Annals of Medicine and Surgery最新文献

Introduction: Sprengel deformity (SD) is a rare congenital deformity consisting of elevation of the scapula, leading to limited range of motion and a visible lump in severe cases. Klippel-Feil syndrome is a rare congenital abnormality characterized by the triad of cervical synostosis, low posterior hairline, and short neck. It is often associated with SD.

Case presentation: We present two cases of SD of a 7-year-old boy and a 10-year-old boy. They were both born with the abnormality and complained of limited range of motion in the affected shoulder.

Clinical discussion: Patients with less severe forms of SD can lead a normal life with supportive treatment, and it is not connected with cognitive impairment; however, there may be a limited range of motion and cosmetic concerns. In severe cases, treatment entails operative therapy with corrective placement of the scapula and resection of the omovertebral band.

Conclusion: Patients with SD require supportive physiotherapy from a young age. Severe cases need operative treatment at a young age. The modified Woodward approach may be an excellent surgical option to correct the deformity.

Introduction: Mycetoma is a chronic disabling inflammatory disease characterized by the formation of granulomatous masses in subcutaneous tissue extending to the skin, deep tissues, and bones.

Findings: An exhaustive and detailed exploration of medical literature unveiled only 11 published articles addressing mycetoma in Somalia since 1927. Among these, six were case reports involving 12 patients, and three were case series encompassing 163 patients, resulting in a total of 175 reported cases. Notably, two articles in French lacking abstracts were excluded from the review. Considering Somalia shares geographical and environmental traits with other mycetoma-endemic regions, a heightened prevalence of the disease is anticipated in the country. It is essential to recognize, however, that mycetoma is not a notifiable disease, and the accuracy of disease reporting in Somalia is compromised due to various factors and consequently, the actual number of mycetoma cases in Somalia is likely to surpass the figures presented in this report.

Conclusion: Ongoing research, international collaboration, and efforts to improve healthcare accessibility and awareness are essential. Encourage country to make mycetoma a notifiable disease with the integration of data collection in the national health information system. Addressing the environmental determinants, describe true burden, disability, impact of quality life, and implementing preventive measures can contribute to mitigating the impact of mycetoma in Somalia.

Introduction and importance: Inflammatory myofibroblastic tumor (IMT) is a rare neoplastic condition that primarily affects children and young adults. This case report highlights the challenges in diagnosing and treating pediatric IMT, emphasizing the importance of tailored interventions.

Case presentation: An 8-year-old boy presented with respiratory symptoms and was diagnosed with an IMT located in the left main bronchus. Imaging studies revealed a soft tissue mass and lymph node enlargement. Bronchoscopy and biopsy confirmed the diagnosis. The patient underwent bronchoscopic debulking procedures followed by lobectomy and bronchoplasty due to persistent disease.

Clinical discussion: IMTs pose diagnostic challenges due to their varied clinical presentation and similarities with other neoplasms. A multidisciplinary approach involving pathologists, radiologists, and surgeons is crucial for accurate diagnosis and optimal treatment planning. The pathogenesis of IMTs is not fully understood, but theories suggest an inflammatory response or involvement of the ALK gene. IMTs can affect various organs, each with distinct symptoms. Imaging modalities lack specificity, emphasizing the importance of histopathological examination.

Conclusion: IMTs require individualized treatment approaches based on the location and extent of the tumor. Long-term follow-up is essential for monitoring recurrence and metastasis. Further research is needed to enhance our understanding of IMT biology and develop targeted therapies to improve patient outcomes. This case report underscores the importance of tailored interventions in pediatric IMT cases and highlights the challenges in diagnosis and treatment.

Objectives: Diabetes mellitus is a metabolic disorder recognized for inducing endothelial dysfunction in coronary arteries. This study aimed to investigate the synergistic effects of valerian hydroalcoholic extract and exercise in diabetic rats.

Methods: Thirty-five Wistar rats were randomly divided into five groups: control, diabetes, diabetic rats undergoing treadmill exercise, diabetic rats administered valerian extract (200 mg/kg, oral), and diabetic rats receiving a combination of valerian extract and treadmill exercise for 8 weeks. Antioxidants and lipoproteins were assessed via blood sampling at the study's conclusion. Hemodynamic parameters and the response of the coronary artery bed to constrictors and dilators were evaluated by connecting the heart to a Langendorff device.

Results: Diabetes was associated with a diminished vascular vasodilator response, which was enhanced by the combined treatment of valerian extract and 8 weeks of exercise. Moreover, elevated levels of glutathione peroxidase (GPx) and superoxide dismutase (SOD) were observed in groups receiving both valerian extract and exercise.

Conclusions: The findings suggest that the combination of treadmill exercise and hydroalcoholic extract may hold promise in managing cardiovascular complications in diabetic patients by leveraging their antioxidant properties.

Introduction: Lumbar spine surgery can be performed under either general or spinal anesthesia. Numerous studies highlight the benefits of spinal anesthesia (SA), including cost-effectiveness, reduced anesthesia-related complications, and suitability for patients who do not favor general anesthesia (GA). Those informal case series emphasizes the advantages of SA and introduces a working protocol tailored for resource-limited countries (RLCs).

Presentation of case: Two patients, aged 35 and 58, underwent spinal surgery using SA combined with local infiltration for the skin and facet joints. We implemented a new protocol believed to be beneficial in RLCs. In both cases, intraoperative vital signs remained stable, and there was effective pain control postoperatively.

Clinical discussion: Spine surgery under SA has gained acceptance due to evidence indicating reduced perioperative risks and lower opioid consumption, alongside decreased healthcare costs. Although there are suggested protocols for SA in spine surgery, many are not applicable in RLCs. Our case series demonstrate similar advantages, suggesting that the protocol used in this study may be helpful. Despite its benefits, SA for spine surgery still faces resistance and has not been widely adopted in many neurosurgery centers.

Conclusion: The study aim to outline essential steps for initiating SA for spine surgery in RLCs. The guidelines utilized in this study have proven effective. SA can lead to reduced healthcare costs, lower opioid usage, and increased patient turnover. The two cases series demonstrate improved anesthesia outcomes. Future randomized clinical trials with sufficiently large sample sizes are necessary to establish high-quality evidence regarding the safety, efficacy, and cost-effectiveness of SA.

Introduction and importance: Melanoma is the fifth most common cancer diagnosed in the US in 2022. While its incidence increased from 1980 to 2017, it rarely happens in children. Its diagnosis and treatment are challenging in pediatric patients due to its rarity and different presentations compared to adults.

Case presentation: An 11.5-year-old boy with a complaint of back pain was admitted to the hospital. Initial examinations were normal; however, due to continued pain and symptoms (e.g., inability to walk, knee pain and ankle ecchymosis, weight loss, vomiting, nausea, and dyspnea), further examinations were performed. Biopsy, nuclear scan, computed tomography (CT) scan, and immunohistochemistry (IHC) confirmed the malignant melanoma diagnosis with bone and lung metastasis. Single-agent treatment with nivolumab was initiated after the diagnosis confirmation with no specific complication. The patient's parents decided to continue the treatment in their city of residence to reduce costs. However, the treatment was not continued, and unfortunately, the patient has passed away.

Clinical discussion: Melanoma is rare in children, making its diagnosis challenging. There are no specific guidelines for treating melanoma in pediatric patients, especially in children under 12, with ongoing debate on the most suitable treatment and follow-up options for these patients. It is important to fully examine resected legions for malignancy.

Conclusion: The study highlights the difficulties in diagnosing and treating malignant melanoma in children, considering its rarity and unusual signs and symptoms compared to adults. Specific guidelines are needed for diagnosing and treating malignant melanoma in pediatric patients.

Background: Global plastic production surged to 400.3 million metric tons in 2022, contributing significantly to environmental pollution. Projections estimate that 13.2 billion tons of plastic waste will be present in ecosystems by 2050. This increase in plastic production has led to substantial human exposure to microplastics (MPs) and nanoplastics (NPs). While their environmental and general health impacts are well-documented, the specific effects on cardiovascular health remain underexplored.

Objectives: This review aims to examine the presence of MPs and NPs in the environment, their routes of human exposure, and their toxicological implications for the cardiovascular system (CVS), focusing on oxidative stress, apoptosis, cardiac fibrosis, and major adverse cardiovascular events (MACE).

Methods: A comprehensive literature review was conducted using PubMed, Scopus, and Google Scholar. Relevant studies from the past 10 years were selected based on keywords like "microplastics," "nanoplastics," and "cardiovascular health."

Results: MPs and NPs are found in air, water, and food, entering the human body primarily through inhalation, ingestion, and dermal contact. These particles induce oxidative stress, mitochondrial dysfunction, and apoptosis, which impair cardiovascular health. MPs have been detected in arterial tissues, particularly in atherosclerotic plaques, correlating with increased MACE risk. MP exposure is linked to VC, reduced vessel flexibility, and increased thrombosis severity. Additionally, MPs contribute to inflammation and lipid metabolism disruption, which further exacerbate heart disease.

Conclusion: The evidence suggests a concerning link between plastic exposure and cardiovascular health, highlighting the urgent need for further research to understand the long-term effects of MPs and NPs on CVSs.

Introduction: Retinoblastoma (RB), the most commonly occurring intraocular malignancy among children globally, represents 3% of childhood cancers. In the current study, the authors aim to evaluate the effectiveness of a new formulation of nelarabine (niosomal nelarabine) on RB cancer cells.

Methods: Field emission scanning electron microscopy (FE-SEM) and dynamic light scattering (DLS) characterized the physical properties of nelarabine nanoparticles. After cultivation of the Y79 cell line, the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) test was performed to determine IC50 of niosomal nelarabine (Nio-Nelarobine) and also the cytotoxicity of Nio-Nelarobine and doxorubicin against Y79 cell line was investigated. The level of apoptosis was assessed by flow cytometry in selected groups. Also, the PTEN/AKT/FOXO1 gene expression level was measured using qRT-PCR.

Results: Y79 cell lines were treated with Nio-Nelarobine and doxorubicin. The treatment resulted in a dose-dependent inhibition of Y79 cell viability. However, Nio-Nelarobine showed a higher inhibitory activity with a diameter of about 167 nm. Both Nio-Nelarobine and doxorubicin induced apoptosis in cells, but Nio-Nelarobine treatment resulted in a higher number of apoptotic cells than doxorubicin treatment. The qRT-PCR results showed that the treatment with Nio-Nelarobine and doxorubicin led to an increase in the expression of PTEN and FOXO1 genes, while decreasing the expression of the AKT gene. Furthermore, the statistical significance of these results was higher in the Nio-Nelarobine group than in the doxorubicin group.

Conclusions: Nio-Nelarobine may be a functional therapeutic combination for RB treatment. Further experimental and preclinical investigations are necessary to verify this impact in greater detail.

Introduction and importance: There are various types of hallucinations reported in the literature (auditory, visual, tactile, gustatory, or olfactory), and most of them are related to psychiatric (schizophrenia) disorders. Olfactory hallucinations related to neurosurgical disorders are uncommon. The authors present a case of a patient with a left insular glioma who developed transient olfactory hallucinations after microsurgical resection of the tumor. Our Objective is to share a rare case of postoperative complication-olfactory hallucination following insular glioma surgery-which can potentially raise awareness among practicing neurosurgeons.

Case presentation: A 32-year-old male patient underwent left insular glioma resection at our institution in 2024. He developed transient olfactory hallucinations after microsurgical resection of the tumor, which resolved within a month postoperatively.

Clinical discussion: Insular gliomas often grow to a considerable size before becoming symptomatic in many patients. The insular region is regarded as one of the brain's most sophisticated areas, with lesions manifesting in a wide range of symptoms and syndromes including olfactory hallucinations.

Conclusion: Olfactory hallucinations following left insular glioma resection can potentially raise awareness among practicing neurosurgeons regarding this rare postoperative complication. These types of postoperative complications may resolve in a short period if no serious vascular injury has been encountered.

Introduction and importance: Road traffic accidents can result in severe ocular injuries, jeopardizing vision. High-speed collisions may lead to facial avulsion and degloving injuries, which pose risks such as airway compromise, bleeding, soft tissue loss, disfigurement, and post-traumatic impairments that necessitate prompt reconstruction.

Case presentation: A 24-year-old woman sustained injuries in a motorcycle accident, which resulted in a left hemifacial avulsion, a degloving injury, and the loss of her left brow. Additionally, she lost the lower eyelid on the left side and a portion of the left maxilla near the medial canthus. Despite these injuries, the movements of her left eye remained normal.

Clinical discussion: The primary objectives of periorbital reconstruction are to restore the patient's vision with minimal discomfort while ensuring stable coverage for orbital protection and achieving functional reconstruction of the defect. Although there are various surgical reconstruction techniques available, skin grafting and regional flap reconstruction methods are the most commonly employed.

Conclusion: The patient expressed satisfaction with the outcome and reported improved social comfort. After a one-year follow-up, both the patient's facial functions and vision were found to be normal.