Postoperative complications of concomitant fat embolism syndrome, pulmonary embolism and tympanic membrane perforation after tibiofibular fracture: A case report.

paythelady.612 shared this article with you from Inoreader Postoperative complications of concomitant fat embolism syndrome, pulmonary embolism and tympanic membrane perforation after tibiofibular fracture: A case report. Μέσω pubmed: "world j clin cases"... Related Articles Postoperative complications of concomitant fat embolism syndrome, pulmonary embolism and tympanic membrane perforation after tibiofibular fracture: A case report. World J Clin Cases. 2021 Jan 16;9(2):476-481 Authors: Shao J, Kong DC, Zheng XH, Chen TN, Yang TY Abstract BACKGROUND: Fat embolism syndrome (FES) is a rare disease characterized by pulmonary distress, neurologic symptoms, and petechial rash and seriously threatens human life and health. It is still neglected clinically because of the lack of verifiable diagnostic criteria and atypical clinical symptoms. No studies on FES with pulmonary embolism (PE) and tympanic membrane perforation have been reported to date. Here, we report a rare case of concomitant FES, PE and tympanic membrane perforation after surgery in a patient with a tibiofibular fracture. CASE SUMMARY: A 39-year-old man presented with right lower extremity pain due to a car accident while driving a motorbike on the road. X-ray and computed tomography scans revealed a fracture of the right mid-shaft tibia and proximal fibula categorized as a type A2 fracture according to the AO classification. A successful minimally invasive operation was performed 3 d after the injury. Postoperatively, the patient developed sudden symptoms of respiratory distress and hearing loss. Early diagnosis was made, and supportive treatments were used at the early stage of FES. Seven days after surgery, he presented a clear recovery from respiratory symptoms. The outcome of fracture healing was excellent, and his hearing of the left ear was mildly impaired at the last follow-up of 4 mo. CONCLUSION: Concomitant FES, PE and tympanic membrane perforation are very rare but represent potentially fatal complications of trauma or orthopedic surgery and present with predominantly pulmonary symptoms. Early diagnosis and treatment can reduce the mortality of FES, and prevention is better than a cure. PMID: 33521118 [PubMed] View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Double-hit lymphoma (rearrangements of MYC, BCL-2) during pregnancy: A case report.

paythelady.612 shared this article with you from Inoreader Double-hit lymphoma (rearrangements of MYC, BCL-2) during pregnancy: A case report. Μέσω pubmed: "world j clin cases"... Related Articles Double-hit lymphoma (rearrangements of MYC, BCL-2) during pregnancy: A case report. World J Clin Cases. 2021 Jan 16;9(2):482-488 Authors: Xie F, Zhang LH, Yue YQ, Gu LL, Wu F Abstract BACKGROUND: Double-hit lymphoma is a highly aggressive B-cell lymphoma that is genetically characterized by rearrangements of MYC and BCL2 and/or BCL6. Lymphoma is often accompanied by atypical systemic symptoms similar to physiological changes during pregnancy and is often ignored. Herein, we describe a gravid patient with high-grade B-cell lymphoma with a MYC and BCL-2 gene rearrangement involving multiple parts of the body. CASE SUMMARY: A 32-year-old female, gestational age 22+5 wk, complained of abdominal distension, chest tightness and limb weakness lasting approximately 4 wk, and ovarian tumors were found 14 d ago. Auxiliary examinations and a trimanual gynecologic examination suggested malignant ovarian tumor and frozen pelvis. Coupled with rapid progression, severe compression symptoms of hydrothorax, ascites and moderate anemia, labor was induced. Next, biopsy and imaging examinations showed high-grade B-cell lymphoma with a MYC and BCL-2 gene rearrangement involving multiple parts of the body. She was referred to the Department of Oncology and Hematology for chemotherapy. Because of multiple recurrences after complete remission, chemotherapy plans were continuously adjusted. At present, the patient remains in treatment and follow-up. CONCLUSION: The early detection and accurate diagnosis of lymphoma during pregnancy can help expedite proper multidisciplinary treatment to delay disease progression and decrease the mortality rate. PMID: 33521119 [PubMed] View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Is sinusoidal obstructive syndrome a recurrent disease after liver transplantation? A case report.

paythelady.612 shared this article with you from Inoreader Is sinusoidal obstructive syndrome a recurrent disease after liver transplantation? A case report. Μέσω pubmed: "world j clin cases"... Related Articles Is sinusoidal obstructive syndrome a recurrent disease after liver transplantation? A case report. World J Clin Cases. 2021 Jan 16;9(2):489-495 Authors: Liu Y, Sun LY, Zhu ZJ, Wei L, Qu W, Zeng ZG Abstract BACKGROUND: Sinusoidal obstructive syndrome (SOS) is a disease that damages hepatic sinusoidal endothelial cells, resulting in progressive occlusion and fibrosis of the lobular central vein and the occurrence of intrahepatic sinusoidal portal hypertension. However, SOS after liver transplantation (LT) is uncommon and potentially fatal. Here, we report a rare case of second-time recurrence of SOS after liver retransplantation (rLT). CASE SUMMARY: A 22-year-old woman received a living donor LT due to SOS. Four years later, she developed abdominal distention and ascites with no apparent cause. She was diagnosed with recurrence of SOS and underwent rLT. But 2 mo post rLT, the patient suffered from aggravated jaundice and ascites again. She was diagnosed with second-time recurrence of SOS post-rLT according to computed tomography and liver pathology. After treatment with warfarin anticoagulation and immunosuppressant conversion, she gradually recovered with improvement of liver function and liver pathology. During the 17-mo follow-up period, she was in good condition with normal liver function and no ascites. CONCLUSION: SOS can be a recurrent disease after LT, and autoimmune antibody and genetic sequencing should be screened before LT. For susceptible patients, anticoagulant drugs should be used for an extended period, and tacrolimus or other pathogenic agents should be avoided. Early diagnosis and treatment can improve the prognosis of patients and avoid graft failure or death. PMID: 33521120 [PubMed] View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Portal hypertension exacerbates intrahepatic portosystemic venous shunt and further induces refractory hepatic encephalopathy: A case report.

paythelady.612 shared this article with you from Inoreader Portal hypertension exacerbates intrahepatic portosystemic venous shunt and further induces refractory hepatic encephalopathy: A case report. Μέσω pubmed: "world j clin cases"... Related Articles Portal hypertension exacerbates intrahepatic portosystemic venous shunt and further induces refractory hepatic encephalopathy: A case report. World J Clin Cases. 2021 Jan 16;9(2):496-501 Authors: Chang YH, Zhou XL, Jing D, Ni Z, Tang SH Abstract BACKGROUND: Intrahepatic portosystemic venous shunt (IPSVS) is a rare hepatic disease with different clinical manifestations. Most IPSVS patients with mild shunts are asymptomatic, while the patients with severe shunts present complications such as hepatic encephalopathy. For patients with portal hypertension accompanied by intrahepatic shunt, portal hypertension may lead to hemodynamic changes that may result in exacerbated portal shunt and increased shunt flow. CASE SUMMARY: A 57-year-old man, with the medical history of chronic hepatitis B and liver cirrhosis, was admitted to our hospital with abnormal behavior for 10 mo. He had received the esophageal varices ligation and entecavir therapy 1 year ago. Comparing with former examination results, the degree of esophageal varices was significantly reduced, while the right branch of the portal vein was significantly expanded and tortuous. Meanwhile, abdominal ultrasound presented the right posterior branch of portal vein connected with the retrohepatic inferior vena cava. The imaging findings indicated the diagnosis of IPSVS and hepatic encephalopathy. Instead of radiologic interventions or surgical therapies, this patient had only accepted symptomatic treatment. No recurrence of hepatic encephalopathy was observed during 1-year follow-up. CONCLUSION: Hemodynamic changes may exacerbate intrahepatic portosystemic shunt. The intervention or surgery should be carefully applied to patients with severe portal hypertension due to the risk of hemorrhage. PMID: 33521121 [PubMed] View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Repair of a severe palm injury with anterolateral thigh and ilioinguinal flaps: A case report.

paythelady.612 shared this article with you from Inoreader Repair of a severe palm injury with anterolateral thigh and ilioinguinal flaps: A case report. Μέσω pubmed: "world j clin cases"... Related Articles Repair of a severe palm injury with anterolateral thigh and ilioinguinal flaps: A case report. World J Clin Cases. 2021 Jan 16;9(2):502-508 Authors: Gong HY, Sun XG, Lu LJ, Liu PC, Yu X Abstract BACKGROUND: In daily life and work, there are more and more patients with trauma to the hand, which often results in skin and soft tissue defects. Although there are many repair methods, the function and appearance of the fingers will be adversely affected if the repair is inadequate. CASE SUMMARY: In the present report we describe an 18-year-old male patient whose right hand was mangled by a machine. X-ray imaging showed that a right hand bone (middle finger) was absent and the alignment was poor. After hospitalization, he was diagnosed with a severe right hand injury, skin and soft tissue defects, partial finger defects, and a skin degloving injury. He underwent reconstructive surgery with anterolateral thigh and ilioinguinal flaps. After two repair operations, satisfactory results were obtained, including good fracture healing, good skin flap shape, and good wrist joint function. CONCLUSION: This case highlights the good effect of anterolateral thigh and ilioinguinal flaps repair technique on severe palm injury. PMID: 33521122 [PubMed] View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Indirect inguinal hernia containing portosystemic shunt vessel: A case report.

paythelady.612 shared this article with you from Inoreader Indirect inguinal hernia containing portosystemic shunt vessel: A case report. Μέσω pubmed: "world j clin cases"... Related Articles Indirect inguinal hernia containing portosystemic shunt vessel: A case report. World J Clin Cases. 2021 Jan 16;9(2):509-515 Authors: Yura M, Yo K, Hara A, Hayashi K, Tajima Y, Kaneko Y, Fujisaki H, Hirata A, Takano K, Hongo K, Yoneyama K, Nakagawa M Abstract BACKGROUND: Inguinal hernia repair is one of the most common general surgical operations worldwide. We present a case of indirect inguinal hernia containing an expanded portosystemic shunt vessel. CASE SUMMARY: We report a 72-year-old man who had a 4 cm × 4 cm swelling in the right inguinal region, which disappeared with light manual pressure. Abdominal-pelvic computed tomography (CT) revealed a right inguinal hernia containing an expanded portosystemic shunt vessel, which had been noted for 7 years due to liver cirrhosis. We performed Lichtenstein's herniorrhaphy and identified the hernia sac as being indirect and the shunt vessel existing in the extraperitoneal cavity through the internal inguinal ring. Then, we found two short branches between the expanded shunt vessel and testicular vein in the middle part of the inguinal canal and cut these branches to allow the shunt vessel to return to the extraperitoneal cavity of the abdomen. The hernia sac was returned as well. We encountered no intraoperative complications. After discharge, groin seroma requiring puncture at the outpatient clinic was observed. CONCLUSION: If an inguinal hernia patient has portal hypertension, ultrasound should be used to determine the contents of the hernia. When atypical vessels are visualized, they may be shunt vessels and additional CT is recommended to ensure the selection of an adequate approach for safe hernia repair. PMID: 33521123 [PubMed] View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Recurrent inverted papilloma coexisted with skull base lymphoma: A case report.

paythelady.612 shared this article with you from Inoreader Recurrent inverted papilloma coexisted with skull base lymphoma: A case report. Μέσω pubmed: "world j clin cases"... Related Articles Recurrent inverted papilloma coexisted with skull base lymphoma: A case report. World J Clin Cases. 2021 Jan 16;9(2):516-520 Authors: Hsu HJ, Huang CC, Chuang MT, Tien CH, Lee JS, Lee PH Abstract BACKGROUND: Inverted papilloma is an uncommon neoplasm in the nasal cavity. It is a histologically benign tumor, but has a high recurrence and local invasion rate. In addition, nasal or skull base lymphoma is another rare neoplasm. The coexistence of these two tumors in one case makes the diagnosis and related treatment difficult. CASE SUMMARY: We report a case of an immunocompetent patient, who had a history of inverted papilloma 20 years ago. The patient presented with an infiltrated mass lesion in the nasal cavity with extension to the frontal base. The repeated biopsies revealed inverted papilloma without any malignant transformation. After the patient underwent a frontobasal craniotomy with total tumor excision, the final pathological examination revealed nasal inverted papilloma coexisting with diffuse large B-cell lymphoma of the skull base. CONCLUSION: Based on this case report, while managing a case of an aggressive recurrent inverted papilloma, not only squamous cell carcinoma transformation, but also other invasive malignancy, such as lymphoma, should be considered. PMID: 33521124 [PubMed] View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Circulatory Histidine levels for the assessment of disease activity in Takayasu arteritis A targeted NMR basedserum metabolomics study

xlomafota.13 shared this article with you from Inoreader Circulatory Histidine levels for the assessment of disease activity in Takayasu arteritis A targeted NMR basedserum metabolomics study Via OMICS International Umesh Kumar View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Eosinophilic Esophagitis and IgG4: Is There a Relationship?

xlomafota.13 shared this article with you from Inoreader Eosinophilic Esophagitis and IgG4: Is There a Relationship? Via Latest Results for Digestive Diseases and Sciences Abstract Our knowledge of the pathophysiology of eosinophilic esophagitis is constantly evolving. There is significant association between eosinophilic esophagitis and atopy; however, multiple studies have refuted the role of IgE in its pathogenesis. Instead, new data have demonstrated an elevated IgG4 level in patients with eosinophilic esophagitis. We review the current understanding of eosinophilic esophagitis pathogenesis and highlight the increasing evidence for the role of IgG4. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

A meta-analysis of the diagnostic accuracy of chest ultrasound for the diagnosis of occult penetrating cardiac injuries in hemodynamically stable patients with penetrating thoracic trauma

xloma.fota13 shared this article with you from Inoreader A meta-analysis of the diagnostic accuracy of chest ultrasound for the diagnosis of occult penetrating cardiac injuries in hemodynamically stable patients with penetrating thoracic trauma Via Journal of Trauma and Acute Care Surgery - Current Issue BACKGROUND We performed a systematic review (SR) and meta-analysis (MA) to determine the diagnostic accuracy of chest ultrasound (US) compared with a pericardial window (PW) for the diagnosis of occult penetrating cardiac injuries in hemodynamically stable patients with penetrating thoracic trauma. METHODS A literature search in five databases identified relevant articles for inclusion in this SR and MA. Studies were eligible if they evaluated the diagnostic accuracy of chest US, compared with a PW, for the diagnosis of occult penetrating cardiac injuries in hemodynamically stable patients presenting with penetrating thoracic trauma. Two investigators independently assessed articles for inclusion and exclusion criteria and selected studies for final analysis. Methodological quality was evaluated using Quality Assessment of Diagnostic Accuracy Studies-2. We performed a MA of binary diagnostic test accuracy within the bivariate mixed-effects logistic regression modeling framework. RESULTS We included five studies in our SR and MA. These studies included a total of 556 trauma patients. The MA found that, compared with PW, the US was 79% sensitive and 92% specific for detecting occult penetrating cardiac injuries in hemodynamically stable patients. The presence of a concomitant left hemothorax was frequent in patients with false-negative results. CONCLUSION This SR and MA found that, compared with PW, US was 79% sensitive and 92% specific for detecting occult penetrating cardiac injuries in hemodynamically stable patients with penetrating thoracic trauma. Caution interpretation of pericardial US results is suggested in the presence of left hemothorax. In these cases, a second diagnostic test should be performed. LEVEL OF EVIDENCE Systematic Review and Meta-analysis, level II. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Increasing BMI is associated with higher mortality, worsening outcomes and highly specific injury patterns following trauma: A multi-institutional analysis of 191,274 patients

xloma.fota13 shared this article with you from Inoreader Increasing BMI is associated with higher mortality, worsening outcomes and highly specific injury patterns following trauma: A multi-institutional analysis of 191,274 patients Via Journal of Trauma and Acute Care Surgery - Current Issue BACKGROUND As the prevalence of obesity has increased, trauma centers are faced with managing this expanding demographics' unique care requirements. Research on the effects of body mass index (BMI) in trauma patients remains conflicting. This study aims to evaluate the impact of BMI on patterns of injury and patient outcomes following trauma. METHODS Patients from 87 hospitals' trauma registries were selected. Those missing height, weight, disposition, or who died in the emergency department were excluded. The BMI categories were calculated from admission height and weight and verified against the electronic medical records. Patients were grouped by the National Institutes of Health–defined obesity class and compared by rate of mortality and in-hospital complications. Logistic regression was used to estimate associations, adjusting for age, gender, race, Injury Severity Score, and number of comorbidities. RESULTS There were 191,274 patients, 53% male; mean age was 60.4 years, mean Glasgow Coma Scale score 14.4, mean Injury Severity Score of 8.8, and 40.4% normal weight. Increased BMI was associated with an injury pattern of increased rates of extremity fractures (humerus, femur, tibia/fibula) and decreased rates of hip fractures and head injuries. Compared with the normal weight group, patients were more likely to die if they were Underweight (adjusted odds ratio [AOR], 1.18; 95% confidence interval [CI], 1.01–1.38), obese class II (AOR, 1.24; 95% CI, 1.07–1.45), or obese class III (AOR, 1.55; 95% CI, 1.29–1.87). Obese class III was associated with higher odds of a National Trauma Data Standard complication (AOR, 1.20; 95% CI, 1.11–1.30). CONCLUSION In this large multicenter study, increasing BMI and lower than normal BMI were strongly associated with higher mortality. Increasing BMI was also associated with longer length of stay, increased complications, and unique injury patterns. These untoward outcomes, coupled with a distinct injury pattern, warrant care guidelines specific to trauma patients with higher BMI, as well as those with BMI lower than normal. LEVEL OF EVIDENCE Epidemiological, Level III. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.