Journal of medical cases最新文献_第8页

Perioperative Care of a Child With Hyperthyroidism 甲状腺功能亢进症儿童的围手术期护理

Journal of medical cases Pub Date : 2024-04-01 DOI: 10.14740/jmc4197

Joseph Bonanno, T. Grannell, Gregory S Maves, Joseph D. Tobias

{"title":"Perioperative Care of a Child With Hyperthyroidism","authors":"Joseph Bonanno, T. Grannell, Gregory S Maves, Joseph D. Tobias","doi":"10.14740/jmc4197","DOIUrl":"https://doi.org/10.14740/jmc4197","url":null,"abstract":"In pediatric-aged patients, hyperthyroidism generally results from the autoimmune disorder, Graves’ disease (GD). Excessive levels of thyroid hormones (triiodothyronine and thyroxine) result in irritability, emotional lability, nervousness, tremors, palpitations, tachycardia, and arrhythmias. The risk of morbidity and mortality is increased when surgical intervention is required in patients with hyperthyroidism due to the potential for the development of thyroid storm (TS). A 3-year, 1-month-old child with a past medical history of GD presented for total thyroidectomy when pharmacologic control with methimazole was not feasible due to intolerance following development of a serum sickness-like illness. Prior to surgery, his thyrotoxicosis symptoms worsened with fever, tachycardia, diaphoresis, and hypertension. He subsequently developed TS and was admitted to the pediatric intensive care unit where management included hydrocortisone, potassium iodide, and β-adrenergic blockade with esmolol and propranolol. Thyroid studies improved prior to surgery, and a total thyroidectomy was successfully completed. Corticosteroid therapy was slowly tapered as an outpatient, and he was discharged home on hospital day 9. Following discharge, his signs and symptoms of thyrotoxicosis resolved, and he was started on oral levothyroxine replacement therapy. The remainder of his postoperative and post-discharge course were unremarkable. Only two case reports of perioperative pediatric TS have been published in the past 20 years. Our case serves as an important reminder of the signs of TS in children and to outline the treatment options in a pediatric patient, especially in those unable to tolerate first-line pharmacologic therapies such as methimazole or propylthiouracil.","PeriodicalId":101328,"journal":{"name":"Journal of medical cases","volume":"195 ","pages":"49 - 54"},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140783849","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

An Uncommon Instance of Tubal Pregnancy With a Vital Fetus at the Thirteenth Week of Gestation. 一个不常见的输卵管妊娠病例，妊娠 13 周时胎儿仍有活力。

Journal of medical cases Pub Date : 2024-01-01 Epub Date: 2024-01-28 DOI: 10.14740/jmc4173

Vlora Ademi Ibishi, Naser Rafuna, Kaltrina Kolgeci

引用次数: 0

Continuous Erector Spinae Plane Block for Pain Management Following Thoracotomy for Aortic Coarctectomy. 连续性脊束肌平面阻滞用于主动脉切除术胸廓切开术后的疼痛治疗

Journal of medical cases Pub Date : 2024-01-01 Epub Date: 2024-01-28 DOI: 10.14740/jmc4177

Jay D Holladay, Christopher McKee, Olubukola O Nafiu, Joseph D Tobias, Ralph J Beltran

引用次数: 0

Early Detection and Diagnostic Approach Through Automated Hematological Analysis for Plasma Cell Leukemia 通过自动血液学分析早期检测和诊断浆细胞白血病的方法

Journal of medical cases Pub Date : 2024-01-01 DOI: 10.14740/jmc4188

Joaquin Jerez, Francisca Sanchez, Francisco Flores, Lissette Guajardo, J. Briones, C. Selman

引用次数: 0

Focal Hepatocellular Carcinoma in Pancreas. 胰腺局灶性肝细胞癌

Journal of medical cases Pub Date : 2024-01-01 Epub Date: 2024-01-10 DOI: 10.14740/jmc4181

Yasir Ahmed, Usama Sakhawat, Fahad Malik, Saadia Haleema, Daniel Chin, Ali Marhaba

{"title":"Focal Hepatocellular Carcinoma in Pancreas.","authors":"Yasir Ahmed, Usama Sakhawat, Fahad Malik, Saadia Haleema, Daniel Chin, Ali Marhaba","doi":"10.14740/jmc4181","DOIUrl":"10.14740/jmc4181","url":null,"abstract":"A 67-year-old man was found to have a pancreatic head mass on abdominal ultrasound. He had compensated liver cirrhosis due to hepatitis C. The fine-needle aspiration (FNA) biopsy of the mass reported an adenocarcinoma of the pancreas, while the subsequent histopathology report of the supraclavicular lymph node showed features of hepatocellular carcinoma (HCC). A second read and additional stains on the FNA specimen confirmed a hepatoid (hepatocellular) carcinoma of the pancreas. He received atezolizumab and bevacizumab and had a good response. Tumors with features of HCC outside of the liver rarely occur and even more rarely in pancreas, with less than 50 cases reported so far. Pure HCC-like morphology is the most common histological form among four subtypes and has a relatively better prognosis. Surgical resection is considered the treatment of choice if amenable and variable outcomes are reported with different chemotherapies. Challenges exist in the diagnosis and the management of this rare and intriguing entity, and the potential misdiagnosis can have grave consequences as the management is completely different for a pancreatic adenocarcinoma and hepatoid carcinoma. We report a case with a challenging diagnosis of metastatic pancreatic hepatoid carcinoma which was treated as unresectable HCC with immunotherapy and the patient had a good response.","PeriodicalId":101328,"journal":{"name":"Journal of medical cases","volume":"15 1","pages":"1-6"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10846500/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139704409","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Hip Dysplasia in a Patient in Late Adolescence With Charcot-Marie-Tooth and Multiple Acyl-CoA Dehydrogenase Deficiency 一名患有 Charcot-Marie-Tooth 和多酰基-CoA 脱氢酶缺乏症的晚青春期患者髋关节发育不良

Journal of medical cases Pub Date : 2024-01-01 DOI: 10.14740/jmc4174

Amirmohammad Heidari, Cameron Stephen, Benan Dala-Ali, Jane Webber, Oliver Pearce, Mohamed H. Ahmed

引用次数: 0

Epidural Abscess Complicating Tunneled Caudal Epidural Catheter in an Infant for Postoperative Pain Management of Open Abdominal Surgery 婴儿硬膜外脓肿并发硬膜外穿刺导管用于开腹手术的术后疼痛治疗

Journal of medical cases Pub Date : 2024-01-01 DOI: 10.14740/jmc4180

Amr Elhamrawy, Savannah Aepli, G. Heydinger, Joseph D. Tobias, Ralph J Beltran

引用次数: 0

Correction to: Spontaneous Coronary Artery Dissection in a Young Man. 更正：一名年轻男子的自发性冠状动脉夹层

Journal of medical cases Pub Date : 2023-12-01 Epub Date: 2023-12-29 DOI: 10.14740/jmc3490c1

Stella Pak, Edinen Asuka, Anastasia Postoev

引用次数: 0

Clinical Evolution After Administering Antivenom in Patients With Loxoscelism. 抗蛇毒血清治疗鼠脑畸形后的临床进展。

Journal of medical cases Pub Date : 2023-11-01 Epub Date: 2023-11-23 DOI: 10.14740/jmc4163

Omar Azuara-Antonio, Mario I Ortiz, Karla D Jimenez-Oliver, Luis E Hernandez-Cruz, Gamaliel Rivero-Veras, Luz Hernandez-Ramirez

{"title":"Clinical Evolution After Administering Antivenom in Patients With Loxoscelism.","authors":"Omar Azuara-Antonio, Mario I Ortiz, Karla D Jimenez-Oliver, Luis E Hernandez-Cruz, Gamaliel Rivero-Veras, Luz Hernandez-Ramirez","doi":"10.14740/jmc4163","DOIUrl":"https://doi.org/10.14740/jmc4163","url":null,"abstract":"Spiders are the most numerous arthropods of the arachnid class. More than 45 thousand species of spiders have been identified, and only a few are dangerous to humans. Among them, the \"violin spider\" or \"brown spider\" of the genus Loxosceles (family Sicariidae) has a worldwide distribution, and its bite can cause loxoscelism. Initial treatment of a Loxosceles spider bite includes application of local cold, rest, elevation of the extremity if possible, and systemic pharmacotherapy with antihistamines, corticosteroids, antibiotics, polymorphonuclear inhibitors, and analgesics or nonsteroidal anti-inflammatory drugs. During cutaneous or systemic loxoscelism, administration of Loxosceles antivenom (immunoglobulin (Ig)G F(ab')2 fragments) may be indicated to prevent progression to severe systemic phases. In this manuscript, we present three cases of patients with loxoscelism treated with the fabotherapeutic Reclusmyn®, developed and manufactured in Mexico. Two patients had a satisfactory outcome without severe skin or systemic damage. Only one patient with loxoscelism, despite early initiation of antivenom, had extensive skin lesions that healed satisfactorily, leaving only a non-disabling scar. Due to the global presence of this clinical problem, further studies are needed to establish local and general guidelines for the treatment and prevention of loxoscelism. This will allow health professionals to provide more efficient and higher quality medical care and feel supported in their decisions.","PeriodicalId":101328,"journal":{"name":"Journal of medical cases","volume":"14 11","pages":"378-386"},"PeriodicalIF":0.0,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10681763/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138465302","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Stepwise Treatment for TAFRO Syndrome. TAFRO综合征的逐步治疗。

Journal of medical cases Pub Date : 2023-11-01 Epub Date: 2023-11-23 DOI: 10.14740/jmc4160

Makoto Ide, Tomoko Yokoyama, Masashi Ishikawa, Kazuki Kojima

{"title":"Stepwise Treatment for TAFRO Syndrome.","authors":"Makoto Ide, Tomoko Yokoyama, Masashi Ishikawa, Kazuki Kojima","doi":"10.14740/jmc4160","DOIUrl":"https://doi.org/10.14740/jmc4160","url":null,"abstract":"TAFRO syndrome, a rapidly progressive and fatal disease, is rare, and its etiology remains unknown. It is characterized by thrombocytopenia, anasarca (edema, pleural effusion, and ascites), fever, reticulin fibrosis (or renal insufficiency), and organomegaly with Castleman disease (CD)-like histological features in the lymph nodes. CD is a rare, indolent, lymphoproliferative disorder with no established curative strategies. Most idiopathic multicentric CD cases are controlled with anti-interleukin (IL)-6 therapy (tocilizumab and siltuximab) and/or rituximab. However, it is unclear whether these therapies can be directly applied to treat TAFRO syndrome. Here, we describe stepwise immunotherapy (rituximab induction therapy and cyclosporine maintenance therapy) for two cases of steroid-refractory TAFRO syndrome. A 32-year-old man visited a local hospital with sudden onset of fever and epigastralgia. The diagnosis of TAFRO syndrome was established based on the diagnostic criteria. After rituximab administration, C-reactive protein and IL-6 levels were normalized. However, the ascites persisted, with increased resistance to rituximab. Tocilizumab was also ineffective; therefore, cyclosporine was administered. After the initiation of cyclosporine treatment, the ascites decreased and ultimately disappeared. Twelve months after immunotherapy, the patient remained asymptomatic under cyclosporine maintenance therapy. Similar stepwise immunosuppressive therapy was administered to a 72-year-old man with TAFRO syndrome complicated by renal failure. After rituximab infusion, C-reactive protein was decreased. Although methylprednisolone, rituximab, tocilizumab, and cyclosporine were administered, other laboratory data and clinical symptoms remained unchanged. His level of consciousness subsequently deteriorated due to herpes zoster encephalitis, and he died. We consider the combination of rituximab induction therapy and cyclosporine maintenance therapy to be effective for TAFRO syndrome if initiated at an early stage.","PeriodicalId":101328,"journal":{"name":"Journal of medical cases","volume":"14 11","pages":"369-377"},"PeriodicalIF":0.0,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10681766/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138465306","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0