Case Series Research Articles

How to plan and provide general anesthesia for a troop of 98 hamadryas baboons (Papio hamadryas) for contraceptive and preventative health interventions.

Present an approach to the safe and efficient provision of anesthesia and birth control measures to a large group of primates. 98 hamadryas baboons (Papio hamadryas) held in a German zoological institution. A group of 12 veterinarians, 2 zookeepers, and 6 volunteers anesthetized all animals within 2 days. The baboons were orally premedicated with midazolam (0.1 to 0.5 mg/kg) and anesthetized with medetomidine (40 to 60 µg/kg, IM) and ketamine (2 to 4 mg/kg, IM); isoflurane at rates of 1.5% to 2% was used for maintaining anesthesia if necessary. All animals received a physical examination, prophylactic medication, and tuberculin testing. For population management, the animals received a contraceptive implant (adult females), orchiectomy (young males), or vasectomy (breeding males). Young males received intratesticular blocks with lidocaine. All animals received atipamezole (125 to 150 µg/kg) before recovery. Premedication resulted in anxiolysis, which facilitated separating and darting. Median time from darting to access to the animal was 10 minutes. Mean anesthetic times were 25 minutes for females and 55 minutes for males. The depth of anesthesia was appropriate for the procedures. No fatalities were recorded. One animal was injured by other baboons but recovered after treatment. Health management and birth control measures are necessary in baboon troops under human care. Anesthesia and/or contraception of individual animals often leads to intraspecific aggression. This case series describes how to provide anesthesia and contraception to an entire troop as an alternative approach that can be adopted to future similar interventions.

The results of femoral lengthening using domestic unilateral external fixation and then plating: The first case series in Vietnam

The results of femoral lengthening using domestic unilateral external fixation and then plating: The first case series in Vietnam

A systematic review on prosthodontic rehabilitation of hemimandibulectomy patients

To restore oral function after tumor excision, practitioners must undertake the enormous challenge of restoring hemimandibulectomy deficits. Depending on the type and extent of mandibular reconstruction (Cantor-Curtis classification), there are many prosthetic treatment options available for the rehabilitation of acquired hemimandibulectomy abnormalities. The objective of this systematic study is to evaluate the range of prosthodontic rehabilitation techniques in relation to the kind of repair and severity of mandibular surgical abnormalities. The databases incorporated for literature search were Google Scholar and Medline (PubMed). Relevant search terms for hemimandibulectomy and reconstruction with prosthetic rehabilitation were used. Two reviewers independently assessed the articles using eligibility criteria; published case reports and case series in the English language and depicting prosthodontic treatment modality of patients greater than 13 years were included. A total of 212 records were identified from the database search of which 29 duplicates were removed.The remaining articles were assessed for eligibility, and 50 articles (comprising 50 cases) were finally included in the study. This review identified a number of prosthetic options, including some novel prosthetic techniques, guiding flange, twin occlusion, palatal ramp, conventional to hybrid partial and complete dentures, and implant-supported prosthesis.The prosthetic options covered in this review included implant-supported prosthesis, guide flange, dual occlusion, palatal ramp, conventional, hybrid, and full dentures, as well as a few cutting-edge prosthetic techniques.As they plan and manage sequential therapy for hemimandibulectomy cases in their daily practice, practitioners and prosthodontists will find this helpful.

Ablative fractional laser treatment for the clinical improvement of acne vulgaris: A case series.

Ablative fractional laser treatment for the clinical improvement of acne vulgaris: A case series.

Clinical features, treatment, and outcome of pembrolizumab induced cholangitis.

Pembrolizumab induced hepatitis has received increasing attention, while pembrolizumab induced cholangitis is poorly understood. This study investigated the clinical features, treatment, and outcome of pembrolizumab induced cholangitis. Case reports, case series and clinical studies of pembrolizumab induced cholangitis were collected by retrieving English and Chinese database from inception until October 30, 2023. Fifty patients with cholecystitis entered our study with a median age of 68years (range 48, 89). The median time to onset of cholecystitis was 1.1months (range 0.3, 24), and the median number of cycles was 5 cycles (range 1, 27) after initial administration. Most of the patients had no clinical symptoms and only showed elevated biliary enzymes (24 cases, 48.0%), while some patients showed jaundice (12 cases, 24.0%), abdominal pain (10 cases, 20.0%) and fever (7 cases, 14.0%). The median alkaline phosphatase value was 1111IU(range 130, 3515) and the median glutamyltransferase value was 649.5IU(range 159, 3475). The imaging features of gallbladder were bile duct dilatation, stenosis and bile duct wall thickening and irregularity. Bile duct biopsy showed inflammatory infiltration, mainly CD8 + T cell infiltration. Immunosuppression treatment resulted in complete response in 4 cases (8.0%), partial response in 28 cases (56.0%), and poor response in 15 cases (30.0%). Cholangitis is a rare and serious adverse effect of pembrolizumab. Clinicians should be aware of the possibility of cholangitis when administering pembrolizumab. Steroids may not be effective in most patients with cholecystitis, and ursodeoxycholic acid may be an option.

Feasibility and complications after transoral endoscopic thyroidectomy via vestibular approach (TOETVA) - a single-center first experience case series.

This paper reports on the first experience after implementation of a transoral endoscopic thyroidectomy via vestibular approach (TOETVA) as an alternative to (partial) thyroidectomy or isthmusectomy in a single center. Feasibility, implementation and specific complications are addressed. All patients who underwent a TOETVA procedure in our center between November 2019 and March 2023 were included. The surgical technique was performed as described by Anuwong et al. All procedures were performed by two dedicated head- and neck surgeons. A total of 20 patients were included. All patients underwent TOETVA surgery as planned and no conversions were needed. Observed complications were post-operative wound infections (POWI) (2/20; 10%), clinically significant seroma (1/20, 5%) and unilateral hemiparesis of the larynx (3/20; 15%). Permanent mental nerve damage was seen in 3/20 patients (15%), and 4 other patients (20%) experienced transient neuropraxia. TOETVA is a feasible alternative to (partial) thyroidectomy or isthmusectomy in selected patients. Special care should be taken when placing the trocars in the oral vestibulum to prevent mental nerve damage. Experience and training are essential for implementing the TOETVA procedure. This study was registered to ClinicalTrials.gov. NCT05396703.

Clinical Course, Antifungal Susceptibility, and Genomic Sequencing of Trichophyton indotineae.

Trichophyton indotineae is an emerging dermatophyte causing outbreaks of extensive tinea infections often unresponsive to terbinafine. This species has been detected worldwide and in multiple US states, yet detailed US data on infections with T indotineae are sparse and could improve treatment practices and medical understanding of transmission. To correlate clinical features of T indotineae infections with in vitro antifungal susceptibility testing results, squalene epoxidase gene sequence variations, and isolate relatedness using whole-genome sequencing. This retrospective cohort study of patients with T indotineae infections in New York City spanned May 2022 to May 2023. Patients with confirmed T indotineae infections were recruited from 6 New York City medical centers. Improvement or resolution at the last follow-up assessment. Among 11 patients with T indotineae (6 male and 5 female patients; median [range] age, 39 [10-65] years), 2 were pregnant; 1 had lymphoma; and the remainder were immunocompetent. Nine patients reported previous travel to Bangladesh. All had widespread lesions with variable scale and inflammation, topical antifungal monotherapy failure, and diagnostic delays (range, 3-42 months). Terbinafine treatment failed in 7 patients at standard doses (250 mg daily) for prolonged duration; these patients also had isolates with amino acid substitutions at positions 393 (L393S) or 397 (F397L) in squalene epoxidase that correlated with elevated terbinafine minimum inhibitory concentrations of 0.5 μg/mL or higher. Patients who were treated with fluconazole and griseofulvin improved in 2 of 4 and 2 of 5 instances, respectively, without correlation between outcomes and antifungal minimum inhibitory concentrations. Furthermore, 5 of 7 patients treated with itraconazole cleared or had improvement at the last follow-up, and 2 of 7 were lost to follow-up or stopped treatment. Based on whole-genome sequencing analysis, US isolates formed a cluster distinct from Indian isolates. The results of this case series suggest that disease severity, diagnostic delays, and lack of response to typically used doses and durations of antifungals for tinea were common in this primarily immunocompetent patient cohort with T indotineae, consistent with published data. Itraconazole was generally effective, and the acquisition of infection was likely in Bangladesh.

An ophthalmologic overview of pituitary adenoma

Pituitary adenomas are the most common tumours of the sellar region. They generally have a slow but severe impact on vision due to compression of the optic nerves, optic chiasm and cavernous sinus. They can have varied presentation depending on the size, location and extension of the mass and its relation to the surrounding structures. This 8 case series reviews the clinical presentation, varied visual field defects, histopathological and neuroimaging findings and the management of the pituitary adenomas.

Prenatal Diagnosis of Fryns Syndrome through Identification of Two Novel Splice Variants in the PIGN Gene—A Case Series

Prenatal Diagnosis of Fryns Syndrome through Identification of Two Novel Splice Variants in the PIGN Gene—A Case Series

Disseminated Carcinomatosis of Bone Marrow with or without an Unknown Primary Site: A Case Series

Disseminated Carcinomatosis of Bone Marrow with or without an Unknown Primary Site: A Case Series

Complete remission of depression and anxiety using a ketogenic diet: case series

Complete remission of depression and anxiety using a ketogenic diet: case series

Early Successful Experiences of Surgical Conversion of Endoscopic Gastric Plication to Roux-en-Y Gastric Bypass.

The primary obesity surgery endoluminal (POSE) procedure is an innovative incision-less endoscopic bariatric procedure that is increasingly used. However, variable weight loss response and recurrence post-endoscopic bariatric procedures have at times necessitated laparoscopic bariatric conversion. The safety and approach of conversion to laparoscopic sleeve gastrectomy (LSG) or Roux-en-Y gastric bypass (RYGB), however, have been an active point of discussion within revisional bariatric surgery. This retrospective review of four consecutive patients is the largest description of medium-term postoperative outcomes and technical highlights of a laparoscopic conversion of POSE to RYGB. Chart review was completed to evaluate patients' post-POSE clinical course and perioperative outcomes after surgical conversion. Early data suggests varied weight loss trajectory with POSE and marked improvement in weight response after surgical conversion. Qualitative review reveals successful single-staged conversions contrary to previous smaller case series describing staged conversions involving endoscopic removal of plications followed by RYGB. Review additionally reveals key perioperative considerations for successful conversions to include intraoperative endoscopy, upper gastrointestinal fluoroscopic studies, and at times computed tomography. The latter study and laparoscopic view of the post-POSE stomach challenge the prior notion that distal POSE allows for easy revision to LSG. Our case series underscores the complex multifactorial nature of metabolic disease and the increasing importance of a conscientious approach to conversion bariatric surgery as the adoption of POSE and the bariatric patient population continues to grow.

Long-term functional success and robust implant survival in lateral unicompartmental knee arthroplasty: A case series with a mean follow-up of twenty two and a halfyears.

Lateral unicompartmental knee arthroplasty (UKA) is an accepted treatment option in cases of end-stage lateral osteoarthritis. While lateral UKA has many proposed advantages compared to total knee arthroplasty, its technical challenges and relatively small number of cases make this an uncommon procedure. The aim of this study was to report the survivorship and functional outcomes beyond 20years of follow-up of isolated UKA. Between January 1988 and October 2003, 54 lateral UKAs were performed in a single center. The fitted prosthesis was a fixed plate and cemented polyethylene (PE). All patients had isolated lateral tibiofemoral osteoarthritis, including five open meniscectomies, three arthroscopies, and three open reductions of lateral tibial plateau fractures. Patients with a minimum of 20years of follow-up were included in the final analysis. Of the 54 UKA, 22 died before reaching the minimum follow-up period and four were lost to follow-up. Twenty-eight were included in the final analysis. Among them, 21 patients remained alive and an additional seven were deceased after 20years. The mean age at the last follow-up was 84.8 ± 11.9years with a mean follow-up duration of 22.5 ± 2.1years. Of the 28 knees, eight underwent revision surgery (5 for the progression of osteoarthritis; 2 for aseptic loosening; 1 for PE wear). Kaplan-Meier survival analysis revealed a survival rate at 20 and 25years of 72.3% (CI 59.1; 88.6). The average time to revision was 14.9 ± 4.9years. At the last follow-up, the mean function Knee Society Score (KSS) was 41.5 ± 32.9 and the mean objective KSS score was 79.4 ± 9.7. In the unrevised population, 94.7% of patients (n = 18) reported being satisfied or very satisfied with the surgery. Lateral UKA remains a viable treatment option for patients with isolated lateral tibiofemoral osteoarthritis, providing satisfactory 20-year implant survivorship and high patient satisfaction.

Iatrogenic open humeral shaft fractures following functional bracing.

The treatment of closed humeral shaft fractures tends to be successful with functional bracing. Treatment failure due to iatrogenic conversion to an open fracture has not been described in the literature. We present a case series of patients that experienced open humeral shaft fractures after initially being treated with functional bracing for closed humeral shaft fractures and describe what factors are associated with this complication. This was a retrospective case series performed at three level 1 trauma centers across North America. All nonoperatively treated humeral shaft fractures were reviewed from 2001 to 2023. Patients were included if they sustained a humeral shaft fracture, > 18 years old, were initially treated non-operatively with functional bracing which subsequently converted to an open fracture. Eight patients met inclusion criteria. All included patients were eventually treated with irrigation, debridement, and open reduction and internal fixation. Outcomes assessed included mortality rate, time until the fracture converted from closed to open, need for further surgery, and bony union. Descriptive statistics were used in analysis. The eight included patients on average were 65 ± 21.4 years old and had a body mass index (BMI) of 25.6 ± 5.2. Six patients were initially injured due to a fall. Time until the fractures became open on average was 5.2 ± 3.6 weeks. Three patients (37.5%) died within 1.8 ± 0.6 years after initial injury. The average Charlson Comorbidity Index (CCI) score was 4.5 ± 3.4. Three patients (37.5%) had dementia. Common characteristics among this cohort included a history of visual disturbances (50.0%), cerebrovascular accident (50.0%), smoking (50.0%), and alcohol abuse (50.0%). Conversion from a closed to open humeral shaft fracture after functional bracing is a potentially devastating complication. Physicians should be especially cognizant of patients with a low BMI, history of falling or visual disturbance, dementia, age ≥ 65, decreased sensorimotor protection, and significant smoking or alcohol history when choosing to use functional bracing as the final treatment modality. IV.

Heated humidified high-flow nasal cannula: a new conservative approach for neonatal nasal stenosis.

The aim of this study is to evaluate the efficacy of heated humidified high flow nasal cannula (HFNC) therapy as a conservative treatment option for newborns suffering from nasal stenosis, a condition that often leads to respiratory distress and feeding difficulties. Given the increasing utilization of HFNC in various upper and lower respiratory tract indications, characterized by its flow-based mechanism and minimal mucosal damage, we seek to investigate its potential benefits in this specific patient population. A retrospective chart review of newborns with congenital nasal stenosis treated with HFNC for respiratory distress or feeding difficulties in a pediatric tertiary center between 2014 and 2022. Data were collected for demographic characteristics, clinical presentation and ventilatory requirements, pre and post HFNC application. Six infants with nasal stenosis were included in the study cohort. Five were diagnosed with congenital pyriform aperture stenosis, three of whom had additional midnasal stenosis. One patient had nasal synechiae. Two patients had failed surgical treatment and all patients failed conservative treatment prior to HFNC treatment. Following HFNC use, improvement was noted in oxygen saturations, heart and respiratory rates, meal volumes and weight. None of the patients required any additional sinonasal surgical treatment. No complications were observed. In this case series, we present the first documented use of HFNC treatment for nasal stenosis, showing favorable results. Further studies with a larger cohort, wider range of conditions and extended follow-up periods are needed to establish the risks and benefits of HFNC for neonatal nasal stenosis.

Hyperkinetic and Hypokinetic Movement Disorders in SSPE: A Systematic Review of Case Reports and Case Series

Hyperkinetic and Hypokinetic Movement Disorders in SSPE: A Systematic Review of Case Reports and Case Series

Self-reported social well-being of children with hearing loss in 2023.

To study the level of social well-being for children with HL using self-completed questionnaires. The data sample relates to a total of 22 children representing a new group of children with hearing loss (HL). This new group is defined as HL detected through neonatal hearing screening and fitted with hearing technology when relevant before 6 months, received bilateral cochlear implants before one year of age followed by specific educational training using the auditory-verbal practice. The age range was from 9 to 12 years. Two self-completed questionnaires were used: The California Bullying Victimisation Scale (CBVS) and the Strengths and Difficulties Questionnaire (SDQ). The project design was a prospective case series. Self-completed assessments revealed levels of social well-being for both questionnaires comparable to populations with normal hearing. CBVS results showed that a total of 52.6% reported being 'not a victim', 36.8% peer victims and 10.5% bully victims. Results from SDQ revealed that 94.7% of the children reported being within the normal level for scores on both social strength and difficulties, 5.3% scored slightly raised/lowered and 0% had high/low scores or very high/low scores. The new group of children with HL presented with self-completed scores comparable to peers with normal hearing. It is time to raise expectations for children with HL in terms of not only outcomes on audition and spoken language but also most importantly on levels of social well-being. Furthermore, it is discussed whether this new group can also be defined as a new generation of children with HL.

Anti-aging Effects of Tirbanibulin 1% Ointment: A Real-Life Experience.

Tirbanibulin 1% ointment has been licensed to treat non-hyperkeratotic actinic keratosis (AKs) on the face and scalp in adults to ensure excellent patient tolerability due to the mild side effects and the brief application time compared to other topical therapies on the market. A growing body of evidence suggests that, beyond their primary function, the treatments for AKs and the cancerization field may inadvertently confer substantial cosmetic benefits to patients. We report a single-center retrospective case series of patients referred to the Dermatology Unit of the University Hospital of Messina, Italy, between February and December 2023 seeking treatment for AKs in the context of photodamaged areas in which the application of tirbanibulin 1% ointment induced, besides clearance of AKs, anti-aging effects on both skin texture and solar lentigos. Seven patients affected by Olsen grade1-2 AKs experienced a powerful rejuvenating effect in the treated areas, with a marked efficacy in skin lightening and clearance of solar lentigo. Tirbanibulin 1% ointment seems able to improve skin aging as a desirable side effect at the site of application for AKs on chronic photodamaged skin. Such preliminary observation needs further confirmation in real-life studies on larger cohorts of patients, to explain the pathogenic mechanisms responsible for such aesthetically relevant results.

Therapeutic value of patent foramen ovale closure for drug-resistant epilepsy: A case series report.

Closure surgery of patent foramen ovale (PFO) has been found to effectively control cryptogenic stroke and migraine, but it is uncertain whether PFO closure could also alleviate epileptic seizures. This study aims to observe the therapeutic effect of PFO closure on epileptic seizures. Since July 11th, 2017, in the neurology department of West China Hospital, Sichuan University, Chengdu, we have been regularly monitoring patients with epilepsy who have undergone PFO closure. The patient's clinical information, such as frequency, duration, and severity of seizures, before and after surgery was recorded in detail as well as postoperative safety events. Of the 31 epilepsy patients who confirmed PFO observed (27 cases were drug-resistant epilepsy, 87.10%), average age of surgery was 23.74 years, and 12 cases were female (38.71%). After one-year follow-up, 26 patients (83.87%) achieved remission of seizure frequency, and 22 of whom (70.97%) experienced a remission of more than 50%. Additionally, compared to before surgery, 22 cases (70.97%) reported a decrease in the average seizure duration, and 20 cases (64.52%) reported a reduction in seizure severity. In the seizure indicators of frequency, average duration and severity, significant differences were identified between preoperative and postoperative comparisons with all test p values were <0.05. Furthermore, no serious safety events were reported except for one patient who briefly reported chest pain, and all patients expressed effective PFO closure. The PFO closure has been shown for the first time to result in a significant reduction in the frequency, duration, and severity of seizures. Patients with drug-resistant epilepsy and PFO with a large shunt are ideal candidates for undergoing PFO closure. Since PFO closure was found to have a good therapeutic effect on cryptogenic stroke and migraine, it has become a credible complementary therapy for the treatment of neurological diseases, and drug-resistant epilepsy with PFO is expected to become the next target disease that PFO closure could significantly improve.

The Wisconsin silicone oil study (report #1): anatomical and functional outcomes of repair of retinal detachment with proliferative vitreoretinopathy.

Silicone oil (SO) is a long-term tamponade for repair of complex retinal pathology but has limitations including late redetachment. This study describes our experience with SO tamponade for repair of retinal detachment with proliferative vitreoretinopathy (PVR), with attention to anatomic and functional outcomes. Retrospective consecutive case series of eyes with retinal detachment (RD) complicated by proliferative vitreoretinopathy (PVR) receiving SO tamponade at the University of Wisconsin between 2013 and 2019. Group 1 defined as primary SO placement; Group 2 had SO placed after failing prior retinal detachment repair. Inclusion criteria of SO placement for repair of RD with PVR was met for 117 eyes. The final reattachment rate was 84% for all eyes, with no difference between Groups 1 and 2. Vision improvement was 2.1 lines for Group 1 (p = 0.06 from baseline) and 4.6 lines for Group 2 (p < 0.0001). The mean number of silicone oil placements was 1.4. Less improvement in vision was noted with repeat SO placement, though overall functional vision of 5/200 or better was achieved in 63.2% of patients. SO tamponade allows long-term anatomical stabilisation and substantial vision recovery in eyes with retinal detachment complicated by PVR. Rates of anatomic and functional success have improved significantly when compared to prior studies using oil tamponade for repair of PVR.