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Frantz tumor, or solid pseudopapillary neoplasm (SPN), is a rare pancreatic tumor of low malignant potential that predominantly affects young women. Its clinical presentation is often nonspecific, and the differential diagnosis from other cystic pancreatic lesions, such as pseudocysts, represents a significant challenge. We report the case of a 31-year-old previously healthy woman who presented with abdominal pain, initially diagnosed and treated as an infected pancreatic pseudocyst. Following the initial surgical intervention and antibiotic therapy, the persistence of imaging findings and subsequent histopathological results led to the definitive diagnosis of a Frantz tumor. The patient subsequently underwent a curative-intent pancreatoduodenectomy. This case highlights the difficulty in distinguishing cystic pancreatic lesions. The patient's initial presentation, with a large fluid collection, gas foci, and elevated inflammatory markers, strongly suggested an infectious process, such as a complicated pseudocyst. Only histopathological examination of the surgical specimen enabled the correct diagnosis of the underlying neoplasm. SPN may show cystic and hemorrhagic degeneration, mimicking other lesions. Frantz tumor should be considered in the differential diagnosis of cystic pancreatic lesions in young women, even when the initial presentation suggests an inflammatory or infectious process. Histopathological confirmation is essential for proper management, which consists of complete surgical resection and is associated with an excellent prognosis.

In frontalis muscle suspension surgery for treating congenital ptosis, the use of expanded polytetrafluoroethylene (ePTFE) sheets often yields stable postoperative outcomes; however, it also carries the risks of foreign body reactions and infection, with few reports describing the detailed course of treatment in such cases. A 15-year-old girl was referred for management of right congenital ptosis. Preoperative margin reflex distance-1 (MRD-1) measurements were 1.5 mm on the right and 4.5 mm on the left, with corresponding levator function of 5 mm and 14 mm on the right and left, respectively. Levator advancement was considered insufficient to correct the asymmetry; therefore, a frontalis muscle suspension using an ePTFE sheet was planned. After positioning the sheet and forming double eyelids, MRD-1 was confirmed to be symmetrical bilaterally (4.5 mm), the curvature was appropriate, and the incision was closed. At the two-week postoperative suture removal, a small portion of the ePTFE sheet was visible through a gap in the wound at the eyelid margin; therefore, it was trimmed, and wound closure was subsequently confirmed. Six weeks after surgery, the patient presented with fever, eyelid redness, and pain. Infection was noted at the eyelid margin wound site; therefore, the ePTFE sheet was removed, followed by wound irrigation. After prompt ePTFE sheet removal, adequate eyelid elevation and curvature were equivalent to those prior to sheet removal, making this protocol a viable treatment option for similar cases.

Thymic neuroendocrine neoplasms (tNENs) are rare anterior mediastinal tumors with aggressive behavior and can be misdiagnosed as type A thymoma on small biopsies or intraoperative frozen sections, although accurate distinction is critical for prognosis and management. Type A thymoma, while generally considered a low-grade malignant tumor with a favorable prognosis, comprises a small subset that exhibits aggressive features and develops distant metastases after surgical resection; these tumors are classified as atypical type A thymomas. A 72-year-old woman had a history of resected atypical type A thymoma two years earlier. Surveillance computed tomography revealed a 15-mm mediastinal nodule located anterior to the superior vena cava with intense fluorodeoxyglucose uptake on positron emission tomography-computed tomography. Frozen sections showed a proliferation of small- to medium-sized polygonal and short spindle cells arranged in solid nests and trabeculae without a lymphocyte-rich background, and were interpreted as recurrent atypical type A thymoma. In contrast, imprint cytology demonstrated monomorphic small- to medium-sized tumor cells with round to oval nuclei, finely granular "salt-and-pepper" chromatin, inconspicuous nucleoli, loose cohesion, and scattered rosette-like structures, strongly suggesting a tNEN. Permanent sections revealed nests, trabeculae, and rosettes of small- to medium-sized polygonal cells with granular chromatin and approximately four mitoses per 10 high-power fields, without large confluent necrosis. Immunohistochemistry showed diffuse positivity for CD56, chromogranin A, synaptophysin, and insulinoma-associated protein 1; a Ki-67 index of about 20%; negativity for CD5, CD117 (c-KIT), p63 (TP63), CK5/6, and CD20; and the absence of TdT/CD99-positive immature T cells, supporting a diagnosis of thymic atypical carcinoid. This case highlights the complementary value of imprint cytology and an appropriate immunohistochemical panel, in addition to frozen sections, in avoiding misclassification of tNENs as type A thymoma.

Attention-Deficit/Hyperactivity Disorder (ADHD) is one of the most prevalent neurobehavioral disorders in childhood. Although its pathophysiology is not fully understood, growing interest has focused on potentially modifiable factors, including iron metabolism. Serum ferritin, a marker of peripheral iron status, has been widely investigated in relation to ADHD due to iron's role in dopamine synthesis and neurodevelopment. This narrative evidence-based review aims to critically synthesize and interpret current clinical and mechanistic evidence regarding the association between serum ferritin levels and the pathophysiology of ADHD in the pediatric population. A literature search was conducted using PubMed and reference lists of relevant articles to identify studies published in the last decade that evaluated serum ferritin in children with ADHD. The available evidence included a limited number of clinical trials, systematic reviews, and one meta-analysis, with heterogeneous methodologies and outcomes. While some studies reported lower serum ferritin levels in children with ADHD and associations with symptom severity, others did not confirm these findings. Overall, current evidence is inconsistent and insufficient to support a definitive association between low serum ferritin levels and ADHD pathophysiology or to recommend routine ferritin assessment in clinical practice. Further well-designed, longitudinal studies are needed to clarify the role of iron status in ADHD and its potential clinical implications.

Pulmonary embolism (PE) remains a leading cause of sudden hemodynamic deterioration and death in emergency department patients. Although diagnostic algorithms frequently incorporate D-dimer testing, in patients with high clinical probability or hemodynamic instability, definitive imaging should not be delayed. We report a case of a 74-year-old man presenting with syncope, hypoxemia, and hypotension, in whom immediate computed tomography pulmonary angiography (CTPA) was performed without prior D-dimer testing due to strong clinical suspicion of high-risk PE. Imaging revealed extensive bilateral pulmonary emboli with radiological signs of right ventricular strain, which were subsequently supported by point-of-care echocardiography. Due to recent head trauma, systemic thrombolysis was contraindicated, and the patient was referred for urgent mechanical thrombectomy. This case highlights the importance of clinical judgment and early imaging in high-risk PE and emphasizes that laboratory testing should not delay life-saving diagnostic and therapeutic decisions in unstable patients.

Chronic arterial ulcers are associated with impaired healing and a high risk of infectious complications and limb loss. Bullous cellulitis represents a severe soft-tissue infection phenotype that may progress to extensive tissue necrosis. We report an 83-year-old woman with advanced atherosclerotic disease and a prior contralateral transfemoral amputation who developed bullous cellulitis complicating a long-standing circumferential distal lower-leg arterial ulcer, resulting in complete circumferential loss of skin and subcutaneous tissue with exposure of deep structures. After infection stabilization, the wound was managed with staged mechanical and chemical debridement, negative pressure wound therapy (NPWT) for wound-bed optimization, and definitive split-thickness skin grafting under NPWT bolster. Complete graft take was achieved without early complications. Limb salvage preserved the patient's mobility and quality of life, avoiding the functional consequences of bilateral major limb loss. The key novelty of this case is that even circumferential ischemic-infective necrosis, often presumed to mandate amputation, can be rendered graftable and salvaged through a strictly staged, NPWT-centered reconstructive strategy.

Background Volar locking plate fixation has become the preferred operative treatment for unstable distal radius fractures because it allows stable fixation and early mobilization. However, long-term clinical outcomes and early complications in Asian populations treated in routine practice remain less well documented. Methods This retrospective cohort study included 40 consecutive adult patients with unstable distal radius fractures treated with volar locking plates by a single hand and wrist surgeon at a university hospital between January 2012 and December 2021. Patients met predefined radiographic criteria for instability and were followed for at least two years. Radiographic parameters (radial inclination, palmar tilt, and ulnar variance) were assessed preoperatively, immediately after surgery, at three months, and at ≥2 years. Wrist range of motion, grip strength, Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH), Patient-Rated Wrist Evaluation (PRWE), and pain visual analog scale (VAS) scores were recorded preoperatively, at two weeks, three months, and at ≥2 years. Early complications within three months (carpal tunnel syndrome, median nerve palmar branch injury, and extensor pollicis longus rupture) were retrieved from medical records. Paired t-tests were used to compare changes over time. Results A total of 40 patients were included (mean age, 55.4 years), of whom 26 (65.0%) were women. Radiographic alignment improved after fixation and was maintained at ≥2 years. Patient-reported outcomes (QuickDASH and PRWE), pain, range of motion, and grip strength improved progressively, with minimal disability and pain at long-term follow-up. Early symptoms consistent with carpal tunnel syndrome occurred in seven (17.5%) patients; no median nerve palmar branch injury, extensor pollicis longus rupture, or flexor pollicis longus rupture was identified. Conclusions In this single-surgeon retrospective cohort with a minimum two-year follow-up, volar locking plate fixation for unstable distal radius fractures achieved durable restoration of radiographic alignment and progressive improvement in wrist-related pain and function. Patient-reported outcomes, range of motion, and grip strength improved over time, and major complications were uncommon; early symptoms consistent with carpal tunnel syndrome occurred in seven (17.5%) patients, and no extensor pollicis longus or flexor pollicis longus rupture was identified. Overall, these findings support volar locking plate fixation as a reliable treatment option for unstable distal radius fractures in routine clinical practice.

We report the case of a 15-day-old neonate presenting with multifocal osteoarticular infection, initially manifesting as septic arthritis of the right wrist, which rapidly progressed to involve multiple sites, including the right deltoid and left hip. The etiological agent was identified as methicillin-sensitive Staphylococcus aureus (MSSA). This case is notable for its multifocality, the severity of the clinical course in the neonatal period, and the association with a prior history of neonatal admission for severe hypernatremic dehydration.

Pulmonary nodules with increased metabolic activity on positron emission tomography (PET) are frequently presumed malignant; however, inflammatory and rare benign neoplastic processes may produce false-positive findings. A 61-year-old African American male with a history of calcified and non-calcified pulmonary nodules and severe emphysema was referred to our pulmonary nodule clinic from the emergency department after a newly discovered lung nodule was identified on computed tomography (CT) of the chest. Subsequent evaluation demonstrated metabolic activity on PET, raising concern for malignancy; however, tissue diagnosis revealed organizing pneumonia. This case highlights diagnostic pitfalls associated with commonly used imaging and biomarker modalities in the evaluation of pulmonary nodules and emphasizes the importance of clinical awareness of a rare tumor, granular cell tumor (GCT), among physicians who may be unfamiliar with or have never encountered this condition.

The most influential timing of continuous renal replacement therapy (CRRT) in gravely ill patients with acutely severe, uncompensated renal dysfunction continues to be a subject of ongoing debate. Although earlier initiation has been hypothesized to limit metabolic disturbances and prevent downstream organ dysfunction, clinical trials have yielded inconsistent findings, in part because of variability in how "early" initiation is defined across studies. This meta-analysis, in conjunction with a systematic review, sought to examine the correlation between early versus delayed CRRT initiation and mortality, with analyses stratified according to initiation strategy, including clinical staging-based benchmark by Kidney Disease: Improving Global Outcomes (KDIGO) and biomarker-driven approaches using neutrophil gelatinase-associated lipocalin (NGAL). A literature search was conducted in PubMed, EMBASE, and the Cochrane Library to identify studies published between January 2015 and June 2025. Eligible studies included randomized controlled trials and observational investigations that compared early and delayed CRRT initiation among critically ill adults with acute kidney injury (AKI). The primary outcome of interest was all-cause mortality measured between 28 and 90 days or at the time of intensive care unit (ICU) discharge. Pooled relative risks (RR) and odds ratios (OR) were estimated using random-effects meta-analytic models, with subgroup analyses performed according to initiation criteria. Nine studies encompassing 2,349 patients were included (six randomized trials and three observational studies). Overall, early CRRT initiation was not associated with a statistically significant decrease in mortality compared with delayed initiation (risk ratio (RR) = 0.87; 95% confidence interval (CI), 0.69-1.10; p = 0.25; I² = 90.4%). Subgroup analysis demonstrated no significant mortality benefit with biomarker-guided (NGAL-based) early initiation (RR = 0.90; 95% CI, 0.41-2.01), whereas KDIGO-based initiation showed a borderline association favoring early therapy (RR = 0.75; 95% CI, 0.57-0.99), though heterogeneity remained substantial. No meaningful interaction was observed between initiation strategy and mortality.