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Τρίτη 9 Φεβρουαρίου 2021

Treatment of cervical spine metastasis with minimally invasive cervical spondylectomy: A case report and literature review.

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Treatment of cervical spine metastasis with minimally invasive cervical spondylectomy: A case report and literature review.

World J Clin Cases. 2021 Jan 26;9(3):644-650

Authors: He LM, Ma X, Chen C, Zhang HY

Abstract
BACKGROUND: Cervical spondylectomy for the treatment of cervical tumors is traumatic, causes bleeding, and is risky. This study reports on the experience with minimally invasive cervical spondylectomy for a cervical metastasis and reviewed the literature on cervical spondylectomy. The purpose was to reduce the risk and trauma of spondylectomy.
CASE SUMMARY: A 60-year-old woman presented with cervical pain and radiating pain in the left upper limb for more than 2 mo. Preoperative diagnosis was C4 metastasis of thyroid cancer. Preoperative visual analogue scale score was 5. American Spinal Cord Injury Association (ASIA) grade was E. Tomita classification was 7. Weinstein-Boriani-Biagini (WBB) classification was A-D, 3-9. Tomita score was 5. Modified Tokuhashi score was 9. Spinal instability neoplastic score (SINS) was 13. The patient underwent minimally invasive cervical spondylectomy on September 28, 2017. The operative time was 200 min; the estimated blood loss was 1200 mL. The operation was successful, without complications. The postoperative visual analogue scale score was 0. The patient remained classified as ASIA grade E at the last follow-up. She accepted regular iodine-131 therapy postoperatively. The serum thyroglobulin (Tg) level of this patient was 299.02 ng/mL at 1 mo after the operation and was 13.57 ng/ mL at the last follow-up. There was no local recurrence at the 25-mo follow-up, according to images, single-photon emission computed tomography, and serum Tg levels. Obvious ossification and solid fusion of C3-C5 were found at the last follow-up.
CONCLUSION: Minimally invasive cervical spondylectomy with tubular retractor could minimize soft tissue trauma, intraoperative traction injury, and paraspinal muscle injury, accelerating postoperative recovery. This technique requires a rich experience in cervical spine surgery with tubular retractors, so that surgeons can visualize the anatomical structure in a small field.

PMID: 33553403 [PubMed]

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Radical resection of hepatic polycystic echinococcosis complicated with hepatocellular carcinoma: A case report.

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Radical resection of hepatic polycystic echinococcosis complicated with hepatocellular carcinoma: A case report.

World J Clin Cases. 2021 Jan 26;9(3):659-665

Authors: Kalifu B, Meng Y, Maimaitinijiati Y, Ma ZG, Tian GL, Wang JG, Chen X

Abstract
BACKGROUND: Hepatic cystic echinococcosis (CE) is an infectious zoonotic parasitic disease, and the insidious onset and slow progression of hepatic CE usually contributes to delayed diagnosis and treatment. Hepatocellular carcinoma (HCC) is the fourth most common malignant tumor. Co-existence of CE and HCC is fairly rare in clinical settings and the association between the two is still not well recognized. We report a case of hepatic CE complicated with HCC which are radically resected and raise some questions worth thinking about.
CASE SUMMARY: A 70-year-old man presented with upper abdominal pain. On admission, laboratory data showed that, except for hepatitis B surface antigen positivity, other indicators were normal, including alpha-fetoprotein. Computed tomography of the abdomen revealed a huge polycystic lesion in left liver lobe, without reinforcement after enhanced scanning and sized about 16.9 cm × 12.2 cm, which was considered a type II hydatid cyst. Multiple small solid lesions were also found adjacent to it, and thus it was highly suspected as a malignant tumor. After a multidisciplinary team discussion, the diagnosis of co-occurrence of hepatic CE and HCC was made. According to Romic classification, the case belongs to type IIb, and radical left hemi-hepatectomy was performed. Postoperative pathological examination revealed CE co-existence with well-differentiated HCC, consistent with the preoperative diagnosis.
CONCLUSION: With the combination of hepatitis B and obvious extrusion by large hydatid, the HCC risk of a patient might be higher.

PMID: 33553405 [PubMed]

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Pleural lump after paragonimiasis treated by thoracoscopy: A case report.

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Pleural lump after paragonimiasis treated by thoracoscopy: A case report.

World J Clin Cases. 2021 Jan 26;9(3):666-671

Authors: Xie Y, Luo YR, Chen M, Xie YM, Sun CY, Chen Q

Abstract
BACKGROUND: Paragonimiasis is a parasitic disease that has multiple symptoms, with pulmonary types being common. According to our clinical practices, the pleural effusion of our patients is full of fibrous contents. Drainage, praziquantel, and triclabendazole are recommended for the treatment, but when fibrous contents are contained in pleural effusion, surgical interventions are necessary. However, no related reports have been noted. Herein, we present a case of pulmonary paragonimiasis treated by thoracoscopy.
CASE SUMMARY: A 12-year-old girl presented to our outpatient clinic complaining of shortness of breath after exercise for several days. Enzyme-linked immunosorbent assay revealed positivity for antibodies against Paragonimus westermani, serological test showed eosinophilia, and moderate left pleural effusion and calcification were detected on computed tomography (CT). She was diagnosed with paragonimiasis, and praziquantel was prescribed. However, radiography showed an egg-sized nodule in the left pleural cavity during follow-up. She was then admitted to our hospital again. The serological results were normal except slight eosinophilia. CT scan displayed a cystic-like node in the lower left pleural cavity. The patient underwent a thoracoscopic mass resection. A mass with a size of 6 cm × 4 cm × 3 cm adhered to the pleura was resected. The pathological examination showed that the mass was composed of non-structured necrotic tissue, indicating a granuloma. The patient remaind ed asymptomatic and follow-up X-ray showed complete removal of the mass.
CONCLUSION: This case highlights that thoracoscopic intervention is necessary when fibrous contents are present on CT scan or chest roentgenogram to avoid later fibrous lump formation in patients with pulmonary paragonimiasis.

PMID: 33553406 [PubMed]

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Deep vein thrombosis in patient with left-sided inferior vena cava draining into the hemiazygos vein: A case report.

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Deep vein thrombosis in patient with left-sided inferior vena cava draining into the hemiazygos vein: A case report.

World J Clin Cases. 2021 Jan 26;9(3):672-676

Authors: Zhang L, Guan WK

Abstract
BACKGROUND: Abnormalities of the inferior vena cava (IVC) are uncommon, and in many cases they are asymptomatic. Even so, it is vital that clinicians be aware of such anomalies prior to surgery in affected individuals. In the present report, we describe a rare anatomical variation of the IVC.
CASE SUMMARY: A 66-year-old male was admitted to the hospital due to deep vein thrombosis of the right lower extremity. Upon contrast-enhanced computed tomography imaging, we found that this patient presented with a case of left-sided IVC draining into the hemiazygos vein, while his hepatic vein was directly draining into the atrium.
CONCLUSION: Cases of left-sided IVC can increase patient susceptibility to thromboembolism owing to the resultant changes in blood flow and/or associated vascular compression.

PMID: 33553407 [PubMed]

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Recurrent Takotsubo cardiomyopathy triggered by emotionally stressful events: A case report.

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Recurrent Takotsubo cardiomyopathy triggered by emotionally stressful events: A case report.

World J Clin Cases. 2021 Jan 26;9(3):677-684

Authors: Wu HY, Cheng G, Liang L, Cao YW

Abstract
BACKGROUND: Takotsubo cardiomyopathy (TCM) is characterized by reversible left ventricular dysfunction triggered by emotional or physical stress. Only 1%-2% of patients with acute coronary syndrome are diagnosed with TCM. Although obstructive coronary artery disease is frequently considered to be the cause of chest pain, TCM should be considered in some clinical settings. In this case, clinicians did not make a timely and accurate diagnosis for TCM due to a lack of knowledge until the third hospitalization with a left ventriculogram.
CASE SUMMARY: A 55-year-old postmenopausal woman had intermittent chest pain following emotionally stressful events three times in the past 3 years. Cardiac troponin levels increased after each instance of symptom onset. A transthoracic echocardiogram showed reversible left ventricular dysfunction. The patient underwent three coronary angiograms without evidence of coronary artery disease. A left ventriculogram was first performed at the third hospitalization and revealed apical akinesia with ballooning of the apical region and consistent hypercontractile basal segments. The diagnosis of TCM was confirmed. The patient was treated with an angiotensin-converting-enzyme inhibitor (perindopril) and a β-blocker (metoprolol). No complications occurred during the patient's hospitalization. The patient was told to avoid stressful events. During the 9-mo follow-up visit, the patient was asymptomatic with an ejection fraction of 55%.
CONCLUSION: Clinicians should be conscious of the possibility of TCM, especially in postmenopausal women presenting with clinical manifestations similar to acute coronary syndrome without coronary occlusion.

PMID: 33553408 [PubMed]

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Oral and perioral herpes simplex virus infection type I in a five-month-old infant: A case report.

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Oral and perioral herpes simplex virus infection type I in a five-month-old infant: A case report.

World J Clin Cases. 2021 Jan 26;9(3):685-689

Authors: Aloyouny AY, Albagieh HN, Al-Serwi RH

Abstract
BACKGROUND: Herpes simplex virus (HSV) is a highly infectious pathogen that is easily transmitted via the bodily fluids of an infected individual. This virus usually affects individuals older than six months of age, and rarely causes lesions or symptoms in younger patients.
CASE SUMMARY: We present the case of a five-month-old healthy girl who presented with painful herpetic gingivostomatitis and perioral vesicles. We discuss the pathophysiology of primary HSV infection and the effect of maternal antibodies on the infant's immune system. In addition, we explain the diagnosis, management, and prognosis of HSV infection in young infants.
CONCLUSION: This case highlights the importance of early diagnosis and management of HSV infections to decrease the risk of developing severe complications and death.

PMID: 33553409 [PubMed]

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Nasal septal foreign body as a complication of dental root canal therapy: A case report.

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Nasal septal foreign body as a complication of dental root canal therapy: A case report.

World J Clin Cases. 2021 Jan 26;9(3):690-696

Authors: Du XW, Zhang JB, Xiao SF

Abstract
BACKGROUND: Currently, there have been no reports on foreign bodies found in the nasal septum after dental root canal therapy. Herein, we present an unusual case of a foreign body found in the nasal septum, which occurred after dental root canal therapy and two unsuccessful surgeries.
CASE SUMMARY: A 55-year-old man was referred to our department due to slight nasal discomfort that persisted for about 1 wk. Before consulting our department, the patient visited three different hospitals/clinics and underwent two surgeries that were not successful in removing a foreign body completely. A computed tomography scan was performed to detect the shift of the foreign body from dental root to the nasal septum, which resulted in the healing of oral inflammation and nasal septum discomfort. An endoscopic foreign body extraction surgery (3rd removal surgery) was then successfully performed, using a needle as the reference. No nasal reconstruction was required after the operation. Postoperative healing was uneventful.
CONCLUSION: Medical healthcare professionals should consider past medical history when dealing with foreign body cases. During septal foreign body extraction surgery, a needle could be used as a helpful reference.

PMID: 33553410 [PubMed]

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Nasal septal foreign body as a complication of dental root canal therapy: A case report.

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Nasal septal foreign body as a complication of dental root canal therapy: A case report.

World J Clin Cases. 2021 Jan 26;9(3):690-696

Authors: Du XW, Zhang JB, Xiao SF

Abstract
BACKGROUND: Currently, there have been no reports on foreign bodies found in the nasal septum after dental root canal therapy. Herein, we present an unusual case of a foreign body found in the nasal septum, which occurred after dental root canal therapy and two unsuccessful surgeries.
CASE SUMMARY: A 55-year-old man was referred to our department due to slight nasal discomfort that persisted for about 1 wk. Before consulting our department, the patient visited three different hospitals/clinics and underwent two surgeries that were not successful in removing a foreign body completely. A computed tomography scan was performed to detect the shift of the foreign body from dental root to the nasal septum, which resulted in the healing of oral inflammation and nasal septum discomfort. An endoscopic foreign body extraction surgery (3rd removal surgery) was then successfully performed, using a needle as the reference. No nasal reconstruction was required after the operation. Postoperative healing was uneventful.
CONCLUSION: Medical healthcare professionals should consider past medical history when dealing with foreign body cases. During septal foreign body extraction surgery, a needle could be used as a helpful reference.

PMID: 33553410 [PubMed]

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Coinheritance of OLFM2 and SIX6 variants in a Chinese family with juvenile-onset primary open-angle glaucoma: A case report.

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Coinheritance of OLFM2 and SIX6 variants in a Chinese family with juvenile-onset primary open-angle glaucoma: A case report.

World J Clin Cases. 2021 Jan 26;9(3):697-706

Authors: Yang X, Sun NN, Zhao ZN, He SX, Zhang M, Zhang DD, Yu XW, Zhang JM, Fan ZG

Abstract
BACKGROUND: Juvenile-onset primary open-angle glaucoma (JOAG), characterized by severe elevation of intraocular pressure and optic neuropathy prior to the age of 40, is a rare subtype of primary open-angle glaucoma. Several genetic mutations have been associated with JOAG.
CASE SUMMARY: The proband patient was a young male, diagnosed with primary open-angle glaucoma at the age of 27. The patient and his unaffected parents who have been excluded from classic genetic mutations for primary open-angle glaucoma were included to explore for other possible genetic variants through whole genome sequencing and bioinformatics analysis. In this trio, we found two heterozygous variants inherited from the parents in the proband: c.281G>A, p.Arg94His in OLFM2 and c.177C>G, p.Ile59Met in SIX6. Both genetic mutations are predicted through bioinformatics analysis to replace evolutionary conserved amino acids, therefore rendering a pathogenic effect on proteins. In contrast, very low frequencies for these genetic mutations were recorded in most common control databases.
CONCLUSION: This is the first report on coinherited mutations of OLFM2 and SIX6 in a JOAG family, which shows the complexity of JOAG inheritance. Large-scale clinical screening and molecular functional investigations on these coinherited mutations are imperative to improve our understanding of the development of JOAG.

PMID: 33553411 [PubMed]

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Systemic lupus erythematosus and antineutrophil cytoplasmic antibody-associated vasculitis overlap syndrome in a 77-year-old man: A case report.

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Systemic lupus erythematosus and antineutrophil cytoplasmic antibody-associated vasculitis overlap syndrome in a 77-year-old man: A case report.

World J Clin Cases. 2021 Jan 26;9(3):707-713

Authors: Xu ZG, Li WL, Wang X, Zhang SY, Zhang YW, Wei X, Li CD, Zeng P, Luan SD

Abstract
BACKGROUND: Systemic lupus erythematosus (SLE) and antineutrophil cytoplasmic antibody-associated vasculitis (AAV) are classically thought to cause renal impairment and small vessel vasculitis with different pathophysiologies. Their overlap constitutes a rare rheumatologic disease. To date, only dozens of such cases with biopsy-proven glomerulonephritis have been reported worldwide typically in women of childbearing age. Here, we present a unique clinical case due to its rarity and individualized treatment of a Chinese man in his eighth decade of life.
CASE SUMMARY: A 77-year-old man was admitted to several hospitals for shortness of breath and received nonspecific treatments over the past 3 years. As his symptoms were not completely relieved, he visited our hospital for further treatment. Laboratory examinations revealed kidney dysfunction, severe anaemia, hypocom-plementemia, glomerular proteinuria, and microscopic haematuria. Antinuclear antibodies, as well as anti-dsDNA antibodies, were positive. Computed tomography of the chest showed right pleural effusion. Renal biopsy was performed, and histology suggested crescentic glomerulonephritis, pauci-immune type. After treatment with plasmapheresis, glucocorticoid, and cyclo-phosphamide, the disease was in remission, and the patient remained in a stable condition for over 3 years post-hospital discharge.
CONCLUSION: Due to its complexity and rarity, SLE and AAV overlap syndrome is easily misdiagnosed. An accurate diagnosis and treatment at the earliest stage may significantly improve the condition and reduce irreversible organ injury.

PMID: 33553412 [PubMed]

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Clinical cure and liver fibrosis reversal after postoperative antiviral combination therapy in hepatitis B-associated non-cirrhotic hepatocellular carcinoma: A case report.

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Clinical cure and liver fibrosis reversal after postoperative antiviral combination therapy in hepatitis B-associated non-cirrhotic hepatocellular carcinoma: A case report.

World J Clin Cases. 2021 Jan 26;9(3):714-721

Authors: Yu XP, Lin Q, Huang ZP, Chen WS, Zheng MH, Zheng YJ, Li JL, Su ZJ

Abstract
BACKGROUND: The incidence of hepatocellular carcinoma (HCC) is high in China, and approximately 15%-20% of HCC cases occur in the absence of cirrhosis. Compared with patients with cirrhotic HCC, those with non-cirrhotic HCC have longer postoperative tumor-free survival. However, the overall survival time is not significantly increased, and the risk of postoperative recurrence remains. Strategies to improve the postoperative survival rate in these patients are currently required.
CASE SUMMARY: A 47-year-old man with a family history of HCC was found to have hepatitis B virus (HBV) infection 25 years ago. In 2000, he was administered lamivudine for 2 years, and entecavir (ETV 0.5 mg) was administered in 2006. In October 2016, magnetic resonance imaging revealed a tumor in the liver (5.3 cm × 5 cm × 5 cm); no intraoperative hepatic and portal vein and bile duct tumor thrombi were found; and postoperative pathological examination confirmed a grade II HCC with no nodular cirrhosis (G1S3). ETV was continued, and no significant changes were observed on imaging. After receiving pegylated interferon alfa-2b (PEG IFNα-2b) (180 μg) + ETV in February 2019, the HBsAg titer decreased significantly within 12 wk. After receiving hepatitis B vaccine (60 μg) in 12 wk, HBsAg serological conversion was realized at 48 wk. During the treatment, no obvious adverse reactions were observed, except for early alanine aminotransferase flares. The reexamination results of l iver pathology were G2S1, and reversal of liver fibrosis was achieved.
CONCLUSION: The therapeutic regimen of ETV+ PEG IFNα-2b + hepatitis B vaccine for patients with HBV-associated non-cirrhotic HCC following hepatectomy can achieve an HBV clinical cure and prolong the recurrence-free survival.

PMID: 33553413 [PubMed]

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