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Pancreaticopleural fistula: Case report and review of the literature. 胰胸膜瘘:病例报告及文献复习。
Pub Date : 2024-11-28 DOI: 10.1016/j.amjms.2024.11.014
Abhinav K Rao, Levi Diggins, Brett Van-Leer Greenberg, James Ravenel, Don C Rockey

A pancreatic fistula is defined as the leakage of pancreatic fluid into another organ or compartment because of pancreatic duct disruption or pseudocyst formation. It is most often seen in middle-aged men between 40 and 50, particularly in patients who have a history of chronic alcoholism and pancreatitis. The tract may fistulae into the pleura, creating a pancreaticopleural fistula, an exceedingly rare condition presenting as a recurrent pleural effusion and extremely high amylase levels, a key distinguishing factor in diagnosis. Here, we present such a case of a recurrent pancreaticopleural fistula and review the presentation, pathophysiology, diagnosis and treatment.

胰瘘的定义是由于胰管破裂或假性囊肿形成而导致的胰液渗漏到另一器官或隔室。最常见于40至50岁的中年男性,特别是有慢性酒精中毒和胰腺炎病史的患者。该导管可瘘入胸膜,形成胰胸膜瘘,这是一种极其罕见的疾病,表现为反复胸腔积液和极高的淀粉酶水平,这是诊断的关键区分因素。在此,我们报告一例复发性胰胸膜瘘,并回顾其表现、病理生理、诊断和治疗。
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引用次数: 0
Predictive value of HIF-1α for left ventricular remodeling following an anterior ST-segment elevation myocardial infarction. HIF-1α对st段抬高型心肌梗死后左室重构的预测价值。
Pub Date : 2024-11-27 DOI: 10.1016/j.amjms.2024.11.009
Jun Wan, Feng Xu, Chunlin Yin, Yang Jiang, Cai Chen, Yulin Wang, Heping Zuo, Jinglin Cheng, He Li

Background: Hypoxia-inducible factor-1α (HIF-1α) has an essential role in ventricular remodeling processes involving myocardial fibrosis and hypertrophy, but the clinical significance of HIF-1α levels in the early period after ST-segment elevation myocardial infarction (STEMI) for the prediction of left ventricular remodeling (LVR) has yet to be fully elucidated.

Objective: To investigate the predictive value of HIF-1α for LVR after STEMI based on the echocardiographic parameters.

Methods: In this prospective observational study, plasma samples were collected within 12 hours of onset from 183 patients with a first reperfused anterior ST-segment elevation myocardial infarction (STEMI), and HIF-1α levels were measured using enzyme-linked immunosorbent assay (ELISA). At baseline and 12 months after discharge, all patients underwent repeat echocardiography. The changes of echocardiography parameters from baseline to 12 months were used to reflect the changes of ventricular structure and function. An increase in end-diastolic volume of ≥20% was defined as LVR.

Results: The levels of HIF-1α were highly correlated with the changes of echocardiography parameters (ΔLVEF, ΔLVEDD, as well as ΔLVEDV). During the follow-up period, patients with higher HIF-1α concentrations had higher incidence of LVR, poorer ventricular function, and a lower MACE-free survival. Multivariate analysis showed the single-point HIF-1α was an independent predictor of LVR (odds ratio[OR]: 4.813; 95% CI: 1.553 to 14.918; P = 0.006). The HIF-1α levels predicted LVR with an AUC of 0.7905 (95% CI: 0.7067 to 0.8744; P < 0.0001). The combination of HIF-1α and N-terminal probrain natriuretic peptide (NT-proBNP) yielded a favorable increase in AUC to 0.8121 (95% CI: 0.7345 to 0.8896; P < 0.0001).

Conclusion: These results demonstrate that serum HIF-1α levels can predict LVR after STEMI independently.

背景:缺氧诱导因子-1α (HIF-1α)在包括心肌纤维化和肥厚在内的心室重构过程中发挥着重要作用,但st段抬高型心肌梗死(STEMI)后早期HIF-1α水平对左心室重构(LVR)的预测临床意义尚未完全阐明。目的:探讨HIF-1α基于超声心动图参数对STEMI后LVR的预测价值。方法:在这项前瞻性观察研究中,183例首次再灌注前st段抬高型心肌梗死(STEMI)患者在发病后12小时内收集血浆样本,并使用酶联免疫吸附试验(ELISA)检测HIF-1α水平。所有患者在基线和出院后12个月复查超声心动图。超声心动图参数从基线到12个月的变化反映心室结构和功能的变化。舒张末期容积增加≥20%定义为LVR。结果:HIF-1α水平与超声心动图参数(ΔLVEF、ΔLVEDD、ΔLVEDV)变化高度相关。在随访期间,HIF-1α浓度较高的患者LVR发生率较高,心室功能较差,无mace生存期较低。多因素分析显示,单点HIF-1α是LVR的独立预测因子(比值比[OR]: 4.813;95%CI:1.553 ~ 14.918;P = 0.006)。HIF-1α水平预测LVR的AUC为0.7905 (95% CI为0.7067 ~ 0.8744)。结论:血清HIF-1α水平可独立预测STEMI后LVR。
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引用次数: 0
Methionine synthetase A2756G and Cystathionine-β-synthase 844ins68 polymorphisms and coronary artery disease: A meta-analysis. 蛋氨酸合成酶A2756G和半胱硫氨酸β合成酶844ins68多态性与冠状动脉疾病:一项荟萃分析
Pub Date : 2024-11-26 DOI: 10.1016/j.amjms.2024.11.011
Yan-Yan Li, Hui Wang, Yang-Yang Zhang

Objective: Methionine synthetase (MS) A2756G and Cystathionine-β-synthase (CBS) 844ins68 gene polymorphisms were indicated to be associated with increased coronary artery disease (CAD) risk. Nevertheless, because the results of each experiment are different, there is no consensus till now. This meta-analysis aimed to clarify the relationship between MS gene A2756G and CBS gene 844ins68 polymorphisms and CAD.

Methods: 11,555 participants from 24 individual studies, 2162 participants from 6 individual studies were included in the MS gene A2756G and CBS 844ins68 gene polymorphisms meta-analysis respectively. To determine whether MS gene A2756G or CBS gene 844ins68 polymorphism was associated with CAD risk, a random or fixed-effect genetic model was adopted using pooled odds ratios (ORs) and their corresponding 95 % confidence intervals (CIs).

Results: MS gene A2756G polymorphism was significantly associated with CAD under recessive (OR: 1.400, 95 % CI: 1.119-1.751, P = 0.003) and homozygous genetic models (OR: 1.360, 95 % CI: 1.084-1.706, P = 0.008). In the African subgroup, the association was significant under the allelic, recessive, dominant, heterozygous, homozygous and additive (P < 0.05) genetic models. In the Asian subgroup, the association was significant under the allelic, recessive and homozygous genetic models (P < 0.05). No significant association was found between CBS 844ins68 gene polymorphism and CAD under all of the genetic models (P > 0.05).

Conclusions: MS gene A2756G polymorphism was significantly associated with increased CAD risk, especially in the African and Asian population. The G allele carriers of MS gene A2756G polymorphism were more susceptible to be suffered from CAD disease than others.

目的:研究蛋氨酸合成酶(MS) A2756G和胱硫氨酸-β-合成酶(CBS) 844ins68基因多态性与冠心病(CAD)发病风险增加相关。然而,由于每次实验的结果都不一样,所以到目前为止还没有达成共识。本荟萃分析旨在阐明MS基因A2756G和CBS基因844ins68多态性与CAD的关系。方法:将来自24项个体研究的11555名受试者和来自6项个体研究的2162名受试者分别纳入MS基因A2756G和CBS 844ins68基因多态性荟萃分析。为了确定MS基因A2756G或CBS基因844ins68多态性是否与CAD风险相关,采用随机或固定效应遗传模型,采用合并优势比(or)及其相应的95%置信区间(ci)。结果:MS基因A2756G多态性在隐性遗传模型(OR: 1.400, 95% CI: 1.119 ~ 1.751, P=0.003)和纯合子遗传模型(OR: 1.360, 95% CI: 1.084 ~ 1.706, P=0.008)下与CAD显著相关。在非洲亚群中,等位基因、隐性基因、显性基因、杂合基因、纯合基因和加性基因的关联均显著(P0.05)。结论:MS基因A2756G多态性与冠心病风险增加显著相关,尤其是在非洲和亚洲人群中。MS基因A2756G多态性的G等位基因携带者比其他人更易患CAD疾病。
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引用次数: 0
Co-administration of albumin and loop diuretic may be associated with reduced mortality in septic shock patients: A retrospective study with PSM analysis. 白蛋白和利尿剂联合应用可能与感染性休克患者死亡率降低有关:一项PSM分析的回顾性研究。
Pub Date : 2024-11-26 DOI: 10.1016/j.amjms.2024.11.010
Shui-Qing Gui, Xi-Si He, Zhi-Ye Zou

Background: This study aimed to investigate the potential impact of administering albumin and loop diuretics together on in-hospital mortality in septic shock patients.

Methods: Data from the MIMIC-IV database was used for a retrospective cohort study analyzing 3,298 adult septic shock patients. The Cox proportional hazards model and propensity score matching (PSM) were utilized to assess the relationship between loop diuretic administration and in-hospital mortality.

Results: The study found that septic shock patients who received albumin in combination with loop diuretic had a significantly lower in-hospital mortality rate compared to those who received albumin alone (19.4 % vs 33.1 %, p < 0.001). Administering diuretics after albumin infusion was associated with lower mortality rates. Optimal furosemide dosages of 10 to 40 mg daily were linked to the lowest mortality rates.

Conclusion: Co-administering albumin and loop diuretics in septic shock patients receiving high-dose crystalloids may be associated with reduced in-hospital mortality. Further investigation through a prospective randomized controlled trial is recommended to validate these findings.

背景:本研究旨在探讨白蛋白和循环利尿剂联合使用对感染性休克患者住院死亡率的潜在影响。方法:使用MIMIC-IV数据库的数据进行回顾性队列研究,分析3298例成人感染性休克患者。采用Cox比例风险模型和倾向评分匹配(PSM)来评估循环利尿剂给药与住院死亡率之间的关系。结果:研究发现,与单独使用白蛋白的患者相比,使用白蛋白联合利尿剂的脓毒性休克患者的住院死亡率显著降低(19.4% vs 33.1%, p < 0.001)。白蛋白输注后使用利尿剂与较低的死亡率相关。最佳速尿剂量为每日10至40毫克,死亡率最低。结论:对接受大剂量晶体药物治疗的感染性休克患者联合使用白蛋白和环状利尿剂可降低住院死亡率。建议通过前瞻性随机对照试验进行进一步调查以验证这些发现。
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引用次数: 0
General and central obesity were significantly correlated with blood lead level in non-smoking, general population aged 30-50, without hypertension. 在不吸烟、年龄在 30-50 岁、无高血压的普通人群中,全身肥胖和中心肥胖与血铅含量明显相关。
Pub Date : 2024-11-24 DOI: 10.1016/j.amjms.2024.11.007
In Cheol Hwang, Kyoung Kon Kim, Jeong Heon Kim, Kyu Rae Lee

To investigate the association between obesity and blood lead level (BLL) in the general population after controlled for menopause, blood pressure, calcium, and smoking; we assessed the relationship between BMI, WC (Waist Circumference), and blood lead levels in the non-smoking middle-aged subjects without hypertension among 2018 KNHANES. All data were recategorized into S1 (BMI<25 kg/m2 & WC<90 cm), S2 (intermediate), and S3 (BMI>25 kg/m2 & WC>90 cm). We made the log transformation of blood lead levels to bring them closer to a normal distribution. Logarithmic transformed BLL was closely related to BMI (p=.010) and WC (p=.020) after adjusting for sociodemographic, energy, working factors, and cardiometabolic variables. The prevalence of ratios of S3, S2, and S1 was comparable according to the quarterly group of BLL. Blood lead levels might increase oxidative stress on triglycerides and low high-density lipoprotein (HDL)-cholesterol; consequently, lead exposure might form peroxynitrite, a reactive oxygen substrate (ROS) susceptible to destroying lipids. Consequently, obesity was significantly correlated with logarithmic blood lead levels irrespective of sociodemographic, energy, working, and cardiometabolic factors in the non-smoking middle-aged population without hypertension. Further controlled clinical trials would be considered.

为了研究普通人群在控制绝经、血压、钙和吸烟后肥胖与血铅水平(BLL)之间的关系,我们评估了2018年KNHANES中无高血压的非吸烟中年受试者的BMI、WC(腰围)和血铅水平之间的关系。所有数据被重新归类为 S1(BMI2 & WC25kg/m2 & WC>90cm)。我们对血铅水平进行了对数变换,使其更接近正态分布。在对社会人口学、能量、工作因素和心脏代谢变量进行调整后,对数变换后的血铅水平与体重指数(P=.010)和体重指数(WC)(P=.020)密切相关。根据血铅含量的季度组别,S3、S2 和 S1 比率的发生率具有可比性。血铅水平可能会增加甘油三酯和低高密度脂蛋白胆固醇的氧化应激;因此,铅暴露可能会形成过氧化亚硝酸盐,这是一种易破坏脂质的活性氧底物(ROS)。因此,在无高血压的非吸烟中年人群中,无论社会人口、能量、工作和心脏代谢因素如何,肥胖都与对数血铅水平显著相关。我们将考虑进一步开展对照临床试验。
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引用次数: 0
Urinary dickkopf-3 as a predictor for postoperative acute kidney injury in the intensive care unit. 尿液 Dickkopf-3 作为重症监护病房术后急性肾损伤的预测因子。
Pub Date : 2024-11-17 DOI: 10.1016/j.amjms.2024.11.003
Yao Sun, Zengli Xiao, Huiying Zhao, Youzhong An

Background: As a life-threatening complication in patients undergoing surgery, acute kidney injury (AKI) is strongly associated with a worse prognosis. Urinary dickkopf-related protein 3 (DKK3) has been identified as a biomarker for predicting postoperative AKI in patients undergoing cardiac surgery.

Objective: To investigate the predictive value of urinary DKK3 on postoperative AKI and develop a clinical model based on the predictor for predicting the development of AKI within seven days for patients undergoing noncardiac surgery.

Methods: All patients who were admitted to the Intensive Care Unit (ICU) after noncardiac surgery from March 2023 to June 2023 were included in this study. The patients' baseline data on demographic characteristics, lifestyle risk factors, medical history, clinical features, and laboratory tests before surgery were collected at the time of admission. Besides, the blood samples for cystatin C and routine laboratory tests and the urine samples for DKK3 tests were simultaneously collected at the time of admission to the ICU. In addition, the independent predictors of postoperative AKI were identified by univariate, multivariate, and LASSO analyses. Moreover, a nomogram for predicting postoperative AKI was developed based on these independent predictors. Finally, the nomogram was evaluated through calibration and decision curve analyses.

Results: A total of 166 patients with a median age of 67 years old were included in this study, including 94 (56.63%) males. Among these patients, 47 patients (28.3%) developed postoperative AKI. Additionally, 7 independent risk factors, including preoperative serum creatinine, preoperative eGFR, preoperative serum albumin, preoperative serum potassium ion, cystatin C, uDKK3/uCr, and SOFA score, were selected by univariate and multivariate regression analyses. Eventually, 4 independent risk factors (including preoperative eGFR, cystatin C, uDKK3/uCr, and SOFA score) identified in this study by LASSO analyses were used to establish the nomogram. The area under the receiver operating characteristic (ROC) curve (AUC) for the prediction model was 0.868. The calibration curve and decision curve analysis results demonstrated that the nomogram had good prediction performance.

Conclusions: Urinary DKK3/creatinine was independently associated with postoperative AKI for patients in the ICU after noncardiac surgery. The nomogram constructed based on uDKK3/uCr, preoperative eGFR, cystatin C, and SOFA score showed a higher accuracy in predicting postoperative AKI.

背景:急性肾损伤(AKI)是威胁手术患者生命的一种并发症,与预后不良密切相关。尿Dickkopf相关蛋白3(DKK3)已被确定为预测心脏手术患者术后AKI的生物标志物:研究尿DKK3对术后AKI的预测价值,并根据该预测因子建立临床模型,以预测非心脏手术患者七天内发生AKI的情况:研究纳入了 2023 年 3 月至 2023 年 6 月期间非心脏手术后入住重症监护室(ICU)的所有患者。入院时收集患者的人口统计学特征、生活方式风险因素、病史、临床特征和手术前实验室检查等基线数据。此外,在入住重症监护室时,还同时采集了检测胱抑素 C 和常规实验室检查的血液样本以及检测 DKK3 的尿液样本。此外,还通过单变量、多变量和 LASSO 分析确定了术后 AKI 的独立预测因素。此外,还根据这些独立的预测因素制定了预测术后 AKI 的提名图。最后,通过校准和决策曲线分析对提名图进行了评估:本研究共纳入 166 例患者,中位年龄为 67 岁,其中男性 94 例(56.63%)。其中,47 名患者(28.3%)发生了术后 AKI。此外,通过单变量和多变量回归分析,筛选出了 7 个独立的风险因素,包括术前血清肌酐、术前 eGFR、术前血清白蛋白、术前血清钾离子、胱抑素 C、uDKK3/uCr 和 SOFA 评分。最终,本研究通过 LASSO 分析确定的 4 个独立风险因素(包括术前 eGFR、胱抑素 C、uDKK3/uCr 和 SOFA 评分)被用于建立提名图。预测模型的接收者操作特征曲线(ROC)下面积(AUC)为 0.868。校准曲线和决策曲线分析结果表明,提名图具有良好的预测性能:结论:尿DKK3/肌酐与ICU非心脏手术患者术后AKI有独立关联。基于尿DKK3/尿Cr、术前eGFR、胱抑素C和SOFA评分构建的提名图在预测术后AKI方面显示出更高的准确性。
{"title":"Urinary dickkopf-3 as a predictor for postoperative acute kidney injury in the intensive care unit.","authors":"Yao Sun, Zengli Xiao, Huiying Zhao, Youzhong An","doi":"10.1016/j.amjms.2024.11.003","DOIUrl":"10.1016/j.amjms.2024.11.003","url":null,"abstract":"<p><strong>Background: </strong>As a life-threatening complication in patients undergoing surgery, acute kidney injury (AKI) is strongly associated with a worse prognosis. Urinary dickkopf-related protein 3 (DKK3) has been identified as a biomarker for predicting postoperative AKI in patients undergoing cardiac surgery.</p><p><strong>Objective: </strong>To investigate the predictive value of urinary DKK3 on postoperative AKI and develop a clinical model based on the predictor for predicting the development of AKI within seven days for patients undergoing noncardiac surgery.</p><p><strong>Methods: </strong>All patients who were admitted to the Intensive Care Unit (ICU) after noncardiac surgery from March 2023 to June 2023 were included in this study. The patients' baseline data on demographic characteristics, lifestyle risk factors, medical history, clinical features, and laboratory tests before surgery were collected at the time of admission. Besides, the blood samples for cystatin C and routine laboratory tests and the urine samples for DKK3 tests were simultaneously collected at the time of admission to the ICU. In addition, the independent predictors of postoperative AKI were identified by univariate, multivariate, and LASSO analyses. Moreover, a nomogram for predicting postoperative AKI was developed based on these independent predictors. Finally, the nomogram was evaluated through calibration and decision curve analyses.</p><p><strong>Results: </strong>A total of 166 patients with a median age of 67 years old were included in this study, including 94 (56.63%) males. Among these patients, 47 patients (28.3%) developed postoperative AKI. Additionally, 7 independent risk factors, including preoperative serum creatinine, preoperative eGFR, preoperative serum albumin, preoperative serum potassium ion, cystatin C, uDKK3/uCr, and SOFA score, were selected by univariate and multivariate regression analyses. Eventually, 4 independent risk factors (including preoperative eGFR, cystatin C, uDKK3/uCr, and SOFA score) identified in this study by LASSO analyses were used to establish the nomogram. The area under the receiver operating characteristic (ROC) curve (AUC) for the prediction model was 0.868. The calibration curve and decision curve analysis results demonstrated that the nomogram had good prediction performance.</p><p><strong>Conclusions: </strong>Urinary DKK3/creatinine was independently associated with postoperative AKI for patients in the ICU after noncardiac surgery. The nomogram constructed based on uDKK3/uCr, preoperative eGFR, cystatin C, and SOFA score showed a higher accuracy in predicting postoperative AKI.</p>","PeriodicalId":94223,"journal":{"name":"The American journal of the medical sciences","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142678146","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}
引用次数: 0
Dyspnea, dysfunctional breathing disorders, and the Bayesian brain hypothesis. 呼吸困难、呼吸功能障碍和贝叶斯大脑假说。
Pub Date : 2024-11-16 DOI: 10.1016/j.amjms.2024.11.006
Gilbert Berdine, Kenneth Nugent

Clinicians frequently evaluate patients who present with dyspnea. This term describes uncomfortable breathing during physical activity, and the intensity or degree of dyspnea can vary in an individual depending on circumstances and between individuals. In some cases, the level of dyspnea appears out of proportion to other information relevant to the cardiorespiratory system, and this situation has been described as dysfunctional breathing. The Bayesian brain hypothesis helps clinicians understand this symptom in these patients. This hypothesis suggests that prior experiences with dyspnea during physical activity or a respiratory disorder provide the background that is used to interpret current symptoms. This review outlines problems associated with the use of the term "dyspnea" and briefly describes how the Bayesian brain hypothesis might help clinicians understand this symptom better.

临床医生经常会对出现呼吸困难的患者进行评估。呼吸困难是指在体力活动时呼吸不畅,个人呼吸困难的强度或程度会因环境和个体差异而不同。在某些情况下,呼吸困难的程度与心肺系统的其他相关信息不成比例,这种情况被称为呼吸功能障碍。贝叶斯大脑假说有助于临床医生理解这些患者的这一症状。该假说认为,先前在体力活动或呼吸紊乱时出现呼吸困难的经历为解释当前症状提供了背景。本综述概述了与使用 "呼吸困难 "一词相关的问题,并简要介绍了贝叶斯脑假说如何帮助临床医生更好地理解这一症状。
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引用次数: 0
Cardiovascular diseases-related mortality among adults with comorbid chronic obstructive pulmonary disease in the United States. 美国患有慢性阻塞性肺病的成年人与心血管疾病相关的死亡率。
Pub Date : 2024-11-08 DOI: 10.1016/j.amjms.2024.11.002
Usama Qamar, Shrihari Nagarajan, Siddharth Agarwal
{"title":"Cardiovascular diseases-related mortality among adults with comorbid chronic obstructive pulmonary disease in the United States.","authors":"Usama Qamar, Shrihari Nagarajan, Siddharth Agarwal","doi":"10.1016/j.amjms.2024.11.002","DOIUrl":"10.1016/j.amjms.2024.11.002","url":null,"abstract":"","PeriodicalId":94223,"journal":{"name":"The American journal of the medical sciences","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142635351","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}
引用次数: 0
Carcinoma erysipeloides, a case-report and review of the sixty-nine cases in the literature. 红斑癌,病例报告和文献中 69 个病例的回顾。
Pub Date : 2024-10-24 DOI: 10.1016/j.amjms.2024.10.008
İmdat Eroğlu, Aytuğ Üner, Fatih Gürler, Ozan Yazıcı, Ahmet Özet, Nuriye Özdemir

Background: Carcinoma erysipeloides (CE) is a rare form of cutaneous metastasis appearing similar to erysipelas or cellulitis. Due to its rarity, little is known about CE.

Methods: We here initially reported a case of CE secondary to rectal carcinoma and then reviewed the literature and analyzed the basic characteristics of the cases reported previously.

Results: Sixty-nine patients(including our case) with CE were identified. The mean age of diagnosis with CE was 60 ± 15 yr(min:25 yr, max:91 yr), and 69.6 % of the patients were female. Breast cancer, skin cancer, and gastroesophageal cancer were the three most commonly seen malignancies presented with CE(52.2 %, 11.6 %, and 10.1 %, respectively). Adenocarcinoma(81.2 %) was the primary histological subtype of the cases. While CE was the first presentation of the disease in 20.3 % of patients, it was associated with recurrence or disease progression in 69.7 %. The median time from the first presentation of the disease to the diagnosis of CE was two years. More than half of the patients(55.1 %) have received local dermatological treatment with another differential diagnosis before diagnosis of CE. Only 21.7 % of the patients responded to the treatment, and median survival after diagnosis of CE was 4 months(min:0 mo, max:24 mo).

Conclusions: CE has a poor prognosis and is most common in individuals with breast cancer and adenocarcinoma. Patients generally receive local dermatological treatments with different diagnoses. CE should be considered in the differential diagnosis, especially in the presence of erysipelas/cellulitis-like lesions in patients with a history of malignancy or who do not respond to local treatments.

背景:红斑癌(CE)是一种罕见的皮肤转移瘤,表现与红斑或蜂窝组织炎相似。由于其罕见性,人们对其知之甚少:方法:我们在此初步报告了一例继发于直肠癌的 CE 病例,然后回顾了文献并分析了之前报告的病例的基本特征:结果:共发现 69 例 CE 患者(包括我们的病例)。平均确诊年龄为 60±15 岁(最小 25 岁,最大 91 岁),69.6% 的患者为女性。乳腺癌、皮肤癌和胃食管癌是最常见的三种恶性肿瘤(分别占 52.2%、11.6% 和 10.1%)。腺癌(81.2%)是病例的主要组织学亚型。20.3%的患者首次发病时为CE,69.7%的患者复发或病情恶化时为CE。从首次发病到确诊 CE 的中位时间为两年。半数以上的患者(55.1%)在确诊 CE 之前曾接受过其他鉴别诊断的局部皮肤病治疗。只有 21.7% 的患者对治疗有反应,确诊 CE 后的中位生存期为 4 个月(最短:0 个月,最长:24 个月):结论:CE预后较差,最常见于乳腺癌和腺癌患者。患者通常会接受不同诊断的局部皮肤病治疗。在鉴别诊断中应考虑 CE,尤其是在有恶性肿瘤病史或对局部治疗无效的患者出现红斑/蜂窝织炎样皮损时。
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引用次数: 0
Coronary embolism and acute limb ischemia without pre-existing atrial fibrillation: Hunt for the hidden thrombus. 无心房颤动的冠状动脉栓塞和急性肢体缺血:寻找隐藏的血栓
Pub Date : 2024-10-23 DOI: 10.1016/j.amjms.2024.10.006
Misha Aftab Khan, Noor Alsammarraie, Alycia Christina Bellino, Yash Bharatkumar Patel, Karldon Iwuchukwu Nwaezeapu

Coronary embolism (CE) is an infrequent etiology of myocardial infarction secondary to embolization of occlusive thrombi within the coronary arteries, typically arising in patients with pre-existing atrial fibrillation. Clinical presentation is similar to atherosclerotic myocardial infarction, however the condition is likely underrecognized. The simultaneous presence of other embolic manifestations may assist with diagnosis, although definitive therapy, medical or interventional, remains inconclusive. We aim to lower the threshold for clinical suspicion in the appropriate setting and promote assessment of predisposing embolic conditions once a tentative diagnosis of CE is established. In addition, we intend to highlight the need for focused refinement of the existing diagnostic criteria and further optimization of management guidelines for CE.

冠状动脉栓塞(Cononary embolism,CE)是继发于冠状动脉内闭塞性血栓栓塞的心肌梗死的一种不常见病因,通常发生在原有心房颤动的患者身上。其临床表现与动脉粥样硬化性心肌梗死相似,但很可能未被充分认识。同时出现其他栓塞表现可能有助于诊断,但明确的药物或介入治疗仍无定论。我们的目标是在适当的情况下降低临床怀疑的门槛,并促进对 CE 初步诊断确定后的易发栓塞情况进行评估。此外,我们还希望强调有必要重点完善现有的诊断标准,并进一步优化 CE 的管理指南。
{"title":"Coronary embolism and acute limb ischemia without pre-existing atrial fibrillation: Hunt for the hidden thrombus.","authors":"Misha Aftab Khan, Noor Alsammarraie, Alycia Christina Bellino, Yash Bharatkumar Patel, Karldon Iwuchukwu Nwaezeapu","doi":"10.1016/j.amjms.2024.10.006","DOIUrl":"10.1016/j.amjms.2024.10.006","url":null,"abstract":"<p><p>Coronary embolism (CE) is an infrequent etiology of myocardial infarction secondary to embolization of occlusive thrombi within the coronary arteries, typically arising in patients with pre-existing atrial fibrillation. Clinical presentation is similar to atherosclerotic myocardial infarction, however the condition is likely underrecognized. The simultaneous presence of other embolic manifestations may assist with diagnosis, although definitive therapy, medical or interventional, remains inconclusive. We aim to lower the threshold for clinical suspicion in the appropriate setting and promote assessment of predisposing embolic conditions once a tentative diagnosis of CE is established. In addition, we intend to highlight the need for focused refinement of the existing diagnostic criteria and further optimization of management guidelines for CE.</p>","PeriodicalId":94223,"journal":{"name":"The American journal of the medical sciences","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142515662","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}
引用次数: 0
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