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Αλέξανδρος Γ. Σφακιανάκης

Thursday, January 7, 2021

Fracture of the scapular neck combined with rotator cuff tear: A case report.

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Fracture of the scapular neck combined with rotator cuff tear: A case report.

World J Clin Cases. 2020 Dec 26;8(24):6450-6455

Authors: Chen L, Liu CL, Wu P

Abstract
BACKGROUND: Scapular fracture has a low incidence rate, accounting for 0.4%-0.9% of all fractures, and scapular neck fractures are extremely rare, comprising approximately 7%-25% of all scapular fractures. Scapular neck fractures are often studied as case reports mostly accompanied by other injuries, thus leading to confusion. All previous cases of scapular neck fractures are not associated with rotator cuff injuries.
CASE SUMMARY: A 62-year-old man was admitted to our emergency department 6 h after his right shoulder and back were impacted by heavy objects. The patient presented chest tightness and shortness of breath. Chest computed tomography (CT) showed pneumohemothorax, multiple rib fractures, and right scapula fractures. Three-dimensional CT reconstruction of the right shoulder joint showed a trans-spinous scapular neck fracture with a glenohumeral joint dislocation. Rotator cuff injury was suspected because the patient had a glenohumeral joint dislocation and was then confirmed by shoulder magnetic resonance imaging. A staged surgery was performed, including open reduction and internal fixation of the right scapula fracture and repairing of rotator cuff by right shoulder arthroscopy. At the 5-mo follow-up, the fracture line was blurred and the shoulder joint function was good.
CONCLUSION: Fracture of the scapular neck combined with rotator cuff tear is rare and the rotator cuff injury should not be ignored in clinical work. Stable internal fixation combined with secondary arthroscopic repair of rotator cuff tear can achieve good results.

PMID: 33392330 [PubMed]

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Synchronous colonic mucosa-associated lymphoid tissue lymphoma found after surgery for adenocarcinoma: A case report and review of literature.

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Synchronous colonic mucosa-associated lymphoid tissue lymphoma found after surgery for adenocarcinoma: A case report and review of literature.

World J Clin Cases. 2020 Dec 26;8(24):6456-6464

Authors: Li JJ, Chen BC, Dong J, Chen Y, Chen YW

Abstract
BACKGROUND: Mucosa-associated lymphoid tissue (MALT) lymphoma is a subtype of non-Hodgkin lymphoma that is mainly involved in the gastrointestinal tract. The synchronous occurrence of colonic MALT lymphoma and adenocarcinoma in the same patient is extremely rare. We here report a case of synchronous colonic MALT lymphoma found on surveillance colonoscopy five months after surgery and chemotherapy for sigmoid adenocarcinoma.
CASE SUMMARY: A 67-year-old man was admitted because of hematochezia for two months. Colonoscopy suggested a colonic tumor before hospitalization. Abdominal computed tomography (CT) revealed local thickening of the sigmoid colon. The patient underwent a left hemicolectomy with local lymph node dissection. The histopathology revealed moderately differentiated adenocarcinoma and partially mucinous adenocarcinoma. The pTNM stage was T3N1Mx. The patient received chemotherapy with six cycles of mFOLFOX6 after surgery. Colonoscopy was performed five months later and revealed single, flat, polypoid lesions of the colon 33 cm away from the anus. Subsequently, the patient underwent endoscopic mucosal resection for further diagnosis. The pathological diagnosis was MALT lymphoma. Positron emission tomography /CT suggested metastasis. The patient refused further treatment and died ten months later.
CONCLUSION: Colonic MALT lymphoma may occur after surgery and chemotherapy for adenocarcinoma as a synchronous malignancy. Regular surveillance colonoscopy and careful monitoring after surgery are critical.

PMID: 33392331 [PubMed]

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Novel mutation in the ASXL3 gene in a Chinese boy with microcephaly and speech impairment: A case report.

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Novel mutation in the ASXL3 gene in a Chinese boy with microcephaly and speech impairment: A case report.

World J Clin Cases. 2020 Dec 26;8(24):6465-6472

Authors: Li JR, Huang Z, Lu Y, Ji QY, Jiang MY, Yang F

Abstract
BACKGROUND: Bainbridge-Ropers syndrome (BRPS) is a severe disorder characterized by failure to thrive, facial dysmorphism, and severe developmental delay. BRPS is caused by a heterozygous loss-of-function mutation in the ASXL3 gene. Due to limited knowledge of the disease and lack of specific features, clinical diagnosis of this syndrome is challenging. With the use of trio-based whole exome sequencing, we identified a novel ASXL3 mutation in a Chinese boy with BRPS and performed a literature review.
CASE SUMMARY: A 3-year-old Chinese boy was referred to our hospital due to progressive postnatal microcephaly and intellectual disability with severe speech impairment for 2 years. His other remarkable clinical features were shown as follows: Facial dysmorphism, feeding difficulties, poor growth, motor delay, and abnormal behavior. For the proband, regular laboratory tests, blood tandem mass spectrometry, urine gas chromatographic mass spectrometry, karyotype, hearing screening, and brain magnetic resonance imaging were performed, with negative results. Therefore, for the proband and his unaffected parents, trio-based whole exome sequencing and subsequent validation by Sanger sequencing were performed. A novel nonsense variant in exon 11 of the ASXL3 gene (c.1795G>T; p.E599*) was detected, present in the patient but absent from his parents. Taking into account the concordant phenotypic features of our patient with reported BRPS patients and the detected truncated variant l ocated in the known mutational cluster region, we confirmed a diagnosis of BRPS for this proband. The rehabilitation treatment seemed to have a mild effect.
CONCLUSION: In this case, a novel nonsense mutation (c.1795G>T, p.E599*) in ASXL3 gene was identified in a Chinese boy with BRPS. This finding not only contributed to better genetic counseling and prenatal diagnosis for this family but also expanded the pathogenic mutation spectrum of ASXL3 gene and provided key information for clinical diagnosis of BRPS.

PMID: 33392332 [PubMed]

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Recurrent thrombosis in the lower extremities after thrombectomy in a patient with polycythemia vera: A case report.

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Recurrent thrombosis in the lower extremities after thrombectomy in a patient with polycythemia vera: A case report.

World J Clin Cases. 2020 Dec 26;8(24):6473-6479

Authors: Jiang BP, Cheng GB, Hu Q, Wu JW, Li XY, Liao S, Wu SY, Lu W

Abstract
BACKGROUND: Acute arterial embolism of the extremities is a surgical emergency. Atrial fibrillation is the major etiology of acute arterial embolism of the extremities. Emergency femoral artery thrombectomy can successfully treat this issue. However, polycythemia vera (PV) may sometimes explain this medical emergency. Recurrent thrombosis in the lower extremities after thrombectomy can be found in patients with PV, and reoperation is needed for this condition.
CASE SUMMARY: A 68-year-old man in China suffered from sudden pain in the left lower extremity for 14 h. The examination in the emergency department showed a diagnosis of acute arterial embolism of the extremities combined with PV. The patient's complaint disappeared after repeat emergency thrombectomy.
CONCLUSION: Patients with acute arterial embolism of the extremities should be treated carefully, especially those who have recurrent thrombosis after emergency thrombectomy. Clinicians should be aware of PV, a rare cause of acute arterial embolism of the extremities. The combination of thrombectomy, phlebotomy, and antiplatelet and anticoagulant drugs may be a suitable therapeutic regimen for these patients.

PMID: 33392333 [PubMed]

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Status epilepticus as an initial manifestation of hepatic encephalopathy: A case report.

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Status epilepticus as an initial manifestation of hepatic encephalopathy: A case report.

World J Clin Cases. 2020 Dec 26;8(24):6480-6486

Authors: Cui B, Wei L, Sun LY, Qu W, Zeng ZG, Liu Y, Zhu ZJ

Abstract
BACKGROUND: Status epilepticus in patients with hepatic encephalopathy (HE) is a rare but serious condition that is refractory to antiepileptic drugs, and current treatment plans are vague. Diagnosis may be difficult without a clear history of cirrhosis. Liver transplantation (LT) is effective to alleviate symptoms, however, there are few reports about LT in the treatment of status epilepticus with HE. To our knowledge, this is the first report of status epilepticus present as initial manifestation of HE.
CASE SUMMARY: A 59-year-old woman with a 20-year history of heavy drinking was hospitalized for generalized tonic-clonic seizures. She reported no history of episodes of HE, stroke, spontaneous bacterial peritonitis, ascites or gastrointestinal bleeding. Neurological examination revealed a comatose patient, without papilledema. Laboratory examination suggested liver cirrhosis. Plasma ammonia levels upon admission were five times normal. Brain computed tomography (CT) was normal, while abdominal CT and ultrasound revealed mild ascites, liver cirrhosis and splenomegaly. Electroencephalography (EEG)showed diffuse slow waves rhythm, consistent with HE, and sharp waves during ictal EEG corresponding to clinical semiology of focal tonic seizures. The symptoms were reversed by continuous antiepileptic treatment and lactulose. She was given oral levetiracetam, and focal aware seizures occasionally affected her 10 mo after LT.
CONCLUSION: Status epilepticus could be an initial manifestation of HE. Antiepileptic drugs combined with lactulose are essential for treatment of status epilepticus with HE, and LT is effective to prevent the relapse.

PMID: 33392334 [PubMed]

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Delayed diagnosis of prosopagnosia following a hemorrhagic stroke in an elderly man: A case report.

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Delayed diagnosis of prosopagnosia following a hemorrhagic stroke in an elderly man: A case report.

World J Clin Cases. 2020 Dec 26;8(24):6487-6498

Authors: Yuan Y, Huang F, Gao ZH, Cai WC, Xiao JX, Yang YE, Zhu PL

Abstract
BACKGROUND: Acquired prosopagnosia is a rare condition characterized by the loss of familiarity with previously known faces and the inability to recognize new ones. It usually occurs after the onset of brain lesions such as in a stroke. The initial identification of prosopagnosia generally relies on a patient's self-report, which can be challenging if it lacks an associated chief complaint. There were few cases of prosopagnosia presenting purely as eye symptoms in the previous literature confirmed by functional magnetic resonance imaging (MRI).
CASE SUMMARY: We present a case of delayed diagnosis of prosopagnosia after a right hemisphere stroke in an elderly man whose chief complaint was persistent and progressive "blurred vision" without facial recognition impairment. Ophthalmic tests revealed a homonymous left upper quadrantanopia, with normal visual acuity. He was found by accident to barely recognize familiar faces. The patient showed severe deficit in face recognition and perception tests, and mild memory loss in neuropsychological assessments. Further functional MRI revealed the visual recognition deficits were face-specific. After behavioral intervention, the patient started to rely on other cues to compensate for poor facial recognition. His prosopagnosia showed no obvious improvement eight months after the stroke, which had negative impact on his social network.
CONCLUSION: Our case demonstrates that the presentation of prosopagnosia can be atypical, and visual difficulties might be a clinical manifestation solely of prosopagnosia, which emphasizes the importance of routinely considering face recognition impairment among elderly patients with brain lesions.

PMID: 33392335 [PubMed]

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Oral myiasis after cerebral infarction in an elderly male patient from southern China: A case report.

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Oral myiasis after cerebral infarction in an elderly male patient from southern China: A case report.

World J Clin Cases. 2020 Dec 26;8(24):6499-6503

Authors: Zhang TZ, Jiang Y, Luo XT, Ling R, Wang JW

Abstract
BACKGROUND: Myiasis is a rare but risky pathology caused by a parasitic infestation of humans and animals by the dipterous larva. Oral myiasis occurs when soft tissues of the oral cavity are invaded by the larvae of flies. It is not a common disease for the reason that the oral cavity is not easily reachable for the fly to lay eggs. But it can cause pain, infection, uncomfortable feeling when the worms move, tissue destruction and/or even life-threatening hemorrhages.
CASE SUMMARY: We reported a case of oral myiasis after cerebral infarction in a 78-year-old male patient from southern China (Guangdong Zhanjiang). As a result of cerebral infarction, he suffered from right hemiplegia, mobility and mental decline for about 3 mo. He had difficulty swallowing and was fed via a feeding tube. He mostly engaged in mouth breathing and had poor oral and dental hygiene. More than 20 live larvae were collected from the patient's oral cavity, which were localized in the maxillary gingiva, the mandibular gingiva and the tongue. The patient recovered after the routine oral cleaning, removal of maggots, debridement and anti-infection treatment.
CONCLUSION: Early diagnosis and treatment of this infestation are essential due to the bothersome symptoms, such as inflammation, intense anxiety over the larvae movement, possible serious complications, etc. Clinical staff should be familiar with this infestation, and this disease should be considered, especially in physically and mentally disabled patients or those at significant risk for infection. Necessary measures, including good sanitation, personal and environmental hygiene and special care should be adopted so as to prevent this disease.

PMID: 33392336 [PubMed]

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Rare case of drain-site hernia after laparoscopic surgery and a novel strategy of prevention: A case report.

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Rare case of drain-site hernia after laparoscopic surgery and a novel strategy of prevention: A case report.

World J Clin Cases. 2020 Dec 26;8(24):6504-6510

Authors: Gao X, Chen Q, Wang C, Yu YY, Yang L, Zhou ZG

Abstract
BACKGROUND: Trocar site hernia (TSH) is a rare but potentially dangerous complication of laparoscopic surgery, and the drain-site TSH is an even rarer type. Due to the difficulty to diagnose at early stages, TSH often leads to a delay in surgical intervention and eventually results in life-threatening consequences. Herein, we report an unusual case of drain-site TSH, followed by a brief literature review. Finally, we provide a novel, simple, and practical method of prevention.
CASE SUMMARY: A 54-year-old female patient underwent laparoscopic subtotal hysterectomy and bilateral adnexectomy for uterine fibroids 8 d ago in another hospital. She was admitted to our hospital with a 2-d history of intermittent abdominal pain, nausea, vomiting, and abdominal enlargement with an inability to pass stool and flatus. The emergency computed tomography scan revealed the small bowel herniated through a 10 mm trocar incision, which was used as a drainage port, with diffuse bowel distension and multiple air-fluid levels with gas in the small intestines. She was diagnosed with drain-site strangulated TSH. The emergency exploratory laparotomy confirmed the diagnosis. A herniorrhaphy followed by standard intestinal resection and anastomosis were performed. The patient recovered well after the operation and was discharged on postoperative day 8 and had no postoperative complications at her 2-wk follow-up visit.
CONCLUSION: TSH must be kept in mind during the differential diagnosis of post-laparoscopic obstruction, especially after the removal of the drainage tube, to avoid the serious consequences caused by delayed diagnosis. Furthermore, all abdomen layers should be carefully closed under direct vision at the trocar port site, especially where the drainage tube was placed. Our simple and practical method of prevention may be a novel strategy worthy of clinical promotion.

PMID: 33392337 [PubMed]

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Extracorporeal shock wave therapy treatment of painful hematoma in the calf: A case report.

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Extracorporeal shock wave therapy treatment of painful hematoma in the calf: A case report.

World J Clin Cases. 2020 Dec 26;8(24):6511-6516

Authors: Jung JW, Kim HS, Yang JH, Lee KH, Park SB

Abstract
BACKGROUND: Extracorporeal shock wave therapy (ESWT) can be applied to various musculoskeletal conditions including calcific tendinitis. Muscle injuries can lead to hematomas, and unabsorbed hematomas sometimes cause pain. We report a case of painful hematoma successfully treated with ESWT. To our knowledge, this is the first reported case of painful intramuscular hematoma treated with ESWT.
CASE SUMMARY: A 65-year-old man visited the outpatient department for left calf pain with swelling that had persisted since he slipped two weeks prior. The calf pain had persisted and was rated visual analog scale 7. On physical examination, there was a localized, stiff, ovoid mass on his left upper posterior calf. The pain was aggravated by dorsiflexion of the left ankle or weight-bearing on the left foot. Initial diagnostic ultrasonography showed a hematoma in the left gastrocnemius muscle; its texture was firm with low heterogeneity. We applied ESWT to the hematoma. His pain decreased immediately to a visual analog scale 3, and the mass was softened. The texture of the hematoma became more heterogeneous on ultrasonography. Due to planned overseas travel, he returned three months after the initial visit to report that the pain and swelling were dramatically relieved after ESWT.
CONCLUSION: We propose that painful hematomas could be a new indication for ESWT. Further investigation on the effects of ESWT for hematomas is needed.

PMID: 33392338 [PubMed]

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Takotsubo cardiomyopathy associated with bronchoscopic operation: A case report.

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Takotsubo cardiomyopathy associated with bronchoscopic operation: A case report.

World J Clin Cases. 2020 Dec 26;8(24):6517-6523

Authors: Wu BF, Shi JR, Zheng LR

Abstract
BACKGROUND: Takotsubo cardiomyopathy (TTC), a syndrome of acute left ventricular (LV) dysfunction, is characterized by transitory hypokinesis of LV apices with compensatory hyperkinesis of the LV basal region. The symptoms of TTC mimic acute myocardial infarction, without significant coronary stenoses on coronary angiography. Echocardiogram plays a key role in the diagnosis and prognosis of TTC. New indicators from echocardiograms may be helpful in disease evaluation.
CASE SUMMARY: A 67-year-old man with a 10-year history of non-small cell lung cancer was admitted to our hospital for emerging facial edema and dry cough. Bronchoscopic lavage, brushing, and biopsy were performed to evaluate tumor progression. During this procedure, he complained of left chest pain, nausea, and vomiting, with elevated troponin levels. Electrocardiogram showed sinus bradycardia with ST-segment elevation in I, AVL, and V4 to V6 leads. Coronary angiography revealed mild stenosis in the right coronary artery. Echocardiography showed hypokinesis of LV apices with compensatory hyperkinesis of the LV basal region. At the 7-d follow-up, echocardiographic pressure-strain analysis showed a normal LV ejection fraction, but partial recovery of LV myocardial work, which fully recovered 5 mo later.
CONCLUSION: This is a case of TTC caused by bronchoscopic operation. We strongly recommend noninvasive myocardial work measured by echocardiographic pressure-strain analysis as a necessary supplementary test for the long-term follow-up of TTC.

PMID: 33392339 [PubMed]

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Idiopathic adulthood ductopenia with elevated transaminase only: A case report.

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Idiopathic adulthood ductopenia with elevated transaminase only: A case report.

World J Clin Cases. 2020 Dec 26;8(24):6524-6528

Authors: Zhang XC, Wang D, Li X, Hu YL, Wang C

Abstract
BACKGROUND: Idiopathic adulthood ductopenia (IAD) is a chronic cholestatic liver disease of unknown etiology that usually presents as unexplained jaundice. It is characterized by adult onset, lack of autoantibodies, inflammatory bowel disease and loss of interlobular bile ducts.
CASE SUMMARY: This case presents a 27-year-old woman with elevation of transaminases and alkaline phosphatase without clinical symptoms. Five years ago, the patient had abnormal transaminases but no cholestasis. Three months before admission, physical examination revealed an increase in transaminases. Oral hepatoprotective drugs did not show any significant improvement, and she was admitted to hospital for further diagnosis and treatment. Liver biopsy confirmed IAD. After about 2 wk of ursodeoxycholic acid treatment, serological and histological examination showed a significant response.
CONCLUSION: IAD is a manifestation of cholestasis, but also may be an abnormal increase in transaminase in the early stage.

PMID: 33392340 [PubMed]

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