Naevus of Ito in a Dutch adult

A more effective approach to lung cancer screening?

Hypotonic pharmacologic lipodissolution (HPL) has gained popularity as a treatment for abdominal fat reduction, especially among Asian individuals. However, research on the effect of HPL on abdominal vascularity and abdominal autologous tissue flap are limited. This case report describes a patient who underwent HPL treatment in November 2022 and subsequently underwent nipple-sparing mastectomy with free transverse rectus abdominis musculocutaneous (TRAM) flap reconstruction on April 4, 2023. The preoperative evaluation included computed tomography (CT) angiography to assess the viability of abdominal perforators and vasculature for TRAM flap reconstruction. Intraoperatively, indocyanine green (ICG) fluoroscopy was performed after TRAM flap elevation to evaluate flap perfusion. The findings revealed compromised skin-side perfusion but satisfactory deep layer perfusion, with subdermal plexus perfusion observed during de-epithelialization. These findings suggest that in nipple sparing mastectomy cases with minimal skin flap preservation requirements, a history of HPL may have less negative impact on TRAM flap reconstruction. However, in skin sparing mastectomy cases with extensive skin flap preservation needs, careful assessment, including preoperative CT angiography and intraoperative ICG imaging, is essential to minimize the risk of partial flap necrosis.

Obstructive sleep apnea (OSA) occurs as an increased collapsibility of the upper airway during sleep, which threatens health and quality of life. Asian men with greater severity of OSA presents less obese and are connected with craniofacial abnormalities. Although the traditional maxillomandibular advancement (MMA) had the comparable effectiveness to the continuous positive airway pressure therapy, the midfacial esthetics might be compromised in Asian individuals. The modified MMA procedure was proposed to balance the esthetic demands and improvement of OSA symptoms. The case report showed a 25-year-old man presented with a diagnosis of severe OSA. The pretreatment Apnea Hypopnea Index (AHI) score was 100 events/h. He exhibited skeletal Class II hyperdivergent facial pattern with mandibular retrognathism. To correct dentofacial deformities and improve sleep function, the modified surgical-orthodontic procedure was undertaken. The surgery-first approach was adopted for early improvement of OSA. The surgical procedures of SMMRA comprise the maxillary LeFort I segmental osteotomy, bilateral sagittal split osteotomy and genioglossus-genioplasty osteotomy. The counterclockwise rotation of maxillomandibular complex was further done to maximize mandibular advancement. The total treatment duration was 13 months. The well-aligned dentitions and solid dental occlusion were achieved. The subjective perception of sleep quality was improved. The patient was satisfied with the post-treatment facial appearance. Following the skeletal movement, the dimension of pharyngeal airway space was increased. The post-treatment AHI score was reduced to 12.1 events/h; the nadir oxygen saturation increased from 74% to 86%. The case report demonstrated the SMMRA procedure effectively improved adult Asian patients with severe OSA without deterioration of facial attractiveness and dental occlusion.

BackgroundSmall cell neuroendocrine carcinoma (SCNEC) of the ureter is a rare tumour, accounting for less than 0.5% of all ureteral tumours. SCNEC tumours are highly aggressive and patients have a poor prognosis. Ureteral SCNEC colliding with other pathological types of tumours is extremely rare. In this paper, we present the case of a patient with ureteral small cell carcinoma colliding with squamous cell carcinoma and review the literature regarding the clinicopathological features, treatment and prognosis of thus tumour. To the best of our knowledge, this is the second identified case of ureteral SCNEC colliding with SCC.Case PresentationA 64-year-old male patient presented with a history of 1 month of gross haematuria and 3 months of left flank pain. CT urography revealed a soft tissue mass in the upper ureter, which was slightly enhanced on contrast-enhanced CT. Nephroureterectomy was performed after the patient was diagnosed with a tumour in the left ureter. Microscopy and immunohistochemical examination confirmed the mass to be a SCNEC collision with SCC. Two months after the surgery, the patient received adjuvant chemotherapy (cisplatin/etoposide). After 14 months of follow-up, no local recurrence or distant metastasis was found.ConclusionUreteral collision carcinoma with SCNEC predominantly occurs in Asian individuals, is difficult to diagnose preoperatively and is highly invasive. The current management of ureteral collision carcinoma is a comprehensive treatment based on surgery.

Objective: Q-switched laser is considered a gold standard treatment for Nevus of Ota (NO). We report how few laser sessions in long intervals of time may achieve satisfying outcomes reducing the rate of possible procedure-linked side effects such as burning, cornea injuries, or hyperpigmentation. Background: NO represents a congenital dermal melanocytosis in the trigeminal distribution majorly occurring in Asian individuals. Multiple reports have shown efficacy and safety of Q-switched laser for the treatment of this condition, but they were based on an empiric regimen, often leading to unnecessary overtreatments. At the best of our knowledge, no long-term follow-up observations of single laser sessions have been conducted to assess the proper intervals and number of treatments. Materials and methods: A 36-year-old Asian woman, Fitzpatrick skin type IV with clinical diagnosis of NO, was treated with 1064 nm 6 ns Q-switched laser one session per year for a total of two sessions. Clinical result was valued by two physicians independently using standardized and polarized light. No use of general anesthesia or sedation was needed in our experience. Corneal shields have been used. Results: After only two sessions of the Q-switched laser performed 1 year apart, the result was excellent with a 95% of clinical response. No side effect was observed. Conclusions: In our experience, Q-switched Nd:YAG laser is an effective treatment for NO with no necessity of high number of treatments. A larger population is needed to confirm this preliminary result.

BACKGROUNDMadelung’s disease (MD) is a chronic alcoholism-associated metabolic syndrome characterized by symmetrical subcutaneous deposition of adipose tissue in the head, neck, shoulders, back, trunk, and nerve roots of the upper and lower limbs. It is relatively rare in Asian individuals and is prone to misdiagnosis. Herein, we report a case of a patient with MD who had undergone surgical management at our hospital, and we discuss the pathogenesis, diagnosis, and treatment of MD.CASE SUMMARYWe report a case of MD in a 65-year-old man of Han descent. The patient had multiple, painless progressive masses for more than five years in the neck and more than 30 years in the upper back. Because of neck mobility limitations and progressive cosmetic deformities caused by the masses, he was admitted to our hospital. He drank approximately 500 mL of liquor per day and smoked heavily for more than 30 years. Contrast-enhanced computed tomography of the neck and chest documented abundant unencapsulated, subcutaneous fatty deposits. We prepared a staged operation plan. The patient was diagnosed with MD; he was advised to abstain from alcohol and was followed up regularly. After a 3-month follow-up, no recurrence of fat accumulation was found in the surgical areas.CONCLUSIONThis report presents a case of surgical treatment for MD to improve clinicians' understanding of the disease.

Pseudomamma of the inguinal region in a female patient: A case report

To analyse the occurrence of calcifying epithelial odontogenic tumours (CEOT) based on biopsy records from different Brazilian geographic regions and to contrast the data with a review of the literature. A 2-step study was conducted. Step 1 consisted of a collaborative study of biopsies obtained from 1953 to 2017 at six Brazilian oral and maxillofacial pathology centres. Evaluation of 86,268 biopsy records was performed. Demographic and histopathological diagnosis data were assessed. In Step 2, a review of the literature of case reports and cases series of CEOT identified across five electronic databases was conducted. In the collaborative study, 32 cases of CEOT were evaluated. This figure represented 0.03% of the oral and maxillofacial lesions and 1.7% of all odontogenic tumours across the centres. Women in the fourth decade of life were more affected. CEOT occurred more in the mandible than in the maxilla (ratio 1.9:1). The review of the literature showed that Asian individuals were more affected by this neoplasm. Useful knowledge on the epidemiology, treatment and follow-up of CEOT has been provided. Demographic data and clinical features of the cases presented in this collaborative study were quite similar to those of studies reported worldwide.

Relevance. This case report presents a comprehensive analysis of impaired carbohydrate metabolism prevalence among Asian individuals in Kyrgyzstan. A dataset encompassing 223 patients aged between 25 and 73 years was scrutinized, revealing noteworthy insights into gender distribution, family history of diabetes mellitus, age demographics, body mass index (BMI) metrics, waist circumference, blood pressure readings, fasting glucose levels, and postprandial glucose concentrations. The findings underscore the imperative for targeted interventions and scientific strategies to tackle the escalating burden of impaired carbohydrate metabolism within this demographic.

Based on strong research evidence and consensus, the most common disease manifestations at diagnosis of pSLE are constitutional symptoms, arthritis, and malar rash. Based on some research evidence and consensus, patients with pSLE tend to have major organ system involvement (renal/central nervous system) and a greater disease burden compared with adults. Despite these findings, mortality is low. Based on some research evidence and consensus, the diagnosis of pSLE is unlikely if the ANA is negative, and most patients with SLE have a positive ANA at a titer ≥1:160. Based on strong research evidence, both MMF and cyclophosphamide can be used for induction therapy in class III and IV lupus nephritis. Based on strong research evidence, patients with SLE and anticardiolipin antibodies or LA have a two and six times greater risk of venous thrombosis, respectively, compared with patients with SLE without antiphospholipid antibodies. Based on strong research evidence, patients with pSLE have a higher risk for subclinical atherosclerosis when there is weight-adjusted prednisone use, azathioprine use, increasing age, male gender, high BMI, abnormal creatinine clearance, and elevated lipoprotein(a) levels.

Thalassemia refers to a group of chronic microcytic hereditary hemolytic anemias characterized by a defect in hemoglobin synthesis. Beta-thalassemia is more prevalent among individuals of Mediterranean, Middle Eastern, South Asian, or Indian descent. Symptoms arise from anemia, hemolysis, splenomegaly, medullary hyperplasia, and, in cases of multiple transfusions, iron overload. Diagnosis relies on genetic and quantitative hemoglobin analysis. This article presents an interesting case with images of chronic tophaceous gout in a patient with beta-thalassemia.

Rett syndrome (RTT) is a severe neurodevelopmental disorder primarily affecting females, characterized by developmental regression and significant communication impairments. Despite the critical role of communication in maintaining quality of life, the long-term efficacy and optimal utilization of augmentative and assistive communication (AAC) devices in RTT remain underexplored. This study evaluates the impact of AAC devices on communication outcomes and quality of life in individuals with RTT through a case report and narrative review. We conducted a comprehensive literature review and thematic analysis categorizing technologies into communication aids, mobility aids, educational tools, and daily living aids, assessing their effectiveness and challenges. The results show that AAC technologies, including eye-tracking devices, speech-generating devices, and adapted computers, enhance communication, cognitive development, and quality of life for individuals with RTT. The case report of Patient E, utilizing the Tobii Dynavox device, highlights the transformative impact of AAC devices despite challenges in device complexity and therapist training. AAC devices are indispensable for supporting individuals with RTT, though challenges persist related to accessibility, device complexity, and therapist training. Future research should focus on longitudinal studies to assess the sustained impact of AAC technologies and explore family-centered approaches to AAC integration.

This case report provides insights into the physiotherapy management of a 12-year-old male with Duchenne muscular dystrophy (DMD). DMD is a devastating genetic disorder characterized by progressive muscle degeneration and weakness.Skeletal muscle degeneration is inducedby a genetic disorder.It is a common X-linked condition that causes hypertrophy of the calves and proximal muscular weakness in children. It frequently results in early mortality, wheelchair confinement, and delays in motor development.Physiotherapy interventions aim to optimize functional abilities and quality of life in individuals with DMD. This case report highlights the effectiveness of physiotherapy in managing DMD progression.This study presents a case exhibiting notable clinical symptoms, highlighting the urgency for advanced treatments to combat this debilitating disease.Outcome measures such as body mass index, spirometry, manual muscle testing, and the World Health Organization Quality-of-Life scale are used to report patient progress. The treatment plan was carried out for six weeks, five times a week. Physiotherapy strategies include diet management, stretching and splinting techniques, and pulmonary training. While current treatments focus on symptom management, ongoing research holds promise for the development of more effective therapies to improve outcomes and quality of life for affected individuals. Multidisciplinary care, including neurophysiotherapy rehabilitation, plays a crucial role in managing the symptoms and complications of DMD, emphasizing the importance of comprehensive support for patients and their families. At the end of our rehabilitation, the patient showed significant improvement in the outcome measures.

Traumatic psychosocial environments directly impact adult life. Compromised self-esteem, emotional self-regulation, and interpersonal relationships are observed, and a predisposition to the presence of mental and personality disorders is exacerbated in cases of sexual abuse. Science has presented quantitative and statistical studies on child abuse and a limited number of studies that have investigated the consequences and long-term impacts on the lives of individuals who suffered maltreatment in childhood and did not have access to forms of protection or social support after the identification of child abuse, especially in Brazil. Therefore, this case report is a qualitative study of an ideographic nature which aims to evaluate the “particular” form of abuse repercussions in the life of a 60-year-old woman, giving voice to the victim of child abuse through the process of the investigation and complex analysis of her life history and family relationships. The psychological assessment protocol included a semi-structured interview, active listening, a genogram, and a mental status examination. The results reveal the coexistence of a rigid and violent environment with the presence of physical punishment and child sexual abuse. Self-injurious episodes and suicide attempts began in adolescence. Changes in mood, changes in remote memory, negative thoughts, self-injurious behavior, suicidal ideation and attempts, clinical comorbidities, a lack of interest in romantic relationships, and the repetition of behaviors that perpetuate the cycle of abuse and violence (physical, psychological, and patrimonial) were identified. The diagnostic criteria for bipolar disorder with dependent and borderline personality traits have been established. The case requires a multi-disciplinary follow-up with the use of medication to control and remit the symptoms.

BackgroundPrimary cardiac synovial sarcoma is a rare condition with limited treatment options for advanced stages. Surgery and chemotherapy are currently the mainstay treatments; however, survival rates remain low.Case presentationA 64-year-old woman presenting with symptoms of chest tightness and shortness of breath was found to have an obstructive right atrial mass, along with pulmonary infarction and metastasis. She was ultimately diagnosed with advanced primary cardiac synovial sarcoma. Following surgery, the patient’s symptoms improved, and she underwent chemotherapy and anti-angiogenic therapy, but unfortunately, her survival time was only 8 months. Conclusion This case report aims to enhance clinicians' understanding of the diagnosis and treatment of primary cardiac synovial sarcoma. Enhancing both survival outcomes and quality of life in individuals with primary cardiac synovial sarcoma continues to present a significant challenge.