World Journal of Clinical Cases最新文献

The positioning of teeth is of significant importance, both in terms of function and aesthetics. Aesthetics is a subjective matter, and there is often a discrepancy between the perceptions of patients and those of medical professionals. The act of wearing a mask has been demonstrated to impair the ability to evaluate facial attractiveness, thereby reaffirming the visual importance of the oral cavity in the context of facial aesthetics. The notion that a face perceived as beautiful is inherently exceptional is a fallacy. An average face is defined as one that exhibits characteristics that are common to the group. However, cultural mutations occur at a faster rate than genetic mutations. With regard to changes in facial aesthetics, cultural differences have a more immediate effect than genetic mutations. The advent of the internet meme may herald the advent of an era in which the average face that defines a beautiful face is determined by the internet.

Background: The tear of the gluteus medius and minimus tendons can cause chronic buttock pain, especially in middle-aged individuals; these tears occur mostly in association with degenerative changes in the muscles and tendons. Chronic injuries are more common than acute injuries, and concurrent injuries to the gluteus medius and minimus tendons without chronic pain are rare, especially isolated injuries to both sides of the gluteus minimus; such a case has not yet been reported.

Case summary: The authors present a case of bilateral acute traumatic injuries to the gluteus minimus during buttock strengthening exercises in a 75-year-old male patient. The patient completely returned to his pre-injury lifestyle after 8 weeks of injury, with no limitations, but the diagnosis was initially delayed due to misdiagnosis as lumbar radiculopathy, resulting in unnecessary socio-economic burden on the patient.

Conclusion: When treating patients who complain of hip pain, it is important to consider various causes to make a correct diagnosis.

In this editorial, we provide a critical review of the article by Tang et al published in the World J Clin Cases, focusing on the utilization of butorphanol for epidural analgesia during labor. Our discussion encompasses recent research developments in epidural labor analgesia, specifically highlighting the current status of clinical applications of butorphanol and associated treatment approaches. Epidural analgesia is widely acknowledged as the primary method for pain management during labor, offering effective and prolonged pain relief while allowing mothers to remain alert and actively participate in the delivery process. Among the various drugs utilized for epidural labor analgesia, butorphanol has received increasing attention due to its potential efficacy and distinctive pharmacological properties. As a synthetic opioid analgesic, butorphanol exhibits both agonistic and antagonistic activity on opioid receptors, striking a balance between analgesia and minimizing side effects. Nevertheless, the safety and efficacy of butorphanol in epidural labor analgesia remains controversial. While certain studies have reported positive outcomes with butorphanol, including effective pain relief and a reduced incidence of side effects, others have raised concerns about its safety and efficacy compared to traditional opioids or alternative analgesics. In addition, the optimal dosing strategy and regimen of butorphanol as an adjuvant in epidural labor analgesia still need to be verified. Through comprehensive synthesis and analysis of existing literature, we aim to evaluate the current evidence regarding the use of butorphanol for epidural labor analgesia, delineate areas of consensus and controversy, and propose future avenues for research and clinical practice in this domain.

Background: Small bowel tumors (SBTs) are a heterogeneous group of difficult-to-diagnose tumors that account for 2%-5% of all gastrointestinal tumors. Single-balloon enteroscopy greatly enhances the diagnosis and treatment of SBTs. However, few epidemiological studies have been conducted in Taiwan to determine the clinical profile of SBTs.

Aim: To investigate the clinical characteristics, managements and prognosis of SBTs in a medical center in Taiwan.

Methods: The study enrolled 51 patients aged 58.9 ± 8.8 years (range, 22-93) diagnosed with SBTs from November 2009 to July 2021. We retrospectively recorded clinical characteristics, indications, endoscopic findings, pathological results, management, and outcomes for further analysis.

Results: A male preponderance was observed (56.8%). The most common indications were suspected small intestinal tumors (52.9%) and obscure gastrointestinal bleeding (39.2%). The most common tumor location was the ileum (41.2%). The performance of imaging studies (P = 0.004) and the types of findings (P = 0.005) differed significantly between malignant and benign SBTs. The most frequent imaging finding was a small intestinal mass (43.1%). The top three malignant tumor types were gastrointestinal stromal tumors (GISTs), adenocarcinomas, and lymphomas. Moreover, the proportions of benign and malignant tumors were 27.5% and 72.5%, respectively. The survival rates of patients with malignant tumors in the GIST and non-GIST groups differed significantly (P = 0.015). Kaplan-Meier survival analysis showed a significant difference in survival between patients in the malignant and benign groups (P = 0.04). All patients with lymphoma underwent chemotherapy (n = 7/8, 87.5%), whereas most patients with GISTs underwent surgery (n = 13/14, 92.8%).

Conclusion: Patients with GISTs have a significantly higher survival rate than those with other malignant SBTs. Therefore, a large-scale nationwide study is warranted to evaluate the population-based epidemiology of SBTs.

Autism spectrum disorder (ASD) is often diagnosed long after symptoms have become noticeable. This delay can make it difficult to provide early intervention, which can impact long-term outcomes. The concept of "pre-autism" highlights the phase before a formal diagnosis of ASD, providing an opportunity for earlier identification and intervention, which could be a turning point in ASD management. In a previous article, we explored different ways of diagnosing pre-autism, including historical records, physical markers, laboratory tests, and radiological evidence. This manuscript builds on that foundation by emphasizing the importance of early diagnosis and intervention in ASD. Recent research advancements have clarified that ASD presentations can be complex, and individualized support strategies are necessary. The significance of pre-autism lies in its potential to alter the trajectory of ASD through early detection and intervention despite challenges such as limited awareness and variability in symptom presentation. Biomarkers and diagnostic tools have shown promise as avenues for early detection, but it is essential to exercise caution and not rely too heavily on yet-to-be-established markers. Addressing these challenges requires a collaborative effort to increase awareness, improve access to diagnostic tools, and foster inclusive environments. Ultimately, this manuscript calls for ongoing research, advocacy, and resource allocation to enhance early detection and intervention efforts, ensuring optimal outcomes for individuals on the autism spectrum.

This manuscript explores the case on the occurrence of uterine artery pseudoaneurysm (UAP) during hysteroscopy endometrial polypectomy and the subsequent successful treatment via uterine artery embolization (UAE). Moreover, we focus on the management and treatment options for UAP in patients of advanced maternal age. A pseudoaneurysm is an extraluminal blood collection with a disrupted flow that communicates with the parent vessel via a defect in the arterial wall. The reported case involved a 48-year-old primiparous woman who developed a UAP after uterine polyp removal. The study enhances the understanding of UAP, a rare but potentially life-threatening condition, by providing a detailed and well-documented account of the comprehensive case presentation, effective use of medical imaging techniques for diagnosis, successful postoperative patient management following UAE, and practical clinical recommendations for clinicians managing similar cases. Overall, this study highlights the importance of considering UAP as a differential diagnosis in patients with abnormal vaginal bleeding following hysteroscopic surgery. Additionally, this manuscript recommends that clinicians with a high index of suspicion for UAP promptly request ultrasonography and computed tomography to facilitate early diagnosis. UAE is suggested as a primary treatment due to its effectiveness and safety, particularly in facilities capable of avoiding hysterectomy.

This editorial explores the study by Mkpoikanke Sunday Otu and Maximus Monaheng Sefotho on the use of cognitive-behavioral career coaching (CBCC) to reduce work anxiety and depression among public employees. Public sector workers often face significant psychological stressors, leading to mental health issues that impair well-being and job performance. The study employed a group-randomized trial design, involving 120 public employees diagnosed with severe anxiety and depression. Participants were divided into a treatment group, receiving CBCC, and a control group with no intervention. Results showed a significant reduction in anxiety and depression levels in the treatment group, sustained through follow-up assessments. The findings underscore the clinical relevance of CBCC as an effective intervention for improving mental health among public employees. Future research should explore the scalability of CBCC across different sectors and cultural contexts, as well as its integration with other mental health interventions. This editorial advocates for the broader implementation of CBCC practices in public service to enhance employee productivity and psychological well-being. By addressing cognitive distortions and fostering adaptive coping mechanisms, CBCC can help public employees navigate complex professional environments, ultimately contributing to a healthier and more efficient workforce.

Background: The combination of immune checkpoint inhibitors and chemotherapy has shown promising results for the treatment of advanced biliary tract cancer (BTC). Based on the results of the TOPAZ-1 trial, a gemcitabine and cisplatin plus durvalumab (GCD) regimen was recently approved as first-line therapy for patients with advanced BTC. However, post-GCD conversion surgery has not been previously studied. Herein, we describe a case of advanced intrahepatic cholangiocarcinoma (ICC) successfully treated with radical surgery after GCD.

Case summary: A 65-year-old female diagnosed with advanced ICC with periductal infiltration into the hepatic hilum underwent eight cycles of GCD, followed by durvalumab maintenance treatment, with mild adverse events. Partial response was obtained. Subsequently, a conversion surgery with extended left hepatectomy and bile duct resection was performed. The resection margins were negative, and the pathological diagnosis was compatible with small duct type ICC. The patient remained disease-free for 8 months without adjuvant chemotherapy.

Conclusion: We describe the case of a patient who received successful conversion surgery after GCD treatment for advanced ICC.

Background: Pneumoparotid is a rare disease associated with retrograde airflow into the ductal system. There is no established treatment for this disease, which has no known complications. Mouth puffing and playing wind instruments are known to be the causes of this disease.

Case summary: We managed a case, in which pneumoparotid suddenly recurred 4 months after surgery for purulent parotiditis. The patient did not report any obvious etiological factors, such as mouth puffing or playing a wind instrument. We reviewed 128 articles (from 1941 to 2023) that reported on a total of 166 patients with pneumoparotid, including the patient from the present case report, with imaging findings. This is the first reported case of pneumoparotid following surgery for purulent parotitis. The etiology in our case was classified as idiopathic.

Conclusion: Imaging findings could be sufficient for accurate pneumoparotid diagnoses and the exclusion of complications; computed tomography could be useful.

Background: Determination of platybasia and basilar kyphosis are significant parts of routine cranial magnetic resonance (MR) interpretations. These situations may explain a patient's symptoms or may be associated with other anomalies.

Aim: To indicate the interobserver and intraobserver reliability of the skull base angles (SBA) (Koenigsberg standard) and modified SBA (mSBA) measurement techniques.

Methods: In total, 391 patients who had undergone cranial MR imaging were re-assessed regarding the SBA measurements. The SBA and mSBA techniques were used on MR images. Two reviewers independently measured the same angles twice within a 15-day interval, using different monitors. Intraclass correlation coefficient (ICC) was calculated to reveal the intraobserver and interobserver agreements.

Results: There was an excellent agreement between reviewers regarding both angle measurements (ICC was 0.998 for SBA and mSBA). Excellent agreement levels were also observed for intraobserver measurements. ICC was 0.998 for SBA and 0.999 for mSBA for reviewer 1. ICC was 0.997 for SBA and 0.999 for mSBA according to the measurement results of reviewer 2. Higher SBA and mSBA values were observed for females compared to males. There was no correlation between SBA and age for SBA. However, a negative and low-level correlation was observed between mSBA values and age for both reviewers.

Conclusion: SBA and mSBA measurements indicated excellent agreement regarding interobserver and intraobserver differences. The study results showed that SBA angles were reliable measurement techniques to be used on MR images.