World Journal of Clinical Cases最新文献

Optic neuritis (ON) is a focal inflammatory demyelinating disorder of the optic nerve. Although classically regarded as a sentinel event for multiple sclerosis (MS), ON also occurs in antibody-mediated entities such as aquaporin-4-IgG-positive neuromyelitis optica spectrum disorder (AQP4-NMOSD) and myelin-oligodendrocyte-glycoprotein-antibody disease. In all these settings biological sex is a pivotal determinant of susceptibility, clinical expression, treatment response and long-term outcome. Data synthesized from an extensive literature analysis utilizing PubMed, Scopus, and Web of Science in this review shows that women experience ON far more frequently - with female-to-male ratios ranging from 3:1 in MS to almost 9:1 in AQP4-NMOSD - yet men, when affected, tend to accumulate irreversible neuro-axonal loss more rapidly. Sex-specific patterns arise at every biological stratum: X-linked gene dosage, epigenetic regulation, hormonal cycles from puberty through menopause, metabolic co-modifiers such as obesity and vitamin-D status, and psychosocial forces that influence healthcare utilization. By weaving these elements into an expanded narrative, the present review provides a detailed resource for clinicians and investigators aiming at gender-tailored management of ON.

Background: Pediatric complicated community-acquired pneumonia (CCAP) is on the rise. The three subtypes include para-pneumonic effusion (PPE), necrotizing pneumonia (NP), and empyema.

Aim: To study different sub-types of pediatric CCAP, and compare their etiology, clinical profile, and outcome in the post-pneumococcal vaccination era.

Methods: This prospective observational study was conducted over a 2-year period. All details (demographics, clinical, management, and outcomes) were recorded. Continuous data were presented either as mean and SD, or as median and inter-quartile range. Categorical data were presented as frequencies and percentages (%). Data were analyzed by using the IBM SPSS Statistics for Windows, version 21 (IBM Corp., Armonk, NY, United States).

Results: Of the 80 cases included (71% aged 4-8 years), the distribution was as follows: PPE (42%), empyema (39%), and NP (19%). Bacterial etiology was identified in 28% (empyema 63%, P = 0.012). Staphylococcus aureus (45%) was most common followed by Escherichia coli (E. coli) (22.7%), and Streptococcus pneumoniae (13.6%). Patients with empyema, compared to PPE and NP, were less likely to receive prior antibiotics (32% vs 56% and 58%, respectively, P = 0.03). Duration (days, mean ± SD) of hospitalization was longer in children with NP compared to empyema and PPE (17.7 ± 9.8, 16.1 ± 7.5, and 13.6 ± 4.2, respectively). All children recovered with the medical management except 2 children requiring decortication.

Conclusion: Staphylococcus aureus and E. coli are the most common bacterial etiology in the post-pneumococcal vaccination era. Empyema might be related to a delay in antibiotics administration. NP is the most severe pediatric CCAP with prolonged hospitalization.

Background: Although obesity is a well-established contributor to surgical risks, evidence regarding the specific outcomes of laparoscopic cholecystectomy (LC) in obese patients remains scarce.

Aim: To assess clinicopathologic differences and 1-year outcomes following elective LC in patients with obesity and gallstone disease.

Methods: This retrospective study analyzed data from 65 patients who underwent elective LC for gallstone disease between January 2020 and May 2022, with outcomes assessed at the 1-year follow-up. Patients were categorized as obese (body mass index ≥ 25 kg/m²) or non-obese (body mass index < 25 kg/m²), and comparisons were made across preoperative laboratory values, intraoperative parameters, and patient-reported outcomes.

Results: The obese group had significantly higher American Society of Anesthesiologists scores, higher glycated hemoglobin levels, and lower vitamin D levels than the non-obese group. Elevated triglycerides were more frequent in the obese group, whereas higher high-density lipoprotein levels were more common in the non-obese group. Intraoperative and postoperative outcomes did not differ between the groups. At the 1-year follow-up, 24.6% of patients reported post-cholecystectomy symptoms, with no group differences.

Conclusion: Obese patients had higher American Society of Anesthesiologists scores, lower vitamin D, and elevated triglycerides preoperatively, but these differences did not significantly affect intraoperative findings or 1-year postoperative outcomes compared to non-obese patients.

Background: Intracranial blister-like microaneurysms are an extremely rare disease. Rupture of intracranial aneurysms can lead to subarachnoid hemorrhage (SAH). Patients with SAH may experience severe neurological symptoms, including severe headache, nausea, vomiting, transient or persistent loss of consciousness, limb weakness, and blurred vision. Ruptured aneurysms should be surgically treated as soon as possible. Intravascular electrocoagulation is becoming a promising treatment method for intracranial blister-like microaneurysms. The short-term follow-up results demonstrated that this method is safe and effective. This article presents a case of endovascular electrocoagulation for the treatment of a blister-like microaneurysm.

Case summary: This article reports the case of 71-year-old female patient with an intracranial aneurysm. The patient experienced a sudden headache with vomiting for 3 hours. Brain computed tomography (CT) scan showed a subarachnoid hemorrhage. She was diagnosed with rupture of an aneurysm and subarachnoid hemorrhage. The aneurysm was located in the choroidal segment of the right internal carotid artery. The size of the aneurysm was 2.00 mm × 1.80 mm × 1.97 mm, and the neck of the aneurysm was less than 0.5 mm wide. We successfully treated this aneurysm with endovascular electrocoagulation, and the patient was safely returned to the ward and discharged after subsequent supportive treatment. CT angiography reexamination 3 months after surgery revealed no contrast agent extravasation in the original lesion, with a good prognosis.

Conclusion: Endovascular electrocoagulation is an effective and safe method for the treatment of intracranial blister-like microaneurysms.

Krishnan et al's article is a comprehensive and vigorous retrospective cohort study regarding the association between obesity and clinical outcomes in acute liver failure (ALF). Among patients with ALF in the United States, mean body mass index (BMI) was significantly greater in those who underwent liver transplantation or who died than among survivors, although acetaminophen induced ALF was the most common etiology. A high BMI was associated with renal failure and high grades of hepatic encephalopathy. The prevalence of obesity and its related fatty liver diseases, such as metabolic dysfunction-associated fatty liver disease/ metabolic dysfunction-associated steatotic liver disease and metabolic dysfunction-associated steatohepatitis, has increased worldwide. Obesity is related to increased serum cytokines and immune abnormalities. These findings may explain why ALF in patients with high BMI is associated with worse clinical outcomes. Further studies are needed to determine the associations among BMI, ALF and acute-on-chronic liver failure.

Background: To evaluate the diagnostic utility of endobronchial ultrasound (EBUS)-guided mediastinal lymph node fenestration biopsy in atypical sarcoidosis using fine biopsy forceps [i.e., EBUS-transbronchial forceps biopsy (TBFB)].

Case summary: In this case series, two atypical sarcoidosis cases admitted in 2024 were retrospectively analyzed, both of whom lacked classical clinical manifestations. After chest computed tomography/positron emission tomography-computed tomography imaging and serum angiotensin-converting enzyme testing, EBUS-transbronchial needle aspiration was performed using a 21-G needle. Subsequently, tissue sampling was performed at the enlarged puncture site by means of a 1.2-mm fine biopsy forceps. At the same time, bronchoalveolar lavage fluid lymphocyte subset analysis was conducted.

Conclusion: Both cases demonstrated non-caseating granulomatous inflammation on histopathology, elevated serum angiotensin-converting enzyme levels, and markedly increased CD4/CD8 ratios in bronchoalveolar lavage fluid. Case 1 was observed after confirmation of stage II sarcoidosis, whereas case 2 required glucocorticoid therapy due to the involvement of multiple systems. EBUS-TBFB can be used to make a definitive pathological diagnosis. For radiologically atypical sarcoidosis, EBUS-TBFB improves diagnostic accuracy by obtaining larger histological samples, thereby addressing the limitations of transbronchial needle aspiration cytology. This approach significantly improves differential diagnostic efficacy and holds substantial clinical relevance for broader adoption.

Background: Malignant pleural mesothelioma (MPM), a rare aggressive malignancy, is primarily caused by asbestos exposure. MPM typically affects older adults (median age, 76 years), is uncommon in those under age 50 years and shows male predominance. Based on the American Society of Clinical Oncology guidelines, F-18 fluorodeoxyglucose positron emission tomography/computed tomography (F-18 FDG PET/CT) is essential for initial MPM staging. Integrating quantitative FDG metabolic data with computed tomography (CT) anatomy optimizes biopsy accuracy and staging.

Case summary: A 21-year-old female college student presented with fever (peak 38.4 °C), cough, and white mucoid sputum after cold exposure. Initial evaluation revealed elevated C-reactive protein [C-reactive protein (CRP); 65.52 mg/L] and Mycoplasma pneumoniae IgM. Despite resolution of fever following a 14-day moxifloxacin regimen, persistent cough prompted chest CT, which demonstrated left pleural mass-like thickenings. Levofloxacin therapy for 2 weeks failed to alleviate symptoms, accompanied by 2.5-kg weight loss over 1 month. Re-evaluation showed rising CRP (88.87 mg/L) with stable CT lesions, and negative T-cell spot test for tuberculosis and tumor markers. Contrast-enhanced CT revealed heterogeneously enhancing masses, while PET/CT detected two broad-based pleural lesions with intense FDG avidity. CT-guided biopsy confirmed epithelioid MPM. Thoracoscopy exposed diffuse fragile, hemorrhagic nodules implanting on diaphragmatic and parietal pleura, confirming metastatic MPM with partial resection performed. This presentation challenges conventional imaging paradigms of MPM, underscoring its diagnostic complexity.

Conclusion: MPM should still be considered an important differential diagnosis in young patients presenting with solitary pleural masses and no history of typical asbestos exposure. F-18 FDG PET/CT, while serving as an essential component of initial staging for MPM, has some inherent limitations.

Background: Groove pancreatitis (GP) is a rare focal chronic pancreatitis of the pancreaticoduodenal groove that is usually diagnosed in chronic alcoholics. However, it is often difficult to differentiate from pancreatic or periampullary cancers. In this study, we report a case of GP with the rare symptom of severe gastric outlet obstruction.

Case summary: A 68-year-old man presented to our institution with severe gastric outlet obstruction accompanied by vomiting persisted for 3 days, severe electrolyte imbalance, and altered mental status with cardiac arrest. Differential diagnosis of cancers of the ampulla of Vater or duodenum was difficult due to discordant findings from preoperative imaging and an endoscopic biopsy of the lesion. In addition, the gastric outlet obstruction did not improve with conservative treatment; therefore, pancreatoduodenectomy was performed. Postoperatively, the histological findings revealed multiple cystic lesions in the duodenal wall that were collectively diagnosed as GP. The patient underwent a follow-up 3 years postoperatively and was found to have no postoperative sequelae.

Conclusion: In this case of GP, pancreatoduodenectomy safely treated severe gastric outlet obstruction when a cancer diagnosis could not be excluded.

Background: Patients with concurrent acute biliary pancreatitis (ABP) and acute cholangitis (AC) may experience exacerbated clinical consequences due to bile duct stones. However, studies exploring this topic remain limited.

Aim: To compare the clinical presentation and outcomes of patients experiencing AC with and without ABP.

Methods: This single-center retrospective cohort study included 358 patients with AC who underwent endoscopic retrograde cholangiopancreatography (ERCP) between January 2016 and December 2017. Patients were divided into two groups: AC with ABP (n = 90) and AC without ABP (n = 268). Clinical characteristics, laboratory data, ERCP results, primary study outcome [intensive care unit (ICU) admission], and secondary outcomes including 30-day mortality, length of hospital stay, and 30-day readmission rate were analyzed and compared.

Results: All patients in the AC with ABP group had interstitial pancreatitis. The AC with ABP group had significantly higher white cell count (WBC) counts (13.1 × 10³/µL vs 10.4 × 10³/µL, P = 0.007) and more abnormal WBC results (61.1% vs 42.3%, P = 0.015). Liver biochemical tests, AC severity, ERCP success, adverse events, ICU admissions, 30-day mortality, hospital stay, and readmission rates did not differ significantly between the two groups. Univariate analysis showed no significant link between concurrent ABP and ICU admission, although significance was marginal in moderate/severe ABP cases (P = 0.051). In the multivariate analysis, age (P = 0.035) and cardiovascular dysfunction (P < 0.001) were independently associated with length of ICU stay.

Conclusion: Concurrent interstitial ABP and AC did not significantly affect outcomes. Age and cardiovascular dysfunction were stronger predictors of ICU admission and should guide clinical monitoring and management.