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

Authors have continued radiological research for the application of three-dimensional computed tomography (3D-CT) using Synapse Vincent, Japan. The patient was a 51-year-old female with bilateral flank pain. For plain and contrasted CT scan, artery and portal late phases showed possible nutcracker syndrome (NCS) or renal vein entrapment syndrome. 3D-CT images suggested that i) there was a clear relationship between the superior mesenteric artery (SMA) and inferior vena cava (IVC), ii) a collateral vessel for the left ovarian vein (LOV), and iii) compression of the small intestine on the left renal vein (LRV). Thus, her pathophysiological mechanism was probably supposed by the 3D-CT reconstruction technique method.

Diabetic Striatopathy (DS) is an uncommon complication of diabetes mellitus (DM), characterized by the manifestation of dyskinesias and associated with imaging abnormalities in the basal ganglia. In this case study, we present a 39-year-old female patient who exhibited chorea due to severe hyperglycemia and diabetic ketoacidosis (DKA). Neuroimaging assessments, including computed tomography (CT) and magnetic resonance imaging (MRI) of the brain, confirmed the diagnosis of DS. Notably, the choreic symptoms resolved following the restoration of glycemic control and the administration of benzodiazepines (BZDs). This case report highlights the diagnostic approach and clinical presentation in a patient with concurrent DS and DKA, and it emphasizes current therapeutic protocols.

Elderly with behavioral and psychological symptoms (BPSD) have increased in nursing homes. For current research, 7 patients with BPSD treated by music therapy sessions for 3 months were evaluated using BPSD25 Questionnaire (BPSD25Q). Furthermore, Impact of Event Scale-Revised (IES-R) was conducted by health care staff who take care of each patient. As a result, four items showed decreased values of both BPSD and IES-R, which are wandering/restlessness, going out without permission, reversal of day and night, and unclean behavior. BPSD for patients and IES-R for staff showed the improvement values as 7.28 to 7.0, and 7.14 to 7.0, respectively.

Background: Machine learning, as an important branch of artificial intelligence, is more and more widely used in emergency medicine, including triage, disease diagnosis, treatment, prognosis prediction, and more. By analyzing the publication status of the literature related to machine learning in emergency medicine through bibliometric analysis, our purpose was to enlighten trends and hotspots for the future development of machine learning in emergency medicine.
Method: Two researchers retrieved and screened all the literature related to machine learning in emergency medicine from Jan. 2014 to Dec. 2023 on the Web of Science. Excel, VOSviewer, CiteSpace, and the Online Analysis Platform of Literature Metrology were applied to visualize the research trends and study the co-occurring keywords in machine learning in emergency medicine.
Results: 536 publications with a total citation of 5,181 times were identified. The global articles have increased over the past decade, and developed countries contribute the most. The United States contributed the most number of publications (34.7%), the highest number of citations (2,412), and the H-index (12.97). The number of publications from China ranked second, and the citations were 327 times with an H-index of 11, which ranked sixth and tied for second respectively. The American Journal of Emergency Medicine is the journal published most in machine learning in emergency medicine. In the identification research cluster, “mortality” and “risk” are determined to be the hotspot, while “emergency medical services” and “out-of-hospital cardiac arrest (OHCA)” are the new trend in machine learning in emergency medicine.
Conclusion: In the past decade, research on machine learning in emergency medicine has increased gradually and will increase rapidly in the next decade. The United States has an absolute advantage and takes the leading position in this field. The quantity and quality of Chinese articles are inconsistent. In the identification research cluster, “mortality” and “risk” are determined to be the hotspot, while “emergency medical services”, “out-of-hospital cardiac arrest (OHCA)” and “emergency medical services” are the new trend in machine learning in emergency medicine.

Background: Left ventricular outflow tract (LVOT) obstruction with systolic anterior motion (SAM) of the mitral valve poses significant perioperative risks during non-cardiac surgery. Transesophageal echocardiography (TEE) plays a critical role in real-time hemodynamic monitoring and management of such patients.
Case Presentation: A 76-year-old female (54 kg) with suspected hypertrophic cardiomyopathy, diagnosed with LVOT obstruction (Vmax = 3.9 m/s, PG = 59 mm Hg) and SAM, underwent laparoscopic cholecystectomy under general anesthesia. TEE-guided management included:
1. Pre-induction fluid resuscitation (500 mL succinylated gelatin) to optimize preload.
2. Anesthetic induction with midazolam, sufentanil, cisatracurium, and propofol, combined with a continuous norepinephrine infusion (0.05 μg/kg/min) to maintain systemic vascular resistance without increasing contractility.
3. Intraoperative TEE monitoring of LVOT obstruction and SAM severity during reverse Trendelenburg positioning and CO₂ pneumoperitoneum (12 cm H₂O). Fluid therapy and vasopressor titration were adjusted based on TEE findings to maintain hemodynamic stability (BP 110–140/50–90 mm Hg, HR 60–80 bpm).
4. Postoperative pain control with oxycodone and tracheal lidocaine inhalation to prevent sympathetic surges during extubation.
Conclusion: TEE-guided anesthesia management effectively mitigated the exacerbation of LVOT obstruction in this high-risk patient, highlighting its value in optimizing perioperative hemodynamics in cases of LVOT obstruction with SAM.

Background: Pheochromocytoma, a rare endocrine tumor, produces substantial quantities of catecholamines, leading to severe cardiovascular complications. Perioperative management for its surgical resection entails significant risks. This case report, detailing the anesthetic and perioperative management of a giant pheochromocytoma excision, underscores the complexity inherent in managing these tumors and emphasizes the critical importance of employing multiple monitoring modalities for dynamic assessment to guide timely therapeutic interventions.
Case Report: We report a case of a 31-year-old female patient who presented with abdominal pain and was found to have a large mass in the left retroperitoneal adrenal region. The diagnosis of pheochromocytoma was confirmed by plasma catecholamine assays and high-resolution computed tomography (HRCT). Following preoperative pharmacologic preparation with alpha-adrenergic blockade, surgical resection of the tumor was performed. Intraoperatively, the patient developed significant hemodynamic instability, notably persistent hypotension after tumor removal that was refractory to empirical management. Combined transesophageal echocardiography (TEE) and pulse index continuous cardiac output (PiCCO) monitoring were employed for comprehensive assessment of cardiac function and volume status. Real-time guidance from this multimodal monitoring facilitated dynamic adjustments to the therapeutic strategy, enabling goal-directed hemodynamic support. Ultimately, the patient experienced an uncomplicated postoperative course.
Conclusion: This article integrates the features of the presented case with a systematic review of the literature on pheochromocytoma, comprehensively summarizing key diagnostic considerations, therapeutic strategies, and perioperative management protocols to serve as a clinical reference.

Art and expression in hospital settings have attracted attention for their potential to heal both body and soul. In the early 20th century, psychiatrists began to show interest in exploring artworks created by patients. Several hospital art programs were initiated in the 1990s, focusing primarily on hospital-based art. Art therapy may help improve emotions and mood, particularly in relation to patient communication and social interaction. Among various methods, the clinical use of art in hospitals using masking tape has gained attention, especially for its application in rehabilitation. This method can produce impressive artworks that benefit the elderly, aligning with the profound philosophy of Hinohara-ism, which promotes practical life maxims.

Importance: Lower back pain (LBP) contributes to a prevalent disease burden that is clinically and financially taxing to patients. Alternative non-pharmacological analgesic treatment methods can help alleviate symptoms while helping to fight the global opioid overdose crisis.
Objective: This case report presents clinical findings of the successful use of frequency-specific microcurrent (FSM) therapy with brief stretching for treating LBP and reviews the secondary outcomes of accelerated increased flexibility.
Design: Medical case report
Setting: Outpatient setting
Participant: 32-year-old female with chronic LBP
Interventions: The patient received 10 FSM treatments over 3 weeks and performed the stand-and-reach stretch in the first 20 min of each FSM session.
Measures: The primary outcome was numerical rating pain scale (NRPS) reduction or elimination of pain symptoms. The secondary outcome was the reduction in the fingertip-to-floor (FTF) distance when performing the toe touch test (TTT).
Outcomes: After the second FSM treatment, the patient stopped having episodes of stiff restricted back pain following prolonged sitting. The patient’s measured FTF distance decreased by 27 cm from an initial baseline of 21 cm at the index fingertip landmark to a final FTF measurement of 2 cm at the flexed index finger metacarpophalangeal (MCP) joint tip landmark. Within each FSM session, the patient’s FTF distance decreased by a mean of 9.4 ± 1.2 cm between the pre- and post-session time points.
Conclusions: FSM is clinically effective and efficient for treating unspecific chronic LBP. FSM can lead to accelerated increases in trunk flexibility levels, comparable to those found in athletes, with minimal effort by the patient, despite a sedentary lifestyle.
Relevance: This case highlights the potential of off-label FSM therapy to improve range of motion and support flexibility goals in patients with medical conditions or injuries, as well as in athletes seeking to enhance physical performance.

As a sedative and analgesic drug, esketamine is widely used in clinical anesthesia. Due to its separation anesthesia, it is particularly suitable for pediatric anesthesia and analgesia. It can not only alleviate the separation anxiety of children, promote smooth separation between children and parents, avoid mental harm to children, but also facilitate relatively stable anesthesia induction. Currently, esketamine is widely used in emergency procedural sedation and analgesia, preoperative sedation, anesthesia outside the operating room, general anesthesia, and regional anesthesia as adjuvant medication. This article reviews the current application status and adverse reactions of esketamine in pediatric anesthesia, providing reference for the application and research of esketamine in pediatric anesthesia.

Airway injury is one of the common complications after endotracheal intubation under general anesthesia. According to the US Closed Claims Database, the larynx is the most common site of airway injury during endotracheal intubation, accounting for one-third of all airway injuries. Common laryngeal injuries include traumatic granuloma, hematoma, and vocal cord paralysis, but only 20% of cases are related to intubation difficulties [1]. Granuloma or hematoma can often be detected using visual equipment for a definitive diagnosis. Vocal fold paralysis is not easily identified during extubation and often causes upper respiratory tract obstruction or even aspiration pneumonia [2,3]. In severe cases, it can be life-threatening. Vocal fold paralysis is mainly manifested as a disorder of vocal fold adduction or abduction. In patients with complete vocal fold paralysis, the vocal fold is often fixed in the paramedian position. The causes of vocal fold paralysis can be roughly divided into three categories: recurrent laryngeal nerve injury, cricoarytenoid joint dislocation, and glottic edema [4]. This article reviews the literature on vocal cord paralysis after surgery in a patient with preoperative recurrent laryngeal nerve injury, analyzes the causes of its occurrence, and explores the diagnosis and prevention procedures for similar cases.

Background: The coronavirus disease 2019 (COVID – 19) pandemic has been recognized by the World Health Organization (WHO) as a global public health emergency. Its sustained impact has exerted profound influence on the global healthcare system, manifested in aspects such as the strain on medical resources and the exacerbation of the workloads of healthcare professionals. As a pivotal component of perioperative nursing, the nursing team in the Post – Anesthesia Care Unit (PACU) is confronted with multiple pressures. Despite the fact that mental health issues triggered by COVID – 19 are prevalent among healthcare workers, the anxiety situation of PACU nurses has yet to receive adequate attention. Thus, this study is designed to analyze the current anxiety status of PACU nurses in China and the associated influencing factors, aiming to provide data – driven support for the optimization of anesthesia nursing strategies.
Methods: This study was a cross-sectional study conducted on PACU nurses from six Grade-III Class-A hospitals in Western China between May and June 2021. The anxiety status of the subjects was evaluated using the DASS-21. Statistical analyses were then performed to explore the inter-group differences. All statistical tests were two – tailed, with a significance level set at α = 0.05.
Results: According to our study, five nurses had mild anxiety, and two nurses had moderate anxiety. (1) Physical health: There are differences in the anxiety levels of PACU nurses under different states of physical health. (P=0.031). (2) Attitude to the prospect of PACU nurse: There are significant differences in anxiety levels among PACU nurses who hold different attitudes towards their career prospects in different working conditions. (P=0.026). (3) Hospital’s attention to PACU nurse: The anxiety levels of PACU nurses exhibit context-dependent variations based on hospitals’ attention. (P=0.002). (4) Patient’s respect for PACU nurse: PACU nurses exhibit significant differences in anxiety levels depending on patients’ degree of respect under clinical conditions. (P=0.000).
Conclusion: The results of our study suggest that anxiety is correlated with several modifiable factors, such as Attitude to the prospect of PACU nurses, physical health condition, Hospital’s attention to PACU nurse, Patient’s respect for PACU nurse. These findings contribute to the dissemination of adaptive strategies. These strategies can be implemented in the nursing practice of the Post – Anesthesia Care Unit (PACU) to resolve and mitigate the issues explored in this study.

Background: Anaphylactic shock is a common clinical emergency that shares mediators involved in the coagulation cascade and can also damage multiple systems, such as the kidneys, resulting in deep venous thrombosis and hematuria. To date, only one case of venous thrombotic events following anaphylaxis has been reported. Herein, we describe the first case of hematuria and deep venous thrombosis occurring in close temporal relation to an anaphylactic event.
Case Presentation: A 74-year-old female (153 cm, 51.5 kg) was diagnosed with, 1. Cervical spinal stenosis; 2. Cervical disc herniation at levels C3/4, C4/5, C5/6, and C6/7; 3. Spinal cord and nerve compression; 4. Chronic inflammation of both lungs; 5. Lacunar cerebral infarction; 6. Brain atrophy. She was scheduled to undergo posterior C3–7 single open-door spinal canal enlargement, laminoplasty, and mini-plate screw fixation. After anesthesia induction, the patient experienced increased airway pressure and urticaria on the anterior chest, followed by anaphylactic shock. After fluid resuscitation, corticosteroids, calcium, and adrenaline administration, the patient developed hematuria. Subsequently, 250 mL of 5% sodium bicarbonate was administered to alkalinize the urine, and blood pressure was continuously maintained. The surgery was suspended after consultation with the chief surgeon and the patient’s family. Once vital signs stabilized, the endotracheal tube was removed, and the patient was safely returned to the ward. On the third postoperative day, vascular color Doppler ultrasound revealed multiple thrombi throughout the body.
Conclusion: Anaphylactic shock causes decreased renal perfusion, ischemia of the renal cortex, and damage to renal tubular epithelial cells. Immune complex deposition can lead to complement activation and subsequent intravascular injury, resulting in hematuria. The coagulation cascade shares many inflammatory mediators with conditions such as sepsis, shock, asthma, allergy, and anaphylaxis. While all these conditions, except anaphylaxis, have been linked to an increased risk of thrombosis and blood clot formation, our findings suggest that anaphylaxis may also be a contributing factor to deep vein thrombosis.

Background: Veratrum poisoning represents a rare form of botanical intoxication; however, due to its recognized medicinal properties and widespread distribution, documented case reports of intoxication have been published in multinational medical literature.
Case Presentation: We report a case of an 80-year-old geriatric patient who presented with dizziness, palpitations, and nausea following ingestion of a Veratrum nigrum decoction. Admission electrocardiogram revealed sinus bradycardia (HR <60 bpm), sinus arrhythmia, a prolonged QT interval, and abnormal T waves in the anteroseptal and lateral leads. Normal sinus rhythm was restored after 7 hours of continuous intravenous atropine infusion.
Conclusion: Patients with a history of therapeutic use of Veratrum-based preparations or foraging of wild herbs require vigilance for Veratrum poisoning. Atropine serves as an established antidote in such intoxications, with continuous intravenous infusion considered for severe cases exhibiting profound cardiovascular compromise.

Renal osteodystrophy (ROD) is a systemic bone metabolic disease caused by renal dysfunction and is a significant complication in patients with late-stage chronic kidney disease (CKD) or those undergoing hemodialysis. Patients with chronic kidney disease undergo long-term dialysis, which can lead to secondary hyperparathyroidism, hypocalcemia, hyperphosphatemia, and aluminium toxicity. This case presents a middle-aged woman who underwent long-term dialysis for uremia and developed hyperparathyroidism. She was scheduled to undergo parathyroidectomy under general anesthesia. During the pre-anesthesia assessment, deformities were found in the patient’s maxillofacial region. It was suspected that there would be difficulty with face mask ventilation and tracheal intubation. In this case, fibreoptic bronchoscopy-guided endotracheal intubation was successfully performed under mild sedation. An individualized anesthesia plan was developed, and successful airway management was achieved. Ultimately, the patient’s surgery went smoothly, with the tracheal tube being safely removed afterwards.

The rupture of a sinus of Valsalva aneurysm (SVA) is a rare occurrence in cardiovascular medicine; however, it often severely compromises patients’ physiological functions and poses a life-threatening risk when it occurs [1]. Pseudoaneurysm of the sinus of Valsalva (SVpA) more frequently affects men [2]. However, we report a case of sinus of Valsalva pseudoaneurysm with thrombosis: a 30-year-old female, who experienced no physical discomfort in her daily life, accidentally discovered a ruptured aneurysm of the Valsalva sinus at the non-coronary sinus during a physical examination. The aneurysm had formed a large pseudoaneurysm, measuring 6.3 × 6.0 cm, located in the right atrioventricular sulcus. This pseudoaneurysm exerted significant pressure on the right atrium, and much of it had been filled with thrombus.

Pregnancy complicated by aortic dissection is relatively rare, and the mortality rate among pregnant women with aortic dissection is extremely high, posing a significant challenge to surgeons and anesthesiologists. This case reports the pathogenesis, surgical timing, anesthetic selection, anesthetic monitoring, induction, and management considerations of type B aortic dissection in twin pregnancies.

A continuous glucose monitoring (CGM) system was applied using FreeStyle Libre 3 to evaluate glucose variability in response to various food intakes and exercise. The subject was a 45-year-old registered nurse with a BMI of 17.9. When she drank 500 cc of a carbonated beverage containing 23.5 g of sugar, her blood glucose increased acutely. She then exercised by jumping for 3 minutes, after which her glucose levels decreased shortly thereafter. Consumption of pound cake, pork bowl, and corn soup caused a rapid rise in blood glucose. She consistently follows a standard low-carbohydrate diet (LCD) and consumes only 15 g of nuts and soybeans for lunch, during which her blood glucose does not increase. Appropriate CGM application significantly contributes to overall well-being.

Intestinal ischemic necrosis is a life-threatening condition caused by compromised intestinal blood flow due to arterial/venous occlusion or vasoconstriction, with acute mesenteric ischemia (60–70% of cases, mortality >60%) and colonic ischemia as primary subtypes. This case report describes the anesthetic management of a 56-year-old male with acute intestinal ischemic necrosis complicated by septic shock, requiring emergent laparotomy. Preoperative assessment revealed hemodynamic instability (HR 130 bpm, BP 85/43 mmHg, SpO₂ 89%) and peritoneal signs.
Anesthesia involved rapid-sequence induction with etomidate/rocuronium and maintenance with sevoflurane–remifentanil under BIS guidance.

Background: The relationship between central obesity and pulmonary function remains a critical area of investigation. The Weight-Adjusted Waist Index (WWI) has emerged as a novel marker for assessing central obesity. This study aimed to investigate the association between WWI and various pulmonary function indices.
Methods: Data were extracted from the National Health and Nutrition Examination Survey (NHANES) 2007–2012, involving 8,361 participants. Participants were categorized into tertiles based on their WWI values. Pulmonary function measures included Forced Vital Capacity (FVC), Forced Expiratory Volume in one second (FEV1), FEV1/FVC ratio, and Peak Expiratory Flow rate at 25–75% of forced vital capacity (PEF25–75%). Multivariate linear regression models were used to assess associations, adjusting for covariates such as gender, age, race, education level, hypertension, diabetes, smoking status, and poverty index ratio.
Results: Higher WWI was significantly associated with lower FVC, FEV1, and PEF25–75%, but not with FEV1/FVC ratio. Specifically, each unit increase in WWI corresponded to reductions in FVC (-603.9 ml, 95% CI: -628.7, -579.2), FEV1 (-527.7 ml, 95% CI: -547.7, -507.7), and PEF25–75% (-550.5 ml/s, 95% CI: -581.7, -519.3). Sensitivity analyses confirmed these findings after adjusting for multiple covariates. Subgroup analyses indicated similar trends across different genders and age groups.
Conclusion: The Weight-Adjusted Waist Index (WWI) is negatively associated with lung volumes and mid-expiratory flow rates, suggesting its potential role in respiratory impairment. These results underscore the importance of considering central adiposity in clinical evaluations of pulmonary health. Future longitudinal studies are warranted to further elucidate the mechanisms underlying these associations and to validate these findings in diverse populations.