Background: Superior vena cava syndrome (SVCS) is most commonly caused by malignant obstruction, particularly lung cancer. Early recognition and accurate staging are essential to guide therapeutic decisions. Case-presentation: We report the case of a 49-year-old woman who presented with respiratory symptoms and was found to have a large right hilar–apical mass. Contrast-enhanced CT demonstrated invasion of the superior vena cava, right atrium, pulmonary artery, bronchus, mediastinal and retroperitoneal lymph nodes, and bone metastases. Initial classification as T3N2M0 was revised to stage IVB (M1c) following oncologic review. The patient developed progressive facial edema and venous congestion, consistent with malignant SVCS. She received anticoagulation, palliative radiotherapy and systemic therapy. Endovascular stenting was not performed due to extensive vascular invasion and disseminated disease. Discussion: This case illustrates the aggressive course of squamous cell lung carcinoma and highlights the pivotal role of contrast-enhanced CT in defining extent, determining unresectability and guiding treatment. Although endovascular stenting provides rapid symptom relief, its feasibility may be limited in advanced mediastinal invasion. Conclusion: Early recognition of malignant SVCS and prompt imaging are essential to optimize multidisciplinary management. In metastatic disease, treatment goals focus on palliation and quality of life.

Background: Primary cardiac lymphoma (PCL) is an extremely rare malignancy, accounting for approximately 1–2% of primary cardiac tumors and about 0.5% of extranodal lymphomas. It primarily affects immunocompetent adults, with a median age of 55–65 years, and male predominance (65–85%). Case Presentation: A 44-year-old male with well-controlled HIV on Rilpivirine presented with a 2-week history of progressive shortness of breath, facial edema, and exertional peripheral cyanosis. His physical exam confirmed facial and upper extremities edema and jugular venous distension suggestive of superior vena cava syndrome. Contrast computed tomography (CT) of the chest identified a large 12 × 6.2 × 7.5 cm lytic rib lesion invading the pleura and chest wall, accompanied by left supraclavicular, axillary, mediastinal, and upper abdominal lymphadenopathy. CT also showed a large (8.3 × 5.8 × 6.0 cm) right atrial mass causing near-complete occlusion of the superior and inferior vena cava (Fig 1A). A transthoracic echocardiogram with contrast-enhanced imaging confirmed a large right atrial mass extending into the IVC (Fig 1B). Cardiac magnetic resonance imaging (MRI) further detailed an 8.3 × 6.5 × 6.4 cm mass nearly filling the right atrium, infiltrating the interatrial septum with mass effect on left atrium and encroaching on the right superior and inferior pulmonary veins (Fig 2A). Biopsy of the rib lesion confirmed high-grade B-cell lymphoma with 11q aberration. The patient was started on Rituximab combined with E-POCH chemotherapy on day 7 of admission. A follow-up PET-CT scan after the first cycle showed significant regression of the intracardiac mass (Fig 2B.) Discussion: PCL is an uncommon extranodal lymphoma, most often presenting as diffuse large B-cell lymphoma (DLBCL). High-grade B-cell lymphoma with 11q aberration (HGBCL-11q) is a distinct entity characterized by a unique 11q gain/loss cytogenetic pattern, typically lacking MYC rearrangement and frequently showing Burkitt-like morphology. Standard treatment for primary cardiac DLBCL involves immunochemotherapy, most commonly R-CHOP unless contraindicated. Curative regimens yield 5-year survival rates of 70–80% in selected cohorts; however, prognosis worsens with advanced or extracardiac disease.

Background:Burns are a sort of trauma that may cause life-threatening consequences, including edema, which delays recovery. So, the aim of the present study was to investigate the effect of chewing gum on reducing edema of burns in the head, face, and neck areas after second-degree burns.Materials and Methods:In 2024, a double-blind, randomized clinical trial was conducted on 64 second-degree burn patients, who were randomly allocated into two groups using permuted block randomization. The 32 participants in the intervention group received head elevation and chewed mint gum every 3 hours for 20 minutes until 3 days after hospitalization. However, the 32 participants in the control group only did head elevation. The Edema Size Detector was completed before and after the intervention. Statistical tests included paired t, independent t, Chi-square, and difference-in-difference regression, which were analyzed in SPSS V.16 at a significance level of less than 0.05.Results:The mean (SD) of burn percentages was 31.86 (2.71). Before the intervention, there were not any significant differences between the two groups for frontal, maxillary, and superior–inferior diameters (p > 0.05). However, after the intervention, these differences were significantly meaningful (p < 0.001). Additionally, assessing the group effect and time effect and adjusting the model showed that in the intervention group, frontal (T = −15.33, p < 0.001), maxillary (T = −12.88, p < 0.001), and superior–inferior diameters (T = −19.20, p < 0.001) have statistically significant variation.Conclusions:Chewing gum for 20 minutes three times a day can reduce burn edema in the head, face, and neck after second-degree burns.

Abstract Introduction Dermatomyositis rashes in Afro-Caribbean individuals can present differently in comparison to individuals with lighter skin tones. Dyschromia, changes in skin colour, can be the presenting feature of dermatomyositis rashes in Afro-Caribbean cohorts. We present a case of an Afro-Caribbean patient who presented with dyschromia. Case description A 45-year-old Afro-Caribbean woman presented with three year history of progressive skin hyperpigmentation affecting her face, forehead, neck and subsequently upper limbs, torso and lower limbs. She is an accountant who does not smoke, drink nor use illicit drugs. She described a preceding itching sensation followed by a burning sensation of her hyperpigmented skin. She denies photosensitivity. She was reviewed by dermatology in the private sector. The first skin biopsy in 2022 showed lichen planus pigmentosus (LPP). When the skin hyperpigmentation progressed, a second skin biopsy in 2024 demonstrated post-inflammation hyperpigmentation. She did not respond to topical calcineurin inhibitor. She has strongly positive ANA. ENA, dsDNA and complements, however, are normal. There are no features to suggest systemic sclerosis, especially Raynaud’s phenomenon. When she was first reviewed by rheumatology, she had dyschromia with hyperpigmentation in pathognomonic locations (images 1-3). She reported a six month history of progressive proximal weakness without bulbar or respiratory involvement. CK was elevated at 1610 U/L with MMT8 score of 133/150. She was found to have strongly positive Mi-2 antibodies. Electromyography was consistent with inflammatory myopathy with fibrillation potentials. MRI demonstrated oedema affecting adductor muscles, gluteal muscles and, to a milder degree, anterior thigh muscles. Muscle biopsy was consistent with inflammatory myositis in the pattern of dermatomyositis with upregulation of HLA Class 1. CT scan of chest, abdomen and pelvis did not show interstitial lung disease but revealed a breast lesion which upon further investigations was benign. She responded well to corticosteroid therapy and was promptly commenced on dual treatment of mycophenolate mofetil and hydroxychloroquine. Her skin is improving with less itching and less dyschromia. MMT8 score improved to 148/150. Discussion Classical dermatomyositis rashes are widely known violaceous heliotrope rashes, Gottron’s papules, V and shawl signs. In an Afro-Caribbean cohort, dermatomyositis rashes can be atypical, leading to delayed or missed diagnoses as described in this case. In African descendants, facial oedema is generally predominant and Gottron’s papules are often hypochromic. In others, the papules, V and shawl signs can appear darker with varying shades of pigmentation. Nailfold abnormalities can be subtle and easier to miss. Dyschromia is the prominent cutaneous features in a case series of 14 myositis patients of black individuals. Skin biopsies in dermatomyositis typically show a combination of vacuolar interface dermatitis, increased dermal mucin and perivascular inflammation. They may also show dyskeratosis and superficial dermal vascular dilatation. None of these were present in the skin biopsies for our patient but the absence clearly does not exclude dermatomyositis. LPP is a chronic disease characterised by hyperpigmented lichenoid lesions in intertriginous and sun-exposed skin of unknown aetiology. LPP and dermatomyositis are distinct diseases but cases of overlap syndrome have been documented, such as in our patient. Key learning points • Dermatomyositis rashes in an Afro-Caribbean cohort can manifest in an atypical pattern and potentially lead to delayed or missed diagnoses alongside increased morbidity and mortality. • The rashes may appear lighter in colour but, in other cases, they can appear darker with varying shades of pigmentation. • Dyschromia can be the prominent feature. • LPP and dermatomyositis are distinct diseases but cases of overlap syndrome have been documented. • Knowledge of clinical appearances of dermatomyositis rashes in darker skin is essential in reducing racial disparity in practice and facilitating early diagnosis and management.

Upadacitinib for treatment of Solid Facial edema

Disclosure: N. Chand: None. R. Yan: None. S. Cholekho: None.Introduction: Cyclic Cushing's syndrome (CCS) is a rare disorder characterized by episodic hypercortisolism alternating with normal cortisol levels, which poses significant diagnostic challenges. It mainly affects women and can lead to serious metabolic and cardiovascular issues. Understanding its cyclical nature is vital for effective management. Method: We present a case of a 47-year-old female with a history of mammary adenosis and lung adenocarcinoma who underwent extensive evaluation for suspected CCS. Results: The patient initially showed no clear signs of hypercortisolism, indicating a subtle onset of CCS. Over 12 months, she developed bilateral adrenal nodules, recurrent facial edema, and mild weight gain.Imaging revealed an irregular right adrenal gland (2.9 × 2.4 cm) and a well-defined left adrenal gland (0.8 cm). Her 24-hour urinary free cortisol (UFC) was 201.7 µg/24 hr, and a dexamethasone suppression test showed ACTH at 1.70 ng/mL and PTC at 28.60 mol/L. Cortisol and ACTH levels fluctuated during hospitalization. After diagnosis, the patient underwent laparoscopic right adrenal tumor resection, revealing a cortical adenoma. Post-surgery, she received a tapering glucocorticoid regimen for one month. Three months later, hormone levels normalized, facial swelling diminished, and her weight decreased from 62 kg to 60 kg, indicating treatment efficacy. However, ongoing monitoring is essential due to recurrence risk. Conclusion: CCS presents unique diagnostic challenges because of its variable manifestations and remission phases. Treatment must be individualized based on hormonal dynamics, with careful monitoring for relapse. The lack of standardized diagnostic criteria complicates CCS identification, highlighting the need for increased clinician awareness, especially in high-risk groups. Further research is crucial to develop effective diagnostic protocols for CCS. Keyword: Cyclic Cushing syndrome, ACTH, Dexamethasone suppression test (DST), Adrenal adenoma.Presentation: Saturday, July 12, 2025

Drug Reaction with Eosinophilia and Systemic Symptoms syndrome is a rare, severe cutaneous adverse reaction characterized by widespread rash, fever, hematologic abnormalities, and potential multi-organ involvement. It is most often associated with anticonvulsants, sulfonamides, and allopurinol, while anti-tubercular drugs are rarely implicated. We report the case of a 66-year-old female with a history of tuberculous pericardial effusion who developed recurrent diffuse erythematous, non-blanchable maculopapular rashes with facial edema and systemic symptoms following re-exposure to anti-tubercular therapy. Her symptoms were temporally related to ATT administration, strongly supporting a diagnosis of ATT-induced DRESS syndrome. The patient’s past medical history included hypothyroidism and cerebrovascular accident, but no significant drug allergies. Clinical evaluation revealed fever, facial swelling, generalized pruritic rash, and systemic complaints without significant abnormalities on chest or abdominal examination. Prompt discontinuation of ATT and supportive management led to clinical improvement. This case underscores the importance of early recognition of DRESS, even with uncommon culprits such as anti-tubercular drugs. Given the global prevalence of tuberculosis, ATT-induced DRESS poses unique therapeutic challenges, particularly in balancing drug hypersensitivity management with effective tuberculosis treatment. Clinician awareness and timely intervention remain key to improving outcomes in this potentially life-threatening condition.

This case report describes a 63-year-old male presenting with facial and leg edema following a tick bite, in the absence of systemic symptoms. Despite a negative Borrelia DNA PCR, the patient was diagnosed with chronic atrophic acrodermatitis (ACA) based on clinical, serological (positive IgG for Borrelia burgdorferi), and histopathological findings (lymphoplasmacytic infiltrate). The patient showed a favorable response to doxycycline, with full resolution of symptoms within one month. ACA typically evolves from an inflammatory phase to atrophy and fibrosis. This case highlights that facial edema may represent an early manifestation of ACA, facilitating earlier diagnosis and intervention. Furthermore, PET/CT imaging may offer valuable insights into early ACA detection.

Introduction: Drug reaction with eosinophilia and systemic symptoms syndrome or DReSS is a rare and life-threatening severe hypersensitivity reaction characterized by multiorgan involvement, with the liver as the common visceral manifestation. Approximately 10% of patients showed no changes in their eosinophil count. Sulfasalazine and non-steroidal anti-inflammatory drugs are frequently associated with DReSS. The diagnosis of this syndrome remains challenging due to the variety of clinical presentations. Case Illustration: We reported a 48-year-old woman who presented with pruritic generalized morbilliform eruption accompanied by facial edema and fever. Five weeks prior, she was treated with sulfasalazine and diclofenac sodium for spondyloarthritis. Her laboratory results showed elevated liver, suggesting drug-induced liver injury. DReSS syndrome was diagnosed by applying the European RegiSCAR. A favorable outcome and recovery of liver function are significantly seen after withdrawal of the suspected drugs, supportive treatment, and administration of systemic corticosteroid. Discussion: Sulfasalazine was one of the drugs frequently reported to cause DReSS syndrome. Liver involvement ranges from reversible elevation of liver function tests to hepatic necrosis. Withdrawal of causative drugs and administration of methylprednisolone were recommended, particularly for DReSS with liver involvement. Conclusions: DReSS syndrome can manifest with typical skin lesions and multiorgan involvement despite the absence of eosinophilia. The leading cause of mortality related to acute liver injury ranges from mild transaminase to acute liver failure. Prompt cessation of the culprit drug, immunosuppressive therapy, and a multidisciplinary approach might prevent further complications and mortality.

Hair loss affects the self-esteem and quality of life of men and women, and hair transplantation is a treatment option, but it is not free from complications. This study aimed to identify the expected events in the postoperative period of hair transplantation using the Follicular Unit Extraction technique, the complications, and the care required for outstanding results. To this end, a literature review was conducted, searching two sources of information in June 2025. The results were presented descriptively. The literature listed the following as expected postoperative events: pain, transient hypotension, scalp pruritus, facial edema, crusting, and hair loss. Complications included infection, hematoma, necrosis, keloids, cysts, effluvium, and others. Care involved: patient education; dressing after the procedure; use of analgesics and anti-inflammatories; saline spray in the first few days; hair washing; early postoperative visits; postural measures; use of cold or warm compresses depending on the clinical condition; application of solutions that stimulate healing; early use of minoxidil and finasteride; topic antibiotics or systemic, when necessary. Preoperative evaluation, postoperative follow-up, and patient education are essential for the success of the transplant.

Abstract Bluetongue (BT) is a vector-borne, non-contagious, and infectious viral disease affecting domestic and wild ruminants, caused by the Bluetongue virus (BTV), a member of the genus Orbivirus in the family Sedoreoviridae. The disease primarily affects sheep, goats, and cattle, with sheep being the most susceptible species. BTV is transmitted by Culicoides biting midges and can cause severe clinical manifestations, including fever, facial and limb edema, oral lesions, lameness, and tongue cyanosis. The disease is associated with significant economic losses due to mortality, reduced production, trade restrictions, and costs related to control and prevention. Morbidity and mortality rates vary widely depending on the species, breed susceptibility, and environmental conditions. Effective control strategies include vector management, movement restrictions, and vaccination programs. While BT has been widely reported in many parts of the world, its presence in Bangladesh has not been fully understood until recent years. New studies have confirmed the circulation of BTV antibodies in small ruminants and, more recently, the molecular detection of the virus itself. This comprehensive review presents an in-depth synthesis of the epidemiology, clinical presentation, diagnostic methods, and control strategies for BT, with special emphasis on Bangladesh and the South Asian context. This review also highlights recent research findings, available diagnostic approaches, and vaccine options, while identifying critical knowledge gaps that need to be addressed to improve disease surveillance and control in the region.

An outbreak of Urochloa decumbens intoxication in goats from Northeast Brazil.

Prone position ventilation (PPV) has been widely used in the treatment strategy of patients with acute respiratory distress syndrome (ARDS). Patients undergoing PPV may develop facial edema and are at risk for pressure injuries due to prolonged prone positioning. In clinical practice, preventive measures such as repositioning, protective dressings, and pressure-relief cushions are commonly used to prevent pressure injuries. However, factors such as improper endotracheal tube placement, self-paid dressings, and delayed clearance of oral and nasal secretions have reduced the effectiveness of preventing facial pressure injuries. To address the above issues, a device for preventing pressure injuries on the faces of patients in the prone position was designed by healthcare workers in the nursing department of Dalian Friendship Hospital, and a National Utility Model Patent of China was obtained (ZL 2024 2 0340439.8). The device consists of a support plate and a circuit control system. The support plate is equipped with two support members. Support member 1 is directly fixed to the support plate, while support member 2 is connected to the support plate via a slide and a spiral rod, serving to support the patient's face and allowing for adjustment of the appropriate width according to the size of the patient's face. Inside the two support members, there are several telescopic rods, with the upper ends designed as spherical supports. The height and position of the telescopic components can be adjusted through a circuit control system, regularly changing the pressure distribution on the patient's face, thereby achieving the purpose of changing the pressure points on the face. The inner wall of support member 2 is equipped with a camera, allowing direct observation of the patient's facial condition through a monitor, avoiding compression of the eyes and nose, and promptly removing secretions from the mouth to keep the face clean, thereby reducing the risk of facial pressure-related injuries. The center of the two support members features a hollow slot, facilitating the placement of a tracheal tube. The circuit control system includes a random module, a time setting module, a control module, and a drive module. Parameters can be set as needed. When the shortest set time is reached, the random module and time setting module send instructions to the control module. Upon receiving the instructions from the time setting module and the random number from the random module, the control module transmits information to the drive module. The drive module, upon receiving the information, controls multiple telescopic rods to adjust their height and position, thereby changing the support points on the patient's face. The device features a simple structure and convenient operation, allowing for flexible adaptation to the patient's facial shape. It can be replaced with the patient's facial pressure area, providing an intuitive view of the patient's facial pressure situation. With automation and high safety, it helps reduce the risk of pressure-related injuries and lightens the workload of medical staff.

Nifuroxazide is a nitrofuran derivative with proven efficacy in the treatment of both acute and chronic bacterial diarrhea. The aim of this study is to assess the safety profile of nifuroxazide and to evaluate the occurrence of adverse drug reactions (ADRs). A retrospective descriptive analysis of ADR reports related to nifuroxazide use was conducted. Data sources included databases: the European EudraVigilance (2001–May 2025) and the global VigiAccess (1980–May 2025). The analysis focused on patient demographics, symptomatology, and the frequency of adverse events. The VigiAccess database documented 846 cases of ADRs up to 2025, approximately 60% of which were reported in the last decade. The highest incidence of ADRs was observed in individuals aged 18 to 64 years with predominant reactions concerning skin and subcutaneous tissue (rash, pruritus, urticaria, angioedema). Most frequent systemic symptoms were facial edema, shivers, and malaise. The EudraVigilance database (2001–2025) reported 439 cases of ADRs, predominantly in individuals aged 18 to 64 years. The most frequently observed adverse effects included dermatological reactions, facial edema, malaise and gastrointestinal disturbances. The analysis of ADR reports from VigiAccess and EudraVigilance supports a favorable safety profile of nifuroxazide, reinforcing its efficacy in bacterial infections of the gastrointestinal tract. Nifuroxazide is recommended as a first-line treatment for mild cases of infectious diarrhea, serving as an alternative to systemic antibiotics reserved for more severe infections. Enhancing awareness among healthcare professionals and patients regarding ADR monitoring is crucial for optimizing pharmacovigilance and ensuring the safe use of nifuroxazide in clinical practice.

Hereditary angioedema (HAE) is a rare disease characterized by episodes of cutaneous and submucosal inflammation. Its global prevalence ranges from 1:50,000 to 1:100,000 individuals and is often underdiagnosed. It is classified into three main types based on C1 inhibitor (C1-INH) levels and functionality. Type 1 is the most common (85% of cases). It is characterized by low plasma concentrations of functional C1-INH as a result of mutations in the SERPING1 gene. We present the case of a 20-year-old male resident of Guadalajara with HAE type 1 diagnosed at age 12 and a history of drug use. He was admitted with edema in the left posterior thoracic region, which progressed to the neck, causing respiratory distress. During ambulance transport, the patient suffered cardiorespiratory arrest, requiring cardiopulmonary resuscitation. He was administered a bradykinin type 2 receptor antagonist and systemic steroid without success, and was admitted to the emergency department under advanced airway management. Laboratory tests and a CT scan revealed no significant findings. Given the persistence of facial edema, a human C1 esterase inhibitor was administered, and the patient was admitted to the intensive care unit for monitoring. Based on laboratory and CT results, substance abuse was suspected as a triggering factor. The literature reports that individuals with cocaine dependence present a persistent proinflammatory state characterized by reduced baseline levels of the anti-inflammatory interleukin IL-10 and a significant increase in the proinflammatory cytokine TNF-α after exposure to stressful stimuli or use. Although the evidence in the medical literature is limited, the use of psychoactive substances could act as a triggering factor for seizures in patients with hereditary angioedema type 1. This case underscores the importance of identifying potential less-studied aggravating factors and suggests the need for a targeted history of psychoactive substance use in patients with HAE. This could be explained by their effects on vasodilation, the release of inflammatory mediators, and increased vascular permeability, mechanisms that promote bradykinin accumulation. Given the potential risk, it is essential to consider drug use in the comprehensive evaluation of precipitating factors in these patients.

Rationale:Microscopic polyangiitis (MPA), a subtype of antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis, is typically characterized by renal impairment but can present in atypical forms. This case underscores an unusual manifestation of MPA, involving solely cardiopulmonary pathology, thereby highlighting the necessity for increased clinical vigilance even in the absence of renal involvement.Patient concerns:An 87-year-old female patient with atrial fibrillation, hypertension, and type 2 diabetes presented with progressive chest tightness, bilateral limb and facial edema, and fatigue over 3 months. Initial evaluations suggested pneumonia accompanied by heart failure. However, standard treatment provided only temporary symptomatic relief.Diagnosis:Laboratory tests indicated that the level of myeloperoxidase ANCA reached 122 RU/mL. High-resolution computed tomography of the chest revealed characteristic findings of interstitial pneumonia, including thickening of lung lobular septa, bilateral ground-glass opacities, and pleural effusion, while other indicators did not suggest renal impairment. As a result, based on the 2022 American College of Rheumatology/European League Against Rheumatism standards, the final diagnosis was MPA.Interventions:The patient was given 80 mg of intravenous methylprednisolone daily for 3 days, then the dose was reduced to 60 mg daily for another 3 days. Afterwards, the patient was switched to oral prednisone 40 mg daily combined with 0.5 g of mycophenolate mofetil twice daily, and responded well to the treatment.Outcomes:On the 6th day of hospitalization, the patient was discharged without complications. Follow-up blood tests that conducted 3 weeks post-discharge indicated normal liver and kidney function. A chest computed tomography scan revealed substantial resolution of bilateral pleural effusion. The majority of ground-glass opacities had resolved, with only a few persisting, primarily in the peripheries of the lobes.Lessons:This case suggests that MPA may present with isolated cardiopulmonary involvement as the initial manifestation without typical renal damage. Clinicians should consider MPA in patients with refractory interstitial pneumonia, pleural effusion, and myeloperoxidase ANCA positivity. Early immunosuppressive therapy may reverse organ damage and improve outcomes.

ObjectivesPatients with cyanotic congenital heart disease (CCHD) may continue to experience hypoxia and worsening cyanosis after undergoing a bidirectional Glenn procedure (BGP). Azygos or hemiazygos vein steal syndrome is a common cause of these complications. This study aimed to evaluate the safety and efficacy of transcatheter closure for azygos or hemiazygos vein steal syndrome following BGP in patients with CCHD.MethodsA retrospective analysis was conducted on clinical data from 13 patients with CCHD who underwent transcatheter closure for azygos or hemiazygos vein steal syndrome after BGP at Fuwai Hospital between December 2007 and September 2019.ResultsAll azygos or hemiazygos veins were successfully closed. Femoral artery oxygen saturation (SFAO2%) significantly increased after closure compared to before closure (86.94 ± 2.63% vs 74.98 ± 3.53%, P < 0.001). The mean pulmonary arterial pressure (mPAP) also showed a statistically significant increase after closure but remained within normal ranges (12.08 ± 2.75 mmHg vs 10.54 ± 3.28 mmHg, P = 0.020). The superior vena cava pressure (SVCP) showed almost no change before and after closure (11.08 ± 3.62 mmHg vs 12.31 ± 3.25 mmHg, P = 0.059). During an average follow-up period of 25.69 ± 9.60 months, all patients showed significant improvement in cyanosis, and none experienced facial or neck edema. The saturation of pulse oximetry (SpO2) was above 90% in all patients.ConclusionsTranscatheter closure of azygos or hemiazygos vein steal syndrome in CCHD patients after BGP is a safe and effective intervention. It offers high technical success and favorable short- to mid-term outcomes, while avoiding the physical and psychological trauma associated with repeat thoracotomy.

Primary polydipsia refers to excessive water intake due to psychogenic or non-psychogenic causes without being secondary to conditions such as hyperglycemia or renal dysfunction. Most cases of primary polydipsia are psychogenic in nature, with few cases of non-psychogenic primary polydipsia reported in the literature. In this case, the patient's excessive water intake appeared to be influenced by both psychogenic and non-psychogenic factors. A 43-year-old male patient with a history of psychiatric illness was diagnosed with ureteral stones and was engaged in excessive water intake in an attempt to facilitate stone passage. Subsequently, he developed facial and bilateral lower extremity edema. On physical examination, the patient appeared anxious, exhibited a depressed mood, and demonstrated poor speech, but remained fully conscious. Physical examination revealed facial and bilateral lower extremity edema with tenderness and percussion pain in the left renal region. Neurological examination and other systemic evaluation revealed no significant abnormalities. Laboratory tests revealed hyponatremia, hypokalemia, and markedly elevated creatine kinase levels. The diagnosis of hypervolemic hypotonic hyponatremia complicated by rhabdomyolysis was established based on the patient's clinical manifestations and laboratory findings. Furosemide was initiated on day 2 for diuresis and transitioned to continuous micropump infusion for precise dosing. Persistent edema prompted albumin administration (day 4) to address hypoalbuminemia and low-dose dopamine for administration renal perfusion. The psychiatric symptoms were managed with quetiapine and sertraline. Urine culture on day 6 confirmed urinary tract infection, prompting cefoperazone therapy. By day 10, the edema had resolved, and ureteroscopic lithotripsy was performed. Following therapeutic interventions, the patient demonstrated marked improvement in hyponatremia and rhabdomyolysis, culminating in discharge on the twelfth hospital day. Physicians should maintain a high index of suspicion for excessive water intake in patients with urolithiasis who exhibit anxiety, fear, or a history of psychiatric disorders because such behavior can lead to life-threatening electrolyte imbalances and associated complications. Such behaviors may be mitigated or prevented by appropriate medical advice and psychological interventions.

Which is the fastest and safest approach? A comparison of time and complications of transparotid and anteroparotid retromandibular approach in management of mandibular subcondylar fractures: A prospective randomized controlled trial.

A Rare Case of Recurrent Abdominal Pain With Facial Edema.