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Use of scaffolds based on polyetheretherketone tubular implant in the treatment of a gunshot multifragmentary fracture of the proximal part of the shoulder with a bone defect: a case report. 使用基于聚醚醚酮管状植入物的支架治疗肩部近端骨缺损的枪伤性多发骨折:病例报告。
IF 0.9 Q3 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-10-26 DOI: 10.1186/s13256-024-04727-5
Oleksandr Buryanov, Igor Lurin, Bazarov Murat, Yurii Yarmoliuk, Artem Bespalenko, Oleg Smyk, Yurii Klapchuk, Dmytro Los

Background: In connection with the war in Ukraine and the use of modern high-energy weapons by the enemy, the nature of injuries have changed. These changes require improvement of approaches to the treatment of patients with gunshot and mine-explosive bone defects.

Case presentation: We present the case of treatment of a 28-year-old Ukranian man with a gunshot multifragmentary fracture of the proximal humerus with a bone defect using three-dimensional printing of a polyetheretherketone frame (scaffold) for alloplastic material. The analysis of this case expands the possibilities of using three-dimensional printing technologies of polyetheretherketone scaffolds in the treatment of significant bone defects.

Conclusion: Modern military trauma requires individualized treatment for each patient. The use of individual polyetheretherketone scaffolds in the treatment of a gunshot multifragmentary fracture with a bone defect has a positive clinical effect.

背景:由于乌克兰战争和敌方使用现代高能武器,伤害的性质发生了变化。这些变化要求改进治疗枪伤和地雷爆炸骨缺损患者的方法:我们介绍了一例使用三维打印聚醚醚酮框架(支架)异体材料治疗肱骨近端枪伤多段骨折伴骨缺损的 28 岁乌克兰男子的病例。对该病例的分析拓展了利用聚醚醚酮支架三维打印技术治疗重大骨缺损的可能性:结论:现代军事创伤需要对每位患者进行个性化治疗。使用单个聚醚醚酮支架治疗伴有骨缺损的枪击多段骨折具有积极的临床效果。
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引用次数: 0
Dextrocardia with complete atrioventricular block-the right clinical approach to pace a heart on the right hemithorax: a case report. 右心室扩张伴完全性房室传导阻滞--右心室心脏起搏的正确临床方法:病例报告。
IF 0.9 Q3 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-10-26 DOI: 10.1186/s13256-024-04854-z
Ralph Abi Nader, Mikhael Kossaify, Antoine Kossaify

Background: A heart positioned on the right side of the thorax can be more a complex situation than it seems, also the potentially associated congenital cardiopathies are variable. In this regard, patients with dextrocardia presenting with complete atrioventricular block require a thorough anatomical investigation to map the veno-arterial system and potential cardiovascular defects before proceeding with a permanent pacing procedure.

Case presentation: A 73-year-old Caucasian woman with no significant medical history presented with syncope. Physical examination showed regular heart sounds with an average heart rate of 35-40 beats per minute and no other relevant physical findings. Chest X-rays revealed a heart positioned in the right hemithorax. A standard electrocardiogram revealed complete atrioventricular block with junctional escape rhythm at nearly 35-40 beats per minute. A transthoracic echocardiogram showed a mirror image dextrocardia without any other remarkable abnormalities. Venogram performed using the left peripheral cephalic vein showed normal venous return into the right atrium positioned on the left side. Surgical intervention consisted of permanent dual chamber pacemaker implantation using the left subclavian vein. Discussion is provided based on the relevant medical literature outlining different potential scenarios with associated cardiac and major vessels abnormalities.

Conclusion: This case highlights an atypical presentation of atrioventricular block in a patient with dextrocardia and situs inversus, for whom a successful dual-pacemaker implantation procedure was performed.

背景:心脏位于胸腔右侧的情况比想象的要复杂得多,而且可能伴有的先天性心脏病也多种多样。因此,对于出现完全性房室传导阻滞的右心室缺血患者,在进行永久性起搏手术之前,需要进行彻底的解剖检查,以确定静脉-动脉系统和潜在的心血管缺陷:一名73岁的白种女性因晕厥前来就诊,无明显病史。体格检查显示心音规则,平均心率为每分钟 35-40 次,无其他相关体格检查结果。胸部 X 光片显示心脏位于右侧半胸。标准心电图显示完全性房室传导阻滞,交界性逸搏心律,每分钟近 35-40 次。经胸超声心动图显示为镜像右心室,无其他明显异常。使用左侧外周头静脉进行的静脉造影显示,位于左侧的右心房静脉回流正常。手术治疗包括通过左锁骨下静脉植入永久性双腔起搏器。本文根据相关医学文献进行了讨论,概述了与心脏和大血管异常相关的不同潜在情况:本病例强调了心室传导阻滞在右心室突出和坐位不正患者中的非典型表现,并为其成功实施了双起搏器植入手术。
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引用次数: 0
Bilateral adrenal hemorrhage in a postpartum woman with multiple thromboemboli: A case report. 一名患有多发性血栓栓塞的产后妇女双侧肾上腺出血:病例报告。
IF 0.9 Q3 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-10-25 DOI: 10.1186/s13256-024-04834-3
Anna Yi Nan Jiang, Joshua Haron Abasszade, Timothy Abrahams, Kirollos Nan, Michael Sze Yuan Low, Sara Laura Barnes, Ann Nee Lim, Jimmy Zhen Long Shen

Background: Bilateral adrenal hemorrhage is a rare but often a fatal cause of primary adrenal insufficiency that can result in adrenal crisis if not identified and managed appropriately.

Case presentation: We present a case of a 27-year-old Caucasian female who was admitted to the hospital 17 days postpartum with pleuritic chest and flank pain, shortness of breath and nausea. Computed tomography imaging confirmed multiple thromboemboli including pulmonary emboli and noted bilateral bulky adrenal glands. She was managed for infection and pulmonary emboli; however, she complained of persistent headaches, nausea, and vomiting despite appropriate management. Radiology re-review found the computed tomography imaging was consistent with bilateral adrenal hemorrhage in hindsight. Subsequent endocrine evaluation with hypothalamic-pituitary-adrenal axis interrogation and adrenocorticotropic hormone (Synacthen) stimulation testing confirmed resultant primary adrenal insufficiency. She required urgent intravenous hydrocortisone and was subsequently discharged on oral adrenal replacement therapy and anticoagulation.

Conclusions: Delay in identification and treatment of adrenal insufficiency can lead to catastrophic outcomes. This case highlights the challenge of diagnosing bilateral adrenal hemorrhage and resultant adrenal insufficiency as patients may not present with the classic risk factors, signs, symptoms, and electrolyte derangements.

背景:双侧肾上腺出血是原发性肾上腺功能不全的一种罕见病因,但往往是一种致命病因,如果不能及时发现和妥善处理,可导致肾上腺危象:本病例为一名 27 岁的白种女性,因胸膜炎性胸部和侧腹疼痛、气短和恶心于产后 17 天入院。计算机断层扫描成像证实了多处血栓栓塞,包括肺栓塞,并发现双侧肾上腺肿大。她因感染和肺栓塞接受了治疗;然而,尽管接受了适当的治疗,她仍抱怨持续头痛、恶心和呕吐。放射科再次复查后发现,计算机断层扫描成像结果与双侧肾上腺出血一致。随后通过下丘脑-垂体-肾上腺轴检查和促肾上腺皮质激素(Synacthen)刺激试验进行了内分泌评估,结果证实为原发性肾上腺功能不全。她需要紧急静脉注射氢化可的松,随后在口服肾上腺替代疗法和抗凝治疗后出院:结论:肾上腺功能不全的诊断和治疗延误可导致灾难性后果。本病例凸显了诊断双侧肾上腺出血和由此导致的肾上腺功能不全所面临的挑战,因为患者可能不会出现典型的危险因素、体征、症状和电解质紊乱。
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引用次数: 0
A 39-year-old woman with transient convulsions and vision disturbances: a case report. 一名 39 岁女性的一过性抽搐和视力障碍:病例报告。
IF 0.9 Q3 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-10-25 DOI: 10.1186/s13256-024-04811-w
Jing Fan, Taojiang Chen, Pian Wang, Tao Hai, Wei Li, Yan Wang

Background: Posterior reversible encephalopathy syndrome is a rare neurological syndrome that refers to reversible subcortical vasogenic brain edema disorder in patients with acute neurological symptoms.

Case presentation: Whether there is a direct causal relationship between pancreatitis and posterior reversible encephalopathy syndrome needs further study. We here report a 39-year-old Chinese woman who was diagnosed with pancreatitis followed by vision disturbance. The patient was finally diagnosed with posterior reversible encephalopathy syndrome. On the basis of this rare case, we analyzed the causes of visual disturbance and proposed diagnostic ideas.

Conclusions: For posterior reversible encephalopathy syndrome, early identification and treatment of the primary disease are particularly important. Imaging and clinical characteristics in posterior reversible encephalopathy syndrome are usually reversible.

背景:后可逆性脑病综合征是一种罕见的神经系统综合征:后可逆性脑病综合征是一种罕见的神经系统综合征,是指具有急性神经系统症状的患者出现可逆性皮层下血管源性脑水肿障碍:胰腺炎与后可逆性脑病综合征之间是否存在直接因果关系尚需进一步研究。我们在此报告一名 39 岁的中国女性,她被诊断为胰腺炎,随后出现视力障碍。患者最终被诊断为后可逆性脑病综合征。在这一罕见病例的基础上,我们分析了视力障碍的原因,并提出了诊断思路:结论:对于后可逆性脑病综合征,早期发现和治疗原发病尤为重要。后可逆性脑病综合征的影像学和临床特征通常是可逆的。
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引用次数: 0
Secondary acute angle closure glaucoma after 25-gauge pars plana vitrectomy for a macular hole: a case report. 25号玻璃体旁切除术治疗黄斑孔后继发急性闭角型青光眼:病例报告。
IF 0.9 Q3 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-10-24 DOI: 10.1186/s13256-024-04859-8
Shigefumi Takahashi, Suguru Nakagawa, Kiyoshi Ishii

Background: Posterior synechiae of the iris rarely cause secondary angle-closure glaucoma after pars plana vitrectomy, mainly reported in cases with high postoperative inflammation. The face-down position with gas tamponade can cause acute angle-closure glaucoma in phakic eyes owing to relative pupillary block. This report presents a rare case of pseudophakic eye with secondary acute angle-closure glaucoma after 25-gauge pars plana vitrectomy and long-term vitreous gas tamponade for a macular hole.

Case presentation: A 61-year-old Japanese female patient presented with a chief complaint of right-sided visual impairment that had persisted for several months. Slit-lamp examination revealed deep anterior chamber and moderate nuclear sclerotic cataracts in both eyes. The axial length of the eye was 23.53 mm right eye and 24.05 mm left eye, and the fundus examination revealed a full-thickness macular hole (stage 3) in the right eye. The patient underwent simultaneous cataract surgery and pars plana vitrectomy with 7-mm diameter 3-piece monofocal intraocular lens implantation, internal limiting membrane peeling, and air tamponade. There were no complications during surgery. Due to non-closure of the macular hole, a second pars plana vitrectomy with internal limiting membrane inverted flap and SF6 gas tamponade was performed 13 days later. The patient maintained face-down position after both surgeries, and 6 days after the second surgery, intraocular pressure was elevated to 53 mmHg, and acute angle-closure glaucoma with iris bombe was diagnosed in the right eye. A laser peripheral iridotomy was performed, resulting in a deepened anterior chamber, normalized intraocular pressure, and a closed macular hole.

Conclusions: This case presents a rare occurrence of secondary acute angle-closure glaucoma in a pseudophakic eye after 25-gauge minimally invasive pars plana vitrectomy and SF6 gas tamponade for macular hole. The cause was presumed to be posterior synechiae of the iris or relative pupillary block due to forward pushing of the intracapsular intraocular lens by vitreous gas. In cases where surgery is repeated without achieving macular hole closure, necessitating long-term face-down position, where vitreous gas is retained for an extended period, or when a large-diameter intraocular lens is implanted, secondary acute angle-closure glaucoma should be considered. This applies even when the 25-gauge pars plana vitrectomy is performed not for a highly invasive proliferative diabetic retinopathy but for macular hole repair, especially if the patient has a pseudophakic eye.

背景:虹膜后膜裂孔很少在玻璃体旁切除术后引起继发性闭角型青光眼,主要见于术后炎症较重的病例。由于瞳孔相对阻滞,面朝下体位加气体填塞可导致法眼急性闭角型青光眼。本报告介绍了一例罕见的假性法眼并继发急性闭角型青光眼的病例,患者因黄斑孔而接受了25号玻璃体旁切除术和长期玻璃体气体填塞术:一名 61 岁的日本女性患者主诉右侧视力受损,且已持续数月。裂隙灯检查发现双眼均有深前房和中度核硬化性白内障。眼轴长度为右眼 23.53 毫米,左眼 24.05 毫米,眼底检查发现右眼有一个全厚黄斑孔(3 期)。患者同时接受了白内障手术和玻璃体旁切除术,并植入了直径 7 毫米的三片式单焦人工晶体,剥离了内限制膜,并进行了空气填塞。手术期间没有出现并发症。由于黄斑裂孔没有闭合,13 天后进行了第二次玻璃体旁切除术,同时进行了内限制膜倒瓣和 SF6 气体填塞。两次手术后患者都保持面朝下的姿势,第二次手术后 6 天,眼压升高至 53 mmHg,诊断为右眼急性闭角型青光眼伴虹膜弹出。患者接受了激光周边虹膜切开术,术后前房加深,眼压恢复正常,黄斑孔闭合:本病例是一例罕见的假性视网膜眼在接受25号微创玻璃体旁切除术和SF6气体填塞治疗黄斑孔后继发急性闭角型青光眼的病例。其原因被推测为虹膜后合或玻璃体气体前推囊内晶状体导致的相对瞳孔阻滞。如果重复手术仍无法实现黄斑孔闭合,需要长期面朝下体位,玻璃体气体长期滞留,或植入大直径眼内晶状体,则应考虑继发性急性闭角型青光眼。即使进行25号玻璃体旁切除术不是为了治疗侵袭性极强的增殖性糖尿病视网膜病变,而是为了修复黄斑裂孔,尤其是如果患者是假性视网膜病变眼,也应考虑到这一点。
{"title":"Secondary acute angle closure glaucoma after 25-gauge pars plana vitrectomy for a macular hole: a case report.","authors":"Shigefumi Takahashi, Suguru Nakagawa, Kiyoshi Ishii","doi":"10.1186/s13256-024-04859-8","DOIUrl":"10.1186/s13256-024-04859-8","url":null,"abstract":"<p><strong>Background: </strong>Posterior synechiae of the iris rarely cause secondary angle-closure glaucoma after pars plana vitrectomy, mainly reported in cases with high postoperative inflammation. The face-down position with gas tamponade can cause acute angle-closure glaucoma in phakic eyes owing to relative pupillary block. This report presents a rare case of pseudophakic eye with secondary acute angle-closure glaucoma after 25-gauge pars plana vitrectomy and long-term vitreous gas tamponade for a macular hole.</p><p><strong>Case presentation: </strong>A 61-year-old Japanese female patient presented with a chief complaint of right-sided visual impairment that had persisted for several months. Slit-lamp examination revealed deep anterior chamber and moderate nuclear sclerotic cataracts in both eyes. The axial length of the eye was 23.53 mm right eye and 24.05 mm left eye, and the fundus examination revealed a full-thickness macular hole (stage 3) in the right eye. The patient underwent simultaneous cataract surgery and pars plana vitrectomy with 7-mm diameter 3-piece monofocal intraocular lens implantation, internal limiting membrane peeling, and air tamponade. There were no complications during surgery. Due to non-closure of the macular hole, a second pars plana vitrectomy with internal limiting membrane inverted flap and SF6 gas tamponade was performed 13 days later. The patient maintained face-down position after both surgeries, and 6 days after the second surgery, intraocular pressure was elevated to 53 mmHg, and acute angle-closure glaucoma with iris bombe was diagnosed in the right eye. A laser peripheral iridotomy was performed, resulting in a deepened anterior chamber, normalized intraocular pressure, and a closed macular hole.</p><p><strong>Conclusions: </strong>This case presents a rare occurrence of secondary acute angle-closure glaucoma in a pseudophakic eye after 25-gauge minimally invasive pars plana vitrectomy and SF6 gas tamponade for macular hole. The cause was presumed to be posterior synechiae of the iris or relative pupillary block due to forward pushing of the intracapsular intraocular lens by vitreous gas. In cases where surgery is repeated without achieving macular hole closure, necessitating long-term face-down position, where vitreous gas is retained for an extended period, or when a large-diameter intraocular lens is implanted, secondary acute angle-closure glaucoma should be considered. This applies even when the 25-gauge pars plana vitrectomy is performed not for a highly invasive proliferative diabetic retinopathy but for macular hole repair, especially if the patient has a pseudophakic eye.</p>","PeriodicalId":16236,"journal":{"name":"Journal of Medical Case Reports","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11515588/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142502128","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Gossypiboma with enterocutaneous fistula after cesarean section: a case report and review of the literature. 剖腹产后伴有肠瘘的绞窄性肛瘘:病例报告和文献综述。
IF 0.9 Q3 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-10-23 DOI: 10.1186/s13256-024-04783-x
Leta Hinkosa Dinsa, Betel Bogale Workineh, Chala Regassa Hunde

Introduction: Although precautions taken for surgical procedures are strict and effective in most operative theaters, the incidence of retained foreign bodies following surgery has a reported rate of 0.01-0.001%, of which gossypibomas make up 80% of cases.

Case presentation: A 42-year-old woman who was Oromo in ethnicity came to the hospital with symptoms of infection, including pus drainage from her lower abdominal incision, fever, chills, and weight loss. Tests indicated an intraabdominal mass consistent with a foreign body from a previous surgery. An exploratory laparotomy revealed a surgical pack causing intestinal perforations. The foreign body was removed, and the patient recovered well postoperatively.

Conclusion: Retained surgical items are serious problems of surgical operations that can result in morbidity and mortality. Therefore, it should be among the differential diagnoses of any abdominal pain in patients having a history of prior surgery.

导言:尽管大多数手术室在手术过程中都采取了严格有效的预防措施,但据报道,手术后异物残留的发生率为 0.01%-0.001%,其中肉芽肿占 80%:一名 42 岁的奥罗莫族妇女因感染症状(包括下腹部切口流脓、发烧、发冷和体重减轻)来医院就诊。检查结果显示,腹腔内肿块与之前手术中的异物一致。探查性开腹手术显示,手术包导致肠穿孔。异物被取出,患者术后恢复良好:结论:手术遗留物是外科手术中的严重问题,可导致发病率和死亡率。因此,对于有手术史的腹痛患者,应将其列为鉴别诊断之一。
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引用次数: 0
Circadian re-set repairs long-COVID in a prodromal Parkinson's parallel: a case series. 帕金森并发症前兆中的昼夜节律重设修复长COVID:一个病例系列。
IF 0.9 Q3 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-10-23 DOI: 10.1186/s13256-024-04812-9
Gregory L Willis, Takuyuki Endo, Saburo Sakoda

Background: In this case series, results from daily visual exposure to intense polychromatic light of 2000 to 4000 LUX is presented. Bright light treatment is a standard procedure for treating seasonal affective disorder and prodromal Parkinson's disease with high success. With the post-encephalitic symptoms of long-COVID closely approximating those of prodromal Parkinson's disease, we treated insomnia and sleep-related parameters in these patients, including total sleep, number of awakenings, tendency to fall back to sleep, and fatigue, to determine whether mending sleep could improve quality of life.

Case presentation: We present three female and two male Caucasian patients aged 42-70 years with long-COVID that persisted from 12 weeks to 139 weeks after contracting coronavirus disease.

Conclusion: A light presentation protocol was adapted for long-COVID that not only restored sleep in all patients, but also unexpectedly repaired the depression, anxiety, and cognitive changes (brain fog) as well. A robust pattern of recovery commencing 4-5 days after treatment and was maintained for weeks to months without relapse. These preliminary findings represent a novel, minimally invasive approach for managing the most debilitating symptoms of long-COVID, making it an ideal candidate for the drug hypersensitive, post-encephalitic brain. That a compromised circadian mechanism seen in Parkinson's disease may also underlie post-encephalitic long-COVID implicates a compromised role of the circadian system in these disorders.

背景:在本系列病例中,介绍了每天在 2000 至 4000 LUX 的多色强光下进行视觉照射的结果。强光治疗是治疗季节性情感障碍和帕金森病前驱症状的标准程序,成功率很高。由于长COVID的脑病后症状与帕金森病前驱症状十分相似,我们对这些患者的失眠和睡眠相关指标进行了治疗,包括总睡眠时间、觉醒次数、再次入睡倾向和疲劳程度,以确定改善睡眠是否能提高生活质量:我们介绍了三位女性和两位男性白种人患者,他们的年龄在 42-70 岁之间,在感染冠状病毒疾病后的 12 周至 139 周内持续出现长 COVID:结论:针对长期慢性阻塞性肺气肿采用了一种轻型演示方案,不仅恢复了所有患者的睡眠,还出乎意料地修复了抑郁、焦虑和认知变化(脑雾)。从治疗后 4-5 天开始,患者就出现了强劲的恢复模式,并可维持数周至数月之久而不再复发。这些初步研究结果代表了一种新颖的微创方法,可用于治疗长期慢性阻塞性脑损伤最令人衰弱的症状,是药物过敏性脑损伤后大脑的理想选择。帕金森病中的昼夜节律机制受损也可能是脑病后长期COVID的基础,这说明昼夜节律系统在这些疾病中的作用受到了损害。
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引用次数: 0
Disseminated Cryptococcus over pancreas, lung, and brain: a case report. 胰腺、肺部和脑部的播散性隐球菌:病例报告。
IF 0.9 Q3 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-10-23 DOI: 10.1186/s13256-024-04836-1
Hsu-En Cheng, Hong-Zen Yeh, Chi-Shun Yang, Sheng-Shun Yang, Szu-Chia Liao

Background: Cryptococcus is an opportunistic infection acquired through inhalation from the environment, primarily affecting individuals with compromised immune systems. It typically leads to pneumonia upon passing through lung tissue. The infection can disseminate to various organs via the bloodstream, resulting in meningitis or encephalitis in the central nervous system. Disseminated Cryptococcus has been reported to involve the skin, liver, eyes, lymph nodes, bone marrow, spleen, kidneys, and intestines, significantly increasing morbidity and mortality. However, pancreatic involvement in Cryptococcus is relatively rare, and a few case reports have highlighted severe organ damage and high mortality rates.

Case presentation: In this case report, we present the case of a 36-year-old Asian man who presented with a 2-week history of headaches and blurred vision in his right eye. Brain magnetic resonance imaging revealed multiple brain masses, along with a mass in the lower left lung field and a tumor in the pancreatic tail, as detected by chest computed tomography. Endoscopic ultrasound-guided fine needle biopsy and computed tomography-guided lung biopsy confirmed the diagnosis of disseminated cryptococcal infection involving the pancreas, lung, and brain. The patient's clinical condition improved following antifungal therapy. Additionally, we identified anti-granulocyte-macrophage colony-stimulating factor antibody as a risk factor for disseminated cryptococcal infection in this patient.

Conclusion: Disseminated cryptococcosis can be a potentially lethal condition, as highlighted by previous literature. However, early diagnosis using contrast-enhanced harmonic endoscopic ultrasound and endoscopic ultrasound-guided biopsies, as well as prompt treatment as demonstrated in our case, can improve outcomes and prevent mortality.

背景:隐球菌是一种通过从环境中吸入而获得的机会性感染,主要影响免疫系统受损的人。它通过肺组织时通常会导致肺炎。感染可通过血液传播到各个器官,导致中枢神经系统的脑膜炎或脑炎。据报道,播散性隐球菌可累及皮肤、肝脏、眼睛、淋巴结、骨髓、脾脏、肾脏和肠道,从而大大增加发病率和死亡率。然而,隐球菌累及胰腺的情况相对罕见,少数病例报告强调了严重的器官损害和高死亡率:在本病例报告中,我们介绍了一名 36 岁亚洲男子的病例,他因头痛和右眼视力模糊就诊 2 周。胸部计算机断层扫描发现,脑磁共振成像显示多发脑肿块,左下肺野也有肿块,胰腺尾部也有肿瘤。内镜超声引导下的细针活检和计算机断层扫描引导下的肺部活检确诊为播散性隐球菌感染,累及胰腺、肺部和大脑。抗真菌治疗后,患者的临床症状有所改善。此外,我们还发现抗粒细胞-巨噬细胞集落刺激因子抗体是该患者感染播散性隐球菌病的危险因素:结论:正如以往文献所强调的,播散性隐球菌病可能是一种潜在的致命疾病。然而,使用对比增强谐波内窥镜超声和内窥镜超声引导下活检进行早期诊断,并在本病例中进行及时治疗,可以改善预后并预防死亡。
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引用次数: 0
Prolonged transcranial magnetic stimulation in a pregnant patient with treatment-resistant depression: a case report. 经颅磁刺激治疗一名妊娠期抑郁症患者:病例报告。
IF 0.9 Q3 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-10-23 DOI: 10.1186/s13256-024-04855-y
Rana Jawish, Marcela Smid, Adam Gordon, Kathleen Shangraw, Brian J Mickey

Introduction: Perinatal depression is a serious and highly prevalent medical condition in the USA. Nearly 85% of individuals with perinatal depression go untreated, leading to significant morbidity and mortality. There is an urgent need to develop and advance safe and effective treatments for perinatal depression. Transcranial magnetic stimulation is an established intervention for depression in non-pregnant individuals yet is not well studied in perinatal depression.

Case presentation: A 33-year-old pregnant Latina female presented with severe, recurrent, treatment-resistant depression and suicidal ideation. The patient had previously trialed psychotherapy, multiple antidepressants, and mood stabilizers and had achieved remission with lithium prior to pregnancy. Due to pregnancy and fetal safety concerns, the patient discontinued lithium and consequently suffered progressive worsening of perinatal depression. At 24 weeks gestation and after additional failed medication trials, a prolonged course of transcranial magnetic stimulation was initiated. Following 46 transcranial magnetic stimulation treatments over 9 weeks using two protocol types (repetitive transcranial magnetic stimulation and intermittent theta burst stimulation), she achieved near-remission of perinatal depression and resolution of suicidal ideation. There were no identified maternal or fetal adverse events at 6 weeks post-delivery.

Conclusion: To our knowledge, this is the first published case of a pregnant individual with perinatal depression who received and tolerated a prolonged transcranial magnetic stimulation course with two distinct protocols (repetitive transcranial magnetic stimulation and intermittent theta burst stimulation) with clinically significant response. Transcranial magnetic stimulation is a well-tolerated and effective intervention that warrants further investigation for use in treatment-resistant perinatal depression.

简介在美国,围产期抑郁症是一种严重且高发的疾病。近 85% 的围产期抑郁症患者未经治疗,导致严重的发病率和死亡率。开发和推广安全有效的围产期抑郁症治疗方法迫在眉睫。经颅磁刺激是一种治疗非孕妇抑郁症的成熟干预方法,但对围产期抑郁症的研究并不充分:病例介绍:一名 33 岁的拉丁裔女性孕妇患有严重的、反复发作的、难治性抑郁症和自杀倾向。该患者曾试用过心理疗法、多种抗抑郁药物和情绪稳定剂,并在怀孕前使用锂剂获得了缓解。出于对妊娠和胎儿安全的考虑,患者停用了锂剂,结果导致围产期抑郁症逐渐恶化。在妊娠 24 周时,经过多次药物治疗失败后,患者开始接受长期的经颅磁刺激治疗。在使用两种方案类型(重复经颅磁刺激和间歇θ脉冲刺激)对患者进行了为期9周的46次经颅磁刺激治疗后,她的围产期抑郁症几乎得到了缓解,自杀倾向也得到了消除。分娩后 6 周,未发现母体或胎儿出现不良反应:据我们所知,这是第一例公开发表的围产期抑郁症孕妇接受并耐受了两种不同方案(重复经颅磁刺激和间歇θ脉冲刺激)的长期经颅磁刺激疗程并获得显著临床反应的病例。经颅磁刺激是一种耐受性良好且有效的干预措施,值得进一步研究用于治疗耐药性围产期抑郁症。
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引用次数: 0
Subcutaneous emphysema during surgical gingival depigmentation: a case report. 牙龈脱色手术中的皮下气肿:病例报告。
IF 0.9 Q3 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-10-22 DOI: 10.1186/s13256-024-04711-z
Rasha Attia, Neveen Nabil, Maged Anis

Background: Subcutaneous emphysema related to dental procedures is well documented in literature. It usually occurs during or within minutes to hours after dental treatment and can be easily diagnosed by the presence of crepitus on palpation. Although it is self-limiting, it can develop to potentially life-threatening complications.

Case presentation: To the authors knowledge, this is the first report documenting the development of subcutaneous emphysema in a 22-year-old Egyptian female during lower surgical gingival depigmentation using NSK high speed, air driven handpiece operated at 0.25 MPa. Sudden swelling developed involving the right side of the face and immediate diagnosis of subcutaneous emphysema was made on the basis of the presence of crepitus during palpation of the swollen area. Intraoral examination revealed small tissue laceration of the loosely attached alveolar mucosa through which the pressurized air might have passed into the fascial spaces. Complete resolution of the swelling occurred after 7 days without further complications.

Conclusion: Straightforward surgical procedures, such as gingival depigmentation, can be complicated by the development of subcutaneous emphysema. The crucial role of dentists is to be aware of its signs and to immediately diagnose and manage it to avoid further complication.

背景:与牙科治疗相关的皮下气肿在文献中有大量记载。皮下气肿通常发生在牙科治疗过程中或治疗后数分钟至数小时内,通过触诊时出现的吱吱声很容易诊断。虽然该病具有自限性,但可能发展成潜在的危及生命的并发症:据作者所知,这是第一例记录一名 22 岁埃及女性在使用 NSK 高速气动手机以 0.25 兆帕进行下牙龈脱色手术时发生皮下气肿的报告。患者右侧面部突然肿胀,在触诊肿胀部位时有吱吱声,因此立即诊断为皮下气肿。口腔内检查发现,松散附着的牙槽粘膜有小的组织裂口,加压的空气可能通过这些裂口进入了筋膜间隙。7 天后肿胀完全消退,未出现其他并发症:结论:简单的外科手术,如牙龈脱色,可能会因皮下气肿的发生而变得复杂。牙医的关键作用在于了解其征兆,并立即进行诊断和处理,以避免进一步的并发症。
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引用次数: 0
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Journal of Medical Case Reports
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