International Medical Case Reports Journal最新文献

{"title":"True Double Umbilical Cord Knots with Good Fetal Outcome: An Incidental Finding on Delivery.","authors":"Leonard Ssebwami, Koros Aron Kiptoo, Joan Diana Nabirye, Immaculate Ayebare, Simon Byonanuwe","doi":"10.2147/IMCRJ.S502107","DOIUrl":"https://doi.org/10.2147/IMCRJ.S502107","url":null,"abstract":"<p><p>Umbilical cord knots are very rare cases. As opposed to single loop knots, double-and more loop knots are extremely rare. When they occur, adverse outcomes become inevitable in most cases. We present this rare case diagnosed coincidentally on cesarean section at term with good fetal outcome.</p>","PeriodicalId":14337,"journal":{"name":"International Medical Case Reports Journal","volume":"18 ","pages":"461-463"},"PeriodicalIF":0.7,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11977564/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143811436","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}

{"title":"The Adjunctive Applications of Integra^® in Free-Flap Surgery to the Scalp: A Two-Case Experience.","authors":"James C Yuen, Elizabeth N Dawson, Connor S Miller, Madalyn H Bowman, Aimee A Tran","doi":"10.2147/IMCRJ.S509768","DOIUrl":"10.2147/IMCRJ.S509768","url":null,"abstract":"<p><p>Free flaps for scalp reconstruction occasionally traverse the face to reach the recipient vessels in the neck if the superficial temporal vessels are unavailable and vein grafts are circumvented. When using the latissimus flap, the facial skin at the exposure incision is not redundant enough to cover the proximal flap. Integra^® (Integra LifeScience) can be applied to cover the exposed portion of the flap containing the vascular pedicle, expediting completion of the operation without the need to perform immediate skin grafting. If flap perfusion is marginal, the surgeon is relieved of the concern for autologous skin graft loss if flap perfusion worsens. After flap perfusion is secured, a skin graft is applied over the neodermis regenerated by Integra. We describe two cases utilizing Integra as an adjunctive skin substitute for coverage of the exposed portion of the flap containing the pedicle, thus obviating the need for immediate skin grafting.</p>","PeriodicalId":14337,"journal":{"name":"International Medical Case Reports Journal","volume":"18 ","pages":"451-460"},"PeriodicalIF":0.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11972001/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143795532","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}

{"title":"Intravitreal Corticosteroids in the Management of Refractory Macular Edema in Birdshot Chorioretinopathy.","authors":"João Alves Ambrósio, Catarina Pestana Aguiar, Pedro Cardoso Teixeira, Vítor Miranda, João Chibante Pedro, Miguel Ruão","doi":"10.2147/IMCRJ.S513752","DOIUrl":"10.2147/IMCRJ.S513752","url":null,"abstract":"<p><strong>Introduction: </strong>Birdshot chorioretinopathy (BCR) is a chronic, bilateral posterior uveitis characterized by yellow-white fundus lesions and a strong association with HLA-A29. Visual decline, often due to cystoid macular edema (CME) and retinal atrophy, necessitates early immunomodulatory therapy. This case report describes the clinical course of BCR and highlights the role of intravitreal corticosteroids in managing inflammation and CME.</p><p><strong>Case report: </strong>A 54-year-old previously healthy male diagnosed with BCR based on clinical findings and a positive HLA-A29 test presented with refractory CME. Over 20 months, his best-corrected visual acuity (BCVA) and central foveal thickness (CFT) were monitored. Initial treatment included topical corticosteroids, methotrexate, and oral corticosteroids to address anterior chamber reaction, vitritis, diffuse retinal lesions, and vasculitis. Cyclosporine was added for persistent inflammation but discontinued due to a cutaneous reaction. Despite these efforts, CME persisted, necessitating intravitreal corticosteroids. BCVA in the right eye (OD) fluctuated between 20/20 and 20/30, while the left eye (OS) ranged from 20/20 to 20/40, with changes linked to treatment adjustments. Recurrent CME episodes were more pronounced in the OS, where CFT varied from 328 to 637 µm, while OD values ranged from 304 to 576 µm. Intravitreal dexamethasone and fluocinolone implants reduced CFT in both eyes, achieving stabilization at the final assessment (OD 341 µm, OS 347 µm).</p><p><strong>Conclusion: </strong>This case illustrates the challenges of managing BCR with refractory CME. While systemic immunomodulatory therapy is foundational, intravitreal corticosteroids play a vital role in controlling CME and preserving visual function. Combining systemic and local therapies proved essential for disease control. Long-term monitoring and individualized treatment are critical in managing this chronic condition.</p>","PeriodicalId":14337,"journal":{"name":"International Medical Case Reports Journal","volume":"18 ","pages":"445-450"},"PeriodicalIF":0.7,"publicationDate":"2025-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11967348/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143779481","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}

{"title":"Anterior Uveitis From Retained Perfluorocarbon Liquid in the Anterior Chamber, A Case Report.","authors":"Gabriel A Gomide, Ryan Zukerman, Royce W S Chen","doi":"10.2147/IMCRJ.S517908","DOIUrl":"10.2147/IMCRJ.S517908","url":null,"abstract":"<p><strong>Purpose: </strong>Perfluorocarbon liquids (PFCL) are routinely used in vitreoretinal surgery to flatten the retina and push subretinal fluid. Perfluorocarbon liquid retention is a common complication of vitreoretinal surgery. While retention in the posterior chamber can lead to an inflammatory response, PFCL in the anterior chamber has been shown to be generally well tolerated.</p><p><strong>Patients and methods: </strong>This report summarizes the findings and treatment of a patient with pathologic myopia and a history of retinal detachment in the left eye repaired with pars plana vitrectomy presenting with one week of blurry vision in the left eye. He was found to have an initial intraocular pressure of 54 mmHg in the left eye along with 1+ conjunctival injection, fine and medium-sized keratic precipitates on the cornea, and 30 cells per high power field. Additionally, there was a retained perfluorocarbon liquid bubble in the anterior chamber from his original retinal detachment repair surgery.</p><p><strong>Results: </strong>After being started on topical steroids and pressure lowering medications, the patient had persistent inflammation and elevated intraocular pressures. The patient's anterior uveitis and elevated intraocular pressure resolved with removal of the perfluorocarbon liquid bubble by anterior chamber tap.</p><p><strong>Conclusion: </strong>Retained PFCL in the anterior chamber can cause anterior uveitis and can be promptly treated by removal.</p>","PeriodicalId":14337,"journal":{"name":"International Medical Case Reports Journal","volume":"18 ","pages":"439-443"},"PeriodicalIF":0.7,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11960470/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143763616","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}

{"title":"Exuberant Granulation Complicating an Episiotomy Wound: Case Report on the Treatment Using Surgical Excision and Estrogen Vaginal Cream.","authors":"Nnabuike Chibuoke Ngene","doi":"10.2147/IMCRJ.S505949","DOIUrl":"10.2147/IMCRJ.S505949","url":null,"abstract":"<p><strong>Background: </strong>Poor wound healing may limit body functionality and is an indication for clinical intervention. Excessive formation of granulation tissue above the edge of the skin surrounding a wound without re-epithelization is termed exuberant granulation, or proud flesh. It is uncommonly reported as a complication of an episiotomy wound.</p><p><strong>Aim: </strong>This study aimed to report exuberant granulation that complicates an episiotomy wound with a friable vaginal epithelium and to describe the successful treatment of the lesion with surgical excision and topical conjugated equine estrogen vaginal cream.</p><p><strong>Case report: </strong>A 24-year-old para 1 had spontaneous vaginal birth of a normal baby at term in a district hospital. Five months later, she presented to a regional hospital with complaints of pain and incomplete wound healing at the episiotomy site. She had used topical povidone-iodine ointment with no success. Following a physical examination, an exuberant granulation at the episiotomy wound was diagnosed. The lesions were located mostly at 5 to 7 o'clock position in the vagina which had a thin and friable mucosa. The patient was treated with surgical excision and postoperative topical conjugated equine estrogen vaginal cream 0.625 mg per 1 g at a dose of 0.5 g per intravaginal application twice weekly for two weeks, and thereafter once weekly for one week. A review after 6 weeks, 12 weeks, and 6 months confirmed complete wound healing and normal function of the genitalia.</p><p><strong>Conclusion: </strong>Exuberant granulation that complicates an episiotomy wound with friable vaginal mucosa is amenable to surgical excision and postoperative intermittent intermediate doses of topical conjugated equine estrogen vaginal cream.</p>","PeriodicalId":14337,"journal":{"name":"International Medical Case Reports Journal","volume":"18 ","pages":"427-432"},"PeriodicalIF":0.7,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11956892/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143752526","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}

{"title":"A Case of HSV Encephalitis Misdiagnosed as Worsening Psychiatric Condition: A Case Report.","authors":"Elham Abdulhakim Mohammed, Medhanet Azene Gebeyehu, Muhudin Arusi Dari, Yodit Alemayehu","doi":"10.2147/IMCRJ.S495100","DOIUrl":"10.2147/IMCRJ.S495100","url":null,"abstract":"<p><p>Herpes simplex virus (HSV) encephalitis is uncommon but serious condition that can lead to significant morbidity and mortality if not promptly diagnosed and treated. Atypical presentations are becoming more common with improved diagnostic methods, but they remain underexplored. We present the case of a 29-year-old known patient with schizophrenia for the past four years on olanzapine 5 mg PO BID who initially presented to psychiatry emergency with difficulty in proper communication, auditory hallucination, blurring of the eyes, and depressive symptoms for which olanzapine was discontinued, trifluoperazine 5 mg PO daily was initiated, and lorazepam 1 mg p. o. nocturnal was added after the diagnosis of schizophrenia relapse. Despite the above management, the patient presented with abnormal body movements characterized by up-rolling of the eyes, drooling of saliva, jaw jerking followed by repetitive flexion and extension of the upper and lower extremities, and postictal loss of consciousness. He also had low-grade fever and headache for 5 days. The patient was started on phenobarbitone 100 mg PO nocturnal and escalated. However, the frequency of seizures increased. Clinical evaluation, MRI, and EEG eventually confirmed HSV encephalitis. The patient was administered acyclovir 500 mg intravenously every 8 hours for 21 days. After antiviral therapy, the patient was discharged with antiepileptic and antipsychotic medications 18 days after the seizure-free period with significant improvement. Here, we illustrate that HSV encephalitis can present in unfamiliar manner and reinforce the need for a low index of suspicion and early empirical use of acyclovir until definitive laboratory test results are available.</p>","PeriodicalId":14337,"journal":{"name":"International Medical Case Reports Journal","volume":"18 ","pages":"433-437"},"PeriodicalIF":0.7,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11956894/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143752525","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}

{"title":"Treatment of Herpes Zoster-Associated Neurological Complications with High-Dose Intravenous Ascorbic Acid: Two Case Reports.","authors":"Raushan Auezova, Assem Adirakhan, Kamila Mussabekova, Nurgul Aldiyarova, Serik Akshulakov, Lizette Auezova","doi":"10.2147/IMCRJ.S514241","DOIUrl":"10.2147/IMCRJ.S514241","url":null,"abstract":"<p><strong>Background: </strong>Herpes zoster (HZ), caused by reactivation of the varicella zoster virus, can be associated with serious and difficult-to-treat neurological complications, especially in immunocompromised people. Ascorbic acid (Asc) administered intravenously in high doses has been shown to possess immunomodulatory and anti-inflammatory effects. Here, we report two cases of patients: 1) with postherpetic neuralgia (PHN) and 2) with myelitis presumably caused by HZ, who were successfully treated using this approach as adjunctive therapy. Regarding HZ-related myelitis, this is the first reported case to our knowledge.</p><p><strong>Cases presentation: </strong>A 72-year-old male came to the clinic with treatment-resistant postherpetic trigeminal neuralgia and cervical sympathetic ganglionitis. He rated pain intensity as 10 on the visual analogue scale (VAS). The second patient, a 34-old female, was referred with a preliminary diagnosis of cervical myelitis. She suffered from right-sided sensory-motor impairments and urinary retention. Previous treatment did not result in improvement. Neurological and MRI findings were typical of cervico-thoracic myelitis associated with right-sided hemiparesis. Two months before the onset of the first symptoms, she developed a HZ rash in the cervico-occipital region on the right, suggesting an association between HZ and myelitis. Both patients received two courses of Asc (each course consisting of 20 g administered intravenously daily for five days). The male noted a gradual pain relief from the initial 10 to 2 points on the VAS, with only a slight increase at night. In the female's case, hemiparesis regressed and bladder function was restored. Only mild neurological deficits remained.</p><p><strong>Conclusion: </strong>This study supports the use of high-dose intravenous Asc as adjunctive therapy for HZ-associated neuralgia and myelitis, especially in treatment-resistant cases. In order to determine the optimal dosages, it is necessary to perform clinical trials. Furthermore, it would be interesting to study the potential use of Asc therapy for other HZ-related complications.</p>","PeriodicalId":14337,"journal":{"name":"International Medical Case Reports Journal","volume":"18 ","pages":"421-425"},"PeriodicalIF":0.7,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11955166/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143752625","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}

{"title":"Extracorporeal Membrane Oxygenation for Treatment of Immune Checkpoint Inhibitor-Related Pneumonia Complicated with Severe ARDS: A Case Report.","authors":"Yanfei Meng, Yamin Yuan, Li Ma, Jiaqi Wang, Bei Zhang","doi":"10.2147/IMCRJ.S507273","DOIUrl":"10.2147/IMCRJ.S507273","url":null,"abstract":"<p><p>This paper utilizes a retrospective analysis to examine the diagnostic and therapeutic processes for a patient afflicted with immune-related pneumonia, which was complicated by severe acute respiratory distress syndrome (ARDS) and was triggered by Tirellizumab following a surgical procedure for a pulmonary malignancy. The patient exhibited unimproved oxygenation levels, which resulted from the implementation of a lung protective ventilation strategy through invasive mechanical ventilation during the early stages of treatment. Consequently, we opted to perform veno-venous extracorporeal membrane oxygenation (ECMO). Complications such as catheter-related infection, hemolysis, and membrane thrombosis occurred during the period under investigation. After the implementation of awake VV-ECMO, there were still difficulties in withdrawing the ventilator, and the disease was identified again and clearly diagnosed as immune checkpoint inhibitor-related pneumonia. Finally, after standardized treatment, the patient exhibited improvement. For patients with severe ARDS who have received invasive mechanical ventilation, It is imperative to standardize lung protective ventilation strategies, and to allow prone position ventilation under specific conditions. In cases where oxygenation remains unimproved, the selection of extracorporeal membrane oxygenation (ECMO) should be guided by cardiac function, with a concomitant understanding of the associated complications and management strategies. Furthermore, it is essential to thoroughly assess the benefits and drawbacks of awake ECMO, and to develop the capacity to discern diseases associated with fever and lung shadow for the purpose of precise treatment.</p>","PeriodicalId":14337,"journal":{"name":"International Medical Case Reports Journal","volume":"18 ","pages":"411-419"},"PeriodicalIF":0.7,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11955177/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143752505","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}

{"title":"Acute Esophageal Necrosis (Gurvits Syndrome): A Rare Cause of Upper Gastrointestinal Bleeding in Somalia.","authors":"Esmail Husein Mohamud, Ali Ahmed Nor, Liban Hussein Ahmed, Ahmed Saed Hussein, Mohamed Ali Ahmed","doi":"10.2147/IMCRJ.S509079","DOIUrl":"10.2147/IMCRJ.S509079","url":null,"abstract":"<p><p>Acute esophageal necrosis, also known as Gurvits syndrome, is a rare condition due to ischemic compromise and thromboembolic injury to esophagus associated with high mortality. Endoscopically, it is characterized by the circumferential black discoloration of the esophagus. We present the case of a 55-year-old male with a history of multiple comorbidities, including uncontrolled type 2 diabetes mellitus, hypertension, smoker, peripheral arterial disease, and a right above-ankle amputation, who presented with active hematemesis and melena with hemodynamic instability. An esophagogastroduodenoscopy revealed diffuse, circumferential necrotizing esophagitis with black discoloration and ulcerations affecting the middle and distal thirds of the esophagus. The severity increased from the proximal to the distal esophagus, abruptly ending at the gastroesophageal junction. These endoscopic findings, combined with the patient's medical history, were consistent with a diagnosis of acute esophageal necrosis. The patient was admitted to the ward and managed conservatively with intravenous fluid resuscitation, IV proton pump inhibitor twice daily, sucralfate 1 gram every six hours, strict glycemic control using insulin, total parenteral nutrition, empirical IV antibiotics, and placed on nil-per-oral (NPO) for three days. A follow-up esophagogastroduodenoscopy conducted twenty-two days post-admission showed complete healing of the esophageal mucosa without stricture formation. Despite its rarity, prompt diagnosis and management of acute esophageal necrosis are crucial due to its association with high morbidity and mortality, as well as the need to minimize complications such as perforations and strictures, particularly in patients with comorbidities. This case report aims to raise awareness among clinicians in Somalia of this condition as a differential diagnosis in upper gastrointestinal bleeding and to highlight the importance of timely intervention to prevent adverse outcomes.</p>","PeriodicalId":14337,"journal":{"name":"International Medical Case Reports Journal","volume":"18 ","pages":"405-409"},"PeriodicalIF":0.7,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11955165/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143752528","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}

{"title":"Case Report: Portable X-Ray Guided Blood Patch in Treating Post Dural Puncture Headache Status Post Intrathecal Pump Placement.","authors":"Mark Li, Dominic Nistal, Ryu Komatsu, Jiang Wu","doi":"10.2147/IMCRJ.S513641","DOIUrl":"10.2147/IMCRJ.S513641","url":null,"abstract":"<p><p>Post dural puncture headache (PDPH) is common after placement of an intrathecal pump (ITP). Treatment of refractory PDPH requires an epidural blood patch (EBP) with fluoroscopic guidance to avoid damaging the intrathecal catheter. However, when patients' symptoms are severe and advanced imaging resources are unavailable, a safe and effective alternative would need to be explored. Here, we describe a successful application of portable X-ray in guiding EBP in the post-anesthesia care unit (PACU) to treat a patient with refractory and debilitating PDPH status post ITP placement. This approach afforded us the advantage of portability as well as real-time imaging guidance in a resource limited setting. The patient's PDPH resolved after the procedure and remained headache-free two months later at follow up with a functioning ITP in place.</p>","PeriodicalId":14337,"journal":{"name":"International Medical Case Reports Journal","volume":"18 ","pages":"387-393"},"PeriodicalIF":0.7,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11952072/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143752437","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}