Reports (MDPI)最新文献

Background and Clinical Significance: Intracerebral hemorrhage (ICH) is a very rare complication following endovascular closure of direct carotid-cavernous fistulas (CCFs). When reported, ICH typically appears within the first 48 h after CCF closure. We performed an extensive literature review, starting from the case of a 48-year-old patient presenting with an intracerebral hemorrhage after CCF closure. Case Presentation: A 48-year-old woman with arterial hypertension developed an intracerebral hemorrhage in the right frontal lobe 12 days after successful closure of a traumatic CCF. The patient exhibited acute neurological deterioration in a previously hypoperfused territory. A narrative review identifies the classical molecular theory of hemodynamic dysregulation, known as Normal Perfusion Pressure Breakthrough (NPPB), as the principal pathophysiological mechanism. Other mechanisms such as oxidative stress, microglial activation, blood-brain barrier disruption, metalloproteinase expression, and possible genetic alterations such as ICA1L variants are also implicated. Conclusions: This case underscores the importance of considering molecular mechanisms in the pathophysiology of delayed post-endovascular treatment of ICH, as well as the need for hemodynamic monitoring and follow-up in patients with vascular comorbidities.

The paper by Mavroudis et al [...].

Background and clinical significance. Penetrating cardiothoracic wounds require prompt treatment in order to decrease mortality and morbidity. Surgical therapy, aimed at bleeding control and removal of damaged tissue, varies widely from the direct suture of parenchymal lacerations to pneumonectomy, which is characterized by high mortality rates. We report our experience with a patient in hemorrhagic shock due to a gunshot wound to the chest, successfully treated by pneumorrhaphy under cardiopulmonary bypass (CPB). Case presentation. A 53-year-old man with a gunshot wound to the chest was admitted to our Emergency Department. A bedside ultrasonography revealed left pleural and pericardial effusion. He was hemodynamically instable, so he was immediately transferred to the operating room by the cardiac and Thoracic Surgery teams. Through a median sternotomy approximately 2 L of blood were evacuated and a deep laceration of the left upper lobe was discovered. The massive bleeding could not be controlled, leading to pleural cavity flooding. The surgical team decided to institute emergency CPB and perform lung repair by pneumorrhaphy, under circulatory support. The patient survived and was discharged on p.o. day 20. Conclusions. Clinical expertise, adequate instrumental equipment and a high level of interdisciplinary team-work favorably affected the patient's outcome.

Background and Clinical Significance: Zolbetuximab, a claudin 18.2-targeted monoclonal antibody, has demonstrated efficacy in advanced gastric cancer. Hypoalbuminemia has emerged as a notable adverse effect, but its underlying mechanism remains unclear. Case Presentation: A 53-year-old male with unresectable advanced gastric cancer received zolbetuximab-based combination therapy, achieving tumor regression enabling conversion surgery. During six cycles of treatment, serum albumin levels decreased from 4.3 g/dL to 3.5-3.6 g/dL (grade 1 hypoalbuminemia). A histopathological examination of the surgical specimen revealed hypertrophic gastritis characterized by marked foveolar hyperplasia, increased mucus secretion, and pyloric gland metaplasia on the lesser curvature. These findings suggest that zolbetuximab-induced mucosal alterations may contribute to hypoalbuminemia through enhanced protein loss. Conclusions: This is the first pathological documentation of hypertrophic gastritis associated with zolbetuximab therapy. Clinicians should monitor albumin levels during treatment and consider nutritional support when indicated. These findings provide important insights for optimizing patient management and ensuring safe conversion surgery planning.

Background and Clinical Significance: Spontaneous intracranial hypotension (SIH) is a rare cause of headache characterised by cerebrospinal fluid (CSF) leakage, with an estimated incidence of 3.7 to 5 cases per 100,000 per year, peaking around the age of 40 years. Its diagnosis and management are particularly challenging in pregnancy due to overlapping symptoms and limited diagnostic options. Case Presentation: We report the case of a 42-year-old pregnant woman at 14 weeks of gestation presenting with a history of orthostatic headache and facial sinus tenderness, later diagnosed as spontaneous intracranial hypotension. Conclusions: Headache is a common clinical symptom that may be associated with a wide spectrum of underlying conditions, ranging from benign causes such as migraine or tension-type headache to potentially life-threatening pathologies, including subarachnoid haemorrhage. This case illustrates the diagnostic complexity of SIH in pregnancy and the importance of a multidisciplinary approach and vigilance for neurological symptoms during pregnancy.

Background and Clinical Significance: Mesonephric adenocarcinoma (MA) of the uterine cervix is an exceptionally uncommon and aggressive cancer that arises from remnants of the mesonephric duct. It was first classified by the World Health Organization (WHO) in the 2020 WHO Classification of Female Genital Tumors as a type of cervical adenocarcinoma, also referred to as Gartner's duct carcinoma. Due to its rarity, both detection and treatment pose significant challenges, and there is little information on its clinical manifestations and prognosis. Mesonephric hyperplasia (MH) in the uterine cervix is an uncommon condition that is often misdiagnosed as adenocarcinoma. Case Presentation: We present the case of a 49-year-old, asymptomatic, perimenopausal woman diagnosed with cervical mesonephric adenocarcinoma following a routine Pap smear, performed by Papanicolaou test, with a III A-B result; however, a cone biopsy revealed stage IB1 mesonephric adenocarcinoma. The patient underwent a radical hysterectomy type C (Querleu-Morrow 2017 classification). The final pathology confirmed stage IB2 of the cancer (2018 classification) according to The International Federation of Gynecology and Obstetrics (FIGO), with previous evidence of mesonephric hyperplasia from a trial abrasion performed three years earlier. Conclusions: This case highlights the challenges in recognizing and managing mesonephric hyperplasia and adenocarcinoma of the cervix. Given the uncommon nature of this cancer, clinicians should consider it when treating patients with ambiguous cervical pathology and mesonephric hyperplasia. Optimizing patient outcomes relies on early detection, accurate staging, and radical surgical treatment.

Background and Clinical Significance: Moyamoya disease is a rare, progressive cerebrovascular disease characterized by steno-occlusion of the terminal internal carotid arteries and the arteries around the circle of Willis, with the formation of abnormal collateral vessels. Early clinical manifestations include recurrent hemodynamic transient ischemic attacks (TIAs), especially in young subjects. Multimodality imaging, including computed tomography, magnetic resonance, and digital subtraction angiography, is necessary to reach a correct diagnosis in young patients with stroke-like symptoms. Various radiological findings are crucial for early diagnosis, staging, and management of moyamoya disease. Case Presentation: We describe the case of a 31-year-old male presenting with acute focal neurological deficits and a history of recurrent TIAs. Neuroimaging was performed to assess vascular pathology, parenchymal injury, and collateral circulation and to provide critical information on vascular anatomy and the extent of ischemic damage. Conclusions: The purpose of this case report is to illustrate the main specific radiological signs and the diagnostic value of multimodality neuroimaging in the evaluation of moyamoya disease, providing a practical imaging-based diagnostic approach for neuroradiologists.

Background and Clinical Significance: Interstitial ectopic pregnancy is a rare but potentially life-threatening type of ectopic gestation that carries high risk of rupture and hemorrhage due to its vascular location and predisposition for delayed presentation. Case Presentation: We present a 33-year-old female with acute abdominal pain and elevated β-hCG, with transvaginal ultrasound demonstrating a live left adnexa ectopic pregnancy dated at approximately 14 weeks. MRI confirmed the gestational sac as tubal ectopic, but poorly localized within the interstitial fallopian tube. Exploratory laparoscopy revealed the gestational sac mainly in the interstitial left fallopian tube without rupture or distal involvement. Conclusions: This case demonstrates absent classic imaging findings associated with tubal, interstitial, and ovarian ectopic gestations including tubal ring sign, interstitial line sign, endo-myometrial mantle measurement, or claw sign due to location and advanced gestational age. Familiarity with these challenges and recognition that interstitial ectopic pregnancy may present atypically are important for timely recognition and management.

Background and Clinical Significance: Maxillary sinus augmentation is a well-established surgical procedure for dental implant placement in the posterior maxilla when the residual alveolar bone height is insufficient. Traditionally, the lateral approach has been preferred in cases with less than 4 mm of bone; however, the crestal approach has emerged as a less invasive alternative, particularly with the advent of advanced techniques and tools such as hydraulic pressure systems and dedicated osteotomy kits. Case Presentation: This case report presents the clinical management of a 68-year-old female patient requiring rehabilitation of the right maxillary molars, where the residual bone height measured only 3.6 mm (in position 1.6) and 2.5 mm (in position 1.7). Using the CAS kit system with rounded drills and hydraulic pressure, a controlled crestal sinus elevation was performed, followed by simultaneous implant placement. Despite the extremely limited bone height, a final insertion torque of 30 Ncm was achieved for both implants, likely due to favorable sinus floor anatomy, under-preparation of the implant sites, and the use of tapered, macro-textured implants. Postoperative follow-up over three years showed stable bone levels and successful prosthetic rehabilitation with single crowns. Conclusions: This case report highlights the potential of the crestal approach in anatomically challenging scenarios. Proper planning, technique, and implant selection are mandatory to achieve predictable and long-lasting outcomes, even in cases previously considered contraindicated for this method. Further randomized controlled trials are needed to confirm this preliminary result.

Background/objectives: Pseudoarthrosis continues to be a public health problem; however, in our country, information is scarce, particularly when talking about the clinical and sociodemographic characterization of the Mexican population with pseudoarthrosis.

Methods: In this study, clinical and sociodemographic characteristics such as sex, age, educational level, nutritional status, comorbidities, affected bone, fracture characteristics, degree of exposure, and waiting time for the patient to undergo surgery were analyzed.

Results: A total of 267 patients were included in the present study. A higher frequency of men (53.6%) was identified compared to women, and the main age group was 46-75 years (50.1%). The main comorbidities identified in our population were smoking (n = 141; 52.8%) and osteoporosis (n = 84; 31.5%). When evaluating the clinical characteristics of pseudoarthrosis, the tibia (n = 65; 24.3%) and radius (n = 54; 20.2%) were the main bones affected. Fracture exposure could be identified in 17.65% (n = 47) of the population, and the main grade of involvement was II (46.8%). Regarding the prevalence of the affected bone, the tibia was the main one, with 13.5% (9.38-17.58%) female patients, 12.7% (8.73-16.73%) with overweight, 18.0% (13.37-22.59%) with osteoporosis, and 14.2% (10.04-18.42%) with a history of smoking.

Conclusions: In our cohort, we identified a high prevalence of the tibia as the affected bone, while overweight, obesity, osteoporosis, and smoking were the clinical and sociodemographic characteristics that characterized our population. The findings of this study lay the groundwork for understanding the clinical and sociodemographic context of a Mexican cohort with nonunion.