Medicine
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In very rare cases, a primary infected abdominal aortic aneurysm (IAAA) is caused by a species of Brucella. In this report, we report such a case that was successfully treated with a novel approach. To the best of our knowledge, this was the first case occurring in China, in which an infection of the abdominal aortic aneurysm was caused by a Brucella species. ⋯ Our case study supports the premise that endovascular aneurysm repair is an appropriate alternative strategy to treat an infected abdominal aortic aneurysm. Compared with conventional surgical treatment, EVAR with long-term oral antibiotics is a simpler, less traumatic, and more efficient procedure. However, this needs to be further evaluated through long-term follow-up.
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Bezold-Jarisch reflex (BJR) occurs when the cardioinhibitory receptors in the walls of ventricles are activated by various stimuli, with typical features of bradycardia, vasorelaxation, and hypotension. This reflex usually happens in parturient intrathecal anesthesia, as a result of decreased venous return by compression of inferior vena cava, but it is only rarely reported during general anesthesia. ⋯ General anesthesia should be induced with great care in patients with giant intra-abdominal masses, and the patient should be kept in the left-lateral table tilt position before induction.
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Abdominal apoplexy is a rare and fatal emergency event, which is coined as a comparison to the cerebrovascular apoplexy. The exact mechanism of abdominal apoplexy was unclear, but arteriosclerosis, hypertension, abdominal aneurysm, and other predisposing angiopathy were considered to be the main reasons of abdominal apoplexy. The development of the imaging technology gave us more opportunities to confirm the diagnosis of abdominal apoplexy. However, the diagnosis and identification of the bleeding sites still continued to be a challenge. ⋯ The reported case is rare, given the very low incidence of abdominal apoplexy with 2 synchronous bleeding sites in GDA and IPDA. The awareness of abdominal apoplexy was still the key point in the management of this disease. Quick diagnosis by the imaging and immediate embolization were very important for the treatment.
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Pancreatic hepatoid carcinoma (PHC) is a rare form of pancreatic malignancy mimicking hepatocellular carcinoma (HCC) in morphology, immunohistochemistry, and behavior. PHC usually has an aggressive clinical course and poor prognosis. Effective treatment strategies are lacking due to poor understanding and extreme rarity of such kind of malignancy. PATIENT CONCERNS:: we present the case of a 75-year-old man with tumors in the liver and the tail of pancreas that were detected in a routine health check-up. ⋯ PHC are often associated with early liver metastasis and a poor prognosis, surgical resection combined with neoadjuvant and adjuvant FOLFIRINOX chemotherapy is proved to be efficient in such kind of malignancy, even with liver metastasis.
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Heptadactylia is a rare congenital disorder from the polydactyly family. Polydactyly is generally classified into 3 major groups: preaxial (medial ray), postaxial (lateral ray), and central polydactyly. Most common cases are related to preaxial or postaxial polydactyly. The rarity of central polydactyly can be explained in 3 ways. First, central polydactyly with duplication appearing on metatarsal is pretty uncommon. Second, the duplication appears isolated on the foot. Polydactyly is mostly associated with other physical defects or others duplications. Last, the duplication of the digital rays does not appear once but twice concerning all the digital rays and makes 7 functional toes appear. We describe this malformation with supporting iconography and radiography as well as its surgical management and functional results. ⋯ We demonstrated that treatment of foot polydactyly requires careful preoperative assessment, including radiographs and photography. A good clinical evaluation of the medial polydactyly improves type-specific recognition which may enhance the accuracy of surgical treatment. Polydactyly is frequently associated with other malformations. We recommend performing a general clinical examination to exclude concomitant malformations. We recommend surgical treatment around the onset of walking.