SN Comprehensive Clinical Medicine最新文献

Abstract

Regarding the preventive treatment of CH, there are few placebo-controlled studies, meaning most treatment recommendations by physicians are limited to results from open observational studies. Additionally, existing effective therapies are believed to be underused because of our underdiagnosis of CH syndrome. Numerous treatment methods are available for different CH attack stages, making them difficult to manage. Some treatment options include inhalation of 100% oxygen or subcutaneous/intranasal administration of sumatriptan for acute cluster attacks and bridging therapy with oral prednisolone until oral prophylactic therapy is effective. Finally, drugs for the preventive treatment of CH include verapamil, lithium, divalproex sodium (Depakote), gabapentin, and topiramate. Patients suffering from CH should first be encouraged to change potentially harmful lifestyle activities, including smoking or alcohol consumption, especially during cluster periods, to minimize CH episodes as much as possible before initiating acute or prophylactic drug treatment. Cluster headaches (CH) are categorized under trigeminal autonomic headaches. CH is generally treated through acute drug therapy and preventive medicine. These excruciating, unilateral headaches are usually accompanied by conjunctival injections and lacrimation, which involve bursts of moderate to severe burning, piercing, or throbbing pain and occur acutely, episodically, or chronically. Increasing controversy continues to challenge research on CH, especially prophylactic treatment, related to the intensities of CH pain and increased ethical concerns surrounding placebo treatments, making the design of randomized controlled trials difficult. Fortunately, as new technologies and genetic studies emerge, researchers better understand the etiology of CH, allowing for more specific targeted therapies. Therefore, this review discusses divalproex, valproate, and other traditional and novel prophylactic treatment options for CH, comparing their safety profiles, pharmacodynamics, pharmacokinetics, and limitations.

Abstract

Ultrasound has become a valuable tool for detecting fluid accumulations due to its ability to reveal the nature of the fluid based on its appearance and anatomical location. This case report explores the use of ultrasound in diagnosing an abdominal collection suggestive of peritonitis by introducing an ultrasonographic dynamic sign. A 37-year-old patient, post-rectal tumor surgery, presented with abdominal pain, peritoneal reaction, and clinical deterioration necessitating intensive care. Point-of-care ultrasound revealed a hyperechoic, mobile, image with septa resembling a jellyfish in the subhepatic region, indicating a complicated fluid collection. Abdominal CT confirmed the presence of free fluid in perihepatic and left subphrenic regions. Subsequent surgery revealed peritonitis, anastomosis suture dehiscence, and successful management in the ICU. Recognizing the “abdominal jellyfish sign” and interpreting it appropriately within the relevant clinical context aids in the diagnosis of complicated abdominal collections. Further studies employing alternative methodologies will be necessary to confirm or refute the true significance of this sign in this context.

Abstract

Antiphospholipid antibody syndrome (APS) is an acquired thrombophilia with multisystem involvement. This study was undertaken to study the antibody profile of pregnant women with APS and their pregnancy outcomes. This retrospective study was conducted in a tertiary care teaching institute in Southern India. Data of 231 APS-positive pregnancies in 104 women were analyzed in this study. The primary outcome was to study the adverse outcomes such as abortions, intrauterine fetal death, neonatal death, maternal thrombotic events, and preeclampsia in APS-complicated pregnancies. Secondary outcomes were to study the adverse clinical outcomes in comparison to various antiphospholipid antibodies; primary versus secondary APS; and obstetric versus thrombotic APS. Anticardiolipin antibody (ACLA) (n = 157, 68%) was the most common antibody identified followed by lupus anticoagulant (LA) (n = 80, 34.6%) and beta-2-glycoprotein (B2GP) (n = 48, 20.8%). B2GP positivity was associated with higher fetal growth restriction (FGR) (66.7% vs 36.3% vs 32.6%, p value 0.05) and stillbirth (30% vs 9.5% vs 13%, p 0.004) in comparison to ACLA and LA. Multiple antibody positivity was associated with a significantly higher first trimester losses (55.2% first trimester loss in double positive versus 43.2% in single antibody positive group; p 0.004). Thrombotic APS was associated with higher rates of intrauterine growth–restricted fetuses than obstetric APS (35.2% vs 55.9%, p 0.032). ACLA is the most common antibody identified in the APS-positive pregnancies in Southern Indian population. The adverse pregnancy outcomes were higher in multiple antibody positivity and B2GP group.

Obesity can affect physical and mental health, as well as quality of life. It is necessary to pay attention to it and its treatment methods. One of the current treatments for morbid obesity is bariatric surgery. Since obesity affects the mental health of people and the mental health of people affects the development of obesity and the consequences and progress of its treatment, the purpose of this article is to investigate the prevalence of mood disorders in applicants for bariatric surgery. A cross-sectional study was conducted on 250 obese patients who were candidates for bariatric surgery and 100 of their normal weight relatives. Questionnaires BSDS, MDQ, and demographic questionnaire were used, and those who showed signs of bipolar disorder were further evaluated through SCID-5. Regarding gender, 24.4% of the total number of obese patients studied were male and 75.6% were female. Twenty-two percent of obese patients suffered from bipolar disorder. Among people with bipolar spectrum disorders, 21.8% had bipolar disorder I, 9.1% had bipolar disorder II, 50.9% had bipolar disorder NOS, and 18.8% had cyclothymia. In the control group, 11 patients (11%) had bipolar disorder, non-obese individuals had significantly lower values compared to obese individuals (p = 0.001), 4 patients (4%) had bipolar disorder type II, and 7 (7%) had bipolar disorder NOS. The prevalence of bipolar spectrum disorders was almost twice that of the control group, indicating the importance of screening for these disorders in patients with obesity.

Abstract

The congenital granular cell tumor is a benign soft tissue lesion, unique to the newborn, which originates from the mucosa of the alveolar ridge of the maxillary and mandibular bone in the anterior region. Its diagnosis is made clinically, generally from birth. It is important to learn about this pathology because depending on the size, the tumor can be threatening to the life of the newborn due to mechanical obstruction of the oral cavity, interfering with functions such as swallowing, feeding, proper closure of the oral cavity, and breathing, leading to cyanosis and dyspnea, and being a potential cause of death by asphyxia.

Case Presentation

A 2-day-old girl was in the Neonatology Service, Hospital Nacional de Niños, Caja Costarricense de Seguro Social, for presenting a tumor in the mouth, which was diagnosed by ultrasound in the prenatal period, and for which she was admitted due to possible respiratory distress and clinical deterioration. In her evaluation, a rounded, mobile, fibrous, vascularized lesion of approximately 40 mm × 40 mm was observed, with a wide base adhered to the maxillary alveolar ridge vestibular mucosa. Therefore, it was decided to schedule surgery for excision and biopsy of the tumor. The histopathological study indicated a diagnosis of congenital ulcerated epulis.

Conclusion

The clinical presentation of congenital granular cell tumor, in these case, is impressive due to its size and aggressive appearance, which is important for health professionals to know the characteristics of this benign, rare, and congenital tumor to avoid complications and decide on the procedure to follow.

This study aimed to investigate the preferences of patients who underwent both transradial access (TRA) and transfemoral access for percutaneous coronary interventions (PCIs). The primary focus was on understanding patient preferences and satisfaction with each method to contribute insights into the choice of arterial access in coronary interventions. A single-center prospective study was conducted, including patients who had previously undergone either femoral or radial access for PCI and subsequently chose the alternative access for a second procedure. A comprehensive questionnaire with 13 inquiries was administered to 100 eligible patients, covering aspects such as procedural comfort, pain, embarrassment, and recovery time. The study received ethical approval, and informed consent was obtained from all participants. Among the 100 surveyed patients, all of whom had experienced both TRA and transfemoral access, a unanimous preference for TRA was observed. Patients reported TRA as less stressful, less embarrassing, and less painful both peri- and post-procedurally. Notably, 98% of participants indicated faster recovery and earlier feeding after TRA angiography. No major complications were reported, supporting the safety of TRA. The findings strongly advocate for transradial access as the preferred method for coronary interventions, emphasizing the importance of patient satisfaction in choosing arterial access. The study underscores TRA’s advantages in terms of patient comfort, recovery time, and overall preference, suggesting its incorporation as a routine method for PCI procedures.

Leiomyomas are benign tumors, mostly located in the uterus. The pelvic localization is quite rare, and it is associated with unusual growth patterns. It is important to make an adequate differential diagnosis between malignant and benign retroperitoneal neoplasm because treatment is different. When it is not possible to have a precise preoperative diagnosis, a laparoscopic or laparotomy surgical tumorectomy is often required. To obtain a certain diagnosis, the goal of surgery is ensuring the complete excision of neoplasms and preservation of urination, defecation, and sexual function. We report a rare case of a 58-year-old woman who underwent a laparoscopic tumorectomy for a pelvic retroperitoneal leiomyoma. The patient reported occasional episodes of dull pain in the pelvic region. Pelvic contrast CT scan and magnetic resonance imaging (MRI) showed a retroperitoneal solid mass in contiguity with the posterior wall of the uterine body-isthmus, to be referred to as a pedunculated uterine fibroma strictly posteriorly adherent to the sigma. She first underwent to explorative laparoscopy by a gynecologist who did not find any uterine mass. The patient was subsequently admitted to the department of general surgery and has done a second operative laparoscopy which highlighted the presence of an extra-peritoneal para-rectal mass which was completely excised. The histological examination of tumor indicated that it was a leiomyoma. The postoperative course was uneventful, and the patient was discharged in III post-operative day (POD).