Clinical Medicine & Research最新文献

Acephalgic migraine (AM), or migraine aura without headache, is a subtype of migraine, characterized by transient neurological symptoms without the accompanying headache phase. Its diagnosis remains challenging due to varied clinical presentation and the tendency to misattribute symptoms to other neurological, psychiatric, or systemic disorders. This case report describes a female patient, age 38 years, presenting with episodic, incapacitating fatigue, nausea, and cognitive dysfunction, initially leading to an extensive but inconclusive diagnostic workup. Partial symptom relief with ondansetron, but not with metoclopramide, suggested involvement of migraine-associated pathways. A detailed history revealed a family history of migraine and specific triggers, including dietary and hormonal factors. A therapeutic trial with triptans led to dramatic symptom resolution, supporting an AM diagnosis. Retrospectively, the patient was able to identify additional aura symptoms, reinforcing the diagnosis. This case underscores the diagnostic challenge of AM and migraine aura variants. It also highlights the pivotal role of careful history-taking, patient-physician communication, and clinical reasoning in the evaluation of atypical symptom presentations. Clinician awareness of migraine spectrum disorders is essential to prevent misdiagnosis, reduce unnecessary testing, and improve patient outcomes. Further research is needed to refine diagnostic criteria and optimize management strategies.

Background/Purpose: We explored the complex relationship between the presence of metastatic cancer and undergoing cancer chemotherapy in adults with moderate to severe trauma and risk of reported physical abuse/assault-related trauma as defined in the American College of Surgeons Trauma Quality Programs Participant (ACS-TQP) dataset. We analyzed how these specific health conditions are associated with vulnerability to assault-related trauma, addressing a significant knowledge gap in existing literature.Methods: We utilized retrospective data from the ACS-TQP from 2017-2019 (N=27,531). The outcome was the report of physical abuse/assault-related trauma (no/yes). We focused on adults (aged ≥ 18 years) diagnosed with moderate to severe physical trauma (Injury Severity Scale: 9-75) who either had metastatic cancer (exposure) or were currently receiving chemotherapy (intervention), adjusting for predisposing factors and need for care factors based on Anderson's Model of Health Service Utilization. We used descriptive statistics, Fisher's exact test, chi-square analysis, and logistic regression using Stata.v18, with a statistical significance of P≤0.05.Results: We found 0.19% of 27,531 overall patients reported assault-related trauma, with 16,261 (0.16%) among those with moderate to severe trauma. Among these, a substantial majority with metastatic cancer reported assault-related trauma compared to those without metastatic cancer (84.62% vs. 15.38%; P value: 0.040). Patients receiving chemotherapy reported less frequent assault-related trauma than those not receiving it (26.92% vs. 73.08%; P value = 0.045). In the adjusted model, patients with metastatic cancer had significantly higher odds of reporting assault-related trauma than those without metastatic cancer (OR:7.847; 95% CI: 1.021-60.337; P<0.05). Chemotherapy was associated with a lower adjusted odds of assault-related trauma (OR 0.31, 95% CI: 0.08-1.14), but this did not reach statistical significance.Conclusion: In this large trauma cohort, metastatic cancer was associated with higher odds of assault-related trauma, while chemotherapy showed a reduced risk only in unadjusted analyses. Our findings highlight the higher vulnerability of patients with metastatic cancer and support further investigation into potential protective associations with active treatment.

Voriconazole-induced hypoglycemia in non-diabetic patients has rarely been reported. We describe a non-diabetic man, aged 50 years, without hepatic or renal dysfunction who developed severe prolonged hypoglycemia about 28 hours after initiating therapeutic dose of intravenous (IV) voriconazole therapy for invasive pulmonary aspergillosis. He required continuous IV infusion of dextrose solutions to maintain euglycemia. He recovered from hypoglycemia after discontinuation of voriconazole. Higher than normal plasma insulin (30.4 μU/mL) as well as C-peptide (10.04 ng/mL) levels were observed, which reached normal levels after he recovered from hypoglycemia. The temporal association between voriconazole administration and hypoglycemia occurrence led to probability that it was voriconazole-induced. The voriconazole trough level (8.9 μg/mL) checked during the hypoglycemia episode was elevated. The mechanism of hypoglycemia may be strongly attributed to insulinemia resulting from high voriconazole concentration. There is a possibility of genetic polymorphisms in the hepatic cytochrome P450 2C19 isoenzyme in this patient, which altered the voriconazole metabolism, causing high trough levels associated with hypoglycemia. This case suggests that voriconazole has a propensity to alter glucose homeostasis in the absence of liver and kidney dysfunction, and it may induce hypoglycemia without drug over dosage or drug interaction that clinicians should be vigilant about.

Objective: To determine whether serum squamous cell carcinoma antigen (SCC-Ag) is predictive of treatment response in patients with squamous cell cervical carcinoma (SCC) undergoing chemoradiation therapy, and to establish the mean normal serum SCC-Ag level in age-matched, apparently healthy female controls.Methods: Patients with histologically confirmed cervical SCC scheduled for concurrent chemoradiation were recruited (75 cases, alongside 75 age-matched apparently healthy controls, N = 150). Blood samples were collected before treatment and 6 weeks post-external beam radiotherapy to assess serum SCC-Ag levels, which were correlated with tumor stage and grade. Age-matched apparently healthy controls were also phlebotomized at baseline and 12 weeks later to determine normal SCC-Ag levels. Serum SCC-Ag was analyzed using Alinity i SCC reagent and analyzer (Abbott Laboratories, Chicago, IL, USA). The manufacturer's reference value for SCC-Ag is ≤1.5 ng/ml. Treatment response was assessed via pre- and post-treatment abdominopelvic computed tomography scans and classified as either complete or partial response. Data analysis was performed using SPSS v22.0, and logistic regression was used to evaluate predictors of treatment response. A P value <0.05 was considered statistically significant.Results: The mean age was 55.1 ± 11.6 years for cases and 55.5 ± 11.4 years for controls. Among cervical cancer patients, the median pre-treatment SCC-Ag level was 7.4 ng/ml, and post-treatment was 1.2 ng/ml, both significantly higher than in controls (0.4 ng/ml and 0.5 ng/ml, respectively). Vaginal bleeding was the most common symptom (94.7%), and 68% presented with locally advanced disease. SCC histology was confirmed in 94.7% of cases, and 61% showed either complete or partial treatment response. Median SCC-Ag levels were significantly associated with disease stage (P<0.001) but not with tumor grade (P=0.159). Logistic regression identified tumor size as a significant predictor of treatment response, while pre-treatment SCC-Ag and SCC-Ag reduction rate were not.Conclusion: Serum SCC-Ag levels were normal among all healthy controls and some patients with prior treatment. SCC-Ag correlated with disease stage but was not predictive of treatment response in patients undergoing chemoradiation. Tumor size was the only significant predictor of treatment response.

Hypopharyngeal carcinoma (HPC) has one of the poorest prognoses among all types of head and neck squamous cell carcinoma (HNSCC). Artificial intelligence (AI) is a scientific field that is in the spotlight, especially in the last decade, and AI has also been widely used in the research field of HPC. This scoping review aimed to describe the improvement of HPC clinical cares brought by AI. Literatures utilizing AI and machine learning in HPC were searched in PubMed, EMBASE, and Web of Science, and 116 articles from 1987 to 2024 were retrieved. After removing duplicate and irrelevant articles, 85 were further selected for detailed review. AI helps analyze large amounts of data from HPC patients and develop models to facilitate clinical practice. The emergence of AI improves the endoscopic, radiologic, and pathologic diagnosis accuracy of HPC and guides personalized treatment and prognosis prediction. However, there are certain unmet challenges that need to be further elucidated, like interpreting the AI algorithms into features that can be observed by humans and promoting the AI models in larger and multi-centered cohorts.

Objective: The purpose of this study was to determine and interpret the results of surgical intervention, namely, preservation of hearing and facial nerve functionality and reduction of the risk of recurrence and mortality from the disease.Methods: The study conducted a retrospective analysis of the clinical records of 26 patients treated at the state-owned public utility enterprise on the right of economic ownership "Multi-speciality City Hospital No. 1" of Astana (Kazakhstan) during the period from January 1, 2016 to December 31. 2023.Results: The mean age of patients was 49.5 years, of whom 69.1% were female. The most common complaints were throbbing tinnitus, hearing impairment, and dizziness. Regional metastases were observed in 15.4% of cases, and one case (3.8%) had a malignant form of paraganglioma with distant metastases to the liver. Most patients (84.6%) underwent surgery with transmastoidal access. Preoperatively, most patients had hearing impairment, both conductive and sensorineural types, as well as mixed. After treatment, deafness on the tumor side was diagnosed in six patients (23%). In the immediate postoperative period, the facial nerve function (I-II degree) was preserved in more than one-third of patients, and significant dysfunction (V-VI degree) was observed in 17.4% of patients. Early postoperative complications were observed in 13% of patients. Recurrence of tumor growth was detected in two patients (7.7%).Conclusion: This study demonstrates that surgical treatment, complemented by preoperative embolization, is an effective approach for managing middle ear paragangliomas, significantly reducing the risk of bleeding and improving postoperative outcomes.

Chromoblastomycosis (CBM) is a rare chronic, granulomatous mycosis affecting the skin and subcutaneous tissue. It is a deep, slow growing, fungal infection that most often presents with epidermal changes that clinically appear as a hypertrophic and verrucous plaque. We describe an atypical presentation of an immunocompromised male patient, age 76 years, who presented with a 4-month history of painless subcutaneous firm nodules of the left fifth finger. The fungal culture grew Exophiala bergeri, and histopathology showed medlar bodies with lack of pseuodepitheliomatous hyperplasia or epidermal changes commonly seen in CBM. To our knowledge, this is the first case of Exophiala bergeri CBM in the United States, highlighting its unique clinical presentation and expanding the differentials for a subcutaneous nodule.

Behçet's disease (BD) is a multi-systemic, chronic inflammatory disease of unknown etiology, with a multisystemic recurrent course and variable vasculitis. Although the disease onset is usually between the second and fourth decades of life, the preliminary symptoms and signs may appear under the age of 16 years. The prevalence of BD in children is unknown, but it is probably very low. The most common ocular manifestations of pediatric BD include anterior and posterior uveitis, panuveitis, retinal vasculitis, and retinitis. The pathogenesis, treatment, and future directions for pediatric BD are also briefly discussed.

Introduction: Leiomyomatosis peritonealis disseminate (LPD) is an entity with uncertain biological behavior, characterized by multiple smooth muscle intra-abdominal and pelvic nodules that may recur after apparently complete resection. LPD has been predominantly described in childbearing age females. Most case reports with short term follow-up describe this as a benign entity. Only isolated case reports indicate the malignant potential of the disease. A comprehensive collation of cases is lacking in literature.Methods: We present a case of malignant transformation of LPD, confirmed by histology and imaging, occurring over two decades. This patient was originally diagnosed with uterine atypical smooth muscle tumor but developed frank malignancy during follow-up. An increasingly malignant aggressive disease course resulted in ultimate development of liver and lung metastases almost 23 years after original diagnoses, resulting in her demise. A comprehensive literature review was performed, and 213 cases of LPD were described, including the present case. Patients were divided into G1 (reportedly benign), G2 (malignant at presentation), and G3 (malignant transformation).Results: Compared to G1, G2 at presentation were more likely to be symptomatic (73%/88%), larger sized (4.1/8.4 cm), and older aged (38/44). In G1, G2, and G3, the average age was 38.5, 44.3, and 37.5 years, respectively; while the disease specific survival was 100%, 71%, and 40%, respectively. The mean number of surgeries performed in G1, G2, and G3 was 1.6, 1.8, and 3.8, respectively. Hormone receptors were found in 24.4% of cases. The mean reported follow-up time in G1, G2, and G3, respectively, was 44.9, 13.1, and 70.5 months. This suggests with longer follow-up, even apparently benign tumors may develop malignancy. The transformation time to malignancy in G3 was 77.8 months, which is more than the average reported follow-up in G1 (44.9 months).Conclusions: LPD is a potentially malignant condition with long latency prior to transformation. Lifelong surveillance should be considered even in cases originally presumed to be benign. Loss of hormone receptor expression may serve as a marker for this transformation. Circulating Tumor DNA (ctDNA) levels may be associated with development of hematogenous metastases and may be a useful biomarker.

Pelvic floor dysfunction is commonly observed in individuals with spinal cord injury, often resulting in urinary, gastrointestinal, and sexual disturbances. Although pelvic floor rehabilitation is a widely accepted treatment for pelvic floor dysfunction in the general population, its application in spinal cord injury remains insufficiently explored. This study presents clinical experiences with pelvic floor rehabilitation in patients with incomplete motor spinal cord injury, aiming to contribute to the growing body of literature.This case series includes three patients with incomplete spinal cord injury, American Spinal Injury Association Impairment Scale, Grade-D, who underwent individualized multimodal pelvic floor rehabilitation programs. Interventions targeted urinary, bowel, and sexual dysfunctions using pelvic floor muscle training, biofeedback, electrical stimulation, tibial nerve stimulation, and sensory retraining strategies. All three patients demonstrated notable improvements in bladder and bowel continence, voluntary voiding, and sexual function. Subjective reports indicated enhanced functional independence and quality of life. Pelvic floor rehabilitation shows promise as an effective therapeutic option for managing neurogenic pelvic floor dysfunction in patients with incomplete spinal cord injury. Further randomized controlled trials are warranted to establish its efficacy and define optimal intervention protocols.