简介：AbstractShark attacks are rare unique pathological processes. Some of them represent devastating injuries with a high morbidity and significant mortality. Related published articles are limited. The increased human interaction within the environment of sharks is the cause of rising incidence of such attacks. This study reported a case of level 4 shark injuries (shark-induced trauma scale) in a 33-year-old male patient, who presented with an extensive injury of the right lower limb with the characteristic features of shark bite. At admission the patient was in a state of shock with profuse bleeding that was controlled by tourniquet. The patient was resuscitated according to the advanced trauma life support. Clinical examination showed hard signs of vascular injury with absent pedal pulse, associated neurological deficits and severance at the knee joint. Prompt vascular intervention after resuscitation was performed to manage the major vascular injuries, together with proper washout and debridement of all the necrotic tissues under strong antibiotic coverage to prevent infection. After that, the patient underwent sequenced plastic, orthopedic, and neurological interventions. Strict follow-up was conducted, which showed that the patient was saved and achieved a functioning limb. This study aims to highlight the management of level 4 shark injuries, which are considered serious and challenging with a high fatality rate and a great risk of amputation due to the associated major vascular injuries. Immediate well organized management plan is crucial. Prompt resuscitation and surgical intervention by a highly-skilled medical team are required to improve the chance of patient survival and limb salvage.

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简介：Extrapulmonarysmallcellcarcinoma(EPSCC)isarareneoplasmcomprising2.5%to5%ofsmallcellcarcinomas(SCCs).BladderSCCisthemostcommonsiteofgenitourinarytract.PrimaryrenalSCCisextremelyrare.WereportacaseofprimarySCCofthekidneywhichisrarelyreportedintheurinarytractandpresentsanaggressiveclinicalpicture.A59-year-oldfemalevisitedaurologicclinicwithcomplaintofpersistentleftflanksoreness10yearsafterundergoingrenaltransplantation.Abdominalcomputedtomographyshowedaleftrenalpelvistumor.Afterthepatientreceivedleftnephroureterectomywithbladdercuffresection,herpathologyresultsshowedSCC.Aftersurgery,shereceivedadjuvantsystemicchemotherapy,andherrecoveryhasbeenuneventfulasof8months.PrimaryrenalSCCpresentswithanadvancedtumorstageandashortmediansurvivalperiod,thereforeearlyinterventionandclosefollow-uparerecommended.

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简介：Inthearticle,theauthorreportsonacasestudyofchronicpainproblemscausedbyherownfootdeformity.TheauthorbeganusingTaiji,ChenstyleChanSiGong(ReelingSilk),andZhanZhuang(standingmeditation)torelievechronicpainsince1986.AftermorethantwoyearsofQigongtraining,thestructureoftheauthor'sfootchangedfromthepreviousdeformitytonormalfootshape.Thesechangesenabledtheauthortowalknormallyandtobefreefrompersistentchronicpain.ThearticlediscussedthemethodsofusingQicurrentsandotherissuesthatneedtobepaidattentiontowhenpracticingTaichi,suchashowtoadjustone'smentalfocusandmaintainastateofrelaxationto"mindful".Taichiinvolvesanumberofinternal"micro-adjusting"abouthowthesetechniquesrelaxandstrengthenmusclestoreducechronicpain.ThereportanddiscussiononthetreatmentprincipleofQigongcanprovidenewstrategiesforthetreatmentofchronicpain.

简介：AbstractIntroduction:Vitiligo and psoriasis are common skin diseases, while its co-occurrence in one patient is rare.Here, we reported a patient with co-occurrence of vitiligo and psoriasis.Case presentation:An 11-year-old girl developed depigmented patches on her right chin for 6 months. The noticed areas of depigmented skin steadily increased in size with no clinical symptoms. Wood’s lamp examination and laser scanning confocal revealed the clinical diagnosis of co-occurrence of vitiligo and psoriasis.Discussion:Speculations related to co-pathogenesis of vitiligo and psoriasis are still elusive, some explanations of this phenomenon like of isomorphic reaction, shared genetic basis of autoimmunity and inflammation, shared cellular immune pathways including Th1, Th17 and related cellular molecules such as TNF-α, IFN-α, IL-17 have been reported.Conclusion:The analysis and summary of the underlying association in co-occurrence of psoriasis and vitiligo may amplify future therapeutic options for both disease. Clinicians should pay attention to the methods that could simultaneously improve these two conditions.

简介：ObjectivePatientswithunilateraleardischargeandhearinglossoftenhaveexternalormiddleeardiseases.Wepresenta55-year-oldmanwhosufferedfrompersistenteardischargeandhearinglossintheleftear.Localfindingsshowedthathisleftearcanalwasfilledwithalargeamountofgranulationtissue,withpurulent,foul-smellingdischarge.Computedtomographyindicatedleftmiddleearcholesteatomaandmassshadowintheleftexternalauditorycanal.Modifiedradicalmastoidectomywasperformed.Apieceofwhiteplasticstickwasfoundinthemiddleearduringtheoperation.Foreignbody-inducedcholesteatomaandexternalauditorycanalgranulomainadultsareveryrare.Wepresentthisrarecasesothattheseconditionscanbebetterrecognizedandunderstood.

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简介：AbstractBackground:Pleural-subarachnoid fistula (PSF) is a rare disease that is difficult to diagnose and treat. Secondary intracranial hypertension and the treatment are seldom mentioned previously among PSF.Case presentation:A 1-year-old boy diagnosed PSF developed into secondary intracranial hypertension after conservative treatment. He was finally cured by down-step treatment of mannitol, avoiding form ventricleperitoneal shunt. Then, we reviewed the literature of pleural-subarachnoid fistula. Fifty-six cases have been reported so far. Most of the cases (51.8%) were caused by surgery; only 17.9% were caused by car accidents. Regarding the treatment, half of the cases cured by surgery and the other by conservative measures. Our case is the first one involving secondary intracranial hypertension and cured by down-step treatment of mannitol.Conclusions:A comprehensive examination should be performed before the treatment to avoid any inappropriate medical strategies. Secondary acute intracranial hypertension may be cured by down step treatment of mannitol, evading from the long-term ventriculoperitoneal shunt.

简介：Renalcellcarcinoma(RCC)accountsforapproximately3%ofallcancercases.RCCsusuallymetastasizetothelungs,bones,liver,orbrain.Only<1%ofpatientswithbonemetastasesmanifestedclavicularRCCmetastases.Thus,clavicularmetastasisastheinitialpresentationofRCCisextremelyrare.WereportapatientwithRCCmetastasistotheleftclavicle,whichwasfirstpresentedwithpaincausedbyapathologicalfracture.Magneticresonanceimagerevealedarenaltumor,andtechnetium-99m–methylenediphosphonatebonescintigraphyshowedmultipleosseousmetastases.Thepatienteventuallyunderwentsurgerytoremovethelateralendoftheleftclavicleandrightkidney.Histopathologyrevealedrenaltumorandclearcellcarcinomaintheclavicle.Finally,wereview17casesofclavicularmetastasesoriginatingfromdifferentmalignancies.

简介：对不完全的肠的阻塞的评估的主要诊断挑战是在传染、恶意的病原学之间区分。我们在场抱怨伴有恶心的腹的疼痛并且呕吐的一个老女人的一个案例，和到通行证气体或凳子的失败。反肺结核药被用来减轻她的腹的疼痛，并且腹洞的针活体检视显示出腹膜(PSCP)的主要的乳突的浆液的癌的证据。这是对在PSCP的背景的肺结核的稀罕描述。这份报告为恶意与风险因素说明恶意的潜在的复杂性质，并且强调需要在病人考虑恶意和感染的共存，特别在那些与抗菌素治疗失败。

简介：AbstractTrauma during pregnancy deserves special attention because of its management objectives, i.e. wellbeing of both pregnant woman and foetus. Maxillofacial trauma directly affects the nutrition of foetus by interfering with the normal functions in a pregnant woman such as mouth opening, mastication and breathing. Hence early restitution of form and function of maxillofacial skeleton is essential. However, the gravid status is associated with numerous anatomical and physiological changes which present with clinical dilemma related to imaging and treatment. A careful scrutiny of the patient's systemic and gestational status is absolutely essential before, during and after instituting any interventional procedures. We present a case of bilateral condyle fracture in a 30-year-old pregnant woman in the third trimester (32 weeks). She was treated with inter maxillary fixation using orthodontic brackets & elastics. After successful restitution of occlusion, the patient was advised aggressive physiotherapy which ensured normal mouth opening. Two weeks later, the patient delivered uneventfully. The patient was followed up at one month and 3 month and demonstrated restitution of normal occlusion, mouth opening and lower facial height. This article aims at analyzing the contemporary principles in management of maxillofacial trauma in a pregnant woman and clarifying the common misconceptions.

简介：AbstractFetal cardiac rhabdomyoma is associated with tuberous sclerosis complex (TSC) which is an autosomal dominant hereditary neurocutaneous disease with an incidence of approximately 1 in 5 000 to 10 000 live birth. It is caused by mutations in the TSC1 or TSC2 gene, de novo mutations accounting for approximately 80% of TSC cases, which can involve multiple organs and systems such as the heart, brain, kidney, lung, skin, and so on. Cardiac rhabdomyoma is the most common fetal heart tumor, accounting for about 60% of cases. It is closely related to TSC and may be the only manifestation of TSC which occurs during pregnancy. This study retrospectively analyzed the clinical data of a neonate with TSC diagnosed with fetal cardiac rhabdomyomas and confirmed by amniocentesis prenatal diagnosis as gene testing TSC1 gene positively. The parents had no such mutation. However, due to the influence of the sudden coronavirus disease 2019 (COVID-19) epidemic, the TSC genetic test report was not obtained until 38 weeks of pregnancy. Multiple hypo-pigmented spots (diameter >5 mm) were found immediately after birth. The characteristic cardiac feature of TSC is a rhabdomyoma and the diagnosis of TSC is based upon genetic testing and multiple ultrasound examinations or magnetic resonance imaging. Most patients with TSC have epilepsy, and one-half or more have cognitive deficits and learning disabilities. So rigorous follow-up will continue for the case we reported.

简介：AbstractIntroduction:Merkel cell carcinoma (MCC) is a rare, aggressive cutaneous malignancy, and its pathogenesis might relate to ultraviolet light and Merkel cell polyomavirus infection. MCC in the Chinese population is uncommon.Here, we present a case of MCC that occurred based on widespread actinic keratosis (AK) in a Chinese female.Case report:An 82-year-old woman presented with two rapidly enlarging and rupture lesions on the face for 1 year. Biopsy was suggestive of squamous cell carcinoma (SCC) on the forehead and MCC on the left cheek. The patient had a history of generalized AK for 3 years. The lesion on the left cheek was also revealed as an AK by histopathological examination 1 year ago. Complete surgical resection was performed to remove the two malignancies.Discussion:The co-occurrence of AK, SCC, and MCC in a Chinese woman is unusual. Immunohistopathological examination is vital for correct diagnosis. The three tumors, in this case, may originate from two different precursor cells and are affected by the same carcinogen. Alternatively, they may come from the same pluripotent epidermal stem cells, and chronic exposure to ultraviolet light and Merkel cell polyomavirus lead to the formation of different types of tumors. The coexist of MCC with other cutaneous tumors provided a train of thought for exploring the origin of MCC.Conclusion:We reported a rare co-existence phenomenon of MCC associated with AK and SCC. Hence, long-term follow-up and early treatment are imperative for patients with premalignant lesions, such as widespread AK.

简介：AbstractSchatzkter type-I tibial plateau fracture is a split fracture of the lateral tibial plateau in sagittal plane, consequent to valgus impaction caused by low velocity of trauma. However, a deep understanding of the different columns of the tibial plateau and patho-mechanisms of the injury led to the unmasking of atypical fractures around the tibial plateau. We have encountered 2 cases with unusual fracture pattern of the lateral tibial condyle caused by road traffic accidents. The fracture pattern and severity of injury deviate from the original description of Schatzker type 1; in view of dual plane split, there is rotation of the posterolateral column fragment along its sagittal plane plus grade-III medial collateral ligament injury. The patients were initially treated with knee spanning external fixator and after a latency of 5 days, definitive fracture specific fixation was done, combined with repair of grade-III medial collateral ligament injury. At the 6 months follow-up both the patients achieved satisfactory knee functions (knee society score case 1:100 and case 2: 92) and returned to their jobs. The severity of fracture pattern and displacement as described should prompt for examination of associated ligament injury. Because of timely diagnosis, early and appropriate care promised an excellent function outcome even in such a severe nature of knee injury. To prompt the description of injury pattern we coined the name "dual split and dislocation" of lateral tibial plateau, as a complex injury variant of split fracture of lateral tibial plateau fracture.

简介：AbstractArthroscopic superior capsular reconstruction is an innovative technique for the irreparable rotator cuff tears, but spontaneous pneumothorax after surgery is very rare. The present case was a 66-year-old female with irreparable rotator cuff tears of the right shoulder, treated with the arthroscopic shoulder superior capsular reconstruction. The general anesthesia and operation went smoothly, but the patient experienced stuffiness in the chest and shortness of breath after recovery from anesthesia. Thoracic CT scans showed spontaneous pneumothorax in the right side, which was successfully treated by the conservative treatments (oxygen therapy) according to multidisciplinary team. Prompt and accurate early-stage diagnosis is necessary in controlling postoperative complications and standardized treatment is the key to relieve the suffering. Spontaneous pneumothorax after arthroscopic shoulder surgery has been rarely reported in previous literatures.

简介：AbstractIntroduction:Nevoid basal cell carcinoma syndrome is an autosomal dominant disorder characterized by developmental malformations and carcinogenic activity. Multi-systemic anomalies may occur in this syndrome, such as odentogenic keratocysts of the mandible and postnatal tumors, especially multiple basal cell carcinoma.Case presentation:A 60 year old man presented with systemic plaques and nodules for more than 30 years. Cutaneous examination revealed that invasive erythema and black papules scattered on the face, trunk and limbs. He underwent extended surgical excision of lesions at multiple sites. No new lesions were found in the treated areas during a 3-year follow-up. Topical 5-aminolevulinic acid-mediated photodynamic therapy (ALA-PDT) was given as a palliative treatment for ulcerated tumors on the right lower eyelid and bleeding of the right temporal lesion. After application of ALA-PDT, the ulcers almost healed and the recurring hemorrhage ceased.Discussion:The management of multiple tumors in patients with nevoid basal cell carcinoma syndrome is extremely difficult, especially in the face. Surgical excision is the standard method, but the procedure can be applied in limited sites and may result in significant disfigurement and the difficulty of wound recovery. PDT can play a significant role in combination therapy for tumors that are extremely difficult to remove completely by surgical excision.Conclusion:We present a rare case manifested as multiple basal cell carcinoma and palmar pits who treated by surgery combined with topical 5-aminolevulinic acid-mediated photodynamic therapy. The combined therapy plays a complementary role in the treatment of nevoid basal cell carcinoma syndrome.

简介：AbstractBackground:Aneurysm of basilar perforator was rarely reported in the literature. It is difficult to treat due to its small size and deep-seated location. Excessive treatment may cause complications that resulted from ischemic events of parent perforators. Therefore, it is important to make clinical strategy for such patients to improve the prognosis.Case presentation:One case, who presented as spontaneous subarachnoid hemorrhage, despite the negative result in computed tomography angiography firstly, was diagnosed angiographically as a ruptured aneurysm of the basilar perforator. A good clinical outcome of the case was achieved during the follow-up after conservative observation for 2 months, as well as the disappearance of previous lesion from angiography.Conclusions:Aneurysm located at perforator of basilar trunk was rare and difficult to treat. Conservative observation for certain cases with periodic angiography follow-up was considered in order to prevent the patients from potential iatrogenic effects.

简介：AbstractObjective:To review current literature and experience with Gore-Tex® implant extrusion following medialization thyroplasty, as well as to report the unique case of Gore-Tex® implant extrusion following revision medialization thyroplasty.Methods:Review of existing literature and description of personal experience with unique case of Gore-Tex® implant extrusion following revision medialization thyroplasty.Results:Review of existing literature found no prior reported cases of Gore-Tex® implant extrusion following revision medialization thyroplasty. Risk factors for implant extrusion include the pressure of the implant on insertion and the inability to secure the implant. Cases of implant extrusion can be managed operatively via an endoscopic or via an external open approach.Conclusion:This is the first reported case of Gore-Tex® implant extrusion following revision medialization thyroplasty. Careful consideration should be given in revision medialization thyroplasty as additional implant material may cause increased pressure, a risk factor for implant extrusion.

简介：摘要A 65-year-old man visited a primary care hospital with a continued fever of 38°C for 3 days. As his fever did not improve until 8 days after, he was admitted into another acute care hospital, where his respiratory condition rapidly worsened. Therefore, the patient was transferred to our hospital. On the day of transfer (day 1) he was started on mechanical ventilation. COVID-19 was diagnosed using a polymerase chain reaction assay 6 days after admission (day 6). The rehabilitation therapy was begun on day 6. The initial rehabilitation programs focused on positioning and postural drainage. The patient was extubated on day 19 and he began standing and stepping on the same day. Gait exercises began on day 22, and endurance training was initiated on day 28. The patient was discharged from our hospital on day 34 as he met the physical function milestones. One month after discharge, the Medical Research Council sum score and Barthel Index had each improved; therefore, muscle strength and daily activities had returned to normal. It was assumed that mobilization should be performed as soon as possible after the end of sedation during the acute phase of severe COVID-19 infection in patients receiving mechanical ventilation.