Prague medical report最新文献

Pleuroparenchymal fibroelastosis (PPFE) is a rare fibrotic lung disease with a poor prognosis. Some patients with PPFE have prominent lesions in one upper lobe. Due to the unilateral nature of lesions, similarities between some patients of PPFE and unilateral upper field pulmonary fibrosis (unilateral upper-PF) have been indicated. A 55-year-old man was referred to our hospital with PPFE, which had developed dyspnea 9 months previously. He had undergone resection of renal cancer 64 months prior to the onset of PPFE. He was administered the antifibrotic drug nintedanib, but passed away due to respiratory failure 43 months after the onset. What were impressive points in the clinical course of this PPFE patient was the similarity to unilateral upper-PF, including his medical history, and the poor prognosis. Although very rare, we do believe that the information on medical history and progression in this patient might provide suggestion into the treatment of future patients with a similar trajectory.

Solitary fibrous tumour (SFT) is an uncommon type of spindle cell tumour that affects soft tissues. Due to the rarity of spinal SFTs, they are often overlooked by healthcare providers, leading to frequent misdiagnosis. The clinical signs of spinal SFT are not specific and can vary based on tumour size and location. Typically, the main symptom is localized pain, which can be associated with limb numbness and other symptoms caused by pressure. Computed tomography scan was used to assess the extent of tumour involvement in the spinal canal and to identify any affected tissues. Magnetic resonance imaging is the most sensitive imaging method, and it is usually similar to disc extrusion or sequestered disc fragments. Surgical removal is the primary treatment for spinal SFT, and additional therapies, such as chemotherapy and radiotherapy, are considered for cases in which the tumour is not fully resected or inoperable.

The urachus remnant is a vestigial structure that results from incomplete involution of the cloaca and allantois, forming a duct between the bladder and the umbilical scar. Normally, it obliterates to form the middle umbilical ligament. Despite its rarity and often nonspecific symptoms, it can be incidentally discovered during imaging tests or due to complications, such as infections or neoplasms. The first diagnostic test usually ordered is an ultrasound, followed by computed tomography or magnetic resonance imaging for a more detailed evaluation. Early diagnosis and appropriate management, which may include surgical resolution, are important to prevent complications. This report discusses the case of a 4-year-old female presenting with abdominal pain, fever, and constipation, who was diagnosed with a urachus remnant through ultrasound. The patient responded well to antibiotic therapy for a urinary tract infection and was advised to follow-up with ultrasound for the urachus remnant. The article reviews the potential complications, diagnostic methods, and treatment options for urachus remnants, highlighting the importance of early detection in preventing more severe outcomes, including malignancies.

Treatments with prostheses on implants must be very well planned and executed, in order to have adequate maintenance and longevity. Thus, the present work demonstrates, through a clinical case report, the making of an overdenture prosthesis on two implants previously installed in the mandible and a conventional complete denture in the upper arch, considering the biopsychosocial principles of the patient. Male patient, 74-year-old, who underwent radiotherapy treatment, attended the Oral Oncology Center - FOA UNESP, for oral rehabilitation, after treatment of squamous cell carcinoma, complaining mainly of masticatory inefficiency due to edentulism. Intraoral clinical examination revealed a healthy gingiva in its entirety. In the maxillary ridge, an adequate bone height of the ridge was observed, however, with a failure in the posterior region on the left side due to surgery performed in the previous oncological treatment. In the lower arch, it was possible to observe bone resorption of the ridges and two implants (S.I.N. Implant System) already installed, parallel and stabilized (monitored by a device named Osstell) in the anterior region of the mandible. The treatment plan was defined by the elaboration of two prostheses, making an upper conventional complete denture and a lower overdenture-type prosthesis, taking advantage of the two implants previously installed in the radiotherapy sessions. After the installation of the prostheses, it was possible to diagnose greater masticatory comfort, improvement in aesthetics and self-esteem, managing to promote quality and longevity in the treatment according to the patient's needs and age, restoring oral health and him.

In the clinical evaluation of upper extremity embolism cases, the anamnesis should focus on identifying potential triggering risk factors. The physical examination may reveal sensory deficits, aiding in the determination of ischemia stages. Imaging diagnosis is crucial, with computed tomography (CT) angiography being the preferred examination due to its ability to provide detailed information about arterial anatomy across multiple planes and clear visualization of adjacent structures. Compared to magnetic resonance imaging angiography, CT angiography offers faster results with minimal distortion, despite the exposure to radiation and contrast use. Doppler ultrasonography is another valuable tool in suspected arterial thromboembolism cases, particularly in emergency settings. It offers advantages over CT angiography as it is non-invasive, cost-effective, and does not involve radiation or contrast administration. We present the case of a 68-year-old man who reported a nodule in the medial region of his right thumb for three months. Initially, he experienced significant local pain and limited movement, which gradually improved over time with the use of analgesic medication. Ultrasonography revealed thrombosis in the princeps pollicis artery, and the patient commenced treatment with acetylsalicylic acid. After four months, the patient reported a marked reduction in the nodule size along with pain improvement.

Temporomandibular disorders (TMDs) are conditions with multifactorial etiology and complex treatment. Among the non-invasive therapeutic possibilities for these conditions is the Front Plateau, a partial anterior plate made from colourless self-curing acrylic resin. It is a simple procedure that can be carried out in a single clinical section promoting muscle relaxation to reduce symptoms associated with TMDs. This study aims to report a prospective, consecutive, single-centric case series to evaluate the Front Plateau's effectiveness in patients with temporomandibular disorders. A questionnaire adapted from the Research Diagnostic Criteria for TMDs was used and 4 patients were treated with the Front Plateau plaque. Patients were monitored after 5 and 9 months, respectively, after starting to use the Front Plateau. Of the 4 cases listed, 2 showed significant improvement in initial signs and symptoms. Front Plateau may be a favourable treatment option for patients with TMD, if the guidelines are followed. Clinical trials on this modality should seek to minimize possible biases and limitations associated with the design of this type of research.

The sternalis is an occasional muscle of the pectoral region with a reported incidence of around 7.8%. Higher rates of occurrences have been noted in females and in Asians. The muscle becomes clinically relevant as the muscle can be mis-interpreted as a pathological mass. Routine dissection was performed in a 68-year-old male and a 65-year-old female donated cadavers in the pectoral region. Gross anatomical features were meticulously noted, photographed and measurements were recorded with digital Vernier callipers. In the male cadaver, a long, slender, flat bi-tendinous sternalis was found, and in the female cadaver, tripartite sternalis possessing three distinct bellies was observed. Both the sternalis was right sided and were supplied by 2nd, 3rd and 4th intercostal nerves. Single bellied and tripartite sternalis are rare and they need to be recognized in the diagnostic images and during surgeries to avoid confusion.

Laparoscopy is widely used technique for renal tumours in the world. After laparoscopy, some complications can occur in the follow-up. Pancreatic fistula incidence is 2.1% after left laparoscopic radical nephrectomy. This complication is very rare after right laparoscopic nephrectomy. I reported a case of pancreatic fistula which was misdiagnosed after surgery and managed conservatively.

Aneurysms are commonly managed by vascular surgeons, primarily affecting proximal arteries in the lower limb. In contrast, pseudoaneurysms often occur in the infrapopliteal region (Nair and Suhania, 2021), with anterior tibial artery involvement being particularly rare. It is even more uncommon for both the anterior and posterior tibial arteries to be affected simultaneously. Here, we present a case of a 21-year-old man who sustained vascular trauma to his right calf and presented one month later with difficulty in ambulation. A diagnosis of pseudoaneurysm involving both the anterior and posterior tibial arteries was made, and he successfully underwent reversed saphenous vein graft interposition for both arteries.

Although the impact of age and gender on QT and QTc intervals on conventional electrocardiogram (ECG) has been well studied, the impact of these factors on mean QT and QTc intervals measured with ambulatory ECG monitoring has not been studied. The aim of this study was to assess the impact of age and gender on mean QT and QTc intervals measured with ambulatory ECG monitoring. Recordings of ambulatory ECG monitoring from 380 patients without significant cardiac abnormalities were analysed. The mean QT interval was longer in women (390.5 [373.0-405.0] ms) than in men (380.0 [366.0-397.5] ms) (p<0.001). The mean QTc interval was also longer in women (439.0 [429.0-447.5] ms) than in men (428.5 [417.0-441.0] ms) (p<0.001). The normal (2.5-97.5 percentiles) mean QTc interval measured with ambulatory ECG monitoring ranged from 393 to 466 ms in men and from 411 to 471 ms in women. QT and QTc intervals increased with age (p<0.001). There was a positive correlation between age and QT interval (r=0.474, p<0.001) as well as between age and QTc interval (r=0.263, p<0.001). Thus, female gender is associated with longer mean QT and QTc intervals measured with ambulatory ECG monitoring. QT and QTc intervals become longer with age.