Bilateral thalamic infarction with posterior cerebral artery variant (the arcade artery): A case report.
Medicine
RATIONALE:Bilateral thalamic infarction is a rare type of posterior circulation stroke, and it often presents with a reduced level of consciousness in the elderly. Arteriosclerosis is the primary etiology of bilateral thalamic infarction, including conditions such as native vessel stenosis or arterial-to-arterial embolism. Cardiogenic or paradoxical embolism can also lead to thrombosis of the perforator branches innervating the thalamus, and these emboli tend to disintegrate and lead to multiple lesions, even in elderly patients. PATIENTS CONCERNS:A 69-year-old man presented to our emergency room with sudden onset of drowsiness lasting for 2 days. A computed tomography scan revealed bilateral hypodense thalamic lesions, which resembled artery of Percheron infarcts. Magnetic resonance imaging confirmed cerebral infarction in the posterior circulation. Magnetic resonance angiography and diagnostic digital subtraction angiography suggested a suspicious embolus obstructing the junction between the arcade artery and the left posterior cerebral artery, which had further migrated. Echocardiography, 24-hour Holter monitoring, and deep venous ultrasonography were all negative; however, transesophageal echocardiography revealed a patent foramen ovale. DIAGNOSIS:Paradoxical embolism is a rare occurrence in older adults. However, when considering the etiology of stroke in this patient, paradoxical embolism should remain a priority in the diagnostic process following a multifactorial risk assessment. INTERVENTION:The patient was treated with antiplatelet, statin therapy, and foramen ovale closure. OUTCOME:He recovered well after the interventional closure surgery and is currently under follow-up. LESSONS:The elderly experiencing a sudden drop in consciousness should be evaluated for thalamic lesions, primarily cerebral infarction in the posterior circulation. Anatomical artery variations may be helpful in attributing multiple and bilateral lesions to a single source of embolism. Digital subtraction angiography and transesophageal echocardiography can help to clarify the etiological categorization and formulate a secondary prevention strategy for cerebral infarction. Paradoxical embolism is a diagnostic dilemma in the elderly population, and treatment principles must be integrated with guidelines, the prospectively validated patent foramen ovale-associated stroke causal likelihood risk stratification system, interdisciplinary collaboration and customized analysis.
10.1097/MD.0000000000040991
A case report of adenomyosis-induced spontaneous rupture in an unscarred and unpregnant uterus.
Medicine
RATIONALE:Spontaneous uterine rupture, although rare, is a life-threatening obstetric emergency with a high maternal and fetal mortality rate. It can occur without warning, leading to severe complications, including hemorrhage, shock, and fetal demise. The risk factors contributing to uterine rupture are diverse and include a history of uterine surgery (such as cesarean section), trauma to the uterus, abnormal uterine contractions during labor, and underlying conditions like adenomyosis. Identifying and understanding these risk factors are crucial for early detection, timely intervention, and improved outcomes in affected pregnancies. PATIENT CONCERNS:Here, we report an exceptionally rare case of spontaneous uterine rupture triggered by adenomyosis in a 34-year-old unmarried and nulliparous woman with no prior scarring or pregnancy. Physical examination revealed abdominal distension, with the uterine fundus at the level of the umbilicus, exhibiting hardness, tenderness upon palpation, and rebound tenderness. Ultrasonography and computerized tomography scans suggested adenomyosis and uterine rupture. During surgery, a rupture was discovered in the left basal layer of the uterus, with a rupture diameter of approximately 3 cm. Additionally, there were multiple internal endometrial lesions in the uterorectal pouch. DIAGNOSES:Adenomyosis-induced spontaneous uterine rupture. INTERVENTIONS:The procedures performed included excision of adenomyotic lesions, repair of the uterine rupture, and electrocoagulation of endometriotic lesions in the pelvic cavity. OUTCOMES:At the 1-month post-surgery follow-up examination, the patient showed good recovery, with no signs of complications. She was able to resume normal daily activities without difficulty. The surgical site was healing well, with no signs of infection or abnormal scarring. Ultrasound and clinical assessments confirmed the resolution of pelvic fluid accumulation, and uterine function appeared to be intact. The patient was advised to continue regular follow-up visits to monitor her recovery and ensure long-term well-being. LESSONS:First, uterine rupture caused by adenomyosis in a nonpregnant, scarless uterus is extremely rare but still possible. When patients with severe adenomyosis present with abdominal pain and pelvic fluid, obstetricians and gynecologists should consider the possibility of uterine rupture. Second, ultrasound examination can quickly and accurately diagnose both adenomyosis and uterine rupture.
10.1097/MD.0000000000041037
Acupuncture and electroacupuncture for cyclic vomiting syndrome with tachygastria in an adult: A case report.
Medicine
RATIONALE:Cyclic vomiting syndrome (CVS) is characterized by recurrent episodes of acute vomiting lasting <1 week, occurring independently and chronically. Management typically involves lifestyle interventions, supportive care, and preventative medication. In rare cases, CVS persists for decades in adults, requiring a multidisciplinary approach to improve symptoms and quality of life. PATIENT CONCERNS:A 30-year-old male patient presented with a 7-year history of recurrent nausea and vomiting, which initially began in 2017. The episodes occurred without identifiable triggers such as alcohol or overeating, increasing in frequency from once every 4 months to 2 months. He expressed fear of severe deterioration, impacting his ability to eat freely, work, and enjoy his hobbies. DIAGNOSES:He was diagnosed with CVS based on the Rome criteria. Cutaneous electrogastrography showed postprandial power decrease and tachygastria. INTERVENTIONS:Regular acupuncture treatments, including electroacupuncture at ST36 with 3 Hz, were administered twice a week for 3 weeks, followed by weekly sessions for 5 additional weeks. OUTCOMES:Over 11 treatment sessions across 8 weeks, no nausea or vomiting was observed. The visual analog scale (VAS) score for subjective gastrointestinal discomfort decreased from 67 to 0 after 4 weeks. The Nausea Severity Scale (NSS) score dropped from 14 to 0 after 4 weeks. The Functional Dyspepsia-related QoL score decreased from 16 to 0 after 8 weeks. The Nepean Dyspepsia Index-Korean version decreased from 80 to 8 after 8 weeks. Furthermore, the patient expressed high satisfaction with the treatment, and no adverse events were observed. LESSONS:Acupuncture offers a significant and safe approach to relieving symptoms and enhancing the quality of life for patients with nausea and vomiting. Although this is a single case report, the findings suggest that acupuncture can improve treatment compliance and manage symptoms in adults with CVS. Further research, including clinical trials, is required to confirm these findings and understand the underlying mechanisms.
10.1097/MD.0000000000040830
All-positive HBsAg, HBsAb, HBeAg, HBeAb, and HBcAb in a patient with hepatitis B: A case report.
Medicine
RATIONALE:Mass vaccination, low cost of immunoglobulins, and new drugs led to the emergence of new, unusual patterns of hepatitis B serum markers. This study reported a rare case of hepatitis B with all 5 positive serum markers, including HBsAg, HBsAb, HBeAg, HBeAb, and HBcAb. PATIENT CONCERNS:A 30-year-old female patient was admitted due to abnormal liver function. The 5 serum markers were all positive (+), including HBsAg, HBsAb, HBeAg, HBeAb, and HBcAb. After antiviral therapy, she was discharged with normal liver function and decreased hepatitis B virus-DNA levels, but all 5 serum markers were still positive. Regular follow-up was conducted every 3 months. DIAGNOSES:Abnormal liver function. INTERVENTIONS:The patient received antiviral treatment and liver protection therapy using entecavir dispersive tablet 0.5 mg po qd and glycyrrhizate diamine enteric capsule 150 mg po tid. OUTCOMES:The patient's liver function was normal, hepatitis B virus-DNA continued to decline, and HBeAb turned negative at 6 months. After 9 and 12 months of follow-up, the results of hepatitis B markers in the patient were stable in HBsAg positive (+), HBeAb positive (+), and HBcAb positive (+). LESSONS:The rare pattern of all 5 positive hepatitis B markers may occur in patients with chronic hepatitis B. Improvements can be achieved using first-line drugs and conventional treatment. Nevertheless, more attention should be paid to the patient's condition.
10.1097/MD.0000000000041197
Traditional Chinese Medicine for Cancer Treatment.
The American journal of Chinese medicine
In recent years, due to advancements in medical conditions and the development of scientific research, the fundamental research of TCM antitumor treatments has progressed from the cellular level to the molecular and genetic levels. Previous studies have demonstrated the significant role of traditional Chinese medicine (TCM) in antitumor therapy through various mechanisms and pathways. Its mechanism of action is closely associated with cancer biology across different stages. This includes inhibiting tumor cell proliferation, blocking invasion and metastasis to surrounding tissues, inducing tumor cell apoptosis, inhibiting tumor angiogenesis, regulating immune function, maintaining genome stability, preventing mutation, and regulating cell energy metabolism. The use of TCM for eliciting antitumor effects not only has a good therapeutic effect and low side effects, it also provides a solid theoretical basis for clinical treatment and medication. This paper reviews the mechanism of the antitumor effects of TCM based on tumor characteristics. Through our review, we found that TCM not only directly inhibits tumors, but also enhances the body's immunity, thereby indirectly inducing an antitumor effect. This function aligns with the TCM theory of "strengthening the body's resistance to eliminate pathogenic factors". Furthermore, TCM will play a significant role in tumor treatment in clinical settings.
10.1142/S0192415X24500253