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Αλέξανδρος Γ. Σφακιανάκης

Wednesday, February 24, 2021

Deep vein thrombosis in patient with left-sided inferior vena cava draining into the hemiazygos vein: A case report

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World J Clin Cases. 2021 Jan 26;9(3):672-676. doi: 10.12998/wjcc.v9.i3.672.

ABSTRACT

BACKGROUND: Abnormalities of the inferior vena cava (IVC) are uncommon, and in many cases they are asymptomatic. Even so, it is vital that clinicians be aware of such anomalies prior to surgery in affected individuals. In the present report, we describe a rare anatomical variation of the IVC.

CASE SUMMARY: A 66-year-old male was admitted to the hospital due to deep vein thrombosis of the right lower extremity. Upon contrast-enhanced computed tomography imaging, we found that this patient presented with a case of left-sided IVC draining into the hemiazygos vein, while his hepatic vein was directly draining into the atrium.

CONCLUSION: Cases of left-sided IVC can increase patient susceptibility to thromboembolism owing to the resultant changes in blood flow and/or associated vascular compression.

PMID:33553407 | PMC:PMC7829718 | DOI:10.12998/wjcc.v9.i3.672

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Facial microcystic adnexal carcinoma - treatment with a 'jigsaw puzzle' advancement flap and immediate esthetic reconstruction: A case report

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World J Clin Cases. 2021 Jan 26;9(3):607-613. doi: 10.12998/wjcc.v9.i3.607.

ABSTRACT

BACKGROUND: Microcystic adnexal carcinoma (MAC) is a rare malignant tumor of the skin that is commonly found on the face. It grows slowly and has a low mortality rate. However, for various reasons, including strong histological invasiveness, clinical inexperience and inadequate procedure design, immediate or permanent facial deformity may occur after surgical operations.

CASE SUMMARY: This article describes a middle-aged female artist who was diagnosed with MAC on the left upper lip. She declined the recommended treatment plan, which included two-stage reconstruction, skin grafting, or surgery that could have resulted in obvious facial dysfunction or esthetic deformity. We accurately designed a personalized procedure involving a "jigsaw puzzle advancement flap" for the patient based on the lesion location and the estimated area of skin loss. The procedure was successful; both pathological R0 resection and immediate and long-term esthetic reconstruction effects were achieved.

CONCLUSION: This study suggests that when treating facial MAC or other skin malignancies, a surgical team should have sufficient plastic surgery-related knowledge and skills. An optimal surgical plan for an individual is needed to achieve good facial esthetics and functional recovery and shorten the treatment course.

PMID:33553398 | PMC:PMC7829729 | DOI:10.12998/wjcc.v9.i3.607

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Recurrent Takotsubo cardiomyopathy triggered by emotionally stressful events: A case report

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World J Clin Cases. 2021 Jan 26;9(3):677-684. doi: 10.12998/wjcc.v9.i3.677.

ABSTRACT

BACKGROUND: Takotsubo cardiomyopathy (TCM) is characterized by reversible left ventricular dysfunction triggered by emotional or physical stress. Only 1%-2% of patients with acute coronary syndrome are diagnosed with TCM. Although obstructive coronary artery disease is frequently considered to be the cause of chest pain, TCM should be considered in some clinical settings. In this case, clinicians did not make a timely and accurate diagnosis for TCM due to a lack of knowledge until the third hospitalization with a left ventriculogram.

CASE SUMMARY: A 55-year-old postmenopausal woman had intermittent chest pain following emotionally stressful events three times in the past 3 years. Cardiac troponin levels increased after each instance of symptom onset. A transthoracic echocardiogram showed reversible left ventricular dysfunction. The patient underw ent three coronary angiograms without evidence of coronary artery disease. A left ventriculogram was first performed at the third hospitalization and revealed apical akinesia with ballooning of the apical region and consistent hypercontractile basal segments. The diagnosis of TCM was confirmed. The patient was treated with an angiotensin-converting-enzyme inhibitor (perindopril) and a β-blocker (metoprolol). No complications occurred during the patient's hospitalization. The patient was told to avoid stressful events. During the 9-mo follow-up visit, the patient was asymptomatic with an ejection fraction of 55%.

CONCLUSION: Clinicians should be conscious of the possibility of TCM, especially in postmenopausal women presenting with clinical manifestations similar to acute coronary syndrome without coronary occlusion.

PMID:33553408 | PMC:PMC7829724 | DOI:10.12998/wjcc.v9.i3.677

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Compound heterozygous mutations in the neuraminidase 1 gene in type 1 sialidosis: A case report and review of literature

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World J Clin Cases. 2021 Jan 26;9(3):623-631. doi: 10.12998/wjcc.v9.i3.623.

ABSTRACT

BACKGROUND: Type 1 sialidosis, also known as cherry-red spot-myoclonus syndrome, is a rare autosomal recessive lysosomal storage disorder presenting in the second decade of life. The most common symptoms are myoclonus, ataxia and seizure. It is rarely encountered in the Chinese mainland.

CASE SUMMARY: A 22-year-old male presented with complaints of progressive myoclonus, ataxia and slurred speech, without visual symptoms; the presenting symptoms began at the age of 15-year-old. Whole exome sequencing revealed two pathogenic heterozygous missense variants [c.239C>T (p.P80L) and c.544A>G (p.S182G) in the neuraminidase 1 (NEU1) gene], both of which have been identified previously in Asian patients with type 1 sialidosis. All three patients identified in Mainland China come from three unrelated families, but all three show the NEU1 mutations p. S182G and p.P80L pathogenic variants. Increasing sialidase activity through chaperones is a promising therapeutic target in sialidosis.

CONCLUSION: Through retrospective analysis and summarizing the clinical and genetic characteristics of type 1 sialidosis, we hope to raise awareness of lysosomal storage disorders among clinicians and minimize the delay in diagnosis.

PMID:33553400 | PMC:PMC7829734 | DOI:10.12998/wjcc.v9.i3.623

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Oral and perioral herpes simplex virus infection type I in a five-month-old infant: A case report

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World J Clin Cases. 2021 Jan 26;9(3):685-689. doi: 10.12998/wjcc.v9.i3.685.

ABSTRACT

BACKGROUND: Herpes simplex virus (HSV) is a highly infectious pathogen that is easily transmitted via the bodily fluids of an infected individual. This virus usually affects individuals older than six months of age, and rarely causes lesions or symptoms in younger patients.

CASE SUMMARY: We present the case of a five-month-old healthy girl who presented with painful herpetic gingivostomatitis and perioral vesicles. We discuss the pathophysiology of primary HSV infection and the effect of maternal antibodies on the infant's immune system. In addition, we explain the diagnosis, management, and prognosis of HSV infection in young infants.

CONCLUSION: This case highlights the importance of early diagnosis and management of HSV infections to decrease the risk of developing severe complications and death.

PMID:33553409 | PMC:PMC7829727 | DOI:10.12998/wjcc.v9.i3.685

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Right-heart contrast echocardiography reveals missed patent ductus arteriosus in a postpartum woman with pulmonary embolism: A case report

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World J Clin Cases. 2021 Jan 26;9(3):639-643. doi: 10.12998/wjcc.v9.i3.639.

ABSTRACT

BACKGROUND: As an established, simple, inexpensive, and surprisingly effective diagnostic tool, right-heart contrast echocardiography (RHCE) might help in solving a vexing diagnostic problem. If performed appropriately and interpreted logically, RHCE allows for differentiation of various usual and unusual right-to-left shunts based on the site of injection and the sequence of microbubble appearance in the heart.

CASE SUMMARY: A 31-year-old woman was readmitted to hospital with a 2-mo history of worsening palpitation and chest distress. Two years prior, she had been diagnosed with postpartum pulmonary embolism by conventional echocardiography and computed tomography angiography. While the latter showed no sign of pulmonary artery embolism, the former showed pulmonary artery hypertension, moderate insufficiency, and mild stenosis of the aortic valv e. RHCE showed microbubbles appearing in the left ventricle, slightly delayed after right-heart filling with microbubbles; no microbubbles appeared in the left atrium and microbubbles' appearance in the descending aorta occurred nearly simultaneous to right pulmonary artery filling with microbubbles. Conventional echocardiography was re-performed, and an arterial horizontal bidirectional shunt was found according to Doppler enhancement effects caused by microbubbles. The original computed tomography angiography findings were reviewed and found to show a patent ductus arteriosus.

CONCLUSION: RHCE shows a special imaging sequence for unexplained pulmonary artery hypertension with aortic valve insufficiency and simultaneous patent ductus arteriosus.

PMID:33553402 | PMC:PMC7829713 | DOI:10.12998/wjcc.v9.i3.639

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Nasal septal foreign body as a complication of dental root canal therapy: A case report

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World J Clin Cases. 2021 Jan 26;9(3):690-696. doi: 10.12998/wjcc.v9.i3.690.

ABSTRACT

BACKGROUND: Currently, there have been no reports on foreign bodies found in the nasal septum after dental root canal therapy. Herein, we present an unusual case of a foreign body found in the nasal septum, which occurred after dental root canal therapy and two unsuccessful surgeries.

CASE SUMMARY: A 55-year-old man was referred to our department due to slight nasal discomfort that persisted for about 1 wk. Before consulting our department, the patient visited three different hospitals/clinics and underwent two surgeries that were not successful in removing a foreign body completely. A computed tomography scan was performed to detect the shift of the foreign body from dental root to the nasal septum, which resulted in the healing of oral inflammation and nasal septum discomfort. An endoscopic foreign body extraction surgery (3rd remova l surgery) was then successfully performed, using a needle as the reference. No nasal reconstruction was required after the operation. Postoperative healing was uneventful.

CONCLUSION: Medical healthcare professionals should consider past medical history when dealing with foreign body cases. During septal foreign body extraction surgery, a needle could be used as a helpful reference.

PMID:33553410 | PMC:PMC7829716 | DOI:10.12998/wjcc.v9.i3.690

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Successful treatment of pyogenic ventriculitis caused by extensively drug-resistant Acinetobacter baumannii with multi-route tigecycline: A case report

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World J Clin Cases. 2021 Jan 26;9(3):651-658. doi: 10.12998/wjcc.v9.i3.651.

ABSTRACT

BACKGROUND: Pyogenic ventriculitis caused by extensively drug-resistant Acinetobacter baumannii (A. baumannii) is one of the most severe complications associated with craniotomy. However, limited therapeutic options exist for the treatment of A. baumannii ventriculitis due to the poor penetration rate of most antibiotics through the blood-brain barrier.

CASE SUMMARY: A 68-year-old male patient with severe traumatic brain injury developed pyogenic ventriculitis on postoperative day 24 caused by extensively drug-resistant A. baumannii susceptible to tigecycline only. Successful treatment was accomplished through multi-route administration of tigecycline, including intravenous combined with continuous ventricular irrigation plus intraventricular administration. The pus was cleared on the 3rd day post-irrigation , and cerebrospinal fluid cultures were negative after 12 d.

CONCLUSION: Our findings suggest that multi-route administration of tigecycline can be a therapeutic option against pyogenic ventriculitis caused by extensively drug-resistant A. baumannii.

PMID:33553404 | PMC:PMC7829735 | DOI:10.12998/wjcc.v9.i3.651

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Coinheritance of OLFM2 and SIX6 variants in a Chinese family with juvenile-onset primary open-angle glaucoma: A case report

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World J Clin Cases. 2021 Jan 26;9(3):697-706. doi: 10.12998/wjcc.v9.i3.697.

ABSTRACT

BACKGROUND: Juvenile-onset primary open-angle glaucoma (JOAG), characterized by severe elevation of intraocular pressure and optic neuropathy prior to the age of 40, is a rare subtype of primary open-angle glaucoma. Several genetic mutations have been associated with JOAG.

CASE SUMMARY: The proband patient was a young male, diagnosed with primary open-angle glaucoma at the age of 27. The patient and his unaffected parents who have been excluded from classic genetic mutations for primary open-angle glaucoma were included to explore for other possible genetic variants through whole genome sequencing and bioinformatics analysis. In this trio, we found two heterozygous variants inherited from the parents in the proband: c.281G>A, p.Arg94His in OLFM2 and c.177C>G, p.Ile59Met in SIX6. Both genetic mutations are predicted through bio informatics analysis to replace evolutionary conserved amino acids, therefore rendering a pathogenic effect on proteins. In contrast, very low frequencies for these genetic mutations were recorded in most common control databases.

CONCLUSION: This is the first report on coinherited mutations of OLFM2 and SIX6 in a JOAG family, which shows the complexity of JOAG inheritance. Large-scale clinical screening and molecular functional investigations on these coinherited mutations are imperative to improve our understanding of the development of JOAG.

PMID:33553411 | PMC:PMC7829722 | DOI:10.12998/wjcc.v9.i3.697

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Pleural lump after paragonimiasis treated by thoracoscopy: A case report

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World J Clin Cases. 2021 Jan 26;9(3):666-671. doi: 10.12998/wjcc.v9.i3.666.

ABSTRACT

BACKGROUND: Paragonimiasis is a parasitic disease that has multiple symptoms, with pulmonary types being common. According to our clinical practices, the pleural effusion of our patients is full of fibrous contents. Drainage, praziquantel, and triclabendazole are recommended for the treatment, but when fibrous contents are contained in pleural effusion, surgical interventions are necessary. However, no related reports have been noted. Herein, we present a case of pulmonary paragonimiasis treated by thoracoscopy.

CASE SUMMARY: A 12-year-old girl presented to our outpatient clinic complaining of shortness of breath after exercise for several days. Enzyme-linked immunosorbent assay revealed positivity for antibodies against Paragonimus westermani, serological test showed eosinophilia, and moderate left pleural effusion and calcification were detected on computed tomography (CT). She was diagnosed with paragonimiasis, and praziquantel was prescribed. However, radiography showed an egg-sized nodule in the left pleural cavity during follow-up. She was then admitted to our hospital again. The serological results were normal except slight eosinophilia. CT scan displayed a cystic-like node in the lower left pleural cavity. The patient underwent a thoracoscopic mass resection. A mass with a size of 6 cm × 4 cm × 3 cm adhered to the pleura was resected. The pathological examination showed that the mass was composed of non-structured necrotic tissue, indicating a granuloma. The patient remainded asymptomatic and follow-up X-ray showed complete removal of the mass.

CONCLUSION: This case highlights that thoracoscopic intervention is necessary when fibrous contents are present on CT scan or chest roentgenogram to avoid later fibrous lump formation in patients with pulmonary paragonimiasis.

PMID:33553406 | PMC:PMC7829717 | DOI:10.12998/wjcc.v9.i3.666

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Systemic lupus erythematosus and antineutrophil cytoplasmic antibody-associated vasculitis overlap syndrome in a 77-year-old man: A case report

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World J Clin Cases. 2021 Jan 26;9(3):707-713. doi: 10.12998/wjcc.v9.i3.707.

ABSTRACT

BACKGROUND: Systemic lupus erythematosus (SLE) and antineutrophil cytoplasmic antibody-associated vasculitis (AAV) are classically thought to cause renal impairment and small vessel vasculitis with different pathophysiologies. Their overlap constitutes a rare rheumatologic disease. To date, only dozens of such cases with biopsy-proven glomerulonephritis have been reported worldwide typically in women of childbearing age. Here, we present a unique clinical case due to its rarity and individualized treatment of a Chinese man in his eighth decade of life.

CASE SUMMARY: A 77-year-old man was admitted to several hospitals for shortness of breath and received nonspecific treatments over the past 3 years. As his symptoms were not completely relieved, he visited our hospital for further treatment. Laboratory examinations revealed kidney dysfunction, seve re anaemia, hypocom-plementemia, glomerular proteinuria, and microscopic haematuria. Antinuclear antibodies, as well as anti-dsDNA antibodies, were positive. Computed tomography of the chest showed right pleural effusion. Renal biopsy was performed, and histology suggested crescentic glomerulonephritis, pauci-immune type. After treatment with plasmapheresis, glucocorticoid, and cyclo-phosphamide, the disease was in remission, and the patient remained in a stable condition for over 3 years post-hospital discharge.

CONCLUSION: Due to its complexity and rarity, SLE and AAV overlap syndrome is easily misdiagnosed. An accurate diagnosis and treatment at the earliest stage may significantly improve the condition and reduce irreversible organ injury.

PMID:33553412 | PMC:PMC7829731 | DOI:10.12998/wjcc.v9.i3.707

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