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Recurrence of Poorly Differenciated Cervical Cancer by Single Splenic Metastasis: Case Report and Literature Review 低分化宫颈癌单发脾转移复发1例报告及文献复习
Pub Date : 2023-01-01 DOI: 10.4236/crcm.2023.124013
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引用次数: 0
Cutaneaous Myiasis: A Rare Tropical Disease in an 11-Year-Old Girl 皮肤蝇蛆病:一种罕见的热带疾病在一个11岁的女孩
Pub Date : 2023-01-01 DOI: 10.4236/crcm.2023.127033
F. Sinyinza, Charles Lukanga Kimera, Linda Ndesipandula Lukolo
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引用次数: 0
An Incidental Finding and Unusual Presentation of Atypical Coccidioidomycosis in a 72-Year-Old Man: A Case Report 一个偶然发现和不寻常的表现非典型球孢子菌病在一个72岁的男人:一个病例报告
Pub Date : 2023-01-01 DOI: 10.4236/crcm.2023.129050
Alise Haddad, Ethan Dimock, Joseph Hanna, Rafi Haddad, Michel Hanna, Stephen Galens
This case report presents an unusual and challenging diagnostic scenario involving a 72-year-old man who recently returned from a trip to Maui, Hawaii. While in Maui, the patient presented with a fever and fatigue that resolved spontaneously. However, he had an observable rash on his head and was given a steroid injection to resolve the rash. Later on his trip, the patient experienced a dry, nonproductive cough which resolved with a five-day course of prednisone. While visiting Michigan, the patient began to experience neck pain and visited Troy Beaumont Hospital for further treatment. Meningitis tests were negative. Vancomycin was given due to the detection of gram positive coccidioidomycosis in the culture, but this was later proven to be a contaminant. Coccidiomycosis does not initially have specific symptoms. Despite negative coccidioidomycosis antigen tests, the patient exhibited features more consistent with blastomycosis and cryptococcus, highlighting the complexities of diagnosing fungal infections with atypical presentations. The case emphasizes the importance of considering alternative fungal pathogens native to endemic regions and pursuing comprehensive diagnostic measures to establish an accurate diagnosis. Lastly, the discussion about recommendations for antifungal therapy and preventative measures for individuals at risk of respiratory fungal infections is critically important for the advancement of early detection of fungal infections.
本病例报告提出了一个不寻常且具有挑战性的诊断情景,涉及一名最近从夏威夷毛伊岛旅行归来的72岁男子。在毛伊岛期间,患者出现发热和疲劳症状,但症状自行消退。然而,他的头部有明显的皮疹,并给予类固醇注射以解决皮疹。后来在他的旅行中,病人经历了干咳,无生产性咳嗽,用强的松治疗了五天。在访问密歇根州时,患者开始感到颈部疼痛,并前往特洛伊博蒙特医院接受进一步治疗。脑膜炎测试呈阴性由于在培养中检测到革兰氏阳性球孢子菌病,因此给予万古霉素,但后来证明这是一种污染物。球虫病最初没有特定的症状。尽管球孢子菌病抗原检测呈阴性,但患者表现出与芽生菌病和隐球菌更一致的特征,突出了诊断非典型真菌感染的复杂性。该病例强调了考虑流行地区特有的其他真菌病原体并采取综合诊断措施以确定准确诊断的重要性。最后,讨论呼吸道真菌感染风险个体的抗真菌治疗和预防措施对早期发现真菌感染至关重要。
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引用次数: 0
A Pilot Study about the First Cases of Coronary Angioplasty in Democratic Republic of Congo/Kinshasa: Patient Profile 刚果民主共和国/金沙萨第一例冠状动脉成形术的初步研究:患者概况
Pub Date : 2023-01-01 DOI: 10.4236/crcm.2023.1210052
David Ipungu Gondele, Eulethère Vita Kintoki, Yves Lubenga, Georges Ngoyi, Trésor Mvunzi, Dominique Mupepe, Nathan Buila, Zéphirin Kamuanga, Fahd Qureshi, Aliosha Nkodila, Jean Robert Rissasi Makulo, Jean René M’buyamba-Kabangu
Background: The objective of this pilot study was to describe clinical profile, electric, echocardiographic and angiographic caracteristics with procedural outcome of congolease patients undergoing coronarography in the first and only one cardiac catheterization center opened in Kinshasa. Methods: An analytical cross-sectional study was carried out over a period from October 2019 (date of establishment of the first coronary angiography unit in DR Congo) to March 2021. We proceeded to a serial sampling of the consecutive cases of all the patients who have an angiographic exploration of coronary arteries. Clinical, ECG and cardiac ultrasound data were collected in all patients. The indications for the coronary angiography examination were set by differents cardiologists on the basis of repolarization troubles in the electrocardiogram, cinetic troubles in echocardiography, positive stress test and chest pain in patients with cardiovascular risq factors. Results: The serie (47 patients) was predominantly male with a sex ratio M/W of 2.6. The average age was 59.8 ± 10.5 years. Arterial hypertension (HBP) was the main risk factor (89.4%); followed by diabetes mellitus (14.9%). Chest pain was the main functional sign with an atypical character in 44.7%. The ECG showed ST segment depression (17%) and T wave inversion (17%), the anterior region being the most affected. Hypokinesia was the most common echocardiographic abnormality (34%), followed by akinesia (10.6%). The anteroseptal and apical territories were affected in 12.8%. Dilated myocardiopathy (DMC) was significantly predominant in the male sex (29.4% vs 7.7%; p = 0.011). With radial puncture as the main approach, coronary angiography was pathological in 44% revealing mono-truncal lesions. The left coronary network was the most affected: the middle inter ventricular artery (12.8%), the proximal interventricular artery (10.6%) and the proximal circonflex artery (10.6%). In multivariate logistic regression analysis, age (for age > 50 years for men and >60 years for women), arterial hypertension and dilated cardiomyopathy emerged as independent determinants of pathological coronary angiography. Transluminal angioplasty was performed in 27.7% of patients. The bypass indication was retained in 4.3% of cases and medical treatment in 68%. Conclusion: Coronary angiography was used to diagnose lesions responsible for ischemic heart disease and to treat 27.7% of patients locally. The young age of patients and limited financial resources encourage the strengthening of preventive measures against cardio vascular risq factors.
背景:本初步研究的目的是描述在金沙萨开设的第一个也是唯一一个心导管中心接受冠状动脉造影的刚果松患者的临床特征、电、超声心动图和血管造影特征和手术结果。方法:从2019年10月(刚果民主共和国第一个冠状动脉造影单元建立之日)到2021年3月,进行了一项分析性横断面研究。我们对所有接受冠状动脉造影检查的患者的连续病例进行了连续抽样。收集所有患者的临床、心电图和心脏超声资料。不同的心脏科医师根据心电图复极障碍、超声心动图动力学障碍、应激试验阳性、有心血管危险因素患者胸痛等情况确定冠状动脉造影检查的适应症。结果:本组47例患者以男性为主,性别比M/W为2.6。平均年龄59.8±10.5岁。动脉高血压(HBP)是主要危险因素(89.4%);其次是糖尿病(14.9%)。胸痛是主要的功能体征,44.7%为不典型。心电图表现为ST段下陷(17%)和T波反转(17%),其中前部受影响最大。运动不足是最常见的超声心动图异常(34%),其次是运动不足(10.6%)。房间隔和根尖区域受影响的占12.8%。扩张型心肌病(DMC)在男性中明显占优势(29.4% vs 7.7%;P = 0.011)。以桡动脉穿刺为主要途径,44%的冠状动脉造影显示单截病变是病理的。左冠状动脉网络受影响最大:室间中动脉(12.8%)、室间近动脉(10.6%)和环状动脉近端(10.6%)。在多变量logistic回归分析中,年龄(男性> 50岁,女性>60岁)、动脉高血压和扩张性心肌病成为病理性冠状动脉造影的独立决定因素。27.7%的患者行腔内血管成形术。4.3%的病例保留了旁路指征,68%的病例保留了药物治疗。结论:冠状动脉造影可诊断缺血性心脏病病变,局部治愈率为27.7%。患者年龄小,财政资源有限,鼓励加强对心血管危险因素的预防措施。
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引用次数: 0
<i>Magnusiomyces capitatus</i> in Immune-Competent Patients with Pulmonary Haemorrhage and Systemic Lupus Erythematosus 打折期,lt; gt; Magnusiomyces菌capitatus&肝移植;打折期/ gt;免疫功能正常的肺出血和系统性红斑狼疮患者
Pub Date : 2023-01-01 DOI: 10.4236/crcm.2023.1210055
Waleed Amasaib Ahmed, Angham Ahmed Almakki, Abeer Ahmed Bashinim, Abdelgaffar A. Mohamed, Amna Al Kalkami, Mohannad AbuRageila
Invasive fungal infections have grown significantly over the last two decades, owing to an increase in immunocompromised hosts and geriatric patients. When the host’s defenses are compromised, such infections are associated with severe morbidity and mortality. Here, a rare case of fungal infection in a 61-year-old immunocompetent male patient from Saudi Arabia was reported, who suffered from pulmonary hemorrhage and Systemic Lupus Erythematous. Bronchoalveolar Lavage was used as a diagnostic tool to identify the fungus reported in the case. The pathogenic fungal specie identified as Magnusiomyces capitatus, in macroscopic and microscopic morphological characteristics of the colonies. Based on clinical evidence, liposomal amphotericin formulation was recommended for initial therapy against fungal infection. Also, liposomal amphotericin B induced mycological eradication up to 70 percent in patients with proven Magnusiomyces capitatus infection. In addition to addressing suspected Systemic lupus erythematosus, the patient’s health has improved with no evidence of pulmonary bleeding and hemoptysis.
在过去的二十年中,由于免疫功能低下的宿主和老年患者的增加,侵袭性真菌感染显著增长。当宿主的防御被破坏时,这种感染与严重的发病率和死亡率有关。本文报告了一例罕见的真菌感染病例,患者为来自沙特阿拉伯的61岁男性免疫功能正常,患有肺出血和系统性红斑狼疮。支气管肺泡灌洗作为诊断工具,以确定真菌报告的情况下。在菌落的宏观和微观形态特征上,鉴定病原真菌属Magnusiomyces capitatus。基于临床证据,两性霉素脂质体制剂被推荐用于抗真菌感染的初始治疗。此外,两性霉素B脂质体诱导的真菌学根除高达70%的患者确诊的Magnusiomyces capitatus感染。除了解决疑似系统性红斑狼疮外,患者的健康状况有所改善,无肺出血和咯血的证据。
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引用次数: 0
Case Report of Combined Sixth and Twelfth Cranial Nerve Palsy: A Rare Case of Clival Syndrome Arising from Thymoma 第六、第十二脑神经联合麻痹1例:罕见胸腺瘤引起的斜坡综合征
Pub Date : 2023-01-01 DOI: 10.4236/crcm.2023.1210053
Yew Chung Chan, Chin Aun Liew, Darcy Jamih, Yin Chin Chan, Mei Dree Lim, Angeline Madatang, Sandhya AP Rajaintharan
Godtfredsen syndrome or clival syndrome is a rare syndrome of abducens and hypoglossal nerve palsies (cranial nerve 6th and 12th respectively) that localizes to a clival mass. There are few reported cases of this clinical presentation. The aim of this case report is to describe this rare manifestation observed in a woman with clival metastases arising from a thymoma. A previously well 34-year-old native lady presented to a district hospital in Sabah, Malaysia, with history of blurring of vision and headache for 1 month. Cranial nerve examination reveals right abducens nerve palsy (right 6th CN) and right hypoglossal nerve palsy (right 12th CN). Initial imaging with CT brain reveals a subtle extra-axial hyperdense mass adjacent to the clivus and a routine chest x-ray reveals a mediastinal mass. Further imaging of thorax showed right anterior mediastinal mass, which then proceeded with Video-Assisted Thoracoscopic Surgery (VATS) guided biopsy. The biopsy result was consistent with the finding of thymoma, type B2. She was then diagnosed with aggressive form of thymoma, which unfortunately has metastasized to the bone, lung, liver and brain. Despite prognosis at the time of diagnosis is guarded, she still opted to undergo chemotherapy. Despite the completion of 6 cycles of chemotherapy, her disease progressed, and she eventually succumbed to the illness. In short, the presence of combined 6th and 12th palsy should alert clinician to the possibility of clival mass or metastases and hence could earlier workup with appropriate imaging can lead to earlier diagnosis and better treatment outcome.
Godtfredsen综合征或斜坡综合征是一种罕见的外展神经和舌下神经麻痹综合征(分别是颅神经第6和第12),它定位于斜坡肿块。这种临床表现的病例报道很少。本病例报告的目的是描述这种罕见的表现,观察到妇女与斜坡转移引起胸腺瘤。先前身体健康的34岁当地妇女,因视力模糊和头痛病史1个月来到马来西亚沙巴一家地区医院就诊。脑神经检查显示右侧展神经麻痹(右侧第六神经中枢)和右侧舌下神经麻痹(右侧第十二神经中枢)。最初的脑部CT显示一个微妙的轴外高密度肿块靠近斜坡,常规胸片显示一个纵隔肿块。进一步的胸部成像显示右侧前纵隔肿块,然后进行视频辅助胸腔镜手术(VATS)指导下的活检。活检结果与胸腺瘤B2型一致。然后她被诊断出患有侵袭性胸腺瘤,不幸的是已经转移到骨、肺、肝和脑。尽管在诊断时的预后是谨慎的,她仍然选择接受化疗。尽管完成了6个周期的化疗,她的病情仍在恶化,最终她死于疾病。总之,第6和第12麻痹合并的存在应该提醒临床医生注意斜坡肿块或转移的可能性,因此早期的检查和适当的影像学检查可以导致早期诊断和更好的治疗结果。
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引用次数: 0
Newborn with Giant Non-Involuting Congenital Hemangioma: Mechanisms of Allodynia, Hyperalgesia and Treatment 新生儿巨大的非渐开式先天性血管瘤:异常性疼痛、痛觉过敏和治疗的机制
Pub Date : 2023-01-01 DOI: 10.4236/crcm.2023.1210054
Valeria Bachiocco, Ilenia Casini, Andrea Gentili
In a newborn affected by a non involuting congenital hemangioma we measured allodynia through the application of a standard tactile stimulus and hyperalgesia through the regular administration of the Comfort scale which rates pain intensity. The baby presented signs of these pathological events over long periods of the disease. They may be attributed to the high amount of the nociceptive ligands in the hemangioma microenviroment and to the elevated concentration of TNF-alpha and IL-6 in the blood. For a long time, the pain was relieved by a combination of opioids, adjuvants and paracetamol, but also by thalidomide and unexpectedly by interferon alpha. A mechanism-based pain treatment needs to take into account the processes underlying pain and also the ongoing pathology.
在一个受先天性血管瘤影响的新生儿中,我们通过应用标准的触觉刺激来测量异常性痛觉,并通过常规的疼痛强度舒适量表来测量痛觉过敏。婴儿在长期患病期间表现出这些病理性事件的迹象。它们可能归因于血管瘤微环境中大量的伤害性配体以及血液中tnf - α和IL-6浓度升高。长期以来,阿片类药物、佐剂和扑热息痛都能缓解疼痛,沙利度胺也能缓解疼痛,出乎意料的是,干扰素也能缓解疼痛。基于机制的疼痛治疗需要考虑到潜在疼痛的过程和正在进行的病理。
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引用次数: 0
Pancreatic Abscess: An Infection Occurring with Minimal Tissue Present 胰腺脓肿:一种仅存在少量组织的感染
Pub Date : 2023-01-01 DOI: 10.4236/crcm.2023.125016
Karnan Rajkumar, A. Mahmoud, M. Abdalla, M. Grossman
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引用次数: 1
A Case of Cerebrospinal Drainage for Paraplegia Complicated by Acute Aortic Dissection (Stanford B) Followed by TEVAR in the Subacute Phase 脑脊液引流治疗截瘫合并急性主动脉夹层(Stanford B)亚急性期TEVAR 1例
Pub Date : 2023-01-01 DOI: 10.4236/crcm.2023.125019
M. Shimizu, Toshifumi Saga, R. Tominaga
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引用次数: 0
Osteogenesis Imperfecta: One Disease, Two or More Faces: A Case Report 成骨不全:一种疾病,两种或多面:1例报告
Pub Date : 2023-01-01 DOI: 10.4236/crcm.2023.122008
Anjali-Larisha Chhiba, F. Nakwa, K. Thandrayen
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引用次数: 0
期刊
Case Reports in Clinical Medicine
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