Gastroesophageal varices in a patient presenting with essential thrombocythemia: A case report

paythelady.612 shared this article with you from Inoreader Gastroesophageal varices in a patient presenting with essential thrombocythemia: A case report Μέσω pubmed: "world j clin cases"... World J Clin Cases. 2021 Mar 16;9(8):1871-1876. doi: 10.12998/wjcc.v9.i8.1871. ABSTRACT BACKGROUND: Gastroesophageal varices are a rare complication of essential thrombocythemia (ET). ET is a chronic myeloproliferative neoplasm (MPN) characterized by an increased number of blood platelets. CASE SUMMARY: A 46-year-old woman, who denied a history of liver disease, was admitted to our hospital on presentation of hematemesis. Laboratory examination revealed a hemoglobin level of 83 g/L, and a platelet count of 397 × 109/L. The appearance of gastric and esophageal varices with red colored signs as displayed by an urgent endoscopy was followed by endoscopic variceal ligation and endoscopic tissue adhesive. Abdominal computed tomography revealed cirrhosis, marked splenomegaly, portal vein thrombosis and portal hypertension. In addition, bone marrow biopsy and evidence of mutated Janus kinase 2, substantiated the onset of ET. The patient was asymptomatic with regular routine blood testing during the 6-mo follow-up period. Therefore, in this case, gastroesophageal varices were induced by ET. CONCLUSION: MPN should be given considerable attention when performing differential diagnoses in patients with gastroesophageal varices. An integrated approach such as laboratory tests, radiological examination, and pathological biopsy, should be included to allow optimal decisions and management. PMID:33748236 | PMC:PMC7953392 | DOI:10.12998/wjcc.v9.i8.1871 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Inadvertent globe penetration during retrobulbar anesthesia: A case report

paythelady.612 shared this article with you from Inoreader Inadvertent globe penetration during retrobulbar anesthesia: A case report Μέσω pubmed: "world j clin cases"... World J Clin Cases. 2021 Mar 16;9(8):2001-2007. doi: 10.12998/wjcc.v9.i8.2001. ABSTRACT BACKGROUND: To report the possible reasons for needle perforation and complications related to perforation, as well as the clinical management of subretinal hemorrhage (SRH) during retrobulbar injection. CASE SUMMARY: A 65-year-old female was scheduled to undergo pars plana vitrectomy (PPV) in her left eye for rhegmatogenous retinal detachment (RRD). During retrobulbar anesthesia, needle perforation of the globe occurred. Massive SRH in the inferotemporal quadrant together with vitreous hemorrhage were observed. The patient underwent PPV combined with retinotomy for removal of the massive SRH. After earlier surgical intervention, successful reattachment of the retina was achieved. CONCLUSION: Inadvertent globe penetration during retrobulbar anesthesia is associated with a poor prognosis and may result in blindness. Timely detection and e arlier intervention may be beneficial. PMID:33748253 | PMC:PMC7953384 | DOI:10.12998/wjcc.v9.i8.2001 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Conservative endodontic management using a calcium silicate bioceramic sealer for delayed root fracture: A case report and review of the literature

paythelady.612 shared this article with you from Inoreader Conservative endodontic management using a calcium silicate bioceramic sealer for delayed root fracture: A case report and review of the literature Μέσω pubmed: "world j clin cases"... World J Clin Cases. 2021 Mar 16;9(8):1835-1843. doi: 10.12998/wjcc.v9.i8.1835. ABSTRACT BACKGROUND: The success rate of conservative endodontic management for root fracture varies greatly based on different methods used. It has been rarely reported that calcium silicate-based materials are applied in root fracture treatment. CASE SUMMARY: A 38-year-old male patient presented with spontaneous pain from the upper left anterior teeth for 1 wk. The spontaneous pain was subsequently relieved, but pain on mastication persisted for 3 d. The patient had a dental trauma from a boxing match 15 years ago. Cone beam computed tomography showed that the maxillary left central incisor had oblique fracture lines and a radiolucent lesion around the fracture line. The tooth was diagnosed with an oblique root fracture with no healing and symptomatic apical periodontitis. In the following conservative endodontic management, the coronal and apical fr agments of the canal both were chemo-mechanically prepared and obturated using a single cone gutta-percha with iRoot SP (Innovative BioCreamix Inc, Vancouver, Canada), a new calcium silicate-based bioceramic root canal sealer. At follow-ups at 1, 6, 12, and 24 mo, the patient was asymptomatic and the radiolucency around the fracture line was healing radiographically. CONCLUSION: Conservative root canal treatment is an alternative treatment in some cases of oblique root fracture with no healing. The application of bioceramic sealers and single core obturation techniques may also be essential to obtain an excellent outcome. PMID:33748232 | PMC:PMC7953412 | DOI:10.12998/wjcc.v9.i8.1835 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Systemic lupus erythematosus combined with primary hyperfibrinolysis and protein C and protein S deficiency: A case report

paythelady.612 shared this article with you from Inoreader Systemic lupus erythematosus combined with primary hyperfibrinolysis and protein C and protein S deficiency: A case report Μέσω pubmed: "world j clin cases"... World J Clin Cases. 2021 Mar 16;9(8):2008-2014. doi: 10.12998/wjcc.v9.i8.2008. ABSTRACT BACKGROUND: Systemic lupus erythematosus (SLE) is an autoimmune disease characterized by systemic involvement and multiple autoantibodies in the serum. Patients with protein C (PC) and protein S (PS) deficiency are prone to thrombosis. In contrast, patients with primary hyperfibrino-lysis tend to bleed. CASE SUMMARY: A 52-year-old female patient with bilateral pleural effusion was diagnosed with "tuberculous pleurisy" and treated with anti-tuberculosis drugs and prednisone. The coagulation-related laboratory results showed decreased fibrinogen, PC activity, PS activity, and antithrombin Ш activity. The immune-related laboratory results showed positive antinuclear antibody, anti-Smith antibody, anticardiolipin antibody (ACL), anti-β2-glycoprotein I antibody (aβ2GPI) and direct Coomb's test and decreased complement 3 and complement 4. Thoraco scopy was performed and bloody pleural fluid was drained. Pathology of the pleural biopsy showed lymphocytes, plasma cells, and a few eosinophils in adipose and fibrous connective tissue. Results of whole exome sequencing of blood showed no genetic mutations suggesting the presence of hereditary hematological diseases. The patient was finally diagnosed with SLE and primary hyperfibrinolysis, and was treated with prednisolone, hydroxychloroquine, and compound cyclophosphamide. CONCLUSION: PC and PS deficiency in SLE might be related to ACL and aβ2GPI. SLE and primary hyperfibrinolysis can coexist in one patient, with both a risk of thrombosis and a risk of bleeding. PMID:33748254 | PMC:PMC7953391 | DOI:10.12998/wjcc.v9.i8.2008 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Severe community-acquired pneumonia caused by Leptospira interrogans: A case report and review of literature

paythelady.612 shared this article with you from Inoreader Severe community-acquired pneumonia caused by <em>Leptospira interrogans</em>: A case report and review of literature Μέσω pubmed: "world j clin cases"... World J Clin Cases. 2021 Mar 16;9(8):1901-1908. doi: 10.12998/wjcc.v9.i8.1901. ABSTRACT BACKGROUND: Leptospira is an uncommon pathogen for adult severe community-acquired pneumonia and its nonspecific manifestations and limited diagnostic tests make it difficult to identify. Although conventional penicillin remains efficacious to treat leptospirosis, failure in early diagnosis and treatment can lead to progression into a deadly syndrome with multiple organ dysfunction. Next generation sequencing is of great value to understand cases with infection of unknown cause, which could help in the diagnosis of uncertain Leptospira infection. CASE SUMMARY: We recently managed a patient with fever, cough and dyspnea on admission that progressed into persistent adult respiratory distress syndrome, hemoptysis and hematuria after admission. In this case, the rare Leptospira infection was clouded by the positive influenza t ests at admission, delaying early Leptospira-targeted antibiotics administration. Next generation sequencing, a novel molecular diagnostic tool, provided a key hint to uncover the crucial pathogen, Leptospira interrogans, further supported by the possible occupational exposure history. Subsequent conventional penicillin and mechanical respiratory support were administrated to cure the patient successfully without any sequela. CONCLUSION: Clinicians must pay attention to possible exposure history and keep uncommon Leptospira in mind when managing pneumonia with unknown causes. PMID:33748240 | PMC:PMC7953396 | DOI:10.12998/wjcc.v9.i8.1901 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Postoperative Surveillance in Older Adults With T1N0M0 Low-risk Papillary Thyroid Cancer

xlomafota13 shared this article with you from Inoreader Postoperative Surveillance in Older Adults With T1N0M0 Low-risk Papillary Thyroid Cancer Via radioactive iodine J Surg Res. 2021 Mar 22;264:37-44. doi: 10.1016/j.jss.2021.01.049. Online ahead of print. ABSTRACT BACKGROUND: The frequency and cost of postoperative surveillance for older adults (>65 y) with T1N0M0 low-risk papillary thyroid cancer (PTC) have not been well studied. METHODS: Using the SEER-Medicare (2006-2013) database, frequency and cost of surveillance concordant with American Thyroid Association (ATA) guidelines (defined as an office visit, ≥1 thyroglobulin measurem ent, and ultrasound 6- to 24-month postoperatively) were analyzed for the overall cohort of single-surgery T1N0M0 low-risk PTC, stratified by lobectomy versus total thyroidectomy. RESULTS: Majority of 2097 patients in the study were white (86.7%) and female (77.5%). Median age and tumor size were 72 y (interquartile range 68-76) and 0.6 cm (interquartile range 0.3-1.1 cm), respectively; 72.9% of patients underwent total thyroidectomy. Approximately 77.5% of patients had a postoperative surveillance visit; however, only 15.9% of patients received ATA-concordant surveillance. Patients who underwent total thyroidectomy as compared with lobectomy were more likely to undergo surveillance testing, thyroglobulin (61.7% versus 24.8%) and ultrasound (37.5% versus 29.2%) (all P < 0.01), and receive ATA-concordant surveillance (18.5% versus 9.0%, P < 0.001). Total surveillance cost during the study period was $621,099. Diagnostic radioactive iodine, ablation, and advanced imaging ( such as positron emission tomography scans) accounted for 55.5% of costs ($344,692), whereas ATA-concordant care accounted for 44.5% of costs. After multivariate adjustment, patients who underwent total thyroidectomy as compared with lobectomy were twice as likely to receive ATA-concordant surveillance (adjusted odds ratio 2.0, 95% confidence interval: 1.5-2.8, P < 0.001). CONCLUSIONS: Majority of older adults with T1N0M0 low-risk PTC do not receive ATA-concordant surveillance; discordant care was costly. Total thyroidectomy was the strongest predictor of receiving ATA-concordant care. PMID:33765509 | DOI:10.1016/j.jss.2021.01.049 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Controversy: For or against thyroid lobectomy in >1 cm differentiated thyroid cancer?

xlomafota13 shared this article with you from Inoreader Controversy: For or against thyroid lobectomy in >1 cm differentiated thyroid cancer? Via radioactive iodine Ann Endocrinol (Paris). 2021 Mar 20:S0003-4266(21)00029-9. doi: 10.1016/j.ando.2021.03.004. Online ahead of print. ABSTRACT In this controversy article, the respective advantages of lobectomy vs total thyroidectomy in differentiated thyroid cancers are argued. The authors conclude that lobectomy has the same oncological prognosis as thyroidectomy in terms of specific survival or recurrence, in case of low risk of recurrence (T1-2N0). However, as a precaution, and taking into accoun t current data, thyroidectomy is recommended that in N0 thyroid papillary cancers with aggressive subtype, with even minimal infiltration of perithyroid tissue and/or vascular invasion, and in N1 cancers with more than 5 lymphadenopathies or lymphadenopathies with a major axis greater than or equal to 0.2 cm. Other forms of papillary cancer should be treated with lobectomy, as risk of morbidity is low and hospital stay is short. Lobectomy allows reliable monitoring, especially by ultrasound. On the other hand, total thyroidectomy, despite a higher rate of surgical complications due to the risk of recurrent paralysis and permanent hypoparathyroidism, is nevertheless preferable to lobectomy, the latter not always avoiding hormone replacement therapy, in particular for more precise monitoring by thyroglobulin assay, which is uninterpretable after lobectomy but allows early diagnosis of local or metastatic recurrence and reduces mortality. Thus, in situations where the diagnostic criter ia for high-risk cancer are not rigorously determined or taken into account, thyroidectomy is recommended. In addition, it will remain preferable as long as the recommendations for administration of radioactive iodine do not change in favor of use reserved for high-risk cancers as in US guidelines. PMID:33757822 | DOI:10.1016/j.ando.2021.03.004 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.