Medicine
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Case Reports
Lung abscess with chronic cough secondary to xanthogranulomatous pyelonephritis: A rare case report.
Xanthogranulomatous pyelonephritis (XGPN) is a form of chronic pyelonephritis caused by chronic calculus obstruction and bacterial infection, leading to the destruction of the renal parenchyma and calyces. Conservative treatment is usually not sufficient, and surgical intervention is still the main curative approach. XGPN with transdiaphragmatic extension and lung abscess formation is a rare condition. ⋯ Lung abscess secondary to transdiaphragmatic extension of XGPN is rare but should be considered in patients with lower lung infections that are unresponsive to treatment, especially infections due to unusual respiratory pathogens such as P mirabilis.
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The diagnosis of mesenteric ischemia in critically ill patients remains challenging; however, the aquarium sign, comprising a large number of bubble images in the right cardiac chambers on echocardiography, may be used as a point-of-care ultrasound finding to diagnose acute mesenteric ischemia (AMI). ⋯ In patients with risk factors for AMI, repeated evaluation for the presence of aquarium signs by echocardiography may be warranted, even if there are no abdominal findings or abnormalities in biomarkers, such as lactate levels and trends. When the aquarium sign is found, AMI should be aggressively suspected, and a definitive diagnosis should be made to initiate early therapeutic intervention.
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Case Reports
Latent infection after spinal cord stimulation device implantation for complex regional pain syndrome: A case report.
Spinal cord stimulation (SCS) is one of the invasive treatments of complex regional pain syndrome (CRPS). The positive effect has been observed for several years after implantation. However, infection is a common cause of SCS failure and device removal. ⋯ While uncommon, infection after SCS implantation can occur even 9 years later. Immediate diagnosis, proper antibiotics, and surgical removal could be needed to prevent further spread of infection and better prognosis.
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Previous studies have shown that proton pump inhibitors (PPIs) are associated with an increased risk of dementia. However, little is known about the relationship between PPIs use and Parkinson's disease (PD). This study aimed to examine whether PPI use was associated with an increased risk of developing clinically verified PD. ⋯ In the subgroup analysis, the adjusted risk of PD in the PPI and non-PPI cohorts increased in the subgroups regardless of age, sex, and comorbidities. The results of this retrospective, nationwide, population-based cohort study in Taiwan indicate that PPI use is associated with the risk of PD development. Further mechanistic studies on the effect of PPI on PD are needed.
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Case Reports
A case series of acute ischemic strokes with contralateral perfusion time delay on brain computed tomography.
Collateral circulation sustains cerebral perfusion in patients with arterial occlusion. Extensive arterial occlusion may redirect cerebral blood flow to compensate for insufficient perfusion. Cerebral artery occlusion can be observed in computed tomography perfusion imaging with increased mean transit time (MTT). However, in some cases, MTT delay occurs contralateral to the site of stenosis or occlusion. This delay cannot be explained simply by the collateral blood supply. Therefore, the authors considered the similarity of the perfusion delay observed at the normal site to that observed in subclavian steal syndrome. ⋯ The site of stenosis or occlusion did not correlate with ipsilateral perfusion delay in these 3 cases. Based on the precedent relationship between infarction and perfusion delay, we developed 2 hypotheses to explain why perfusion decreases on the contralateral side of the occlusion or stenosis. However, this study was limited because we could not identify events, like volume loss or decreased blood pressure, before stroke development.