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Hypophysitis induced by anti-programmed cell death protein 1 immunotherapy in non-small cell lung cancer:Three case reports

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World Journal of Clinical cases 2022年第30期10卷 11049-11058页

作者： Yun Zheng Chen-Yu Zhu Jing Lin Wang-Shan Chen Yu-Jie Wang Hong-Ye Fu Qiong Zhao Zhejiang University School of Medicine Zhejiang UniversityHangzhou 310030Zhejiang ProvinceChina Department of Thoracic Oncology Shulan(Hangzhou)Hospital affiliated to Zhejiang Shuren University Shulan International Medical CollegeHangzhou 310000Zhejiang ProvinceChina Zhejiang Chinese Medical University Hangzhou 311402Zhejiang ProvinceChina

BACKGROUND Hypophysitis induced by programmed cell death 1 protein(PD-1)immune checkpoint inhibitors is rare and poorly described.We report three patients with non-small cell lung cancer who developed hypophysitis after anti-PD-1 immunotherapy.case SUMMARY Both case 1 and case 2 presented with common symptoms of fatigue,nausea,and vomiting.However,case 3 showed rare acute severe symptoms such as hoarse voice,bucking,and difficulty in breathing even when sitting.Following two cycles of immunotherapy in case 3,the above severe symptoms and pituitary gland enlargement were found on magnetic resonance imaging at the onset of hypophysitis.These symptoms were relieved after 10 d of steroid treatment.case 3 was the first patient with these specific symptoms,which provided a new insight into the diagnosis of hypophysitis.In addition,we found that the clinical prognosis of patients with hypophysitis was related to the dose of steroid therapy.case 3 was treated with high-dose hormone therapy and her pituitary-corticotropic axis dysfunction returned to normal after more than 6 mo of steroid treatment.cases 1 and 2 were treated with the low-dose hormone,and dysfunction of the pituitary-corticotropic axis was still present after up to 7 mo of steroid treatment.CONCLUSION The clinical symptoms described in this study provide a valuable reference for the diagnosis and treatment of immune-related hypophysitis.

关键词： Programmed cell death protein 1 Immunotherapy Hypophysitis Lung cancer case reports

Emergency treatment and anesthesia management of internal carotid artery injury during neurosurgery:Four case reports

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World Journal of Clinical cases 2022年第27期10卷 9865-9872页

作者： Jie Wang Yu-Ming Peng Department of Anesthesiology Beijing Tiantan HospitalCapital Medical UniversityBeijing 100070China

BACKGROUND During skull base surgery,intraoperative internal carotid artery(ICA) injury is a catastrophic complication that can lead to fatal blood loss or secondary cerebral ischemia.Appropriate management of ICA injury plays a crucial role in the prognosis of patients.Neurosurgeons have reported multiple techniques and management strategies;however,the literature on managing this complication from the anesthesiologist’s perspective is limited,especially in the aspect of circulation management and airway management when patients need transit for further endovascular treatment.case SUMMARY We describe 4 cases of ICA injury during neurosurgery;there were 3 cases of pathologically proven pituitary adenoma and 1 case of cavernous sinus endothelial meningioma.After the onset of ICA injury,all four patients were immediately transferred for endovascular therapy under general anesthesia with vital signs monitored and mechanical ventilation.Three patients were transferred to the hybrid operating room,and one patient was transferred to the catheter operating room.Three patients underwent covered stent implantation,and one patient underwent embolization.All four patients experienced hypovolemic shock and received blood products infusion and vasoactive drugs to maintain stable circulation.After the neurosurgery,one patient was extubated and returned to the ward,and the other three were delayed tracheal extubation and returned to the intensive care unit.One patient died from serious neurological complications after 62 d in the hospital,but the other three showed good clinical outcomes.CONCLUSION ICA injury imposes a high risk of massive hemorrhage and subsequent infarction.Immediate treatment is critical and requires interdisciplinary collaboration among neurosurgeons,anesthesiologists,and interventional neuroradiologists.Effective hemostatic methods,stable hemodynamics sufficient to ensure perfusion of vital organs,airway safety during transit,rapid localization and implementation of appropriate measures to occlude the dama

关键词： Complication Internal carotid artery injury Neurosurgery Anesthesia Management Literature review case reports

Malignant melanotic nerve sheath tumors in the spinal canal of psammomatous and non-psammomatous type: Two case reports

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World Journal of Clinical cases 2022年第24期10卷 8735-8741页

作者： Jeong A Yeom You Seon Song In Sook Lee In Ho Han Kyung Un Choi Department of Radiology Pusan National University Yangsan HospitalYangsan 50612South Korea Department of Radiology Pusan National University HospitalBusan 49241South Korea Department of Neurosurgery Pusan National University HospitalBusan 49241South Korea Department of Pathology Pusan National University HospitalBusan 49241South Korea

BACKGROUND A malignant melanotic nerve sheath tumor(MMNST),previously known as a melanotic schwannoma,is a rare variant of a peripheral nerve sheath tumor composed of Schwann cells with melanotic differentiation.Only a few reports of spinal MMNST have been reported.case SUMMARY In the first case,a 58-year-old woman presented with a history of low back pain and paresthesia.Magnetic resonance imaging(MRI)and computed tomography(CT)of the lumbar spine revealed an intradural extramedullary mass lesion with amorphous linear calcification.Complete tumor resection was performed and histological examination revealed a psammomatous melanotic schwannoma.In the second case,a 72-year-old man presented with low back pain and paresthesia.MRI of the thoracolumbar spine revealed an intramedullary mass lesion at the T11 vertebral body level.The mass lesion was hypointense on T2WI and hyperintense on T1WI.Tumor resection was performed and the histologic result was melanotic schwannoma.CONCLUSION MMNST should be considered in the differential diagnosis when calcification or melanin is seen in an intradural spinal tumor.

关键词： Nerve sheath neoplasm Extramedullary Malignant Melanotic Magnetic resonance imaging case reports

Using clinical cases to guide healthcare

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World Journal of Clinical cases 2024年第9期12卷 1555-1559页

作者： Michael Colwill Samantha Baillie Richard Pollok Andrew Poullis Department of Gastroenterology St George's University Hospital NHS Foundation TrustLondon SW170QTUnited Kingdom

Evidence-based practice(EBP)has been the gold standard in healthcare for nearly three centuries and aims to assist physicians in providing the safest and most effective healthcare for their patients.The well-established hierarchy of evidence lists systematic reviews and meta-analyses at the top however these methodologies are not always appropriate or possible and in these instances case-control studies,case series and case reports are utilised to support EBP.case-control studies allow simultaneous study of multiple risk factors and can be performed rapidly and relatively cheaply.A recent example was during the Coronavirus pandemic where case-control studies were used to assess the efficacy of personal protective equipment for healthcare workers.case series and case reports also play a role in EBP and are particularly useful to study rare diseases such as inflammatory bowel disease in transgender and gender non-conforming individuals.They are also vital in generating and disseminating early signals and encouraging further research.Whilst these methodologies have weaknesses,particularly with regards to bias and loss of patient confidentiality for rare pathologies,they have an important part to play in EBP and when appropriately utilised can significantly impact upon clinical practice.

关键词： Evidence based medicine Hierarchy of evidence case reports case series

Effect of liver transplantation with primary hyperoxaluria type 1:Five case reports and review of literature

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World Journal of Clinical cases 2023年第5期11卷 1068-1076页

作者： Xin-Yue Wang Zhi-Gui Zeng Zhi-Jun Zhu Lin Wei Wei Qu Ying Liu Yu-Le Tan Jun Wang Hai-Ming Zhang Wen Shi Li-Ying Sun Department of Critical Liver Diseases Liver Research CenterBeijing Friendship HospitalCapital Medical UniversityBeijing 101100China Liver Transplantation Center Beijing Friendship HospitalCapital Medical UniversityBeijing 101100China Clinical Center for Pediatric Liver Transplantation Capital Medical UniversityBeijing 101100China National Clinical Research Center for Digestive Diseases Beijing Friendship HospitalCapital Medical UniversityBeijing 101100China Beijing Clinical Research Institute Beijing Friendship HospitalCapital Medical UniversityBeijing 100050China

BACKGROUND Primary hyperoxaluria type 1(PH1)is a rare autosomal recessive disease stemming from a deficiency in liver-specific alanine-glyoxylate aminotransferase,resulting in increased endogenous oxalate deposition and end-stage renal disease.Organ transplantation is the only effective treatment.However,its approach and timing remain controversial.case SUMMARY We retrospectively analyzed 5 patients diagnosed with PH1 from the Liver Transplant Center of the Beijing Friendship Hospital from March 2017 to December 2020.Our cohort included 4 males and 1 female.The median age at onset was 4.0 years(range:1.0-5.0),age at diagnosis was 12.2 years(range:6.7-23.5),age at liver transplantation(LT)was 12.2 years(range:7.0-25.1),and the follow-up time was 26.3 mo(range:12.8-40.1).All patients had delayed diagnosis,and 3patients had progressed to end-stage renal disease by the time they were diagnosed.Two patients received preemptive LT;their estimated glomerular filtration rate was maintained at>120 mL/min/1.73 m2,indicating a better prognosis.Three patients received sequential liver and kidney transplantation.After transplantation,serum and urinary oxalate decreased,and liver function recovered.At the last follow-up,the estimated glomerular filtration rates of the latter 3 patients were 179,52 and 21 mL/min/1.73 m2.CONCLUSION Different transplantation strategies should be adopted for patients based on their renal function stage.Preemptive-LT offers a good therapeutic approach for PH1.

关键词： Primary hyperoxaluria type 1 Liver transplantation Combined liver and kidney transplantation Sequential liver and kidney transplantation Renal calculi End-stage renal disease case reports

Reporting Characteristics of case reports of Acupuncture Therapy with CARE Guidelines

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Chinese Journal of Integrative Medicine 2018年第1期24卷 56-63页

作者： AN Guang-hui TANG Xiao-ting CHEN Yao-long ZHAO Yi College of Acupuncture-Moxibustion and Massage Shanghai University of Traditional Chinese Medicine Shanghai 201203China Wanggang Community Health Service Center Shanghai 201201 China Evidence-Based Medicine Center School of Basic Medical Sciences Lanzhou University Lanzhou 730000 China

Objective： To investigate the reporting characteristics of case reports of acupuncture therapy with case Report （CARE） guidelines, and to explore the applicability of the guidelines for these case reports. Methods： case reports published from January 1, 2011 to December 31, 2013, were identified by searching PubMed and the China Biomedicine Database by using MeSH terms. Screening and data extraction of case reports were conducted by two independent researchers. Assessments based on CARE guidelines and data analysis were conducted by using Excel 2003 and RevMan 5.0. Results： A total of 61 case reports published in 19 journals were identified, which involved 16 major types of diseases. Fifteen （24.6%） case reports declared no conflict of interests, and 5 （8.2%） reported funding sources. None of these case reports met all items of CARE guidelines, and only 6 subordinate items were fully reported among 50% of the case reports. Subgroup analysis indicated that case reports published in English or those that did not have competing interests had higher reporting quality. Conclusions： The reporting quality of case reports of acupuncture therapy is rather low. The reason might be a lack of awareness among authors and the poor dissemination of information regarding CARE guidelines in China. More evaluation studies are needed to promote and improve adherence to CARE guidelines. Moreover, an extended version of CARE guidelines should be developed for cases reports of special interventions such as acupuncture or adverse events caused by interventions.

关键词： case reports acupuncture therapy reporting guideline CARE （case reports） guidelines

Effect of acupuncture treatment on nonketotic hyperglycemic hemichorea-hemiballismus:a case report

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中医杂志:英文版 2023年第4期43卷 829-833页

作者： CHEN Ying SUN Jingqing LYU Tianli HONG Jiahui LIU Yuhan ZHU Liying LI Bin LIU Lu Department of Acupuncture and Moxibustion Beijing Hospital of Traditional Chinese MedicineCapital Medical UniversityBeijing 100010China

Nonketotic hyperglycemic hemichorea-hemiballismus is a rare syndrome in the clinic,and treatment is often delayed.Hypoglycemic therapy is the most widely used and effective treatment,but some patients experience a slower improvement.Other symptomatic treatment medicines have some degree of side effects.Acupuncture treatment is beneficial for hemichoreahemiballismus.A male patient,aged 59 years,first visited our hospital outpatient department due to motor agitation with involuntary movements of the right limb.He had a history of type 2 diabetes mellitus and poor blood glucose control.His serum glucose was 26.5 mmol/L(normal:4.4-6.1 mmol/L),and magnetic resonance imaging demonstrated an irregular area of high signal intensity in T1-weighted imaging,low signal intensity on T2-weighted imaging,and high signal intensity in the left corpus striatum in T2-FLAIR imaging.Hospitalization was recommended for the patient.After ruling out other possibilities,he was eventually diagnosed with nonketotic hyperglycemic hemichorea-hemiballismus.Intensive glycemic control was immediately started with subcutaneous injection and acupuncture treatment at“governor vessel 13 acupoints”,and the involuntary movements completely disappeared on the ninth day of hospitalization.The pathophysiology of nonketotic hyperglycemic hemichorea-hemiballismus is unclear.Different patient histories lead to different brain tissue conditions,and relapses and uncontrolled blood glucose add difficulties to treatment.According to Traditional Chinese Medicine theory,insufficient kidney essence leads to brain dystrophy and causes the symptoms of hemichorea-hemiballismus.Research evidence has shown that acupuncture at"governor vessel 13 acupoints"has a beneficial treatment effect on nonketotic hyperglycemic hemichorea-hemiballismus.

关键词： nonketotic hyperglycemic hemichorea-hemiballismus governor vessel acupuncture therapy case reports

Antiphospholipid syndrome with renal and splenic infarction after blunt trauma:A case report

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World Journal of Clinical cases 2022年第26期10卷 9404-9410页

作者： Na-A Lee Eui-Sung Jeong Hyun-Seok Jang Yun-Chul Park Ji-Hyoun Kang Jung-Chul Kim Young-Goun Jo Division of Trauma Department of SurgeryChonnam National University Medical School and HospitalGwangju 61469South Korea Division of Rheumatology Department of Internal MedicineChonnam National University Medical School and HospitalGwangju 61469South Korea

BACKGROUND In trauma patients,bleeding is an immediate major concern.At the same time,there are few cases of acute vascular occlusion after blunt trauma,and it is unclear what assessment and diagnosis should be considered for these cases.Herein,we describe a patient diagnosed with antiphospholipid syndrome after a hypercoagulable workup for acute renal and splenic vascular occlusion due to blunt trauma.case SUMMARY A 20-year-old man was admitted to the emergency department with abdominal pain after hitting a tree while riding a sled 10 h ago.He had no medical history.Radiological investigations revealed occlusion of the left renal artery with global infarction of the left kidney and occlusion of branches of the splenic artery with infarction of the central portion of the spleen.Attempted revascularization of the left renal artery occlusion through percutaneous transluminal angioplasty failed due to difficulty in passing the wire through the total occlusion.Considering the presence of acute multivascular occlusions in a young man with low cardiovascular risk,additional laboratory tests were performed to evaluate hypercoagulability.The results suggested a high possibility of antiphospholipid syndrome.Treatment with a subcutaneous injection of enoxaparin was started and changed to oral warfarin after two weeks.The diagnosis was confirmed,and he continued to visit the rheumatology outpatient clinic while taking warfarin.CONCLUSION A hypercoagulable workup can be considered in trauma patients with acute multivascular occlusion,especially in young patients with low cardiovascular risk.

关键词： Wounds and injuries Wounds Nonpenetrating Antiphospholipid syndrome Renal artery obstruction Splenic infarction case reports

Traumatic subcutaneous emphysema of the hand/forearm: A case report

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Chinese Journal of Traumatology 2022年第6期25卷 395-399页

作者： Stephen Saela Alexander Decilveo Roman Isaac Deepak V.Patel Department of Orthopaedic Surgery St Josephs University Medical CenterPatersonNJ 07503USA Department of Orthopaedic Surgery Seton Hall UniversitySouth OrangeNJ 07079US

Subcutaneous emphysema is commonly associated with infection caused by gas-producing organisms.In this case report,we describe a rare instance of traumatic subcutaneous emphysema of the hand and forearm caused by a puncture injury to the first web space of the hand.Our objective is to increase awareness of the potential for seemingly minor trauma to cause entrapment of significant air in subcutaneous tissues,thereby decreasing the likelihood that a clinically benign-appearing patient will be started down an unnecessarily aggressive treatment pathway.A 16-year-old,otherwise healthy white female,presented to the pediatric emergency room with an impressive amount of subcutaneous emphysema that developed over a 12-h period after sustaining an accidental laceration to the first web space of her right hand.She appeared nontoxic and had a clinically benign presentation.A comprehensive work-up was performed.She was splinted by the orthopedic surgery resident on call,and was admitted to the Pediatric Intensive Care Unit for overnight monitoring.She received tetanus vaccination and broad-spectrum antibiotics.The patient was discharged 2 days after admittance,with a splint applied to her right hand and forearm.She undertook home-based physical and occupational therapy.She had a pain-free range-of-motion in the right wrist,elbow and shoulder.The swelling in the right hand subsided completely.Although initially alarming,traumatic subcutaneous emphysema in an otherwise healthy patient from minor wounds(as featured in this case)does not necessarily mean one ought to proceed down an aggressive treatment algorithm.Careful evaluation of the patient's history,clinical examination findings,and determination of the Laboratory Risk Indicator for Necrotizing Fasciitis score can help guide physicians in the management of traumatic subcutaneous emphysema and potentially avoid unnecessary and costly interventions.

关键词： Upper extremity Traumatic subcutaneous emphysema Sucking-wounds Penetrating Necrotizing fasciitis case reports Laboratory Risk Indicator for Necrotizing Fasciitis(LRINEC)