Medicine
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Recurrent laryngeal nerve block is an uncommon complication that can occur after an interscalene brachial plexus block (ISB), which may lead to vocal cord palsy or paresis. However, if the recurrent laryngeal nerve is blocked in patients with a preexisting contralateral vocal cord palsy following neck surgery, this may lead to devastating acute respiratory failure. Thus, ISB is contraindicated in patients with contralateral vocal cord lesion. To the best of our knowledge, there are no reports of bilateral vocal cord paresis, which occurred after a continuous ISB and endotracheal intubation in a patient with no history of vocal cord injury or surgery of the neck. ⋯ When ISB is planned, a detailed history-taking and examination of the airway are essential for patient safety and we recommend that any local anesthetics be carefully injected under ultrasound guidance. We also recommend the use of low concentration of local anesthetics to avoid possible paralysis of the vocal cord.
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Peripheral neurological complications in primary Sjögren's syndrome (pSS) seem the most common, however the involvement of central nervous system (CNS) remains unclear. While abnormalities in pSS revealed by brain magnetic resonance imaging (MRI) are usually small discrete hyperintense areas in the white matter on T2-FLAIR weighted MRI, massive brain lesions have been rarely reported, particularly in bilateral basal ganglia. ⋯ The present case suggests that symmetry bilateral lesions can occur as a symptom of pSS, which could be induced by an autoimmune mechanism.
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Case Reports
Gastrointestinal Mucormycosis of the Jejunum in an Immunocompetent Patient: A Case Report.
Gastrointestinal Mucormycosis (GIM) is a kind of opportunistic fungal infection with poor prognosis. It usually occurs in patients with immune deficiency. We reported a case of immunocompetent male patient. ⋯ The diagnosis mainly relies on pathological examination. Early diagnosis and early application of systemic amphotericin B liposome were fundamental for improving the prognosis.
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Observational Study
Serum resistin positively correlates with serum lipids, but not with insulin resistance, in first-degree relatives of type-2 diabetes patients: an observational study in China.
To investigate whether serum resistin correlated with hypertension, obesity, dyslipidemia, or insulin resistance (IR) in Chinese type 2 diabetes mellitus (T2DM) patients and their first-degree relatives (DFDRs) in a case-control observational study. We determined the serum levels of resistin, plasma lipids, glucose, and insulin, and performed clinical assessments of hypertension, obesity, and IR for 42 T2DM patients, 74 of their DFDRs, and 51 healthy control participants with no family history of T2DM (NC group). The biochemical and clinical variables were compared between the 3 groups, and relationships between serum resistin and the other variables were evaluated using a Pearson correlation analysis. ⋯ A stratified analysis revealed significant trends in the resistin level and scores for homeostasis model assessment (HOMA) indexes for IR and insulin sensitivity in women and in the HbA1c and resistin levels in men (P < .05 for all), with DFDR subjects exhibiting intermediate values. The Pearson analysis showed that serum resistin positively correlated with total cholesterol and low-density lipoprotein cholesterol in the DFDR group only (P < .05 for both), and that resistin did not correlate significantly with HOMA indexes, blood glucose, insulin, HbA1c, triglyceride, high-density lipoprotein cholesterol, BMI, waist or hip circumference, or blood pressure. Our results suggest that elevated serum resistin might contribute to an increased risk of hyperlipidemia in DFDRs of Chinese T2DM patients.
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Primary spinal glioblastoma multiforme (GBM) is a rare clinical entity with an aggressive course and an invariably dismal prognosis. Its clinical characteristics, radiologic and pathologic findings, and treatment protocols have been discussed in a few cases. ⋯ Although therapeutic options have been improving, the prognosis of the primary spinal GBM remains poor. The treatment of primary spinal GBM entered into a central registry and multiple-center cooperation is important in establishing future therapeutic strategies.