Archive of clinical cases最新文献

{"title":"A case of peripartum cardiomyopathy in dichorionic diamniotic twin pregnancy.","authors":"Kanis Fatema, Zhi Ying Tan, Uduwarage Ranaweera","doi":"10.22551/2024.45.1104.10299","DOIUrl":"10.22551/2024.45.1104.10299","url":null,"abstract":"<p><p>Peripartum cardiomyopathy (PPCM) is an uncommon life-threatening condition that is characterized by heart failure with reduced ejection fraction during late pregnancy or within 5 months of postpartum in the absence of other causes of heart failure. Despite advances in managing PPCM, the pathophysiology of it is still poorly understood. This article reviews the diagnostic challenges and management of PPCM, specifically highlighting a rare presentation of PPCM characterized by oxygen desaturation alone.</p>","PeriodicalId":72274,"journal":{"name":"Archive of clinical cases","volume":"11 4","pages":"108-109"},"PeriodicalIF":0.8,"publicationDate":"2024-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11632602/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142815213","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":"Innovative surgical management of gestational gigantomastia.","authors":"Shafic Abdulkarim, Ammar Saed Aldien, Abdulaziz Alazzam, Karyne Martel","doi":"10.22551/2024.45.1104.10300","DOIUrl":"10.22551/2024.45.1104.10300","url":null,"abstract":"<p><p>Gigantomastia is a rare condition characterized by excessive breast enlargement, which can lead to physical and psychological distress. Gestational gigantomastia (GG) occurs during pregnancy, often presenting significant management challenges. This case contributes to the limited literature on GG management by highlighting the successful use of the Goldilocks technique combined with free nipple grafting, offering insights into an effective surgical approach. A pregnant woman presented with severe GG. She underwent bilateral skin-sparing mastectomy and immediate reconstruction using the Goldilocks technique with free nipple grafting. The intervention provided both functional and aesthetic outcomes, significantly improving the patient's quality of life. This case underscores the effectiveness of modern reconstructive surgical techniques in managing GG, particularly in complex cases where hormonal therapy is insufficient.</p>","PeriodicalId":72274,"journal":{"name":"Archive of clinical cases","volume":"11 4","pages":"110-113"},"PeriodicalIF":0.8,"publicationDate":"2024-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11632603/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142815217","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":"Incidental diagnosis of medullary thyroid microcarcinoma in COVID-19 patient with elevated procalcitonin levels.","authors":"Milka Jandric, Biljana Zlojutro, Danica Momcicevic, Sasa Dragic, Sandra Topolovac, Tijana Kovacevic, Pedja Kovacevic","doi":"10.22551/2024.45.1104.10297","DOIUrl":"10.22551/2024.45.1104.10297","url":null,"abstract":"<p><p>A 38-year-old male patient was admitted to the Medical Intensive Care Unit during the second wave of the coronavirus disease (COVID-19) pandemic presenting with fever, headache, muscle pain, and cough. The low-dose chest computed tomography (CT) result was normal, but an increased serum level of procalcitonin (PCT) was detected. Due to COVID-19, pronounced symptoms, and increased inflammatory markers, empiric antibiotic therapy was started. PCT level remained elevated despite 7 days of antimicrobial treatment. Hence, the diagnostic evaluation of the patient was expanded, and we identified medullary thyroid microcarcinoma. After diagnosis, a total thyroidectomy with cervical lymph node resection was performed, and the patient was discharged with oral levothyroxine. Control measurements of serum calcitonin and 18F-fluorodihydroxyphenylalanine positron emission tomography (18F-PET/CT) showed cervical and mediastinal lymph node metastases. Beside surgical treatment, the patient was not motivated for any adjuvant therapy and no new lesions were detected on control PET/CT two years after. In conclusion, clinicians should also consider malignancies such as medullary thyroid carcinoma as a potential cause of increased PCT levels, and as a next step should measure serum calcitonin level and perform neck ultrasound.</p>","PeriodicalId":72274,"journal":{"name":"Archive of clinical cases","volume":"11 4","pages":"98-101"},"PeriodicalIF":0.8,"publicationDate":"2024-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11615157/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142787898","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":"Recurrent pneumothoraces in a patient with pulmonary Langerhans cell histiocytosis accompanied with unexpected histological changes.","authors":"Clement Tan, Prahalath Sundaram","doi":"10.22551/2024.45.1104.10298","DOIUrl":"10.22551/2024.45.1104.10298","url":null,"abstract":"<p><p>Pulmonary Langerhans cell histiocytosis (PLCH) in adults is an uncommon disorder that occurs almost exclusively in smokers. PLCH has no known gender predilection, and the current consensus of its true aetiology is unknown. Lungs may the sole organ involved, however other organs in the body may be involved as well. With the introduction of 2 possible diagnostic categories, it makes PLCH easier and possibly quicker to diagnose. In this report, we present a 34-year-old adult male PLCH case that was negative for the typical immunohistochemistry findings necessary for a \"definite\" diagnosis but was instead diagnosed based on his florid imaging findings - who also had an unexpected histological finding of a non-specific interstitial pneumonia.</p>","PeriodicalId":72274,"journal":{"name":"Archive of clinical cases","volume":"11 4","pages":"102-107"},"PeriodicalIF":0.8,"publicationDate":"2024-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11615159/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142787900","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":"Unveiling the uncommon: a captivating case of multiple autoimmune syndrome.","authors":"Karan J Yagnik, Payal Chhabria, Hardikkumar Bhanderi, Peter N Fish","doi":"10.22551/2024.44.1103.10293","DOIUrl":"10.22551/2024.44.1103.10293","url":null,"abstract":"<p><p>Multiple autoimmune syndrome (MAS) is characterized by the coexistence of three or more autoimmune diseases. We are reporting a unique case of MAS, presented as a Myasthenia Gravis exacerbation, found to have unexpected sero-abnormalities. A 39-year-old female presented with complaints of progressive difficulty swallowing of solids and liquids, droopy eyelids, and facial weakness. Physical examination revealed bilateral ptosis and proptosis, slow-muffled speech, loss of EOM, inability to smile, puff cheeks, clench teeth, or protrude tongue and an asymmetrical shoulder shrug. Motor tone was normal except ⅘ in the left arm and ⅗ in left hand with loss of flexion at left DIP joints. Acetylcholine receptor binding antibodies, ANA, Antithyroid peroxidase, antithyroglobulin and Anti SS-A were positive. MAS, while not a life-threatening condition, greatly degrades patients' quality of life. We recommend that when you encounter patients with one or more autoimmune disorder, you consider MAS in your differential.</p>","PeriodicalId":72274,"journal":{"name":"Archive of clinical cases","volume":"11 3","pages":"83-85"},"PeriodicalIF":0.8,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11520170/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142549241","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":"Metastatic colorectal adenocarcinoma of mandible.","authors":"Nalini Aswath, N Aravindha Babu, Parthasarathy Shruthi, S Priyadarshini","doi":"10.22551/2024.44.1103.10295","DOIUrl":"10.22551/2024.44.1103.10295","url":null,"abstract":"<p><p>Oral metastasis from the colon is quite rare with limited reporting and scientific evidence. The most common metastasis from colorectal cancer is to the liver followed by lungs, bones, and other organs. However rare occurrences like metastasis to the oral cavity might worsen the prognosis and treatment outcome. Oral metastatic tumors account only 1% of all the malignant neoplasms of the jaw. In most of the cases metastasis has been reported in the jaw bones compared to soft tissues. Persistent pain and delayed, prolonged healing should raise the question of an underlying lesion. An unusual case of secondary oral metastasis presenting as an ulcero-proliferative growth in left mandibular alveolus from the primary colon adeno carcinoma has been reported.</p>","PeriodicalId":72274,"journal":{"name":"Archive of clinical cases","volume":"11 3","pages":"90-92"},"PeriodicalIF":0.8,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11520173/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142549240","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":"Urinary tract infections with <i>Burkholderia cepacia</i>. A narrative review.","authors":"Viorel Dragoş Radu, Pavel Onofrei, Marius Vaida, Radu Cristian Costache","doi":"10.22551/2024.44.1103.10294","DOIUrl":"10.22551/2024.44.1103.10294","url":null,"abstract":"<p><p><i>Burkholderia cepacia</i> is an opportunistic Gram-negative bacillus that is found naturally in soil and water and usually causes respiratory infections in patients with cystic pulmonary fibrosis. Few cases of urinary tract infections with <i>B. cepacia</i> have been described in the literature, all of them clinical case presentations or case series. Therefore, we have compiled the data from the literature on this topic in a review to gain a better understanding of the etiopathogenesis, diagnosis and treatment methods of this disease. <i>B. cepacia</i> can lead to multidrug-resistant urinary tract infections in hospitals when surfaces and medical equipment are contaminated. The diagnosis is made after the onset of postoperative febrile syndrome or prolonged hospitalization in the intensive care unit. The evolution can be unfavorable, with the occurrence of sepsis and increased mortality.</p>","PeriodicalId":72274,"journal":{"name":"Archive of clinical cases","volume":"11 3","pages":"86-89"},"PeriodicalIF":0.8,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11520171/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142549242","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":"In vitro fertilization impact on the risk of breast cancer.","authors":"Ana-Maria Mihai, Laura Maria Ianculescu, Dragoş Creţoiu, Nicolae Suciu","doi":"10.22551/2024.44.1103.10292","DOIUrl":"10.22551/2024.44.1103.10292","url":null,"abstract":"<p><p>Breast cancer, with its increasing incidence and high mortality rates, remains a major global health challenge, significantly impacting individuals, families, and societies. Understanding the multifactorial risk factors contributing to its development is crucial for effective prevention and management. Hormonal factors play a significant role in breast cancer development. Given that ovarian steroid hormones influence breast function, any gonadotropin hormone or fertility drug that stimulates ovulation may also impact breast tissue. Contrary to the findings of studies with smaller sample sizes, concerns have emerged regarding the potential increased risk of breast cancer following in vitro fertilization (IVF) treatments. This article explores the potential risk of breast cancer associated with hormonal cycles during IVF, supported by a literature review and a case study conducted in a tertiary hospital in Bucharest, Romania. The case involves a 38-year-old patient with a history of hormonally treated endometriosis and five IVF cycles, who presented for mammographic and ultrasound screening. The screening revealed multicentric and multifocal BIRADS-5 lesions, with histopathological and immunohistochemical analysis confirming invasive breast carcinoma of no special type with ductal carcinoma in situ, HER2 positive (3+), estrogen receptor and progesterone receptor negative, and a Ki-67 proliferation index of 50%.</p>","PeriodicalId":72274,"journal":{"name":"Archive of clinical cases","volume":"11 3","pages":"73-82"},"PeriodicalIF":0.8,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11520175/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142549238","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":"Incidence of transient and chronic hypoparathyroidism after total thyroidectomy - the experience of a tertiary center.","authors":"Cristian Velicescu, Stefana Catalina Bilha, Alexandra Teleman, Andrada Vitelariu, Laura Teodoriu, Alexandru Florescu, Roxana Novac","doi":"10.22551/2024.44.1103.10296","DOIUrl":"10.22551/2024.44.1103.10296","url":null,"abstract":"<p><strong>Background: </strong>The most common cause of hypoparathyroidism (hypoPT) in adults is iatrogenic due to total thyroidectomy, while the ideal moment for considering it chronic is still under debate. Our study aims at reporting the prevalence of transient and permanent hypoPT following thyroid surgery in a tertiary surgical center, as well as serum Parathormone (PTH) variation up to 12 months after surgery stratified according to the type of thyroid disease.</p><p><strong>Material and methods: </strong>519 patients who underwent total thyroidectomy in a tertiary surgical center from 2018 to 2023 were analyzed. Postoperative hypoPT was defined as low PTH (less than 15 pg/ml) and/or hypocalcemia (albumin-corrected levels less than 8.5 mg/dl) on day 1 after surgery. Patients were considered to have permanent hypoPT if they had not recovered completely within 1 year after total thyroidectomy. PTH levels were compared according to the underlying thyroid disease.</p><p><strong>Results: </strong>140 patients (26.97%) had postoperative hypoPT. Twenty-two patients (4.23%) were considered to have permanent hypoPT 12 months after surgery. Approximately half of the patients recovered between 3 months and 12 months after surgery. HypoPT thyroiditis patients had higher PTH levels 3 months after surgery compared to papillary/follicular cancer and multinodular goiter, respectively, and all recovered 1 year after surgery. Papillary/follicular carcinoma was associated with a 29.4% rate of transient and 8.5% rate of chronic hypoPT, respectively.</p><p><strong>Conclusion: </strong>Most patients without incidental parathyroidectomy that still develop postoperative hypoPT will eventually recover; nevertheless, it can take up to 1 year for full resolution. Measuring serum PTH 3 months postoperative may be of interest.</p>","PeriodicalId":72274,"journal":{"name":"Archive of clinical cases","volume":"11 3","pages":"93-97"},"PeriodicalIF":0.8,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11520184/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142549239","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 value of presepsin and procalcitonin as prognostic factors for mortality in patients with alcoholic liver cirrhosis and acute on chronic liver failure.","authors":"Răzvan Igna, Cristina Muzica, Sebastian Zenovia, Horia Minea, Irina Girleanu, Laura Huiban, Anca Trifan","doi":"10.22551/2024.43.1102.10290","DOIUrl":"10.22551/2024.43.1102.10290","url":null,"abstract":"<p><p><b>Background:</b> Acute on chronic liver failure (ACLF) is typically characterized by a rapid progression of liver failure in patients with liver cirrhosis and it is triggered by a precipitant factor, usually a bacterial infection (BI). Considering the low accuracy of the inflammation biomarkers in liver cirrhosis, presepsin and procalcitonin have demonstrated a good diagnostic performance for BI. Understanding the key prognostic factors that influence patient outcomes can significantly impact clinical decision-making and improve patient care in ACLF which can lead to lower mortality rates. <b>Aim:</b> To evaluate the prognostic factors associated with 30-day mortality in patients with alcohol-related liver cirrhosis and ACLF. <b>Methods:</b> This retrospective study on 227 patients diagnosed with ACLF and alcohol-related liver cirrhosis analyzed the prognostic role of presepsin and procalcitonin serum levels. <b>Results:</b> The survival analysis according to the grade of ACLF showed that more than 80% of patients with ACLF grade 1 survived after 30 days, with a mean estimated time of death of 29 ±0.44 days (95 % CI: 28.17-29.92) compared to ACLF grade 2 (24.9±1.064 days; 95 % CI: 22.82-26.99) and ACLF grade 3 (21.05±1.17 days; 95 % CI: 18.75-23.34), with a mean overall survival on entire cohort of 25.69±0.52 days (95 % CI: 24.65-26.73). Presepsin (OR: 4.008, CI 95:3.130-6.456, p=0.001) and procalcitonin (OR: 3.666, CI 95:2.312-5.813, p=0.001) were the most significant factors associated with 30-day mortality. In ACLF grade 2, presepsin provides a better prediction of mortality at the cutoff value of 1050 pg/mL (Sensitivity 72%, Specificity 69%) than procalcitonin (AUC=0.727 95% CI 0.594-0.860, p<0.002) whereas in ACLF grade 3, a cutoff of 1450 pg/mL (Sensitivity 89%, Specificity 91%) presepsin had a more significant accuracy of mortality prediction (AUC=0.93 95% CI 0.81-0.99, p<0.001) than procalcitonin (AUC=0.731 95% CI 0.655-0.807, p<0.001). <b>Conclusion:</b> ACLF is associated with a high mortality rate and the risk of death increases with the grade of ACLF. Presepsin and procalcitonin serum levels are good prognostic factors for 30-day mortality and should be used in clinical practice to stratify the risk and provide and early and efficient treatment in patients with ACLF.</p>","PeriodicalId":72274,"journal":{"name":"Archive of clinical cases","volume":"11 2","pages":"61-68"},"PeriodicalIF":0.8,"publicationDate":"2024-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11250657/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141629400","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}