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International Journal of Surgery Case... May 2024Embryonal Rhabdomyosarcoma is a rare form of sarcoma mainly seen in children and adolescents. In the specific case of the cervix, embryonal Rhabdomyosarcoma is an...
INTRODUCTION AND IMPORTANCE
Embryonal Rhabdomyosarcoma is a rare form of sarcoma mainly seen in children and adolescents. In the specific case of the cervix, embryonal Rhabdomyosarcoma is an extremely rare mesenchymal tumor, accounting for <1 % of all cervical cancers. This highly malignant tumor mainly affects adolescents and young adults.
CASE PRESENTATION
We describe the case of a 29-year-old woman with embryonal rhabdomyosarcoma of the cervix, which manifested as an exophytic cervical mass. Histopathological and immunohistochemical findings confirmed the presence of embryonal rhabdomyosarcoma of the cervix. This patient was successfully treated with a combination of neoadjuvant chemoradiotherapy, total abdominal hysterectomy with bilateral ovary transposition, and adjuvant chemoradiotherapy.
CLINICAL DISCUSSION
Embryonal Rhabdomyosarcoma of the cervix may manifest by vaginal bleeding, a cervical mass and pelvic symptoms. The diagnosis is confirmed by histopathology and immunohistochemistry. With multimodal treatment including surgery, chemotherapy and radiotherapy, outcomes improve for patients.
CONCLUSIONS
Uterine cervix embryonal RMS is an uncommon cancer in adult patients. While rare, it should be considered as a potential diagnosis in patients presenting with vaginal bleeding and a significant cervical polyp. Histopathology, complemented by relevant immunohistochemistry, is crucial for accurately detecting the tumor and guiding appropriate management strategies.
PubMed: 38759402
DOI: 10.1016/j.ijscr.2024.109742 -
Medicine May 2024Bilateral vestibulopathy is an important cause of imbalance. There are multiple etiologies of bilateral vestibulopathy (BVP), but reports of BVP due to otosyphilis are...
RATIONALE
Bilateral vestibulopathy is an important cause of imbalance. There are multiple etiologies of bilateral vestibulopathy (BVP), but reports of BVP due to otosyphilis are rare.
PATIENT CONCERNS
A 39-year-old male was referred to our medical center due to vertigo, persistent dizziness and gait disturbance for 2 months.
DIAGNOSES
Bilateral vestibulopathy due to otosyphilis was considered in this case, as confirmed through analyses of vestibular function, laboratory tests, and penicillin treatment.
INTERVENTIONS
The patient was was treated with a high dose of penicillin G (24 × 106 IU/d) for 14 days.
OUTCOMES
The patient's symptoms had improved greatly following treatment, with dizziness and gait disturbance having completely resolved at 3 months following hospital discharge.
LESSONS
Bilateral vestibulopathy should be considered when evaluating patients with acute or subacute persistent dizziness. Clinicians should also be aware of the potential for otosyphilis among patients who report BVP.
Topics: Humans; Male; Adult; Bilateral Vestibulopathy; Syphilis; Dizziness; Anti-Bacterial Agents; Penicillin G; Vertigo
PubMed: 38758873
DOI: 10.1097/MD.0000000000038149 -
Medicine May 2024Follicular carcinoma of thyroid is a rare pathological type of thyroid carcinoma, accounting for 4.5% of the total. At present, the main treatment methods include... (Review)
Review
RATIONALE
Follicular carcinoma of thyroid is a rare pathological type of thyroid carcinoma, accounting for 4.5% of the total. At present, the main treatment methods include surgery, iodine therapy, thyroid hormone inhibitors, etc. Targeted drug therapy is very important for distant metastasis and iodine-refractory differentiated thyroid cancer.
PATIENT CONCERNS
This clinical case is a 51-year-old male patient with follicular carcinoma of thyroid.
DIAGNOSES
After 7 years of total thyroidectomy, multiple distant metastasis occurred to bilateral lungs, bones, multiple lymph nodes, etc.
INTERVENTION
After multidisciplinary consultation in the department of oncology, thoracic surgery, nuclear medicine and other departments, he received targeted drug therapy of Lenvatinib.
OUTCOMES
After 3 months, his condition was partially relieved, and his quality of life was significantly improved. After 11 months of treatment, the evaluated efficacy was still in remission.
LESSON
Late metastatic thyroid cancer is faced with dilemma of radioiodine refractory after traditional treatment. This will provide further evidence for therapeutic intervention in similar patients in the future.
Topics: Humans; Male; Middle Aged; Thyroid Neoplasms; Adenocarcinoma, Follicular; Thyroidectomy; Palliative Care; Phenylurea Compounds; Quinolines; Antineoplastic Agents
PubMed: 38758843
DOI: 10.1097/MD.0000000000038237 -
Folia Morphologica May 2024Any intervention to the maxillary posterior teeth (MPT) and alveola pose a risk of sinus perforation. Given the proximity of these structures, this study aimed to...
BACKGROUND
Any intervention to the maxillary posterior teeth (MPT) and alveola pose a risk of sinus perforation. Given the proximity of these structures, this study aimed to investigate the relationship between the maxillary sinus (MS) and MPT.
MATERIALS AND METHODS
CBCT images obtained from 207 patients (mean age, 45 ± 17 years; age range: 18-92 years) including 99 females and 108 males were examined retrospectively. Patients with sinus pathologies affecting the structure of MS and a history of oral and maxillofacial surgery were excluded from the study. On these images, the relationship of maxillary sinus floor (MSF) with 2 premolars and 3 molars was examined bilaterally for each patient using Kwak H. H. et al.'s classification. The presence, number, frequency and location of septa within the MSF were investigated.
RESULTS
Examination of a total of 410 maxillary sinuses on the images of 207 patients with no sinus perforation or pathology revealed that septa were most commonly (48.7%) located in the middle segment (second molars). When the relationship between the MSF and MPT was evaluated, molar teeth were found to have a closer relationship with the MSF than premolars.
CONCLUSIONS
It is believed that the findings of this study may provide further guidance to the dental practitioners and other clinicians for future studies.
PubMed: 38757496
DOI: 10.5603/fm.99268 -
International Journal of Particle... Mar 2024Pediatric acute myeloid leukemia (AML) often involves extramedullary sites, which can be resistant to standard induction chemotherapy. Consolidative radiation therapy...
PURPOSE
Pediatric acute myeloid leukemia (AML) often involves extramedullary sites, which can be resistant to standard induction chemotherapy. Consolidative radiation therapy can be used in select cases to improve local control rates and help bridge patients to curative stem cell transplants. However, there is no previously published data to support the use of proton radiotherapy (PT) in this setting. We present radiographic findings and pathologic outcomes of the first reported patient with extramedullary ocular AML to be treated with PT.
PATIENTS AND METHODS
Details regarding diagnostic evaluation and treatment were obtained from the electronic medical records at the University of Florida Proton Therapy Institute, Nemours Children's Health, and St. Joseph's Children's Hospital.
RESULTS
This 7-month-old patient presented with biopsy-proven relapsed AML in the bilateral anterior chambers of the eyes, which did not resolve with induction chemotherapy. The patient then received PT to a dose of 24 cobalt gray equivalent to both eyes and was found to have no evidence of disease following treatment.
CONCLUSION
This case provides further evidence that consolidative radiotherapy may be considered for select patients with extramedullary AML who have limited response to induction chemotherapy. Given the increased prevalence of extramedullary AML in pediatric patients, it is worth considering the utilization of PT to mitigate damage to nearby organs and the risk of secondary malignancies.
PubMed: 38757078
DOI: 10.1016/j.ijpt.2023.12.001 -
Frontiers in Pediatrics 2024Pretransplant vaccination is generally recommended to solid organ transplant recipients. In infants with congenital nephrotic syndrome (CNS), the immune response is...
BACKGROUND
Pretransplant vaccination is generally recommended to solid organ transplant recipients. In infants with congenital nephrotic syndrome (CNS), the immune response is hypothetically inferior to other patients due to young age and urinary loss of immunoglobulins, but data on the immunization response in severely nephrotic children remain scarce. If effective, however, early immunization of infants with CNS would clinically be advantageous.
METHODS
We investigated serological vaccine responses in seven children with CNS who were immunized during nephrosis. Antibody responses to measles-mumps-rubella -vaccine (MMR), a pentavalent DTaP-IPV-Hib -vaccine (diphtheria, tetanus, acellular pertussis, inactivated poliovirus, type b), varicella vaccine, combined hepatitis A and B vaccine, and pneumococcal conjugate vaccine (PCV) were measured after nephrectomy either before or after kidney transplantation.
RESULTS
Immunizations were started at a median age of 7 months [interquartile range (IQR) 7-8], with a concurrent median proteinuria of 36,500 mg/L (IQR 30,900-64,250). Bilateral nephrectomy was performed at a median age of 20 months (IQR 14-25), and kidney transplantation 10-88 days after the nephrectomy. Antibody levels were measured at median 18 months (IQR 6-23) after immunization. Protective antibody levels were detected in all examined children for hepatitis B (5/5), (7/7), rubella virus (2/2), and mumps virus (1/1); in 5/6 children for varicella; in 4/6 for poliovirus and vaccine-type pneumococcal serotypes; in 4/7 for type B and ; in 1/2 for measles virus; and in 2/5 for hepatitis A. None of the seven children had protective IgG levels against .
CONCLUSION
Immunization during severe congenital proteinuria resulted in variable serological responses, with both vaccine- and patient-related differences. Nephrosis appears not to be a barrier to successful immunization.
PubMed: 38756974
DOI: 10.3389/fped.2024.1392873 -
Frontiers in Medicine 2024This study aimed to explore the postoperative myopic shift and its relationship to visual acuity rehabilitation in patients with bilateral congenital cataracts (CCs).
BACKGROUND
This study aimed to explore the postoperative myopic shift and its relationship to visual acuity rehabilitation in patients with bilateral congenital cataracts (CCs).
METHODS
Bilateral CC patients who underwent cataract extraction and primary intraocular lens implantations before 6 years old were included and divided into five groups according to surgical ages (<2, 2-3, 3-4, 4-5, and 5-6 years). The postoperative myopic shift rates, spherical equivalents (SEs), and the best corrected visual acuity (BCVA) were measured and analyzed.
RESULTS
A total of 1,137 refractive measurements from 234 patients were included, with a mean follow-up period of 34 months. The postoperative mean SEs at each follow-up in the five groups were linearly fitted with a mean = 0.93 ± 0.03, which showed a downtrend of SE with age (linear regression). Among patients with a follow-up of 4 years, the mean postoperative myopic shift rate was 0.84, 0.81, 0.68, 0.24, and 0.28 diopters per year (D/y) in the five age groups (from young to old), respectively. The BCVA of those with a surgical age of <2 years at the 4-year visit was 0.26 (LogMAR), and the mean postoperative myopic shift rate was 0.84 D/y. For patients with a surgical age of 2-6 years, a poorer BCVA at the 4-year visit was found in those with higher postoperative myopic shift rates ( = 0.974, = 0.026, Pearson's correlation test).
CONCLUSION
Performing cataract surgery for patients before 2 years old and decreasing the postoperative myopic shift rates for those with a surgical age of 2-6 years may benefit visual acuity rehabilitation.
PubMed: 38756946
DOI: 10.3389/fmed.2024.1406287 -
Heliyon May 2024In this study, we thoroughly analyzed how balanced the left and right sides of the external acoustic meatus are. Despite previous research focusing on the consistency of...
OBJECTIVE
In this study, we thoroughly analyzed how balanced the left and right sides of the external acoustic meatus are. Despite previous research focusing on the consistency of various anatomical features and the shape of the external acoustic meatus, which are important for creating guidelines to assess changes in the skull, there hasn't been enough attention given to how symmetrical it is. Our aim was to fill this gap by providing a comprehensive examination of its bilateral symmetry, which is crucial for accurate evaluations in dentistry and medicine.
STUDY DESIGN
After importing 26 cone-beam computed tomography scans of patients into the ITK-SNAP 3D imaging software, a midsagittal plane was set up as the plane of symmetry for each patient. With this plane, we compared the positions of the most superior and inferior left and right points of the external acoustic meatus. We also compared the lengths and depths of the lines connecting the two points.
RESULTS
There were no statistically significant differences in the position, length, or depth of the external acoustic meatus between the right and left halves of the skull.
CONCLUSION
Specific points on the skull, such as the highest (most superior MSP) and lowest (most inferior MIP) points, demonstrated a high degree of symmetry in the left and right halves. They demonstrated sufficient symmetry to establish a reliable reference plane. Along with the trajectory connecting them, these points can serve as viable alternatives to the Porion for three-dimensional imaging.
PubMed: 38756604
DOI: 10.1016/j.heliyon.2024.e30460 -
Frontiers in Aging Neuroscience 2024This research aims to investigate putative mechanisms between glymphatic activity and cognition in mild cognitive impairment (MCI) and analyzes whether the relationship...
OBJECTIVE
This research aims to investigate putative mechanisms between glymphatic activity and cognition in mild cognitive impairment (MCI) and analyzes whether the relationship between cognitive reserve (CR) and cognition was mediated by glymphatic activity.
METHODS
54 MCI patients and 31 NCs were enrolled to evaluate the bilateral diffusivity along the perivascular spaces and to acquire an index for diffusivity along the perivascular space (ALPS-index) on diffusion tensor imaging (DTI). The year of education was used as a proxy for CR. The ALPS-index was compared between two groups and correlation analyses among the ALPS-index, cognitive function, and CR were conducted. Mediation analyses were applied to investigate the correlations among CR, glymphatic activity and cognition.
RESULTS
MCI group had a significantly lower right ALPS-index and whole brain ALPS-index, but higher bilateral diffusivity along the y-axis in projection fiber area (Dyproj) than NCs. In MCI group, the left Dyproj was negatively related to cognitive test scores and CR, the whole brain ALPS-index was positively correlated with cognitive test scores and CR. Mediation analysis demonstrated that glymphatic activity partially mediated the correlations between CR and cognitive function.
CONCLUSION
MCI exhibited decreased glymphatic activity compared to NCs. CR has a protective effect against cognitive decline in MCI, and this effect may be partially mediated by changes in glymphatic activity.
PubMed: 38756534
DOI: 10.3389/fnagi.2024.1399943 -
Case report: Successful anesthesia management of noncardiac surgery in a patient with single atrium.Frontiers in Pharmacology 2024Single atrium is very rare congenital cardiac anomaly in adults. The prognosis of patients with single atrium is very poor, with 50% of patients dying owing to...
BACKGROUND
Single atrium is very rare congenital cardiac anomaly in adults. The prognosis of patients with single atrium is very poor, with 50% of patients dying owing to cardiopulmonary complications in childhood. Herein, we focused on anesthesia management for noncardiac surgery in patients with single atrium.
CASE PRESENTATION
A 58-year-old male with a history of bilateral varicocele underwent laparotomy for high-position ligation of the spermatic vein. The patient also had a history of single atrium, atrial fibrillation, chronic heart failure, pulmonary hypertension (PH), and complete right bundle branch block (CRBBB). Given the significant complications associated with general anesthesia in patients with PH, we preferred to use low-dose epidural anesthesia for this patient. Transthoracic echocardiography was used to assess cardiac function before and during surgery and guide perioperative fluid therapy. To limit the stress response, we used a regional nerve block for reducing postoperative pain. Furthermore, we used norepinephrine to appropriately increase the systemic vascular resistance in response to the reduction of systemic vascular resistance caused by epidural anesthesia.
CONCLUSION
Low-dose epidural anesthesia can be safely used in patients with single atrium and PH. The use of perioperative transthoracic echocardiography is helpful in guiding fluid therapy and effectively assessing the cardiac structure and function of patients. Prophylactic administration of norepinephrine before epidural injection may make it easier to maintain the patient's BP.
PubMed: 38756372
DOI: 10.3389/fphar.2024.1370263