Pub Date : 2024-07-24DOI: 10.1097/md9.0000000000000335
Liu Qian, Lingmin Chen, Yanjun Lin
This case describes the rapid resolution of acute airway obstruction after anesthesia induction in a young man with a massive 12.7 × 9 × 12 cm anterior mediastinal tumor. It emphasizes the remarkable effectiveness of positional adjustments in immediately alleviating airway compression caused by large mediastinal masses. The crisis was resolved quickly and without invasive measures through only positional tactics, without the need for emergency invasive interventions. This highlights the decisive role of strategic patient positioning as a primary technique for perioperative management of mediastinal masses, ensuring adequate ventilation and preventing catastrophic outcomes. Due to the unique anatomical location of mediastinal tumors, the anesthesia risks for patients with mediastinal tumors are very high. These tumors can cause airway compression, leading to severe cardiovascular dysfunction and even mortality during general anesthesia. Combining the patient’s medical history, symptoms and signs, fiberoptic bronchoscopy and excluding other causes, it was confirmed that the tumor compressed the airway and blocked the airway. Ventilation was rapidly improved by adjusting the patient’s position, ultimately to the left lateral decubitus position with head-up tilt. Through positional adjustment, the patient’s airway obstruction symptoms rapidly improved. Airway pressure decreased significantly, end-tidal carbon dioxide returned to 40 mm Hg, and oxygen saturation increased to 95%. The mediastinal tumor was ultimately successfully resected. The surgical procedure went smoothly with successful extubation on the first postoperative day. The patient had a smooth recovery and was discharged on the seventh postoperative day without any lingering postoperative complications. This case provides an important educational illustration of how mediastinal mass patients can develop sudden catastrophic airway obstruction after induction despite being asymptomatic preoperatively. It demonstrates an effective crisis rescue technique through positioning that may help inform management of similar high-risk cases.
{"title":"Rapid alleviation of perioperative airway obstruction through positional adjustments in a patient with a giant anterior mediastinal mass: A case report","authors":"Liu Qian, Lingmin Chen, Yanjun Lin","doi":"10.1097/md9.0000000000000335","DOIUrl":"https://doi.org/10.1097/md9.0000000000000335","url":null,"abstract":"\u0000 \u0000 This case describes the rapid resolution of acute airway obstruction after anesthesia induction in a young man with a massive 12.7 × 9 × 12 cm anterior mediastinal tumor. It emphasizes the remarkable effectiveness of positional adjustments in immediately alleviating airway compression caused by large mediastinal masses. The crisis was resolved quickly and without invasive measures through only positional tactics, without the need for emergency invasive interventions. This highlights the decisive role of strategic patient positioning as a primary technique for perioperative management of mediastinal masses, ensuring adequate ventilation and preventing catastrophic outcomes.\u0000 \u0000 \u0000 \u0000 Due to the unique anatomical location of mediastinal tumors, the anesthesia risks for patients with mediastinal tumors are very high. These tumors can cause airway compression, leading to severe cardiovascular dysfunction and even mortality during general anesthesia.\u0000 \u0000 \u0000 \u0000 Combining the patient’s medical history, symptoms and signs, fiberoptic bronchoscopy and excluding other causes, it was confirmed that the tumor compressed the airway and blocked the airway.\u0000 \u0000 \u0000 \u0000 Ventilation was rapidly improved by adjusting the patient’s position, ultimately to the left lateral decubitus position with head-up tilt.\u0000 \u0000 \u0000 \u0000 Through positional adjustment, the patient’s airway obstruction symptoms rapidly improved. Airway pressure decreased significantly, end-tidal carbon dioxide returned to 40 mm Hg, and oxygen saturation increased to 95%. The mediastinal tumor was ultimately successfully resected. The surgical procedure went smoothly with successful extubation on the first postoperative day. The patient had a smooth recovery and was discharged on the seventh postoperative day without any lingering postoperative complications.\u0000 \u0000 \u0000 \u0000 This case provides an important educational illustration of how mediastinal mass patients can develop sudden catastrophic airway obstruction after induction despite being asymptomatic preoperatively. It demonstrates an effective crisis rescue technique through positioning that may help inform management of similar high-risk cases.\u0000","PeriodicalId":325445,"journal":{"name":"Medicine: Case Reports and Study Protocols","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141808483","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-01DOI: 10.1097/md9.0000000000000329
Meredith Schade, A. Payatakes, Julie Fanburg-Smith, Jonelle M Petscavage-Thomas
We present a case of a healthy 51-year-old female who developed extensive flexor tenosynovitis due to Candida parapsilosis following treatment for trigger thumb. Initial care had included corticosteroid injections and operative trigger finger release. She presented to us with reduced range of motion of her right thumb and a nodular swelling of the thenar eminence. No purulence was found with incision and drainage of the nodule and an empiric course of trimethoprim-sulfamethoxazole was given. Weeks later, an increase in thenar swelling and inability to extend her fingers lead to operative debridement. Multiple intraoperative samples grew C. parapsilosis, and a diagnosis of extensive flexor tenosynovitis was made. We suspect that corticosteroid injections to treat trigger finger and exposure to a broad-spectrum antibacterial selected for the growth of Candida species. The unique anatomy of the hand, indolent nature of Candida in a normal host and underestimation of the infectious burden contributed to a delay in diagnosis. The purpose of our report is to alert others to consider all commensal organisms of the skin in recalcitrant infections of the hand.
{"title":"Just the tip of the iceberg: Extensive flexor tenosynovitis due to Candida parapsilosis, a case report","authors":"Meredith Schade, A. Payatakes, Julie Fanburg-Smith, Jonelle M Petscavage-Thomas","doi":"10.1097/md9.0000000000000329","DOIUrl":"https://doi.org/10.1097/md9.0000000000000329","url":null,"abstract":"\u0000 \u0000 We present a case of a healthy 51-year-old female who developed extensive flexor tenosynovitis due to Candida parapsilosis following treatment for trigger thumb.\u0000 \u0000 \u0000 \u0000 Initial care had included corticosteroid injections and operative trigger finger release. She presented to us with reduced range of motion of her right thumb and a nodular swelling of the thenar eminence. No purulence was found with incision and drainage of the nodule and an empiric course of trimethoprim-sulfamethoxazole was given.\u0000 \u0000 \u0000 \u0000 Weeks later, an increase in thenar swelling and inability to extend her fingers lead to operative debridement. Multiple intraoperative samples grew C. parapsilosis, and a diagnosis of extensive flexor tenosynovitis was made.\u0000 \u0000 \u0000 \u0000 We suspect that corticosteroid injections to treat trigger finger and exposure to a broad-spectrum antibacterial selected for the growth of Candida species. The unique anatomy of the hand, indolent nature of Candida in a normal host and underestimation of the infectious burden contributed to a delay in diagnosis.\u0000 \u0000 \u0000 \u0000 The purpose of our report is to alert others to consider all commensal organisms of the skin in recalcitrant infections of the hand.\u0000","PeriodicalId":325445,"journal":{"name":"Medicine: Case Reports and Study Protocols","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141712318","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Xanthelasma, characterized by yellowish plaques around the eyelids due to lipid deposits, is typically treated through invasive methods like laser therapy or surgery, which often leads to scarring and dyspigmentation. This case series investigates the potential of Zhuang medicine medicated thread moxibustion as a less invasive alternative. Three female patients, aged 34, 45, and 55, presented with non-tender, soft yellow plaques near the medial canthi of both upper eyelids. The lesions varied in size and had been present for durations ranging from 6 months to 2 years. These patients expressed concerns about the pain and potential adverse reactions associated with conventional treatments, opting instead for an alternative approach. Each patient was diagnosed with xanthelasma based on clinical evaluation. Standard diagnostic tests returned normal results, confirming the absence of underlying systemic issues. The treatment regimen involved Zhuang medicine medicated thread moxibustion applied at 10-day intervals for a total of three sessions. This traditional method was selected due to its minimally invasive nature. After the first session, patients experienced mild edema, which resolved within 24 h. A significant reduction in the size of the plaques was observed after the second session, and by the third session, there was complete resolution of the plaques. Throughout the treatment and follow-up period of 3 months, no adverse reactions or recurrence of the xanthelasma was noted. This case series suggests that Zhuang medicine medicated thread moxibustion could be a safe and effective alternative for the treatment of xanthelasma, avoiding the complications associated with more invasive conventional methods. Further research involving larger sample sizes is recommended to validate these preliminary findings and possibly integrate this method into broader clinical practice.
{"title":"Effectiveness of Zhuang medicine medicated thread moxibustion on human xanthelasma – a case series","authors":"Yuan Jiang, C. Suriyonplengsaeng, Mengyi Wu, Jinran Lin, Qingmei Liu, Yinghui Zhou, Jui-Ming Lin, Saowaluck Meesin, Atchima Suwanchinda, Wenyu Wu, Traidit Thianthanyakij","doi":"10.1097/md9.0000000000000333","DOIUrl":"https://doi.org/10.1097/md9.0000000000000333","url":null,"abstract":"\u0000 \u0000 Xanthelasma, characterized by yellowish plaques around the eyelids due to lipid deposits, is typically treated through invasive methods like laser therapy or surgery, which often leads to scarring and dyspigmentation. This case series investigates the potential of Zhuang medicine medicated thread moxibustion as a less invasive alternative.\u0000 \u0000 \u0000 \u0000 Three female patients, aged 34, 45, and 55, presented with non-tender, soft yellow plaques near the medial canthi of both upper eyelids. The lesions varied in size and had been present for durations ranging from 6 months to 2 years. These patients expressed concerns about the pain and potential adverse reactions associated with conventional treatments, opting instead for an alternative approach.\u0000 \u0000 \u0000 \u0000 Each patient was diagnosed with xanthelasma based on clinical evaluation. Standard diagnostic tests returned normal results, confirming the absence of underlying systemic issues.\u0000 \u0000 \u0000 \u0000 The treatment regimen involved Zhuang medicine medicated thread moxibustion applied at 10-day intervals for a total of three sessions. This traditional method was selected due to its minimally invasive nature.\u0000 \u0000 \u0000 \u0000 After the first session, patients experienced mild edema, which resolved within 24 h. A significant reduction in the size of the plaques was observed after the second session, and by the third session, there was complete resolution of the plaques. Throughout the treatment and follow-up period of 3 months, no adverse reactions or recurrence of the xanthelasma was noted.\u0000 \u0000 \u0000 \u0000 This case series suggests that Zhuang medicine medicated thread moxibustion could be a safe and effective alternative for the treatment of xanthelasma, avoiding the complications associated with more invasive conventional methods. Further research involving larger sample sizes is recommended to validate these preliminary findings and possibly integrate this method into broader clinical practice.\u0000","PeriodicalId":325445,"journal":{"name":"Medicine: Case Reports and Study Protocols","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141693608","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-01DOI: 10.1097/md9.0000000000000326
Chu-Chun Liang, Jeng Wei, Chung-Yi Chang
Cefuroxime is a commonly prescribed antibiotic known for its overall safety profile. However, in rare instances, it can lead to a life-threatening condition known as idiosyncratic drug-induced agranulocytosis (IDIA). While there have been few documented cases linking cefuroxime to this severe adverse reaction, a recent study sheds light on a critical case involving a patient awaiting a heart transplant. In this study, the patient developed agranulocytosis after 16 days and 72 grams of cefuroxime treatment. Agranulocytosis is characterized by a drastic reduction in neutrophil count, in this case dropping to 0/mm3. IDIA is characterized by a drastic reduction in neutrophil count, in this case dropping to 0/mm3. This IDIA coincided with the availability of a donor heart, prompting the medical team to proceed with an immediate heart transplant despite the patient’s compromised immune status. Ceasing cefuroxime administration and initiating treatment with G-CSF for 3 days played a pivotal role in normalizing neutrophil levels. A meticulously planned immunosuppressant regimen was also initiated. Precise management of immunosuppressants contributed to the patient’s successful recovery, leading to discharge. The rationale for studying cases like these lies in the need for heightened awareness among healthcare providers. By documenting and analyzing such cases, medical professionals can better understand the risk factors, clinical presentation, and optimal management strategies for this uncommon yet serious adverse reaction. Furthermore, the study underscores the significance of individualized patient care, especially in complex scenarios such as organ transplantation. Precise adjustments to immunosuppressant therapy are crucial to balance the risks of rejection and infection, particularly in patients with compromised immune systems due to drug-induced agranulocytosis. In conclusion, this case serves as a reminder of the unpredictable nature of drug reactions and the importance of vigilant monitoring and rapid intervention in managing potentially life-threatening complications.
{"title":"Cefuroxime induced agranulocytosis during heart transplant period: A case report","authors":"Chu-Chun Liang, Jeng Wei, Chung-Yi Chang","doi":"10.1097/md9.0000000000000326","DOIUrl":"https://doi.org/10.1097/md9.0000000000000326","url":null,"abstract":"\u0000 \u0000 Cefuroxime is a commonly prescribed antibiotic known for its overall safety profile. However, in rare instances, it can lead to a life-threatening condition known as idiosyncratic drug-induced agranulocytosis (IDIA). While there have been few documented cases linking cefuroxime to this severe adverse reaction, a recent study sheds light on a critical case involving a patient awaiting a heart transplant.\u0000 \u0000 \u0000 \u0000 In this study, the patient developed agranulocytosis after 16 days and 72 grams of cefuroxime treatment. Agranulocytosis is characterized by a drastic reduction in neutrophil count, in this case dropping to 0/mm3.\u0000 \u0000 \u0000 \u0000 IDIA is characterized by a drastic reduction in neutrophil count, in this case dropping to 0/mm3.\u0000 \u0000 \u0000 \u0000 This IDIA coincided with the availability of a donor heart, prompting the medical team to proceed with an immediate heart transplant despite the patient’s compromised immune status. Ceasing cefuroxime administration and initiating treatment with G-CSF for 3 days played a pivotal role in normalizing neutrophil levels. A meticulously planned immunosuppressant regimen was also initiated.\u0000 \u0000 \u0000 \u0000 Precise management of immunosuppressants contributed to the patient’s successful recovery, leading to discharge.\u0000 \u0000 \u0000 \u0000 The rationale for studying cases like these lies in the need for heightened awareness among healthcare providers. By documenting and analyzing such cases, medical professionals can better understand the risk factors, clinical presentation, and optimal management strategies for this uncommon yet serious adverse reaction. Furthermore, the study underscores the significance of individualized patient care, especially in complex scenarios such as organ transplantation. Precise adjustments to immunosuppressant therapy are crucial to balance the risks of rejection and infection, particularly in patients with compromised immune systems due to drug-induced agranulocytosis. In conclusion, this case serves as a reminder of the unpredictable nature of drug reactions and the importance of vigilant monitoring and rapid intervention in managing potentially life-threatening complications.\u0000","PeriodicalId":325445,"journal":{"name":"Medicine: Case Reports and Study Protocols","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141390436","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-01DOI: 10.1097/md9.0000000000000324
Chang-Hoon Lee, N. Lee, Eun-Kee Song, So-Yeon Jeon
Solid organ transplant recipients face an elevated risk of malignancies due to immunosuppressive drugs and viral infections. Colorectal cancer is a common malignancy in kidney transplant (KT) recipients, with liver metastasis associated with worse. This case report highlights the successful resolution of colorectal cancer with liver metastasis following KT and subsequent triumph in a second KT after the cancer cure. A man who had undergone KT 10 years earlier presented with rectal bleeding. He was diagnosed with rectal cancer with no distant metastasis and recurrence of renal failure, with a creatinine level of 2 mg/dL. He underwent an anterior resection of a pathologic T3N0M0 tumor without risk features. Three months after surgery, a liver metastasis was detected, and a metastasectomy was performed. After the metastasectomy, the patient’s renal function further declined, and his creatinine levels increased from 5 mg/dL to over 12 mg/dL. A consultation to discuss adjuvant chemotherapy was postponed in favor of discussions regarding dialysis. He visited the oncologic clinic to discuss adjuvant treatment options 7 months post-metastasectomy. The decision was made to monitor for cancer recurrence without adjuvant therapy. The patient remained cancer-free for 5 years, and was declared cured. Another 6 years passed, and he achieved renal recovery through a second KT and maintained good health for the subsequent 2 years. Despite the poor prognosis for posttransplant malignancies, this case underscores the significance of early detection and tailored intervention in achieving successful outcomes for posttransplant malignancies and advocates for considering a second transplantation for cancer-cured patients experiencing organ function loss.
{"title":"Successful second kidney transplantation following cured metastatic rectal cancer after first kidney transplantation, 20-year history: A case report","authors":"Chang-Hoon Lee, N. Lee, Eun-Kee Song, So-Yeon Jeon","doi":"10.1097/md9.0000000000000324","DOIUrl":"https://doi.org/10.1097/md9.0000000000000324","url":null,"abstract":"\u0000 \u0000 Solid organ transplant recipients face an elevated risk of malignancies due to immunosuppressive drugs and viral infections. Colorectal cancer is a common malignancy in kidney transplant (KT) recipients, with liver metastasis associated with worse. This case report highlights the successful resolution of colorectal cancer with liver metastasis following KT and subsequent triumph in a second KT after the cancer cure.\u0000 \u0000 \u0000 \u0000 A man who had undergone KT 10 years earlier presented with rectal bleeding. He was diagnosed with rectal cancer with no distant metastasis and recurrence of renal failure, with a creatinine level of 2 mg/dL.\u0000 \u0000 \u0000 \u0000 He underwent an anterior resection of a pathologic T3N0M0 tumor without risk features. Three months after surgery, a liver metastasis was detected, and a metastasectomy was performed. After the metastasectomy, the patient’s renal function further declined, and his creatinine levels increased from 5 mg/dL to over 12 mg/dL.\u0000 \u0000 \u0000 \u0000 A consultation to discuss adjuvant chemotherapy was postponed in favor of discussions regarding dialysis. He visited the oncologic clinic to discuss adjuvant treatment options 7 months post-metastasectomy. The decision was made to monitor for cancer recurrence without adjuvant therapy.\u0000 \u0000 \u0000 \u0000 The patient remained cancer-free for 5 years, and was declared cured. Another 6 years passed, and he achieved renal recovery through a second KT and maintained good health for the subsequent 2 years.\u0000 \u0000 \u0000 \u0000 Despite the poor prognosis for posttransplant malignancies, this case underscores the significance of early detection and tailored intervention in achieving successful outcomes for posttransplant malignancies and advocates for considering a second transplantation for cancer-cured patients experiencing organ function loss.\u0000","PeriodicalId":325445,"journal":{"name":"Medicine: Case Reports and Study Protocols","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141402788","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-01DOI: 10.1097/md9.0000000000000320
Holden Archer, Esteban Zapata Nuñez, Mauricio Valdez, Brandon Everett, Joel E. Wells
Septic arthritis (SA) is an uncommon condition in which a pathogen invades a joint. SA presents clinically with monoarticular joint pain, swelling, and fever. Computed tomography and magnetic resonance imaging are common diagnostic modalities for SA in conjunction with lab work such as white blood cell count. SA is typically treated by joint drainage and antibiotics and is associated with poor outcomes. A 38-year-old woman with 3 prior arthroscopies over a seven-year period presented with an unresolved eight-year history of sharp intermittent pain in the groin and lateral hip. She was referred for nonsurgical treatment of her pain and received 2 corticosteroid hip injections. Subsequently following the injection, the patient developed fever, chills, and a mottled rash over her hip. Magnetic resonance imaging and inflammatory markers were obtained. Osteomyelitis with septic arthritis of the right hip with extension into the retroperitoneum was confirmed. The patient underwent resection arthroplasty with open retroperitoneal decompression of the iliopsoas abscess. Cultures isolated Staphylococcus aureus. Subsequent staged articulating hip spacer followed by reimplantation with total hip arthroplasty were performed. The patient had significant improvement as measured by patient reported outcomes scores. This case report describes a unique case of hip septic arthritis, with retroperitoneal abscess post-intra articular injection, that resulted in subsequent open retroperitoneal incision and debridement followed by two-stage resection arthroplasty with articulating spacer and total hip arthroplasty.
{"title":"38-year-old woman with septic arthritis and retroperitoneal abscess after intraarticular corticosteroid injection: A case report","authors":"Holden Archer, Esteban Zapata Nuñez, Mauricio Valdez, Brandon Everett, Joel E. Wells","doi":"10.1097/md9.0000000000000320","DOIUrl":"https://doi.org/10.1097/md9.0000000000000320","url":null,"abstract":"\u0000 \u0000 Septic arthritis (SA) is an uncommon condition in which a pathogen invades a joint. SA presents clinically with monoarticular joint pain, swelling, and fever. Computed tomography and magnetic resonance imaging are common diagnostic modalities for SA in conjunction with lab work such as white blood cell count. SA is typically treated by joint drainage and antibiotics and is associated with poor outcomes.\u0000 \u0000 \u0000 \u0000 A 38-year-old woman with 3 prior arthroscopies over a seven-year period presented with an unresolved eight-year history of sharp intermittent pain in the groin and lateral hip. She was referred for nonsurgical treatment of her pain and received 2 corticosteroid hip injections. Subsequently following the injection, the patient developed fever, chills, and a mottled rash over her hip.\u0000 \u0000 \u0000 \u0000 Magnetic resonance imaging and inflammatory markers were obtained. Osteomyelitis with septic arthritis of the right hip with extension into the retroperitoneum was confirmed.\u0000 \u0000 \u0000 \u0000 The patient underwent resection arthroplasty with open retroperitoneal decompression of the iliopsoas abscess. Cultures isolated Staphylococcus aureus. Subsequent staged articulating hip spacer followed by reimplantation with total hip arthroplasty were performed.\u0000 \u0000 \u0000 \u0000 The patient had significant improvement as measured by patient reported outcomes scores.\u0000 \u0000 \u0000 \u0000 This case report describes a unique case of hip septic arthritis, with retroperitoneal abscess post-intra articular injection, that resulted in subsequent open retroperitoneal incision and debridement followed by two-stage resection arthroplasty with articulating spacer and total hip arthroplasty.\u0000","PeriodicalId":325445,"journal":{"name":"Medicine: Case Reports and Study Protocols","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141045244","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-01DOI: 10.1097/md9.0000000000000321
Z. Wendimagegn, Selam Habtu, Atsede Birhanu Worku, Tsebelu Worku Shirshawa, Z. Getachew
Diethylene glycol (DEG) has been implicated in several cases of poisoning over the years. The most common mechanism of poisoning is accidental or deliberate ingestion of anti-freezer; however, poisoning from transcutaneous absorption is extremely rare. Treatment is not well defined but fomepizole or ethanol can be an effective antidote specially if started early. Furthermore, early hemodialysis will reduce the burden of toxic metabolites. Here, we report a rare case of diethylene glycol poisoning from transcutaneous absorption. Our patient presented complaining of gastrointestinal and renal symptoms. Initial laboratory results showed values consistent with acute kidney injury and metabolic acidosis. Therefore, hemodialysis was started right away. On the 7th day of admission, the patient started showing features suggestive of impending respiratory failure which prompted a transfer to intensive care unit (ICU) for mechanical ventilation. After ICU admission, the patient’s family reported previously concealed history of the patient applying brake fluid, a substance containing diethylene glycol, as traditional remedy for rash. Unfortunately, at that time, the antidote for diethylene glycol poisoning was not available in our country, Ethiopia. Hence, supportive treatment alone was given. Regrettably, the patient died on the 12th day of ICU admission. This case represents the unique clinical aspects of DEG poisoning. It also underscores the importance of suspecting DEG poisoning in acute renal failure patients with poor response to hemodialysis. Furthermore, taking detailed history will provide the initial clue to consider DEG poisoning. Lastly, further study should be done to identify factors that determine the occurrence of DEG poisoning from cutaneous brake fluid exposure.
{"title":"Diethylene glycol poisoning from transcutaneous absorption: Case report","authors":"Z. Wendimagegn, Selam Habtu, Atsede Birhanu Worku, Tsebelu Worku Shirshawa, Z. Getachew","doi":"10.1097/md9.0000000000000321","DOIUrl":"https://doi.org/10.1097/md9.0000000000000321","url":null,"abstract":"\u0000 \u0000 Diethylene glycol (DEG) has been implicated in several cases of poisoning over the years. The most common mechanism of poisoning is accidental or deliberate ingestion of anti-freezer; however, poisoning from transcutaneous absorption is extremely rare. Treatment is not well defined but fomepizole or ethanol can be an effective antidote specially if started early. Furthermore, early hemodialysis will reduce the burden of toxic metabolites.\u0000 \u0000 \u0000 \u0000 Here, we report a rare case of diethylene glycol poisoning from transcutaneous absorption. Our patient presented complaining of gastrointestinal and renal symptoms. Initial laboratory results showed values consistent with acute kidney injury and metabolic acidosis. Therefore, hemodialysis was started right away. On the 7th day of admission, the patient started showing features suggestive of impending respiratory failure which prompted a transfer to intensive care unit (ICU) for mechanical ventilation. After ICU admission, the patient’s family reported previously concealed history of the patient applying brake fluid, a substance containing diethylene glycol, as traditional remedy for rash. Unfortunately, at that time, the antidote for diethylene glycol poisoning was not available in our country, Ethiopia. Hence, supportive treatment alone was given. Regrettably, the patient died on the 12th day of ICU admission.\u0000 \u0000 \u0000 \u0000 This case represents the unique clinical aspects of DEG poisoning. It also underscores the importance of suspecting DEG poisoning in acute renal failure patients with poor response to hemodialysis. Furthermore, taking detailed history will provide the initial clue to consider DEG poisoning. Lastly, further study should be done to identify factors that determine the occurrence of DEG poisoning from cutaneous brake fluid exposure.\u0000","PeriodicalId":325445,"journal":{"name":"Medicine: Case Reports and Study Protocols","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141058393","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-01DOI: 10.1097/md9.0000000000000316
Zelu Han, Lingshuang Liu, Yi Jiang, Xintong Gao
Almonertinib is the first independently developed third generation epidermal growth factor receptor tyrosine kinase inhibitors in China. It can be used not only for epidermal growth factor receptor (EGFR) sensitive mutation patients but also for T790M (+) resistant patients, and has better safety and survivability compared to the first and second generation EGFR-TKIs. The previous literature and case studies have reported significant treatment-related adverse reactions in non-small cell lung cancers patients treated with almonertinib, including elevated blood creatine phosphatase, prolonged cardiac QT interval, altered myocardial contractility, interstitial lung disease, eye disease, and hematological events. But there are few individual reports of pulmonary embolism events. A 55-year-old female with no history of smoking visited a local hospital with mild cough and lower sacrococcygeal pain without obvious cause. She was diagnosed with right lung adenocarcinoma with multiple bone metastases (T2bN1M1c, stage IVB) after image and histological examination, with EGFR 21 exon L858R sensitive mutation. She initially underwent surgical treatment due to the discovery of a sacral tumor, and the pathology of the surgery indicated metastatic lung adenocarcinoma. Genetic testing results showed EGFR 21 exon L858R sensitive mutation. Combined with positron emission tomography/computed tomography imaging results and sacral tumor surgical pathology results, it was considered that the patient had lung adenocarcinoma with multiple bone metastases. Treatment plan: targeted treatment with almonertinib which is the third-generation EGFR-TKIs. After only 1 month of targeted treatment, chest enhanced computed tomography revealed pulmonary embolism imaging, combined with coagulation indicators, considering pulmonary embolism. As the thromboembolic site is located at the end of the pulmonary artery branch and imaging shows that tumor lesions are stable. Consider continuing targeted treatment with almonertinib and adjuvant oral anticoagulant therapy with rivaroxaban for treatment. Two months later, the patient’s condition was followed up and it was found that the imaging manifestations of pulmonary embolism disappeared, but the coagulation indicators remained in a hypercoagulable state. The patient’s treatment plan remained unchanged, and the patient was hospitalized for follow-up every 6 to 8 weeks to closely observe changes in the condition. There are many reasons for the occurrence of hypercoagulable blood in tumor patients, and there are very few reports of treatment-related pulmonary embolism events in patients who are treated with almonertinib targeted therapy. It is particularly important to determine whether the hypercoagulable blood in such patients is related to targeted therapy drugs in clinical practice, as this will affect the clinical benefits of patients in epidermal growth factor receptor tyrosine kinase inhibitors t
{"title":"Case report: NSCLC with pulmonary embolism after treatment with almonertinib","authors":"Zelu Han, Lingshuang Liu, Yi Jiang, Xintong Gao","doi":"10.1097/md9.0000000000000316","DOIUrl":"https://doi.org/10.1097/md9.0000000000000316","url":null,"abstract":"\u0000 \u0000 Almonertinib is the first independently developed third generation epidermal growth factor receptor tyrosine kinase inhibitors in China. It can be used not only for epidermal growth factor receptor (EGFR) sensitive mutation patients but also for T790M (+) resistant patients, and has better safety and survivability compared to the first and second generation EGFR-TKIs. The previous literature and case studies have reported significant treatment-related adverse reactions in non-small cell lung cancers patients treated with almonertinib, including elevated blood creatine phosphatase, prolonged cardiac QT interval, altered myocardial contractility, interstitial lung disease, eye disease, and hematological events. But there are few individual reports of pulmonary embolism events.\u0000 \u0000 \u0000 \u0000 A 55-year-old female with no history of smoking visited a local hospital with mild cough and lower sacrococcygeal pain without obvious cause.\u0000 \u0000 \u0000 \u0000 She was diagnosed with right lung adenocarcinoma with multiple bone metastases (T2bN1M1c, stage IVB) after image and histological examination, with EGFR 21 exon L858R sensitive mutation.\u0000 \u0000 \u0000 \u0000 She initially underwent surgical treatment due to the discovery of a sacral tumor, and the pathology of the surgery indicated metastatic lung adenocarcinoma. Genetic testing results showed EGFR 21 exon L858R sensitive mutation. Combined with positron emission tomography/computed tomography imaging results and sacral tumor surgical pathology results, it was considered that the patient had lung adenocarcinoma with multiple bone metastases. Treatment plan: targeted treatment with almonertinib which is the third-generation EGFR-TKIs. After only 1 month of targeted treatment, chest enhanced computed tomography revealed pulmonary embolism imaging, combined with coagulation indicators, considering pulmonary embolism. As the thromboembolic site is located at the end of the pulmonary artery branch and imaging shows that tumor lesions are stable. Consider continuing targeted treatment with almonertinib and adjuvant oral anticoagulant therapy with rivaroxaban for treatment.\u0000 \u0000 \u0000 \u0000 Two months later, the patient’s condition was followed up and it was found that the imaging manifestations of pulmonary embolism disappeared, but the coagulation indicators remained in a hypercoagulable state. The patient’s treatment plan remained unchanged, and the patient was hospitalized for follow-up every 6 to 8 weeks to closely observe changes in the condition.\u0000 \u0000 \u0000 \u0000 There are many reasons for the occurrence of hypercoagulable blood in tumor patients, and there are very few reports of treatment-related pulmonary embolism events in patients who are treated with almonertinib targeted therapy. It is particularly important to determine whether the hypercoagulable blood in such patients is related to targeted therapy drugs in clinical practice, as this will affect the clinical benefits of patients in epidermal growth factor receptor tyrosine kinase inhibitors t","PeriodicalId":325445,"journal":{"name":"Medicine: Case Reports and Study Protocols","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141043697","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-01DOI: 10.1097/md9.0000000000000322
M. Romeo, M. Dallio, R. Pellegrino, F. Lucido, S. Parisi, C. Gambardella, I. Panarese, Anna Russo, L. Docimo, Alessandro Federico
Intestinal pseudo-obstruction (IPO) represents an unclarified dysmotility disorder characterized by clinic-radiological signs of intestinal obstruction not associated with organic conditions. IPO may occur as a rare complication of autoimmune connective tissue diseases, including Systemic Lupus Erythematosus (SLE). Surgery is recognized as having a marginal management position for IPO patients: this case investigates its role, in the context of a multidisciplinary approach, in the diagnosis and treatment of acute complications of IPO. An SLE-affected 44-year-old man with a history of recurring nonspecific abdominal sub-obstructive episodes was admitted to our department for constipation, vomiting, and unintentional weight loss. Clinical examination revealed a family history of eosinophilic gastroenteritis (EG). Laboratory tests, including Systemic Sclerosis screening, presented no significant alterations. Abdominal X-ray highlighted multiple air-fluid levels; contrast-enhanced CT showed fluid surrounding dilated loops, and fluid-filled ileal loops, without evidence of organic intrinsic/ab-extrinsic obstruction, perforation, or extraluminal gas. Considering these findings, stenosing-pattern Crohn disease and strictures-complicated EG were mainly suspected. However, ileum-colonoscopy with the histological analysis resulted in inconclusive for Crohn disease and EG. The histological examination, by showing an SLE fibro-inflammatory pattern, not sparing the enteric plexus, infiltrating the intestinal wall of the surgical samples collected during the right hemicolectomy intervention, allowed the diagnosis of IPO. The patient, indeed, was initially managed conservatively with nasogastric decompression, immunosuppressive therapy, and parenteral nutrition by a multidisciplinary team including gastroenterologists, rheumatologists, and nutritionists. Unfortunately, 2 weeks later, the worsening symptoms required a lifesaving right hemicolectomy followed by ileostomy. IPO should be suspected in SLE patients presenting treated-unresponsive GI symptoms. Its early recognition finalized to start a tailored multidisciplinary approach appears prognostically crucial. Surgery could represent a paramount diagnostic moment and therapeutic life-saving approach.
{"title":"Intestinal pseudo-obstruction as systemic lupus erythematosus complication: is it time to reconsider the role of surgery?: A case report of a tailored multidisciplinary managed 44-year-old male patient","authors":"M. Romeo, M. Dallio, R. Pellegrino, F. Lucido, S. Parisi, C. Gambardella, I. Panarese, Anna Russo, L. Docimo, Alessandro Federico","doi":"10.1097/md9.0000000000000322","DOIUrl":"https://doi.org/10.1097/md9.0000000000000322","url":null,"abstract":"\u0000 \u0000 Intestinal pseudo-obstruction (IPO) represents an unclarified dysmotility disorder characterized by clinic-radiological signs of intestinal obstruction not associated with organic conditions. IPO may occur as a rare complication of autoimmune connective tissue diseases, including Systemic Lupus Erythematosus (SLE). Surgery is recognized as having a marginal management position for IPO patients: this case investigates its role, in the context of a multidisciplinary approach, in the diagnosis and treatment of acute complications of IPO.\u0000 \u0000 \u0000 \u0000 An SLE-affected 44-year-old man with a history of recurring nonspecific abdominal sub-obstructive episodes was admitted to our department for constipation, vomiting, and unintentional weight loss. Clinical examination revealed a family history of eosinophilic gastroenteritis (EG). Laboratory tests, including Systemic Sclerosis screening, presented no significant alterations. Abdominal X-ray highlighted multiple air-fluid levels; contrast-enhanced CT showed fluid surrounding dilated loops, and fluid-filled ileal loops, without evidence of organic intrinsic/ab-extrinsic obstruction, perforation, or extraluminal gas. Considering these findings, stenosing-pattern Crohn disease and strictures-complicated EG were mainly suspected. However, ileum-colonoscopy with the histological analysis resulted in inconclusive for Crohn disease and EG.\u0000 \u0000 \u0000 \u0000 The histological examination, by showing an SLE fibro-inflammatory pattern, not sparing the enteric plexus, infiltrating the intestinal wall of the surgical samples collected during the right hemicolectomy intervention, allowed the diagnosis of IPO.\u0000 \u0000 \u0000 \u0000 The patient, indeed, was initially managed conservatively with nasogastric decompression, immunosuppressive therapy, and parenteral nutrition by a multidisciplinary team including gastroenterologists, rheumatologists, and nutritionists. Unfortunately, 2 weeks later, the worsening symptoms required a lifesaving right hemicolectomy followed by ileostomy.\u0000 \u0000 \u0000 \u0000 IPO should be suspected in SLE patients presenting treated-unresponsive GI symptoms. Its early recognition finalized to start a tailored multidisciplinary approach appears prognostically crucial. Surgery could represent a paramount diagnostic moment and therapeutic life-saving approach.\u0000","PeriodicalId":325445,"journal":{"name":"Medicine: Case Reports and Study Protocols","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141047216","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-23DOI: 10.1097/md9.0000000000000315
Xue Li
Wallenberg syndrome, also referred to as posterior inferior cerebellar artery syndrome, represents the most prevalent form of bulbar syndrome and typically arises from occlusion of the posterior inferior cerebellar artery or its perforator artery. This vascular impairment can result in profound dysphagia, significantly compromising both survival time and quality of life for stroke survivors. Managing swallowing disorders associated with Wallenberg syndrome alone poses considerable challenges, while diagnosing and treating complex swallowing disorders stemming from other etiologies present formidable obstacles for clinicians and rehabilitation therapists alike. Naturally, such intricate swallowing disorders are infrequently encountered in clinical practice. The dysphagia experienced by a 60-year-old Asian male with right medulla infarction was severe, rendering him unable to swallow any food or saliva. However, unlike typical bulbar palsy patients, these individuals exhibit functional dysphagia disorders in addition to neurodysphagia. Notably, there is no damage observed in the brain’s cognitive areas; however, evident cognitive impairment related to swallowing is present. Swallowing disorders associated with Wallenberg syndrome, in conjunction with swallowing hysteria syndrome, were examined. Cognitive training incorporating mirror swallowing techniques, high‐intensity electrical stimulation, and balloon expansion therapy. Following treatment, the patient swiftly regained normal swallowing function within a span of 21 days, and this functionality was sustained during the six-month follow-up period. Wallenberg syndrome frequently presents with severe dysphagia, characterized by complex and debilitating symptoms, resulting in a poor prognosis. Due to the prolonged requirement of nasogastric feeding even after treatment, alternative etiologies for dysphagia are often overlooked. Isolated hysterical swallowing syndrome is relatively uncommon in clinical practice, particularly when coexisting with Wallenberg syndrome; however, fortunately, it exhibits a more favorable recovery outcome. The objective of this case report is to prompt clinicians and rehabilitation therapists to consider other potential causes of swallowing disorders in patients with Wallenberg syndrome when conventional treatments prove ineffective, thereby enhancing the rehabilitative outcomes for these individuals.
{"title":"Wallenberg syndrome associated with hysteria: A case report","authors":"Xue Li","doi":"10.1097/md9.0000000000000315","DOIUrl":"https://doi.org/10.1097/md9.0000000000000315","url":null,"abstract":"\u0000 \u0000 Wallenberg syndrome, also referred to as posterior inferior cerebellar artery syndrome, represents the most prevalent form of bulbar syndrome and typically arises from occlusion of the posterior inferior cerebellar artery or its perforator artery. This vascular impairment can result in profound dysphagia, significantly compromising both survival time and quality of life for stroke survivors. Managing swallowing disorders associated with Wallenberg syndrome alone poses considerable challenges, while diagnosing and treating complex swallowing disorders stemming from other etiologies present formidable obstacles for clinicians and rehabilitation therapists alike. Naturally, such intricate swallowing disorders are infrequently encountered in clinical practice.\u0000 \u0000 \u0000 \u0000 The dysphagia experienced by a 60-year-old Asian male with right medulla infarction was severe, rendering him unable to swallow any food or saliva. However, unlike typical bulbar palsy patients, these individuals exhibit functional dysphagia disorders in addition to neurodysphagia. Notably, there is no damage observed in the brain’s cognitive areas; however, evident cognitive impairment related to swallowing is present.\u0000 \u0000 \u0000 \u0000 Swallowing disorders associated with Wallenberg syndrome, in conjunction with swallowing hysteria syndrome, were examined.\u0000 \u0000 \u0000 \u0000 Cognitive training incorporating mirror swallowing techniques, high‐intensity electrical stimulation, and balloon expansion therapy.\u0000 \u0000 \u0000 \u0000 Following treatment, the patient swiftly regained normal swallowing function within a span of 21 days, and this functionality was sustained during the six-month follow-up period.\u0000 \u0000 \u0000 \u0000 Wallenberg syndrome frequently presents with severe dysphagia, characterized by complex and debilitating symptoms, resulting in a poor prognosis. Due to the prolonged requirement of nasogastric feeding even after treatment, alternative etiologies for dysphagia are often overlooked. Isolated hysterical swallowing syndrome is relatively uncommon in clinical practice, particularly when coexisting with Wallenberg syndrome; however, fortunately, it exhibits a more favorable recovery outcome. The objective of this case report is to prompt clinicians and rehabilitation therapists to consider other potential causes of swallowing disorders in patients with Wallenberg syndrome when conventional treatments prove ineffective, thereby enhancing the rehabilitative outcomes for these individuals.\u0000","PeriodicalId":325445,"journal":{"name":"Medicine: Case Reports and Study Protocols","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140670438","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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