Cureus最新文献

{"title":"Incidence, Risk Factors, and Outcomes of Recurrent Laryngeal Nerve Injury and Dysphonia Following Anterior Cervical Spine Surgery: A Systematic Review and Meta-Analysis.","authors":"Adam A Abu-Gameh, Jonathan E J Koch, David Schleifer, Yuval Baruch, Itzhak Engel, Eyal Yaacobi, Nissim Ohana","doi":"10.7759/cureus.78763","DOIUrl":"10.7759/cureus.78763","url":null,"abstract":"<p><p>Anterior cervical spine surgery (ACSS) is an effective treatment for various cervical spine conditions but carries a risk of recurrent laryngeal nerve (RLN) injury and dysphonia. This systematic review and meta-analysis aimed to evaluate the incidence of these complications and their associated risk factors. An analysis of 17 studies involving 5,706 patients revealed a pooled RLN injury incidence of 3.41% and a dysphonia incidence of 2.5%. Prolonged surgeries exceeding two hours and multilevel procedures were associated with higher risks, while implant material demonstrated minimal impact. These findings highlight the importance of surgical planning to mitigate RLN injury risk and improve patient outcomes in ACSS.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"17 2","pages":"e78763"},"PeriodicalIF":1.0,"publicationDate":"2025-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11807342/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143384442","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":"Persistent Vegetative State Following a Cardiac Arrest in a Patient With Preeclampsia and Posterior Reversible Encephalopathy Syndrome: A Case Report.","authors":"Nebojsa Brezic, Aleksandar Sic, Strahinja Gligorevic","doi":"10.7759/cureus.78757","DOIUrl":"10.7759/cureus.78757","url":null,"abstract":"<p><p>We report the case of a 35-year-old female patient who presented to a tertiary referral hospital in a persistent vegetative state (PVS) following a cardiac arrest that occurred approximately one hour after an elective cesarean delivery for a postterm pregnancy complicated by preeclampsia. Magnetic resonance imaging (MRI) of the brain performed seven days after the cardiac arrest showed findings consistent with posterior reversible encephalopathy syndrome (PRES). Following transfer to our hospital, the patient was carefully evaluated, stabilized, and successfully weaned off mechanical ventilation. However, due to the lack of neurological recovery, the decision was made to transfer her to a neurorehabilitation center for further management. This case report explores the potential link between PRES and PVS.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"17 2","pages":"e78757"},"PeriodicalIF":1.0,"publicationDate":"2025-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11809669/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143392078","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":"Uterine Arteriovenous Malformation: A Rare Cause of Postpartum Hemorrhage.","authors":"Lina Ahmad Omar Alhaj, Shadan Ahmed Falih Al-Tameemi, Tania El Hamarneh","doi":"10.7759/cureus.78730","DOIUrl":"10.7759/cureus.78730","url":null,"abstract":"<p><p>Uterine arteriovenous malformation (AVM) is a rare but serious cause of secondary postpartum hemorrhage (PPH). Although its overall prevalence in the general population remains uncertain, uterine AVM is recognized as an underdiagnosed condition due to its nonspecific symptoms and variable presentation. It poses significant diagnostic and therapeutic challenges, especially when presenting in the delayed postpartum period. Uterine AVM can be acquired following uterine instrumentation or trauma, leading to abnormal vascular connections within the uterine wall. This study describes a unique instance of uterine AVM identified after a cesarean section in a patient with an in vitro fertilization (IVF)-conceived pregnancy, highlighting the potential implications of assisted reproductive techniques on uterine vascular remodeling. Early recognition and multidisciplinary management ensured successful treatment, preserving the patient's fertility and preventing severe complications.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"17 2","pages":"e78730"},"PeriodicalIF":1.0,"publicationDate":"2025-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11809465/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143392460","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 Relationship Between Neutrophil/Lymphocyte Ratio Before Coronary Angiography and Coronary Collateral Development.","authors":"Sefa Sural, Tarkan Tekten, Hasan Gungor","doi":"10.7759/cureus.78739","DOIUrl":"10.7759/cureus.78739","url":null,"abstract":"<p><strong>Objective: </strong>The aim of this study was to determine the relationship between the neutrophil/lymphocyte ratio (NLR) measured before coronary angiography and coronary collateral (CC) development.</p><p><strong>Method: </strong>This retrospective descriptive study was carried out between January 2012 and June 2013 in the cardiology outpatient clinic of a university hospital in Aydın, with 165 patients who were diagnosed with acute coronary syndrome or stable angina pectoris and who had 95% or more stenosis in at least one coronary artery according to angiography. Coronary artery stenosis was determined by Gensini scoring. The classification of CC was performed by the Rentrop method, and patients were divided into two groups: Rentrop stages 0 and 1 (poor CC filling (group 1)) and Rentrop stages 2 and 3 (good CC filling (group 2)). The data were analyzed using appropriate statistical analyses. Multivariate logistic regression was used to determine the predictors of CC level, and receiver operating characteristic (ROC) curve analysis was performed to calculate the predictive value of predictors.</p><p><strong>Results: </strong>When the groups were compared, the mean age (p=0.023), Gensini score (p<0.001), smoking status (p=0.012), creatinine level (p=0.032), and aspartate aminotransferase level (p=0.032) of the patients in group 1 were significantly lower than those in group 2, while their total cholesterol (p=0.006) and low-density lipoprotein (LDL) levels (p=0.020) were higher. Neutrophils (p=0.016) and NLR (p<0.001) were significantly higher in group 2 patients. A significant positive correlation was found between CC level and neutrophils (p=0.035) and NLR (p=0.011). In regression analysis, high NLR, high Gensini score, and smoking were predictors of good CC filling. According to ROC curve analysis, the sensitivity and specificity of NLR ≥3.53 at the time of presentation to the clinic for predicting good CC filling were 37.6% and 85%, respectively.</p><p><strong>Conclusion: </strong>This study showed that NLR was significantly associated with the development of good CC filling; as NLR increased, the development of good CC filling increased in patients.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"17 2","pages":"e78739"},"PeriodicalIF":1.0,"publicationDate":"2025-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11807405/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143384455","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":"A Screening Tool to Predict Sepsis in Patients With Suspected Infection in the Emergency Department.","authors":"Yasufumi Oi, Fumihiro Ogawa, Hiroshi Honzawa, Takeru Abe, Shouhei Imaki, Ichiro Takeuchi","doi":"10.7759/cureus.78728","DOIUrl":"10.7759/cureus.78728","url":null,"abstract":"&lt;p&gt;&lt;p&gt;Background and objective Sepsis is a life-threatening condition associated with high morbidity and mortality, and hence early recognition and treatment are crucial. The 2016 Sepsis-3 guidelines introduced the quick Sequential Organ Failure Assessment (qSOFA), but its low sensitivity limits early detection. The 2021 Surviving Sepsis Campaign Guidelines (SSCG) discourage relying solely on qSOFA and recommend additional tools such as the systemic inflammatory response syndrome (SIRS) score, the National Early Warning Score (NEWS), and the Modified Early Warning Score (MEWS) along with lactate measurement. This study assessed whether combining qSOFA with quantitative capillary refill time (Q-CRT) or lactate levels enhances early sepsis diagnosis in emergency departments. Methods This retrospective, multi-facility observational study was conducted at two hospitals in Yokohama, Japan. Patients with suspected infections who underwent Q-CRT measurement were included. Q-CRT was measured using a pulse oximeter-based device that records the time taken for blood flow to return to 90% after compression. Receiver operating characteristic (ROC) curves determined the area under the curve (AUC), sensitivity, and specificity. Statistical significance was set at p&lt;0.05. Results Of the 357 patients who underwent Q-CRT measurement, 75 (21%) were suspected of having an infection, with 48 (64%) classified as having sepsis with organ dysfunction. Patients in the sepsis group had higher age, heart rate, lactate level, creatinine level, NEWS, MEWS, and Sequential Organ Failure Assessment (SOFA) scores compared to those without organ dysfunction. Among individual tools, the qSOFA, NEWS, and MEWS scores showed high AUCs (&gt;0.8), while Q-CRT and lactate levels demonstrated moderate predictive accuracy with AUCs exceeding 0.7. The SIRS score had the lowest predictive ability, with an AUC of approximately 0.6. Combining qSOFA with Q-CRT or lactate levels significantly improved sensitivity and specificity. The qSOFA+Q-CRT combination resulted in an AUC of 0.821, sensitivity of 83.3%, and specificity of 81.4%, while the qSOFA+lactate combination yielded an AUC of 0.844, sensitivity of 87.5%, and specificity of 81.4%. These combinations exceeded 80% in both sensitivity and specificity, unlike the SIRS-based combinations, which showed limited improvement and specificity below 40%. While the qSOFA score alone demonstrated limited sensitivity, combining it with Q-CRT or lactate levels enhanced its predictive performance for early sepsis detection. This approach improved sensitivity without compromising specificity. The increase in sensitivity and specificity is likely due to Q-CRT and lactate identifying sepsis cases not detected by qSOFA, thereby making the combined approach more reliable for clinical use. Lactate levels are well-established markers associated with sepsis severity, and Q-CRT offers a non-invasive means of assessing peripheral perfusion. Conclusions Combining q","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"17 2","pages":"e78728"},"PeriodicalIF":1.0,"publicationDate":"2025-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11806647/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143384430","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":"Delayed Splenic Rupture Secondary to Chronic Staple Line Leak Following Laparoscopic Sleeve Gastrectomy: A Case Report.","authors":"Justin M Hsieh, Gabriel Land, Nariyoshi Miyata, Tasmea Sefa, Francis Asomah","doi":"10.7759/cureus.78697","DOIUrl":"10.7759/cureus.78697","url":null,"abstract":"<p><p>Laparoscopic sleeve gastrectomy (LSG) is one of the most frequently performed bariatric procedures worldwide due to its efficacy in achieving significant and sustained weight loss. While generally safe, rare but life-threatening complications can occur. This case report describes a 54-year-old female who presented with acute left-sided abdominal pain and hemodynamic instability six months after an otherwise uneventful LSG. She was found to have a delayed spontaneous splenic rupture secondary to a chronic gastric staple line leak. Following urgent surgical intervention with splenectomy, the patient's condition initially improved but persistent abdominal collections and ongoing pain prompted further investigation, ultimately revealing a small staple line defect. Endoluminal vacuum therapy (EVT) and prolonged intravenous antibiotics were required. This case emphasizes the importance of maintaining a high index of suspicion for delayed postoperative complications such as chronic staple line leaks and their potential to precipitate rare events like spontaneous splenic rupture. Early recognition, prompt surgical intervention, and appropriate multidisciplinary management are critical in preventing catastrophic outcomes.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"17 2","pages":"e78697"},"PeriodicalIF":1.0,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11805583/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143384422","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":"Creating Alternative Afferent Input to Facilitate the Regeneration of Injured Primary Afferent Neurons.","authors":"Emi Sawada, Toru Yamamoto, Naotaka Kishimoto, Dai Ooishi, Hiroyuki Sasakura, Kosei Takeuchi, Kenji Seo","doi":"10.7759/cureus.78708","DOIUrl":"10.7759/cureus.78708","url":null,"abstract":"<p><p>The trigeminal spinal tract nucleus receives primary afferent input from the orofacial region, serving as a relay between peripheral terminals and secondary neurons. The trigeminal nerve is divided into ophthalmic, maxillary, and mandibular. While it is known that primary afferent terminals synapse with secondary neurons, the interaction between different primary terminals remains unclear. Recent studies have shown that trigeminal neurons with lost input can be activated through electrical stimulation of other afferent terminals. Therefore, we examined the possibility of inducing neural activity using synaptic organizers to promote circuit reorganization. To assess the regeneration of the injured inferior alveolar nerve (third division of the trigeminal nerve), the potential involvement of input from the infraorbital nerve (second division of the trigeminal nerve) in the regeneration of the injured inferior alveolar nerve (third division of the trigeminal nerve) was investigated. Intact and injured groups were created for the second and third divisions to facilitate comparative analysis. A synapse organizer was applied to establish input between the primary afferent terminals of these divisions. This study aimed to determine if central connections between different terminals can activate trigeminal neurons with lost input, ultimately promoting peripheral nerve regeneration. In this research, male C57BL/6J mice (seven to nine weeks old) (total n=40) underwent transection of the inferior alveolar nerve. They were divided into three groups: intact (n=10), injured (saline control) (n=10), and synapse organizer (n=10). In addition, the mice were divided into two groups: one group underwent inferior alveolar nerve transection only (II, intact; III, injured, n=5), and the other group underwent transection of both the infraorbital and inferior alveolar nerves (II, injured; III, injured, n=5), followed by local administration of a synapse organizer. Regeneration was assessed using immunostaining, sensory tests, and retrograde tracing. Regeneration was confirmed by retrograde tracing and functional recovery of sensory thresholds in the skin of the mental region. These findings align with previous observations that infraorbital nerve transection reduced regeneration activity, suggesting that infraorbital input triggered regeneration in the mandibular nerve. Thus, the results propose a novel therapeutic approach where mandibular nerve injury can be treated by stimulating the infraorbital nerve immediately after injury, enhancing peripheral nerve regeneration.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"17 2","pages":"e78708"},"PeriodicalIF":1.0,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11805595/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143384419","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":"Testicular Rupture: Clinical, Sonographic, and Surgical Correlation in an Adolescent Patient.","authors":"Zafeiria G Papathanassiou, Konstantina Michalopoulou, Vasileios Alexopoulos, Antonios Panagidis","doi":"10.7759/cureus.78688","DOIUrl":"10.7759/cureus.78688","url":null,"abstract":"<p><p>Testicular tears, although uncommon, require early detection and control for symptom relief and, most importantly, organ salvage. Clinical examination of the scrotum cannot solely facilitate a valid diagnosis. Depending on the severity of the scrotal injury, treatment can be either conservative or surgical. Scrotal ultrasound is the preferred examination not only for the depiction and surveillance of testicular ruptures but also for guiding treatment planning. This case study describes the clinical assessment, imaging investigation, and management of an extensive testicular tear in a 14-year-old adolescent football athlete.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"17 2","pages":"e78688"},"PeriodicalIF":1.0,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11804949/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143384449","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 Appendiceal Neuroendocrine Tumor Post Appendectomy: Surgery Is Here to Stay.","authors":"Jerry Kourkoumelis, Haitham Siag, Malia Loustalot, Shani K Palmer","doi":"10.7759/cureus.78700","DOIUrl":"10.7759/cureus.78700","url":null,"abstract":"<p><p>Neuroendocrine tumors (NETs) arising from the appendix are rare neoplasms but carry significant consequences if missed. These malignancies are typically diagnosed after an appendectomy via histopathological evaluation of the appendix. This aspect further solidifies surgery's place in the treatment of appendicitis. A 25-year-old female patient presented to the emergency department with a three-day history of right-sided abdominal pain associated with nausea and two episodes of non-bilious vomiting. Physical examination was initially benign but later showed tenderness to the right of the umbilicus. A CT scan revealed an inflamed appendix. Based on clinical and radiological findings, the diagnosis of acute appendicitis was made. The patient underwent a laparoscopic appendectomy. Histopathological analysis of the appendix was performed, identifying an appendiceal neuroendocrine tumor (aNET). Following the initial diagnosis, an appropriate workup was conducted, which included a colonoscopy, computed tomography (CT) scan, and further biopsies. Histopathological analysis of the appendix revealed a well-differentiated grade 1 NET, measuring 3.5 cm, with invasion into peri-appendiceal tissues. Further evaluation through a repeat CT scan and colonoscopy revealed inflammation in the rectum, cecum, and right colon. Furthermore, a subsequent laparoscopic right hemicolectomy was performed. Pathology of the hemicolectomy specimen revealed no residual NET, though lymph node involvement was present, with three out of 18 nodes testing positive for lymphatic spread. This case report highlights the diagnostic and management challenges associated with aNETs, emphasizing the importance of surgical intervention in the context of acute appendicitis. The discovery of aNETs can significantly alter the clinical management course, as it did for this patient, who required further surgical intervention and ongoing surveillance. The timely identification and removal of the tumor likely improved the patient's prognosis.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"17 2","pages":"e78700"},"PeriodicalIF":1.0,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11805582/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143384444","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":"Folie à Deux in the Family Environment: A Case of Shared Delusion Between a Mother and Her Son.","authors":"Christian Galindo, Lesmer Galindo","doi":"10.7759/cureus.78703","DOIUrl":"10.7759/cureus.78703","url":null,"abstract":"<p><p>Shared psychotic disorder (SPD), also called folie à deux, is an uncommon clinical entity characterized by the transmission of delusions from one psychotic individual to another within the framework of a close relationship, typically isolated from the social environment. Although rare, this phenomenon poses a significant diagnostic and therapeutic challenge, particularly in family settings. This report presents a clinical case of folie à deux between a mother and her child, highlighting the complexities of therapeutic management and providing a succinct review of the literature to adequately frame the clinical approach. The report illustrates the need for a comprehensive therapeutic intervention involving both the management of the underlying psychotic disorder and the dissolution of pathological family dynamics that perpetuate shared delusions. Additionally, the importance of a multidisciplinary approach is emphasized, as shared delusions can involve multiple members of a nuclear family, increasing the risk of negative consequences at both individual and social levels.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"17 2","pages":"e78703"},"PeriodicalIF":1.0,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11806268/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143384425","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}