Tratamiento de Sonrisa Gingival. Informe de Caso

El recontorneo estético es una cirugía plástica periodontal que tiene como objetivo restablecer una sonrisa más armoniosa de acuerdo al aspecto facial del paciente, el principal motivo para realizar este procedimiento es cuando existe un diagnóstico de una erupción pasiva alterada o sonrisa gingival. La sonrisa gingival es una de las principales preocupaciones de acuerdo a la estética cuando existe una exposición gingival de más de 3 mm en lo cual es justificable realizar el recontorneo estético. Paciente femenino de 28 años de edad, con diagnóstico de erupción pasiva alterada 1B con un seguimiento de 4 meses. El tratamiento consistió en realizar el recontorneo estético para corregir la sonrisa gingival. El recontorneo estético es un procedimiento quirúrgico que se realiza con el objetivo de mejorar la estética del paciente cuando existe una exposición gingival excesiva y para facilitar la armonía de acuerdo a su aspecto facial.

Esthetic recontouring is a periodontal plastic surgery that aims to restore a more harmonious smile according to the patient's facial appearance, since the main reason to perform this procedure is when there is a diagnosis of an altered passive eruption or gingival smile. The gingival smile is one of the main concerns according to aesthetics when there is a gingival exposure of more than 3 mm in which it is justifiable to perform the aesthetic recontouring. 28-year-old female patient with a diagnosis of altered passive eruption 1B with a 4-month follow-up. Treatment consisted of esthetic recontouring to correct the gingival smile. Esthetic recontouring is a surgical procedure performed with the aim of improving the patient's esthetics when there is excessive gingival exposure and to facilitate harmony according to facial appearance.

Diabetes mellitus tipo 2 en adolescente de 15 años: reporte de un caso y revisión de la literatura

La diabetes mellitus tipo 2 de inicio temprano ha aumentado su prevalencia en los últimos años. Los principales factores de riesgo de padecerla en la adolescencia son: la obesidad, la predisposición genética y los antecedentes familiares. Se presenta el caso de una paciente de sexo femenino, de 15 años, que acudió a los servicios de salud con diagnóstico previo de prediabetes y sobrepeso. Al examen físico se observó sobrepeso y distribución de grasa central. Los exámenes de laboratorio indicaron hiperglucemia y hormonas tiroideas dentro de rangos de normalidad. Se diagnosticó diabetes mellitus tipo 2 y se propuso tratamiento con dieta, ejercicios físicos y metformina. Se reevaluó a los 3 meses y se constató que la paciente no cumplía el tratamiento a cabalidad. Este reporte de caso tiene como objetivo describir las características clínicas y de laboratorio de una paciente adolescente con diagnóstico de diabetes mellitus tipo 2 porque el diagnóstico precoz y el tratamiento intensivo es fundamental en el manejo de esta patología en este grupo etáreo.

Early-onset type 2 diabetes mellitus has increased in prevalence in recent years. The main risk factors for suffering from it in adolescents are: obesity, genetic predisposition and family history. The case of a 15-year-old female patient who attended health services with a previous diagnosis of prediabetes and overweight is presented. The physical examination revealed overweight and central fat distribution. Laboratory tests indicated hyperglycemia and thyroid hormones within normal ranges. Type 2 diabetes mellitus was diagnosed and treatment with diet, physical exercise and metformin was proposed. She was reassessed after 3 months and it was found that the patient was not fully complying with the treatment. This case report aims to describe the clinical and laboratory characteristics of an adolescent patient diagnosed with type 2 diabetes mellitus because early diagnosis and intensive treatment is essential in the management of this pathology in this age group.

Left ventricular hypertrophy: hypertensive or hypertrophic cardiomyopathy? What a dilemma! A case report / Hipertrofia ventricular izquierda: ¿cardiopatía hipertensiva o miocardiopatía hipertrófica? ¡Vaya dilema! Reporte de caso

Abstract In the presence of the left ventricle hypertrophy (LVH), the differential diagnosis with hypertrophic cardiomyopathy (HCM) or some phenocopy must be always considered, which can be easily suspected when the hypertrophy is markedly asymmetric. However, when the hypertrophy is homogeneous, especially if the patient has concomitant hypertension, it may be a challenge to distinguish between hypertensive and HCM, although some clinical features may help us to suspect it. In addition, patients with HCM may present with exertional angina due to microcirculation involvement in the setting of the hypertrophy itself or dynamic obstruction in the left ventricular outflow tract, but in some cases, the presence of concomitant coronary artery disease must be suspected as the cause of angina, especially if the patient has an intermediate or high-risk probability of having ischemic heart disease. We present the case of a 46-year-old Afro-American man with poorly controlled hypertension who was found to have severe LVH, and who presented with symptoms of exertional angina during follow-up. We will review the clinical features that can help us in the differential diagnosis in this context.

Resumen Ante la presencia de hipertrofia del ventrículo izquierdo (HVI), siempre se debe considerar el diagnóstico diferencial con la miocardiopatía hipertrófica (MCH) o alguna fenocopia, que puede sospecharse fácilmente cuando la hipertrofia es marcadamente asimétrica. Además, los pacientes con MCH pueden presentar angina de esfuerzo debido a la afectación de la microcirculación en el contexto de la propia hipertrofia o si ésta condiciona obstrucción dinámica al tracto de salida del ventrículo izquierdo, pero en algunos casos debe sospecharse la presencia de enfermedad coronaria concomitante como causa de la angina, especialmente si el paciente tiene una probabilidad de riesgo intermedio o alto de padecer cardiopatía isquémica. Presentamos el caso de un varón de 46 años de afroamericana con hipertensión arterial mal controlada a quien se le detectó una HVI severa, y que durante el seguimiento presentó síntomas de angina de esfuerzo. Revisaremos las características clínicas que nos pueden ayudar en el diagnóstico diferencial en este contexto.

Hiponatremia y traumatismo craneoencefálico, una asociación importante. Reporte de caso / Hyponatremia and traumatic brain injury, an important association. Case report

Introducción: La hiponatremia se encuentra asociada aproximadamente con el 10% de los pacientes con traumatismo craneoencefálico, su baja frecuencia y la intuición clínica de esta relación la hace importante en el presente informe de caso. Objetivo: Describir la asociación de la hiponatremia con el traumatismo craneoen-cefálico con la finalidad de mejorar la comprensión de esta relación en el personal de salud y promover la implementación de estrategias de diagnóstico y manejo más efectivas basadas en predicciones bioquímicas y anatómicas actualizadas. Presentación del caso: Paciente masculino, adulto joven, con antecedentes de dos traumatismos craneoencefálicos, con hiponatremia sérica severa y síntomas persistentes de mareo y cefalea, tratado con diuréticos de asa y cloruro de sodio vía oral, con mejoría posterior al vigésimo día de hospitalización. Discusión: Ciertas alteraciones neurológicas con manifestación clínica evidente, se presentan por bajos niveles de sodio sérico, o por causas anatómicas y fisioló-gicas diferentes. Se ha demostrado una relación causal con mecanismo fisiopato-lógico no bien descrito sobre la hiponatremia y el traumatismo craneoencefálico. Conclusión: Es crucial tener una vigilancia meticulosa en pacientes con hipona-tremia severa, aunque presenten pocos síntomas clínicos (considerando antece-dentes como el traumatismo craneoencefálico en la anamnesis inicial y de segui-miento) como en este caso. Además, se destaca la necesidad de investigar las vías metabólicas que podrían verse afectadas por traumatismos craneoencefálicos, y que podrían tener un impacto directo en los niveles de sodio en sangre.

Introduction: Hyponatremia is found to be associated with approximately 10% of patients with traumatic brain injury. Despite its low frequency, the clinical intuition regarding this relationship underscores its significance in this case report. Objective: Describe the association between hyponatremia and traumatic brain in-jury, aiming to enhance healthcare professionals' understanding of this correlation and to advocate for the implementation of more effective diagnostic and manage-ment strategies based on updated biochemical and anatomical predictions. Case Presentation: A young adult male patient with a history of two traumatic brain injuries, severe serum hyponatremia, and persistent symptoms of dizziness and headache, treated with loop diuretics and oral sodium chloride, exhibited improvement after twenty days of hospitalization. Discussion: Certain neurological alterations with evident clinical manifestation are characterized by low levels of serum sodium, possibly stemming from distinct ana-tomical and physiological causes. A causal relationship with a poorly described pathophysiological mechanism between hyponatremia and traumatic brain injury has been suggested. Conclusion: Meticulous monitoring is imperative for patients with severe hypona-tremia, even when clinical symptoms are minimal, as observed in this case. Fur-thermore, emphasis is placed on the need to investigate metabolic pathways that may be affected by traumatic brain injuries, potentially exerting a direct impact on blood sodium levels.

Relato de caso clínico de infecção odontogênica resultando em complicação cervicofacial / Reporte de caso clínico de infección odontogênica com resultado de complicación cervicofacial / Clinical case reportof odontogenic infectionresulting cervicofacial complication

Introdução: A saúde bucal é um aspecto que não deve ser subestimado pelos pacientes, principalmente se considerar que as infecções odontogênicas podem levar a quadros graves, incluindo complicações cervicotorácicas, como Mediastinite e cervicofaciais, como Angina de Ludwig. Para tanto, é imprescindível que os profissionais da odontologia saibam reconhecer os principais sinais e sintomas dessas infecções, sua evolução, conhecer as complicações associadas e qual o manejo adequado. Objetivo: Assim, é objetivo deste trabalho, relatar, discutir um caso clínico de uma infecção odontogênica grave que acarretou em complicação cervical, com trajeto em direção ao mediastino, necessitando manejo multidisciplinar, e explorar os principais aspectos desse quadro e a conduta necessária, que exige, no mínimo, intervenção cirúrgica, antibioticoterapia e manutenção das vias aéreas. Relato de caso: O caso trata de um paciente com infecção odontogênica, iniciada como uma pericoronarite do dente 38 semieruptado, que evoluiu para a área cervical, demandando imediata drenagem nesta região pois encaminhava-se para uma mediastinite. Após a drenagem cervical e antibioticoterapia e, assim que houve redução do trismo, foi removido o dente 38, evoluindo para a cura.Conclusões:As infecções odontogênicas, principalmente as que acometem os espaços fasciais e cervicais profundos, são potencialmente graves e devem ter suas principais manifestações clínicas entre os domínios de conhecimento dos profissionais Bucomaxilofaciais, pois necessitam de diagnóstico preciso, manejo rápido e tratamento adequado e precoce, considerando a velocidade com que podem evoluir (AU).

Introduction: Oral healthis an aspect that should not be underestimated by patients, especially considering that dental infections can lead to serious symptoms, including cervicothoracic complications, such as Mediastinitis and cervicofacial complications, such as Ludwig's Angina. Therefore, it is essential that dental professionals know how to recognize the main signs and symptoms of these infections, their evolution, know the associated complications and appropriate management.Objective: Thus, this work aims to report and discuss a clinical case of a serious odontogenic infection that resulted in a cervical complication, with a path towards the mediastinum, requiring multidisciplinary management, and to explore the main aspects of this condition and the necessary conduct, which requires, at least, surgical intervention, antibiotic therapy and airway maintenance.Case report: The case concerns a patient with odontogenic infection, which began as pericoronitis of semi-erupted tooth 38, which progressed to the cervical area, requiring immediate drainage in this region as it was heading towards mediastinitis. After cervical drainage and antibiotic therapy and, as soon as the trismus was reduced, tooth 38 was removed, progressing towards healing.Conclusions: Odontogenic infections, especially those that affect the fascial and deep cervical spaces, are potentially serious and should have their main clinical manifestations among the domains of knowledge ofOral and Maxillofacial professionals, as they require accurate diagnosis, rapid management and adequate and early treatment, considering the speed at which they can evolve (AU).

Introducción: La salud bucal es un aspecto que los pacientes no deben subestimar, especialmente considerando que las infecciones odontógenas pueden derivar en afecciones graves, incluidas complicaciones cervicotorácicas, como la mediastinitis, y complicaciones cervicofaciales, como la angina de Ludwig.Para ello, es fundamental que los profesionales odontológicos sepan reconocer las principales señalesy síntomas de estas infecciones, su evolución, conocer las complicaciones asociadas y el manejo adecuado.Objetivo: Así,el objetivo de este trabajo es reportar y discutir un caso clínico de infección odontogénica grave que resultó en una complicación cervical, con trayecto hacia el mediastino, que requirió manejo multidisciplinario, y explorar los principales aspectos de esta condicióny las medidas necesarias, que requiere, como mínimo, intervención quirúrgica, terapia con antibióticos y mantenimiento de las vías respiratorias.Reporte de caso: El caso se trata de un paciente con una infección odontogénica, que comenzó como pericoronaritis del diente 38 semi-erupcionado, la cual progresó hacia la zona cervical, requiriendo drenaje inmediato en esta región ya que se encaminaba para una mediastinitis.Después del drenaje cervical y la terapia antibiótica y, una vez reducido el trismo, se extrajo el diente 38, evolucijjonando hacia la cura.Conclusiones: Las infecciones odontogénicas, especialmente aquellas que afectan los espacios fasciales y cervicales profundos, son potencialmente graves y deben tener sus principales manifestaciones clínicas entre los dominios del conocimiento de los profesionales Orales y Maxilofaciales, pues requieren de un diagnóstico certero, un manejo rápido y un tratamiento adecuado y temprano, considerando la velocidad a la que pueden evolucionar (AU).

Radical surgical approach to chronic suppurative osteomyelitis: Case report / Abordaje quirúrgico radical de una osteomielitis crónica supurativa: reporte de caso

Abstract Diabetes mellitus is a systemic condition potentially related to an increased risk of progression of various infections such as chronic osteomyelitis by accelerating the inflammatory process with bone tissue necrosis and suppuration. Therefore, if there is no proper management of these infections, they can be life-threatening as they spread to deeper spaces in the head and neck. We describe the case of a 52-year-old male patient with a history of diabetes mellitus and grade III osteoarthritis who was diagnosed with chronic suppurative osteomyelitis of the mandible. He underwent a multidisciplinary surgical intervention in which he underwent a hemimandibulectomy with immediate mandibular reconstruction. The present case highlights the importance of early and radical treatment of patients with chronic suppurative osteomyelitis of the mandible and systemic comorbidities. In addition, this case presents a review of diabetes mellitus and the risk of developing odontogenic infections and complications when invading deeper spaces in the head and neck. Therefore, in this population, careful planning is required for early surgical and pharmacological treatment.

Resumen La diabetes mellitus es una condición sistémica potencialmente relacionada con un mayor riesgo de progresión de diversas infecciones como la osteomielitis crónica al acelerar el proceso inflamatorio con necrosis del tejido óseo y supuración. Por lo tanto, si no hay un manejo adecuado de estas infecciones pueden ser potencialmente mortales al llegar a propagarse a espacios más profundos de la cabeza y cuello. Describimos el caso de un paciente varón de 52 años con antecedentes de diabetes mellitus y osteoartrosis grado III a quien se le diagnosticó de osteomielitis crónica supurativa mandibular. Se le realizó una intervención quirúrgica multidisciplinaria en la cual se le realizó una hemimandibulectomía con reconstrucción mandibular inmediata. El presente caso destaca la importancia del tratamiento temprano y radical de los pacientes con osteomielitis mandibular crónica supurativa y comorbilidades sistémicas. Además, en este caso se presenta una revisión sobre la diabetes mellitus y el riesgo de desarrollar infecciones odontogénicas y complicaciones al invadir espacios más profundos de la cabeza y cuello. Por lo tanto, en esta población se requiere de una planificación cuidadosa para realizar un tratamiento quirúrgico y farmacológico temprano.

Abordaje reconstructivo para un defecto de periimplantitis / Reconstructive approach for a peri-implantitis defect

Si bien el conocimiento científico para el tratamiento de la periimplantitis ha avanzado significativamente en los últimos años, sigue en discusión qué tipo de abordaje quirúrgico genera los mejores resultados clínicos y si el uso de biomateriales da mejoras significativas en dicho tratamiento. Este reporte de caso describe un abordaje quirúrgico reconstructivo de un defecto intraóseo por periimplantitis en una paciente que refería dolor y un intenso sangrado en sus implantes dentales, empleando un sustituto óseo anorgánico mineral bovino, sin el uso de una membrana o barrera, y con un protocolo de descontaminación de la superficie del implante mecánico y químico. Posteriormente, a las 20 semanas de realizado el procedimiento, se hizo la evaluación del defecto, obteniendo profundidades al sondeo menores a 5 mm, ausencia de sangrado al sondeo en todos los sitios y un llenado óseo radiográfico de aproximadamente 90%; cumpliendo con los criterios de éxito de la terapia periimplantaria. Lo anterior muestra que la terapia reconstructiva para los defectos por periimplantitis puede ser posible mediante el uso de un sustituto óseo xenogénico únicamente y con una correcta descontaminación de la superficie del implante (AU)

Although scientific knowledge for the treatment of peri-implantitis have advanced significantly in recent years, the type of surgical approach that generates the best clinical results is still under discussion and whether the use of biomaterials gives significant improvements in said treatment. This case report describes a reconstructive surgical approach for a periimplantitis intrabony defect using an anorganic bovine bone substitute, without the use of a membrane or barrier, and with a mechanical and chemical implant surface decontamination protocol. Twenty weeks after the procedure, the defect was reassessed, obtaining probing depths of less than 5 mm, no bleeding on probing in all sites, and radiographic bone filling of approximately 90%; meeting the success criteria for the peri-implant therapy. This shows that reconstructive therapy for periimplantitis defects may be possible using a xenogeneic bone substitute only and proper decontamination of the implant surface (AU)

Síndrome de Aarskog: um relato de caso / Aarskog syndrome: a case report

Introdução: A Síndrome de Aarskog-Scott (AAS) é uma rara displasia faciogenital ligada ao gene FGD1, afetando principalmente meninos. Relato de caso: Descreve-se um caso de um menino de 4 anos com AAS, destacando sua importância científica devido à raridade, escassez de descrições e morbidade associada. Ele apresentou fenda sacral, criptorquidia bilateral, atrasos no crescimento e histórico familiar semelhante. A AAS é caracterizada por estatura baixa, anomalias faciais e diversos comprometimentos. Este caso ressalta a importância do acompanhamento médico especializado. Considerações finais: A escassez de estudos comparáveis destaca a relevância dos relatos de casos para aprofundar a compreensão de condições clínicas singulares.

Introduction: Aarskog-Scott Syndrome (AAS) is a rare faciogenital dysplasia linked to the FGD1 gene, primarily affecting boys. Case report: We describe a case of a 4-year-old boy with AAS, highlighting its scientific importance due to its rarity, scarcity of descriptions, and associated morbidity. He presented with sacral cleft, bilateral cryptorchidism, growth delays, and similar family history. AAS is characterized by short stature, facial anomalies, and various impairments. Final considerations: This case underscores the importance of specialized medical care, and the scarcity of comparable studies highlights the relevance of case reports in deepening the understanding of unique clinical conditions.

Absceso periamigdalino bilateral. Reporte de un caso y revisión de las controversias en el diagnóstico y tratamiento / Bilateral peritonsillar abscess. A case report and review of controversies surrounding diagnosis and management

La presentación bilateral del absceso periamigdalino es poco frecuente. Su abordaje es controversial y se discute si realizar amigdalectomía en caliente versus diferida. Se presenta el caso de un paciente de sexo masculino, de 14 años, con odinofagia, trismo y fiebre. Presentaba hipertrofia amigdalina bilateral, pilares abombados y edema de paladar blando. Tomografía computada: hipertrofia amigdalina bilateral, con realce poscontraste, ambas con colección, edema con moderada estenosis faríngea. Se decidió internación para tratamiento endovenoso y amigdalectomía con drenaje bilateral. Resolución completa del cuadro con alta a las 48 horas. Ante la presencia de un absceso periamigdalino, debe considerarse la posibilidad de un absceso contralateral oculto. Debe ser diagnosticado y tratado adecuadamente para prevenir complicaciones. La amigdalectomía en caliente podría ser un tratamiento seguro y debería ser considerado en pacientes que serán sometidos a anestesia para drenaje. La decisión final debe ser determinada para cada caso en particular.

The bilateral presentation of peritonsillar abscess is uncommon. Its management is controversial and it has been argued whether a quinsy tonsillectomy or an interval tonsillectomy should be performed. Here we describe the case of a 14-year-old boy with sore throat, trismus, and fever. He had bilateral tonsillar hypertrophy, convex arches, and soft palate edema. Computed tomography: bilateral tonsillar hypertrophy, with post-contrast enhancement, both with collection, edema with moderate pharyngeal stenosis. The patient was hospitalized for intravenous therapy and tonsillectomy with bilateral drainage resulting in a complete resolution of his condition and discharge at 48 hours. In the presence of a peritonsillar abscess, an unsuspected contralateral abscess should be considered. It should be diagnosed and managed adequately to prevent complications. Quinsy tonsillectomy could be safe and should be considered in patients who will undergo anesthesia for abscess drainage. The final decision should be made for each patient on an individual basis.

Investigation and analysis of the current situation of case reporting ethical review and patient informed consent reports in comprehensive journals of clinical medicine in China / 中国医学伦理学

ObjectiveTo investigate and analyze case reporting ethical review and patient informed consent reports published in the comprehensive journals of clinical medicine in China in 2022. MethodsAccording to the data from the 2022 Edition of the Chinese Science and Technology Journal of the Citation Reports （Extended Version），the case reports published in comprehensive journals of clinical medicine in 2022 were selected as the research objects.The information on ethics and patient informed consent was extracted from the case reports that met the selection criteria，and Microsoft Excel 2021 and SPSS 21.0 were used to sort out and analyze the data. ResultsA total of 587 case reporting articles were published in the 42 included journals in 2022，of which 36 （6.13%） reported on science and technology ethics and/or informed consent.Case reports reporting on science and technology ethics and/or informed consent mostly came from the key magazine of China technology （88.89% Vs.65.88%），and the proportion of manuscripts involving science and technology ethics on the official website of the journal was relatively high （86.11% Vs.63.88%），and the difference was statistically significant （P<0.01）. ConclusionThe proportion of case reports of science and technology ethics and/or informed consent in journals of comprehensive discipline classification of clinical medicine was relatively low.Currently，most international journals are required to obtain the informed consent of patients or legal guardians before publishing case reports.Compared with this，there are still certain gaps in China，which need to be paid great attention to.

Clinical and genetic characteristics of myotonic dystrophy type 1(report of one family) / 临床神经病学杂志

Objective To investigate the clinical and genetic characteristics of myotonic dystrophy type 1(DM1).Methods A DM1 patient and his family members admitted to the First Affiliated Hospital of Soochow University in May 2023 were examined by physical examination,EMG,muscle biopsy and genetic detection,and the family pedigree was drawn to analyze the clinical characteristics and genetic manifestations of the patients.Results There were 9 members in this family,2 of whom were suffering from DM1,and there was a phenomenon of genetic anticipation.Both patients with DM1 had typical symptoms such as myotonia and myasthenia,accompanied by involvement of multiple systems such as the central nervous system,heart,and endocrine system.The electromyogram showed characteristic myotonic potentials.Muscle biopsy of the proband showed typical myotonic dystrophy with rimmed vacuoles.Genetic detection found that their DMPK genes both had a large number of CTG trinucleotide repeat expansions.Oxcarbazepine treatment is effective.Conclusions DM1 is a genetic disease with typical symptoms of myotonia and myasthenia gravis,accompanied by involvement of central nervous system,heart,endocrine and other systems.Electromyography,muscle biopsy and gene detection can help to diagnose DM1.Rimmed vacuoles are rare in muscle pathology.Oxcarbazepine can improve the symptoms of myotonia.

Lung metastasis manifested by solitary pure ground-glass opacity: A case report / 中国胸心血管外科临床杂志

@#We reported a 32 years female patient in whom lung metastasis from breast cancer was presented as solitary pulmonary pure ground-glass opacity (GGO) lesion. The patient received rational preoperative examinations and surgery though the preoperative diagnosis was not accurate. Because of different therapy strategies and purposes, it is crucial to make distinction of atypical metastases from primary cancers. Thus, for patients with a history of malignancy, possible metastasis should be taken into consideration if new GGO was found on the CT. Besides this, the follow-up interval of CT should be shortened appropriately, preoperative examinations and surgical procedures should be made according to the suggestions of multidisciplinary team.

Giant extralobar pulmonary sequestration with severe pleural effusion in neonatal period: A case report / 中国胸心血管外科临床杂志

@#Giant extralobar pulmonary sequestration in newborns is still relatively rare in pulmonary diseases, and there are few relevant studies published. A neonate with the giant extralobar pulmonary sequestration accompanied by severe pleural effusion was reported here. After 12 days of birth, the diseased lung tissue was surgically extracted. The patient had an uneventful postoperative recovery and was discharged from the hospital. The case shows the advantage of early surgical treatment to extralobar pulmonary sequestration with severe pleural effusion in neonatal period.

Totally arterialized minimally invasive coronary artery bypass grafting under the guidance of coronary artery function: A case report / 中国胸心血管外科临床杂志

@#We reported a 59-year-old male with exertional angina pectoris, and the coronary angiography showed multiple vessel lesions. The initial strategy was coronary artery bypass grafting (CABG). The measurement of quantitative flow ration (QFR) before operation indicated that the posterior descending branch (PD) did not need to be treated. The left circumflex branch (LCX) was small, and the QFR of the left anterior descending branch (LAD) and the first diagonal branch (D1) was<0.8. Therefore, the LAD and D1 were re-vascularized. The operation strategy was changed to on-pump CABG through a small incision, and the final strategy was LIMA-D1-LAD (sequential), fractional flow reserve (FFR) of distal LAD and D1 after CABG were>0.8 by computed tomography FFR. SYNTAX scores after CABG were 20 and the functional SYNTAX scores after CABG were 3, indicating a good prognosis.

Insertion of a totally implantable venous access port in a patient with isolated persistent left superior vena cava: A case report / 中国胸心血管外科临床杂志

@#Persistent left superior vena cava (PLSVC) with absence of right superior vena cava (SVC), also known as isolated PLSVC, is a relatively rare type of congenital body venous malformation. Isolated PLSVC is asymptomatic, however, it will bring clinical difficulties to the implantation of the totally implantable venous access port (TIVAP). We reported a 41 years, male patient with esophageal cancer, who needed neoadjuvant chemoimmunotherapy. Through doppler ultrasonography, computed tomography (CT) and vascular 3D-reconstruction, we found him to be a patient with PLSVC with absence of right SVC before the insertion of TIVAP. Hence, we chose the left approach in which the needle was inserted into the sternocleidomastoid clavicular head lateral notch in left supraclavicular fossa as the puncture point. The depth of the catheter tip from the root of the neck to the puncture point was 21.5 cm and the catheter tip was located at the junction of the PLSVC and the right atrium, at the dilated coronary sinus. The procedure was successful and the patient received expected neoadjuvant chemotherapy combined with immunotherapy after operation, and anticoagulant therapy was performed to prevent thrombosis in coronary sinus and superior vena cava. There was no major catheter-related complication during the period of TIVAP.

Unilateral nevoid hyperkeratosis of nipple and areola in a Filipino woman: A case report and literature review

@#Nevoid hyperkeratosis of the nipple and areola (NHNA) is a rare, asymptomatic skin condition characterized by verrucous, hyperpigmented papules, and plaques. It predominantly affects the nipple and areola, often bilaterally. Less than 50 cases have been reported worldwide, with only 39% showing unilateral breast involvement. In the Philippines, a single medical literature from 2014 describes two cases of adolescent‑onset NHNA. We report a rare case of a 40‑year‑old, Filipino woman with a 1‑year history of a mildly pruritic, solitary, well‑demarcated, irregularly shaped, black papule that progressed into a plaque on her right areola. There was suspicion of cutaneous malignancy due to some of the clinical features of the lesion and lack of response to initial treatment. With a correlation between clinical presentation and histopathologic findings, the features were consistent with NHNA. This is a benign skin condition that can mimic and must be differentiated from malignant tumors. Various treatment modalities were described in different medical literatures, some resulting in recurrence or treatment failure, but there is no standard management for this condition. Skin biopsy is crucial to rule out malignancy in cases presenting with persistent and progressively solitary pigmented lesions that do not respond to topical medications. The usual treatment options based on literature include various topicals, lasers, and surgical procedures. In our case, clobetasol propionate ointment was used. While most published cases show varied responses to topical corticosteroids, the result in our case was significant.

Plasmodium falciparum malaria with acute abdominal pain as the first symptom: a case report / 中国血吸虫病防治杂志

Plasmodium falciparum malaria, caused by Plasmodium falciparum infection, is an Anopheles mosquito-transmitted infectious diseases, which predominantly occurs in tropical areas of Africa. P. falciparum malaria is characterized by complex and atypical clinical manifestations, and high likelihood of misdiagnosis and missing diagnosis, and may be life-threatening if treated untimely. This case report presents the diagnosis and treatment of a P. falciparum malaria case with acute abdominal pain as the first symptom.

Anesthetic challenges during endobronchial brachytherapy: A case report

@#Lung cancer is the leading cause of cancer death worldwide. It may present as airway obstruction in a patient with endobronchial masses. Endobronchial brachytherapy (EBBT) has been shown to provide palliative therapy. It is the insertion of a radioactive material near the mass to reduce tumor size, thereby improving airway obstruction. This is the first case of EBBT done in our institution during the COVID-19 pandemic. A 53-year-old male, 60 kg, ASA Physical Status 2 for hypertension, smoker, malignancy, and previous pulmonary tuberculosis patient, presented with a cough and dyspnea. An endobronchial mass almost obstructing the right mainstem bronchus was seen on a computed tomography (CT) scan. He was diagnosed with squamous cell carcinoma of the lung and underwent radiotherapy and erlotinib chemotherapy. On repeat CT scan, there was no noted decrease in the size of the mass. EBBT was suggested, and a multi-disciplinary team was formed for the planned procedure. Pulmonology, radiation oncology, and anesthesiology teams were identified, and thorough planning was done prior to the actual procedure. Three fractions of EBBT were done under sedation using midazolam, fentanyl, and dexmedetomidine infusion. Lidocaine spray and transtracheal block were also performed as adjuncts prior to sedation. The procedure went as planned, and points for improvement were discussed for subsequent fractions. Due to persistent cough and discomfort from the catheter, additional ipratropium nebulization for minimization of secretions, and oral dextromethorphan for cough suppression were incorporated. After each fraction, the patient was monitored post-procedure for any side effects both from the radiotherapy and anesthetic technique. Qualitative reduction in mass size was noted in subsequent fractions. The patient was able to complete 3 fractions and was advised to follow-up after a month. EBBT is an emerging palliative and treatment modality for lung cancer, especially for intraluminal masses. Anesthetic considerations will depend on each case’s characteristics such as airway anatomy, patient comfort and capacity, and procedural requirements. Conscious sedation with topical anesthesia is an adequate and appropriate anesthetic option, especially in cases where severe airway obstruction may compromise ventilation if airway reflexes are blunted. A multidisciplinary approach with different services and stakeholders is important for the proper planning, execution, and management of such patients.

Anesthesia spearheading perioperative safety efforts in a patient with inclusion body myositis: A case report

@#Anesthesiologists have been at the forefront of initiatives addressing perioperative patient safety. As anesthesia has no direct therapeutic benefit, its risk must be minimized. At times the surgery is simple but the patient’s condition complicates anesthetic management, increasing the risk for complications. This report describes the anesthetic management of an adult patient diagnosed with inclusion body myositis (IBM), a rare inflammatory degenerative myopathy, who initially presented with decreased motor function in both lower and upper extremities causing him to be bedbound for two years. Due to the progression of his disease, he eventually developed dysphagia, hence he was scheduled for esophagoscopy, cricopharyngeal Botox injection, and percutaneous endoscopic gastrostomy. As patients with IBM are at risk for exaggerated sensitivity to neuromuscular blockers and respiratory compromise, anesthesia was at the helm of a multidisciplinary team approach. The perioperative management centered on preoperative optimization, prevention of aspiration, avoidance of anesthetics that may trigger malignant hyperthermia, and prevention of postoperative pulmonary complication. The hospital course was uncomplicated and the patient was discharged well after one day. This report emphasizes how improvements in resources, technology, and healthcare delivery, especially in anesthesia, help prevent perioperative adverse events.

Primary systemic amyloidosis in a 66-year old Filipina presenting with extracardiac uptake on Tc-99m pyrophosphate (Tc-99m PYP) scintigraphy

@#This is a case of a 66-year-old, Filipina, who presented with persistent proteinuria diagnosed with renal amyloidosis. In the presented case, the equivocal cardiac and incidental extracardiac findings in the Tc-99m pyrophosphate (Tc-99m PYP) scan aided in the diagnosis of primary systemic light chain amyloidosis (AL amyloidosis). Tc-99m PYP scan with single photon emission computed tomography (SPECT) is currently used as a non-invasive imaging modality to diagnose Transthyretin amyloidosis (ATTR amyloidosis) however its role in diagnosing AL amyloidosis is not well documented. The case highlights its role in detecting extracardiac amyloid burden and suggests possible biopsy sites. The researchers recommend an additional whole-body planar scan with possible SPECT/CT on the 3rd hour delay to survey other areas with possible amyloid protein deposit.