The American Journal of Case Reports最新文献_第5页

Bilateral Salpingo-Oophorectomy for Intracardiac Leiomyomatosis: A Case Report. 双侧输卵管卵巢切除术治疗心内平滑肌瘤1例。

IF 1.2

The American Journal of Case Reports Pub Date : 2022-10-20 DOI: 10.12659/AJCR.937266

Jinxiao Liang, Lijuan Wang, Xiaoting Ling, Lingling Xie, Mingwei Xie, Chunxian Huang

{"title":"Bilateral Salpingo-Oophorectomy for Intracardiac Leiomyomatosis: A Case Report.","authors":"Jinxiao Liang, Lijuan Wang, Xiaoting Ling, Lingling Xie, Mingwei Xie, Chunxian Huang","doi":"10.12659/AJCR.937266","DOIUrl":"https://doi.org/10.12659/AJCR.937266","url":null,"abstract":"BACKGROUND Intracardiac leiomyomatosis (ICLM) is an extremely rare tumor which is benign but presents with aggressive behavior. To date, there is still no standard of care for ICLM therapy, and treatment for complicated ICLM has obtained even less attention. Radical surgery was usually recommended to remove the patients' tumors completely. Since initial complete surgical resection cannot be performed in all cases, bilateral salpingo-oophorectomy (BSO), via its effects of estrogen deprivation, may be a feasible primary step in the treatment of premenopausal women with unresectable ICLM. CASE REPORT We describe a case of a residual mass in the inferior vena cava and right atrium that shrank dramatically after BSO. The patient was a 41-year-old woman with initially unresectable ICLM. Total hysterectomy with BSO and excision of the retroperitoneal mass was performed, but the intracaval tumor above L5 was not removed. Pathology revealed a benign leiomyoma which was strongly positive for both estrogen receptor and progesterone receptor. Two weeks after the BSO, the patient's serum estradiol level had decreased to a postmenopausal level. At the same time, the proximal end of the intracaval tumor shrank dramatically from the level of the right atrium to the level of L3 only 2 weeks after the surgery. Therefore, this may provide a therapeutic window for a second reduction surgery. CONCLUSIONS BSO, via its estrogen deprivation effect, may provide a simple but effective initial treatment choice for premenopausal women who suffer from primary unresectable ICLM.","PeriodicalId":205256,"journal":{"name":"The American Journal of Case Reports","volume":" ","pages":"e937266"},"PeriodicalIF":1.2,"publicationDate":"2022-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/04/ed/amjcaserep-23-e937266.PMC9597260.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40558722","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

Estrogen-Eluting Ring for Contraception and Possible Issues of Severe Pulmonary Emboli. 雌激素洗脱环用于避孕和严重肺栓塞的可能问题。

IF 1.2

The American Journal of Case Reports Pub Date : 2022-10-20 DOI: 10.12659/AJCR.936256

Alexander Santos, Christopher R Chew, Anthony Hatoum

引用次数: 1

Severe Retinal Necrosis Due to Klebsiella pneumoniae After Acute Prostatitis. 急性前列腺炎后肺炎克雷伯菌所致严重视网膜坏死。

IF 1.2

The American Journal of Case Reports Pub Date : 2022-10-19 DOI: 10.12659/AJCR.937512

Filippo Confalonieri, Boža Gorenjak de Souza, Goran Petrovski, Xhevat Lumi

{"title":"Severe Retinal Necrosis Due to Klebsiella pneumoniae After Acute Prostatitis.","authors":"Filippo Confalonieri, Boža Gorenjak de Souza, Goran Petrovski, Xhevat Lumi","doi":"10.12659/AJCR.937512","DOIUrl":"https://doi.org/10.12659/AJCR.937512","url":null,"abstract":"BACKGROUND We report a rare case of unilateral Klebsiella pneumoniae endogenous endophthalmitis with retinal necrosis secondary to acute prostatitis and its clinical management. CASE REPORT A 72-year-old immunocompetent male presented with high fever and gastrointestinal and genitourinary symptoms. He was diagnosed with acute prostatitis, hospitalized, and started on a systemic antibiotic. After 3 days, he experienced floaters in the right eye with subsequent loss of vision. He was referred to the ophthalmology department, where endophthalmitis was diagnosed. The patient underwent complete pars plana vitrectomy (PPV); vitreous samples were taken, and intravitreal antibiotics were injected. Intraoperatively, the retina appeared moderately ischemic, with signs of vasculitis and an area of infiltrated retina temporal to the central fovea. The microbiology results from the vitreous samples showed Klebsiella pneumoniae presence. After 9 days, rhegmatogenous retinal detachment ensued and the patient underwent phacoemulsification + intraocular lens implantation in the capsular bag, a second PPV, and silicone oil tamponade. Temporal to the fovea, a large area of retinal necrosis was observed. After a 10-month followup period, the silicone oil was removed, and subsequently, visual acuity improved, while the retina remained attached. CONCLUSIONS Klebsiella pneumoniae can be an aggressive microorganism that can cause retinal necrosis and compromise visual function. Prompt PPV can lead to some preservation of vision. This case demonstrates that a second PPV can prove to be a good therapeutic solution and should not be delayed.","PeriodicalId":205256,"journal":{"name":"The American Journal of Case Reports","volume":" ","pages":"e937512"},"PeriodicalIF":1.2,"publicationDate":"2022-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/67/e7/amjcaserep-23-e937512.PMC9597266.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40342925","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

Case Report: A 29-Year-Old Pregnant Woman at 24 Weeks of Gestation Presenting with Laryngotracheitis and COVID-19 Due to the R.1 Variant of SARS-CoV-2. 病例报告:一名29岁妊娠24周的孕妇因SARS-CoV-2的R.1变异而出现喉气管炎和COVID-19。

IF 1.2

The American Journal of Case Reports Pub Date : 2022-10-18 DOI: 10.12659/AJCR.937834

Yoshihito Tanaka, Kojiro Hirano, Eriko Sekino, Toshikazu Shimane, Hitome Kobayashi

{"title":"Case Report: A 29-Year-Old Pregnant Woman at 24 Weeks of Gestation Presenting with Laryngotracheitis and COVID-19 Due to the R.1 Variant of SARS-CoV-2.","authors":"Yoshihito Tanaka, Kojiro Hirano, Eriko Sekino, Toshikazu Shimane, Hitome Kobayashi","doi":"10.12659/AJCR.937834","DOIUrl":"https://doi.org/10.12659/AJCR.937834","url":null,"abstract":"BACKGROUND Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was discovered in December 2019 in Wuhan, China. Coronavirus disease (COVID-19) mainly presents with lower respiratory tract symptoms. On the other hand, laryngotracheitis or croup shows barky cough and it is rare in adults. There were no reports of laryngotracheitis with COVID-19 in pregnant women. We report the case of a pregnant woman at 24 weeks of gestation presenting with acute laryngotracheitis and COVID-19 due to the R.1 variant of SARS-CoV-2. CASE REPORT A 29-year-old previously healthy woman at 24 weeks of gestation presented with hoarseness and sore throat without fever, of 1-day duration. Although she was treated by her primary care physician with nebulized epinephrine, her symptoms did not resolve. She came to our hospital the same day. On arrival at our department, she was tachypneic and had a 95% oxygen saturation. She had stridor and barking cough. Laryngeal endoscopy revealed edema under the vocal cords. She was hospitalized urgently. SARS-CoV-2 polymerase chain reaction (PCR) testing was positive and the E484K mutation was confirmed. She was treated with oral and inhaled corticosteroids. Two days after admission, her symptoms were improved. She was discharged 10 days after admission. Edema under the vocal cords was completely improved 24 days after discharge. There were no adverse effects on the pregnancy. CONCLUSIONS COVID-19 laryngotracheitis has a more severe disease course than other causes, especially in pregnancy. COVID-19 laryngotracheitis should be use corticosteroids to treatment. Prednisolone is recommended for laryngotracheitis with COVID-19 during pregnancy.","PeriodicalId":205256,"journal":{"name":"The American Journal of Case Reports","volume":" ","pages":"e937834"},"PeriodicalIF":1.2,"publicationDate":"2022-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/05/62/amjcaserep-23-e937834.PMC9594643.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40320610","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

Metolachlor Poisoning with Lactic Acidosis Improved by Thiamine Administration: A Case Report. 甲草胺中毒伴乳酸性酸中毒经硫胺素治疗1例。

IF 1.2

The American Journal of Case Reports Pub Date : 2022-10-18 DOI: 10.12659/AJCR.937873

Akira Suekane, Masato Edamoto, Keisuke Kubo, Tomohiro Abe, Keita Nakatsutsumi, Tatsunori Ameda

{"title":"Metolachlor Poisoning with Lactic Acidosis Improved by Thiamine Administration: A Case Report.","authors":"Akira Suekane, Masato Edamoto, Keisuke Kubo, Tomohiro Abe, Keita Nakatsutsumi, Tatsunori Ameda","doi":"10.12659/AJCR.937873","DOIUrl":"https://doi.org/10.12659/AJCR.937873","url":null,"abstract":"BACKGROUND Metolachlor is a chloroacetamide herbicide that is extensively used worldwide. Ingestion of metolachlor causes acute toxicity via the generation of methemoglobin. Elevated levels of methemoglobin inhibit the transport of oxygen to tissue, causing hypoxia and lactic acidosis. A common treatment approach has been to reduce methemoglobin by administration of methylene blue. Herein, we present a case of metolachlor poisoning causing lactic acidosis that was treatable by thiamine administration, in which the methemoglobin level was not elevated. CASE REPORT A 61-year-old man was admitted to the emergency room with seizures and impaired consciousness after the ingestion of metolachlor (250 mL, 83%) with the intent to commit suicide. The patient's methemoglobin and lactate levels on admission were 0.9% and 11.8 mmol/L, respectively. After admission, the levels of lactate decreased gradually; however, they increased 13 h after admission. There was no evidence of heavy alcohol consumption, hyponutrition, or chronic thiamine deficiency. We initially administered a thiamine bolus (100 mg), which immediately improved his consciousness, followed by continuous administration of the same substance (1500 mg/day). The patient's consciousness improved, and was discharged from the intensive care unit on day 4. CONCLUSIONS Metolachlor can cause metabolic dysfunction and lactic acidosis without an increase in methemoglobin. Moreover, thiamine administration may be beneficial for patients with metolachlor intoxication exhibiting symptoms of elevated lactate levels, impaired consciousness, and lack of elevated methemoglobin levels.","PeriodicalId":205256,"journal":{"name":"The American Journal of Case Reports","volume":" ","pages":"e937873"},"PeriodicalIF":1.2,"publicationDate":"2022-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/74/01/amjcaserep-23-e937873.PMC9594642.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40336675","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

Post-Injection Delirium/Sedation Syndrome: A Case Report and 2-Year Follow-Up. 注射后谵妄/镇静综合征1例及2年随访。

IF 1.2

The American Journal of Case Reports Pub Date : 2022-10-17 DOI: 10.12659/AJCR.937579

Gabriela Podgorná, Jakub Albrecht, Jozef Buday, Tadeáš Mareš, Thai Hong Le, Lucie Kališová, Martin Anders

{"title":"Post-Injection Delirium/Sedation Syndrome: A Case Report and 2-Year Follow-Up.","authors":"Gabriela Podgorná, Jakub Albrecht, Jozef Buday, Tadeáš Mareš, Thai Hong Le, Lucie Kališová, Martin Anders","doi":"10.12659/AJCR.937579","DOIUrl":"https://doi.org/10.12659/AJCR.937579","url":null,"abstract":"BACKGROUND Long-acting injectable (LAI) antipsychotics are one of the forms of therapy for severe mental illness. Post-injection delirium/sedation syndrome (PDSS) is a very rare but serious adverse effect following the application of an olanzapine in a long-acting form. The most common symptoms of the syndrome are sedation, delirium, dysarthria, ataxia, extrapyramidal symptoms, agitation, dizziness, or seizure. The predispositions, prevention, and exact mechanism of PDSS remain unclear. CASE REPORT We present a case report of a 30-year-old male patient experiencing PDSS, including the main symptoms of PDSS, diagnostic methods, olanzapine plasma concentrations, therapeutic process, and outcome. We then include a follow-up of the patient 2.5 years later. The patient did not have any long-term damage, had no disabilities, and no post-traumatic stress disorder following the event. We include information about his current medications, further use of LAI antipsychotics, and update about his everyday life. CONCLUSIONS PDSS is a life-threatening condition clinicians must be aware of, and the easiest precaution is a 3-h observation after the application of an injection. Because the predispositions, prevention, and exact mechanism of PDSS remains unclear, it is very important to report the rare cases of PDSS and conduct further research for the safety of our patients. The follow-up of the patient showed that the patient is doing well, he has no post-traumatic stress disorder following the event, and he did continue to use LAI antipsychotic medication.","PeriodicalId":205256,"journal":{"name":"The American Journal of Case Reports","volume":" ","pages":"e937579"},"PeriodicalIF":1.2,"publicationDate":"2022-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/75/98/amjcaserep-23-e937579.PMC9586135.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33512977","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

Physiologic Response to Exercise or Rhabdomyolysis? Creatine Phosphokinase Elevation in 16 Asymptomatic Firefighters. 运动或横纹肌溶解的生理反应?16名无症状消防员肌酸磷酸激酶升高。

IF 1.2

The American Journal of Case Reports Pub Date : 2022-10-16 DOI: 10.12659/AJCR.937084

Rajia Arbab, Carla Erb, Justin Joy, Hanady Zainah, Majed Mark Samarneh

{"title":"Physiologic Response to Exercise or Rhabdomyolysis? Creatine Phosphokinase Elevation in 16 Asymptomatic Firefighters.","authors":"Rajia Arbab, Carla Erb, Justin Joy, Hanady Zainah, Majed Mark Samarneh","doi":"10.12659/AJCR.937084","DOIUrl":"https://doi.org/10.12659/AJCR.937084","url":null,"abstract":"BACKGROUND We present a case series of 16 trainee firefighters who presented to the Emergency Department with elevated creatine phosphokinase levels of greater than 14 000 units per liter 3 days after the initiation of intense aerobic exercise. All 16 patients were diagnosed with exercise-induced rhabdomyolysis and were mostly asymptomatic. While exercise-induced rhabdomyolysis often affects untrained individuals who abruptly initiate strenuous exercises, our patients were all physically well-trained and maintained an active training regimen. In review of this unusual case series, we assess the patients' risk factors for exercise-induced rhabdomyolysis and the complications of their elevated creatine phosphokinase levels despite their asymptomatic presentations. CASE REPORT We focus on the exercise routine, hospital admission, and course of treatment for 4 of the 16 patients who gave written consent to participate in the study. Therapy was targeted towards intravenous fluids and the lowering of creatine phosphokinase levels. Patients 1, 2, 3, and 4 were discharged when creatine phosphokinase levels decreased by 17%, 40%, 39%, and 40%, respectively. CONCLUSIONS Given the differing guidelines for diagnosis, treatment, and discharge for asymptomatic exercise-induced rhabdomyolysis, it was unclear if this was a physiologic or pathologic response to exercise, if hospital admission was indicated, and the extent to which creatine phosphokinase had to decrease for discharge. Our aim is to: 1) determine recommendations to prevent muscle injury following exercise, 2) distinguish between physiologic response to exercise and clinically significant muscle damage, and 3) and recommend a course of treatment given asymptomatic presentation.","PeriodicalId":205256,"journal":{"name":"The American Journal of Case Reports","volume":" ","pages":"e937084"},"PeriodicalIF":1.2,"publicationDate":"2022-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/82/42/amjcaserep-23-e937084.PMC9583044.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33512539","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

Case of Secondary Syphilis with Mucocutaneous, Articular, and Pulmonary Involvement in a 74-Year-Old Moroccan Man. 74岁摩洛哥男子继发性梅毒伴皮肤粘膜、关节和肺部受累1例。

IF 1.2

The American Journal of Case Reports Pub Date : 2022-10-15 DOI: 10.12659/AJCR.937513

Ahmed Mougui, Zineb Baba, Imane El Bouchti

{"title":"Case of Secondary Syphilis with Mucocutaneous, Articular, and Pulmonary Involvement in a 74-Year-Old Moroccan Man.","authors":"Ahmed Mougui, Zineb Baba, Imane El Bouchti","doi":"10.12659/AJCR.937513","DOIUrl":"https://doi.org/10.12659/AJCR.937513","url":null,"abstract":"BACKGROUND Syphilis is a sexually transmitted infection (STI) caused by Treponema pallidum. If untreated, primary syphilis can progress to secondary syphilis, which has a characteristic rash and diverse systemic features. This report is of a case of secondary syphilis with mucocutaneous, articular, and pulmonary involvement. CASE REPORT A 74-year-old Moroccan man presented with an 8-week history of bilateral knee pain and swelling. On examination, he had bilateral knee effusions. Articular puncture brought an inflammatory fluid with a significant presence of white blood cells. Inflammatory markers were elevated. X-rays of both knees showed bilateral osteoarthritis with intra-articular calcification in the left knee. Nonsteroidal anti-inflammatory drugs and colchicine were prescribed, but were ineffective. A closer clinical examination of the patient revealed pigmented papules on the palms, soles, oral mucosa, trunk, and genitals. Treponema pallidum hemagglutination assay and Venereal Disease Research Laboratory results were positive in the blood (titers 1: 32) and joint fluid. A computed tomography scan of the chest revealed a focal opacity in the lateral basal segment of the right lung. The diagnosis of secondary syphilis with mucocutaneous, articular, and pulmonary involvement was made. The evolution was favorable after a single intramuscular injection of benzathine-penicillin. CONCLUSIONS Arthritis, mucocutaneous involvement, and lung lesions can be manifestations of secondary syphilis. A detailed anamnesis, clinical examination, serology, and imaging techniques are the pillars of diagnosing this condition.","PeriodicalId":205256,"journal":{"name":"The American Journal of Case Reports","volume":" ","pages":"e937513"},"PeriodicalIF":1.2,"publicationDate":"2022-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/ca/c5/amjcaserep-23-e937513.PMC9579994.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33513974","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

Rare Ischemic Complications of Giant Cell Arteritis: Case Series and Literature Review. 巨细胞动脉炎罕见的缺血性并发症:病例系列及文献回顾。

IF 1.2

The American Journal of Case Reports Pub Date : 2022-10-14 DOI: 10.12659/AJCR.937565

Darya S Jalaledin, Carolyn Ross, Jean-Paul Makhzoum

{"title":"Rare Ischemic Complications of Giant Cell Arteritis: Case Series and Literature Review.","authors":"Darya S Jalaledin, Carolyn Ross, Jean-Paul Makhzoum","doi":"10.12659/AJCR.937565","DOIUrl":"https://doi.org/10.12659/AJCR.937565","url":null,"abstract":"BACKGROUND Some ischemic complications due to giant cell arteritis (GCA) are rare and underdiagnosed. We describe the clinical features and outcomes of patients with GCA presenting with rare ischemic complications. CASE REPORT Our single-center retrospective database of patients with GCA was reviewed from 1994 to 2020. We describe 3 cases of rare ischemic complications secondary to GCA. We review the literature regarding ischemic complications due to GCA and their outcomes. All 3 cases met the American College of Rheumatology criteria for GCA. All patients experienced rare ischemic complications due to GCA. In case 1, the patient presented with a sixth cranial nerve palsy. In case 2, the patient presented with tongue and scalp necrosis, and with permanent visual loss due to anterior ischemic optic neuropathy. In case 3, the patient presented with scalp necrosis. In all 3 cases, the patients received glucocorticoids either intravenously and/or orally, which led to improvement. They all improved within the course of their followup visits. A literature review was performed to identify similar cases and outcomes. CONCLUSIONS Ischemic complications due to GCA can be part of the initial presentation of the vasculitis, making confirmation of the diagnosis more difficult. Physicians should be aware of these rare complications since rapid diagnosis and initiation of glucocorticoids may alter the course of the disease.","PeriodicalId":205256,"journal":{"name":"The American Journal of Case Reports","volume":" ","pages":"e937565"},"PeriodicalIF":1.2,"publicationDate":"2022-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/6d/d7/amjcaserep-23-e937565.PMC9578098.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33538811","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: 2

Case Report: Successful Reversal of Residual Block with Sugammadex in a Patient Not Known to Have Myasthenia Gravis. 病例报告:用Sugammadex成功逆转未确诊重症肌无力患者的残留阻滞。

IF 1.2

The American Journal of Case Reports Pub Date : 2022-10-14 DOI: 10.12659/AJCR.937128

Ko-Ching Kuo, Chih-Shung Wong, Tzong-Jeng Wu

{"title":"Case Report: Successful Reversal of Residual Block with Sugammadex in a Patient Not Known to Have Myasthenia Gravis.","authors":"Ko-Ching Kuo, Chih-Shung Wong, Tzong-Jeng Wu","doi":"10.12659/AJCR.937128","DOIUrl":"https://doi.org/10.12659/AJCR.937128","url":null,"abstract":"BACKGROUND Incomplete recovery from residual neuromuscular block agent (NMBA) after anesthesia is a serious adverse event in the post-anesthesia care unit. Acetylcholinesterase neostigmine is usually used to reverse residual neuromuscular blockade and facilitate spontaneous breathing and endotracheal extubation. CASE REPORT A 40-year-old woman received general anesthesia for strabismus correction surgery. At the end of surgery, repeated doses of neostigmine up to 85 µg/kg failed to reverse the residual neuromuscular blockade (train-of-four [TOF] ratio below 21%). Sugammadex (200 mg) provided immediate reversal, with the TOF ratio up to 100%. The patient regained spontaneous breathing, and the endotracheal tube was removed. After surgery, myasthenia gravis was diagnosed. CONCLUSIONS When unexpected prolonged neuromuscular blockade presents, the TOF ratio should be used to detect its depth and guide a reasonable dose of reversal agents. Anticholinesterase has a ceiling effect; once acetylcholinesterase activity is fully inhibited, administration of additional anticholinesterase can result in no further recovery. Furthermore, excessive acetylcholine can cause muscle weakness. In contrast, sugammadex is a selective reversal agent for steroidal NMBA, which works by encapsulation via tight water-soluble complexes with amino steroids (eg, rocuronium) rather than increasing acetylcholine at the neuromuscular junction. In this case, the recovery from moderate neuromuscular blockade by sugammadex was more effective and rapid than that by neostigmine. When refractory and prolonged residual neuromuscular blockade presents after repeated doses of anticholinesterase, sugammadex should be considered as an effective reversal agent. Particularly in cases of myasthenia gravis, sugammadex is superior to neostigmine for reversing rocuronium-induced NMBA in patients undergoing surgery.","PeriodicalId":205256,"journal":{"name":"The American Journal of Case Reports","volume":" ","pages":"e937128"},"PeriodicalIF":1.2,"publicationDate":"2022-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/b7/2b/amjcaserep-23-e937128.PMC9578055.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33505907","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