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Spontaneous thrombosis of a giant cavernous-carotid aneurysm with simultaneous ipsilateral complete parent artery occlusion: a rare phenomenon and review of the literature. 巨大海绵状颈动脉瘤自发性血栓形成并同时发生同侧完全母动脉闭塞:罕见现象及文献回顾。
Q3 MEDICINE, GENERAL & INTERNAL Pub Date : 2023-01-01 DOI: 10.22551/2023.38.1001.10234
Yousef A I Abousedu, Athary Saleem, Saqer Alenezi, Petar Bosnjakovic, Lazar Lazovic, Tarik M Alsheikh

Cavernous-carotid artery (CCA) aneurysms represent about 3-5% of all intracranial aneurysms. Spontaneous thrombosis of a CCA aneurysm with simultaneous occlusion of its parent vessel is an extremely rare phenomenon with few reported cases in the literature offering different management strategies. A 54-year-old Asian female presented with a one day-history of painless left eye conjunctival injection, proptosis, and features of cavernous sinus syndrome (cranial nerve III, IV, V1, V2, and VI palsies). Imaging revealed a giant thrombosed CCA aneurysm measuring 3.6cmx3.4cm with complete thrombosis of the left cervical internal carotid artery (ICA) and adequate collaterals from the anterior and posterior communicating artery and branches of the left external carotid artery. Management was conservative with antiplatelet therapy and close clinical-radiological follow-ups. The outcome was satisfactory. Data in the literature on this condition is limited due to its exceedingly rare occurrence. The majority of patients do well via a conservative approach and surgery is rarely indicated. For clinically stable patients, especially those with adequate collateral circulation and tolerance to Balloon Test Occlusion, we advocate for a conservative approach and initiation of anti-platelet therapy to treat these patients. Emphasis is needed on close serial clinical-radiological surveillance in these cases to monitor the propagation of the thrombus as well as the development of new and/or enlarging pre-existing aneurysms in the contralateral ICA circulation.

海绵状颈动脉(CCA)动脉瘤约占所有颅内动脉瘤的3-5%。CCA动脉瘤自发性血栓形成并同时阻塞其母血管是一种极其罕见的现象,文献中很少有报道的病例提供不同的治疗策略。54岁亚洲女性,一日无痛左眼结膜注射史,眼球突出,海绵窦综合征(颅神经III、IV、V1、V2和VI麻痹)。影像学显示一个巨大的血栓形成的CCA动脉瘤,尺寸为3.6cmx3.4cm,左侧颈内动脉(ICA)完全血栓形成,左侧颈外动脉前、后交通动脉和分支有足够的侧支。治疗是保守的抗血小板治疗和密切的临床放射随访。结果令人满意。由于这种情况极为罕见,文献中关于这种情况的数据有限。大多数患者通过保守方法治疗效果良好,很少需要手术。对于临床稳定的患者,特别是那些侧支循环充足且对球囊试验闭塞耐受的患者,我们建议采用保守方法并开始抗血小板治疗。在这些病例中,需要强调密切的连续临床放射监测,以监测血栓的扩散以及对侧ICA循环中新的和/或扩大的原有动脉瘤的发展。
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引用次数: 1
From recurrent rhabdomyolysis in a young adult to carnitine palmitoyltransferase II deficiency. 从年轻成人复发性横纹肌溶解到肉碱棕榈酰转移酶II缺乏。
Q3 MEDICINE, GENERAL & INTERNAL Pub Date : 2023-01-01 DOI: 10.22551/2023.38.1001.10238
Cristina Marques, Catarina Silva, Carina Silva, João Pedro Abreu, Márcia Ribeiro, Arlindo Guimas

Metabolic myopathies are a diverse group of rare genetic disorders associated with recurrent episodes of rhabdomyolysis, induced by triggers such as fever or exercise. In these disorders, the energetic metabolism is compromised resulting in damage of the muscle cells. The diagnosis can be challenging but is essential for the correct treatment. Carnitine palmitoytransferase II (CPT-II) deficiency is the most common long-chain fatty acid oxidation defect, with the adulthood form requiring additional external triggers. The authors present a case of a young-male adult with recurrent episodes of rhabdomyolysis, one of them presented with acute renal failure and acute hepatitis. The diagnostic is demanding, which requires a high level of suspicion. The adequate treatment of these patients improves the muscle function and prevents other episodes of severe rhabdomyolysis.

代谢性肌病是一组罕见的遗传性疾病,与反复发作的横纹肌溶解有关,由发烧或运动等诱发因素引起。在这些疾病中,能量代谢受到损害,导致肌肉细胞受损。诊断可能具有挑战性,但对正确治疗至关重要。肉碱棕榈酰基转移酶II (CPT-II)缺乏症是最常见的长链脂肪酸氧化缺陷,成人形式需要额外的外部触发。作者提出了一例年轻男性成人反复发作的横纹肌溶解,其中一个表现为急性肾功能衰竭和急性肝炎。诊断要求很高,需要高度的怀疑。适当的治疗可以改善这些患者的肌肉功能,防止其他严重横纹肌溶解的发作。
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引用次数: 0
Acute meningitis complicated with ventriculitis caused by Streptococcus dysgalactiae subsp. dysgalactiae. 急性脑膜炎并发脑室炎由欠乳链球菌引起。dysgalactiae。
Q3 MEDICINE, GENERAL & INTERNAL Pub Date : 2023-01-01 DOI: 10.22551/2023.38.1001.10231
Mariana Guerra, Daniela Marado, Jorge Fortuna

Streptococcus dysgalactiae subspecies dysgalactiae (SDSD), also known as Lancefield group C streptococcus, is a pathogen found in animals. It is known to cause pyogenic infections in animals and is one of the most common pathogens that can cause mastitis in cattle. Very few reports of SDSD causing human diseases to have been reported in the literature, but we report a case of community-acquired meningitis and pyogenic ventriculitis caused by SDSD. This report is the first case of SDSD causing a central nervous system (CNS) infection in humans and aims to raise awareness about the role of SDSD in CNS infections. It also seeks to promote the recognition of this bacteria as a potential cause of invasive diseases.

乳糖分泌不良链球菌亚种(SDSD),又称兰斯菲尔德C群链球菌,是一种动物病原体。已知在动物中引起化脓性感染,是引起牛乳腺炎的最常见病原体之一。文献中很少有关于SDSD引起人类疾病的报道,但我们报告了一例由SDSD引起的社区获得性脑膜炎和化脓性脑室炎。本报告是首例SDSD引起人类中枢神经系统(CNS)感染的病例,旨在提高人们对SDSD在中枢神经系统感染中的作用的认识。它还寻求促进对这种细菌作为侵袭性疾病的潜在原因的认识。
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引用次数: 0
A rare case of mobile diplopodia mistaken for polydactyly. 罕见的活动二元足误认为多指畸形一例。
Q3 MEDICINE, GENERAL & INTERNAL Pub Date : 2023-01-01 DOI: 10.22551/2023.38.1001.10232
Timothy Woodacre, Sarah Dunkerley, Peter J Cox

We present a rare case of a mobile diplopodia in an infant with disorganization syndrome. This was initially mistaken for polydactyly due to the more typical association between these conditions. The resulting corrective surgery was more extensive and complicated than anticipated, with the removal of a partial foot duplication and reconstruction of residual hindfoot structures, rather than the planned digit amputation. We highlight the association of diplopodia with disorganization syndrome, discuss differentiating diplopodia from polydactyly and describe the surgical management of an unusual case.

我们提出一个罕见的情况下,移动二足在一个婴儿紊乱综合征。由于这些疾病之间更典型的关联,这最初被误认为是多指畸形。最终的矫正手术比预期的更广泛和复杂,切除了部分重复的足部并重建了残留的后足结构,而不是计划的手指截肢。我们强调二足与组织紊乱综合征的关系,讨论区分二足与多指畸形,并描述一个不寻常的情况下的手术处理。
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引用次数: 0
Concomitant hypofibrinogenemia and factor XI deficiency as rare cause of bleeding during urgent dentistry: case report and short review of the literature.
Q3 MEDICINE, GENERAL & INTERNAL Pub Date : 2023-01-01 DOI: 10.22551/2023.39.1002.10253
Christoph Sucker, Christof Geisen, Jens Litmathe, Ursula Schmitt

Hypofibrinogenemia and Factor XI deficiency are rare defects of hemostasis, potentially leading to spontaneous bleeding manifestations and increased bleeding risk during surgery, dentistry, and interventions. Due to the different mode of inheritance, the concomitance of both defects is extremely rare and the clinical management of combined hypofibrinogenemia and factor XI deficiency is not standardized. Here, we report a rare case of concomitant genetically determined hypofibrinogenemia and factor XI deficiency as a cause of increased spontaneous bleeding and bleeding complications during dentistry. The diagnostic procedure including screening assays, single clotting factor determinations, genetic analyses, and also use of thrombin generation assays (TGA) are described. Also, we present our considerations regarding the development of an adequate prophylaxis of bleeding with fibrinogen concentrate in this case. The literature regarding the issue is briefly discussed.

诊断程序包括筛选分析,单凝血因子测定,遗传分析,也使用凝血酶生成测定(TGA)描述。此外,我们提出我们的考虑,关于发展充分预防出血与纤维蛋白原浓缩在这种情况下。本文简要讨论了有关这一问题的文献。
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引用次数: 0
'Patience is a virtue' - Post-traumatic Axillary Web Syndrome - resolution without intervention. “耐心是一种美德”——创伤后腋窝网综合征——无需干预即可解决。
Q3 MEDICINE, GENERAL & INTERNAL Pub Date : 2023-01-01 DOI: 10.22551/2023.38.1001.10233
Jaleel Mohammed, Catherine Ash, Jayanti Rai

The current case report showcases an atypical symptomatic post-traumatic Axillary Web Syndrome in a 63-year-old Caucasian male patient with complete resolution of symptoms with no intervention. Axillary web syndrome is a condition where the skin area under the axilla becomes taut and on palpation there is a cord-like feeling similar to a guitar string, usually bound together as spider web appearance. The case report highlights the importance of appropriate physical examination and also the need for Community Diagnostic Centres and Point of Care Ultrasound services to help provide patients with timely diagnosis, reduce patient anxiety, and enhance patient experience and outcomes. The current case study is specifically useful for healthcare professionals working in primary care, especially in the National Health Service, where resources are already stretched to avoid unnecessary referrals, interventions and investigations. The case report is atypical since axillary web syndrome is typically and largely seen in cancer patients, specifically post breast cancer surgery in females and very rarely seen as a post traumatic presentation in acute setting.

目前的病例报告显示一个不典型的症状创伤后腋窝窝综合征在一个63岁的高加索男性患者完全解决症状没有干预。腋窝网综合征是一种腋窝下的皮肤区域变得紧绷,触诊时有类似吉他弦的绳状感觉,通常像蜘蛛网一样绑在一起。该病例报告强调了适当的身体检查的重要性,以及社区诊断中心和护理点超声服务的必要性,以帮助患者及时诊断,减少患者的焦虑,并改善患者的体验和结果。目前的案例研究对从事初级保健工作的卫生保健专业人员特别有用,特别是在国家卫生服务部门,那里的资源已经捉襟见肘,以避免不必要的转诊、干预和调查。该病例报告是非典型的,因为腋窝网综合征通常见于癌症患者,特别是女性乳腺癌手术后,在急性环境中很少见于创伤后表现。
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引用次数: 1
Effectiveness of levosimendan and role of cardiac magnetic resonance in cardiogenic shock due to COVID-19 related lymphocytic myocarditis in the course of viral sepsis. 左西孟旦在病毒性败血症过程中COVID-19相关淋巴细胞性心肌炎心源性休克中的疗效及心脏磁共振的作用
Q3 MEDICINE, GENERAL & INTERNAL Pub Date : 2023-01-01 DOI: 10.22551/2023.38.1001.10236
Francesco Mangini, Elvira Bruno, Remo Caramia, Roberto Flora, Eluisa Muscogiuri, Antonio Medico, Grazia Casavecchia, Robert W W Biederman, Rinaldo Giaccari

COVID-19 and sepsis pose great challenges to clinicians and growing evidence is demonstrating links between the two conditions. Both can be complicated by acute heart failure. The use of levosimendan in patients with ventricular dysfunction during COVID-19 infection and sepsis has very little evidence. A 46-year-old, hypertensive and obese patient was admitted for severe left ventricular failure and shock during sepsis following a COVID-19 infection. The patient was treated first with norepinephrine, which was partially effective, then with the addition of levosimendan as a continuous 24 hours infusion. Vital signs and echocardiographic systolic performance indices, such as FE, SVi, CI, dP/dT, TAPSE, and tricuspid S-wave velocity, as well as diastolic function, were recorded at access, 12 and 24 hours. After initiation of levosimendan, a rapid improvement in vital signs and systolic and diastolic performance indices was observed, not depending on changes in preload, afterload, and inflammatory status. Blood cultures were negative for the presence of bacteria, thus defining the picture of likely viral sepsis. Cardiac magnetic resonance was determinant, showing a picture of myocarditis sustained by immune processes rather than direct viral injury, which was confirmed by endomyocardial biopsy. In conclusion, this case highlights the efficacy of levosimendan in acute heart failure complicated by shock due to COVID-19-related myocarditis and concomitant sepsis and confirms cardiac magnetic resonance as the gold standard for the diagnosis of myocardial inflammatory disease. To the best of our knowledge, this is the first documented case of effective use of levosimendan in this context.

COVID-19和败血症给临床医生带来了巨大挑战,越来越多的证据表明这两种疾病之间存在联系。两者都可能并发急性心力衰竭。在COVID-19感染和败血症期间心室功能障碍患者中使用左西孟旦的证据很少。一名46岁的高血压和肥胖患者在COVID-19感染后败血症期间因严重左心室衰竭和休克入院。患者首先使用去甲肾上腺素治疗,这是部分有效的,然后添加左西孟旦作为连续24小时输注。分别记录患儿入路、12、24小时的生命体征和超声心动图收缩期指标,如FE、SVi、CI、dP/dT、TAPSE、三尖瓣s波速度及舒张功能。开始左西孟旦后,观察到生命体征和收缩期和舒张期表现指标的快速改善,而不依赖于负荷前、负荷后和炎症状态的变化。血液培养对细菌的存在呈阴性,因此确定了可能是病毒性败血症的情况。心脏磁共振是决定性的,显示了由免疫过程而不是直接病毒损伤持续的心肌炎,这是由心内膜肌活检证实的。综上所述,本病例突出了左西孟旦治疗新冠肺炎相关心肌炎并发脓毒症急性心力衰竭并发休克的疗效,证实了心脏磁共振是诊断心肌炎症性疾病的金标准。据我们所知,这是第一例在这种情况下有效使用左西孟旦的病例。
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引用次数: 0
Acute Aortic Syndrome in a patient with COVID-19. COVID-19患者的急性主动脉综合征
Q3 MEDICINE, GENERAL & INTERNAL Pub Date : 2023-01-01 DOI: 10.22551/2023.38.1001.10239
João Campos Cunha, António José Cruz, Beatriz Madureira, Yolanda Martins, Gonçalo Sarmento

The global effects of the COVID-19 pandemic make it of the utmost importance to comprehend its mechanisms and define strategies for the most effective approach possible. The SARS-CoV-2 virus can be responsible for the induction of a hypercoagulable state, which can trigger vascular phenomena of venous etiology, specifically deep venous thrombosis or pulmonary embolism. Arterial thrombotic events associated with COVID-19 have also been described in the medical literature, although less frequently. In this paper the authors report the case of a 66-year-old man who was diagnosed with an Acute Aortic Syndrome, specifically an intramural thrombus on the aortic arch, while he was still infected with the virus. Anticoagulation with low weight molecular heparin was initiated and the patient was admitted at the Internal Medicine ward for a conservative therapeutic approach. The thrombus remained stable on a serial imaging evaluation; therefore, the patient was discharged with oral anticoagulation with subsequent follow-up in the outpatient clinic. This case describes a rare and potentially serious complication of COVID-19, which highlights how broad its clinical spectrum can be, affecting systems other than the pulmonary.

鉴于2019冠状病毒病大流行的全球影响,了解其机制并确定最有效对策的战略至关重要。SARS-CoV-2病毒可诱导高凝状态,从而引发静脉病因性血管现象,特别是深静脉血栓形成或肺栓塞。与COVID-19相关的动脉血栓形成事件在医学文献中也有描述,尽管频率较低。在本文中,作者报告了一名66岁男子的病例,他被诊断为急性主动脉综合征,特别是主动脉弓上的壁内血栓,而他仍然感染了病毒。开始使用低质量分子肝素抗凝治疗,患者住进内科病房接受保守治疗。在一系列影像学评估中,血栓保持稳定;因此,患者出院时给予口服抗凝治疗,并在门诊随访。该病例描述了COVID-19的一种罕见且可能严重的并发症,凸显了其临床谱系的广泛性,影响肺部以外的系统。
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引用次数: 0
Lithium-induced parkinsonism associated with vocal cord paralysis: an atypical presentation. 锂诱发的帕金森病伴声带麻痹:一个不典型的表现。
Q3 MEDICINE, GENERAL & INTERNAL Pub Date : 2023-01-01 DOI: 10.22551/2023.39.1002.10252
Accursio Raia, Clara Montalbano, Valerio Caruso, Bruno Pacciardi, Stefano Pini

Drug-induced parkinsonism has been commonly studied and discussed regarding antipsychotic agents, but lithium-induced parkinsonism should also be considered when patients present with parkinsonian symptoms and chronic lithium use. There are several reports of parkinsonism arising during lithium administration and regressing following its reduction or discontinuation. Our case is, to date, the first case in the literature in which vocal cord paralysis occurred as the first symptom of lithium-induced parkinsonism, contributing to confuse doctors and patients and to delay diagnosis and treatment. In our clinical case prompt withdrawal of lithium and its reintroduction at lower doses led to complete resolution of this disabling clinical presentation. This report emphasizes the importance of careful monitoring of lithium levels, especially in elderly subjects, and the need to consider lithium-induced parkinsonism even when unusual motor symptoms appear in chronic lithium users.

药物性帕金森氏症已被广泛研究和讨论,但当患者出现帕金森症状并长期使用锂时,也应考虑锂诱发的帕金森氏症。有几份报告显示,帕金森病在锂治疗期间出现,并在减少或停药后消退。到目前为止,我们的病例是文献中第一例以锂离子诱发的帕金森病为首发症状的声带麻痹病例,这使医生和患者感到困惑,延误了诊断和治疗。在我们的临床病例中,及时停用锂并以较低剂量重新引入锂可完全解决这种致残的临床表现。本报告强调了仔细监测锂水平的重要性,特别是在老年受试者中,并且需要考虑锂诱发的帕金森病,即使在慢性锂使用者中出现不寻常的运动症状。
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引用次数: 0
Non-islet cell tumor hypoglycemia associated with Gastrointestinal Stromal Tumor: Case report and review of the literature. 非胰岛细胞肿瘤低血糖与胃肠道间质瘤:病例报告及文献复习。
Q3 MEDICINE, GENERAL & INTERNAL Pub Date : 2023-01-01 DOI: 10.22551/2023.38.1001.10240
Vikash Kumar, Dhir Gala, Carson Wonders, Sabrin Marowa, Arnold Forlemu, Vijay Gayam, Madhavi Reddy

Non-islet cell tumor hypoglycemia is an uncommon paraneoplastic phenomenon commonly associated with tumors of mesenchymal origin like gastrointestinal stromal tumors (GIST). It causes the release of insulin-like growth factor type II. GIST are frequently asymptomatic but can present with vague symptoms such as gastrointestinal bleeding, gastric pain, anorexia, nausea, and vomiting. We present an interesting case of A 62-year-old male with GIST tumor admitted for refractory hypoglycemia found to have non-islet cell tumor hypoglycemia which is a relatively uncommon cause of hypoglycemia.

非胰岛细胞肿瘤低血糖是一种罕见的副肿瘤现象,通常与胃肠道间质肿瘤(GIST)等间质肿瘤相关。它引起胰岛素样生长因子II型的释放。胃肠道间质瘤通常无症状,但可表现出胃肠道出血、胃痛、厌食、恶心和呕吐等模糊症状。我们报告一个有趣的病例,一名62岁男性GIST肿瘤患者因难治性低血糖入院,发现有非胰岛细胞肿瘤低血糖,这是一个相对罕见的低血糖的原因。
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引用次数: 0
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Archive of clinical cases
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