臨床症例報告ジャーナル

Amyloidosis is a sistemic disease characterized by accumulation in the extracellular and perivascular spaces of insoluble fibrillar proteins (amyloid), which determines the impairment of the function of the affected tissues. Clinically it can mimic conditions. In the case report we reported the case of a clinical overlap with Sjögren's syndrome.

A 59-year-old man with Benign Symmetrical Lipomatosis (BSL) who underwent the neck and chest lipomas resection under general anesthesia is described. Benign Symmetrical Lipomatosis (BSL) is a rare fat metabolism disorder characterized by the most common symptom of nonencapsulated axial lipomas symmetrically diffused around the neck. The airway was secured by video laryngoscopy intubation in this case. Sober local anesthesia or topical anesthesia may provide a simple and safe available method to retain spontaneous breathing for patients with BSL under general anesthesia. 

Objective: To find out the incidence of iatrogenic bile duct injury following open and laparoscopic cholecystectomy and their postoperative outcome.

Material and methods: Twenty patients with iatrogenic bile duct injuries were admitted through the OPD and emergency department of PMC Hospital Nawabshah. Apart from baseline investigations, MRCP and ERCP were performed in selected cases. Postoperatively patients were monitored in the surgical ward and sent home after removing their drains. Patients were followed up in the OPD for 6 months. Data was collected and analyzed on SPSS Version 10.

Results: Out of 20 cases, 8 (40%) sustained injuries in our unit while 12 (60%) were referred from peripheral hospitals. The mean age was 40± 3 years and the male to female ratio was 1:4. Presenting complaints were jaundice, abdominal pain and persistent bile discharge. Procedure performed included Roux en Y (65%), choledochoduodenostomy (25%) and primary repair over T-tube (10%). Post-operative complications were bile leak (10%), wound infection (15%) and recurrent cholangitis (5%). Mortality was zero. The average hospital stay was 10-15 days.

Conclusion: Roux en Y choledochojejunostomy is the preferred surgical procedure for iatrogenic bile duct injuries with minimal postoperative complications.

A 29-year-old woman with an 8-year history of retinitis pigmentosa presented with decreased visual acuity in both eyes. We collected her examinations and diagnosed her with retinitis pigmentosa, macular schisis and lamellar macular holes in both eyes. We proposed the poor condition of retina, caused by retinal pigmentosa, resulted in macular schisis and lamellar macular holes. 

The ingestion of a foreign body is a frequent cause of gastrointestinal emergency in pediatric population. Toothbrush swallowing is a rare event. Foreign bodies greater than 6-10 cm length are unable to negotiate the curvature of the duodenum with its fixed retroperitoneal attachment. Therefore, spontaneous passage of a toothbrush is unlikely and its removal via endoscopy is highly recommended. When the ingested object is a toothbrush, eating disorders as bulimia or other psychiatric disorders should be suspected. We present a case of a 15-year-old girl who swallowed accidentally a toothbrush that was removed via laparoscopy after unsuccessful endoscopy.

Tongue piercing has a long history of being associated with religious and cultural symbolism. In recent years it has grown popular among teenagers and young adults. Several complications may be associated with this practice. Infection of the piercing site is a common complication, which can result in abscess formation or formation of granuloma over the period of time. The management of this complication is always removal of the tongue stud and surgical debridement of the infected site. We present the case report of a patient with chronic infection of the tongue which resulted due to a tongue stud which got embedded submucosally within the tongue.

Introduction: Testosterone (T) therapy is able to promote biochemical, body composition and Cardiovascular (CV) alterations in Transgender Men (TM). However, existing data concern TM between 18 and 50 years old. Objective: To describe the first year of usage of T in a 52-year-old TM: Hormonal and biochemical changes, body composition and CV aspects during exercise. Methods: Medical record review was accessed as well as laboratorial and image exams performed during the first year of T use. Results: TM, 52-years-old, no previous usage of T, initiated testosterone undecanoate 1000 mg. A second dose was given 6 weeks after the first one and then every 12 weeks. By the third month of treatment, the highest level of T was noted (586 ng/dL). After 7 months of treatment, hemoglobin and hematocrit reached their highest levels, 16.3 g/dL and 47.1% respectively, and dropped to 15.5 g/dL and 43.6% by the twelfth month. LDLc increased 31% by the seventh month and returned to baseline by the twelfth month. Bone density increased 3.1% in lumbar spine (L1-L4) and 2.7% in femoral neck. The Muscle Mass (MM) increased 10.9% in one year. Pretreatment Ergometric Test (ET) showed increase in Systolic Blood Pressure (SBP) of 38.4% (130 to 180 mmHg) during exertion and decrease of >100% in the sixth minute of passive recovery. Heart Rate (HR) increased 73 bpm during ET and returned to baseline at the third minute of rest (reduction of 72 bpm). One year post treatment results showed that SBP increased 61.5% (130 to 210 mmHg) and decreased >100% after six minutes of rest. HR increased 67 bpm during exertion and decreased by 75 bpm at the third minute of rest. Discussion: A meta-analysis covering studies lasting 6 to 12 months with TM using testosterone undecanoate 1000 mg every 12 weeks showed that the increase of Hb and HT ranges from 4.9% to 12.5%  and 4.4% to 17.6%, respectively, which is much lower than the averages presented in our case (23 and 27%, respectively). Progressive increase of LDLc up to 18.7% is described in the literature. The lowest drop in fat mass is described in young TM. Young cis women and men present an increase in SBP during ET around 34.0% and 39.8%, respectively, and in the third minute of recovery a drop around 20.6% and 23.4%. HR drops from 60.5 to 64.53 bpm in the third minute of rest and higher recoveries are associated with better parasympathetic reactivation and lower mortality. Conclusion: TM over 50 years old seems to present higher increase of Hb/HT and decrease of HDLc when compared to younger TM. The lowest HR increase and highest variation of SBP during ET after 1 year of T might be a consequence of enlarged cardiac chambers, increased systolic volume and peripheral vascular resistance. 

The restoration of a fractured anterior tooth by fragment reattachment is biological, conservative, and the most currently acceptable treatment option. In addition, the advancements in adhesive dentistry, tooth fragment reattachment procedure has become simpler and clinically reliable. This article presents management of two cases of complicated crown fracture of maxillary incisors by reattachment of the fractured tooth segment.