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Disseminated melioidosis-challenge to routine antibiotic therapy: a case report. 播散性美拉德氏病--对常规抗生素治疗的挑战:病例报告。
IF 0.9 Q3 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-10-09 DOI: 10.1186/s13256-024-04808-5
Atish Mohapatra, Pragya Agarwala, Hari Prasad Sirigiri, Padma Das

Introduction: Melioidosis caused by Burkholderia pseudomallei, often referred to as a great mimicker or escapist, evades not only the immune system, but also all manual identification methods in an under-equipped clinical microbiology laboratory due to its tedious identification process. This is a case report of disseminated melioidosis with septic arthritis, misdiagnosed both clinicoradiologically and microbiologically as disseminated tuberculosis or other bacterial infection.

Case history: A middle-aged Asian diabetic male presented with high-grade fever and breathlessness for 4 days along with left knee and ankle swelling for 40 days. Previous hospitalization records revealed growth of pan-sensitive Acinetobacter spp. from ankle and a chest X-ray suspecting tuberculosis for which antibiotic and antitubercular regimen were initiated. After admission, repeated blood cultures and pus culture (ankle and knee joint) confirmed Burkholderia pseudomallei with VITEK-II automated identification system. Recommended therapy was initiated according to revised Darwin's guideline, leading to gradual cure of the patient.

Conclusion: Misidentification leads to inadequate treatment, as melioidosis medication is different from other bacterial infections. Here initiation of meropenem- and cotrimoxazole-intensive therapy for 4 weeks, and 6-month eradication phase with cotrimoxazole, resulted in gradual recovery of the patient. It took around 21 days of intensive antibiotic therapy to get bacteriological clearance from blood, which signifies the tenacious nature of this infection.

导言:由假马来伯克霍尔德氏菌(Burkholderia pseudomallei)引起的美拉德氏病通常被称为 "伟大的模仿者 "或 "逃逸者",由于其鉴定过程繁琐,不仅可以躲避免疫系统,还可以躲避设备不足的临床微生物实验室的所有人工鉴定方法。这是一例播散性髓鞘病合并化脓性关节炎的病例报告,临床放射学和微生物学均将其误诊为播散性结核或其他细菌感染:一名亚裔中年男性糖尿病患者因高热、呼吸困难 4 天,左膝和踝关节肿胀 40 天前来就诊。之前的住院记录显示,脚踝处长出了对泛敏感的醋杆菌属细菌,胸部 X 光检查怀疑是肺结核,因此开始使用抗生素和抗结核治疗。入院后,经 VITEK-II 自动识别系统反复血液培养和脓液培养(踝关节和膝关节)证实为假马利伯克霍尔德氏菌。根据修订后的达尔文指南开始了建议的治疗,患者逐渐痊愈:结论:由于类鼻疽的用药与其他细菌感染不同,错误的鉴别会导致治疗不当。在这里,美罗培南和复方新诺明强化治疗 4 周,并使用复方新诺明进行为期 6 个月的根除治疗,患者逐渐康复。经过约 21 天的强化抗生素治疗后,血液中的细菌才被清除,这表明这种感染具有顽固性。
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引用次数: 0
Triphallia: the first cadaveric description of internal penile triplication: a case report. Triphallia:首例阴茎内侧三叠的尸体描述:病例报告。
IF 0.9 Q3 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-10-09 DOI: 10.1186/s13256-024-04751-5
John Buchanan, Madeleine Gadd, Rose How, Edward Mathews, Andre Coetzee, Karuna Katti

Introduction: Triphallia, a rare congenital anomaly describing the presence of three distinct penile shafts, has been reported only once in the literature. This case report, based on an extensive literature review, describes the serendipitous discovery during cadaveric dissection of the second reported human case of triphallia, distinctly morphologically different from the previous case.

Case presentation: Despite the normal appearance of external genitalia on examination, the dissection of a 78-year-old white male revealed a remarkable anatomical variation: two small supernumerary penises stacked in a sagittal orientation posteroinferiorly to the primary penis. Each penile shaft displayed its own corpora cavernosa and glans penis. The primary penis and largest and most superficial of the supernumerary penises shared a single urethra, which coursed through the secondary penis prior to its passage through the primary penis. A urethra-like structure was absent from the smallest supernumerary penis.

Conclusion: This case report provides a comprehensive description of the anatomical features of triphallia in a cadaver, shedding light on the morphology, embryology, and clinical implications of this anomaly. Without dissection, this anatomical variation would have remained undiscovered, suggesting the prevalence of polyphallia may be greater than expected. The single tortuous urethra present in this case, as well as the supernumerary and blind ending urethras present in many cases of penile duplication, may pose significant risk of infection, sexual dysfunction, subfertility, and traumatic catheterization.

Significance: These findings underscore the importance of meticulous anatomical dissections and may act as a resource for anatomists and those studying genitourinary anomalies. Although we can only speculate as to which functional implications this patient may have experienced, understanding such anatomical variations contributes to both knowledge of human anatomy and clinical management should the condition be encountered in living individuals.

简介三阴茎畸形是一种罕见的先天性畸形,是指存在三根不同的阴茎轴,文献中仅报道过一例。本病例报告在广泛查阅文献的基础上,描述了在解剖尸体时偶然发现的第二例人类三股畸形病例,其形态与前一病例明显不同:尽管外生殖器在检查时外观正常,但在解剖一名 78 岁的白人男性时却发现了一个显著的解剖变异:两个小的编外阴茎以矢状方向堆叠在主阴茎的后方。每根阴茎都有自己的海绵体和龟头。主阴茎和最大最浅的编外阴茎共用一条尿道,尿道在穿过主阴茎之前先穿过次阴茎。结论:本病例报告全面描述了一具尸体上三阴茎的解剖特征,揭示了这种异常的形态学、胚胎学和临床意义。如果不进行解剖,这种解剖学上的变异可能一直不会被发现,这表明多睾丸症的发病率可能比预期的要高。本病例中出现的单一迂曲尿道,以及许多阴茎重复畸形病例中出现的编外尿道和盲端尿道,可能会带来感染、性功能障碍、不育和导尿创伤等重大风险:这些发现强调了细致解剖的重要性,可作为解剖学家和研究泌尿生殖系统畸形者的参考资料。虽然我们只能推测这名患者可能会经历哪些功能性影响,但了解这种解剖变异有助于了解人体解剖学知识,并在活人遇到这种情况时进行临床处理。
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引用次数: 0
Arthroscopic shoulder surgery for gouty long head of biceps tendinitis: a case report. 痛风性肱二头肌长头肌腱炎的肩关节镜手术:病例报告。
IF 0.9 Q3 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-10-09 DOI: 10.1186/s13256-024-04827-2
Xingrui Huang, Jianhua Wang, Zhigang Xiong, Qirong Dong, Bo Tian

Objective: The objective of the case report is to analyze the clinical manifestations and imaging features of gouty long head of biceps tendinitis, and to summarize the methods and effects of shoulder arthroscopic surgery.

Clinical presentation and intervention: The clinical data of a 39-year-old Han Chinese female with gouty long head of the biceps tendinitis was retrospectively analyzed, and the clinical manifestations, imaging features, and diagnosis and treatment were analyzed. The patient presented with pain and limited movement of right shoulder joint. Computed tomography showed irregular high-density shadows above the glenoid and adjacent to the coracoid process of the right shoulder. Magnetic resonance imaging revealed superior labrum anterior and posterior injury with edema in the upper recess and axillary sac. After arthroscopic surgery, the "tofu residue" tissue of the long head of the biceps was removed, and the postoperative pathological examination proved that it was gout stone.

Conclusion: Gouty long head of the biceps tendinitis is a rare disease. Arthroscopic surgery can probe the structural lesions of shoulder cavity in all aspects, improve the surgical accuracy, and reduce the trauma.

摘要本病例报告旨在分析痛风性肱二头肌长头肌腱炎的临床表现和影像学特征,总结肩关节镜手术的方法和效果:回顾性分析一名39岁汉族女性痛风性肱二头肌长头肌腱炎患者的临床资料,分析其临床表现、影像学特征和诊断治疗。患者表现为右肩关节疼痛和活动受限。计算机断层扫描显示,右肩关节盂上方和冠状突附近有不规则的高密度阴影。磁共振成像显示上唇盂前后损伤,上凹和腋囊水肿。关节镜手术后,切除了肱二头肌长头的 "豆腐渣 "组织,术后病理检查证实为痛风石:结论:痛风性肱二头肌长头肌腱炎是一种罕见疾病。结论:痛风性肱二头肌长头腱鞘炎是一种罕见疾病,关节镜手术可以全方位探查肩腔结构病变,提高手术准确性,减少创伤。
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引用次数: 0
Synchronous sigmoid-cecal volvulus: a rare case of large-bowel obstruction-a case report. 乙状结肠与盲肠同步下卷:一例罕见的大肠梗阻病例--病例报告。
IF 0.9 Q3 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-10-09 DOI: 10.1186/s13256-024-04775-x
Yasa Abdullhi Mohamed, Kyomukama Amagara Lauben, Umaru Kabuye, Daniel Asiimwe, Emmanuel Mswelo Venance, Michael Mugenyi

Introduction and importance: Large bowel obstruction caused by volvulus poses a life-threatening risk without immediate intervention. Sigmoid colon volvulus is predominant (43-75%), followed by cecal volvulus 10-52%). Synchronous double colonic volvulus is extremely rare, with limited documented cases in academic literature.

Case presentation: We report a case of synchronous volvulus involving the sigmoid colon and cecum in a 45-year-old male of the Toro tribe from Fort Portal city in western Uganda who presented with acute abdominal pain, distension, and complete constipation for 2 days, accompanied by five episodes of non-bloody feculent vomiting and anorexia.

Clinical discussion: Upon admission, the patient presented with stable vital signs and a mildly tender, tympanic, distended abdomen with absent bowel sounds. Plain radiographs revealed the characteristic "coffee bean" sign, indicative of sigmoid volvulus. Following optimization, laparotomy confirmed synchronous volvulus involving both the sigmoid and cecum. Subsequently, a total colectomy with end ileostomy was performed, after which the patient experienced an uneventful recovery.

Conclusion: Synchronous double colonic volvulus, a rare condition, is frequently overlooked clinically. Timely recognition and intervention are crucial to address diagnostic challenges and prevent potentially fatal outcomes.

导言和重要性:大肠蠕动引起的大肠梗阻如不及时干预,会有危及生命的危险。乙状结肠空洞占多数(43-75%),其次是盲肠空洞(10-52%)。同步双结肠肠卷极为罕见,学术文献中的病例记录有限:我们报告了一例涉及乙状结肠和盲肠的同步性结肠肠卷积病例,患者是一名来自乌干达西部波尔塔尔堡市托罗部落的 45 岁男性,因急性腹痛、腹胀和完全性便秘就诊 2 天,伴有 5 次非血性脓性呕吐和厌食:入院时,患者生命体征平稳,腹部轻度压痛、鼓胀,肠鸣音消失。平片显示出特征性的 "咖啡豆 "征,表明有乙状结肠空洞。经过优化后,腹腔镜手术证实了乙状结肠和盲肠同步卷曲。随后,进行了全结肠切除术和回肠末端造口术,术后患者恢复顺利:结论:同步双结肠肠卷是一种罕见病,在临床上经常被忽视。及时识别和干预对于解决诊断难题和防止潜在的致命后果至关重要。
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引用次数: 0
Ectatic vertebral artery associated medullary compression treated with microvascular decompression: a case report and review of literature. 微血管减压术治疗外生椎动脉相关髓质压迫:病例报告和文献综述。
IF 0.9 Q3 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-10-08 DOI: 10.1186/s13256-024-04713-x
Jorrdan N Bissell, Brandon Edelbach, Vadim Gospodarev, Kenneth M De Los Reyes, Promod Pillai

Background: Vertebral artery compression syndrome is a rare condition defined as the clinical presentation of dizziness, vertigo, ataxia, dysarthria, dysphagia, progressive or acute paralysis, hemisensory loss, and cervical myelopathy secondary to compression of the medulla and upper spinal cord by the vertebral artery.

Case description: Here we describe a 57-year-old Mexican-American male with bulbar symptoms, positional vertigo, and diplopia. The patient's symptoms were managed through microsurgical decompression of the medulla utilizing a far lateral transcondylar approach. The patient reported clinical improvement on follow-up.

Conclusion: This case underscores the clinical complexity and heterogeneity of this rare neurovascular pathology and the importance of elucidating the pathophysiological mechanisms underlying the symptomatic presentation of vertebral artery compression syndrome.

背景:椎动脉压迫综合征是一种罕见的疾病,临床表现为头晕、眩晕、共济失调、构音障碍、吞咽困难、进行性或急性瘫痪、半身感觉丧失以及颈椎病,继发于髓质和脊髓上部:我们在此描述一名 57 岁的墨西哥裔美国男性,他患有球部症状、位置性眩晕和复视。我们采用远外侧经髁入路对髓质进行显微手术减压,控制了患者的症状。患者在随访中表示临床症状有所改善:本病例强调了这种罕见神经血管病变的临床复杂性和异质性,以及阐明椎动脉受压综合征症状表现的病理生理机制的重要性。
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引用次数: 0
Unusual presentation of PYGM gene mutation as late-onset McArdle disease with camptocormia: a case report. PYGM基因突变罕见地表现为晚发性麦卡德尔病伴凸眼症:病例报告。
IF 0.9 Q3 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-10-08 DOI: 10.1186/s13256-024-04802-x
Johannes Stalter, Ursula Gies, Christian Mathys, Karsten Witt

Background: Glycogen storage disease type 5 (McArdle disease) leads to a deficiency in the activity of myophosphorylase resulting in an impaired glucose utilization. The disease can be caused by a variety of mutations in the PYGM gene, and its typical clinical manifestation is muscles weakness within the first three decades of life.

Case presentation: In this case report we present the diagnostic work-up of a physically active 78-year-old Caucasian patient suffering from a 2-year history of progressive camptocormia including clinical, radiologic, histological, and genetic tests. There was no history of neuro-muscular diseases in the family. Serum CK levels were moderately increased while other blood/urine parameters were normal. Magnetic resonance imaging showed fatty remodeling of the muscles of the back. Histochemical examination of a muscle biopsy revealed the absence of myophosphorylase activity, while gene analysis identified a known early-onset McArdle mutation in the PYGM gene.

Conclusion: This case highlights that the clinical spectrum of PYGM gene mutation typically manifest during adolescence, but it is also a differential diagnosis in late onset muscle disorders and emphases the investigation of the role of ACE inhibitors in this disease.

背景:5型糖原贮积病(McArdle病)是一种肌磷酸化酶活性缺乏导致的葡萄糖利用障碍性疾病。该病可由PYGM基因的多种突变引起,典型的临床表现是出生后30年内肌肉无力:在本病例报告中,我们介绍了一名 78 岁的白种人患者的诊断工作,该患者体力充沛,有两年的进行性肌无力病史,包括临床、放射学、组织学和遗传学检查。患者家族中没有神经肌肉疾病史。血清 CK 水平中度升高,而其他血液/尿液指标正常。磁共振成像显示背部肌肉发生了脂肪重塑。肌肉活检的组织化学检查显示缺乏肌磷酸酶活性,而基因分析发现PYGM基因存在已知的早发麦卡德尔突变:本病例突出表明,PYGM 基因突变的临床表现通常出现在青春期,但它也是晚发性肌肉疾病的鉴别诊断之一,并强调了 ACE 抑制剂在该疾病中的作用。
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引用次数: 0
Significance of early diagnosis and treatment of adult late-onset Pompe disease on the effectiveness of enzyme replacement therapy in improving muscle strength and respiratory function: a case report. 成人晚发型庞贝氏症的早期诊断和治疗对酶替代疗法改善肌力和呼吸功能效果的意义:病例报告。
IF 0.9 Q3 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-10-08 DOI: 10.1186/s13256-024-04837-0
Moein Mir, Kianmehr Rouhani, Kiana Rouhani, Mohammadjavad Hassani, Mohammadrafi Damirchi, Sajjad Yazdansetad, Mehrdad Aghaei

Background: Pompe disease, a rare autosomal recessive disorder, is caused by mutations in the acid α-glucosidase gene. Pompe disease is a congenital metabolic disorder that affects all organs, particularly the striated muscle and nerve cells. Diagnosis is typically confirmed through enzyme assays that reveal reduced acid α-glucosidase activity. Enzyme replacement therapy utilizing human α-glucosidase is an available treatment option. Timely diagnosis and treatment in the early stages of the disease significantly impact the effectiveness of enzyme replacement therapy in enhancing patient condition. Here, we present a case of a patient with Pompe disease diagnosed 20 years after the onset of clinical symptoms.

Case presentation: A 38-year-old Iranian Baloch woman referred to our rheumatology clinic with progressive muscle weakness presents with a complex medical history. On mechanical ventilation for 12 years, she has endured fatigue and limb weakness since the age of 16, exacerbated following an abortion at 19. Despite undergoing corticosteroid and azathioprine therapies, the suspected diagnosis of inflammatory myopathy did not yield improvement. Hospitalization at 23 due to respiratory failure post-pregnancy led to her continued reliance on a ventilator. A dried blood spot test indicated reduced GAA enzyme activity, confirming a diagnosis of Pompe disease through genetic testing. Treatment with myozyme for 2 years demonstrated limited efficacy, as the patient experienced improved breathing but no significant overall improvement in limb-girdle muscular weakness. This case underscores the challenges and complexities involved in diagnosing and managing rare neuromuscular disorders like Pompe disease.

Conclusion: Early intervention with enzyme replacement therapy plays a crucial role in halting further muscle loss and disease progression in Pompe disease patients. It is important to note that treatment during advanced stages of the disease may not yield substantial benefits. Nevertheless, enzyme instability and denaturation due to temperature and neutral pH levels, along with limited delivery to disease-relevant tissues, can pose challenges in treatment. However, timely diagnosis of Pompe disease is paramount for its effective management and improved outcomes.

背景:庞贝氏症是一种罕见的常染色体隐性遗传疾病,由酸 α-葡萄糖苷酶基因突变引起。庞贝氏症是一种先天性代谢性疾病,影响所有器官,尤其是横纹肌和神经细胞。诊断通常是通过酶测定发现酸 α-葡萄糖苷酶活性降低。利用人体α-葡萄糖苷酶进行酶替代治疗是一种可行的治疗方法。疾病早期的及时诊断和治疗对酶替代疗法改善患者病情的效果有很大影响。在此,我们介绍了一例庞贝病患者,她在出现临床症状 20 年后才被确诊:一名 38 岁的伊朗俾路支妇女因进行性肌无力转诊至我们的风湿病诊所,病史复杂。她使用机械通气 12 年,自 16 岁起就出现疲劳和四肢无力,19 岁堕胎后病情加重。尽管接受了皮质类固醇和硫唑嘌呤治疗,但疑似炎症性肌病的诊断结果并未好转。23 岁时,她在怀孕后因呼吸衰竭住院,因此一直依赖呼吸机。干血斑检测显示 GAA 酶活性降低,通过基因检测确诊为庞贝氏症。使用肌酶治疗 2 年的疗效有限,患者的呼吸有所改善,但四肢肌肉无力的总体情况没有明显改善。本病例强调了诊断和管理庞贝氏症等罕见神经肌肉疾病所面临的挑战和复杂性:结论:酶替代疗法的早期干预在阻止庞贝病患者肌肉进一步萎缩和疾病进展方面发挥着至关重要的作用。值得注意的是,疾病晚期的治疗可能不会产生实质性的益处。然而,温度和中性 pH 值导致的酶不稳定性和变性,以及向疾病相关组织的有限输送,都会给治疗带来挑战。不过,及时诊断庞贝氏症对于有效治疗和改善预后至关重要。
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引用次数: 0
Giant pedunculated liver hydatid cyst causing inferior vena cava syndrome: a case report. 引起下腔静脉综合征的巨大梗阻性肝包虫囊肿:病例报告。
IF 0.9 Q3 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-10-07 DOI: 10.1186/s13256-024-04772-0
Abdi Tesemma, Miheret Adane, Kebebe Bekele, Bekam Debebe, Edoardo Rosso, Demisu Zenbaba, Degefa Gomora, Girma Beressa

Background: Hydatid disease is a zoonotic infection caused by the species Echinococcus that typically affects the liver. Most liver hydatid cysts are asymptomatic at first, but as the cyst grows larger, symptoms, such as compression effects, start to appear. Ultrasonography and computed tomography scans are the widely used diagnostic tools, and surgery is considered the mainstay of treatment.

Case presentation: We present an unusual case of a giant pedunculated hydatid cyst causing inferior vena cava syndrome in a 20-year-old male patient from the Oromo ethnic group from a rural area of the country. Abdominal ultrasound and computed tomography scan confirmed the diagnosis. Our patient underwent radical surgical resection of the cyst and had a good outcome.

Conclusion: Hydatid liver cyst diagnosis needs a high index of suspicion for echinococcal etiology when dealing with a giant liver cyst as it results in grave complications without any manifestations.

背景:包虫病是一种由棘球蚴引起的人畜共患传染病,通常会影响肝脏。大多数肝包虫囊肿起初没有症状,但随着囊肿的增大,开始出现压迫效应等症状。超声波和计算机断层扫描是广泛使用的诊断工具,手术被认为是治疗的主要手段:我们介绍了一例来自该国农村地区奥罗莫族的 20 岁男性患者,他的巨大有蒂包虫囊肿引起了下腔静脉综合征。腹部超声波和计算机断层扫描证实了诊断结果。我们的患者接受了囊肿根治性手术切除,结果良好:结论:在诊断巨大肝囊肿时,需要高度怀疑棘球蚴病的病因,因为它会在没有任何表现的情况下导致严重的并发症。
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引用次数: 0
Severe hydronephrosis complicated with primary aldosteronism: a case report and review of the literature. 严重肾积水并发原发性醛固酮增多症:病例报告和文献综述。
IF 0.9 Q3 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-10-06 DOI: 10.1186/s13256-024-04798-4
Jianjuan Sun, Qiurong Zeng, Longbing Lai, Mingjun Gu, Dingrong Liu, Guangxiu Wu, Chuan Peng, Shuming Yang, Qifu Li, Jiangang Lu

Background: Primary aldosteronism is characterized by high plasma aldosterone and low renin. The plasma aldosterone-to-renin ratio is recommended for screening. Severe hydronephrosis leads to renal parenchymal ischemia, resulting in increased renin secretion. Since nonsuppression of renin may cause a negative result in the aldosterone-to-renin ratio test, severe hydronephrosis and primary aldosteronism occurring simultaneously in a patient are challenging to diagnose.

Case presentation: A 54-year-old Chinese man of Han ethnicity was diagnosed with hypertension and severe hypokalemia (minimum 1.57 mmol/L) 13 years prior, and was also diagnosed with severe hydronephrosis due to congenital ureteral stenosis on the left side. His clinical features suggested primary aldosteronism, but the aldosterone-to-renin ratio result of the patient was negative every time he underwent the primary aldosteronism screening test. No further treatment for primary aldosteronism was performed, which led the patient to suffer from severe hypokalemia, such that he was taking 12-15 g/day potassium chloride orally to keep his blood potassium between 3.0 and 3.5 mmol/L (reference value, 3.5-5.5 mmol/L) for 13 years, and the patient needed to be hospitalized in the intensive care unit for rescue several times. At admission, although the aldosterone-to-renin ratio result of the patient was negative, we still did the saline stress test and captopril inhibition test, and the results showed that the plasma aldosterone level was not lower after the test than before the test. Adrenal enhanced computed tomography suggested an adenoma in the left adrenal gland, and the results of adrenal vein sampling suggested that the left side was the dominant side. Therefore, laparoscopic total resection of the left adrenal gland was performed, and 2 weeks later, the patient developed short-term renal function impairment and hyperkalemia, but his renal function and blood potassium returned to normal after treatment that included fluid rehydration. The patient's biochemical test results and clinical symptoms were completely normal after 1 year.

Conclusion: We suggest that for patients with a high suspicion of primary aldosteronism in the clinic, comprehensive analysis must be performed in combination with clinical characteristic assessments, such as severe hydronephrosis, if renin is within the normal range or if the aldosterone-to-renin ratio result is negative at screening and diagnostic tests, and adrenal vein sampling should be performed if necessary. It can help avoid misdiagnoses and contribute to the treatment of patients with severe hydronephrosis and primary aldosteronism.

背景:原发性醛固酮增多症的特点是血浆醛固酮高而肾素低。建议通过血浆醛固酮与肾素的比值进行筛查。严重肾积水会导致肾实质缺血,从而导致肾素分泌增加。由于肾素的非抑制性可能会导致醛固酮与肾素比值检测结果呈阴性,因此同时出现严重肾积水和原发性醛固酮增多症的患者很难诊断:一名 54 岁的中国汉族男子在 13 年前被诊断出患有高血压和严重低钾血症(最低 1.57 mmol/L),同时还被诊断出因左侧先天性输尿管狭窄而导致严重肾积水。他的临床特征表明他患有原发性醛固酮增多症,但每次接受原发性醛固酮增多症筛查时,醛固酮与肾素的比值结果都是阴性。由于没有对原发性醛固酮增多症进行进一步治疗,患者患上了严重的低钾血症,13 年来,他每天口服 12-15 克氯化钾,使血钾保持在 3.0 至 3.5 毫摩尔/升(参考值为 3.5 至 5.5 毫摩尔/升)之间,并多次入住重症监护室进行抢救。入院时,虽然患者的醛固酮-肾素比值结果为阴性,但我们还是为其做了生理盐水压力试验和卡托普利抑制试验,结果显示试验后血浆醛固酮水平并不比试验前低。肾上腺增强计算机断层扫描提示左侧肾上腺腺瘤,肾上腺静脉取样结果显示左侧为优势侧。因此,患者接受了腹腔镜下左侧肾上腺全切除术。两周后,患者出现了短期肾功能损害和高钾血症,但经过补液等治疗后,肾功能和血钾恢复正常。1 年后,患者的生化检查结果和临床症状完全正常:我们建议,对于临床高度怀疑原发性醛固酮增多症的患者,必须结合临床特征评估进行综合分析,如严重肾积水,如果肾素在正常范围内或筛查和诊断性检查中醛固酮与肾素比值结果为阴性,必要时应进行肾上腺静脉采样。这有助于避免误诊,并有助于治疗严重肾积水和原发性醛固酮增多症患者。
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引用次数: 0
A presentation of basal cell adenoma: a case report. 基底细胞腺瘤:病例报告。
IF 0.9 Q3 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-10-05 DOI: 10.1186/s13256-024-04692-z
Deviprasad Dosemane, Meera Niranjan Khadilkar, Nithya Chandy, Shikha Jayasheelan

Background: While statistically rare in comparison to other head and neck tumours, parotid gland swellings are often encountered in clinical practice where one of the primary goals of examination becomes distinction between benign and malignant lesions. Hallmarks of malignancy are characterized by a female preponderance, history of radiation exposure, a positive family history, and clinical features like heterogenous consistency, fixity to skin/underlying tissues and involvement of facial nerve.

Case presentation: Here we present a case of parotid swelling in a 72-year old gentleman from south India that had a curious amalgamation of both benign and malignant features.

Conclusions: While benign, the risk of malignant transformation and rare multicentric occurrence indicates a need to keep basal cell adenoma in mind in case of parotid swellings and their surgical management.

背景:虽然与其他头颈部肿瘤相比,腮腺肿物在统计数字上比较罕见,但在临床实践中经常会遇到,检查的主要目的之一就是区分良性和恶性病变。恶性肿瘤的特征是女性居多、有放射线暴露史、阳性家族史,以及异质性、与皮肤/下层组织固定、累及面神经等临床特征:我们在此介绍一例来自印度南部的 72 岁腮腺肿物病例,该病例同时具有良性和恶性特征:结论:腮腺肿物虽然是良性的,但其恶变的风险和罕见的多中心发生表明,在腮腺肿物及其手术治疗中需要牢记基底细胞腺瘤。
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Journal of Medical Case Reports
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