Nonspecific Complaints Research Articles

Ectopic Mediastinal Thyroid: A Crossroad Between a Multi-Layered Endocrine Perspective and a Contemporary Approach in Thoracic Surgery

An ectopic thyroid (ET) involves numerous scenarios of detection and outcomes, while its current management is not standardised. A mediastinal ET (MET) represents a low index of suspicion. In this paper, we introduce a 47-year-old female who was accidentally identified with an MET, and a modern surgical approach was provided. An anterior mediastinal mass of 3.2 cm was found at CT upon a prior COVID-19 infection. Previous to the infection, she experienced non-specific complaints for a few months (intermittent night sweats, facial erythema, chest pressure, and dyspnoea). Also, CT identified a thymus-like mass and a left adrenal incidentaloma of 3 cm. The endocrine panel was normal, and the subject declined further investigations. She was re-admitted 12 months later: the MET had increased +1 cm (+45% volume) and was confirmed at a 99mTc pertechnetate scintigraphy. Noting the symptoms, mediastinal anatomy, and size change, the MET was removed via a minimally invasive trans-cervical approach (eutopic gland preservation) with the help of a Cooper thymectomy retractor (which also allowed for a synchronous thymus mass resection). No post-operatory complications were registered, the thyroid function remained normal, and the mentioned symptoms were remitted. A histological exam confirmed a benign MET and thymus hyperplasia, respectively. To conclude, this case pinpoints important aspects, such as the clinical picture became clear only upon thoracic surgery due to the complete remission of the complaints that initially seemed widely non-specific. The incidental MET finding was associated with a second (adrenal) incidentaloma, a scenario that might not be so rare, following multiple imaging scans amid the COVID-19 era (no common pathogenic traits have been identified so far). The co-presence of a thymus mass represented one more argument for surgery. Minimally invasive cervicotomy associated with eutopic gland conservation and the use of a Cooper thymectomy retractor highlight modern aspects in video-assisted thoracic surgery, which provided an excellent outcome, involving one of the lowest mediastinal thyroids to be removed by this specific procedure. Awareness of such unusual entities helps inform individualised, multidisciplinary decisions for optimum prognoses.

Serious conditions among conveyed and non-conveyed patients presenting with nonspecific chief complaints to the ambulance service

BackgroundIt is a challenge for the ambulance service to identify which patients to convey to the emergency department (ED). Ideally this would be the patients with serious conditions requiring further care in the ED. However, patients presenting with non-specific chief complaints are difficult to prioritize and typically have normal or near normal vital signs despite up to one third having underlying serious conditions. The proportion of patients with serious conditions among non-conveyed patients with non-specific chief complaints (NSC) as assessed by ambulance clinicians is not known. Therefore, the primary aim was to study the proportion of serious conditions among conveyed and non-conveyed patients presenting to the ambulance service with NSCs. The secondary aim was to study the mortality rate among patients with NSCs in relation to conveyance and serious and nonserious conditions.MethodA retrospective cohort study of patients ≥ 18 years of age presenting with NSCs to the ambulance service in Stockholm Region between January 1st, 2013 and December 31st, 2013. Patients were identified via the ambulance service electronic health record and followed via records from the the National Patient Register and Causes of Death Registry at Sweden’s National Board for Health and Welfare. Descriptive statistics as well as regression analyses were used.ResultsA total of 4744 patients were included with a median age of 76 years. A serious condition was present in 1398 (29.5%) of the patients. After index assessment by the ambulance service, 3780 (79.7%) were conveyed of which 1334 (35.3%) had serious conditions, compared to 964 (20.3%) who were non-conveyed of which 64 (6.6%) had serious conditions. 30-day mortality was 372 (9.8%) in the conveyance group compared to 32 (3.3%) in the non-conveyance group. If serious conditions were present, the mortality rates were 269 (20.2%) in the conveyance group compared to 11 (17.2%) in the non-conveyance group.ConclusionThe results show that serious conditions were more than five times more common among conveyed as compared to non-conveyed patients. Mortality rates were three times higher in the conveyance group as compared to the non-conveyance group. Our results suggest that the ambulance personnel play an important role in identifying patients with serious conditions, hence, likely to be in need of treatment in the ED.Trial registrationN/A

Patients with Non-Specific Complaints in Emergency Departments: A Growing Patient Safety Concern in an Aging Population with Multimorbidity.

In this opinion, we offer a new perspective on the important and persistent problem of diagnostic errors for patients with non-specific complaints (NSCs). As an increasing number of complex patients present clinicians with challenging diagnostic work in the time-pressured and high-volume contexts of EDs, we need to improve how clinicians and healthcare organizations can understand and perform safe diagnostics for patients with NSCs. The combination of a growing number of patients with NSCs and the ways in which clinicians use the categories 'non-specific complaints' and 'non-specific diagnosis' in diagnostic work in emergency departments presents a growing patient safety concern especially for older patients with multimorbidity that require the integration of clinical and organizational research. We argue why the growing numbers of patients with NSCs and clinicians' use of these categories have implications for patient safety both within and beyond the acute care context. We end by pointing to the importance of an interdisciplinary patient safety research agenda, ideally followed by the development of targeted usable protocols for older multimorbid patients with non-specific complaints.

6928 Vitamin D excess in a patient with hypoparathyroidism after parathyroidectomy

Abstract Disclosure: Z. Zavgorodneva: None. A. Barsegian: None. F. Zhang: None. Introduction. We describe a case of a patient with mild persistent hypoparathyroidism after parathyroidectomy with autotransplantation, which was indicated for ESRD-related secondary hyperparathyroidism. The patient presented with nonspecific complaints and was found to have a high Vitamin D level after long-term moderate-dose Vitamin D supplementation. Case report. A 71-year-old male with a past medical history of end-stage renal disease (ESRD) undergoing hemodialysis for the past 18 years, as well as a history of parathyroidectomy with autoimplantation of parathyroid glands in the forearm in 2010 due to severe secondary hyperparathyroidism, presented to the hospital complaining of generalized weakness and lower extremity cramps that had been ongoing for a few weeks. Further investigations did not reveal evidence of infectious processes. A review of medications indicated the absence of statins among his outpatient medications. No focal neurological deficits or objective signs of muscle weakness were identified. Laboratory findings showed no significant metabolic derangements or haematological abnormalities. Inflammatory markers and creatine phosphokinase were within normal ranges. As part of the workup for generalized subjective weakness and ESRD, Vitamin D levels were checked, revealing a result of of120 ng/mL. The patient reported taking over-the-counter 2000 IU of Vitamin D twice daily for the past six years despite having a normal level of Vitamin D checked five years prior to admission. Calcium supplements were initiated in the postoperative period and continue to be administered at a dose of 600 mg daily. Analysis of the PTH-calcium axis demonstrated persistent mild hypoparathyroidism with hypocalcemia since the time of the surgery. However, there was an observed tendency for calcium levels to improve, especially in the last six years. Vitamin D supplement was discontinued, and the patient was subsequently discharged home with the continuation of physical therapy. Discussion. Explaining the origin of the high level of Vitamin D in this patient poses a challenge. There is limited data in the literature regarding the long-term effects of vitamin D use when the initial Vitamin D levels are normal. Additionally, there are numerous abstracts suggesting significantly higher doses of Vitamin D received for up to 6 years without any evident biochemical or clinical consequences. Moreover, the typical consequences of Vitamin D toxicity, such as hypercalcemia, can not be present in patients who underwent parathyroidectomy. Therefore, it is possible to consider that the severe generalized subjective weakness may be a sign of Vitamin D toxicity itself. Presentation: 6/1/2024

Knowledge, attitudes and practices around urinary tract infections of general practitioners in the Netherlands: a cross-sectional internet survey

ObjectivesUrinary tract infections (UTIs) are the most common reason for women to consult a general practitioner (GP). Current diagnostic tests are inadequate, complicating diagnosis and treatment decisions for GPs. To...

Myxomatous cause of multiple intracranial aneurysms and cognitive decline: a case report

BackgroundThe occurrence of cerebral aneurysm in a case of cardiac myxoma is rare with less than 60 cases reported worldwide. The course of management is still debatable given its rarity. We present a case of multiple intracranial aneurysms secondary to atrial myxoma in a young lady with a brief review of the literature.Case presentationA young lady in her late 30s with a history of right middle cerebral artery territory stroke eight years ago presented with gradually progressive symptoms in the form of holocranial headache, inattention and forgetfulness for the last few years. On neuroimaging, she was found to have multi-territorial lacunar infarcts and multiple intracranial artery aneurysms which was confirmed with a digital subtraction angiogram. A cardiac evaluation revealed a left atrial myxoma. The aetiology of subcortical cognitive decline and intracranial aneurysms was attributed to the myxoma with secondary myxomatous embolism. Other secondary causes were ruled out. She is being followed up medically after resection of the myxoma.ConclusionIntracranial aneurysms are rare complications of cardiac myxoma which may present before, concurrent or many years after diagnosis of the myxoma. Nonspecific neurological complaints occasionally are the ominous signs of intracranial aneurysms which mandate a low threshold for neuroimaging in a case of cardiac myxoma. Given the absence of definitive risk factors and unclear natural history, clinical and radiological follow-ups are critical.Learning PointsIntracranial aneurysms are rare complications of cardiac myxoma that may present before, concurrent or many years after diagnosis of the myxoma.Special attention must be given to nonspecific neurological complaints with a low threshold for neuroimaging in those with a prior history of cardiac myxoma.Given the absence of definitive risk factors and unclear natural history, clinical and radiological follow-up including conventional angiography and/or magnetic resonance imaging is critical.

Late Presentation of Coarctation of the Aorta in an 11-Year-Old Male Child: A Case Study

Introduction: Coarctation of the aorta is a condition characterized by a narrowed segment of the aorta due to thickening of the artery wall. This case study highlights the late diagnosis of coarctation of the aorta in an 11-year-old male child who presented with symptoms initially suggestive of a respiratory infection. Case study: An 11-year-old male presented to the outpatient department with chief complaints of fever, cough, and poor appetite. He developed two episodes of epistaxis and hypertension with soft systolic murmur. Echocardiography showed severe coarctation of the aorta. Discussion: Coarctation of the aorta is a relatively common congenital heart defect that can remain asymptomatic until later in childhood or adulthood. It is the seventh most common type of CHD. The delay in the diagnosis of coarctation of the aorta underscores the challenges of recognizing cardiac anomalies in pediatric patients presenting with nonspecific complaints. Conclusion: Healthcare providers must remain vigilant and thorough in their assessment to prevent late diagnoses and associated complications in pediatric patients.

Applicability of the Pancreatic Exocrine Insufficiency Test (PEI-TEST) in Pediatric Patients.

In mild cases, it is difficult to diagnose pancreatic exocrine insufficiency (PEI). There is no gold standard method for the diagnosis of PEI. A reliable method is needed for preliminary diagnosis of PEI. The PEI-TEST was applied to the patients with nonspecific gastrointestinal complaints. Serum amylase, lipase, serum trypsinogen, and fecal elastase 1 (FE-1) were analyzed from each patient. According to the PEI-TEST, PEI was present in 42 (47.7%) and PEI was not present in 46 (52.3%) patients. No significant difference was observed between the 2 groups with regard to age, gender and amylase, lipase, serum trypsinogen, and FE-1. When an FE-1 value of <200 µg/dL was considered as indicating PEI, the sensitivity and specificity of the test were found to be 47.4% and 52.2%, respectively. Although it is promising that PEI-TEST is a validated test in our country and suitable for our society, it is not suitable for pediatric patients.

Personalized Approach to Olfactory Neuroblastoma Care.

Olfactory neuroblastoma (ONB) is an uncommon neuroendocrine malignancy arising from the olfactory neuroepithelium. ONB frequently presents with nonspecific sinonasal complaints, including nasal obstruction and epistaxis, and diagnosis can be obtained through a combination of physical examination, nasal endoscopy, and computed tomography and magnetic resonance imaging. Endoscopic resection with negative margins, with or without craniotomy, as necessary, is the standard of care for definitive treatment of ONB. Regional metastasis to the neck is often detected at presentation or may occur in a delayed fashion and should be addressed through elective neck dissection or radiation. Adjuvant radiotherapy should be considered, particularly in the case of high grade or tumor stage, as well as positive surgical margins. Systemic therapy is an area of active investigation in both the neoadjuvant and adjuvant setting, with many advocating in favor of induction chemotherapy for significant orbital or intracranial involvement prior to surgical resection. Various targeted immunotherapies are currently being studied for the treatment of recurrent or metastatic ONB. Prolonged locoregional and distant surveillance are indicated following definitive treatment, given the tendency for delayed recurrence and metastasis.

Prognostic value of cognitive impairment, assessed by the Clock Drawing Test, in emergency department patients presenting with non-specific complaints

BackgroundCognitive impairment (CI) is common among older patients presenting to the emergency department (ED). The failure to recognize CI at ED presentation constitutes a high risk of additional morbidity, mortality, and functional decline. The Clock Drawing Test (CDT) is a well-established cognitive screening test. AimIn patients presenting to the ED with non-specific complaints (NSCs), we aimed to investigate the usability of the CDT and its prognostic value regarding length of hospital stay (LOS) and mortality. MethodSecondary analysis of the Basel Non-specific Complaints (BANC) trial, a prospective delayed type cross-sectional study with a 30-day follow-up. In three EDs, patients presenting with NSCs were enrolled. The CDT was administered at enrollment. ResultsIn the 1,278 patients enrolled, median age was 81 [74, 87] years and 782 were female (61.19%). A valid CDT was obtained in 737 (57.7%) patients. In patients without a valid CDT median LOS was higher (29 [9, 49] days vs. 22 [9, 45] days), and 30-day mortality was significantly higher than in patients with a valid CDT (n = 45 (8.32%) vs. n = 39 (5.29%)). Of all valid CDTs, 154 clocks (20.9%) were classified as normal, 55 (7.5%) as mildly deficient, 297 (40.3%) as moderately deficient, and 231 (31.3%) as severely deficient. Mortality and LOS increased along with the CDT deficits (p = 0.012 for 30-day mortality; p < 0.001 for LOS). ConclusionThe early identification of patients with CI may lead to improved patient management and resource allocation. The CDT could be used as a risk stratification tool for older ED patients presenting with NSCs, as it is a predictor for 30-day mortality and LOS.

A 5-Year-Old Boy with Scurvy, Severe Anemia, and Severe Malnutrition: A Challenge

Background: Scurvy is a rare disease caused by a severe vitamin C deficiency in the diet. Due to its rarity compared to other dietary deficiencies, it is seldom recognized, resulting in a typical delay in diagnosis. This issue is more common in children with physical disabilities or poor eating habits. This study aims to examine the medical history of a healthy young individual who was unexpectedly diagnosed with scurvy. Case description: We report a five-year-old male with hearing impairment presented to our clinic with a movement limitation in lower limbs in one week. The patient's dietary history indicated that meat, fruits, and vegetables were strictly limited. Based on the X-ray results of the right and left genu, there is evidence of spur formation accompanied by sclerosis and irregular metaphysis in the femur and tibia of both sides (known as Pelken's spur). Additionally, there are dense areas with calcification on the surface of the spur (referred to as the Frankel line), as well as reduced bone trabeculation and thinning of the outer layer of the bone (referred to as pencil thin cortex). The presence of radiographic characteristics indicated osteopenia raises suspicions of scurvy. According to the complete blood count examination, the patient had severe anemia. The patient is severely malnourished. Based on the dietary history, clinical symptoms, and radiographic evidence, scurvy was diagnosed. Conclusion: Our case demonstrates the importance of emphasizing the need for dietary screening to reduce over-examination in patients with non-specific complaints.

Clinical features of post-COVID syndrome in patients with carbohydrate metabolism disorders

Objective: clinical characteristics of patients with carbohydrate metabolism disorders (CDM) in the post-COVID period. Material and methods. 72 people with CDM in the post-COVID period were examined. Results. When detailing complaints, the incidence of respiratory symptoms in patients with impaired glucose tolerance (IGT) and diabetes mellitus (DM) was comparable. In both groups, nonspecific (general weakness) and neurological (memory deterioration, sleep disturbances, decreased vital activity) symptoms predominated. The development of NUD in the post-COVID period was facilitated by such risk factors as age &gt;45 years, body mass index &gt;25 kg/m2, family history of type 2 diabetes, hypertension. The most common concomitant diseases were overweight and obesity — in 64 (88.9%) patients, dyslipidemia — in 44 (61.1%), hypertension — in 32 (44.4%). In the group of patients with IGT, the frequency of re-infection with SARS-CoV-2 was higher compared to the group of patients with diabetes, and there was a tendency for the course to become more severe with re-infection. Conclusion. In the post-COVID period, patients with IGT and diabetes are more likely to have nonspecific and neurological complaints, while identified NDEs can aggravate the course of concomitant diseases and lead to re-infection with SARS-CoV-2.

RECURRENT MUCOEPIDERMOID CARCINOMA OF THE MAXILLARY SINUS

Mucoepidermoid carcinoma of the maxillary sinus is extremely rare. Our patient was admitted to our hospital with nonspecific complaints such as nasal obstruction and nasal bleeding. As a result of the histopathological and immunohistochemical examination of the biopsy taken, the case was diagnosed as "mucoepidermoid carcinoma." The mass could not be completely resected due to its anatomical location, and the patient received postoperative radiotherapy. Our patient's tumor recurred after two years.

Abstract P239: Association of Presence of Non-Specific Physical Complaints With Future Development of Cardiovascular Disease in Middle-Aged Japanese Workers: Finding From the Aichi Workers Cohort Study

Introduction: Stress responses to work-related stressors often manifest in non-specific physical complaints, by monitoring it may provide early indications of underlying health issues. Hypothesis: We hypothesized that there is a significant association between non-specific physical complaints and the subsequent incidence of cardiovascular diseases (CVD) in middle-aged Japanese. Methods: A cohort of 4820 Japanese workers (3876 male, 944 female) ages 35 to 65 years were followed from 2007 to 2019 for CVD incidence (stroke and acute coronary artery diseases). Non-specific physical complaints were assessed as a domain of stress response in the 57-item brief job stress questionnaire and consisted of 11 items: felt dizzy; experienced joint pains; experienced headaches; had stiff neck or shoulders; had lower back pain; had eyestrain; had heart palpitations or shortness of breath; had stomach or intestine problems; lost appetite; had diarrhea or constipation; couldn’t sleep well. Each item had four possible responses from never, sometimes, often, to always, corresponding scores of which are 1, 2, 3, and 4, respectively. The presence of non-specific physical complaints was defined as a sum score of 27-44 for males and 30-44 for females according to the recommended standard values. Hazard ratios (HRs) and the corresponding 95% confidence intervals (CIs) of non-specific physical complaints for CVD were estimated and adjusted for age, sex, smoking status, alcohol consumption, regular exercise, sleep duration, body mass index, systolic blood pressure, total cholesterol, and histories of hypertension, hyperlipidemia, and diabetes. Results: During a median of 10.4 years of follow-up, 90 CVD cases were identified. The presence of non-specific physical complaints was significantly associated with the incidence of CVD independent of confounding variables (HR: 2.04, 95% CI: 1.02-4.07). Conclusion: The present study revealed that the presence of non-specific physical complaints was associated with a higher risk of developing CVD.

Cannulated prolactin test in the diagnosis of the hyperprolactinemia syndrome

Hyperprolactinemia (HP) is a persistent pathological increase in a prolactin serum concentration amounting to more than 20 ng/ml in males and 25 ng/ml in females and leads to developing the pathological symptom complex of HP primarily from the reproductive system. To confirm the persistent etiology of HP and to eliminate physiological short-term hormone enhancement, a number of recommendations, including Russian and Belarusian, were proposed to make several prolactin measurements.This study included 120 patients with HP (96 females, 78.0 %) and (27 males, 22.0 %) aged 18–50 years who sought medical help at the Health Institution “Minsk City Clinical Endocrinology Center” in the period from December 2022 to September 2023. After catheterizing the vein, a venous cannula was inserted and blood was taken immediately after cannulating (T0), and then in 60 minutes (T1) and 120 minutes (T2). The cannulated prolactin test results were considered positive – with HP remaining in all three samples (T0, T1, T2), questionable – if HP was kept at T0 and T1, and negative if HP was only at T0. When evaluating the cannulated test results, true HP is 36.7 %. Patients with a positive cannulated test had a higher prolactin at T0, which was 888.5 mME/L (U = 97.0; z = 7.92; p &lt; 0.001). Patients with stress-induced HP (negative test) and patients with true HP (positive test) had no statistically significant differences in age and occurrence frequency of specific and non-specific complaints and symptoms for HP.

Ocular extraintestinal manifestations and treatments in patients with inflammatory bowel disease.

Between 3-47% of patients with inflammatory bowel disease (IBD) have extraintestinal manifestations (EIMs), and between 1.3-86.9% of patients with IBD suffer from ocular EIMs (O-EIMs) making the eye the third most common organ affected. These O-EIMs exist among a spectrum, with a variety of types and amounts of inflammation which can lead to decreased vision, and in some cases, vision loss, without treatment. We performed a literature review concerning O-EIMs in patients who had or were later found to have a diagnosis of IBD in order to identify ocular EIMs that commonly occur with IBD and to assess which patients with IBD may be at higher risk of developing O-EIMs. We were also interested in ascertaining whether O-EIMs were more common in specific populations of people or in specific subtypes of IBD. Lastly, we explored the common treatments of O-EIMs in patients with IBD. Upon review of the literature, we found that the most common O-EIMs are episcleritis and uveitis. Anterior uveitis is more commonly seen, although, inflammation may occur in the posterior segment of the eye as well and may also manifest as retinal vasculitis. While these diagnoses are sometimes known retrospectively, most patients present with nonspecific eye complaints of which decreased vision with or without pain is the most common. Visual symptoms associated with ocular EIMs may be non-specific so physicians should have a low threshold to refer to ophthalmology for visual complaints. It is important to keep in mind that ocular EIMs can cluster with skin and joint EIMs. Screening should be prioritized for female patients with Crohn's disease and concurrent arthritis. Treatments for O-EIMs are outlined and compared in this paper as well.

Sick building syndrome: do outdoor pollutants and pollen affect it?

Sick building syndrome (SBS) refers to non-specific complaints, including upper-respiratory irritative symptoms, headaches, fatigue, and rash, which are usually associated with a particular building by their temporal pattern of occurrence and clustering among inhabitants or colleagues. The aim of the study was to determine the association between the clinical manifestations of sick building syndrome with outdoor pollutants and airborne pollen. It was a descriptive and prospective observational study conducted from November 2021 to April 2022. It included subjects over 18 years old who completed an online survey on sick building syndrome (general symptoms, nasal, ocular, oropharyngeal, and skin symptoms) presented at home, housing information and personal history. The APS-330 from Pollen Sense ® was used to obtain data on pollen in the air and the local pollution monitoring system (SIMA) to obtain information regarding pollutants. For statistical analysis, SPSS version 16 was used. A total of 402 surveys were included; 91% of the subjects reported having at least 1 symptom. Females presented more general symptoms (fatigue and headache) than males. Subjects with a personal history of atopy showed a higher prevalence of practically all symptoms. Airborne pollen exposure was positively associated with mucosal symptoms in eyes and nose. Outdoor fungi spore exposure was positively associated with oculo-nasal and cutaneous symptoms in the scalp. This study found significant associations with female gender and a history of atopy, which suggests a higher risk for these subjects. Despite the limitations of the study, we can conclude that there is an association between the clinical manifestations of sick building syndrome with indoor and outdoor pollution.

Investigation of brucellosis cases in and around Yozgat Province

Aims: Brucellosis causes a zoonotic infectious disease that is very common in our country as well as around the whole world. Infected individuals most frequently present with nonspecific symptoms such as fever, chills, malaise, and generalized body pain. Therefore, it is very difficult to diagnose. When diagnosis and treatment are delayed, it causes serious complications. It can cause pictures with high mortality, such as epididymoorchitis, endocarditis, hepatitis, neurobrucellosis, and pancytopenia. The first approach to treatment is rest. Antibiotics with intracellular bactericidal action should be used in combination due to resistance development. Methods: 136 individuals with serum titers who were diagnosed with brucellosis by serological tests and who applied to our hospital between 2017-2022 were included in the study. The patient files were analyzed to evaluate the complaints of these individuals, their Brucella ELISA titers, serum aspartate aminotransferase (AST), alanine aminotranspherase (ALT), C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), lactate dehydrogenase (LDH) values, if any, at the time of diagnosis, the treatments they received, and the response to the treatment. Results: The first complaints of 136 patients who were diagnosed with brucellosis by serological tests were the most common; Joint pain was present in 48 (35.29%), widespread body pain in 26 (19.11%), and fever in 18 (13.23%). Sacroiliitis in 5 (3.67%), gonarthrosis in 4 (2.94%), bursitis in 4 (2.94%), discitis in 3 (2.2), and psoriasis in 1 of the patients’ abscess (0.73%) was detected. R=0.28 in the same direction between the first titers recognized by the patients and ALT; the same direction between titer and LDH R=0.30; the same ratio between titer and CRP is R=0.45; and there is a correlation coefficient of R=0.26 between titer and sediment in the same direction. It is important to take these correlation coefficients statistically (p&lt;0.05). Accordingly, these values also change when it titrates. But it is weakened weights as a measure of relationship. Conclusion: Although fever comes to mind first in Brucellosis, it was observed that the first complaint of individuals in our study was complicated surgery, and fever ranked third. For this reason, Brucellosis should be approached with suspicion, since it is endemic in individuals presenting with non-specific complaints. It is widely present between serum titer and ESR, and C-reactive protein as markers of inflammation. In individuals with high vibration and inflammation markers, controlled caution should be exercised. Even treatment times can be changed.

Clinical case of laser ablation of lingual amygdala

Hypertrophy of the lingual tonsil is a condition in which the lingual tonsil, located at the base of the tongue, enlarges. This tonsil consists of clusters of follicles separated by a central groove. In children under 5 years old, the number of follicles usually ranges from 10 to 12, while in adults up to 40 years old, it can reach 35 to 40. This structure plays an important role in the immune system, helping the body fight infections and microbes. Like other tonsils in the throat, the lingual tonsil can sometimes cause problems, such as hypertrophy (enlargement) or chronic infections. The causes of lingual tonsil hypertrophy can be diverse. In some cases, it develops as a compensatory process after the removal of the palatine tonsils. The primary cause in adults may be chronic inflammation of the pharynx. Severe degrees of lingual tonsil hypertrophy are very rare but can lead to various symptoms, such as coughing, difficulty swallowing and breathing, a feeling of pressure in the area beneath the tongue, and other nonspecific complaints. These symptoms are not pathognomonic for lingual tonsil hypertrophy. The challenges in diagnosis and the lack of a standardized approach to surgical treatment require detailed consideration and description in each individual case. Sometimes, patients with lingual tonsil hypertrophy complain of coughing paroxysms. In such cases, mechanical irritation of the lingual tonsil with a probe can provide some assistance in diagnosis. In the context of this study, lingual tonsillectomy surgery was performed on a patient using a diode laser. The results obtained confirmed the high level of technological feasibility and appropriateness of using laser ablation for the treatment of lingual tonsil hypertrophy. Laser ablation is one of the possible surgical procedures for treating lingual tonsil hypertrophy. It can be an effective and technologically advanced method, although it requires experience and qualification of specialists.

Clinical case of laser ablation of lingual amygdala

Hypertrophy of the lingual tonsil is a condition in which the lingual tonsil, located at the base of the tongue, enlarges. This tonsil consists of clusters of follicles separated by a central groove. In children under 5 years old, the number of follicles usually ranges from 10 to 12, while in adults up to 40 years old, it can reach 35 to 40. This structure plays an important role in the immune system, helping the body fight infections and microbes. Like other tonsils in the throat, the lingual tonsil can sometimes cause problems, such as hypertrophy (enlargement) or chronic infections. The causes of lingual tonsil hypertrophy can be diverse. In some cases, it develops as a compensatory process after the removal of the palatine tonsils. The primary cause in adults may be chronic inflammation of the pharynx. Severe degrees of lingual tonsil hypertrophy are very rare but can lead to various symptoms, such as coughing, difficulty swallowing and breathing, a feeling of pressure in the area beneath the tongue, and other nonspecific complaints. These symptoms are not pathognomonic for lingual tonsil hypertrophy. The challenges in diagnosis and the lack of a standardized approach to surgical treatment require detailed consideration and description in each individual case. Sometimes, patients with lingual tonsil hypertrophy complain of coughing paroxysms. In such cases, mechanical irritation of the lingual tonsil with a probe can provide some assistance in diagnosis. In the context of this study, lingual tonsillectomy surgery was performed on a patient using a diode laser. The results obtained confirmed the high level of technological feasibility and appropriateness of using laser ablation for the treatment of lingual tonsil hypertrophy. Laser ablation is one of the possible surgical procedures for treating lingual tonsil hypertrophy. It can be an effective and technologically advanced method, although it requires experience and qualification of specialists.