Cureus最新文献

Laparoscopic sleeve gastrectomy (LSG) is one of the most frequently performed bariatric procedures worldwide due to its efficacy in achieving significant and sustained weight loss. While generally safe, rare but life-threatening complications can occur. This case report describes a 54-year-old female who presented with acute left-sided abdominal pain and hemodynamic instability six months after an otherwise uneventful LSG. She was found to have a delayed spontaneous splenic rupture secondary to a chronic gastric staple line leak. Following urgent surgical intervention with splenectomy, the patient's condition initially improved but persistent abdominal collections and ongoing pain prompted further investigation, ultimately revealing a small staple line defect. Endoluminal vacuum therapy (EVT) and prolonged intravenous antibiotics were required. This case emphasizes the importance of maintaining a high index of suspicion for delayed postoperative complications such as chronic staple line leaks and their potential to precipitate rare events like spontaneous splenic rupture. Early recognition, prompt surgical intervention, and appropriate multidisciplinary management are critical in preventing catastrophic outcomes.

The trigeminal spinal tract nucleus receives primary afferent input from the orofacial region, serving as a relay between peripheral terminals and secondary neurons. The trigeminal nerve is divided into ophthalmic, maxillary, and mandibular. While it is known that primary afferent terminals synapse with secondary neurons, the interaction between different primary terminals remains unclear. Recent studies have shown that trigeminal neurons with lost input can be activated through electrical stimulation of other afferent terminals. Therefore, we examined the possibility of inducing neural activity using synaptic organizers to promote circuit reorganization. To assess the regeneration of the injured inferior alveolar nerve (third division of the trigeminal nerve), the potential involvement of input from the infraorbital nerve (second division of the trigeminal nerve) in the regeneration of the injured inferior alveolar nerve (third division of the trigeminal nerve) was investigated. Intact and injured groups were created for the second and third divisions to facilitate comparative analysis. A synapse organizer was applied to establish input between the primary afferent terminals of these divisions. This study aimed to determine if central connections between different terminals can activate trigeminal neurons with lost input, ultimately promoting peripheral nerve regeneration. In this research, male C57BL/6J mice (seven to nine weeks old) (total n=40) underwent transection of the inferior alveolar nerve. They were divided into three groups: intact (n=10), injured (saline control) (n=10), and synapse organizer (n=10). In addition, the mice were divided into two groups: one group underwent inferior alveolar nerve transection only (II, intact; III, injured, n=5), and the other group underwent transection of both the infraorbital and inferior alveolar nerves (II, injured; III, injured, n=5), followed by local administration of a synapse organizer. Regeneration was assessed using immunostaining, sensory tests, and retrograde tracing. Regeneration was confirmed by retrograde tracing and functional recovery of sensory thresholds in the skin of the mental region. These findings align with previous observations that infraorbital nerve transection reduced regeneration activity, suggesting that infraorbital input triggered regeneration in the mandibular nerve. Thus, the results propose a novel therapeutic approach where mandibular nerve injury can be treated by stimulating the infraorbital nerve immediately after injury, enhancing peripheral nerve regeneration.

Testicular tears, although uncommon, require early detection and control for symptom relief and, most importantly, organ salvage. Clinical examination of the scrotum cannot solely facilitate a valid diagnosis. Depending on the severity of the scrotal injury, treatment can be either conservative or surgical. Scrotal ultrasound is the preferred examination not only for the depiction and surveillance of testicular ruptures but also for guiding treatment planning. This case study describes the clinical assessment, imaging investigation, and management of an extensive testicular tear in a 14-year-old adolescent football athlete.

Neuroendocrine tumors (NETs) arising from the appendix are rare neoplasms but carry significant consequences if missed. These malignancies are typically diagnosed after an appendectomy via histopathological evaluation of the appendix. This aspect further solidifies surgery's place in the treatment of appendicitis. A 25-year-old female patient presented to the emergency department with a three-day history of right-sided abdominal pain associated with nausea and two episodes of non-bilious vomiting. Physical examination was initially benign but later showed tenderness to the right of the umbilicus. A CT scan revealed an inflamed appendix. Based on clinical and radiological findings, the diagnosis of acute appendicitis was made. The patient underwent a laparoscopic appendectomy. Histopathological analysis of the appendix was performed, identifying an appendiceal neuroendocrine tumor (aNET). Following the initial diagnosis, an appropriate workup was conducted, which included a colonoscopy, computed tomography (CT) scan, and further biopsies. Histopathological analysis of the appendix revealed a well-differentiated grade 1 NET, measuring 3.5 cm, with invasion into peri-appendiceal tissues. Further evaluation through a repeat CT scan and colonoscopy revealed inflammation in the rectum, cecum, and right colon. Furthermore, a subsequent laparoscopic right hemicolectomy was performed. Pathology of the hemicolectomy specimen revealed no residual NET, though lymph node involvement was present, with three out of 18 nodes testing positive for lymphatic spread. This case report highlights the diagnostic and management challenges associated with aNETs, emphasizing the importance of surgical intervention in the context of acute appendicitis. The discovery of aNETs can significantly alter the clinical management course, as it did for this patient, who required further surgical intervention and ongoing surveillance. The timely identification and removal of the tumor likely improved the patient's prognosis.

Shared psychotic disorder (SPD), also called folie à deux, is an uncommon clinical entity characterized by the transmission of delusions from one psychotic individual to another within the framework of a close relationship, typically isolated from the social environment. Although rare, this phenomenon poses a significant diagnostic and therapeutic challenge, particularly in family settings. This report presents a clinical case of folie à deux between a mother and her child, highlighting the complexities of therapeutic management and providing a succinct review of the literature to adequately frame the clinical approach. The report illustrates the need for a comprehensive therapeutic intervention involving both the management of the underlying psychotic disorder and the dissolution of pathological family dynamics that perpetuate shared delusions. Additionally, the importance of a multidisciplinary approach is emphasized, as shared delusions can involve multiple members of a nuclear family, increasing the risk of negative consequences at both individual and social levels.

Nosocomial infections are increasingly problematic due to growing bacterial resistance. Biofilms play a key role in the persistence of these infections, leading to treatment failures and poor patient outcomes. Addressing antibiotic resistance within biofilms is especially critical in hospitals, making it essential to develop new strategies to manage biofilm-related infections and curb bacterial resistance. The study, conducted at the regional hospital center in Agadir, Morocco, analyzed 75 bacteria (37 antibiotic-sensitive and 38 resistant). Seven bacteria were isolated from catheters, and others from preserved samples. Biofilm formation was assessed using the tissue culture plate (TCP) method, involving strain recovery; culture on cystine, lactose, electrolyte-deficient (CLED) medium; microplate inoculation; staining with crystal violet; and optical density (OD) measurement. The results showed that 77.33% of the bacteria formed biofilms. All catheter-isolated bacteria showed biofilm formation. Strong biofilm production was observed in 66.67% of Acinetobacter baumannii and in most Pseudomonas aeruginosa strains. Enterobacteriaceae also demonstrated significant biofilm formation. Notably, 70% of carbapenem-resistant bacteria showed strong biofilm production. Most nosocomial bacteria form biofilms, with a higher prevalence in antibiotic-resistant strains. Sensitive bacteria also form biofilms but less frequently. Bacterial conjugation may facilitate the acquisition of carbapenem resistance within biofilms.

Hikikomori, first identified in Japan, refers to individuals who withdraw from society and confine themselves to their homes, often remaining isolated in their bedrooms. Those affected typically disengage from education, employment, and daily activities, leading to significant functional impairment. While initially considered a culture-bound syndrome, growing evidence in recent decades suggests that hikikomori is a global phenomenon. Individuals with this condition often come into contact with healthcare systems through legal interventions. Here, we present two cases of Portuguese males with hikikomori syndrome who have committed sexual crimes.

Colonic diverticular bleeding is a leading cause of lower gastrointestinal bleeding, accounting for the increasing hospitalization rate in Japan. Although over-the-scope clips (OTSCs) have demonstrated favorable outcomes as an initial hemostatic method, their effectiveness as a rescue therapy after rebleeding from primary endoscopic hemostasis remains unclear. This study describes four patients with colonic diverticular bleeding who underwent an OTSC procedure after rebleeding from primary endoscopic hemostasis using standard methods. Immediate hemostasis was achieved in all cases; however, three patients experienced rebleeding during hospitalization, requiring interventional radiology or surgical intervention. Although immediate hemostasis can be achieved using OTSCs in cases of rebleeding after primary endoscopic hemostasis, their effectiveness in reducing short-term rebleeding might be limited. Further large-scale studies are warranted to evaluate OTSC efficacy in managing colonic diverticular bleeding after rebleeding from primary endoscopic hemostasis.

Introduction Third molar impaction surgeries are part of the most common minor oral surgeries performed by maxillofacial surgeons. In spite of being part of the everyday evaluation, the importance of preoperative planning and intraoperative and postoperative complications cannot be overlooked. This study aims to evaluate the prevalence, patterns, available eruption space, and impact of third molar impaction on the adjacent second molar in an adult population. Methods A retrospective observational cross-sectional study was conducted over a total of 380 panoramic radiographs from patients aged 18-65 years, which was analyzed to assess the incidence, angulation, and space available for the eruption of impacted third molars and their effects on the adjacent second molars. Orthopantomograms (OPGs) from January 2023 to December 2023 were included in the study. A total of 1280 third molars from 380 OPGs were studied encompassing an extensive range of demographics. Results The results showed that 54.7% (208/380) of the studied population had at least one impacted third molar, with a higher prevalence in the mandibular arch. Vertical impaction was the most common pattern (224/419, 53.46%), followed by mesioangular (92/419, 21.95%), horizontal (85/419, 20.28%), and distoangular (18/419, 4.29%) impactions. Notably, the study found a relevant association between impacted third molars and the development of distal caries in the adjacent second molar (76/419, 18.13%). These findings highlight the importance of early radiographic evaluation of impacted third molars to prevent potential damage to adjacent teeth and inform clinical decisions regarding the management of such cases. The study also highlights that there is a significant amount of third molar impaction seen in women (211/380, 55.52%) compared to men, and the age group range with the highest incidence of third molar impaction is 18-25 years (399/1280, 31.20%). Additionally, a significant number of mandibular impacted third molars present with some level of nerve involvement, whereas more than 80% of maxillary impacted third molars showed sinus approximation. This study also presents a novel concept of "eruption space ratio," which is the ratioof the mesiodistal width of the crown of the third molar to the space available posterior to the second molar for eruption. When it was compared to the angulation, a substantial link was seen, although none was seen in relation to the level of impaction. Conclusion This study underlines the need for proactive dental care in populations with a high prevalence of third molar impaction, aiming to mitigate the risks to the adjacent second molars and to eliminate possible postoperative complications through timely intervention.