Archive of clinical cases最新文献

Hemobilia is a potentially fatal condition if not diagnosed and treated early. One of the rare causes of hemobilia is hepatic artery pseudoaneurysm. Herein, we present a case of hemobilia caused by hepatic artery pseudoaneurysm rupture. A patient with a benign stricture in the distal common bile duct who had undergone multiple endoscopic retrograde cholangiopancreatography (ERCP) procedures had a pigtail stent placed during the last ERCP. Ten days after the procedure, the patient presented to our emergency department with abdominal pain and was admitted with a diagnosis of acute pancreatitis. During follow-up, the patient underwent another ERCP due to suspected cholangitis, and severe hemobilia was observed following removal of the pigtail stent. Computed tomography (CT) angiography revealed a hepatic artery pseudoaneurysm, which was successfully treated with coil embolization. Patients with hemobilia may present with symptoms of upper gastrointestinal bleeding as well as conditions such as cholangitis and pancreatitis due to hepatic artery pseudoaneurysm rupture. Coil embolization is the first-line of interventional to stop bleeding. If this method is insufficient, surgical treatment may be considered.

Simultaneous presentation of bilateral proximal femoral fractures following a traumatic event are considered very rare injuries. A literature search revealed that the fracture pattern in bilateral simultaneous proximal femoral fractures is most commonly similar to the anatomical region. We report a case of traumatic bilateral proximal femoral fractures with dissimilar pattern and anatomical location following a low energy trauma. A 90-year-old female presented with a right extracapsular - intertrochanteric neck of femur fracture and a left intracapsular - subcapital neck of femur fracture following a fall. The surgical plan was to fix the right side with a dynamic hip screw (DHS), directly followed by left cemented hip hemiarthroplasty on the left. Anesthetic concerns were raised towards the end of the first procedure hence the hemiarthroplasty was postponed. Following medical optimization, a bipolar cemented hip hemiarthroplasty was performed 4 days later. The patient was discharged after 16 days with carers support at home. Careful planning should take place in cases of simultaneous bilateral hip fracture given increased morbidity and mortality. Operation of both sides in a single stage is acceptable to reduce the risk of anesthetic complications and reduce costs. Dissimilar or asymmetrical bilateral hip fractures present a unique challenge, primarily because of the need to change the patient's position. Communication between the surgical and the anesthetic team throughout any procedure is important, but even more so in high-risk cases. To our knowledge, dissimilar or asymmetrical bilateral proximal hip fractures in the elderly presenting simultaneously have only been described twice in literature. Their rarity necessitates careful preoperative planning. The aim should be to address both injuries in a single operation, however contingency planning is important.

Functional Dyspepsia (FD) is a disorder of gut-brain interaction (DGBI) characterized by chronic symptoms without an organic cause. Diagnosis follows the Rome IV criteria, requiring symptoms for at least six months. FD affects up to 20% of the population, significantly impacting the quality of life and healthcare systems. Upper gastrointestinal endoscopy is often performed to rule out organic disorders but has limited utility in typical FD cases. FD's etiology involves gastric motility alterations, dysbiosis, and immune and central nervous system dysfunction. This review summarizes FD diagnostic methods. A PubMed search was conducted using keywords: Functional Dyspepsia, Gastric Motility Assessment, ROME IV, and Gastric Emptying (GE). Relevant studies were manually reviewed, excluding those unrelated to FD or gastric motility assessment. Despite extensive research on organic gastrointestinal diseases, FD's pathophysiology remains unclear, necessitating further studies. Diagnostic methods include the rapid water and nutrient drink tests for assessing impaired gastric accommodation, hypersensitivity, and delayed gastric emptying. Drinking-ultrasonography and three-dimensional ultrasound evaluate gastric motor and sensory functions. MRI-based assessments provide detailed stomach volume and geometry insights. Gastric emptying scintigraphy and the 13C-gastric emptying breath test measure gastric emptying rates. High-resolution electrogastrography (HR-EGG) assesses gastric myoelectrical activity, while EndoFLIP measures sphincter function. Functional MRI and PET scans analyze brain activity related to FD symptoms.  These methodologies enhance the understanding and management of FD by providing objective measures of gastric motility, accommodation, and sensory function. The integration of these advanced techniques into clinical practice holds the potential to move beyond symptom-based diagnosis, allowing for a more precise, individualized approach to treatment. Standardizing these diagnostic modalities will be crucial in optimizing patient care and alleviating the burden of FD on healthcare systems.

Ureteral lithiasis in high-risk patients demands a personalized approach due to the interplay of multiple comorbidities and procedural risks. This case report examines a 66-year-old female with recurrent lower ureteral stones resistant to multiple extracorporeal shock wave lithotripsy sessions, complicated by multidrug-resistant Enterococcus faecium infections, chronic coronary syndrome, heart failure with preserved ejection fraction, diabetes mellitus, and a history of ischemic stroke. The failure of conservative treatments required a shift to ureteroscopic laser lithotripsy, preceded by cardiovascular risk optimization and targeted antimicrobial therapy based on advanced microbial diagnostics. Postoperative imaging confirmed complete stone clearance and correct stent placement, ensuring ureteral patency. This case underscores the necessity of multidisciplinary management, integrating precise infection control, cardiovascular stabilization, and minimally invasive techniques to achieve a favorable outcome in a complex patient.

Cardiac metastases are rare but devastating complications of malignancies. Squamous cell carcinoma (SCC), particularly from non-pulmonary origins, infrequently metastasizes to the heart, making its cardiac involvement an unusual and underreported phenomenon. We present a case series of four patients diagnosed with myocardial and endocardial metastases from SCC at our center over two years. Clinical presentation, imaging modalities, suspected metastatic pathways, management strategies, and outcomes were analyzed. Patients (ages 41-74, three males, one female) had primary SCC in the vulva, tongue, buccal mucosa, and lung. Symptoms varied, including dyspnea, hypotension, chest pain, and stroke. All patients had elevated troponin levels. Echocardiography was crucial for initial detection, while PET/CT confirmed metastases, with one patient undergoing cardiac MRI. Hematogenous spread was likely metastatic pathway in most cases. Treatment was primarily palliative; only one patient received chemotherapy post-diagnosis. Survival post-cardiac metastasis diagnosis ranged from a few days to six months. Myocardial and endocardial metastases from SCC are rare and often indicate advanced disease with poor prognosis. Early recognition through multimodal imaging and biomarkers such as troponin may facilitate timely palliative interventions. Increased collaboration between oncology and cardiology may improve supportive care and symptom management in these patients.

Desquamative gingivitis (DG) is important in oral medicine because it is not a pathologic entity itself; rather, it is a clinical manifestation of dermatological disease most frequently associated with chronic inflammatory (e.g., oral lichen planus) and autoimmune diseases, mainly pemphigus vulgaris and mucous membrane pemphigoid, and several cases have been reported till date. Herein, we describe a case of pemphigus vulgaris-associated DG with unusual clinical behavior, in which the gingival lesions spontaneously resolved after consistently showing no response to various treatments. Additionally, a brief review of the literature focusing on the management of DG is provided.

Although nontoxigenic Vibrio cholerae usually stands in the shadow of the two serogroups (O1 and O139) that cause pandemic cholera, its role in human pathology is increasingly recognized and described in the literature. The habitat of these pathogens is brackish seawater or even freshwater, and the infections caused by them include contact with these waters or consumption of seafood originating in this habitat, which is constantly expanding because of global warming. This habitat extension is a typical example of climate change's impact on infectious diseases. Although nontoxigenic Vibrio cholerae strains are rarely capable of producing the classical cholera toxin, they possess many other virulence factors, can secrete various other toxins, and thus produce illnesses that are sometimes even severe or life-threatening, more frequently in immunocompromised patients. Vibriosis may manifest as gastrointestinal illnesses, wounds, skin or subcutaneous tissue infections, or septicemia. To establish the correct etiological diagnosis for these infections, a high index of suspicion must be maintained, as the diagnostic techniques require targeted investigations and specific collection and transportation of the samples. Empiric treatment recommendations are available, but owing to the increasing resistance of this pathogen, susceptibility testing is needed for every diagnosed case. We intend to raise awareness regarding these infections, as they tend to be more frequent than they were in the past and to appear in areas where they had not been recognized before.

Pembrolizumab, an immune checkpoint inhibitor (ICI) targeting the programmed cell death protein 1 (PD-1) receptor on T cells, enhances the immune system's ability to recognize and attack cancer cells. However, immune-related adverse events (irAEs) may arise, necessitating careful monitoring during treatment. Here, we present the case of a 47-year-old woman who developed multiple irAEs following pembrolizumab therapy. Initially diagnosed with Stage IIIB non-small cell lung cancer, she underwent chemotherapy followed by concurrent chemoradiotherapy. After two years of monitoring, progression of disease was observed, and pembrolizumab was initiated as second-line chemotherapy. Shortly thereafter, she presented with left-sided ptosis and weakness in both upper and lower extremities. Diagnostic evaluation, including a tensilon test and laboratory findings, confirmed with myositis, hepatitis, and myasthenia gravis. Treatment with steroids and neostigmine led to marked clinical improvement. Two months later, the patient developed additional dermatological symptoms, including rash and pruritus. Skin biopsy confirmed a diagnosis of pityriasis lichenoides. She is currently receiving antihistamines therapy, with no further exacerbation. This case underscores the importance of recognizing and promptly managing irAEs associated with ICIs to ensure patient safety and treatment efficacy.

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.