International Medical Case Reports Journal最新文献

Cases involving both cerebral infarction due to internal carotid artery occlusion and acute coronary syndrome are clinically rare and challenging to treat. A 50-year-old male patient was admitted to the hospital due to coexistence of internal carotid artery occlusion ischemic stroke and acute coronary syndrome. After coronary angiography and percutaneous coronary intervention (PCI), immediately perform cerebral angiography, followed by right internal carotid artery occlusion balloon dilation and stent formation, intracranial artery thrombectomy, and complete recovery of cerebral blood flow. His condition improved significantly after 15 days, and the weakness of the left limbs and alalia improved a lot. The patient who was followed up for 1 years had stable conditions and was able to take care of himself, with an mRS score of 1. Patients with acute cerebral infarction typically receive rt-PA treatment within 4.5 hours. If head and neck CTA reveals occlusion of a large artery, endovascular therapy can be used as a bridge. The therapeutic sequence of coronary stenting followed by endovascular thrombectomy and carotid artery stenting may have been critical to the patient's favorable clinical outcome. While Antiplatelet aggregation is crucial during the perioperative period of carotid artery stenting or/and coronary stent implantation, its initiation within 24 hours of intravenous thrombolysis must balance efficacy against bleeding risk. Tirofiban represents a potential option during this high-risk period.

The simultaneous occurrence of pure esophageal atresia (EA) and duodenal atresia (DA) is an exceptionally rare congenital anomaly, posing significant diagnostic and surgical challenges. While each condition alone is well-documented, their coexistence is reported in only a small fraction of EA cases, and often necessitates complex, staged interventions. We present a unique case of a neonate with Down Syndrome diagnosed with both pure EA and DA. Intraoperatively, the esophageal segments were found in unexpectedly close proximity, allowing for a tension-free primary anastomosis-an outcome less likely achievable in pure EA which typically has a long-gap. Postoperative imaging confirmed DA, which was subsequently repaired. Despite initial surgical success, the patient experienced a complicated postoperative course and ultimately succumbed to multi-organ failure. This case highlights the diagnostic complexity and high morbidity associated with dual gastrointestinal atresia. Notably, the gastric distension caused by DA appeared to facilitate esophageal approximation, prompting the hypothesis of a novel technique: Gastric Distension-Assisted Esophageal Approximation (GDEA). GDEA proposes pyloric occlusion with monitored physiologic or controlled gastric loading-as a means to approximate esophageal segments in long-gap EA. This approach may offer a new adjunct to existing surgical strategies. The hypothesized GDEA technique, inspired by this case, introduces a potentially transformative concept in the treatment of long-gap EA. We emphasize that GDEA is a speculative hypothesis derived from a single clinical observation and is not supported by experimental or clinical evidence.

Background: Cyclopia is an extremely rare and fatal congenital anomaly in which causes are not commonly known. This condition is marked by the failure of the eye orbits to properly divide, resulting in a single eye field or closely positioned eye fields. There is no specific treatment, and the prognosis is generally poor with most babies dying shortly after birth or during infancy.

Case presentation: These two newborns were born to multiparous mothers, which died soon after birth. Diagnosis was made postpartum with centrally located single eye and long proboscis on the midline of the forehead, with the second had associated with cystic hygroma. Both cases had no other gross visible congenital anomalies on the extremities, abdomen, and head. But other anomalies as renal, central nervous system, cardiac and chromosomal anomalies cannot be excluded.

Conclusion: Both cases had died immediately, and health professionals should experience with detailed antenatal ultrasound scanning to detect these congenital anomalies antepartum for better counseling of patients. Routine antenatal ultrasound assessment is crucial in low resource countries where ultrasound scanning is commonly done in higher health facilities.

Introduction and purpose: Hospitalised older patients are at high risk of functional decline due to prolonged inactivity. Gerontechnology, including robot-assisted physical exercise, may support early mobilisation, but its use in acute hospital settings remains underexplored. This case report provides an in-depth insight into robot-assisted physical exercise in an older patient admitted to a geriatric department, reflecting the clinical setting of geriatric care during acute hospitalisation and highlighting real-world challenges related to engagement and adherence.

Method and materials: As part of an ongoing randomised controlled trial (RCT), this case report includes a 98-year-old woman randomised to active robot-assisted physical exercise. The intervention was offered twice daily during hospital stay. A structured, semi-guided interview was conducted at discharge to explore the patient's experiences, motivation, and perceived impact of the exercise. This report presents a detailed description of the intervention including exercise, progression, adherence and the patient's experience.

Results: The patient described the exercise as engaging, mood-lifting, and beneficial. However, fatigue impacted adherence, resulting in 50% adherence. Functionally, the patient demonstrated increased independence, reflected by an improvement in Barthel Index (0-100, higher scores indicate greater independence) from 57 at admission to 69 at discharge. Chair stand test performance did not change.

Conclusion: Based on this single case, robot-assisted physical exercise was positively perceived, even by a frail, hospitalised older patient. However, fluctuating energy levels highlight the need for flexible, patient-centred strategies. This case provides early insight into feasibility, motivation, and real-world adherence, contributing to understanding how robotic rehabilitation may support early mobilisation. Further evidence from the ongoing RCT will clarify its effectiveness in improving outcomes in this population.

Trial registration: ClinicalTrials.gov NCT05782855.

Background: The etiology of adenomyosis remains uncertain, and factors such as pregnancy, postpartum endometritis, cesarean delivery, uterine surgery, and uterine trauma are suspected to cause myometrial disruption that may trigger smooth muscle hyperplasia.

Case: We present a case of a bicornuate uterus with focal adenomyosis confined to the left hemiuterus in a 43-year-old woman who experienced chronic pelvic pain, severe progressive dysmenorrhea, and secondary infertility for three years. She had previously been diagnosed with a bicornuate uterus during two cesarean sections and had a history of curettage, both of which may have contributed to the localized pathology. After thorough counseling regarding management options, a laparotomy total abdominal hysterectomy was performed primarily for pain relief. The postoperative course was uneventful, and the patient was discharged on the third day with complete resolution of pelvic pain, reporting a visual analogue score of 0/10 at follow-up.

Discussion: Previous caesarean sections and curettage are possible in cases of a bicornuate uterus with adenomyosis pathology of hemiuterus. Pain caused by adenomyosis can be managed with laparotomy total abdominal hysterectomy as a gold standard management.

septic arthritis is the consequence of bacterial aggression of the articular synovium, which can occur during meningitis. We report two cases of arthritis in patients hospitalized for meningitis in the infectious and tropical diseases department of Zinder National Hospital. Two cases admitted initially for meningitis at the Zinder National Hospital, developed secondary localized arthritis. Laboratory confirmation was carried out using QIAstat-Dx Meningitis/Encephalitis Panel kit (QIAGEN) on cerebrospinal fluid and joint fluid for the respective diagnosis of meningitis and arthritis. While Haemophilus influenzae and Neisseria meningitis were confirmed in the cerebrospinal fluid, the presence of Haemophilus influenzae and co-infection with Neisseria meningitis and Streptococcus pyogenes was established in the joint fluid. Both patients were cured after antibiotic treatment and symptomatic management. Meningitis can lead to osteoarticular localization in severe forms. Dual antibiotic therapy may improve the prognosis.

Dysphagia may be caused by stroke, cranial trauma, head and neck tumor surgery, and neurodegeneration. The overall prevalence of dysphagia in China is 38.7%, which can lead to aspiration pneumonia and malnutrition, increasing mortality rates and prolonging hospitalization. As an independent predictor of death, post-stroke dysphagia mortality ranges from 29% to 37%. Indwelling nasogastric tube feeding is widely used for dysphagic patients, but complications include mucosal bleeding, tumefaction, pneumonia, and acid regurgitation. Intermittent nasogastric tubes are an alternative option, though rarely reported. This paper describes a stroke patient with dysphagia and tracheotomy who received intermittent oroesophageal tube feeding. Notably, epiglottis tumefaction caused by the indwelling nasogastric tube disappeared after switching to intermittent oroesophageal tube feeding, with concurrent improvements in nutritional indicators, gastrointestinal tolerance, and swallowing function. To avoid side effects of indwelling nasogastric tubes in dysphagic patients, intermittent oroesophageal tube feeding deserves clinical consideration.

Introduction: Gestational trophoblastic neoplasia (GTN) is a highly curable malignancy, but cases arising after abortion are uncommon and often diagnosed late. We report a recurrent high-risk GTN following abortion that relapsed multiple times despite etoposide-methotrexate-actinomycin D/cyclophosphamide-vincristine (EMA/CO).

Case report: A 26-year-old woman achieved initial remission with six cycles of EMA/CO but experienced several recurrences from 2021 to 2023. She presented again with rising β-hCG (16,925.8 mIU/mL) and an intrauterine mass. Paclitaxel/cisplatin alternating with paclitaxel/etoposide (TP/TE) was given for six cycles plus two consolidation cycles, resulting in complete remission. β-hCG normalized by January 2024 and remained undetectable for 12 months.

Conclusion: This case highlights diagnostic challenges of post-abortion GTN and shows that TP/TE is an effective and well-tolerated salvage option for recurrent or EMA/CO-resistant GTN. Long-term β-hCG surveillance is essential to ensure durable remission and assess fertility outcomes.

Gastric-type endocervical adenocarcinoma (G-EAC), an uncommon HPV-negative mucinous adenocarcinoma of gastric pyloric-type epithelial differentiation, represents a significant diagnostic challenge due to its insidious etiology and vague clinical presentation. The anatomic depth of lesions within the endocervical canal frequently makes suboptimal biopsy samples both responsible for decreased diagnostic sensitivity and repeated false-negative biopsies delaying early detection. Most of the cases are diagnosed at late stages with frequent extrapelvic metastases, and these are linked with poor clinical outcomes. This case report retrospectively examines the clinicopathological characteristics, pitfalls in diagnosis, and treatment strategies for G-EAC to ensure better identification and management of this virulent neoplasm.

Hashimoto's thyroiditis (HT) is a chronic autoimmune disease with lymphocytic infiltration of the thyroid gland and autoantibodies against endogenous components. A 45-year-old male professor at an academic institution with positive family history for autoimmune diseases among his brother and sister came to clinical hospital because of unspecific systemic symptoms, elevated TSH, low normal Free T4 (fT4), positivity autoantibodies against the thyroid gland. The biochemical signs of inflammatory process were shown in a report and image form ultrasound of thyroid gland, this indicates enlargement and thyroiditis. The case was diagnosed by elevated TSH, positive anti-TPO and thyroid ultrasound as subclinical stage of HT. The treating physician had prescribed 50 micrograms levothyroxine per day with selenium and zinc supplements. The case emphasizes early detection and integrative management based on our experience about importance for interdisciplinary diagnostics when it comes to autoimmune thyroiditis together with multi-system involvement and non-specific complaints.