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The Coexistence of Fibromuscular Dysplasia of the Renal Artery and Graves’ Disease in an Adolescent: A Case Report 一名青少年同时患有肾动脉纤维肌性发育不良和巴塞杜氏病:病例报告
Pub Date : 2023-12-30 DOI: 10.15746/sms.23.013
Jinsol Jeong, Haesook Kim, Dongwon Lee
Here we present a rare case of an adolescent with hypertension, concurrently diagnosed with fibromuscular dysplasia of the renal artery and Graves’ disease. Although fibromuscular dysplasia and Graves’ disease have distinct pathogenic mechanisms, it is possible to infer the potential correlation between the two from the perspective of vascular involvement. It is believed that transforming growth factor-β, as the shared element of both diseases, may contribute to their development and progression. The overactivation of the sympathetic nervous system in Graves’ disease may induce hyperplasia of vascular smooth muscle cells, similar to that observed in fibromuscular dysplasia. In Graves’ disease, the excessive synthesis and secretion of angiotensin II due to the overactivation of the renin-angiotensin system, along with the up-regulation of angiotensin II receptors, may also induce pathological changes in the vasculature throughout the body. In this regard, exploring the correlation between fibromuscular dysplasia and Graves’ disease is of significant clinical importance.
我们在这里介绍一例罕见的青少年高血压患者,他同时被诊断出患有肾动脉纤维肌性发育不良和巴塞杜氏病。虽然纤维肌性发育不良和巴塞杜氏病的致病机制不同,但从血管受累的角度可以推断出两者之间潜在的相关性。据认为,转化生长因子-β作为这两种疾病的共同因素,可能有助于它们的发展和恶化。巴塞杜氏病中交感神经系统的过度活跃可能会诱发血管平滑肌细胞的增生,这与纤维肌肉发育不良症中观察到的情况类似。在巴塞杜氏病中,由于肾素-血管紧张素系统的过度激活,血管紧张素 II 合成和分泌过多,再加上血管紧张素 II 受体的上调,也可能诱发全身血管的病理变化。因此,探讨纤维肌发育不良与巴塞杜氏病之间的相关性具有重要的临床意义。
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引用次数: 0
Kawasaki Disease Complicated with Giant Coronary Aneurysm in Case of Systematized Epidermal Nevus 系统性表皮痣病例并发巨大冠状动脉瘤的川崎病
Pub Date : 2023-12-30 DOI: 10.15746/sms.23.020
G. Yoo
Kawasaki disease (KD) is an acute systemic vasculitis that involves coronary arteries. Systematized epidermal nevus is a skin disease characterized by extensive verrucous and hyperchromic plaques. A male patient, previously diagnosed with systematized epidermal nevus, was referred for high fever. Eye injection, red lip, strawberry tongue, and enlarged neck node were accompanied. Intravenous immunoglobulin (IVGG) and high-dose aspirin were given for the treatment of KD. An echocardiogram revealed a small aneurysm in the right coronary artery (RCA). Second IVGG was administered because of refractoriness. The size of the aneurysm was increased to medium in RCA and another medium-sized aneurysm was found in the left anterior descending artery (LAD). Clopidogrel was added. After 3 days of defervescence, he was discharged. Warfarin was added for a giant aneurysm in LAD, aggravated 8 weeks later after the presentation. 11 months later, giant aneurysm was changed to medium sized aneurysm. Patient is at following with dual antiplatelet therapy without warfarin.
川崎病(KD)是一种累及冠状动脉的急性全身性血管炎。系统性表皮痣是一种以广泛疣状和高色素斑块为特征的皮肤病。一名男性患者曾被诊断为系统性表皮痣,因高烧而转诊。患者伴有眼球注射、红唇、草莓舌和颈部结节增大。患者接受了静脉注射免疫球蛋白(IVGG)和大剂量阿司匹林治疗 KD。超声心动图显示右冠状动脉(RCA)有一个小动脉瘤。由于反跳,患者接受了第二次 IVGG 治疗。RCA 动脉瘤增大到中等大小,左前降支动脉(LAD)也发现了一个中等大小的动脉瘤。患者加用了氯吡格雷。休养 3 天后,他出院了。因 LAD 巨大动脉瘤加用华法林,8 周后病情加重。11 个月后,巨大动脉瘤变为中型动脉瘤。患者目前仍在接受双联抗血小板治疗,未使用华法林。
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引用次数: 0
Spontaneous Intracranial Hypotension Treated with Epidural Blood Patch: A Case Report 硬膜外血贴治疗自发性颅内低血压1例
Pub Date : 2023-06-30 DOI: 10.15746/sms.23.005
D. Moon, Byung-Chan Kim, Young-Ju Kim, Kwang-Soo Lee
Spontaneous intracranial hypotension (SIH) is a condition caused by spontaneous cerebrospinal fluid (CSF) leakage, resulting in orthostatic headache as the main symptom, but other symptoms such as memory loss, nausea, and tinnitus may also be present. Various imaging techniques are used to diagnose SIH, with magnetic resonance imaging myelography being an important tool for detecting the leakage site of CSF. Conservative treatments including hydration, bed rest, and intravenous caffeine have been tried with limited success. Epidural blood patch (EBP) is the most commonly performed treatment for SIH after the failure of conservative management. There are different opinions about the EBP procedure (e.g., blind EBP vs. targeted EBP). This report describes the treatment of SIH with targeted EBP according to imaging diagnosis after the failure of initial blind lumbar EBP.
自发性颅内低血压(SIH)是一种由自发性脑脊液(CSF)渗漏引起的疾病,以直立性头痛为主要症状,但也可能出现记忆力减退、恶心、耳鸣等其他症状。SIH的诊断采用多种影像学技术,其中磁共振脊髓造影是检测脑脊液渗漏部位的重要工具。保守疗法包括补水、卧床休息和静脉注射咖啡因,但收效甚微。硬膜外补血(EBP)是保守治疗失败后SIH最常用的治疗方法。关于EBP程序有不同的意见(例如,盲EBP与靶向EBP)。本报告描述了初始盲腰椎EBP失败后,根据影像学诊断靶向EBP治疗SIH。
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引用次数: 1
Adult-Onset Still’s Disease after COVID-19 Vaccination: A Case Report and Review COVID-19疫苗接种后成人发病Still 's病1例报告及回顾
Pub Date : 2023-06-30 DOI: 10.15746/sms.23.002
J. Park, S. Lee
To overcome the global pandemic of coronavirus disease 2019 (COVID-19), COVID-19 vaccination has been developed and distributed. Many people have received the vaccination worldwide. However, there are some vaccinated individuals who complain of side effects due to COVID-19 vaccination. We report the case of a patient who developed adult-onset Still’s disease (AOSD) after receiving the messenger RNA COVID-19 vaccine. A 21-year-old male patient without a previous medical history developed a fever on the day of the first dose of the vaccine. He had persistent fever, arthralgia of the knee and wrist, hyperferritinemia, transient skin rash, and negative test results for rheumatoid factor or antinuclear antibody. Positron emission tomography-computed tomography scan showed lymphadenopathies with reactive patterns and no malignancy. His symptoms and laboratory abnormalities gradually improved with glucocorticoid, cyclosporine, methotrexate, and tocilizumab treatment. Although its causality is still not confirmed, AOSD should be considered in a case that meets the diagnostic criteria after COVID-19 vaccination.
为克服2019冠状病毒病(COVID-19)全球大流行,已经开发并分发了COVID-19疫苗。全世界有许多人接种了疫苗。但是,也有一些接种过疫苗的人抱怨接种新冠病毒疫苗会产生副作用。我们报告了一例接受信使RNA COVID-19疫苗后发生成人发病的斯蒂尔氏病(AOSD)的患者。一名没有既往病史的21岁男性患者在接种第一剂疫苗当天出现发烧。患者持续发热,膝关节和手腕关节痛,高铁蛋白血症,短暂性皮疹,类风湿因子或抗核抗体阴性。正电子发射断层扫描-计算机断层扫描显示反应性淋巴结病变,无恶性肿瘤。经糖皮质激素、环孢素、甲氨蝶呤和托珠单抗治疗,他的症状和实验室异常逐渐改善。虽然其因果关系尚未确定,但在COVID-19疫苗接种后符合诊断标准的病例中应考虑AOSD。
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引用次数: 0
Recurrent Pneumothorax Caused by an Unexpected Lymphangioleiomyomatosis: A Case Report 意外的淋巴管平滑肌瘤病所致复发性气胸1例
Pub Date : 2023-06-30 DOI: 10.15746/sms.23.001
Y. Seok
Lymphangioleiomyomatosis is a rare disease characterized by the proliferation of atypical smooth muscle cells. Recurrent pneumothorax is a frequent complication of lymphangioleiomyomatosis. We present the case of a 41-year-old woman who presented with recurrent pneumothorax. Video-assisted thoracic surgery was performed. We did not suspect the possibility of lymphangioleiomyomatosis because of the presence of very few cysts on chest computed tomography.
摘要淋巴管平滑肌瘤病是一种以非典型平滑肌细胞增生为特征的罕见疾病。复发性气胸是淋巴管平滑肌瘤病的常见并发症。我们提出的情况下,41岁的妇女谁提出了复发性气胸。进行了视频辅助胸外科手术。我们没有怀疑淋巴管平滑肌瘤病的可能性,因为胸部计算机断层扫描显示很少有囊肿。
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引用次数: 0
Papillary Histiocytic and Mesothelial Hyperplasia of the Ovary Related to a Huge Uterus: A Case Report 巨大子宫所致卵巢乳头状组织细胞及间皮增生1例
Pub Date : 2023-06-30 DOI: 10.15746/sms.23.003
Kyeoung-Soo Park, Kye-Weol Kim, Y. Kim, Yoon Mee Jeen, Dongho Kim, S. Jin, I. Choi
Nodular histiocytic/mesothelial hyperplasia (NHMH) is a very rare condition. It is generally thought to be associated with repeated mechanical or chemical stimulation. This study reported NHMH with papillary growth pattern in the ovary following high-intensity focused ultrasound (HIFU) treatment for uterine leiomyoma and adenomyosis. A 48-year-old female, who had a history of undergoing HIFU treatment 7 times for adenomyosis and leiomyoma of the uterus 6 months ago, was referred to the hospital. After the hysterectomy and right salpingo-oophorectomy, the patient was confirmedly diagnosed with nodular histiocytic and mesothelial hyperplasia with the papillary growth pattern of the right ovary. This benign reactive inflammatory lesion of the mesothelium mimicking malignancy must be kept in mind to avoid unnecessary treatment.
结节性组织细胞/间皮增生是一种非常罕见的疾病。一般认为它与反复的机械或化学刺激有关。本研究报道了高强度聚焦超声(HIFU)治疗子宫平滑肌瘤和子宫腺肌症后,卵巢出现乳头状生长模式的NHMH。一名48岁女性,6个月前因乳腺肿大和子宫平滑肌瘤接受HIFU治疗7次,被转介到医院。经子宫切除及右侧输卵管卵巢切除术后,确诊为结节性组织细胞及间皮增生,右侧卵巢呈乳头状生长。这种良性反应性炎症病变的间皮层模拟恶性肿瘤必须牢记,以避免不必要的治疗。
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引用次数: 0
Anesthetic Management of a Patient with Type II Alexander Disease: A Case Report II型亚历山大病患者的麻醉管理1例报告
Pub Date : 2023-06-30 DOI: 10.15746/sms.23.004
Y. Yoon, J. Yeom
Patients with type II Alexander disease have white matter dysplasia, which may cause various symptoms due to nerve conduction impairment. When providing anesthesia to a patient with Alexander disease, careful and patient-specific individualized risk evaluation must be preceded by planning the method of anesthesia and anesthetic drugs. This is the first case report of a patient with type II Alexander disease who underwent general anesthesia. We performed general anesthesia on a 45-year-old male with type II Alexander disease for laparoscopic cholecystectomy, using remimazolam, remifentanil, and rocuronium. Despite the use of reversal agents including flumazenil, naloxone, and sugammadex, the patient manifested a delay in emergence but successfully recovered from anesthesia without postoperative complications. In consideration of the possibility that leukodystrophy may have altered responses to anesthetics, the action of an anesthetic agent may be prolonged or delayed in patients with type II Alexander disease. We recommend using drugs with a short duration of action and which can be reversed immediately by a reversal agent.
II型亚历山大病患者有白质发育不良,由于神经传导受损,可引起各种症状。在为亚历山大病患者提供麻醉时,必须在规划麻醉方法和麻醉药物之前进行仔细和针对患者的个体化风险评估。这是第一例报告的病人与II型亚历山大病谁接受全身麻醉。我们对一名45岁男性II型亚历山大病患者行腹腔镜胆囊切除术全麻,使用雷马唑仑、瑞芬太尼和罗库溴铵。尽管使用了包括氟马西尼、纳洛酮和糖马德在内的逆转药物,但患者表现出急诊延迟,但成功从麻醉中恢复,无术后并发症。考虑到脑白质萎缩可能改变了对麻醉剂的反应,在II型亚历山大病患者中,麻醉剂的作用可能延长或延迟。我们建议使用作用时间短且可以通过逆转剂立即逆转的药物。
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引用次数: 0
Tatton-Brown-Rahman Syndrome: A Report of a Case with a Novel DNMT3A Mutation Presented Hemihypertrophy 塔顿-布朗-拉赫曼综合征:一个新的DNMT3A突变的报告,表现为半肥厚
Pub Date : 2023-06-30 DOI: 10.15746/sms.23.007
Mi Le Kim, Jeongho Lee
Tatton-Brown-Rahman syndrome (TBRS) is a relatively new congenital anomaly syndrome manifesting overgrowth and a broad spectrum of intellectual disability. It is caused by pathogenic variants in the DNA methyltransferase 3 alpha (DNMT3A) gene, mainly de novo inheritance. Overgrowth, mild-to-severe intellectual disability, and other clinical features of TBRS may affect the quality of life of patients and their family members. Thus, early diagnosis by genetic testing and management of these symptoms is critical. We report a case of a 17-year-old male patient with hemihypertrophy who suffered back pain since school age, diagnosed with TBRS-identified DNMT3A gene mutation.
塔顿-布朗-拉赫曼综合征(TBRS)是一种相对较新的先天性异常综合征,表现为过度生长和广泛的智力残疾。它是由DNA甲基转移酶3 α (DNMT3A)基因的致病性变异引起的,主要是从头遗传。TBRS的过度生长、轻至重度智力残疾等临床特征可能影响患者及其家庭成员的生活质量。因此,通过基因检测的早期诊断和这些症状的管理是至关重要的。我们报告一例17岁的男性半肥厚症患者,自学龄期以来遭受背部疼痛,诊断为tbrs鉴定的DNMT3A基因突变。
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引用次数: 0
Bone Biopsy Confirmed Imatinib-Induced Bone Marrow Necrosis in Patient with Gastrointestinal Tumor: A Case Report 骨活检证实胃肠道肿瘤患者伊马替尼诱导的骨髓坏死1例
Pub Date : 2023-06-30 DOI: 10.15746/sms.23.006
H. Kim
Imatinib mesylate is an effective, small-molecule, selective tyrosine kinase inhibitor, which inhibits BCR-ABL in patients with chronic myeloid leukemia, c-kit in patients with gastrointestinal tumor (GIST), and platelet-derived growth factors in hypereosinophilic syndrome. Above all, bone marrow necrosis is a rare complication of imatinib usage. If newly developed increased opacity bone lesions are seen in patients with metastatic GIST, it is usual to consider those lesions as bone metastasis. Also, it is true that making a differential diagnosis between bone marrow change (bone marrow necrosis) and disease progression (bone metastasis) is both clinically and radiologically difficult. Because it may alter treatment options according to early distinguish bone metastasis and imatinib related-bone necrosis, a bone biopsy is recommended. Here, we report a case that a biopsy confirmed bone marrow necrosis due to imatinib, even though investigations such as magnetic resonance imaging, and whole-body bone scan indicated more favor to the metastatic lesion.
甲磺酸伊马替尼是一种有效的小分子选择性酪氨酸激酶抑制剂,可抑制慢性髓性白血病患者的BCR-ABL,胃肠道肿瘤(GIST)患者的c-kit,以及嗜酸性粒细胞增多综合征患者的血小板源性生长因子。最重要的是,骨髓坏死是使用伊马替尼的罕见并发症。如果在转移性GIST患者中发现新发展的增加的不透明骨病变,通常认为这些病变是骨转移。此外,骨髓改变(骨髓坏死)和疾病进展(骨转移)的鉴别诊断在临床和影像学上都是困难的。因为它可能根据早期区分骨转移和伊马替尼相关骨坏死而改变治疗方案,因此建议进行骨活检。在这里,我们报告了一例活检证实伊马替尼导致骨髓坏死的病例,尽管磁共振成像和全身骨扫描等检查更倾向于转移灶。
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引用次数: 0
Human Herpesvirus-8 Positive Multicentric Castleman’s Disease with Complete Response after Rituximab Monotherapy: A Case Report 利妥昔单抗单药治疗后完全缓解的人疱疹病毒-8阳性多中心Castleman病1例报告
Pub Date : 2023-06-29 DOI: 10.15746/sms.23.008
Jun Young Kim, S. Yoon, M. Lee, N. Lee, Jongchan Won, I. Choi, K. Kim, Kyoungha Kim
Castleman’s disease is a rare non-neoplastic lymphoproliferative disorder of unknown origin. It is classified into unicentric or multicentric based on its anatomical distribution. Multicentric Castleman’s disease can be subdivided according to the presence of human herpesvirus-8 (HHV-8) infection. Castleman’s disease has a rare incidence, and HHV-8-positive multicentric Castleman’s disease is even rarer. There are several types of natural course for this disease, and the rapidly progressing type can lead to death within a few weeks, emphasizing the need for prompt diagnosis and treatment. We report a recent case from Korea, presenting with multiple lymphadenopathies, confirmed as HHV-8-positive multicentric Castleman’s disease through biopsy, and achieving complete response with rituximab monotherapy.
Castleman氏病是一种罕见的病因不明的非肿瘤性淋巴细胞增生性疾病。根据其解剖分布可分为单中心型和多中心型。多中心Castleman病可根据是否存在人类疱疹病毒-8 (HHV-8)感染而细分。Castleman病的发病率很少见,而hhv -8阳性的多中心Castleman病更是罕见。这种疾病有几种自然病程,进展迅速的类型可在几周内导致死亡,这强调了及时诊断和治疗的必要性。我们报告一个最近来自韩国的病例,表现为多发性淋巴结病变,通过活检证实为hhv -8阳性多中心Castleman病,并通过利妥昔单抗治疗获得完全缓解。
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引用次数: 0
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Soonchunhyang Medical Science
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