World Journal of Clinical Cases最新文献

Background: Autoimmune and rare ophthalmic diseases can affect not only vision but also patients' mental well-being and everyday functioning; however, psychological aspects remain under-assessed in routine eye care.

Aim: To investigate a descriptive consecutive case series reporting 18 adults evaluated at a newly established integrated psycho-ophthalmology clinic in Catania, Italy, where ophthalmologists and psychologists jointly assessed patients with complex inflammatory, autoimmune, or degenerative ocular conditions.

Methods: All participants completed a semi-structured clinical psychological interview and brief standardized screening for anxiety/depressive symptoms and health-related quality of life [Hospital Anxiety and Depression Scale (HADS); 12-item Short Form Health Survey (SF-12)].

Results: The cohort had a mean age of 54.2 ± 15.6 years (range 24-85), and most patients (17/18) had systemic autoimmune, rheumatologic, or demyelinating comorbidity; dry eye/ocular surface disease was present in 6/18 (33.3%). Clinically significant anxiety symptoms (HADS-anxiety ≥ 11) were observed in 9/18 patients (50.0%), while clinically significant depressive symptoms [HADS-depression (HADS-D) ≥ 11] were present in 3/18 (16.7%), with an additional 6/18 (33.3%) showing borderline depressive scores (HADS-D 8-10). Physical health-related quality of life was markedly reduced (mean SF-12 physical 35.8 ± 10.9), with 12/18 (66.7%) scoring < 40; mental quality of life was more heterogeneous (mean SF-12 mental 41.3 ± 12.3), with 8/18 (44.4%) scoring < 40. Findings were clinically actionable: Based on the integrated assessment (scores plus interview), structured psychological support or psychotherapy was recommended for 9/18 (50.0%) patients, and a more in-depth psychiatric/psychological evaluation for 2/18 (11.1%).

Conclusion: This pilot series highlights the high psychological burden and functional impairment in autoimmune and rare ophthalmic populations and supports the feasibility and clinical utility of embedding brief mental health screening plus focused interview within routine ophthalmic care.

Background: Chromovitrectomy using vital dyes has become integral to internal limiting membrane (ILM) peeling in macular surgery. Although brilliant blue G (BBG) is considered safer than earlier dyes, emerging clinical and experimental evidence suggests that dye-light interactions during surgery may result in retinal phototoxicity under specific conditions.

Aim: To describe the retinal phototoxicity features associated with BBG dye in patients undergoing ILM peeling for macular surgeries.

Methods: This observational, comparative, retrospective case series analyzed 9 eyes of 9 patients demonstrating retinal phototoxicity after uneventful BBG-assisted ILM peeling. Surgical indications included full-thickness macular hole (MH) in 4 eyes, epiretinal membrane associated retinal traction in 4 eyes, and vitreomacular traction in 1 eye. Retinal phototoxicity was assessed during clinical examination, using optical coherence tomography, and fundus autofluorescence imaging. Parameters such as preoperative and postoperative visual acuity (VA), macular thickness, BBG exposure characteristics (single/repeated staining, exposure duration, staining medium), and follow-up outcomes were recorded. Cases were grouped based on surgical indications: Group A (MH, 4 eyes) and group B (non-MH, 5 eyes).

Results: In group A, all cases showed foveal phototoxic damage along with macular involvement despite successful MH closure. Two eyes experienced worsened VA, while the other two maintained baseline VA. In group B, phototoxicity involved the macular region but spared the fovea; VA improved in 3 eyes (60%) and was maintained in 2 eyes (40%). Retinal toxicity, characterized by photoreceptor and retinal pigment epithelium damage, was evident within 1-4 weeks postoperatively.

Conclusion: BBG-related retinal phototoxicity may occur following ILM peeling, with eyes undergoing MH surgery appearing more vulnerable, possibly due to the absence of protective foveal neurosensory tissue. Awareness of this potential risk may encourage surgeons to consider minimizing illumination intensity and dye exposure, and to adopt protective intraoperative strategies aimed at preserving foveal integrity and optimizing visual outcomes.

Keratorefractive surgery is typically performed to correct refractive errors, resulting in good postoperative outcomes. Certain conditions, such as autoimmune diseases, metabolic diseases like diabetes mellitus (DM), and the use of some drugs, may be absolutely or relatively contraindicated for refractive surgery. DM is a multisystemic disorder affecting various organs and can result in retinopathy, nephropathy, and neuropathy. Persistent hyperglycemia leads to various pathophysiological changes that can alter the biomechanical profile and the wound healing process of the cornea. Proper patient counselling, optimizing blood glucose levels, and frequent follow-up visits to monitor and manage potential complications, such as dry eye, non-healing epithelial defects, and neurotrophic keratitis, are essential for refractive surgeons. Laser-assisted in situ keratomileusis is preferred over photorefractive keratectomy due to its faster healing process. Cataract surgery in people with diabetes warrants various preoperative, intraoperative, and postoperative considerations for the best visual outcomes. This review focuses on the current evidence pertaining to various structural and functional corneal changes occurring in diabetics and their impact on keratorefractive procedures, thus providing a unified, clinically oriented framework to guide refractive surgeons in risk stratification, procedure selection, and postoperative management in patients with DM.

Background: Accurate preoperative assessment of physical function is vital for determining surgical indications and selecting appropriate procedures in older adults. In potentially malignant cases of giant ovarian tumors, tumor capsule intraoperative rupture can cause upstaging and increase malignant ovarian tumor recurrence risk; thus, avoiding it is essential.

Case summary: An 81-year-old woman with a giant ovarian tumor underwent preoperative evaluation using the estimation of physiologic ability and surgical stress (E-PASS) scoring system and the FRAIL scale. Laparoscopy-assisted surgery was performed using the Aron alpha method, and postoperative management followed the enhanced recovery after surgery (ERAS) protocol, resulting in successful perioperative management without complications. The patient exhibited a 30 cm cystic mass in the ovary identified on abdominal computed tomography. Preoperative assessment using E-PASS and FRAIL Scale yielded a preoperative risk score, surgical stress score, and comprehensive risk score of 0.49, 0.41, and 0.53, respectively, corresponding to a 4.2% in-hospital mortality rate. The FRAIL scale indicated a state of frailty. Following an anesthesiology consultation on the overall condition and surgical feasibility, the Aron alpha method was performed. Postoperatively, ERAS-based management was implemented, and the patient was discharged on postoperative day 5. Activities of daily living or cognitive function remained unchanged.

Conclusion: Detailed preoperative evaluation and the Aron alpha method could assist older women with giant ovarian tumors, with suspected malignancy.

Background: Streptococcus bovis (S. bovis) bacteremia and infective endocarditis have a well-established association with colorectal cancer (CRC), though the mechanisms underlying this potentially bidirectional relationship remain poorly understood.

Case summary: This case report describes a 55-year-old male with a history of hypertension and hemicolectomy due to advanced colorectal adenomas who presented with syncope, septic shock, and a 12-pound weight loss over 3 weeks. Subsequent blood cultures grew S. bovis, with a transthoracic echocardiogram revealed mobile vegetations on both the aortic and mitral valves. A sessile, non-obstructing cecal adenocarcinoma was also observed on colonoscopy. The patient was started on 6 weeks of intravenous ceftriaxone, followed by surgical repair of both heart valves and a laparoscopic right hemicolectomy.

Conclusion: This presentation underscores how CRC-induced mucosal disruption may predispose to bacterial translocation, resulting in systemic infection and endocarditis.

Background: The management of stage IV pressure ulcers (PUs) in elderly, high-risk surgical patients remains a formidable clinical challenge, often limited by the invasiveness and risks of standard surgical options. Although Aloe vera has known wound-healing properties, clinical evidence of its efficacy in complex, severe PUs is scarce. This case report details a novel, non-invasive combination therapy centered around an aloe-derived micellar emulsion dressing (Aloe vera barbadensis extract R, AVBER) and demonstrates its potential as a viable palliative strategy for this vulnerable population.

Case summary: A 90-year-old, severely malnourished female (body mass index 13.3 kg/m²) presented with extensive, bilateral stage IV ischial PUs following a femoral fracture. Given her frailty and high surgical risk, a conservative regimen was initiated. This regimen comprised the topical application of an AVBER dressing, targeted red light therapy, and intensive nutritional support, all guided through telemedicine. Over a period of 8.5 months, this treatment was associated with complete healing of the left ulcer and near-complete resolution (from 15 cm × 15 cm to 0.8 cm × 3.0 cm) of the right ulcer, with no serious adverse events reported. The PU scale for healing score for the right ischial ulcer decreased markedly from 17 to 6.

Conclusion: AVBER-based combination therapy represents a promising non-invasive option for managing severe PUs in surgically ineligible patients.

Background: Histiocytic sarcoma (HS) is a rare lymphohematopoietic malignancy with nonspecific clinical manifestations, diagnostic challenges, high aggressiveness, and a poor prognosis. Primary HSs arising in the spleen are extremely uncommon, with few cases reported globally. Here, we present the clinical course of a patient with splenic HS.

Case summary: A 67-year-old woman was admitted to our hospital because of a large splenic mass that was detected during a routine health examination 1 month before presentation. Abdominal computed tomography revealed a large occupying lesion in the spleen, which was possibly a lymphangioma. The patient underwent splenectomy, and postoperative pathological examination confirmed the diagnosis of splenic HS. At the 6-month telephonic follow-up, the patient reported feeling well.

Conclusion: Given the paucity of cases and the poor prognosis of splenic HS, whose definitive diagnosis hinges exclusively on pathology, and given that all current therapeutic strategies are based on isolated case reports, it is imperative to enhance our understanding of this disease to improve patient diagnosis and management.

Background: Postdural puncture headache (PDPH) is a significant complication of neuraxial procedures. Although conservative treatments and the invasive epidural blood patch (EBP) are currently standard approaches, the sphenopalatine ganglion (SPG) block is emerging as a promising, less-invasive alternative. The pathophysiology of PDPH involves cerebrospinal fluid leakage, resulting in reduced intracranial pressure and compensatory cerebral vasodilation, which is partially mediated by SPG stimulation. The SPG block aims to interrupt this vasodilation using local anesthetics, thereby alleviating headache symptoms.

Aim: To provide a comprehensive overview of current evidence regarding the use of the SPG block in treating PDPH, explores the anatomical and physiological basis of this intervention, describes various administration techniques for administering the block, and critically assesses the efficacy and safety data from clinical studies.

Methods: A systematic literature search was conducted on PubMed and the Cochrane Database to identify systematic reviews and meta-analyses published up to April 2025, using the keywords "sphenopalatine ganglion block" and "post-dural puncture headache".

Results: The SPG block is a simple, noninvasive, and effective bedside procedure. Clinical studies have demonstrated that it provides rapid pain relief, with high success rates and an onset of action typically within 10-30 minutes. The most used technique is the transnasal approach, which is associated with minimal and transient adverse effects such as nasal discomfort and bitter taste.

Conclusion: Although EBP remains the preferred treatment for severe PDPH, the SPG block is a viable alternative for mild-to-moderate cases, often allowing patients to postpone or avoid EBP. Comparative studies suggest that SPG block has a quicker onset than EBP, though in some cases, it provides shorter duration relief. Overall, the SPG block is a safe, effective, and readily accessible treatment for PDPH. Its minimally invasive nature and high success rate in providing rapid pain relief make it an excellent first-line alternative to more invasive procedures. Further large-scale, standardized randomized controlled trials are required to optimize protocols and fully integrate the SPG block into mainstream clinical practice.

Background: Familial Mediterranean fever (FMF) is the most common autoinflammatory disease, characterized by uncontrolled activation of the innate immune system that manifests as recurrent fever and polyserositis (e.g., peritonitis, pleuritis, and arthritis). However, diagnosing atypical cases remains challenging.

Case summary: A 9-year-old girl had a history of progressive loss of appetite, weight loss, and myalgia over the preceding three months. She developed high-grade fever over the preceding three weeks, occasionally associated with abdominal pain. The girl is one of a triplet; neither of the other two sisters had similar symptoms. Family history was irrelevant. She presented with cachexia, generalized body aches, and fever without evident arthritis. She had splenomegaly and a markedly elevated erythrocyte sedimentation rate. After exclusion of rheumatological and malignant causes, FMF was suspected. Serum amyloid A was high. The patient received colchicine therapy. There was a significant improvement in her symptoms with normalization of acute-phase reactants. Polymerase chain reaction test for FMF gene mutation returned negative.

Conclusion: FMF can present with atypical symptoms. Detailed history and meticulous clinical evaluation were key clues suggesting the diagnosis.