Cytomegalovirus colitis induced segmental colonic hypoganglionosis in an immunocompetent patient: A case report

paythelady.612 shared this article with you from Inoreader Cytomegalovirus colitis induced segmental colonic hypoganglionosis in an immunocompetent patient: A case report Μέσω pubmed: "world j clin cases"... World J Clin Cases. 2021 Jul 16;9(20):5631-5636. doi: 10.12998/wjcc.v9.i20.5631. ABSTRACT BACKGROUND: Cytomegalovirus (CMV) colitis is usually seen in immunocompromised patients with risk factors such as human immunodeficiency virus infection, solid organ transplant, inflammatory bowel disease, or malignancy. Therefore, many clinicians usually do not consider the possibility of CMV colitis in immunocompetent patients. We reported a rare case of segmental colonic hypoganglionosis associated with CMV colitis in an immunocompetent patient. CASE SUMMARY: A 48-year-old woman with no underlying disease was admitted to our hospital for severe abdominal pain and constipation. Computed tomography of the abdomen showed diffuse dilatation of the small intestine and the entire colon. Initial sigmoidoscopic findings and result of polymerase chain reaction (PCR) for CMV revealed the compatible findings of CMV colitis, the patient was treated w ith intravenous ganciclovir. After treatment, sigmoidoscopic findings and CMV PCR results improved. However the patient continued to suffered from constipation. Eight months after the initial admission, patient visited the emergency department with severe abdominal pain and imaging revealed aggravation of fecal impaction and bowel dilatation. We performed subtotal colectomy to control patient's symptom. Histological examination of the resected specimen showed significantly reduced number of mature ganglion cells in the sigmoid colon compared to that in the proximal colon. CONCLUSION: Our case demonstrates that CMV colitis can develop even in patients with no other underlying disease, and that CMV colitis can be one of the causes for developing colonic hypoganglionosis. PMID:34307618 | PMC:PMC8281438 | DOI:10.12998/wjcc.v9.i20.5631 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Prospective, randomized comparison of two supplemental oxygen methods during gastroscopy with propofol mono-sedation in obese patients

paythelady.612 shared this article with you from Inoreader Prospective, randomized comparison of two supplemental oxygen methods during gastroscopy with propofol mono-sedation in obese patients Μέσω pubmed: "world j clin cases"... World J Clin Cases. 2021 Jul 16;9(20):5479-5489. doi: 10.12998/wjcc.v9.i20.5479. ABSTRACT BACKGROUND: Hypoxemia is a common complication in obese patients during gastroscopy with sedation. The Wei nasal jet tube (WNJT) is a new special nasopharyngeal airway with the ability to provide supraglottic jet ventilation and oxygen insufflation via its built-in wall channels. The aim of this study was to compare the efficacy and safety of the WNJT vs a nasal cannula for supplemental oxygen during gastroscopy with propofol mono-sedation in obese patients. AIM: To compare the efficacy and safety of the WNJT vs a nasal cannula for supplemental oxygen during gastroscopy with propofol mono-sedation in obese patients. METHODS: A total of 103 obese patients with a body mass index of 30 kg/m2 or more undergoing elective gastroscopy under propofol mono-sedation were randomly assigned to receive supplemental o xygen at 5 L/min through either a WNJT (WNJT group, n = 51) or a nasal cannula (nasal cannula group, n = 52). The lowest pulse oxygen saturation (SpO2) and mild and severe hypoxemia during gastroscopy were recorded. The primary outcome was the incidence of hypoxemia. RESULTS: The lowest SpO2 during gastroscopy with propofol mono-sedation was significantly increased in the WNJT group compared with the nasal cannula group. The incidence of mild hypoxemia and total incidence of hypoxemia were significantly lower in the WNJT group than in the nasal cannula group. Other than a higher incidence of epistaxis in the WNJT group, the occurrence of adverse events was similar between the devices. While neither device demonstrated a statistically significant difference in satisfaction among patients, the WNJT did result in improved satisfaction among anesthetists and physicians. CONCLUSION: During gastroscopy with propofol mono-sedation in obese pa tients, the WNJT, when compared with a nasal cannula for supplemental oxygen, can significantly reduce the occurrence of hypoxemia and improve both arterial oxygenation and satisfaction among anesthetists and physicians. The use of the WNJT may, however, lead to epistaxis in a few patients. In view of this clinically acceptable risk-benefit ratio, the WNJT may be recommended as an alternative tool for supplemental oxygen for the prevention of hypoxemia during gastroscopy with propofol mono-sedation in obese patients. PMID:34307602 | PMC:PMC8281412 | DOI:10.12998/wjcc.v9.i20.5479 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Primary extra-pancreatic pancreatic-type acinar cell carcinoma in the right perinephric space: A case report and review of literature

paythelady.612 shared this article with you from Inoreader Primary extra-pancreatic pancreatic-type acinar cell carcinoma in the right perinephric space: A case report and review of literature Μέσω pubmed: "world j clin cases"... World J Clin Cases. 2021 Jul 16;9(20):5637-5646. doi: 10.12998/wjcc.v9.i20.5637. ABSTRACT BACKGROUND: Primary extra-pancreatic pancreatic-type acinar cell carcinoma (ACC) is a rare malignancy, and has only been reported in the gastrointestinal tract, liver, and lymph nodes until now. Extra-pancreatic pancreatic-type ACC in the perinephric space has not been reported. Herein, we report the first case of ACC in the perinephric space and describe its clinical and imaging features, which should be considered when differentiating perinephric space neoplasms. CASE SUMMARY: A 48-year-old man with a 5-year history of hypertension was incidentally found to have an asymptomatic right retroperitoneal mass during a routine health check-up. Laboratory tests were normal. Abdominal computed tomography and magnetic resonance imaging showed an oval hypervascular mass with a central scar and enhanced capsule in the right perinephric space. After s urgical resection of the neoplasm, the diagnosis was primary extra-pancreatic pancreatic-type ACC. The patient was alive without recurrence or metastasis during a 15-mo follow-up. CONCLUSION: This is the first report of an extra-pancreatic ACC in right perinephric space, which should be considered as a possible diagnosis in perinephric tumors. PMID:34307619 | PMC:PMC8281426 | DOI:10.12998/wjcc.v9.i20.5637 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Type 2 diabetes mellitus increases liver transplant-free mortality in patients with cirrhosis: A systematic review and meta-analysis

paythelady.612 shared this article with you from Inoreader Type 2 diabetes mellitus increases liver transplant-free mortality in patients with cirrhosis: A systematic review and meta-analysis Μέσω pubmed: "world j clin cases"... World J Clin Cases. 2021 Jul 16;9(20):5514-5525. doi: 10.12998/wjcc.v9.i20.5514. ABSTRACT BACKGROUND: The impact of type 2 diabetes mellitus (T2DM) on the prognosis and complications of liver cirrhosis is not fully clarified. AIM: To clarify the mortality and related risk factors as well as complications in cirrhotic patients with T2DM. METHODS: We searched PubMed, EMBASE, and the Cochrane Library from their inception to December 1, 2020 for cohort studies comparing liver transplant-free mortality, hepatocellular carcinoma (HCC), ascites, spontaneous bacterial peritonitis (SBP), variceal bleeding, and hepatic encephalopathy (HE) in cirrhotic patients with vs without T2DM. Odds ratios (ORs) were combined by using fixed-effects or random-effects models with RevMan software. RESULTS: The database search generated a total of 17 cohort studies that met the inclusion criteria. Among these studies, eight reported the risk of mortality, and eight reported the risk of HCC. Three studies provided SBP rates, and two documented ascites rates. Four articles focused on HE rates, and three focused on variceal bleeding rates. Meta-analysis indicated that T2DM was significantly associated with an increased risk of liver transplant-free mortality [OR: 1.28, 95% confidence intervals (CI): 1.16-1.41, P < 0.0001] and HCC incidence (OR: 1.82, 95%CI: 1.32-2.51, P = 0.003). The risk of SBP was not significantly increased (OR: 1.16 95%CI: 0.86-1.57, P = 0.34). Additionally, T2DM did not significantly increase HE (OR: 1.31 95%CI: 0.97-1.77, P = 0.08), ascites (OR: 1.11 95%CI: 0.84-1.46, P = 0.46), and variceal bleeding (OR: 1.34, 95%CI: 0.99-1.82, P = 0.06). CONCLUSION: The findings suggest that cirrhotic patients with T2DM have a poor prognosis and high risk of HCC. T2DM may not be associated with an increased risk of SBP, variceal bleeding, ascites, or HE in cir rhotic patients with T2DM. PMID:34307604 | PMC:PMC8281398 | DOI:10.12998/wjcc.v9.i20.5514 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Muscular atrophy and weakness in the lower extremities in Behçet's disease: A case report and review of literature

paythelady.612 shared this article with you from Inoreader Muscular atrophy and weakness in the lower extremities in Behçet's disease: A case report and review of literature Μέσω pubmed: "world j clin cases"... World J Clin Cases. 2021 Jul 16;9(20):5647-5654. doi: 10.12998/wjcc.v9.i20.5647. ABSTRACT BACKGROUND: In Behçet's disease (BD), very few cases of muscular involvement have been reported previously. The natural history and therapeutic protocol for muscular involvement in BD are obscure due to the low incidence of peripheral neuropathy or myopathy in BD. The purpose of our study was to report a rare case of BD with chronic, focal forms of neuromyopathy and review the relevant literature. CASE SUMMARY: We herein report the case of a 54-year-old man who presented with progressive muscular atrophy and weakness of both thighs 2 years after the presentation of the cardinal symptoms of BD. The past medical history, electrophysiological study, neurological examination, blood tests, magnetic resonance imaging study, and histological exam were performed for the differential diagnosis. Relevant literature on muscular involvement in BD was r eviewed. Neurological examination revealed that muscular involvement was predominantly localized in the proximal parts of the lower extremities. Heterogeneous enhancement of several thigh muscles was observed on magnetic resonance imaging, which corresponded with the clinical manifestations. Histological study of one of the enhanced muscles showed denervation atrophy of the muscle with superimposed myopathic changes, while electrophysiological studies only suggested denervation. CONCLUSION: To our knowledge, this is the first case of neurogenic muscular atrophy with a specific set of clinical, radiological, electrophysiological, and histological findings reported in BD. PMID:34307620 | PMC:PMC8281428 | DOI:10.12998/wjcc.v9.i20.5647 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Multiple left ventricular myxomas combined with severe rheumatic valvular lesions: A case report

paythelady.612 shared this article with you from Inoreader Multiple left ventricular myxomas combined with severe rheumatic valvular lesions: A case report Μέσω pubmed: "world j clin cases"... World J Clin Cases. 2021 Jul 16;9(20):5535-5539. doi: 10.12998/wjcc.v9.i20.5535. ABSTRACT BACKGROUND: Primary cardiac tumors are uncommon, of which cardiac myxoma accounts for 50%-80%. Left ventricular myxoma has been rarely reported, accounting for only 3%-4% of all cardiac myxomas. Multiple left ventricular myxomas are, relatively, even rarer. CASE SUMMARY: In this report, we present a case of multiple left ventricular myxomas combined with severe rheumatic valve lesions. Symptomatically, the patient presented with fatigue, shortness of breath, and palpitation after activities. The patient underwent complete surgical resection of multiple left ventricular myxomas combined with mechanical replacement of the mitral and aortic valves, tricuspid valvuloplasty. The patient recovered well after the operation, with no obvious related complications. CONCLUSION: Multiple left ventricular myxomas may coexist with severe rheumatic v alve disease. Operation is an effective treatment. PMID:34307606 | PMC:PMC8281407 | DOI:10.12998/wjcc.v9.i20.5535 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Novel technique of extracorporeal intrauterine morcellation after total laparoscopic hysterectomy: Three emblematic case reports

paythelady.612 shared this article with you from Inoreader Novel technique of extracorporeal intrauterine morcellation after total laparoscopic hysterectomy: Three emblematic case reports Μέσω pubmed: "world j clin cases"... World J Clin Cases. 2021 Jul 16;9(20):5655-5660. doi: 10.12998/wjcc.v9.i20.5655. ABSTRACT BACKGROUND: In the presence of a large uterus, total laparoscopic hysterectomy (TLH), always requires morcellation to allow removal of the tissues from the abdominal cavity. However, uncontained morcellation has been scrutinized because of the possible spread of occult leiomyosarcoma. Therefore, in-bag extracorporeal morcellation has been developed. However, tissue containment and extraction are extremely challenging, especially when considering the increasing uterine size to be removed through minimally invasive surgery. CASE SUMMARY: Herein, we describe a novel technique for extracorporeal intrauterine morcellation using the uterus outermost layer as a bag to achieve tissue extraction of very large uteri with suspected occult leiomyosarcoma after TLH. The study enrolled patients who were planned for TLH for large uteri (weight > 500 g). TLH was performed following the procedure reported in our previous studies. The novel technique has been described step-by-step in a video, which representatively describes the preoperative imaging and morcellation procedure of three very large uteri weighing 1500 g, 1700 g, and 3700 g, respectively. The procedures were performed without any complications. The patients had an uneventful postoperative course, and in all cases, the pathology was benign leiomyoma. CONCLUSION: Extracorporeal intrauterine morcellation using the uterus outmost layer as a bag was found to be a feasible technique that allows a careful diagnosis and safe removal of suspected occult malignancies. The technique herein presented may be adopted in surgical practice, by adding it to the other available techniques of contained morcellation. It may represent a valid and feasible alternative, especially useful in cases of very large uteri exceeding the capacity of specimen retrieval bags. PMID:34307621 | PMC:PMC8281410 | DOI:10.12998/wjcc.v9.i20.5655 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Successful reversal of ostomy 13 years after Hartmann procedure in a patient with colon cancer: A case report

paythelady.612 shared this article with you from Inoreader Successful reversal of ostomy 13 years after Hartmann procedure in a patient with colon cancer: A case report Μέσω pubmed: "world j clin cases"... World J Clin Cases. 2021 Jul 16;9(20):5547-5555. doi: 10.12998/wjcc.v9.i20.5547. ABSTRACT BACKGROUND: The Hartmann procedure is currently recognized as a common, safe, and feasible surgical procedure. However, its reversal rate is low, and the optimal timing for Hartmann reversal surgery is controversial. CASE SUMMARY: A 65-year-old man came to our hospital with a complaint of an intestinal fistula next to the stoma. The patient had undergone a Hartmann procedure 13 years prior. We performed colonoscopy, computed tomography, and other diagnostics before successfully reversing the stoma. CONCLUSION: Although the optimal time for Hartmann procedure reversal is controversial, time may ultimately not be a factor in the success of reversal. PMID:34307608 | PMC:PMC8281400 | DOI:10.12998/wjcc.v9.i20.5547 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Rare isolated extra-hepatic bile duct injury: A case report

paythelady.612 shared this article with you from Inoreader Rare isolated extra-hepatic bile duct injury: A case report Μέσω pubmed: "world j clin cases"... World J Clin Cases. 2021 Jul 16;9(20):5661-5667. doi: 10.12998/wjcc.v9.i20.5661. ABSTRACT BACKGROUND: Extra-hepatic bile duct injury (EHBDI) is very rare among all blunt abdominal injuries. According to literature statistics, it only accounts for 3%-5% of abdominal injuries, most of which are combined injuries. Isolated EHBDI is more rare, with a special injury mechanism, clinical presentation and treatment strategy, so missed diagnosis easily occurs. CASE SUMMARY: We report a case of unexplained abdominal effusion and jaundice following blunt abdominal trauma in our department. Of which, surgical exploration of the case was performed and a large amount of bile leakage in the abdominal cavity was found. No obvious abdominal organ damage or bile duct rupture was found. Surgery was terminated after the common bile duct indwelled with a T tube. After 2 wk, a T-tube angiography revealed the lesion in the common bile duct pancreatic s egment, confirming isolated EHBDI. And 2 mo later, the T tube was pulled out with re-examined magnetic resonance cholangiopancreatography, indicating narrowing of the common bile duct injury, with no special treatment due to no clinical symptoms and no abnormality in the current follow-up. CONCLUSION: This case was featured by intraoperative bile leakage and no EHBDI. This type of rare isolated EHBDI is prone to missed and delayed diagnosis due to its atypical clinical manifestations and imaging features. Surgery is still the main treatment, and the indications and principles of bile duct injury repair must be followed. PMID:34307622 | PMC:PMC8281421 | DOI:10.12998/wjcc.v9.i20.5661 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Temporary coronary sinus pacing to improve ventricular dyssynchrony with cardiogenic shock: A case report

paythelady.612 shared this article with you from Inoreader Temporary coronary sinus pacing to improve ventricular dyssynchrony with cardiogenic shock: A case report Μέσω pubmed: "world j clin cases"... World J Clin Cases. 2021 Jul 16;9(20):5562-5567. doi: 10.12998/wjcc.v9.i20.5562. ABSTRACT BACKGROUND: Temporary transvenous pacing through the coronary sinus is a novel approach rarely used in treating unstable bradycardia. This modality could provide cardiac pacing while achieving better ventricular synchrony. We present a case who received cardiac pacing through the coronary sinus and provide a summary of evidence in the current literature. CASE SUMMARY: A 55-year-old woman with a history of advanced heart failure was admitted to the rehabilitation ward after a recent stroke. During hospitalization, she had paroxysmal atrial fibrillation with rapid ventricular response resulting from fluid overload. While atrial fibrillation was spontaneously reversed to sinus rhythm after diuresis, she developed multiple episodes of polymorphic ventricular tachycardia along with sinus bradycardia and prolonged QTc interval. She became hypotens ive despite appropriate medical management. Pacing through her implantable cardioverter-defibrillator was attempted but worsened her hypotension. Ventricular dyssynchrony was suspected. Temporary transvenous atrial pacing through the coronary sinus was performed, which stabilized her blood pressure and improved end-organ perfusion. A permanent biventricular pacemaker was later implanted, and she was safely discharged to a nursing home. CONCLUSION: Temporary transvenous pacing through the coronary sinus, a novel approach to treat unstable bradycardia, may reduce ventricular dyssynchrony. PMID:34307610 | PMC:PMC8281420 | DOI:10.12998/wjcc.v9.i20.5562 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.