SN Comprehensive Clinical Medicine最新文献

CT arthrography is a reasonable imaging tool that has been utilized in the ankle in sustained post-sprained pain and ankle impingement syndromes. The main indications of CT arthrography are to assess the osteochondral and chondral lesions, in both situations; many other non-osseous non-chondral pathologic changes could be adequately observed in the same study. The aim of this study was to demonstrate the ability of CT arthrography of the ankle to detect a not uncommon group of injuries other than the osteochondral, chondral, and ligamentous lesions in internal derangement of the ankle joint. Forty-seven patients diagnosed with osteochondral lesion or suspected to have hyaline chondral defect of the ankle joint underwent CT arthrography of the ankle. The synovial and joint space pathologic features are the most frequent observed findings, and the other interesting findings were the uneven joint space widening and the extra-articular pathologic changes in posterior ankle and hind foot locations. There were significant reasonable positive correlations between high VAS score with the presence of synovial thickening and tarsal sinus abnormalities. Regarding the complications of arthrographic procedure, two minor complications have occurred, the inadvertent extra-articular contrast injection and vasovagal syncope, and no major complication has occurred. CT arthrography of the ankle is a helpful imaging tool that could benefit from the extra-articular flow of contrast beyond the talo-crural joint cavity to reveal many pain-producing pathologic conditions other than the osteochondral, chondral, and ligamentous lesions. It could also benefit from procedural joint distension to support diagnosis of mechanical ankle instability although being a static imaging modality.

Headache is a common symptom during pregnancy that requires special attention due to the associated potential risks of life-threatening conditions. The aim of this study was to investigate headache characteristics in pregnant women. This study included pregnant women who presented to the antenatal outpatient clinic with a chief complaint of headache between February 2022 and July 2023. Eligible participants were recruited. Patients with high-risk pregnancies, fetal complications, postpartum headaches, smoking or opiate use, age less than 18 years, or pathological headaches were excluded from the study. The instruments used included a demographic form that collected information on headache history, the International Headache Society (IHS) criteria, and a visual analog scale. A total of 400 pregnant women with headache were selected. The mean age was 27.3 ± 5.06 years, mean gestational age was 32.2 ± 6.05 weeks, and parity was 2 ± 0.70. Multivariate analysis showed that age and gestational age were significantly associated with an increased incidence of migraine without aura and that a history of headache was significantly associated with the occurrence of tension headache. In addition, headache before pregnancy had a significant impact on headache intensity during pregnancy. We observed a significant interaction effect between time and headache type and a significant effect on headache intensity between headache types over time. These findings contribute to a better understanding of headache in pregnancy and emphasize the importance of tailored treatment strategies for pregnant women suffering from these symptoms, especially in emergency situations.

The frequency of tramadol poisoning is on the rise in numerous countries. This study aimed to assess changes in blood glucose concentrations during the first day of hospitalization among tramadol-intoxicated patients. Tramadol-intoxicated patients were evaluated over a 1-year period in a referral poisoning center. Blood glucose was investigated upon admission, 6 h after admission, and 24 h after admission. The study excluded patients with diabetes or other medical conditions and those taking additional medications or substances. A total of 150 patients, comprising 116 males (77.3%), were included in the study, with a mean age of 22.7 ± 10.16 years. The most common manner of poisoning was suicide attempts (42.7%) and tramadol abuse for premature ejaculation. Seizures (35.3%) and altered consciousness (22%) were the most prevalent symptoms. A gradual decreasing trend in blood sugar levels at the 6th and 24th hours after admission (P < 0.001) was found. The mean blood sugar levels of conscious tramadol-intoxicated patients were significantly higher than those of altered consciousness cases at all evaluation times, while there was no difference between patients with seizures and those without seizures. This study clinically confirms that tramadol overdose leads to a continuous decrease in blood glucose levels for at least 1 day after intoxication. Therefore, clinicians should be mindful of the risk of delayed hypoglycemia in tramadol-intoxicated patients and be cautious about discharging them too early from the emergency room.

To assess if preterm termination of pregnancy improves maternal outcome in COVID-19 ARDS. A 35-year-old, woman at 36 weeks period of gestation with severe COVID-19-related ARDS, whose rapid deterioration despite starting steroids, antibiotics, low molecular weight heparin, and optimizing ventilatory support, led us to intervene with a preterm emergency cesarean section. The most important factor in consideration was the limitation of maternal respiratory management due to pregnancy and superimposed maternal metabolic acidosis with the risk of fetal acidosis. The rationale of delivery was to improve respiratory mechanics and decrease maternal oxygen requirement. Some studies have discussed the importance of preterm termination of pregnancy with severe COVID-19 ARDS and investigated its impact on feto-maternal outcomes. This aspect is important as ethical and physiologic considerations in pregnancy, obviate the use of a single protocol for all pregnant women. Timely termination of pregnancy may improve maternal outcome in severe COVID-19 ARDS.

The liver is the most common metastatic site of colorectal carcinoma. Adrenal metastasis is the second most common reason for “adrenal incidentaloma.” For malignant adrenal tumors, open adrenalectomy is the choice of operation. We present a 60-year-old man whose radiological evaluations revealed a metastatic lesion in the right adrenal gland, with a history of colorectal carcinoma. We conducted a literature analysis regarding the accuracy of imaging methods and laboratory tests. It is seen that radiological examinations and laboratory test results do not always comply with the postoperative results. Differential diagnosis and different diagnostic procedures should be considered.

Lateral medullary syndrome (Wallenberg syndrome) and Killian Jamieson diverticulum are both conditions known to cause dysphagia. Here, we present the first reported case of severe dysphagia due to Wallenberg syndrome and a Killian Jamieson diverticulum discovered incidentally during videofluoroscopic swallowing study. A 66-year-old male previously diagnosed with Wallenberg syndrome was referred to our hospital due to severe dysphagia. Pre-operative work-up revealed decreased left-sided pharyngeal contraction, left vocal fold paralysis, impaired laryngeal elevation, and poor upper esophageal sphincter relaxation during swallowing. Furthermore, on videofluoroscopic swallowing study, an incidental finding of a contrast-filled outpouching of the esophagus on the left, below the level of the cricopharyngeus, indicated the presence of a pharyngoesophageal diverticulum. The patient underwent bilateral cricopharyngeal myotomy with diverticulectomy, laryngeal suspension surgery, and tracheostoma revision. The diagnosis of a Killian Jamieson diverticulum was confirmed based on intra-operative findings, as the diverticular pouch was indeed seen to be located below the cricopharyngeal muscle. For patients with severe dysphagia that does not improve with swallowing rehabilitation, swallowing improvement surgery is an option. It aims to improve pre-operatively identified dysfunctional sites in the swallowing mechanism. It is important to always consider pharyngoesophageal diverticula as a possible cause of dysphagia so as not to miss the diagnosis. In this patient’s case, diverticulectomy was necessary to ensure the best possible outcomes in terms of improving his dysphagia.

Wilson’s disease (WD) is a rare autosomal recessive disorder characterized by copper accumulation in the liver, brain, and cornea, resulting from mutations in the ATPase copper transporting beta (ATP7B) gene. This case report presents a unique manifestation of WD, as a 14-year-old female from rural Pakistan presented with acute encephalitis and the “Face of the Giant Panda Sign.” Encephalitis is an uncommon initial presentation of WD, and this case highlights the diagnostic challenges, especially in resource-limited settings. The patient exhibited sudden-onset fever, generalized tonic–clonic seizures, and altered mental status. Initially misattributed to possession by the parents, the patient underwent empirical treatment for encephalitis in the hospital without improvement. Further evaluation revealed abnormal liver function, positive hepatitis B surface antigen (HepBsAg), and characteristic brain magnetic resonance imaging (MRI) findings indicative of WD. Confirmation was made through low ceruloplasmin, Kayser-Fleischer rings, and modified Leipzig criteria. Treatment with penicillamine and vitamin B6 resulted in clinical improvement. This case emphasizes the importance of considering WD in cases of encephalitis, even in the absence of typical hepatic symptoms. The delay in diagnosis and initial misinterpretation underscore the need for increased awareness and education, particularly in regions with limited healthcare resources. Early recognition and intervention can prevent the progression of WD, improving patient outcomes. The report also underscores the significance of familial screening and long-term follow-up to manage the chronic nature of the disease. Further studies and reporting of atypical presentations contribute to the understanding and management of this rare and clinically heterogeneous disorder.

The oral mucosa presents different lesions and conditions, which must be identified through a systematic and detailed examination of the oral cavity aided by a precise medical history and diagnostic tests, pillars, all of the diagnostic process, since this influences the prognosis and the implementation of treatment at the right time. To determine the spectrum of lesions in the oral cavity diagnosed through histopathological study and define their prevalence in the Faculty of Dentistry, Universidad de Costa Rica, during the period 2016–2019. The study was descriptive and retrospective, based on data from the histopathological reports of patients who underwent biopsy. The statistical techniques used were descriptive, with frequency distribution and crossing of variables. The statistical processing of the data was designed in a database created in Excel. The population consisted of 160 histopathological reports, of which 11 were excluded. The age range was 2–78 years old, with the 51–60-year group predominating. The predominant gender was female (58.4%). The anatomical site that prevailed was the tongue (20.0%). The histopathological groups of reactive and hyperplastic lesions (36.1%) and focal fibrous hyperplasia lesions were those that prevailed in the study. Determining the prevalence of lesions in the oral cavity in a specific population helps to know the type and severity of lesions that tend to occur, as well as identifying different patterns of diseases, thus contextualizing the general and at-risk population, which strengthens early diagnosis and timely treatment.

Movement disorders in neuropsychiatric systemic lupus erythematosus (NPSLE) are rare. Chorea remains the predominant phenomenology whereas tremors are reported as a treatment-related side effect or as a component of another syndrome. However, an isolated tremor is rarely reported as a movement-related NPSLE manifestation. We report a 27-year-old female initially admitted because of a 2-month history of undocumented fever, malaise, anorexia, weight loss, and progressive dyspnea. She was eventually referred to the Neurology service because of tremors. Evaluation revealed postural and intention tremors involving bilateral arms with no signs of parkinsonism, ataxia, or other movement abnormalities. Propranolol 20 mg/day was started and afforded tremor reduction whereas neuroimaging revealed findings suggestive of central nervous system (CNS) vasculitis. She was eventually diagnosed with SLE given the over-all findings of positive anti-nuclear antibody, low complement 3, pericarditis, pleuritis, leukopenia, and hemolytic anemia. Her tremors and CNS vasculitis were also deemed active neuropsychiatric manifestations of her lupus. Plan was to administer methylprednisolone pulse but prior to her first dose, she succumbed to pulmonary embolism. A systematic search of literature yielded four studies reporting 12 NPSLE cases with isolated tremor syndromes. Tremors in lupus likely result from the autoantibody attack of the extrapyramidal system on top of previously described tremor generation mechanisms. NPSLE may rarely present with an isolated tremor syndrome. Although much had been discovered regarding tremor generation pathways, those occurring as a result of systemic conditions may reflect additional mechanisms that have yet to be explored further.