World Journal of Clinical Cases最新文献

Background: Ulcerative colitis (UC) is a chronic inflammatory bowel disease treated with immunosuppressants to control inflammation. Drugs like azathioprine (AZA) and anti-tumor necrosis factor agents increase the risk of extraintestinal malignancies. However, no association has been established between these therapies and endometrial stromal sarcoma. This report presents a rare case of endometrial stromal sarcoma in a patient with UC undergoing immunosuppressive treatment and includes a literature review to explore any possible correlation between the disease, the therapies used, and the development of this rare tumor.

Case summary: Female, 49 years old, with UC pancolitis extension since 2017. She used aminosalicylates and AZA with non-response. She started infliximab and AZA combination therapy in 2020, with optimization in 2021 due to endoscopic activity. In the same year, the patient presented to the emergency room with ascitis and underwent diagnostic paracentesis, which showed serum-ascites albumin gradient < 1.1 g/dL, absence of neoplastic cells, and abdominal and pelvic tomography reported a hypoechoic nodular lesion in the posterior wall of the uterus and elevated carbohydrate antigen 125. Given the suspicion of neoplasia, the suspension of immunosuppressive therapy was indicated. The patient underwent a total abdominal hysterectomy and bilateral salpingo-oophorectomy, and the pathological result reported low-grade endometrial sarcoma. It was decided to introduce vedolizumab for the management of UC; however, even after induction therapy, intense clinical and endoscopic disease activity was maintained, with total proctocolectomy being indicated due to clinical refractoriness and a history of neoplasia.

Conclusion: Patients with inflammatory bowel disease have a higher risk of cancer due to inflammation or treatment. Proper screening with multidisciplinary care can improve outcomes.

Background: Median sternotomy has been considered the gold standard approach for anterior mediastinal tumor resection. However, recent advances in video-assisted thoracoscopic surgery and robotic-assisted thoracoscopic surgery with carbon dioxide insufflation have allowed minimally invasive approaches even for large and locally invasive tumors of the upper-anterior mediastinum. The subxiphoid robotic optical approach is a recently developed technique for accessing the mediastinum. The trans-subxiphoid technique offers excellent exposure of the surgical field, reduces postoperative pain, facilitates specimen retrieval even for large tumors, and potentially improves early surgical outcomes.

Aim: To evaluate the safety, feasibility, and outcomes of a robotic subxiphoid approach for the resecting of large/invasive mediastinal tumors.

Methods: Between July 2024 and September 2025, 12 patients underwent subxiphoid robotic mediastinal resection. The diameter of the operated lesions ranged from 30 mm to 70 mm. A 3 cm subxiphoid incision was made at the subxiphoid level for GelPort placement, allowing for optical port access. Two operating ports were placed at the sixth intercostal space bilaterally. Carbon dioxide insufflations (8-10 mmHg) enlarged the surgical field, improving visualization of critical anatomical landmarks, such as the internal mammary arteries and phrenic nerves. This approach allowed complete resection of large or invasive tumors, preserving thoracic stability and reducing the risk of postoperative myasthenic crisis.

Results: The mean operating time was 170.2 minutes, and the median hospital stay was 3.5 days. No major postoperative complications occurred. Two conversions were necessary: One with a lateral robotic approach due to previous abdominal surgery, and one with a sternotomy for tumor invasion of the aortic arch. Histopathological analysis identified nine thymomas and one solitary fibrous tumor.

Conclusion: Subxiphoid robotic approach is a safe, effective technique for extended thymectomy, fulfilling both oncological and myasthenia gravis surgical objectives.

Background: Immunoglobulin A (IgA) vasculitis, formerly known as Henoch-Schönlein purpura, is a small vessel vasculitis predominantly affecting children. It commonly presents with a triad of purpuric rash, arthralgia, and abdominal pain. However, dermatologic manifestations of IgA vasculitis in black-skinned individuals are poorly documented in literature.

Case summary: This case report describes an 11-year-old black girl with acute onset of rash, joint pain, and abdominal pain, subsequently diagnosed with IgA vasculitis.

Conclusion: The case highlights the importance of early recognition and supportive management in ensuring a favorable outcome, particularly in dark-skinned populations.

The study included all patients at risk for chemotherapy-related cardiotoxicity, without exclusions based on the type of cancer, reflecting the institution's epidemiology with a predominance of breast cancer. Myocarditis was not an exclusion; its absence may reflect underdiagnosis. Age, although a known risk factor, showed no significant differences, and no upper chemotherapy dose limits were imposed to better capture real-world scenarios. A typographical error in the patient count was amended to 195. Limitations include its retrospective design, selection bias, and incomplete dose data. A prospective multicenter registry is underway to enhance diagnostic accuracy, include diverse types of cancer, and improve generalizability.

Background: The frequent occurrence of respiratory diseases in the island reef environment of the navy severely affects the health of personnel and the combat effectiveness of the troops. Current common screening methods can only indicate whether there is an infection with pathogenic microorganisms but not the degree of disease progression. Therefore, it is necessary to identify simple-to-operate and cost-effective methods that indicate the degree of disease progression, based on traditional screening methods.

Aim: To explores correlation between serum concentrations of nicotinamide phosphoribosyltransferase (NAMPT), nicotinamide nucleotide adenylyltransferase 1 (NMNAT1), and the risk of upper respiratory infections in the island reef envirsonment.

Methods: A total of 600 cases of upper respiratory infections among naval officers and soldiers were included. Types of infection were confirmed through sputum culture combined with multiplex polymerase chain reaction. The serum concentrations of NAMPT and NMNAT1 were measured using ELISA, and infection severity was assessed using the pneumonia severity index (PSI). Statistical analysis was performed using nonparametric tests and Spearman correlation analysis.

Results: The serum concentrations of NAMPT and NMNAT1 in high-risk group patients with PSI were significantly lower than those in the medium and low-risk groups (P < 0.05), and the concentrations increased in a stepwise manner with disease progression. However, within the same risk group, the differences in concentrations of NAMPT and NMNAT1 among patients infected with different pathogens were not significant (P > 0.05).

Conclusion: Concentrations of NAMPT and NMNAT1 are closely related to severity of upper respiratory infections, and their common regulatory mechanisms provide new directions for development of broad-spectrum anti-infection strategies.

Background: Posterior shoulder dislocation is a rare injury. It accounts for only 1%-4% of all shoulder dislocation cases. However, this injury is often underdiagnosed. Massive rotator cuff tears associated with posterior shoulder dislocation are exceptionally rare. Early diagnosis and surgical management are crucial for restoring shoulder function and preventing long-term disability.

Case summary: A 60-year-old male with no previous shoulder injuries presented to our hospital with severe right shoulder pain and immobility after a motorcycle accident. He reported that he braced his fall with his right hand. Initial imaging examination revealed posterior shoulder dislocation with minimal glenoid bone loss. Six days after the injury, the patient exhibited pseudoparalysis and active forward flexion limited to 10°. Two weeks after the injury, magnetic resonance imaging revealed complete tears of the supraspinatus, infraspinatus, and subscapularis muscles as well as dislocation of the long head of the biceps tendon. Arthroscopic rotator cuff repair was performed 6 weeks after injury. The tendon quality was acceptable with minimal fatty infiltration. At the 12-month surgical follow-up, the patient had recovered full strength and complete range of motion.

Conclusion: Early diagnosis and tailored repair of massive rotator cuff tears after dislocation are crucial for restoring shoulder function in older patients.

Background: Complications occur in approximately 12% of cases of diverticulitis, with perforation occurring in up to 10% of complications. Typically, patient with perforated diverticulitis present intraperitoneally with abdominal pain and peritoneal signs. By contrast, pneumoretroperitoneum and pneumomediastinum are rare complications and lack typical symptoms, making their diagnosis difficult and often delayed, leading to increased morbidity and mortality.

Case summary: A 66-year-old man presented with lower abdominal pain for 3 days. On examination, his vital signs were stable, and the abdomen was soft with mild distension and left lower quadrant tenderness, but no peritoneal signs were noted. Laboratory tests indicated leukocytosis and a markedly elevated C-reactive protein level. Abdominal computed tomography (CT) revealed focal wall thickening and fat stranding near the rectosigmoid junction as well as pneumoretroperitoneum, pneumomediastinum, and minor pneumoperitoneum. Suspecting hollow organ perforation, an emergent exploratory laparotomy was performed which revealed a retroperitoneal abscess with mesocolonic necrosis, likely due to perforated sigmoid diverticulitis. The patient underwent sigmoid resection with Hartmann's procedure and retroperitoneal drainage. Follow-up CT on postoperative day 14 confirmed resolution of the free air, and the patient was discharged on postoperative day 40 with an uneventful recovery.

Conclusion: Pneumoretroperitoneum and pneumomediastinum are rare complications of perforated diverticulitis, often with delayed diagnosis due to the absence of peritoneal signs. CT aids detection, and timely surgical intervention is crucial.

Background: The special physiological changes during pregnancy pose a huge challenge to the diagnosis of cervical cancer in pregnancy (CCIP). However, due to the poor prognosis of advanced-stage CCIP, there is currently no consensus or guideline for diagnosis and treatment.

Case summary: In this case report, we presented the case of a 30-year-old woman at 30 weeks of gestation who presented with irregular vaginal bleeding and was admitted to a local hospital at 35 weeks of gestation with a sudden gush of fluid and underwent a C-section. During the surgery, a rotten fish-like solid mass in the lower segment of the posterior wall of the uterus was excised for biopsy. The patient was referred to our hospital because she experienced heavy vaginal bleeding 13 days after one chemotherapy session. The solid mass was initially misdiagnosed as uterine clear-cell carcinoma at local hospital but later confirmed as cervical adenosquamous carcinoma by a multidisciplinary team. Three months posttreatment, she succumbed to multiple tumor metastases. The infant was healthy at the latest 2-year follow-up.

Conclusion: Obstetricians should expand differential diagnoses when obstetric factors cannot explain symptoms of persistent vaginal bleeding during pregnancy. Atypical and insidious clinical presentations are often concealed by physiological changes during pregnancy, which may increase the difficulty of diagnosis and result in misdiagnosis.

The prognostic impact of obesity in acute liver failure (ALF) remains underexplored in recent United States cohorts despite the global rise in obesity prevalence. The aim of this letter is to appraise and contextualize the findings of Krishnan et al, who examined the association between body mass index (BMI) and ALF outcomes in a large, retrospective United States cohort. Krishnan et al analyzed 196 ALF patients over two decades, demonstrating that both overweight and obesity independently doubled the risk of death or need for liver transplantation after adjustment for confounders. Elevated BMI was also associated with higher grades of hepatic encephalopathy and renal dysfunction; two major contributors to ALF mortality. Future research should consider additional markers of metabolic health beyond BMI to refine prognostication. This study provides timely, robust evidence linking elevated BMI to adverse ALF outcomes and highlights the need for targeted clinical strategies in this vulnerable subgroup.