ResearchPad - case-series https://www.researchpad.co Default RSS Feed en-us © 2020 Newgen KnowledgeWorks <![CDATA[Interstitial lung diseases associated with metal content in silicone breast implants: a case series]]> https://www.researchpad.co/article/elastic_article_13782 Background: Silicone gel-filled breast implants have been widely used for breast augmentation and reconstruction since the 1960’s when the FDA approved them in women over 22 years of age. Concerns have been raised about the safety of those implants, with the focus upon whether silicone leak can spread to regional lymph nodes and remote organs and possibly cause inflammatory and immune responses. Objective: To present laboratory workup findings in 3 cases of interstitial lung diseases (ILD) linked with silicone implant leakage. Methods: ILD was diagnosed by tissue biopsy and Computerized Tomography (CT). We analyzed the metal content in both biological samples and raw material of the implants by means of scanning electron microscopy (SEM) and X-ray fluorescence (XRF). The metals lymphocyte proliferation analysis (MELISA®) was used to assess sensitization of the immune system to 19 metals. Results: The biological samples contained metals (silicon, nickel, zinc, tungsten, iron, aluminum, and zirconium) which are also present in the silicone implant. The MELISA test showed sensitization to nickel, zinc and tin. Limitations: Some of the immunogenic metals present in the implant were under the limits of detection of SEM and XRF and the sensitivity of MELISA test is unknown. Conclusions: The laboratory assessments of the 3 herein described women indicated that their interstitial lung disease was associated with the metal content of their silicone gel-filled breast implantations. (Sarcoidosis Vasc Diffuse Lung Dis 2018; 35: 381-389)

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<![CDATA[Outcome of patients with sarcoidosis refractory to TNF antagonists: a case series]]> https://www.researchpad.co/article/elastic_article_13781 Background: Tumor necrosis factor (TNF) antagonists have been reported as an efficient third-line therapy for sarcoidosis but there is no data regarding patients who do not respond to this treatment. Objective: To report the characteristics, the outcome and the response to therapy of patients with sarcoidosis resistant to TNF antagonists. Methods: Patients from the French STAT (Sarcoidosis Treatment with Anti-TNF) registry who were classified as non-responders and who were followed-up for >1 year were included. The response to further therapies was classified as complete response, or partial response, and the others were classified as non-responders. Results: Among the 132 patients from the registry, 14 were considered as non-responders to anti-TNF. Nine patients (66% of women; mean age 48 years) were analyzed. The mean number of organs involved was 4.2. Seven patients were previously treated with more than 2 immunosuppressive treatments. The mean duration of the anti-TNF treatment was 9 months (range, 3-24). After a mean follow-up duration of 58 months (median, 35; range, 19-128) a complete response was observed in 2/9 cases, a partial response in 5/9 cases, and 2/9 cases were considered as non-responders. In all but one patient, the immunosuppressant that allowed the clinical response had previously been used. Furthermore, the dosage was not necessarily increased to gain efficacy. Non-responders were treated by corticosteroids only because of their comorbidities or noncompliance. Conclusion: In patients who do not respond to TNF antagonists, previously used immunosuppressants may be useful. Excluding a differential diagnosis, assessing compliance and testing for anti-drug antibodies should be systematic. (Sarcoidosis Vasc Diffuse Lung Dis 2018; 35: 371-375)

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<![CDATA[Predominant dendriform pulmonary ossification in a usual interstitial pneumonia-like distribution: to be distinguished from idiopathic pulmonary fibrosis]]> https://www.researchpad.co/article/elastic_article_13763 Idiopathic dendriform diffuse pulmonary ossification (DPO) is a rare disorder. High resolution CT (HRCT) with appropriate osteoporosis window setting reveals the diagnosis. We report the features of eight patients, of whom two brothers, with HRCT findings compatible with predominant DPO in a bibasal subpleural distribution (usual interstitial pneumonia (UIP)-like distribution) and review the literature for DPO in this UIP-like distribution. DPO in a UIP-like distribution seems to be a disorder of the very old (age 75-87 (mean 83.6) male (8 out of 8), with familial occurrence, with associated cardiovascular disease and frequent use of anticoagulants as common findings, and with a slowly progressive nature and the absence of radiological honeycombing despite long lasting disease contrasting with idiopathic pulmonary fibrosis (IPF). Idiopathic pulmonary fibrosis (IPF) should be differentiated from predominant DPO in a UIP-like distibution. (Sarcoidosis Vasc Diffuse Lung Dis 2017; 34: 251-256)

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<![CDATA[Dynamic smile reanimation in facial nerve palsy]]> https://www.researchpad.co/article/elastic_article_13883 Long-term facial paralysis results in degeneration of the distal nerve segment and atrophy of the supplied muscles. Options for these patients include free muscle transfer, temporalis myoplasty, and botulinum toxin injections for smile reanimation. In this study we aimed to evaluate the subjective and objective outcomes of these procedures.Materials and MethodsIn our study, we retrospectively analyzed smile symmetry in patients with facial palsy (n=8) who underwent facial reanimation procedures.ResultsSubjective analysis showed high satisfaction in seven out of eight patients. Objective analysis showed statistically significant improvement postoperatively in both vertical and horizontal smile symmetry at rest and during maximum smile (P<0.001).ConclusionChoosing the ideal procedure for the patients is the most critical aspect for facial reanimation. Though free muscle transfer is considered gold standard procedure, temporalis myoplasty also gives satisfactory results. Residual synkinesis which can lead to disturbing aesthetic deformity can be effectively treated with botulinum toxin. ]]> <![CDATA[Sarcoidosis and colon cancer: a possible association]]> https://www.researchpad.co/article/elastic_article_13779 Sarcoidosis is a multisystem inflammatory disease characterized by non-caseating granulomas which mainly affect the pulmonary lymphatic system and lungs; although any organs can be interested. The association between sarcoidosis and cancer is still controversial, but many studies demonstrated an increased risk of cancer in patients with sarcoidosis, whereas few cases of sarcoidosis occurring after cancer have been reported. This report outlines and describes clinical, biologic and radiologic features of 3 patients with a history of surgical treatment and adjuvant chemotherapy for colon cancer, followed by a diagnosis of sarcoidosis some years later. The history of cancer and the lymph nodes positivity found through PET scan induced us to hypothesize a relapsing cancer disease. However, this hypothesis was not confirmed by the lymph nodes biopsy, which is the core method of diagnosis of sarcoidosis. (Sarcoidosis Vasc Diffuse Lung Dis 2018; 35: 376-380)

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<![CDATA[A Case Series of Stent Thrombosis During the COVID-19 Pandemic]]> https://www.researchpad.co/article/elastic_article_13587 Coronavirus disease-2019 (COVID-19) triggers a hypercoagulable state with a high incidence of thrombotic complications. We have noted a higher than…

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<![CDATA[Managing Cardiac Resynchronization Therapy Nonresponse: Conventional and Unconventional Techniques]]> https://www.researchpad.co/article/elastic_article_13186 Cardiac resynchronization therapy (CRT) is an established option for select patients with systolic heart failure. Nonresponse to CRT remains a significant problem. We present five patients who were CRT nonresponders and discuss the conventional and nonconventional approaches employed to achieve CRT benefit.

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<![CDATA[Novel coronavirus 19 (COVID-19) associated sinus node dysfunction: a case series]]> https://www.researchpad.co/article/elastic_article_12439 Novel coronavirus-19 disease (COVID-19) is associated with significant cardiovascular morbidity and mortality. To date, there have not been reports of sinus node dysfunction (SND) associated with COVID-19. This case series describes clinical characteristics, potential mechanisms, and short-term outcomes of COVID-19 patients who experience de novo SND.Case summaryWe present two cases of new-onset SND in patients recently diagnosed with COVID-19. Patient 1 is a 70-year-old female with no major past medical history who was intubated for acute hypoxic respiratory failure secondary to COVID-19 pneumonia and developed new-onset sinus bradycardia without a compensatory increase in heart rate in response to relative hypotension. Patient 2 is an 81-year-old male with a past medical history of an ascending aortic aneurysm, hypertension, and obstructive sleep apnoea who required intubation for COVID-19-induced acute hypoxic respiratory failure and exhibited new-onset sinus bradycardia followed by numerous episodes of haemodynamically significant accelerated idioventricular rhythm. Two weeks following the onset of SND, both patients remain in sinus bradycardia.DiscussionCOVID-19-associated SND has not previously been described. The potential mechanisms for SND in patients with COVID-19 include myocardial inflammation or direct viral infiltration. Patients diagnosed with COVID-19 should be monitored closely for the development of bradyarrhythmia and haemodynamic instability. ]]> <![CDATA[Percutaneous Bioelectric Current Stimulation for Chronic Cluster Headache – A Possible Transformative Approach to Cluster Headache]]> https://www.researchpad.co/article/elastic_article_7839 Cluster headache (CH) is considered to be a catastrophic disease presenting the most severe human pain condition. Available pharmacological treatments are hampered by unwanted side effects, and there is an urgent need for non-pharmacological treatment alternatives. We present a novel therapeutic approach for chronic CH, having evolved from an episodic CH, using a non-invasive percutaneous bioelectric current stimulation (PBCS), which generates static electric fields in the range of the naturally occurring electric potentials.Patients and MethodsThis study employed a retrospective data analysis of 20 cases of chronic cluster headache (CCH) patients, four of those having had cluster-related surgery (SPG, ONS). All patients were treated with PBCS between 2014 and 2018. Data of these patients were analyzed with respect to frequency of CH attacks and triptan application and followed up for one (20 cases) or two (12 cases) years.ResultsFour weeks after the first PBCS treatment, cluster headache attacks were reduced from 2.8 to 1.7 per day and triptan application decreased from 2.5 to 1.5 times/day. Six non-responders, 4 of which had pre-CH surgery, did not show any reaction to PBCS, while 14 responders improved within 4 weeks from 2.2 to 0.7 attacks/day and 2.0 to 0.4 triptan applications/day. A 50% or greater reduction of attack frequency was observed in 10 patients after 4 weeks and in 11 patients after 12 weeks. One year after the first treatment, 13/20 patients experienced a reduction of attack frequency of 50% or more, while remarkably 10 patients were completely free of attack. After 2 years, 8 of 12 patients experienced a reduction of attack frequency of 50% or more and 7 of those were completely symptom-free. No serious adverse effects were observed.ConclusionPBCS is a promising transformative treatment approach for CCH patients. Drug consumption was reduced significantly, and the CCH may revert back to an episodic cluster headache with increasingly long times of remission. Responders can be clearly differentiated from non-responders. The data support the need for randomized controlled trials. ]]> <![CDATA[Granulomatous lymphocytic interstitial lung disease: limiting immunosuppressive therapy—a single‐centre experience]]> https://www.researchpad.co/article/N64d6454e-d0af-4ee0-b7bf-5f5eebeffa72 Granulomatous lymphocytic interstitial lung disease (GLILD) can be a progressive ILD‐associated common variable immunodeficiency (CVID) that results in increased mortality. There are no treatment guidelines; however, progressive disease often responds to immunosuppression when intravenous immunoglobulin g (IVIg) monotherapy fails. This series adds evidence that immunosuppression can be limited with close observation in clinically stable patients and some patients can consider ceasing immunosuppression when disease has initially responded.

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<![CDATA[Burr-Assisted Anterior Lamellar Keratoplasty (DALK) in Patients with Corneal Stromal Scarring: A Case Series]]> https://www.researchpad.co/article/Nea2e14aa-a0f7-4e00-915c-215a8a7aac46 To describe a modified technique of deep anterior lamellar keratoplasty (DALK) assisted by diamond ophthalmic burr (DOB) in two patients with corneal stromal scarring.MethodsTwo patients with corneal stromal scarring underwent a modified DALK technique with corneal stromal polishing assisted by a DOB until the level of the Descemet membrane.ResultsThere were no intra- or postoperative complications. Six months postoperatively, the corneal graft was clear, while corrected distance visual acuity improved in both cases.ConclusionsBurr-assisted DALK seems to represent an alternative surgical technique in patients with corneal stromal scarring.Electronic supplementary materialThe online version of this article (10.1007/s40123-020-00248-8) contains supplementary material, which is available to authorized users. ]]> <![CDATA[Seroprevalence of rubella in pregnant women in Southern Morocco]]> https://www.researchpad.co/article/N89943a04-0623-4524-83b2-6637aab83866 Rubella is a generally benign but dangerous viral infection in early pregnancy, due to the teratogenic potential of the virus. Indeed, it causes spontaneous abortions, in-utero fetal death, premature labor and congenital malformations known as congenital rubella syndrome. The purpose of this study is to determine the immune status of rubella in pregnant women in southern Morocco. A prospective, multicentre study was conducted in 2017 for the detection of rubella IgG and IgM antibodies in 380 pregnant women aged 17 to 46 years, using the Architect i1000 chemiluminescent microparticle immunoassay. Eigthy for percent (84.7%) of women were seropositive. Ten percent of multiparous women remained seronegative despite recommendations for vaccination after delivery. Preventive measures against congenital rubella need to be strengthened, and vaccination is needed in non-immunized women. Vaccination awareness campaigns, especially among non-immunized multiparous women, remain essential.

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<![CDATA[Late Onset Ornithine Transcarbamylase Deficiency Triggered by an Acute Increase in Protein Intake: A Review of 10 Cases Reported in the Literature]]> https://www.researchpad.co/article/Nf98c2652-56ae-4253-a4c5-d3d632fefdd0 While the urea cycle disorders (UCDs) classically present in the neonatal stage, they have become increasingly recognized as a rare cause of unexplained hyperammonemic encephalopathy in adults. Many metabolic triggers for late-onset UCDs have been described in the literature including excessive protein intake. In this case series, ten such documented cases are reviewed with analysis of patient demographic, protein load, treatment course, and patient outcome. Common delays in treatment include recognition of hyperammonemia as the cause of encephalopathy and initiation of hemodialysis. In only one case was a diet history used to raise suspicion for a metabolic derangement. Metabolic disorders remain an important consideration in adults presenting with encephalopathy not explained by more common etiologies, and recent and remote dietary history may provide valuable information.

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<![CDATA[Lichen Planopilaris and Low-Level Light Therapy: Four Case Reports and Review of the Literature About Low-Level Light Therapy and Lichenoid Dermatosis]]> https://www.researchpad.co/article/N4ccc40e5-a557-4d51-ad5b-5f31cc745cba

Lichen planopilaris (LPP) is a cell-mediated scarring alopecia that causes inflammation of the scalp and the eventual destruction of hair follicles in affected areas. Current literature on treatment of LPP remains limited with no definitive treatment approach being recognized, although a combination of topical/intralesional steroids and orally administered hydroxychloroquine remains the most utilized option. Low-level light therapy (LLLT) is an expanding technology shown to be effective in a variety of dermatologic conditions. We report here four patients with LPP who show a dramatic response to LLLT, including a reduction of inflammation, disappearance of symptoms, and evident hair regrowth with no side effects. We review the possible role of LLLT in LPP and other lichenoid conditions.

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<![CDATA[Extracorporeal membrane oxygenation for blastomycosis-related acute respiratory distress syndrome: a case series]]> https://www.researchpad.co/article/N0b051155-3ae4-40e6-a709-bc50b788799b

Purpose

Blastomyces dermatitidis is a dimorphic fungus endemic to North America capable of causing fatal respiratory failure. Acute respiratory distress syndrome (ARDS) complicates up to 10% of pulmonary blastomycosis in hospitalized patients and carries a mortality of 50-90%. This report describes the clinical course of four consecutive patients with blastomycosis-related ARDS treated with venovenous extracorporeal membrane oxygenation (ECMO) during 2009-2014.

Clinical features

Four adults were referred from northwestern Ontario, Canada with progressive respiratory illnesses. All patients developed diffuse bilateral opacities on chest radiography and required mechanical ventilation within 6-72 hr. Patients satisfied Berlin criteria for severe ARDS with trough PaO2/FiO2 ratios of 44-61 on positive end-expiratory pressure of 12-24 cm H2O. Wet mount microscopy from respiratory samples showed broad-based yeast consistent with B.dermatitidis. Despite lung protective ventilation strategies with maximal FiO2 (patients A-D), neuromuscular blockade (patients A-D), inhaled nitric oxide (patients A and D), and prone positioning (patient D), progressive hypoxemia resulted in initiation of venovenous ECMO by hours 24-90 of mechanical ventilation with subsequent de-escalation of ventilatory support. In all four cases, ECMO decannulation was performed (7-23 days), mechanical ventilation was withdrawn (18-52 days), and the patients survived to hospital discharge (31-87 days).

Conclusion

This report describes the successful application of ECMO as rescue therapy in aid of four patients with refractory blastomycosis-associated ARDS. In addition to early appropriate antimicrobial therapy, transfer to an institution experienced with ECMO should be considered when caring for patients from endemic areas with rapidly progressive respiratory failure.

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<![CDATA[Profil évolutif de l'insuffisance rénale aiguë chez les personnes vivant avec le VIH à Abidjan, Côte d'Ivoire du 1er janvier 2014 au 31 décembre 2017]]> https://www.researchpad.co/article/Ncce81caf-b455-4164-8cba-56be612291b2

En Côte d'Ivoire, la prévalence de l'infection au virus de l'immunodéficience humaine (VIH) est élevée. Tous les organes peuvent être atteints, en particulier le rein. Certaines études en Côte d'Ivoire ont retrouvé les infections opportunistes comme facteur de mauvais pronostic de l'insuffisance rénale aiguë (IRA). L'objectif de cette étude était de rechercher les éventuels autres facteurs associés à l'évolution de l'IRA chez les personnes infectées par le VIH. Une étude rétrospective, analytique, menée au Centre Hospitalier et Universitaire de Yopougon de janvier 2014 à décembre 2017. Etaient inclus tous les patients âgés de plus de 18 ans, infectés par le VIH et ayant présenté une IRA. Soixante-treize (73) patients ont été inclus, soit une prévalence de 24%. L'âge moyen des patients était de 39,32 ± 10,50 ans avec des extrêmes de 18 et 65 ans. Un sexe ratio de 1,6 en faveur des femmes. L'obésité (p=0,047; OR=8,72; IC (95%)=1,07-39,21) et le taux de CD4< 200/mm3 (p=0,000; OR=58,50; IC (95%)=10,31-55,12) étaient associés à un mauvais pronostic de l'IRA. En Côte d'Ivoire, la prévalence hospitalière l'IRA au cours du VIH demeure élevée. Son évolution est défavorable avec le décès ou le passage à la chronicité. En plus de l'immunodépression profonde déjà connue comme facteur de mauvais pronostic, cette étude a montré que l'obésité était associée à une évolution défavorable de l'IRA chez les personnes vivant avec le VIH.

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<![CDATA[Less frequent cardiac and extracardiac findings during 99mTc-methoxyisobutylisonitrile myocardial perfusion single-photon emission computed tomography with radiological correlates]]> https://www.researchpad.co/article/Nc1a8cf83-4b8f-4eac-9295-339476eb0b88

Myocardial perfusion single-photon emission computed tomography (SPECT) as a common imaging procedure in nuclear medicine laboratories may encompass findings in the heart or beyond it, in the thorax or abdomen, which may be related or unrelated to the symptoms of the patients. Sometimes, these findings may be discovered incidentally. In the present article, it is aimed to present some less frequent cardiac and extracardiac findings including radiolabeled emboli, transposition of great arteries, breast prosthesis, breast tissue uptake, pericardial effusion, hiatal hernia, hepatocellular carcinoma, ascites, aortic aneurysm, splenomegaly, and polycystic kidney disease during 99mTc-methoxyisobutylisonitrile myocardial perfusion SPECT with their radiological correlates.

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<![CDATA[Demodex-induced follicular mucinosis of the head and neck mimicking folliculotropic mycosis fungoides]]> https://www.researchpad.co/article/N970903b5-a549-4c96-a245-b1a163246677 ]]> <![CDATA[Review of thyroid eye disease in euthyroid state with periocular mucinosis]]> https://www.researchpad.co/article/N7f87625f-ebb1-4d3a-97dd-d16f54079dbc ]]> <![CDATA[Iodine toxicity after iodinated contrast: New observations in iododerma]]> https://www.researchpad.co/article/N0825e76c-b325-4f0d-8d45-b7c06c16cf26 ]]>