Annals of Medicine and Surgery最新文献

Introduction: Breast cancer (BC) remains the most prevalent malignancy among women globally, encompassing a variety of tumor subtypes with differing biological behaviors, prognoses, and responses to treatment. Among these, invasive ductal carcinoma (IDC) is the most common, followed by other subtypes such as lobular carcinoma and triple-negative breast cancer. Metaplastic breast carcinoma (MpBC) is a rare and highly aggressive form of BC, representing less than 2% of cases. Characterized by its heterogeneous nature and poorer prognosis compared to other BC subtypes, MpBC often presents significant diagnostic and therapeutic challenges.

Case description: We present the case of a 70-year-old woman who presented to our breast care clinic with right mastodynia following a recent trauma. She reported a palpable retro-areolar mass in the right breast that had increased in size over several years and was associated with calcifications. Imaging studies, including mammography and ultrasound, revealed a 3-cm irregular, heavily calcified mass with indistinct borders. Histological analysis of a biopsy confirmed metaplastic carcinoma with chondrosarcoma and osteosarcoma elements, high histological grade, and lymphovascular involvement. The patient underwent successful tumor excision with sentinel lymph node removal. Adjuvant chemotherapy and radiotherapy were planned based on a multidisciplinary team's recommendations.

Discussion: MpBC typically presents as a palpable, irregular mass that may exhibit rapid growth or changes, often complicating its differentiation from other breast malignancies. Standard imaging techniques like mammography and ultrasound may fail to clearly distinguish MpBC from other tumors, leading to potential misdiagnosis. The heterogeneous nature of MpBC, with both epithelial and mesenchymal components, poses additional challenges in diagnosis and treatment. Although MpBC is generally more aggressive and less responsive to conventional therapies compared to IDC, recent analyses suggest that, when adjusted for confounding factors, survival outcomes for MpBC may align more closely with those of aggressive IDC subtypes. Current treatment strategies include surgery, chemotherapy, and radiotherapy, with emerging targeted therapies offering potential for improved outcomes.

Conclusion: MpBC remains a rare and challenging BC subtype with a typically poor prognosis. Our case highlights the diagnostic difficulties and the aggressive nature of MpBC. Despite its severe clinical features and histological grades, survival outcomes for MpBC may be comparable to those of aggressive IDC subtypes when appropriate treatment adjustments are made. Continued research into targeted therapies and novel treatment approaches is essential to enhance management strategies and improve outcomes for patients with MpBC.

Background: The modified Mallampati test (MMT) is one of the most widely used airway assessment tests, for predicting laryngoscopy and tracheal intubation difficulty. The MMT without phonation is routinely performed, but its specificity in identifying easy intubation is controversial. This study aimed to compare the MMT with and without phonation in predicting difficult laryngoscopy and tracheal intubation in adult elective surgical patients who underwent general anesthesia.

Materials and methods: An institution-based cross-sectional study was performed on 258 adult elective surgical patients who required tracheal intubation. A systemic random sampling technique was employed to select study participants, and the MMT, with and without phonation, was performed during the preoperative assessment. A laryngoscopic view was recorded at the time of tracheal intubation and classified as easy or difficult for tracheal intubation. The collected data were entered into Epi-info and analyzed using the statistics package of social science software version 26. Statistical significance was defined as a P value of less than 0.05. This study used specificity, sensitivity, accuracy, and positive and negative predictive values as the statistical measures.

Results: The prevalence of laryngoscopy and intubation difficulties was observed to be 13.6% and 10.5%, respectively. MMT conducted without phonation had the higher sensitivity for predicting difficult laryngoscopy and intubation, than MMT with phonation. But MMT performed with phonation had higher specificity for identifying easy intubation, than MMT without phonation.

Conclusion: The MMT with phonation has higher accuracy, specificity, and positive predictive value for difficult laryngoscopy and intubation than the non-phonation approach. MMT combined with phonation can be used as an alternative assessment tool to predict difficult airways.

Introduction and importance: Metastatic prostate cancer (mPCa) is an advanced form of cancer that spreads beyond the prostate to distant organs such as bones and lymph nodes. While prostate-specific antigen (PSA) testing is commonly used for diagnosis, rare cases with normal PSA levels complicate detection. This case highlights the crucial role of immunohistochemistry (IHC) in diagnosing mPCa with normal PSA and its management in resource-limited settings.

Case presentation: A 63-year-old male presented with 2 months of persistent back pain without neurological deficits. Initial diagnostics, including PSA levels, CT, MRI, and TRUS guided prostate biopsy, revealed no prostate abnormalities. However, an MRI and Bone scan showed a suspicious vertebral lesion, and a subsequent biopsy confirmed malignancy. IHC demonstrated overexpression of alpha-methyl acyl-CoA racemase (AMACR), leading to the diagnosis of mPCa. The patient underwent bilateral subcapsular orchiectomy and received external beam radiotherapy (EBRT) to manage symptoms and control disease progression.

Clinical discussion: This case highlights the diagnostic challenges of mPCa in patients with normal PSA levels. Standard diagnostics, including imaging and biopsy, may fail to detect prostate cancer, making IHC, specifically AMACR, an essential tool for diagnosis. Early surgical intervention followed by EBRT offered significant symptomatic relief and disease control.

Conclusion: This case demonstrates the importance of IHC in diagnosing atypical presentations of mPCa with normal PSA. A multidisciplinary approach combining surgery and radiotherapy can improve outcomes and quality of life, even in resource-limited settings.

Electrocardiography (ECG) remains a cornerstone of non-invasive cardiac diagnostics, yet manual interpretation poses challenges due to its complexity and time consumption. The integration of Artificial Intelligence (AI), particularly through Deep Learning (DL) models, has revolutionized ECG analysis by enabling automated, high-precision diagnostics. This review highlights the recent advancements in AI-driven ECG applications, focusing on arrhythmia detection, abnormal beat classification, and the prediction of structural heart diseases. AI algorithms, especially convolutional neural networks (CNNs), have demonstrated superior accuracy compared to human experts in several studies, achieving precise classification of ECG patterns across multiple diagnostic categories. Despite the promise, real-world implementation faces challenges, including model interpretability, data privacy concerns, and the need for diversified training datasets. Addressing these challenges through ongoing research will be crucial to fully realize AI's potential in enhancing clinical workflows and personalizing cardiac care. AI-driven ECG systems are poised to significantly advance the accuracy, efficiency, and scalability of cardiac diagnostics.

Introduction: Upper limb replantation requires rapid intervention by a multidisciplinary team and appropriate equipment to rescue the limb. Note that the success of the operation and the decision to perform it depend on several factors. This case report presents an upper limb replantation performed using traditional surgical techniques.

Case presentation: A 12-year-old boy presented to our hospital with a crushing injury to the right upper arm, which was amputated at the lower third of the humerus, with the biceps brachii tendon remaining intact. The first aid included resuscitation and intravenous fluid administration to maintain hemodynamic stability. The surgeons replanted the arm by immobilizing the fracture with Kirschner wires, performing several arterial and venous anastomoses, and suturing the damaged nerve and muscle aponeurosis in a 3-h operation. The patient was discharged after 5 days without any complications but was recommended to undergo physical therapy to regain his arm movement and is currently undergoing monthly follow-ups to ensure the required improvement.

Discussion: Upper limb replantation is a complicated process that enables the conservation of arm function and appearance. This requires rapid intervention by a multidisciplinary team. Additionally, advanced equipment, such as microsurgical tools, provides greater success and ease of revascularization.

Conclusion: To successfully re-implant an amputated limb, several factors must be considered: surgeon experience, availability of necessary equipment, and provision of post-operative care. Despite lacking advanced tools, surgeons can rely on their surgical skills to overcome this challenge.

Background: Patients who experience postoperative nausea and vomiting are not happy with their surgical outcomes. Preventing this problem expedites the patients' return to normal activities following surgery and significantly increases their satisfaction. There are no condensed results that show the prevalence and contributing variables of postoperative nausea and vomiting in Africa. Thus, the purpose of this meta-analysis and comprehensive review was to ascertain the prevalence and contributing variables of postoperative nausea and vomiting in Africa.

Methods: Studies were retrieved from the PubMed, EMBASE, Cochrane Database, CINAHL, Scopus, Mednar, and Google Scholar databases using combinations of searching terms and Boolean operators. I-squared (I ²) statistics is used for evaluating study heterogeneity. Every publication is assessed for methodological quality using the Joanna Briggs Institute (JBI) Critical Appraisal criteria. Using a funnel plot, publication bias is visually assessed. Subgroup analyses investigate the source of heterogeneity. To determine whether publication bias exists, the Eggers weighted regression test is employed. STATA software version 14 was used to perform statistical analyses.

Results: In Africa, the combined incidences of nausea 24.96 % (95% CI: 17.903-32.018), vomiting 23.655 % (95% CI: 17.542-29.769) and nausea with vomiting 15.27 % (95% CI: 9.118-21.424) . History of motion sickness (odds ratio [OR]: 3.19 (95% CI 1.08-9.42), P < 0.036) and history of postoperative nausea and vomiting (OR: 4.33 (95% CI 2.654-7.07), P < 0.001) were factors linked to postoperative nausea and vomiting. Compared to their counterparts, patients who underwent more risky surgical procedures had a 1.4-fold increased chance of developing postoperative nausea and vomiting. Patients who skipped the use of prophylactic medication for nausea and vomiting had a 59% higher risk of experiencing postoperative nausea and vomiting than those who did [OR: 1.39 (95% CI (1.074-1.769), P < 0.012) and OR: 0.194 (95% CI (0.04-0.935), P < 0.001)], respectively.

Conclusion: Postoperative nausea and vomiting were more common in surgically treated African individuals. Clinical interventions are needed to prevent, diagnose, and treat postoperative nausea and vomiting (PONV), with a focus on patients who have experienced motion sickness, high-risk surgery, or PONV in the past. It is advisable to use whole intravenous anesthesia based on Propofol for surgery, if feasible.

Introduction and importance: Mesenteric laceration after screening colonoscopy is a rare and fatal complication. This case reported a giant hematoma due to a small intestinal mesenteric laceration after a screening colonoscopy.

Case description: A 56-year-old woman complained of persistent dramatic abdominal pain after the screening colonoscopy. This patient has appendectomy, rheumatic heart disease, IgG4-related disease, type 2 diabetes mellitus, and coronary atherosclerotic heart disease. Blood tests showed hemoglobin concentration sharply fell to 87 g/L and computed tomography scans confirmed a 16.4 cm × 6.1 cm × 9.5 cm hematoma abdominal hematoma near the small intestine. Digital subtraction angiography consistently showed rough and disordered the fourth group of the superior mesenteric artery. The main diagnosis was mesenteric laceration of the small intestine following colonoscopy. The patient was treated with fasting, gastrointestinal decompression, rehydration, inhibition of gastric acid, and meropenem to fight infection, 4 U suspended red blood cells and 400 mL fresh frozen plasma. Finally, this patient was discharged after conservative treatment, and the abdominal hematoma was significantly shrunk after 3 months.

Clinical discussion: Anticoagulants, a history of previous abdominal surgery, and IgG-RD leading to abdominal fibrosis were possible risk factors for mesenteric laceration. When the patient's condition is complex and has no absolute indication for surgery, conservative management could be appropriately considered.

Conclusions: We reported a case of abdominal hematoma due to colonoscopy. The successful conservative therapy may provide a novel experience for intra-abdominal hematoma treatment.

Background: Arboviruses are one of the greatest threats to animal and public health. Culicidae family is one of the most important vectors for the transmission of arboviruses in the world. According to the geographical, demographic, and climatic features of Qom city in Iran, it can be a suitable region for vectors and therefore transmission of arboviruses.

Methods: In this study, which was conducted between 2019 and 2020 in different parts of Qom city, 83 414 mosquitoes were collected, and after evaluating the species of mosquitoes based on morphological and molecular detection, the presence of alphaviruses, flaviviruses, and phleboviruses were evaluated using genus-specific Reverse transcription polymerase chain reaction (RT-PCR) assays.

Results: In this study, Culex tarsalis, Culex theileri, and Culex quinquefasciatus were detected, including the first recorded presence of Culex tarsalis in Iran. No infections with alphavirus, flavivirus, or phlebovirus were identified in the collected mosquitoes.

Conclusion: Climatic and weather changes are the basis for the growth and spread of vectors and, consequently, the spread of arboviral diseases, and this issue seems to be very important to the necessity of increasing and continuing entomological and virological studies.