Pub Date : 2024-10-30DOI: 10.1186/s13256-024-04840-5
Diana Jodeh, Milan Terzic, Evan Wenig, Amit Amin, Tareq Al Baghdadi
Background: Leptomeningeal metastasis occurs in 5% of patients with prostate cancer and indicates a very poor prognosis.
Case presentation: A 60-year-old Caucasian male patient diagnosed with metastatic castration-resistant prostate cancer with sclerotic bone metastases and soft tissue metastases underwent multiple courses of chemotherapy and hormone therapy. The diagnosis of prostate cancer is based on elevated prostate-specific antigen levels and tissue biopsy. He subsequently presented with expressive aphasia. Nonspecific, diffuse irregular dural/pachymeningeal thickening enhancement was noted on magnetic resonance imaging. Upon evaluation by neurology, electroencephalogram was negative for an epileptiform correlate. The workup included a lumbar puncture to rule out infectious etiology. The patient's neurological status stabilized, and he was discharged home with a plan for continued therapy with abiraterone and prednisone. Due to advanced malignancy, the patient enrolled in hospice and died 3 weeks after hospital discharge.
Conclusions: Central nervous system metastasis occurs very rarely in prostate cancer. With the increase in life expectancy and advances in oncologic therapy for prostate cancer, physicians should be aware of and consider central nervous system metastasis in men aged 50 years and above.
{"title":"Dysphasia: metastatic prostate cancer to the leptomeninges: a case report.","authors":"Diana Jodeh, Milan Terzic, Evan Wenig, Amit Amin, Tareq Al Baghdadi","doi":"10.1186/s13256-024-04840-5","DOIUrl":"10.1186/s13256-024-04840-5","url":null,"abstract":"<p><strong>Background: </strong>Leptomeningeal metastasis occurs in 5% of patients with prostate cancer and indicates a very poor prognosis.</p><p><strong>Case presentation: </strong>A 60-year-old Caucasian male patient diagnosed with metastatic castration-resistant prostate cancer with sclerotic bone metastases and soft tissue metastases underwent multiple courses of chemotherapy and hormone therapy. The diagnosis of prostate cancer is based on elevated prostate-specific antigen levels and tissue biopsy. He subsequently presented with expressive aphasia. Nonspecific, diffuse irregular dural/pachymeningeal thickening enhancement was noted on magnetic resonance imaging. Upon evaluation by neurology, electroencephalogram was negative for an epileptiform correlate. The workup included a lumbar puncture to rule out infectious etiology. The patient's neurological status stabilized, and he was discharged home with a plan for continued therapy with abiraterone and prednisone. Due to advanced malignancy, the patient enrolled in hospice and died 3 weeks after hospital discharge.</p><p><strong>Conclusions: </strong>Central nervous system metastasis occurs very rarely in prostate cancer. With the increase in life expectancy and advances in oncologic therapy for prostate cancer, physicians should be aware of and consider central nervous system metastasis in men aged 50 years and above.</p>","PeriodicalId":16236,"journal":{"name":"Journal of Medical Case Reports","volume":"18 1","pages":"532"},"PeriodicalIF":0.9,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11526645/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142545885","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}
Background: Segregated-nucleus-containing atypical monocytes have recently been identified in mice. Segregated-nucleus-containing atypical monocytes are thought to originate from the bone marrow and induce fibrosis in the drug-injured lung. The Lyc6c- murine monocyte subset is the counterpart to human CD14-CD16++ non-classical monocytes; however, the human counterpart to murine segregated-nucleus-containing atypical monocytes has not yet been identified. Primary myelofibrosis is a well-known disease of progressive marrow fibrosis, and atypical megakaryocytes are thought to be closely related to fibrosis in primary myelofibrosis bone marrow. However, recently, monocytes have been reported to play an important role in marrow fibrosis in primary myelofibrosis. We speculated that, if there is a human counterpart to murine segregated-nucleus-containing atypical monocytes, it would present the same markers as murine segregated-nucleus-containing atypical monocytes, such as CD14-CD16+ macrophage-1 antigen (CD11b/CD18 complex)+, MSR1+, and CEACAM1+, and it might exist in the bone marrow of patients with primary myelofibrosis.
Case presentation: A 74-year-old Japanese male visited our hospital for clinical follow-up after total prostatectomy for prostatic cancer. Anemia, thrombocytosis, and elevated lactate dehydrogenase were suddenly observed in a periodic examination. CALR mutation type 2 (p.K385fs*47) was observed. The histological features of the patient's bone marrow were consistent with fibrotic primary myelofibrosis. We immunohistochemically studied the bone marrow in an attempt to identify a human counterpart to murine segregated-nucleus-containing atypical monocytes. We detected a few CD16+MSR1+CEACAM1+ cells, but not CD14+MSR1+CEACAM1+ cells, by triple immunostaining. The patient is in a good condition and does not require treatment for primary myelofibrosis.
Conclusion: There is a possibility that human segregated-nucleus-containing atypical monocytes exist in the bone marrow of primary myelofibrosis patients and might be related to marrow fibrosis.
{"title":"Triple immunostaining demonstrates the possible existence of segregated-nucleus-containing atypical monocytes in human primary myelofibrosis bone marrow: a case report.","authors":"Shunsuke Homma, Toshie Ogasawara, Michie Suga, Yoshiyasu Nakamura, Katsuya Takenaka, Shoko Marshall, Kiyotaka Kawauchi, Naoki Mori, Hajime Kuroda, Naoya Nakamura, Yohei Miyagi, Atsuko Masunaga","doi":"10.1186/s13256-024-04844-1","DOIUrl":"10.1186/s13256-024-04844-1","url":null,"abstract":"<p><strong>Background: </strong>Segregated-nucleus-containing atypical monocytes have recently been identified in mice. Segregated-nucleus-containing atypical monocytes are thought to originate from the bone marrow and induce fibrosis in the drug-injured lung. The Lyc6c<sup>-</sup> murine monocyte subset is the counterpart to human CD14<sup>-</sup>CD16<sup>++</sup> non-classical monocytes; however, the human counterpart to murine segregated-nucleus-containing atypical monocytes has not yet been identified. Primary myelofibrosis is a well-known disease of progressive marrow fibrosis, and atypical megakaryocytes are thought to be closely related to fibrosis in primary myelofibrosis bone marrow. However, recently, monocytes have been reported to play an important role in marrow fibrosis in primary myelofibrosis. We speculated that, if there is a human counterpart to murine segregated-nucleus-containing atypical monocytes, it would present the same markers as murine segregated-nucleus-containing atypical monocytes, such as CD14<sup>-</sup>CD16<sup>+</sup> macrophage-1 antigen (CD11b/CD18 complex)<sup>+</sup>, MSR1<sup>+</sup>, and CEACAM1<sup>+</sup>, and it might exist in the bone marrow of patients with primary myelofibrosis.</p><p><strong>Case presentation: </strong>A 74-year-old Japanese male visited our hospital for clinical follow-up after total prostatectomy for prostatic cancer. Anemia, thrombocytosis, and elevated lactate dehydrogenase were suddenly observed in a periodic examination. CALR mutation type 2 (p.K385fs*47) was observed. The histological features of the patient's bone marrow were consistent with fibrotic primary myelofibrosis. We immunohistochemically studied the bone marrow in an attempt to identify a human counterpart to murine segregated-nucleus-containing atypical monocytes. We detected a few CD16<sup>+</sup>MSR1<sup>+</sup>CEACAM1<sup>+</sup> cells, but not CD14<sup>+</sup>MSR1<sup>+</sup>CEACAM1<sup>+</sup> cells, by triple immunostaining. The patient is in a good condition and does not require treatment for primary myelofibrosis.</p><p><strong>Conclusion: </strong>There is a possibility that human segregated-nucleus-containing atypical monocytes exist in the bone marrow of primary myelofibrosis patients and might be related to marrow fibrosis.</p>","PeriodicalId":16236,"journal":{"name":"Journal of Medical Case Reports","volume":"18 1","pages":"510"},"PeriodicalIF":0.9,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11524003/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142545938","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}
Pub Date : 2024-10-30DOI: 10.1186/s13256-024-04865-w
Assil Mahamid, Sana Zahalka, David Maman, Liad Alfandari, Amit Keren, Eyal Behrbalk
Introduction: Spinal cord ischemic reperfusion injury is characterized by an abrupt decline in neurological function and only a few cases have been published in literature. Herein, we present a white cord syndrome following anterior decompression cervical fusion.
Case report: A 54-year-old Jewish male patient was diagnosed with disc herniation among the intervertebral discs at C2, C3, C4, C6, and C7, along with ossification of the posterior longitudinal ligament, pressuring more to the right side of the spinal canal, ruling-out cervical myelopathy. Under general anesthesia and multimodal intraoperative monitoring, he underwent laminectomy surgery from C3 to C6 and cervical fixation from C3 to C7. No blood pressure fluctuations occurred during surgery, and complete pressure release was achieved on the spinal cord and the nerve roots. In addition, neuromonitoring did not indicate any nerve damage during the surgery. A neurologic exam in the post-anesthesia care unit revealed weakness in his right hand and leg. A brain computed tomography scan ruled out cerebrovascular accident, neck computed tomography revealed optimal implant position, and magnetic resonance imaging ruled out spinal cord distress or injury. We treated him with intravenous fluids, steroids, painkillers, and anticoagulants. Following surgery, we involved the occupational therapy department. After a few days, we observed a significant improvement in motor function in the right leg; however, there was no change in the right hand.
Conclusion: White cord syndrome likely arises from reperfusion injury subsequent to surgical decompression of a compressed spinal cord segment. Although infrequent, it is imperative for spine surgeons to recognize this potential complication and apprise patients of it prior to the procedure.
{"title":"Reperfusion injury case following cervical fusion with OPLL: a case report and literature review.","authors":"Assil Mahamid, Sana Zahalka, David Maman, Liad Alfandari, Amit Keren, Eyal Behrbalk","doi":"10.1186/s13256-024-04865-w","DOIUrl":"10.1186/s13256-024-04865-w","url":null,"abstract":"<p><strong>Introduction: </strong>Spinal cord ischemic reperfusion injury is characterized by an abrupt decline in neurological function and only a few cases have been published in literature. Herein, we present a white cord syndrome following anterior decompression cervical fusion.</p><p><strong>Case report: </strong>A 54-year-old Jewish male patient was diagnosed with disc herniation among the intervertebral discs at C2, C3, C4, C6, and C7, along with ossification of the posterior longitudinal ligament, pressuring more to the right side of the spinal canal, ruling-out cervical myelopathy. Under general anesthesia and multimodal intraoperative monitoring, he underwent laminectomy surgery from C3 to C6 and cervical fixation from C3 to C7. No blood pressure fluctuations occurred during surgery, and complete pressure release was achieved on the spinal cord and the nerve roots. In addition, neuromonitoring did not indicate any nerve damage during the surgery. A neurologic exam in the post-anesthesia care unit revealed weakness in his right hand and leg. A brain computed tomography scan ruled out cerebrovascular accident, neck computed tomography revealed optimal implant position, and magnetic resonance imaging ruled out spinal cord distress or injury. We treated him with intravenous fluids, steroids, painkillers, and anticoagulants. Following surgery, we involved the occupational therapy department. After a few days, we observed a significant improvement in motor function in the right leg; however, there was no change in the right hand.</p><p><strong>Conclusion: </strong>White cord syndrome likely arises from reperfusion injury subsequent to surgical decompression of a compressed spinal cord segment. Although infrequent, it is imperative for spine surgeons to recognize this potential complication and apprise patients of it prior to the procedure.</p>","PeriodicalId":16236,"journal":{"name":"Journal of Medical Case Reports","volume":"18 1","pages":"527"},"PeriodicalIF":0.9,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11523587/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142545897","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}
Pub Date : 2024-10-29DOI: 10.1186/s13256-024-04863-y
Wankiun Lee, Daeyoung Kim, Jae-Moon Kim, Eun Young Kim
Background: An estimated 30% of patients with epilepsy experience drug-resistant epilepsy, which is the failure to control seizures despite the use of two or more antiseizure medications. Although other treatment options are considered, these alternatives often prove ineffective.
Case presentation: A 60-year-old East Asian male patient diagnosed with drug-resistant epilepsy experienced several seizures daily despite being on eight different antiseizure medications. Seizures began at age 15. He underwent epilepsy surgery at age 34, yet the seizures persisted. An electroencephalogram revealed multifocal sharp waves in the left hemisphere. Cerebral hemorrhages at ages 47, 50, and 56 were caused by head trauma during seizures. The patient became wheelchair-bound and now resides in a nursing home. At age 58, after suffering an acute cerebral infarction due to occlusion of the left internal carotid artery, his daily seizures ceased entirely. Despite remaining wheelchair-bound, he did not experience a significant decline in his quality of life. The cessation of seizures has reduced his risk of further trauma, and he has remained seizure-free for 3 years on just one antiseizure medication.
Conclusion: Surgical treatments for epilepsy often fail, with insufficient resection being a leading cause of these failures. In some cases, extensive destruction from an ischemic stroke may be beneficial. Furthermore, this case suggests that infarction therapy could be a potential treatment for patients with drug-resistant epilepsy.
{"title":"Dramatic improvement of drug-resistant epilepsy following cerebral infarction: a case report.","authors":"Wankiun Lee, Daeyoung Kim, Jae-Moon Kim, Eun Young Kim","doi":"10.1186/s13256-024-04863-y","DOIUrl":"10.1186/s13256-024-04863-y","url":null,"abstract":"<p><strong>Background: </strong>An estimated 30% of patients with epilepsy experience drug-resistant epilepsy, which is the failure to control seizures despite the use of two or more antiseizure medications. Although other treatment options are considered, these alternatives often prove ineffective.</p><p><strong>Case presentation: </strong>A 60-year-old East Asian male patient diagnosed with drug-resistant epilepsy experienced several seizures daily despite being on eight different antiseizure medications. Seizures began at age 15. He underwent epilepsy surgery at age 34, yet the seizures persisted. An electroencephalogram revealed multifocal sharp waves in the left hemisphere. Cerebral hemorrhages at ages 47, 50, and 56 were caused by head trauma during seizures. The patient became wheelchair-bound and now resides in a nursing home. At age 58, after suffering an acute cerebral infarction due to occlusion of the left internal carotid artery, his daily seizures ceased entirely. Despite remaining wheelchair-bound, he did not experience a significant decline in his quality of life. The cessation of seizures has reduced his risk of further trauma, and he has remained seizure-free for 3 years on just one antiseizure medication.</p><p><strong>Conclusion: </strong>Surgical treatments for epilepsy often fail, with insufficient resection being a leading cause of these failures. In some cases, extensive destruction from an ischemic stroke may be beneficial. Furthermore, this case suggests that infarction therapy could be a potential treatment for patients with drug-resistant epilepsy.</p>","PeriodicalId":16236,"journal":{"name":"Journal of Medical Case Reports","volume":"18 1","pages":"509"},"PeriodicalIF":0.9,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11520484/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142522105","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}
Pub Date : 2024-10-28DOI: 10.1186/s13256-024-04817-4
B Haluk Güvenç, Kemal Rasa
Background: Chilaiditi's sign is an incidental radiographic finding, associated with intestinal disposition located between liver and right diaphragm. It is considered as an acquired rather than a congenital condition and the prevalence ranges from 1.18% to 2.4% according to recent adult retrospective studies. The aspects of this rare entity with regards to a 7-month-old male initially misdiagnosed as diaphragmatic hernia is discussed.
Case presentation: A 4-month-old Caucasian male was misdiagnosed with a congenital diaphragmatic hernia owing to previous hospitalization with complaints of respiratory tract infection. On admission 3 months later, he was free of any signs and symptoms of intestinal obstruction or respiratory distress. Thorax computed tomography revealed Chilaiditi's sign. A diagnostic laparoscopy was regarded necessary to evaluate the anatomical details. The most prominent finding was the lack of muscle fibers and almost transparent appearance of the medial aspect of the partially eventrated right hemidiaphragm. Owing to delicate anatomical presentation, diaphragmatic plication was considered hazardous. The patient is doing well and under follow-up.
Conclusions: It is obvious that Chilaiditi's sign is not always a completely incidental finding of no consequence, and may indicate an underlying congenital diaphragmatic pathology, clearly defined by laparoscopic evaluation in this case.
{"title":"Congenital partial diaphragmatic eventration presenting with Chilaiditi's sign: a case report.","authors":"B Haluk Güvenç, Kemal Rasa","doi":"10.1186/s13256-024-04817-4","DOIUrl":"10.1186/s13256-024-04817-4","url":null,"abstract":"<p><strong>Background: </strong>Chilaiditi's sign is an incidental radiographic finding, associated with intestinal disposition located between liver and right diaphragm. It is considered as an acquired rather than a congenital condition and the prevalence ranges from 1.18% to 2.4% according to recent adult retrospective studies. The aspects of this rare entity with regards to a 7-month-old male initially misdiagnosed as diaphragmatic hernia is discussed.</p><p><strong>Case presentation: </strong>A 4-month-old Caucasian male was misdiagnosed with a congenital diaphragmatic hernia owing to previous hospitalization with complaints of respiratory tract infection. On admission 3 months later, he was free of any signs and symptoms of intestinal obstruction or respiratory distress. Thorax computed tomography revealed Chilaiditi's sign. A diagnostic laparoscopy was regarded necessary to evaluate the anatomical details. The most prominent finding was the lack of muscle fibers and almost transparent appearance of the medial aspect of the partially eventrated right hemidiaphragm. Owing to delicate anatomical presentation, diaphragmatic plication was considered hazardous. The patient is doing well and under follow-up.</p><p><strong>Conclusions: </strong>It is obvious that Chilaiditi's sign is not always a completely incidental finding of no consequence, and may indicate an underlying congenital diaphragmatic pathology, clearly defined by laparoscopic evaluation in this case.</p>","PeriodicalId":16236,"journal":{"name":"Journal of Medical Case Reports","volume":"18 1","pages":"508"},"PeriodicalIF":0.9,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11520078/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142502114","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}
Pub Date : 2024-10-27DOI: 10.1186/s13256-024-04847-y
Ahmed Albadrani
Background: Unlike acute appendicitis, chronic appendicitis is characterized by nonspecific abdominal pain and intermittent course. This may lead to late diagnosis or misdiagnosis, with the possibility of serious complications.
Case report: A male patient of Arab origin aged 55 years had a 2-year history of recurrent episodes of mild pain in the right lower quadrant of the abdomen. The episodes were associated with nausea, chills, and abdominal bloating but no vomiting, rectal bleeding, or weight loss. On examination, the patient showed soft and lax abdomen with mild tenderness in the right lower quadrant, with no organomegaly or abdominal masses. Laboratory findings showed normal complete blood count and C-reactive protein. The patient underwent colonoscopy to rule out malignancy, which showed appendiceal orifice polyp that required resection. The computed tomography scan showed an enlarged appendix with multiple intraluminal dense appendicoliths. The largest stone at the appendiceal orifice measured 1.5 cm × 0.9 cm and was partially protruding within the cecal lumen. The diagnosis of chronic appendicitis was confirmed. The patient underwent appendectomy and was asymptomatic a few days after discharge.
Conclusions: We are reporting a patient with chronic appendicitis presented with multiple appendicoliths. The patient was initially misdiagnosed as periappendiceal orifice polyp. The current finding highlights the importance of imaging, especially computed tomography in confirming the diagnosis in patients with atypical appendicitis presentation.
{"title":"Chronic appendicitis misdiagnosed as a periappendiceal orifice polyp: a case report.","authors":"Ahmed Albadrani","doi":"10.1186/s13256-024-04847-y","DOIUrl":"10.1186/s13256-024-04847-y","url":null,"abstract":"<p><strong>Background: </strong>Unlike acute appendicitis, chronic appendicitis is characterized by nonspecific abdominal pain and intermittent course. This may lead to late diagnosis or misdiagnosis, with the possibility of serious complications.</p><p><strong>Case report: </strong>A male patient of Arab origin aged 55 years had a 2-year history of recurrent episodes of mild pain in the right lower quadrant of the abdomen. The episodes were associated with nausea, chills, and abdominal bloating but no vomiting, rectal bleeding, or weight loss. On examination, the patient showed soft and lax abdomen with mild tenderness in the right lower quadrant, with no organomegaly or abdominal masses. Laboratory findings showed normal complete blood count and C-reactive protein. The patient underwent colonoscopy to rule out malignancy, which showed appendiceal orifice polyp that required resection. The computed tomography scan showed an enlarged appendix with multiple intraluminal dense appendicoliths. The largest stone at the appendiceal orifice measured 1.5 cm × 0.9 cm and was partially protruding within the cecal lumen. The diagnosis of chronic appendicitis was confirmed. The patient underwent appendectomy and was asymptomatic a few days after discharge.</p><p><strong>Conclusions: </strong>We are reporting a patient with chronic appendicitis presented with multiple appendicoliths. The patient was initially misdiagnosed as periappendiceal orifice polyp. The current finding highlights the importance of imaging, especially computed tomography in confirming the diagnosis in patients with atypical appendicitis presentation.</p>","PeriodicalId":16236,"journal":{"name":"Journal of Medical Case Reports","volume":"18 1","pages":"507"},"PeriodicalIF":0.9,"publicationDate":"2024-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11514870/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142502112","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}
Pub Date : 2024-10-26DOI: 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.
{"title":"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.","authors":"Oleksandr Buryanov, Igor Lurin, Bazarov Murat, Yurii Yarmoliuk, Artem Bespalenko, Oleg Smyk, Yurii Klapchuk, Dmytro Los","doi":"10.1186/s13256-024-04727-5","DOIUrl":"10.1186/s13256-024-04727-5","url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Case presentation: </strong>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.</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":16236,"journal":{"name":"Journal of Medical Case Reports","volume":"18 1","pages":"521"},"PeriodicalIF":0.9,"publicationDate":"2024-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11515124/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142502130","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}
Pub Date : 2024-10-26DOI: 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。
{"title":"Dextrocardia with complete atrioventricular block-the right clinical approach to pace a heart on the right hemithorax: a case report.","authors":"Ralph Abi Nader, Mikhael Kossaify, Antoine Kossaify","doi":"10.1186/s13256-024-04854-z","DOIUrl":"10.1186/s13256-024-04854-z","url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Case presentation: </strong>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.</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":16236,"journal":{"name":"Journal of Medical Case Reports","volume":"18 1","pages":"504"},"PeriodicalIF":0.9,"publicationDate":"2024-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11515208/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142502124","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}
Pub Date : 2024-10-25DOI: 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.
{"title":"Bilateral adrenal hemorrhage in a postpartum woman with multiple thromboemboli: A case report.","authors":"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","doi":"10.1186/s13256-024-04834-3","DOIUrl":"10.1186/s13256-024-04834-3","url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Case presentation: </strong>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.</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":16236,"journal":{"name":"Journal of Medical Case Reports","volume":"18 1","pages":"518"},"PeriodicalIF":0.9,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11515325/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142502111","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}
Pub Date : 2024-10-25DOI: 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.
{"title":"A 39-year-old woman with transient convulsions and vision disturbances: a case report.","authors":"Jing Fan, Taojiang Chen, Pian Wang, Tao Hai, Wei Li, Yan Wang","doi":"10.1186/s13256-024-04811-w","DOIUrl":"10.1186/s13256-024-04811-w","url":null,"abstract":"<p><strong>Background: </strong>Posterior reversible encephalopathy syndrome is a rare neurological syndrome that refers to reversible subcortical vasogenic brain edema disorder in patients with acute neurological symptoms.</p><p><strong>Case presentation: </strong>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.</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":16236,"journal":{"name":"Journal of Medical Case Reports","volume":"18 1","pages":"503"},"PeriodicalIF":0.9,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11520122/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142502110","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}