Cryptogenic Multifocal Ulcerous Stenosing Enteritis Treated by Integrated Traditional Chinese and Western Medicine： A Case Report / 中医杂志

Cryptogenic multifocal ulcerous stenosing enteritis（CMUSE） is a rare and difficult disease characte-rized by chronic recurrent intestinal obstruction and gastrointestinal bleeding caused by multiple ulcers and strictures of the small intestine. There is still a lack of mature and systematic guidance for the treatment of the disease. This paper reported a case of CMUSE mainly manifested as fatigue， abdominal distention， and edema of both lower limbs ， who is treated by integrated traditional Chinese and western medicine. In western medicine treatment， hormone and symptomatic treatment are mainly used. In traditional Chinese medicine treatment， the method of fortifying spleen and reinforcing healthy qi is taken as the basis； during the active stage of the disease， the method of moving qi and removing stagnation， clearing and removing dampness and heat， astringing and engendering flesh should be combined with， while during the remission stage， it is advised to unite with the method of diffusing lung and moving water， regulating and harmonizing zang-fu （脏腑） organs； simultaneously， replenishing qi and invigorating blood can be used throughout the treatment， and attach importance to the maintenance therapy of the traditional Chinese medicine immunomo-dulatory agent Tripterygium glycosides. After more than 2 years of treatment， the patient's clinical symptoms were significantly relieved， and all indicators basically restored to normal， having a stable condition.

A case of acute severe cryptogenic organic pneumonia with secondary hemophilia / 中南大学学报(医学版)

Cryptogenic organic pneumonia (COP) refers to organic pneumonia that has not been identified a clear cause by current medical methods. A small proportion of COP can exhibit severe and progressive characteristics, while severe COP can cause systemic inflammatory storms and can be secondary to hemophilia. This article reported a case of acute severe COP secondary to hemophilia. A 67-year-old male patient was admitted to the hospital due to cough, shortness of breath, and fever. At first, he was misdiagnosed as severe pneumonia, but failed to receive anti infection treatments. Sputum pathogenetic examination and Macrogene testing of alveolar lavage fluid were performed, and no etiology was found to explain the patient's condition. The condition was gradually worsened and hemophilia occurred to explain, suggesting that acute severe COP was relevant. After receiving hormone treatment, the condition gradually relieved and the absorption of lung lesions improved. Hemophilia secondary to COP is rare, and the specific mechanism needs further study.

Diagnostic analysis of cTTE for patent foramen ovale and the value of combined NLR monitoring in predicting cryptogenic stroke / 中国医师杂志

Objective:To investigate the diagnostic value of transthoracic echocardiographic contrast-enhanced ultrasound (cTTE) in patent foramen ovale (PFO) and the value of combined neutrophil to lymphocyte ratio (NLR) in predicting cryptogenic stroke.Methods:A total of 120 suspected PFO patients admitted to the Affiliated Hospital of Jining Medical College from January 2021 to December 2021 were selected and examined by cTTE and transesophageal echocardiography (TEE) to analyze the diagnostic value of cTTE in PFO. The clinical data and cTTE parameters of PFO patients with and without cryptogenic stroke were analyzed.Results:A total of 69 patients with PFO were confirmed. Among the 69 patients, 23 patients with cryptogenic stroke and 46 patients without cryptogenic stroke were confirmed by magnetic resonance imaging (MRI). The value of cTTE in the diagnosis of PFO was high: the sensitivity, accuracy and negative predictive value of cTTE under Valsalva motion in the diagnosis of PFO were 95.65%, 91.67% and 93.62%, respectively, which were significantly higher than that of cTTE at rest (all P<0.05). The NLR, the proportion of large shunt of PFO right to left shunt (PFO-RLS), the inlet width of patent foramen ovale (PFO) and the outlet width of PFO in patients with PFO complicated with cryptogenic stroke were (3.01±0.89), 43.48%(10/23), (2.54±0.65)mm and (1.51±0.35)mm, respectively, which were significantly higher than those in patients without cryptogenic stroke (all P<0.05). Logistic regression analysis showed that NLR and the degree of PFO-RLS shunt were the influencing factors of patients with PFO complicated with cryptogenic stroke (both P<0.05). The area under the Receiver operating characteristic (ROC) curve predicted by NLR combined with PFO-RLS shunt was 0.905, which was significantly higher than that predicted by NLR and PFO-RLS shunt alone (all P<0.05). Conclusions:cTTE has a good value in the diagnosis of PFO, and cTTE combined with NLR has a certain application value in predicting PFO complicated with cryptogenic stroke.

Recent advance in pathogenesis and treatments of neurological complications related to patent foramen ovale / 中华神经医学杂志

Patent foramen ovale (PFO) is the most prevalent congenital heart disease, often accompanied by neurological symptoms as migraine, unexplained dizziness, and even anxiety and depression. Recent research findings indicate that the pathogenesis of neurological complications related to PFO involves abnormal embolism hypothesis, vasoactive substance hypothesis, impaired cerebral blood flow regulation and genetic inheritance. Treatments include primarily encompass pharmacological intervention and foramen ovale occlusion. This article summarizes the aforementioned research progress in order to provide clinical guidance for managing nervous system complications related to PFO.

Organizing pneumonia due to anti-synthetase syndrome: Presentation of a clinical case

Introduction: Organizing pneumonia is a rare clinico-pathological syndrome. This crypto-genic or secondary condition is of unknown origin, and may be infectious, or associated with autoimmune diseases, cancer, drugs, or radiation. Case description: The case is presented of a 52-year-old patient who was diagnosed with organizing pneumonia secondary to anti-synthetase syndrome. Discussion: It is intended to make known that not all pulmonary consolidative clinical pictures correspond to infectious processes. In this case, an organizing pneumonia secondary to anti-synthetase syndrome is documented. Despite being a disorder that is classified as an idiopathic inflammatory myopathy, it manifests as an interstitial lung disease with predominantly respiratory symptoms.

Introducción: La neumonía organizativa es un síndrome clínico-patológico poco frecuente, dentro del cual se desconoce la etiología de la denominada neumonía criptogénica o secundaria, que puede ser infecciosa o asociada con enfermedades autoinmunes, cáncer, fármacos o radiación. Descripción del caso: Se presenta el caso de una paciente de 52 arios a quien se le diagnostica neumonía organizativa secundaria a síndrome antisintetasa. Discusión: Se busca dar a conocer que no todos los cuadros clínicos de consolidación pulmonar corresponden a procesos infecciosos. En este caso se documentó una neumonía organizativa secundaria a síndrome antisintetasa, la cual a pesar de ser una patología que se cataloga como una miopatía inflamatoria idiopática, se manifestó como una enfermedad pulmonar intersticial con síntomas predominantemente respiratorios.

Patrones tomográficos de neumonía en organización. Serie de casos y revisión de la literatura / Tomographic patterns of organizing pneumonia. Case series and review

Resumen La neumonía en organización es un tipo de enfermedad pulmonar intersticial difusa que puede ser idiopática (criptogénica) o secundaria a numerosas etiologías, y se asocia con hallazgos clínicos y de laboratorio inespecíficos. Su diagnóstico y tratamiento exigen un equipo interdisciplinario, en el que las imágenes desempeñan un papel indispensable. Se presenta una serie de nueve casos, haciendo énfasis en las características clínicas y profundizando en los diversos patrones imagenológicos identificados. También se aporta una revisión de las variantes recientemente descritas.

Abstract Organizing pneumonia is a type of diffuse interstitial lung disease that can be idiopathic (cryptogenic) or secondary to numerous etiologies, and is an entity associated with nonspecific clinical and laboratory findings. Its diagnosis and treatment require an interdisciplinary team in which images play an indispensable role. The presentation of a series of nine cases is made, emphasizing the clinical characteristics and delving into the various identified imaging patterns. A review of the recently described variants is also provided.

Scanning of paroxysmal atrial fibrillation as an etiological risk factor in patients with acute ischemic stroke: prospective study

Abstract BACKGROUND: Prevention of recurrence of stroke depends on recognition of the underlying mechanism of ischemia. OBJECTIVE: To screen patients who were hospitalized with diagnosis of acute ischemic stroke in terms of atrial fibrillation (AF) with repeated Holter electrocardiography recordings. DESIGN AND SETTING: Prospective study conducted at Konya Education and Research Hospital, Turkey. METHODS: Patients with a diagnosis of acute ischemic stroke, without atrial fibrillation on electrocardiography (ECG), were evaluated. Their age, gender, histories of previous ischemic attack, occurrences of paroxysmal atrial fibrillation (PAF) and other risks were assessed during the first week after acute ischemic stroke and one month thereafter. ECG recordings were obtained from 130 patients through 24-hour ambulatory Holter. Patients without PAF attack during the first Holter were re-evaluated. RESULTS: PAF was detected through the first Holter in 33 (25.4%) out of 130 acute ischemic stroke patients. A second Holter was planned for 97 patients: 53 (54.6%) of them could not attend due to COVID-19 pandemic; while 44 (45.3%) patients had the second Holter and, among these, 4 (9.1%) had PAF. The only parameter associated with PAF was older age. Four (10.8%) of the 37 patients with PAF had also symptomatic carotid stenosis. CONCLUSIONS: Detecting the presence of PAF by screening patients with no AF in the ECG through Holter ECG examinations is valuable in terms of changing the course of the treatment. It should be kept in mind that the possibility of accompanying PAF cannot be ruled out in the presence of other factors that pose a risk of stroke.

The relation of cryptogenic ischemic stroke and migraine with aura patients with different right-to-left shunt volume by contrast enhanced transcranial Doppler / 中风与神经疾病杂志

@#Objective　To investigate the feature of the shunt volume of right-to-left shunt (RLS) in cryptogenic ischemic stroke (CIS) and migraine with aura (MA) and to analyze the different pathogenesis of CIS and MA with RLS.Methods　Forty-eight CIS patients and 42 MA patients from two case groups and 33 healthy volunteers from normal control group(NCG),using contrast enhanced transcranial doppler (cTCD) for diagnosing RLS and shunt volume grades,the positive rate of the three groups were analyzed.Results　In the case groups，the positive rate of RLS was MA 57.1% (24/42) and CIS 60.4%(29/48),of which large shunt accounted for MA 16.7% (7/42) and CIS 29.2%(14/48).In the NCG,the positive rate of RLS was 30.3% (10/33),of which large shunt accounted for 9.1% (3/33).Comparison of the three groups of the total positive rate，the total positive rate of two case groups were higher than NCG (MA vs NCG,P=0.02),(CIS vs NCG,P=0.008).Large shunt rate in CIS group was significantly higher than NCG (P=0.029).Conclusion　CIS and MA are significantly related to RLS.The large shunt rate of RLS in CIS patients was significantly higher than that in NCG.

Clinical characteristics and outcomes of patients with COVID-19 infection and acute ischemic stroke at Eka Kotebe general hospital in Addis Ababa, Ethiopia

BACKGROUND: Acute ischemic stroke has been reported to occur in a significantly higher number of COVID-19 patients as compared to healthy controls with variable proposed pathophysiologic mechanisms. To our knowledge, sufficient data regarding this subject is lacking in Ethiopia and the African continent at large. In this case series, we report the clinical characteristics and management of 5 cases with COVID-19 infection and acute ischemic stroke to shed light on the diagnostic and therapeutic challenges in resource-limited setups. METHODS: This is a case series including data collected from the medical records of 5 participants with confirmed RT-PCR positive COVID-19 infection and radiologically confirmed acute ischemic stroke, admitted at Eka Kotebe General Hospital Intensive Care Unit (ICU) in Addis Ababa, Ethiopia from June 10, 2020, to November 04, 2020. RESULTS: Cryptogenic stroke was documented in 4/5 participants included in this series with the most common vascular risk factors identified for stroke being hypertension and diabetes mellitus. The median time from onset of COVID-19 symptoms to the identification of stroke was 07 days. Two fifth of the participants in this series died during their ICU admission with the immediate cause of deaths reported to be related to the severe COVID-19 infection but not stroke. CONCLUSION: Cryptogenic stroke was documented in 4/5 patients in this series despite the presence of vascular risk factors for other stroke subtypes. The overall prevalence, subtypes, and outcomes of stroke in COVID-19 patients in Ethiopia and the African continent as a whole needs additional research to elucidate the local burden of the disease and define the predominant pathophysiologic mechanisms for stroke in COVID-19 in the region

Recent advance in patent foramen ovale related cryptogenic stroke / 中华神经医学杂志

Patent foramen ovale (PFO) is a congenital cardiac disease that occurs in up to 25% of the general adults, and up to 46% of young adults with cryptogenic stroke(CS). PFO is associated with several diseases, the most important of which is stroke. Stroke associated with PFO is usually classified as CS, and currently paradoxical embolism caused by PFO is believed to be the most common pathogenic mechanism. The features, diagnoses and treatments of PFO related CS have been paid more and more attention. This article reviews the related research advance in recent years, to provide new clinical evidences and strategies for the diagnoses and treatments of CS associated with PFO.

A single center study on the correlation between Cryptogenic stroke and right-to-left shunt by contrast enhanced transcranial doppler in Liaoning province / 中风与神经疾病杂志

@#Objective　To investigate the prevalence of right-to-left shunt（RLS） in cryptogenic stroke patients and analyze the relationship between cryptogenic stroke and RLS. Methods　We enrolled 44 cryptogenic stroke patients between 18-55 years old as case grope and 33 healthy volunteers as control group，using contrast enhanced transcranial doppler（cTCD） and contrast transthoracic echocardiography（cTTE） for diagnosis of RLS and grade，the positive rate of the two groups were statistically analyzed. Results　In the case group，the positive rate of RLS was 47.7%（21 /44），of which large shunt accounted for 27.3%（12/44）. In the control group，the positive rate of RLS was 30.3%（10 /33），of which large shunt accounted for 9%（3/33）. Comparison of two groups of the total positive rate，the total positive rate of case group was same to the control group，there was not statistically significant difference（χ2=2.380，P=0.123） ．Large shunt rate in case group was significantly higher than the control group（χ2=3.974，P=0.042）. Conclusion　cTCD is a responsible approach to diagnose RLS. Cryptogenic stroke is related to RLS，and the large shunt may be the important cause of cryptogenic stroke，which should be paid more attention to.

Deficiencia de lipasa ácida lisosomal, una patología infrecuente / Lysosomal acid lipase deficiency, a rare pathology

Resumen El déficit de lipasa ácida lisosomal es una enfermedad genética poco prevalente, con alta morbimortalidad en niños y adultos. Se caracteriza por alteración del metabolismo lipídico que genera depósitos de ésteres de colesterol y triglicéridos en el organismo. La presentación clínica depende de la actividad enzimática. Se debe sospechar en pacientes con alteraciones lipídicas o alteraciones hepáticas después de descartar otros diagnósticos. Actualmente existe la opción de utilizar enzima recombinante, la cual puede mejorar los parámetros lipídicos y hepáticos, así como detener la progresión de la enfermedad. Es imperioso realizar el diagnóstico oportuno para iniciar de forma temprana el tratamiento específico, con el fin de prevenir la morbimortalidad. Se llevó a cabo revisión de la literatura en torno del déficit de lipasa ácida lisosomal, para orientar acerca de su fisiopatología, manifestaciones clínicas, diagnóstico y tratamiento.

Abstract Lysosomal acid lipase deficiency is a genetic disease with a low prevalence and high morbidity and mortality in children and adults. It is characterized by an alteration of lipid metabolism, which generates cholesterol and triglyceride esters deposits in the body. Its clinical presentation depends on enzymatic activity. This condition should be suspected in patients with lipid or liver alterations after ruling out other diagnoses. Currently, there is the option of using a recombinant enzyme, which can improve lipid and liver parameters, as well as disease progression. Establishing a timely diagnosis in order to initiate specific treatment early is imperative for the prevention of morbidity and mortality. The purpose of this work is to perform a review of the literature about lysosomal acid lipase deficiency and to guide about its pathophysiology, clinical manifestations, diagnosis and treatment.

Signo del halo invertido como manifestación inhabitual de neumonía organizada criptogénica: reporte de un caso / Reversed halo sign as an unusual manifestation of cryptogenic organized pneumonia: report of one case

We report a 64 years old female admitted with fever, cough, dyspnea and lung opacities in the chest X ray. A chest tomography scan (CTS) showed multiple-bilateral ring-shaped opacities and the reversed halo sign (RHS). The patient did not improve with antimicrobial therapy (AT). Infection and rheumatologic causes were excluded, therefore Cryptogenic organizing pneumonia (COP) was suspected with compatible percutaneous biopsy. Systemic steroids were started with a good clinical response. The patient was discharged four weeks after admission in good general conditions and practically no lungs opacities.

The prevalence and associated factors of viral hepatitis and cryptogenic related hepatocellular carcinoma at King Abdulaziz Medical city-Riyadh

Background: Worldwide, viral hepatitis is the major risk factor for HCC with hepatitis B (HBV) being more than hepatitis C (HCV). Saudi Arabia is one of the endemic areas of viral hepatitis. Cryptogenic HCC is thought to arias from unknown causes of liver cancers. Thus, the purpose of this study was to find the prevalence of viral and cryptogenic HCC in King Abdulaziz Medical City-Riyadh (KAMC-R).Methods: A retrospective chart review was performed for all HCC patients diagnosed between 2010 to 2017 at KAMC-R. Information regarding age, gender, comorbidity, alcohol consumption, serology tests, liver enzymes, body mass index, model for end-stage liver disease score, alpha-fetoprotein and Child-Turcotte-Pugh score were included. The Chi-square test was used to determine the differences between categorical data. A p<0.05 was considered statistically significant.Results: Total of 294 patients with HCC charts were reviewed. HCV and HBV were found in 42.85% and 20.74% of the patients, respectively. Co-infection with HBV and HCV were reported in 1.7% whereas cryptogenic HCC was found in 32.65% of the patients. High BMI and DLP were noticeably higher in cryptogenic group (p=0.045 and p=0.022 respectively). Multiple lesions were noticed more in HCV group whereas single lesion was more in the cryptogenic group (p=0.0343). Also, large lesions (>5 cm) were remarkably found more in cryptogenic HCC whereas small lesions were more in HCV group (p=0.006).Conclusions: Hepatitis C was the major risk factor associated with HCC, followed by Cryptogenic HCC. High BMI and DLP were common features of cryptogenic HCC.

Latest diagnosis and treatment strategy for patent foramen ovale and cryptogenic stroke / 中国实用内科杂志

The diagnosis and treatment of cryptogenic stroke(CS) has always been the direction of clinical researchers, and its relationship with patent foramen ovale(PFO) has become a research hotspot in recent years. It is essential to correctly understand its cause and carry out targeted treatment. This article discusses the relationship between PFO and CS and the latest diagnosis and treatment strategies, aiming to standardize and guide PFO closure, so that the true CS patients with PFO can benefit from the closure treatment.

The clinical thinking of diagnosis and treatment of cryptogenic cirrhosis / 医学研究生学报

Cryptogenic cirrhosis (CC), cirrhosis of unknown cause, is common in clinic. With the improvement of the level of diagnosis and the diversification of the diagnosis and treatment, the incidence of CC is gradually declining. In the process of diagnosis and treatment, perfect clinical thinking can help clinicians to analyze and evaluate the existing clinical data, and it is expected to further improve the diagnostic rate of CC. In this paper, the clinical thinking of CC diagnosis and treatment is expounded from the aspects of disease spectrum thinking, anatomy thinking and macroscopic micro thinking.

Recent advances in carotid web and ischemic stroke / 中华神经医学杂志

As a non-atherosclerotic disease in the extracranial segment of the carotid artery, carotid web is a ridge-like intraluminal protrusion beyond the bifurcation of the posterior wall of the carotid artery bulb. Carotid web also has been referred to as an atypical variant of fibromuscular dysplasia. In recent years, more and more studies indicate that carotid web is a rare but important risk factor for ischemic stroke. In order to accurately diagnose carotid artery web, implement targeted intervention and treatment for ischemic stroke caused by carotid web, the authors summarized the recent advances in carotid web and ischemic stroke.

Simplified percutaneous closure of patent foramen ovale and atrial septal defect with use of plain fluoroscopy: Single operator experience in 110 consecutive patients

Objective Percutaneous closure of patent foramen ovale (PFO) and atrial septal defect (ASD) is routinely performed under general anesthesia or deep sedation and use of transesophageal (TEE) or intracardiac echocardiography, incurring longer duration and higher cost. We have used a simplified, economical, fluoroscopy-only guided approach with local anesthesia, and herein report our data. Methods The study includes 112 procedures in 110 patients with PFO (n = 75) or ASD (n = 35), with use of an Amplatzer occluder, heparin and prophylactic antibiotics. Balloon sizing guided ASD-device selection. All patients received aspirin and clopidogrel for 6 months, when they all underwent TEE. Results All PFOs but one (98.7%) and all (100%) ASDs were successfully closed with only one complication (local pseudoaneurysm). At the 6-month TEE, there was no residual shunt in PFO patients, but 2 ASD patients had residual shunts. During long-term (4.3-year) follow-up, no stroke recurrence in PFO patients, and no other problems were encountered. Among 54 patients suffering from migraine, symptom relief or resolution was reported by 45 (83.3%) patients. Conclusion Percutaneous placement of an Amplatzer occluder was safe and effective with use of local anesthesia and fluoroscopy alone. There were no recurrent strokes over >4 years. Migraine relief was reported by >80% of patients.

Clinical characteristics of patients with cryptogenic stroke and patent foramen ovale / 第二军医大学学报

Objective To investigate the clinical characteristics of patients with cryptogenic stroke and patent foramen ovale (PFO). Methods The clinical features, imaging findings and therapeutic outcomes of 51 patients with cryptogenic stroke and PFO, who received treatment in Stroke Center of Changhai Hospital of Navy Medical University (Second Military Medical University) between Sep. 2013 and Jan. 2018, were retrospectively analyzed. Results Of the 51 cases, 41 were male and 10 were female; and the mean age was (53.92±14.83) years (ranging from 21 to 84 years). Diffusion weighted imaging (DWI) showed that 46 patients developed new infarction including 20 cases (43.5%) of single lesion and 26 cases (56.5%) of multiple lesions, of which 15 cases (57.7%) involved single arterial territory and 11 cases (42.3%) involved two or more arterial territories (4 cases of bilateral anterior circulation, and 7 cases of both the anterior and posterior circulations). Thirty-seven patients underwent contrast-enhanced transcranial Doppler (cTCD) examination, which showed that 31 cases (83.8%) had microbubble sign (air microbubble emboli of 4 cases looked like raindrops or curtains). In 50 patients undergoing transesophageal echocardiography (TEE) examination, 49 cases (98.0%) were accompanied with PFO. Nine patients received intravenous thrombolysis. In secondary prevention, 18 patients received single antiplatelet therapy, 12 dual antiplatelet therapy, 8 anticoagulation therapy, and 13 PFO closure+single antiplatelet therapy. One patient with single antiplatelet therapy had recurrent ischemic stroke, 2 patients with dual antiplatelet therapy had recurrent ischemic stroke, and the patients with percutaneous closure of PFO had no recurrent stroke. Conclusion The infarction of cryptogenic stroke with PFO involves single or multiple arterial territories, cTCD and TEE have high positive diagnosis rate for PFO, and the patients with selective antithrombotic therapy and PFO closure have a low risk of recurrent stroke.