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JFMS Open Reports 2023Two castrated male domestic shorthair cats (aged 8 months [case 1] and 13 years [case 2]) were presented at the Small Animal Clinic of the Veterinary Medicine University...
CASE SERIES SUMMARY
Two castrated male domestic shorthair cats (aged 8 months [case 1] and 13 years [case 2]) were presented at the Small Animal Clinic of the Veterinary Medicine University of Vienna, Austria, both with acute vomiting and distended abdomen, as well as a history of chronic apathy, recurrent vomiting and diarrhoea. Both cats underwent invasive diagnostic procedures approximately 1 month before the diagnosis of sclerosing encapsulating peritonitis (SEP), namely an exploratory laparotomy and a bronchoscopy, respectively. Abdominal ultrasound revealed severely corrugated intestinal loops and, in case 2, the presence of peritoneal effusion. A thick and diffuse fibrous capsule around the intestine was detected and removed surgically, and biopsies were taken from the affected organs confirming the SEP. Case 1 recovered well, was discharged some days after surgery and was clinically unremarkable for the next 2 years. Case 2 showed unsatisfactory improvement directly after surgery and was euthanased a few days later, as the owner declined any further therapy.
RELEVANCE AND NOVEL INFORMATION
SEP is a very rare condition of unclear origins in cats. Here we describe the clinical and diagnostic imaging features, surgical treatment, and outcome of SEP in two cats. The results indicate that prompt diagnosis and appropriate interventions may improve the outcome.
PubMed: 37434990
DOI: 10.1177/20551169231178447 -
Frontiers in Physiology 2023Escape room's popularity has raised over the past years among young adults. It creates a distended competitive environment, where participants collaborate to achieve a...
Escape room's popularity has raised over the past years among young adults. It creates a distended competitive environment, where participants collaborate to achieve a common objective through teamwork. We decided to apply this format as a teaching method for medical students at the University of Malaga, Spain. A peer-to-peer physiological cardiorespiratory escape room was designed by intern undergraduate students, collaborating within the Department of Human Physiology. This activity integrated the contents of the Human Physiology syllabus, which were organized into four stages that culminated in a final medical case. Intern students oversaw the design, promotion, preparation and execution of the activity, and were in charge of conducting the evaluation and follow up. The escape room was done in mid-December, after all theoretical and practical contents had been delivered, for four consecutive years, improving from each year's experience. The target group for this activity were second year medical students, who were asked to team up freely in groups of four to six students before the start of the activity. The students in each group cooperated with each other while trying to solve the different puzzles and questions in each stage of the escape room. After the activity, the results of the final evaluation exam of these participants were compared against non-participants, who served as a control group. Qualitative feedback was also received from the participants a special survey that was designed for this task. Results between 2020 and 2023 (three last activities) show that the final mark of the participants was significantly higher than in non-participants (6.39 ± 0.14 vs. 5.04 ± 0.2; < 0.0007). The global exam mark also increased in the participants (5.43 ± 0.10 vs. 4.44 ± 0.15; < 0.0007). A significant difference was observed in the performance in cardiovascular ( < 0.0007) and respiratory-related questions ( < 0.0007), which was substantial in the participants. The qualitative feedback received from the participants was mainly positive, indicating an overall acceptance of the format by the students. We conclude that escape room format with a peer-to-peer structure is an efficient teaching tool for medical students performed by medical students in the field of Human Physiology.
PubMed: 37711460
DOI: 10.3389/fphys.2023.1242847 -
Anatomical Record (Hoboken, N.J. : 2007) Sep 2023This study aimed to examine the distribution and quantitative parameters of the epicardiac ventricular neural ganglionated plexus in the hearts of humans and sheep,...
This study aimed to examine the distribution and quantitative parameters of the epicardiac ventricular neural ganglionated plexus in the hearts of humans and sheep, highlighting the differences of this plexus in humans and large models. Five non-sectioned pressure distended whole hearts of the human newborns and 10 hearts of newborn German black-faced lambs were investigated applying a histochemical method for acetylcholinesterase to stain epicardiac neural structures with their subsequent stereomicroscopic examination. In humans, the ventricular nerves are spread by four epicardiac nerve subplexuses, that is, the left and right coronary as well as the left and middle dorsal. In sheep, the ventricular nerves are spread by five epicardiac nerve subplexuses, that is, the left and right coronary, the left and middle dorsal and the right ventral ones. The ventricular epicardium involved up to 129 ganglia in humans and up to 198-in sheep. The largest number of the ventricular ganglionic cells in humans were located on the ventral side, in front of the conus arteriosus, while on sheep ventricles, the most numerous neurons distributed on the dorsal wall of the left ventricle. This comparative study of the morphological patterns of the human and sheep ventricles demonstrates that the sheep heart is neuroanatomically distinct from the human one and this must be taking into consideration using the sheep model for the heart physiology experiments.
Topics: Humans; Animals; Infant, Newborn; Sheep; Heart Ventricles; Acetylcholinesterase; Heart; Ganglia; Neurons
PubMed: 36181389
DOI: 10.1002/ar.25085 -
BMC Medical Genomics Oct 2023Cranio-lenticulo-sutural dysplasia (CLSD) is a rare dysmorphic syndrome characterized by skeletal dysmorphism, late-closing fontanels, and cataracts. CLSD is caused by...
Novel compound heterozygous variants of the SEC23A gene in a Chinese family with cranio-lenticulo-sutural dysplasia based on data from a large cohort of congenital cataract patients.
BACKGROUND
Cranio-lenticulo-sutural dysplasia (CLSD) is a rare dysmorphic syndrome characterized by skeletal dysmorphism, late-closing fontanels, and cataracts. CLSD is caused by mutations in the SEC23A gene (OMIM# 607812) and can be inherited in either an autosomal dominant or autosomal recessive pattern. To date, only four mutations have been reported to cause CLSD. This study aims to identify the disease-causing variants in a large cohort of congenital cataract patients, to expand the genotypic and phenotypic spectrum of CLSD, and to confirm the association between SEC23A and autosomal recessive CLSD (ARCLSD).
METHODS
We collected detailed medical records and performed comprehensive ocular examinations and whole-exome sequencing (WES) on 115 patients with congenital cataracts. After suspecting that a patient may have CLSD based on the sequencing results, we proceeded to conduct transmission electron microscopy (TEM) on the cultured skin fibroblasts. The clinical validity of the reported gene-disease relationships for the gene and the disease was evaluated using the ClinGen gene curation framework.
RESULTS
Two novel compound heterozygous variants (c.710A > C p.Asp237Ala, c.1946T > C p.Leu649Pro) of the SEC23A gene, classified as variant of uncertain significance, were identified in the proband with skeletal, cardiac, ocular, and hearing defects. The observation of typical distended endoplasmic reticulum cisternae further supported the diagnosis of CLSD. Application of the ClinGen gene curation framework confirmed the association between SEC23A and ARCLSD.
CONCLUSION
This study expands the genotypic and phenotypic spectrum of CLSD, proposes TEM as a supplemental diagnostic method, and indicates that congenital cataracts are a typical sign of ARCLSD.
Topics: Humans; Cataract; East Asian People; Endoplasmic Reticulum; Family; Mutation; Pedigree; Vesicular Transport Proteins
PubMed: 37828500
DOI: 10.1186/s12920-023-01667-9 -
Revista Espanola de Enfermedades... Oct 2023Endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) is recommended as a rescue treatment of malignant distal biliary obstruction (MBDO) after failed ERCP and...
Endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) is recommended as a rescue treatment of malignant distal biliary obstruction (MBDO) after failed ERCP and endoscopic ultrasound-guided biliary drainage (EUS-BD). A 64-year-old male was admitted for painless obstructive jaundice and anemia. For religious reasons, he refused any blood transfusions. Abdominal computed tomography scan showed a pancreatic tumor with dilation biliary tree and liver metastasis. ERCP failed and advanced biliary cannulation technique such as precut were avoided due to a high risk of bleeding. We avoided the two transmural EUS-BD approaches, which include EUS-guided choledochoduodenostomy and EUS-guided hepaticogastrostomy, due to smaller targets and considered riskier in this patient. Since the gallbladder was markedly distended and the cystic duct was patent, we performed a cholecystogastrostomy with a 15x10 mm electrocautery lumen-apposing metal stent (EC-LAMS) as a second option of biliary drainage. After a week, the serum bilirubin levels decreased to normal values and the patient was uneventfully discharged. At follow-up, he refused to receive chemotherapy and died six months later due to cancer progression.
PubMed: 37882194
DOI: 10.17235/reed.2023.9973/2023 -
Skin Appendage Disorders Apr 2024Psoriasis is an autoimmune papulosquamous disorder characterized by erythematous plaques. There are various subtypes, of which follicular psoriasis (FP) is an...
INTRODUCTION
Psoriasis is an autoimmune papulosquamous disorder characterized by erythematous plaques. There are various subtypes, of which follicular psoriasis (FP) is an underreported entity, presenting as scaly follicular papules. Only a few cases have been reported, with limited dermoscopy findings having been described. This report aims to review the literature and emphasize the role of dermoscopy in the diagnosis of this rare variant.
CASE REPORT
A 31-year-old diabetic and obese male presented with symmetrical, itchy, scaly follicular lesions on his axillae, elbows, and knees for 6 months. Clinical differentials included follicular pityriasis rosea, pityriasis versicolor, or eczema. Dermoscopy revealed white scales and erythematous areas with multiple red dots present around hair follicles. Histopathology showed distended follicular infundibula with parakeratotic scales and psoriasiform changes, leading to a diagnosis of FP. Treatment with topical mometasone furoate and oral levocetirizine led to complete resolution within a month.
DISCUSSION
FP is a relatively uncommon subtype of psoriasis, manifesting differently in adults and juveniles. Although its exact cause remains unknown, hair follicle immune cells and/or keratin 17 (K17) may be involved. Dermoscopy can help distinguish it by revealing typical features including perifollicular white scales and vascular structures. Further epidemiological studies and long-term follow-up are needed for a comprehensive understanding of FP.
PubMed: 38572197
DOI: 10.1159/000536049 -
Cureus Nov 2023The most common benign tumor that affects female reproductive system is a uterine fibroid or leiomyomas, especially during their reproductive years. The prevalence is...
The most common benign tumor that affects female reproductive system is a uterine fibroid or leiomyomas, especially during their reproductive years. The prevalence is around 20-40% women in the age group of 14-45 years. The following case report proffers the diagnosis and management of a female diagnosed with uterine fibroids. In this case a 45-year-old woman presented to the tertiary rural hospital with an unusually large distended abdomen which on examination and imaging revealed a big fibroid growing inside the uterus. The case highlights the significance of a collaborative approach involving gynecologists, interventional radiologists, and surgeons. Their combined expertise provides patients with various treatment options: medical management, minimally invasive procedures, and surgical interventions. During the decision-making process, factors such as the patient's age, desire for fertility preservation, and impact of fibroids on her quality of life are taken into account. This particular case showcases successful pre-hysterectomy uterine artery embolization of large uterine leiomyoma while emphasizing the importance of personalized care and shared decision making for optimal patient outcomes.
PubMed: 38046766
DOI: 10.7759/cureus.48169 -
The American Journal of Case Reports Jul 2023BACKGROUND Hemorrhagic cholecystitis is a rare cause of abdominal pain, which can result from malignancy, bleeding, or trauma. The presentation, which includes right...
BACKGROUND Hemorrhagic cholecystitis is a rare cause of abdominal pain, which can result from malignancy, bleeding, or trauma. The presentation, which includes right upper-quadrant pain, nausea, and vomiting, can overlap with other disease states, thereby rendering the diagnosis challenging. CASE REPORT We describe a patient taking apixaban wo had paroxysmal atrial fibrillation with history of joint pain on long-term steroids who developed hemorrhagic cholecystitis following an episode of pneumonia secondary to SARS-CoV-2 virus (COVID-19) infection. The hospital COVID-19 pneumonia protocol included the administration of steroids and symptomatic care. Following discharge, he presented to our hospital with a sudden onset of severe abdominal pain and distention accompanied by elevated liver enzymes and a low hemoglobin level of 78 g/L. Magnetic resonance cholangiopancreatography revealed a distended gallbladder and intraluminal layering, early subacute blood products, and increased wall thickness, which was thought to represent non-calcular hemorrhagic cholecystitis. Furthermore, a stable 18×16×20 mm cyst in the tail of the pancreas was also located posteriorly, with indentation to the splenic vein. The patient was managed conservatively, and the pain subsided on day 3 after admission. CONCLUSIONS Hemorrhagic cholecystitis is rarely reported with the use of the direct oral anticoagulants (DOACs). In our case the combination of a recent COVID-19 hospitalization, steroid use, and possible pancreatic cancer (CA 19-9 288.4 kU/L) may have contributed to such incidence in the setting of apixaban utilization; however, it is not possible to make definitive correlations. Investigating hemorrhagic cholecystitis in the setting of DOAC use in patients with multiple risk factors such as those that existed in our patient is imperative for proper diagnosis and management.
Topics: Humans; Male; Abdominal Pain; Cholecystitis; COVID-19; Hemorrhage; Aged
PubMed: 37475204
DOI: 10.12659/AJCR.939677 -
Zhonghua Er Bi Yan Hou Tou Jing Wai Ke... Apr 2024To assess the clinical features and CT diagnostic characteristics of Branchio-Oto-Renal or Branchio-Oto Syndrome The temporal CT findings and clinical features...
To assess the clinical features and CT diagnostic characteristics of Branchio-Oto-Renal or Branchio-Oto Syndrome The temporal CT findings and clinical features observations of 13 patients with Branchio-Oto-Renal Syndrome (BORS) or Branchio-Oto Syndrome(BOS) confirmed by genetic testing were retrospectively analyzed. There were 8 males and 5 females, aged from 1 to 39 years, with a median age of 9 years, in which 3 pairs (6 cases) were parent-child relationship. All of 13 cases had hearing loss and preauricular fistula, 11 cases accompanied by 2nd branchial fistulas. There were 20 ears of mixed hearing loss, 3 ears of sensorineural hearing loss, and 2 ears of conductive hearing loss. The mutation point of gene testing was located in in 12 cases and in 1 case. Twenty ears showed gradually narrowing of the diameter of basal turn, with hypoplasia in the second turn and aplasia in apical turn. There were irregular wall of vestibule and horizontal semicircular canal in 10 ears,widened vestibular in 7 ears, and vestibular fusion with horizontal semicircular canal in 3 ears. Three ears had an enlarged vestibular aqueduct, 8 ears showed enlargement of internal auditory canal. Seventeen ears had adhesion of malleolus to tympanic cavity. Six ears could not measured the incudostapedial joint angle by reason of tympanic inflammatory cover, 3 ears could not show incudostapedial joint, and 8 ears showed the incudostapedial joint angle more than 122°. Six ears showed poor oval window, and 1 ear had poor round window. Eighteen ears showed distended eustachian tube, and accompanied by tympanic or mastoiditis in 11 ears. Anterolateral shift of tympanum was found in 22 ears, 17 ears had low middle cranial fossa, and 3 ears had stenotic external auditory canal. Cochlear dysplasia, ossicular chain malformation and distended eustachian tube comprise the characteristic CT signs of BOS/BORS, which possesses versatile and complex CT findings. Temporal CT can accurately assess the important structures such as cochlea, ossicles, vestibule, semicircular canal, vestibular aqueduct and internal auditory canal. Combing with the clinical characteristics of bilateral, mixed hearing loss, preauricular fistula and branchial fistula can provide valuable information for early diagnosis and treatment.
Topics: Male; Female; Humans; Child; Hearing Loss, Mixed Conductive-Sensorineural; Retrospective Studies; Branchio-Oto-Renal Syndrome; Vestibule, Labyrinth; Tomography, X-Ray Computed; Fistula; Homeodomain Proteins
PubMed: 38622020
DOI: 10.3760/cma.j.cn115330-20231019-00160 -
International Journal of Surgery Case... Oct 2023Pneumatosis cystoides intestinalis (PCI) is defined as the presence of air-filled cysts in the bowel wall. The overall incidence of pneumatosis cystoides intestinalis in...
INTRODUCTION AND IMPORTANCE
Pneumatosis cystoides intestinalis (PCI) is defined as the presence of air-filled cysts in the bowel wall. The overall incidence of pneumatosis cystoides intestinalis in the general population is very rare.
PRESENTATION OF CASE
This is a 44-year-old male patient who presented with epigastric abdominal pain and repeated vomiting of one-month duration. The patient was emaciated; vital signs were within normal limits. The abdomen was grossly distended. Laboratory tests, radiologic imaging, and upper gastrointestinal endoscopy were performed. The diagnosis of gastric outlet obstruction (GOO) secondary to peptic ulcer disease cicatrization along with the coincidental finding of PCI with hepato-diaphragmatic interposition of the small bowel (Chilaiditi sign) was made. Truncal vagotomy, gastrojejunostomy, and Braun jejunojejunostomy was performed. Adhesionolysis and repositioning of the ileum back into its' normal infracolic location was also done.
CLINICAL DISCUSSION
The causes of PCIs are multifactorial; however, the exact etiology is not well known. PCIs have a wide range of non-specific presenting symptoms such as bloody stools, diarrhea or constipation, vomiting, abdominal pain, flatulence, and weight loss. The diagnosis of PCI is made based on endoscopy and radiographic evaluation of the alimentary tract. The appropriate therapy depends on the underlying etiology and the presence of complications.
CONCLUSION
In the absence of complication, PCI can be managed conservatively. However, in the presence of an indication for surgery, PCI related with bowel interposition in the hepato-diaphragmatic space; concomitant repositioning and adhesion release may help to alleviate the symptoms and prevent further complication of PCI.
PubMed: 37716064
DOI: 10.1016/j.ijscr.2023.108828