Αρχειοθήκη ιστολογίου

Αλέξανδρος Γ. Σφακιανάκης
ΩτοΡινοΛαρυγγολόγος
Αναπαύσεως 5
Άγιος Νικόλαος Κρήτη 72100
2841026182
6032607174

Τρίτη 2 Μαρτίου 2021

Noninvasive tools based on immune biomarkers for the diagnosis of central nervous system graft-vs-host disease: Two case reports and a review of the literature

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World J Clin Cases. 2021 Feb 26;9(6):1359-1366. doi: 10.12998/wjcc.v9.i6.1359.

ABSTRACT

BACKGROUND: Central nervous system graft-vs-host disease (CNS-GVHD) is a rare cause of CNS disorders after allogeneic hematopoietic stem cell transplantation. Currently, establishing a diagnosis of CNS-GVHD is challenging because the diagnostic criteria and diagnostic methods are not well defined and many confounding factors need to be ruled out.

CASE SUMMARY: Here, we present two patients with CNS-GVHD. Both patients with a history of acute GVHD or chronic GVHD developed neurological symptoms that could not be explained by other causes, and had abnormal cerebrospinal fluid (CSF) studies as determined by CSF and blood immune biomarker examinations, suggestive of suspected CNS-GVHD. Due to the lack of specific magnetic resonance imaging abnormalities and the rapid clinical deterioration of the patients, we did not attempt to perform a br ain biopsy, but prompted the initiation of empirical immunosuppressive therapy. In view of the rapid and favorable response to local and systematic immunosuppressive treatment and the aforementioned neurologic manifestations together with CSF abnormalities and other negative findings, a final diagnosis of CNS-GVHD was made.

CONCLUSION: CSF and blood immune biomarker examinations facilitated the diagnosis of CNS-GVHD, which are particularly suitable for patients who are critically ill and require urgent treatment and for those who are unsuitable for invasive diagnostic procedures.

PMID:33644203 | PMC:PMC7896680 | DOI:10.12998/wjcc.v9.i6.1359

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Management protocol for Fournier's gangrene in sanitary regime caused by SARS-CoV-2 pandemic: A case report

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World J Clin Cases. 2021 Feb 16;9(5):1215-1220. doi: 10.12998/wjcc.v9.i5.1215.

ABSTRACT

BACKGROUND: Fournier's gangrene (FG) is a serious, aggressive and often deadly polymicrobial infection of the soft tissues of the perineum, the rectum and the external genital organs. It is an anatomical subcategory of necrotizing fasciitis, which has a similar etiology and treatment strategy.

CASE SUMMARY: A 60-year-old man was admitted to the hospital during severe acute respiratory syndrome coronavirus 2 pandemic with complaints of fever up to 38.9 °C, abdominal pain, and edema of the scrotum, the penis, the perineum, and the right gluteal region for 2 d. Computed tomography of the abdomen and the pelvis revealed extensive inflammatory infiltrations of the subcutaneous tissue of the hypogastrium, and the penis; along with liquefaction and presence of gas in the subcutaneous tissues of the scrotum, the perineum, and the right gluteal region . The patient was diagnosed with FG, and was urgently qualified to undergo surgery in the Department of Urology. After performing the necessary examinations, a resection of the necrotic tissues with bilateral orchiectomy and excision of the penile and scrotal skin was performed. After surgery, he was transferred to the intensive care unit for further management.

CONCLUSION: Early management prevents the resection of the other organs by inhibiting the contiguous spread of infection.

PMID:33644187 | PMC:PMC7896664 | DOI:10.12998/wjcc.v9.i5.1215

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Periodontally accelerated osteogenic orthodontics with platelet-rich fibrin in an adult patient with periodontal disease: A case report and review of literature

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World J Clin Cases. 2021 Feb 26;9(6):1367-1378. doi: 10.12998/wjcc.v9.i6.1367.

ABSTRACT

BACKGROUND: In the clinical scenario, adult patients with periodontal diseases and dental malformation, characterized by dental crowding in lower anterior teeth with the thin biotype, often require orthodontic treatment. This case report aimed to evaluate the clinical and radiographic outcomes of periodontally accelerated osteogenic orthodontics (PAOO) combined with autologous platelet-rich fibrin (PRF) in an adult patient with class I malocclusion along with dental crowding, a thin periodontal biotype, and buccal plate deficiency.

CASE SUMMARY: A 32-year-old female complaining of dental crowding and gingival bleeding was referred to the orthodontic clinic. The patient underwent periodontal risk assessment prior to orthodontic treatment. She was diagnosed with a high risk of gingival recession due to dental crowding, root prominence, loss of b uccal plates, and a thin gingival tissue biotype. The treatment regimen included PAOO combined with autologous PRF for alveolar augmentation and interproximal enamel reduction for moderate dental crowding. Clinically, PAOO-assisted orthodontic tooth movement in this case showed enhanced periodontium remodeling. Radiographic outcomes also showed statistically significant improvements (P < 0.01) in the mandibular buccal alveolar bone.

CONCLUSION: This case report suggests the combination of autologous PRF with PAOO to enhance bone augmentation and long-term tissue support in adult orthodontic patients with periodontal disease.

PMID:33644204 | PMC:PMC7896698 | DOI:10.12998/wjcc.v9.i6.1367

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Endoscopic repair of delayed stomach perforation caused by penetrating trauma: A case report

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World J Clin Cases. 2021 Feb 16;9(5):1228-1236. doi: 10.12998/wjcc.v9.i5.1228.

ABSTRACT

BACKGROUND: Primary endoscopic closure of a perforated gastric wall during endoscopic procedures is mostly effective and well-tolerated; however, there are very few studies on the efficacy of endoscopic management of delayed traumatic gastric perforation. Herein, we report a novel case of a patient who was successfully treated for delayed traumatic stomach perforation using an alternative endoscopic modality.

CASE SUMMARY: A 39-year-old woman presented with multiple penetrating traumas in the back and left abdominal cavity. Initial imaging studies revealed left diaphragmatic disruption and peri-splenic hemorrhage without gastric perforation. An emergency primary repair of the disrupted diaphragm with omental reduction and suturing of the lacerated lung was performed; however, delayed free perforation of the gastric wall was noted on computed t omography after 3 d. Following an emergency abdominal surgery for the primary repair of the gastric wall, re-perforation was noted 15 d postoperatively. The high risk associated with re-surgery prompted an endoscopic intervention using 2 endoloops and 11 endoscopic clips using a novel modified purse-string suture technique. The free perforated gastric wall was successfully repaired without additional surgery or intervention. The patient was discharged after 46 d without any complications.

CONCLUSION: Endoscopic closure with endoloops and clips can be a useful therapeutic alternative to re-surgery for delayed traumatic gastric perforation.

PMID:33644189 | PMC:PMC7896642 | DOI:10.12998/wjcc.v9.i5.1228

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Subtalar joint pigmented villonodular synovitis misdiagnosed at the first visit: A case report

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World J Clin Cases. 2021 Feb 26;9(6):1379-1385. doi: 10.12998/wjcc.v9.i6.1379.

ABSTRACT

BACKGROUND: Pigmented villonodular synovitis (PVNS) is an uncommon disease that usually occurs in large joints, and involvement of the subtalar joint is rare. The lack of comprehensive knowledge of subtalar joint PVNS could lead to misdiagnosis.

CASE SUMMARY: We present a 64-year-old woman who, at her first visit, complained of discomfort in the right ankle when she walked. Based on the physical signs and X-ray report, the physician failed to make the suspected diagnosis of PVNS. Eighteen months later, the patient returned with a complaint of a mass in her right lateral malleolus with intermittent blunt pain. The X-ray presented an osteophyte formation and soft tissue calcification at the margin of the subtalar joint. The laboratory tests were normal, whereas magnetic resonance imaging (MRI) showed a low-intensity area on both T1- and T2-weigh ted images. A suspected diagnosis of PVNS was made and later confirmed by postoperative pathology. Subsequently, the patient received radiotherapy with 32 Gy in 16 fractions. At 6 mo postoperatively, the patient only complained of discomfort after walking three blocks. The American Orthopedic Foot and Ankle Society Ankle-Hindfoot score was 97.

CONCLUSION: MRI is necessary for the diagnosis of PVNS. Early soft tissue calcification and painless joint swelling should be of concern.

PMID:33644205 | PMC:PMC7896681 | DOI:10.12998/wjcc.v9.i6.1379

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Interactive platform for peer review: A proposal to improve the current peer review system

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World J Clin Cases. 2021 Feb 26;9(6):1247-1250. doi: 10.12998/wjcc.v9.i6.1247.

ABSTRACT

Peer review is the cornerstone in scientific publication. Although peer review has paramount importance in ensuring the quality of the published literature, it still has a number of shortcomings. The present manuscript proposes a new method to improve the current peer review system by providing an interactive, dynamic platform that allows direct, anonymous interaction between the authors of submitted manuscripts and the reviewers. Such real-time interaction may help eliminate any problems related to misunderstanding or misinterpretation of the reviewer's comments or the authors' response, and would save time while keeping the identity of both parties anonymous.

PMID:33644191 | PMC:PMC7896679 | DOI:10.12998/wjcc.v9.i6.1247

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Wilson disease - the impact of hyperimmunity on disease activity: A case report

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World J Clin Cases. 2021 Feb 26;9(6):1386-1393. doi: 10.12998/wjcc.v9.i6.1386.

ABSTRACT

BACKGROUND: In Wilson disease lack of biliary copper excretion causes hepatocellular injury by accumulation of free toxic copper. Its overspill to serum accounts for neuronal damage as second common manifestation. Therapy with copper chelators or zinc targets the removal of this free copper. However, in some patients liver disease persists for unknown reason despite normalized free copper. The discovery of a hyperimmunity as a contributing pathogenetic factor was discovered in this case report with implication also for other liver diseases.

CASE SUMMARY: A 9-year-old girl was diagnosed in August 2009 by family screening of having asymptomatic Wilson disease with elevated transaminases. Already at time of diagnosis antinuclear antibodies (ANA) were elevated without hyperimmunoglobulinemia (immunoglobulin G, IgG). After one year of therapy with D-penicillamine transaminases normalized together with free serum copper. Under continuous therapy with copper chelators free copper remained normal until today, whereas transaminases raised to alanine aminotransferase values of 571 U/L in December 2019. For hyperimmunity a tentative steroid course on top of D-penicillamine improved transaminases. Thus, hyperimmunity may have impact on liver inflammation after control of the metabolic disturbance. A retrospective cohort study confirmed the common association of elevated transaminases with ANA, but no IgG elevation.

CONCLUSION: This hyperimmune-triggered condition may represent a new entity which per se or on top of other liver diseases induces liver inflammation responsive to steroids.

PMID:33644206 | PMC:PMC7896689 | DOI:10.12998/wjcc.v9.i6.1386

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New indicators in evaluation of hemolysis, elevated liver enzymes, and low platelet syndrome: A case-control study

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World J Clin Cases. 2021 Feb 26;9(6):1259-1270. doi: 10.12998/wjcc.v9.i6.1259.

ABSTRACT

BACKGROUND: Indices such as the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), mean platelet volume (MPV), platelet distribution width (PDW), and red cell distribution width (RDW) are considered new markers of the systemic inflammatory response (SIR), and have been widely implemented for the diagnosis of patients with inflammatory diseases. These new indicators have also been widely investigated in preeclampsia (PE) but less analyzed in hemolysis, elevated liver enzymes, and low platelet (HELLP) syndrome.

AIM: To compare SIR markers among HELLP patients, PE only patients, and healthy gravidae.

METHODS: This retrospective case-control study enrolled 630 cases, including 210 patients with HELLP syndrome (HELLP group), 210 patients with only PE (PE group) and 210 healthy gravidae (control group). The three groups were matched by age, parity, status of assisted reproduction, and multiple pregnancies. Birthweight, gestational age at complete blood count collection, gestational age at delivery, mode of delivery, etc. were recorded. The main indices as NLR, PLR, MPV, PDW, and RDW among the groups were compared, as well as some secondary outcomes including neutrophil, platelets, and hemoglobin.

RESULTS: The NLR (6.4 vs 4.3 vs 3.5), MPV (11.9 vs 11.2 vs 10.7), PDW (16.4 vs 13.3 vs 14.2), leukocyte (12.4 × 109/L vs 9.7 × 109/L vs 8.7 × 109/L) and neutrophil count (9.9 × 109/L vs 7.3 × 109/L vs 6.1 × 109/L) were highest in the HELLP group, lower in the PE group, and lowest in the control group. Both the overall comparisons between the three groups (all b P < 0.01) and pairwise comparisons between every two groups elicit ed statistically significant differences (all d P < 0.01, except control vs PE: c P < 0.05 in PDW). The average lymphocyte counts were 1.4 (1.1, 2.0) × 109/L in the HELLP group, 1.6 (1.3, 2.0) × 109/L in the PE group and 1.7 (1.4, 2.0) × 109/L in the control group. The overall comparison of lymphocyte count within the three groups had statistically significant differences (P = 0.000). The pairwise comparisons between every two groups demonstrated that the HELLP group had a lower lymphocyte count than both the PE (P = 0.019) and control groups (P = 0.000), but the difference between the PE and control groups was not statistically significant (P = 0.432). The overall comparisons on platelet counts and the PLR among these three groups also showed statistically significant differences (both P = 0.000), from low to high being those in the HELLP group (43.4 × 109/L, 64.0), control group (180.5 × 109/L, 103.6) and PE group (181.5 × 109/L, 112.8). Pairwise comparisons of neither index displayed statistically significant differences between the PE and control groups (both P > 0.05), while the differences in the two indices between the HELLP group and the two other groups were still statistically significant (all P = 0.000). RDW values were highest in the HELLP group (14.5% [13.6, 15.3]), lower in the control group (14.1% [13.5, 14.8]) and lowest in the PE group (13.9% [13.4, 14.9]). The difference between the PE and control group did not show statistical significance (P = 1.000), while RDW values in the HELLP group were higher than those in the other two groups (c P < 0.05 vs control, d P < 0.01 vs PE).

CONCLUSION: SIR markers such as NLR, RDW, MPV, and PDW were increased and PLR was decreased in HELLP. These SIR markers may become new indicators in the evaluation of HELLP syndrome.

PMID:33644193 | PMC:PMC7896688 | DOI:10.12998/wjcc.v9.i6.1259

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Unexplained elevation of erythrocyte sedimentation rate in a patient recovering from COVID-19: A case report

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World J Clin Cases. 2021 Feb 26;9(6):1394-1401. doi: 10.12998/wjcc.v9.i6.1394.

ABSTRACT

BACKGROUND: A disease caused by a novel coronavirus virus, named coronavirus disease 2019 (COVID-19), broke out in Wuhan, China in December 2019, and spread around the word. As of March 4, 2020, 93090 confirmed cases and 2984 deaths have been reported in more than 80 countries and territories. It has triggered global public health security. However, the features and prognosis of COVID-19 are incompletely understood.

CASE SUMMARY: We here report that the erythrocyte sedimentation rate (ESR) increased in a confirmed COVID patient. The high level of ESR sustained for a long time even after the patient recovered from COVID-19, while all results related to tumor, tuberculosis, rheumatic diseases, anemia, etc. cannot explain the abnormal elevation of ESR presented in this case.

CONCLUSION: Although the increased ESR cannot be explained by all existing evidence, it possibly links the abnormal pathologic change in some COVID-19 patients and negative prognosis, and provides the clue to dissect the mechanism of illness progressing in COVID-19 and its prognosis.

PMID:33644207 | PMC:PMC7896696 | DOI:10.12998/wjcc.v9.i6.1394

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Effect of alprostadil in the treatment of intensive care unit patients with acute renal injury

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World J Clin Cases. 2021 Feb 26;9(6):1284-1292. doi: 10.12998/wjcc.v9.i6.1284.

ABSTRACT

BACKGROUND: Acute kidney injury (AKI) is a sudden or rapid decline in the filtration function of the kidneys which is marked by increased serum creatinine or blood urea nitrogen.

AIM: To examine the value of alprostadil-assisted continuous venous-venous hemofiltration (CVVH) in the treatment of severe AKI in severely ill patients.

METHODS: This was a retrospective study and the inclusion criteria were as follows: (1) Age of patients (≥ 18 years); (2) Admission to intensive care unit due to non-renal primary disease, APACHE II score (≥ 18 points); (3) The diagnostic criteria of AKI guidelines were formulated with reference to the Global Organization for the Improvement of Prognosis in Kidney Diseases, with AKI grades of II-III; (4) All patients were treated with CVVH; and (5) Complete basic data were obtained for all patients.

R ESULTS: The clinical effect of alprostadil administered in the treatment group was better than that observed in the control group (P < 0.05). The urine output of patients in the alprostadil group returned to normal time (9.1 ± 2.0 d) and was lower than that in the control group (10.6 ± 2.5 d), the difference was statistically significant (P < 0.05); adverse reactions occurred in the alprostadil group compared with the control group, but the difference was not statistically significant (P > 0.05).

CONCLUSION: Alprostadil-assisted CVVH in the treatment of severely ill patients with AKI can effectively improve the renal resistance index and partial pressure of urine oxygen, and has a positive effect on improving renal function.

PMID:33644195 | PMC:PMC7896675 | DOI:10.12998/wjcc.v9.i6.1284

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