Reports (MDPI)最新文献

{"title":"Isolated Thyroid Metastasis from High-Grade Clear Cell Renal Cell Carcinoma After Radical Nephrectomy: A Case Report.","authors":"Constantinos Papadopoulos, Konstantina Dinaki, Rafail Ioannidis, Ioanna Gravalidou, Anna Zisi","doi":"10.3390/reports9040346","DOIUrl":"https://doi.org/10.3390/reports9040346","url":null,"abstract":"<p><p><b>Background and Clinical Significance</b>: Thyroid metastasis from clear cell renal cell carcinoma (ccRCC) is uncommon and may occur after radical nephrectomy despite no evidence of residual or metastatic disease at that time. Diagnosis can be challenging because imaging and fine-needle aspiration (FNA) may mimic benign or primary thyroid lesions. <b>Case Presentation</b>: A 55-year-old man underwent left radical nephrectomy for WHO/ISUP grade 3 ccRCC with focal grade 4 differentiation. Two years later, surveillance ultrasonography detected a suspicious lesion involving the thyroid isthmus and left lobe. FNA was interpreted as Bethesda II (benign), but metastatic ccRCC was subsequently confirmed after total thyroidectomy. Histopathology showed focal vascular and capsular invasion. Tumor reached the margin of the main thyroid specimen, whereas separately submitted perithyroidal soft tissue had tumor-free margins, resulting in a final R0 resection. The tumor was positive for CK8/18, PAX8, EMA, vimentin, and CD10 and negative for TTF-1, thyroglobulin, calcitonin, and CD5. Postoperative 18F-FDG PET/CT showed no additional metastatic disease. <b>Conclusions</b>: Benign thyroid cytology should be interpreted cautiously in patients with previous ccRCC when clinical or imaging findings remain suspicious. Diagnosis requires integration of oncological history, imaging, histopathology, and immunohistochemistry. Surgical resection may provide local disease control in selected patients, with surveillance.</p>","PeriodicalId":74664,"journal":{"name":"Reports (MDPI)","volume":"9 4","pages":""},"PeriodicalIF":0.5,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13692422/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149278341","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":"Walking Distance and Interlimb Gait Differences Across 51 kg of Weight Loss After Total Knee Arthroplasty: A Three-Session Wearable Sensor Case Report.","authors":"Andrei Machado Viegas da Trindade, Leonardo Pinheiro Rezende, Junichiro Sado Junior, Marcos Henrique Alves Resende, Claudia Santos Oliveira","doi":"10.3390/reports9040345","DOIUrl":"https://doi.org/10.3390/reports9040345","url":null,"abstract":"<p><p><b>Background and Clinical Significance:</b> Longitudinal observations that combine major postoperative weight loss with limb-specific gait assessment after total knee arthroplasty (TKA) are uncommon. This case report describes three single-trial instrumented assessments in one patient and is intended as a descriptive observation; it does not establish causality, measurement stability, mechanical loading, or a clinically meaningful persistent deficit; <b>Case Presentation:</b> A man in his early sixties at the first assessment had undergone left TKA for end-stage osteoarthritis and subsequently underwent Roux-en-Y gastric bypass. Three assessments were available from approximately 31 to 67 months after TKA. Body mass was 120, 88, and 69 kg (body mass index 43.03, 31.55, and 24.74 kg/m²), while two-minute walk distance (2MWT) was 67.8, 105.1, and 118.1 m. The third walk test was launched in the software's six-minute module and stopped at 1 min 58 s, so 118.1 m is the distance accumulated over 118 s and was neither adjusted nor extrapolated to 120 s. The operated limb showed longer stance duration than the non-operated limb by 3.04, 5.28, and 2.05 percentage points, and a proprietary propulsion index was lower on the operated side by 18.18%, 17.95%, and 14.06%; the direction of both differences was the same at every session but the magnitude was not, and the index has no published calculation or post-TKA interpretive threshold. Each session comprised one trial, and the third-session gait means were based on only five operated-limb and four non-operated-limb steps. Valid Timed Up and Go (TUG) totals were available for sessions 1 and 2 (13.41 and 14.95 s); the available source documentation did not contain a valid session-3 TUG result. Vendor-derived walk-test speed was excluded from primary interpretation because its calculation could not be reconciled with distance divided by test duration; <b>Conclusions:</b> Across these three observations, 2MWT distance increased while side-to-side differences in stance duration and the exploratory propulsion index were present at each session. These co-occurring changes cannot be attributed to weight loss specifically, because time since arthroplasty, rehabilitation exposure and repeated testing varied together with body mass. The findings are descriptive and hypothesis-generating; confirmation requires prospective studies with repeated trials per session, an adequate number of analysed steps, and validated kinetic or limb-specific outcomes.</p>","PeriodicalId":74664,"journal":{"name":"Reports (MDPI)","volume":"9 4","pages":""},"PeriodicalIF":0.5,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13692334/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149278515","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":"Long-Term Asymptomatic Medial Migration of a Tympanostomy Tube into the Middle Ear: A Case Report and Review of the Literature.","authors":"Nikolaos Fylaktou, Athanasios Vlachodimitropoulos, Gerasimos Danielides, Georgios Batsaouras, Spyridon Lygeros","doi":"10.3390/reports9040343","DOIUrl":"https://doi.org/10.3390/reports9040343","url":null,"abstract":"<p><p><b>Background and Clinical Significance:</b> Tympanostomy tubes (TTs) are normally extruded into the external auditory canal within 6-18 months, whereas medial migration into the middle ear is a rare complication. Medialized tubes have been associated with otalgia, otorrhea, conductive hearing loss, granuloma and perilymphatic fistula, yet may remain clinically silent; no consensus exists on whether asymptomatic medialized tubes should be removed. <b>Case Presentation:</b> A 24-year-old man attended a routine otorhinolaryngological examination without otological complaints. He had undergone bilateral TT insertion at four years of age for otitis media with effusion, with complete resolution and no further otological procedures. Otoscopy demonstrated an intact tympanic membrane through which a round, blue structure was visible within the posteroinferior quadrant of the tympanic cavity; otoendoscopy confirmed a foreign body in contact with the middle ear mucosa. Tympanometry showed a type A curve and pure-tone audiometry showed normal, symmetrical thresholds. High-resolution computed tomography showed an aerated middle ear cleft, well pneumatized mastoid cavities, an intact ossicular chain and no radiological features of chronic otitis media. Conservative management was adopted, with clinical and audiological review planned at 6-12-month intervals; at the most recent review, three months after diagnosis, the patient remained asymptomatic. <b>Conclusions:</b> A medially migrated TT may be retained within the middle ear for two decades without inflammation, structural damage or hearing loss. In selected patients with an intact tympanic membrane, normal audiometry and unremarkable imaging, structured observation is a defensible alternative to removal, provided the patient is counseled about the symptoms that should prompt review.</p>","PeriodicalId":74664,"journal":{"name":"Reports (MDPI)","volume":"9 4","pages":""},"PeriodicalIF":0.5,"publicationDate":"2026-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13692540/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149278377","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":"Liver Transplantation in Severe Hemophilia A: A Two-Patient Case Series with Divergent Long-Term Outcomes.","authors":"Alexey Vasilyevich Shabunin, Pavel Alexeevich Drozdov, Oksana Nikolaevna Levina, Sergey Andreevich Astapovich, Daria Andreevna Teplyuk, Dzhennet Agamovna Beibalaeva","doi":"10.3390/reports9040342","DOIUrl":"https://doi.org/10.3390/reports9040342","url":null,"abstract":"<p><p><b>Background and Clinical Significance:</b> Before effective viral inactivation of plasma-derived factor concentrates, many patients with hemophilia acquired hepatitis C virus infection and later developed cirrhosis or hepatocellular carcinoma. Liver transplantation treats end-stage liver disease and may also restore factor VIII production; however, long-term oncologic outcomes in this setting are rarely reported. <b>Case Presentation:</b> Two men with severe hemophilia A (baseline factor VIII activity < 1%) and hepatitis C-related cirrhosis underwent deceased-donor orthotopic liver transplantation. Both received an extended-half-life recombinant factor VIII (efmoroctocog alfa; 33,000 and 35,000 IU in total) tapered until postoperative days 13-14, and intraoperative hemostasis was guided by conventional coagulation tests and thromboelastography. Neither patient had major bleeding or thrombotic events, and replacement therapy was not required thereafter. In Patient 1, graft function remained satisfactory 45 months after transplantation, with factor VIII activity of 62.5%. Patient 2 was transplanted for hepatocellular carcinoma outside the Milan criteria (two lesions of 6.8 and 2.7 cm; alpha-fetoprotein 110-150 ng/mL) under center-specific expanded criteria, without bridging therapy. Factor VIII activity remained clinically sufficient, but pulmonary nodules suspected 20 months after transplantation progressed; atypical pulmonary resections 45 months after transplantation confirmed metastatic hepatocellular carcinoma, and lenvatinib was initiated. <b>Conclusions:</b> Liver transplantation can provide durable correction of severe hemophilia A without long-term replacement therapy. However, correction of the coagulation disorder does not eliminate risks related to the original liver disease; in patients transplanted for hepatocellular carcinoma, particularly beyond conventional criteria, long-term outcome remains dependent on tumor burden, tumor biology, candidate selection, and sustained oncologic surveillance.</p>","PeriodicalId":74664,"journal":{"name":"Reports (MDPI)","volume":"9 4","pages":""},"PeriodicalIF":0.5,"publicationDate":"2026-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13692406/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149278379","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":"Beyond Ophthalmoplegia: Wernicke Encephalopathy with Anisocoria.","authors":"Yoshihiro Ito, Koji Hayashi, Haruka Kurihara, Yuka Nakaya, Mamiko Sato","doi":"10.3390/reports9040341","DOIUrl":"https://doi.org/10.3390/reports9040341","url":null,"abstract":"<p><p>A 69-year-old man with a history of heavy alcohol consumption and poor nutrition presented with disorientation and gait instability. The cognitive assessment was severely affected, with the Hasegawa Dementia Scale-Revised score was 4. Neurological examination revealed anisocoria (right 4.0 mm, left 2.0 mm) with sluggish light reflexes, gaze-evoked horizontal nystagmus, and vertical gaze restrictions. He exhibited disorientation and limb ataxia; deep tendon reflexes were normal. Brain MRI showed bilateral thalamic hyperintensities on diffusion-weighted imaging and periaqueductal high signal on T2 FLAIR. Laboratory testing confirmed a severely reduced serum thiamine level of 10.5 ng/mL, establishing Wernicke encephalopathy (WE) based on Caine's criteria. Immediately upon admission (Day 1), high-dose thiamine therapy was initiated at 700 mg/day (300 mg/day intravenous drip plus 400 mg/day oral) for 7 days, followed by 400 mg/day oral. Despite prompt, high-dose thiamine administration, the 2.0 mm anisocoria persisted consistently throughout the 19-day hospitalization, whereas cognitive function and ataxia partially improved. The 2.0 mm interocular difference confirmed pathologic anisocoria, indicating asymmetric autonomic disruption involving descending sympathetic pathways in the periaqueductal gray matter. While neuro-ophthalmic signs in WE are typically reversible, this case demonstrates that autonomic deficits may persist despite comprehensive thiamine therapy, highlighting WE as a critical metabolic mimic of life-threatening structural brainstem disorders.</p>","PeriodicalId":74664,"journal":{"name":"Reports (MDPI)","volume":"9 4","pages":""},"PeriodicalIF":0.5,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13692475/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149278520","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":"Palliative Transcatheter Arterial Embolization for Life-Threatening Hemorrhage from Advanced Buccal Mucosal Carcinoma: A Case Report.","authors":"Yoshiyuki Miyamoto, Keigo Kubota, Hiroshi Kawakami, Atsushi Hosono, Yasuhiko Tsuyama","doi":"10.3390/reports9040340","DOIUrl":"https://doi.org/10.3390/reports9040340","url":null,"abstract":"<p><p><b>Background and Clinical Significance:</b> Hemorrhage from advanced oral cancer can threaten both circulation and airway patency. <b>Case Presentation:</b> A 60-year-old man with advanced left buccal mucosal squamous cell carcinoma (cT4bN2bM0, Stage IVB) was medically unsuitable for radical surgery. Definitive radiotherapy was initiated, but after 20 Gy in 10 fractions, massive tumor hemorrhage on 12 July 2022 posed an imminent risk of airway obstruction and required intubation. After local hemostatic measures and transfusion, transcatheter arterial embolization (TAE) of tumor-feeding external carotid branches was performed on 14 July using coils and n-butyl-2-cyanoacrylate. Angiography showed markedly reduced tumor staining; the patient was extubated the next day. No recurrent tumor bleeding or clinically apparent neurological deficit was documented through the last outpatient evaluation on 8 August 2022. <b>Conclusions:</b> TAE achieved short-term hemostasis and facilitated early extubation in this patient; durable efficacy and survival benefit cannot be established from this case.</p>","PeriodicalId":74664,"journal":{"name":"Reports (MDPI)","volume":"9 4","pages":""},"PeriodicalIF":0.5,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13692386/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149278417","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":"Idiopathic Segmental Megacolon-Intestinal Neuronal Dysplasia Type B, Cajal Cells Abnormality, or Still \"Idiopathic\" Disease?-Case Report and Literature Review.","authors":"Georgi Popivanov, Boryana Ilcheva, Marina Konaktchieva, Roberto Cirocchi, Mihail Tabakov, Vladimir Pavlov, Ventsislav Mutafchiyski","doi":"10.3390/reports9040339","DOIUrl":"https://doi.org/10.3390/reports9040339","url":null,"abstract":"&lt;p&gt;&lt;p&gt;&lt;b&gt;Background and Clinical Significance:&lt;/b&gt; Idiopathic megacolon (IM) in adults is a rare disease with an unknown aetiology. The condition remains poorly understood, with ongoing debate over the specificity of its histopathology. &lt;b&gt;Case Presentation:&lt;/b&gt; Case 1: A 40-year-old man was admitted due to moderate lower abdominal pain and a distended, asymmetric abdomen. X-ray demonstrated the sigmoid colon with a diameter of 13 cm. Colonoscopy found a significantly enlarged and elongated sigmoid colon, which precluded the examination of the entire colon due to the insufficient length of the colonoscope. All blood assays were within the normal range. Intraoperatively, there was a significantly dilated sigmoid colon measuring 20 cm in width with a length of 60 cm. A sigmoid resection with mechanical T-T anastomosis between the descending colon and proximal rectum circular stapler was performed. The patient had an uneventful recovery. Seven years after the operation, he is symptom-free. The histopathological examination revealed a slight oedema of the lamina propria, submucosal fibrosis, hyperplastic submucosal ganglia and nerve fibres, hypertrophy of the muscle layers and hyperplastic myenteric nerve plexuses and ganglion cells. Case 2: A 28-year-old otherwise healthy man was admitted due to intermittent diffuse abdominal pain that manifested suddenly during a military mission. There was no remarkable medical history. The abdominal contrast CT revealed a segmental sigmoid megacolon with a diameter of 10 cm without any other noteworthy pathology. All organic causes for megacolon were excluded. No conservative treatment was applied. The intraoperative finding was a dilated sigmoid measuring 15 cm in diameter. A sigmoid resection was performed, followed by T-T anastomosis between the descending colon and proximal rectum. During the postoperative course, there was significant anastomotic bleeding, which was managed successfully by blood transfusion and haemostatic clips. The patient was discharged on the 8th postoperative day. Eighteen months after the operation, he is symptom-free. The histopathological examination was performed using Formalin-Fixed Paraffin-Embedded (FFPE) tissue, cut at 3 µm. Immunohistochemistry was performed on an autostainer Leica Bond with ready-to-use reagents-CD117 clone EP10 and S100 clone EP32. The dilated part revealed a fibrotic submucosa with hyperplastic vessels and nonspecific inflammatory changes, hypertrophy of the muscle layers, and hyperplastic submucosal and myenteric ganglia and plexuses, but did not fulfil the criteria for IND. The same picture was observed in both the distal narrowed part and the resection lines. There was no obvious abnormality of the Cajal cells in both parts of the specimen. &lt;b&gt;Conclusions:&lt;/b&gt; We were unable to identify a specific cause of IM in the presented cases. The histopathological findings were not compatible with IND, Hirschsprung disease, or other neuromuscular pathology. The cri","PeriodicalId":74664,"journal":{"name":"Reports (MDPI)","volume":"9 4","pages":""},"PeriodicalIF":0.5,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13692320/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149278532","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":"Missed Perforated Appendicitis in a Nonverbal Patient with Autism and Duchenne Muscular Dystrophy: A Case Report.","authors":"Mona Makhlouf, Stanley Calderwood","doi":"10.3390/reports9040337","DOIUrl":"https://doi.org/10.3390/reports9040337","url":null,"abstract":"<p><p><b>Background and Clinical Significance:</b> A 4-year-old nonverbal boy with level 3 autism spectrum disorder and Duchenne muscular dystrophy (DMD) who was receiving chronic prednisone therapy presented to the emergency room with acute appendicitis. The diagnosis was significantly delayed due to atypical pain presentation, a potentially blunted inflammatory response from chronic steroid use, and an uncertain contribution from DMD-related muscle weakness. <b>Case Presentation:</b> The patient presented with five days of fever, poor oral intake, decreased stool output and behavioral changes. Initial physical examination and evaluation over two emergency department visits failed to establish the diagnosis. By the third visit, the patient exhibited abdominal distension, hypoactive bowel sounds, and bandemia. Computed tomography demonstrated perforated appendicitis with a walled-off abscess. Nonoperative management was unsuccessful, resulting in the development of multiple intra-abdominal abscesses that required percutaneous drainage. Following a 10-day hospitalization, the patient improved and was discharged. He subsequently underwent a scheduled laparoscopic appendectomy two months later, with pathology demonstrating persistent inflammation. <b>Conclusions:</b> This case raises awareness of the atypical presentation of pain in children with autism and the potential for DMD and chronic steroid therapy to complicate clinical assessment. These factors should prompt clinicians to maintain a low threshold for advanced imaging when clinical concern is present. It also illustrates the importance of close monitoring during nonoperative management of perforated appendicitis in medically complex or immunosuppressed children.</p>","PeriodicalId":74664,"journal":{"name":"Reports (MDPI)","volume":"9 4","pages":""},"PeriodicalIF":0.5,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13692520/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149278427","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":"Refractory Multivessel Coronary Artery Spasm Unresponsive to Renal Sympathetic Denervation, with Recurrent Transient ST-Segment Elevation and an Episode of Accelerated Idioventricular Rhythm: A Case Report.","authors":"Al-Naser Al Bahlani, Hiba Saadeddin, Ayman Al Husini, Mubarak Al Dosari, Hussein Hado","doi":"10.3390/reports9040338","DOIUrl":"https://doi.org/10.3390/reports9040338","url":null,"abstract":"<p><p><b>Background and Clinical Significance:</b> Multivessel coronary artery spasm (CAS) is an uncommon, high-risk form of vasospastic angina that can produce transient ST-segment elevation mimicking acute myocardial infarction. Evidence to guide management when calcium channel blockers and nitrates fail is scarce, and renal sympathetic denervation (RSD) has been reported in very few patients; <b>Case Presentation:</b> A 53-year-old man with hypertension, type 2 diabetes, and dyslipidemia presented with nocturnal chest pain and inferior ST-segment elevation. Coronary angiography showed severe spontaneous spasm of the right coronary and left anterior descending arteries that resolved completely with intracoronary nitrate; the coronary arteries were otherwise angiographically normal. High-sensitivity cardiac troponin I remained below 10 ng/L (reference 0-34 ng/L), and echocardiography was normal, fulfilling the criteria for definite vasospastic angina without myocardial infarction. The same two-vessel spasm was documented at a second angiogram three months later. Despite maximally tolerated dual calcium channel blockade, nitrates, and statin therapy, he required more than ten further admissions. A self-terminating accelerated idioventricular rhythm lasting about two minutes was recorded. No syncope or malignant arrhythmia occurred, and an electrophysiology review found no current indication for an implantable cardioverter-defibrillator. Radiofrequency RSD was performed off-label for refractory symptoms without complications, but at six months, his symptoms and admissions were unchanged; <b>Conclusions:</b> Our case highlights the diagnostic and therapeutic difficulties in refractory CAS. Accelerated idioventricular rhythm after relief of spasm is a reperfusion rhythm and does not by itself indicate device therapy. In this patient, RSD did not control refractory multivessel CAS, a negative observation that adds to the very limited evidence on autonomic modulation in this setting.</p>","PeriodicalId":74664,"journal":{"name":"Reports (MDPI)","volume":"9 4","pages":""},"PeriodicalIF":0.5,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13692388/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149278500","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":"Multiple Myeloma in a 45-Year-Old Woman with Screening-Detected Anemia and Unintentional Weight Loss: A Case Report.","authors":"Kosuke Mori, Hidehiro Someko, Miyuki Ando","doi":"10.3390/reports9040336","DOIUrl":"https://doi.org/10.3390/reports9040336","url":null,"abstract":"<p><p><b>Background and Clinical Significance</b>: Anemia is commonly detected during health screening and may initially appear to be an isolated hematologic abnormality. Careful history-taking is important because associated symptoms may provide clues to serious underlying disease. We report a case of multiple myeloma in which unintentional weight loss was the key clinical clue during evaluation of screening-detected anemia. <b>Case Presentation</b>: A 45-year-old woman was referred for evaluation of anemia detected during routine health screening. Initial laboratory testing showed normocytic anemia without evidence of iron deficiency, vitamin B12 deficiency, or folate deficiency. Routine history-taking for anemia revealed unintentional weight loss of 3.5 kg (4.6% of her body weight) over three months, prompting evaluation for malignancy. Non-contrast computed tomography demonstrated an osteolytic lesion in the manubrium. Serum protein electrophoresis showed an M-peak, and immunofixation detected an IgA-kappa monoclonal protein and urinary kappa-type Bence Jones protein. Serum free light-chain testing revealed a markedly elevated kappa/lambda ratio. At the referral hematology department, bone marrow aspiration showed 77.8% plasma cells, and biopsy and clot sections showed extensive infiltration by CD138-positive plasma cells, consistent with plasma cell myeloma. She subsequently received chemotherapy at the referral hospital, achieved remission, and has returned to work. <b>Conclusions</b>: Unintentional weight loss can serve as an important red flag when evaluating non-iron-deficiency anemia detected through health screening. Actively eliciting weight change may facilitate prompt diagnosis of an otherwise unsuspected hematologic malignancy.</p>","PeriodicalId":74664,"journal":{"name":"Reports (MDPI)","volume":"9 4","pages":""},"PeriodicalIF":0.5,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13692521/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149278354","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}