Medicine in ophthalmology
Ophthalmology is often a branch of medicine that is viewed as minor in relation to other specialities. However, there are numerous ophthalmic manifestations of neurological, rheumatological and general medical conditions. Some of these are considered emergencies (see pages xx of this chapter), but often signs are found within the eye that lead to systemic diagnoses requiring further intervention. (Source: Medicine)
Source: Medicine - November 19, 2018 Category: Internal Medicine Authors: L.Z. Heng, Robin D. Hamilton Tags: Medicine and other specialties Source Type: research

Ocular emergencies
Ophthalmic emergencies vary widely in their nature, speed of onset and associated pathology. They can be life-threatening or sight-threatening. The medical practitioner needs to be able to identify when an ocular pathology requires intervention immediately or within 24 hours, or can be referred to outpatients. This chapter discusses the presentation, basic investigations and treatment that can save vision and, on occasions, life. (Source: Medicine)
Source: Medicine - November 15, 2018 Category: Internal Medicine Authors: L.Z. Heng, Robin D. Hamilton Tags: Medicine and other specialties Source Type: research

Physical health in psychiatric patients
Psychiatric patients have complex physical co-morbidities. They die on average 17 years prematurely, and their final years are often blighted by poor physical health. Common physical diseases are described here, along with their pathogenesis and the multiple levels of interventions to prevent and treat them. The interventions that achieve the best results are already known; the challenge is using the best evidence in the right health setting to engage patients and professionals with consistency. (Source: Medicine)
Source: Medicine - November 14, 2018 Category: Internal Medicine Authors: Peter Byrne Tags: Medicine and other specialties Source Type: research

The diagnosis and management of chronic pain
Chronic or persistent pain lasting longer than 3 months is not an uncommon problem in western Europe. It is associated with psychosocial effects that may have a serious effect on a patient's general health. Chronic pain may be nociceptive, neuropathic or mixed in nature, which may be borne out by the history and examination. Clinical examination should include an assessment of pain severity to ascertain the effects of subsequent treatment. Management of chronic pain tends to be multimodal and aims at controlling the pain to optimize patient function. (Source: Medicine)
Source: Medicine - November 12, 2018 Category: Internal Medicine Authors: J.P. Blackburn Tags: Medicine and other specialties Source Type: research

Postoperative care
Optimal postoperative care involves a multidisciplinary team of healthcare professionals and a patient-centred approach to avoid postoperative complications and enable a rapid return to normal function. During the last decade, enhanced recovery after surgery programmes have been implemented worldwide to reduce complications and length of stay – challenging traditional models of perioperative care. Some aspects of perioperative care have consensus guidelines without significant controversy, whereas others, such as perioperative fluid therapy, remain contentious. (Source: Medicine)
Source: Medicine - November 12, 2018 Category: Internal Medicine Authors: Emma Tyson, Ben Creagh-Brown Tags: Medicine and other specialties Source Type: research

Sleep disorders
Obstructive sleep apnoea –hypopnoea syndrome (OSAHS), obesity hypoventilation syndrome (OHS), periodic limb movement disorder and narcolepsy are the sleep disorders most commonly encountered in clinical practice. All four are characterized by sleep disturbance leading to daytime hypersomnolence. In OSAHS, repetitive parti al or complete upper airway obstruction leads to respiratory effort-related arousals and sleep fragmentation. Weight loss can lead to resolution of symptoms. The mainstay of treatment is continuous positive airway pressure (CPAP). (Source: Medicine)
Source: Medicine - November 12, 2018 Category: Internal Medicine Authors: James Tonkin, Susannah K. Leaver Tags: Medicine and other specialties Source Type: research

The management of acute pain
This article outlines the general principles of acute pain assessment and management in medical patients. The challenges of managing patients with acute neuropathic pain, patients with drug dependency issues and elderly patients are specifically addressed. (Source: Medicine)
Source: Medicine - November 12, 2018 Category: Internal Medicine Authors: Lenny Ng, Jeremy Cashman Tags: Medicine and other specialties Source Type: research

Acute back pain and cauda equina
Acute low back pain is a very common presentation in primary care. In the vast majority of patients, it is benign and will run an indolent course. There are multiple causes, of which most are structural. Back pain can be isolated as well as present with sciatica, which is usually unilateral. Provided there are no signs or symptoms that might suggest a more sinister cause, further investigation is rarely helpful, and patients will improve with time and simple analgesia. Education is important to alter abnormal health beliefs, and a multidisciplinary and biopsychosocial approach is ideal. (Source: Medicine)
Source: Medicine - November 12, 2018 Category: Internal Medicine Authors: Oliver Seyfried Tags: Medicine and other specialties Source Type: research

The management of pre-existing (type 1 and type 2) diabetes mellitus in pregnancy
Diabetes mellitus is common and complicates 2 –5% of pregnancies in the UK, with an increasing prevalence of pre-existing diabetes mellitus in pregnancy. Hyperglycaemia directly correlates with adverse maternal and fetal outcomes, including congenital anomaly, miscarriage, pre-eclampsia, pre-term delivery, macrosomia, stillbirth and neonatal hypoglycaemia. Optimal glycaemic control before conception and during the antenatal period is paramount to reduce these risks. Pre-pregnancy preparation should focus on glycaemic control, medication review and end-organ disease assessment. (Source: Medicine)
Source: Medicine - November 10, 2018 Category: Internal Medicine Authors: Oseme Etomi, Anita Banerjee Tags: Medicine and other specialties Source Type: research

Hypertension in pregnancy
As women are becoming pregnant at older ages, hypertension in pregnancy is more commonly encountered. Pre-eclampsia affects 5% of women. Women with known medical problems who become pregnant can also have pre-existing hypertension. This all requires careful management, particularly regarding medication review to avoid teratogenicity. These women require a multidisciplinary approach, to monitor for and reduce the risk of developing pre-eclampsia. (Source: Medicine)
Source: Medicine - November 10, 2018 Category: Internal Medicine Authors: Paarul Prinja, Catherine Nelson-Piercy Tags: Medicine and other specialties Source Type: research

Endocrine disorders in pregnancy
Endocrine disorders are a significant reason for consultation during pregnancy. Many of these conditions are common in women of fertile age and can have a profound impact on fertility and pregnancy outcome if they are not managed optimally. Diagnosis is often difficult because of the wide range of symptoms that can be experienced, especially as many of them occur as part of an otherwise normal pregnancy. Pregnancy physiology alters the normal biochemical parameters for many hormones, and interpretation must take into account the trimester of pregnancy as well as view the results in the context of the clinical presentation. (Source: Medicine)
Source: Medicine - November 9, 2018 Category: Internal Medicine Authors: Harry Gibson, Catherine Nelson-Piercy Tags: Medicine and other specialties Source Type: research

Preoperative and operative care
A huge number of surgical procedures are carried out annually. Although estimates of mortality and morbidity vary, they are generally accepted to be significant in high-risk patients. It is important to identify and optimize these patient groups before proceeding with surgery. Furthermore, accurate estimates of the risk of both mortality and morbidity in individual patients should be carried out in order to obtain valid consent. Once in theatre, a number of evidence-based interventions are undertaken to ensure optimal outcomes, with the aim of both restoring normal physiology and ensuring that postoperative recovery is as ...
Source: Medicine - November 9, 2018 Category: Internal Medicine Authors: Aoife Hegarty, Nirav Shah Tags: Medicine and other specialties Source Type: research

Genomics in medicine
Nearly all diseases have a genomic basis. This varies from rare ‘single-gene disorders’ such as Duchenne muscular dystrophy, to ‘complex’ or ‘polygenic’ diseases such as type II diabetes mellitus and ulcerative colitis. Cancer is a genomic disease in which tumour evolution is driven by serial acquisition of somatic mutations. Investigation of genetic disorders has been predicated on available technologies, which until recently have been expensive, slow, low-throughput and therefore limited in availability. (Source: Medicine)
Source: Medicine - November 9, 2018 Category: Internal Medicine Authors: Clare Turnbull Tags: Medicine and other specialties Source Type: research

Self assessment/CPD answers
Correct answer: C. Although he seems an unreliable witness, the companion is describing a new symptom (diarrhoea) in a street drinker in poor health who is unlikely to have eaten lately and is now both confused and ataxic. These suggest Wernicke's encephalopathy. Benzodiazepines (A) will reduce withdrawal symptoms, but intravenous B vitamins will save his brain (from Korsakoff's psychosis) – if this is in the earlier stages. Once his withdrawals are responding to benzodiazepines, he may need a CT scan of the head (E) if there are clinical signs of injury or localizing neurological deficits. (Source: Medicine)
Source: Medicine - November 9, 2018 Category: Internal Medicine Tags: Self assessment/CPD answers Source Type: research

Awareness, incidence and clinical significance of acute kidney injury after non-general anesthesia: A retrospective cohort study Erratum
No abstract available (Source: Medicine)
Source: Medicine - November 1, 2018 Category: Internal Medicine Tags: Erratum Source Type: research

Effectiveness of neuromuscular electrical stimulation for wrist rehabilitation after acute ischemic stroke: Erratum
No abstract available (Source: Medicine)
Source: Medicine - November 1, 2018 Category: Internal Medicine Tags: Erratum Source Type: research

Effect of LED therapy for the treatment nipple fissures: Study protocol for a randomized controlled trial Erratum
No abstract available (Source: Medicine)
Source: Medicine - November 1, 2018 Category: Internal Medicine Tags: Erratum Source Type: research

Prenatal diagnosis and pregnancy outcome analysis of thickened nuchal fold in the second trimester
To summarize the results of prenatal diagnoses and pregnancy outcomes of fetuses with thickened nuchal fold (TNF) in the second trimester. From 2009 to 2016, we studied 72 pregnant women with fetal nuchal fold (NF) measurements over 5 mm at 14 to 19 + 6 weeks or 6 mm at 20 to 28 weeks of gestation who received prenatal diagnosis. Karyotypes were first used to detect common chromosomal diseases, and then chromosome microarray analysis (CMA) was performed if karyotypes were normal. Prognoses were followed up by documentation in the hospital or over the telephone. In total, 12 fetuses with chromosomal defects, inclu...
Source: Medicine - November 1, 2018 Category: Internal Medicine Tags: Research Article: Observational Study Source Type: research

Evaluation of prognostic values of inflammation-based makers in patients with HBV-related acute-on-chronic liver failure
This study aimed to evaluate the prognostic values of these inflammatory markers in patients with hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF). 203 HBV-ACLF patients, 79 cirrhosis patients (LC), 63 chronic hepatitis B (CHB), and 81 healthy subjects (HS) participated in this cohort study. Complete blood counts and biochemical examinations were obtained after overnight fasting. Multivariate analyses of 90-day outcome predictors were analyzed by Cox regression models. Survival probability curves were calculated by the Kaplan–Meier method. The levels of NLR, MLR, RDW, MPV, RPR, and MPR were signi...
Source: Medicine - November 1, 2018 Category: Internal Medicine Tags: Research Article: Observational Study Source Type: research

Prognostic and clinical value of Targeting protein for Xenopus kinesin-like protein 2 in patients with gastrointestinal tract cancers: A meta-analysis
This study was aimed to comprehensively explore the prognostic and clinical significance of TPX2 in GI tract cancers. Methods: Eligible studies were systematically retrieved in PubMed, Embase, Web of Science, China National Knowledge Infrastructure (CNKI) and Wanfang database. The eligible studies were collected to evaluate the association of TPX2 with prognosis and clinicopathological features, with the pooling hazard ratio (HR) and odds ratio (OR) with 95% confidence interval (CI). Result: The meta-analysis suggested that overexpression of TPX2 protein was significantly correlated with poor overall survival (OS) (H...
Source: Medicine - November 1, 2018 Category: Internal Medicine Tags: Research Article: Systematic Review and Meta-Analysis Source Type: research

Ability of preschoolers to achieve maximal exercise and its correlation with oxygen uptake efficiency slope ∼ an observational study by direct cardiopulmonary exercise testing
The oxygen uptake efficiency slope (OUES) is a well-established substitute for maximum oxygen uptake ( JOURNAL/medi/04.02/00005792-201811160-00059/math_59MM4/v/2018-11-14T125209Z/r/image-tiff O2 max) in submaximal exercise effort among adolescents and adults. Few studies have analyzed the exercise capacity (EC) and OUES of children aged 4 to 6 (preschoolers). Body fat has been proved to negatively affect EC among schoolchildren. The purposes of this study were to assess the capacity of preschoolers in achieving JOURNAL/medi/04.02/00005792-201811160-00059/math_59MM5/v/2018-11-14T125209Z/r/image-tiff O2 max and evaluate...
Source: Medicine - November 1, 2018 Category: Internal Medicine Tags: Research Article: Observational Study Source Type: research

Retroperitoneal extramedullary plasmacytoma: A case report and review of the literature
Rationale: The incidence of extramedullary plasmacytoma (EMP) accounts for 3% to 4% of all cases of generalized plasmacytoma. The most common pathogenic sites are the head and the neck. It is noteworthy that the pathogenic site in this case is extraperitoneal, which is uncommon in clinical practice. In this case report, we aim to discuss the clinical features and diagnosis as well as the treatment methods of EMP. Patient concerns: A 30-year-old female was admitted to our hospital due to a palpable right upper abdominal mass without symptoms of abdominal pain, diarrhea, constipation, fever, or oliguria. Diagnosis and ...
Source: Medicine - November 1, 2018 Category: Internal Medicine Tags: Research Article: Clinical Case Report Source Type: research

Changes in choriocapillaris and retinal morphology after laser photocoagulation by OCT angiography: A case report
Rationale: Earlier studies have shown that laser photocoagulation treatments are associated with good long-term visual acuity in most patients with severe nonproliferative diabetic retinopathy (S-NPDR). Histopathologic studies of autopsied eyes have demonstrated defects in the choriocapillaris beneath the retinal laser lesions secondary to photocoagulation for S-NPDR. These lesions have been observed to expand centrifugally over time especially in the posterior pole, and the atrophy of the retinal pigment epithelium (RPE) can be significantly enlarged. There are, however, limited studies detailing the in vivo changes tha...
Source: Medicine - November 1, 2018 Category: Internal Medicine Tags: Research Article: Clinical Case Report Source Type: research

Isolated hook of hamate fracture in sports that require a strong grip comprehensive literature review
This article included case reports and literature reviews for patients with isolated hook of hamate fractures related to sports that require a strong grip from 1977 to 2016. Two experienced reviewers extracted data from each study. The following data were extracted: sample size, patient's characteristics, cause of injury, injury side, time to diagnosis and symptoms, physical examination results, diagnostic work-up, treatment, complications, and recovery period. Results: A total of 21 case reports and literature reviews with 120 patients satisfied our inclusion criteria. There was no significant difference in the time t...
Source: Medicine - November 1, 2018 Category: Internal Medicine Tags: Research Article: Systematic Review and Meta-Analysis Source Type: research

The associations among Helicobacter pylori infection, white blood cell count and nonalcoholic fatty liver disease in a large Chinese population
This study included 20,389 subjects enrolled at the International Health Care Center of the Second Affiliated Hospital of the Zhejiang University School of Medicine from January 2015 to December 2015. All participants underwent a 13C-UBT for the diagnosis of H pylori infection and ultrasonography for NAFLD as well as a blood test to determine WBC count. Multivariate logistic regression was then performed to evaluate the relationship among H pylori infection, WBC count and NAFLD. H pylori infection was detected in 38.49% (7,848/20,389) of the subjects via the UBT, and NAFLD was present in 37.24% (7,592/20,389) of the subje...
Source: Medicine - November 1, 2018 Category: Internal Medicine Tags: Research Article: Observational Study Source Type: research

Successful conservative treatment of acute traumatic occlusions of the celiac artery and superior mesenteric artery: A case report emphasizing the importance of the visceral collateral circulations
Rationale: Blunt injury of major visceral arteries such as celiac artery (CA) and superior mesenteric artery (SMA) are very rare but fatal, therefore, these injuries are challenging to trauma surgeons. The patient with occlusion of CA or SMA is theoretically viable by visceral collateral circulation. However, there are very rare cases in clinics. To date, there have been few reports of both CA and SMA occlusions after blunt trauma. Herein we describe our successful conservative treatment of patients with both CA and SMA occlusions. Patient concerns: Fifteen-year-old girl suffering from schizophrenia was transferred to...
Source: Medicine - November 1, 2018 Category: Internal Medicine Tags: Research Article: Clinical Case Report Source Type: research

Periodic paralysis with normokalemia in a patient with hyperthyroidism: A case report
Rationale: Thyrotoxic periodic paralysis is characterized by a sudden onset of hypokalemia and paralysis. This condition mainly affects the lower extremities and is secondary to thyrotoxicosis. The underlying hyperthyroidism is often subtle without typical symptoms such as palpitations, tremors, anxiety, and weight loss; this causes a difficulty in early diagnosis. Here, we reported a case of periodic paralysis in a patient with hyperthyroidism whose potassium level was within the normal range. Patient concerns: A 33-year-old Taiwanese man presented to the emergency department with bilateral limb weakness (more severe...
Source: Medicine - November 1, 2018 Category: Internal Medicine Tags: Research Article: Clinical Case Report Source Type: research

Serum levels of fetuin-A are negatively associated with log transformation levels of thyroid-stimulating hormone in patients with hyperthyroidism or euthyroidism: An observational study at a medical center in Taiwan
Fetuin-A is a protein with various biological functions. It plays a role in insulin resistance and arterial calcium deposition. Thyroid dysfunction may affect energy expenditure, glucose metabolism, and the risk of cardiovascular diseases. In the present study, we compared the serum fetuin-A concentrations in hyperthyroid patients with those in euthyroid patients. We recruited 30 newly-diagnosed hyperthyroid patients (the HY group) and treated them with anti-thyroid regimens as clinically indicated. We recruited 30 euthyroid individuals (the EU group) as controls. We compared laboratory parameters at the baseline and at 6...
Source: Medicine - November 1, 2018 Category: Internal Medicine Tags: Research Article: Observational Study Source Type: research

A prospective evaluation and management of different types of placenta praevia using parallel vertical compression suture to preserve uterus
The rising tendency of cesarean sections will lead invariably to more complications such as placenta praevia. The aim of our study was to evaluate the utility of parallel vertical compression suture to preserve uterus in cases of placenta praevia, and to propose a rational approach of these problematic cases, according to their grade of myometrial invasion. We prospectively included 95 consecutive cases diagnosed with placenta praevia (group1 [Gr1]) where we used parallel compression suture and compared to retrospectively analyzed 100 consecutive cases managed without using this technique (group 2 [Gr2]). We differentiate...
Source: Medicine - November 1, 2018 Category: Internal Medicine Tags: Research Article: Quality Improvement Study Source Type: research

Surgically treated rare intestinal bleeding due to submucosal hematoma in a patient on oral anticoagulant therapy: A case report
This report presents the case of a 70-year-old woman with acute hematochezia induced by AT. She underwent computed tomography and endoscopy. Diagnoses: Colon submucosal hematoma. Interventions: Conservative treatment had no effect, and the patient underwent emergency surgery. Outcomes: Surgical resection showed hemorrhage and necrosis in the left colon, and the patient recovered 24 hours after surgery and continued AT. Lessons: The present case indicates that the ISH should be kept in mind as a complication of AT. It can be managed conservatively in some stable patients, but emergency surgery may be needed in...
Source: Medicine - November 1, 2018 Category: Internal Medicine Tags: Research Article: Clinical Case Report Source Type: research

An estrogen receptor-positive locally aggressive smooth muscle neoplasm of the transverse colon: A case report
Rationale: Extrauterine leiomyomas (LMs) in women are often positive for the estrogen receptor (ER); however, almost all extrauterine leiomyosarcomas (LMSs) are negative for ER. Invasive smooth muscle neoplasms (SMNs) of the gastrointestinal tract walls are very rare and those ER statuses have not been well studied. Patient concerns: A 48-year-old woman presented to our hospital with a 10 years history of recurrent severe abdominal pain and diarrhea lasting about an hour, with frequency of about twice per year. She was clinically diagnosed with a submucosal tumor (SMT) of the transverse colon and underwent a partial t...
Source: Medicine - November 1, 2018 Category: Internal Medicine Tags: Research Article: Clinical Case Report Source Type: research

Urethral defect due to periurethral abscess treated with a tunica vaginalis flap: A case report
Rationale: Periurethral abscess is a life-threatening disease, and the occurrence of a urethral defect with periurethral abscess is a rare finding. In this case, the patient had a lengthy urethral defect from the bulbous urethra to the membranous urethra accompanied by periurethral abscess that developed within a short time. Herein, we report a case of a pedicle-sparing tunica vaginalis flap utilized in urethral reconstruction which degenerated due to fibrotic changes and soft tissue defects in the urethral bed. Patient concerns: The patient was a 36-year-old man with fever and lower urinary tract symptoms who had bee...
Source: Medicine - November 1, 2018 Category: Internal Medicine Tags: Research Article: Clinical Case Report Source Type: research

Modified quadruple therapy versus bismuth-containing quadruple therapy in first-line treatment of Helicobacter pylori infection in Korea; rationale and design of an open-label, multicenter, randomized controlled trial
Conclusion: The results of this study will provide solid evidence for determining the optimal treatment regimen for first-line H pylori eradication in Korea. (Source: Medicine)
Source: Medicine - November 1, 2018 Category: Internal Medicine Tags: Research Article: Study Protocol Clinical Trial Source Type: research

Effect of prophylactic palonosetron and sugammadex on postoperative nausea and vomiting in patients undergoing microvascular decompression under propofol-maintained anesthesia: A retrospective observational study
Microvascular decompression (MVD) is associated with a particularly high risk of postoperative nausea and vomiting (PONV) among craniotomy patients. However, there is no information regarding the effect of prophylactic palonosetron and sugammadex on PONV in patients undergoing MVD under propofol-maintained anesthesia. Medical records of 274 adults who had undergone MVD under propofol-maintained anesthesia were reviewed. Patients were classified into 4 groups, based on the reversal agent used (sugammadex/pyridostigmine) and whether or not prophylactic palonosetron was used. The PONV incidence and risk factors were analyzed...
Source: Medicine - November 1, 2018 Category: Internal Medicine Tags: Research Article: Observational Study Source Type: research

Feasibility of a single mediastinal drain through the abdominal wall after esophagectomy
This study evaluated the safety and effectiveness of a single mediastinal drainage tube in the thoracic and abdominal cavity after minimally invasive esophagectomy (MIE). This study was undertaken to determine if the procedure could be included in a fast-track surgery program for resectable esophageal carcinoma (EC). From June 17 to November 30, 2015, clinical data for 78 eligible patients who had undergone a fast-track surgery program and MIE were retrospectively analyzed. Twenty-eight patients had a chest tube and mediastinal drainage tube. Thirty-four patients had only a mediastinal drainage tube through the intercosta...
Source: Medicine - November 1, 2018 Category: Internal Medicine Tags: Research Article: Observational Study Source Type: research

Musculoskeletal ultrasonography for arthropathy assessment in patients with hemophilia: A single-center cross-sectional study from Shanxi Province, China
Magnetic resonance imaging (MRI) is currently considered the gold standard for assessing hemophilic arthropathy (HA) severity; however, MRI is often costly, time-consuming, and difficult to perform in children. In the present study, we evaluated the joint status of hemophilic patients from Shanxi Province, China, using musculoskeletal ultrasonography (MSKUS) and identified the factors that most strongly correlated with disease severity. The study included 104 patients with hemophilia, who underwent MSKUS examination. A total of 1248 joints (including the shoulder, elbow, wrist, hip, knee, and ankle joints on both sides) f...
Source: Medicine - November 1, 2018 Category: Internal Medicine Tags: Research Article: Observational Study Source Type: research

Complete heart block in systemic sclerosis: A case report and literature review
In this study, we report the case of a 48-year-old Chinese male who suffers from SSc and CHB. Diagnose: The patient was previously diagnosed with left anterior hemiblock (LAHB) and right bundle block with normal heart function. CHB was observed on a regular follow-up electrocardiogram (ECG) examination 1 month before his hospitalization. Interventions: A permanent dual chamber pacemaker was implanted. Outcomes: The patient responded well to pacemaker implantation treatment, and his exertional dyspnea disappeared. Lessons: The occurrence of heart block associated with SSc often appears concealed. The case highli...
Source: Medicine - November 1, 2018 Category: Internal Medicine Tags: Research Article: Clinical Case Report Source Type: research

The drug use to treat community-acquired pneumonia in children: A cross-sectional study in China
This study illustrated that drug use was partly not consistent with the recommendations of current guidelines, especially antibiotics. The drug use of CAP in children needs to pay more attention to. (Source: Medicine)
Source: Medicine - November 1, 2018 Category: Internal Medicine Tags: Research Article: Observational Study Source Type: research

Pneumomediastinum and pneumopericardium as rare complications after retroperitoneal transpsoas lateral lumbar interbody fusion surgery: A case report
We present the first report of rare complications (pneumomediastinum and pneumopericardium) after retroperitoneal transpsoas lateral lumbar interbody fusion (LLIF) surgery. Patient concerns: A 73-year-old female who underwent LLIF using the retroperitoneal approach complained of dysphagia but no other abnormal symptom after surgery. Diagnosis and interventions: A plain chest radiograph (CXR) taken immediately the following surgery did not show any unusual findings but CXR took on postoperative day (POD) 1 indicated pneumopericardium and pneumomediastinum with abnormal air density along the pericardium and mediastinum...
Source: Medicine - November 1, 2018 Category: Internal Medicine Tags: Research Article: Clinical Case Report Source Type: research

MLL-PTD in a 13-year-old patient with blast phase myeloproliferative neoplasm: A case report
In this study, we present a JAK2V617F positive MPN patient who experienced fatigue and splenomegaly, transforming into JAK2V617F negative AML. Diagnoses: A diagnosis of acute monocytic leukemia was made in MPN blast phase. Interventions: The patient received chemotherapy and allogeneic hematopoietic stem cell transplantation (Allo-SCT). Outcomes: The patient achieved complete remission twice, but relapsed twice. Relapse-free survival was only 3 months. She died about 24 months after her diagnosis. Lessons: MLL-PTD occurs in the progression of JAK2V617F positive MPN into JAK2V617F negative AML, which may be a no...
Source: Medicine - November 1, 2018 Category: Internal Medicine Tags: Research Article: Clinical Case Report Source Type: research

Perioperative predictors of moderate and severe postoperative pain in idiopathic scoliosis patients following spinal correction and fusion operations
This study explored the influencing factors of postoperative pain from a novel perspective, but some limitations existed in this present study, and future studies are needed. (Source: Medicine)
Source: Medicine - November 1, 2018 Category: Internal Medicine Tags: Research Article: Observational Study Source Type: research

Evaluating the optimal radiation dose for definitive chemoradiotherapy for esophageal squamous cell carcinoma: A single institution experience
In this study, we evaluated the effect of doses greater than the conventional radiation dose (50.4 Gy) on tumor control, tumor response, overall survival (OS), and disease-free survival (DFS). The database of patients diagnosed with inoperable ESCC from 2007 to 2015 was obtained from the cancer registry of Chi-Mei Medical Center. All categorical variables were compared using Chi-squared test. The risk of OS and DFS were estimated using Cox proportional hazards regression, and Kaplan–Meier plots presented the trend of OS and DFS with log-rank tests used to compare differences. All significance levels were set at P ...
Source: Medicine - November 1, 2018 Category: Internal Medicine Tags: Research Article: Observational Study Source Type: research

Efficacy of tasquinimod in men with metastatic castration-resistant prostate cancer: A meta-analysis of randomized controlled trials
Conclusions: Tasquinimod is associated with better rPFS in mCRPC. The toxicity of tasquinimod requires further investigation, it is not recommended for routine clinical use. (Source: Medicine)
Source: Medicine - November 1, 2018 Category: Internal Medicine Tags: Research Article: Systematic Review and Meta-Analysis Source Type: research

CT diagnosis for metastasis of clear cell renal cell carcinoma to the pancreas: Three case reports
Rationale: Clear cell renal cell carcinoma (CCRCC) metastasis to pancreas is clinically rare. Misdiagnosis for these cases is frequently due to the low incidence, lack of specific clinical symptoms, and laboratory results. Patient concerns: Three female patients aged 47 years, 69 years, and 76 years, respectively, were admitted to hospital for routine examination after resection of clear cell carcinoma of kidney for 69 months, 57 months, and 123 months, respectively. All 3 cases had no specific clinical symptoms. Routine laboratory tests and common tumor markers including CEA, AFP, CA19-9, and CA125 showed no obvious ...
Source: Medicine - November 1, 2018 Category: Internal Medicine Tags: Research Article: Clinical Case Report Source Type: research

A case report on cystic meningioma in cerebellopontine angle and recommendations for management
Rationale: Cystic meningioma located at the cerebellopontine angle (CPA) is an extremely rare occurrence. It is frequently misdiagnosed preoperatively. Little is known about the clinical features and outcome of this rare disease. Patient concerns: A 70-year-old male presenting with progressive headache and gait disturbance. Diagnosis: According to the symptoms, signs, and Gd-enhanced magnetic resonance images (MRI), a preoperative diagnosis of hemangioblastoma located in left CPA was made. Finally, the histological examination revealed a meningioma. Interventions: A complete resection, including the part of the ...
Source: Medicine - November 1, 2018 Category: Internal Medicine Tags: Research Article: Clinical Case Report Source Type: research

Rapid-onset hyponatremia and delirium following duloxetine treatment for postherpetic neuralgia: Case report and literature review
Rationale: Hyponatremia following duloxetine treatment has been reported in patients with major depressive disorder, fibromyalgia, diabetic neuropathy, or sciatic pain. The manifestations of duloxetine-induced hyponatremia are varying in different individuals. The overall prognosis for this type of hyponatremia is favorable if properly managed. Patient concerns and diagnoses: Herein, we reported rapid-onset hyponatremia and delirium in an older patient after 2 doses of duloxetine, which was used to control his postherpetic neuralgia. Laboratory examinations revealed a rapid decline in serum sodium level and indicated ...
Source: Medicine - November 1, 2018 Category: Internal Medicine Tags: Research Article: Clinical Case Report Source Type: research

Ureteral inflammatory myofibroblastic tumor: A case report and literature review
We reported an extremely exceptional case of IMT arising from the ureteral submucosa in a 54-year-old man. The patient was hospitalized with the main complaint of intermittent and moderate left abdominal pain for 2 months. Diagnoses and Interventions: Computed tomography scan revealed a nearly circular mass in the left upper ureter. Ureteroscopy showed that the ureteral lumen mucosa was smooth. However, the upper ureter was compressed and narrow. Renal dynamic imaging was performed and the measured glomerular filtration rate was 46.98 mL/min (right renal) and 9.77 mL/min (left renal), respectively. A retroperitoneos...
Source: Medicine - November 1, 2018 Category: Internal Medicine Tags: Research Article: Clinical Case Report Source Type: research

Meta-analysis of clinical trials comparing the efficacy and safety of liposomal cisplatin versus conventional nonliposomal cisplatin in nonsmall cell lung cancer (NSCLC) and squamous cell carcinoma of the head and neck (SCCHN)
Conclusions: This meta-analysis revealed that with both NSCLC and squamous cell carcinoma of the head and neck (SCCHN) patients, liposomal cisplatin-based chemotherapy offers significant advantages regarding the PD and reduced toxicities relative to conventional cisplatin. (Source: Medicine)
Source: Medicine - November 1, 2018 Category: Internal Medicine Tags: Research Article: Systematic Review and Meta-Analysis Source Type: research

Dexmedetomidine combined with local anesthetics in thoracic paravertebral block: A systematic review and meta-analysis of randomized controlled trials
Background Dexmedetomidine (DEX) improves postoperative pain scores and prolongs the duration of blockage when combined with local anesthetics (LAs) for neuraxial and brachial plexus block; however, there is little information about the effectiveness of DEX as an adjuvant to LAs in paravertebral block (PVB). Therefore, a systematic review and meta-analysis were performed to evaluate the safety and efficacy of DEX combined with LAs in PVB. Method An electronic database search from inception date to February 2018 was performed. Randomized controlled trials (RCTs) comparing DEX as an adjuvant to LAs with LAs alone for PV...
Source: Medicine - November 1, 2018 Category: Internal Medicine Tags: Research Article: Systematic Review and Meta-Analysis Source Type: research

Efficacy and safety of rituximab in childhood-onset, difficult-to-treat nephrotic syndrome: A multicenter open-label trial in Korea
Conclusions: RTX administration was safe and effective in patients with difficult-to-treat NS. One or 2 doses of RTX may be sufficient to deplete B cells and achieve better control of pediatric NS. (Source: Medicine)
Source: Medicine - November 1, 2018 Category: Internal Medicine Tags: Research Article: Clinical Trial/Experimental Study Source Type: research