Spontaneous Resolution Research Articles

Rheumatoid neutrophilic dermatitis: A case report and review of the literature

AbstractRheumatoid neutrophilic dermatitis (RND) is a dermatological condition typically associated with rheumatoid arthritis (RA). The low prevalence of RND and the wide spectrum of its possible clinical appearances make the diagnosis challenging. Current literature is still lacking a comprehensive overview of this rare cutaneous disorder. The aim of this review is to summarize data from the existing literature on RND, focusing on its epidemiology, clinical manifestations, histopathology and treatment. Hence, a comprehensive literature search of case reports and series was made, starting from a Medline (via PubMed) and Scopus databases. We also included in the analysis one patient attending to our dermatology department and diagnosed with RND. Overall, 54 cases of RND were identified. The majority of patients were female (72.3%) with a median (IQR) age at the time of diagnosis of 58 (65‐45) years. RND followed the onset of RA in 87% of patients with an average (SD) latency time of approximately 10 (8.9) years. In 1 (1.8%) case the dermatitis preceded the appearance of joint symptoms, while in three (5.5%) cases it occurred concomitantly with them. Seropositive RA was the major associated form (76.5%). Clinically, asymptomatic papules (31%), nodules (15.1%) and/or plaques (13.5%) distributed bilaterally on extremities were most frequently described. Notably, females were more prone to develop a painful dermatitis (84.6%) compared to males. The vesicobullous (12.7%) and pustular (9.2%) clinical subtypes were the most demonstrative in contrast to the urticarial skin manifestations and the potential figurative/annular distribution of the lesions. Spontaneous resolution of RND was rare (5.5%). Systemic treatments, mainly represented by steroids and anti‐neutrophilic agents (dapsone, colchicine), were consistently required.

Spontaneous resolution of macular detachment in myopic maculopathy

We are reporting a case of myopic maculopathy in a 52-year-old man, which showed spontaneous resolution of macular schisis and foveal detachment. Spontaneous resolution has been reported after posterior vitreous detachment (PVD) or rupture of the internal limiting membrane (ILM). It has also been reported in cases where either of these two were absent. Our report adds to the literature that spontaneous resolution can occur in the absence of PVD or ILM rupture.

Additional treatment after primary conservative treatment in patients with chronic subdural hematoma-A retrospective study.

Chronic subdural hematoma (CSDH) is a common neurological condition and is typically treated with burr hole craniostomy. Nevertheless, conservative treatment may lead to spontaneous hematoma resolution in some patients. This study aims to describe the characteristics of patients who were treated conservatively without the eventual need for additional treatment. Data were retrospectively collected from patients who were primarily treated conservatively in three hospitals in the Netherlands from 2008 to 2018. The Primary outcome was the nonnecessity of additional treatment within 3 months after the initial CSDH diagnosis. We used univariable and multivariable logistic regression analyses to identify factors associated with not receiving additional treatment. In this study, 83 patients were included and 61 patients (73%) did not receive additional treatment within 3 months. Upon first presentation, the patients had a Markwalder Grading Scale score (MGS) of 0 (n=5, 6%), 1 (n=43, 52%), and 2 (n=35, 42%). Additional treatment was less often received by patients with smaller hematoma volumes (adjusted odds ratio [aOR] 0.78 per 10mL; 95% confidence interval [CI] 0.64-0.92). Patients using antithrombotic medication also received less additional treatment, but this association was not significant (aOR 2.02; 95% CI 0.61-6.69). Three quarters of the initially conservatively treated CSDH patients do not receive additional management. Typically, these patients have smaller hematoma volumes. Further, prospective research is needed to distinguish which patients require surgical intervention and in whom primary conservative treatment suffices.

Pediatric gallstone disease—Management difficulties in clinical practice

BackgroundGallstone disease (GD) is no longer an exclusive condition of adulthood, and its prevalence is increasing in pediatric age. The management and the extent of the etiological investigation of GD in children and adolescents remains controversial. This study aimed to analyze the difficulties in the work-up and management of pediatric GD patients. MethodsA retrospective study performed in a single tertiary center enrolled sixty-five patients with GD followed from January 2014 to June 2021. Patients were categorized conveniently according to their age at diagnosis: Group A (<10years, n=35) and Group B (≥10years, n=30). We analyzed demographic, clinical and laboratory data, ultrasonographic findings at presentation, therapeutics and complications. ResultsSymptoms were more frequent in patients >10years old (p=0.001). Cholecystectomy was performed in 31 patients (47.7%). A multivariate regression logistic model identified the age >10years (OR=6.440, p=0.005) and underlying entities (OR=6.823, p=0.017) as independent variables to perform surgery. Spontaneous resolution of GD was more common in children <2years old. A multivariate regression logistic model showed a trend for those >10years old to develop more complications. Two out of 18 patients were diagnosed with ABCB4 gene mutations in heterozygosity. ConclusionsDecision-making on cholecystectomy remains challenging in asymptomatic patients. Identifying predictive factors for the development of complications has proven difficult. However, we found a trend toward the development of complications in individuals older than 10years.

X-linked transient antenatal Bartter syndrome related to MAGED2 gene: Enriching the phenotypic description and pathophysiologic investigation

PurposeTransient Bartter syndrome related to pathogenic variants of MAGED2 is the most recently described antenatal Bartter syndrome. Despite its transient nature, it is the most severe form of Bartter syndrome in the perinatal period. Our aim was to describe 14 new cases and to try to explain the incomplete penetrance in women. MethodsWe report on 14 new cases, including 3 females, and review the 40 cases described to date. We tested the hypothesis that MAGED2 is transcriptionally regulated by differential methylation of its CpG-rich promotor by pyrosequencing of DNA samples extracted from fetal and adult leukocytes and kidney samples. ResultsAnalysis of the data from 54 symptomatic patients showed spontaneous resolution of symptoms in 27% of cases, persistent complications in 41% of cases, and fatality in 32% of cases. Clinical anomalies were reported in 76% of patients, mostly renal anomalies (52%), cardiovascular anomalies (29%), and dysmorphic features (13%). A developmental delay was reported in 24% of patients. Variants were found in all regions of the gene. Methylation analysis of the MAGED2 CpG-rich promotor showed a correlation with gender, independent of age, tissue or presence of symptoms, excluding a role for this mechanism in the incomplete penetrance in women. ConclusionThis work enriches the phenotypic and genetic description of this recently described disease and deepens our understanding of the pathophysiological role and regulation of MAGED2. Finally, by describing the wide range of outcomes in patients, this work opens the discussion on genetic counseling offered to families.

Micro-CT-assisted identification of the optimal time-window for antifibrotic treatment in a bleomycin mouse model of long-lasting pulmonary fibrosis

Idiopathic Pulmonary Fibrosis (IPF) is a debilitating and fatal lung disease characterized by the excessive formation of scar tissue and decline of lung function. Despite extensive research, only two FDA-approved drugs exist for IPF, with limited efficacy and relevant side effects. Thus, there is an urgent need for new effective therapies, whose discovery strongly relies on IPF animal models. Despite some limitations, the Bleomycin (BLM)-induced lung fibrosis mouse model is widely used for antifibrotic drug discovery and for investigating disease pathogenesis. The initial acute inflammation triggered by BLM instillation and the spontaneous fibrosis resolution that occurs after 3 weeks are the major drawbacks of this system. In the present study, we applied micro-CT technology to a longer-lasting, triple BLM administration fibrosis mouse model to define the best time-window for Nintedanib (NINT) treatment. Two different treatment regimens were examined, with a daily NINT administration from day 7 to 28 (NINT 7–28), and from day 14 to 28 (NINT 14–28). For the first time, we automatically derived both morphological and functional readouts from longitudinal micro-CT. NINT 14–28 showed significant effects on morphological parameters after just 1 week of treatment, while no modulations of these biomarkers were observed during the preceding 7–14-days period, likely due to persistent inflammation. Micro-CT morphological data evaluated on day 28 were confirmed by lung histology and bronchoalveolar lavage fluid (BALF) cells; Once again, the NINT 7–21 regimen did not provide substantial benefits over the NINT 14–28. Interestingly, both NINT treatments failed to improve micro-CT-derived functional parameters. Altogether, our findings support the need for optimized protocols in preclinical studies to expedite the drug discovery process for antifibrotic agents. This study represents a significant advancement in pulmonary fibrosis animal modeling and antifibrotic treatment understanding, with the potential for improved translatability through the concurrent structural–functional analysis offered by longitudinal micro-CT.

Adult Multissystem Inflamatory Síndrome (MIS-A): case report

Introduction: The COVID-19 pandemic has resulted in a global health crisis. SARS-CoV-2 infection and its broad spectrum of systemic involvement have demonstrated the existence of equally serious extrapulmonary complications in adult patients. In this context, Multisystem Inflammatory Syndrome (MIS), a serious complication that occurs after acute infection and has a hyperinflammatory nature with potential multisystem involvement, began to be reported as it developed in pediatric patients and in young and middle-aged adults. Experience report: Man, 36 years old, without previous comorbidities, with a history of COVID-19 infection, 4 months ago, with mild evolution and spontaneous resolution, seeks care for persistent fever for 20 days, generalized malaise, jaundice, choluria, chest pain and neck edema. Exams showed leukocytosis, with left shift, elevated PCR, negative blood culture. The tomography revealed an expansive lesion in the chest and cervical lymph node enlargement. The patient was admitted and underwent an exploratory cervicotomy for drainage and debridement, with prescription of intravenous antibiotics. Discussion: Multisystem Inflammatory Syndrome (MIS) associated with COVID-19 is a hyperinflammatory phenomenon that can cause organ dysfunction. Corticosteroids have been shown to be effective in treatment, but early diagnosis is crucial for a good prognosis. Conclusion: Adult Multisystem Inflammatory Syndrome (MIS-A) is a post-COVID-19 complication that can occur weeks after the initial infection. In this patient's case, multidisciplinary treatment, including surgery and various drug therapies, resulted in recovery. The case emphasizes the importance of raising awareness about MIS-A among health professionals and the need for research to improve diagnoses and treatments, as well as the importance of early interventions to manage the condition.

Sweet syndrome in pregnancy: A narrative review.

The aim of this review is to increase obstetrician awareness of pregnancy-associated Sweet syndrome. Patients present with fever, leukocytosis, and skin eruption, which can mimic other infectious or inflammatory conditions, but do not respond to antibiotics. A search using PubMed, EMBASE, and Web of Science Core Collection was conducted to review all reported cases of pregnancy-associated Sweet syndrome, an acute febrile neutrophilic dermatosis occurring during pregnancy or postpartum. A total of 33 episodes among 30 patients were identified, with the majority (54.5% [18]) of cases occurringwithin the second trimester. Among the 30 patients, skin lesions most commonly affected the head and neck (73.3% [22]), with rare oral or ocular involvement. Leukocytosis was the most common laboratory finding, reported in 96.7% [29] of patients, with neutrophil predominance noted in 70.0% [21]. The diagnosis was confirmed for all patients with pathognomonic results of skin biopsies. Of the 27 cases detailing treatment, systemic corticosteroids were most frequently used (19 cases), followed by conservative management (seven cases), and dapsone (one case). The dapsone-treated patient and 15 of the 19 steroid-treated patients experienced resolution, but additional management strategies were required in the remaining four individuals. Spontaneous resolution occurred during pregnancy in six of the seven conservatively managed individuals, with one patient experiencing spontaneous abortion shortly after skin eruption at 10 weeks of gestation. No associated maternal deaths were reported. Obstetric complications of pregnancy-associated Sweet syndrome included endomyometritis, sterile placental abscesses, and abdominal wall necrosis. Delivery of healthy infants occurred in 24 of the 25 cases that presented fetal outcome, which included two infants who underwent medically indicated preterm deliveries.

Antegrade long giant ileocolic intussusception via colon–cecum cancer lead points: case report with focus on the sign of the python colon

BackgroundIleocolic intussusception is a rare condition that is difficult to diagnose. A pathological lead point, usually malignant, is often the cause of adult intussusception. In emergency scenarios, radiologists must be able to identify this entity and its causes and express their opinions on associated complications.Case presentationThe hospital's emergency room admitted a 75-year-old woman who was suffering from intermittent abdominal pain and constipation. An abdominal contrast-enhanced computed tomography revealed a long giant ileocolic intussusception. Considering the clinical stability and the absence of signs of complications on CT, the patient did not undergo an urgent surgical procedure but underwent a colonoscopy the following day. Surprisingly, the colonoscopy highlighted the spontaneous resolution and revealed the presence of the three tumour lead points in the cecum and ascending colon. A CT was performed after the colonoscopy, confirming the intussusception's resolution. The surgeon performed a right oncological hemicolectomy. The malignant lead points on histological examination were moderate to poorly differentiated adenocarcinomas.ConclusionsA giant and long ileocolic intussusception with a long embedded visceral segment (the python colon sign) could suggest pathological lead points in the cecum and ascending colon. Despite the large size, a spontaneous resolution of the python colon is possible. In this scenario, even if, on imaging, it is impossible to macroscopically identify a lead point, in cases of giant and long ileocolic intussusceptions, every effort must be undertaken to search for the cause of the intussusception.

Spontaneous resolution and magnetic properties of lanthanide metal organic frameworks based on oxydiacetate

Chiral lanthanide metal organic frameworks (Ln-MOFs) have become a kind of promising platform for developing various chiral functional materials. However, their members are still scarce up to now, especially those obtained from spontaneous resolution. In this work, two pairs of enantiomers of chiral Ln-MOFs, namely, [Ln2(oda)3(H2O)4]·2H2O [Ln = Dy (Λ-1 and Δ-1), Gd (Λ-2 and Δ-2); oda = oxydiacetate], have been prepared from an achiral H2oda ligand by spontaneous resolution. They display homochiral Λ- or Δ-configurational 2D grid-like frameworks in the absence of any chiral source, where four carboxylate groups of oda2− ligands within each [LnIII(oda)3]3− module link to adjacent four Ln ions either in a left- or right-handed fashions. Their homochirality was further confirmed by solid-state circular dichroism (CD) spectrum. Magnetic measurements revealed that Λ-1 exhibits field-induced dual-relaxation behavior of single-molecule magnet (SMM). The effective energy barrier (Ueff) and relaxation time (τ0) of slow relaxation (SR) process are 92.63 K and 1.49 × 10−12 s, respectively. Furthermore, Λ-2 was found to show magnetocaloric effect (MCE), with the maximum magnetic entropy change (−ΔSm) of 10.02 J kg−1 K−1 at 7.0 T and 2.0 K.

A Rare Case of Membranous Nephropathy Complicated by Chylothorax.

Chylothorax can be classified into traumatic and nontraumatic based on the etiology. Nephrotic syndrome is a very rare cause of nontraumatic chylothorax in adults. A 66-year-old woman with membranous nephropathy who was non-compliant with her management, presented with dyspnea, and was found to have a large right sided chylothorax. Her chylothorax was secondary to membranous nephropathy after excluding other causes, which has been rarely reported in literature. This case highlights the possibility of nephrotic syndrome causing chylothorax, especially in patients with undiagnosed nephrotic syndrome or patients non-compliant with their management. When evaluating a patient with chylothorax, providers should consider nephrotic syndrome in the differential diagnosis. Chylothorax can be secondary to nephrotic syndrome which has been rarely reported in literature.Providers should be aware of nephrotic syndrome as a cause of chylothorax especially in patients with undiagnosed nephrotic syndrome or non-compliance with their management.Treatment of underlying cause is usually sufficient for spontaneous resolution of chylothorax with or without pleural fluid evacuation.

Coordinated expansion of memory T follicular helper and B cells mediates spontaneous clearance of HCV reinfection.

Follicular helper T cells are essential for helping in the maturation of B cells and the production of neutralizing antibodies (NAbs) during primary viral infections. However, their role during recall responses is unclear. Here, we used hepatitis C virus (HCV) reinfection in humans as a model to study the recall collaborative interaction between circulating CD4 T follicular helper cells (cTfh) and memory B cells (MBCs) leading to the generation of NAbs. We evaluated this interaction longitudinally in subjects who have spontaneously resolved primary HCV infection during a subsequent reinfection episode that resulted in either another spontaneous resolution (SR/SR, n = 14) or chronic infection (SR/CI, n = 8). Both groups exhibited virus-specific memory T cells that expanded upon reinfection. However, early expansion of activated cTfh (CD4+CXCR5+PD-1+ICOS+FoxP3-) occurred in SR/SR only. The frequency of activated cTfh negatively correlated with time post-infection. Concomitantly, NAbs and HCV-specific MBCs (CD19+CD27+IgM-E2-Tet+) peaked during the early acute phase in SR/SR but not in SR/CI. Finally, the frequency of the activated cTfh1 (CXCR3+CCR6-) subset correlated with the neutralization breadth and potency of NAbs. These results underscore a key role for early activation of cTfh1 cells in helping antigen-specific B cells to produce NAbs that mediate the clearance of HCV reinfection.

Endovascular surgery for chronic subdural hematoma

Background: Endovascular surgery is rapidly advancing and is widely used for the management of various cerebrovascular diseases. Usually, chronic subdural hematomas are treated surgically; however, endovascular surgery is recently being attempted as a new treatment option based on the pathophysiology of this condition.Current Concepts: Chronic subdural hematomas have an outer membrane derived from the dura mater. Sinusoidal capillaries in the outer membrane are a source of bleeding, which leads to hematoma growth and postoperative recurrence. Theoretically, embolization of the middle meningeal artery using endovascular procedures can prevent bleeding from the outer membrane and promote spontaneous resolution of a hematoma. Clinical studies, including recent prospective trials, have demonstrated the superior efficacy and safety of middle meningeal artery embolization over conventional treatment.Discussion and Conclusion: More clinical trials on endovascular surgery for chronic subdural hematomas are forthcoming. We expect that the results of future studies will strengthen the findings of recent prospective trials and contribute to a major shift in the management of chronic subdural hematomas.

A clinical dilemma: Performing or avoiding root instrumentation in the treatment of the acute phase of endodontic‐periodontal lesions? A case report

AbstractBackgroundThis study presents the diagnois, management, and tissue response to an acute periodontal lesion with deep pocketing affecting a maxillary central incisor in a young patient devoid of caries or a history of periodontitis.MethodsClinical and radiographic examinations facilitated the diagnosis of the pathology as an endoperiodontal lesion (EPL) with root damage, exhibiting supracrestal invasive root resorption. Orthograde endodontic therapy was employed to decontaminate and seal the endodontic space. The resorptive site was treated through the endodontic access, debrided, and sealed. No periodontal therapy (surgical or nonsurgical) was performed. No mechanical instrumentation was performed within the pocketed root surface.ResultsAt 6‐month and 1‐year follow‐ups after endodontic therapy the periodontium displayed a physiologically healthy condition without pus or inflammation, exhibiting a circumferential probing depth of 2 mm, and absence of tooth mobility. These favorable outcomes persisted throughout a 4‐year follow‐up period.ConclusionsThe spontaneous healing of pocketing and abscess occurred without mechanical root instrumentation following endodontic therapy and treatment of external invasive root resorption in an EPL.Key Points Accurate diagnosis and identification of relevant etiologic factors are pivotal for effectively managing endodontic‐periodontal lesions. Once a diagnosis is established, the therapy focuses on eliminating the primary cause, followed by a subsequent diagnostic phase after healing. The definitive understanding of the diagnosis and etiology of endodontic‐periodontal lesions often becomes clear in retrospect, based on the outcomes of the therapy. When probing acute periodontal lesions, deep probing depths may occur without permanent loss of periodontal attachment. If the acute lesion was not induced by a periodontal cause and if no periodontal etiology arises secondarily, resolving the primary cause of the endoperiodontal lesion can lead to the spontaneous resolution of the pocketing. This results in spontaneous healing of periodontium without the need for intentional periodontal therapy. A clinical dilemma arises when considering periodontal treatment during the acute inflammatory phase of endo‐periodontal pathology. It is advisable to refrain from mechanical root instrumentation particularly if a clear periodontal cause is not apparent, to prevent from iatrogenic damage to periodontal fibers and the potential risk of gingival recessions. However, this does not imply avoiding periodontal therapy entirely for every case. Rather, it is recommended to delay the decision on root instrumentation until a new diagnostic phase is conducted following the healing of the endodontic etiology.

Stiffness sensing via Piezo1 enhances macrophage efferocytosis and promotes the resolution of liver fibrosis.

Tissue stiffening is a predominant feature of fibrotic disorders, but the response of macrophages to changes in tissue stiffness and cellular context in fibrotic diseases remains unclear. Here, we found that the mechanosensitive ion channel Piezo1 was up-regulated in hepatic fibrosis. Macrophages lacking Piezo1 showed sustained inflammation and impaired spontaneous resolution of early liver fibrosis. Further analysis revealed an impairment of clearance of apoptotic cells by macrophages in the fibrotic liver. Macrophages showed enhanced efferocytosis when cultured on rigid substrates but not soft ones, suggesting stiffness-dependent efferocytosis of macrophages required Piezo1 activation. Besides, Piezo1 was involved in the efficient acidification of the engulfed cargo in the phagolysosomes and affected the subsequent expression of anti-inflammation genes after efferocytosis. Pharmacological activation of Piezo1 increased the efferocytosis capacity of macrophages and accelerated the resolution of inflammation and fibrosis. Our study supports the antifibrotic role of Piezo1-mediated mechanical sensation in liver fibrosis, suggesting that targeting PIEZO1 to enhance macrophage efferocytosis could induce fibrosis regression.

Spontaneous Resolution of Acute Subdural Hematoma in a Patient with Thrombocytopenia: A Blessing in Disguise

AbstractAcute subdural hematoma (SDH) constitutes one of the most common emergencies in neurosurgery and its spontaneous resolution is an uncommon phenomenon. Several theories have been described to explain this phenomenon including redistribution of subdural blood, dilution by cerebrospinal fluid, and brain atrophy. Rapid resolution of acute SDH related to thrombocytopenia is a rare phenomenon. We report a case of a patient who showed rapid resolution of acute SDH with thrombocytopenia and also discuss such a rare case with speculation of the thrombocytopenia as a factor to promote this phenomenon.

An initial experience of robot-assisted breast conserving surgery: A multicenter study of the Korea Robot-Endoscopy Minimal Access Breast Surgery Study Group (KoREa-BSG).

543 Background: Robot-assisted breast conserving surgery (RABCS) have cosmetic benefit without any scar on the breast over conventional breast conserving surgery (CBCS). However, data on the feasibility and safety of the RABCS are limited. The aim of this study was to present the results of early experience of RABCS. Methods: A multi-center retrospective review was conducted to identify women who underwent RABCS as part of the Korea Robot-Endoscopy &amp; Minimal Access Breast Surgery Study Group (KoREa-BSG) between August 2019 and October 2023. Information of the clinicopathologic characteristics, perioperative complications, operation time, recurrence, and re-operation were collected. Results: A total of150 patients underwent the RABCS procedure conducted by 10 breast surgeons at seven institutions. Invasive breast cancer was noted in 121 cases and ductal carcinoma in-situ was detected in 29 cases. Further, 75.3% and 65.3% of the patients had an estrogen and progesterone receptor positive status, respectively. A total of 35.3% of the patients had a HER2-positive status. In terms of the surgical technique, the Da Vinci SP system was more frequently used (60%). Gas insufflation was applied in 97.33% of the cases, and s entinel lymph node biopsy (SLNB) only was the most common axillary surgery (89.3%). The median duration of postoperative days was 5.4 days (range, 1.0-15.0 days). The incision location was the mid-axillary line and the median incision length was 37.1 mm (range, 27.0-60.0 mm). The median total operation time was 133.8 minutes (range, 62.0-295.0 minutes). 11 cases (7.3%) showed frozen margin positive, however only one case (0.7%) required re-operation because of permanent margin positive. Six patients (4%) developed surgical complications. Postoperative bleeding was found in one case and skin burn was found in five cases (3.3%); two cases (1.3%) required skin excision and three cases (2.0%) showed spontaneous resolution. There were no cases of conversion to open surgery or mortality. Only one case (0.7%) had recurrence. Conclusions: This was the first multicenter report of RABCS in the world. RABCS could be a technically feasible and safe. Further subsequent comparative study with CBCS and prospective research are needed to evaluate the surgical and oncologic outcomes.

Vitreomacular traction: diagnostics, natural course, treatment decision and guideline recommendations

Vitreomacular traction is atractive foveolar adhesion of the posterior vitreous limiting membrane, resulting in pathological structural alterations of the vitreomacular interface. This must be differentiated from physiological vitreomacular adhesion, which exhibits acompletely preserved foveolar depression. Symptoms depend on the severity of the macular changes and typically include reduced visual acuity, reading problems and metamorphopsia. High-resolution spectral domain optical coherence tomography (SDOCT) imaging enables classification of the sometimes only subtle morphological changes. If pronounced vitreomacular traction is accompanied by epiretinal gliosis and alterations to the outer retina, it is referred to as avitreomacular traction syndrome. Vitreomacular traction has ahigh probability of spontaneous resolution within 12months. Therefore, treatment should only be carried out in cases of undue suffering of the patient and with symptoms during bilateral vision and alack of spontaneous resolution. In addition to pars plana vitrectomy, alternative treatment options, such as intravitreal injection of ocriplasmin and pneumatic vitreolysis are discussed for vitreomacular traction with an associated macular hole; however, ocriplasmin is no longer available in Germany. The best anatomical results in comparative investigations were achieved by vitrectomy. Pneumatic vitreolysis is controversially discussed due to the increased risk of retinal tears. In one of the current S1guidelines of the German ophthalmological societies evidence-based recommendations for the diagnostics and treatment of vitreomacular traction are summarized.

Presumed Pituitary Apoplexy Resulting in the Spontaneous Resolution of a Pituitary Neuroendocrine Tumor: A Case Report

Presumed Pituitary Apoplexy Resulting in the Spontaneous Resolution of a Pituitary Neuroendocrine Tumor: A Case Report

Beyond the liver: unveiling rhabdomyolysis as a rare complication of hepatitis A

Hepatitis A is a mild self-limiting infection of the liver with spontaneous resolution of symptoms in most cases. However, clinicians should be aware of some commonly encountered complications and extrahepatic manifestations associated with hepatitis A for timely diagnosis and treatment. Rhabdomyolysis, an exceedingly rare complication of hepatitis A, is scarcely documented. We present a case of a 64-year-old man with symptoms consistent with rhabdomyolysis and an evanescent rash secondary to acute hepatitis A. He eventually recovered with conservative management. This case emphasizes the importance of recognizing and treating atypical presentations of acute hepatitis A infection.