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Total hip arthroplasty as a single procedure for subtrochanteric femur fracture with concurrent hip osteoarthritis: A case report 股骨转子下骨折并发髋关节骨性关节炎的全髋关节置换术：病例报告

Medical Reports

Pub Date : 2024-11-14 DOI: 10.1016/j.hmedic.2024.100131

Adam Maestas , Parsa Charkhchi , Farbod Malek

Femoral subtrochanteric (ST) fractures have a bimodal age distribution and often the result of high-energy trauma in young patients and minor trauma in elderly patients. Intramedullary nailing (IMN) has been the mainstay for repair and is favorable over fixed angle plating due to greater stability and decreased complications. Many elderly patients with femoral fractures also suffer from other general bone-related comorbidities such as osteoarthritis (OA). Traditionally, concurrent ST femur fractures and severe hip osteoarthritis have been treated separately, but there is growing evidence supporting the use of total hip arthroplasty (THA) as a viable treatment choice. Here the case of a 71-year-old female with a right femoral ST spiral fracture and advanced hip OA is presented. The patient was treated for her fracture and hip OA simultaneously through a THA with a long stem prosthesis and FiberTape cerclage wires. The patient followed up in good condition and was able to ambulate with the assistance of a walker then transitioned to a cane. It is proposed that patients with ST femur fractures and hip OA would significantly benefit from THA as a single procedure, and its consideration is recommended in future cases with similar presentations.

股骨转子下（ST）骨折呈双峰年龄分布，通常是年轻患者高能量创伤和老年患者轻微创伤的结果。髓内钉（IMN）一直是主要的修复方法，与固定角钢板相比，其稳定性更高，并发症更少。许多股骨骨折的老年患者还患有骨关节炎（OA）等其他与骨相关的并发症。传统上，并发 ST 股骨骨折和严重的髋关节骨关节炎是分开治疗的，但越来越多的证据支持将全髋关节置换术（THA）作为一种可行的治疗选择。这里介绍的是一名 71 岁女性的病例，她患有右股骨 ST 螺旋形骨折和晚期髋关节 OA。患者同时接受了骨折和髋关节 OA 的治疗，采用长柄假体和 FiberTape 黏附钢丝进行全髋关节置换术。患者术后情况良好，能够在助行器的帮助下行走，然后过渡到使用拐杖。我们认为，股骨ST段骨折合并髋关节OA的患者可从THA单次手术中显著获益，建议今后在类似病例中考虑采用这种手术。

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引用次数: 0

A hidden duodenal neuroendocrine tumor: A case report 隐匿性十二指肠神经内分泌肿瘤：病例报告

Medical Reports

Pub Date : 2024-11-13 DOI: 10.1016/j.hmedic.2024.100135

Karam Karam , Alaa Taha , Melissa Kyriakos Saad , Khaled Soukarieh , Rafca Challita , Joseph Amara , Elias Fiani , Elias Saikaly

Duodenal neuroendocrine tumor is a rare tumor mostly asymptomatic and found incidentally on radiography or endoscopy. Treatment options include endoscopic or surgical resection. The incidence of D-NET is increasing due to advanced detection techniques. The diagnosis of duodenal neuroendocrine tumor is a challenge due to the vague presenting symptoms. Herein, we report a rare case of duodenal neuroendocrine tumor in a middle-aged woman who presented with recurrent episodes of melena and anemia.

十二指肠神经内分泌瘤是一种罕见的肿瘤，大多无症状，在放射摄影或内窥镜检查中偶然发现。治疗方法包括内镜或手术切除。由于采用了先进的检测技术，D-NET 的发病率正在上升。由于十二指肠神经内分泌肿瘤的症状比较模糊，因此诊断难度很大。在此，我们报告了一例罕见的十二指肠神经内分泌肿瘤病例，患者为一名中年女性，反复出现血便和贫血。

引用次数: 0

Hemorrhagic pre-Descemet’s membrane detachment after nonpenetrating deep sclerectomy 非穿透性深层巩膜切除术后的出血性前脱落

Medical Reports

Pub Date : 2024-11-13 DOI: 10.1016/j.hmedic.2024.100136

Anna Soldevila , Marina García , Halima Berrada Zizzi , Francisco Ruíz Tolosa

Introduction

Hemorrhagic Descemet’s membrane (DM) detachment is a rare complication after glaucoma surgery. Related to nonpenetrating deep sclerectomy (NPDS), it is postulated to be caused due to blood reflux from the Schlemm’s canal or from a hemorrhage originated under the scleral flap. Different therapeutic approaches are described: from observation to Nd:YAG laser, ab interno membranotomy or evacuation through corneal incision. This condition might compromise the patient’s visual acuity so the treatment must be done early.

Case report

A 69-year-old black male underwent a phacoemulsification and a NPDS without incidents. In the early postoperative period, an hemorrhagic pre- Descemet detachment associated to an hemorrhagic bleb and an uncontrolled intraocular pressure (IOP) were observed. A Nd:YAG laser endothelial puncture and a suturolysis were performed without an optimal IOP control. After 10 days, an anterior chamber lavage combined with a needling achieved a complete transparent cornea and a controlled IOP without topical treatment.

Discussion

The pathophysiology of the presented case could be explained by an hemorrhage originated from vessels under the scleral flap due to an elevated intrableb pressure that favored the dissection of the weakest connected site, the DM. A Nd:YAG laser puncture was capital to avoid corneal staining and to lower the pressure from the filtration bleb (FB). Nevertheless, IOP was not controlled because of hypema and fibrosis of the trabeculo-descemetic membrane. After anterior chamber lavage and a needling with piercing of the TDM the IOP normalized and the FB was functional again.

The treatment in a hemorrhagic pre-Descemet detachment is personalized and it is very important to understand the pathophysiology to approach it properly.

导言出血性戴斯麦膜（DM）脱离是青光眼手术后的一种罕见并发症。它与非穿透性深巩膜切除术（NPDS）有关，推测是由于 Schlemm 管的血液回流或巩膜瓣下的出血引起的。目前有多种不同的治疗方法：从观察到 Nd:YAG 激光、ab interno 膜切开术或通过角膜切口排空。这种情况可能会影响患者的视力，因此必须及早治疗。病例报告一位 69 岁的黑人男性接受了超声乳化手术和 NPDS，未发生意外。在术后早期，观察到出血性前去膜脱离，伴有出血眼泡和无法控制的眼压（IOP）。在无法控制眼压的情况下，进行了 Nd:YAG 激光内皮穿刺和缝合术。讨论本病例的病理生理学可以解释为巩膜瓣下血管出血，原因是巩膜瓣内压升高，有利于剥离最薄弱的连接部位--DM。为了避免角膜染色并降低滤过瓣（FB）的压力，医生采用了 Nd:YAG 激光穿刺。然而，由于小梁-止血膜水肿和纤维化，眼压没有得到控制。经过前房灌洗和穿刺 TDM 后，眼压恢复正常，滤过睫状体也恢复了功能。

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引用次数: 0

Gallbladder glandular proliferation mimicking an adenocarcinoma – A case report 胆囊腺增生模拟腺癌--病例报告

Medical Reports

Pub Date : 2024-11-12 DOI: 10.1016/j.hmedic.2024.100132

Tiziana Salviato , Stefania Caramaschi , Giuseppe Esposito , Volkan Adsay

This case report presents a 39-year-old woman with a history of abdominal discomfort, gastroesophageal reflux disease, and previous biliary colic. Radiological investigations suggested a suspicious infundibular lesion in the gallbladder, prompting further examinations including magnetic resonance cholangiopancreatography, endoscopic retrograde cholangiopancreatography, and PET/CT scan. Despite inconclusive findings, the patient underwent robot-assisted cholecystectomy, revealing a fistula between the gallbladder infundibulum, and the common bile duct. Histological examination revealed a complex conglomerate of non-neoplastic processes, including gastric heterotopia, pseudo-pyloric glandular proliferation, and traumatic neuroma-like neural proliferation within the gallbladder wall. Discussion highlights the developmental anomalies and reactive mechanisms potentially underlying these findings, suggesting a connection between gastric heterotopia, glandular proliferation, and neural proliferation. The presence of three different 'pathological entities' in the same case represents the uniqueness of our case report, and the type of growth that sometimes appears to simulate an infiltration is an important element to consider as its misdiagnosis could lead to erroneous considerations and incorrect treatment.

本病例报告介绍了一名 39 岁的女性，她有腹部不适、胃食管反流病和胆绞痛病史。放射学检查提示胆囊内有可疑的胆囊底病变，促使患者接受进一步检查，包括磁共振胰胆管造影、内镜逆行胰胆管造影和 PET/CT 扫描。尽管没有得出结论，患者还是接受了机器人辅助胆囊切除术，结果发现胆囊底和胆总管之间有一个瘘管。组织学检查显示，胆囊壁内有复杂的非肿瘤性过程，包括胃异位、假性幽门腺增生和创伤性神经瘤样神经增生。讨论强调了这些发现背后潜在的发育异常和反应机制，表明胃异位、腺体增生和神经增生之间存在联系。在同一病例中出现三种不同的 "病理实体 "代表了我们病例报告的独特性，而有时看似模拟浸润的增生类型是需要考虑的重要因素，因为误诊可能导致错误的考虑和错误的治疗。

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引用次数: 0

Maintenance Electroconvulsive Therapy (ECT) for the management of bipolar disorder in pregnancy and the post-partum period: A case report 维持性电休克疗法（ECT）用于治疗妊娠期和产后双相情感障碍：病例报告

Medical Reports

Pub Date : 2024-11-04 DOI: 10.1016/j.hmedic.2024.100128

Matthew Batliner , Rebecca Frost , Marnie Welch , Julia Knight

The management of bipolar disorder during pregnancy and in the post-partum period can often be a challenge for psychiatrists. Psychiatrists and patients must consider both the elevated risks of break-through mood episodes during pregnancy and the post-partum period as well as the potential side effects associated with ongoing pharmacotherapy. Electroconvulsive therapy (ECT) may offer an alternative to pharmacotherapy during pregnancy, though there is very limited information on the use of ECT as a monotherapy or maintenance treatment during pregnancy and in the post-partum period. We present a case of 32 year old woman with bipolar disorder who received maintenance ECT without adjunctive mood stabilizing medications throughout her pregnancy, per patient preference. ECT was found to provide adequate mood stabilization with no adverse effects noted throughout the pregnancy. During the post-partum period which coincided with a brief hiatus of ECTs, the patient experienced a manic episode which resulted in hospitalization, an acute ECT course, and re-initiation of mood stabilizing medications. This case provides a framework for considering the role of ECT as a maintenance option for pregnant patients and emphasizes the need for further information on protocols for ECT treatment in the post-partum period.

妊娠期和产后双相情感障碍的治疗往往是精神科医生面临的一项挑战。精神科医生和患者必须同时考虑到妊娠期和产后情绪爆发的高风险，以及持续药物治疗的潜在副作用。电休克疗法（ECT）可能是孕期药物治疗的替代疗法，但有关在孕期和产后使用电休克疗法作为单一疗法或维持疗法的资料非常有限。我们介绍了一例 32 岁的双相情感障碍女性患者，她在整个孕期都根据患者的意愿接受了电痉挛疗法的维持治疗，而没有辅助使用稳定情绪的药物。在整个孕期，电痉挛疗法都能充分稳定情绪，没有发现任何不良反应。产后期间，恰逢电痉挛疗法短暂中断，患者出现躁狂发作，导致住院治疗、急性电痉挛疗法疗程和重新开始服用情绪稳定药物。本病例为考虑将电痉挛疗法作为妊娠期患者的维持治疗方案提供了一个框架，并强调了进一步了解产后电痉挛疗法治疗方案的必要性。

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引用次数: 0

Oral manifestations as the first sign of Granulomatosis with polyangiitis – A case report 作为多血管炎肉芽肿病首发症状的口腔表现--病例报告

Medical Reports

Pub Date : 2024-11-03 DOI: 10.1016/j.hmedic.2024.100129

Yousra Akhlef , Ulrik Ørsø Andersen , Preben Homøe

Granulomatosis with polyangiitis (GPA) is a rare and potentially life-threatening systemic vasculitis characterized by necrotizing granulomatous inflammation of small- to medium-sized vessels. This case reports a unique case of a 38-year-old woman who presents with strawberry gingivitis as the first sign of GPA. The patient was seen in different departments and was finally diagnosed with GPA after a delay of 3 months from the first sign of gingival lesions. The patient did not suffer from any serious complications of this delay besides from tinnitus, reduced hearing and sensitivity to sound. The present case highlights the importance of early recognition of the oral manifestations of GPA in order to start the comprehensive treatment timely for successful outcome.

肉芽肿伴多血管炎（GPA）是一种罕见的、可能危及生命的全身性血管炎，其特征是中小型血管的坏死性肉芽肿炎症。本病例报告了一例独特的病例，患者是一名 38 岁女性，以草莓状牙龈炎作为 GPA 的首发症状。患者曾在不同科室就诊，在出现牙龈病变的第一个征兆后拖延了 3 个月，最终被确诊为 GPA。除了耳鸣、听力下降和对声音敏感之外，患者并没有因延误就诊而出现任何严重的并发症。本病例强调了早期识别 GPA 口腔表现的重要性，以便及时开始综合治疗，获得成功的结果。

引用次数: 0

Deciphering a potential causality between autoimmune atrophic gastritis and Crohn’s disease: A report of two cases 解读自身免疫性萎缩性胃炎与克罗恩病之间的潜在因果关系：两个病例的报告

Medical Reports

Pub Date : 2024-11-03 DOI: 10.1016/j.hmedic.2024.100130

Karam Karam , Houssein Chebbo , Sarah Saleh , Elias Fiani

Autoimmune atrophic gastritis (AAG) is a chronic condition characterized by the atrophy of gastric oxyntic mucosa mediated by anti-parietal cells antibodies. AAG is a pre-neoplastic condition that is conducive to gastric neuroendocrine tumor type I and gastric adenocarcinoma. The diagnosis of AAG is made by a combined serological and histological profile. AAG-induced iron deficiency can lead to iron-deficiency anemia, whereas vitamin B12 deficiency can lead to pernicious anemia. Management of AAG is by replenishment of iron and vitamin B12 deficiencies and endoscopic surveillance. Crohn’s disease is an inflammatory bowel disease that can target any portion of the gastrointestinal tract, with a predilection for the ileo-colonic area. Crohn’s disease is characterized by skipped lesions and transmural involvement. We herein present two cases of AAG occurring in conjunction with Crohn’s disease, unveiling a potential causality between the two entities.

自身免疫性萎缩性胃炎（AAG）是一种由抗顶叶细胞抗体介导的以胃黏膜萎缩为特征的慢性疾病。AAG 是一种肿瘤前病变，容易诱发胃神经内分泌肿瘤 I 型和胃腺癌。AAG 的诊断需要结合血清学和组织学检查。AAG 引起的铁缺乏可导致缺铁性贫血，而维生素 B12 缺乏可导致恶性贫血。治疗 AAG 的方法是补充铁和维生素 B12 的缺乏，并进行内窥镜监测。克罗恩病是一种炎症性肠病，可侵犯胃肠道的任何部位，但偏爱回肠结肠部位。克罗恩病的特点是跳跃性病变和跨膜受累。我们在此介绍两例与克罗恩病同时发生的 AAG 病例，揭示这两种疾病之间的潜在因果关系。

引用次数: 0

US medical education landscape: Now and beyond 美国医学教育格局：现在和未来

Medical Reports

Pub Date : 2024-10-30 DOI: 10.1016/j.hmedic.2024.100127

Farzana Hoque

引用次数: 0

Recurrent cerebral venous thrombosis in a child due to Factor V Leiden mutation leading to activated protein C resistance: A case report 因子 V Leiden 突变导致活化蛋白 C 抗性，导致一名儿童反复出现脑静脉血栓：病例报告

Medical Reports

Pub Date : 2024-10-28 DOI: 10.1016/j.hmedic.2024.100126

S. El Gazzane , G. Jaabouti , S. Aminou , N. El Hafidi , A. Masrar , H. Andour , L. Chat , C. Mahraoui , S. Benchekroun

Background

Because of the Factor V Leiden Mutation, activated protein C resistance is the most common hereditary condition predisposing individuals to venous thrombosis in infancy and childhood. The prevalence of this mutation varies among ethnic groups and geographical regions. Laboratory tests for thrombophilic markers, including Activated Protein C Resistance (APCR) and Factor V Leiden, are essential for diagnosis. While genetic tests are essential for confirming the diagnosis, determining homozygous or heterozygous status, and assessing recurrence risk, coagulation methods often use APCR detection as the primary screening approach.

Case presentation

We describe a 10-year-old North African male patient with recurrent thrombosis of the right internal jugular vein who was found to have protein C resistance. Further genetic testing revealed that the patient is heterozygous for the Factor V Leiden mutation.

Conclusions

This case highlights the importance of considering the Factor V Leiden mutation in pediatric patients presenting with recurrent venous thrombosis. Early detection and accurate diagnosis are critical for effective management and prevention of future thrombotic events.

背景由于因子 V Leiden 突变，活化蛋白 C 抗性是婴幼儿时期最常见的易患静脉血栓的遗传性疾病。这种突变的发生率因种族群体和地理区域而异。嗜血栓标记物的实验室检测，包括活化蛋白 C 抵抗（APCR）和因子 V 莱登（Factor V Leiden），对诊断至关重要。虽然基因检测对于确诊、确定同卵或异卵状态以及评估复发风险至关重要，但凝血方法通常将 APCR 检测作为主要筛查方法。病例介绍我们描述了一名右颈内静脉反复血栓形成的 10 岁北非男性患者，他被发现患有蛋白 C 抗性。进一步的基因检测发现，该患者是因子 V Leiden 突变的杂合子。结论本病例强调了考虑因子 V Leiden 突变对反复出现静脉血栓的儿童患者的重要性。早期发现和准确诊断对于有效治疗和预防未来的血栓事件至关重要。

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引用次数: 0

Intestinal lymphangiectasia secondary to chronic midgut volvulus: A rare childhood presentation case report 继发于慢性中肠下垂的肠淋巴管扩张症：罕见的儿童病例报告

Medical Reports

Pub Date : 2024-10-28 DOI: 10.1016/j.hmedic.2024.100125

Jasmin Martin , Narayanan Venkatasubramani , Nancy McGreal

Intestinal lymphangiectasia (IL) is a rare and unusual condition characterized by the abnormal dilation of lymphatic vessels within the intestines. IL can arise from an intrinsic defect in lymphatic development or as a secondary consequence of factors that obstruct the lymphatic system. In this case study, a 2-year-old child presenting with chronic diarrhea, vomiting, and inadequate weight gain was ultimately diagnosed with IL secondary to chronic volvulus, confirmed by CT abdomen/pelvis and MRI abdomen, with persistent manifestations of protein losing enteropathy requiring two exploratory laparotomies. The condition in this patient was attributed to lymphatic obstruction resulting from recurrent episodes of midgut volvulus, which led to impaired lymphatic drainage and subsequent development of IL. The main takeaway from this case reports is the importance of IL to the differential diagnosis because early abdominal imaging and surgical interventions are lifesaving.

肠道淋巴管扩张症（IL）是一种罕见的异常病症，其特征是肠道内淋巴管异常扩张。肠淋巴管扩张症可能源于淋巴管发育的内在缺陷，也可能是淋巴系统受阻的继发性后果。在本病例研究中，一名 2 岁儿童因长期腹泻、呕吐和体重增加不足而最终被诊断为继发于慢性肠道裂孔的 IL，腹部 CT/骨盆和核磁共振腹部成像证实了这一诊断，该患儿持续表现为蛋白丢失性肠病，需要进行两次探查性开腹手术。该患者的病因是反复发作的中肠肠套叠导致淋巴管阻塞，淋巴管引流受阻，继而发展为IL。本病例报告的主要启示是IL在鉴别诊断中的重要性，因为早期腹部成像和手术干预可以挽救患者的生命。

引用次数: 0

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