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Dysphasia: metastatic prostate cancer to the leptomeninges: a case report. 失语症:前列腺癌转移到脑膜:病例报告。
IF 0.9 Q3 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-10-30 DOI: 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.

背景:5%的前列腺癌患者会出现脑膜转移,预后极差:一名 60 岁的白种男性患者被诊断为转移性去势抵抗性前列腺癌,并伴有硬化性骨转移和软组织转移,患者接受了多个疗程的化疗和激素治疗。前列腺癌的诊断依据是前列腺特异性抗原水平升高和组织活检。随后,他出现了表达性失语。磁共振成像显示他的硬脑膜/脑膜不规则弥漫性增厚。经神经内科评估,脑电图显示癫痫相关症状为阴性。检查包括腰椎穿刺,以排除感染病因。患者的神经状况趋于稳定,出院回家,计划继续接受阿比特龙和泼尼松治疗。由于恶性肿瘤晚期,患者接受了临终关怀,出院3周后去世:结论:前列腺癌很少发生中枢神经系统转移。结论:中枢神经系统转移在前列腺癌中极少发生,随着预期寿命的延长和前列腺癌肿瘤治疗的进步,医生应注意并考虑 50 岁及以上男性的中枢神经系统转移。
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引用次数: 0
Triple immunostaining demonstrates the possible existence of segregated-nucleus-containing atypical monocytes in human primary myelofibrosis bone marrow: a case report. 三重免疫染色显示人类原发性骨髓纤维化骨髓中可能存在含分离核的非典型单核细胞:一份病例报告。
IF 0.9 Q3 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-10-30 DOI: 10.1186/s13256-024-04844-1
Shunsuke Homma, Toshie Ogasawara, Michie Suga, Yoshiyasu Nakamura, Katsuya Takenaka, Shoko Marshall, Kiyotaka Kawauchi, Naoki Mori, Hajime Kuroda, Naoya Nakamura, Yohei Miyagi, Atsuko Masunaga

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.

背景:最近在小鼠体内发现了含分离核的非典型单核细胞。含分离核的非典型单核细胞被认为起源于骨髓,并诱导药物损伤肺的纤维化。Lyc6c-小鼠单核细胞亚群与人类 CD14-CD16++ 非典型单核细胞相对应;然而,与小鼠含分离核非典型单核细胞相对应的人类单核细胞尚未发现。原发性骨髓纤维化是一种众所周知的进行性骨髓纤维化疾病,非典型巨核细胞被认为与原发性骨髓纤维化骨髓纤维化密切相关。然而,最近有报道称,单核细胞在原发性骨髓纤维化的骨髓纤维化中起着重要作用。我们推测,如果存在与小鼠含分离核的非典型单核细胞相对应的人类单核细胞,那么它将呈现与小鼠含分离核的非典型单核细胞相同的标记,如CD14-CD16+巨噬细胞-1抗原(CD11b/CD18复合物)+、MSR1+和CEACAM1+,而且它可能存在于原发性骨髓纤维化患者的骨髓中:一名 74 岁的日本男性因前列腺癌行全前列腺切除术后到我院进行临床随访。在定期检查中突然发现贫血、血小板减少和乳酸脱氢酶升高。经检查发现,该患者存在 CALR 2 型突变(p.K385fs*47)。患者骨髓的组织学特征与纤维化原发性骨髓纤维化一致。我们对骨髓进行了免疫组化研究,试图找出与鼠类含分离核的非典型单核细胞相对应的人类单核细胞。通过三重免疫染色,我们检测到少量 CD16+MSR1+CEACAM1+ 细胞,但没有 CD14+MSR1+CEACAM1+ 细胞。患者目前状况良好,无需接受原发性骨髓纤维化治疗:结论:原发性骨髓纤维化患者骨髓中可能存在含人类分离核的非典型单核细胞,并可能与骨髓纤维化有关。
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引用次数: 0
Reperfusion injury case following cervical fusion with OPLL: a case report and literature review. OPLL颈椎融合术后再灌注损伤病例:病例报告和文献综述。
IF 0.9 Q3 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-10-30 DOI: 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.

简介脊髓缺血再灌注损伤的特点是神经功能突然衰退,目前仅有少数病例发表在文献中。在此,我们介绍一例颈椎前路减压融合术后的白脊髓综合征:一名 54 岁的犹太裔男性患者被诊断为 C2、C3、C4、C6 和 C7 椎间盘突出,同时伴有后纵韧带骨化,椎管右侧受压较重,排除了颈椎病的可能。在全身麻醉和多模式术中监测下,他接受了C3至C6椎板切除手术和C3至C7颈椎固定术。手术过程中没有出现血压波动,脊髓和神经根的压力完全释放。此外,神经监测仪也没有显示手术过程中有任何神经损伤。麻醉后护理病房的神经系统检查显示,他的右手和右腿无力。脑部计算机断层扫描排除了脑血管意外,颈部计算机断层扫描显示植入体位置最佳,磁共振成像排除了脊髓窘迫或损伤。我们对他进行了静脉输液、类固醇、止痛药和抗凝血剂治疗。手术后,我们让职业治疗部门介入。几天后,我们观察到右腿的运动功能明显改善,但右手没有任何变化:结论:白脊髓综合征很可能是由于脊髓受压段手术减压后的再灌注损伤引起的。尽管这种情况并不常见,但脊柱外科医生必须认识到这种潜在的并发症,并在手术前告知患者。
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引用次数: 0
Dramatic improvement of drug-resistant epilepsy following cerebral infarction: a case report. 脑梗塞后耐药性癫痫的显著改善:病例报告。
IF 0.9 Q3 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-10-29 DOI: 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.

背景:估计有 30% 的癫痫患者会出现耐药性癫痫,即使用两种或两种以上抗癫痫药物仍无法控制癫痫发作。尽管考虑了其他治疗方案,但这些替代方案往往被证明无效:一名 60 岁的东亚男性患者被诊断为耐药性癫痫,尽管服用了 8 种不同的抗癫痫药物,但每天仍有数次癫痫发作。他从 15 岁开始癫痫发作。他在 34 岁时接受了癫痫手术,但癫痫仍持续发作。脑电图显示左半球有多灶性尖波。47 岁、50 岁和 56 岁时的脑出血是由癫痫发作时的头部外伤引起的。患者后来只能坐轮椅,现在住在疗养院。58 岁时,左颈内动脉闭塞导致急性脑梗塞,之后他每天的癫痫发作完全停止。尽管仍然需要坐轮椅,但他的生活质量并没有显著下降。癫痫发作的停止降低了他再受外伤的风险,而且他只需服用一种抗癫痫药物就能保持 3 年不发作:结论:癫痫手术治疗经常失败,切除不足是失败的主要原因。在某些病例中,缺血性中风造成的广泛破坏可能是有益的。此外,本病例还表明,脑梗塞疗法可能是治疗耐药性癫痫患者的一种潜在方法。
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引用次数: 0
Congenital partial diaphragmatic eventration presenting with Chilaiditi's sign: a case report. 先天性部分膈肌分离伴有 Chilaiditi 征:病例报告。
IF 0.9 Q3 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-10-28 DOI: 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.

背景:奇莱蒂氏征是一种偶然的影像学发现,与位于肝脏和右膈之间的肠道布局有关。根据最近的成人回顾性研究,它被认为是一种获得性而非先天性疾病,发病率在 1.18% 至 2.4% 之间。本病例涉及一名 7 个月大的男性,起初被误诊为膈疝:一名 4 个月大的白种男性因呼吸道感染住院,被误诊为先天性膈疝。3 个月后入院时,他没有任何肠梗阻或呼吸困难的症状和体征。胸部计算机断层扫描显示他有奇莱迪蒂征。诊断性腹腔镜检查被认为是评估解剖细节的必要手段。最突出的发现是右半膈内侧缺乏肌纤维,部分偶发的右半膈几乎呈透明状。由于解剖结构复杂,膈肌成形术被认为是危险的。目前患者情况良好,正在接受随访:很明显,奇莱迪蒂征并不总是毫无影响的偶然发现,它可能预示着潜在的先天性膈肌病变。
{"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}
引用次数: 0
Chronic appendicitis misdiagnosed as a periappendiceal orifice polyp: a case report. 被误诊为阑尾周围孔息肉的慢性阑尾炎:病例报告。
IF 0.9 Q3 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-10-27 DOI: 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.

背景:与急性阑尾炎不同,慢性阑尾炎的特点是非特异性腹痛和间歇性病程。病例报告:一名阿拉伯裔男性患者,55 岁,反复发作腹痛 2 年:一名 55 岁的阿拉伯裔男性患者有 2 年反复发作右下腹轻微疼痛的病史。发作时伴有恶心、发冷和腹胀,但没有呕吐、直肠出血或体重减轻。经检查,患者腹部柔软、松弛,右下腹有轻度压痛,无脏器肿大或腹部肿块。实验室检查结果显示全血细胞计数和C反应蛋白正常。患者接受了结肠镜检查以排除恶性肿瘤,结果显示阑尾口息肉需要切除。计算机断层扫描显示阑尾肿大,阑尾腔内有多个致密的阑尾结石。阑尾口最大的结石大小为 1.5 厘米×0.9 厘米,部分突出于盲肠腔内。慢性阑尾炎的诊断得到确认。患者接受了阑尾切除术,出院后数天无任何症状:我们报告了一名伴有多个阑尾结石的慢性阑尾炎患者。该患者最初被误诊为阑尾周围孔息肉。目前的发现凸显了影像学检查,尤其是计算机断层扫描在确诊非典型阑尾炎患者方面的重要性。
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引用次数: 0
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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Journal of Medical Case Reports
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