Cognitive decline in administration of the nonsteroidal antiinflammatory drug loxoprofen with misoprostol in a 91‐year‐old Japanese woman

We report a case of a neuroendocrine carcinoma arising in a wound of the postoperative maxillary sinus that was difficult to distinguish from a postoperative maxillary cyst. The patient was a 65-year-old Japanese woman who complained of left exophthalmos with cheek swelling and eye movement disorders. In past history, she had, 40 years previously undergone operation on the bilateral maxillary sinus by Caldwell-Luc’s method. In a preoperative computed tomography, a mass occupied the left maxillary sinus showing irregular densities with destruction of the posterior bone walls and invasion into the left orbital. Both TI and T2 weighted magnetic resonance imaging showed low intensities and unevenness in the mass. We performed a biopsy of the maxillary tumor according to Caldwell-Luc’s method. Histological examination diagnosed neuroendocrine carcinoma. Radiation therapy (total 66Gy) resulted in partial response for this tumor. However, sinonasal neuroendocrine carcinoma has been identified as highly aggressive, with a high probability of recurrence and metastasis.

Download Full-text

Severe infection including disseminated herpes zoster triggered by subclinical Cushing’s disease: a case report

BMC Endocrine Disorders ◽

10.1186/s12902-021-00757-y ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Yuki Yamauchi ◽

Hiraku Kameda ◽

Kazuno Omori ◽

Michio Tani ◽

Kyu Yong Cho ◽

...

Keyword(s):

Herpes Zoster ◽

Cushing’S Disease ◽

Cardiopulmonary Arrest ◽

Severe Infection ◽

Japanese Woman ◽

The Body ◽

Cushing's Disease ◽

Old Japanese ◽

Subclinical Cushing’S Disease ◽

Physical Features

Abstract Background Subclinical Cushing’s disease (SCD) is defined by corticotroph adenoma-induced mild hypercortisolism without typical physical features of Cushing’s disease. Infection is an important complication associated with mortality in Cushing’s disease, while no reports on infection in SCD are available. To make clinicians aware of the risk of infection in SCD, we report a case of SCD with disseminated herpes zoster (DHZ) with the mortal outcome. Case presentation An 83-year-old Japanese woman was diagnosed with SCD, treated with cabergoline in the outpatient. She was hospitalized for acute pyelonephritis, and her fever gradually resolved with antibiotics. However, herpes zoster appeared on her chest, and the eruptions rapidly spread over the body. She suddenly went into cardiopulmonary arrest and died. Autopsy demonstrated adrenocorticotropic hormone-positive pituitary adenoma, renal abscess, and DHZ. Conclusions As immunosuppression caused by SCD may be one of the triggers of severe infection, the patients with SCD should be assessed not only for the metabolic but also for the immunodeficient status.

Download Full-text

Conservatively Treated Femoral Intertrochanteric Fracture With Early Asymptomatic Novel Coronavirus Disease 2019 (COVID-19): A Case Report

Geriatric Orthopaedic Surgery & Rehabilitation ◽

10.1177/2151459320969380 ◽

2020 ◽

Vol 11 ◽

pp. 215145932096938

Author(s):

Yuki Suzuki ◽

Toshihiko Kasashima ◽

Kazutoshi Hontani ◽

Yasuhiro Yamamoto ◽

Kanako Ito ◽

...

Keyword(s):

Intertrochanteric Fracture ◽

Screening Method ◽

Oxygen Demand ◽

Japanese Woman ◽

Trauma Patients ◽

Lung Field ◽

Old Japanese ◽

Femoral Intertrochanteric Fracture ◽

Novel Coronavirus ◽

The Right

Introduction: The ongoing outbreak of novel coronavirus disease 2019 (COVID-19) is a worldwide problem. Although diagnosing COVID-19 in fracture patients is important for selecting treatment, diagnosing early asymptomatic COVID-19 is difficult. We describe herein a rare case of femoral intertrochanteric fracture concomitant with early asymptomatic novel COVID-19. Case presentation: An 87-year-old Japanese woman was transferred to our emergency room with a right hip pain after she fell. She had no fever, fatigue, or respiratory symptoms on admission and within the 14 days before presenting to our hospital, and no specific shadow was detected in chest X-ray. However, chest computed tomography (CT) was performed considering COVID-19 pandemic, and showed ground-glass opacities with consolidation in the dorsal segment of the right lower lung field. Then, qualitative real-time reverse-transcriptase-polymerase-chain-reaction (RT-PCR) was carried out and turned out to be positive. She was diagnosed right femoral intertrochanteric fracture with concomitant COVID-19 infection. Conservative treatment was applied to the fracture due to infection. After admission, fever and oxygen demand occurred but she recovered from COVID-19. Throughout the treatment period, no cross-infection from the patient was identified in our hospital. Conclusion: This case highlights the importance of considering chest CT as an effective screening method for infection on hospital admission in COVID-19-affected areas, especially in trauma patients with early asymptomatic novel COVID-19.

Download Full-text

Rapid Deterioration of Latent HBV Hepatitis during Cushing Disease and Posttraumatic Stress Disorder after Earthquake

Journal of Neurological Surgery Part A Central European Neurosurgery ◽

10.1055/s-0037-1598052 ◽

2017 ◽

Vol 78 (04) ◽

pp. 407-411 ◽

Cited By ~ 1

Author(s):

Ryosuke Tashiro ◽

Teiji Tominaga ◽

Yoshikazu Ogawa

Keyword(s):

Hepatic Dysfunction ◽

Residual Tumor ◽

Optic Chiasm ◽

Japanese Woman ◽

Hbv Reactivation ◽

Cushing Disease ◽

Old Japanese ◽

Threatening Condition ◽

The Right ◽

Subtotal Removal

AbstractReactivation of the hepatitis B virus (HBV) is a risk in the 350 million HBV carriers worldwide. HBV reactivation may cause hepatocellular carcinoma, cirrhosis, and fulminant hepatitis, and HBV reactivation accompanied with malignant tumor and/or chemotherapy is a critical problem for patients with chronic HBV infection. Multiple risk factors causing an immunosuppressive state can also induce HBV reactivation.We present a case of HBV reactivation during an immunosuppressive state caused by Cushing disease and physical and psychological stress after a disaster. A 47-year-old Japanese woman was an inactive HBV carrier until the Great East Japan Earthquake occurred and follow-up was discontinued. One year after the earthquake she had intractable hypertension, and her visual acuity gradually worsened. Head magnetic resonance imaging showed a sellar tumor compressing the optic chiasm, and hepatic dysfunction with HBV reactivation was identified. Endocrinologic examination established the diagnosis as Cushing disease. After normalization of hepatic dysfunction with antiviral therapy, transsphenoidal tumor removal was performed that resulted in subtotal removal except the right cavernous portion. Steroid hormone supplementation was discontinued after 3 days of administration, and gamma knife therapy was performed for the residual tumor. Eighteen months after the operation, adrenocorticotropic hormone and cortisol values returned to normal. The patient has been free from tumor regrowth and HBV reactivation throughout the postoperative course.Accomplishment of normalization with intrinsic steroid value with minimization of steroid supplementation should be established. Precise operative procedures and careful treatment planning are essential to avoid HBV reactivation in patients with this threatening condition.

Download Full-text

Pain Intensity after Laseruvulopalatoplasty and Tonsillectomy

Otolaryngology ◽

10.1067/mhn.2003.82 ◽

2003 ◽

Vol 128 (2) ◽

pp. 273-279 ◽

Cited By ~ 12

Author(s):

Hannu Kokki ◽

Elina Nikanne ◽

Mikko Aho ◽

Jukka Virtaniemi

Keyword(s):

Pain Relief ◽

Pain Intensity ◽

Pain Treatment ◽

Antiinflammatory Drug ◽

Nonsteroidal Antiinflammatory Drug ◽

Free Access ◽

Fentanyl Citrate ◽

Rescue Analgesia ◽

Parallel Group ◽

At Home

OBJECTIVE: The first objective of this study was to evaluate pain intensity and opioid consumption during the first 24 hours after uvulopalatoplasty and tonsillectomy in the hospital, and the second was to evaluate pain intensity and its progression during the first 2 weeks after surgery at home. STUDY DESIGN AND SETTINGS: In a prospective parallel group study, 51 patients with uvulopalatoplasty or tonsillectomy were studied. Ketoprofen, a nonsteroidal antiinflammatory drug, and fentanyl citrate, an opioid, were used as analgesics. RESULTS: Despite ketoprofen infusion and free access to a patient-controlled pump with fentanyl citrate for rescue analgesia, inadequate pain relief was common both after uvulopalatoplasty (35%) and after tonsillectomy (28%) during the first 24 hours after surgery. The consumption of fentanyl citrate was similar after both operations. At home, pain intensity was highest in the mornings during the first 5 days, and 10 patients had some pain still after 2 weeks. Also at home, high pain scores were reported commonly in both groups. CONCLUSION: Sgnificant pain after uvulopalatoplasty and tonsillectomy lasted for several days. Ketoprofen in the commercial capsule form proved to be too short acting for overnight pain relief. SIGNIFICANCE: Pain treatment in patients with uvulopalatoplasty and tonsillectomy should be improved to allow patients a peaceful recovery after surgery.

Download Full-text