Archive of clinical cases最新文献

Brain tumors, despite the high mortality and morbidity, they are a rare type of heterogenous tumors that are highly dependent on sex, age, race, level of education, and socioeconomic status. Due to their high mortality rates, it is important to identify as many potential biomarkers for early detection as the earlier the tumor is discovered, the better the prognosis. One such early biomarker we propose in the current paper is the assessment of anxiety, depression, and cognitive changes. In most cancer patients, a certain degree of anxiety and depression is expected upon receiving the diagnosis as it triggers fears regarding the prognosis, possible side effects of the treatment, and even the possibility of the treatment failing. In this paper we analyzed the way anxiety, depression, and cognitive changes present themselves in the case of several types of tumors and whether these could be used as early markers. We have observed that most of the cognitive changes present are due to the location, size, and type of the tumor with some highly connected to anxiety and depression. Moreover, in the case of certain tumors, the removal of the mass has not improved the mood or cognitive function.

The development of an arterial pseudoaneurysm is an unusual complication of chronic pancreatitis. The most commonly involved artery is the splenic artery. This is a case report describing a case of a superior pancreaticoduodenal artery pseudoaneurysm in a patient with chronic pancreatitis who developed hemosuccus pancreaticus. A 46-year-old man with history of binge ethanol intake presented to the emergency department with abdominal pain. A computed tomography (CT) scan showed features of chronic pancreatitis along with a 2 x 1.8 cm enhancing mass at the level of the pancreatic head, consistent with an arterial pseudoaneurysm in close proximity to the pancreatic duct as confirmed on endoscopic ultrasound. He underwent an endoscopic retrograde cholangiopancreatography in the context of a rise in his liver enzymes with the presence of gallbladder sludge. This was complicated by hemosuccus pancreaticus, which was successfully managed with percutaneous angioembolization. Despite its unusual incidence, pseudoaneurysm remains an important complication of chronic pancreatitis with a high mortality rate in case of acute hemorrhage. Diagnostic modalities include abdominal CT and Color Doppler ultrasound. Endovascular techniques are considered to be the first line of therapy in most cases. Early recognition and management of pancreatic pseudoaneurysms is important to avoid life-threatening hemorrhage.

Peripartum cardiomyopathy (PPCM) is an uncommon life-threatening condition that is characterized by heart failure with reduced ejection fraction during late pregnancy or within 5 months of postpartum in the absence of other causes of heart failure. Despite advances in managing PPCM, the pathophysiology of it is still poorly understood. This article reviews the diagnostic challenges and management of PPCM, specifically highlighting a rare presentation of PPCM characterized by oxygen desaturation alone.

Gigantomastia is a rare condition characterized by excessive breast enlargement, which can lead to physical and psychological distress. Gestational gigantomastia (GG) occurs during pregnancy, often presenting significant management challenges. This case contributes to the limited literature on GG management by highlighting the successful use of the Goldilocks technique combined with free nipple grafting, offering insights into an effective surgical approach. A pregnant woman presented with severe GG. She underwent bilateral skin-sparing mastectomy and immediate reconstruction using the Goldilocks technique with free nipple grafting. The intervention provided both functional and aesthetic outcomes, significantly improving the patient's quality of life. This case underscores the effectiveness of modern reconstructive surgical techniques in managing GG, particularly in complex cases where hormonal therapy is insufficient.

A 38-year-old male patient was admitted to the Medical Intensive Care Unit during the second wave of the coronavirus disease (COVID-19) pandemic presenting with fever, headache, muscle pain, and cough. The low-dose chest computed tomography (CT) result was normal, but an increased serum level of procalcitonin (PCT) was detected. Due to COVID-19, pronounced symptoms, and increased inflammatory markers, empiric antibiotic therapy was started. PCT level remained elevated despite 7 days of antimicrobial treatment. Hence, the diagnostic evaluation of the patient was expanded, and we identified medullary thyroid microcarcinoma. After diagnosis, a total thyroidectomy with cervical lymph node resection was performed, and the patient was discharged with oral levothyroxine. Control measurements of serum calcitonin and 18F-fluorodihydroxyphenylalanine positron emission tomography (18F-PET/CT) showed cervical and mediastinal lymph node metastases. Beside surgical treatment, the patient was not motivated for any adjuvant therapy and no new lesions were detected on control PET/CT two years after. In conclusion, clinicians should also consider malignancies such as medullary thyroid carcinoma as a potential cause of increased PCT levels, and as a next step should measure serum calcitonin level and perform neck ultrasound.

Pulmonary Langerhans cell histiocytosis (PLCH) in adults is an uncommon disorder that occurs almost exclusively in smokers. PLCH has no known gender predilection, and the current consensus of its true aetiology is unknown. Lungs may the sole organ involved, however other organs in the body may be involved as well. With the introduction of 2 possible diagnostic categories, it makes PLCH easier and possibly quicker to diagnose. In this report, we present a 34-year-old adult male PLCH case that was negative for the typical immunohistochemistry findings necessary for a "definite" diagnosis but was instead diagnosed based on his florid imaging findings - who also had an unexpected histological finding of a non-specific interstitial pneumonia.

Multiple autoimmune syndrome (MAS) is characterized by the coexistence of three or more autoimmune diseases. We are reporting a unique case of MAS, presented as a Myasthenia Gravis exacerbation, found to have unexpected sero-abnormalities. A 39-year-old female presented with complaints of progressive difficulty swallowing of solids and liquids, droopy eyelids, and facial weakness. Physical examination revealed bilateral ptosis and proptosis, slow-muffled speech, loss of EOM, inability to smile, puff cheeks, clench teeth, or protrude tongue and an asymmetrical shoulder shrug. Motor tone was normal except ⅘ in the left arm and ⅗ in left hand with loss of flexion at left DIP joints. Acetylcholine receptor binding antibodies, ANA, Antithyroid peroxidase, antithyroglobulin and Anti SS-A were positive. MAS, while not a life-threatening condition, greatly degrades patients' quality of life. We recommend that when you encounter patients with one or more autoimmune disorder, you consider MAS in your differential.

Oral metastasis from the colon is quite rare with limited reporting and scientific evidence. The most common metastasis from colorectal cancer is to the liver followed by lungs, bones, and other organs. However rare occurrences like metastasis to the oral cavity might worsen the prognosis and treatment outcome. Oral metastatic tumors account only 1% of all the malignant neoplasms of the jaw. In most of the cases metastasis has been reported in the jaw bones compared to soft tissues. Persistent pain and delayed, prolonged healing should raise the question of an underlying lesion. An unusual case of secondary oral metastasis presenting as an ulcero-proliferative growth in left mandibular alveolus from the primary colon adeno carcinoma has been reported.

Burkholderia cepacia is an opportunistic Gram-negative bacillus that is found naturally in soil and water and usually causes respiratory infections in patients with cystic pulmonary fibrosis. Few cases of urinary tract infections with B. cepacia have been described in the literature, all of them clinical case presentations or case series. Therefore, we have compiled the data from the literature on this topic in a review to gain a better understanding of the etiopathogenesis, diagnosis and treatment methods of this disease. B. cepacia can lead to multidrug-resistant urinary tract infections in hospitals when surfaces and medical equipment are contaminated. The diagnosis is made after the onset of postoperative febrile syndrome or prolonged hospitalization in the intensive care unit. The evolution can be unfavorable, with the occurrence of sepsis and increased mortality.

Breast cancer, with its increasing incidence and high mortality rates, remains a major global health challenge, significantly impacting individuals, families, and societies. Understanding the multifactorial risk factors contributing to its development is crucial for effective prevention and management. Hormonal factors play a significant role in breast cancer development. Given that ovarian steroid hormones influence breast function, any gonadotropin hormone or fertility drug that stimulates ovulation may also impact breast tissue. Contrary to the findings of studies with smaller sample sizes, concerns have emerged regarding the potential increased risk of breast cancer following in vitro fertilization (IVF) treatments. This article explores the potential risk of breast cancer associated with hormonal cycles during IVF, supported by a literature review and a case study conducted in a tertiary hospital in Bucharest, Romania. The case involves a 38-year-old patient with a history of hormonally treated endometriosis and five IVF cycles, who presented for mammographic and ultrasound screening. The screening revealed multicentric and multifocal BIRADS-5 lesions, with histopathological and immunohistochemical analysis confirming invasive breast carcinoma of no special type with ductal carcinoma in situ, HER2 positive (3+), estrogen receptor and progesterone receptor negative, and a Ki-67 proliferation index of 50%.