Reports (MDPI)最新文献

Background: Anxiety disorders, depressive disorders, and insomnia often co-occur and impair functioning in psychiatric patients. Virtual reality (VR) is a promising relaxation tool, yet its efficacy relative to classical Schultz autogenic training (AT) remains insufficiently characterized. Methods: Thirty-seven female patients were randomly assigned to four groups: (1) inpatient AT (n = 10), (2) inpatient VR (n = 10), (3) home-based AT (n = 10), and (4) home-based VR (n = 7). Interventions lasted 2 weeks (≥10 sessions). Depressive and anxiety symptoms, sleep quality, and cognitive function were assessed pre- and post-intervention. Results: In the total sample, anxiety and depressive symptoms decreased and sleep quality improved, while cognitive functions showed slight improvement. In subgroup analyses, inpatient AT reduced anxiety and improved sleep, whereas inpatient VR reduced both anxiety and depressive symptoms and improved sleep. In the home-based modality, AT did not significantly affect sleep, anxiety, or depressive symptoms but was associated with modest cognitive gains, while home-based VR improved sleep without significant changes in anxiety or depression. Conclusions: Both methods are straightforward to implement and promote improvement in selected mental health parameters; however, their effect profiles are context-dependent. Interventions delivered in the inpatient setting were more effective than those at home, suggesting a substantial influence of contextual factors (fewer distractions, therapeutic structure, group component). Among the tested conditions, inpatient VR-based relaxation produced the broadest pattern of improvement in anxiety, depression, and sleep. These pilot findings require confirmation in larger, prospectively designed studies.

Background and Clinical Significance: Morbid obesity is a recognized risk factor for perioperative neuropathies, but simultaneous involvement of multiple peripheral nerves is rare. Case presentation: We report a 49-year-old woman (BMI 45) who underwent open total hysterectomy under combined general and epidural anesthesia in the supine position with Trendelenburg tilt. Despite preoperative positioning simulation, she developed postoperative numbness of the left fingers and bilateral upper limb weakness, followed by bilateral lower limb weakness and severe right thigh pain. Imaging excluded epidural hematoma. Iliopsoas weakness persisted despite epidural discontinuation. Rehabilitation and pregabalin partially improved symptoms, but sensory deficits and gait disturbance remained. At long-term follow-up, she was able to ambulate with a Lofstrand crutch, although right thigh numbness persisted. Two years postoperatively, diabetes mellitus was diagnosed. Conclusions: Morbid obesity may predispose to multiple perioperative neuropathies through mechanical compression and metabolic vulnerability. Careful intraoperative reassessment of pillow height, limb position, and retractor placement, combined with early recognition and multidisciplinary management, is essential to prevent neuropathy and optimize recovery.

Background and Clinical Significance: Collagenous colitis is an uncommon form of microscopic colitis characterized by chronic watery diarrhea and thickening of the subepithelial collagen layer. While various medications have been implicated in its pathogenesis, paclitaxel-associated collagenous colitis remains exceptionally rare in the literature. Recognition of this adverse event is crucial for appropriate management, particularly in patients receiving dose-modified chemotherapy regimens. This case highlights the importance of considering drug-induced collagenous colitis in cancer patients presenting with severe diarrhea during chemotherapy. Case Presentation: We report a 71-year-old Japanese male with metastatic breast cancer who developed acute-onset collagenous colitis during paclitaxel treatment. His primary tumor was invasive ductal carcinoma with hormone receptor-positive, HER2-negative disease (ER+, PgR+, HER2-, Ki-67 46%) and progressive metastatic disease. Given pre-existing renal dysfunction, paclitaxel was initiated at 60% dose reduction. Sixteen days after treatment initiation, the patient experienced abrupt onset of profuse watery diarrhea with approximately 10 bowel movements daily, necessitating hospital admission. Colonoscopic evaluation demonstrated increased vascular permeability and superficial mucosal erosions. Histopathological analysis revealed diagnostic features of collagenous colitis with a markedly thickened subepithelial collagen band measuring 23 μm. Following immediate cessation of paclitaxel, the patient experienced complete resolution of diarrheal symptoms without subsequent relapse. Conclusions: This case represents a rare manifestation of paclitaxel-induced collagenous colitis. Clinicians should maintain heightened awareness of this potential complication in patients receiving taxane-based chemotherapy who develop significant diarrhea. Prompt recognition and immediate drug discontinuation are essential for favorable outcomes and symptom resolution.

Background and Clinical Significance: Warty (condylomatous) squamous cell carcinoma (SCC) of the uterine cervix is a rare papillary variant of SCC, usually associated with good prognosis. Case Presentation: We report the clinical case of a postmenopausal woman with vaginal bleeding, anemia, and an enlarged, exophytic tumor mass protruding from the cervix. MRI showed a solid-necrotic cervical-uterine mass with invasion of bladder, rectum, both parametria, and the left ureter, with regional lymphadenopathy and FIGO IVA stage was established. Biopsies from the cervical tumor revealed invasive, well-differentiated SCC with conspicuous koilocytic atypia in superficial and deep nests, consistent with warty (condylomatous) SCC. Immunohistochemistry showed p16 overexpression, an intermediate nuclear proliferation rate, and a non-mutational pattern for p53 immunostaining. Radiotherapy was recommended but the patient's condition deteriorated rapidly and she died three months after initial diagnosis. Due to the rarity of this type of tumor, we conducted a search on PubMed, Scopus, and Web of Science from inception to 31 July 2025 and we identified ten reports available for evaluation. A total of 32 cases were identified, usually with FIGO stage I or II, mostly with low-risk HPV infection and with good prognosis. Conclusions: The advanced stage and limited tolerance for therapy in this case emphasize the importance of HPV vaccination and HPV-based screening to prevent late, non-curable presentations. Accurate distinction from condyloma acuminatum and verrucous or papillary SCC is clinically relevant because management and outcomes differ. Since some of the cases reported in the literature had a worse clinical course, with shorter disease-free survival and overall survival, including our case, further research is mandatory in the future to unravel those features which might predict a poor outcome.

Background and Clinical Significance: Medication-related osteonecrosis of the jaw (MRONJ) is a severe complication of antiresorptive therapies such as Zolendronic acid, used for bone metastases. Its management remains challenging, with outcomes often unpredictable. Platelet-rich fibrin (PRF), rich in growth factors, has been proposed as a potential adjunct to surgical treatment, aiming to promote tissue regeneration and improve patient outcomes. Case Presentation: We reported three clinical cases of MRONJ in patients previously treated with Zolendronic acid. All patients underwent surgical sequestrectomy combined with A-PRF application. Disease stages ranged from early to advanced (stages I-III). The success of treatment was evaluated based on how well the tissue healed, the extent of bone recovery, the amount of pain relief, and improvements in the patient's quality of life. The patient with early-stage MRONJ achieved complete healing. On the other hand, the patients with stage II and III disease showed only partial clinical improvement. Nevertheless, all cases demonstrated significant subjective reduction in pain and enhanced overall quality of life following PRF therapy. Conclusions: Early-stage intervention offers the best prognosis for MRONJ. While A-PRF may improve postoperative comfort and quality of life, its curative effect appears limited in advanced disease. This highlights the need for further randomized clinical trials to demonstrate the role of A-PRF in the treatment of MRONJ.

Gossypiboma is a retained surgical item, most commonly gauze or sponge, inadvertently left inside a patient's body after surgery. Although preventable, it can cause severe complications and is often underreported due to medicolegal concerns. We present a case of a 61-year-old woman who experienced left lower abdominal pain for three days. Her history included lumbar disc surgery via the lower left abdomen a decade earlier. Physical examination revealed a non-tender pelvic mass, and abdominal computed tomography (CT) showed a 4.5 × 4.7 × 6.1 cm high-attenuation lesion with internal low-attenuation areas in the left retroperitoneal space. The mass was surgically removed, and gauze material was identified inside, confirming the diagnosis of gossypiboma. The patient recovered uneventfully postoperatively. Gossypiboma can present with subacute or chronic symptoms, making diagnosis challenging. While uncommon, gossypiboma should be considered in differential diagnoses of patients with unexplained abdominal masses and prior surgical history. Prompt surgical management is essential to prevent complications. This case highlights the importance of meticulous surgical counts and awareness of this rare but serious condition.

Background and Clinical Significance: Sengstaken-Blakemore tube insertion is a temporary but important intervention for uncontrolled upper gastrointestinal bleeding, especially when endoscopic hemostasis fails. Case presentation: We present the case of a 63-year-old man with a history of esophageal cancer surgery and gastric variceal treatment who presented to the emergency department with hematemesis and altered consciousness. Endoscopy revealed a bleeding ulcer at the intrathoracic esophagus. Endoscopic band ligation failed, and the patient's condition deteriorated, prompting the insertion of an Sengstaken-Blakemore tube. Owing to prior Ivor Lewis surgery, the gastric balloon was not used; only the esophageal balloon was inflated, and hemostasis was successfully achieved. Despite the relative contraindication of prior esophageal surgery, no complications occurred. The patient was discharged on hospital day 20 without recurrence. Conclusions: This case illustrates that in patients with unstable upper gastrointestinal bleeding with surgical history, selective use of Sengstaken-Blakemore tube may offer life-saving hemostasis when endoscopy fails, even when standard indications are not met.

Background and Clinical Significance: VACTERL association is a rare spectrum of congenital malformations that may involve the genitourinary system. We describe a challenging case of hypotonic, hyporeflexic, large-capacity bladder with bilateral obstructive megaureter in a boy with VACTERL syndrome, highlighting diagnostic and therapeutic challenges. Case Presentation: A 16-year-old boy with VACTERL syndrome, previously operated for esophageal atresia, Fallot's tetralogy, Y-type urethral duplication, and bilateral vesicoureteral reflux, presented with breakthrough urinary tract infections, orchiepididymitis, and flank pain. Investigations revealed an enlarged bladder capacity (1000 mL), detrusor underactivity, high post-void residual volume, and bilateral hydronephrosis with megaureter. Obstruction of the bladder neck and neurological causes were excluded. After multidisciplinary discussion, bilateral ureteral reimplantation and limited reductive cystoplasty were performed. Histology revealed granulomatous foreign-body reaction due to previous bulking agent injection. Postoperative course was uneventful. At the three-year follow-up, the patient is asymptomatic with normal voiding and preserved renal function. Conclusions: This case illustrates the diagnostic and therapeutic challenges of managing late urological complications in a VACTERL patient with pre-existing urinary anomalies. The overlap of congenital and iatrogenic factors made the diagnostic pathway complex, requiring careful exclusion of neurogenic and mechanical causes. A tailored surgical strategy restored bladder function and preserved renal outcome.

Background and Clinical Significance: Atrophic rhinitis (AR) is a rare, chronic inflammatory condition characterized by progressive atrophy of the nasal mucosa and underlying bone. The present report describes a case of severe secondary AR as a sequela of COVID-19-associated necrotizing rhinitis, highlighting the diagnostic and management challenges posed by multi-drug resistant pathogens and extensive anatomical destruction. Case Presentation: A 75-year-old female developed progressive necrotizing rhinosinusitis with osteomyelitis following a COVID-19 infection. Computed tomography (CT) confirmed an osteolytic process and subsequent profound anatomical destruction, while histopathology ruled out invasive fungal disease. The resulting cavity was colonized by multi-drug resistant Pseudomonas aeruginosa and Staphylococcus aureus. Management and Outcome: Management focused on preventing crust formation through a structured "nasal rest" protocol, supplemented by cleansing nasal douching with a surfactant (baby soap) and mechanical crust removal. This treatment led to significant clinical improvement, with reduced crusting and complete resolution of ozena symptoms. Conclusions: This case illustrates the potential for SARS-CoV-2 infection to precipitate severe necrotizing sinonasal complications leading to secondary AR. It demonstrates the efficacy of a management strategy focused on mechanical cleansing and nasal rest, particularly when conventional antibiotic therapy is limited by extensive drug resistance.

Background and Clinical Significance: Premature infants are at high risk of life-threatening complications due to the immaturity of multiple organ systems, and close monitoring in neonatal intensive care units is indispensable for their stabilization, survival, and morbidities. Despite major advances in perinatal care, cardiovascular pathology remains one of the most frequent morbidities in this population. Targeted neonatal echocardiography is implemented in many neonatal intensive care units around the world; it provides earlier and precise assessment during hemodynamic instability, allowing targeted management and follow-up. It can also detect red flags for anatomical heart defects. Left ventricular to right atrial shunt is a rare and presents a challenging diagnostic entity in very premature neonates. Case Presentation: We present a case of left ventricular to right atrial shunt in a preterm baby that was diagnosed by the Targeted neonatal echocardiography team. Conclusions: The purpose of this case report is to illustrate how targeted neonatal echocardiography enabled the identification of this rare diagnosis in a premature infant, which underscores its growing utility and value in neonatal care.