Unexpected finding of cholecystogastric fistula in a patient undergoing laparoscopic cholecystectomy: A case report

BACKGROUND

Gallbladder stones are a common occurrence, with a prevalence of approximately 10% in the Pakistani population. A rare but potentially fatal complication of gallstones is cholecystogastric fistulas. The underlying mechanism involves chronic inflammation due to cholelithiasis, causing gradual erosion and eventually leading to fistula formation.

CASE SUMMARY

We present a rare case of a cholecystogastric fistula in a 40-year-old female patient, successfully managed with an open surgical approach. The patient initially presented with a 6-month history of intermittent epigastric pain, nausea, and vomiting, which worsened over time. Laboratory investigations and abdominal ultrasound confirmed cholelithiasis, and laparoscopic cholecystectomy was planned. However, intraoperative findings revealed a cholecystogastric fistula, a rare complication of chronic gallstone disease. Given the dense adhesions between the gallbladder and the stomach, the procedure was converted to an open surgery. The fistula was divided, and a cholecystectomy was performed, along with primary repair of the gastric defect using a double-layer suture and reinforcement with an omental patch. The patient recovered uneventfully and was discharged on the third postoperative day.

CONCLUSION

This case highlights the importance of considering cholecystogastric fistula in patients with vague gastrointestinal symptoms and chronic cholelithiasis. The report discusses diagnostic challenges, surgical approaches, and a review of the current literature on managing such rare but serious complications of gallstones.

Surgical management of patients with corneal lesions due to lid pathologies

BACKGROUND

The surgical management of corneal lesions resulting from eyelid pathologies requires a comprehensive approach to ensure optimal patient outcomes. Eyelid lesions, ranging from benign to malignant, can lead to corneal damage through mechanisms such as mechanical abrasion, secondary infection, or inflammatory responses.

AIM

To assess the surgical methodologies utilized in the treatment of corneal lesions resulting from eyelid disorders and evaluate their effects on patient outcomes, recurrence rates, and postoperative complications. The incorporation of advanced imaging techniques, including optical coherence tomography and ultrasound biomicroscopy, in conjunction with histopathological analysis, is addressed to improve surgical accuracy and patient outcomes.

METHODS

The authors searched online databases (PubMed and Cochrane) for publications on the surgical management of lid lesions. Records received from the two databases were checked for duplicates and relevance. Only records with full texts and in English language were included.

RESULTS

A total of 28 records were obtained following the screening for relevancy and duplication. The review underscores essential surgical approaches employed in the treatment of corneal lesions resulting from common eyelid diseases, focusing on operative efficacy, complication rates, and long-term results.

CONCLUSION

This systematic review emphasizes the significance of choosing suitable surgical techniques tailored to individual patient characteristics and stresses the need for interdisciplinary collaboration in ophthalmic care. The results indicate that sophisticated imaging techniques and careful preoperative preparation markedly improve surgical accuracy and long-term results.

Lumbar methicillin-resistant Staphylococcus aureus infection caused by a peripherally inserted central catheter: A case report

BACKGROUND

Peripherally inserted central catheters (PICCs) are widely used for administering chemotherapy to breast cancer patients due to their long-term indwelling capability, versatility in drug administration, and flexibility. PICCs infection are a relatively common occurrence, yet there were no reported instances that it can metastasise to the lumbar spine.

CASE SUMMARY

This case report describes a breast cancer patient who developed a methicillin-resistant Staphylococcus aureus lumbar vertebral infection secondary to a PICC-related infection during chemotherapy. Following PICC removal, bacterial culture confirmed the presence of highly virulent methicillin-resistant Staphylococcus aureus. The patient presented with fever and severe lumbar pain. Lumbar magnetic resonance imaging revealed paraspinal muscle edema from L1 to L3 with abnormal signal intensity in the affected regions, suggestive of vertebral osteomyelitis. Prompt initiation of appropriate antibiotic therapy based on the culture results led to significant improvement in the patient’s lumbar pain.

CONCLUSION

This case highlights the importance of vigilant infection prevention and control measures to minimize the risk of PICC-related complications, such as bloodstream infections and subsequent metastatic infections.

Wernicke encephalopathy presenting as a stroke mimic: A case report

BACKGROUND

Several conditions may present with acute neurological symptoms, thus mimicking the presentation of stroke. Although the underlying disorder can be diagnosed after careful medical, neurological, and radiological examinations, a few conditions, such as Wernicke encephalopathy (WE), may present a particular diagnostic difficulty. WE is a neurological disorder caused by deficiency of thiamine (B1 vitamin), most often resulting from alcoholism, malnutrition, hyperemesis gravidarum or bariatric surgery. The diagnosis of WE in a certain historical, clinical setting is easily suggested, but in a few cases presenting with acute neurological deficits, it can be particularly challenging.

CASE SUMMARY

We present the case of a 63-year-old man who was brought to the emergency department after developing weakness of the left extremities, dizziness and a confusional state, which had lasted for approximately 30 minutes. The patient had a similar episode of a confusional state approximately two months earlier; at that time, a transient ischemic attack was suspected and he was started on aspirin. The initial clinical evaluation and imaging findings were unremarkable for stroke, but the patient’s symptoms, history of chronic alcohol abuse and abnormal liver function tests prompted the consideration of WE. Magnetic resonance imaging findings in subthalamic areas and electroencephalogram data of diffuse delta activity supported this diagnosis.

CONCLUSION

Through this case report, we aim to underscore the importance of considering WE as a differential diagnosis in patients presenting with symptoms suggestive of stroke, especially when the presentation is atypical or when risk factors for thiamine deficiency are present. Since intravenous thiamine significantly improves outcomes, delayed recognition and treatment in some cases might be deleterious.

Chronic hepatitis B triggering antineutrophil cytoplasmic antibody-associated vasculitis complicated by glomerulonephritis: A case report

BACKGROUND

Hepatitis B virus (HBV) infection can lead to renal involvement, commonly manifested as HBV-associated glomerulonephritis (HBV-GN), which typically presents as nephrotic or nephritic syndrome. Antineutrophil cytoplasmic antibody-associated vasculitis (AAV) is a systemic disease characterized by immune necrotizing inflammation of small blood vessels involving multiple organs with complex and severe clinical implications. The coexistence of HBV-GN and AAV is sporadic, with limited data existing regarding its diagnosis, management, clinical outcomes, and prognosis, especially in patients with AAV.

CASE SUMMARY

This manuscript presents the case of an older male patient who presented with persistent foamy urine lasting over two weeks. Initial clinical findings included nephrotic syndrome and renal insufficiency, which subsequently progressed to involve the lungs, immune system, hematologic system, and other organ systems. The patient was diagnosed with HBV-GN complicated by AAV, a rare and complex condition. Despite receiving comprehensive treatment, including corticosteroids, cyclophosphamide for immune regulation, plasma exchange, and immunoadsorption targeting antineutrophil cytoplasmic antibody-associated antibodies, the patient required long-term dialysis and demonstrated a poor prognosis.

CONCLUSION

HBV infection may trigger nephropathy with AAV. Early recognition and intervention are crucial for improving patient prognosis.

Unusual foreign body in the buccal mucosa: A case report

BACKGROUND

Intraoral honeybee stings are very rare. Stings by these insects occur 25% of the time in the head and neck region. In addition, a stinger intraorally can lead to persistent irritation, inflammation, and secondary infections if not promptly excised.

CASE SUMMARY

We report the case of a 52-year-old female patient who was stung in her mouth by a honeybee, causing a local irritation. The patient presented with a one-month history of pain, swelling, and redness in the left buccal mucosa. Inadvertently retained, the stinger was discovered during a clinical evaluation following initial treatment for facial swelling and erythema. After the stinger was removed, the patient’s symptoms resolved without complications.

CONCLUSION

This case emphasizes the importance of thorough examination and prompt management of insect stings to prevent prolonged discomfort and potential complications.

Diced cartilage in capsula based on diced cartilage in fascia technique: A case report

BACKGROUND

The Turkish Delight technique, initially described by Erol in 2000, involves the use of diced cartilage wrapped in oxidized cellulose (Surgicel™) for nasal grafting in secondary rhinoplasty.

CASE SUMMARY

This paper presents a novel adaptation called Diced Cartilage in Capsula, where diced cartilage is wrapped in the periprosthetic capsule material formed from a previous breast augmentation procedure instead of fascia, a technique based on the Diced Cartilage in Fascia method. Utilizing autologous, biocompatible material minimizes foreign body reactions and enhances graft integration. This innovative approach demonstrates the potential for specific practices in cosmetic surgery by optimizing patient-specific resources and improving surgical outcomes.

CONCLUSION

The report compares traditional Turkish Delight applications with this new method, discussing biocompatibility, technique efficacy, and benefits in rhinoplasty.

Innovative approaches to managing chronic multimorbidity: A multidisciplinary perspective

The rising prevalence of chronic multimorbidity poses substantial challenges to healthcare systems, necessitating the development of innovative management strategies to optimize patient care and system efficiency. The study by Fontalba-Navas et al investigates the implementation of a novel high complexity unit (HCU) specifically designed to improve the management of patients with chronic complex conditions. By adopting a multidisciplinary approach, the HCU aims to provide comprehensive, patient-centered care that enhances health outcomes and alleviates the strain on traditional hospital services. Utilizing a longitudinal analysis of data from the Basic Minimum Data Set, this study compares hospitalization metrics among the HCU, Internal Medicine, and other departments within a regional hospital throughout 2022. The findings reveal that the HCU's integrated care model significantly reduces readmission rates and boosts patient satisfaction compared to conventional care practices. The study highlights the HCU's potential as a replicable model for managing chronic multimorbidity, emphasizing its effectiveness in minimizing unnecessary hospitalizations and enhancing the overall quality of patient care. This innovative approach not only addresses the complexities associated with chronic multimorbid conditions but also offers a sustainable framework for healthcare systems confronting similar challenges.

Brain and scalp metastasis of cervical cancer in a patient with human immunodeficiency virus infection: A case report

BACKGROUND

Cervical cancer is the most commonly diagnosed cancer worldwide and the most common cancer in females living with human immunodeficiency virus (HIV). Cervical cancer is classified as an acquired immune deficiency syndrome-defining disease. Brain metastases (BMs) from cervical cancer are extremely rare, with an incidence rate of approximately 0.63%, and there is limited information on optimal treatment protocols and patient outcomes. Since brain lesions are sequestered behind the blood-brain barrier, multimodal treatment approaches are crucial to help improve the prognosis of cervical cancer in patients with BMs who are also living with HIV.

CASE SUMMARY

A 42-year-old Chinese female with HIV infection was diagnosed with stage IIIC1r cervical cancer in March 2022 based on the International Federation of Gynecology and Obstetrics system. Fourteen months after undergoing the initial treatment with concurrent chemotherapy and radiotherapy in January 2024, the patient presented to a local hospital with a severe explosive headache. The patient underwent craniotomy and postoperative pathological examination confirmed metastasis of cervical squamous cell carcinoma to the brain on February 1, 2024. Following surgery, the patient received external beam radiotherapy for the metastatic lesions. The patient has been under observation for 7 months with no evidence of tumor recurrence.

CONCLUSION

Females living with HIV are more than three times more likely to be diagnosed with cervical cancer. Due to the scarcity of cervical cancer BMs, therapeutic protocol experience is limited. In addition to the existence of the blood-brain barrier, the treatment of cervical cancer BMs appears to be exceptionally complex, and a multi-modal treatment approach consisting of chemotherapy, surgery, and radiation may help prolong patients’ life. For females living with HIV, antiretroviral therapy should be prioritized, as recommended by the Center for Disease Control in China. An intact immune system and a high CD4⁺ count are positive indicators of treatment response and tumor reduction. The overall survival of patients with cervical cancer after brain metastasis is approximately 3-5 months. However, owing to multimodal therapy and the use of antiretroviral therapy, the patient reported in this case showed no signs of recurrence after prolonged follow-up.

Potential role of large language models and personalized medicine to innovate cardiac rehabilitation

Cardiac rehabilitation is a crucial multidisciplinary approach to improve patient outcomes. There is a growing body of evidence that suggests that these programs contribute towards reducing cardiovascular mortality and recurrence. Despite this, cardiac rehabilitation is underutilized and adherence to these programs has been a demonstrated barrier in achieving these outcomes. As a result, there is a growing focus on innovating these programs, especially from the standpoint of digital health and personalized medicine. This editorial discusses the possible roles of large language models, such as their role in ChatGPT, in further personalizing cardiac rehabilitation programs through simplifying medical jargon and employing motivational interviewing techniques, thus boosting patient engagement and adherence. However, these possibilities must be further investigated in the clinical literature. Likewise, the integration of large language models in cardiac rehabilitation will be challenging in its nascent stages to ensure accurate and ethical information delivery.

Treatment of immunoglobulin A nephropathy: Current perspective and future prospects

Immunoglobulin (Ig) A nephropathy is the most common type of primary glomerulonephritis globally. It typically manifests with microscopic hematuria and a spectrum of proteinuria, although rapidly progressive glomerulonephritis may occur in rare instances. Deposition of IgA in the mesangium seems to be the underlying disease mechanism. Despite current treatment, IgA nephropathy may progress into end-stage renal disease, indicating the necessity for the development of new therapeutic agents. Lifestyle modifications and anti-proteinuric treatment are recommended, and steroids have shown to be beneficial to high risk groups. Nevertheless, other conventional immunosuppressive agents, such as cyclophosphamide and mycophenolate mofetil, may be considered, despite the lack of sufficient evidence to support their efficacy. A considerable proportion of cases remain unresponsive to these treatments, underscoring the need for novel therapeutic approaches. There are several promising immunosuppressive drugs, such as B-cell lineage depleting agents or complement system inhibitors, that are currently undergoing clinical trials. These therapies may be considered for use in selected cases.

Delayed diagnosis of pulmonary tuberculosis with pleuritis due to ampicillin/sulbactam: A case report

BACKGROUND

Tuberculosis (TB) remains a global health concern despite decreasing incidence. Delayed TB diagnosis can exacerbate patient outcomes and lead to broader public health issues such as mass infections. Differentiation between TB and bacterial pneumonia is often complicated by variable clinical and radiological manifestations of TB, leading to diagnostic delays.

CASE SUMMARY

An 89-year-old, Japanese male patient with a history of diabetes mellitus, hypertension, and hypothyroidism presented with right-sided chest pain. Based on the elevated inflammatory response, right pleural effusion, and infiltrating shadow in the lung field, the diagnosis of right pleurisy was made and the antibiotic, ampicillin/sulbactam, was administered. The patient’s condition, inflammatory reaction, and right pleural effusion temporarily improved. However, persistent low-grade fever and malaise prompted further evaluation, revealing repeated right pleural effusion and inflammatory response. A right thoracentesis was performed; the patient was diagnosed with tuberculous pleurisy as a result of exudative effusion with lymphocyte predominance, elevated adenosine deaminase levels, and positive Mycobacterium TB polymerase chain reaction test. Anti-TB treatment, including isoniazid, rifampicin, and ethambutol was initiated, leading to significant clinical improvement. The patient successfully completed a 12-month course of TB therapy without recurrence or deterioration.

CONCLUSION

There are cases of TB wherein temporary improvement apparently could be shown through treatment with antimicrobial agents other than anti-TB drugs, necessitating careful evaluation in atypical cases of bacterial pneumonia.

Successful treatment of depressed esophageal squamous papilloma with interferon- alpha 2a: A case report

BACKGROUND

Esophageal squamous papilloma (ESP) is a rare benign tumor of the esophagus, typically characterized by an exophytic and warty appearance, with a diameter of less than 5 mm. Endoscopic resection is considered the most effective treatment for these tumors.

CASE SUMMARY

In this paper, we discussed the pathogenesis, clinical characteristics, and therapeutic options of ESP based on our experience with a case presenting a depressed appearance and treated with interferon-alpha 2a (IFNα2a) injection.

CONCLUSION

This paper reports the first successful clinical case of using the human IFNα2a for the treatment of ESP with a depressed endoscopic appearance. However, the efficacy of interferon treatment requires to validation in a large number of subsequent cases.

Total adenosine deaminase cases as an inflammatory biomarker of pleural effusion syndrome

BACKGROUND

Although inflammatory diseases commonly affect the pleura and pleural space, their mechanisms of action remain unclear. The presence of several mediators emphasizes the concept of pleural inflammation. Adenosine deaminase (ADA) is an inflammatory mediator detected at increased levels in the pleural fluid.

AIM

To determine the role of total pleural ADA (P-ADA) levels in the diagnosis of pleural inflammatory diseases.

METHODS

157 patients with inflammatory pleural effusion (exudates, n = 124, 79%) and non-inflammatory pleural effusion (transudates, n = 33, 21%) were included in this observational retrospective cohort study. The P-ADA assay was tested using a kinetic technique. The performance of the model was evaluated using the area under the receiver operating characteristic (ROC) curve (AUC). The ideal cutoff value for P-ADA in pleural inflammation was determined using the Youden index in the ROC curve.

RESULTS

The transudates included congestive heart failure (n = 26), cirrhosis of the liver with ascites (n = 3), chronic renal failure (n = 3), and low total protein levels (n = 1). The exudate cases included tuberculosis (n = 44), adenocarcinoma (n = 37), simple parapneumonic effusions (n = 15), complicated parapneumonic effusions/empyema (n = 8), lymphoma (n = 7), and other diseases (n = 13). The optimal cutoff value of P-ADA was ≥ 9.00 U/L. The diagnostic parameters as sensitivity, specificity, positive and negative predictive values, positive and negative likelihood values, odds ratio, and accuracy were 77.69 (95%CI: 69.22-84.75); 68.75 (95%CI: 49.99-83.88); 90.38 and 44.90 (95%CI: 83.03-95.29; 30.67-59.77); 2.48 and 0.32 (95%CI: 2.21-11.2; 0.27-0.51); 7.65 (95%CI: 0.78-18.34), and 75.82 (95%CI: 68.24-82.37), respectively (χ² = 29.51, P = 0.00001). An AUC value of 0.8107 (95%CI: 0.7174-0.8754; P = 0.0000) was clinically useful. The Hosmer-Lemeshow test showed excellent discrimination.

CONCLUSION

P-ADA biomarker has high diagnostic performance for pleural inflammatory exudates.

Necessity of collaboration between pain physicians and orthotists in pain medicine

In this editorial, we comment on the article by Nagamine et al, published in the World Journal of Clinical Cases. The authors suggest that virtual reality technology has potential in alleviating pain by enhancing brain network functionality. Alongside virtual reality, various treatment methods are used to effectively manage musculoskeletal pain. One such method is the use of orthoses, which are applied in clinical settings. We emphasize the need for collaboration between pain physicians and orthotists when applying orthoses for pain management. The efficacy of orthoses is maximized when customized to the physical characteristics of each patient, type of disease, and location of pain. Orthoses are designed to restore anatomical alignment and biomechanical function; however, their success depends on the expertise of trained orthotists, who should effectively communicate with physicians and understand the mechanical principles of musculoskeletal alignment. The professional knowledge of orthotists is critical in ensuring that orthoses are appropriately designed and applied to achieve therapeutic efficacy. Since no single treatment modality typically offers sufficient relief for musculoskeletal pain, effective collaboration between pain physicians and orthotists is crucial to optimize the use of orthoses in the management of pain.

Primary mucosa associated lymphoid tissue lymphoma of the gallbladder: A case report and review of literature

BACKGROUND

The primary lymphomas of mucosa associated lymphoid tissue (MALT) of the gallbladder (GB) is an extremely rare of non-Hodgkin lymphoma. Many patients exhibit symptoms like gallstone disease, and in some cases, the lymphoma may be detected through imaging even without apparent symptoms. Only 19 cases of primary MALT lymphoma in the GB have been previously reported. Differential diagnosis from typical GB carcinoma based solely on imaging findings can be challenging, and definitive diagnosis often requires surgical intervention.

CASE SUMMARY

We present a patient in an 82-year-old man who was initially diagnosed with prostate cancer but incidentally detected GB wall thickening from magnetic resonance imaging conducted for prostatic surgery and subsequent radical cholecystectomy revealed primary MALT lymphoma of the GB. The patient was followed up by a medical oncologist, and after discussion, the decision was made to continue observation with close monitoring without systemic chemotherapy given the asymptomatic presentation. The patient has been free of recurrence for 16 months after the surgery. Although precise diagnosis before the surgery was difficult in this case, preoperative examinations revealed a submucosal tumor-like lesion.

CONCLUSION

MALT lymphoma of GB remains little known in many previous studies. It is really difficult to preoperatively diagnose. The combination of clinical presentation, postoperative histology and immunohistochemistry contribute to diagnosis and carry out appropriate management.

New surgical approach for distal clavicle fractures: A case report

BACKGROUND

Clavicle fractures are a common type of fracture that often occurs after high-energy trauma. The treatment methods for clavicle fractures remain controversial. Both locking compression and hook plates are recommended.

CASE SUMMARY

A 44-year-old male suffered an injury during skiing. Radiography revealed a right-sided distal clavicular fracture. The fracture was treated using a hook plate due to its small size. During the surgical procedure, Kirschner wires were used to drill holes in the acromion. The end of the hook plate was inserted into the hole rather than below the edge of the acromion.

CONCLUSION

One year later, imaging revealed complete healing of the fracture, and the hook plate was removed. The patient was satisfied with the course and treatment results. Additionally, a new classification system was proposed based on the degree of injury to the distal clavicle joint surface. The incidence of postoperative complications associated with the use of hook plates for clavicular fracture treatment is relatively high. Complications can be reduced by changing the hook plate placement.

Temporal changes in computed tomography findings of a persimmon bezoar: A case report

BACKGROUND

Gastric bezoars are masses of indigestible material that accumulate in the stomach, causing nausea, abdominal pain, and vomiting. Persimmon bezoars (diospyrobezoars), which comprise tannins and fibers from persimmons, are relatively rare but may cause significant gastric complications, including gastric outlet obstruction or ileus. Although computed tomography (CT) is a useful imaging tool, diagnosing bezoars can be challenging because their density is similar to that of food debris and gastric content.

CASE SUMMARY

Here, we report the case of a 72-year-old woman with a persimmon bezoar that was diagnosed using serial CT imaging and confirmed by endoscopy. CT performed over several months revealed changes in the internal structure and density of the bezoar, suggesting progressive hardening. The patient had a history of a partial gastrectomy and excessive persimmon consumption, both of which are risk factors for bezoar formation. Endoscopic fragmentation of the bezoar successfully resolved symptoms.

CONCLUSION

Gastric bezoars, particularly persimmon bezoars, present diagnostic challenges because of their variable imaging characteristics. Serial CT can document temporal changes in bezoar density, potentially reflecting changes in hardness. Early diagnosis and endoscopic treatment are essential for effective management, particularly in patients with predisposing factors. This case underscores the importance of considering bezoars in the differential diagnosis of gastric masses, and highlights the value of CT for monitoring changes in bezoar characteristics over time.

Refractory Crohn's disease complicated with Guillain-Barré syndrome: A case report

BACKGROUND

Inflammatory bowel disease (IBD) comprises a group of chronic inflammatory gastrointestinal disorders, including Crohn's disease (CD) and ulcerative colitis, with uncertain etiologies. The natural course of IBD can be accompanied by extraintestinal manifestations involving the skin, mucous membranes, musculoskeletal structures, eyes, cardiovascular system and nervous system. Guillain-Barré syndrome (GBS) is a type of peripheral neuropathy. However, the etiology and pathogenesis of IBD combined with GBS are unclear, and only a few clinical cases have been reported. Here, we report a case of refractory CD complicated by GBS and review the previous literature to improve the understanding of these diseases.

CASE SUMMARY

A 34-year-old man had a 9-year history of refractory CD. He became unresponsive to multiple drugs and experienced recurrent intestinal fistulas. After several abdominal surgeries and treatment with ustekinumab, he achieved clinical remission. Unfortunately, he developed GBS during maintenance treatment with ustekinumab. According to previous reports, in some patients with IBD combined with GBS, GBS may be a comorbidity, an extraintestinal manifestation of IBD, or an adverse reaction to IBD therapeutic drugs. After a comprehensive evaluation, we suspected that GBS might have been a comorbidity in this patient. To avoid fatal disease relapse after medication discontinuation, we concluded that ustekinumab should not be withdrawn. On the basis of a joint decision between doctors and the patient, we decided to continue maintenance treatment with ustekinumab along with intravenous immunoglobulin, dexamethasone and traditional Chinese medicine acupuncture, which resulted in a steady improvement in his GBS symptoms and sustained remission of CD.

CONCLUSION

When IBD is complicated by a neurological disease, it is first necessary to analyze the patient's condition and then choose the corresponding treatment strategy. If the neurological disease is a specific comorbidity, treatment of both IBD and the comorbid disease should be considered. For IBD patients with extraintestinal manifestations involving the nervous system, neurological manifestations tend to resolve when the active IBD is controlled. When an adverse drug reaction is suspected, the medication should be discontinued, and symptomatic treatment should be administered.

Concurrent invasive ductal carcinoma and ductal carcinoma in situ arising inside and outside a breast hamartoma: A case report

BACKGROUND

Breast hamartomas are rare benign breast tumors, with an incidence rate of 0.8%-4.8%. Further, the coexistence of hamartomas and carcinoma is also uncommon. Our case report presents a unique instance where invasive ductal carcinoma (IDC) and ductal carcinoma in situ were found both inside and outside a breast hamartoma. This is the second case reported in the literature.

CASE SUMMARY

A 51-year-old woman presented with a 6.0 cm breast tumor on mammography and ultrasound, with suspicious areas indicative of malignant transformation. Biopsy of the suspicious area confirmed IDC with intraductal carcinoma. Breast magnetic resonance imaging showed typical hamartoma changes with irregular areas of abnormal enhancement both inside and outside. A breast-conserving surgery was performed, and postoperative pathology confirmed mammary hamartoma, concurrent with IDC and intraductal carcinoma occurring both inside and outside the hamartoma. Subsequently, appropriate adjuvant therapy was initiated. Currently, the patient is in good condition. Breast cancer may be located both inside and outside the ipsilateral mammary hamartoma, which is difficult to detect preoperatively, especially when there is a focus of intraductal carcinoma, requiring accurate assessment of the tumor extent by modern imaging techniques. Early detection of the coexistence of cancer is clinically important as it can alter patient management.

CONCLUSION

This case emphasizes the importance of modern imaging techniques in accurately evaluating mammary hamartomas associated with malignancies prior to surgery.

Abdominal tuberculosis with pancreatic head involvement mimicking pancreatic malignancy in a young man: A case report

BACKGROUND

Pancreatic tuberculosis (PTB) is a rare disease, even in immunocompetent hosts. Abdominal tuberculosis involving the pancreatic head and peripancreatic areas may simulate pancreatic head carcinoma.

CASE SUMMARY

We present the case of a 32-year-old man who was admitted to our hospital for intermittent epigastric pain and weight loss. A computed tomography scan and magnetic resonance imaging revealed a mass in the head of the pancreas. The lesion was initially diagnosed as pancreatic head carcinoma on abdominal imaging. Laparotomy confirmed the diagnosis of PTB and the patient received antituberculosis therapy.

CONCLUSION

The present case is reported to emphasize the importance of including PTB in the differential diagnosis of pancreatic lesions.

Improved superelastic Ni–Ti alloy wire for treating skeletal class III malocclusion combined with anterior crossbite: A case report

BACKGROUND

Correcting skeletal class III malocclusion with anterior crossbite in adolescents using only orthodontic treatment poses challenges. This report highlights a novel approach leveraging improved superelastic Ni–Ti alloy wire (ISW) to address these conditions effectively.

CASE SUMMARY

A 17-year-old male patient presented with the chief complaint of an underbite. The patient was given a diagnosis of skeletal class III malocclusion and anterior crossbite. The orthodontic treatment plan was implemented and did not require teeth extractions or orthognathic surgery. Key interventions involved the application of ISW, intermaxillary elastics, and ISW unilateral multi-bend edgewise archwire. The unique combination of these techniques enabled the correction without the need for extractions or surgery. This approach leverages the advanced biomechanical properties of ISW, including its super-elasticity and shape memory, to enhance treatment efficacy. The treatment lasted 17 months, and major improvements in overjet, overbite, and alignment were achieved. The results were favorable, and stability was discovered during follow-up.

CONCLUSION

The application of ISW for treating skeletal class III malocclusion with anterior crossbite in a 17-year-old male patient resulted in exceptional outcomes. The treatment led to a marked improvement in the patient’s facial profile and to proper overjet, overbite, and midline alignment. These results were maintained over a one-year follow-up, indicating that a minimally invasive orthodontic approach can effectively address complex skeletal discrepancies in adolescent patients. This case illustrates that with the careful use of advanced orthodontic techniques, major skeletal challenges can be resolved without resorting to surgical procedures.

Misdiagnosis of psoriatic arthritis in a patient with paronychia confirmed by dermatological examination: A case report

BACKGROUND

This case highlights the importance of a multidisciplinary approach in differentiating localized infections from systemic inflammatory diseases like psoriatic arthritis. Nail psoriasis can mimic conditions like paronychia, complicating diagnosis. We wrote this report to emphasize the need for clinical vigilance when interpreting imaging findings, especially in patients with a family history of psoriasis. Misdiagnosis can lead to unnecessary systemic treatments, underscoring the significance of dermatological input in achieving accurate diagnoses.

CASE SUMMARY

A 56-year-old woman presented with redness and swelling of multiple fingertips. Her family history of psoriasis raised suspicion of psoriatic arthritis. Two rheumatologists diagnosed psoriatic arthritis based on ultrasound findings of enthesitis with a positive Doppler signal and recommended methotrexate. However, she was reluctant to initiate therapy due to potential side effects. At our Rheumatology Center, paronychia was suspected, and laboratory tests excluded systemic inflammatory arthritis. Dermatological examination confirmed paronychia, and treatment with fluconazole and ceftriaxone was initiated to address suspected mixed bacterial and fungal infections. Imaging studies, including hand and wrist X-rays, showed no erosions or other signs of psoriatic arthritis. The patient responded well to antimicrobial therapy, with resolution of symptoms. This case highlights the need for thorough clinical evaluation, careful interpretation of imaging findings, and collaboration between rheumatologists and dermatologists to avoid misdiagnosis and inappropriate treatment.

CONCLUSION

This case underscores the need for thorough clinical evaluation and caution in interpreting nonspecific imaging findings, especially in patients with a family history of psoriasis. While familial predisposition may raise suspicion for psoriatic arthritis, it is essential to integrate laboratory data, imaging studies, and clinical presentation, including response to targeted antimicrobial therapy. A multidisciplinary approach, involving both rheumatologists and dermatologists, is crucial to preventing misdiagnosis, ensuring appropriate treatment, and avoiding the potential harms of unwarranted therapies.

Temporary bilateral uterine artery occlusion in the control of hemorrhage: A case report and review of literature

BACKGROUND

Intramural pregnancy is rare, with an unclear etiology and pathophysiology. Surgical, medical, and expectant management options are available for this condition. However, most reported cases are managed surgically. Despite the risks of massive intraoperative bleeding and acute and long-term complications, uterine artery embolization is often selected. Temporary occlusion of the bilateral uterine arteries during surgery is associated with fewer complications.

CASE SUMMARY

We reported the case of a patient who was diagnosed with intramural pregnancy approximately one month after medical abortion. We performed laparoscopic resection with hysteroscopy. Since the lesion had abundant blood flow, we temporarily blocked the bilateral uterine arteries to prevent massive intraoperative bleeding. The surgical process went smoothly. The postoperative course was uneventful.

CONCLUSION

Temporary occlusion of the bilateral uterine arteries in the treatment of intramural pregnancy may prevent excessive uterine bleeding during surgery.

Luscan-Lumish syndrome: A case report

BACKGROUND

Luscan-Lumish syndrome (LLS) is a rare genetic congenital anomaly syndrome characterised by neurodevelopmental disorders, including delayed psychomotor development, behavioral difficulties, relative or true macrocephaly and, in individual cases, ocular abnormalities. This paper aims to present the case of a child with ocular abnormalities associated with LLS.

CASE SUMMARY

A 10-year-old girl born at 40 weeks gestation with features of dysmorphia, neurodevelopmental disorders, genetically confirmed LLS, convergent strabismus and suspected congenital glaucoma. Eye examination, ultrasound, optical coherence tomography (OCT), perimetry and electrophysiological study [pattern visually evoked potentials (VEP)] were performed. Best-corrected distance visual acuity was 0.5 in the right eye (correction -1.0 Dsph, -1.0 Dcyl, axis 180°) and 0.62 in the left eye (correction -2.0 Dsph). Near visual acuity (Snellen Chart) with the above correction was -0.5 D. A cycloplegic refraction test yielded -1.25 Dsph, -1.25 Dcyl, axis 165° in the right eye, and -2.0 Dsph, -0.25 Dcyl, axis 154° in the left eye. Intraocular pressure was 15 mmHg in both eyes. OCT of the maculae showed no abnormalities. In both eyes, the average ganglion cell layer and inner plexiform layer thickness was 73 μm. OCT of the optic nerve disc showed an average retinal nerve fibre layer thickness of 89 μm in the right eye and 81 μm in the left eye, with symmetry of 90%. The rim area was 1.59 mm² and 1.74 mm² in the right and left eye, respectively. The disc area was 2.77 mm² in the right eye and 2.89 mm² in the left. The average cup-to-disc ratio was 0.64 in the right eye and 0.62 in the left eye. Ocular ultrasound depicted single extra echoes inside the vitreous chamber; otherwise, there were no abnormalities. Right and left eyeball lengths were 24.59 mm and 24.51 mm, respectively. Kinetic perimetry revealed no visual field defects, while static testing showed single relative scotomas. The mean defect was 4.7 dB in the right and 2.6 dB in the left eye. The loss variance values were 4.8 and 3.8 dB for the right and left eye, respectively. Pattern VEP test revealed normal values of P100 Latency. Wave amplitude in the right eye was 50% at a visual angle of 1.0° and 30% at 15’. Due to the rarity of LLS, it seems interesting to present the child ophthalmological examination with changes in the electrophysiological examination.

CONCLUSION

Although eye abnormalities are infrequently described in children with LLS, the patients should undergo eye examinations, especially as they may have central nervous system anomalies that may give rise to visual impairments. Generally, children with genetically determined congenital syndromes should receive regular ophthalmic check-ups for a thorough evaluation of the eyes and prognosis of the development of visual function.