Cureus最新文献

Graves' disease, caused by autoimmune thyrotropin receptor antibody-mediated activation of the thyroid, is characterized by hyperthyroidism, orbitopathy, dermopathy, and acropachy. Graves' disease is treated by anti-thyroid drug therapy, radioactive iodine ablation, or total thyroidectomy. We report the case of a 39-year-old female patient with hyperthyroidism secondary to Graves' disease that was managed through lifestyle interventions only. On presentation, she reported intermittent headaches and had an undetectable thyroid-stimulating hormone (TSH) level. Two weeks later, repeat testing showed an undetectable TSH, free thyroxine (free T4) 2.7 ng/dL (normal range: 0.70-1.48 ng/dL), total triiodothyronine (T3) 5.08 ng/mL (normal range: 0.40-1.93 ng/mL), thyrotropin receptor antibody (TRAb) 20.3 IU/L (reference range: ≤1.75 IU/L), thyroid stimulating immunoglobulin (TSI) 2.3 IU/L (reference range: ≤0.54 IU/L), thyroid peroxidase antibody (TPO) 7.66 IU/mL (reference range: <5.61 IU/mL), confirming hyperthyroidism due to Graves' disease. An iodine-123 (I-123) thyroid uptake and scan showed homogeneously increased iodine uptake (68%) at 4 hours (normal range: 3-16%) and (60%) 24 hours (normal range: 8-25%). The patient was prescribed anti-thyroid drug therapy through methimazole but elected not to take it due to concerns about side effects. She incorporated lifestyle interventions and, over a span of three months, was able to improve clinically and biochemically (TSH: 0.824 mcIU/mL, free T4: 0.77 ng/dL, total T3: 0.73 ng/mL, TRAb: 2.93 IU/L, TSI: 0.26 IU/L, and TPO antibody: undetectable). The lifestyle interventions she pursued included going dairy and gluten-free, ingestion of one to two Brazil nuts daily, regular exercise, mindfulness-based stress management, and cold-water immersion therapy. We review the evidence behind these interventions and discuss the utility of these measures in the management of Graves' disease.

Primary intrarenal neuroblastoma is an exceedingly rare entity that often mimics Wilms tumor in clinical and radiologic presentation, making prompt differentiation crucial given their divergent treatment pathways and prognostic implications. We present the case of a four-month-old male infant incidentally discovered to have a right-sided abdominal mass. Imaging suggested a renal malignancy, most likely Wilms tumor, but urgent surgical intervention was required due to intralesional bleeding and a precipitous drop in hemoglobin. Elevated urine catecholamine metabolites (homovanillic acid and vanillylmandelic acid) were subsequently detected, but only after the decision for surgery. Intraoperatively, the mass was confirmed to arise from the renal parenchyma rather than the adrenal gland. Pathologic examination revealed sheets of small round blue cells positive for chromogranin, synaptophysin, and cluster of differentiation 56, establishing the diagnosis of neuroblastoma. Four lymph nodes were positive for metastatic involvement, but there was no amplification of the MYCN oncogene. Postoperative urinary catecholamine metabolite levels normalized, and follow-up imaging demonstrated no residual disease at ten months. This case highlights the importance of considering primary intrarenal neuroblastoma in the differential diagnosis of pediatric renal masses and underscores the need for comprehensive imaging and laboratory evaluation to guide appropriate surgical management and postoperative surveillance.

Acute colonic pseudo-obstruction, also known as Ogilvie's syndrome, is a rare but critical cause of abdominal pain and distension, potentially mimicking mechanical obstruction or toxic megacolon. Patients with sickle cell disease (SCD) have additional risk factors such as vaso-occlusive crises, chronic hemolysis, and susceptibility to infections, which further complicate diagnosis. We report the case of a 14-year-old male patient with SCD who presented with severe generalized abdominal pain, vomiting, and progressive distension with no fever. Imaging revealed significant colonic dilation and pneumatosis, suggesting pseudo-obstruction or ischemic bowel. Infectious evaluations ultimately identified enteropathogenic Escherichia coli. Despite initial concern for toxic megacolon, a multidisciplinary evaluation by hematology, gastroenterology, infectious disease, and surgery confirmed acute colonic pseudo-obstruction associated with enterocolitis. The patient's condition was managed nonoperatively with nasogastric decompression, intravenous antibiotics, total parenteral nutrition, and prokinetic agents. Serial imaging demonstrated gradual improvement in colonic distension, facilitating a safe return to oral feeding and subsequent discharge. This case underscores the importance of early recognition of enterocolitis-associated colonic pseudo-obstruction in patients with SCD, highlighting the value of comprehensive infection screening and a careful, multidisciplinary management approach to avoid unnecessary surgery and improve outcomes.

We aimed to assess the emotional, psychological, and social factors affecting women's health today, focusing on their impact on overall well-being and the extent to which these nonphysical determinants influence health outcomes. This review will synthesize findings from in-depth interviews, focus group discussions, and narrative analysis to provide insight into women's experiences and perceptions of their health, including emotional, psychological, and social challenges in Saudi Arabia. This qualitative review will utilize a rigorous, iterative search across PubMed/MEDLINE, Scopus, PsycINFO, and Web of Science from 2000 to 2023, supplemented by grey literature searches via Google Scholar and relevant organizational websites, to identify studies employing in-depth interviews, focus groups, or narrative analysis, focusing on qualitative studies examining women's health across various ages, backgrounds, and socioeconomic statuses. Two independent reviewers will screen studies, resolve discrepancies via discussion or a third reviewer, and critically appraise study quality using the CASP Qualitative Checklist to ensure the credibility and trustworthiness of the synthesized findings. Data extraction will be structured to capture rich, descriptive data related to women's experiences and perceptions, and NVivo software will support thematic synthesis, with a reflective journal maintained throughout the process to ensure transparency and acknowledge potential researcher biases. A narrative synthesis will be included to show the relationships between the developed themes, and how they relate to the women participating in the various studies. The qualitative review revealed that women's health is profoundly influenced by a complex interplay of emotional, psychological, and social factors. The analysis identified six key themes: (1) societal expectations and gender roles, (2) access to healthcare and resources, (3) emotional well-being and mental health, (4) social support networks and relationships, (5) cultural and environmental factors, and (6) empowerment and autonomy. The findings highlighted the significance of addressing these factors to improve women's health outcomes, emphasizing the need for holistic and culturally sensitive approaches to healthcare that prioritize women's emotional, psychological, and social well-being. The findings highlight the need for integrated healthcare strategies addressing these dimensions, promoting mental health awareness, and providing support systems to enhance overall well-being. Better women's health outcome requires education and policy-level interventions in diverse settings.

Pneumomediastinum is the abnormal presence of air in the mediastinum. It is typically classified into two types: spontaneous (occurring without any underlying lung disease) and secondary (resulting from various conditions, including trauma). The most common clinical symptoms include retrosternal chest pain, difficulty breathing, subcutaneous emphysema in the neck or chest, and, in some cases, Hamman's sign, which involves crackles that occur in sync with the heartbeat. This study has two main objectives: first, to assess whether there is consistency between the definition of spontaneous pneumomediastinum presented by the authors and the description provided in their articles, and second, to evaluate whether the classification of spontaneous pneumomediastinum aligns with its definition. We conducted a literature search using PubMed, Google Scholar, and the Springer Journal Archive databases.

Objective The aim of this study is to examine whether the length of the proximal diaphyseal screws of volar locking plates used in distal radius fractures affects the clinical outcomes. Material and methods The study included patients who were over 18 years of age and underwent volar locking plate application due to distal radius fracture with a minimum follow-up period of 12 months. Demographic data, Quick Disabilities of the Arm, Shoulder, and Hand (QDASH), grip strength, range of motion, and extensor tendon irritations were evaluated in patients. The prominence of the proximal cortical screws of the plates from the dorsal cortex was measured (in mm) on the lateral radiographs of the patients. Results The median follow-up time of the 73 patients in our study was 17 (14-26) months. The median age of the patients was 51 (44-58) years. Extensor tenosynovitis was detected in 22 patients due to proximal screw length. Proximal screw prominence over 1.2 mm was found to be statistically significant for extensor synovitis (p<0.05). Range of motion, radiological measurements, grip strength, QDASH, and other demographic data had no association with extensor tenosynovitis. Conclusion In the surgical treatment of distal radius fractures, dorsal cortex protrusion of proximal cortical screws of volar locking plates more than 1.2 mm plays a role in postoperative patient dissatisfaction.

Complement factor I (CFI) deficiency is a rare primary immunodeficiency that disrupts the classical and alternative complement pathways, potentially causing severe recurrent infections and autoimmune manifestations in pediatric patients. However, the coexistence of both pathways in a pediatric patient is extremely uncommon. We report a seven-year-old patient with a rare primary immunodeficiency disorder who presented with recurrent middle ear infections, paronychia, gastrointestinal infections, and respiratory infections. Genetic testing revealed a previously unreported homozygous variant in the CFI gene (c.848A>G; p.D283G). Immunological testing showed a decrease in complement C3, CFI, and CFH levels in the patient. Interestingly, the patient presented with IgA vasculitis, with renal pathology showing deposits of immune complexes containing IgA, IgG, IgM, and C1q. By considering the child's condition and genetic test results, the child was treated symptomatically and received regular peritoneal dialysis treatment. Subsequently, the child's condition improved compared to before and was discharged from the hospital. This case highlights the importance of considering CFI deficiency in children with recurrent infections and abnormalities in both the classical and alternative complement pathways. Our findings expand the known phenotypic spectrum of CFI deficiency and contribute to understanding genotype-phenotype correlations in complement disorders.

Adaptive four-dimensional (4D) spiral computed tomography (CT) scans facilitate the acquisition of volume perfusion data for organs or long-range vessels; however, optimizing image quality and reducing noise while minimizing radiation doses remains challenging. Thus, image-processing techniques such as temporal maximum intensity projection (MIP) and average intensity projection (AIP) are crucial in this context. This ex vivo study aimed to compare the image noise, spatial resolution, and measurements of temporal MIP and AIP images generated from low radiation dose 4D CT scans data with those of conventional CT images using phantoms. Three phantoms were scanned with equivalent radiation doses using single helical and adaptive 10-phase 4D spiral scans using a third-generation dual-source CT scanner. Temporal MIP and AIP images of 4D CT scans were generated by summing varying numbers of phases, incorporating automatic motion correction with non-rigid registration and noise reduction algorithm. The CT values and image noise of the temporal MIP and AIP images were compared to conventional CT images. The task transfer function (TTF) was calculated using static phantoms. Vessel diameters of the phantoms for each image dataset were evaluated using motion phantoms. Temporal AIP images showed comparable CT values with those of the reference image. In contrast, the CT values of the temporal MIP images were significantly higher than those of the reference images (p<0.01). The image noise of temporal AIP images with six or more phases was equal to or lower than that of the reference images. In contrast, temporal MIP images exhibited consistently high noise levels regardless of the number of summed phases. The TTF of temporal AIP images was comparable to that of the reference CT images. However, the TTF of temporal MIP images gradually decreased as the number of summed phases increased. No significant differences were observed in vessel diameter measurements among the three groups or with varying numbers of summed phases (p>0.05). In conclusion, temporal MIP and AIP images generated from low radiation dose 4D CT scans could effectively reduce noise while preserving measurement reliability in the motion phantom, achieving performance comparable to conventional CT images.

Hyperkalemia is a life-threatening condition if not treated urgently. However, certain conditions can cause pseudohyperkalemia and the treating physician must be able to distinguish between the two to prevent complications of overtreatment that can lead to hypokalemia, itself a life-threatening condition. One of the causes of pseudohyperkalemia is thrombocytosis. Here we present three cases of pseudohyperkalemia secondary to reactive thrombocytosis in cancer (solid malignancy) patients. This case series emphasizes the importance of recognizing pseudohyperkalemia from a physician's perspective to avoid inadvertent treatment.

Background: Minimally invasive mitral valve surgery (MiMVS), particularly via right mini-thoracotomy, has gained popularity as an alternative to median sternotomy, potentially reducing surgical trauma and recovery time. However, recent data on its surgical outcomes remain limited. To provide updated insights while minimizing selection bias, we analyzed elective patients undergoing mitral valve surgery, comparing MiMVS and sternotomy in terms of survival, operative times, and perioperative complications.

Methods: We conducted a single-center retrospective cohort study that included patients who underwent mitral valve surgery between 2015 and 2024. Patients were stratified into MiMVS or sternotomy groups. Kaplan-Meier survival curves and log-rank tests assessed survival, while propensity score matching (PSM) minimized selection bias.

Results: Among 422 patients (319 MiMVS, 103 sternotomy), the MiMVS group had a shorter hospital stay (5.0 vs. 8.0 days, p < 0.01) and lower postoperative bleeding (3.9% vs. 9%). Median cross-clamp and cardiopulmonary bypass (CPB) times were shorter in MiMVS (76 vs. 94 min, p < 0.01; and 114 vs. 140 min, p < 0.01, respectively). Survival analysis showed no significant difference between groups (log-rank p = 0.07) after PSM. The adjusted hazard ratio for mortality in MiMVS versus sternotomy was 0.30 (95% CI: 0.08-1.12, p = 0.07). However, mitral replacement was associated with a significantly higher mortality risk than mitral repair (HR 5.22, 95% CI: 1.26-21.61, p = 0.04). In-hospital mortality was comparable (1.9% for sternotomy vs. 0.6% for MiMVS, p = 0.25). Reoperation rates at five and 10 years were lower in MiMVS (1.7% vs. 2.1% at five years and 1.7% vs. 3.2% at 10 years).

Conclusions: While MiMVS offers advantages such as shorter hospital stays and lower postoperative bleeding rates, no statistically significant difference in overall survival was found compared to sternotomy. However, a trend toward improved survival with MiMVS was observed. Notably, mitral valve replacement was associated with a significantly higher mortality risk than mitral repair, emphasizing the importance of prioritizing repair whenever feasible.