Pub Date : 2023-08-03DOI: 10.36502/2023/asjbccr.6313
X. Wang
This case report presents a 67-year-old female with Parkinson’s disease who underwent deep brain stimulation (DBS) electrode replacement surgery. Following extubation, the patient developed persistent laryngospasm, requiring immediate intervention. Suspecting symptoms similar to levodopa withdrawal, the patient received intravenous propofol and enteral levodopa supplementation, leading to symptom improvement. The case underscores the importance of perioperative management, including timely medication supplementation and DBS functioning, in Parkinson’s patients to prevent neuroleptic malignant syndrome (NMS)-like complications. Anesthesiologists should be vigilant about potential airway issues and NMS in this population and maintain optimal fluid status during surgery. Prompt intervention can prevent irreversible damage and improve patient outcomes.
{"title":"Postoperative Respiratory Dysfunction in Patients with Parkinson’s Disease","authors":"X. Wang","doi":"10.36502/2023/asjbccr.6313","DOIUrl":"https://doi.org/10.36502/2023/asjbccr.6313","url":null,"abstract":"This case report presents a 67-year-old female with Parkinson’s disease who underwent deep brain stimulation (DBS) electrode replacement surgery. Following extubation, the patient developed persistent laryngospasm, requiring immediate intervention. Suspecting symptoms similar to levodopa withdrawal, the patient received intravenous propofol and enteral levodopa supplementation, leading to symptom improvement. The case underscores the importance of perioperative management, including timely medication supplementation and DBS functioning, in Parkinson’s patients to prevent neuroleptic malignant syndrome (NMS)-like complications. Anesthesiologists should be vigilant about potential airway issues and NMS in this population and maintain optimal fluid status during surgery. Prompt intervention can prevent irreversible damage and improve patient outcomes.","PeriodicalId":93523,"journal":{"name":"Asploro journal of biomedical and clinical case reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49195253","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-31DOI: 10.36502/2023/asjbccr.6312
Tomoko Kusumoto, H. Bando, Kenji Hayashi, Eri Yasuoka, Michiaki Shibata, Hikaru Takagishi
The case is a 51-year-old male with obesity, type 2 diabetes (T2D), dyslipidemia, and hypertension. His HbA1c value increased to 8.0%, accompanied by oral semaglutide administration. Glucose variability was exacerbated after that, and then novel imeglimin (Twymeeg) was initiated. HbA1c decreased from 7.4% to 6.7% over 4 months with a 3 kg weight reduction. The case also had low back pain (LBP) and lumbar spinal stenosis (LSS), probably resulting from Metabolic syndrome (Met-S), and had actual experience with a low carbohydrate diet (LCD) in the hospital meals. Four patterns of LCD meals had carbohydrates ranging from 17.8g to 28.0g, with 501-690kcal.
{"title":"Actual Meal of Low Carbohydrate Diet (LCD) for Diabetic Patient Treated by Effective Imeglimin (Twymeeg)","authors":"Tomoko Kusumoto, H. Bando, Kenji Hayashi, Eri Yasuoka, Michiaki Shibata, Hikaru Takagishi","doi":"10.36502/2023/asjbccr.6312","DOIUrl":"https://doi.org/10.36502/2023/asjbccr.6312","url":null,"abstract":"The case is a 51-year-old male with obesity, type 2 diabetes (T2D), dyslipidemia, and hypertension. His HbA1c value increased to 8.0%, accompanied by oral semaglutide administration. Glucose variability was exacerbated after that, and then novel imeglimin (Twymeeg) was initiated. HbA1c decreased from 7.4% to 6.7% over 4 months with a 3 kg weight reduction. The case also had low back pain (LBP) and lumbar spinal stenosis (LSS), probably resulting from Metabolic syndrome (Met-S), and had actual experience with a low carbohydrate diet (LCD) in the hospital meals. Four patterns of LCD meals had carbohydrates ranging from 17.8g to 28.0g, with 501-690kcal.","PeriodicalId":93523,"journal":{"name":"Asploro journal of biomedical and clinical case reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47129157","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-21DOI: 10.36502/2023/asjbccr.6311
Yan Zeng, Jun Zeng
The incidence of bladder spasm in children with hypospadias treated with caudal block before surgery is uncommon. We presented a case of bladder spasm after urethroplasty surgery that was successfully treated with anisodamine without any sequelae. The caudal block plane may only reach the sacrum and does not reach the bladder wall. I suggest a local anesthetic drug dose of 1 ml/kg, totaling not more than 20 ml, to avoid the occurrence of postoperative bladder spasm and increase the comfort of children.
{"title":"Bladder Spasm in Children after Surgery for Urethroplasty: A Case Report","authors":"Yan Zeng, Jun Zeng","doi":"10.36502/2023/asjbccr.6311","DOIUrl":"https://doi.org/10.36502/2023/asjbccr.6311","url":null,"abstract":"The incidence of bladder spasm in children with hypospadias treated with caudal block before surgery is uncommon. We presented a case of bladder spasm after urethroplasty surgery that was successfully treated with anisodamine without any sequelae. The caudal block plane may only reach the sacrum and does not reach the bladder wall. I suggest a local anesthetic drug dose of 1 ml/kg, totaling not more than 20 ml, to avoid the occurrence of postoperative bladder spasm and increase the comfort of children.","PeriodicalId":93523,"journal":{"name":"Asploro journal of biomedical and clinical case reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42129991","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-03DOI: 10.36502/2023/asjbccr.6310
Xinghui Xiong, Wei Wei
Serious anaphylactic reactions to anesthetics can be life-threatening events. Vecuronium is promoted as a neuromuscular blocking drug that is least likely to cause anaphylaxis due to its low histamine-releasing potential. Perioperative hypoxemia in patients with tetralogy of Fallot (TOF) due to anaphylactic reactions can be easily misdiagnosed as anoxic spells. We report a patient with TOF who suffered from symmetrical peripheral gangrene after undergoing catecholamine-refractory anaphylactic shock to vecuronium perioperatively. CPB (cardiopulmonary bypass) is the most effective support for severe anaphylactic shock during the perioperative period. Intradermal test screening for anaphylaxis to anesthetics is an effective method for prevention and diagnosis.
{"title":"Catecholamine-Refractory Anaphylactic Shock to Vecuronium in a Patient with Tetralogy of Fallot: A Case Report","authors":"Xinghui Xiong, Wei Wei","doi":"10.36502/2023/asjbccr.6310","DOIUrl":"https://doi.org/10.36502/2023/asjbccr.6310","url":null,"abstract":"Serious anaphylactic reactions to anesthetics can be life-threatening events. Vecuronium is promoted as a neuromuscular blocking drug that is least likely to cause anaphylaxis due to its low histamine-releasing potential. Perioperative hypoxemia in patients with tetralogy of Fallot (TOF) due to anaphylactic reactions can be easily misdiagnosed as anoxic spells. We report a patient with TOF who suffered from symmetrical peripheral gangrene after undergoing catecholamine-refractory anaphylactic shock to vecuronium perioperatively. CPB (cardiopulmonary bypass) is the most effective support for severe anaphylactic shock during the perioperative period. Intradermal test screening for anaphylaxis to anesthetics is an effective method for prevention and diagnosis.","PeriodicalId":93523,"journal":{"name":"Asploro journal of biomedical and clinical case reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45860315","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-01DOI: 10.36502/2023/asjbccr.6309
M. Kalambo, Toma S Omofoye, Ethan O. Cohen, J. Leung, T. Nghiem
Objective: Direct radiologist to patient communication has been linked to higher levels of patient satisfaction, compliance, and overall treatment outcomes. Recent studies examining patient expectations in breast imaging indicate that 90% of women prefer result communication and review of imaging directly from their radiologist. Though the primary components of diagnostic breast imaging are patient centered, supplemental data suggests that screening mammography result consultation may represent an additional opportunity for engagement in the new era of patient-experience driven care. The primary aim of our study was to examine patient preferences for receiving real time screening mammography result communication (RTRC) and characteristics that may influence their willingness to participate. Material and Methods: This quality-improvement based, IRB-approved, study was performed at three community-based academic breast radiology centers in a large metropolitan area between October 5, 2020, and January 2, 2021. Female patients presenting for screening mammography were invited to opt in for RTRC and/or participate in an electronic, HIPAA-compliant, simple survey that could be completed on the personal subject’s phone or tablet. Subjects opting in for RTRC were invited to wait in a consultation room during staff radiologist review. Once interpreted, the radiologist would discuss the results and next step recommendations with the patient. Self-reported patient demographic characteristics and RTRC preferences by age, race, ethnicity, level of education, household income, prior personal or family history of breast cancer, active (non-breast) cancer history and prior history of abnormal mammogram were assessed by categorical variable analysis using Chi-squared tests. A p-value <0.05 was determined to be statistically significant. Results: 1714 screening mammograms were performed across our three community-based breast imaging centers and 11% (186/1714) of women completed the survey during the study timeframe. White women (92%) were statistically more likely to opt in for RTRC when compared with non-white (80%) counterparts (p=.026). Patients with a personal history (p=0.001) or family history (p=0.006) of breast cancer were statistically more likely to opt in for RTRC when compared with other cohorts. A positive correlation was observed between prior history of abnormal mammogram and preference for receiving RTRC (93%) but did not achieve statistical significance (p=.082). There was no correlation observed between RTRC preference and an active (non-breast) cancer diagnosis (p=0.415). Conclusion: Our study confirms previous data suggesting that patients vastly prefer direct verbal communication ahead of written letter result notification. Our study also suggests that screening mammography RTRC may be of particular interest in patients with higher (personal or familial) risk for developing breast cancer. While this service may operationally add demand on ra
{"title":"What Women Want: Real Time Results for Screening Mammography in the Era of Value-Based Care | A Single Institution Experience During the COVID-19 SARS-COV2 Pandemic","authors":"M. Kalambo, Toma S Omofoye, Ethan O. Cohen, J. Leung, T. Nghiem","doi":"10.36502/2023/asjbccr.6309","DOIUrl":"https://doi.org/10.36502/2023/asjbccr.6309","url":null,"abstract":"Objective: Direct radiologist to patient communication has been linked to higher levels of patient satisfaction, compliance, and overall treatment outcomes. Recent studies examining patient expectations in breast imaging indicate that 90% of women prefer result communication and review of imaging directly from their radiologist. Though the primary components of diagnostic breast imaging are patient centered, supplemental data suggests that screening mammography result consultation may represent an additional opportunity for engagement in the new era of patient-experience driven care. The primary aim of our study was to examine patient preferences for receiving real time screening mammography result communication (RTRC) and characteristics that may influence their willingness to participate.\u0000Material and Methods: This quality-improvement based, IRB-approved, study was performed at three community-based academic breast radiology centers in a large metropolitan area between October 5, 2020, and January 2, 2021. Female patients presenting for screening mammography were invited to opt in for RTRC and/or participate in an electronic, HIPAA-compliant, simple survey that could be completed on the personal subject’s phone or tablet. Subjects opting in for RTRC were invited to wait in a consultation room during staff radiologist review. Once interpreted, the radiologist would discuss the results and next step recommendations with the patient. Self-reported patient demographic characteristics and RTRC preferences by age, race, ethnicity, level of education, household income, prior personal or family history of breast cancer, active (non-breast) cancer history and prior history of abnormal mammogram were assessed by categorical variable analysis using Chi-squared tests. A p-value <0.05 was determined to be statistically significant.\u0000Results: 1714 screening mammograms were performed across our three community-based breast imaging centers and 11% (186/1714) of women completed the survey during the study timeframe. White women (92%) were statistically more likely to opt in for RTRC when compared with non-white (80%) counterparts (p=.026). Patients with a personal history (p=0.001) or family history (p=0.006) of breast cancer were statistically more likely to opt in for RTRC when compared with other cohorts. A positive correlation was observed between prior history of abnormal mammogram and preference for receiving RTRC (93%) but did not achieve statistical significance (p=.082). There was no correlation observed between RTRC preference and an active (non-breast) cancer diagnosis (p=0.415).\u0000Conclusion: Our study confirms previous data suggesting that patients vastly prefer direct verbal communication ahead of written letter result notification. Our study also suggests that screening mammography RTRC may be of particular interest in patients with higher (personal or familial) risk for developing breast cancer. While this service may operationally add demand on ra","PeriodicalId":93523,"journal":{"name":"Asploro journal of biomedical and clinical case reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45506485","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-06-27DOI: 10.36502/2023/asjbccr.6308
X. Xiong
Postoperative recurrence and metastasis of papillary thyroid carcinoma (PTC) to the superior vena cava (SVC) and right atrium (RA) are rare. The application of Extracorporeal Jugular-femoral Vein Bypass and anesthesia management for SVC reconstruction in this rare situation holds instructive significance. In this case, we describe the successful anesthesia management of a patient with multiple tumor thrombi due to postoperative recurrence of PTC. The diagnosis was based on computed tomography of the chest and blood vessels, revealing three-dimensional SVC, postoperative recurrence of PTC, and multiple tumor thrombi in the internal jugular vein (IJV), subclavian vein, brachiocephalic vein, SVC, and RA. An experienced multidisciplinary team was established, and a detailed plan was made for respiration and circulation support, with cardiopulmonary bypass on standby.
{"title":"Anesthesia Management of a Patient with Papillary Thyroid Carcinoma Recurrence and Metastasis to the Right Atrium and Superior Vena Cava: A Case Report","authors":"X. Xiong","doi":"10.36502/2023/asjbccr.6308","DOIUrl":"https://doi.org/10.36502/2023/asjbccr.6308","url":null,"abstract":"Postoperative recurrence and metastasis of papillary thyroid carcinoma (PTC) to the superior vena cava (SVC) and right atrium (RA) are rare. The application of Extracorporeal Jugular-femoral Vein Bypass and anesthesia management for SVC reconstruction in this rare situation holds instructive significance. In this case, we describe the successful anesthesia management of a patient with multiple tumor thrombi due to postoperative recurrence of PTC. The diagnosis was based on computed tomography of the chest and blood vessels, revealing three-dimensional SVC, postoperative recurrence of PTC, and multiple tumor thrombi in the internal jugular vein (IJV), subclavian vein, brachiocephalic vein, SVC, and RA. An experienced multidisciplinary team was established, and a detailed plan was made for respiration and circulation support, with cardiopulmonary bypass on standby.","PeriodicalId":93523,"journal":{"name":"Asploro journal of biomedical and clinical case reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41871869","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-06-26DOI: 10.36502/2023/asjbccr.6307
V. Onama, Geoffrey Babughirana
Background: The humanitarian situation in Somalia is characterized by unstable government, insecurity, fragility, and limited investments in funding essential public services and maternal newborn and health services are not spared. The health system in Somalia remained under-resourced to meet the urgent lifesaving, essential, and preventive health services. This study sought to assess the access and utilization of maternal and newborn child health services in Somalia. Methodology: A cross-sectional design was used in this study. Descriptive and inferential statistical data analysis was conducted to establish the performance of indicators and relationships. The study targeted mothers of children 0-59 months. Results: The results show a low (13.1%) attendance of focused (4th visit) antenatal care among the mothers. 23.3% of the mothers from Somaliland attended at least three antenatal care visits, while the rest of the states only achieved less than 10%. At least 41.5% of the deliveries occurred at the health facility. Skilled attendants assisted 42.7% of the deliveries. No significant difference was observed in the number of women having an extra meal during pregnancy or delivery at the health facility or in predicting the number of ANC visits. Nonetheless, 43.2% of the infants in Somalia had not been exclusively breastfed for the first six months of life. The results equally demonstrated poor nutritional index with only 38.4% of the pregnant women having an extra meal during pregnancy. In Somalia, early health care seeking for common childhood illnesses is still low, with Respiratory Tract infections (RTIs) at 40%, malaria at 56.6%, and diarrhea at 63.4%. Conclusion and Recommendations: There is a need for deliberate efforts to improve low-performing indicators and hence improve the survival of mothers and children.
{"title":"Access and Utilization of Maternal Newborn and Child Health Services in the Fragile Context of Somalia","authors":"V. Onama, Geoffrey Babughirana","doi":"10.36502/2023/asjbccr.6307","DOIUrl":"https://doi.org/10.36502/2023/asjbccr.6307","url":null,"abstract":"Background: The humanitarian situation in Somalia is characterized by unstable government, insecurity, fragility, and limited investments in funding essential public services and maternal newborn and health services are not spared. The health system in Somalia remained under-resourced to meet the urgent lifesaving, essential, and preventive health services. This study sought to assess the access and utilization of maternal and newborn child health services in Somalia.\u0000Methodology: A cross-sectional design was used in this study. Descriptive and inferential statistical data analysis was conducted to establish the performance of indicators and relationships. The study targeted mothers of children 0-59 months.\u0000Results: The results show a low (13.1%) attendance of focused (4th visit) antenatal care among the mothers. 23.3% of the mothers from Somaliland attended at least three antenatal care visits, while the rest of the states only achieved less than 10%. At least 41.5% of the deliveries occurred at the health facility. Skilled attendants assisted 42.7% of the deliveries. No significant difference was observed in the number of women having an extra meal during pregnancy or delivery at the health facility or in predicting the number of ANC visits. Nonetheless, 43.2% of the infants in Somalia had not been exclusively breastfed for the first six months of life. The results equally demonstrated poor nutritional index with only 38.4% of the pregnant women having an extra meal during pregnancy. In Somalia, early health care seeking for common childhood illnesses is still low, with Respiratory Tract infections (RTIs) at 40%, malaria at 56.6%, and diarrhea at 63.4%.\u0000Conclusion and Recommendations: There is a need for deliberate efforts to improve low-performing indicators and hence improve the survival of mothers and children.","PeriodicalId":93523,"journal":{"name":"Asploro journal of biomedical and clinical case reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43318498","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-06-26DOI: 10.36502/2023/asjbccr.6306
Ashwin Sidhu, Harrison Chu
FMD is a rare systemic vascular disease characterized by abnormal cell proliferation in the artery walls, leading to artery narrowing, twisting, or bulging. It commonly affects the carotid and renal arteries and can result in renal diseases and stroke. This paper presents a case study of a 39-year-old unhoused female patient who experienced a stroke secondary to fibromuscular dysplasia (FMD) and left ventricular thrombus. The patient presented with asymmetric movement of the extremities and psychosis, so intoxication was initially suspected. However, further examination revealed facial asymmetry and motor weakness. CT scans showed a left anterior cerebral artery infarction and irregular contour of the cervical internal carotid arteries, consistent with FMD and carotid thrombus. Management involved stabilizing the patient, providing supportive treatment, and controlling blood pressure. Thrombolytic therapy was not administered due to the time elapsed since symptom onset. The patient was started on anticoagulation for the carotid plaque and left ventricular thrombus. A transthoracic echocardiogram revealed a large left ventricular thrombus and left atrial enlargement, and the patient was started on heart failure medications. FMD and left ventricular thrombus are not directly related, but FMD can contribute to thrombus development through its impact on the cardiovascular system, including hypertension, arterial wall damage, aneurysm development, or dissection. Treatment for FMD may involve medication, observation, or surgical interventions like angioplasty and stenting. Anticoagulation therapy is essential for managing the left ventricular thrombus. This case highlights the importance of early diagnosis and treatment of FMD to prevent complications such as stroke. It is important to consider FMD in the diagnosis of younger patients with a stroke, especially those with a history of hypertension, substance abuse, or other risk factors. Further research is needed to better understand the relationship between FMD and stroke and to optimize treatment strategies for these patients.
{"title":"Stroke Secondary to Fibromuscular Dysplasia","authors":"Ashwin Sidhu, Harrison Chu","doi":"10.36502/2023/asjbccr.6306","DOIUrl":"https://doi.org/10.36502/2023/asjbccr.6306","url":null,"abstract":"FMD is a rare systemic vascular disease characterized by abnormal cell proliferation in the artery walls, leading to artery narrowing, twisting, or bulging. It commonly affects the carotid and renal arteries and can result in renal diseases and stroke. This paper presents a case study of a 39-year-old unhoused female patient who experienced a stroke secondary to fibromuscular dysplasia (FMD) and left ventricular thrombus. The patient presented with asymmetric movement of the extremities and psychosis, so intoxication was initially suspected. However, further examination revealed facial asymmetry and motor weakness. CT scans showed a left anterior cerebral artery infarction and irregular contour of the cervical internal carotid arteries, consistent with FMD and carotid thrombus. Management involved stabilizing the patient, providing supportive treatment, and controlling blood pressure. Thrombolytic therapy was not administered due to the time elapsed since symptom onset. The patient was started on anticoagulation for the carotid plaque and left ventricular thrombus. A transthoracic echocardiogram revealed a large left ventricular thrombus and left atrial enlargement, and the patient was started on heart failure medications.\u0000\u0000FMD and left ventricular thrombus are not directly related, but FMD can contribute to thrombus development through its impact on the cardiovascular system, including hypertension, arterial wall damage, aneurysm development, or dissection. Treatment for FMD may involve medication, observation, or surgical interventions like angioplasty and stenting. Anticoagulation therapy is essential for managing the left ventricular thrombus.\u0000\u0000This case highlights the importance of early diagnosis and treatment of FMD to prevent complications such as stroke. It is important to consider FMD in the diagnosis of younger patients with a stroke, especially those with a history of hypertension, substance abuse, or other risk factors. Further research is needed to better understand the relationship between FMD and stroke and to optimize treatment strategies for these patients.","PeriodicalId":93523,"journal":{"name":"Asploro journal of biomedical and clinical case reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43531190","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-06-24DOI: 10.36502/2023/asjbccr.6305
H. Bando, Noboru Iwatsuki, M. Okada, T. Ogawa, K. Sakamoto
The case involves a 74-year-old male with type 2 diabetes (T2D), hypertension, dyslipidemia, and diabetic kidney disease (DKD) at nephropathy stage G3b. He has been receiving treatment with insulin and anti-hypertensive agents (AHAs). In July 2021, his HbA1c was elevated to 7.9%. As a result, the extent of his low carbohydrate diet (LCD) was increased, and insulin doses were raised. The AHAs were changed from Olmesartan to Valsartan/Amlodipine, and Irbesartan/Amlodipine until 2023. By January 2023, his HbA1c had decreased to 6.8%, and his eGFR (CKD-EPI) had remained stable at 34-48 mL/min/1.73/m2 for 4 years. A recent study demonstrated clinical improvement in renal function through continuous LCD in patients with DKD.
{"title":"Maintained Renal Function by Blood Pressure Control in Patient with Diabetic Kidney Disease (DKD)","authors":"H. Bando, Noboru Iwatsuki, M. Okada, T. Ogawa, K. Sakamoto","doi":"10.36502/2023/asjbccr.6305","DOIUrl":"https://doi.org/10.36502/2023/asjbccr.6305","url":null,"abstract":"The case involves a 74-year-old male with type 2 diabetes (T2D), hypertension, dyslipidemia, and diabetic kidney disease (DKD) at nephropathy stage G3b. He has been receiving treatment with insulin and anti-hypertensive agents (AHAs). In July 2021, his HbA1c was elevated to 7.9%. As a result, the extent of his low carbohydrate diet (LCD) was increased, and insulin doses were raised. The AHAs were changed from Olmesartan to Valsartan/Amlodipine, and Irbesartan/Amlodipine until 2023. By January 2023, his HbA1c had decreased to 6.8%, and his eGFR (CKD-EPI) had remained stable at 34-48 mL/min/1.73/m2 for 4 years. A recent study demonstrated clinical improvement in renal function through continuous LCD in patients with DKD.","PeriodicalId":93523,"journal":{"name":"Asploro journal of biomedical and clinical case reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44619416","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-06-13DOI: 10.36502/2023/asjbccr.6304
P. Sun
The perioperative management of pulmonary hypertension continues to be a great challenge for anesthesiologists. Among the various types of pulmonary hypertension, pulmonary hypertension associated with left heart disease is the most common, while pulmonary hypertensive crisis is one of the causes of perioperative mortality in these patients. We present the case of a 54-year-old female with severe valvular heart disease complicated by severe pulmonary hypertension and massive hemothorax, who underwent emergency exploratory thoracotomy, mitral valve replacement, and tricuspid valvuloplasty. The patient was in critical condition and suspected to have a pulmonary hypertension crisis. The rationale for this case report is to learn about the anesthetic management of patients with severe pulmonary hypertension.
{"title":"Anesthetic Management of an Unusual Case of Severe Pulmonary Hypertensive","authors":"P. Sun","doi":"10.36502/2023/asjbccr.6304","DOIUrl":"https://doi.org/10.36502/2023/asjbccr.6304","url":null,"abstract":"The perioperative management of pulmonary hypertension continues to be a great challenge for anesthesiologists. Among the various types of pulmonary hypertension, pulmonary hypertension associated with left heart disease is the most common, while pulmonary hypertensive crisis is one of the causes of perioperative mortality in these patients. We present the case of a 54-year-old female with severe valvular heart disease complicated by severe pulmonary hypertension and massive hemothorax, who underwent emergency exploratory thoracotomy, mitral valve replacement, and tricuspid valvuloplasty. The patient was in critical condition and suspected to have a pulmonary hypertension crisis. The rationale for this case report is to learn about the anesthetic management of patients with severe pulmonary hypertension.","PeriodicalId":93523,"journal":{"name":"Asploro journal of biomedical and clinical case reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43613951","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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