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A 10 mm polypoid lesion removed with cold snare polypectomy (G2, Ki67 PI 6%, R1) needed immediate subsequent surgical resection with lymphadenectomy (six of the sixteen lymph nodes that were removed were positive). | 3.275391 | 0.91748 | sec[2]/p[5] | en | 0.999997 | PMC11276314 | https://doi.org/10.3390/diagnostics14141484 |
Local recurrence occurred after 14 months in a 7 mm polypoid lesion removed with cold snare polypectomy (G1, Ki67 PI 2%, R1), which was then treated with cap-assisted EMR with a negative subsequent 50-month follow-up. | 3.253906 | 0.942871 | sec[2]/p[6] | en | 0.999999 | PMC11276314 | https://doi.org/10.3390/diagnostics14141484 |
One patient met the revised Chompret criteria for LFS because of a BC diagnosis at 28 years of age; that is, she met the criteria of juvenile breast cancer (<31 years). She was submitted to two molecular tests (a multigene out-of-pocket test and the specific one for p.R337H offered by the study). This patient was born in the Federal District, with a family from the Midwest region, presented with stage IIIA invasive ductal carcinoma, histological grade 2, ER+/HER2-negative, and Ki67 > 14%. The patient underwent neoadjuvant chemotherapy, followed by bilateral mastectomy and adjuvant hormone therapy. Familial cascade testing revealed variant segregation through the maternal side of the family. | 3.84375 | 0.868652 | sec[2]/sec[2]/p[1] | en | 0.999997 | PMC11276326 | https://doi.org/10.3390/genes15070928 |
Case MOL1984-1 was diagnosed at the age of 10 years with reduced visual acuity, mild myopia (−3 D), and photophobia. His best corrected visual acuity (BCVA) at the age of 16 was 0.6/0.5 in the right and left eye, respectively, and OCT showed a retinoschisis pattern. He has no family history of visual deficiencies. An ERG test at the age of 18 years revealed sub-normal responses, including cone flicker, mixed cone-rod b-wave, and rod responses. Color vision was within the normal range. An ophthalmic evaluation at the age of 19 years revealed atrophic chorioretinal patches next to the optic disk and the inferior arcade. Following a clinical evaluation at the age of 19, no other clinical features were identified in this case, as reported in a few other KIF11 cases . The patient was therefore diagnosed with non-syndromic chorioretinopathy. Interestingly, gene panel analysis revealed a heterozygous frameshift mutation in KIF11 ( Table S1 ). | 4 | 0.966797 | sec[2]/sec[4]/sec[0]/p[1] | en | 0.999997 | PMC11276581 | https://doi.org/10.3390/genes15070926 |
Case MOL2101-1 was diagnosed with a congenital retinal disease, including chorioretinal scars and retinoschisis. Visual acuity deteriorated and at the age of 11 reached 0.4 in the right eye and hand motion in the left eye with mild myopia (−3.5 diopters). Multiple electroretinography (ERG) examinations revealed non-progressive sub-normal ERG responses, including cone flicker, mixed cone-rod a and b-wave and rod responses. Following multiple clinical evaluations between ages 1 and 19 years, no other clinical features were identified in this case. The patient was therefore diagnosed with non-syndromic chorioretinopathy. Interestingly, gene panel analysis revealed a heterozygous de novo nonsense mutation in KIF11 ( Table S1 ). | 4.011719 | 0.945313 | sec[2]/sec[4]/sec[0]/p[2] | en | 0.999995 | PMC11276581 | https://doi.org/10.3390/genes15070926 |
Case MOL2246-1 was diagnosed with a congenital syndrome due to polydactyly (of both fingers and toes), nephrolithiasis, dysmorphism, hypotonia, developmental delay, patent foramen ovale in the heart, ocular gaze abnormality, and hypermetropia (+5.0 diopter). An ERG examination at the age of 7 months was performed under anesthesia and revealed reduced cone function in the right eye (to 60% of lower normal limit). The parents of the index case were consanguineous of Bedouin origin and no other affected individuals were reported in the family. The genetic analysis revealed a homozygous splice-site variant, c.51+5G>T (IVS2+5G>T) in the ARMC9 gene. This variant has already been reported in an Israeli patient with similar symptoms , and in addition, it has been reported as a VUS (two reports), LP (likely pathogenic) and P (one report each) in ClinVar. It is predicted to affect splicing by multiple splicing analysis tools (SpliceAI, dbscSNV Ada, and dbscSNV RF). | 4.066406 | 0.911133 | sec[2]/sec[4]/sec[2]/p[1] | en | 0.999998 | PMC11276581 | https://doi.org/10.3390/genes15070926 |
Case MOL2215-1 was diagnosed with molar tooth sign, dysplastic cerebellum, developmental delay, growth delay, high myopia (−17 diopters), and esotropia. His visual acuity at the age of 5 years was 6/45 both eyes and latent horizontal nystagmus was noted. ERG testing at the age of 11 years showed low rod (75% of normal) and cone (30% of normal) amplitudes. The parents of the index case are consanguineous of Arab-Muslim origin and no other affected individual were reported in the family. The genetic analysis revealed a homozygous splice-site variant, c.2344C>T (p.R782*), in the LAMA1 gene. The variant has already been reported in two patients with similar phenotypes and is expected to create a pre-mature stop codon in exon 17 out of 62 exons. | 3.966797 | 0.931641 | sec[2]/sec[4]/sec[2]/p[2] | en | 0.999998 | PMC11276581 | https://doi.org/10.3390/genes15070926 |
Several imagistic techniques are being used to detect myocardial abnormalities. However, in recent years, advanced echocardiographic techniques such as speckle tracking have become more popular for assessing the myocardium even in the intensive care unit . Because of its high sensitivity and low inter-observer variability compared to conventional echocardiography, this method can detect early myocardium abnormalities based on coronary artery vascularization territories, despite a normal ejection fraction (EF) calculated with the standard echocardiography methods. In this case, we aim to present global and regional myocardial function changes in the case of ALCAPA in an infant patient using speckle-tracking echocardiography. | 4.101563 | 0.625 | sec[0]/p[1] | en | 0.999997 | 39057639 | https://doi.org/10.3390/jcdd11070219 |
Physical examination revealed low cardiac output and acute HF symptoms (pale skin with cold extremities, respiratory distress, tachycardia, a 4/6 holosystolic murmur at the left side of the sternal border, hepatomegaly). Laboratory tests indicated elevated serum creatinine levels, suggesting an acute pre-renal failure due to severely reduced systemic output. Moreover, significantly elevated NT-proBNP, Troponin T hs and Lactate levels were observed (60,477 pg/mL, 138 pg/mL and 6.3 mmol/L). Chest radiography revealed cardiomegaly, and the electrocardiogram revealed septal ischemia with a characteristic ALCAPA QR pattern in lateral leads. A transthoracic echocardiography revealed severe dilatation of the LV compressing the right cavities and severe mitral valve regurgitation with a dilated mitral annulus. The origin of the LCA from the pulmonary artery was visualised using two-dimensional and three-dimensional techniques. Color Doppler revealed retrograde flow from the pulmonary artery into the LCA . | 4.164063 | 0.833496 | sec[1]/p[1] | en | 0.999998 | 39057639 | https://doi.org/10.3390/jcdd11070219 |
Due to the critical state of the patient, preoperative inotropic treatment with Levosimendan was initiated along with anticoagulation with Enoxaparine. After stabilizing the patient, the surgical intervention was performed three days after the presentation. The LCA was re-implanted into the aorta using an aortic flap and a Proxicor patch as an extension of LCA, with further reconstruction of the pulmonary artery with a pericardial patch. | 3.632813 | 0.975586 | sec[1]/p[3] | en | 0.999997 | 39057639 | https://doi.org/10.3390/jcdd11070219 |
In the postoperative period, the patient was hospitalized in the ICU for 63 days. In the first three days, sternum closure was delayed to stabilise the patient. Also, during the immediate postoperative care, the patient required aggressive treatment for HF, including the administration of various inotropes such as Adrenaline, Milrinone and Levosimendan. Considering the compromised global contractility with persistent LV dilation and dyskinetic interventricular septum, treatment with Adrenaline was continued and tapered off on day 70 postoperatively. In the first 20 days after surgery, laboratory tests revealed a significant decrease in NT-proBNP values (15,000 pg/mL). Furthermore, transthoracic echocardiography confirmed the patency of the new LCA button, a slightly increased LV EF (25%) and GLS (−10). Additionally, there was an improvement in mitral valve insufficiency from severe to moderate. Compared to the preoperative period, the electrocardiogram still showed a QR pattern in lateral leads, albeit with a reduced q wave amplitude. However, infectious complications such as sepsis with Klebsiella BLSE led to a slight reduction in GLS (−5) and LV EF (20%). Also, in the early postoperative period, the patient developed thrombosis in the left atrium, likely due to decreased LV function. Consequently, a continuous infusion of Heparin was administered, followed by Enoxaparin, resulting in complete thrombus resolution. Additionally, pleural and pericardial effusion necessitated pleural drainage and increased diuretic therapy. In evolution, after the tapering of Adrenaline, a combination therapy for HF comprising a Beta-blocker, ACE inhibitor and aldosterone antagonist was gradually introduced. When the patient was discharged, laboratory tests revealed a significantly lower NT-proBNP value and the speckle-tracking analysis indicated improvement in regional and GLS (−7.9%) compared with the initial measurements, with an LV EF of 30% ( Table 1 ). | 4.0625 | 0.959473 | sec[1]/p[4] | en | 0.999996 | 39057639 | https://doi.org/10.3390/jcdd11070219 |
In conclusion, despite clinical improvement and increased ejection fraction following surgical repair in ALCAPA patients, a short-term follow-up revealed that some regions of LV remained dysfunctional. This case highlights the importance of speckle-tracking echocardiography as a non-invasive tool for detecting myocardial abnormalities in both pre- and postoperative follow-up in ALCAPA patients. | 4.003906 | 0.69043 | sec[3]/p[0] | en | 0.999996 | 39057639 | https://doi.org/10.3390/jcdd11070219 |
Recent studies have demonstrated the benefits of performing complex percutaneous coronary interventions (PCIs) with the support of intracoronary imaging techniques, and international clinical guidelines recommend their use . Optical Coherence Tomography (OCT) uses near-infrared light to obtain in vivo images with high spatial resolution, enabling detailed examination of the interior of coronary vessels. This makes it an invaluable tool for the diagnosis, planning and optimization of PCI in complex scenarios. While complications are rare, the occurrence of ventricular arrhythmias during its use is one of the most feared. Unfortunately, the mechanism by which these arrhythmias arise remains unclear. Understanding the mechanism of their occurrence is essential for prevention. Here, we discuss a case of OCT-guided PCI during which ventricular fibrillation occurred. | 4.132813 | 0.819824 | sec[0]/p[0] | en | 0.999996 | 39057620 | https://doi.org/10.3390/jcdd11070200 |
A 60-year-old male, current smoker and dyslipidemic, was admitted to the emergency room due to chest pain. He referred to several episodes of chest pain on slight exertion in the last 48 h. His vitals revealed a temperature of 36.5 °C, a heart rate of 55 beats per minute, blood pressure of 130/78 mmHg and oxygen saturation of 99% on room air. A physical examination did not reveal either cardiac murmurs or signs of congestive heart failure. The initial ECG showed sinus rhythm with first-degree atrioventricular block, without repolarization alterations . The transthoracic echocardiogram showed a normal left-ventricular ejection fraction without segmental alterations of contractility and no valvular disease. Initial laboratory reports revealed a slight elevation of cardiac damage markers (ultrahigh-sensitivity troponin I of 158 ng/L [reference range level, 0.0–54.0 ng/L]), with the rest of the analytical parameters in the normal range. With the diagnosis of non-ST-elevation acute coronary syndrome, 300 mg of acetylsalicylic acid and 180 mg of Ticagrelor were administered and the patient was admitted to Cardiology with telemetry. The following morning, the patient underwent a diagnostic coronary angiography via the right radial artery, which revealed a critical stenosis in the ostium of the left anterior descending artery (LAD) and an intermediate stenosis in its middle segment, with diffuse disease between both segments (TIMI III flow). No other significant stenosis was observed in the rest of the coronary vessels . | 3.929688 | 0.980957 | sec[1]/p[0] | en | 0.999998 | 39057620 | https://doi.org/10.3390/jcdd11070200 |
The patient was informed of the findings and the various treatment options. It was decided to perform PCI in the same procedure guided by intracoronary OCT imaging to assess the anatomy, take measurements and evaluate the possible involvement of the distal left main coronary artery (LMA) as well as the ostium of the LAD and circumflex artery (CX). | 3.248047 | 0.931641 | sec[1]/p[1] | en | 0.999999 | 39057620 | https://doi.org/10.3390/jcdd11070200 |
Intravenous unfractionated heparin (100 U per kg) was administered. The LMA was catheterized with a 6F 4 EBU guiding catheter, then a Sion guidewire was advanced to the distal segment of the LAD, and a Sion blue guidewire was advanced to the distal segment of the CX. Subsequently, the ostial stenosis of the LAD was dilated using a semi-compliant balloon with a diameter of 2.5 mm. The OCT catheter was then advanced to the mid-distal segment of the LAD, and a first pullback was performed by injecting 16 mL of contrast (4 mL/s for 4 s) without achieving clear intracoronary images. Subsequently, a second pullback was performed, and 29 mL of contrast (5 mL/s for 6 s) were injected through the guide catheter, acquiring optimal images . | 3.982422 | 0.507813 | sec[1]/p[2] | en | 0.999998 | 39057620 | https://doi.org/10.3390/jcdd11070200 |
Immediately after completing the injection, the patient experienced ventricular fibrillation (VF) , requiring external defibrillation with 360 J, which successfully restored sinus rhythm. The patient recovered promptly. Based on the OCT images obtained from the prior OCT, we proceed with the deployment of a 3.5/18 mm sirolimus-eluting stent from the proximal LAD to the ostium of the LMA, followed by postdilatation of the proximal segment with a 4.5 mm non-compliant balloon at 16 atm. Additionally, the stent struts were opened towards the ostium of the CX using a 2.5 mm non-compliant balloon, concluding with a LAD-CX kissing balloon inflation. Finally, a 2.75/20 mm sirolimus-eluting stent was implanted at 20 atm in the intermediate stenosis of the middle segment of the LAD, which had a minimum luminal area of 2.1 mm 2 . | 3.964844 | 0.959473 | sec[1]/p[3] | en | 0.999997 | 39057620 | https://doi.org/10.3390/jcdd11070200 |
A new OCT, injecting 15 mL of contrast (4 mL/s for 4 s), revealed adequate apposition and expansion of the LMA stent, with no evidence of distal or proximal dissection, and it also confirmed the correct opening of the stent struts at the ostium of the CX . The patient did not experience any further ventricular arrhythmias during this last OCT. | 3.689453 | 0.934082 | sec[1]/p[4] | en | 0.999997 | 39057620 | https://doi.org/10.3390/jcdd11070200 |
Therefore, we believe that the primary cause of the arrhythmia in our patient was myocardial ischemia, which may be attributed to the significant volume of contrast utilized during the second pullback. The posterior R-on-T phenomenon was a key factor in precipitating the subsequent VF. | 3.517578 | 0.824219 | sec[2]/p[6] | en | 0.999997 | 39057620 | https://doi.org/10.3390/jcdd11070200 |
To the best of our knowledge, this is the first reported case of VF during OCT preceded by widening of the QRS complex and ST elevation, suggesting myocardial ischemia as the mechanism favoring VF. With high probability, the amount of contrast administered in the second pullback was the determinant of VF. For this reason, it is recommended to adjust the volume of contrast injected during OCT acquisition, seeking in each case the balance between image quality and contrast volume. Possible electrical changes in telemetry in the first seconds after OCT should be monitored closely, and a defibrillator should always be available so that rapid action can be taken if ventricular arrhythmia occurs. | 4.082031 | 0.935059 | sec[3]/p[0] | en | 0.999996 | 39057620 | https://doi.org/10.3390/jcdd11070200 |
We report a preterm male newborn with a predisposition to WS, who presented with multiple complications at birth. Despite early respiratory and feeding challenges, he stabilized with no neurological issues. Genetic testing confirmed WS and multisystem anomalies were managed effectively. The infant’s recovery was supported by a multidisciplinary team, ensuring a successful transition to regular oral feeding and ongoing specialized care. | 3.296875 | 0.986816 | sec[0]/p[1] | en | 0.999996 | PMC11277181 | https://doi.org/10.7759/cureus.63206 |
A newborn male with a strong genetic predisposition to WS was born prematurely at 35 weeks of gestation via urgent cesarean section due to complications, including meconium aspiration, gestational hypertension, and maternal diabetes mellitus. He weighed 3400 grams at birth. The delivery required immediate resuscitative measures as the infant was flaccid and cyanosed. Apgar scores were 2 and 6 at one and five minutes, respectively, and special management of an umbilical cord injury was necessary. | 3.740234 | 0.98291 | sec[1]/p[0] | en | 0.999995 | PMC11277181 | https://doi.org/10.7759/cureus.63206 |
Upon admission to the neonatal intensive care unit (NICU), the infant exhibited symptoms consistent with transient tachypnea of the newborn (TTN). The initial assessment revealed moderate respiratory distress characterized by mild subcostal and intercostal retractions, with an initial oxygen saturation of 88% on room air. Echocardiography showed no evidence of persistent pulmonary hypertension of the newborn (PPHN). Given the clinical picture, the infant was promptly admitted to the NICU for specialized care. | 3.652344 | 0.979492 | sec[1]/p[1] | en | 0.999997 | PMC11277181 | https://doi.org/10.7759/cureus.63206 |
Treatment began with supplemental oxygen via nasal cannula, but due to worsening respiratory status, including increased work of breathing and intermittent desaturation, it was intensified to endotracheal intubation and mechanical ventilation. The highest ventilator settings recorded were a peak inspiratory pressure (PIP) of 20 cm H2O, positive end-expiratory pressure (PEEP) of 4 cm H2O, a fraction of inspired oxygen (FiO2) of 40%, and a rate of 30 breaths per minute. | 3.869141 | 0.63623 | sec[1]/p[2] | en | 0.999997 | PMC11277181 | https://doi.org/10.7759/cureus.63206 |
Despite standard ventilatory support, the infant continued to struggle with hypoxemia. This led to a brief period of high-frequency oscillatory (HFO) ventilation before a return to conventional methods. Alongside surfactant therapy, the medical team made frequent adjustments to the ventilatory settings, closely monitored blood gas levels (Table 1 ), and conducted serial chest X-rays . | 3.474609 | 0.942383 | sec[1]/p[4] | en | 0.999998 | PMC11277181 | https://doi.org/10.7759/cureus.63206 |
Sepsis management involved treating elevated inflammatory markers with broad-spectrum antibiotics (Table 1 ), despite negative blood cultures. The antibiotics were initially started at admission to the NICU due to the generalized sickness level of the baby, even though the initial absolute neutrophil count (ANC) was not low and CRP was normal. This was a precautionary measure due to the severe clinical presentation, including generalized hypotonia and bulging open anterior fontanelle. On day five, with CRP being elevated, the sepsis management continued with broad-spectrum antibiotics, leading to the normalization of inflammatory markers and resolution of clinical signs of sepsis. Meningitis was ruled out via lumbar puncture. | 3.824219 | 0.960938 | sec[1]/p[5] | en | 0.999996 | PMC11277181 | https://doi.org/10.7759/cureus.63206 |
On the third day after birth, the infant’s hyperbilirubinemia reached its highest level, with total serum bilirubin (TSB) levels peaking at approximately 10-12 mg/dL (171-205 µmol/L). Effective management with phototherapy was initiated, as this value exceeded the cut-off for a premature infant (35-37 weeks gestation). The total duration of phototherapy was six days. The maximum TSB value recorded was 14.5 mg/dL. This treatment resulted in a gradual reduction of bilirubin levels. To ensure the infant’s well-being, bilirubin levels continued to be carefully monitored following the phototherapy treatment to prevent any rebound hyperbilirubinemia. Apart from suspected sepsis, risk factors for hyperbilirubinemia included prematurity and potential genetic predispositions. | 4.035156 | 0.90625 | sec[1]/p[6] | en | 0.999997 | PMC11277181 | https://doi.org/10.7759/cureus.63206 |
The cardiac assessment uncovered a spectrum of anomalies. Notably, there was a patent foramen ovale with a left-to-right shunt and left ventricular hypertrophy of the non-obstructive variety. Additionally, a moderate tricuspid valve regurgitation was measured at 60 mmHg, alongside a small muscular ventricular septal defect. A significant finding was a large patent ductus arteriosus (PDA), measuring 5 mm with a bidirectional shunt, which fortunately demonstrated considerable improvement over time. The shunt direction was predominantly left-to-right as it became more restrictive with a maximum gradient of approximately 20 mmHg. The left atrium (LA) ratio and superior mesenteric artery (SMA) Doppler were not specified, and no features indicated hemodynamic compromise. These cardiac abnormalities were managed with a conservative approach, showing no indications of heart failure. Despite requiring heightened respiratory support to HFO due to severe respiratory distress, the PDA was managed conservatively because of features suggestive of PPHN, where maintaining a PDA can be beneficial. | 4.152344 | 0.937012 | sec[1]/p[7] | en | 0.999997 | PMC11277181 | https://doi.org/10.7759/cureus.63206 |
The abdominal ultrasound brought to light a series of renal abnormalities. Among these was a left-sided multicystic dysplastic kidney, accompanied by bilateral hydronephrosis. The left ureter appeared tortuous and dilated, extending all the way to the ureterovesical junction, which was associated with a grade 4 vesicoureteral reflux (VUR). On the other hand, the right ureter showed mild changes consistent with grade 2 VUR. These findings are corroborated by a voiding cystourethrogram. Additionally, there was a suggestion of a duplicated collecting system on the left side. Initial renal function tests indicated elevated creatinine levels, but these levels showed improvement over time (Table 1 ). As a preventive measure, prophylactic antibiotics were prescribed. | 4.011719 | 0.952148 | sec[1]/p[8] | en | 0.999997 | PMC11277181 | https://doi.org/10.7759/cureus.63206 |
During the patient's hospitalization, multiple clinical signs raised suspicions of WS, as the patient exhibited several distinctive facial features. These included dystopia canthorum, telecanthus, a striking white forelock, and a notably broad nasal root and bridge. A thorough examination revealed no signs of organomegaly. The patient's male genitalia were within normal parameters, and no skeletal abnormalities were detected. In light of this presentation, a series of tests were recommended, including chromosomal analysis, genetic screening, and hearing evaluations. | 3.166016 | 0.986816 | sec[1]/p[10] | en | 0.999996 | PMC11277181 | https://doi.org/10.7759/cureus.63206 |
Upon conducting an auditory brainstem response test, the infant was diagnosed with bilateral sensorineural hearing loss. The infant exhibited neither abnormal movements nor signs of seizures. Additional neurological examinations and brain ultrasound scans were conducted, all of which returned normal findings with no evidence of ventriculomegaly, intraventricular hemorrhage, or structural anomalies. | 3.115234 | 0.977051 | sec[1]/p[11] | en | 0.999996 | PMC11277181 | https://doi.org/10.7759/cureus.63206 |
Finally, we highlight the intricate management of a newborn diagnosed with WS type 1, emphasizing the necessity for a thorough and interdisciplinary approach to complex genetic conditions. The infant exhibited hallmark symptoms of WS, along with unanticipated renal and cardiac abnormalities, which called for meticulous neonatal care and genetic evaluation. | 3.660156 | 0.819824 | sec[3]/p[0] | en | 0.999997 | PMC11277181 | https://doi.org/10.7759/cureus.63206 |
Prompt and effective treatment of critical conditions, including transient tachypnea and hyperbilirubinemia, as well as specialized management of renal and cardiac complications, highlighted the significance of prompt and ongoing care. Furthermore, this case accentuated the vital importance of addressing early hearing impairment and providing genetic counseling to the family, reinforcing the need for early detection and comprehensive care strategies. | 3.398438 | 0.956543 | sec[3]/p[1] | en | 0.999995 | PMC11277181 | https://doi.org/10.7759/cureus.63206 |
This case study describes a 64-year-old man with left-sided hemiparesis and a failed surgical treatment of a pertrochanteric fracture of the proximal femur in the spastic limb. He was admitted to the Department of Rehabilitation and Orthopedics in December 2022 for diagnostic evaluation and treatment planning after five months of non-ambulatory status. | 3.263672 | 0.989258 | sec[1]/sec[0]/p[0] | en | 0.999998 | PMC11277479 | https://doi.org/10.3390/jcm13144023 |
Following a hemorrhagic stroke in 2005, the patient underwent extensive rehabilitation, focusing on locomotion and upper limb manipulation. Following recovery, he was able to walk independently using a hand cane. His Barthel scale score was 85, indicating slight disability and independence in daily activities, although his Tinetti scale score was 10 out of 28, indicating a high fall risk . Table 1 shows the Barthel scale scores, indicating the patient’s functional status before and after treatment. Table 2 displays the Tinetti scale scores, assessing balance and fall risk. | 3.701172 | 0.971191 | sec[1]/sec[2]/p[0] | en | 0.999997 | PMC11277479 | https://doi.org/10.3390/jcm13144023 |
In July 2022, the patient came to the emergency room due to severe pain in the left hemiparetic limb and the inability to bear weight on it after a fall from his own height. During the examination, an X-ray revealed a pertrochanteric fracture of the left lower limb. The second day after the fracture, surgery was performed to stabilize the fracture with a Gamma nail. Figure 1 shows the X-ray taken after the initial surgery, illustrating the successful fusion of the fracture. | 3.076172 | 0.990234 | sec[1]/sec[3]/p[0] | en | 0.999997 | PMC11277479 | https://doi.org/10.3390/jcm13144023 |
The first stage of treatment, performed in January 2023, involved the removal of the failed fixation and the use of an absorbable calcium sulfate antibiotic carrier with Gentamicin to fill bone defects. This was followed by comprehensive perioperative care, including antibiotic therapy, antithrombotic prophylaxis, and anti-edema management. Figure 2 shows the X-ray taken after the first stage of treatment, illustrating the successful removal of the failed fixation and filling of the bone defects. | 3.160156 | 0.898926 | sec[1]/sec[4]/p[1] | en | 0.999998 | PMC11277479 | https://doi.org/10.3390/jcm13144023 |
Before the botulinum treatment, the muscle tension of the paretic limb was assessed as 3 according to the Ashworth scale (mm. gastrocnemius, soleus, posterior tibialis, and adductors). There was also a significant limitation of mobility in the hip joint (flexion–adduction contracture 20 degrees), knee joint (flexion contracture 30 degrees), and a fixed equinus foot position. In the upper limb, the muscle tension of the elbow and wrist flexors was 4 on the Ashworth scale. The left upper limb was assessed as unusable due to severe spasticity and the persistent limitation of mobility of the wrist and finger joints. | 3.894531 | 0.917969 | sec[1]/sec[4]/p[4] | en | 0.999997 | PMC11277479 | https://doi.org/10.3390/jcm13144023 |
After the final stage of the treatment, which involved the insertion of a complete bipolar snap-on prosthesis and adductor muscle tenotomy, the patient was able to walk short distances (about 30 m) and climb the stairs with support . His Barthel scale score improved to 60, although his Tinetti scale score remained low at 6, indicating ongoing balance and mobility challenges. The patient was discharged home after five weeks of rehabilitation with recommendations to continue the exercises at home (balance and mobility training to decrease the risk of further falls) and to continue the botulinum therapy every 3 months. Figure 6 displays a detailed timeline of the patient’s treatment. | 3.492188 | 0.983887 | sec[1]/sec[4]/p[9] | en | 0.999997 | PMC11277479 | https://doi.org/10.3390/jcm13144023 |
Our patient scored 10 on the Tinetti scale following a stroke, indicating a high fall risk and underscoring the need for targeted rehabilitation to improve balance and coordination . The Barthel scale, used to assess patient independence in daily activities, showed a score of 60, indicating moderate disability and partial assistance needs . | 3.335938 | 0.942871 | sec[2]/p[1] | en | 0.999996 | PMC11277479 | https://doi.org/10.3390/jcm13144023 |
The research also indicates that patients with hemiplegia experience longer hospital stays and more frequent postoperative complications, highlighting the need for specialized care protocols. Choosing the appropriate surgical approach, such as the direct anterior approach, and selecting the optimal type of artificial hip joint are critical for successful rehabilitation and reduced postoperative complications. Effective spasticity management requires a multimodal approach, including botulinum toxin injections combined with electrical stimulation and gait training. The use of intrathecal baclofen pumps is also beneficial for patients with refractory spasticity. A staged treatment program, starting with botulinum toxin injections to reduce muscle spasticity, followed by continuous therapeutic rehabilitation, and culminating in hip arthroplasty, significantly enhances the patient outcomes by promoting independent movement and greater autonomy. In conclusion, the management of hip fractures in patients with spastic paralysis requires a multidisciplinary approach and the development of standardized treatment protocols. This case underscores the importance of comprehensive pre- and postoperative rehabilitation to improve patient outcomes. | 4.195313 | 0.523926 | sec[3]/p[1] | en | 0.999998 | PMC11277479 | https://doi.org/10.3390/jcm13144023 |
A 70-year-old active smoker without any prior surgical history nor a known family history for aortic diseases presented to the emergency department with a 2-week history of intermittent chest pain, hoarseness, and dry cough. Computed tomography (CT) angiography revealed a 13-cm TAA with left-side pleural effusion . The patient had a bovine configuration with a type II arch. The landing zone length between the left common carotid artery (LCCA) and left subclavian artery (LSA) was 13 mm measured on centerline and 18 mm on the outer, as well as 13 mm on the inner curvature. The left vertebral artery was chronically occluded. Given the risk of impending rupture and the anatomical configuration of the patient’s vessels, the patient was scheduled for an urgent TEVAR with ISLF for the LSA and a chimney for the LCCA. In this particular case, the chimney technique for LCCA was used due to the patient’s bovine arch with a large common origin of the brachiocephalic trunk and LCCA and the early takeoff of the LCCA from this common origin. The chimney technique allowed maintaining antegrade flow to both arteries without resorting to open surgery on the neck or chest. Fig 1 Preoperative three-dimensional reconstructions of 13-cm thoracic aortic aneurysm ( TAA ) that was treated with implantation of a thoracic stent graft with proximal landing with partial coverage of the left common carotid artery ( LCCA ) and the left subclavian artery ( LSA ). The LCCS was revascularized with a chimney stent graft, and the LSA with in situ laser fenestration ( ISLF ) and stent graft implantation in this fenestration. | 3.951172 | 0.974121 | sec[0]/p[0] | en | 0.999995 | PMC11277743 | https://doi.org/10.1016/j.jvscit.2024.101550 |
An 8-mm Advanta V12 (Atrium) was deployed in the LCCA using the chimney graft technique. Subsequently, a steerable sheet was used to access the LSA, and an ISLF was performed with a 1.7-mm Turbo-Elite Laser Catheter (Philips), with an 0.018 wire passing into the ascending aorta through the ISLF fenestration. The fenestration was ballooned up to 5 mm afterwards. After the creation of the ISLF, a 9-mm Gore Viabahn VBX Balloon Expandable Endoprosthesis (W. L. Gore & Associates) was deployed. Completion angiography revealed normal flow to the LSA and LCCA, with complete endovascular exclusion of the TAA without any visible signs of stent compression or endoleaks . The patient was discharged after 7 days with single antiplatelet therapy (ASA) and without any complications. Fig 2 Completion angiography demonstrating a fully patent left subclavian artery ( LSA ) bridge stent after in situ laser fenestration ( ISLF ) technique ( green arrowhead ). | 3.935547 | 0.949219 | sec[0]/p[3] | en | 0.999997 | PMC11277743 | https://doi.org/10.1016/j.jvscit.2024.101550 |
The first follow-up CT angiography 2 months postoperatively showed a significant stenosis of the LSA bridging stent graft . The patient was scheduled for a reintervention. Imaging at time of reintervention showed a fully fractured LSA stent . Successful cannulation of the LSA was performed through left brachial access, and the stent graft was realigned with a 9-mm Advanta V12 . Completion angiography showed good flow to the LSA and no visible endoleaks. The patient had uneventful recoveries after both procedures, and no spinal cord protection measures were necessary. The patient underwent a follow-up CT scan 2 months after the reintervention and had a clinic visit a month later without any signs of restenosis. Fig 3 A, Three-dimensional reconstruction of the fractured left subclavian artery ( LSA ) bridging stent ( red arrow ). B, Two-month computed tomography ( CT ) scan showing significant stenosis of the LSA bridging stent graft ( red arrow ). C, Intraoperative image of the fractured bridging stent graft ( red arrow ). Fig 4 A-C, Left subclavian artery ( LSA ) bridging stent fracture was re-lined with a 9-mm Advanta V12 ( blue arrows ). | 3.855469 | 0.974121 | sec[0]/p[4] | en | 0.999997 | PMC11277743 | https://doi.org/10.1016/j.jvscit.2024.101550 |
In this paper, we describe the first case of bridging stent graft fracture after ISLF during TEVAR. According to existing literature, balloon expandable stents are more rigid and straight, which makes them more susceptible to collapse and fractures when the external pressure is high. 11 , 12 The non-reinforced character of the ISLF makes the bridging stent grafts theoretically more prone to instability. One of the possible mechanics advocated is that of a direct compression due to the metal struts of the TEVAR stent graft. This could lead to a considerable mechanical stress in the region of the ISLF. A systematic analysis conducted by Prendes et al suggests the use of multifilament polyethylene terephthalate, followed by dilation with noncompliant balloons, as the most durable in vitro technique for ISLF. 5 | 4.199219 | 0.546875 | sec[1]/p[2] | en | 0.999997 | PMC11277743 | https://doi.org/10.1016/j.jvscit.2024.101550 |
Considering the unexpected complication that occurred after the ISLF during this emergent TEVAR, an individualized follow-up plan was utilized for this patient. The first CT scan was performed 2 months after the reintervention, with a yearly CT scan being planned. Any target vessel instability seen during the follow-up scan would be addressed accordingly. The open conversion (ie, a carotid-subclavian bypass or a total debranching based on the patency of the chimney to the left common carotid artery) could be considered as an option. | 3.4375 | 0.853516 | sec[1]/p[4] | en | 0.999996 | PMC11277743 | https://doi.org/10.1016/j.jvscit.2024.101550 |
A 7-month-old male Rottweiler was referred for consultation because of severe swelling on the left side of the jaw, with a suspected jaw tumor. Clinical examination revealed no abnormalities in the aforementioned lymph glands and no soreness on palpation. Intraoral examination on the left side revealed severe asymmetry, with enlargement of the facial soft and hard tissues, an absence of permanent teeth, and buccal displacement of deciduous teeth. On the left side, rhinoscopic examination revealed normal anterior nostrils and a left nasal aperture with a lack of patency from the level of the nasal bony inlet to the posterior nostrils. A roentgenogram in the dorsal–ventral projection showed the presence of four ectopic teeth in the maxilla, with the formation of a dentigerous cyst . Using the CLP technique, the ectopic teeth were removed and the cyst walls were lanced. The bone loss caused by the cyst was 7.3 cm × 4.6 cm, and the jawbone left behind was too thin to provide a scaffold for the surrounding tissues and to ensure nasal cavity patency. From a 5 cm pellet of hydroxyapatite polymer material with curdlan previously soaked in saline (according to the manufacturer’s instructions), longitudinal flaps of 5 cm long, 1 cm wide, and 0.1–0.2 cm thick were cut and placed in the bony defect to strengthen the bony scaffolding of the jaw and nasal septum . The gingival flap was sutured with a single suture using 4-0 monofilament material. The first radiological follow-up was performed after 4 weeks, but due to the size of the defect and the size of the pellets of material used, the hydroxyapatite obscured the structures in the nasal cavity, preventing accurate assessment. A rhinoscopic examination revealed patency of the left nasal cavity. It was decided to conduct a radiological follow-up 6 months after the procedure, but the owner, for personal reasons, did not attend the follow-up appointment. After 12 months, another roentgenogram was performed, where a properly healed jawbone with closure of the cyst cavity could be observed. The nasal septum was formed properly, and the resulting bony scaffolding resulted in patency of the left nasal aperture, along with normal airflow on the left side . | 4.015625 | 0.978027 | sec[1]/sec[1]/p[0] | en | 0.999997 | PMC11277777 | https://doi.org/10.3390/life14070879 |
A 3-year-old German Shepherd dog was referred with a suspected periapical abscess of a tooth on the right side. The medical history of the pet client reported that the dog had been treated for chronic rhinitis for 6 months. On clinical examination, tooth 104 (right maxillary fang) was observed to be missing, with no wounds or fistulas in the oral cavity. Rhinoscopic examination showed features of chronic rhinosinusitis, with convexity of the nasal wall mucosa on the right side of the nasal cavity, without proliferative changes or foreign bodies. Radiological examination revealed the presence of an ectopic tooth located outside the alveolar process in the region of the maxillary cranium. Its shape was not characteristic of any normal tooth. It had a soppy crown and an incompletely formed root. The tooth was surrounded by a dentigerous cyst measuring 5.6 × 2.8 cm . After tooth extraction using the CLP technique and cyst lysing, the bone defect was filled with a hydroxyapatite polymer material previously soaked in 0.9% NaCl. The plasticity of the material was exploited so that it was possible to fill the bone defect with the material through a dissected bone window of 3 cm in diameter without enlarging the bone defect. A follow-up X-ray 28 days after the procedure showed normal filling of the defect with bone, without signs of inflammation or granulation formation within the jawbone. On clinical examination, resolution of nasal discharge problems and the absence of features of inflammation within the nasal cavity were observed . | 3.982422 | 0.978027 | sec[1]/sec[1]/p[1] | en | 0.999997 | PMC11277777 | https://doi.org/10.3390/life14070879 |
A 10-month-old American Staffordshire Terrier dog was referred for an orthodontic consultation due to abnormal alignment of the maxillary teeth and the resulting bite injuries. Clinical examination revealed three properly aligned incisors on the right side and four incisors (including one tooth with a double crown) on the left side arranged chaotically . Intraoral examination revealed an abnormal palatal crease in the projection of teeth 103–203 and a hard and painful protrusion about 3 cm in diameter on the left side. The roentgenogram showed the presence of three additional incisors, including two unerupted ones, growing in the opposite direction to the alveolar process. The double tooth on the X-ray appeared to be a fused tooth (tooth fusion occurs as a result of physical force or pressure on an adjacent tooth’s bud, leading to the contact of the two tooth buds and their fusion before calcification) . The abnormal growth of the incisors on the left side caused pressure on the incisal bone, along with skewing of the nasal septum to the right side . The third incisor, along with an additional third incisor, showed radiographic features of a dentigerous cyst. A decision was made to perform open extraction of the ectopic teeth using the CLP method. | 3.994141 | 0.975098 | sec[1]/sec[1]/p[2] | en | 0.999996 | PMC11277777 | https://doi.org/10.3390/life14070879 |
The bone cavity, after such a large open extraction, was 3.0 cm × 4.2 cm; so, the decision was made to implant polymeric hydroxyapatite with curdlan soaked in 0.9% NaCl into the areas of bone loss. The flap was sutured with 4-0 monofilament single sutures. A follow-up radiograph was taken 28 days after surgery. On clinical examination, the soft tissues were healed properly. On the follow-up radiograph, the bone tissue was healed properly, with new bone formation. | 3.078125 | 0.978516 | sec[1]/sec[1]/p[3] | en | 0.999996 | PMC11277777 | https://doi.org/10.3390/life14070879 |
A 14-month-old female Cane Corso was referred for dental diagnosis due to the absence of tooth 204 and periodic swelling of the left suborbital region. The dog had been treated ophthalmologically for 4 months for recurrent conjunctivitis of the left eye and increased epiphora. Ophthalmologic examination revealed obstruction of the left nasolacrimal duct, the cause of which was attributed to recurrent inflammation of the infraorbital region. The roentgenogram in the oblique projection, in the view of teeth 205–207, showed the presence of a shadow with saturation characteristic of tooth tissue, with an atypical shape . The roentgenogram confirmed the presence of an ectopic tooth, along with a dentigerous cyst measuring 3 cm × 1.7 cm in the area of the maxillary cranium and the fossa of the lacrimal sac . The tooth was accessed using the CLP technique, then an opening was drilled into the anterior wall of the maxillary cusp and the horizontally lying ectopic tooth 204 was visualized. After removal of the tooth, the lumen of the bone defect was reviewed and the empty space was filled with hydroxyapatite polymer material with curdlan. The bone substitute material was soaked in 0.9% NaCl before surgery, making it malleable and allowing the bone defect to be filled through a 2 cm bone window. The mucosa was sutured with a 4-0 absorbable monofilament suture. Radiological follow-up was carried out 28 days later, which showed that the defect was filled with newly formed bone. No inflammatory changes or granulation tissue formation were found in the area of the defect . | 4.042969 | 0.972656 | sec[1]/sec[1]/p[4] | en | 0.999996 | PMC11277777 | https://doi.org/10.3390/life14070879 |
Case 1 : A 33-year-old male dentist, born in 1979, had been suffering from very early detumescence since adolescence. He was impatient to wait for other options and resorted to penile implantation to treat his ED. Thus, he underwent penile venous coil embolization (CE) to treat veno-occlusive dysfunction (VOD) due to a long-term venous leak in 2011. Unfortunately, after the coil implant, the early detumescence remained the same and poorer erection rigidity ensued; he was referred for our medical assistance in 2012. A dual pharmaco-cavernosography scout film demonstrated several dozen coils lodged within the periprostatic venous plexus , and VOD was confirmed in a corresponding pharmaco-cavernosography . The coils remained in situ at the patient’s last evaluation . | 3.720703 | 0.984863 | sec[1]/sec[0]/p[0] | en | 0.999995 | PMC11278194 | https://doi.org/10.3390/life14070911 |
Case 2 : A 42-year-old housebuilder, born in 1972, had suffered from ED resulting from VOD since 1994 and received penile venous CE in 2000. He experienced some improvement in erection quality from 2000 to 2003, but then ED recurred, with a subsequent physician declining his request for CE in 2005. Refractory ED prompted him to seek out medical assistance for which he traveled over 10,000 km in November 2014. Pharmarco-cavernosography demonstrated significant VOD. Surprisingly, although a pelvic X-ray failed to find coil imaging, a chest X-ray disclosed five coils lodged in pulmonary arteries . | 3.230469 | 0.988281 | sec[1]/sec[0]/p[1] | en | 0.999996 | PMC11278194 | https://doi.org/10.3390/life14070911 |
A contrast CT scan confirmed two coils installed in the left and right pulmonary arterial trees. The coils were tightly adhesive to the vessel wall; a coil had traversed the right ventricle wall and lodged within the pericardium . He received PVS of the excessive drainage veins with an uneventful postoperative course. He experienced a significant improvement parallel to a postoperative cavernosogram with enhanced intracorporeal retention, although it was not entirely satisfactory. Then, a revisit was decided upon to salvage the PVS in April 2016. A chest X-ray and spiral CT demonstrated further migration and perforation of the right ventricle wall and diaphragm by the coil . The liver border was irregular and penetrated, and cirrhosis was incidentally noted. He eventually benefited somewhat from our ambulatory surgery, although our primary concern was morbidity from the uncontrolled coil. | 3.683594 | 0.983398 | sec[1]/sec[0]/p[2] | en | 0.999999 | PMC11278194 | https://doi.org/10.3390/life14070911 |
Case 3 : A 31-year-old banker, born in 1985, had suffered from ED resulting from VOD since age 23. He then underwent his first penile venous CE in the northern hemisphere in 2010, with no improvement in erectile function. Table 1 summarizes three CE courses at different medical school-affiliated hospitals. Acute chest pain led him to the emergency room. From an imaging study, he was told that a dumbbell-shaped coil complex was evident in the right pulmonary artery eight days postoperatively. Refractory ED prompted him to receive second and third penile venous CE procedures in 2012 and 2014 at different medical schools. Tapeworm-shaped and pigtail-shaped coils were demonstrated . His ED did not improve. Refractory ED prompted him to seek out medical assistance after a long trip in August 2016. A chest X-ray confirmed a twisted coil complex lodged in the right pulmonary artery, although this patient had experienced no more chest pain since the painful episode in 2010. An abdominal x-ray showed two coils at 90-degree to the body axis: one lodged in the bifurcation region of the left iliac region and the other installed in the right internal pudendal vein level , which corresponded to the coils inserted in 2012 and 2014, respectively. Dual pharmaco-cavernosography showed that the coils did not fit within the internal iliac or pudendal veins regardless of VOD . He had an uneventful course after PVS, which caused significant intracorporeal retention, conspicuously in the penile crura , and flew home on the third postoperative day. Erectile functional improvement is ongoing, and he has resumed sexual activity. | 3.949219 | 0.982422 | sec[1]/sec[0]/p[3] | en | 0.999996 | PMC11278194 | https://doi.org/10.3390/life14070911 |
Case 4 and 5: Two university students, born in 1992 and 1993, respectively, had suffered from ED resulting from VOD since the ages of 23 and 21. They underwent their first penile venous CE in the northern hemisphere in 2015 and 2017 with no improvement in erectile function. In 2017 and 2018, intractable ED prompted them to visit our institute, where many inserted coils were noted in the proximal deep dorsal vein and the superficial dorsal vein . Then, they had an uneventful course after PVS and flew home on the third and fourth postoperative days. Erectile functional improvement was noted, and sexual activity was resumed. | 3.244141 | 0.989746 | sec[1]/sec[0]/p[4] | en | 0.999997 | PMC11278194 | https://doi.org/10.3390/life14070911 |
Anomalous arteriovenous shunts between meningeal arteries and dural venous sinuses or cortical veins are known as dural arteriovenous fistulas (DAVFs). This abnormality accounts for 10–15% of all intracranial arteriovenous malformations . Ethmoid branches of the ophthalmic artery provide eDAVFs, which make up about 2–3% of DAVFs . eDAVFs often drain into the dilated cortical vein without sinus drainage . Some very dangerous venous drainage features, such as direct cortical venous drainage, cortical vein reflux (CVR), and venous ectasia, are associated with a high risk of cerebral bleeding and severe neurological impairments. These traits frequently indicate a malignant nature proclivity in eDAVFs . Most eDAVFs with CVR necessitate prompt treatment . For eDAVFs, endovascular embolization and surgery are the two major treatments. Surgery, in particular, offers a significantly lower risk of complications than endovascular techniques, as well as an outstanding record of completely obliterating eDAVFs . Bifrontal interhemispheric, low subfrontal, pterional, unilateral high frontal, and transfrontal sinus approaches are among the several surgical approaches for eDAVFs . In this case report, we describe successful mini-invasive surgery for treating Cognard type IV eDAVFs in two cases using a unilateral supraorbital keyhole subfrontal approach. | 4.285156 | 0.853516 | sec[0]/p[0] | en | 0.999997 | PMC11278917 | https://doi.org/10.3390/medicina60071128 |
In December 2022, a 60-year-old man with a high fever and Lemierre syndrome diagnosis was admitted to Chung Shan University Hospital. After the patient’s admission, a head and neck computer tomography (CT) scan and a brain magnetic resonance angiography were performed to assess the cause of the fever. These tests unintentionally revealed a cerebral vascular lesion in the right anterior frontal base area without any bleeding or infarction. A right anterior frontal vein with a large venous ectasia that drained back to the superior sagittal sinus (SSS) and a right frontal basal vein that drained back to the inferior petrosal sinus were the two cortical veins with CVR that were fed by the ethmoidal branches of the bilateral ophthalmic arteries, according to brain digital subtraction angiography (DSA) . The patient had neither a neurologic deficiency nor any symptoms. Cognard type IV was assigned to the eDAVF . We scheduled a surgical procedure for eDAVF treatment a month after the Lemierre syndrome patient finished receiving antibiotic therapy. First, we used neuronavigational guidance (CranialMap 3.0 Navigation Software, Stryker NAV3i Platform). The skin incision was made from the right supraorbital incisura in the eyebrow, starting laterally and moving medially. Next, a high-speed electric burr and saws were used to accomplish a right supraorbital keyhole craniotomy. After releasing the cerebrospinal fluid, the surgeon detached the bilateral cribriform galli fistulous site and used micro scissors and bipolar coagulation to skeletonize the right frontal basal vein. Two titanium clips clamped the right anterior frontal vein at the location of the DAVF frontal base dura fistula point. There was no disruption whatsoever to the olfactory bulbs and tracts. At the frontal lobe section, the right anterior cortical veins were unharmed . We performed intraoperative indocyanine green (ICG) angiography to verify the absence of early arterialized venous outflow into the right anterior frontal vein . A follow-up brain CT angiography performed one month after surgery revealed that the prior eDAVF had been effectively obliterated . After an uncomplicated postoperative stay, the hospital discharged the patient one week after the procedure. He was then routinely monitored in the outpatient department for six months, during which he did not exhibit any new neurologic deficits or symptoms except for numbness in the right supraorbital craniotomy region. | 3.962891 | 0.975586 | sec[1]/p[1] | en | 0.999998 | PMC11278917 | https://doi.org/10.3390/medicina60071128 |
In April 2024, a 71-year-old man was found with a right side eDAVF incidentally in Linkou Chang Gung Memorial Hospital. An initial brain CTA showed a right frontal base vascular lesion. The right superficial temporal artery and the right ethmoidal branches of the right ophthalmic artery feeded blood into the eDAVF. The vein located at the right frontal base was twisted and engorged, with a venous ectasia, and served as the drainage vein of the eDAVF. The eDAVF was designated as a Cognard type IV. We adapted the right supraorbital keyhole craniotomy for the asymptomatic eDAVF. The brain CT angiography, cerebral angiography, operation procedure, and intraoperative can be seen in the video 1 . | 3.720703 | 0.972656 | sec[1]/p[3] | en | 0.999998 | PMC11278917 | https://doi.org/10.3390/medicina60071128 |
A 47-year-old non-smoking man presented at the clinic of periodontics at the University Hospital of Lille, Lille, France, on January 24th, 2022, with a chief complaint of a generalized gingival overgrowth. His medical history revealed a diagnosis of hypertension nine months ago which was treated with a combination of perindopril/amlodipine 10mg /10mg since April 2021. Gingival symptoms manifested only a few weeks after starting the medication, with complaints of spontaneous gingival bleeding and halitosis. Clinical examination revealed a generalized gingival overgrowth, on both the labial and oral sides of both the upper and the lower arch, involving the interdental papilla, gingival margin, and attached gingiva particularly in the molars . | 3.775391 | 0.982422 | sec[1]/p[1] | en | 0.999996 | PMC11279205 | https://doi.org/10.7759/cureus.63214 |
Despite reporting brushing twice a day, the patient exhibited poor oral hygiene. The complete periodontal examination revealed generalized pseudo-pockets (probing depth from 4 to 9 mm) and a bleeding on probing (BOP) score of 100%. Radiographs revealed generalized moderate bone loss on both maxillary and mandibular arches . | 3.216797 | 0.983887 | sec[1]/p[2] | en | 0.999996 | PMC11279205 | https://doi.org/10.7759/cureus.63214 |
A 58-year-old male patient presented at the Department of Periodontics at Louis Mourier’s University Hospital, Paris, France, on March 1st, 2023, with a chief complaint of gingival overgrowth associated with spontaneous gum bleeding, gingival pain, halitosis, and self-reported tooth mobility. The medical history included hypertension and type 1 diabetes (glycated hemoglobin HbA1c = 7.7%) and the patient had undergone a kidney transplant in 2016. Relevant medications included metformin (antidiabetic drug), amlodipine (calcium channel blocker), tacrolimus, and mycophenolate mofetil (immunosuppressants used to prevent graft rejection). Gingival symptoms manifested a few weeks after starting amlodipine. Clinical examination revealed gingival enlargement similar to Case 1, pseudo-pockets (probing depth from 4 to 12 mm), inadequate plaque control, and generalized inflammation (BOP = 100%) . | 3.876953 | 0.982422 | sec[1]/p[5] | en | 0.999995 | PMC11279205 | https://doi.org/10.7759/cureus.63214 |
Step 1 involved referring the patients to their physician for a switch in medication suspected to be causing gingival enlargement. Additionally, comprehensive oral hygiene instructions were provided, along with a full-mouth supragingival instrumentation using standard ultrasonic tips (Acteon Satelec, Mérignac, France). In Case 1, amlodipine was replaced by Lercanidipine 10 mg and Irbesartan 150 mg, while urapidil 60 mg was prescribed in Case 2. | 3.054688 | 0.885742 | sec[1]/p[11] | en | 0.999994 | PMC11279205 | https://doi.org/10.7759/cureus.63214 |
In Step 3 for the non-responding sites (sites with or without residual bleeding pocket associated with gingival overgrowth), retreatment was carried out through non-surgical repeated subgingival instrumentation only. In Case 1, systemic antibiotics were administered as adjunctive therapy due to the high number of non-responding sites (deep and bleeding pockets) despite significant improvements in oral hygiene at repeated sessions of mechanical instrumentation in Step 2. | 3.511719 | 0.872559 | sec[1]/p[15] | en | 0.999997 | PMC11279205 | https://doi.org/10.7759/cureus.63214 |
One patient presented in this case report (Case 1) received systemic antibiotics as an adjunct to periodontal treatment. Even though the clinical situation improved after a thorough hygiene motivation phase and several sessions of supra and subgingival instrumentation, it was not completely successful as many bleeding deep pockets persisted. In this patient, the combination of amoxicillin and metronidazole was chosen based on current clinical practice guidelines for the treatment of Stage I-III periodontitis . While the ideal timing for antibiotic administration during periodontal therapy remains an unanswered question, supragingival plaque control seems to offer substantial clinical and microbial benefits in periodontal patients treated with systemic antibiotics . In the other patient (Case 2), only antibioprophylaxis (amoxicillin 500 mg) was performed before subgingival instrumentation due to the patient's immunosuppression . Interestingly, this patient used mycophenolate mofetil, an immunosuppressant that has been reported to induce DIGE when combined with Cyclosporine A . This drug was not substituted after discussion with the physician because of its benefit-risk balance and good tolerance. However, the favorable gingival outcomes obtained after Amlodipine substitution only could suggest a minor role of this molecule in this patient’s DIGE. | 4.105469 | 0.935059 | sec[2]/p[3] | en | 0.999998 | PMC11279205 | https://doi.org/10.7759/cureus.63214 |
This report highlights two successful cases demonstrating the complete resolution of severe DIGE, primarily influenced by amlodipine. The resolution was achieved through a non-surgical approach only, involving drug substitution and repeated sessions of mechanical instrumentation. Not all patients may respond to this treatment modality; however, clinicians may consider this approach as a viable alternative to more invasive and costly surgical treatments, offering potential for successful clinical outcomes and a high level of patient satisfaction. | 3.925781 | 0.957031 | sec[3]/p[0] | en | 0.999997 | PMC11279205 | https://doi.org/10.7759/cureus.63214 |
A 52-year-old Caucasian woman had a history of stage IV (presence of solitary liver metastasis, which disappeared after neoadjuvant chemotherapy) triple-negative breast cancer in remission for over five years . She presented with CIPN in her feet and neuropathic pain around her right axilla and shoulder. She had previously received neoadjuvant chemotherapy and immunotherapy between 26 January 2016 and 19 April 2016 in the form of four cycles of paclitaxel and two anti-HER2 monoclonal antibodies (trastuzumab–pertuzumab). She then underwent a bilateral mastectomy and left axillary lymph node dissection, followed by adjuvant immunotherapy and radiotherapy between 19 April 2016 and 14 July 2020. Immunotherapy consisted of 74 cycles of trastuzumab–pertuzumab, and 40.05 Gy of radiation was delivered in 15 fractions to the whole left breast, supraclavicular, and internal mammary nodes. Her comorbidities included liver steatosis, osteoarthrosis, and lymphedema. | 3.896484 | 0.982422 | sec[1]/p[0] | en | 0.999996 | PMC11279394 | https://doi.org/10.3390/ph17070834 |
At baseline (BL), the patient’s PBMC count, CRP count, and absolute monocyte count were moderately elevated, but her lymphocyte percentage was normal ( Table 1 ). The woman was moderately active and her painDETECT was consistent with a neuropathic type of pain ( Table 2 ). | 3.017578 | 0.890625 | sec[1]/p[2] | en | 0.999996 | PMC11279394 | https://doi.org/10.3390/ph17070834 |
This case report provides initial but holistic evidence supporting complementary approaches for addressing CIPN in cancer survivors. It suggests that clinically meaningful improvements in CIPN symptoms, quality of life, and functional status can be achieved through combining the oral administration of 300 mg/day of CBD with a multi-modal exercise program. The synergistic benefit of this combination may be explained through an increase in circulating endocannabinoids and beneficial changes in the gut microbiota. Both CBD and exercise were also found to be better tolerated than duloxetine. | 4.09375 | 0.908691 | sec[3]/p[0] | en | 0.999997 | PMC11279394 | https://doi.org/10.3390/ph17070834 |
General treatment guidelines for RA include nonsteroidal anti-inflammatory drugs, glucocorticoids, disease-modifying antirheumatic drugs, and biologics. Tofacitinib, a Janus kinase (JAK) inhibitor that was Food and Drug Administration approved for RA in 2012, has been shown to be relatively well tolerated. 3 Tofacitinib has been used in various granulomatous diseases with success. 4 Most notably, there have been cases of lung rheumatoid nodules that have been successfully treated with tofacitinib. 5 , 6 Here, we describe a patient case of seronegative cutaneous rheumatoid nodules with positive response to tofacitinib. | 3.876953 | 0.877441 | sec[0]/p[1] | en | 0.999996 | PMC11280084 | https://doi.org/10.1016/j.jdcr.2024.05.033 |
A 29-year-old woman with history of seronegative RA presented with severe pain and morning stiffness particularly of the wrists and ankles thus limiting her activities of daily living. Her symptoms began at age 8, and both her father and sister are similarly affected. Her medication trials include intralesional steroid injections, methotrexate, anakinra, infliximab, sulfasalazine, rituximab, abatacept, systemic corticosteroids, and hydroxychloroquine with some relief. Examination showed chronic nodules of the arms and legs and ulcerated nodules and plaques over the metacarpophalangeal joints of the right hand and bilateral cheeks . Moderate-to-severe synovitis was noted in the wrists and ankles bilaterally. Fig 1 Open nodules of ( A ) the left cheek, ( B ) right cheek, and over the metacarpophalangeal joints of ( C ) the right hand before treatment with tofacitinib. | 3.755859 | 0.98584 | sec[1]/p[0] | en | 0.999998 | PMC11280084 | https://doi.org/10.1016/j.jdcr.2024.05.033 |
Complete blood count, comprehensive metabolic panel, antinuclear antibody were within normal limits. C-reactive protein and erythrocyte sedimentation rate were elevated to 1.23 and 53, respectively. She was negative for Lyme disease. Rheumatoid factor was <14 and anticyclic citrullinated peptide was <20. Imaging showed soft tissue swelling and joint effusions in the knee and ankle. Biopsy showed fibrinoid necrobiotic granulomata with plasma cells, consistent with rheumatoid nodules . Fig 2 A, Palisading granulomas with central area showing fibrinoid necrosis. B , Palisading granulomas surrounding fibrin, with necrobiosis. C , Granulomatous inflammation surrounding fibrin admixed with plasma cells. (Original magnifications: A , ×2; B , ×4; C , ×20.) | 3.777344 | 0.952148 | sec[1]/p[1] | en | 0.999996 | PMC11280084 | https://doi.org/10.1016/j.jdcr.2024.05.033 |
Because of the severity of her joint pain, and resistance to multiple other treatments, she was started on a trial of tofacitinib 5 mg twice daily and hydroxychloroquine. With treatment, the patient had improvement in her chronic rheumatoid nodules with resolution of active skin lesions. Because of a change in her insurance, the patient had to stop tofacitinib, resulting in recurrence of her skin lesions. Eight months after discontinuing the medication she was noted to have numerous atrophic scars, 3 eroded nodules with crust on the right elbow, nondraining nodules of the right knee, and 2 actively draining pink nodules of left knee with thick yellowish discharge . Fig 3 Open pink nodules of ( A ) the right elbow and ( B ) right forearm, and actively draining nodules of ( C ) the left knee with thick yellowish discharge before treatment with tofacitinib. | 3.507813 | 0.98584 | sec[1]/p[2] | en | 0.999998 | PMC11280084 | https://doi.org/10.1016/j.jdcr.2024.05.033 |
Since restarting tofacitinib, the patient was noted to have improvements in chronic rheumatoid nodules as well as a reduction in flares and open ulcers. Skin examination showed numerous scarred and atrophic plaques and nodules over the cheeks, lateral aspect of the arms, elbows, forearms, hands with emphasis at extensor joints, knees, ankles, and shins . Additionally, ulcers were noted to be less painful and remain open for a shorter duration of time. Her ability to ambulate and perform activities of daily living was noted to improve as well. Fig 4 Scarred and atrophic plaques and nodules of ( A ) the face, ( B , C ) bilateral elbows, and ( D ) metacarpophalangeal joints after treatment with tofacitinib. | 3.505859 | 0.98291 | sec[1]/p[3] | en | 0.999996 | PMC11280084 | https://doi.org/10.1016/j.jdcr.2024.05.033 |
A 7-month-old male child from Malappuram District, Kerala, the third child of non-consanguineous parents, presented with persistent pneumonia for the last two months. His growth parameters and developmental milestones were normal. The child received two doses of OPV (birth dose and at 20 weeks) ( Table 1 ). Investigations revealed lymphopenia, and he was suspected to have SCID. Nephelometric assay showed reduced levels of IgG (0.35 g/L) and IgM (0.16 g/L), with normal levels of IgA (0.26 g/L) and IgE (17.1 IU/mL). | 3.712891 | 0.976563 | sec[2]/sec[0]/p[0] | en | 0.999997 | PMC11281642 | https://doi.org/10.3390/vaccines12070759 |
The child underwent a haploidentical hematopoietic stem cell transplantation with TCR alpha beta depleted peripheral blood stem cells from his father. Two days later, he developed a fever and breathlessness, followed by watery diarrhea. His chest X-ray was suggestive of right upper lobe collapse with pneumonitis. Four days post-HSCT, the child’s sensorium worsened, with the progressive deterioration of GCS; his fever persisted, and his breathlessness worsened. He had unilateral LMN facial palsy. He developed cardiogenic shock with echocardiographic features of left ventricular dysfunction and was being mechanically ventilated. His ECG and troponin I levels were suggestive of severe myocarditis. He was engrafted on day +10 and with donor chimerism 92% on day 14. However, despite all efforts, the child expired three weeks following HSCT. | 3.978516 | 0.981445 | sec[2]/sec[5]/p[0] | en | 0.999996 | PMC11281642 | https://doi.org/10.3390/vaccines12070759 |
Overall, the management of ameloblastoma depends on eradicating the affected tissue, along with clean reconstruction of the remaining parts, which makes it a challenging goal to achieve. This highlights the importance of individualized surgical planning and treatment based on both patient factors and tumor factors . Ameloblastoma is still a subject of concern and controversy because of its convoluted behavior. Here, we report a case of maxillary ameloblastoma with pulmonary metastasis. To our knowledge, this is the first report of pulmonary metastasis in Saudi Arabia. | 3.601563 | 0.939941 | sec[0]/p[3] | en | 0.999997 | PMC11281802 | https://doi.org/10.7759/cureus.63233 |
A 17-year-old male patient was referred to the Ear, Nose, and Throat Department at National Guard Hospital, Jeddah, Saudi Arabia, in 2006, complaining of a painless right facial swelling that had lasted for two months. The swelling was gradually increasing in size, and there were no reports of weight loss, loss of appetite, or difficulty in breathing or swallowing. On examination, the patient was in good general condition. The observed swelling exhibited characteristics of being non-tender, immobile, irregular in shape, pink in color, with a propensity for bleeding, and situated within the buccogingival sulcus in close association with the right maxillary molar teeth No. 17 and 18. Its dimensions were approximately 3 x 2.5 cm. The ears, nose, and throat (ENT) examination was unremarkable. There was no lymph node involvement. A biopsy from the right gingival mass suggested the presence of islands or nests of odontogenic epithelium within a fibrous stroma and anastomosing cords or sheets within a less cellular, loosely collagenous stroma. This confirmed the presence of ameloblastoma with both plexiform and follicular histopathology. The computed tomography (CT) scan showed a soft tissue mass destroying the posterior part of the right maxilla and extending into the maxillary antrum, completely filling it, with no lymph node involvement. As a result, the patient underwent partial right maxillectomy with obturator sealing to the hard palate and received antibiotics. | 3.810547 | 0.986328 | sec[1]/p[1] | en | 0.999998 | PMC11281802 | https://doi.org/10.7759/cureus.63233 |
After two years, in 2008, the patient complained of painless swelling of the right maxilla. The swelling was compressing the eye globe, leading to reduced visual acuity. Upon evaluation, a smooth-surfaced, non-tender cystic mass was identified above the right lower orbital rim, with normal extra-ocular muscle movements. The CT scan showed a mucocele and surgical excision was performed. Histopathology results showed recurrent ameloblastoma, characterized by features such as peripheral palisading columnar cells, reverse polarity, central stellate reticulum-like cells, cystic degeneration, and occasional squamous metaplasia within the tumor islands. Postoperatively, the patient was doing well with no active complaints such as nasal obstruction, rhinorrhea, or allergic symptoms. ENT examination revealed hypertrophied inferior turbinate with pale mucosa. The patient was discharged and followed up regularly. | 3.689453 | 0.98877 | sec[1]/p[3] | en | 0.999996 | PMC11281802 | https://doi.org/10.7759/cureus.63233 |
In 2011, the patient presented with a recurrence of ameloblastoma, which was evidenced by a swelling in the right maxilla persisting for a duration of eight months. There was no reported history of nasal obstruction, visual impairments, feeding difficulties, trismus, or chronic ailments. Upon physical examination, the patient appeared to be in overall good health, with a noticeable mass in the right cheek region. The ear, nose, and throat (ENT) assessment revealed no significant abnormalities. Following a thorough evaluation that included a CT of the nose and paranasal sinuses and a brain MRI, a right maxillectomy was performed. This surgical procedure aimed to remove the mass while ensuring the preservation of the eye. The imaging studies revealed the presence of a sizable mass with both solid and cystic components. Moreover, the mass was located in the area of a previously excised tumor in the right maxillary sinus, measuring 6.5 x 6.0 cm at its largest dimensions. This lesion extended to the right nasal cavity and right ethmoidal air cells. Right neck dissection followed by reconstruction of the maxilla, hard palate, and orbital floor with a rectus abdominis free myocutaneous flap along with an iliac crest bone graft was performed. The patient was followed regularly up to 2017 when he presented with ectropion of the right lower eyelid and exposed plate. A facial bone and neck CT excluded local recurrence and most importantly revealed incidental findings of two suspicious pulmonary nodules highly concerning for metastasis. Therefore, a CT chest was ordered and showed a left lobulated para mediastinal hypodense enhancing lesion measuring 2.5 x 4.3 cm and other scattered pulmonary nodules in the right upper lobe. The patient underwent a transthoracic left lung lesion biopsy and histopathology confirmed the presence of metastatic ameloblastoma. The microscopic examination showed multiple cores of fibrous tissue with no lung parenchyma. The cores were infiltrated by neoplastic growth in the form of nests and islands with prominent peripheral palisading and reverse polarity. The cells have abundant eosinophilic cytoplasm with bland-looking nuclei. No aberrant mitosis or necrosis was identified. A panel of immunohistochemistry stains was performed, including P63, CK5/6, epithelial antigen membrane (EMA), Calretinin, and CD56. The target cell was strongly positive for P63 and CK5/6 and focally for EMA but negative for Calretinin and CD56. These microscopic and immunohistochemistry findings, in addition to the clinical history, were consistent with metastatic ameloblastoma. Over the subsequent two-year period, the metastatic disease exhibited progression, characterized by the emergence of new lung lesions and the involvement of the pleural, pericardial, peritoneal, and suprahepatic regions of the inferior vena cava. Regrettably, the histological subtype demonstrated resistance to conventional chemotherapy, and the thoracic lesions were deemed inoperable by the cardiothoracic surgeon. The Tc-99m bone scan identified a potential new periodontal lesion in the left anterior-lateral aspect of the mandible. Concurrently, as the disease advanced, the patient experienced worsening dyspnea and orthopnea attributed to massive pleural effusion and an incidental pulmonary embolism. Acute kidney injury and hypercalcemia resolved within two days after pleural tapping. | 4.09375 | 0.973145 | sec[1]/p[5] | en | 0.999997 | PMC11281802 | https://doi.org/10.7759/cureus.63233 |
Maxillary ameloblastoma is a rare form of odontogenic epithelial tumor, with 80% of ameloblastomas occurring in the mandible. We reviewed similar case reports from the literature. According to these reports, this subtype typically presents as a painless mass, likely due to the anatomical location of the maxilla. The tumor's proximity to the nasal cavity, nasopharynx, paranasal sinuses, orbits, and skull base, combined with the absence of a cortical plate, often results in delayed diagnosis . Most cases in the literature, including ours, show painless swelling as the primary symptom. However, Len et al. reported a case of a 30-year-old male who experienced painful swelling in the right zygomatico-maxillary region, leading to a diagnosis of ameloblastoma . | 3.923828 | 0.442627 | sec[2]/p[0] | en | 0.999997 | PMC11281802 | https://doi.org/10.7759/cureus.63233 |
We report a rare case where a urinoma was developed because of urine leakage from bilateral ureteric injuries that occurred after an abdominal hysterectomy. The urinoma was initially misdiagnosed as an intraperitoneal hematoma. Appropriate radiological investigations enhanced the accurate diagnosis of urinoma and led to avoiding inappropriate exploratory laparotomy. | 3.615234 | 0.983398 | sec[0]/p[5] | en | 0.999997 | PMC11281829 | https://doi.org/10.7759/cureus.63235 |
A 41-year-old woman, P2, presented to the emergency department (ED) for adults with abdominal pain and bloating. She had undergone an abdominal hysterectomy for large fibroids six days earlier in a private hospital. Her post-operative period in the primary hospital was unremarkable, and she was discharged home on the third post-operative day. She had normal bowel and bladder function. Vaginal bleeding was mild. However, from post-operative day 4, she developed pain in the left side of the abdomen, which was associated with distension of the abdomen. She did not have a fever, nausea, vomiting, abnormal vaginal discharge, or urinary symptoms. Her previous medical history was insignificant. She had a prior history of an abdominal myomectomy, which was performed one year ago in the same hospital. She did not smoke and had an unremarkable family history. | 3.025391 | 0.990723 | sec[1]/p[1] | en | 0.999997 | PMC11281829 | https://doi.org/10.7759/cureus.63235 |
The results of the laboratory tests showed a mild leukocytosis (13.1 × 10^3/uL), with a slight increase in alanine transaminase (ALT = 72 U/L) and aspartate transaminase (AST = 72 U/L). Her hemoglobin was 10 g/dL, C-reactive protein (CRP) was 5 mg/L, and the results of the renal function tests were in the normal range. Ultrasound of the pelvis was reported as a pelvic collection (hematoma) measuring 10.6 × 8.1 × 7.3 cm, volume 332 mL with septations and echogenic components. As she was clinically stable, a diagnosis of post-hysterectomy hematoma was made. Broad-spectrum antibiotics, analgesics, and follow-up were requested. She was discharged from the ED in stable condition. | 3.625 | 0.979492 | sec[1]/p[5] | en | 0.999997 | PMC11281829 | https://doi.org/10.7759/cureus.63235 |
Laboratory results revealed a decrease in hemoglobin from 10 to 8.8 gm/dL, an increased total leukocyte count of 14.3 × 10^3/uL, and an elevated CRP of 89 mg/L. Serum creatinine was 248 umol/L (normal range, 50-98 umol/L) with an elevated prothrombin time of 18.1 seconds (normal range, 9.4-12.5 s) and an activated partial thromboplastin time of 39.6 s (normal range, 25.1-36.5 s). Liver enzymes were normal. | 3.890625 | 0.696289 | sec[1]/p[9] | en | 0.999998 | PMC11281829 | https://doi.org/10.7759/cureus.63235 |
Based on her clinical findings, laboratory results, and previous sonography results, pelvic hematoma and sepsis were suspected. A repeat ultrasound was performed . An intra-abdominal fluid collection with internal echoes and septa was seen in the pelvic cavity close to the uterine bed, measuring approximately 15.3 × 11.7 × 11.9, 1122.3 cc in volume (previously 332 mL on last sonography, four days back). Bilateral prominent renal pelvic cysts were noted with minimal free fluid in the left upper quadrant and left perinephric area. A laparotomy was planned due to the significant increase in size of the pelvic hematoma. The ureteral injury was suspected due to elevated creatinine and radiological findings. A CT scan of the abdomen and pelvis with contrast revealed that contrast material was leaking from the left kidney and surrounding tissues, indicating damage to the left renal structures. Additionally, there was also leakage of contrast material from the right ureter, which did not appear to be functioning properly. This led to a buildup of urine in the pelvis, a condition known as a pelvic urinoma, likely due to a tear in the right distal ureter . A urologist was consulted, who advised a CT urogram . It showed a left-sided forniceal rupture secondary to back pressure changes. The right distal ureter was not visualized, and contrast was seen pooling near the right distal ureter, leading to a urinoma suggestive of a right distal ureteral rupture. | 3.925781 | 0.977051 | sec[1]/p[11] | en | 0.999997 | PMC11281829 | https://doi.org/10.7759/cureus.63235 |
With CT urogram, diagnosis of left ureteric injury was confirmed. So, the initial plan for laparotomy was abandoned. Two units of packed red blood cells and two units of fresh frozen plasma were transfused. She had a right percutaneous nephrostomy with left ureteric antegrade double-J stenting and CT-guided drainage of pelvic collection. Double-J stent was removed after eight weeks. A week later, cystoscopy, right ureteroscopy, and antegrade pyelography were performed. Intraoperative findings of an obliterated right ureter at about 4 cm from the ureteric orifice with severe adhesions in the site of the right lower ureter were observed. A long ureteric stricture of about 8 cm was identified. Then, right ureteric reimplantation (Boari flap) + right double-j stent insertion were carried out. She had an uneventful post-operative period. She was discharged home in stable condition. The right nephrostomy tube was removed after one week. She had regular urology clinic follow-ups for six months. | 3.503906 | 0.986328 | sec[1]/p[13] | en | 0.999998 | PMC11281829 | https://doi.org/10.7759/cureus.63235 |
In cases where urine leaks require more extensive treatment, a combination of antibiotic therapy, minimally invasive procedures, and catheterization can be used to effectively manage the condition. This approach typically involves the placement of percutaneous urinoma drainage catheters, percutaneous nephrostomy catheters, and ureteral stents, as well as bladder drainage . When implemented in the appropriate setting, this treatment plan can help reduce the risk of complications associated with urinoma and potentially avoid the need for surgical intervention. In our patient’s case, the result of CT imaging guided the need for further urological intervention in the form of Boari flap (right ureteric re-implantation) repair, as the right lower ureter was ruptured and developed stricture. | 3.986328 | 0.625977 | sec[2]/p[8] | en | 0.999996 | PMC11281829 | https://doi.org/10.7759/cureus.63235 |
This unusual case serves as a reminder to remain vigilant in identifying both intra-operative and post-operative urinary tract trauma, emphasizing the importance of timely diagnosis and repair to prevent adverse outcomes. | 3.082031 | 0.966309 | sec[2]/p[16] | en | 0.999997 | PMC11281829 | https://doi.org/10.7759/cureus.63235 |
A 77-year-old man had undergone pancreatoduodenectomy 1 year earlier for cholangiocarcinoma. At his current presentation, he was admitted to our hospital for acute pancreatitis due to PJS. First, EUS-guided pancreatic duct drainage using a plastic stent was performed. Then 2 weeks later, PJS treatment was attempted. First, guidewire passage through the PJS into the intestine was attempted, although with no success. Thereafter, a pancreatoscope (eyeMax; Micro-Tech, Nanjing, China) was antegradely inserted . The stricture was confirmed as being a benign tight PJS . Next, since the endoscopic retrograde cholangiopancreatography (ERCP) catheter could not be inserted into the intestine through the PJS site, endopancreatic RFA was attempted . Subsequently, the pancreatoscope was inserted and dilation of the PJS was achieved without bleeding or perforation . Finally, a plastic stent was deployed ( Video 1 ). No recurrence of PJS or adverse events were observed at the 1-year follow-up. | 3.861328 | 0.980469 | sec[0]/p[1] | en | 0.999997 | PMC11281845 | https://doi.org/10.1055/a-2357-2274 |
A 19-year-old nulliparous woman presented in the emergency room (ER) with an intentional polysubstance overdose of unknown quantities of ibuprofen, acetaminophen, and dextromethorphan/pseudoephedrine in an attempt to end her life. There was no evidence of hepatitis, acidosis, or other toxidrome. She was thoroughly evaluated on voluntary inpatient psychiatric admission due to impulsivity and persistent suicidal ideation. Her medical history included asthma and her surgical history was unremarkable. She had no allergies. She was a non-smoker and consumed alcohol socially. She had a positive family history of her father with alcoholism, a paternal uncle with bipolar and substance use disorder, and a paternal cousin with bipolar disorder. She had no history of sexually transmitted infections or abnormal cervical cytology. Her menstrual flow was normal. | 3.416016 | 0.987793 | sec[1]/p[0] | en | 0.999995 | PMC11281859 | https://doi.org/10.7759/cureus.63238 |
She reported becoming more argumentative and emotionally labile, and various episodes of uncontrollable and erratic behavior for the last six months. Her gynecological history included irregular menstrual cycles occurring once or twice a year since her menarche at 11 years old. She tried birth control pills for her irregular menstrual cycles which helped with the regulation of her cycles but she started experiencing depressive and irritable mood episodes and discontinued the pills. Six months ago, she became sexually active and started levonorgestrel-ethinyl estradiol for birth control. Her cycles became regular but her "mood episodes" began again. Two days before presenting in the ER, she started drospirenone/ethinyl estradiol for birth control and reported various episodes of irrational anger that she couldn’t control. The patient presented a history of severe physical and psychological symptoms related to her menses. She described that "I am not myself doing crazy things" and described depersonalization and derealization during the outbursts. One to two weeks before her menstruation, she would have various episodes of uncontrollable irritability and anger towards her mother and boyfriend. Some of the episodes included sending texts to them expressing anxiety that they don’t love her; throwing her phone shattering it into pieces; cutting herself to feel relief but it didn’t help her, and ingesting several pills in her dorm room because of feeling overwhelmed with her upcoming midterms; and returning to her mother and boyfriend with slurred speech while they were waiting for her outside her dorm. After these outbursts were over, she would become regretful and apologetic for her behavior. She also reported low mood, anhedonia, increased sleep, difficulty concentrating on school assignments, fatigue, and severe abdominal cramping during her premenstrual period which would abate three to five days after the onset of menstruation. Her fluctuating mood symptoms severely affected her normal functioning and interpersonal relationships. She had started taking therapy sessions in her early teenage years due to the physical and verbal abuse endured by her alcoholic father. Coping mechanisms taught during her therapy like deep breathing didn't help her regain control during the episodes. Lifestyle modifications recommended by her primary care physician including reduced consumption of refined carbohydrates and artificial sweeteners, reduced caffeine intake, and cognitive behavioral therapy were ineffective. | 3.673828 | 0.97998 | sec[1]/p[1] | en | 0.999995 | PMC11281859 | https://doi.org/10.7759/cureus.63238 |
She maintained a diary of her symptoms and found a clear cyclical pattern related to her menstruation. Her mood symptoms increased dramatically in the premenstrual period, followed by a sense of relief after periods started. The Daily Record of Severity of Problems (DRSP) score, which is used for diagnosis and assessment of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) PMDD, was completed for two menstrual cycles and the woman scored highly indicating extreme symptoms. At least five symptoms (affective lability, irritability, anger, depressed mood, and lethargy) were present in the final week before the onset of her menses. Her symptoms started to improve within a few days after the onset of her menses and became minimal or absent in the week post-menses. Her symptoms were not attributable to the physiological effects of a substance (e.g. drug abuse, medication, or other treatment) or another medical condition (e.g. hyperthyroidism). | 4.046875 | 0.912109 | sec[1]/p[3] | en | 0.999995 | PMC11281859 | https://doi.org/10.7759/cureus.63238 |
Pregnancy was excluded prior to starting treatment. As the detailed evaluation of the patient was being carried out and the patient reported a family history of bipolar disorder, she was initiated on 25 mg lamotrigine for mood stabilization instead of a selective serotonin reuptake inhibitor (SSRI) as the latter can precipitate mania in bipolar disorder. After bipolar was ruled out, lamotrigine was discontinued and the patient was started on sertraline 50 mg one tablet daily to target her PMDD symptoms. She was counseled about its side effects including nausea, headache, dizziness, and dry mouth. Drospirenone/ethinyl estradiol 3-0.02 mg one tablet daily was prescribed for birth control. The patient was discharged on this treatment plan. | 3.1875 | 0.977539 | sec[1]/p[5] | en | 0.999996 | PMC11281859 | https://doi.org/10.7759/cureus.63238 |
On subsequent outpatient follow-up visits, our patient expressed great emotional relief, and "stability" in her own words, following her diagnosis of PMDD. She finally felt "listened to" and felt motivated to start working towards her dream of getting an education degree and becoming a middle school English teacher. Her positive response to treatment with SSRIs provided clinical evidence that her premenstrual mood disruption was due to a malfunctioning serotonergic system. The DRSP questionnaire following her treatment with SSRIs indicated minimal symptoms, and she reported an improvement in her quality of life. | 3.1875 | 0.986816 | sec[1]/p[6] | en | 0.999997 | PMC11281859 | https://doi.org/10.7759/cureus.63238 |
Our patient fulfilled the PMDD criteria of having at least 5 out of 11 stipulated symptoms identified in the DSM-5, one of which must include mood, behavioral, or physical symptoms with substantial stress or functional impairment. Confirming symptoms by prospective patient mood charting for at least two menstrual cycles was followed as recommendations. DRSP as a reliable tool is applied for at least two symptomatic cycles to confirm the timing of mood symptoms that our patient followed, hence confirming her PMDD diagnosis. A thorough history was taken from our patient to rule out the possibility of premenstrual symptoms as an exacerbation of an underlying disorder. Also, though PMDD can be superimposed on an axis I or II disorder, this was not the case in our patient either. | 3.988281 | 0.85791 | sec[2]/p[2] | en | 0.999996 | PMC11281859 | https://doi.org/10.7759/cureus.63238 |
Management options for PMDD include psychotropic agents (SSRIs) and ovulation suppression agents (combined oral contraceptive pill (COCP) or gonadotropin-releasing hormone (GnRH) agonists). The recommended doses of SSRIs include sertraline 50-100 mg, fluoxetine 20 mg, escitalopram 10-20 mg, and paroxetine 10-20 mg. Our patient was discharged on sertraline 50 mg one tablet daily targeting her PMDD mood symptoms and was counseled about its side effects including nausea, headache, dizziness, and dry mouth. Drospirenone/ethinyl estradiol of 3 mg/0.02 mg one tablet daily was prescribed for birth control. On her outpatient follow-up visits, she expressed marked emotional relief and improvement in her aggression and irritability symptoms helping her to maintain stability in her life. | 3.808594 | 0.843262 | sec[2]/p[6] | en | 0.999998 | PMC11281859 | https://doi.org/10.7759/cureus.63238 |
Similarly, a 45-year-old Caucasian female diagnosed with bipolar disorder with psychotic features, PMDD, panic disorder, and repeated occurrence of suicide attempts and self-harming behavior reported limited gains through standard medicinal treatment and showed dramatic clinical improvement after introduction of lifestyle interventions including dietary change, coffee enemas, dry-skin brushing and meditation, suggesting lifestyle modifications as the first-line therapy in PMDD patients with comorbidities when medications fail . Another case report of a young woman diagnosed with polycystic ovarian syndrome (PCOS) described three episodes of premenstrual mixed mood and psychotic symptoms making already challenging PMDD diagnosis more difficult . | 3.816406 | 0.913574 | sec[2]/p[14] | en | 0.999998 | PMC11281859 | https://doi.org/10.7759/cureus.63238 |
In this report, we present a case of a middle-aged male who presented with chest pain and breathlessness and was found to have multiple congenital cardiac conditions. The report details the subsequent evaluation and surgical correction performed. | 3.054688 | 0.989258 | sec[0]/p[1] | en | 0.999997 | PMC11281883 | https://doi.org/10.7759/cureus.63194 |
A 41-year-old male presented to a tertiary care hospital in the cardiac outpatient department (OPD) with complaints of chest pain, breathlessness (New York Heart Association (NYHA) grade 3), and an on-and-off headache for a month. The patient was diagnosed with polycythemia (Hb 22 g/dL) one and a half months ago. He has a documented case of pulmonary tuberculosis, diagnosed five years ago, and has successfully completed a six-month course of anti-tubercular drug therapy. There is no concurrent presence of hypertension or diabetes mellitus. The patient was advised to undergo diagnostic procedures including a chest X-ray, electrocardiography (ECG), computed tomography, aortogram, and angiography. There is no significant family history. | 3.554688 | 0.988281 | sec[1]/p[0] | en | 0.999997 | PMC11281883 | https://doi.org/10.7759/cureus.63194 |
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