Precision en-bloc retroperitoneal paraganglioma resection performed laparoscopically: A case report

BACKGROUND

Phaeochromocytoma and paragangliomas (PPGL) are rare neuroendocrine tumors usually caused by parasympathetic or sympathetic nerves, with an overall incidence of approximately 0.66 cases per 100000 people per year. Most PPGLs are asymptomatic, and a few develop symptoms, such as elevated blood pressure and rapid heart rate, because of the release of catecholamines. According to the literature, surgical resection is the mainstay of PPGL treatment. However, the choice between minimally invasive surgery and open surgery remains controversial, particularly in cases involving complex anatomical relationships. We successfully resected a tumor located between the inferior vena cava and abdominal aorta using a minimally invasive approach with the assistance of computed tomography (CT) angiography and three-dimensional reconstruction, resulting in a favorable outcome.

CASE SUMMARY

A 56-year-old woman was admitted to the hospital with right upper abdominal discomfort for more than 6 months, experiencing occasional pins and needles sensation and radiation from the right shoulder and back. Prehospital CT of the upper abdomen revealed a retroperitoneal mass suspected to be a retroperitoneal ganglioneuroma. Surgery was recommended, and an enhanced CT scan of the upper abdomen, along with preoperative three-dimensional reconstruction, was performed after admission. The imaging indicated that the mass, measuring approximately 4.1 cm × 3.8 cm × 4.8 cm, was situated between the abdominal aorta and the inferior vena cava, extending downward to the level of the left renal vein. After ruling out any contraindications to surgery, a minimally invasive laparoscopy was performed to excise the mass precisely. The surgery was successful without any postoperative complications, and the 2-month follow-up revealed no abnormal signs of recurrence.

CONCLUSION

This case report describes successful and precise laparoscopic resection of a retroperitoneal tumor. The patient recovered well during the 2-month follow-up, and postoperative pathology revealed a paraganglioma.

Intraluminal migration of a surgical drain near an anastomosis site after total gastrectomy: A case report

BACKGROUND

Esophagojejunal anastomotic leakage (EJAL) is a severe complication following gastrectomy for gastric cancer, typically treated with drainage and nutritional support. We report a case of intraluminal drain migration near the esophagojejunal anastomosis (EJA), resulting in persistent drainage and mimicking EJAL after total gastrectomy.

CASE SUMMARY

A 64-year-old male underwent open total gastrectomy with Roux-en-Y reconstruction for gastric adenocarcinoma, with two silicone drains placed near the EJA. On postoperative day (POD) 4, the patient developed signs of peritonitis and sepsis, necessitating surgical re-exploration abscess drainage, peritoneal lavage, and drain repositioning. A contrast swallow study on POD 18 revealed rapid filling of the abdominal drain without extraluminal contrast collection. Persistent drainage prompted an upper gastrointestinal endoscopy on POD 59, which revealed approximately 5 cm of the drain within the esophagus, with the perforation site located 2 cm distal to the intact EJA. The drain was repositioned under endoscopic guidance. A repeat contrast radiograph on POD 67 demonstrated no evidence of extraluminal contrast extravasation or filling of the abdominal drain. The patient was subsequently discharged without further incident.

CONCLUSION

Intraluminal drain migration is a rare complication following gastric surgery but should be considered when persistent drainage occurs.

Concurrent occurrence of adenocarcinoma and urothelial carcinoma of the prostate: Coexistence mechanisms from multiple perspectives

This article discusses the coexistence of prostate adenocarcinoma and prostate urothelial carcinoma. Combining existing literature and research results, the potential mechanisms of the co-occurrence of these two cancers are explored, including the role of androgen receptor, gene mutations, and their complex interactions in cell signaling pathways, etc. Also, the hypothesis of prostate cancer transformation into urothelial carcinoma is explained from some perspectives, including tumor multipotent stem cell differentiation, epithelial-mesenchymal transition, mesenchymal-epithelial transition, and other mechanisms. Ultimately, the goal is to provide more accurate diagnoses and more personalized treatments in clinical practice, as well as to lay the foundation for improving patient prognoses in the future.

Enhancing orthodontic osteodilated arch treatment through comprehensive nursing interventions and cognitive behavioral therapy

Orthodontic osteodilated arch treatment represents a pivotal approach in dental orthodontics to address dental crowding and misalignment. Integrating cognitive behavioral therapy (CBT) into comprehensive nursing interventions (CNI) aims to address these issues holistically. This editorial explores the effectiveness of CBT-based CNI in improving patient outcomes in orthodontic care. Innovations in remote CBT delivery, such as virtual reality, have also shown potential in reducing pain, anxiety, and depression, emphasizing CBT's adaptability in orthodontic settings. The findings underscore the importance of integrating psychological support into orthodontic care to enhance patient adherence, satisfaction, and overall treatment success. The editorial advocates for a holistic approach that combines psychological and physiological care, highlighting the transformative potential of CBT-based interventions in orthodontic treatment.

Small bowel obstruction due to intra-abdominal hernia: New thoughts on diagnosis and treatment

Internal herniation (IH) refers to the movement of intra-abdominal organs or tissues out of their original position through normal or abnormal orifices and fissures in the peritoneum or mesentery and into an anatomic space within the abdominal cavity. Although the incidence of small bowel obstruction (SBO) caused by IH is very low (approximately 0.2% to 0.9%), its incidence may be increased in certain specific populations or in postoperative patients. Recently Kaw et al shared their 13-year experience of managing IHs in a tertiary care hospital in India. This retrospective study analyzed and determined the clinico-demographic profiles, radiological and operative findings and postoperative course of patients with IH and the association with SBO. The results provide valuable insights into early diagnosis and establishment of a timely treatment regimen for this condition and emphasize the importance of combining rapid imaging evaluation with the traditional therapeutic approach of laparoscopic surgery, thus providing a novel perspective on the diagnosis and treatment of SBO caused by IH.

Gastrointestinal bleeding due to small bowel metastasis from lung adenocarcinoma: A case report

BACKGROUND

Lung cancer is the most prevalent malignant tumor in human body, and is characterized by a high level of malignancy. The most common metastatic sites include the liver, bone, brain, and adrenal gland, while lung cancer resulting in gastrointestinal tract metastasis is uncommon.

CASE SUMMARY

A 74-years-old man with lung cancer was hospitalized owing to blood in the stool, The cause was identified as metastasis to the small intestine, and the patient subsequently underwent radical resection of the small intestine tumor. Currently, the overall condition of the patient is good, and undergoing combined chemotherapy.

CONCLUSION

Early intervention in patients with metastatic tumors can significantly improve prognosis.

Corticosteroids in posterior reversible encephalopathy syndrome: Friend or foe? A systematic review

BACKGROUND

Posterior reversible encephalopathy syndrome (PRES) is a complex neurological disorder characterized by symptoms such as headaches, seizures, confusion, and visual disturbances. The pathophysiology of PRES involves endothelial dysfunction, disrupted cerebral autoregulation, and resulting vasogenic edema. Hypertension and other factors that alter cerebral autoregulation are critical in its development. Corticosteroids, widely used for their anti-inflammatory and immunosuppressive properties, play a controversial role in PRES.

AIM

To elucidate the dual role of corticosteroids in the context of PRES by critically evaluating the existing literature. Specifically, it seeks to assess the results of PRES induced by corticosteroid therapy and the efficacy and safety of corticosteroids in the treatment of PRES. By synthesizing case reports and series, this review aims to provide a comprehensive understanding of the mechanisms, clinical presentations, and management strategies associated with corticosteroid-related PRES.

METHODS

The review was carried out according to the PRISMA guidelines. The databases searched included Science Direct, PubMed, and Hinari. The search strategy encompassed terms related to corticosteroids and PRES. Studies were included if they were peer-reviewed articles examining corticosteroids in PRES, excluding non-English publications, reviews, and editorials. Data on patient demographics, clinical characteristics, imaging findings, corticosteroid regimens, and outcomes were extracted. The risk of bias was evaluated using the Joanna Briggs Institute tool for case reports.

RESULTS

A total of 56 cases of PRES (66.1% women, 33.9% men) potentially induced by corticosteroids and 14 cases in which corticosteroids were used to treat PRES were identified. Cases of PRES reportedly caused by corticosteroids showed a mean age of approximately 25.2 years, with seizures, headaches, hypertension, and visual disturbances being common clinical sequelae. Magnetic resonance findings typically revealed vasogenic edema in the bilateral parieto-occipital lobes. High-dose or prolonged corticosteroid therapy was a significant risk factor. On the contrary, in the treatment cases, corticosteroids were associated with positive outcomes, including resolution of vasogenic edema and stabilization of symptoms, particularly in patients with underlying inflammatory or autoimmune diseases.

CONCLUSION

Corticosteroids have a dual role in PRES, capable of both inducing and treating the condition. The current body of literature suggests that corticosteroids may play a greater role as a precipitating agent of PRES rather than treating. Corticosteroids may induce PRES through hypertension and subsequent increased cerebral blood flow and loss of autoregulation. Corticosteroids may aid in the management of PRES: (1) Enhancing endothelial stability; (2) Anti-inflammatory properties; and (3) Improving blood-brain barrier integrity. Mechanisms which may reduce or mitigate vasogenic edema formation.

Diagnostic value of upper gastrointestinal imaging for duodenal webbing in adults: A case report

BACKGROUND

Duodenal web is a rare congenital malformation, exceedingly uncommon in adults, and often misdiagnosed due to the subtle imaging features.

CASE SUMMARY

By analyzing the clinical diagnosis process and various imaging findings of a patient from our institution, this case report emphasizes the necessity of upper gastrointestinal series in diagnosing duodenal webs, outlines its typical radiographic features, and provides a literature review on the etiology, clinical presentation, and management of this condition.

CONCLUSION

This case report emphasizes the necessity of upper gastrointestinal series in diagnosing duodenal webs.

Integration of rehabilitation and palliative care in cancer management: A futuristic model

It explores the integration of rehabilitation and palliative care in cancer management, advocating for a holistic approach that addresses the diverse needs of patients throughout their treatment journey. Traditional cancer care often prioritizes curative interventions at the expense of overall well-being, leading to a fragmented experience for patients. By combining rehabilitation-focused on restoring function and improving physical health-with palliative care-emphasizing symptom management and quality of life-healthcare providers can create a comprehensive support system. The essay highlights the importance of interdisciplinary collaboration among healthcare professionals, as well as the need for education and training to implement this integrated model effectively. Additionally, it addresses potential barriers such as funding limitations and institutional resistance. Ultimately, the integration of these two disciplines represents a critical evolution in cancer care, enhancing patient outcomes and ensuring that individuals receive compassionate, patient-centered support throughout their journey.

Enhancing outcomes in severe lymphedema through combined treatment strategies

Lymphedema, particularly in its advanced stages, presents significant challenges in treatment, often necessitating a combination of therapies to manage symptoms effectively and improve patient outcomes. This article reviews the findings of Wang et al, regarding the use of lymphovenous anastomosis and complex decongestive therapy in treating severe, deformed stage III lymphedema with recurrent infections. The case report details the promising results achieved through this combined therapy, highlighting substantial reductions in limb volume and the complete resolution of recurrent lymphangitis. The patient experienced notable improvements in weight loss, physical function, and quality of life. Despite its strengths, the study has several limitations. It lacks specific details on the types of lymphovenous anastomoses performed and complex decongestive therapy protocols, such as frequency and adherence, making reproducibility difficult. The short follow-up period of six months limits understanding of long-term efficacy, and more consistent reporting of key metrics such as weight loss and body mass index would enhance outcome assessments. This article emphasizes the importance of integrating minimally invasive surgical techniques with conservative therapies to address both the symptoms and underlying causes of lymphedema. Further research is essential to standardize protocols and refine combined treatment strategies.

Hepatic hemangiomas mimicking gastrointestinal stromal tumors: A case report

BACKGROUND

Hepatic hemangiomas can be challenging to diagnose, particularly when they present with atypical features that mimic other conditions, such as gastrointestinal stromal tumors (GISTs). This case highlights the diagnostic difficulties encountered when imaging subepithelial lesions, especially when conventional methods such as computed tomography (CT) and endoscopic ultrasound (EUS) are used.

CASE SUMMARY

A 44-year-old woman presented with intermittent abdominal distension and heartburn for three months. Her medical history included iron deficiency anemia, menorrhagia, and previous cholecystectomy. One week prior to admission, an endoscopy suggested a bulging gastric fundus, which was likely a GIST, along with chronic nonatrophic gastritis and bile reflux. CT and EUS revealed nodules in the gastric fundus, which were initially considered benign tumors with a differential diagnosis of stromal tumor or leiomyoma. During surgery, unexpected lesions were found in the liver pressing against the gastric fundus, leading to laparoscopic liver resection. Postoperative pathology confirmed the diagnosis of hepatic cavernous hemangiomas. The patient recovered well and was discharged five days later, with normal follow-up results at three months.

CONCLUSION

This case underscores the challenges in the preoperative diagnosis of GISTs, particularly the limitations of the use of CT and EUS for the evaluation of subepithelial lesions. While CT is the primary tool for visualizing abdominal tumors, it is difficult to detect smaller lesions and assess the layers of the gastrointestinal wall on CT. EUS is recommended for the evaluation of nodules smaller than 2 cm and is useful for distinguishing GISTs from other lesions; however, its accuracy with regard to the differential diagnosis is relatively low. In this case, the gastric distension observed on imaging led to the compression of a liver tumor against the stomach, resulting in the misinterpretation of the tumor as a gastric wall lesion.

Parietal peritoneal hernia after abdominal hysterectomy for forty years: A case report

BACKGROUND

Internal hernia is a rare complication following abdominal surgery, primarily resulting from structural defects caused by anastomosis. We report a unique case of a late abdominal wall internal hernia highly suspected as resulting from insufficient peritoneal closure.

CASE SUMMARY

A 72-year-old woman presented with symptoms of intestinal obstruction 40 years after undergoing an abdominal hysterectomy. Abdominal computed tomography revealed a suspicious closed loop of intestine; then, a laparotomy was performed for suspected internal hernia. During the procedure, herniation of intestine into the preperitoneal space through a parietal peritoneal defect between rectus abdominis and sigmoid colon was identified. Intestinal reduction, resection of the ischemic segment and closure of the peritoneal defect were performed. The patient recovered well.

CONCLUSION

Non-closure of peritoneum might lead to late internal hernias. Meticulous peritoneal closure should be considered to prevent this potentially lethal complication.

Dystrophic epidermolysis bullosa caused by novel frameshift mutation in the COL7A1 gene: A case report

BACKGROUND

Dystrophic epidermolysis bullosa is characterized by fragile ulcerations of the skin caused by mutations in specific genes. However, genetic typing of this condition is rare.

CASE SUMMARY

An 11-year-old female suffered from recurrent fever, visible ulcerations of the entire skin, and severe malnutrition. Genetic testing revealed a frameshift mutation in the coding region 4047 of the 35th intron region of COL7A1, and she was diagnosed as malnutrition-type epidermolysis bullosa. Drug therapy (immunoglobulin, fresh frozen plasma), topical therapy (silver ion dressing), fever reduction, cough relief, and promotion of gastrointestinal peristalsis are mainly used for respiratory and gastrointestinal complications. The patient's condition improved after treatment.

CONCLUSION

Dystrophic epidermolysis bullosa caused by a new framework shift mutation in COL7A1 should be taken seriously.

Utilizing complementary therapy to enhance quality of life and reduce stress and fatigue in pediatric cancer patients

The international scientific literature presents still incipient results regarding the management of cancer symptom clusters by oncology nursing, especially in pediatric oncology. This is a promising field of investigation for clinical nurses and researchers, and when it is subsidized by medium-range theories, they corroborate the diagnoses and interventions of nursing in oncology, enhancing the science of nursing care. This minireview article aims to discuss the utilizing the hospital clowns as a complementary therapy, to enhance quality of life and reduce stress and fatigue in pediatric cancer patients. Overall, the evidence presented so far pointed out that complementary therapy might help improve the quality of life of pediatric cancer patients, and that complementary therapy usage should be part of a health comprehensive care model, delivering therapeutic approaches that might enhance the mind-body during a pediatric cancer patients' life span. The results of scientific investigations by nurses, particularly those linked to the basic sciences, play a critical role in advancing personalized care in pediatric integrative oncology.

Exercise rehabilitation on patients with non-small cell lung cancer: A meta-analysis of randomized controlled trials

BACKGROUND

Lung cancer is one of the most common and deadly cancers worldwide. As the disease progresses and due to the side effects of treatment, patients' physical activity significantly decreases.

AIM

To systematically review and conduct a meta-analysis on the effects of exercise rehabilitation on the physical activity of lung cancer patients and determine the best implementation methods to provide clinical guidance.

METHODS

Literature was searched through multiple electronic databases. A random effects model was used to combine effect sizes through standardized mean difference (SMD). The Cochrane risk of bias tool was used to assess the quality of the literature, sensitivity analysis was used to ensure the robustness of the results, and Egger's test was used to detect publication bias and asymmetry.

RESULTS

A total of 11 studies involving 541 patients were included in this study. The physical endurance, muscle function and cardiopulmonary function of non-small cell lung cancer (NSCLC) patients were evaluated. The overall effect size of the six-minute walk test (6MWT) was not statistically significant. However, subgroup analysis found that endurance significantly improved when exercise duration exceeded 0.5 hours (P ≤ 0.05). In terms of muscle function, the overall effect size was SMD = 0.619. Subgroup analysis showed that strength training, respiratory training, and cross-training (XT) significantly improved muscle function. Exercise rehabilitation significantly enhanced cardiopulmonary endurance (SMD = 0.856, P = 0.002), and the effect was better when the single exercise duration was more than 1 hour, age was over 65 years, and the intervention period was more than 3 months.

CONCLUSION

Exercise rehabilitation effectively improved muscle function in NSCLC patients, especially strength training, respiratory training, and cross-training. Cardiopulmonary function also showed improvement, particularly when exercise duration exceeded 1 hour, age was ≥ 65 years, and the intervention period was more than 3 months. A single exercise duration of more than 0.5 hours can enhance patients' physical endurance. Appropriately increasing exercise duration and selecting suitable exercise forms can effectively improve the physical activity of NSCLC patients.

Nipah virus: Preventing the next outbreak

Nipah is a deadly viral infection which has come to the news highlight recently, due to its fresh onslaught in Southern India. As the world continues to recover from coronavirus disease 2019, the World Health Organization has identified a list of high-priority pathogens with the potential to cause future pandemics. Among them is the Nipah virus (NiV), which poses a significant threat. Even a small outbreak could trigger widespread panic among the public. The emergence and re-emergence of NiV among other zoonotic infections is a stern reminder of the importance of One health concept.

Rapid improvement in postpartum pulmonary hypertension associated with hereditary hemorrhagic telangiectasia: A case report and review of literature

BACKGROUND

Postpartum pulmonary arterial hypertension (PAH) complicated with hereditary hemorrhagic telangiectasia (HHT) is a rare condition. Diagnosing and treating PAH in patients with HHT can be challenging. To the best of our knowledge, no previous reports have investigated the efficacy of pulmonary vasodilators in improving hemodynamics in postpartum patients with this disease.

CASE SUMMARY

In this paper, we report a postpartum case of HHT combined with PAH, presenting with worsening dyspnea. Genetic testing revealed that the patient carried a heterozygous variant of activin receptor-like kinase 1. The patient received various treatments, including diuretics, anticoagulants, sildenafil, macitentan, inhalation of nitric oxide, and iloprost. Changes in PaO2/FiO2, pulmonary artery systolic pressure as assessed by echocardiography, and N-terminus pro-brain natriuretic peptide levels suggested that, except for iloprost inhalation, the other treatments appeared to have limited efficacy.

CONCLUSION

To our knowledge, this is the first report on efficacy of pulmonary vasodilators in postpartum patients with HHT and PAH.

Predicting outcomes using neural networks in the intensive care unit

Patients in intensive care units (ICUs) require rapid critical decision making. Modern ICUs are data rich, where information streams from diverse sources. Machine learning (ML) and neural networks (NN) can leverage the rich data for prognostication and clinical care. They can handle complex nonlinear relationships in medical data and have advantages over traditional predictive methods. A number of models are used: (1) Feedforward networks; and (2) Recurrent NN and convolutional NN to predict key outcomes such as mortality, length of stay in the ICU and the likelihood of complications. Current NN models exist in silos; their integration into clinical workflow requires greater transparency on data that are analyzed. Most models that are accurate enough for use in clinical care operate as 'black-boxes' in which the logic behind their decision making is opaque. Advances have occurred to see through the opacity and peer into the processing of the black-box. In the near future ML is positioned to help in clinical decision making far beyond what is currently possible. Transparency is the first step toward validation which is followed by clinical trust and adoption. In summary, NNs have the transformative ability to enhance predictive accuracy and improve patient management in ICUs. The concept should soon be turning into reality.

High-grade pancreatic intraepithelial neoplasia: A commentary of magnetic resonance cholangiopancreatography findings

Commentary on the role of magnetic resonance cholangiopancreatography findings in diagnosing high grade pancreatic intraepithelial neoplasms.

Treatment of thymoma with low-dose glucocorticoids before surgery for significant tumor shrinkage: A case report

BACKGROUND

Thymic epithelial neoplasms are rare malignant neoplasms originating in the thymus gland. There have been case reports of patients with advanced thymomas treated with a methylprednisolone pulse or with glucocorticoid (GCs) shock before surgery, followed by surgical treatment, all of whom achieved good results. The effect of GCs on thymomas is related mainly to the action on GC receptors in thymic lymphocytes and epithelial cells. GC receptor expression has been associated with a better prognosis in patients with thymomas, including those with surgically removed thymomas.

CASE SUMMARY

We report a case of a patient with thymoma who had a significant response to preoperative low-dose GC therapy. A mediastinal tumor was detected in the patient via computerized tomography upon admission. The tumor was initially suspected to be a thymic tumor, but lymphoma could not be ruled out. The tumor shrank significantly after low-dose (5 mg/day) GC therapy. Thoracoscopic thymoma resection was performed after puncture pathology was confirmed. The patient recovered well after the operation and is currently performing well with no recurrence of the tumor.

CONCLUSION

This case highlights that low-dose GCs are effective in the treatment of thymomas, and we believe that GCs should be applied more frequently and studied more thoroughly in the treatment of thymomas.

Role of pancreatic juice cytology in diagnosis of high-grade pancreatic intraepithelial neoplasia

High-grade pancreatic intraepithelial neoplasia is a challenging diagnosis and it does not exhibit mass lesions. It is suspected based on changes in the main pancreatic duct in magnetic resonance cholangiopancreatography. Sometimes only an unclear duct shows in magnetic resonance cholangiopancreatography with no focal strictures and upstream dilatation of the main pancreatic duct. Serial pancreatic juice cytology is valuable in diagnosis of those patients.

Beta thalassemia syndromes: New insights

Beta thalassemia (β-thalassemia) syndromes are a heterogeneous group of inherited hemoglobinopathies caused by molecular defects in the beta-globin gene that lead to the impaired synthesis of beta-globin chains of the hemoglobin. The hallmarks of the disease include ineffective erythropoiesis, chronic hemolytic anemia, and iron overload. Clinical presentation ranges from asymptomatic carriers to severe anemia requiring lifelong blood transfusions with subsequent devastating complications. The management of patients with severe β-thalassemia represents a global health problem, particularly in low-income countries. Until recently, management strategies were limited to regular transfusions and iron chelation therapy, with allogeneic hematopoietic stem cell transplantation available only for a subset of patients. Better understanding of the underlying pathophysiological mechanisms of β-thalassemia syndromes and associated clinical phenotypes has paved the way for novel therapeutic options, including pharmacologic enhancers of effective erythropoiesis and gene therapy.

Homozygous phytosterolemia and a literature review: A case report

BACKGROUND

Phytosterolemia, also known as sitosterolemia, is a rare autosomal recessive disease characterized by elevated plasma plant sterol levels and xanthomata, which is easily misdiagnosed as familial hypercholesterolemia. Patients with homozygous phytosterolemia often have severe clinical manifestations, with xanthomata in childhood and premature atherosclerosis. Our patient had a milder clinical phenotype.

CASE SUMMARY

This report describes a patient with homozygous phytosterolemia who presented with only elevated cholesterol and low-density lipoprotein cholesterol (LDL-C) without xanthomata, arteriosclerosis, or hematological abnormalities. Homozygous mutation of ABCG5 which encodes an ATP-binding cassette transporter, was detected by whole exome sequencing and diagnosed as phytosterolemia. Measurement of the patient's plasma plant sterol levels detected significant elevations in stigmasterol, rapeseed oil-derived plant sterol, and β-glutaminol levels. Ezetimibe was started and a low plant sterol diet was recommended. The patient's blood lipid profile was reexamined one month later and showed significant decreases in total cholesterol and LDL-C levels. Phytosterolemia has similar clinical features as familial hypercholesterolemia, is highly susceptible to misdiagnosis, and has a very low incidence, and therefore clinicians need to consider a genetic diagnosis of a definitively hyperlipidemic disorder when statin drugs fail to lower lipid levels.

CONCLUSION

Phytosterolemia is easily misdiagnosed as familial hypercholesterolaemia and can be treated by dietary modification and cholesterol absorption inhibitors to lower blood lipids.

Cauda equina syndrome with urinary retention as a postoperative complication of lumbar spine surgery: A case report

BACKGROUND

Cauda equina syndrome (CES) is characterized by a group of symptoms that may be caused by inflammation, spinal cord compression, venous congestion, or ischemia. This syndrome is commonly an indication for surgical intervention but has not been determined as a postoperative complication following surgery for lumbar spine disease.

CASE SUMMARY

To report the case of a 54-year-old male patient who had CES following spinal surgery, with no obvious compression lesions found during re-exploration, suggesting that vascular insufficiency may have contributed to the condition. Furthermore, a series of urodynamic studies on bladder recovery patterns in such complications have also been investigated.

CONCLUSION

Postoperative CES requires urgent imaging and exploration to rule out compression; noncompressive cases, including vascular insufficiency may performed conservative management.

Maternal and fetal death associated with acute pancreatitis during pregnancy: A case report

BACKGROUND

Acute pancreatitis in pregnancy is a rare but serious condition that can lead to high maternal mortality and fetal loss. Instances of pregnancy complicated by severe acute pancreatitis, particularly with subsequent respiratory and cardiac arrest, are rarely reported.

CASE SUMMARY

We present the case of a 35-year-old woman, at 36 + 5 weeks of gestation, who presented with paroxysmal epigastric pain accompanied by low back pain, nausea, and vomiting. According to the clinical symptoms, B-ultrasound imaging and biochemical indicators, the patient was diagnosed with acute pancreatitis and initially managed conservatively. However, 3 hours after admission, the patient experienced respiratory and cardiac arrest, and the fetus died. In this case, the adverse outcomes occurred due to the lack of aggressive fluid resuscitation and an active surgical intervention.

CONCLUSION

Implementing aggressive fluid resuscitation to sustain tissue perfusion, alongside the proactive evaluation of pharmacological agents that suppress gastric acid secretion and inhibit pancreatic enzyme activity, may be beneficial in mitigating the risk of a severely adverse prognosis. Effective management of acute pancreatitis during pregnancy requires careful timing of surgical intervention, a thorough evaluation of the risks and benefits regarding the continuation or termination of pregnancy, and a focus on safeguarding both maternal and fetal health.