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Prolonged Honeymoon Period in Type I Diabetes (T1D) Patients on Low-Carbohydrate Diet (LCD) 低碳水化合物饮食延长1型糖尿病患者蜜月期
Pub Date : 2023-10-24 DOI: 10.36502/2023/asjbccr.6324
Michael Wood, Koji Ebe, Hiroshi Bando
The presented case is a 68-year-old female with Type 1 diabetes (T1D). She was admitted for an emergency case with acute distress in January 2018 and was diagnosed with T1D with a blood glucose (BG) level of 459 mg/dL, HbA1c of 13.7%, glutamic acid decarboxylase autoantibody (GADA) level >2000 U/mL (<5 U/mL), and C-reactive protein (CRP) level of 1.10 ng/mL. She received Multiple Daily Injections (MDI) of insulin for 3 months, and then her HbA1c decreased to 7.3%. After that, she has been on a super-low carbohydrate diet (LCD) and received only Lantus XR and ipragliflozin. Serum CRP showed 0.2 ng/mL, suggesting a prolonged honeymoon period for years through continuous LCD.
本病例为68岁女性1型糖尿病(T1D)患者。患者于2018年1月因急性窘迫急诊入院,诊断为T1D,血糖(BG) 459 mg/dL,糖化血红蛋白(HbA1c) 13.7%,谷氨酸脱羧酶自身抗体(GADA) 2000 U/mL (5 U/mL), c反应蛋白(CRP) 1.10 ng/mL。患者接受MDI胰岛素注射3个月后,HbA1c降至7.3%。在那之后,她一直在进行超低碳水化合物饮食(LCD),只接受了Lantus XR和ipragliflozin。血清CRP为0.2 ng/mL,通过连续LCD提示蜜月期延长数年。
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引用次数: 0
The Spanish Hospital in Cayey in the Latter Part of the 19th Century 19世纪后半叶Cayey的西班牙医院
Pub Date : 2023-10-16 DOI: 10.36502/2023/asjbccr.6323
Joseph Orlando Prewitt Díaz, James J. Prewitt
This paper provides a detailed historical account of the Spanish Miliary Hospital in Cayey, Puerto Rico during the latter part of the 19th century, focusing on its role during the Spanish-American War and its impact on public health in Puerto Rico. The paper is divided into ten sections, each highlighting the development, growth, and function of the hospital during the Spanish American War and concludes with a look at the hospital today. Overall, this paper provides a comprehensive historical account of the Spanish Hospital in Cayey in Puerto Rican history, shedding light on its role in military medicine and public health during the Spanish-American War in the Central Mountain Region of Puerto Rico.
本文提供了19世纪后半叶波多黎各Cayey的西班牙军事医院的详细历史记录,重点关注其在美西战争期间的作用及其对波多黎各公共卫生的影响。本文分为十个部分,每个部分都突出了美西战争期间医院的发展、成长和功能,并以今天的医院作为总结。总体而言,本文提供了波多黎各历史上Cayey西班牙医院的全面历史记录,揭示了其在美西战争期间在波多黎各中央山区的军事医学和公共卫生中的作用。
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引用次数: 0
Type 2 Diabetes (T2D) Case with Digestive and Cardiovascular Disorders Treated by EquMet and Twymeeg EquMet和Twymeeg治疗2型糖尿病合并消化和心血管疾病1例
Pub Date : 2023-09-09 DOI: 10.36502/2023/asjbccr.6322
Naoki Kondo, Hiroshi Bando, Masaki Okada, Noboru Iwatsuki, Tomoya Ogawa, Kazuki Sakamoto
This case involves a 76-year-old female patient with type 2 diabetes (T2D), diabetic gastroenteropathy, and slight arteriosclerosis. Her HbA1c levels have been unstable for years due to her typical carbohydrate intake. Her symptoms include constipation, nausea, and abdominal fullness. Despite being on magnesium oxide and picosulfate, she experiences difficulty achieving smooth bowel movements for an extended period. In March 2023, her HbA1c levels increased to 8.5%. Subsequently, EquMet and Twymeeg were initiated, resulting in remarkable clinical effects, with her HbA1c dropping to 5.9% by August 2023. A Holter ECG recorded ventricular premature contractions (VPC) occurring 10 times (0.010%) over a 24-hour period. Additionally, plethysmography indicated a cardio-ankle vascular index (CAVI) of 9.5/9.3, suggesting slight arteriosclerosis.
该病例涉及一名76岁女性2型糖尿病(T2D),糖尿病胃肠炎和轻微动脉硬化。由于典型的碳水化合物摄入,她的糖化血红蛋白水平多年来一直不稳定。她的症状包括便秘、恶心和腹胀。尽管服用氧化镁和硫酸氢酯,她仍难以长时间顺利排便。2023年3月,她的HbA1c水平升至8.5%。随后,EquMet和Twymeeg开始治疗,临床效果显著,到2023年8月,患者的HbA1c降至5.9%。动态心电图记录心室早搏(VPC)在24小时内发生10次(0.010%)。此外,脉搏波显示心踝血管指数(CAVI)为9.5/9.3,提示轻度动脉硬化。
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引用次数: 0
A Case of Air Embolism during Transoral Vestibular Endoscopic Thyroidectomy 经口前庭内窥镜甲状腺切除术中空气栓塞1例
Pub Date : 2023-09-01 DOI: 10.36502/2023/asjbccr.6320
Bo Xu, Rurong Wang
Background: Carbon dioxide (CO2) embolism is a rare but potentially life-threatening complication of endoscopic surgery. While endoscopic thyroidectomy is superior to traditional open thyroidectomy in terms of cosmetic results, it may lead to venous or fatal paradoxical CO2 embolism. CO2 embolism involves the inadvertent injection of carbon dioxide into a large vein, artery, or solid organ. The clinical manifestations of CO2 embolism can vary from asymptomatic to neurological damage, cardiac failure, and even death, depending on the rate and volume of CO2 entry and the patient’s general condition. This case can enhance our understanding of CO2 embolization during endoscopic surgery.Case Presentation: This case report describes an incident in which a gas embolism occurred during endoscopic right lobe and isthmus thyroidectomy, resulting in arrhythmia and dramatic fluctuations in circulation and oxygen levels. The operation was halted, and CO2 injection was stopped. The surgical wound was covered with saline gauze, and the patient inhaled 100% pure oxygen while undergoing aggressive repeated manual pulmonary recruitment maneuvers. Additionally, vasoactive drugs such as m-hydroxyamine and ephedrine were administered to aid in treating the condition. The patient’s position was adjusted using the Durant maneuver (partial left lateral and Trendelenburg position). Following the aforementioned treatments, the patient’s ventricular arrhythmia transitioned back to a normal and regular sinus rhythm, and both circulation and oxygen levels stabilized.Conclusions: Carbon dioxide embolism is an uncommon yet potentially severe complication of laparoscopic procedures. We anticipate that this particular case will enhance our comprehension of carbon dioxide embolism during endoscopic surgery.
背景:二氧化碳栓塞是内镜手术中一种罕见但可能危及生命的并发症。虽然内窥镜甲状腺切除术在美容效果上优于传统的开放式甲状腺切除术,但它可能导致静脉或致命的矛盾CO2栓塞。二氧化碳栓塞是指不小心将二氧化碳注入大静脉、动脉或实体器官。二氧化碳栓塞的临床表现可能从无症状到神经损伤、心力衰竭甚至死亡,这取决于二氧化碳进入的速度和体积以及患者的一般情况。本病例可提高我们对内镜手术中CO2栓塞的认识。病例介绍:本病例报告描述了在内镜下右肺和峡部甲状腺切除术中发生气体栓塞的事件,导致心律失常和循环和氧水平的剧烈波动。作业停止,CO2注入停止。手术创面用生理盐水纱布覆盖,患者吸入100%纯氧,同时进行积极的反复手动肺补充操作。此外,血管活性药物,如间羟胺和麻黄碱被用于帮助治疗病情。采用Durant手法调整患者体位(部分左侧位和Trendelenburg位)。经过上述治疗,患者的室性心律失常恢复到正常和规律的窦性心律,循环和氧水平稳定。结论:二氧化碳栓塞是腹腔镜手术中一种罕见但潜在的严重并发症。我们期望这个特殊的病例将增强我们对内窥镜手术中二氧化碳栓塞的理解。
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引用次数: 0
Slight Bronchopneumonia in A Centenarian Diagnosed by Chest CT Scan with Maximum Intensity Projection (MIP) 百岁老人轻度支气管肺炎1例胸部CT最大强度投影诊断
Pub Date : 2023-08-24 DOI: 10.36502/2023/asjbccr.6319
Hisako Yamashita, Katsunori Ogura, Hiroshi Bando, Yoshinobu Kato, Yoshikane Kato
The current case is a 102-year-old female centenarian with slight bronchopneumonia. She did not have any remarkable health or medical problems until 2022. In May 2023, she developed a cough and fever and underwent a lung CT scan, which revealed a consolidation shadow in the left posterior middle lung. This image was created with a 1mm width for each 1mm interval. Additionally, a further image was generated using maximum intensity projection (MIP) with a 3mm width for a slab thickness of 20mm. Based on this data, a diagnosis of slight bronchopneumonia in the left lung was made. She was treated with levofloxacin 500mg/day for 5 days, which led to clinical improvement.
目前的病例是一名患有轻微支气管肺炎的102岁百岁女性。直到2022年,她都没有任何明显的健康或医疗问题。2023年5月,她出现咳嗽和发烧,并进行肺部CT扫描,发现左肺后中部有实变影。该图像以每1mm间隔1mm的宽度创建。此外,使用最大强度投影(MIP)生成进一步的图像,宽度为3mm,板厚为20mm。根据这些数据,诊断为左肺轻度支气管肺炎。给予左氧氟沙星500mg/d治疗5 d,临床好转。
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引用次数: 0
An Unexpected Diagnosis of Femoral Paraganglioma: A Case Report 意外诊断股副神经节瘤1例
Pub Date : 2023-08-19 DOI: 10.36502/2023/asjbccr.6318
Xiao-ye Wei, Lingcan Tan, Rurong Wang
Paragangliomas are rare neuroendocrine neoplasms, commonly located in the head and neck. They are sometimes first found in the bone, especially when there are contributing factors such as trauma, which can make clinical diagnosis more challenging. In this reported case, a patient presented with a painful mass in the right thigh caused by trauma. During the procedure for resecting the right femoral mass, the patient’s blood pressure significantly increased upon touching the tumor. Subsequently, a biopsy of the right thigh femur and a whole-body contrast-enhanced computed tomography (CT) examination confirmed the diagnosis of a right femoral paraganglioma with metastasis to the right neck.
副神经节瘤是一种罕见的神经内分泌肿瘤,常见于头颈部。它们有时首先在骨骼中被发现,特别是当有创伤等因素的时候,这可能使临床诊断更具挑战性。在此报告的病例中,患者表现为右大腿创伤引起的疼痛肿块。在切除右股肿块过程中,患者接触肿瘤后血压明显升高。随后,右大腿股骨活检和全身增强计算机断层扫描(CT)检查证实了右股副神经节瘤并转移到右颈部的诊断。
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引用次数: 0
Massive Splenic Infarction Abscess in A Teenager with Sickle Cell Disease: A Case Report in Northern Benin 贝宁北部一例镰状细胞病青少年大面积脾梗死脓肿
Pub Date : 2023-08-15 DOI: 10.36502/2023/asjbccr.6317
A. Falilatou, Hadonou Armel Ayaovi, Noudamadjo Alphonse, Kpanidja Métédinmè Gérard, Doha Fabrice, A. Didier, Agossou Joseph
Introduction: Splenic abscess is rare in children. This report discusses a case of splenic abscess complicating an infarction in a teenager at the Teaching Hospital of Borgou/Alibori in Benin Republic.Patient and Observation: The patient was a 14-year-old teenager with hemoglobinopathy (SC), admitted to the pediatric department for generalized abdominal pain associated with fever and a dry cough. On physical examination, he presented with an infectious syndrome, generalized abdominal pain, highly sensitive splenomegaly, left lung consolidation, and severe malnutrition. Abdominal ultrasound and thoraco-abdominal CT-scan revealed a splenic infarction abscess. Following medical treatment, which included broad-spectrum antibiotic therapy and analgesia, a total splenectomy was performed. During surgery, the spleen appeared greyish and contained pus, which, upon cytobacteriological examination, isolated a Klebsiella pneumoniae strain sensitive to the combination of amoxicillin-clavulanic acid. The patient showed favorable evolution under this treatment.Conclusion: Splenic abscess should be suspected in any subject with sickle cell disease presenting with painful and febrile splenomegaly.
简介:小儿脾脓肿罕见。本报告讨论了一例脾脓肿并发梗死的青少年在博古/阿里博里教学医院在贝宁共和国。患者和观察:患者是一名14岁的青少年,患有血红蛋白病(SC),因全身腹痛伴有发烧和干咳而入院儿科。体格检查时,他表现为感染综合征、全身腹痛、高度敏感性脾肿大、左肺实变和严重营养不良。腹部超声和胸腹ct扫描显示脾梗死脓肿。在药物治疗后,包括广谱抗生素治疗和镇痛,进行全脾切除术。术中脾脏呈灰色,含脓液,经细胞细菌学检查,分离出一株对阿莫西林-克拉维酸联合用药敏感的肺炎克雷伯菌。在这种治疗下,病人病情好转。结论:镰状细胞病患者出现疼痛性脾肿大和发热性脾肿大时应怀疑有脾脓肿。
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引用次数: 0
Pulmonary Actinomycosis, A Lesson Learned Story 肺放线菌病,一个教训的故事
Pub Date : 2023-08-14 DOI: 10.36502/2023/asjbccr.6316
Claudia Moreno-Diaz, César Prócel-Ramírez, Lucy Baldeón-Rojas
The bacteria Actinomyces spp. a gram-positive bacteria responsible for the actinomycosis disease. Its 15–20% pulmonary presentation is generally chronic, progresses slowly, and might be misinterpreted as lung cancer or other long-term conditions. We describe a man in his 60s with weight loss and dyspnea. The presence of Actinomyces spp. was identified in a bronchial biopsy of the middle lobe, ruling out lung cancer as the initial diagnostic possibility. After a month of intravenously administered antibiotic treatment, the patient experienced bronchiectasis. Pulmonary actinomycosis should be considered since it is challenging to detect and sometimes mistaken for lung neoplasia or TB due to its comparable clinical and radiographic presentations. The prognosis of pulmonary actinomycosis (PA) is favorable, and it is feasible to avoid recurring complications with the correct antibiotic treatment.
放线菌属细菌是引起放线菌病的革兰氏阳性细菌。其15-20%的肺部表现通常是慢性的,进展缓慢,可能被误解为肺癌或其他长期疾病。我们描述了一个60多岁的男人,体重减轻,呼吸困难。放线菌属的存在被发现在支气管活检的中叶,排除肺癌作为初步诊断的可能性。经过一个月的静脉注射抗生素治疗后,患者出现了支气管扩张。肺部放线菌病应考虑,因为它是具有挑战性的检测和有时被误认为肺肿瘤或结核病,由于其相似的临床和放射学表现。肺放线菌病(PA)预后良好,通过正确的抗生素治疗,避免并发症复发是可行的。
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引用次数: 0
Carbon Dioxide Embolism During Laparoscopic Right Hepatectomy: A Case Report 腹腔镜右肝切除术中二氧化碳栓塞1例
Pub Date : 2023-08-05 DOI: 10.36502/2023/asjbccr.6315
Dong-sheng Wu
Complications of laparoscopic surgery include carbon dioxide (CO2) embolism, primarily caused by the entry of CO2 gas into blood vessels or solid organs. If significant clinical symptoms occur, timely intervention is crucial as it can be life-threatening. We report a case of CO2 embolism during laparoscopic right hepatectomy. The patient was a 37-year-old male with no history of liver or kidney dysfunction. During the procedure, there were two episodes of oxygen desaturation (SpO2), and the second episode was accompanied by a significant drop in blood pressure and an increase in heart rate. However, there was no sudden decrease in the end-tidal CO2 partial pressure (ETCO2). Simultaneously, a grinding murmur was auscultated in the precordial area, and foamy blood was aspirated from the right internal jugular vein catheter. This article describes a case of CO2 embolism during laparoscopic surgery and provides a summary of its causes, clinical manifestations, diagnosis, and treatment. It is hoped that this article will contribute to the timely recognition and management of such cases, thereby preventing any potential adverse outcomes for patients.
腹腔镜手术的并发症包括二氧化碳(CO2)栓塞,主要是由二氧化碳气体进入血管或实体器官引起的。如果出现明显的临床症状,及时干预是至关重要的,因为它可能危及生命。我们报告一例CO2栓塞在腹腔镜右肝切除术。患者男性,37岁,无肝肾功能障碍史。在手术过程中,有两次血氧饱和度(SpO2)发作,第二次发作伴有血压明显下降和心率增加。然而,潮末CO2分压(ETCO2)没有突然下降。同时,听诊心前区有磨碎性杂音,并从右颈内静脉导管吸出泡沫性血液。本文描述了一例腹腔镜手术中CO2栓塞的病例,并对其原因、临床表现、诊断和治疗进行了总结。希望本文能对此类病例的及时识别和管理有所帮助,从而防止患者发生任何潜在的不良后果。
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引用次数: 0
Right Ventricle Systolic Dysfunction: A Rare Cause of Right-To-Left Interatrial Shunt with Normal Pulmonary Artery Pressure 右心室收缩功能障碍:肺动脉压正常的右至左心房分流的一个罕见原因
Pub Date : 2023-08-05 DOI: 10.36502/2023/asjbccr.6314
Dai-liang Zhao, Yan Li
There is little information about right-to-left shunting with normal pulmonary artery pressure, which is produced as a consequence of right ventricle systolic dysfunction. We presented a case of unexpected transesophageal echocardiography findings of right-to-left shunting through an atrial septal defect despite normal pulmonary artery pressure, related to right ventricle systolic dysfunction in a 27-year-old young woman. Transesophageal echocardiography imaging revealed right ventricular systolic dysfunction and normal pulmonary artery pressure.
关于肺动脉压正常的右至左分流的信息很少,这是由于右心室收缩功能障碍造成的。我们报告了一位27岁的年轻女性,在肺动脉压正常的情况下,经食管超声心动图意外发现心房间隔缺损右至左分流,与右心室收缩功能障碍有关。经食道超声心动图显示右心室收缩功能不全,肺动脉压正常。
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引用次数: 0
期刊
Asploro journal of biomedical and clinical case reports
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