bluuebunny/crossref_metadata_2025 huggingface dataset:
Motor action changes pain perception: a sensory attenuation paradigm in the context of pain
Authors: Pinto Eleana A. , van Ryckeghem Dimitri M.L. , Meulders Ann , Torta Diana M. , Claus Amber , Van Damme Stefaan
Published: April 2021

A large body of evidence indicates how pain affects motor control, yet the way the motor system influences pain perception remains unclear. We present 2 experiments that investigated sensory attenuation of pain implementing a 2-alternative forced choice paradigm. Particularly, healthy participants received painful stimuli on a moving and nonmoving hand during the execution or the preparation of reaching motor actions. At the end of each trial, they indicated on which hand they perceived the stimulus stronger. The point of subjective equality was obtained to measure sensory attenuation. The intensity (experiment 1) and the threat value (experiment 2) of the pain stimuli were manipulated between-subjects to examine their impact on sensory attenuation. Results of experiment 1 (N = 68) revealed that executing a motor action attenuates pain processing in the moving hand. Sensory attenuation during motor preparation alone occurred with stronger stimulus intensities. Sensory attenuation was not affected by the intensity of the pain stimuli. Results of experiment 2 (N = 79) replicated the phenomenon of sensory attenuation of pain during motor action execution. However, sensory attenuation was not affected by the threat value of pain. Together these findings indicate that executing, but not preparing, a motor action affects pain processing in that body part. No significant associations were found between sensory attenuation indices and inhibitory control abilities or pain catastrophizing, vigilance and rumination. These results provide insight into the inhibitory effects of motor actions on pain processing, suggesting that pain perception is a dynamic experience susceptible to individuals' actions in the environment.
Endogenous opioids contribute to the feeling of pain relief in humans
Authors: Sirucek Laura , Price Rebecca Christine , Gandhi Wiebke , Hoeppli Marie-Eve , Fahey Emma , Qu Annie , Becker Susanne , Schweinhardt Petra
Published: April 2021

Endogenous opioids mediate the pleasurable responses to positively reinforcing stimuli such as palatable food. Yet, the reduction or omission of a negative experience can also be rewarding (negative reinforcement). As such, pain relief leads to negative reinforcement and evokes a pleasant feeling in humans. Although it has been shown that the feeling of pleasure associated with positive reinforcement is at least partly mediated through endogenous opioids, it is currently unknown whether similar neurochemical mechanisms are involved in the pleasant feeling evoked by pain relief. In this study, 27 healthy participants completed 2 identical experimental sessions, 1 with placebo and 1 with naltrexone, an endogenous opioid antagonist. Pain relief was induced by superficial cooling after heat stimulation of capsaicin-sensitized skin. Participants rated the relief and pleasantness in response to the cooling. Endogenous opioid blockade by naltrexone decreased relief and pleasantness ratings compared with placebo (P = 0.0027). This study provides evidence that endogenous opioids play a role in mediating the pleasant feeling of pain relief in humans. Clinically, the rewarding nature of pain relief and its underlying mechanisms require consideration because of their potential reinforcing effects on behaviors that might be beneficial short-term but maladaptive long-term.
Gender differences in activity-limiting pain trajectories over a 17-year period in the Mexican Health and Aging Study
Authors: Milani Sadaf Arefi , Howrey Bret , Rodriguez Martin A. , Samper-Ternent Rafael , Wong Rebeca
Published: April 2021

Pain increases with age, disproportionately affects women, and is a major contributor to decreased quality of life. Because pain is dynamic, trajectories are important to consider. Few studies have examined longitudinal trajectories of pain, by gender, in Mexico. We used data from 5 waves (over 2001–2018) of the Mexican Health and Aging Study, a nationally representative sample of Mexicans aged 50 years and older. Pain was categorized as self-reported frequent pain that makes it difficult to do usual activities. Latent class mixture models were used to create pain trajectories (n = 9824). The sample was majority female (56.15%), with a mean age of 61.72 years. We identified 2 pain trajectories: low-stable (81.88%) and moderate-increasing (18.12%). Women had 1.75 times the odds of being in the moderate-increasing group compared with men (95% confidence interval= 1.41, 2.17). In addition, having zero years of education was associated with higher odds of being in the moderate-increasing group, compared with having any years of education. Fair/poor self-rated health, obesity, arthritis, elevated depressive symptoms, and falls were positively associated with pain for both trajectory groups. Being married was positively associated with pain in the low-stable group. Insurance status was negatively associated with pain in the low-stable group, but positively associated with pain in the moderate-increasing group. We identified 2 trajectories of activity-limiting pain, among older Mexican adults (50+) over 17 years of follow-up. Understanding gender differences in pain trajectories in later life and the factors associated with trajectory development is crucial to improve quality of life, especially in vulnerable populations.
Shedding light on pain for the clinic: a comprehensive review of using functional near-infrared spectroscopy to monitor its process in the brain
Authors: Hu Xiao-Su , Nascimento Thiago D. , DaSilva Alexandre F.
Published: April 2021

Pain is a complex experience that involves sensation, emotion, and cognition. The subjectivity of the traditional pain measurement tools has expedited the interest in developing neuroimaging techniques to monitor pain objectively. Among noninvasive neuroimaging techniques, functional near-infrared spectroscopy (fNIRS) has balanced spatial and temporal resolution; yet, it is portable, quiet, and cost-effective. These features enable fNIRS to image the cortical mechanisms of pain in a clinical environment. In this article, we evaluated pain neuroimaging studies that used the fNIRS technique in the past decade. Starting from the experimental design, we reviewed the regions of interest, probe localization, data processing, and primary findings of these existing fNIRS studies. We also discussed the fNIRS imaging's potential as a brain surveillance technique for pain, in combination with artificial intelligence and extended reality techniques. We concluded that fNIRS is a brain imaging technique with great potential for objective pain assessment in the clinical environment.
Myalgia as a symptom at hospital admission by severe acute respiratory syndrome coronavirus 2 infection is associated with persistent musculoskeletal pain as long-term post-COVID sequelae: a case-control study
Authors: Fernández-de-las-Peñas César , Rodríguez-Jiménez Jorge , Fuensalida-Novo Stella , Palacios-Ceña María , Gómez-Mayordomo Víctor , Florencio Lidiane L. , Hernández-Barrera Valentín , Arendt-Nielsen Lars
Published: April 2021

This study investigated the association between COVID-related myalgia experienced by patients at hospital admission and the presence of post-COVID symptoms. A case-control study including patients hospitalised due to COVID-19 between February 20 and May 31, 2020, was conducted. Patients reporting myalgia and patients without myalgia at hospital admission were scheduled for a telephone interview 7 months after hospital discharge. Hospitalisation and clinical data were collected from medical records. A list of post-COVID symptoms with attention to musculoskeletal pain was evaluated. Anxiety and depressive symptoms, and sleep quality were likewise assessed. From a total of 1200 hospitalised patients with COVID-19, 369 with and 369 without myalgia at hospital admission were assessed 7.2 months (SD 0.6) after hospital discharge. A greater proportion (P = 0.03) of patients with myalgia at hospital admission (20%) showed ≥3 post-COVID symptoms when compared with individuals without myalgia (13%). A higher proportion of patients presenting myalgia (odds Rratio 1.41, 95% confidence interval 1.04-1.90) exhibited musculoskeletal post-COVID pain when compared to those without myalgia. The prevalence of musculoskeletal post-COVID pain in the total sample was 38%. Fifty percent of individuals with preexisting musculoskeletal pain experienced a worsening of their symptoms after COVID-19. No differences in fatigue, dyspnoea, anxiety/depressive levels, or sleep quality were observed between myalgia and nonmyalgia groups. The presence of myalgia at hospital admission was associated with preexisting history of musculoskeletal pain (OR 1.62, 95% confidence interval 1.10-2.40). In conclusion, myalgia at the acute phase was associated with musculoskeletal pain as long-term post-COVID sequelae. In addition, half of the patients with preexisting pain conditions experienced a persistent exacerbation of their previous syndromes.
Central amygdala inflammation drives pain hypersensitivity and attenuates morphine analgesia in experimental autoimmune encephalomyelitis
Authors: Dworsky-Fried Zoë , Faig Christian A. , Vogel Holly A. , Kerr Bradley J. , Taylor Anna M.W.
Published: April 2021

Chronic pain is a highly prevalent symptom associated with the autoimmune disorder multiple sclerosis (MS). The central nucleus of the amygdala plays a critical role in pain processing and modulation. Neuropathic pain alters nociceptive signaling in the central amygdala, contributing to pain chronicity and opioid tolerance. Here, we demonstrate that activated microglia within the central amygdala disrupt nociceptive sensory processing and contribute to pain hypersensitivity in experimental autoimmune encephalomyelitis (EAE), the most frequently used animal model of MS. Male and female mice with EAE exhibited differences in microglial morphology in the central amygdala, which was associated with heat hyperalgesia, impaired morphine reward, and reduced morphine antinociception in females. Animals with EAE displayed a lack of morphine-evoked activity in cells expressing somatostatin within the central amygdala, which drive antinociception. Induction of focal microglial activation in naïve mice via injection of lipopolysaccharide into the central amygdala produced a loss of morphine analgesia in females, similar to as observed in EAE animals. Our data indicate that activated microglia within the central amygdala may contribute to the sexually dimorphic effects of morphine and may drive neuronal adaptations that lead to pain hypersensitivity in EAE. Our results provide a possible mechanism underlying the decreased efficacy of opioid analgesics in the management of MS-related pain, identifying microglial activation as a potential therapeutic target for pain symptoms in this patient population.
From acute to long-term alterations in pain processing and modulation after spinal cord injury: mechanisms related to chronification of central neuropathic pain
Authors: Defrin Ruth , Gruener Hila , Gaidukov Evgeni , Bondi Moshe , Rachamim-Katz Orna , Ringler Erez , Blumen Nava , Zeilig Gabi
Published: April 2021

A severe and debilitating consequence of a spinal cord injury (SCI) is central neuropathic pain (CNP). Our aim was to investigate the processes leading to CNP emergence and chronification by analyzing causal relationship over time between spinothalamic function, pain excitability, and pain inhibition after SCI. This longitudinal follow-up study included 53 patients with acute SCI and 20 healthy controls. Spinothalamic, pain excitability, and intrasegmental and extrasegmental pain inhibition indices were repeatedly evaluated at 1.5, 3, and 6 months post-SCI. Between- and within-group analyses were conducted among those patients who eventually developed CNP and those who did not. Healthy controls were evaluated twice for repeatability analysis. Patients who developed CNP, compared with those who did not, exhibited increased thermal thresholds (P < 0.05), reduced pain adaptation (P < 0.01), and conditioned pain modulation (P < 0.05), early post-injury, and the CNP group's manifestations remained worse throughout the follow-up. By contrast, allodynia frequency was initially similar across SCI groups, but gradually increased in the subacute phase onward only among the CNP group (P < 0.001), along with CNP emergence. Early worse spinothalamic and pain inhibition preceded CNP and predicted its occurrence, and early worse pain inhibition mediated the link between spinothalamic function and CNP. Crossover associations were observed between early and late pain inhibition and excitability. Inefficient intrasegmental and extrasegmental inhibition, possibly resulting from spinothalamic deafferentation, seems to ignite CNP chronification. Pain excitability probably contributes to CNP maintenance, possibly via further exhaustion of the inhibitory control. Preemptive treatment promoting antinociception early post-SCI may mitigate or prevent CNP.
The Relationship Between the Activities-Specific Balance Confidence Scale and Balance Performance, Self-perceived Handicap, and Fall Status in Patients With Peripheral Dizziness or Imbalance
Authors: Herssens Nolan , Swinnen Eva , Dobbels Bieke , Van de Heyning Paul , Van Rompaey Vincent , Hallemans Ann , Vereeck Luc
Published: April 2021

Objective:

Describe the relationship between the Activities-Specific Balance Confidence (ABC) scale and Dizziness Handicap Inventory (DHI) with balance performance, as well as fall status in patients with peripheral vestibular disorders.

Study Design:

Retrospective.

Setting:

Outpatient balance clinic, tertiary referral center.

Patients:

Data from 97 patients (age: 54.8 ± 12.3 yrs; 48 women) with dizziness or imbalance symptoms of peripheral vestibular origin were used for analysis.

Intervention(s):

/

Main Outcome Measure(s):

ABC-scores, DHI-scores, static and dynamic balance tests, and fall status of the past 4 weeks, 2 months, and 6 months before the time of measurement were collected. Spearman's rho correlations, χ2 with post-hoc testing, and Kruskal–Wallis with post-hoc Mann–Whitney U test results were interpreted.

Results:

The ABC- and DHI-scores show moderate correlations with static balance (ABC: r = 0.44; DHI: r = –0.34) and dynamic balance tests (ABC: r = [–0.47;0.56]; DHI: r = [–0.48;0.39]) and a strong inverse correlation with each other (ABC: 70 ± 25; DHI: 33 ± 26; r = –0.84). Related to fall status, weak correlations were found (ABC: r = [–0.29;–0.21]; DHI: r = [0.29;0.33]). Additional results show that subjects in the low-level functioning (ABC) or severe self-perceived disability (DHI) categories have a poorer balance assessed by standing balance, Timed-Up-and-Go and Functional Gait Assessment and are more likely to have experienced multiple falls.

Conclusions:

The ABC-scale and DHI showed a strong convergent validity, additionally the ABC-scale showed a better concurrent validity with balance performances and the DHI with fall history. In general, patients with peripheral vestibular impairments reporting a lower self-confidence or a more severe self-perceived disability show worse balance performances and a higher fall incidence.
Participation of the Anterior Cingulate Cortex in Sodium Salicylate-induced Tinnitus
Authors: Fan Xin , Song Yu , Du Yali , Liu Junxiu , Xiong Shan , Zhao Gang , Wang Menglin , Wang Jiang , Ma Furong , Mao Lanqun
Published: April 2021

Hypothesis:

The anterior cingulate cortex (ACC) participates in sodium salicylate (SS)-induced tinnitus through alteration of the disordered neural activity and modulates the neuronal changes in the auditory cortex (AC).

Background:

Although the mechanism underlying tinnitus remains unclear, the crucial roles of the auditory center and limbic system in this process have been elucidated. Recent reports suggest that dysfunction of the ACC, an important component of the limbic system that regulates and controls the conduction of multiple sensations, is involved in tinnitus. Although altered functional connectivity between the ACC and the auditory system has been observed in humans with tinnitus, the underlying neuronal mechanism remains unexplored.

Methods:

SS (350 mg/kg, 10%, i.p.) was used to yield tinnitus model in rats, followed by comparison of the alteration in the spontaneous firing rate (SFR), local field potential (LFP), and extracellular glutamic acid in the ACC. The responses of neurons in the AC to electrical stimulation from the ACC were also observed.

Results:

We determined significant increases in the neuronal SFR and extracellular glutamate level in the ACC after SS injection (p < 0.05). These effects were accompanied by decreased alpha band activity and increased beta and gamma band activity (p < 0.05). In the majority of AC neurons, the SFR decreased in response to ACC stimulation (p < 0.05).

Conclusions:

Our results demonstrated that disordered neural activity in the ACC contributes to SS-induced tinnitus and that ACC activation can modulate AC activity.
How do we identify the crashing traumatic brain injury patient – the intensivist's view
Authors: McCredie Victoria A. , Chavarría Javier , Baker Andrew J.
Published: April 2021

Purpose of review

Over 40% of patients with severe traumatic brain injury (TBI) show clinically significant neurological worsening within the acute admission period. This review addresses the importance of identifying the crashing TBI patient, the difficulties appreciating clinical neurological deterioration in the comatose patient and how neuromonitoring may provide continuous real-time ancillary information to detect physiologic worsening.

Recent findings

The latest editions of the Brain Trauma Foundation's Guidelines omitted management algorithms for adult patients with severe TBI. Subsequently, three consensus-based management algorithms were published using a Delphi method approach to provide a bridge between the evidence-based guidelines and integration of the individual treatment modalities at the bedside. These consensus statements highlight the serious situation of critical deterioration requiring emergent evaluation and guidance on sedation holds to obtain a neurological examination while balancing the potential risks of inducing a stress response.

One of the central tenets of neurocritical care is to detect the brain in trouble. The first and most fundamental neurological monitoring tool is the clinical exam. Ancillary neuromonitoring data may provide early physiologic biomarkers to help anticipate, prevent or halt secondary brain injury processes. Future research should seek to understand how data integration and visualization technologies may reduce the cognitive workload to improve timely detection of neurological deterioration.
Immediate postcardiac arrest treatment: coronary catherization or not?
Authors: Dumas Florence , Bougouin Wulfran , Cariou Alain
Published: April 2021

Purpose of review

Early coronary angiogram (CAG) remains a cornerstone in postcardiac arrest management as coronary disease (CAD)-related cardiac arrest is the leading cause of sudden death in adults. The opportunity to treat the cause early on with immediate CAG may improve outcome in cardiac arrest patients with AMI. Identifying the patients who will benefit from such an early invasive strategy is an unanswered question. Recent and ongoing trials may improve the level of evidence on this problematic, especially for some subgroup; however, current guidelines remain founded upon a very heterogeneous level of evidence.

Recent findings

The key variable to argue for immediate CAD remains the pattern of the ECG monitored after return of spontaneous of circulation (ROSC). ST-segment elevation (STE) on postresuscitation ECG is the strongest argument to rule for an early CAG strategy. In other situations, identifying the best candidates for early CAG is very challenging. Different approaches including elements, such as circumstances of cardiac arrest and expected outcomes. may also drive the strategy.

This review aims to provide an overview of these different discussion points. The indication for early CAG should rely on multiple factors and an individual approach.
Rare chromosomal aberrations detected in children with multiple congenital anomalies: utility of multiple ligation dependant probe amplification for developing countries
Authors: Pulipaka Shirisha , Kaur Anit , Bhatia Prateek , Panigrahi Inusha , Kaur Anupriya
Published: April 2021

Chromosomal aberrations are an important cause of multiple malformation syndromes. Multiple ligation-dependent probe amplification (MLPA) a molecular cytogenetic technique has been suggested as a screening tool for the detection of chromosomal aberrations in resource-limited settings. MLPA can detect chromosomal microdeletions or duplications at approximately 40 chromosomal regions in a single experiment. Several MLPA kits are available to target the chromosomal regions of interest. In the present study, we aimed to detect the yield and utility of MLPA in a cohort of children with multiple malformations and developmental delay. MLPA was performed using kits P245, P070 and P036. The overall yield of MLPA in our cohort was 8%. The manuscript describes very rare and interesting cases of congenital anomalies, such as severe buphthalmos and biphalangeal fingers with a chromosomal etiology. The study demonstrates the usefulness of MLPA as screening technique for chromosomal aberrations in children with multiple malformation syndromes, especially for developing countries such as India.
A simple way to manage a chronic ulcer at the cranioplasty titanium implant exposure site by dermal autograft and platelet-rich plasma
Authors: Lee I-Lung , Lin Yun-Nan , Huang Shu-Hung , Chung Chia-Li , Chuang Chieh-Han , Chen Rong-Fu , Kuo Yur-Ren
Published: April 2021

Rationale:

Titanium implant exposure is not a rare complication after cranioplasty. Usually, we apply a free flap or local flap for reconstruction.

Patient concerns:

A 56-year-old male with a medical history of gout, hepatitis and chronic renal disease presented with an ulcer and implant exposure after titanium cranioplasty. The flap around the ulcer was too thin to perform local flap reconstruction. Free flap surgery was rejected by the patient.

Diagnoses:

The ulcer with implant exposure had little exudate without malodor. The underlying wound had epithelial ingrowth and was 1.5 cm × 0.5 cm in size over the left parietal region of the head. The wound culture was staphylococcus lugdunensis-positive.

Interventions:

Oral antibiotics and biofilm decontamination were used to manage peri-implantitis for 6 weeks. Dermal autografts were harvested with a thickness of 0.020 inches. A 2 mm wide area of de-epithelization was created around the ulcer margin. Platelet-rich plasma was locally injected into the periwound skin.

Outcomes:

The patient was followed up by telephone at 9 months postoperatively, and the scar condition was stable without recurrent ulcers.

Lessons:

Dermal autografts with platelet-rich plasma may serve as an alternative method when a local flap is not feasible and the wound defect is smaller than 1 cm2.
Combined treatment with lymphaticovenular anastomosis and ethanol sclerotherapy for femoral lymphocele with lymphedema after oncologic surgery
Authors: Yoshida Shuhei , Koshima Isao , Imai Hirofumi , Sasaki Ayano , Nagamatsu Shogo , Yokota Kazunori
Published: April 2021

Introduction:

Several treatment options like sclerotherapy and surgical excision of lymphocele are available for the management of lymphocele, although each modality has its own advantages and disadvantages. Lymphaticovenular anastomosis (LVA) has recently been gaining attention in the field of microsurgery as a minimally invasive form of surgical reconstruction. Combined treatment using surgical excision of lymphocele and LVA for large or long-lasting lymphoceles has been reported, but the combination can be very invasive. Here, we report a combined use of LVA and sclerotherapy in the treatment of a large lymphocele with satisfactory results. Hence this combination can be a complementary minimally invasive treatment of large lymphoceles.

Patient concerns:

The patient was a 49-year-old man with a refractory lymphocele in the lateral aspect of the left thigh after wide resection of a sarcoma 2 months earlier.

Diagnosis:

The patient was diagnosed as femoral lymphocele with lymphedema. Percutaneous needle aspiration was performed once weekly, and 2000 to 3000 mL fluid was aspirated each time. On indocyanine green (ICG) lymphography, the actual lymphatic routes flowing into the lymphocele could not be detected because of extensive dermal backflow in the thigh area.

Interventions:

We performed combined treatment using LVA and ethanol sclerotherapy to treat the lymphocele and reduce the risk of lymphedema progression.

Outcomes:

The lymphocele resolved and no recurrence was noted. Postoperative ICG lymphography after a follow-up period of 12 months revealed reduced dermal backflow.

Conclusion:

LVA is an excellent treatment option when the lymphatics flowing into the cyst are detectable or can be targeted. However, this is not always the case, especially for the lymphoceles that are large, long-lasting, or infected. For this reason, we combined LVA with sclerotherapy. This allowed for a relatively less invasive method with closure of the dead space using sclerotherapy without further exacerbating the lymphedema. Hence, combined treatment using LVA with sclerotherapy can be a complementary minimally invasive treatment option for a large or long-lasting lymphocele.
Diagnostic and therapeutic challenges of BRASH syndrome
Authors: Ata Fateen , yasir Muhammad , Javed Saad , Bilal Ammara Bint I , Muthanna Bassam , Minhas Bushra , Chaudhry Hammad Shabir
Published: April 2021

Rationale:

BRASH syndrome is a relatively unknown medical entity in which there is a combination of bradycardia, renal injury, hypoperfusion, and hyperkalemia. It is clinically essential to take these manifestations as a syndrome rather than isolated findings because they are interrelated and have synergistic effects. Bradycardia can result in hypoperfusion, which can cause renal injury. The resultant renal injury causes hyperkalemia (which can also be the initial trigger), which potentiates the bradycardia. Deteriorating patients with the syndrome usually do not respond to regular Advanced Cardiac Life Support resuscitation protocols. Treatment focused on the timely replacement of fluids and electrolytes gives better outcomes. It is vital to keep BRASH syndrome in diagnostic possibilities while seeing patients with refractory bradycardia, hyperkalemia, and renal injury, especially when other diagnoses are ruled out.

Patient concerns:

In this report, we present a 64-years-old gentleman who came with generalized fatigue, non-bloody diarrhea, vomiting, and low oral intake for the past 5 days.

Diagnoses:

The patient was diagnosed with BRASH syndrome.

Interventions:

The patient received intravenous fluids, 2 doses of atropine 0.5 mg and received dextrose 50 percent with insulin regular 10 units, and salbutamol 5 mg for hyperkalemia. He was intubated due to a low Glasgow Coma Scale and received dialysis for resistant hyperkalemia. A transvenous pacemaker was inserted due to bradycardia.

Outcomes:

The patient had 2 cardiac arrests and could not survive the second.

Lessons:

BRASH is a life-threatening yet largely underdiagnosed condition. Physicians should keep a high index of suspicion for BRASH while seeing patients with resistant and self-potentiating bradycardia, hyperkalemia, and renal failure, as a timely diagnosis is crucial in the management. Variable clinical presentations and limited literature create a diagnostic challenge. Further studies are warranted to understand the pathophysiology and develop better and accurate management algorithms. Patients’ risk of developing BRASH syndrome should be considered while prescribing causative medications (Atrioventricular nodal blocking drugs such as beta-blockers) in hospitals and outpatient settings.
FIP1L1- platelet-derived growth factor receptor A -positive chronic eosinophilic leukemia showing dramatic response to imatinib
Authors: Abu-Tineh Mohammad , Aljaloudi Esra’a , Amer Aliaa , Ibrahim Firyal , Ibrahim Wanis H. , Alhasson Hussam , Yassin Mohamed A.
Published: April 2021

Introduction:

Eosinophilia associated with FIP1L1- platelet-derived growth factor receptor A (PDGFRA) rearrangement is one of a subgroup of chronic eosinophilic leukemia, The 2008 World Health Organization classification of tumors of hematopoietic and lymphoid tissues established a new category for myeloid and lymphoid neoplasms with eosinophilia and abnormalities in PDGFRA, platelet-derived growth factor receptor Beta (PDGFRB) or Fibroblast growth factor receptor 1. The number of reported cases is limited worldwide, with limited data on the best modality of treatment of such disease.

Patient concerns:

A 48-year-old male patient with recurrent visits to the hospital presenting with multiple vague symptoms but found to have persistent marked eosinophilia.

Diagnosis:

The patient was diagnosed as a case of Myeloid/lymphoid neoplasms with eosinophilia and rearrangement of PDGFRA

Interventions:

The patient was started on Tyrosine kinase inhibitor (Imatinib) 100 mg daily.

Outcomes:

The patient eosinophilia has improved markedly, and the patient's eosinophils levels dropped to normal levels within 3 weeks period.

Conclusion:

This case indicates that in the era of Tyrosine Kinase inhibitors such as imatinib, the prognosis of Eosinophilia associated with FIP1L1-PDGFRA rearrangement has significantly improved And Prompt treatment with imatinib can lead to complete hematological response and resolution of any organ damage involved with this disease.
Certolizumab pegol-induced immunoglobulin A vasculitis in a patient with rheumatoid arthritis
Authors: Yamamoto Shintaro , Mukai Tomoyuki , Fujita Shunichi , Morita Yoshitaka
Published: April 2021

Rationale:

Certolizumab pegol (CZP) is a tumor necrosis factor (TNF) inhibitor with the unique characteristic of being a humanized Fab′ fragment. Immunoglobulin A (IgA) vasculitis has been reported to be associated with the use of TNF inhibitors, including infliximab, etanercept, and adalimumab.

Patient concerns:

The case was a 34-year-old Japanese woman with rheumatoid arthritis who had been treated with CZP for 3 years. She had delivered a healthy child 5 months earlier. On presentation, she had a 2-day history of abdominal pain and purpura on the lower extremities.

Diagnoses:

Histological analyses of a skin specimen revealed inflammatory cell infiltrates around the vessel walls and IgA and C3 deposits in the vessel walls of the upper dermis. Computed tomography showed terminal ileitis. The diagnosis was IgA vasculitis, presumably associated with use of CZP.

Intervention:

CZP was discontinued and prednisolone was administered.

Outcomes:

The abdominal pain and purpura promptly improved in response to treatment. No relapse of vasculitis occurred after discontinuation of CZP.

Lessons:

In this case, the cumulative immunomodulatory effects of the TNF inhibitor and the patient postpartum status were considered to be involved in inducing IgA vasculitis. Clinicians should be aware of IgA vasculitis-related symptoms as a possible adverse effect of TNF inhibitors to ensure prompt diagnosis and appropriate treatment.
Rapid malignant transformation of mature ovarian cystic teratoma into undifferentiated carcinoma
Authors: Takasaki Kazuki , Ikeda Sayaka , Suminokura Jin , Kishimoto Naohisa , Takano Masashi , Ito Yuji , Kudoh Kazuya
Published: April 2021

Introduction:

Malignant transformation of mature cystic teratoma (MCT) is extremely rare and has poor prognosis. We report a case of malignant transformation of ovarian MCT into undifferentiated carcinoma, that showed extremely rapid progression after surgery.

Patient concerns:

A 51-year-old woman presented with complaints of abdominal swelling, pain and fever. Computed tomography (CT) and transvaginal ultrasonography revealed a cystic mass in the pelvis.

Diagnosis:

Based on the CT findings, ovarian tumor with possible rupture was provisionally diagnosed. However, post-operative histopathology showed malignant transformation of mature ovarian cystic teratoma into undifferentiated carcinoma.

Interventions:

Total abdominal hysterectomy with bilateral salpingo-oophorectomy and omentectomy was performed.

Outcomes:

Positron emission tomography with 18-fluorodeoxyglucose (FDG-PET) after surgery showed multiple FDG uptake in liver, paraaortic lymph nodes and mesentery. Adjuvant chemotherapy was started, but the patient died 3 months after the surgery due to disease progression. Autopsy findings confirmed the metastases of undifferentiated carcinoma in liver, mesentery and left lung.

Conclusions:

Malignant transformation of MCT into undifferentiated carcinoma can be rapid and has poor outcomes. Pre-operative diagnosis is very difficult. Moreover, limited literature makes it difficult to establish the standardized treatment strategy for these patients. This case report shows that progression of this malignancy can be rapid despite surgery and chemotherapy.
A fatal case of severe pufferfish poisoning
Authors: Zhu Siqi , Yang Ying , Fan Zhao , Zhou Qidi , Fan Xiaoran
Published: April 2021

Introduction:

Pufferfish poisoning is the main cause of death due to food poisoning in China. No effective treatment has been proposed so far. The artificial airway and early mechanical ventilation are crucial for the prognosis, but the optimal time for these interventions remains unclear. Here we present an unsuccessful use of mechanical respiratory support in a patient with pufferfish poisoning.

Patient concerns:

A 62-year-old male patient presented to the emergency department with complaints of numbness around the mouth. He gave a history of eating pufferfish 3 hours before the coming to the hospital.

Diagnosis:

He was diagnosed as pufferfish poisoning based on the history of consuming pufferfish and the symptom of numbness.

Interventions:

Gastric lavage was performed in time, but he did not receive protective endotracheal intubation. His condition worsened rapidly with respiratory failure and cardiac arrest. He received active treatment in the intensive care unit with mechanical ventilation.

Outcomes:

Spontaneous breathing was not restored during the intensive care unit stay. He underwent treatment with hyperbaric oxygen in another hospital and died of respiratory failure eventually.

Conclusion:

The establishment of artificial airway and early implementation of mechanical ventilation are crucial for good prognosis. Our case report provides a valuable experience for implementing early endotracheal intubation intervention in patients with pufferfish poisoning.
Case report of surgically treated primary breast lymphoma in a very elderly patient
Authors: Yoneto Toshihiko , Hasumi Kenichiro , Takahashi Nobukazu , Takeda Yasutaka , Yoshimoto Takayuki
Published: April 2021

Introduction:

Primary malignant lymphoma of the breast (PBL) is a rare disease, and few cases have been reported in very elderly patients. Generally, first-line therapies for primary PBL are chemotherapy and radiation therapy. However, these invasive therapies may not always be the best choice, especially for very elderly patients who desire a better quality of life rather than improved prognosis over a long period of time. In addition, no studies have reported whether findings from preoperative imaging can be used to distinguish PBL from normal breast cancer and other malignant diseases.

Patient concerns:

A 91-year-old woman presented with an elastic, hard tumor in the upper lateral part of the right breast. The right axillary lymph node was palpable as an elastic hard mass of approximately 30 × 20 mm.

Diagnoses:

Needle biopsy of the breast strongly suggested malignant lymphoma. Ultrasonographic analysis revealed a maximal 90-mm hypoechoic area with hyperechoic margins. Thoracoabdominal computed tomography scanning revealed lesions only in the mammary gland and ipsilateral axillary lymph nodes. No other lymph node swelling was observed. Therefore, the patient was preoperatively diagnosed with PBL, stage II as per the Ann Arbor staging classification. After histopathological and immunohistochemical examinations, the patient was finally diagnosed with non-germinal center B-cell-like diffuse large B-cell lymphoma.

Interventions:

Right radical mastectomy and axillary lymph node dissection were performed in September 2019. Thereafter, the patient only received follow-up observation.

Outcomes:

Her postoperative progress was uneventful, and she was discharged 9 days post-surgery. She was followed-up for 1 year and there was no relapse.

Conclusion:

PBL should always be considered among other breast cancer diagnoses, although its incidence is very low. This is because PBL is highly malignant and frequently spreads to systemic lymph nodes, and its treatment differs from that of other breast cancers. Therefore, it should be definitively diagnosed preoperatively via histological analysis using adequate tissue obtained from either needle or open biopsies. Thus, surgical resection is a good choice, even for very elderly patients who wish to have a better quality of life.
Case report of a bilateral medial medullary infarct complicated with tetraplegia and respiratory failure
Authors: Nair Shaalina , Chai Low Soon
Published: April 2021

Rationale:

Medial medullary infarction is an uncommon stroke resulting from occlusion of a vertebral artery or its branch to the anterior spinal artery and it involves the pyramid, the medial lemniscus, and, sometimes, the hypoglossal nerve. As a result, it is usually described as a triad of ipsilateral hypoglossal paralysis, contralateral hemiparesis sparing the face and contralateral loss of deep sensation. Considering the rarity of the clinical diagnosis and paucity of case reports on this subject, we present a case of a successful detection of a bilateral medial medullary infarct in a patient which was later complicated with tetraplegia and respiratory failure.

Patient concerns:

This is a 62-year-old gentleman who presented to our center with sudden onset of left sided body weakness, slurring of speech and headache for 3 days. Past medical history includes smoking, hypertension and diabetes mellitus with poor glycemic control.

Diagnoses:

Subsequently, 3 days later, he developed right sided body weakness with power 0/5 (based on Medical Research Council scale for muscle power assessment) over the right upper and lower limbs with a right hemi sensory loss. Urgent Magnetic Resonance Imaging (MRI) of the brain revealed an acute ‘heart-shaped’ infarct of the bilateral medial medullary regions with a beaded appearance of V4 segment of right vertebral artery and M1 segment of left middle cerebral artery. A diagnosis of bilateral medial medullary infarct was made.

Interventions:

The patient was then started on oral Aspirin 100 mg once daily and his usual oral antihypertensive, Amlodipine 10 mg per day and oral hypoglycemic medication, Metformin 500 mg twice daily were continued as a part of the risk factor modification.

Outcomes:

He was tetraplegic and on day 4 post-infract, he developed acute respiratory failure requiring intubation and admission to the intensive care unit.

Lessons:

A bilateral medial medullary infarct is very rare and we believe that this patient's poorly controlled comorbid conditions have led to progressive atherosclerosis and thrombosis of the right vertebral and left middle cerebral arteries. This patient's respiratory failure is due to the involvement of the medulla oblongata that houses the respiratory center.
The FloTrac/VigileoTM system for continuous cardiac output monitoring in a paraplegic woman undergoing general anesthesia for cesarean section
Authors: Li Murong , Yao Qi , Wang Jinping
Published: April 2021

Rationale:

Paraplegic women requiring cesarean section present plenty of challenges for anesthesiologists. One of the most serious challenges is cardiovascular instability induced by autonomic hyperreflexia. The FloTrac/Vigileo TM system is a pulse contour analysis device for continuous hemodynamic index monitoring. Here, we present a case report of a paraplegic woman who underwent general anesthesia for cesarean section under FloTrac/VigileoTM monitoring.

Patient concerns:

A 33-year-old paraplegic woman was scheduled for cesarean section at the 38th week of gestation. The woman was completely paralyzed below T4 after a surgical treatment for a spinal cord bulge at the neck-chest junction.

Diagnoses:

A paraplegic G1 P0 patient at 38 week gestation following in-vitro fertilization and embryo transfer requiring elective cesarean section.

Interventions:

We chose general anesthesia for the patient under FloTrac/VigileoTM system monitoring. In accordance with the FloTrac/VigileoTM system monitoring, vasoactive drugs and liquid infusion were adjusted in real time.

Outcomes:

Autonomic hyperreflexia emerged during the surgery and the patient was treated in a timely manner because of the FloTrac/VigileoTM system. There were no complications, and the patient delivered a healthy baby girl.

Lessons:

Paraplegic women can be treated with general anesthesia under FloTrac/VigileoTM system monitoring. The FloTrac/VigileoTM system monitoring can be used to help monitor and maintain a paraplegic patient's hemodynamic stability.
A case report of isoniazid adverse drug reaction in a pediatric patient with defective NAT2 gene
Authors: Cocciadiferro Dario , Cursi Laura , Cairoli Sara , Agolini Emanuele , Simeoli Raffaele , Lancella Laura , Chiurchiu Sara , Novelli Antonio , Dionisi-Vici Carlo , Villani Alberto , Goffredo Bianca Maria
Published: April 2021

Rationale:

Adverse drug reactions (ADRs) represent a major health problem worldwide, with high morbidity and mortality rates, ranging from 0.5% to 16.8% in hospitalized children. One of the most effective and widely used drugs for anti-tuberculosis treatment is Isoniazid (INH). INH is a pro-drug and following oxidative activation, forms an adduct with NAD+ that inhibits NADH-dependent targets of Mycobacterium tuberculosis. Although this regimen is effective in treating active tuberculosis, it is associated with many ADRs considered as the main complication during therapy

Patient concerns:

The patient, a 14-year-old girl, presented with nodal tuberculosis exhibiting mobile laterocervical and angle-mandibular lymphadenopathy

Diagnoses:

INH plasmatic concentration levels above the therapeutic range and a custom NGS gene panel including NAT2 gene allowed the identification of the NAT2∗5C/∗6B slow metabolizer haplotype

Interventions:

The Patient was hospitalized and initially treated with quadruple antituberculosis therapy. After treatment, she was not able to continue the anti-tuberculosis treatment owing to ADR including overwhelming vomiting, nausea, worsening of clinical conditions, and hypertransaminasemia.

Outcomes:

Isoniazid and Rifampicin dosage was halved and then, because of the further increase of transaminases, anti-tuberculosis therapy was suspended. Clinical conditions and hematic parameters rapidly improved after suspension of anti-tuberculosis drugs

Lessons:

We report a 14-year-old girl with defective NAT2 that showed ADRs during anti-tuberculosis therapy. Combined strategy of therapeutic drug monitoring and pharmacogenetic analysis should be widely adopted during the routine clinical practice in order to optimize therapy and minimize ADRs
A case report of lymphoplasmacytic lymphoma with paraprotein IgA and IgM
Authors: Zheng Li , Guo Zhenxing
Published: April 2021

Introduction:

Lymphoplasmacytic lymphoma (LPL) is a rare indolent mature B-cell lymphoma and 90% to 95% LPL secrete monoclonal immunoglobulin M (IgM) protein. Only a small number of LPL secrete non-IgM monoclonal protein.

Patient concerns:

We report the case of an 86-year-old-male who was admitted to our hospital with a history of fatigue for 7 years and poor appetite for 3 months.

Diagnoses:

According to the M component IgA-κ and IgM-κ, plasmacytic differentiation lymphocytes in bone marrow biopsy and MYD88 mutation, the patient was diagnosed as LPL with paraprotein IgA and IgM.

Interventions:

Given the old age and expensive cost, the patient gave up chemotherapy and target therapy, and received only supportive treatment of intermittent transfusion.

Outcomes:

The patient has survived for more than 1 year with the supportive treatment.

Conclusion:

LPL with paraprotein IgA and IgM is a very rare indolent disease. Further studies with more patients are required to investigate the clinical outcomes.
Glisson pedicle ligation for unresectable hepatocellular carcinoma
Authors: Chen Qin-Qin , Yang Ling-Zhi , Yang Jian , Zhang Hong-Wei , Li Ke , Xiong Wei-Dong , Cheng Xiao , Bai Rong , Peng Xin-Yu
Published: April 2021

Introduction:

Hepatocellular carcinoma (HCC) is 1 of the most common malignant neoplasms worldwide. Surgical resection is the first choice of treatment. However, surgical resection is unsuitable for certain types of HCC.

Patient concerns:

A 47-years-old male patient presented with Child-Pugh class A liver function and the indocyanine green retention rate at 15 min effectively was 3.5%. Computed tomography and magnetic resonance imaging indicated that the tumors were distributed in the anterior segment of right lobe, and near the hepatic portal area. The maximum size of the tumor was approximately 86mm×82 mm.

Diagnosis:

The patient was diagnosed with hepatocellular carcinoma Stage IIIB. After pre-operative evaluation, hepatic segmentectomy by Glisson pedicle approach was recommended.

Interventions:

Hepatic segmentectomy by Glisson pedicle approach was recommended. But there was heavy bleeding during hepatic resection after the ligation of the Glisson pedicle on the right anterior branches. Hence only Glisson pedicle ligation was performed without hepatic segmentectomy.

Outcomes:

During 1 year of postoperative follow-up, the patient had no obvious complications. The computed tomography and magnetic resonance imaging indicated significant reduction in the size of tumor. The tumor was observed to have undergone liquefaction necrosis after 6 months. The serum a-fetoprotein also decreased significantly.

Conclusion:

The Glisson pedicle ligation may be an optional treatment in selected cases of unresectable HCC. However, further research is needed to understand the effectiveness of this treatment.