Medicine international最新文献

Recurrence following the surgical evacuation of a chronic subdural hematoma (CSDH) occurs in up to 33% of cases. Several clinical and radiologic factors have been identified that are associated with the recurrence of hematoma. However, the optimal treatment for recurrent CSDH has not yet been determined. The present study, based on a case report, reviews the predictors and treatment options for refractory CSDHs. An 85-year-old male patient presented with a symptomatic bilateral CSDH. The hematoma was initially removed through a burr hole and closed drainage system, resulting in clinical improvement and in the radiographic resolution of the hematoma. At the first recurrence, steroids were administered and the hematoma was re-evacuated. After 1 month, the patient returned comatose due to a massive right subdural hematoma and was treated with an ipsilateral craniotomy and a membranectomy. After 2 days, the patient succumbed due to massive intraparenchymal bleeding. The treatment of refractory CSDHs is challenging. The failure of brain re-expansion and senile atrophy appear to be the key predictors of recurrence. Patients who are at high-risk need to be identified promptly and treated with a multidisciplinary approach that considers adjuvant medications, middle meningeal artery embolization and repeat hematoma evacuation, probably with a membranectomy and an endoscope.

Osteosarcoma (OS) is the most prevalent bone neoplasm of mesenchymal origin, accounting for 20% of all bone tumors worldwide. It mainly affects the marrow of long bones, and its diagnosis is more common among adolescents and the geriatric population. Histologically, it is characterized by high cellular variability, abundant osteoid and fibrotic material. In the early stages, it presents with only local symptoms such as pain, edema and limited joint mobility. This neoplasm, when detected promptly, is associated with a favorable prognosis and can be effectively treated through surgical removal and adjuvant therapy. The development of tumors in pregnant women is rare, and the occurrence of osteosarcoma is even more exceptional, with only 10 cases documented in the literature. Given its rarity, the present study describes the case of a female patient with OS diagnosed in the first trimester of pregnancy, where the patient responded well to treatment, resulting in no adverse effects on the pregnancy outcome.

The association between hypertension as a pre-existing comorbidity and the severe form of coronavirus disease 2019 (COVID-19) remains unclear due to the contradictory results of previously published studies. The present study evaluated the predictive significance of hypertension in the incidence of complications among critically ill patients with COVID-19. The present study included 372 critically ill adults with COVID-19 pneumonia, hospitalized between January 1 and December 31, 2021. The study cohort was divided into the hypertension group (HTA group), which included 245 patients with a history of hypertension, or a non-HTA group (control group), which included 127 patients without hypertension. The incidence of complications was retrospectively extracted from medical records and compared between groups. Multivariate regression analysis (adjusted for potential confounders) and receiver operating characteristic (ROC) curve analysis determined the predictive significance of hypertension on the incidence of complications. The patients in the HTA group were more likely to receive invasive mechanical ventilation [odds ratio (OR), 1.696; P<0.02], develop sepsis (OR, 1.807; P<0.01) and develop complications (OR, 3.101; P<0.001). Hypertension was an independent positive predictor for invasive mechanical ventilation [area under the curve (AUC), 0.67; positive predictive value (PPV), 71.7%; P<0.05], sepsis (AUC, 0.69; PPV, 77.5%; P<0.026) and total complications per patient (AUC, 0.71; PPV, 81.4%; P<0.001). On the whole, the data of the present study indicate that a history of hypertension should be considered as an independent clinical predictor of a higher incidence of complications in critically ill patients with COVID-19. Patients with pre-existing hypertension and a diagnosis of COVID-19 require timely identification, additional attention and treatment to avoid a critical course and help improve outcomes.