World Journal of Clinical Cases最新文献

Background: Intramuscular corticosteroid injection may cause adverse effects such as dermal and/or subcutaneous atrophy, alopecia, hypopigmentation, and hyperpigmentation. Although cutaneous atrophy can spontaneously resolve, several treatment options have been suggested for this condition.

Case summary: In this paper, we report a case of corticosteroid injection induced lipoatrophy treated with autologous whole blood (AWB) injection, as the condition had been unresponsive to fractional laser therapy. A 29-year-old female patient visited the dermatology clinic complaining of skin depression on her right buttock area, which had appeared six months earlier. There had been only subtle improvement at the margins after fractional CO₂ laser treatment; therefore, after obtaining informed consent from the patient, AWB treatment was initiated. One month after the first AWB injection, the size and depth of the lesion had noticeably improved, and a slight improvement was also observed in discoloration.

Conclusion: Close observation is the initial treatment of choice for steroid induced skin atrophy; however, for patients in need of immediate cosmetic improvement, AWB injection may be a safe and cost-effective alternative.

Foot reflexology is a non-invasive and safe complementary therapy that works by massaging the reflex zones of the feet and exerts systemic or whole-body regulation through meridian nerve conduction. This therapy is commonly used in the treatment of various conditions such as autism and Parkinson's disease. However, there is limited reporting on the use of foot reflexology therapy for infants with sensorineural hearing loss (SNHL). Currently, there is no definitive conclusion on how foot reflexology therapy can influence hearing. This editorial holds some guiding significance regarding this clinical issue. The aim is to present physiological evidence of how foot reflexology therapy can impact infants with SNHL, thereby enhancing clinician's awareness of foot reflexology in treating infants with SNHL.

Sotos syndrome is characterized by overgrowth features and is caused by alterations in the nuclear receptor binding SET domain protein 1 gene. Attention-deficit/hyperactivity disorder (ADHD) is considered a neurodevelopment and psychiatric disorder in childhood. Genetic characteristics and clinical presentation could play an important role in the diagnosis of Sotos syndrome and ADHD. Magnetic resonance imaging (MRI) has been used to assess medical images in Sotos syndrome and ADHD. The images process is considered to display in MRI while wavelet fusion has been used to integrate distinct images for achieving more complete information in single image in this editorial. In the future, genetic mechanisms and artificial intelligence related to medical images could be used in the clinical diagnosis of Sotos syndrome and ADHD.

This editorial explores the potential integration of non-Western medicine into radiotherapy for cervical cancer. While radiotherapy remains a radical treatment for cervical cancer, its associated toxicity and decline in quality of life can significantly impact patients' lives. Currently, most treatments are supportive, with no specific treatment options available in Western medicine. Non-Western medicine, often less toxic and easier to administer, has shown promising results when used alongside radiotherapy for cervical cancer. Despite these potential benefits, challenges such as limited evidence and restricted application areas persist. While non-Western medicines may offer potential improvements in chemoradiotherapy outcomes for cervical cancer, further research is necessary to substantiate these benefits.

This article provides a comprehensive analysis of the study by Hou et al, focusing on the complex interplay between psychological and physical factors in the post-operative recovery (POR) of patients with perianal diseases. The study sheds light on how illness perception, anxiety, and depression significantly influence recovery outcomes. Hou et al developed a predictive model that demonstrated high accuracy in identifying patients at risk of poor recovery. The article explores the critical role of pre-operative psychological assessment, highlighting the need for mental health support and personalized recovery plans in enhancing POR quality. A multidisciplinary approach, integrating mental health professionals with surgeons, anesthesiologists, and other specialists, is emphasized to ensure comprehensive care for patients. The study's findings serve as a call to integrate psychological care into surgical practice to optimize outcomes for patients with perianal diseases.

In the intricate landscape of healthcare, vicarious liability looms large, shaping the responsibilities and actions of healthcare practitioners and administrators alike. Illustrated by a poignant scenario of a medication error, this article navigates the complexities of vicarious liability in healthcare. It explains the legal basis and ramifications of this theory, emphasizing its importance in fostering responsibility, protecting patient welfare, and easing access to justice. The paper explores the practical effects of vicarious responsibility on day-to-day operations, leadership practices, and decision-making processes via the eyes of senior consultants, junior doctors, and hospital administrators. Through comprehensive insights and real-world examples, it underscores the imperative of fostering a culture of accountability, communication, and quality care to navigate the intricate web of liabilities inherent in modern healthcare.

Background: The classification of uterine sarcomas is based on distinctive morphological and immunophenotypic characteristics, increasingly supported by molecular genetic diagnostics. Data on neurotrophic tyrosine receptor kinase (NTRK) gene fusion-positive uterine sarcoma, potentially aggressive and morphologically similar to fibrosarcoma, are limited due to its recent recognition. Pan-TRK immunohistochemistry (IHC) analysis serves as an effective screening tool with high sensitivity and specificity for NTRK-fusion malignancies.

Case summary: We report a case of a malignant mesenchymal tumor originating from the uterine cervix, which was pan-TRK IHC-positive but lacked NTRK gene fusions, accompanied by a brief literature review. A 55-year-old woman presented to the emergency department with abdominal pain and distension, exhibiting significant ascites and multiple solid pelvic masses. Pelvic examination revealed a tumor encompassing the uterine cervix, extending to the vagina and uterine corpus. A punch biopsy of the cervix indicated NTRK sarcoma with positive immunochemical pan-TRK stain. However, subsequent next generation sequencing revealed no NTRK gene fusion, leading to a diagnosis of poorly differentiated, advanced-stage sarcoma.

Conclusion: The clinical significance of NTRK gene fusion lies in potential treatment with TRK inhibitors for positive sarcomas. Identifying such rare tumors is crucial due to the potential applicability of tropomyosin receptor kinase inhibitor treatment.

Carcinosarcoma (CS), also known as metaplastic breast carcinoma with mesenchymal differentiation, is one of the five distinct subtypes of metaplastic breast cancer. It is considered as a mixed, biphasic neoplasm consisting of a carcinomatous component combined with a malignant nonepithelial element of mesenchymal origin without an intermediate transition zone. Although cellular origin of this neoplasm remains controversial, most researchers declare that neoplastic cells derive from a cellular structure with potential biphasic differentiation. Despite recent research on the therapeutic strategies against CS neoplastic disorders, surgical resection appears the only potentially curative approach. Since CS metastasize by the lymphatic route, axillary assessment with sentinel lymph node biopsy and/or axillary lymph node dissection is always implemented. Nevertheless, the tumor also presents a hematogenous metastatic pattern including pleural, pulmonary, liver, brain and less commonly bone metastases. Thus, surgical removal of breast CS does not necessarily ensure patient's long-term recovery. Moreover, alternative therapies, such as radio- and chemotherapy proved insufficient and 5-year survival rate is limited. Nevertheless, there is evidence that following surgery, the combination of radio and chemotherapy is associated with a better prognosis than either treatment alone. The aim of this review is to evaluate the results of surgical treatment for breast CS with special reference to the extent of its histological spread. Clinical features, histogenesis, morphological and immunochemical findings are discussed, while the role of current diagnostic and therapeutic management of this aggressive neoplasm is emphasized.

Background: Autologous fat injection in facial reconstruction is a common cosmetic surgery. Although cerebral fat embolism (CFE) as a complication is rare, it carries serious health risks.

Case summary: We present a case of a 29-year-old female patient who developed acute CFE following facial fat filling surgery. After the surgery, the patient experienced symptoms including headache, nausea, vomiting, and difficulty breathing, which was followed by neurological symptoms such as slurred speech and left-sided weakness. Comprehensive physical examination and auxiliary investigations, including blood tests, head and neck computed tomography angiography, and cranial magnetic resonance diffusion-weighted imaging, were performed upon admission. The clinical diagnosis was acute cerebral embolism following facial fat filling surgery. Treatment included measures to improve cerebral circulation, dehydration for intracranial pressure reduction, nutritional support, and rehabilitation therapy for left limb function. The patient showed a significant improvement in symptoms after 2 weeks of treatment. She recovered left limb muscle strength to grade 5, had clear speech, and experienced complete relief of headache.

Conclusion: Our case highlights the potential occurrence of severe complications in patients undergoing fat injection in facial reconstruction. To prevent these complications, plastic surgeons should enhance their professional knowledge and skills.