Asploro Journal of Biomedical and Clinical Case Reports | ISSN: 2582-0370

This case describes a 52-year-old female who presented with abnormal movements of the left side of her tongue. The patient was diagnosed with radiation induced myokymia of the tongue. This diagnosis was established based on history and exam findings, while also ruling out the original concern of recurrence of her tonsillar cancer using MRI imaging. The standard for diagnosing myokymia is through the use of electromyographic studies, however this study was not possible with the resources at the hospital.

Background: Liver transplantation serves as an essential therapeutic intervention for patients with end-stage liver disease. However, the occurrence of postoperative acute kidney injury (AKI) can markedly affect the clinical prognosis of these patients. Existing models to predict AKI after liver transplantation have limitations in specificity and accuracy, necessitating an updated model.
Methods: We conducted a study adhering to the TRIPOD guidelines, including patients who underwent liver transplantation at West China Hospital from 2016 to 2020. Clinical data encompassing demographics, comorbidities, and intraoperative variables were collected. The LASSO regression was used to identify optimal predictors of AKI, leading to the development of a predictive nomogram. The model’s discrimination and calibration were assessed using AUC and calibration curves, respectively.
Results: The nomogram, developed from 296 patients in the development cohort and validated on 142 patients, identified surgery duration, intraoperative blood loss, and preoperative serum creatinine as predictors of AKI. It demonstrated good discrimination with AUCs of 0.720 and 0.725 for the development and validation cohorts, respectively. The calibration curve confirmed the model’s accuracy in predicting AKI probabilities.
Conclusion: The developed nomogram offers a novel model for predicting AKI risk after liver transplantation, with robust discrimination and calibration. Further multicenter validation and potential integration of genetic and molecular biomarkers for improved accuracy are needed.

The incidence of spontaneous cerebellar hematomas (SCHs) during late pregnancy is increasing, though still rare. Managing parturients with SCHs poses significant challenges due to the need to balance maternal safety with neonatal considerations, requiring a multidisciplinary approach. This report presents two cases where general anesthesia was used for concurrent Caesarean section and craniotomy. Both patients, at 36 weeks’ gestation, presented with severe headaches, nausea, vomiting, and gait ataxia. MRI scans revealed cerebellar hematomas, necessitating surgical intervention. Both surgeries were successful with stable maternal vital signs and healthy neonates delivered with high APGAR scores. Postoperative recovery was uneventful, and both patients were discharged without neurological deficits. The report emphasizes the importance of rapid induction and recovery, maintaining hemodynamic stability, and ensuring sufficient cerebral perfusion while avoiding fetal depression during such complex procedures.Background

Type 2 diabetes (T2D) is a crucial disease, and glucagon-like peptide 1 receptor agonists (GLP-1RA) have become prevalent as effective oral hypoglycemic agents (OHA). GLP-1RA has clinical effects such as improving glucose variability, reducing weight, and decreasing the risk of cardiovascular disease (CVD). However, recent problems include discontinuation, dropout, and incomplete adherence to GLP-1RA. The discontinuation rates of GLP-1RA were 26.2%, 30.8%, and 36.5% at 3, 6, and 12 months, respectively, and increased to 50.3% for obese patients without T2D. Discontinuation was significantly higher for patients with heart failure (odds ratio 1.09) and CVD (1.08), but not for those with CKD (1.03).

Background: Emphysematous cystitis (EC) and emphysematous pyelonephritis (EPN) are severe emphysematous urinary tract infections with high mortality. Early diagnosis is often missed due to the lack of typical clinical manifestations.
Case Presentation: A 64-year-old woman with type 2 diabetes was transferred to the emergency department for cough and expectoration with shortness of breath. A CT scan revealed gas formation in the bilateral renal pelvis, bilateral ureter, and bladder cavity. Urine bacterial cultures showed Escherichia coli and Streptococcus gallolyticus. The patient’s bladder was drained, and she was administered antibiotics, insulin, and a non-invasive ventilator. The gas disappeared completely, and the patient recovered uneventfully.
Conclusion: This is the first reported case of Escherichia coli combined with Streptococcus gallolyticus infection in EC and EPN. More attention should be paid to EC and EPN in diabetes patients. Early conservative treatment is effective.

Mechanical ventilation is the cornerstone of management for critically ill patients and those undergoing general anesthesia. Currently, lung protective ventilation strategies primarily include low tidal volume, positive end-expiratory pressure, and limited pressure, combined with certain recruitment maneuvers. Recently, driving pressure has been proposed as a key parameter to optimize mechanical ventilation. This study reviewed the relevant literature and suggests that driving pressure may be correlated with improved survival in patients with acute respiratory distress syndrome, enhanced intraoperative pulmonary mechanics, reduced postoperative atelectasis, and better gas exchange and oxygenation, even in normal lungs. However, the correlation between driving pressure and postoperative pulmonary complications has also been described as controversial. These findings could serve as a reference for future clinical practice.

Hepatoblastoma is a rare type of pediatric malignant disease and represents the most frequent cause of liver tumors during childhood. We describe the diagnosis and treatment of a 14-month-old female patient who presented with abdominal swelling, anorexia, and weight loss. Initial investigations indicated elevated alpha-fetoprotein levels and thrombocytosis. A CT scan showed a heterogeneous mass arising in the right lobe of the liver. Histology revealed hepatoblastoma, epithelial type, and fetal pattern. The patient was treated as a standard risk according to the Pretext classification (Pretext I-III) with neoadjuvant Cisplatin (4 cycles) following the SIOPEL 3 protocol, resulting in a 40% reduction in tumor size and a successful partial hepatectomy.

Objective: To evaluate preoperative, postoperative, and follow-up of spinal and pelvic parameters using EOS 3D imaging in adolescent idiopathic scoliosis (AIS) patients who underwent simultaneous translation on two rods (ST2R) technique for corrective posterior spinal surgery.
Methods: Five patients had surgical correction of Lenke type 1 or 2 AIS using the ST2R technique. The preoperative average Cobb angle was 72.4° ± 19.4. Low-dose standing biplanar radiographs were obtained to evaluate several spinal and pelvic parameters preoperatively (five patients), immediately postoperatively (four patients), and at follow-up (four patients). Three-dimensional reconstructions were performed (a total of 13 reconstructions).
Results: The mean number of levels fused was 11.2° ± 2.0. The number of pedicle screws used for constructs averaged 19.2° ± 3.06 (1.75 density screw per vertebra). The Cobb angle values were significantly changed by the operation (75° ± 21 to 28° ± 7, p = 0.009), but no other parameters were altered. The maximal apical axial change at the junctional region was 32.8° (absolute value), and the minimal apical axial change at the apical region was 4.8° (absolute value). The intervertebral rotation difference in the axial plane was larger near the apical region (T8-T9), from 2.1° ± 2.7 to -14° ± 6.9, and smaller near the junctional region (T12-L1), from -2.6° ± 2.9 to -1.1° ± 8.4.
Conclusion: This case series suggests that corrective posterior spinal surgery for AIS using ST2R can achieve both 3D correction of the spine and additional intervertebral axial rotation, with minimal deterioration during follow-up. Preoperative, postoperative, and follow-up evaluation can be accurately evaluated with EOS low-dose 3D imaging.

The incidence of magnet ingestion among children is increasing, though it remains rare. This case describes a 3-year-old child who ingested multiple magnetic beads and was planned to have the foreign bodies removed by endoscopy under sedation. However, perioperative hypoxemia occurred because gastric perforation had not been detected beforehand. An exploratory laparotomy was performed immediately, all magnetic beads were extracted, and the stomach perforation was closed. This report emphasizes the importance of anesthesia evaluation, anesthesia preparation, airway management, and intraoperative circulation maintenance.

A 52-year-old woman with chronic low back pain was found to have a leiomyosarcoma causing a tumor thrombus obstructing the IVC, visible on transesophageal echocardiography. After surgery, which included tumor and thrombus removal, a residual thrombus was seen on imaging. Anticoagulation was started postoperatively, and the patient had a successful recovery.

Coronary artery disease is a major type of heart disease, and coronary angiography has been widely utilized as a diagnostic method. Percutaneous coronary intervention (PCI) has become an important approach for restoring coronary perfusion. The vasovagal reflex is a common and potentially life-threatening acute complication associated with coronary interventions, which can lead to cardiac arrest in severe cases. This case report describes a patient with coronary heart disease who experienced vasovagal reflex-induced shock during the post-anesthesia care unit (PACU) period following the procedure.

Background: Postoperative delirium (POD) is a common complication that affects the prognosis and outcome. The risk factors of different surgical types have significance in preventing POD. Still, there are few studies on the risk factors for this complication of thoracic surgery, and further research and exploration are necessary.
Method: This study intends to conduct a prospective cross-sectional study, including patients undergoing elective thoracic surgery. The primary outcome is the incidence of POD 1-7 days after surgery or before discharge. The essential information on patients, surgery, anesthesia, and postoperative details are gathered for statistical analysis. We are exploring the potential relationship between anesthesia-related factors and POD.
Result: One hundred seventy-five patients were included in this study, and 17 (9.7%) patients developed POD. Univariate analysis showed that age-adjusted Charlson Comorbidity Index (aCCI), educational attainment, blood transfusion, artificial blood vessel replacement, and indwelling urinary catheter were statistically different. Logistic regression results showed that the aCCI index (OR 1.811, 95% CI 1.058-3.103; P=0.030), the ambulation time (OR 12.303, 95% CI 2.670-56.686; P=0.001) increased POD risk. In patients undergoing thoracotomy, blood transfusion (RR 16.875, 95% CI 2.149-132.508; P=0.012) was statistically different between POD and non-POD groups.
Conclusion: The results of this study showed that the higher the aCCI index, the later the ambulation time is the risk factor for POD in thoracic surgery patients. The risk of POD may be heightened in thoracic surgery patients who require a blood transfusion. However, additional research is warranted to confirm these findings.

Tracheal stenosis is a severe condition that significantly affects patients’ quality of life, with airway reconstruction surgery being the primary treatment. Airway management is critical during general anesthesia, especially when the airway is the surgical site. This report presents clinical concepts and cases of the successful use of laryngeal masks as a supraglottic airway for intraoperative tracheal management in patients with tracheal stenosis. As a transitional device for airway management, a laryngeal mask can provide adequate ventilation and oxygenation and should be incorporated into airway control protocols for individuals with tracheal stenosis.

We report the tracheal intubation of a 51-year-old woman with maxillofacial bone metastasis and bone destruction following surgery for breast cancer. The patient had previously undergone radical surgery for left breast cancer and was currently experiencing complications, including bone destruction and pus discharge in the left maxillofacial region. Due to the inability to eat orally and the failure of multiple nasogastric tube placements, it was decided, after multi-department consultation, to perform a jejunostomy under general anesthesia and place a jejunal nutrition tube. Preoperative head and neck CT showed that most of the mandible was missing, there was bilateral maxillofacial and neck soft tissue swelling, and bilateral nasal stenosis. The preoperative anesthesia evaluation indicated that the patient would likely have difficulties with mask ventilation, nasal intubation, and oral laryngoscopy placement. Since conventional anesthesia methods for airway establishment through the mouth or nose were not feasible, spontaneous breathing was maintained in the awake state, and endotracheal intubation was performed under combined tracheal surface anesthesia with basic sedation and analgesia. The patient cooperated well during the intubation process. After the operation, the endotracheal tube was removed, and the patient was returned to the ward.

Compared to traditional peripheral venous puncture, ultrasound-guided venous puncture has a higher success rate and fewer complications. In this case, the ultrasound-guided puncture technique successfully established two peripheral venous channels for fluid rehydration, despite the surgical position limiting the field of view and scope of the scan and circulatory failure. Ultrasound-guided peripheral venous puncture can save time for patients with hemorrhagic shock and help form a more effective rescue strategy.

This case involves a 59-year-old female with no past medical history. She was a former smoker, consuming 5 cigarettes daily from the age of 20 to 44. In late June 2024, she underwent a health check-up and was advised to have a chest CT scan. As a result, an unexpected lesion was found in the middle to upper area of the left lung, visible in the transverse aspect. The lesion had an irregular shape and measured 25.46 x 11.89 mm. Using the reconstruction method of three-dimensional (3D) computed tomography (CT) by Synapse Vincent, detailed images of the transverse, coronal, and sagittal aspects were obtained. Tumor markers were negative for CRP, CEA, and cytokeratin 19 fragment (CYFRA).

This case study presents a 53-year-old male with a history of obstructive sleep apnea, hypertension, Gastroesophageal Reflux Disease (GERD), morbid obesity, and chronic lower extremity edema who was found to be unresponsive and was diagnosed with an incidental asymptomatic portal vein aneurysm. This patient’s aneurysm was completely asymptomatic with no related findings despite this vascular anomaly usually occurring with clinical implications.

Purpose: This prospective, randomized, double-blinded study aimed to evaluate the effectiveness and safety of hydromorphone combined with ropivacaine for caudal block in children.
Patients and Methods: One hundred children scheduled to undergo hypospadias repair or congenital hip arthroplasty at West China Hospital were included. The patients were randomly allocated into the HR group (hydromorphone combined with ropivacaine) or the R group (ropivacaine only). In the HR group, patients received a single-shot caudal block with hydromorphone 10 μg/kg combined with 0.2% ropivacaine 1 ml/kg. In the R group, only 0.2% ropivacaine 1 ml/kg was administered for the single-shot caudal block. The primary outcome was the postoperative pain score for the first 72 hours in both groups.
Results: A total of 106 eligible children were screened, and 100 were included in this trial, with 50 in the HR group and 50 in the R group. The average postoperative FLACC pain score within 12 hours after surgery was significantly lower in the HR group compared to the R group (P < 0.05). The pain scores at 1 h, 6 h, and 12 h post-surgery in the HR group were significantly lower than those in the R group (P < 0.05). The incidence of moderate-to-severe pain in the HR group was markedly lower than that in the R group (P < 0.05).
Conclusion: The use of hydromorphone 10 μg/kg combined with 0.2% ropivacaine for single-shot caudal block in children can effectively reduce early postoperative pain scores and the incidence of moderate-to-severe pain. No adverse reactions were noted from hydromorphone, except pruritus.

Paroxysmal supraventricular tachycardia (PSVT) is a frequently encountered arrhythmia in emergency departments, significantly affecting cardiac function and hemodynamics. The sudden onset of severe chest pain with accompanying ST-segment elevation on the electrocardiogram (ECG) during pharmacological cardioversion is rare but requires immediate intervention with coronary vasodilators, anticoagulants, and antiplatelet agents. Continuous ECG monitoring and assessment of cardiac biomarkers are essential. In facilities with appropriate resources, urgent coronary angiography is recommended to evaluate coronary anatomy, blood flow, and collateral circulation. Due to the rarity of this presentation, we report this case as a reference for clinical diagnosis and management.

Multiple myeloma (MM) is a malignant hematologic disease characterized by the neoplastic proliferation of plasma cells in the bone marrow. It exhibits high heterogeneity, a tendency for relapse, and resistance to treatment. The primary goal of first-line therapy is to achieve deep remission and durable disease control. Current conventional treatment approaches can improve patient prognosis but have significant limitations. The emergence of novel therapies, including proteasome inhibitors, immunomodulatory agents, monoclonal antibodies, chimeric antigen receptor T-cell therapy, and immune checkpoint inhibitors, marks a new era in MM treatment. However, due to the relapsed and refractory nature of MM, future applications should consider various factors and tailor treatment strategies to individual circumstances to optimize therapeutic efficacy.

The authors have conducted various research studies in medical care, anti-aging, psychosomatic medicine, health, and sports. The VibraImage project has recently begun. Using a 70-second video of the subject’s eye, face, and head, the micro-movement and vibration parameters of frequency and amplitude are determined. The vestibulo-ocular reflex (VOR) is involved in the mechanism. These data can suggest mental attractiveness or charm. The obtained results include 10 items: aggression, stress, tension, suspicion, stability, leadership, vitality, self-control, inhibition, and nervousness. The most attractive person is referred to as a “charismatic” person, and the project is therefore named the “charisma judge evaluation.