AME Case Reports最新文献

Background: Bioelectrical impedance analysis (BIA) is a commonly used noninvasive technique for body composition assessment with recently expanded indications. This reproducible measurement method uses electrical conductivity to evaluate body composition, including fluid status. In pediatric idiopathic nephrotic syndrome (INS), albumin leaks into the urine, resulting in dysregulated colloid-osmotic pressure in the blood vessels. This results in decreased circulating blood volume and edema. Blood tests are a useful evaluation method; however, it cannot be performed frequently in children because of their invasive nature. Herein, we present a case of a child with INS demonstrating a longitudinal correlation between serum albumin (S-Alb) levels and extracellular water (ECW)/total body water (TBW) ratio.

Case description: A 6-year-old boy was admitted to the hospital for INS treatment after informed consent was obtained. He presented with severe proteinuria symptoms and an increased weight of 3 kg before the onset of INS. Standard treatment with prednisolone (PSL) for 28 days was initiated, and his proteinuria resolved on day 7. During the acute course, albumin replacement was conducted thrice for fluid management purposes and did not cause severe intravascular dehydration. The fluid composition was assessed over time; each measurement lasted for approximately 10 minutes and was performed on the same day as the blood tests. Nine measurements were taken, and S-Alb levels and the ECW/TBW ratio (r=-0.72, P<0.04) exhibited a significant negative correlation.

Conclusions: BIA can potentially predict S-Alb levels objectively and noninvasively within a short period. Although further validation is needed, this measurement can reduce the invasiveness of testing in children with INS.

Background: Pregnancy-associated fulminant type 1 diabetes (PF) occurs during pregnancy or within 2 weeks of delivery. Although it occurs infrequently, it is associated with high fetal mortality rate. Few studies have examined whether PF is associated with gestational diabetes mellitus (GDM).

Case description: A 29-year-old woman diagnosed with GDM at 24 weeks of gestation developed a fever, sore throat, nausea and vomiting at 29 weeks of gestation. Ketoacidosis was considered based on her blood ketone and glucose levels and the results of a blood gas analysis. Since the patient's islet function declined rapidly, fluid replacement, insulin therapy, and other treatments were administered. The patient was ultimately diagnosed with PF, and has required ongoing insulin therapy. She delivered a healthy baby girl by elective cesarean section at 37-week gestation. Her blood glucose has been satisfactorily controlled over the 12 months since her acute presentation.

Conclusions: PF is characterized by poor maternal and infant outcomes and a high stillbirth rate. Blood glucose should be regularly monitored in pregnant women with GDM. A sudden increase in blood glucose may indicate the possibility of PF, which needs to be managed in a timely manner to avoid adverse pregnancy outcomes.

Background: Plexiform fibrohistiocytic tumor (PFH) is a rarely metastasizing slowly growing neoplasm usually affecting children and young adults. The tumor usually has a dermal-subcutaneous location, is poorly circumscribed, and is comprised of a plexiform or multinodular proliferation of a variable admixture of fibroblasts and histiocytoid cells with a distinctive biphasic morphology. Myxoid change in PFH is extremely rare with only five cases of myxoid variant of PFH reported to date in the English literature.

Case description: In this case report, the author describes a rare case in a 39-year-old man who had presented with a newly developed right forearm mass. Given the tumor's unusual morphology an extensive immunohistochemical and molecular workup was performed to rule out common superficial myxoid neoplasms and potential mimickers. The overall ancillary findings along with the histomorphologic features and immunoprofile of the entirely excised mass were eventually compatible with myxoid PFH.

Conclusions: Myxoid PFH is a rare or underrecognized entity that can present as a diagnostic pitfall and can lead to an erroneous diagnosis especially if the pathologist is unaware of such entity. In this case report the author sheds light on this unique tumor, myxoid PFH, discusses the pitfalls inherent to its differential diagnosis, and reviews the literature on such a rare phenomenon.

Background: Epithelioid angiomyolipoma (EAML), a subtype of angiomyolipoma, is distinct. It has a biologic behavior of borderline tumor, a malignant tendency, and a risk of metastasis and recurrence. Adrenal EAML is very rare. It is true that only six cases of adrenal EAML have been documented in the English-language literature.

Case description: A 65-year-old man who underwent a laparoscopic left adrenalectomy in July 2022 has adrenal EAML and this is a case report about it. The mass was surrounded by abundant blood vessels and adherence with surround-tissue. Postoperative pathology of the tumor analysis revealed adrenal epithelioid vascular smooth muscle lipoma. The patient underwent left upper abdomen and lumbar pain in July 2022. The enhanced computed tomography (CT) scan of the abdomen showed markedly enhanced masses in and around the left adrenal gland. A second left laparoscopic adrenalectomy was performed under general anesthesia. Postoperative pathology showed two taupe nodules of left adrenal, maximum diameter 0.9 to 1.1 cm. The postoperative pathological diagnosis in combination with immunohistochemistry was EAML. The patient was discharged 10 days later with symptomatic treatment with low molecular heparin.

Conclusions: Adrenal EAML has a biologic behavior of borderline tumor with malignant potential and a risk of distant metastasis and recurrence. Therefore, radical surgical resection should be considered as its necessary treatment. Long-term postoperative follow-up is an important part of the treatment.

Background: There is evidence indicating patients with spinal deformity have impaired postural control and balance issues. Often, previous surgical intervention excludes the older patient from further invasive procedures leaving them with limited treatment options. The purpose of this case is to report on the clinically significant improvement in postural control as measured by force plate after a multimodal treatment program of Chiropractic Biophysics^® (CBP^®) posture rehabilitation as well as balance rehabilitation in an elderly patient with long-standing spinal deformity including thoracic hyperkyphosis and a T10-L4 Harrington rod instrumentation for thoracolumbar scoliosis.

Case description: A 69-year-old female presented with the main complaint of balance and gait impairment as well as back pain and headaches. Balance assessment on a force plate showed impaired balance, in the vestibular challenging condition (eyed closed; standing on foam). Radiography showed a forward stooped posture and surgical hardware. Treatment was directed at posture by CBP methods and balance rehabilitation by a whole-body vibration exercise program. Treatment progressed over a 10-month period. The patient experienced relief of back pains and headaches. There was a clinically significant improvement in posturography including a 102 cm reduction in center of pressure (COP) path length. There was an inch reduction in forward sagittal stoop.

Conclusions: A non-surgical rehabilitation program demonstrated a clinically significant improvement in balance performance in an elderly female diagnosed with osteopenia, spinal deformity, and previous spine deformity surgery. This approach to improving postural stability is important and further investigations should be undertaken.

Background: Idiopathic cardiac osseous metaplasia in the right atrium of a 9-year-old boy, accompanied by right atrial Chiari network and right pulmonary artery embolism. This case is rare and can easily be misdiagnosed.

Case description: We encountered a case of a 9-year-old boy with a 3.5 cm diameter neoplasm in the right atrium. Preoperative imaging diagnosis could not determine the nature of the tumor, and the initial clinical suspicion of cardiac myxoma. After admission, a cardiotomy to remove foreign bodies and a pulmonary artery thrombectomy were performed.

Conclusions: Idiopathic cardiac osseous metaplasia is relatively rare, and it is even rarer to be accompanied by a Chiari network in the right atrium. Due to the location and characteristics of the lesion in this case, it is easy to be misdiagnosed as atrial myxoma in clinical practice. Whether it is idiopathic osseous metaplasia or myxoma, it needs to be performed surgical treatment and pathological examination can easily rule out the diagnosis of myxoma. However, as idiopathic cardiac metaplasia is difficult to encounter in clinical work and there are few reports in the literature, clinicians and pathologists need to consult more relevant literature. Learn to understand and master the disease through multi-party consultation.

Background: Mild cognitive impairment (MCI) is a condition often preceding Alzheimer's disease and other dementias, characterized by subtle changes in cognitive function. While the importance of early detection is recognised, MCI is frequently underdiagnosed, especially when patients consult primary care physicians for non-cognitive health concerns. The case series aims to investigate the incidental identification of MCI in older patients who visit primary care settings for reasons unrelated to memory issues.

Case description: This is a retrospective case series comprising eight patients, ranging in age from 67 to 77 years, who initially presented in primary care settings for diverse non-memory-related concerns such as headaches, urinary tract infection (UTI) symptoms, and knee pain. Despite the lack of memory-related complaints, incidental findings suggestive of MCI were observed during clinical evaluations. The study explores the distinctions in clinical presentations and diagnostic pathways through thorough history taking and cognitive assessments, including the Montreal Cognitive Assessment (MoCA) and brain magnetic resonance imaging (MRI).

Conclusions: The study highlights the critical role that primary care settings can play in the early detection of MCI, even when patients present with non-cognitive complaints. It emphasizes the importance of comprehensive history taking as a tool for incidental identification of cognitive impairment. Although limited by sample size, the study calls for increased vigilance in primary care settings and suggests the need for future research aimed at optimizing early detection and management strategies for MCI in a primary care context.

Background: Meckel's diverticulum (MD) is the most common congenital defect of the gastrointestinal tract, occurring in about 1% to 2% of population. Most MD are rarely symptomatic, with presenting symptoms including diverticulitis, digestive tract hemorrhage and intestinal obstruction. The semblance of symptoms to enteritis and appendicitis makes preoperative diagnosis challenging. Current diagnosis of MD includes technetium-99m pertechnate scan, laparoscopic or intraoperative findings and examining surgical specimens. Here, we report that a double-balloon enteroscopy (DBE) improves the diagnosis accuracy of MD and presents high clinical application value.

Case description: A 12-year-old male patient was admitted to our hospital due to recurrent abdominal pain and black stools for more than half a year, recurrence for 2 days, accompanied by vomiting. The boy had anemic appearance, with periumbilical tenderness, and no mass was detected upon palpations. Past medical records revealed recurrent abdominal pain episodes thrice. Pre-surgery ⁹⁹Tc^mO₄-single-photon emission computed tomography/computed tomography (SPECT/CT) imaging was performed but did not reach the condition for diagnosis of MD. DBE was then performed and identified an upper ileum mass. After surgery, it was confirmed that the patient was an inverted MD, and the pathology showed gastric mucosa and pancreatic tissue. The patient recovered well after surgery and was discharged.

Conclusions: DBE is not widely used in the diagnosis of MD, but its accuracy is higher than that of radionuclide scanning imaging. In addition, several advantages such as hemostasis treatment, direct detection and observation of the diverticulum, and demarcation of the site and scope of the lesion prior to surgery brings high clinical application value.

Background: Rheumatoid arthritis (RA) is a chronic systemic autoimmune disease, and one of the main complications of RA is osteoporosis, which can cause osteoporotic vertebral compression fractures (OVCFs) that lead to low back pain and spinal deformation. For RA patients with OVCFs, the symptoms of osteoporosis are more severe, if surgical treatment is to be carried out, it is important to focus on the treatment of osteoporosis caused by RA.

Case description: We report a case of a 68-year-old woman with RA and successional osteoporotic vertebral body fractures treated by percutaneous vertebroplasty (PVP) and percutaneous kyphoplasty (PKP). The patient experienced spontaneous multiple OVCFs on three occasions: in the course of 5 months, she underwent one PKP and two PVP operations with five cement-augmented vertebrae from the first to fifth lumbar vertebrae. The mean interval between each operation was 75 days (range, 2-3 months). The case report makes us look into the treatment of each stage and think about the reasons, we reviewed the literatures on advancements in the treatment of OVCFs caused by RA, so that we can choose a better method for similar patients in the future.

Conclusions: For OVCFs secondary to RA without neurological damage, if we carry out surgical treatment, the systematic treatments, including RA treatment, pain management, brace treatment, and anti-osteoporosis measures are important. among them, anti-osteoporosis treatment has the highest priority because of the reversible nature of osteoporosis caused by RA.

Background: Breast cancer has a high incidence and is prone to metastasis, while isolated liver metastasis is rare. A growing body of evidence supports the effectiveness of treating breast cancer with anti-human epidermal growth factor receptor-2 (HER2) therapy in combination with chemotherapy. However, little is known about its impact on metastatic liver disease. There is also a lack of consensus on managing liver metastases from breast cancer, and no studies have been conducted on managing the disappearance of liver metastases after treatment.

Case description: In May 2021, a 51-year-old female patient with HER2-positive breast cancer with isolated liver metastases had immunohistochemistry of estrogen receptor (ER) (-), progesterone receptor (PR) (-), and HER2 (3+) for both her primary lesion and liver metastases. After undergoing 17 cycles of anti-HER2 therapy and chemotherapy, the patient expressed a desire for surgery. Then a preoperative examination was performed, which revealed the disappearance of both the primary breast lesion and the liver metastases. Immediately afterwards, a left mastectomy was performed, and postoperative pathology showed a complete response to the breast tumor. As for the liver, where the metastatic lesions disappeared, no relevant study has reported how to deal with this situation. Finally, after a hospital-wide discussion, the patient was given trastuzumab maintenance therapy. Until now, no obvious signs of recurrence or metastasis have been observed during regular follow-ups.

Conclusions: This case suggests that maintenance therapy may be the best option for patients with breast cancer whose liver metastases disappear by medication. Also, it can be inferred that in HER2-positive metastatic breast cancer (MBC), patients with isolated liver metastases may be more likely to achieve a cure-like outcome. Nevertheless, more cases and follow-up information are needed to support these views.