: A case study in the management of traumatic brain injury 高原特异性神经危重症护理：创伤性脑损伤管理的个案研究

Medical Reports

Pub Date : 2025-11-04 DOI: 10.1016/j.hmedic.2025.100385

Fausto Maldonado-Coronel , Catty Castillo-Caicedo , Antonio Viruez-Soto , Roger Huanca-Payehuanca , Amílcar Tinoco-Solórzano , Daniel Molano-Franco , Christian Arias-Reyes , Jorge Soliz

Introduction

This case illustrates a unique challenge in neurocritical care at high altitude, where sea-level ventilation protocols can be detrimental. It adds novel clinical evidence by showing the pathophysiological consequences and therapeutic reversal of hypercapnia-induced cerebral hyperemia in a high-altitude native with traumatic brain injury (TBI).

Main symptoms and findings

A 25-year-old man, lifelong resident at 3600 m above sea level (m.a.s.l.), presented with moderate-to-severe TBI following a motor vehicle accident. He exhibited cerebral edema and hemorrhagic contusions on CT, with transcranial Doppler indicating cerebral hyperemia.

Diagnosis, intervention, and outcomes

Initial ventilation based on sea-level PaCO₂ norms led to iatrogenic hypercapnia and cerebral hyperemia. Upon adjusting the ventilatory targets to an altitude-appropriate PaCO₂ range (26–28 mmHg), cerebral blood flow normalized, as confirmed by Doppler. The patient rapidly recovered and was discharged neurologically intact.

Conclusion

In high-altitude settings, standard ventilation protocols may provoke secondary cerebral complications. This case highlights the critical importance of individualized, altitude-specific neurocritical strategies, with transcranial Doppler serving as a valuable bedside guide to optimize outcomes in altitude-acclimatized TBI patients.

本病例说明了高海拔地区神经危重症护理的独特挑战，在那里海平面通气方案可能是有害的。它通过显示高原创伤性脑损伤（TBI）高碳酸血症引起的脑充血的病理生理后果和治疗逆转，增加了新的临床证据。1例25岁男性，海拔3600 m （m.a.s.l）终身居民，机动车事故后出现中度至重度脑外伤。CT表现为脑水肿和出血性挫伤，经颅多普勒显示脑充血。诊断、干预和结果：基于海平面PaCO 2标准的初始通气导致医源性高碳酸血症和脑充血。经多普勒证实，将通气目标调整到海拔适宜的PaCO₂范围（26-28 mmHg）后，脑血流量恢复正常。患者迅速恢复，出院时神经系统完好。结论在高海拔环境下，标准通气方案可能引起继发性脑并发症。该病例强调了个性化、海拔特异性神经危重症策略的重要性，经颅多普勒可作为优化海拔适应性TBI患者预后的有价值的床边指导。

{"title":"Altitude-specific neurocritical care: A case study in the management of traumatic brain injury","authors":"Fausto Maldonado-Coronel , Catty Castillo-Caicedo , Antonio Viruez-Soto , Roger Huanca-Payehuanca , Amílcar Tinoco-Solórzano , Daniel Molano-Franco , Christian Arias-Reyes , Jorge Soliz","doi":"10.1016/j.hmedic.2025.100385","DOIUrl":"10.1016/j.hmedic.2025.100385","url":null,"abstract":"<div><h3>Introduction</h3><div>This case illustrates a unique challenge in neurocritical care at high altitude, where sea-level ventilation protocols can be detrimental. It adds novel clinical evidence by showing the pathophysiological consequences and therapeutic reversal of hypercapnia-induced cerebral hyperemia in a high-altitude native with traumatic brain injury (TBI).</div></div><div><h3>Main symptoms and findings</h3><div>A 25-year-old man, lifelong resident at 3600 m above sea level (m.a.s.l.), presented with moderate-to-severe TBI following a motor vehicle accident. He exhibited cerebral edema and hemorrhagic contusions on CT, with transcranial Doppler indicating cerebral hyperemia.</div></div><div><h3>Diagnosis, intervention, and outcomes</h3><div>Initial ventilation based on sea-level PaCO₂ norms led to iatrogenic hypercapnia and cerebral hyperemia. Upon adjusting the ventilatory targets to an altitude-appropriate PaCO₂ range (26–28 mmHg), cerebral blood flow normalized, as confirmed by Doppler. The patient rapidly recovered and was discharged neurologically intact.</div></div><div><h3>Conclusion</h3><div>In high-altitude settings, standard ventilation protocols may provoke secondary cerebral complications. This case highlights the critical importance of individualized, altitude-specific neurocritical strategies, with transcranial Doppler serving as a valuable bedside guide to optimize outcomes in altitude-acclimatized TBI patients.</div></div>","PeriodicalId":100908,"journal":{"name":"Medical Reports","volume":"14 ","pages":"Article 100385"},"PeriodicalIF":0.0,"publicationDate":"2025-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145465871","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Adjunctive long-term use of Mucinex® leading to improvement in stable chronic bronchitis and patient’s quality of life: A case report 辅助长期使用Mucinex®导致稳定性慢性支气管炎和患者生活质量的改善：1例报告

Medical Reports

Pub Date : 2025-10-16 DOI: 10.1016/j.hmedic.2025.100384

Selwyn Spangenthal , Connie Divel , Oktawia Borecka , Samuel Llewellyn

We describe a case of a chronic obstructive pulmonary disease patient with stable chronic bronchitis who experienced improved quality of life and reduced symptoms during daily long-term Mucinex® (extended-release guaifenesin) use. Through a validated patient-reported outcome, the cough and sputum assessment questionnaire (CASA-Q), cough impact and symptoms scores showed improvements of 37.5 and 50 points, respectively, at week 11 compared to baseline. Similarly, sputum impact and symptoms scores improved by 37.5 and 41.7 points. While these observations support a potential benefit of adjunctive mucoactive therapy in chronic respiratory conditions, they should be interpreted cautiously and considered hypothesis-generating, highlighting the need for further controlled studies.

我们描述了一例慢性阻塞性肺疾病合并稳定型慢性支气管炎患者，在每日长期使用Mucinex®（缓释愈创酚松）期间，患者的生活质量得到改善，症状减轻。通过验证的患者报告结果，咳嗽和痰评估问卷（CASA-Q）、咳嗽影响和症状评分在第11周与基线相比分别改善了37.5分和50分。同样，痰液影响和症状得分分别提高了37.5分和41.7分。虽然这些观察结果支持辅助黏液活性治疗对慢性呼吸系统疾病的潜在益处，但应谨慎解释，并考虑为假设生成，强调需要进一步的对照研究。

引用次数: 0

Diagnostic findings after local anesthetic systemic toxicity with articaine: A case report 阿替卡因局部麻醉全身性中毒后的诊断结果：1例报告

Medical Reports

Pub Date : 2025-10-15 DOI: 10.1016/j.hmedic.2025.100383

A.A. Sharif , N. Adhikari, M.B. Foroozesh

Objective

To review the diagnostic findings following local anesthetic systemic toxicity (LAST) with articaine and assess the prognosis given appropriate management.

Background

Articaine is widely used in the dental field due to its relatively safe profile, fast onset, and short half-life. We present a case of LAST following articaine administration.

Case report

A 61-year-old female with a past medical history of essential hypertension, prediabetes, and nontoxic multinodular goiter presented with acute onset altered mental status and generalized tonic clonic seizure requiring intubation in the field from her dentist’s office following the administration of articaine for a root canal. Diagnostic studies, including MRI, echocardiography (ECHO), and electrocardiogram (EKG), were consistent with the suspected diagnosis of LAST. Notably, her left ventricular ejection fraction (LVEF) declined from 60 % to 65 % (per ECHO nine days prior) to 20 to 25 % on the second day of hospitalization. Brain MRI demonstrated multifocal areas of gyriform cortical restricted diffusion seen in both cerebral hemispheres. She was successfully treated with lipid emulsion therapy with continued supportive care and subsequently discharged 10 days later to continue physical therapy and rehab after her LAST episode.

Conclusion

LAST acutely presents with dramatic findings including cardiac and neurologic manifestations. Our patient presented with tonic clonic seizure, acute encephalopathy, Severe reduction in LVEF, and brain MRI showing multiple watershed lesions. Treatment with lipid emulsion therapy and supportive measures led to substantial recovery, with a near-complete return to baseline function within six months.

目的回顾阿替卡因局麻全身毒性（LAST）的诊断表现，并评价适当处理后的预后。阿替卡因因其相对安全、起效快、半衰期短等优点在牙科领域得到广泛应用。我们报告一例阿替卡因给药后的最后一例。病例报告：一名61岁女性，既往有原发性高血压、糖尿病前期和无毒多结节性甲状腺肿病史，急性发作时精神状态改变，全身性强直性阵挛发作，需要在牙科诊所接受阿替卡因根管治疗后进行现场插管。诊断研究，包括MRI，超声心动图（ECHO）和心电图（EKG），与疑似LAST的诊断一致。值得注意的是，她的左心室射血分数（LVEF）从60 %下降到65 %(9天前每ECHO)，住院第二天下降到20 ~ 25 %。脑MRI显示双脑半球出现脑回状皮质扩散受限的多灶区。她成功地接受了脂质乳疗法和持续的支持治疗，并于10天后出院，在最后一次发作后继续进行物理治疗和康复。结论last急性表现出明显的表现，包括心脏和神经系统的表现。我们的患者表现为强直性阵挛性发作，急性脑病，LVEF严重降低，脑MRI显示多个分水岭病变。脂质乳疗法和支持性措施的治疗导致了实质性的恢复，在六个月内几乎完全恢复到基线功能。

{"title":"Diagnostic findings after local anesthetic systemic toxicity with articaine: A case report","authors":"A.A. Sharif , N. Adhikari, M.B. Foroozesh","doi":"10.1016/j.hmedic.2025.100383","DOIUrl":"10.1016/j.hmedic.2025.100383","url":null,"abstract":"<div><h3>Objective</h3><div>To review the diagnostic findings following local anesthetic systemic toxicity (LAST) with articaine and assess the prognosis given appropriate management.</div></div><div><h3>Background</h3><div>Articaine is widely used in the dental field due to its relatively safe profile, fast onset, and short half-life. We present a case of LAST following articaine administration.</div></div><div><h3>Case report</h3><div>A 61-year-old female with a past medical history of essential hypertension, prediabetes, and nontoxic multinodular goiter presented with acute onset altered mental status and generalized tonic clonic seizure requiring intubation in the field from her dentist’s office following the administration of articaine for a root canal. Diagnostic studies, including MRI, echocardiography (ECHO), and electrocardiogram (EKG), were consistent with the suspected diagnosis of LAST. Notably, her left ventricular ejection fraction (LVEF) declined from 60 % to 65 % (per ECHO nine days prior) to 20 to 25 % on the second day of hospitalization. Brain MRI demonstrated multifocal areas of gyriform cortical restricted diffusion seen in both cerebral hemispheres. She was successfully treated with lipid emulsion therapy with continued supportive care and subsequently discharged 10 days later to continue physical therapy and rehab after her LAST episode.</div></div><div><h3>Conclusion</h3><div>LAST acutely presents with dramatic findings including cardiac and neurologic manifestations. Our patient presented with tonic clonic seizure, acute encephalopathy, Severe reduction in LVEF, and brain MRI showing multiple watershed lesions. Treatment with lipid emulsion therapy and supportive measures led to substantial recovery, with a near-complete return to baseline function within six months.</div></div>","PeriodicalId":100908,"journal":{"name":"Medical Reports","volume":"14 ","pages":"Article 100383"},"PeriodicalIF":0.0,"publicationDate":"2025-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145324041","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Coexistence of cornual ectopic pregnancy and septated uterus anomaly: A case report of ultrasound diagnosis and surgical intervention 角异位妊娠合并子宫分离畸形：超声诊断及手术治疗1例

Medical Reports

Pub Date : 2025-10-10 DOI: 10.1016/j.hmedic.2025.100380

Abdulaziz Hussein , Ali A. Obaid , Nadia M. A Almikhlafi

Cornual ectopic pregnancy is a rare and potentially life-threatening form of ectopic gestation that occurs within the uterine cornua, often presenting diagnostic and management challenges. Early detection is crucial to prevent catastrophic hemorrhage and preserve future fertility. This report describes a 30-year-old woman presenting with lower abdominal pain, vaginal spotting, and amenorrhea at seven weeks of gestation. Ultrasonography revealed a complex mass in the right uterine cornua with features suggestive of cornual pregnancy. The patient underwent a carefully planned surgical intervention involving laparotomy and excision of the ectopic tissue, with meticulous preservation of uterine integrity. The case spots light the importance of high clinical suspicion and detailed imaging for prompt diagnosis, especially in patients with uterine anomalies such as septate uterus. Early surgical management in this case effectively prevented rupture and hemorrhage, improving her prognosis and future reproductive potential. This case underscores the significance of prompt diagnosis and tailored surgical approaches in managing cornual ectopic pregnancies, particularly when complicated by uterine anomalies.

子宫角异位妊娠是一种罕见且可能危及生命的异位妊娠，发生在子宫角内，通常呈现诊断和治疗方面的挑战。早期发现对于预防灾难性出血和保护未来生育能力至关重要。本报告描述了一位30岁的妇女，在妊娠7周时出现下腹疼痛、阴道斑点和闭经。超声检查显示右侧子宫角部有复杂的肿块，提示子宫角部妊娠。患者接受了精心计划的手术干预，包括剖腹手术和切除异位组织，并一丝不苟地保留了子宫的完整性。该病例提示高度临床怀疑和详细的影像学检查对于及时诊断的重要性，特别是对子宫异常如分隔子宫的患者。该病例的早期手术处理有效地防止了破裂和出血，改善了她的预后和未来的生殖潜力。本病例强调了及时诊断和量身定制的手术方法在处理角异位妊娠的重要性，特别是当合并子宫异常时。

{"title":"Coexistence of cornual ectopic pregnancy and septated uterus anomaly: A case report of ultrasound diagnosis and surgical intervention","authors":"Abdulaziz Hussein , Ali A. Obaid , Nadia M. A Almikhlafi","doi":"10.1016/j.hmedic.2025.100380","DOIUrl":"10.1016/j.hmedic.2025.100380","url":null,"abstract":"<div><div>Cornual ectopic pregnancy is a rare and potentially life-threatening form of ectopic gestation that occurs within the uterine cornua, often presenting diagnostic and management challenges. Early detection is crucial to prevent catastrophic hemorrhage and preserve future fertility. This report describes a 30-year-old woman presenting with lower abdominal pain, vaginal spotting, and amenorrhea at seven weeks of gestation. Ultrasonography revealed a complex mass in the right uterine cornua with features suggestive of cornual pregnancy. The patient underwent a carefully planned surgical intervention involving laparotomy and excision of the ectopic tissue, with meticulous preservation of uterine integrity. The case spots light the importance of high clinical suspicion and detailed imaging for prompt diagnosis, especially in patients with uterine anomalies such as septate uterus. Early surgical management in this case effectively prevented rupture and hemorrhage, improving her prognosis and future reproductive potential. This case underscores the significance of prompt diagnosis and tailored surgical approaches in managing cornual ectopic pregnancies, particularly when complicated by uterine anomalies.</div></div>","PeriodicalId":100908,"journal":{"name":"Medical Reports","volume":"14 ","pages":"Article 100380"},"PeriodicalIF":0.0,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145324042","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Medical Reports

Pub Date : 2025-09-30 DOI: 10.1016/j.hmedic.2025.100382

Fadi Fares , Layal Abou Zeki , Omar Aawar

Elderly patients with cervical spinal fractures present unique challenges in management due to the increased risk of respiratory complications. This case report highlights the significance of age as a major risk factor for early tracheostomy in a 90-year-old healthy male patient who sustained a cervical spine fracture following a fall. Despite presenting with mild neurological deficits and no major comorbidities, the patient experienced significant respiratory issues postoperatively, including difficulty clearing lung secretions and developing type II respiratory failure. These complications necessitated re-intubation and, ultimately, the insertion of a tracheostomy. This case emphasizes that advanced age, even without other typical risk factors, can lead to a higher likelihood of respiratory failure and the need for prolonged airway support. While anterior cervical spine surgery itself carries inherent risks of postoperative respiratory compromise, this case highlights the added impact of advanced age as an independent predictor of respiratory failure. Early tracheostomy intervention in elderly patients with cervical spinal fractures may be crucial for reducing complications, improving outcomes, and facilitating early recovery thus decreasing the hospital length of stay.

由于呼吸系统并发症的风险增加，老年颈椎骨折患者在治疗方面面临着独特的挑战。本病例报告强调了年龄作为早期气管切开术的主要危险因素的重要性，该患者为90岁健康男性，在跌倒后持续发生颈椎骨折。尽管表现为轻度神经功能障碍，无重大合并症，但患者术后出现明显的呼吸问题，包括清除肺分泌物困难和II型呼吸衰竭。这些并发症需要再次插管，并最终进行气管切开术。该病例强调，即使没有其他典型的危险因素，高龄也可能导致呼吸衰竭的可能性更高，需要长时间的气道支持。虽然颈椎前路手术本身存在术后呼吸损伤的固有风险，但该病例强调了高龄作为呼吸衰竭的独立预测因素的附加影响。老年颈椎骨折患者的早期气管切开术干预可能对减少并发症、改善预后、促进早期恢复从而缩短住院时间至关重要。

{"title":"Age-related challenges in the management of cervical spinal fractures: A case report on the need for early tracheostomy in an elderly patient","authors":"Fadi Fares , Layal Abou Zeki , Omar Aawar","doi":"10.1016/j.hmedic.2025.100382","DOIUrl":"10.1016/j.hmedic.2025.100382","url":null,"abstract":"<div><div>Elderly patients with cervical spinal fractures present unique challenges in management due to the increased risk of respiratory complications. This case report highlights the significance of age as a major risk factor for early tracheostomy in a 90-year-old healthy male patient who sustained a cervical spine fracture following a fall. Despite presenting with mild neurological deficits and no major comorbidities, the patient experienced significant respiratory issues postoperatively, including difficulty clearing lung secretions and developing type II respiratory failure. These complications necessitated re-intubation and, ultimately, the insertion of a tracheostomy. This case emphasizes that advanced age, even without other typical risk factors, can lead to a higher likelihood of respiratory failure and the need for prolonged airway support. While anterior cervical spine surgery itself carries inherent risks of postoperative respiratory compromise, this case highlights the added impact of advanced age as an independent predictor of respiratory failure. Early tracheostomy intervention in elderly patients with cervical spinal fractures may be crucial for reducing complications, improving outcomes, and facilitating early recovery thus decreasing the hospital length of stay.</div></div>","PeriodicalId":100908,"journal":{"name":"Medical Reports","volume":"14 ","pages":"Article 100382"},"PeriodicalIF":0.0,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145265462","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

An undigested garlic clove induced gastric outlet obstruction: A case report 未消化的蒜瓣致胃出口梗阻1例

Medical Reports

Pub Date : 2025-09-28 DOI: 10.1016/j.hmedic.2025.100381

Anthony Bedran , Ryan Akl , Karam Karam , Elias Fiani , Ihab I. El Hajj

Hypertension is a widespread global health issue, and dietary modifications are an important nonpharmacologic approach to its management. Increasing the consumption of fiber-rich foods, such as fruits, vegetables, and garlic, has been shown to reduce blood pressure and improve cardiovascular health. People consume garlic for proposed benefits, including management of hypertension. Rarely, excessive intake of these foods can lead to gastrointestinal complications, including the formation of phytobezoar, masses of indigestible plant material that may cause severe obstructions. Bezoars are responsible for 0.4–4 % of cases of gastric outlet obstruction. Although rare, these obstructions can result in symptoms like nausea, vomiting, and abdominal pain, and may require surgical intervention. In the absence of treatment, lodged bezoars in the gastrointestinal tract have been associated with mortality rates as high as 30 %. This case report presents a 59-year-old woman with a history of poorly controlled hypertension, whose blood pressure remained high at 180/100 mmHg despite increased doses of antihypertensive medication. In an attempt to manage her condition, she ingested a large garlic clove, unchewed, as a dietary supplement. She subsequently presented to the emergency department with two days of epigastric pain, persistent nausea, and vomiting after eating. Imaging, including an unenhanced CT scan, revealed a fluid-filled stomach with a 2 cm irregular dense mass at the gastric pylorus, suggesting a phytobezoar. Gastroscopy confirmed the presence of a large, undigested garlic clove in the pre-pyloric region, which was successfully removed using a Roth net. The pyloric area showed signs of mild inflammation, with the diameter of the pyloric channel smaller than the garlic clove. The patient was discharged in stable condition. This case highlights the potential gastrointestinal risks of consumption of unchewed foods, such as a garlic clove, and emphasizes the importance of careful dietary management in patients with hypertension.

高血压是一个广泛的全球健康问题，饮食调整是一个重要的非药物治疗方法。增加食用富含纤维的食物，如水果、蔬菜和大蒜，已被证明可以降低血压，改善心血管健康。人们食用大蒜的好处包括控制高血压。很少情况下，过量摄入这些食物会导致胃肠道并发症，包括形成植物粪黄，这是一种难以消化的植物物质，可能会导致严重的阻塞。胃出口梗阻的病例中，有0.4-4 %是由牛黄引起的。虽然罕见，但这些阻塞可导致恶心、呕吐和腹痛等症状，可能需要手术干预。在没有治疗的情况下，滞留在胃肠道的牛黄与死亡率高达30% %有关。本病例报告提出一名59岁女性，既往高血压控制不佳，尽管增加降压药剂量，其血压仍保持在180/100 mmHg的高位。为了控制自己的病情，她吃了一瓣大蒜瓣，没有咀嚼，作为膳食补充剂。随后，她以两天的上腹部疼痛、持续恶心和进食后呕吐就诊于急诊科。影像学（包括普通CT扫描）显示胃充满液体，幽门处有一个2 厘米的不规则致密肿块，提示植物粪黄。胃镜检查证实幽门前区存在一个大的未消化的蒜瓣，使用罗斯网成功地将其移除。幽门区域显示轻度炎症的迹象，幽门通道的直径小于蒜瓣。患者病情稳定出院。本病例强调了食用未咀嚼食物（如蒜瓣）的潜在胃肠道风险，并强调了高血压患者仔细饮食管理的重要性。

{"title":"An undigested garlic clove induced gastric outlet obstruction: A case report","authors":"Anthony Bedran , Ryan Akl , Karam Karam , Elias Fiani , Ihab I. El Hajj","doi":"10.1016/j.hmedic.2025.100381","DOIUrl":"10.1016/j.hmedic.2025.100381","url":null,"abstract":"<div><div>Hypertension is a widespread global health issue, and dietary modifications are an important nonpharmacologic approach to its management. Increasing the consumption of fiber-rich foods, such as fruits, vegetables, and garlic, has been shown to reduce blood pressure and improve cardiovascular health. People consume garlic for proposed benefits, including management of hypertension. Rarely, excessive intake of these foods can lead to gastrointestinal complications, including the formation of phytobezoar, masses of indigestible plant material that may cause severe obstructions. Bezoars are responsible for 0.4–4 % of cases of gastric outlet obstruction. Although rare, these obstructions can result in symptoms like nausea, vomiting, and abdominal pain, and may require surgical intervention. In the absence of treatment, lodged bezoars in the gastrointestinal tract have been associated with mortality rates as high as 30 %. This case report presents a 59-year-old woman with a history of poorly controlled hypertension, whose blood pressure remained high at 180/100 mmHg despite increased doses of antihypertensive medication. In an attempt to manage her condition, she ingested a large garlic clove, unchewed, as a dietary supplement. She subsequently presented to the emergency department with two days of epigastric pain, persistent nausea, and vomiting after eating. Imaging, including an unenhanced CT scan, revealed a fluid-filled stomach with a 2 cm irregular dense mass at the gastric pylorus, suggesting a phytobezoar. Gastroscopy confirmed the presence of a large, undigested garlic clove in the pre-pyloric region, which was successfully removed using a Roth net. The pyloric area showed signs of mild inflammation, with the diameter of the pyloric channel smaller than the garlic clove. The patient was discharged in stable condition. This case highlights the potential gastrointestinal risks of consumption of unchewed foods, such as a garlic clove, and emphasizes the importance of careful dietary management in patients with hypertension.</div></div>","PeriodicalId":100908,"journal":{"name":"Medical Reports","volume":"14 ","pages":"Article 100381"},"PeriodicalIF":0.0,"publicationDate":"2025-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145218928","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0