Annals of Medicine and Surgery最新文献

Endovascular thrombectomy (EVT) has improved the therapy of acute ischemic stroke, patients still have functional impairments after reperfusion. This updated meta-analysis assesses whether intense blood pressure (BP) management following successful EVT enhances results and reduces problems associated with reperfusion. PubMed, Embase, and Cochrane databases were systematically searched using relevant keywords from inception until July 2025. A total of five studies were included after final screening. Outcomes were reported as excellent clinical outcomes, functional independence, all-cause mortality at 90 days, any intracranial hemorrhage within 24 h, etc. Interstudy heterogeneity was assessed using I ² and X ² statistics (I ² > 50% = significant heterogeneity). Statistical calculations used Review Manager 5.4.1, with a P-value of <0.05 indicating statistical significance. A moderate but substantial improvement in neurological outcomes (mean National Institutes of Health Stroke Scale difference = 1.07; P = 0.03) and functional independence (mRS modified Rankin Scale 0-2) was both markedly enhanced by intensive BP control (RR = 0.82; 95% CI: 0.74-0.91; P = 0.0002). It did not, however, have a significant effect on all-cause death at 90 days, symptomatic or any cerebral bleeding, stroke recurrence, or excellent clinical outcomes (mRS 0-1). A significant correlation was seen between a greater incidence of hypotensive episodes and severe BP lowering (RR = 1.77; P < 0.00001). It also raises the risk of hypotension without reducing the danger of hemorrhage or death. Following EVT, intense BP control may enhance early neurological results and functional independence, but it also raises the risk of hypotension without reducing death or hemorrhage.

Introduction: Tobacco use disorder is associated with increased morbidity and mortality from heart failure (HF) in the United States. Despite this burden, long-term trends in HF mortality among tobacco users and the extent of demographic and geographic disparities remain poorly understood, limiting targeted prevention and intervention strategies. This study examines these trends and disparities using the CDC WONDER database.

Methods: Mortality data from 2003 to 2020 were analyzed for individuals aged ≥25 years with tobacco use disorder who died from HF. Age-adjusted mortality rates (AAMRs) per 100 000 general population were calculated. Joinpoint regression estimated annual percentage changes. Subgroup analyses were conducted by sex, race/ethnicity, region, and rural-urban classification.

Results: From 2003 to 2020, 576 781 HF deaths occurred among tobacco users aged ≥25 years. The overall AAMR nearly quadrupled during this period. Men consistently exhibited higher AAMRs than women. Among racial/ethnic groups, American Indians or Alaska Natives had the highest rates, followed by Whites, Blacks, and Asian or Pacific Islanders. Regionally, the Midwest recorded the highest mortality, followed by the South, Northeast, and West. Rural populations had higher AAMRs than urban populations. At the state level, Oregon showed the highest AAMR, while California had the lowest.

Conclusion: The sharp rise in HF mortality among tobacco users underscores critical public health gaps. Disparities were most pronounced among men, American Indians or Alaska Natives, Midwestern residents, and rural populations. By identifying high-risk populations and regions, this study provides actionable insights to guide targeted interventions, tobacco cessation programs, and equitable healthcare access, helping to address the growing burden of HF in tobacco users.

Introduction and importance: Partial nephrectomy is the standard surgical technique for the management of early-stage renal neoplasms. Bilateral synchronous sporadic renal tumors are a rare subtype of renal tumors, for which no consensus has been reached on the optimal surgical strategy.

Case presentation: A 73-year-old man was diagnosed with bilateral renal masses. Owing to a history of prior abdominal surgeries and underlying medical conditions, including ankylosing spondylitis, we herein report for the first time the performance of robotic-assisted one-stage bilateral partial nephrectomy in the prone position. No severe intraoperative or postoperative complications or renal failure were observed, and the patient achieved a satisfactory recovery at the 3-month postoperative follow-up.

Clinical discussion: Conventional partial nephrectomy via either transperitoneal or retroperitoneal approaches has been performed in the lateral decubitus position. For patients with bilateral renal tumors, this approach necessitates intraoperative repositioning, while prolonged lateral decubitus may compromise respiratory function and cause compression of peripheral nerves. In contrast, the prone position approach not only resolves these issues but also simplifies the surgical procedure and provides greater benefits to patients.

Conclusion: Prone retroperitoneal robotic assisted partial nephrectomy is a novel approach for the management of BSSRCC, and expanded samples and large-scale clinical studies are warranted to confirm the safety and feasibility of this surgical technique in future investigations.

Background: Chronic kidney disease (CKD) and dementia are major causes of morbidity and mortality among older adults and frequently coexist due to shared vascular and metabolic risk factors. Despite their clinical importance, national mortality trends for these conditions remain underexplored. This study aimed to examine temporal and demographic patterns of mortality among individuals with coexisting CKD and dementia in the United States from 1999 to 2020.

Methods: In this retrospective, population-based study, mortality data for adults aged ≥25 years were extracted from the Centers for Disease Control and Prevention's Wide-ranging Online Data for Epidemiologic Research database. Deaths listing both CKD [International Statistical Classification of Diseases and Related Health Problems, 10th Revision (ICD-10 N18.x)] and dementia (ICD-10 F01.x, F03, G30.x) as causes were included. Age-adjusted mortality rates (AAMRs) per 100 000 were calculated using the 2000 U.S. standard population. Temporal trends were analyzed using Joinpoint regression to estimate annual percent change and average annual percent change (AAPC) with P < 0.05 considered significant. Subgroup analyses were stratified by gender, race/ethnicity, age, region, and urbanization.

Results: Between 1999 and 2020, 170 375 deaths were attributed to CKD and dementia. The overall AAMR increased from 1.03 to 5.92 per 100 000 (AAPC 7.41%). Mortality increased significantly across both genders, older adults, and all census regions, peaking in 2012, briefly declining between 2012 and 2015, then rising during 2015 to 2020. Males had higher mortality (AAMR 4.24) than females (3.16). Non-Hispanic Black individuals exhibited the highest rate (6.20), followed by non-Hispanic White (3.35) and Hispanic (3.09) populations. The Midwest showed the highest regional burden (AAMR 3.90), while rural counties recorded greater mortality (3.89) than urban areas (3.49).

Conclusion: The increasing mortality trends show a close relationship between CKD and dementia. Thus, improving early diagnosis, ensuring equal access to care, and providing a holistic treatment approach targeting both the organs is key to enhancing optimal patient care and consequently reducing mortality.

Introduction and importance: Tumor-induced osteomalacia (TIO) is a rare paraneoplastic disorder caused by phosphaturic mesenchymal tumors (PMTs), characterized by chronic hypophosphatemia and impaired bone mineralization.

Case presentation: A 65-year-old man presented with progressive bone pain lasting 3 years. Laboratory results showed persistent hypophosphatemia and elevated fibroblast growth factor 23. Imaging revealed a hypermetabolic lesion in the left acetabulum. The tumor was surgically resected, and histology confirmed a spindle cell neoplasm without vascular invasion. Serum phosphorus normalized postoperatively, and the patient showed sustained clinical improvement over 1 year.

Clinical discussion: This case underscores the diagnostic challenges of TIO, often mimicking other metabolic bone diseases and leading to significant delays. Compared with similar reports, our case highlights the utility of combined positron emission tomography and magnetic resonance imaging in localizing PMTs and the dramatic clinical improvement following resection.

Conclusion: This case underscores the importance of recognizing TIO early to enable effective treatment and avoid prolonged morbidity.

Introduction and importance: Immunoglobulin A vasculitis (IgAV), though primarily a childhood disease, is uncommon in adults and often presents atypically, leading to diagnostic delays. We report the first known case of adult-onset IgAV from Nepal, presenting as recurrent episodes of acute gastroenteritis. The delayed appearance of purpuric rash - nearly a year after symptom onset - and the rapid response to oral corticosteroids make this case unique and thus add to the existing literature on adult IgAV.

Case presentation: A 57-year-old male presented with 4 days of purpuric rash, abdominal pain, and loose stools. He reported five similar gastroenteritis-like episodes over the prior year, resolving temporarily with antibiotics. Examination revealed palpable purpuric lesions on limbs and trunk. IgAV was diagnosed clinically per EULAR/PRINTO/PRES criteria. Oral prednisolone (60 mg/day) with gastric protection led to complete symptom resolution within 1 week. Antibiotics were discontinued after negative stool cultures. Steroids were tapered over 2 months without relapse.

Clinical discussion: IgAV presents with purpura, abdominal pain, arthralgia, and renal involvement. Diagnosis is often delayed in adults due to atypical symptoms and the absence of rash. Early corticosteroid therapy is effective even without biopsy confirmation in resource-constrained settings. This case underscores the importance of considering IgAV in recurrent gastrointestinal complaints and highlights the effectiveness of corticosteroids, emphasizing the need for clinical vigilance.

Conclusion: IgAV should be considered in adults with unexplained recurrent abdominal pain. Early recognition of the condition, even before the skin manifestations, can significantly improve the prognosis and patient outcome.

Hypoparathyroidism (HypoPT) is a rare endocrine disorder characterized by insufficient parathyroid hormone (PTH) levels, leading to hypocalcemia and hyperphosphatemia. Affecting approximately 70 000-90 000 individuals in the United States, HypoPT can arise from genetic mutations or, most commonly, as a result of surgical removal of the parathyroid glands. Traditional treatments involve calcium and vitamin D supplementation, which can pose long-term risks such as renal complications. On 9 August 2024, the U.S. Food and Drug Administration (FDA) approved Palopegteriparatide (Yorvipath, Ascendis, Denmark), a synthetic long-acting PTH analog, for subcutaneous use in adult patients with chronic HypoPT. Palopegteriparatide is designed as a pro-drug that undergoes auto-cleavage, offering sustained release and prolonged systemic exposure to recombinant PTH (1-34). Clinical trials have demonstrated its ability to maintain normocalcemia with minimal need for supplemental calcium or vitamin D. The treatment also showed a favorable safety profile, with mild transient side effects and no significant toxicity. Unlike standard-of-care therapies, Palopegteriparatide maintains balanced calcium-phosphate levels with less renal strain, making it a particularly promising option for patients with compromised kidney function. Although concerns remain regarding long-term safety, its FDA approval and orphan drug designation underscore its importance in addressing the unmet therapeutic needs of HypoPT. Continued investigation is warranted to optimize patient outcomes and further define its risk-benefit profile. This approval marks a critical milestone in endocrine therapeutics and offers renewed hope for patients struggling with the burdens of chronic HypoPT.