Retroperitoneoscopic lumbar sympathectomy for the treatment of primary plantar hyperhidrosis

Background Primary plantar hyperhidrosis (PPH) is an idiopathic disease, characterized by excessive sweating of the feet. It leads to significant disturbance in private and professional daily lifestyle, due to excessive sweating. The aim of this study is to present the safety, efficacy and procedures of retroperitoneoscopic lumbar sympathectomy (RLS) for treatment of PPH. Methods RLS was performed 60 times in 30 patients (18 men, 12 women) with PPH in our institution from May 2019 to October 2020. All procedures were carried out by laparoscopy with retroperitoneal approach. Clinical data including patient demographics and perioperative, postoperative outcomes were evaluated. Recurrence of symptoms, and any adverse effects of surgery were evaluated after 7 to 30 days in outpatient clinic, and thereafter every 6 months. Results Mean age of patients was 33.6 (± standard deviation 10.8) years. Fourteen and fifteen patients were previously treated with medical therapy or endoscopic thoracic sympathectomy (ETS) respectively. Mean preoperative quality of life (QoL) score of patients was 91.8 (VERY BAD), but postoperative 12 months (QoL) score decreased to 29.1 (MUCH BETTER). There was no serious postoperative complication. During the mean 22 months of follow-up period, no compensatory sweating was observed. Conclusions RLS can be a safe and effective surgical treatment for severe PPH, especially for the patients with persistent plantar sweating even after conservative management and ETS. RLS also could be offered to surgeons who are familiar with retroperitoneal space anatomy as feasible surgical treatment for PPH.

Clinical Characteristics and Prognosis of Idiopathic Acute Pancreatitis

Objective: Acute pancreatitis is a serious diagnosis with an increasing incidence in the Western world. In this study we sought to investigate the incidence of idiopathic AP and to compare clinical and prognostic characteristics of idiopathic cases with cases of AP with known etiology. Methods: In this retrospective study of adult hospitalized patients diagnosed with acute pancreatitis between 2012 and 2015, a comparison was made between admissions of patients with known etiology and those for whom no cause was found. Primary outcome was defined as composite outcome of 30-day mortality and complications. Results:Among 560 admissions of 437 patients with a primary diagnosis of acute pancreatitis, the main factors identified were gallstones (51.2%) and idiopathic pancreatitis (35.9%), with alcohol ranked third at only 4.8%. Mortality rate within 30 days of hospitalization was 2.9% and within one year was 7.1%. Use of lipid-lowering, anti-hypertensive, and anti-diabetic medications was more frequent among patients with “idiopathic” disease (70%, 68%, and 33% versus 59%, 56%, and 27%, respectively). Patients admitted with idiopathic AP, in comparison to patients with known AP etiology, had milder disease with shorter hospital stay (3 days versus 4, respectively), and less re-admission in 30 days (7.5% versus 21.2%). Idiopathic AP patients had better prognosis in terms of 30-day death and complication (HR 0.33, 95% CI 0.08–0.40, P<0.001). Conclusion: Idiopathic disease is common among acute pancreatitis patients; the two study groups differed in severity of disease and prognosis. Common use of medications with doubtful value suggests possible under-diagnosis of drug-induced acute idiopathic pancreatitis.

Pulmonary hypertension

Pulmonary arterial hypertension (PH) is an often-misdiagnosed lung disorder occurring as a primary idiopathic disease or as a complication of a large number of respiratory and cardiac diseases. It was previously thought to be a rare condition with a relentlessly progressive course and few treatment options. However, it is increasingly recognized in association with other conditions and recent advances have resulted in the development of effective therapies. This has focused attention on making an early and accurate diagnosis. Despite these recent advances, it is important to consider that it remains an alarming, incurable disease with a poor prognosis. PH describes a number of devastating diseases causing breathlessness, loss of exercise capacity, and death due to right-sided heart failure. This chapter begins by defining the condition, including the ESC and ERS guidelines, then goes on to give help with diagnosis and functional classification. Clinical features and investigations are outlined, as well as further assessment and key respiratory, cardiac, and haematological investigations. Specific targeted therapies, general treatment, and nursing care and advice are covered too.

A rare, but to be considered disease, in the differential diagnosis of abdominal pain: Mesenteric Panniculitis

Abdominal pains are one of the major topics of emergency clinics. Mesenteric panniculitis (MP) is one of the rarely encountered causes of abdominal pain and is known as an idiopathic disease with a good prognosis. MP may cause abdominal pain, abdominal mass and intestinal obstruction. Infections, autoimmune diseases and abdominal traumas may trigger MP. The disease may coexist with malignancy and has a high probability of developing malignancy in MP patients. In this case report, a 59-year-old female patient, who came to our Internal Medicine Outpatient Clinic with abdominal pain and who was diagnosed with MP, is presented.

Association between HLA-A gene polymorphism and early-onset preeclampsia in Chinese pregnant women early-onset

Background Preeclampsia is an idiopathic disease during pregnancy. This study explores the correlation between HLA-A polymorphism and the onset of preeclampsia. Methods The Illumina HiSeq2500 sequencing platform was used to genotyping HLA-A allele in venous blood DNA of 50 preeclampsia pregnant women and 48 normal pregnant women and umbilical cord blood DNA of their children of Han nationality in China. The frequencies and distributions of alleles and genotypes among the mothers and their children were compared between the two groups. The differences of frequencies and distributions of genotypes were compared between the two groups according to the mothers’ genotype compatibility. Results Twenty HLA-A alleles were detected in preeclampsia pregnant women and normal pregnant women; 21 HLA-A alleles were found in preeclampsia group fetuses and 22 HLA-A alleles in control group fetuses. There was no statistical difference in the HLA-A genes’ frequency between the two groups of pregnant women and their fetuses. When the sharing antigen was 1, the number of maternal-fetal pairs in the preeclampsia group was more than that in the control group; the difference was statistically significant (P < 0.05). The frequency of neither mother nor fetus carrying the HLA-A * 24: 02 gene in the preeclampsia group was significantly lower than that in the control group (P < 0.05). HLA-A gene homozygosity in fetuses of early-onset preeclampsia group was substantially higher than that of the control group (P = 0.0148); there is no significant difference in pregnant women’s genes homozygosity between early-onset preeclampsia group and the control group. Conclusions HLA-A * 24: 02 may be a susceptibility gene for early preeclampsia.

Tracheobronchopathia Osteochondroplastica: A Case Report

Background: Tracheobronchopathia osteochondroplastica (TO) is a rare idiopathic disease with a stable course that involves the mucous membrane of the tracheobronchial tree. Most cases present no specific symptoms, and there are currently no established guidelines for diagnosis and treatment. In this report, we discuss a single case of a patient with TO who was diagnosed based on clinical imaging and histopathology. Case Summary: A patient with a history of smoking and alcohol consumption, but no specific clinical symptoms, was diagnosed with TO after undergoing fiber-optic bronchoscopy. Nodular processes with smooth surface mucosa and detached bronchial mucosa were observed. The presence of TO was confirmed by pathological examination. Conclusion: The diagnosis of TO is difficult, and early fiber-optic bronchoscopy and pathological examination should be performed to facilitate the diagnosis.

A rare case report of Coats’ disease

Coats’ disease was first described by George Coats, as a unilateral retinal vascular abnormality.Coats’ disease is a nonhereditary, idiopathic disease presenting with vascular telangiectasia withintraretinal and subretinal exudation with no racial preponderance and systemic associations. Coats’disease presents with a wide ambit of clinical features- vision loss, strabismus, leukocoria, ornystagmus. The three classical features that are pathognomonic of Coats’ are exudative retinaldetachment, telangiectatic vessels, and peripheral retinal ischemia. The modalities for treatment ofCoats disease that can be used are laser photocoagulation, anti-VEGF agents, or a combination ofboth and cryotherapy. This article describes a case report of a 10-year-old male child withcomplaints of painless loss of vision, his ophthalmological evaluation, and the treatment isundertaken.

An Unusual Presentation of Idiopathic Multicentric Castleman Disease: The Great Masquerader

Castleman disease is an uncommon, non-clonal, lymphoproliferative disorder characterized by lymphadenopathy and symptoms related to hypercytokinemia. Clinically it is classified as unicentric and multicentric disease. Multicentric disease is further subclassified as HHV- 8 associated disease and idiopathic disease, which is the rarest subtype. The incidence of idiopathic disease is estimated to be 5 per million person years. The diagnosis of Idiopathic Multicentric Castleman disease is complicated by an array of clinical mimics and non-specific symptoms. We report a rare case of Idiopathic Multicentric Castleman disease in a young female where a detailed pathological work up helped to secure the diagnosis and exclude its mimics.

MANAGEMENT OF ANESTHESIA ON PATIENTS WHO WALK IN SESAROUS SECTION WITH ARTERITICAL TAKAYASU DISEASE

Takayasu Arteritis Disease (TA) is a chronic inflammatory, progressive, and idiopathic disease causes narrowing, obstruction and aneurysms in systemic arterial and pulmonary artery, which mainly attacks the aorta and its branches. During pregnancy, these patients should be given special attention, in connection with any complications that may occur. Case is a woman 32 years 38 weeks pregnant with TA disease with changes in several branches of the aorta since thirteen years ago. During pregnancy there are no complaints, and now she went to the hospital with 37-38 weeks gestation. Caesarean section has been done with regional anesthesia - epidural. Local anesthesia is administered by titration with the hope of sensory blockade obtained gradually. After procedure patient had observation in the recovery room and hemodynamic was stable then moved to ward. Conclusion of the case is some complications can affect pregnancy in patients with TA. In pre anesthetic evaluation should be done carefully, treatment of complications and anesthetic planning are essential. Maintenance of perfusion is a major concern for patients and neuraxial blocks can be used without harming the mother and fetus. In patients with complications of TA was still compensated, monitoring during the procedure the same as routinely used. Provision of continuous epidural anesthesia with titration to maintain hemodynamic stability and allows monitoring of cerebral perfusion through the levels of consciousness. To avoid hypoperfusion or postoperative complications of hypertensive patients should be monitored closely for 24 hours.