Small bowel ulcer bleeding due to suspected clopidogrel use in a patient with clopidogrel resistance: A case report

paythelady.612 shared this article with you from Inoreader Small bowel ulcer bleeding due to suspected clopidogrel use in a patient with clopidogrel resistance: A case report Μέσω pubmed: "world j clin cases"... World J Clin Cases. 2021 May 26;9(15):3689-3695. doi: 10.12998/wjcc.v9.i15.3689. ABSTRACT BACKGROUND: Clopidogrel is a platelet aggregation inhibitor used for the management of cardiovascular disease. While antiplatelet therapy decreases cardiovascular events after successful coronary drug-eluting stenting, it increases the risk of gastrointestinal (GI) bleeding. About 20% of the patients who take clopidogrel exhibit resistance to the drug. CASE SUMMARY: We report the first case of a small bowel bleeding ulcer in an 86-year-old man with clopidogrel resistance. He had a history of taking clopidogrel due to unstable angina. There was no evidence of bleeding in the stomach, duodenum, or colon through upper and lower GI endoscopies. The abdominal computed tomography showed the extravasation of radiocontrast media at the ileum. Because of unstable vital signs, emergency surgery was performed. Multiple ulcers with inflammation were fou nd in the ileum. The pathologic findings revealed simple inflammation. The VerifyNow P2Y12 test showed clopidogrel resistance. One year after changing to aspirin, capsule endoscopy was performed and the small bowel ulcers were improved. CONCLUSION: Small bowel ulcers and bleeding due to clopidogrel are not very common, but the prevalence is expected to increase in older age patients with risk factors despite clopidogrel resistance. PMID:34046471 | PMC:PMC8130066 | DOI:10.12998/wjcc.v9.i15.3689 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Bilateral cerebral infarction in diabetic ketoacidosis and bilateral internal carotid artery occlusion: A case report and review of literature

paythelady.612 shared this article with you from Inoreader Bilateral cerebral infarction in diabetic ketoacidosis and bilateral internal carotid artery occlusion: A case report and review of literature Μέσω pubmed: "world j clin cases"... World J Clin Cases. 2021 May 26;9(15):3787-3795. doi: 10.12998/wjcc.v9.i15.3787. ABSTRACT BACKGROUND: Diabetic ketoacidosis (DKA) is a serious complication of type 1 diabetes mellitus (T1DM). Very rarely does DKA lead to cerebral edema, and it is even rarer for it to result in cerebral infarction. Bilateral internal carotid artery occlusion (BICAO) is also rare and can cause fatal stroke. Moreover, case reports about acute cerebral infarction throughout both internal carotid arteries with simultaneous BICAO are very scarce. In this study, we present a patient with BICAO, T1DM, hypertension, and hyperlipidemia, who had a catastrophic bilateral cerebral infarction after a DKA episode. We briefly introduce BICAO and the mechanisms by which DKA results in cerebral infarction. CASE SUMMARY: A 41-year-old woman presented with ischemic stroke that took place 3 mo prior over the left corona radiata, bilateral frontal lobe, and parietal l obe with right hemiplegia and Broca's aphasia. She had a history of hypertension for 5 years, hyperlipidemia for 4 years, hyperthyroidism for 3 years, and T1DM for 31 years. The first brain magnetic resonance imaging not only revealed the aforementioned ischemic lesions but also bilateral internal carotid artery occlusion. She was admitted to our ward for rehabilitation due to prior stroke sequalae. DKA took place on hospital day 2. On hospital day 6, she had a new massive infarction over the bilateral anterior cerebral artery and middle cerebral artery territory. After weeks of aggressive treatment, she remained in a coma and on mechanical ventilation due to respiratory failure. After discussion with her family, compassionate extubation was performed on hospital day 29 and she died. CONCLUSION: DKA can lead to cerebral infarction due to several mechanisms. In people with existing BICAO and several stroke risk factors such as hypertension, T1DM, hyperlipidemia, DKA has the pot ential to cause more serious ischemic strokes. PMID:34046484 | PMC:PMC8130090 | DOI:10.12998/wjcc.v9.i15.3787 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Recurrent abdominal pain due to small bowel volvulus after transabdominal preperitoneal hernioplasty: A case report and review of literature

paythelady.612 shared this article with you from Inoreader Recurrent abdominal pain due to small bowel volvulus after transabdominal preperitoneal hernioplasty: A case report and review of literature Μέσω pubmed: "world j clin cases"... World J Clin Cases. 2021 May 26;9(15):3696-3703. doi: 10.12998/wjcc.v9.i15.3696. ABSTRACT BACKGROUND: Compared with open mesh repair, transabdominal preperitoneal (TAPP) hernioplasty results in less chronic postoperative inguinal pain and faster postoperative recovery. However, it may still lead to rare but serious complications. Here we report a case of intestinal volvulus with recurrent abdominal pain as the only clinical symptom, which occurred 3 mo after TAPP repair for bilateral inguinal hernia. CASE SUMMARY: A 50-year-old male patient underwent laparoscopic TAPP for bilateral inguinal hernias. After the operation, he experienced recurring pain in his lower right abdomen around the surgical area, which was relieved after symptomatic treatment. Three months after the surgery, the abdominal pain became severe and was aggravated over time. The whirlpool sign of the mesentery was seen on contrast-enhanced computed tomography (CT ). Laparoscopic exploration confirmed that a barb of the V-Loc™ suture penetrated the peritoneum, which caused the adhesion of the small intestinal wall to the site of peritoneal injury, forming intestinal volvulus. Since there was no closed-loop obstruction or intestinal ischemia, recurrent abdominal pain became the only clinical manifestation in this case. After laparoscopic lysis of adhesions and reduction of intestinal volvulus, the patient recovered and was discharged. CONCLUSION: The possibility of intestinal volvulus should be considered in patients who experience recurrent abdominal pain following TAPP surgery during which barbed V-Loc sutures are used for closing the peritoneum. Contrast-enhanced CT and active laparoscopic exploration can confirm the diagnosis and prevent serious complications. PMID:34046472 | PMC:PMC8130073 | DOI:10.12998/wjcc.v9.i15.3696 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Progressive familial intrahepatic cholestasis - farnesoid X receptor deficiency due to NR1H4 mutation: A case report

paythelady.612 shared this article with you from Inoreader Progressive familial intrahepatic cholestasis - farnesoid X receptor deficiency due to <em>NR1H4</em> mutation: A case report Μέσω pubmed: "world j clin cases"... World J Clin Cases. 2021 May 26;9(15):3631-3636. doi: 10.12998/wjcc.v9.i15.3631. ABSTRACT BACKGROUND: Functioning farnesoid X receptor (FXR; encoded by NR1H4) is key to normal bile acid homeostasis. Biallelic mutations in NR1H4 are reported in a few children with intrahepatic cholestasis. We describe a boy with progressive familial intrahepatic cholestasis and homozygous mutation in NR1H4. CASE SUMMARY: A boy had severe neonatal cholestasis with moderate hypercholanemia and persistently elevated alpha-fetoprotein. Despite medical treatment, coagulopathy was uncontrollable, prompting liver transplantation at age 8 mo with incidental splenectomy. The patient experienced catch-up growth with good liver function and did not develop allograft steatosis. However, 1 year after transplant, he died from an acute infection, considered secondary to immunosuppression and asplenia. A homozygous protein-truncating mutation , c.547C > T, p.(Arg183Ter), was subsequently identified in NR1H4, and both parents were shown to be heterozygous carriers. Absence of FXR and of bile salt export pump expression was confirmed by immunostaining of explanted liver. CONCLUSION: Severe cholestasis with persistently high alpha-fetoprotein and modest elevation of serum bile acid levels may suggest FXR deficiency. Some patients with FXR deficiency may not develop allograft steatosis and may respond well to liver transplantation. PMID:34046462 | PMC:PMC8130085 | DOI:10.12998/wjcc.v9.i15.3631 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Malignant giant cell tumor in the left upper arm soft tissue of an adolescent: A case report

paythelady.612 shared this article with you from Inoreader Malignant giant cell tumor in the left upper arm soft tissue of an adolescent: A case report Μέσω pubmed: "world j clin cases"... World J Clin Cases. 2021 May 26;9(15):3704-3710. doi: 10.12998/wjcc.v9.i15.3704. ABSTRACT BACKGROUND: Giant cell tumor of soft tissue (GCT-ST) is an extremely rare low-grade soft tissue tumor that is originates in superficial tissue and rarely spreads deeper. GCT-ST has unpredictable behavior. It is mainly benign, but may sometimes become aggressive and potentially increase in size within a short period of time. CASE SUMMARY: A 17-year-old man was suspected of having a fracture, based on radiography following left shoulder trauma. One month later, the swelling of the left shoulder continued to increase and the pain was obvious. Computed tomography (CT) revealed a soft tissue mass with strip-like calcifications in the left shoulder. The mass invaded the adjacent humerus and showed an insect-like area of destruction at the edge of the cortical bone of the upper humerus. The marrow cavity of the upper humerus was enlarged, and a sof t tissue density was seen in the medullary cavity. Thoracic CT revealed multiple small nodules beneath the pleura of both lungs. A bone scan demonstrated increased activity in the left shoulder joint and proximal humerus. The mass showed mixed moderate hypointensity and hyperintensity on T1-weighted images, and mixed hyperintensity on T2-weighted fat-saturated images. The final diagnosis of GCT-ST was confirmed by pathology. CONCLUSION: GCT-STs should be considered in the differential diagnosis of soft tissue tumors and monitored for large increases in size. PMID:34046473 | PMC:PMC8130095 | DOI:10.12998/wjcc.v9.i15.3704 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Combined cesarean delivery and repair of acute aortic dissection at 34 weeks of pregnancy during COVID-19 outbreak: A case report

paythelady.612 shared this article with you from Inoreader Combined cesarean delivery and repair of acute aortic dissection at 34 weeks of pregnancy during COVID-19 outbreak: A case report Μέσω pubmed: "world j clin cases"... World J Clin Cases. 2021 May 26;9(15):3644-3648. doi: 10.12998/wjcc.v9.i15.3644. ABSTRACT BACKGROUND: Since the outbreak of the coronavirus disease 2019 (COVID-19) pandemic, the exclusion of a patient from COVID-19 should be performed before surgery. However, patients with type A acute aortic dissection (AAD) during pregnancy can seriously endanger the health of either the mother or fetus that requires emergency surgical treatment without the test for COVID-19. CASE SUMMARY: A 38-year-old woman without Marfan syndrome was admitted to the hospital because of chest pain in the 34th week of gestation. She has diagnosed as having a Stanford type-A AAD involving an aortic arch and descending aorta via aortic computed tomographic angiography. The patient was transferred to the isolated negative pressure operating room in one hour and underwent cesarean delivery and ascending aorta replacement. All medical staff adopte d third-level medical protection measures throughout the patient transfer and surgical procedure. After surgery, the patient was transferred to the isolated negative pressure intensive care unit ward. The nucleic acid test and anti-COVID-19 immunoglobulin (Ig) G and IgM were performed and were negative. The patient and infant were discharged without complication nine days later and recovered uneventfully. CONCLUSION: The results indicated that the procedure that we used is feasible in patients with a combined cesarean delivery and surgery for Stanford type-A AAD during the COVID-19 outbreak, which was mainly attributed to rapid multidisciplinary consultation, collaboration, and quick decision-making. PMID:3404 6464 | PMC:PMC8130093 | DOI:10.12998/wjcc.v9.i15.3644 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Anesthetic management of bilateral pheochromocytoma resection in Von Hippel-Lindau syndrome: A case report

paythelady.612 shared this article with you from Inoreader Anesthetic management of bilateral pheochromocytoma resection in Von Hippel-Lindau syndrome: A case report Μέσω pubmed: "world j clin cases"... World J Clin Cases. 2021 May 26;9(15):3711-3715. doi: 10.12998/wjcc.v9.i15.3711. ABSTRACT BACKGROUND: Von Hippel-Lindau disease (also known as VHL syndrome), is an autosomal dominant inherited disease. We describe a sporadic case of VHL syndrome where bilateral pheochromocytomas were unexpectedly identified. The patient underwent selective laparoscopic resections of the pheochromocytomas, and the anesthetic management during surgery was complex and challenging. CASE SUMMARY: A 22-year-old man presented to our hospital to seek medical advice for infertility without any other complaints. The results of computed tomography and catecholamine levels in blood and urine demonstrated adrenal gland masses which were diagnosed as pheochromocytomas. Further examination confirmed that the patient also had VHL syndrome. After thorough preparation, the patient underwent selective laparoscopic resection of the pheochromocytomas and was discharg ed 10 d after surgery. We describe the process of perioperative anesthesia management in this patient undergoing pheochromocytoma resection. CONCLUSION: This case summaries specific clinical traits and considerations in perioperative anesthesia management for VHL syndrome patients undergoing bilateral pheochromocytoma resection. PMID:34046474 | PMC:PMC8130083 | DOI:10.12998/wjcc.v9.i15.3711 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Recalcitrant paradoxical pustular psoriasis induced by infliximab: Two case reports

paythelady.612 shared this article with you from Inoreader Recalcitrant paradoxical pustular psoriasis induced by infliximab: Two case reports Μέσω pubmed: "world j clin cases"... World J Clin Cases. 2021 May 26;9(15):3655-3661. doi: 10.12998/wjcc.v9.i15.3655. ABSTRACT BACKGROUND: Paradoxical psoriasis induced by tumor necrosis factor alpha antagonists is a rare side effect of those drugs and has similarities with and differences from classical psoriasis in clinical and pathological characteristics. Treating severe paradoxical psoriasis is challenging because the reported cases are rare, with treatment experience being only anecdotal. CASE SUMMARY: We report 2 cases of paradoxical psoriasis caused by infliximab. Both cases manifested with a significant number of pustular lesions and had protracted and complicated clinical courses. In case 1, secukinumab alone could not control the eruptions, but colchicine supplementation markedly decreased disease activity. In case 2 miscellaneous medications were administered, including the systemic drug acitretin, the immunosuppressive drug cyclosporine, and the biologi c agent ustekinumab. However, multiple applications of those medications failed to prevent new lesions from occurring. Both cases showed moderate-to-high anti-nuclear antibody titers. CONCLUSION: Based on these cases, moderate-to-high anti-nuclear antibody titer seems to be a risk factor for paradoxical psoriasis. In addition, extensive pustular presentation may be a negative prognostic indicator and may portend a protracted clinical course refractory to therapy. PMID:34046466 | PMC:PMC8130067 | DOI:10.12998/wjcc.v9.i15.3655 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Sarcomatoid carcinoma of the pancreas - a rare tumor with an uncommon presentation and course: A case report and review of literature

paythelady.612 shared this article with you from Inoreader Sarcomatoid carcinoma of the pancreas - a rare tumor with an uncommon presentation and course: A case report and review of literature Μέσω pubmed: "world j clin cases"... World J Clin Cases. 2021 May 26;9(15):3716-3725. doi: 10.12998/wjcc.v9.i15.3716. ABSTRACT BACKGROUND: Sarcomatoid carcinoma of the pancreas (SCP) is a rare type of pancreatic neoplasm, and only a few cases have been described in the literature. Histologically, it is composed mostly of atypical spindle cells with apparent sarcomatous features. CASE SUMMARY: This is a report of a 61-year-old Chilean woman who underwent medical investigation for acute abdominal pain. Computed tomography identified a solid tumor in the tail of the pancreas with features suspicious of malignancy. En-bloc distal pancreatectomy and splenectomy were performed to excise the tumor. Histopathology and immunohistochemistry were confirmatory of sarcomatoid carcinoma with lymphovascular invasion. After surgery, the patient did not receive chemotherapy. Previous studies indicate a poor prognosis for this type of malignancy. However, our patient has survi ved for 35 mo with no recurrence to date. CONCLUSION: The case presented herein is a patient with an SCP with a rare presentation and long-term survival after surgery despite not receiving adjuvant chemotherapy. PMID:34046475 | PMC:PMC8130075 | DOI:10.12998/wjcc.v9.i15.3716 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Association of hidradenitis suppurativa with Crohn's disease

paythelady.612 shared this article with you from Inoreader Association of hidradenitis suppurativa with Crohn's disease Μέσω pubmed: "world j clin cases"... World J Clin Cases. 2021 May 26;9(15):3506-3516. doi: 10.12998/wjcc.v9.i15.3506. ABSTRACT Hidradenitis suppurativa (HS) is a chronic inflammatory skin disorder characterized by recurrent nodules, abscesses, and sinus tracts. Crohn's disease (CD) is characterized by inflammation of the entire digestive tract and belongs to the group of inflammatory bowel diseases, and there are many extraintestinal manifestations, among which hidradenitis suppurativa is one of the rare extraintestinal manifestations. There appears to be a strong association between CD and HS based on clinical and histological similarities (sinus tract development, granulomatous inflammation, and scarring), intersections in pathogenesis (genetic loci, immune dysregulation mechanisms, and microbiome changes), and commonality in treatment. In this review, we summarize recent studies on the association between HS and CD. PMID:34046451 | PMC:PMC8130070 | DOI:10.12998/wjcc.v9.i15.3506 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Fulminant amebic colitis in a patient with concomitant cytomegalovirus infection after systemic steroid therapy: A case report

paythelady.612 shared this article with you from Inoreader Fulminant amebic colitis in a patient with concomitant cytomegalovirus infection after systemic steroid therapy: A case report Μέσω pubmed: "world j clin cases"... World J Clin Cases. 2021 May 26;9(15):3726-3732. doi: 10.12998/wjcc.v9.i15.3726. ABSTRACT BACKGROUND: Amebic colitis is an infection caused by Entamoeba histolytica and most commonly observed in regions with poor sanitation. It is also seen as a sexually transmitted disease in developed countries. While amebic colitis usually has a chronic course with repeated exacerbations and remissions, it may also manifest as a fulminant form that rapidly progresses and leads to severe, life-threatening complications, such as intestinal perforation, peritonitis, and sepsis, that have a high mortality rate. CASE SUMMARY: A 68-year-old man was admitted to our hospital with chest pain and acute dyspnea. He was diagnosed with acute coronary syndrome, acute heart failure, and bacterial pneumonia. His respiratory condition worsened despite receiving intensive care and intravenous antibiotics. On the fifth day of hospitalization, he was diagn osed with acute respiratory distress syndrome and was started on steroid therapy. He subsequently developed bloody stools and was diagnosed with cytomegalovirus (CMV) enterocolitis based on biopsy results and a peripheral blood CMV pp65 antigenemia test result. Although we started antiviral therapy with ganciclovir, which was successful in reducing his antigen titers, he continued to have bloody diarrhea. Three weeks after initiation of ganciclovir therapy and six weeks after his admission, the patient died from intestinal perforation. We only posthumously diagnosed him with amebic colitis and CMV enterocolitis based on autopsy findings of transmural necrosis of the entire colon with massive ameba infiltration. CONCLUSION: We urge clinicians to consider Entamoeba histolytica infection if severe colitis progresses after steroid therapy. Preemptive treatment is recommended then. PMID:34046476 | PMC:PMC8130080 | DOI:10.12998/wjcc.v9.i15.3726 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.