Medicine
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Cystic parathyroid adenomas are rare and seldom arise in ectopically located glands which may be found within the carotid sheath, mediastinum, thymus, or thyroid grand. They cannot be detected consistently by any imaging methods. Unusual symptoms may bring about certain pitfalls and difficulties for the diagnosis of primary hyperparathyroidism (PHPT) caused by cystic parathyroid adenomas. Until now, there are no specific guidelines on the management of cystic ectopic intrathyroidal parathyroid adenoma (ETPA). ⋯ The diagnosis of cystic ETPA is easily overlooked for its rarity. Diagnostic pitfalls, including atypical symptoms, inconclusive imaging manifestation, and unidentified gross specimen, are highlighted. They make the diagnosis of PHPT caused by cystic ETPA challenging. Patients would rather choose surgical excision directly than invasive FNA. Acute hemorrhage of the preexisting ETPA may account for the cystic degeneration.
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Case Reports
Parathyroid adenoma presenting with spontaneous cervical and anterior mediastinal hemorrhage: A case report.
Spontaneous anterior cervical or mediastinal hemorrhage is a rare presentation of parathyroid adenoma. ⋯ In conclusion, imaging may not always be specific in identifying the source of neck hematoma and so laboratory studies should be done to rule out parathyroid adenoma as the underlying etiology.
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Non-small cell cancer with isolated unilateral renal metastasis is rare, and the role of radical nephrectomy has not been determined. In the present study, a case of a patient with solitary kidney metastasis from squamous cell lung cancer who underwent radical nephrectomy is reported. ⋯ Solitary renal metastasis is rare and squamous cell lung cancer might be the primary disease. Abdominal computed tomography (CT) is important in detecting solitary kidney metastasis during the follow up of patients with squamous cell lung cancer. Due to the rareness of isolated renal metastasis, the role of radical nephrectomy needs to be further investigated.
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Observational Study
High preoperative C-reactive protein level is a risk factor for acute exacerbation of interstitial lung disease after non-pulmonary surgery.
Several studies have investigated the incidence of and risk factors for acute exacerbation (AE) in patients with interstitial lung disease (ILD) after lung resection surgery. However, the incidence and risk factors for AE-ILD after non-pulmonary surgery are not known. The aim of this study was to investigate the incidence of and risk factors for AE-ILD after non-pulmonary surgery. ⋯ In multivariate analysis, only a high CRP level (odds ratio 2.556, 95% confidence interval 1.110-5.889, P = .028) was identified as an independent risk factor for AE-ILD after non-pulmonary surgery. The risk of AE-ILD should be kept in mind in patients with ILD and a high CRP level before non-pulmonary surgery. These patients should also be monitored carefully for development of AE-ILD after surgery.
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Case Reports
Thrombolysis in an acute ischemic stroke patient with rivaroxaban anticoagulation: A case report.
Whether intravenous recombinant tissue plasminogen activator (r-TPA) therapy can be administered in acute ischemic stroke patients treated with novel oral anticoagulants (NOACs), including rivaroxaban, remains controversial. ⋯ Although current guidelines do not recommend administering thrombolytics in patients using NOACs with a doubtful anticoagulation status and administered within the last 24 or, even more strictly, 48 hours, this and other case studies suggest that r-TPA treatment could be considered in selected acute ischemic stroke patients receiving rivaroxaban or other Xa inhibitors, taking the patient's clinical condition and the prospective clinical benefits of r-TPA into account.