World Journal of Clinical Cases最新文献

Despite advancements in neuroimaging, false positive diagnoses of intracranial aneurysms remain a significant concern. This article examines the causes, prevalence, and implications of such false-positive diagnoses. We discuss how conditions like arterial occlusion with vascular stump formation and infundibular widening can mimic aneurysms, particularly in the anterior circulation. The article compares various imaging modalities, including computer tomography angiogram, magnetic resonance imaging/angiography, and digital subtraction angiogram, highlighting their strengths and limitations. We emphasize the importance of accurate differentiation to avoid unnecessary surgical interventions. The potential of emerging technologies, such as high-resolution vessel wall imaging and deep neural networks for automated detection, is explored as promising avenues for improving diagnostic accuracy. This manuscript underscores the need for continued research and clinical vigilance in the diagnosis of intracranial aneurysms.

Background: This manuscript describes the first known cases of sick sinus syndrome (SSS) associated with the use of anlotinib in non-small cell lung cancer patients, highlighting the need for increased vigilance and cardiac monitoring.

Case summary: Two patients with non-small cell lung cancer developed SSS after 15 months and 5 months of anlotinib treatment, respectively, presenting with syncope and palpitations. Electrocardiogram confirmed SSS, and different treatment approaches were taken for each patient. One patient received a dual-chamber permanent pacemaker, while the other discontinued the medication and experienced symptom resolution.

Conclusion: Anlotinib can induce SSS, suggesting that cardiac monitoring is crucial during anlotinib treatment. Individualized management strategies are necessary for affected individuals.

Background: Rheumatic immune diseases are a group of chronic inflammatory diseases characterized by joint and systemic multi-organ involvement, including rheumatoid arthritis, systemic lupus erythematosus, and Sjogren's syndrome, among others. The pathogenesis of these diseases is related to the abnormal activation and regulatory imbalance of the immune system. The prevalence and morbidity of rheumatic immune diseases are high, imposing a significant burden on patients' quality of life and socio-economic costs. Currently, the treatment of rheumatic immune diseases mainly relies on Western medicine, such as non-steroidal anti-inflammatory drugs, glucocorticoids, disease-modifying antirheumatic drugs, and biologics. However, the therapeutic effects of Western medicine are not ideal, some patients poorly respond or are resistant to Western medicine, and long-term use often causes various adverse reactions.

Aim: To systematically evaluate the efficacy and safety of Tripterygium wilfordii glycosides tablets combined with Western medicine in the treatment of patients with rheumatic immune diseases.

Methods: This study conducted a meta-analysis to systematically evaluate the efficacy and safety of Tripterygium wilfordii glycosides tablets combined with Western medicine for patients with rheumatic immune diseases. Chinese and English databases were searched for randomized controlled trials (RCTs) on the treatment of rheumatic immune diseases with Tripterygium wilfordii glycosides tablets combined with Western medicine. The quality of the included studies was assessed using the Cochrane risk of bias assessment tool. Meta-analysis was performed using RevMan 5.4 software.

Results: The meta-analysis included 11 RCTs involving 1026 patients with rheumatic immune diseases. The combined treatment significantly reduced the risk of disease recurrence (relative risk = 1.07, 95% confidence interval: 1.01-1.15, P < 0.05) and showed no significant heterogeneity (I ² = 0%, P = 0.53), indicating that Tripterygium wilfordii glycosides tablets combined with Western medicine is an effective method to reduce the possibility of postoperative recurrence in patients with rheumatic immune diseases. However, due to the limited number and quality of the studies included, these results should be interpreted with caution.

Conclusion: Tripterygium wilfordii glycosides tablets combined with Western medicine is an effective and safe treatment option for patients with rheumatic immune diseases and can be considered a clinical choice. However, more high-quality research is needed to validate this conclusion and provide more solid evidence for clinical practice.

Background: Abdominal aortic aneurysm (AAA) repair often involves significant postoperative pain, traditionally managed with systemic opioids, which can cause undesirable side effects. This case report explores the novel use of a surgically-initiated rectus sheath block with a catheter-over-needle assembly for pain management in AAA repair.

Case summary: A 67-year-old female with hypertension and previous aortic dissection underwent elective open repair of an infrarenal AAA, which had grown from 3.4 cm to 4.3 cm over 14 months. A rectus sheath block was initiated surgically for postoperative pain control. The patient reported low pain scores and did not require systemic intravenous opioids, enabling early ambulation and discharge on postoperative day seven without complications. By preventing complications of systemic opioids, the method indicating a promising direction for postoperative pain management in major vascular surgeries.

Conclusion: Surgically-initiated rectus sheath block as a valuable tool for managing postoperative pain in AAA repair.

Background: Food protein-induced enterocolitis syndrome (FPIES) is the most serious type of non-immunoglobulin E (IgE)-mediated food allergic reaction manifesting as sepsis-like symptom, which can lead to shock. Saccharomyces boulardii (S. boulardii), a probiotic prescribed frequently in clinical settings, has been reported to trigger FPIES in an infant with soy-triggered FPIES. In this report, we describe a new clinical FPIES in which S. boulardii was the sole triggering factor of acute FPIES adverse reaction in seven healthy infants.

Case summary: Seven FPIES cases triggered by only S. boulardii were gathered from 2011 to the present. None of the patients had previously experienced any allergic reaction to cow's milk, soy, or complementary food. The age of the patients was 4-10-months old, and the symptoms of FPIES developed after ingestion of S. boulardii, which is mostly prescribed for the treatment of gastroenteritis or antibiotic-associated diarrhea. All patients experienced severe repetitive vomiting 1-3 hours after S. boulardii ingestion. Extreme lethargy, marked pallor, and cyanosis were also observed. No IgE-mediated hypersensitivity developed in any patient. Diarrhea was followed by initial intense vomiting in approximately 5-10 hours after S. boulardii ingestion, and only one case showed bloody, purulent, and foul-smelling diarrhea. The patients stabilized quickly, mostly within 6 hours. Symptoms got all improved within 24 hours after discontinuation of S. boulardii.

Conclusion: S. boulardii can be the sole trigger of acute FPIES and be prescribed cautiously even in healthy children without FPIES.

Background: Patients with inflammatory bowel disease are at a 2-8-fold higher risk of developing venous thromboembolism (VTE) as compared to the general population. Although the exact pathogenesis is unclear, the literature suggests that increased risk of thromboembolic events in such patients occurs as a result of increased coagulation factors, inflammatory cytokines, and reduction in anticoagulants leading to a prothrombotic state.

Aim: To assess the prevalence, risk factors, management, and outcome of ulcerative colitis (UC) patients who develop VTE.

Methods: This was a retrospective chart review done in The Gastroenterology Department of The Aga Khan University Hospital. Data was collected from medical records for all patients admitted with a diagnosis of UC from January 2012 to December 2022.

Results: Seventy-four patients fulfilled the inclusion criteria. The mean ± SD of age at presentation of all UC patients was 45 years ± 10 years whereas for those who developed VTE, it was 47.6 years ± 14.7 years. Hypertension and diabetes were the most common co-morbid seen among UC patients with a frequency of 17 (22.9%) and 12 (16.2%), respectively. A total of 5 (6.7%) patients developed VTE. Deep venous thrombosis was the most common thromboembolic phenomenon seen in 3 (60%) patients. All the patients with UC and concomitant VTE were discharged home (5; 100%).

Conclusion: The prevalence of VTE with UC in Pakistani patients corresponds with the international literature. However, multi-centric studies are required to further explore these results.

Optimal health during pregnancy is crucial for ensuring the well-being of the mother and the developing fetus. This article is focused on the impact of oral health and the role of personalized oral hygiene management in addressing prevalent dental issues among pregnant women, with particular emphasis on periodontal disease and dental caries. Despite the high prevalence of these dental problems and their association with obstetric complications such as pre-term birth and low birth weight, many pregnant women do not receive adequate dental care. This gap in care is often due to misconceptions about the safety of dental treatments during pregnancy and lack of awareness on the part of healthcare professionals. Appreciations of the impacts of oral health and personalization of oral hygiene strategies such as tailored education and support, have proven effective in improving oral health in this population. Significant reductions in the incidence of caries and periodontal disease may be achieved by adapting care to the specific needs of each patient, thereby enhancing maternal and fetal health outcomes. Integration of personalized oral hygiene management into maternal health programs and enhancement of ongoing education for pregnant women and healthcare professionals are essential steps in the reduction of pregnancy-related risks and improvement of maternal and neonatal well-being.

Colonoscopy represents a safe procedure that is widely used in medical practice either to diagnose or treat various gastrointestinal diseases. During the last few years, the incidence rate of perforations in colonoscopic procedures has increased, especially in therapeutic colonoscopies. The recent advancements in endoscopic techniques and gastrointestinal tumoral resection procedures such as endoscopic mucosal resection, endoscopic full-thickness resection, and endoscopic submucosal dissection (ESD) could be a risk factor for this increased risk. The incidence rate of mortality of serious colonoscopic perforations is 7.1%. The management plan for these perforations starts with conservative treatment in mild cases, endoscopic closure, and surgical management in severe cases. Recently, endoluminal vacuum therapy was found to be effective in the management of colorectal perforations and this has been reported in multiple case reports. This editorial provides an overview of the current guidelines for the management of iatrogenic colorectal perforations. These insights are from the perspectives of endoscopists and gastroenterologists. We also present a management algorithm based on the guidelines of the European Society of Gastrointestinal Endoscopy, the American Gastroenterological Association, and the World Society of Emergency Surgery. We also discussed in brief the use of endoluminal vacuum therapy in colorectal perforations.

The use of virtual reality to educate preoperative patients has a positive impact on nurses as well as patients undergoing treatment. It can help improve patient satisfaction and improve favorable outcomes by reducing patient anxiety and proving adequate knowledge about the procedure and possible outcomes to the patient. It also reduces burden on nursing staff and counsellors. Larger and more diverse cohort studies will help us understand the wider application of this tool on the patient population. It may be difficult to apply this tool on elderly patients with failing eyesight, multiple physical comorbidities. Also, there may be reduced acceptance of this modality by older nursing staff and practitioners who may prefer the traditional verbal version for counselling. We will benefit from a combined approach of using virtual reality apps with tradition one-on-one counselling to help alleviate patient concerns and improve patient and healthcare professional satisfaction.

Background: Hydroxyurea, an antimetabolite, is frequently prescribed for various hematological disorders, and its common side effects include gastrointestinal problems, cutaneous or mucosal lesions and pyrexia/fever.

Case summary: This study reports the case of a 67-year-old woman who developed recurrent abdominal pain after 10 years of continuous hydroxyurea therapy for primary thrombocythemia. Colonoscopy revealed an ileocecal ulcer. After discontinuing hydroxyurea therapy for 6 months, follow-up colonoscopy showed a significant reduction in the ulceration.

Conclusion: We consider cecal ulcers as a rare complication of hydroxyurea therapy which typically resolves upon stopping the drug.