Bone cement implantation syndrome during hip replacement in a patient with pemphigus and Parkinson’s disease: A case report

BACKGROUNDBone cement implantation syndrome (BCIS) is characterized by hypotension, arrhythmia, diffuse pulmonary microvascular embolism, shock, cardiac arrest, any combination of these factors, or even death following bone cement implantation.CASE SUMMARYAn 80-year-old patient with pemphigus and Parkinson’s disease underwent total hip replacement under spinal subarachnoid block and developed acute pulmonary embolism after bone cement implantation. The patient received mask mechanical ventilation with a continuous intravenous infusion of adrenaline (2 μg/mL) at a rate of 30 mL/h. Subsequently, the symptoms of BCIS were markedly alleviated, and the infusion rate of adrenaline was gradually reduced until the infusion was completely stopped 45 min later. The patient was then transferred to the Department of Orthopedics, and anticoagulation therapy began at 12 h postoperatively. No other complications were observed.CONCLUSIONThis is a rare case of BCIS in a high-risk patient with pemphigus and Parkinson’s disease.     

Delayed right coronary ostial obstruction after J-valve deployment in transcatheter aortic valve implantation: A case report

BACKGROUND Aortic stenosis is the most common valve disease in adults.Transcatheter aortic valve implantation(TAVI)is being increasingly applied for intermediate-to lowrisk patients.Here,we describe an uncommon complication of delayed right coronary obstruction in a transapical TAVI case.CASE SUMMARY A 73-year-old woman with a EuroSCORE II of 1.21%underwent transapical TAVI because of severe aortic stenosis.The surgical procedure was uneventful.However,during routine monitoring after valve placement,the patient had a sudden onset of slow heart rate,the systolic blood pressure dropped sharply from 115 to 60 mmHg,and the central venous pressure abruptly increased from 10 to 33 cmH2O.The patient had a poor response to vasoactive agents.Transesophageal echocardiography revealed poor myocardial contractility,and electrocardiography showed a significant depression of ST-segment.Another angiography was performed immediately,which suggested complete obstruction of the right coronary artery.An emergency protocol was initiated.Cardiopulmonary bypass was established immediately.An aortic biological valve replacement under cardiopulmonary bypass was performed.CONCLUSION Perioperative monitoring,early recognition,and diagnosis of obstruction of coronary arteries in TAVI are important.Transesophageal echocardiography is a useful diagnostic and monitoring tool in this situation.Emergency protocols should be established during TAVI.     

Liver cirrhosis in a child associated with Castleman's disease: A case report

BACKGROUND Castleman's disease(CD)is a lymphoproliferative disorder.TAFRO syndrome is classified as a variant of CD based on its key clinical manifestations of thrombocytopenia,anasarca(generalized edema and pleural effusion),fever(pyrexia),reticulin fibrosis in the bone marrow and the proliferation of megakaryocytes,and organomegaly(such as hepatosplenomegaly and multiple lymphadenopathies);TAFRO syndrome is mainly reported in Japanese patients.To our knowledge,this is the first pediatric case report detailing a CD-associated disorder progressing to cirrhosis.CASE SUMMARY A 10-year old male patient presented with fever and anemia.Six months before hospitalization,he had remarkable abdominal distention.Subsequently,he visited a clinic for a fever that lasted 5 d.The physical findings were marked hepatosplenomegaly and cervical lymphadenopathy.A blood test revealed leukocytosis,microcytic anemia,aspartate aminotransferase-dominant transaminase elevation,high levels of C-reactive protein,polyclonal hypergammaglobulinemia,and high levels of interleukin-6 and vascular endothelial growth factor.Abdominal contrast computed tomography and magnetic resonance imaging suggested cirrhosis,which was confirmed by liver histology.Histological findings in the enlarged hepatic lymph nodes revealed both hyperplasia and atrophy of lymphoid follicles with some vascular hyperplasia and moderate plasmacytosis between the lymphoid follicles,which is compatible with lymph node histology in TAFRO syndrome.Prednisolone was not effective in reducing the patient’s symptoms;therefore,the patient was prescribed tocilizumab.To date,the patient remains free of fever and continues to receive tocilizumab.CONCLUSION We described the clinicopathological features of TAFRO syndrome to highlight the clinical presentation of this rare disease in a pediatric case.