International Medical Case Reports Journal最新文献

Deep brain stimulation (DBS) is an effective treatment for medically refractory essential tremor (ET) and Parkinson's disease. We present the case of a patient treated with thalamic DBS for ET who developed a large right peri-lead cyst with associated edema three months postoperatively, causing symptoms of dysarthria and left-sided weakness. The patient was treated nonoperatively with a course of steroids and serial observation. Over three months, the cyst regressed in size, with resolution of the associated symptoms. The patient was ultimately able to continue bilateral DBS for ET, which provided relief from upper-extremity tremor. By 9 months after the cyst was diagnosed (one year postoperatively from DBS) he was fully recovered back to baseline. We review other cases of peri-lead cysts and edema, of which etiology and presentation remain varied and unclear. Peri-lead cysts are a rare complication of DBS with an estimated incidence of 0.8%. Ultimately, this case shows that appropriately selected peri-lead cysts may be managed nonoperatively, allowing for continued DBS benefit in patients by avoiding lead removal.

Background: In clinical scenarios like wisdom tooth extractions, compressed air may infiltrate tissue gaps or venous vessels. We observed a patient who developed a pulmonary air embolism secondary to subcutaneous emphysema (SE) during a wisdom tooth extraction performed with an air turbine. The patient required immediate cardiopulmonary resuscitation (CPR) and was successfully revived from pulseless electrical activity (PEA).

Case description: This case was a 47-year-old female, and upper and lower pericoronitis on the right side and multiple dental caries were noted. Due to her intellectual disabilities (ID), so the extraction of the upper and lower right wisdom teeth was scheduled under general anesthesia. At approximately 10 minutes after starting the oral surgery, the monitor showed plethysmograph and the end-tidal carbon dioxide (E_TCO₂) waveform disappeared following the sudden drop in SpO₂. Based on these findings, cardiopulmonary arrest (CPA) was diagnosed, and PEA was confirmed on the ECG. CPR was immediately initiated on the dental unit. However, because the dental unit remained in a supine position, it sank with each chest compression. To stabilize the surface and prevent vertical movement, a dental chair was placed under the backrest of the dental unit. Approximately 3 minutes after starting CPR, the SpO₂ plethysmograph reappeared on the monitor during artificial ventilation. A CT scan was performed, and she was diagnosed pulmonary air embolism resulting from SE caused by the use of an air turbine with compressed air.

Conclusion: This case highlights that SE can easily occur when using an air turbine with compressed air in dental procedures. In severe instances, an air embolism resulting from SE may lead to CPA. Therefore, caution is needed when using dental instruments and drills that utilized compressed air during dental procedures.

Patients with cerebral palsy may have intellectual disabilities, convulsions, scoliosis, or thoracic deformities. Scoliosis is a complex deformity of the spine resulting in secondary involvement of the respiratory, cardiovascular and neurologic systems which may affect the anesthesia for those patients We reported a case of a 17-year-old female with cerebral palsy and severe scoliosis who presented for dental caries operation under general anesthesia. General anesthesia was conducted, difficult airway management sets have been prepared, and pressure control ventilation to minimize peak airway pressure was adopted. Anesthetic management was performed without anesthesia-related complications. We recognize that considerable attention is required in patients with cerebral palsy. Perioperative management and general anesthesia of patients with cerebral palsy who have severe scoliosis represent significant challenges. Multidisciplinary approach through team included surgeons, anesthesiologists, neurophysiologists, pediatricians, nurses, nutritionists, and physiotherapists is required.

Trichotillomania disorder is a psychiatric condition characterized by recurrent hair-pulling behaviors that result in substantial distress or impairment. Comorbidity between trichotillomania and adult attention-deficit/hyperactivity disorder (ADHD) is challenging, and an increasing body of evidence suggests a neurobiological overlap between the two conditions, particularly in the areas of executive functioning and inhibitory control. Atomoxetine is a selective norepinephrine reuptake inhibitor approved for ADHD by the Food and Drug Administration (FDA). It has been recommended for ADHD patients comorbid with anxiety disorders. Although most people can tolerate atomoxetine, there have been reports of uncommon side effects, such as sexual problems. This case report describes a 37-year-old man diagnosed initially with trichotillomania and generalized anxiety disorder and started on fluoxetine 20 mg for six weeks with substantial symptoms improvement of both disorders. Unfortunately, the patient exhibited increased impulsivity and irritability, which hindered his daily life functioning. Given this paradoxical response, fluoxetine was terminated. A multisession reassessment revealed lifelong ADHD with inattention, disorganization, emotional dysregulation, and impulsiveness. Consequently, Atomoxetine initiation/titration (25→75 mg) was attempted; however, he experienced spontaneous seminal discharge 6 weeks later. The assessment and workup included a normal urologic exam. We systematically evaluated potential infectious, inflammatory, and endocrine causes, checking testosterone, prolactin, LH/FSH, TSH, and urinalysis, all of which fell within the reference ranges. Subsequently, Atomoxetine was gradually withdrawn, and this rare side effect, seminal discharge, resolved within five days post-cessation of the medicine. After three months of monitoring, we re-evaluated ADHD and trichotillomania, adjusted the therapy, and observed that there was no recurrence of symptoms. This instance shows the importance of careful monitoring for rare side effects in people with complex psychiatric comorbidities.

Introduction: Nonsteroidal anti-inflammatory drugs (NSAIDs) are widely used perioperatively and postoperatively in ocular inflammation and pain management. However, NSAIDs may cause ocular adverse effects. Postsurgical complications, including corneal stromal inflammation with or without epithelial ulceration and stromal melts, have been reported after anterior segment surgery, such as cataract surgery, penetrating keratoplasty, and photorefractive keratectomy. However, these drugs are also frequently used in vitreoretinal surgery for several indications, including the prevention and treatment of postoperative cystoid macular edema.

Case presentation: A 61-year-old man with rheumatoid arthritis, with no prior history of ocular surface disease, underwent uneventful combined phacovitrectomy in the right eye for macular pucker and cataract. Postoperatively, diclofenac 0.1% was added to the topical therapy. Within two weeks, the patient reported blurred vision and discomfort. Slit-lamp examination showed diffuse corneal edema with Descemet's membrane striae and a large epithelial defect with stromal ulceration in the inferior paracentral cornea. Best-corrected visual acuity (BCVA) dropped to counting fingers. Corneal topography revealed a wide thinning area. Diclofenac was immediately discontinued, and treatment with preservative-free dexamethasone 0.15%, ofloxacin 0.3%, and artificial tears was initiated. During follow-up, progressive improvement was observed with reduction of corneal opacity and thinning, along with recovery of BCVA. At the final visit, anterior segment OCT confirmed complete re-epithelization, a hyperreflective anterior stromal band, and mild residual thinning. BCVA improved to 20/20 with refractive correction (-3.50 sphere -3.25 cylinder axis 10).

Conclusion: Corneal melting has usually been described after anterior segment surgeries. Our case highlights the need for caution in the postoperative use of topical NSAIDs, particularly diclofenac, also in vitreoretinal surgery. Patients with autoimmune diseases, such as rheumatoid arthritis, may be at higher risk of adverse corneal effects, and careful consideration should be given when prescribing NSAIDs in this context.

Background: While upper gastrointestinal ulcers are a common condition in adults, with well-established surgical approaches such as Billroth I, Billroth II, and Roux-en-Y (RY) reconstruction, their occurrence in the pediatric population is markedly less common and presents distinct diagnostic and management challenges. Consequently, surgical intervention for pediatric ulcers remains relatively infrequent and less studied. Although procedures like Billroth I, Billroth II, and RY are technically feasible options, there is a notable lack of robust evidence and specific guidelines to inform optimal surgical management strategies tailored specifically for children.

Case presentation: We report the treatment of a 13-year-old female patient with a duodenal bulbar ulcer leading to scar stenosis, who was managed with a laparoscopic subtotal gastrectomy and gastro-jejunal Roux-en-Y anastomosis. The patient demonstrated excellent growth and development over a three-year follow-up period, with no significant early or long-term complications.

Conclusion: Although severe complications of peptic ulcer disease (PUD) are uncommon in the pediatric population, gastric resection combined with Roux-en-Y anastomosis represents a safe and efficacious surgical strategy for refractory cases. In this report, we compare the Roux-en-Y procedure with other reconstructive methods, such as Billroth I and II, and discuss the indications and outcomes of various surgical therapies for upper gastrointestinal ulcers in children. We advocate for Roux-en-Y anastomosis as the preferred surgical method for treating complicated upper gastrointestinal ulcers in children, primarily due to its superior long-term outcomes in preventing bile reflux and residual gastritis.

Objective: To present an extremely rare case of atlantoaxial spondyloptosis in a neglected case of odontoid fracture, type-2, with complete anterior displacement. The surgical approach in such cases are always challenging.

Background: C2 fractures are the most common type of spinal traumatic injury. Among them, odontoid fracture represents the most variable and complicated C2 fractures. When non-operative management is planned, close follow-up and patient compliance are mandatory. Neglecting these cases can lead to complications such as malunion, nonunion and subluxation, of which, atlantoaxial spondyloptosis is the most severe form.

Presentation of case: The patient was a 20-year-old male with the chief complaint of neck pain, progressive quadriparesis, and gait disturbance since 8 months prior to presentation, with Japanese orthopedic association score of 11. Imaging studies showed anterior non-reducible, malunited atlantoaxial spondyloptosis, associated with a type-II odontoid fracture.

Methods: The patient underwent open reduction and posterior atlantoaxial instrumented fusion using Harm's technique. One-year Follow-up examination and imaging evaluations revealed complete neurological recovery, with Japanese orthopedic association score of 15, and complete fusion in normal alignment.

Conclusion: A posterior-only approach for the management of atlantoaxial spondyloptosis with malunited type-2 odontoid fracture is associated with lower morbidity and fewer complications than anterior or combined approaches, while still achieving all surgical goals. The integrity of the transverse ligament is mandatory in such cases.

Background: Immune thrombocytopenic purpura (ITP) is an autoimmune disorder characterized by low platelet counts, typically presenting with mucocutaneous bleeding. Bernard-Soulier Syndrome (BSS) is a rare inherited platelet disorder associated with thrombocytopenia, giant platelets, and impaired platelet function.

Case report: We present the case of an 8-year-old girl presenting with recurrent epistaxis, mucosal bleeding, and thrombocytopenia. Genetic analysis revealed a heterozygous germline ETV6 mutation associated with thrombocytopenia and leukemia risk, and a GP1BB mutation diagnostic of BSS. She was managed with intravenous immunoglobulin (IVIG) and corticosteroids; Eltrombopag was discontinued due of leukemic risk. The patient's platelet counts stabilized with supportive management and she remains clinically stable without recurrent severe bleeding.

Conclusion: The purpose of this case report is to illustrate the diagnostic challenges and therapeutic considerations in children with coexisting acquired (ITP) and inherited (BSS) thrombocytopenias, particularly in the presence of a leukemogenic predisposition gene (ETV6). This case underscores the importance of comprehensive genetic evaluation in guiding individualized therapy and long-term surveillance.

Hemosuccus pancreaticus (HP) is a rare cause of upper gastrointestinal (GI) bleeding, characterized by bleeding into the GI tract via the pancreatic duct and major papilla. It often occurs in conjunction with chronic pancreatitis and the development of pseudoaneurysms in the vessels near the pancreas. This association is attributed to the close proximity of these vessels, such as the splenic and gastroduodenal arteries, to the pancreatic parenchyma and duct, making them susceptible to pancreatic enzyme damage. The patient was a 50-year-old male with a known history of chronic alcoholism and pancreatitis who had recurrent admissions due to abdominal pain, hematemesis, melena stools, early satiety, and anemia. On admission, his hemoglobin level was 3.6 g/dL, and he exhibited deranged liver function test results. Contrast-enhanced abdominal CT done showed a complex, heterodense mass in the pancreatic head.

Background: Thyroid tuberculosis (TTB), either in its primary or secondary form, is a rare occurrence, even in recent years, with a high incidence of tuberculosis in China. Nowadays, with the increasing morbidity of thyroid nodules, it is apt to be misdiagnosed with malignant tumors. In this case, a suspicious malignant lesion was found on thyroid ultrasound (US), but the result after the surgery showed TTB.

Case presentation: This article reported a 67-year-old woman who was found left thyroid nodules during a physical examination three month ago. Thyroid US showed two suspicious hypoechoic lesions in the left thyroid gland and diagnosed as Chinese Thyroid Imaging Reporting and Data System. (C-TI-RADS) 4A category. The patient underwent US-guided fine needle aspiration of the two lesions, the results of which showed that suspected malignant tumors were not excluded. The patient underwent a left thyroidectomy and central group lymph node dissection. Postoperative pathological examination showed granulomatous inflammation with caseous necrosis in the thyroid gland, and diagnosed as tuberculosis. The patient had nonspecific clinical symptoms, no history of exposition, and no pulmonary involvement. Subsequently, the patient visited the tuberculosis specialist outpatient clinic for treatment.

Conclusion: This case report aims to enhance clinicians' awareness of TTB. With the increasing detection rate of thyroid nodules in US, it is crucial to distinguish between benign and malignant ones. TTB is often overlooked. Considering the existence of tuberculosis, unnecessary surgical treatment can be avoided.