World Journal of Clinical Cases最新文献

{"title":"Medial olivocochlear reflex dysfunction in multiple sclerosis: The influence of brainstem lesion localization and its clinical implications.","authors":"Ibrahim Salih Gecer, Alper Tabaru, Beyhan Yilmaz, Elif Kaya, Nurhan Kaya Tutar, Bekircan Gumuslu, Mehmet Faruk Oktay","doi":"10.12998/wjcc.v13.i28.108180","DOIUrl":"10.12998/wjcc.v13.i28.108180","url":null,"abstract":"<p><strong>Background: </strong>Multiple sclerosis (MS) is known to affect many sensory systems, yet most auditory research in MS has focused on the afferent pathways, with relatively few studies examining efferent function. The brainstem is a common site for MS plaques, and the medial olivocochlear (MOC) system is located in the superior olivary complex (SOC) of the brainstem. The cochlear nuclei are also involved in the MOC reflex arc. Additionally, the temporal cortex can modulate the SOC and cochlear nucleus, so lesions in the brainstem or temporal cortex may affect the MOC reflex in MS.</p><p><strong>Aim: </strong>To investigate efferent auditory system activity in patients with multiple sclerosis <i>via</i> the MOC reflex.</p><p><strong>Methods: </strong>The study included 50 patients with MS and 50 healthy controls. Patients with MS were divided into three subgroups according to cranial magnetic resonance imaging findings: Patients with brainstem lesions (Group 1, <i>n</i> = 20); patients with temporal cortex lesions without brainstem involvement (Group 2, <i>n</i> = 20); and patients without any lesions in the brainstem or temporal cortex (Group 3, <i>n</i> = 10). Tympanometry, acoustic stapedial reflex thresholds, pure-tone audiometry, and transient-evoked otoacoustic emission (TEOAE) tests (with and without contralateral noise) were performed for all participants.</p><p><strong>Results: </strong>There was no significant difference in pure-tone hearing thresholds or baseline TEOAE amplitudes between the MS and control groups, indicating normal cochlear function in patients with MS; however, MOC reflex suppression was significantly reduced in patients with MS compared to controls (<i>P</i> = 0.021). In particular, Group 1 (MS with brainstem lesions) showed the lowest mean suppression values, which was significantly lower than that of Group 2 and the control group (<i>P</i> = 0.002). By contrast, Group 2 and Group 3 did not significantly differ from controls. Additionally, patients with MS exhibited a sex difference in MOC function: Male patients had significantly lower suppression compared to female patients both within Group 1 and in the MS group as a whole.</p><p><strong>Conclusion: </strong>The findings indicate that the efferent auditory system (specifically the MOC reflex) is affected by MS. MOC reflex activity was most significantly decreased in patients with MS with brainstem lesions, while temporal cortex lesions alone did not appear to notably impair the MOC reflex. Diminished MOC activity may underlie various auditory difficulties in patients with MS (<i>e.g.</i>, hearing in noise), and loss of efferent suppression could contribute to symptoms such as hyperacusis or tinnitus in this population. Further studies are needed to better understand the relationship between MOC dysfunction and auditory symptoms in MS, as well as the potential diagnostic value of MOC testing in MS.</p>","PeriodicalId":23912,"journal":{"name":"World Journal of Clinical Cases","volume":"13 28","pages":"108180"},"PeriodicalIF":1.0,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12362488/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144971603","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Splenic histiocytic sarcoma: Disease progression from the perspective of pathophysiology.","authors":"Meng-Ting Yao, Tao Wang, Hao Luo, Meng-Yuan Yao, Kai Chen, Yong-Qiang Zhu","doi":"10.12998/wjcc.v13.i28.109077","DOIUrl":"10.12998/wjcc.v13.i28.109077","url":null,"abstract":"<p><p>Splenic histiocytic sarcoma (SHS) is a rare, aggressive hematological malignancy with unclear progression and management. Our case illustrates the progression and pathophysiological processes of SHS and provides key data for the diagnosis, treatment and management of SHS. A 60-year-old female with incidentally detected splenic mass (6.0 cm × 5.7 cm) underwent splenectomy, confirmed as SHS in 2020. Post-op imatinib therapy was given. In 2022, hepatic metastases (2.4 cm × 2.9 cm) with pancytopenia led to supportive care. Lesions enlarged to 4.3 cm × 2.7 cm, leading to multi-organ failure and death at 33 months. The case was categorized into three distinct stages based on the pathophysiology of SHS: Early-stage splenic tumor growth, mid-stage liver metastasis with hematological abnormalities, and late-stage tumor infiltration leading to multiorgan failure. For SHS, this case highlights the pivotal role of early intervention and the value of personalized treatment strategies.</p>","PeriodicalId":23912,"journal":{"name":"World Journal of Clinical Cases","volume":"13 28","pages":"109077"},"PeriodicalIF":1.0,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12362440/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144971555","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Kelleni's protocol incorporating non-steroidal anti-inflammatory drugs and nitazoxanide to early manage dengue virus disease: An antiviral silver bullet.","authors":"Mina Thabet Kelleni","doi":"10.12998/wjcc.v13.i28.108181","DOIUrl":"10.12998/wjcc.v13.i28.108181","url":null,"abstract":"<p><p>The current recommendation to avoid non-steroidal anti-inflammatory drugs (NSAIDs) in the management of dengue virus disease (DVD) is scientifically considered of very low to low certainty, despite being widely adopted worldwide. The same recommendation, initially made during the coronavirus disease 2019 (COVID-19) pandemic, was subsequently proven incorrect. In this clinical report, we present evidence, for the first time globally, from a real-life practice that NSAIDs may actually be lifesaving in the early management of DVD as they have proved to be in COVID-19. Moreover, we propose that the personalized immune-modulatory Kelleni's protocol, which includes nitazoxanide as a key component, can be safely and effectively used to manage various separate or concomitant viral infections and co-infections, including DVD. Importantly, this article contributes to the current medical knowledge in the global pursuit of a safe and effective broad-spectrum antiviral protocol that can be used to early manage multiple highly infectious viruses. However, it's crucial that sufficiently powered controlled randomized clinical trials be conducted to thoroughly assess and evaluate the safety of NSAIDs in the early management of DVD as well as the efficacy of nitazoxanide with or without NSAIDs in its management.</p>","PeriodicalId":23912,"journal":{"name":"World Journal of Clinical Cases","volume":"13 28","pages":"108181"},"PeriodicalIF":1.0,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12362463/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144971547","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effective application of an innovative acemannan-enriched glycolipid sphere dressing in diabetic foot ulcer wound healing: A case report and review of literature.","authors":"Shu-Ting Mei, Jie-Jing Li","doi":"10.12998/wjcc.v13.i28.109358","DOIUrl":"10.12998/wjcc.v13.i28.109358","url":null,"abstract":"<p><strong>Background: </strong><i>Aloe vera</i> has been used as a traditional herbal therapy for wound management and dermatological conditions worldwide for thousands of years. Scientific evidence has confirmed that acemannan, the bioactive compound in aloe vera gel, exhibits significant anti-inflammatory and immunomodulatory properties that enhance tissue regeneration. This case report describes the successful application of an innovative acemannan-enriched glycolipid sphere dressing derived from aloe vera gel in diabetic foot ulcer (DFU) treatment, which achieved a clinically remarkable outcome.</p><p><strong>Case summary: </strong>An 80-year-old female patient with a 20-year history of type 2 diabetes mellitus experienced recurrent diabetic foot pain for 15 years. She had multiple hospitalizations due to acute infections and poorly controlled hyperglycemia. Long-term treatments included metformin and gliclazide. Upon presentation, she had a nonhealing wound on her left dorsal foot, diagnosed as a severe DFU (Texas classification: Grade II, stage D). She declined amputation and opted for conservative treatment. The medical team applied an acemannan-enriched glycolipid sphere dressing five times daily to the left calf and foot, avoiding the wound area. Frequency was reduced to three times daily after scab formation. Weight-bearing on the injured foot was avoided. Through in-person and online consultations, the team managed her lifestyle and diet, emphasizing natural foods. After 5 months, the DFU healed without significant scarring or functional loss. No recurrence was observed during the 2-year follow-up.</p><p><strong>Conclusion: </strong>Acemannan-enriched glycolipid sphere dressings promote DFU healing. This suggests the potential of these dressings for treating other refractory wounds.</p>","PeriodicalId":23912,"journal":{"name":"World Journal of Clinical Cases","volume":"13 28","pages":"109358"},"PeriodicalIF":1.0,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12362459/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144971634","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adenomyosis-associated uterine rupture and pulmonary endometriosis mimicking advanced-stage uterine malignancy in an adolescent female: A case report.","authors":"U Chul Ju, Woo Dae Kang, Seok Mo Kim","doi":"10.12998/wjcc.v13.i28.109536","DOIUrl":"10.12998/wjcc.v13.i28.109536","url":null,"abstract":"<p><strong>Background: </strong>Uterine adenomyosis and pulmonary endometriosis are exceptionally rare in adolescents and can pose significant diagnostic challenges due to their nonspecific clinical presentation and imaging features, which may mimic malignancy. Here, we describe a case of adenomyosis-associated uterine rupture (secondary to hemorrhagic necrosis) and concurrent pulmonary endometriosis in a 16-year-old girl initially suspected of having advanced uterine cancer.</p><p><strong>Case summary: </strong>A 16-year-old girl presented with acute abdominal pain and oliguria. Imaging studies revealed a 15-cm ruptured uterine mass accompanied by hemoperitoneum and multiple pulmonary nodules suggestive of metastatic disease. Laboratory tests demonstrated severe anemia and markedly elevated tumor markers [cancer antigen (CA)-125: 1063 U/mL; CA-19-9: 1347 U/mL]. Emergency laparotomy revealed adenomyosis-associated uterine rupture secondary to hemorrhagic necrosis, with no macroscopic abnormalities in other organs. A total abdominal hysterectomy was performed. Histopathological analysis confirmed uterine adenomyosis with hemorrhagic necrosis. Subsequent thoracoscopic wedge resections of the pulmonary lesions demonstrated histologically confirmed endometriosis. The patient has remained disease-free under treatment with oral dienogest.</p><p><strong>Conclusion: </strong>This case of an adolescent patient highlights how benign gynecological conditions can mimic malignancy, necessitating broad differential diagnoses despite alarming presentations.</p>","PeriodicalId":23912,"journal":{"name":"World Journal of Clinical Cases","volume":"13 28","pages":"109536"},"PeriodicalIF":1.0,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12362443/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144971531","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Middle meningeal artery embolisation in chronic subdural hematoma: A double-edged sword.","authors":"Arvind K Morya, Ranjan K Behera, Parul C Gupta","doi":"10.12998/wjcc.v13.i28.109364","DOIUrl":"10.12998/wjcc.v13.i28.109364","url":null,"abstract":"<p><p>Chronic subdural hematoma is essentially managed by surgical intervention. In recent times, middle meningeal artery embolisation has emerged as a less invasive procedure in such cases. The use of fine catheters to selectively embolise the specific involved branches of the middle meningeal artery using polyvinyl alcohol particles looks promising; however, the presence of anastomotic arteries can result in reflux and embolisation of these atypical branches, causing a myriad of complications. There is a need to identify these abnormal vessels in time to have a positive outcome with the least complications.</p>","PeriodicalId":23912,"journal":{"name":"World Journal of Clinical Cases","volume":"13 28","pages":"109364"},"PeriodicalIF":1.0,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12362439/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144971600","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Postoperative massive hemorrhage in oral cancer surgery nursing interventions and outcomes: A case report.","authors":"Dan-Dan Shi, Meng Zhang, Jing Ding, Ju Tian","doi":"10.12998/wjcc.v13.i28.109334","DOIUrl":"10.12998/wjcc.v13.i28.109334","url":null,"abstract":"<p><strong>Background: </strong>Post-operative massive hemorrhage is a critical concern in oral cancer surgery, associated with severe complications and heightened morbidity and mortality rates.</p><p><strong>Case summary: </strong>A 46-year-old male with advanced poorly differentiated squamous cell carcinoma (ypT4aN3bN0M0) of the oral floor underwent extensive surgery, including total glossectomy, partial mandibulectomy, and free flap reconstruction. Postoperatively, he developed life-threatening hemorrhage on day 3 due to wound dehiscence. Rapid nursing interventions-prompt suture removal, pressure hemostasis, and multidisciplinary collaboration-controlled bleeding. Postoperative care emphasized hemodynamic monitoring, infection prevention, and rehabilitation. Despite comorbidities (hypertension, diabetes, prior stroke), the patient achieved functional recovery: Oral flap epithelialization, restored swallowing (water swallow test: Grade 1), 70% tongue mobility, and 80% preoperative chewing efficiency at 6-month follow-up. This case underscores the critical role of structured nursing protocols in managing postoperative hemorrhage and optimizing outcomes in high-risk oral cancer surgery.</p><p><strong>Conclusion: </strong>This case report highlights the pivotal role of structured nursing interventions in managing life-threatening postoperative hemorrhage following complex oral cancer surgery. By integrating meticulous preoperative risk stratification, intraoperative hemostatic collaboration, and vigilant postoperative monitoring (<i>e.g.</i>, timely suture management, pressure hemostasis, blood product administration), the interdisciplinary team achieved rapid hemorrhage control. Comprehensive psychological care and rehabilitation protocols further facilitated functional recovery, enabling the patient to regain swallowing, speech, and mobility despite advanced disease and comorbidities. The findings underscore that standardized nursing workflows, balancing procedural rigor with holistic patient support, are essential for mitigating complications and enhancing outcomes in high-risk head and neck surgical populations.</p>","PeriodicalId":23912,"journal":{"name":"World Journal of Clinical Cases","volume":"13 28","pages":"109334"},"PeriodicalIF":1.0,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12362487/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144971588","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Airway management strategies in a pediatric patient with MURCS association: A case report.","authors":"Xu-Nian Lin, Wing-Sum Chan, Cheng-Wei Lu","doi":"10.12998/wjcc.v13.i28.106852","DOIUrl":"10.12998/wjcc.v13.i28.106852","url":null,"abstract":"<p><strong>Background: </strong>MURCS association, an acronym for Müllerian duct aplasia/hypoplasia, congenital renal agenesis/ectopia, and cervical somite dysplasia, presents unique anaesthetic challenges, particularly for airway control due to cervical spine anomalies. This case report adds to the limited literature by detailing airway management strategies in a paediatric patient with MURCS, emphasising the need for thorough preoperative evaluation and curated planning.</p><p><strong>Case summary: </strong>This report describes the successful anaesthetic and airway management of a 6-year-old girl with MURCS undergoing dental extraction. To address the complexities of the patient's condition, a multidisciplinary approach involving comprehensive preoperative assessment, meticulous planning, and advanced airway management techniques was adopted.</p><p><strong>Conclusion: </strong>This report emphasizes individualized anesthetic strategies and interprofessional collaboration for managing rare congenital syndromes.</p>","PeriodicalId":23912,"journal":{"name":"World Journal of Clinical Cases","volume":"13 28","pages":"106852"},"PeriodicalIF":1.0,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12362489/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144971460","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Advancing predictive oncology: Integrating clinical and radiomic models to optimize transarterial chemoembolization outcomes in hepatocellular carcinoma.","authors":"Sujatha Baddam","doi":"10.12998/wjcc.v13.i28.109397","DOIUrl":"10.12998/wjcc.v13.i28.109397","url":null,"abstract":"<p><p>This article discusses the innovative use of computed tomography radiomics combined with clinical factors to predict treatment response to first-line transarterial chemoembolization in hepatocellular carcinoma. Zhao <i>et al</i> developed a robust predictive model demonstrating high accuracy (area under the curve 0.92 in the training cohort) by integrating venous phase radiomic features with alpha-fetoprotein levels. This noninvasive approach enables early identification of patients unlikely to benefit from transarterial chemoembolization, allowing a timely transition to alternative therapies such as targeted agents or immunotherapy. Such precision strategies may improve clinical outcomes, optimize resource utilization, and increase survival in advanced hepatocellular carcinoma management. Future studies should emphasize external validation and broader clinical adoption.</p>","PeriodicalId":23912,"journal":{"name":"World Journal of Clinical Cases","volume":"13 28","pages":"109397"},"PeriodicalIF":1.0,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12362475/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144971520","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Appendicolith in non-operative management of acute appendicitis: Implications for recurrence and future directions.","authors":"Ju Tian","doi":"10.12998/wjcc.v13.i28.109664","DOIUrl":"10.12998/wjcc.v13.i28.109664","url":null,"abstract":"<p><p>Appendicoliths are frequently encountered in acute appendicitis (AA) and historically considered a risk factor for treatment failure in nonoperative management (NOM). However, the impact of appendicoliths on recurrence rates in uncomplicated AA remains controversial. This editorial critically appraises the study by Kupietzky <i>et al</i>, which explored the relationship between appendicolith characteristics and NOM outcomes. Kupietzky <i>et al</i> conducted a retrospective analysis of 797 patients with uncomplicated AA, comparing recurrence rates between those with and without appendicoliths. The study focused on long-term follow-up (median 44.2 months) and subgroup analyses of stone characteristics. The study revealed no significant difference in overall recurrence rates between groups (26.5% <i>vs</i> 19.1%, <i>P</i> = 0.14). However, patients with appendicoliths experienced earlier recurrence (3.9 months <i>vs</i> 5.9 months, <i>P</i> = 0.04) and had larger appendix diameters (10.2 mm <i>vs</i> 8.5 mm, <i>P</i> = 0.001). Subgroup analyses showed no correlation between stone size, location, or number and recurrence risk. Appendicoliths do not independently increase the overall recurrence risk after NOM for uncomplicated AA but may accelerate recurrence timelines. Clinical decisions should prioritize individualized risk assessment, considering patient age, symptom severity, and radiological features. These findings challenge traditional paradigms and advocate for shared decision-making between clinicians and patients.</p>","PeriodicalId":23912,"journal":{"name":"World Journal of Clinical Cases","volume":"13 28","pages":"109664"},"PeriodicalIF":1.0,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12362470/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144971493","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}