Medicine
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Spontaneous retroperitoneal hematoma (SRH) is a rare but potentially fatal condition, often associated with anticoagulation therapy. With the global prevalence of COVID-19 and the widespread use of anticoagulants in its management, there is an increasing need to recognize rare but serious complications like SRH. This case report aims to emphasize the importance of early recognition and intervention of SRH in patients with COVID-19 undergoing anticoagulation therapy, to improve patient outcomes and reduce mortality. ⋯ This case underscores the critical need for vigilance in monitoring patients on anticoagulation therapy, particularly those with COVID-19, for signs of SRH. Early recognition and prompt intervention are essential to improve outcomes. Clinicians should maintain a high index of suspicion for SRH in patients presenting with unexplained abdominal pain and hypovolemic shock, even in the absence of typical risk factors.
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Carbapenem-resistant Klebsiella pneumoniae (CRKP) bloodstream infections are a severe complication resulting from granulocyte deficiency following chemotherapy for hematologic malignancies and have a high mortality rate. However, reports of disseminated organ infections secondary to bloodstream infections are rare. ⋯ Ceftazidime-avibactam exhibited satisfactory efficacy and safety in the 2 cases of disseminated organ infection secondary to CRKP bloodstream infection following chemotherapy for acute lymphoblastic leukemia.
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Observational Study
Predictive value of preoperative circulating tumor cells combined with hematological indexes for liver metastasis after radical resection of colorectal cancer.
Colorectal cancer is one of the most common malignant tumors in the world, and about 50% of its advanced patients will have liver metastasis. Preoperative assessment of the risk of liver metastasis in patients with colorectal cancer is of great significance for making individualized treatment plans. Traditional imaging examinations and tumor markers have some limitations in predicting the risk of liver metastasis. ⋯ Furthermore, the data obtained were included in multivariate regression analysis, and CEA, CA72-4, CK-7, and CTC counts were independent risk factors for liver metastasis after radical resection of colorectal cancer (P < .05). This study confirmed that CEA, CA72-4, CK-7, and CTC counts are independent risk factors for liver metastasis after radical resection of colorectal cancer. In addition, the prediction model of this study can help gastrointestinal surgeons accurately identify patients who are prone to liver metastasis after colorectal cancer surgery.
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Gitelman syndrome (GS) is a rare hereditary electrolyte disorder caused by mutations in the SLC12A3 gene. There is limited literature on the role of hydrochlorothiazide (HCT) testing and the SLC12A3 single heterozygous mutation in the diagnosis and management of patients with GS. In addition, cases of GS with concomitant kidney stones are rare. ⋯ When unexplained hypokalemia is observed, the HCT test can help with the diagnosis of GS. When genetic testing reveals that a patient only carries only 1 SLC12A3 mutant allele, he requires further genetic evaluation. The patient's combination of kidney stones and cysts could not exclude the diagnosis of GS. Patients with GS and diabetes should be monitored for the development of diabetic ketoacidosis.
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Observational Study
Distinct prognostic impacts of age-adjusted Charlson comorbidity index and geriatric nutritional risk index in patients with intraductal papillary mucinous neoplasm.
The optimal surgical indication for intraductal papillary mucinous neoplasms (IPMN) remains highly contentious. We aimed to determine the preoperative predictive factors of malignancy and independent prognostic factors in patients with IPMN who underwent curative-intent resection. In this study, 104 patients with a pathological diagnosis of IPMN who underwent curative-intent resection were included. ⋯ These 2 factors were associated with significantly worse disease-specific survival after surgery. The ACCI and GNRI emerged as independent prognostic factors after surgery in patients with IPMN. These findings highlight the importance of patient-conditional factors as valuable indicators for predicting favorable long-term survival outcomes after surgery and for facilitating a more precise assessment of surgical eligibility in patients with IPMN.