Aborder la perte auditive

ObjectiveTo provide family physicians with a practical evidence-based approach to the management of patients with hearing loss.Sources of informationMEDLINE and PubMed databases were searched for English-language hearing loss research, review articles, and guidelines published between 1980 and 2020. Most of the retrieved articles provided level II or III evidence.Main messageHearing loss is one of the most common sensory impairments worldwide and causes great detriment to a patient’s overall well-being by affecting physical health, finances, social inclusion, and mental health. A robust clinical assessment of hearing loss includes a history and physical examination that effectively characterizes the deficit as conductive, sensorineural, or mixed. Patients presenting with red flags (such as sudden unilateral sensorineural hearing loss) must be urgently referred to otolaryngology–head and neck surgery or immediately assessed in the emergency department. Many nonurgent presentations of hearing loss will also require referral for further audiological assessment, diagnosis, and management.ConclusionAs primary care providers, family physicians are well equipped to manage the psychological concerns associated with hearing loss and to reinforce conservative treatment strategies. Frequently, referral or urgent workup, including imaging, is necessary to confirm a patient’s diagnosis and initiate management in order to prevent further complications.     

使用TPA及TPA＋Nance弓支抗形式矫治双颌前突的临床研究

目的：比较单独使用TPA和联合使用TPA、Nance弓支抗形式矫治青少年双颌前突的疗效。方法：选取11～18岁双颌前突患者20例,随机分为：TPA与TPA＋Nance弓两组;两组病例均拔除4个第一前磨牙,使用直丝弓矫治技术,一步法关闭拔牙间隙,分析治疗前后X线头颅侧位片及牙颌模型的各项指标变化。结果：单独使用TPA和联合使用TPA、Nance弓在矢状向上颌磨牙平均近中前移量分别为3．15mm和1．92mm;而在垂直和水平方向上两者差异无显著性（P〉0．05）。结论：TPA和Nance弓是一种制作简单的、有效的、增加支抗的口内装置,对双颌前突的患者疗效显著。     

Adult with mass burnt lime aspiration: A case report and literature review

BACKGROUNDForeign body aspiration mainly occurs in children, which can cause a severe concurrent syndrome and even death without timely treatment. As a rare foreign body, aspiration of lime is seldom reported, and most cases involve a small amount of hydrated lime. Although the symptoms are usually severe, the prognosis is good after suitable treatment. Experience of treatment for lime aspiration is lacking, and this report provides novel evidence for treatment of mass burnt lime aspiration using bronchoscopy.CASE SUMMARYWe report an adult with a large amount of burnt lime aspiration. Because of delay in clearance of the inhaled lime in the trachea and bronchus at the local hospital, he suffered several severe complications, including complete occlusion of the right primary bronchus, aeropleura, aerodermectasia, pneumomediastinum, secondary infection and hypoxemia at 4 d after injury. After transferring to our department, bronchoscopy was immediately carried out to clear the lime in the major airway, using foreign body forceps, biopsy forceps, puncture needle, and hairbrush. The patient’s condition recovered rapidly and at 3-months’ follow-up, he demonstrated good recovery of the bronchus and lung parenchyma.CONCLUSIONAfter mass lime aspiration, flexible fiberoptic bronchoscopy is suggested as early as possible, using clamping, flushing or cryotherapy.     

Roxadustat as treatment for a blood transfusion-dependent maintenance hemodialysis patient: A case report and review of literature

BACKGROUNDErythropoiesis-stimulating agents (ESAs) have revolutionized the therapeutic strategy for anemia in chronic kidney disease. However, some cases are resistant or hyporesponsive to ESAs. Roxadustat is an oral hypoxia-inducible factor-prolyl hydroxylase inhibitor that stimulates erythropoiesis and regulates iron metabolism. Here, we describe a hemodialysis patient with refractory anemia who did not respond to traditional treatments and depended on blood transfusion for more than 1 year. After applying Roxadustat, the patient’s anemia improved significantly.CASE SUMMARYA 44-year-old man was diagnosed with uremia accompanied by severe anemia with a hemoglobin (Hb) level ranging from 30-40 g/L. His anemia did not improve after sufficient dialysis or high doses of active ESAs; other causes of anemia were excluded. The patient required approximately 600-1000 mL of red blood cell suspension every 15-30 d for more than 1 year. After accepting Roxadustat therapy, the patient’s anemia symptoms improved significantly; his Hb level gradually increased to 50 g/L, and no further blood transfusions were administered. His Hb level reached 69 g/L by the 34^th week. Although a Hb level of 60-70 g/L cannot be considered satisfactory, he no longer required blood transfusions and his quality of life was substantially improved. Roxadustat showed good efficacy and safety in this case.CONCLUSIONRoxadustat represents an innovative and effective agent for the clinical treatment of renal anemia caused by multiple complex factors.     

Acute urinary retention in the first and second-trimester of pregnancy: Three case reports

BACKGROUNDAcute urinary retention (AUR) is rare during pregnancy. CASE SUMMARYWe report on three pregnant women with AUR between the 10^th and 18^th wk of gestation. Case 1 was first diagnosed as urinary tract infection and developed a urinary tract infection due to urinary retention caused by urethral obstruction. Case 2 had a history of previous abdominal surgery for pelvic tuberculosis, leading to severe adhesions and a persistent retroverted uterus. In case 3, healthcare providers focused on the patient’s gastrointestinal symptoms and did not investigate her inability to void. Case 1 required manual disimpaction of the uterus and the knee-chest position. The other cases required immediate catheterization. The condition resolved in cases 1 and 2; these patients had normal pregnancies. Case 3 had severe complications at the time of consultation, leading to an abortion. CONCLUSIONRetroverted uterus is the most common cause of AUR. Prompt recognition and diagnosis are required. Clinicians should be aware of the risk factors, etiology, and clinical presentation of AUR in the first and second trimester of pregnancy.     

Changes in sleep parameters following biomimetic oral appliance therapy: A case report

BACKGROUNDMandibular advancement devices (MADs) are used to treat mild to moderate obstructive sleep apnea (OSA), but there is a risk that the underlying condition can worsen in the long-term. Therefore, this case report is based on biomimetic oral appliance therapy as an alternative to MADs, which was found to be beneficial in the treatment of a case with severe OSA.CASE SUMMARYAn overnight sleep study was undertaken in a 50-year-old male with excessive daytime sleepiness that lead to a diagnosis of severe OSA as the apnea-hypopnea index (AHI) was found to be 32.8/h. Since the patient was unable to comply with continuous positive airway pressure therapy and declined surgical intervention, treatment with a MAD was initiated. Approximately 10 years later, another sleep study was performed with no MAD in the mouth, which revealed an AHI of 67.9/h. In view of the deterioration in sleep quality, the patient sought alternative treatment and elected on biomimetic oral appliance therapy, using a mandibular repositioning nighttime appliance (mRNA appliance^®, Vivos Therapeutics, Inc., United States). After 10 mo, another sleep study was performed with no device in the patient’s mouth, which revealed an AHI of 11.8/h, a mean oxygen saturation of 94% and a mean oxygen desaturation index of 5.3% while sleeping. Finite-element analysis of the pre- and post-treatment study models of the upper jaw showed localized size increases of 15%-17% in the premolar regions and 15%-23% in the molar regions.CONCLUSIONIn adults with severe OSA that are unable to accept continuous positive airway pressure or surgical treatment, biomimetic oral appliance therapy may be preferable over MADs since biomimetic oral appliance therapy may be able to prevent worsening of sleep parameters by remodeling the nasomaxillary complex. Long-term follow up studies are required to verify these novel findings.     

Posthepatectomy jaundice induced by paroxysmal nocturnal hemoglobinuria: A case report

BACKGROUNDJaundice is a major manifestation of posthepatectomy liver failure, a feared complication after hepatic resection. Herein, we report a case of posthepatectomy jaundice that was not caused by liver failure but by paroxysmal nocturnal hemoglobinuria (PNH)-induced hemolysis.CASE SUMMARYA 56-year-old woman underwent right hepatectomy and biliary tract exploration surgery due to hepatic duct stones. Prior to surgery, the patient was mildly anemic. The direct antiglobulin test was negative. A bone marrow biopsy showed mild histiocyte hyperplasia. After surgery, the patient suffered a progressive increase in serum bilirubin. Meanwhile, the patient developed hemolytic symptoms after blood transfusion. She was ultimately diagnosed with PNH. PNH is a rare bone marrow failure disorder that manifests as complement-dependent intravascular hemolysis with varying severity. After steroid treatment, the patient’s jaundice gradually decreased, and the patient was discharged on the 35^th postoperative day.CONCLUSIONPNH-induced hemolysis is a rare cause of posthepatectomy jaundice. It should be suspected in patients having posthepatectomy hyperbilirubinemia without other signs of liver failure. Steroid therapy can be considered for the treatment of PNH in such cases.     

Familial left cervical neurofibromatosis 1 with scoliosis: A case report

BACKGROUNDNeurofibromatosis type 1 (NF1) is an inherited autosomal dominant disorder affecting many parts of the body with café au lait spots, skeletal deformity, and scoliosis. A familial case of NF1 with scoliosis and a painless mass had not yet been reported.CASE SUMMARYWe describe the case of a 15-year-old male patient with a painless lump on the left side of his neck for 10 years and scoliosis. His right shoulder was about 5 cm lower than the left, the left side of his face was deformed, and the left submandibular skin was relaxed. The folding and drooping were obvious and movement was poor. Computed tomography revealed the involvement of the neck, upper chest wall, and surrounding left shoulder, accompanied by bone changes and scoliosis. Histological evaluation showed subepidermal pale blue mucoid degeneration, fibrous fusiform cells in the dermis in a fascicular, woven arrangement. His mother had the same medical history. The diagnosis was neurofibromatosis of the left neck. Various parts of the tumor tissue were serially resected during several visits. Eight months after surgery, there was a slight tendency to regrow.CONCLUSIONThis case of slow-progressing NF1 highlights the importance of early diagnosis and treatment to reduce its impact on the patient’s growth and development.     

Alström syndrome with a novel mutation of ALMS1 and Graves’ hyperthyroidism: A case report and review of the literature

BACKGROUNDAlström syndrome (AS, OMIM ID 203800) is a rare disease involving multiple organs in children and is mostly reported in non-Chinese patients. In the Chinese population, there are few reports on the clinical manifestations and pathogenesis of AS. This is the first report on the association between AS and Graves’ hyperthyroidism.CASE SUMMARYAn 8-year-old Chinese girl was diagnosed with AS. Two years later, Graves’ hyperthyroidism developed with progressive liver dysfunction. The patient’s clinical data were collected; DNA from peripheral blood of the proband, parents and sibling was collected for gene mutation detection using the second-generation sequencing method and gene panel for diabetes. The association between the patient’s genotype and clinical phenotype was analyzed. She carried the pathogenic compound heterozygous mutation of ALMS1 (c.2296_2299del4 and c.11460C>A). These stop-gain mutations likely caused truncation of the ALMS1 protein.CONCLUSIONThe manifestation of hyperthyroidism may suggest rapid progression of AS.     

Peri-implant keratinized gingiva augmentation using xenogeneic collagen matrix and platelet-rich fibrin: A case report

BACKGROUNDKeratinized gingival insufficiency is a disease attributed to long-term tooth loss, can severely jeopardizes the long-term health of implants. A simple and effective augmentation surgery method should be urgently developed.CASE SUMMARYA healthy female patient, 45-year-old, requested implant restoration of the her left mandibular first molar and second molar. Before considering a stage II, as suggested from the probing depth measurements, the widths of the mesial, medial, and distal buccal keratinized gingiva of second molar (tooth #37) were measured and found to be 0.5 mm, 0.5 mm, and 0 mm, respectively. This suggested that the gingiva was insufficient to resist damage from bacterial and mechanical stimulation. Accordingly, modified apically repositioned flap (ARF) surgery combined with xenogeneic collagen matrix (XCM) and platelet-rich fibrin (PRF) was employed to increase the width of gingival tissue. After 1 mo of healing, the widths of mesial, medial, and distal buccal keratinized gingiva reached 4 mm, 4 mm, and 3 mm, respectively, and the thickness of the augmented mucosa was 4.5 mm. Subsequently, through the second-stage operation, the patient obtained an ideal soft tissue shape around the implant.CONCLUSIONFor cases with keratinized gingiva widths around implants less than 2mm，the soft tissue width and thickness could be increased by modified ARF surgery combined with XCM and PRF. Moreover, this surgery significantly alleviated patients’ pain and ameliorated oral functional comfort.     

Congenital nephrogenic diabetes insipidus due to the mutation in AVPR2 (c.541C>T) in a neonate: A case report

BACKGROUNDCongenital nephrogenic diabetes insipidus (CNDI) is a rare hereditary renal disorder that is caused by mutations in AVPR2 or aquaporin 2 (AQP2). Up to now, there are few reports about CNDI in neonates. Early clinical manifestations of CNDI in neonates are atypical. A lack of understanding of the disease by clinicians causes frequent misdiagnoses or missed diagnoses, which may result in failure to administer treatments in time and ultimately leads to severe complications. In this study, clinical data of a case of AVPR2 gene mutation-induced CNDI, which was confirmed by genetic testing, were retrospectively analyzed to improve our understanding of this disease.CASE SUMMARYOn February 1, 2020, a male neonate was hospitalized 17 d after birth due to a 7 d period of pyrexia. The patient’s symptoms included recurrent pyrexia, hypernatremia and hyperchloremia, which were difficult to treat. The patient was fed on demand, and water was additionally provided between milk intakes. A combination treatment of hydrochlorothiazide and amiloride was administered. After the treatment, body temperature and electrolyte levels returned to normal, the volume of urine was significantly reduced and the patient was subsequently discharged. Genetic tests confirmed that the patient carried the AVPR2 gene missense mutation c.541C>T (P.R181C), and the patient’s mother carried a heterozygous mutation at the same locus. After clinical treatment with a combination of hydrochlorothiazide and amiloride, the body temperature and electrolyte levels returned to normal. Up until the most recent follow-up examination, normal body temperature, electrolyte levels and growth and development were observed.CONCLUSIONCNDI in the neonatal period is rare, and its clinical manifestations are unspecific with some patients merely showing recurrent fever and electrolyte disturbance. Genetic testing of AVPR2 and AQP2 can be used for screening and genetic diagnosis of CNDI.     

Atezolizumab-induced anaphylactic shock in a patient with hepatocellular carcinoma undergoing immunotherapy: A case report

BACKGROUNDAtezolizumab is a programmed death ligand 1 (PD-L1) inhibitor, and its combination with bevacizumab has been proven an effective immunotherapy for unresectable hepatocellular carcinoma (HCC). Treatment with immune checkpoint inhibitors (ICIs) can lead to hypersensitivity reactions; however, anaphylactic shock is rare. We present a case of life-threatening anaphylactic shock during atezolizumab infusion and performed a relevant literature review.CASE SUMMARYA 75-year-old man was diagnosed with HCC recurrence after hepatectomy. He was administered immunotherapy with atezolizumab plus bevacizumab after an allergy to a programmed death-1 (PD-1) inhibitor. The patient showed a sudden onset of dizziness, numbness, and lack of consciousness with severe hypotension during atezolizumab infusion. The treatment was stopped immediately. The patient’s symptoms resolved after 5 mg dexamethasone was administered. Because of repeated hypersensitivity reactions to ICIs, treatment was changed to oral targeted regorafenib therapy. CONCLUSIONFurther research is necessary for elucidating the hypersensitivity mechanisms and establishing standardized skin test and desensitization protocols associated with PD-1 and PD-L1 to ensure effective treatment with ICIs.     

Three-dimensional modeling of an individualized functional masticatory system and bite force analysis with an orthodontic bite plate

Purpose

Orthodontic tooth movement is affected by bite forces generated from the masticatory system. This study aims to study three-dimensional (3D) modeling of the individualized functional masticatory system and explore its application in orthodontics.

Methods

An individualized masticatory system model containing the craniomaxilla, mandible, 4 pairs of primary masticatory muscles and complete dentition, including roots and precise dental crowns, was developed using 3D images from spiral computed tomography and digital casts. By registering global coordinates and using data transformation, individual movement data for mandibular opening, lateral excursion and protrusion were recorded with an Arcus Digma system and applied to this model to simulate the functional movements of the mandible. Using the finite element method, deformations and displacement of the masticatory muscles were simulated along with the mandibular movements. Under individualized muscle loading, the bite forces of the lower incisors with the orthodontic bite plate were analyzed.

Results

Individualized mandibular movements were simulated, and the performance of the masticatory muscles along with the mandibular movements was measured. The bite force generated on the lower incisors with different thicknesses and the orientations of the orthodontic bite plate were acquired.

Conclusion

An individualized 3D masticatory system model was constructed using advanced 3D data processing software that integrated 3D images from different sources. Individualized mandibular movement and masticatory muscle performance were simulated using this model. The analysis of the bite force generated on the lower incisors with the orthodontic bite plate suggested that a thickness of 3 mm may be appropriate for clinical use.

     

Neonatal necrotizing enterocolitis caused by umbilical arterial catheter-associated abdominal aortic embolism: A case report

BACKGROUNDReports of necrotizing enterocolitis (NEC) caused by umbilical arterial catheter (UAC)-associated abdominal aortic embolism in neonates are rare. Herein, we report the case of an extremely low birth weight (ELBW) infant with NEC caused by UAC-associated abdominal aortic embolism.CASE SUMMARYA female infant, aged 21 min and weighing 830 g at 28⁺⁶ wk of gestational age, was referred to our hospital because of premature birth and shallow breathing. The patient was diagnosed with ELBW, neonatal respiratory distress syndrome, neonatal intrauterine infection, and neonatal asphyxia. Umbilical arterial and venous catheters were inserted on the day after birth and were removed 9 d later, according to the doctor’s plan. Within 48 h after extubation, the patient’s manifestations included poor responsiveness, heart rate range of 175-185/min, and currant jelly stool. Therefore, we considered a diagnosis of NEC. To determine the cause, we used B-mode ultrasound, which revealed a partial abdominal aortic embolism (2 cm × 0.3 cm) and abdominal effusion. The patient was treated with nil per os, gastrointestinal decompression, anti-infective therapy, blood transfusion, and low-molecular-weight heparin sodium q12h for anticoagulant therapy (from May 20 to June 1, the dosage of low-molecular-weight heparin sodium was adjusted according to the anti-Xa activity during treatment). On the 67^th day after admission, the patient fully recovered and was discharged.CONCLUSIONThe abdominal aortic thrombosis in this patient was considered to be catheter related, which requires immediate treatment once diagnosed. The choice of treatment should be determined according to the location of the thrombus and the patient’s condition.     

Disappeared intralenticular foreign body: A case report

BACKGROUNDIntralenticular foreign body is rarely encountered in ophthalmic practice. In most cases, subsequent traumatic cataract requires cataract surgery for visual rehabilitation.CASE SUMMARYA 35-year-old man was injured by iron filings in his left eye. After the injury, the patient tried to draw the object out by himself using a magnet; however, the foreign body (FB) was pushed to the equator of the lens. The FB was removed by a magnet through the anterior chamber accessed through the original capsular wound. Since most of the lens was transparent and only partially opaque after the operation, the lens was kept under close observation. After the surgery, the patient’s visual acuity reached 20/20 from 2/20, visual function recovered very well, and local opacity of the lens remained stable.CONCLUSIONFor intralenticular FB in the anterior cortex under the capsule, magnet may be a more advantageous way to remove the object.     

口外弓联合唇挡推下颌磨牙远移的临床应用

目的 应用口外弓联合唇挡推下颌磨牙远移，观察远移后牙颌变化。方法 对11例平均年龄10.6岁，骨性Ⅰ类牙性Ⅲ类关系的替牙期及恒牙初期患者行口外弓联合唇挡推下颌磨牙远移，取矫治前后研究模型、头颅定位侧位片数据行配对样本T检验，评价矫治效果。 结果 平均矫治时间3.7月，磨牙远移2.46mm，下颌轻度顺时针旋转，下切牙轻度舌倾。 结论 口外弓联合唇挡推下磨牙远移无口内支抗消耗，效果可靠。     

直丝弓技术矫治双颌前突或上颌前突的临床体会

目的验证直丝弓技术矫治双颌前突或上颌前突的临床效果。方法对10例双颌前突或上颌前突患者应用直丝弓技术，通过拔牙或不拔牙的方法进行矫治。结果10例患者在平均23个月的矫治结束后，最终上下牙列均排齐整平、无间隙，前牙的覆合覆盖关系都调节到了正常，磨牙关系都调整到中性，面型分别得到了不同程度的改善。结论应用直丝弓技术矫治双颌前突或上颌前突是非常安全有效的，能很好的改善患者的面型突度，再适当配合Ⅱ类牵引和口外弓或微型种植体支抗能更好的使患者的咬合关系和侧貌达到正常。     

Tigecycline sclerotherapy for recurrent pseudotumor in aseptic lymphocyte-dominant vasculitis-associated lesion after metal-on-metal total hip arthroplasty: A case report

BACKGROUNDMetal-on-metal (MoM) total hip arthroplasty (THA) has been associated with adverse reactions to metal debris, presenting clinically as pseudotumors.CASE SUMMARYThis case report presents a female aged 73 year-old with MoM THA-related pseudotumor. After arthrotomy and bursectomy surgeries, histologic examinations of surgical specimens revealed a specific lymphocyte-dominant immunologic response, now known as aseptic lymphocyte-dominant vasculitis-associated lesion (ALVAL). Due to soft tissue persisting effusion after arthrotomy and bursectomy, revision surgery was then performed with ceramic-on-polyethylene THA. However, revision did not resolve the patient’s symptoms. Here we describe our application of tigecycline sclerotherapy to treat recurrent pseudotumor after revision THA and no recurrence after 24-mo follow-up.CONCLUSIONTigecycline sclerotherapy is safe and effective in the management of recurrent pseudotumor after revision non-MoM THA in ALVAL cases.     

Acquired haemophilia in patients with malignant disease: A case report

BACKGROUNDAcquired haemophilia is a rare coagulation disorder characterized by autoantibodies against coagulation factor VIII leading to severe and potentially life-threatening haemorrhages. The underlying disorder causing the development of an autoimmune phenomenon is not always known, but 10%-15% could be linked to malignancies. Patients with cancer who require surgical resection represent a treatment challenge not solely due to increased risk of bleeding but also due to adverse events of immunosuppressive therapy.CASE SUMMARYWe present the case of a 67-year-old man with non-metastatic adenocarcinoma of the distal bile duct who developed concomitant acquired haemophilia a month after having been diagnosed with malignant disease. Haemostasis was established with recombinant activated factor VII, and immunosuppressive therapy was started immediately. An extensive surgical procedure was performed in order to remove the cancer and, therefore, eliminate the inhibitory autoantibodies. Due to a complicated postoperative course, relatively short period of treatment and likelihood of micrometastases, no improvement in the patient’s status was observed. Diagnosis and treatment of acquired haemophilia as well as other coagulation disorders in patients with cancer are discussed.CONCLUSIONPrompt diagnosis of acquired haemophilia is required in order to start appropriate treatment and reduce mortality. Among patients with cancer, other causes of abnormal bleeding related to malignancy should be considered.     

Spinal dural arteriovenous fistula 8 years after lumbar discectomy surgery: A case report and review of literature

BACKGROUNDSpinal dural arteriovenous fistula (SDAVF) is an extremely rare vascular malformation of the central nervous system that is often confused with degenerative spinal disorders due to similar early symptoms and clinical features. Here, we report a case of SDAVF recurrence 8 years after lumbar spine surgery and summarize relevant literature.CASE SUMMARYA 54-year-old male was admitted to our hospital complaining of lower back pain, numbness in both lower extremities and intermittent claudication. Subsequent imaging identified lumbar spinal stenosis. Following surgical treatment, the patient’s symptoms significantly resolved, and he was able to perform daily activities. However, similar symptoms appeared 8 years later, followed by confirmation of SDAVF diagnosis. The patient underwent neurosurgery 7 mo after symptom onset. The follow-up period lasted 14 mo, and the patient remains with marginal neurological symptoms.CONCLUSIONThis case highlights the importance of prompt SDAVF diagnosis. Due to its nonspecific clinical presentation, the clinical experience of the surgeon and definitive imaging examination are indispensable. Additionally, timely neurosurgery is effective and may significantly improve patient outcomes.