AME Case Reports最新文献

Background: Acute aortic dissection causes major morbidities and mortalities. The treatment of choice for type A aortic dissection (TAAD) is emergent surgical intervention. However, surgery per se may be associated with significant risk, in part due to the general surgical challenges, and the inherent hemodynamic- and organ malperfusion effects. In particular, surgery correlates with marked perioperative mortality in octo- and nonagenarians and those with severe comorbidities. Conservative medical treatment represents an alternative approach to patients for whom surgery is deemed high-risk, but case literature in this field remains sparse.

Case description: We present a case of an 86-year-old female admitted with TAAD and deemed inoperable by the cardiothoracic surgical team due to excessive risks. The patient was treated conservatively with an extensive and aggressive antihypertensive regimen, leading to an uneventful recovery.

Conclusions: Most cases of TAADs require emergent surgery. However, surgery is often contraindicated in comorbid and older patients due to excessive risks. The patient in this report is unique due to the long follow-up after conservative treatment and the close adherence to treatment protocol due to continuous therapeutic monitoring. It is important to consider factors for and against conservative therapeutic strategies, and, importantly, adherence to such should be carefully monitored to optimize patient outcomes.

Background: Acquired perforating dermatosis (APD) is a heterogeneous group of unfrequented diseases (2.5 cases for 100,000 habitants) associated with multiple pathologies like end-stage renal disease and other concomitant conditions such as diabetes mellitus (DM).

Case description: We described 3 cases of APD in patients on peritoneal dialysis (PD), one of them with a giant variant of reactive perforating collagenosis (RPC). The first case is a 28-year-old man with chronic kidney disease on PD and a lousy control of disturbances of calcium and phosphorus metabolism that develops an APD. The second case is a 44-year-old man with DM, chronic kidney disease (CKD) on PD, and poor control of disturbances of calcium and phosphorus metabolism that develops an RPC. The third case is a 58-year-old man with DM, rheumatoid arthritis, hypothyroidism, CKD and bad control of calcium and phosphorus metabolism that develops a giant variant of RPC with poor evolution.

Conclusions: CKD and concomitant conditions such as DM present an increased risk of developing APD. Poor control of calcium and phosphorus metabolism is frequently found in patients with CKD and seems to be related to the development of APD in our cases. With the description of these cases, we want to emphasize the importance of knowing this rare disease, in order to promptly refer to Dermatology and start treatment.

Background: Generalized chronic pruritus (CP) can be associated with seborrheic dermatitis and psoriasis but often can present without any noticeable diagnosis or obvious skin lesion. When not related to a clear diagnosis, CP can be characterized as idiopathic pruritus. CP is both a diagnostically and therapeutically challenging presentation due to the variety of systemic, dermatological, neurological, and psychogenic diseases that must be ruled out before diagnosing idiopathic pruritus. This presentation is often overlooked but can lead to a greatly diminished quality of life for patients who present with idiopathic generalized pruritus. The course of treatment will vary between providers and specialties, however, most dermatologists will attempt control with antihistamines, topical steroids, or oral steroids. The use of gabapentinoids for the treatment of CP is understudied. Gabapentin was initially developed as an antiepileptic that has since been approved to treat neuropathic pain and has a common off-label use in dermatology and can be used to effectively treat CP.

Case description: Here we present a case of a 56-year-old Caucasian male who presented to the outpatient dermatology clinic with new-onset, diffuse, and intense pruritic symptoms that gradually progressed over a period of seven weeks. This case study details a patient with Idiopathic generalized pruritus previously uncontrolled that was well-controlled with the use of gabapentin after trials of other common treatments failed.

Conclusions: The understudied off-label use of gabapentin in the case of generalized chronic idiopathic pruritus should be explored and later implemented as a mainstay for patients suffering from uncontrolled CP as it was shown to completely eliminate pruritic symptoms and improve the quality of life for this patient.

Background: Gangliocytoma is an uncommon disease. In this report, we report a patient who was admitted to the hospital with a mediastinal tumor which is giant rarely.

Case description: A 30-year-old male patient was found to have a mediastinal mass 2 weeks ago during a routine examination. The patient occasionally had chest pain before 1 month. Computed tomography of the chest showed a mass occupying the posterior mediastinum and located anterior to the spine, above the diaphragm. The mass is removed by thoracoscopic surgery. In the surgical field of view, the tumor was loosely adhered to the surrounding organs and was freed by blunt-sharp combination Histologically confirmed mediastinal gangliocytoma with a size of 9.5 cm × 6.0 cm × 3.0 cm. The surgery was successful, and the patient's symptoms were completely relieved after the surgery. The patient underwent chest X-ray review at the 6th month after discharge, and no recurrence was found.

Conclusions: Gangliocytomas are rare tumors of the peripheral nervous system. However, most of these tumors are retroperitoneal and are more common in children and young adults. Ganglioneuromas arise from neural crest cells. Most of these tumors are asymptomatic, but some may develop high blood pressure and flushing. Surgery is the best way to treat such tumors, and attention should be paid to protecting the normal tissue around the tumor during surgery to prevent postoperative complications.