Healthy Young Man Research Articles

Two episodes of delayed emergence in a healthy young man.

Two episodes of delayed emergence in a healthy young man.

The Silent Threat of Hypokalemia after High Voltage Electrical Injuries: A Case Study and Review of the Literature.

High-voltage electrical injuries, especially from lightning strikes, can cause life-threatening complications due to extreme temperature and voltage exposure. While burns and cardiac complications have been widely described, the documentation of metabolic imbalances, particularly hypokalemia, has not been as prevalent. This report focuses on a patient with profound transient hypokalemia following a lightning strike, alongside a review of three similar cases of transient hypokalemia from the literature. Our patient, a previously healthy young man, was struck by lightning and subsequently suffered transient hypokalemia with lower extremity sensory changes, which resolved after the normalization of serum potassium levels. While the exact underlying mechanisms of transient hypokalemia following high-voltage electrical injuries are unknown, we propose a multifactorial mechanism, which includes massive intracellular shifts of potassium due to elevated epinephrine levels and the prevention of potassium efflux through the electrical disruption of voltage-gated potassium channels. Our report underscores the importance of recognizing hypokalemia in patients with high-voltage electrical injuries and contributes to the understanding of the complex mechanisms involved. Further research is necessary to understand the connection between cellular changes induced by high-voltage exposure and their effects on metabolism, particularly in relation to hypokalemia.

Idiopathic Spontaneous Intraperitoneal Bleeding Secondary to Rupture of Short Gastric Artery

Idiopathic spontaneous intraperitoneal bleeding (ISIH) is an uncommon surgical condition. Patients often present with various abdominal complaints, and it may mimic other common surgical pathologies. A high index of suspicion is needed to diagnose a patient presenting with this condition. We shared a case of ISIH secondary to a rupture of a short gastric artery in a previously healthy young man.

Nonbacterial thrombotic endocarditis of mitral valve associated with a lymphoproliferative malignancy: case report and literature review

BackgroundNon-bacterial thrombotic endocarditis (NBTE) is a rare condition marked by sterile vegetations on cardiac valves, often linked to rheumatologic diseases, autoimmune disorders, and advanced solid malignancies. An early diagnosis and treatment of the associated clinical condition are mandatory, although they do not usually eliminate valvular vegetations, making anticoagulation essential to prevent embolic events. Despite variability, the prognosis of NBTE is usually unfavorable due to recurrent embolic events and the severity of the primary condition, typically advanced cancer.Case presentationWe present a case of a 57 years-old male who presented to the emergency department with a 5-day history of painful bilateral digital edema and color change episodes (from pallor to cyanosis). Physical examination revealed erythrocyanosis in the distal extremities, prompting consideration of secondary Raynaud syndrome.Despite medical therapy, progressive digital ischemia led to multiple finger amputations. During etiological investigation, anticoagulation tests and autoimmune analysis yielded negative results. A transesophageal echocardiogram was performed, revealing an irregular hyperechogenic mass on the anterior leaflet of the mitral valve without valve dysfunction, and a thoracic computed tomography scan with contrast showed an enlarged right paratracheal lymph node. Histopathological analysis from a transthoracic needle biopsy of the paratracheal lymph node revealed diffuse large B-cell lymphoma. The patient underwent aggressive R-CHOP chemotherapy, achieving a favorable complete response.ConclusionThis is a particular case involving the occurrence of NBTE and Raynaud phenomenon as the initial paraneoplastic manifestations in a previously healthy young man. Reports of NBTE associated with lymphoproliferative conditions are quite rare, with fewer than ten cases described in the literature. To our knowledge, this is the first case of NBTE specifically associated with diffuse large B-cell lymphoma.

EN PARTANT D’UNE METAPHORE: PHENOMENOLOGIE DU STATUT DE L’INERTIE

My paper highlights some meanings of the metaphor of aging, used by André Gorz (1923-2007) in his homonymous article published in Les Temps Modernes in December 1961 and January 1962, the first part of which was republished by Gallimard in 2005 (copyright Éditions Galilée in 2004) as a coda to the new edition of one of his "most philosophical" pieces, The Traitor (1958), as noted by Christophe Fourel in André Gorz, a thinker for the 21st century (Éditions La Découverte, 2009, p. 10). Aging is a process based on inertia and generating – because aging also generates – more and more inertia. But what kind of inertia, that of continuing the movements testifying to the vivacity of body and mind, or that of resisting them, therefore of stopping the rest, of flowing into it while forgetting the previous momentum? To the healthy young man of 36, the metaphor of aging appears to have a bitter correspondence with the shock of suddenly feeling the end of existence while living it. The well-known tripartite division of life – childhood youth, maturity, old age – has been transformed into the youth, old age diptych because maturity itself has become the negation of youth, not a mere stable state but already a slope, a masked old age, a fact. If yet young, "he started over again" (André Gorz, The traitor, followed by The aging, p. 377) that is to say, he was the author of audacious movements that took into account only his aspirations of creativity, aging requires of him only the qualities that conform to the specific roles that are asked of him and that are expected to be assumed without the slightest doubt. The phenomenology of this becoming, meticulously dissected, envisages not only the transformation of the unique being who is the subject of the story (but not the master of the phenomenological approach as such because he is desperate before "the cowardice" of his “free choice” of “integration” into the anonymity of the “Others” producing the society which imposes this decline on him (“Aging (II)”, Les Temps Modernes, nº 188, January 1962, p. 829- 852 (830-832). Because the picture of the individual, torn between his existential resistance against all the factors that impose inertia and, on the other hand, the conformism that has become "his nature", extends into the representation of society which is the counterweight to this individual and at the same time frames him. The development of the metaphor of aging has involved the phenomenology of its elements, among which the principal, inertia, and the phenomenology itself has generated messages of social philosophy, pioneers of the powerful ideas commented on in the philosophical thought of the decades later. The phenomenology of the text is and describes awareness, namely the awakening of consciousness, and the metaphor is a manifestation of this process. The metaphor of the aging of the individual thus resonates with the theoretical descriptions of crises and decadence, of degeneration: here, of the capitalist society. The construction of André Gorz is a suggestive model. Today our conclusion in front of such models can only forget the hypocritical criticisms of the phases of the decline, indeed accomplices for their persistence: and, thus, to learn from the previous models. But, it must be emphasized, the metaphor of inertia refers to the awareness of the limits of the figurative meanings of such – and these – metaphors. The awareness of the text is an awareness of metaphors, too, and thus, they become means of intellectual resistance for man.

First Presentation of Pheochromocytoma As Acute Myocarditis in Otherwise Young Healthy Man

First Presentation of Pheochromocytoma As Acute Myocarditis in Otherwise Young Healthy Man

Aerococcus urinae infective endocarditis in a healthy young man: a case report

BackgroundAerococcus urinae infection is a rare clinical condition that causes urinary tract infections in older individuals. Infective endocarditis (IE) caused by A. urinae in healthy young men is extremely rare; however, the mortality rates of IE caused by A.urinae are high if appropriate surgical treatment is not performed.Case presentationA 39-year-old healthy man was admitted to our hospital with complaints of fever, cough, and dyspnea. Blood cultures revealed gram-positive cocci, and echocardiography revealed a 20 × 12-mm vegetation on the aortic valve and perforation of the anterior mitral valve leaflet. He was diagnosed with IE and underwent aortic valve replacement and mitral valve repair after removal of the infective focus. Matrix-assisted laser desorption ionization time-of-flight mass spectrometry was used to identify A. urinae. The patient was discharged in good health after 6 weeks of ampicillin/sulbactam therapy.ConclusionPrompt diagnosis and surgical removal of infectious foci with optimal antibacterial therapy are critical to protect patients from rare and potentially fatal IE caused by A. urinae.

A rare post-COVID neurological complication: Case report of peripheral axonal sensory neuropathy

The present outbreak of Severe Acute Respiratory Syndrome CoronaVirus-2 (SARS-CoV-2), a “novel coronavirus” with neurotropic potential, has presented with multiple cases of neurological manifestations also. SARS-CoV-2 infection is found to be associated with an increased incidence of diverse neurological manifestations such as hyposmia/anosmia, encephalopathy and encephalomyelitis, ischemic stroke and intracerebral hemorrhage, and neuromuscular diseases involving both central and peripheral nervous system. People with these severe complications were most likely elderly with medical comorbidities, especially hypertension and other vascular risk factors. However, in our case a 35-year-old young healthy man developed severe post-COVID neuropathy debilitating his daily activity further requiring rehospitalization. Our patient had developed severe SARS-CoV-2 pneumonia, with a computed tomography severity score of 18/25, needing non-invasive ventilation support, and intensive care unit care for a week, thereafter recovering well without complications and being discharged on room air. He had to be readmitted after 3 days in view of severe bilateral leg pain, being described as “pain crisis.” He was evaluated, a neurologist was involved in the case, with nerve conduction veloci (NCV) lower limbs revealing an axonal sensory neuropathy, which was treated with corticosteroid pulse therapy, gabapentin, and vitamin supplementation to which the patient responded well. Our case presented with pure sensory neuropathy post-COVID which is a rare presentation. The previous reports of treatment of SARS-CoV-2-associated neuropathy have also included corticosteroids and IVIG usually. Our patient improved with pulse therapy of corticosteroid and gabapentin. Thus, awareness and early treatment of peripheral neuropathy after SARS-CoV-2 is needed for good clinical outcomes.

COVID-19 and pulmonary Tubercuiosis coinfection: three case reports from Iran

Tubercuiosis is still a significant problem worldwide. Until the COVID-19 pandemic, tuberculosis was the leading cause of mortality from a single infectious agent. Pulmonary Tubercuiosis patients are more tending to be co-infected with COVID-19 notably when they have a history of exposure. There are some case reports relating to pulmonary TB and COVID-19 coinfection but the information about TB and COVID-19 was still little. We report three coinfected patients. Case one and two were both middle-aged Iranian mans with history of opium addiction, case one presented with dyspnea and weakness and case two presented with progressive weakness. Case three was a healthy young man with history of progressive dyspnea, productive cough and hemoptysis. Case one and case three were improved. In conclusion, COVID-19 is still an important issue and can coexist with other lung infections such as Pulmonary Tubercuiosis, so we should be aware of the advancement of the Tubercuiosis epidemic after the COVID-19 pandemic.

PD23-10 REAL-TIME MRI REVEALS A CHANGE IN PROSTATIC URETHRAL ANGLE DURING VOIDING

You have accessJournal of UrologyCME1 Apr 2023PD23-10 REAL-TIME MRI REVEALS A CHANGE IN PROSTATIC URETHRAL ANGLE DURING VOIDING Cody Johnson, Juan P. Gonzalez-Pereira, Labib Shahid, Maxwell Kounga, Shane Wells, Wade Bushman, and Alejandro Roldan-Alzate Cody JohnsonCody Johnson More articles by this author , Juan P. Gonzalez-PereiraJuan P. Gonzalez-Pereira More articles by this author , Labib ShahidLabib Shahid More articles by this author , Maxwell KoungaMaxwell Kounga More articles by this author , Shane WellsShane Wells More articles by this author , Wade BushmanWade Bushman More articles by this author , and Alejandro Roldan-AlzateAlejandro Roldan-Alzate More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003296.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Dynamic changes in urethral anatomy during voiding have never been quantitatively assessed. We used real-time magnetic resonance imaging (MRI) to obtain dynamic, high-fidelity 3D images of the lower urinary tract during voiding. These were then used to create accurate real-time urethral reconstructions throughput the voiding event coupled with determinations of urine flow, pressure and wall shear stress by computational fluid dynamics (CFD). METHODS: MRI scans were performed on a healthy young man using a clinical 3T scanner according to an IRB-approved protocol to acquire a 3D image every 3.7 s during voiding. 3D models of the urethral lumen were created using MIMICS (Materialise, Leuven, Belgium). RESULTS: Diameters of the internal and external urethral sphincter (IUS, EUS) and prostatic urethral angle (PUA) were obtained throughout voiding. CFD, using computational software to model and simulate fluid behavior under specified constraints of geometry and flow, was used to determine wall shear stress (WSS), pressures and fluid velocities along the length of the urethra during maximum flow (Figure 1). IUS diameter remains unchanged throughout voiding whereas EUS diameter correlates positively with urine flow rate (data not shown here). Most notably, we noted a striking change in PUA during voiding. PUA becomes less acute as flow increases, being straightest at peak flow rate (Figure 2). CONCLUSIONS: Real-time MRI can be used to define the biomechanics of the urethra during voiding and reveals – for the first time – a change in prostatic urethral angle during voiding that correlates with urinary flow rate. Source of Funding: NIH: R01 DK126850-01 © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e675 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Cody Johnson More articles by this author Juan P. Gonzalez-Pereira More articles by this author Labib Shahid More articles by this author Maxwell Kounga More articles by this author Shane Wells More articles by this author Wade Bushman More articles by this author Alejandro Roldan-Alzate More articles by this author Expand All Advertisement PDF downloadLoading ...

A case of mpox reinfection.

A healthy young man first diagnosed with mpox in May 2022 presented again in November 2022 with anal proctitis and a positive PCR on a rectal swab for MPX virus (MPXV) after a recent trip to Brazil, where he engaged in condomless sexual intercourse with multiple male partners.

Sudden Ankle Pain in a Healthy Young Man

Sudden Ankle Pain in a Healthy Young Man

Retinal pigment epithelium tear in an idiopathic acute onset bullous central serous chorioretinopathy

Although retinal pigment epithelium (RPE) tears are common in patients with chronic conditions such as exudative age-related macular degeneration or may occur in response to anti-vascular endothelial growth factor or laser treatment, a spontaneous RPE tear can occur in patients with acute and new-onset bullous central serous chorioretinopathy (CSCR). We present a rare case of a healthy young Asian man with unilateral massive subretinal fluid (SRF). An idiopathic acute-onset bullous CSCR with an RPE tear was diagnosed through ancillary examinations. This patient exhibited good visual recovery as indicated by foveal sparing, spontaneous resolution of SRF, and the lack of a need for unnecessary surgery.

Virtual reality visualization of the right and left heart chambers anatomical position

Objective(s). To create a normal heart virtual model and visualize the anatomical position of the right and left chambers.
 Methods. The material for the investigation was cardiac CT scan results of a young healthy man. From these data, a three-dimensional heart model was created and anatomical position of the right and left chambers investigated.
 Results. Three-dimensional model of a normally formed, normally located heart was created. Segmentation, rotation of the virtual model, virtual horizontal dissection at the level of the middle of the interventricular septum were carried out, the created model was rotated in virtual reality. It was found that in the anatomically correct position the right chambers of the heart are located in front, and the left chambers are located behind.
 Conclusion. Virtual heart reconstruction reproduces digital data taken from a living person, so virtual reality shows the functioning structure of the heart and its chambers. In the anatomical position of the heart, the right atrium and ventricle are located ventrally, and the left atrium and ventricle are located dorsally. It is advisable for morphologists, cardiologists, and surgeons to take into account the identified discrepancies between the terms and the actual location of the heart chambers.

The Reaction of Myocardial Capillaries to Crystalloid Cardioplegia of Different Durations in Patients with Valvular Pathology and Coronary Heart Disease

The aim. To study the morphological manifestations of the response of the myocardial capillaries to cardioplegia in patients with valvular defects and coronary heart disease.
 Materials and methods. Morphological research of operative and sectional material was carried out. Myocardium fragments for microscopical study were obtained from patients at different stages of an open-heart surgery and patients who died at the stage of conservative treatment without surgical intervention. Similar samples of the myocardium of a healthy young man who died from injuries incompatible with life were studied as a control. For electron microscopy study, samples of myocardium were taken from patients at the 185th minute of perfusion.
 Results. Histological preparations of the myocardium showed pronounced diffuse hypertrophy of cardiomyocytes (CMCs), sometimes at the stage of decompensation (perinuclear edema, loss of myofibrils, apoptosis). This transformation of CMCs was obviously related to their functional overload caused by combined defects of the mitral and aortic valves. Changes in muscle fibers were accompanied by interstitial and perinuclear fibrosis. In the pool of coronary arteries affected by atherosclerosis, signs of small focal coronary fibrosis were visible, as well as rough post-infarction scars in 3 patients. All the patients had signs of acute hypoxic damage to the myocardium in the form of CMCs shortening and interstitial edema.
 Conclusions. In patients with combined defects of the aortic and mitral valves of the heart with coronary artery disease, the phenomena of myocardial fibrosis prevail. Heart valve disease combined with coronary heart disease lead to the development of both alterative and compensatory-adaptiveprocesses in the vessels of the microcirculatory bed. The greatest loss of vital organelles in small vessels is observed at 185 min after administration of cardioplegic solution, irreversible changes develop 3 h after perfusion.

126: A CASE REPORT OF ELECTRICAL STORM POST-COVID-19 VACCINATION

Introduction: Post-vaccination arrhythmia is reported as a possible cardiovascular side effect of COVID-19 vaccination. We present a case of ventricular tachycardia (VT) storm in a young healthy man following the 2nd dose of COVID-19 vaccination in the absence of underlying structural heart disease, myocarditis or arrhythmic syndromes. Description: A 38-year-old male with no medical history was admitted after an out-of-hospital cardiac arrest and found to be in VT storm within 24 hours of receiving his 2nd dose of COVID-19 vaccination. He received 4 shocks en route and had another episode of pulseless VT on arrival where Amiodarone was initiated. Laboratory values showed elevated inflammatory markers, and COVID tests were negative. Troponin peaked at 1.5 ng/ml. Initial transthoracic echocardiogram (TTE) revealed normal left ventricular ejection fraction (LVEF) without regional wall motion abnormality. On Day 2, he developed VT storm and was given magnesium sulfate, lidocaine and an additional bolus of amiodarone. Repeat TTE revealed a significant decrease in EF. He became hypotensive requiring inotropes and was emergently taken to the cath lab where intra-aortic balloon pump (IABP) and temporary transvenous pacing (TVP) were placed. Cardiac catheterization revealed normal coronary arteries, elevated left ventricular end diastolic pressure and mildly dilated LV with global hypokinesis and EF of 30%. His condition slowly improved without further occurrences of VT storm. Follow up TTE revealed normal LVEF, IABP and TVP were removed, and he was extubated. Cardiovascular magnetic resonance imaging showed no evidence of myocarditis with normal LV size. An automatic implantable cardioverter-defibrillator was placed. Genetic testing for Brugada syndrome was negative. Discussion: VT storm typically occurs with underlying structural heart disease, inherited arrhythmic syndromes or myocarditis, and is often difficult to identify a specific trigger. Although this is the first case report of VT storm occurring after the COVID-19 vaccine, it is important to note that the lack of a definitive test to diagnose myocarditis such as biopsy is a major limiting factor. This case report also supports the need for structured studies regarding a possible relationship between VT storm and COVID-19 vaccination.

Case report on right ventricular mural endocarditis, not diagnosed clinically, but histopathologically after cardiac surgery

BackgroundRight ventricular mural endocarditis (RVME) is an extremely rare type of infective endocarditis that can occur even in the absence of predisposing factors. The diagnosis is a challenge when no causative pathogen can be detected.Case summaryA previously healthy young man was admitted to a local hospital with a diagnosis of prolonged febrile syndrome and treated for acute sinusitis. As complaints returned, he was hospitalized 3 weeks later, where an echocardiogram demonstrated multiple mobile masses in the right ventricle, and a computed tomography scan revealed extensive pulmonary thromboembolism. During surgery, the endocardial masses were excised, and the pathologist considered an inflammatory myofibroblastic tumour. Despite appropriate medication and initial improvements, the complaints persisted, and 2 weeks after the surgery, the patient returned to the hospital. Imaging studies documented reappearance to the previous findings, whereas blood cultures remained negative. During the second surgery, the new masses resembling vegetations were excised, and histologic analysis indicated infective endocarditis. Adjusted medication was given for 30 days. Just before discharge, no vegetations were seen. At follow-up, 5 years later, he was in a healthy condition.DiscussionDespite careful examinations, initial treatments according to standard protocols were unsuccessful. At final discharge, the patient reported that a tattoo complication prior to the first hospitalization was treated by antibiotics but that he did not complete the course. This omission in the communication further complicated the diagnostic and management processes, leading to surgical interventions that could have been prevented if the neglected antibiotic course was properly disclosed.

Primary Cardiac Angiosarcoma: Pericardial Erosion and Disseminated Metastasis in a Young Active Duty Man

Primary cardiac tumors are exceedingly rare with a reported prevalence of 0.0017% to 0.028%. Seventy-five percent of these tumors are benign. Of the primary malignant tumors, the most common are sarcomas. Primary cardiac sarcomas are often rapidly progressive and carry a very poor prognosis because of distant metastasis, erosion within the heart, and the development of circulatory obstruction. We describe an unfortunate case of primary cardiac angiosarcoma leading to the death of an otherwise healthy young man.

Listeria Necrotizing Cellulitis: A Case Report

Listeria-associated soft tissue infections are exceedingly rare and are typically seen in immunocompromised individuals, with the usual culprit being Listeria monocytogenes. We report the first ever case of a Listeria grayi associated soft tissue infection, in a previously healthy young man 3 months after recovery from COVID-19 infection.

Subcutaneous Lipoma Mimicking Irreducible Inguinal Hernia

Inguinal or groin region is an area of diagnostic mysteries. It is usually associated with a painless or painful swellings. Swellings in this area can be congenital or acquired, acute or chronic, single or multiple, soft to hard, mobile to immobile and appear suddenly or gradually. Commonest swelling in this region is a simple direct or indirect inguinal hernia in children and adults with a positive cough impulse. The next common lump is a femoral hernia, hydrocoele, sebaceous cyst or an enlarged reactive or malignant lymph node. Other uncommon Differential diagnosis includes ectopic testes, funiculitis, femoral artery aneurysm, pseudoaneurysm, hidradenitis, epididymitis, varicocele and abscess. Subcutaneous lipoma is a rare condition which can mimic a diagnosis of irreducible indirect inguinal hernia and other diagnostic problems for the attending physicians. We present a case of groin lipoma mimicking irreducible right sided indirect inguinal hernia in young healthy man.