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Clinical Medicine Insights. Case Reports

Ashraf Abugroun, Marion Gonzalez, Daniel Vilchez
Renal artery stenosis (RAS) is the leading cause of secondary hypertension. Renal artery stenosis can result in various cardiopulmonary complications mostly through activation of neurohormonal pathways that result in fluid overload and systemic hypertension. We herein describe a 72-year-old man with recurrent rapidly accumulating transudative pleural effusion in a patient with severe bilateral RAS. Patient pleural effusion resolved following stent placement with revascularization of the left renal artery despite absence of improvement of renal function...
2018: Clinical Medicine Insights. Case Reports
A Suárez-Lledó, A Padullés, T Lozano, S Cobo-Sacristán, M Colls, R Jódar
Most drugs that act on the central nervous system (CNS) require dose titration to avoid withdrawal syndrome. Tizanidine withdrawal syndrome is caused by adrenergic discharge due to its α2 -agonist mechanism and is characterized by hypertension, reflex tachycardia, hypertonicity, and anxiety. Although tizanidine withdrawal syndrome is mentioned as a potential side effect of cessation, it is not common and there have been few reports. We present the case of a 31-year-old woman with tizanidine withdrawal syndrome after discontinuing medication prescribed for a muscle contracture (tizanidine)...
2018: Clinical Medicine Insights. Case Reports
Navneet K Singh, Alexander J Sweidan, Sarah Strube, Ignacio Carrillo-Nunez
Neuromyelitis optica spectrum disorders (NMOSDs) are a set of demyelinating disorders that primarily target the optic nerves and the spinal cord. Previously thought to be a subset of multiple sclerosis (MS), now is recognized as a distinct entity. We present a 59-year-old female patient who was admitted for acute upper and lower extremity weakness. The patient had woken up from sleep with sudden onset of weakness. Patient was initially diagnosed with a right hemispheric stroke; however, magnetic resonance imaging of the cervical spine later performed showed abnormal enhancement from C2-C4, representing transverse myelitis...
2018: Clinical Medicine Insights. Case Reports
Raffaella Liccardo, Marina De Rosa, Francesca Duraturo
Lynch syndrome is an autosomal dominant syndrome that can be subdivided into Lynch syndrome I, or site-specific colonic cancer, and Lynch syndrome II, or extracolonic cancers, particularly carcinomas of the stomach, endometrium, biliary and pancreatic systems, and urinary tract. Lynch syndrome is associated with point mutations and large rearrangements in DNA MisMatch Repair (MMR) genes. This syndrome shows a variable phenotypic expression in people who carry pathogenetic mutations. So far, a correlation in genotype-phenotype has not been definitely established...
2018: Clinical Medicine Insights. Case Reports
Julie Mariam Joshua, Salima Kd, Pavithran K, Meenu Vijayan
Introduction: ROS1 rearrangement has recently emerged as a new molecular subtype in non-small-cell lung cancer (NSCLC) and is predominantly found in lung adenocarcinoma compared with other oncogenes such as EGFR, KRAS, or ALK. It has been identified in only 1% to 2% of NSCLC cases. Case Report: We report a case of 52-year-old man (nonsmoker) with a medical history of allergic rhinitis and bronchial asthma. Histopathologic examination of bronchoscopic-guided biopsy showed adenocarcinoma histology on September 2015...
2018: Clinical Medicine Insights. Case Reports
Ryo Igarashi, Atsushi Irisawa, Goro Shibukawa, Nobutoshi Soeta, Ai Sato, Akane Yamabe, Mariko Fujisawa, Noriyuki Arakawa, Yoshitsugu Yoshida, Tsunehiko Ikeda, Yoko Abe, Takumi Maki, Shogo Yamamoto, Ikuro Oshibe, Takuro Saito, Hiroshi Hojo
Gastric neuroendocrine tumors (GNETs) are rare lesions characterized by enterochromaffin-like cells of the stomach. Optimal management of GNETs has not yet been definitively determined. Endoscopic resection is approximately recommended for small GNETs associated with hypergastrinemia. However, endoscopic resection might present risk of perforation or positive vertical margin because neuroendocrine tumors occur in the deep mucosa, with some invading the submucosa. In this case, a patient with type A chronic atrophic gastritis had a small subepithelial lesion in a deep submucosal layer, and we diagnosed it as GNET using endoscopic ultrasound-guided fine-needle aspiration biopsy using a forward-viewing and curved linear-array echoendoscope...
2018: Clinical Medicine Insights. Case Reports
Miramir Aghdashi, Seyed-Mostafa Seidmardani, Sara Vossoughian, Seyed Arman Seyed Mokhtari
Familial Mediterranean fever (FMF) is characterized by recurrent episodes of fever accompanied by serosal, synovial, or cutaneous inflammation. The central nervous system (CNS) is rarely involved in FMF. The CNS involvement includes demyelinating lesions, posterior reversible encephalopathy syndrome, pseudotumor cerebri, optic neuritis, and cerebral vasculitis. Here, we present a 20-year-old man, a known case of FMF with abrupt left-sided hemiparesis. Brain magnetic resonance imaging revealed right periventricular infarction...
2018: Clinical Medicine Insights. Case Reports
Madeline K Mahowald, Melinda Davis
Background: Peripartum cardiomyopathy (PPCM) is a distinct type of heart failure with reduced ejection fraction (EF) with variable outcomes. Rates of recovery range from 29% to 72% and mortality rates range from 0% to 25%. In studies, outcomes are often determined at 6 to 12 months following diagnosis, and many of those who recover stop following with cardiology and are lost to follow-up. Case report: Patient 1 was a 25-year-old G2P1 who was diagnosed with PPCM 5 days after childbirth with an EF of 25%...
2017: Clinical Medicine Insights. Case Reports
Yosuke Niimi, Satoko Mori, Masaki Takeuchi
Negative pressure wound therapy (NPWT) is a method for treating wound. However, there are no case reports using NPWT for treating congestion after arterialized venous flap. Therefore, this study reported favorable outcomes after using a single-use NPWT system for managing congestion. A 39-year-old man had his index finger caught by a press machine. The finger had a soft tissue defect at the ventral part. An arterialized venous flap taken from the right forearm was transplanted. Perfusion of the flap was favorable, but on postoperative day 5, congestion and the edema of the flap were found...
2017: Clinical Medicine Insights. Case Reports
Mandi M Miller, Jessica M Ray, R Scott Van Zant
Purpose: Limited research exists regarding use of Astym® therapy with neurologic conditions. The purpose of this case was to describe using Astym therapy in treating spastic diplegic cerebral palsy (CP). Case description: A 6-year-old female was treated more than 9 months (36 sessions) for decreased flexibility, muscle weakness, spasticity, and abnormal gait. Examination findings: Gait performed with articulated ankle-foot orthoses (75% of the time) or foot orthosis (25%); lack of active dorsiflexion (DF); lack of heel strike during gait; spasticity in hamstrings, gastrocnemius, hip adductors; hamstring flexibility (90/90 test position) 50° right and 60° left; gastrocnemius flexibility neutral bilaterally; and Peabody Developmental Motor Scales, second edition (PDMS-2) age equivalence (in months) 23 locomotion, 25 object manipulation, and 21 stationary tasks...
2017: Clinical Medicine Insights. Case Reports
Reika Imai, Tetsu Akimoto, Takaaki Kimura, Marina Kohara, Toshihiro Shimizu, Kentaro Oka, Miwa Shuto, Maki Asakura, Izumi Nagayama, Shin-Ichi Takeda, Takashi Yagisawa, Shigeaki Muto, Daisuke Nagata
Peritoneal dialysis (PD) is an accepted modality for managing end-stage kidney disease. We herein report a 75-year-old female patient on chronic PD who was complicated by renal cell carcinoma. She was successfully treated with retroperitoneal laparoscopic radical nephrectomy followed by a prompt resumption of the procedure. Various surgeries disturbing the abdominal wall integrity often disrupt the regular PD schedule, and using minimally invasive approaches is therefore an attractive therapeutic option. Our experience emphasizes the feasibility and safety of a retroperitoneal approach-based laparoscopic technique based on several empirical examples...
2017: Clinical Medicine Insights. Case Reports
Genshin Mouri, Hidenori Suzuki, Seiji Hatazaki, Toshio Matsubara, Waro Taki
We present the first report of intraosseous meningioma accompanied by intradural cyst formation. A 76-year-old woman had previously undergone breast cancer treatment, so the preoperative diagnosis was metastatic breast cancer. This case reminds us that the possibility of meningioma should be kept in mind in patients with breast cancer, irrespective of neuroimaging findings.
2017: Clinical Medicine Insights. Case Reports
Yosuke Niimi, Takashi Yamaki, Kejiro Hori, Miho Kirita, Yoji Nagashima, Hiroyuki Sakurai
Iatrogenic venous pseudoaneurysm (VP) formation after venipuncture is rare. This report showed 2 cases of VP following venipuncture, and VPs were resected surgically. A 58-year-old woman and a 56-year-old woman developed a soft antecubital mass after blood sampling from the basilic veins. One patient had the sensory disturbance of forearm. The mass was diagnosed as a VP with thrombus by duplex ultrasound and magnetic resonance imaging. The aneurysm was resected completely, and the sensory disturbance of the patient was improved...
2017: Clinical Medicine Insights. Case Reports
Viviana Scollo, Luca Zanoli, Elisa Russo, Giulio Distefano, Francesco Rapisarda
It is well known that some disorders can cause concomitant kidney dysfunction with lung involvement. These syndromes, characterized by the simultaneous presence of intra-alveolar hemorrhage and acute glomerulonephritis, are caused by numerous and variable disorders. The most frequent are the antineutrophil cytoplasmic antibodies (ANCA)-associated vasculitis and Goodpasture syndrome. A quick discerning of the underlying causes and initiation of adequate treatment is crucial to prevent acute respiratory failure and irreversible loss of renal function...
2017: Clinical Medicine Insights. Case Reports
Pascale S Grzonka, Raoul Sutter
Invasive pneumococcal meningitis is a life-threatening infectious disease affecting the central nervous system. It continues to be the most common type of community-acquired acute bacterial meningitides. Despite advances in neuro-critical care, the case fatality rate remains high. Rapid diagnosis and initiation of antibiotic therapy precludes mortality and long-term neurological sequelae in survivors. However, not all cases are easily recognised, and unanticipated complications may impede optimal course and outcome...
2017: Clinical Medicine Insights. Case Reports
Tetsu Akimoto, Tomoyuki Yamazaki, Marina Kohara, Saki Nakagawa, Yoshihiko Kanai, Sayoko Izawa, Hisashi Yamamoto, Eiko Nakazawa, Takahiro Masuda, Takahisa Kobayashi, Osamu Saito, Shigeaki Muto, Eiji Kusano, Daisuke Nagata
Peritoneal dialysis has been a widely accepted modality for treating end-stage kidney disease, but a regular dialysis schedule can be seriously disrupted by various comorbid conditions requiring surgical intervention. A 40-year-old woman who had been receiving peritoneal dialysis was sequentially but separately complicated by pleuroperitoneal communication and ovarian cancer. Despite the need for temporary interruption of her peritoneal dialysis schedule, it was successfully resumed after the relevant surgeries for each disease...
2017: Clinical Medicine Insights. Case Reports
Yulia Vainshenker, Vsevolod Zinserling, Alexander Korotkov, Svyatoslav Medvedev
Patient recovering from traumatic vegetative state has suddenly died from cardiac arrest. In-life improvement of consciousness appeared after reduction of generalized spasticity due to botulinum toxin administration. Neuropathologic examination revealed Musashi1+, Nestin+, PCNA+, and Ki67+ cells in the hippocampus, frontal, parietal and occipital cortex, caudate, thalamus, mammillary bodies, brainstem, cerebellum, and near the posterior horn of the lateral ventricle. New neurons with neurite growth (TUC4+) appeared in corpus callosum...
2017: Clinical Medicine Insights. Case Reports
Silje Bergland Ellingsen, Elisabet Nordmo, Knut Tore Lappegård
Severe hepatotoxicity is a rare but well-known adverse reaction to statins. However, despite the widespread use of statins, only a few cases describing statin reexposure or switch to another statin after liver injury have been published. The literature on hepatotoxicity with ezetimibe alone or in combination with statins is also scarce. We report a case where a patient with a history of elevated liver enzymes while using atorvastatin, but prior and subsequent good tolerance to simvastatin and pravastatin, developed drug-induced liver injury on reexposure to a combination of atorvastatin and ezetimibe...
2017: Clinical Medicine Insights. Case Reports
Tomoki Ishigaki, Yotaro Kitano, Hirofumi Nishikawa, Genshin Mouri, Shigetoshi Shimizu, Fumitaka Miya, Hidenori Suzuki
Post-traumatic pituitary apoplexy is uncommon, most of which present with a sudden onset of severe headache and visual impairments associated with a dumbbell-shaped pituitary tumor. We experienced an unusual case of post-traumatic pituitary apoplexy with atypical clinical features. A 66-year-old man presented with mild cerebral contusion and an incidentally diagnosed intrasellar tumor after a fall accident with no loss of consciousness. The patients denied any symptoms before the accident. After 4 days, the left oculomotor nerve palsy developed and deteriorated associated with no severe headache...
2017: Clinical Medicine Insights. Case Reports
Antoine Kossaify, Hiba Hamdar
A 66-year-old patient with a DR pacemaker for intermittent atrioventricular block presented with an electrocardiogram (ECG) showing some P waves non followed by QRS complexes, raising suspicion of device dysfunction. The device was equipped with a special algorithm (Managed Ventricular Pacing; Medtronic), and the observed ECG tracing was a normal consequence of the function of such algorithms. Being aware of the function of specific algorithms is essential to adequately analyze rhythms.
2017: Clinical Medicine Insights. Case Reports
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