Cureus最新文献

{"title":"Clinical Experience With an Aragonite-Based Scaffold Implant for Knee Cartilage Repair: A Multicenter Case Series.","authors":"Nirav H Amin, Scott C Faucett, Charles Qin, Chaitu S Malempati, Ronak M Patel, Christopher P Dougherty, Arnold Lim, Corey Kendall, R Kyle Martin, Cassandra A Lee","doi":"10.7759/cureus.86127","DOIUrl":"10.7759/cureus.86127","url":null,"abstract":"<p><p>Background There is a growing interest in the use of biomaterials to treat chondral and osteochondral knee lesions, given their ability to replicate the biological and functional properties needed for simultaneous cartilage and bone regeneration. A novel aragonite-based, cell-free biomimetic scaffold (CARTIHEAL AGILI-C^TM, Smith + Nephew, UK) was developed for treating chondral and osteochondral defects in traumatic and osteoarthritic joints. A short-term follow-up study was designed to assess the safety and feasibility of this scaffold.  Materials and methods This retrospective review included data from nine centers in the United States (US) between August 22, 2023 and December 30, 2024. Adult patients (≥18 years of age) who received the aragonite-based scaffold as standard of care for the treatment of knee chondral/osteochondral lesions in accordance with the manufacturer's instructions for use were eligible. There were no prespecified exclusion criteria. All patients underwent magnetic resonance imaging (MRI) for radiologic assessment of knee cartilage lesions, which informed the development of presurgical plans. A diagnostic arthroscopy was performed before arthrotomy to confirm the radiographic findings obtained for preoperative planning. The primary endpoint was the incidence of early clinical and radiographic complications occurring within at least 30 days after the operation. Secondary endpoints included an assessment of the accuracy of presurgical planning relative to intraoperative findings, proportion of implants determined to be improperly implanted based on the first postoperative X-rays, change in the numeric pain rating score from baseline, and the proportion of patients cleared for various postoperative activities. Results A total of 33 patients (34 knees; mean age, 47.2 years; 18 (52.9%) male) were included. After a mean postoperative follow-up of 45.7 days (standard deviation, 14.4), one patient (2.9%) experienced a postoperative complication (pain, with no associated infection). Success rate was 96.97% (95% CI, 84.24-99.92). In 27 (79.4%) cases, the presurgical plan based on MRI was modified following arthroscopic visualization of the knee joint surface. Postoperative radiography revealed no complications for the 28 patients with data. Mean postoperative numeric pain rating significantly improved from 6.6 at baseline to 3.9 at follow-up (p<0.05). The majority of patients (n=24; 70.6%) were cleared for partial or full weightbearing by the 30-day postoperative follow-up visit.  Conclusions This case series across multiple centers in the US demonstrates the clinical safety and feasibility of aragonite scaffold implantation. The flexibility of the scaffold in accommodating intraoperative findings and the low rate of early complications are encouraging.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"17 6","pages":"e86127"},"PeriodicalIF":1.0,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12174689/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144328184","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":"Human Chorionic Gonadotropin as a Marker of Parathyroid Carcinoma: Findings From a Scoping Review.","authors":"Maxim J Barnett, Sarah Eidbo, Carlo Casipit, Justin Lam, Catherine Anastasopoulou","doi":"10.7759/cureus.86141","DOIUrl":"10.7759/cureus.86141","url":null,"abstract":"<p><p>Parathyroid carcinoma is an extremely uncommon cause of primary hyperparathyroidism; however, it is associated with excess morbidity and mortality. With the similarity in presentation from benign etiologies (such as an adenoma or hyperplasia), there is often a delay in diagnosis and initiation of treatment. Currently, there are no approved biomarkers to assist in the diagnosis of carcinoma. Over the last century, limited studies have investigated the role of human chorionic gonadotropin (hCG), particularly in its ability to differentiate cancerous from benign parathyroid disease. We performed a scoping review to analyze the existing literature regarding hCG (serum, urine, and histochemical staining) and its role in identifying malignant parathyroid disease. Across three databases and an endocrine abstract repertoire, we identified seven relevant articles meeting the prespecified inclusion criteria. We highlighted the normal physiology of hCG, alongside the pathophysiological expression and the rationale for its use as a biomarker for parathyroid cancer. Each article was analyzed, with emphasis on the methodologies, outcomes, and limitations. Although promising, the role of hCG as a biomarker has not been established due to heterogeneous methodologies and limited studies, which prohibit a firm conclusion. Further research (including larger prospective studies) is required to validate the role of hCG as a biomarker for parathyroid carcinoma.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"17 6","pages":"e86141"},"PeriodicalIF":1.0,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12170258/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144319004","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":"Critical Illness-Associated Cerebral Microbleed in a Young Patient With Sickle Cell Disease.","authors":"Ruth Pius, Moustafa M Shaaban, Jose A Suarez","doi":"10.7759/cureus.86166","DOIUrl":"10.7759/cureus.86166","url":null,"abstract":"<p><p>Critical illness-associated cerebral microbleeds (CICMs) are a recent clinical entity described as occurring in critically ill and mechanically ventilated patients, especially those with a risk of cerebral hypoxia. CICMs have been associated with progressive cognitive decline, and the management is supportive. We report the case of a 29-year-old male patient with sickle cell disease admitted for vaso-occlusive crises, which was complicated by multifocal pneumonia, and acute chest syndrome requiring intensive care unit admission and mechanical ventilation. He was noted to have poor mental status off sedation, with a brain MRI showing innumerable microhemorrhages throughout the bilateral cerebral and cerebellar hemispheres, suggestive of CICM.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"17 6","pages":"e86166"},"PeriodicalIF":1.0,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12174821/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144328185","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":"Masson's Hemangioma of the Vastus Medialis: A Rare Case Involving the Musculoarticular Branch of the Descending Genicular Artery.","authors":"Christos Lyrtzis, Alexandra Arhonidu, Nikolaos Anastasopoulos, Anastasia Fotiadou, George Paraskevas","doi":"10.7759/cureus.86038","DOIUrl":"10.7759/cureus.86038","url":null,"abstract":"<p><p>Masson's hemangioma, or intravascular papillary endothelial hyperplasia (IPEH), is a rare, benign vascular lesion that can mimic malignancies such as angiosarcoma. Although commonly found in the head, neck, and extremities, intramuscular involvement near joints is unusual. This report presents a rare case of IPEH originating within the vastus medialis muscle and involving the musculoarticular branch of the descending genicular artery in an adolescent male. An 18-year-old male presented with right knee pain and a palpable mass without prior trauma or systemic disease. MRI revealed a vascular lesion within the vastus medialis in proximity to the knee joint. Surgical excision was performed, and histopathology confirmed the diagnosis of IPEH with no malignant features. Postoperatively, the patient regained full knee function without recurrence at 10-month follow-up. Recognition of IPEH in atypical intramuscular and periarticular locations is essential to avoid misdiagnosis and overtreatment. Histopathological examination remains the cornerstone for distinguishing this benign entity from aggressive vascular malignancies.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"17 6","pages":"e86038"},"PeriodicalIF":1.0,"publicationDate":"2025-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12168828/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144311073","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":"Silent Fungal Invasion: A Case of Aspergillus Brain Abscesses in an Immunocompetent Older Adult Patient.","authors":"Jamie Therese Abad, Amanda Darzi, Kashmira Wani, Jasmine Omar","doi":"10.7759/cureus.86084","DOIUrl":"10.7759/cureus.86084","url":null,"abstract":"<p><p>Brain abscesses caused by fungal pathogens are uncommon in immunocompetent individuals. An 84-year-old man presented with fever and headache. Brain imaging identified a nonspecific right frontal lesion. He returned with worsening symptoms and confusion after two weeks, with magnetic resonance imaging (MRI) revealing multiple abscesses with ring enhancement. Cultures from surgical resection and drainage samples grew <i>Aspergillus</i>. Despite antifungal therapy, his neurological condition declined. This case highlights the importance of considering fungal pathogens in older patients with nonspecific brain lesions, even without focal neurological symptoms or evidence of a primary infection.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"17 6","pages":"e86084"},"PeriodicalIF":1.0,"publicationDate":"2025-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12170245/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144319005","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":"Survival Impact of Neoadjuvant Chemotherapy With Bevacizumab Followed by Radical Hysterectomy for Locally Advanced Cervical Cancer With Lymph Node Metastasis: Insights From a Single-Institution Experience.","authors":"Takeshi Motohara, Akiho Nishimura, Munekage Yamaguchi, Hidetaka Katabuchi, Eiji Kondoh","doi":"10.7759/cureus.86032","DOIUrl":"10.7759/cureus.86032","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the therapeutic efficacy of neoadjuvant chemotherapy (NAC) with bevacizumab prior to radical hysterectomy in locally advanced cervical cancer with lymph node metastasis.</p><p><strong>Methods: </strong>This single-institution, retrospective study was conducted at Kumamoto University Hospital (Kumamoto, JPN). The medical records of six consecutive patients with stage IIIC cervical cancer who received NAC with bevacizumab followed by radical hysterectomy were reviewed. Patients were treated between January 2022 and January 2024, with follow-up continuing through April 2025. Treatment responses, survival outcomes, and perioperative outcomes, including surgical complications and adverse events, were analyzed.</p><p><strong>Results: </strong>All six patients had tumors ≥4 cm with parametrial invasion (T2b); two had stage IIIC1r and four had IIIC2r disease. All patients completed three to four cycles of platinum-based NAC with bevacizumab and subsequently underwent radical surgery. Substantial tumor regression after NAC was observed in all cases, and notably, pathological complete response was achieved in three patients (50.0%). At a median follow-up of 25.5 months, five patients (83.3%) remained recurrence-free, and no deaths had occurred. One patient with pelvic nodal recurrence underwent complete resection followed by concurrent chemoradiotherapy, achieving sustained disease-free status. All surgeries were completed without severe perioperative complications. No severe bevacizumab-related adverse events were observed.</p><p><strong>Conclusion: </strong>The NAC with bevacizumab followed by radical hysterectomy was feasible, well tolerated, and demonstrated promising efficacy in patients with locally advanced cervical cancer accompanied by lymph node metastasis. This strategy demonstrated remarkably high clinical response and survival outcomes, along with favorable perioperative safety, supporting its potential as a multimodal treatment option for selected high-risk patients.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"17 6","pages":"e86032"},"PeriodicalIF":1.0,"publicationDate":"2025-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12167431/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144304083","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 Case Report on Ventriculoperitoneal Shunt Insertion Using a Novel Modification: The Receded Shunt Technique.","authors":"Candice Marie Elizabeth D Tiongson, Joseph Erroll V Navarro, Oliver Ryan M Malilay","doi":"10.7759/cureus.86083","DOIUrl":"10.7759/cureus.86083","url":null,"abstract":"<p><p>A 36-year-old female with obstructive hydrocephalus secondary to adult-onset aqueductal stenosis and a right posterior parietal ventriculoperitoneal shunt presented with headaches and discomfort whenever the skin overlying her current valve was touched during hygiene and hair combing. She was diagnosed with a shunt malfunction and underwent removal of the previous shunt and insertion of a new shunt at the left frontal region using a novel method - the receded shunt technique. This involves creating a depression in the outer table where the shunt valve will be set to eliminate the apparent prominence of the valve. The advantages of this approach include better cosmesis, decreased skin tension, and increased patient comfort. Indeed, a simple modification such as this can provide a significant improvement to this age-old neurosurgical procedure.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"17 6","pages":"e86083"},"PeriodicalIF":1.0,"publicationDate":"2025-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12168781/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144311070","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":"Multimodal Pain Management in Knee Osteoarthritis: A Comparative Study of Pregabalin and Duloxetine as Adjuncts to Naproxen.","authors":"Muhammad Nauman Zafar, Syeda Fatima, Saima Ambreen, Muhammad Khurram, Tahir Iqbal, Muhammad Arif, Afzaal Aleem Khan","doi":"10.7759/cureus.86076","DOIUrl":"10.7759/cureus.86076","url":null,"abstract":"<p><strong>Objective: </strong>This single-blinded, randomised, prospective study was carried out to investigate the effectiveness of a combination drug regimen including pregabalin and duloxetine as adjuncts to naproxen in pain management of patients with knee osteoarthritis (OA).</p><p><strong>Methods: </strong>One hundred and five patients were inducted into the study following the inclusion and exclusion criteria. Using simple randomisation, patients were allocated into group A (naproxen only), group B (naproxen + duloxetine), and group C (naproxen + pregabalin). Visual analogue scale (VAS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores were used to measure pain severity, while secondary outcomes of sleep quality and depression were assessed by using the Pittsburgh Sleep Quality Index (PSQI) and Beck Depression Inventory (BDI) scale, respectively. Assessments were done at day 0, week 4, and week 12 in the study. Appropriate tests were utilised to analyse the data.</p><p><strong>Results: </strong>Mean pain scores at 12 weeks were significantly lower in group B (p=0.009 for VAS, p=0.002 for WOMAC) and group C (p=0.012 for VAS, p=0.005 for WOMAC), as compared to group A (naproxen only). Sleep quality (p=0.00) and depression scales (p=0.00) were also similarly improved in the combination drug regimen groups as compared to the naproxen-only group.</p><p><strong>Conclusion: </strong>Addition of either duloxetine or pregabalin to the naproxen drug regimen may result in better management and improved quality of life in patients suffering from knee OA.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"17 6","pages":"e86076"},"PeriodicalIF":1.0,"publicationDate":"2025-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12168876/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144311074","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":"Reversible Dementia With Hypereosinophilia: An Intricate Connection.","authors":"Ajay Emani, Ramakant Yadav, Roopesh Kirar, Midhun Mohan","doi":"10.7759/cureus.86009","DOIUrl":"10.7759/cureus.86009","url":null,"abstract":"<p><p>Hypereosinophilic syndrome (HES) is a rare group of disorders characterized by elevated eosinophil levels, leading to tissue infiltration and damage. Neurological complications are observed in over half of the patients. This case study discusses a 45-year-old male patient diagnosed with HES and rapidly progressive dementia. The patient presented with difficulties in routine tasks, attention deficits, memory loss, and frontal headaches lasting one year. His medical history included allergic rhinitis and eczematoid skin lesions. General and neurological examinations revealed deficits in higher mental functions without other abnormalities. Laboratory tests showed significant eosinophilia, and magnetic resonance imaging (MRI) of the brain indicated diffuse cortical atrophy and periventricular hyperintensities. The diagnosis of HES was supported by clinical and laboratory findings. The case highlights the importance of considering HES in patients with unexplained neurological symptoms and eosinophilia to prevent irreversible organ damage. Early recognition and appropriate management are crucial for improving patient outcomes. This study underscores the need for further research to understand HES's pathophysiology and develop targeted therapies.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"17 6","pages":"e86009"},"PeriodicalIF":1.0,"publicationDate":"2025-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12168827/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144311076","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":"Two Consecutive Days of Low-Dose Methotrexate Toxicity: A Diagnostic Challenge.","authors":"Hridya Harimohan, Quynh Huynh, Mia Yasonova, Leila Moosavi, Melanie Khamlong, Igor Garcia Pacheco","doi":"10.7759/cureus.86023","DOIUrl":"10.7759/cureus.86023","url":null,"abstract":"<p><p>Methotrexate is an immunosuppressive medication commonly used to treat rheumatological disorders, primarily by inhibiting the folic acid cycle, with dose-dependent toxicity affecting multiple organ systems. A 54-year-old woman with a history of rheumatoid arthritis (RA), previously treated with methotrexate but later switched to leflunomide, etanercept, and prednisone, presented to the emergency department due to abnormal lab results. After running out of leflunomide and experiencing increased joint pain, she resumed methotrexate for two consecutive days without folic acid supplementation. Three days later, she developed oral ulcers, blisters, decreased oral intake, and fatigue. Lab results revealed pancytopenia, with markedly low white blood cells, hemoglobin, platelets, and absolute neutrophil count. Initially, Stevens-Johnson Syndrome (SJS) was considered due to mucosal symptoms, but lack of rash made methotrexate toxicity more likely. Rheumatology and hematology consultations led to the discontinuation of methotrexate, administration of filgrastim and leucovorin, and subsequent clinical improvement. This case highlights the diagnostic challenge in differentiating methotrexate toxicity from SJS, as both can present with mucosal lesions, though pancytopenia pointed toward toxicity. Despite methotrexate's known dose-dependent toxicity, this patient's reaction at a low dose suggests a rare idiosyncratic response, underscoring the importance of vigilance even with standard dosing and the necessity of folic acid supplementation to reduce adverse effects.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"17 6","pages":"e86023"},"PeriodicalIF":1.0,"publicationDate":"2025-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12167167/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144304085","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}