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Retroperitoneal liposarcoma: unveiling diagnostic delays and multimodal treatment dilemmas. 腹膜后脂肪肉瘤:揭示诊断延误和多模式治疗困境。
Q3 MEDICINE, GENERAL & INTERNAL Pub Date : 2023-12-14 eCollection Date: 2023-01-01 DOI: 10.22551/2023.41.1004.10272
Vlad Ionuţ Vlăsceanu, Radu Petru Soroceanu, Daniel Vasile Timofte, Andi Gabriel Iordache, Cristina Ciobanu Strobescu, Sergiu Timofeiov

Liposarcomas are a prevalent subtype of soft tissue sarcomas, constituting less than 1% of all malignancies. Originating in the adipose tissue, they can manifest in various locations and are categorized by the World Health Organization into several subtypes: well-differentiated liposarcomas, dedifferentiated liposarcomas, myxoid liposarcomas, pleomorphic liposarcomas and mixed-type liposarcomas. These tumors typically affect middle-aged and older individuals, and their incidence has been progressively increasing over the years. As liposarcomas advance they tend to encase blood vessels and major organs, particularly in the retroperitoneal area. Often asymptomatic initially, symptoms arise as the tumor reaches a considerable size, exerting pressure on adjacent tissues and organs. This report features a 54-year-old patient incidentally diagnosed with a substantial retroperitoneal tumor extending to the antero-lateral abdominal wall and inner thigh via the right inguinal ligament. The patient, with a previous three-year history of a right inguinal mass, sought acute care for a perianal abscess The histological examination revealed morphological aspects consistent with a low-grade myxoid liposarcoma. While surgery remains the primary treatment for retroperitoneal liposarcomas, controversies exist regarding the role of radiotherapy and chemotherapy in improving survival rates. This case highlights the challenges in managing retroperitoneal tumors and underscores the importance of a personalized, multidisciplinary approach to optimize patient outcomes.

脂肪肉瘤是软组织肉瘤的一种常见亚型,占所有恶性肿瘤的 1%以下。脂肪肉瘤起源于脂肪组织,可表现在不同部位,世界卫生组织将其分为几种亚型:分化良好的脂肪肉瘤、未分化的脂肪肉瘤、肌样脂肪肉瘤、多形性脂肪肉瘤和混合型脂肪肉瘤。这些肿瘤通常发生在中老年人身上,发病率逐年上升。随着脂肪肉瘤的发展,它们往往会包绕血管和主要器官,尤其是在腹膜后区域。最初往往没有症状,当肿瘤达到相当大的体积,对邻近组织和器官造成压力时,症状就会出现。本报告中的患者 54 岁,偶然被诊断出患有腹膜后巨大肿瘤,肿瘤通过右侧腹股沟韧带延伸至前外侧腹壁和大腿内侧。患者曾有三年右腹股沟肿块病史,因肛周脓肿就医。组织学检查显示,其形态与低级别肌样脂肪肉瘤一致。虽然手术仍是腹膜后脂肪肉瘤的主要治疗方法,但放疗和化疗在提高存活率方面的作用仍存在争议。本病例凸显了腹膜后肿瘤治疗的挑战,强调了采用个性化、多学科方法优化患者预后的重要性。
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引用次数: 0
Small fiber neuropathy with normal intra-epidermal nerve fiber density but reduced sweat gland density after third BNT162b2 shot. 小纤维神经病,表皮内神经纤维密度正常,但第三次注射BNT162b2后汗腺密度降低。
Q3 MEDICINE, GENERAL & INTERNAL Pub Date : 2023-11-21 eCollection Date: 2023-01-01 DOI: 10.22551/2023.41.1004.10264
Josef Finsterer

Small fiber neuropathy (SFN) has not been reported after the third dose of BNT162b2 in a previously healthy vaccinee. A 44-year-old previously healthy female developed pain and sensory disturbances in varying locations after the third BNT162b2 dose. Additionally, she developed recurrent tinnitus, headaches, arthralgia, neck stiffness, and motor dysfunction. A skin biopsy five months after symptom onset revealed normal intra-epidermal nerve fiber density (IENFD) but reduced sweat gland nerve fiber density. She is intended for a first series of intravenous immunoglobulins. SARS-CoV-2 vaccinations may be complicated by SFN; the diagnosis SARS-CoV-2 vaccination SFN may be delayed; IENFD may be normal, but sweat gland nerve fiber density may document SFN; and full recovery after SFN cannot always be achieved quickly.

以前健康的疫苗接种者在第三剂BNT162b2后未见小纤维神经病变(SFN)的报道。一名44岁的健康女性在第三次BNT162b2剂量后出现不同部位的疼痛和感觉障碍。此外,她出现复发性耳鸣、头痛、关节痛、颈部僵硬和运动功能障碍。症状出现5个月后皮肤活检显示表皮内神经纤维密度(IENFD)正常,但汗腺神经纤维密度降低。她将接受第一次免疫球蛋白静脉注射。SARS-CoV-2疫苗接种可能因SFN而复杂化;SARS-CoV-2疫苗接种SFN可能延迟诊断;IENFD可能是正常的,但汗腺神经纤维密度可能表明SFN;SFN后的完全恢复并不总是很快实现的。
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引用次数: 0
Unilateral complicated pleural empyema in a patient with bronchial asthma due to clindamycin-resistant Prevotella buccae. 支气管哮喘患者单侧并发胸膜脓胸1例,原因为耐克林霉素结核菌普氏菌。
Q3 MEDICINE, GENERAL & INTERNAL Pub Date : 2023-11-21 eCollection Date: 2023-01-01 DOI: 10.22551/2023.41.1004.10263
Sakshi Patel, Hamza Hanfe, Alkesh Kumar Khurana, Arati Bhadade, Shashwati Nema

Prevotella buccae (P. buccae) is a gram-negative obligate anaerobe mainly associated with infections of odontogenic origin. Non-oral monomicrobial infection by these obligate anaerobic bacteria is rare. Only a few cases of monomicrobial non-oral infections by P. buccae have been reported in the literature. We are reporting a case of unilateral complicated pleural empyema in a patient with bronchial asthma infected by P. buccae. Pleural fluid aerobic culture and blood culture reports were sterile. No acid-fast bacilli were detected by Acid Fast Bacilli (AFB) staining, and cartridge-based nucleic acid assay test (CBNAAT) reports were negative for Mycobacterium tuberculosis. The isolate, P. buccae was found susceptible to Metronidazole (MIC = 3 μg/ml) and resistant to Clindamycin (MIC = 256 μg/ml). In view of rising trends of antimicrobial resistance among anaerobes, it is recommended to perform anaerobic culture and sensitivity testing in clinically suspected cases of pleuropulmonary infection for appropriate diagnosis and optimal patient management. Clindamycin should be used with caution for empiric treatment.

布氏普雷沃氏菌(P. buccae)是一种革兰氏阴性专性厌氧菌,主要与牙源性感染有关。由这些专性厌氧菌引起的非口腔单菌感染是罕见的。只有少数病例的单菌非口腔感染的布氏假单胞菌已在文献报道。我们报告一例单侧并发胸膜积气肿的患者支气管哮喘感染假单胞杆菌。胸水有氧培养和血培养报告无菌。抗酸杆菌(AFB)染色未检出抗酸杆菌,核酸检测(CBNAAT)报告结核分枝杆菌阴性。菌株对甲硝唑(MIC = 3 μg/ml)敏感,对克林霉素(MIC = 256 μg/ml)耐药。鉴于厌氧菌抗菌药物耐药性呈上升趋势,建议对临床疑似胸膜肺感染病例进行厌氧菌培养和敏感性试验,以便正确诊断和优化患者管理。对于经验性治疗,应谨慎使用克林霉素。
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引用次数: 0
From spotlight to shadow: ALK inhibitor-induced acute liver failure in a patient with non-small cell lung cancer. 从聚光灯到阴影:ALK抑制剂诱导的非小细胞肺癌患者急性肝衰竭。
Q3 MEDICINE, GENERAL & INTERNAL Pub Date : 2023-11-21 eCollection Date: 2023-01-01 DOI: 10.22551/2023.41.1004.10266
Simona Ştefania Juncu, Anca Victorita Trifan, Horia Minea, Raluca-Ioana Avram, Camelia Cojocariu, Ana-Maria Sîngeap
Novel oncological therapies substantially improved the prognosis of cancer patients. Immunotherapies (immune checkpoint inhibitors) and targeted therapies (tyrosine kinase inhibitors) represent innovative strategies, which have revolutionized cancer patient's approaches. However, the new treatments may bring additional adverse effects, therefore right selection, close monitoring, and appropriate clinical decisions in the event of a complication are of upmost importance in these patients' management. We present an elderly male patient undergoing treatment with alectinib - anaplastic lymphoma kinase (ALK) inhibitor for metastatic non-small cell lung cancer, who was diagnosed with acute liver failure by drug-induced liver injury, five months after the start of the therapy. After the other possible causes of hepatocellular injury were excluded, the drug was discontinued. Using corticotherapy and supportive measures, the evolution of the patient was favorable. Up to this moment, data showed that alectinib was less associated with liver function abnormalities compared to other ALK inhibitors, however most commonly of mild or moderate grade of severity, especially in the first two months of treatment. The case we report presented acute onset liver failure, with a relatively late occurrence during alectinib therapy. Timely recognition may improve patients' prognosis, and monitoring must be carried out rigorously. Awareness and effective interdisciplinary communication among medical specialties play a pivotal role in the comprehensive care of cancer patients.
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引用次数: 0
An uncommon culprit of neutropenic fever: a case of Sweet syndrome following induction therapy for acute myeloid leukemia. 中性粒细胞减少热的罕见病因:急性髓性白血病诱导治疗后出现Sweet综合征1例。
Q3 MEDICINE, GENERAL & INTERNAL Pub Date : 2023-11-21 eCollection Date: 2023-01-01 DOI: 10.22551/2023.41.1004.10262
Ahmed Alderazi, Alec B Rezigh

Sweet syndrome (SS) is a rare inflammatory disorder characterized by the rapid onset of a characteristically tender rash, fever, and other systemic symptoms. These manifestations are often mistaken for an infection that is not responding to antimicrobials, especially in immunocompromised hosts. We present the case of a 44-year-old woman who developed SS following induction chemotherapy for newly diagnosed acute myeloid leukemia (AML). She exhibited a painful rash on the anterior chest, which spread centrifugally, along with neutropenic fever unresponsive to broad-spectrum antimicrobials. Biopsy of the rash revealed a dense neutrophilic infiltrate within the dermis, confirming the diagnosis of SS. The patient was subsequently treated with systemic steroids with prompt resolution of fevers and improvement of her rash. This case highlights that SS can manifest with a robust neutrophilic infiltrate, even in the context of neutropenia stemming from chemotherapy. SS serves as a crucial consideration in hematologic malignancies, particularly AML, when patients present with fever and cutaneous eruptions. Prompt recognition followed by systemic steroid therapy often leads to symptom resolution.

甜综合征(SS)是一种罕见的炎症性疾病,其特征是迅速出现特征性的软疹、发烧和其他全身症状。这些表现常常被误认为是对抗菌剂无反应的感染,特别是在免疫功能低下的宿主中。我们提出的情况下,44岁的妇女谁发展SS诱导化疗后新诊断急性髓性白血病(AML)。她表现出胸部前部疼痛的皮疹,并离心扩散,同时伴有中性粒细胞减少热,对广谱抗菌素无反应。皮疹活检显示真皮内有致密的中性粒细胞浸润,证实了SS的诊断。患者随后接受全身类固醇治疗,发烧迅速消退,皮疹得到改善。该病例强调SS可以表现为强大的中性粒细胞浸润,即使是在化疗引起的中性粒细胞减少的情况下。当患者出现发热和皮肤疹时,SS是血液系统恶性肿瘤,特别是AML的关键考虑因素。及时识别,然后进行全身类固醇治疗通常会导致症状缓解。
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引用次数: 0
Sodium valproate: cacosmia and dysgeusia as uncommon side effects. 丙戊酸钠:不常见的不良反应。
Q3 MEDICINE, GENERAL & INTERNAL Pub Date : 2023-11-21 eCollection Date: 2023-01-01 DOI: 10.22551/2023.41.1004.10265
Clara Montalbano, Accursio Raia, Valerio Caruso, Lavinia Migli

Smell and taste disturbances are potential adverse reactions of many drugs used in Psychiatry, such as antidepressants, anti-Parkinson agents, lithium, minor and major tranquilizers. To our knowledge, only one clinical case regarding valproate and cacosmia has been reported so far. However, several anticonvulsants are reported to cause taste and smell disturbances, although the underlying etiology is currently unclear. Our patient developed cacosmia and dysgeusia when taking valproic acid, both effects quickly disappeared upon drug discontinuation. In this article we not only report this uncommon side effect, but we discuss the plausible mechanisms behind such an adverse reaction. Our case is to date the second similar case in the literature. The aim of the present article is to make clinicians informed about this very uncommon and unpleasant side effect.

嗅觉和味觉障碍是精神病学中使用的许多药物的潜在不良反应,如抗抑郁药、抗帕金森药、锂、小剂量和大剂量镇静剂。据我们所知,目前仅有一例丙戊酸钠与钙血症相关的临床病例报道。然而,据报道,几种抗惊厥药会引起味觉和嗅觉障碍,尽管潜在的病因目前尚不清楚。本例患者在服用丙戊酸时出现失忆和记忆障碍,停药后两种症状均迅速消失。在这篇文章中,我们不仅报告了这种不常见的副作用,而且讨论了这种不良反应背后的合理机制。我们的病例是迄今为止文献中第二个类似的病例。本文的目的是使临床医生了解这种非常罕见和令人不快的副作用。
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引用次数: 0
Xanthogranulomatous epithelial tumor: a novel entity of uncertain biologic potential. 黄粒细胞性上皮肿瘤:一种生物学潜力不确定的新实体。
Q3 MEDICINE, GENERAL & INTERNAL Pub Date : 2023-10-05 eCollection Date: 2023-01-01 DOI: 10.22551/2023.40.1003.10261
Teodor Svantesson, Kim van Oudenaarde, Bruno Fuchs, Beata Bode, Alexander Vogetseder

Xanthogranulomatous epithelial tumor (XGET) is an extremely rare and recently described mesenchymal neoplasm characterized by a distinctive histological appearance and clinical presentation. This case report describes a unique case of XGET in a 66-year-old female patient who presented with a 5 cm mass in the dorsal distal left thigh. The clinical, radiological, and pathological findings, as well as the management and follow-up, are discussed.

黄粒细胞瘤上皮肿瘤(XGET)是一种极为罕见的间充质肿瘤,其特征是具有独特的组织学外观和临床表现。本病例报告描述了一名66岁女性患者的XGET独特病例,该患者左大腿远端背侧出现5cm肿块。讨论了临床、放射学和病理学表现,以及治疗和随访。
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引用次数: 0
A challenging case of bradykinin-mediated angioedema with airway obstruction: management and therapeutic strategies. 缓激肽介导的血管性水肿伴气道阻塞的一个具有挑战性的病例:管理和治疗策略。
Q3 MEDICINE, GENERAL & INTERNAL Pub Date : 2023-10-03 eCollection Date: 2023-01-01 DOI: 10.22551/2023.40.1003.10260
Lisete Rolo Nunes, Mónica Palma Anselmo, Tiago Salvador Brito

Angioedema is a potentially life-threatening condition that can have an allergic origin, usually mediated by histamine or a non-allergic origin, mediated by bradykinin. The distinction between these origins may present a clinical challenge at first approach, especially in cases that appear as an emergency and the outcome is time dependent. The authors describe a rare case of bradykinin angioedema associated with airway obstruction and discuss the right approach and therapeutic options. A 46-year-old patient under ACE inhibitor, renin-angiotensin-aldosterone blocker and beta blocker presented with difficulty swallowing, shortness of breath and angioedema, associated with inspiratory stridor, incapacity of talking, plantar pruritus and vomits minutes after ingestion of shrimp. The symptoms did not respond to epinephrine, anti-histamines or steroids. The airway quickly became an emergency and the authors discuss the importance of airway obstruction management and having a multidisciplinary well-defined plan of approach with backup plans. Exuberant angioedema persisted leading to the suspicion of drug induced angioedema. Treatment with tranexamic acid 1g 6/6h and icatibant 30 mg 6/6h (3 doses) was started with resolution. In these cases, the rapid institution of the right pharmacological line will relate significantly to a better outcome. It is particularly important because, as their underlying physiopathologic mechanism differ, bradykinin mediated angioedema does not respond to drugs that histamine mediated angioedema does, like corticosteroids and antihistaminic. In severe and life-threatening cases icatibant and tranexamic acid have proven to be an effective therapy.

血管水肿是一种潜在的危及生命的疾病,可能有过敏性来源,通常由组胺介导,或由缓激肽介导的非过敏性来源。这些起源之间的区别可能会对最初的方法提出临床挑战,尤其是在出现紧急情况且结果取决于时间的情况下。作者描述了一例罕见的缓激肽血管性水肿伴气道阻塞的病例,并讨论了正确的治疗方法和治疗方案。一名46岁的患者在服用ACE抑制剂、肾素-血管紧张素-醛固酮阻断剂和β受体阻断剂后,出现吞咽困难、呼吸急促和血管性水肿,并伴有吸气性喘鸣、不能说话、足底瘙痒和进食虾几分钟后呕吐。这些症状对肾上腺素、抗组胺药或类固醇没有反应。气道很快成为紧急情况,作者讨论了气道阻塞管理的重要性,以及制定多学科明确的方法计划和备用计划的重要性。肿胀性血管性水肿持续存在,导致怀疑为药物诱导的血管性水肿。开始用氨甲环酸1g 6/6h和艾替班30mg 6/6h(3剂)进行治疗,并得到缓解。在这些情况下,快速制定正确的药理学路线将与更好的结果显著相关。这一点尤为重要,因为缓激肽介导的血管性水肿对组胺介导的药物(如皮质类固醇和抗组胺药)没有反应,因为它们的潜在生理病理机制不同。在严重和危及生命的情况下,艾替班和氨甲环酸已被证明是一种有效的治疗方法。
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引用次数: 0
Solitary superficial angiomyxoma of the ear pinna: a diagnostic dilemma with a review of literature. 耳廓孤立性浅表血管黏液瘤:诊断难题及文献复习。
Q3 MEDICINE, GENERAL & INTERNAL Pub Date : 2023-09-26 eCollection Date: 2023-01-01 DOI: 10.22551/2023.40.1003.10258
Anurag Singh, Shalini Rawat, Gulshan Kumar, Uma Shankar Singh, Mala Sagar

Superficial angiomyxoma is an extremely rare subcutaneously placed myxoid soft tissue neoplasm. There are few case reports with fine needle aspiration cytological and histopathological findings available for this tumor because of its rarity. Here, we describe a case of superficial angiomyxoma in a 24-year-old girl who had a solitary left ear pinna mass without a Carney's complex at the time of presentation or at the end of two years of follow-up next to the surgical removal of the tumor. The clinical, cytomorphological, and histological findings, together with the immunohistochemical markers, in a case of superficial angiomyxoma are described in this rare case report for the first time in the English literature.

浅表性血管黏液瘤是一种极为罕见的皮下黏液样软组织肿瘤。由于这种肿瘤的罕见性,很少有细针抽吸细胞学和组织病理学结果的病例报告。在这里,我们描述了一例浅表性血管黏液瘤,发生在一名24岁女孩身上,她在出现时或在手术切除肿瘤后的两年随访结束时,有一个没有卡尼综合征的孤立左耳耳廓肿块。浅表血管黏液瘤的临床、细胞形态学和组织学表现,以及免疫组织化学标志物,在英国文献中首次在这一罕见病例报告中进行了描述。
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引用次数: 0
Emergency colectomy for massive rectal bleeding in a patient with well-controlled ulcerative colitis receiving Vedolizumab. 紧急结肠切除术治疗一名接受韦多利珠单抗治疗的溃疡性结肠炎患者的直肠大出血。
Q3 MEDICINE, GENERAL & INTERNAL Pub Date : 2023-09-26 eCollection Date: 2023-01-01 DOI: 10.22551/2023.40.1003.10259
Irina Ciortescu, Roxana Nemteanu, Liliana Gheorghe, Corina Hincu, Liliana Fortu, Oreste Chiriac, Andreea Clim, Alina Plesa

Ulcerative colitis (UC) is a chronic inflammatory condition, with a relapsing-remitting course. The case presented poses some valid questions regarding short-term and long-term management of patients with UC, and if the outcome (colectomy) could have been delayed or even prevented. Rectal bleeding is a cardinal symptom in patients with UC and it occurs among all patients during active disease. Massive rectal bleeding is an uncommon, but serious, complication of UC accounting for 0.1-1.4% of admissions. It is, nonetheless, noteworthy that instances of acute significant lower gastrointestinal bleeding accompanied by hemodynamic instability are infrequent. The rate of colectomy appears to be positively impacted by biological treatment. However, a refractory condition is still the primary reason for surgery, indicating a pressing need for new treatment approaches. Here we present the case of a young male patient who developed massive rectal bleeding and underwent emergent colectomy with ileostomy while having clinical and biological remission (normal calprotectin levels) at week 10 of Vedolizumab treatment.

溃疡性结肠炎(UC)是一种慢性炎症性疾病,有复发-缓解过程。该病例提出了一些关于UC患者短期和长期管理的有效问题,以及是否可以推迟甚至预防结果(结肠切除术)。直肠出血是UC患者的主要症状,它发生在所有活动性疾病患者中。直肠大出血是UC的一种罕见但严重的并发症,占入院人数的0.1-1.4%。然而,值得注意的是,伴有血液动力学不稳定的急性显著下消化道出血的情况很少发生。结肠切除率似乎受到生物治疗的积极影响。然而,难治性疾病仍然是手术的主要原因,这表明迫切需要新的治疗方法。在这里,我们介绍了一名年轻男性患者的病例,他出现了直肠大出血,并接受了紧急结肠切除术和回肠造口术,同时在韦多利珠单抗治疗的第10周出现了临床和生物学缓解(钙卫蛋白水平正常)。
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引用次数: 0
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