Annals of Medicine and Surgery最新文献

{"title":"Severe hemophagocytic lymphohistiocytosis secondary to disseminated histoplasmosis in a patient with HIV/AIDS: a case report.","authors":"Dipesh Kumar Rohita, Karun Bhattarai, Jigyanshu Adhikari, Ali Usama, Anees Cheema, Anubhav Poudel, Prakash Poudel, Zin Hinn Phyu, Abeera W Rabbani, Zeyar Thet","doi":"10.1097/MS9.0000000000003350","DOIUrl":"10.1097/MS9.0000000000003350","url":null,"abstract":"<p><strong>Introduction and importance: </strong>Hemophagocytic lymphohistiocytosis (HLH) is a life-threatening disorder marked by immune system dysregulation, leading to a severe inflammatory response that can affect multiple organs. It can be triggered by infections, and HLH secondary to disseminated histoplasmosis remains poorly understood, with uncertain guidelines on immunosuppressive therapy. Early diagnosis and prompt treatment are critical in preventing fatal outcomes, but challenges in diagnosis complicate this process, particularly in immunocompromised patients.</p><p><strong>Case presentation: </strong>A 51-year-old immunocompromised woman with asthma, gastritis, and anemia presented with fever, malaise, weight loss, and respiratory symptoms. Initial workup revealed pancytopenia, elevated ferritin levels, and an HIV diagnosis with a low CD4 count. Suspecting HLH, she was treated with antiretrovirals, antifungals, and steroids. Her condition worsened, and she developed MRSA sepsis, metabolic acidosis, and multiorgan failure. Histoplasmosis was confirmed, and treatment with liposomal amphotericin B was initiated. Unfortunately, she suffered a cardiac arrest and died on day 11. Postmortem findings confirmed disseminated histoplasmosis-induced HLH.</p><p><strong>Clinical discussion: </strong>HLH is a rare but severe immune activation disorder causing systemic inflammation, multi-organ failure, and high mortality. It can be primary (genetic) or secondary. Diagnosis follows HLH-2004 criteria, and treatment includes immunosuppressive therapy and hematopoietic cell transplantation.</p><p><strong>Conclusion: </strong>This case illustrates the complexities of diagnosing HLH in immunocompromised patients. Delays in obtaining critical lab results and initiating treatment contributed to the patient's rapid deterioration. Early intervention and careful monitoring are crucial in managing such complex cases, where timely diagnosis can significantly impact patient outcomes.</p>","PeriodicalId":8025,"journal":{"name":"Annals of Medicine and Surgery","volume":"87 6","pages":"3988-3993"},"PeriodicalIF":1.7,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12140668/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144246061","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 legal and ethical considerations in cross-border telesurgical procedures.","authors":"Chukwuka Elendu, Dependable C Amaechi, Tochi C Elendu, Emmanuel C Amaechi, Ijeoma D Elendu, Olutomiwa A Omokore, Nwamaka C Onubogu, Janet C Omeludike, Eunice T Aregbesola, Oluwagbemiga O Fajimi, Omoyelemi F Idowu, Sopuruchukwu L Emechebe, Mbanefo C Uyanwune, Johnson Yonni","doi":"10.1097/MS9.0000000000003344","DOIUrl":"10.1097/MS9.0000000000003344","url":null,"abstract":"<p><p>Telesurgery, or remote surgery, represents a transformative fusion of medicine and technology, enabling surgeons to perform procedures on patients located miles away using robotic systems and advanced telecommunications. However, its widespread adoption remains limited, with fewer than 50 documented fully remote telesurgical procedures in the past two decades. While robotic-assisted surgery is increasingly common - accounting for over 1.2 million procedures in 2019 - true cross-border telesurgery is rare due to technological, legal, and ethical barriers. The lack of a unified regulatory framework presents jurisdiction, licensing, liability, and data security challenges, particularly when procedures span international borders. The absence of standardized legal mechanisms creates uncertainty, especially in surgical complications or malpractice claims. A global regulatory framework should address these challenges, incorporating mutual recognition of medical licenses, standardized liability agreements, and uniform data protection protocols aligned with General Data Protection Regulation and Health Insurance Portability and Accountability Act. Additionally, real-time 5G-enabled monitoring systems could mitigate latency issues, reducing the risk of surgical errors due to connectivity disruptions. Ethically, telesurgery raises concerns regarding informed consent, equitable access, and accountability. Language barriers, differing cultural attitudes toward robotic surgery, and disparities in healthcare infrastructure complicate ethical oversight. Establishing an international telesurgical ethics board could ensure adherence to standardized consent procedures and promote equitable access through global partnerships. Investment in telesurgical training programs and AI-driven risk mitigation strategies could enhance patient safety. While technological advancements will continue to drive telesurgery's growth, addressing these legal and ethical considerations through harmonized global regulations and strategic policy interventions is crucial for sustainable and equitable integration into modern healthcare.</p>","PeriodicalId":8025,"journal":{"name":"Annals of Medicine and Surgery","volume":"87 6","pages":"3660-3672"},"PeriodicalIF":1.7,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12140691/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144246064","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":"Anticoagulation strategies for stroke prevention in atrial fibrillation: a comprehensive review of current literature.","authors":"Zainab Aslam Castro-Vidal, Asad Gandapur, Rohit Prakash, Khaled Azab, Khushi Nayyar, Fnu Rinkoo, Sravani Kommuru, Youssef Elsoussi, Nagavenakta Lova Surya Vamsi Avinash Bojanki, Anil Kumar Yennam, Syeed Mahmud Nishat, Jatin Motwani","doi":"10.1097/MS9.0000000000003364","DOIUrl":"10.1097/MS9.0000000000003364","url":null,"abstract":"<p><p>Atrial fibrillation (AF) significantly increases stroke risk and hence requires anticoagulation for the prevention of stroke. This review discusses strategies of anticoagulation, including the paradigm shift from traditional vitamin K antagonists (VKAs), such as warfarin, to direct oral anticoagulants (DOACs): dabigatran, rivaroxaban, apixaban, and edoxaban. VKAs are effective but require regular monitoring of international normalized ratio and also pose challenges because of their drug and dietary interactions. In contrast, DOACs provide predictable pharmacokinetics, fewer interactions, and no requirement for routine monitoring, and their use is increasingly favored in clinical practice. The review puts an emphasis on the considerations that are patient-specific when choosing an anticoagulant agent, including age, renal function, and associated diseases; stroke risk or risk factors for bleeding; and it explains how tools such as the use of CHA2DS2-VASc and HAS-BLED scores can be relevant for assessing stroke and bleeding risk, respectively. Also, it is explored that the use of emerging therapies like factor XI inhibitors and combinations such as dual antiplatelet therapy with anticoagulants has the potential to provide maximum stroke prevention but fewer bleeding complications. This review evaluated the effect of reversal agents for anticoagulants that may act as a safety measure during instances of serious bleeding. In summary, AF anticoagulation has to be individually tailored based on patient characteristics and meticulous reading of clinical guidelines. As much as DOACs present a tremendous step forward in stroke prevention related to AF, future studies and emerging treatments show promise to further optimize therapeutic outcomes.</p>","PeriodicalId":8025,"journal":{"name":"Annals of Medicine and Surgery","volume":"87 6","pages":"3691-3699"},"PeriodicalIF":1.7,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12140764/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144245940","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Treatment of non-union scaphoid fractures by Kirschner wires and ipsilateral distal radius bone grafts: a case series.","authors":"Dinesh Kumar Bk, Pratik Lamichhane, Pukar Pandit, Kishor Thapa","doi":"10.1097/MS9.0000000000003342","DOIUrl":"10.1097/MS9.0000000000003342","url":null,"abstract":"<p><strong>Background: </strong>Non-union scaphoid fractures are a hazard to the wrist because of the increasing risk of avascular necrosis and degenerative changes. We managed non-union scaphoid fractures by open reduction, Kirschner (K)-wire fixation, and bone graft from distal radius.</p><p><strong>Methods: </strong>This retrospective case series included seven patients with missed, established cases of non-union scaphoid fractures diagnosed by imaging at a tertiary care center between 2015 and 2017 in Nepal. All patients were treated with open reduction, K-wire fixation, and ipsilateral distal radius bone grafting. The patients were followed up at one, two, three, six and eight month post-surgery with imaging and at six and eight months with the modified Mayo wrist score (MMWS).</p><p><strong>Results: </strong>The mean duration of treatment time after the primary injury was 7 months. All the cases were males and the mean age of patients at surgery was 27 (range = 17-46) years. The mean duration of radiological and clinical evidence of healing was 4.3 months. The radiological healing was confirmed in all treated patients. All of the patients had improved outcomes in wrist function as indicated by improvement in MMWS at six and eight months.</p><p><strong>Conclusion: </strong>Our case series showed that the standard method using open reduction, K-wire fixation, and ipsilateral distal radius bone grafting is a reliable and cost-effective procedure for most untreated and non-union scaphoid fractures.</p>","PeriodicalId":8025,"journal":{"name":"Annals of Medicine and Surgery","volume":"87 6","pages":"3076-3081"},"PeriodicalIF":1.7,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12140770/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144246070","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":"Pulmonary pleomorphic carcinoma with intrathecal metastasis: a case report.","authors":"Ying-Hsin Chang, Wei-Hao Lin","doi":"10.1097/MS9.0000000000003341","DOIUrl":"10.1097/MS9.0000000000003341","url":null,"abstract":"<p><strong>Introduction: </strong>Pulmonary pleomorphic carcinoma (PC) is a rare and aggressive subtype of lung cancer. To date, spinal cord metastasis from pulmonary PC has not been reported.</p><p><strong>Presentation of case: </strong>A 67-year-old woman was diagnosed with left upper lobe (LUL) lung tumor, and surgical pathology confirmed PC with spindle and giant cell components. Following surgery, she developed progressive paraparesis with ascending hypesthesia. Contrast-enhanced cervicothoracic spine MRI revealed direct invasion of the T1-T3 vertebrae and pedicles by the LUL tumor, resulting in spinal cord compression and paraspinal muscle involvement. Neurogenic shock subsequently developed, and the patient died 2 weeks later.</p><p><strong>Discussion: </strong>Pulmonary PC is associated with a poorer prognosis than other non-small cell lung carcinomas. While it commonly metastasizes to the brain, bones, and liver, spinal cord involvement is exceedingly rare. Such metastasis can result in acute paraplegia, incontinence, and neurogenic shock, which increase mortality and lead to severe complications.</p><p><strong>Conclusion: </strong>Although spinal cord metastasis is extremely rare in pulmonary PC, clinicians should maintain a high index of suspicion in patients presenting with new-onset neurological symptoms. Early MRI evaluation is crucial for prompt diagnosis and management, potentially improving outcomes and avoiding life-threatening complications.</p>","PeriodicalId":8025,"journal":{"name":"Annals of Medicine and Surgery","volume":"87 6","pages":"3984-3987"},"PeriodicalIF":1.7,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12140673/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144246037","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 chyluria warranting surgical managementa case report.","authors":"Uttam Chaulagain, Kapil Khanal, Kailash Mani Pokhrel, Nischal Shrestha, Urusha Naaz","doi":"10.1097/MS9.0000000000003323","DOIUrl":"10.1097/MS9.0000000000003323","url":null,"abstract":"<p><strong>Introduction: </strong>Chyluria is a rare condition characterized by milky urine usually occurring due to rupture of lymphatic channels into the urinary system. Common symptoms include milky urine, clot colic, urinary retention, weight loss, edema, etc. Diagnosis is based on clinical suspicion, laboratory tests and imaging techniques such as USG, CT, MRI, and lymphangioscintigraphy. Management is based on dietary modifications, pharmacological treatment, minimally invasive endoscopic sclerotherapy, and laparoscopic chylolymphatic disconnection. Other procedures such as lymphovenous anastomosis or simple nephrectomy can also be adapted.</p><p><strong>Case description: </strong>A 33-year-old female from a filariasis endemic region of Nepal presented with chief complaints of whitish urine for 15 months associated with weight loss. The patient was initially treated with diethylcarbamazine (DEC) for 21 days, a year ago with some dietary modifications. She also underwent two episodes of endoscopic sclerosant instillations. The immunochromatographic test for filariasis was positive. Milky efflux was seen from the left ureteric orifice. Retrograde pyelography showed lymphatic backflow. The patient was managed with laparoscopic left chylolymphatic disconnection (Hilar stripping and nephron lympholysis), and the symptoms resolved.</p><p><strong>Discussion: </strong>Refractory cases of chyluria require surgical intervention to prevent long-term morbidity. Traditional open surgical ligation and excision of renal pedicle lymphatics are replaced by the minimally invasive approach of retroperitoneoscopy. The laparoscopic method is a preferred treatment as it has minimal incision-related morbidity and is safe, effective, and efficient. Other surgical options include lymphovenous anastomosis or renal autotransplantation.</p><p><strong>Conclusion: </strong>This case highlights the success of surgical intervention in treating refractory chyluria. Chylolymphatic disconnection could be safely performed with a laparoscopic approach without significant complications and reoccurrence.</p>","PeriodicalId":8025,"journal":{"name":"Annals of Medicine and Surgery","volume":"87 6","pages":"3945-3948"},"PeriodicalIF":1.7,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12140728/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144246040","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":"Investigating the relationship between the intoxicated drug and clinical profile of children with drug poisoning: a cross-sectional study in a tertiary referral hospital.","authors":"Mohammad Rezazadeh, Forozan Fares, Farhad Rasulpour, Maryam Kachuei, Ahmadreza Kheradpishe, Mohammad Taghi Joghataei, Ramin Zareh, Youssef Fathaliyan","doi":"10.1097/MS9.0000000000003306","DOIUrl":"10.1097/MS9.0000000000003306","url":null,"abstract":"<p><strong>Background: </strong>Pediatric drug poisoning is a significant public health concern, with opioids being the most common agents in poisoning cases. Despite its importance, limited data are available on the relationship between clinical presentations, laboratory findings, and the age of affected children.</p><p><strong>Objectives: </strong>This study aimed to evaluate the clinical and laboratory profiles of pediatric drug poisoning cases and to assess age-related variations in symptoms and laboratory markers.</p><p><strong>Methods: </strong>A retrospective analytical cross-sectional study was conducted in the emergency department, from April to October 2023. The study included 82 children aged below 12 years with positive toxicology tests. Demographic data, clinical symptoms (lethargy, seizures, respiratory and gastrointestinal symptoms), and laboratory findings (pH, HCO₃, base excess [BE], PCO₂, and heart rate) were analyzed using SPSS version 27. Statistical significance was set at <i>P</i> < 0.05.</p><p><strong>Results: </strong>Methadone (48.8%) was the most common substance involved in poisoning, and lethargy (89.0%) was the most prevalent symptom. Respiratory symptoms were more common in younger children (<i>P</i> < 0.001), while lethargy was more frequent in older children (<i>P</i> = 0.032). Laboratory findings indicated metabolic acidosis with reduced pH (7.24 ± 0.15), BE (-8.13 ± 6.0), and HCO₃ (19.3 ± 4.5). Tachycardia was observed in most cases (116.6 ± 26.1 bpm).</p><p><strong>Conclusion: </strong>Pediatric drug poisoning, particularly methadone poisoning, poses significant risks, with lethargy and respiratory symptoms being prominent age-related presentations. Metabolic acidosis emerges as a key diagnostic marker. These findings underscore the importance of early recognition, targeted interventions, and prevention strategies, including safe medication storage and caregiver education.</p>","PeriodicalId":8025,"journal":{"name":"Annals of Medicine and Surgery","volume":"87 6","pages":"3171-3177"},"PeriodicalIF":1.7,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12140741/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144246033","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":"Duodenal ulcer perforation peritonitis as a cause of acute abdomen in pediatric population: a rare case report and review of literature.","authors":"K C Suraj, Tek Nath Yogi, Krish Rauniyar, Rajesh Prasad Sah, Amrit Bhusal, Rijan Kafle, Nakendra Malla, Manish Gahatraj","doi":"10.1097/MS9.0000000000003315","DOIUrl":"10.1097/MS9.0000000000003315","url":null,"abstract":"<p><strong>Introduction: </strong>Acute abdomen in pediatric patients presents diagnostic challenges due to the wide range of potential causes and overlapping clinical features. Duodenal ulcer perforation, though rare, can mimic more common conditions like appendicitis, complicating diagnosis and management. Perforated peptic ulcer disease (PUD) in children, especially without chronic nonsteroidal anti-inflammatory drug (NSAID) use or <i>Helicobacter pylori</i> infection, is uncommon but requires prompt recognition.</p><p><strong>Case presentation: </strong>A 9-year-old male presented with severe diffuse abdominal pain, fever, and a history of chills. Physical examination revealed tenderness, board-like rigidity, and sluggish bowel sounds. Laboratory tests showed leukocytosis, but radiological findings, including abdominal X-ray, were normal. Ultrasound indicated gaseous abdomen and fluid collection. An exploratory laparotomy revealed a perforation in the first part of the duodenum, which was repaired using a Graham omental patch. Postoperatively, the patient recovered well with intravenous antibiotics and was discharged on the sixth postoperative day.</p><p><strong>Clinical discussion: </strong>Duodenal ulcer perforation, though rare, should be considered in pediatric cases of acute abdomen. Common causes of PUD include <i>H. pylori</i> infection, NSAIDs, and stress-related ulcers. Diagnosis is often delayed, particularly when typical radiological signs like pneumoperitoneum are absent, as in this case. Timely surgical intervention is critical to prevent morbidity and mortality.</p><p><strong>Conclusion: </strong>Duodenal ulcer perforation should be considered as a potential cause of peritonitis in children with acute abdomen, even in the absence of typical radiographic signs. Early recognition and surgical intervention are essential for favorable outcomes.</p>","PeriodicalId":8025,"journal":{"name":"Annals of Medicine and Surgery","volume":"87 6","pages":"3915-3919"},"PeriodicalIF":1.7,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12140785/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144246017","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":"Cardiac myosin inhibitors for hypertrophic cardiomyopathy: a systematic review and meta-analysis of randomized controlled trials.","authors":"Uswa Hasana, Mayank Korpal, Faseeh Haider, Mohammad Umer, Nang Phyu Thant Lwin, Sohaba Iqbal, Rajanikant Kumar, Maria Ahsan, Ebaad Hassan, Waheed Ullah, Saif Khalid, Akhil Gupta, Asma'a Munasar Ali Alsubari, Muhammad Ehsan, Adeel Ahmad","doi":"10.1097/MS9.0000000000003326","DOIUrl":"10.1097/MS9.0000000000003326","url":null,"abstract":"<p><strong>Background/objective: </strong>HCM is a structural disorder of the myocardium that leads to sudden cardiac death in young adults. We synthesized an updated understanding of the role of Cardiac Myosin Inhibitors (CMIs) in HCM by pooling data from RCTs.</p><p><strong>Methods: </strong>We identified six published RCTs, involving 826 participants. Data were extracted pertaining to study characteristics; primary outcomes of interest-(1) change from baseline in resting left ventricular outflow tract (LVOT) peak gradient, (2) change from baseline in Valsalva LVOT peak gradient, and (3) improvement of ≥1 NYHA class-and secondary outcomes. These were pooled using Review Manager 5.4, employing a random-effects model, and reported as odds ratios (ORs) or mean differences (MDs).</p><p><strong>Results: </strong>We found statistically significant between-group difference favoring CMIs in change from baseline in LVOT peak gradient: at rest (MD -39.33; -53.01 to -25.64), post-Valsalva (MD -48.99; -53.96 to -44.03), and post-exercise (MD -37.11; -44.34 to -29.87); ≥1 NYHA class improvement (OR 4.10; 2.79-6.02), change from baseline in peak oxygen uptake (MD -37.11; -44.34 to -29.87), LVOT gradient ≤30 mm hg (RR 14.89; 7.47-29.67), participants eligible for septal reduction therapy (RR 0.26; 0.18-0.36), and change from baseline in KCCQ-CSS score (MD 8.54; 5.36-11.71). Subgrouping by intervention type (mavacamten vs. aficamten) revealed non-significant results for all primary outcomes.</p><p><strong>Conclusions: </strong>CMIs can contribute to improving key efficacy outcomes for patients with HCM while reducing incidence of SRT.</p>","PeriodicalId":8025,"journal":{"name":"Annals of Medicine and Surgery","volume":"87 6","pages":"3810-3818"},"PeriodicalIF":1.7,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12140712/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144246000","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":"Cervical esophageal stenosis: an uncommon complication of thyroidectomy.","authors":"Linda Angela Mbah, Sara Tabassum, Tabish Mahmood Khan, Saima Batool, Oluwasayo J Owolabi, Pugazhendi Inban, Carlo Kristian C Carredo, Faiza Arslan, Isioma Isioma Okobia, Mansi Singh","doi":"10.1097/MS9.0000000000003335","DOIUrl":"10.1097/MS9.0000000000003335","url":null,"abstract":"<p><strong>Introduction and importance: </strong>Cervical esophageal stenosis is a rare but serious complication following thyroidectomy. It presents with dysphagia and odynophagia, which can mimic common postoperative symptoms, leading to delayed diagnosis. Early recognition is crucial for timely intervention and improving patient outcomes.</p><p><strong>Case presentation: </strong>A 64-year-old female with papillary thyroid carcinoma (PTC) underwent total thyroidectomy. Intraoperatively, an iatrogenic esophageal injury was sutured. Postoperatively, she developed dysphagia, dyspnea, and neck swelling. Imaging revealed cervical esophageal stenosis, and despite initial management with a nasogastric tube and gastrostomy tube, her dysphagia persisted. A corrective partial cervical esophagectomy was performed, and the patient recovered uneventfully, resuming oral intake after 6 days.</p><p><strong>Clinical discussion: </strong>Cervical esophageal stenosis can result from surgical trauma or inflammation during thyroidectomy, particularly in patients with PTC. Early imaging and clinical assessment are key for diagnosis. Severe stenosis may require surgical correction, such as esophagectomy, when endoscopic dilation is not sufficient.</p><p><strong>Conclusion: </strong>Cervical esophageal stenosis should be considered in patients with post-thyroidectomy dysphagia. Prompt diagnosis and intervention, including surgery when necessary, can prevent long-term complications and improve quality of life.</p>","PeriodicalId":8025,"journal":{"name":"Annals of Medicine and Surgery","volume":"87 6","pages":"3973-3979"},"PeriodicalIF":1.7,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12140769/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144246002","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}