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Clinical Medicine Insights. Case Reports

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https://www.readbyqxmd.com/read/28904525/knowing-about-device-algorithms-to-understand-the-rhythm-and-role-of-managed-ventricular-pacing
#1
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
https://www.readbyqxmd.com/read/28890660/flow-cytometric-immune-profiling-in-infliximab-associated-tuberculosis
#2
Kelly Pennington, Humberto C Sasieta, Guiherme P Ramos, Courtney L Erskine, Virginia P Van Keulen, Tobias Peikert, Patricio Escalante
Tumor necrosis factor α antagonists are increasingly used to treat inflammatory and autoimmune disorders and are associated with increased risk of active tuberculosis. Diagnosis of active tuberculosis in patients taking tumor necrosis factor α antagonists can be challenging owing to increased incidence of extrapulmonary manifestations and false-negative results on current available diagnostic tests. We present a case of a young woman on infliximab for ulcerative colitis who presented with disseminated tuberculosis...
2017: Clinical Medicine Insights. Case Reports
https://www.readbyqxmd.com/read/28890659/loeffler-endocarditis-a-unique-presentation-of-right-sided-heart-failure-due-to-eosinophil-induced-endomyocardial-fibrosis
#3
Amit Alam, Shankar Thampi, Shahryar G Saba, Rita Jermyn
Loeffler endocarditis is a rare restrictive cardiomyopathy caused by abnormal endomyocardial infiltration of eosinophils, with subsequent tissue damage from degranulation, eventually leading to fibrosis. Although an uncommon entity, it is still a disease with significant morbidity and mortality. Often identified only at late stages, treatment options are limited once fibrosis occurs, usually requiring heart failure medications or surgical intervention. We present a unique case of a woman with remote history of hypereosinophilic syndrome, attributed to treatment of rheumatoid arthritis with infliximab, who presented with symptoms of heart failure refractory to medical management and was found to have Loeffler endocarditis...
2017: Clinical Medicine Insights. Case Reports
https://www.readbyqxmd.com/read/28811743/retroperitoneal-bleeding-an-experience-during-prophylactic-anticoagulation-in-a-patient-with-nephrotic-syndrome
#4
Mari Okada, Tetsu Akimoto, Mutsumi Kawamata, Toshimi Imai, Erika Hishida, Marina Kohara, Atsushi Miki, Takuya Murakami, Taro Sugase, Takahiro Masuda, Yuko Ono, Yoshihiko Ueda, Osamu Saito, Shigeaki Muto, Daisuke Nagata
The association between nephrotic syndrome (NS) and a hypercoagulable state has been demonstrated. Controlling the blood clotting activity may therefore be attractive for patients with nephrosis in terms of thromboembolism prophylaxis. We herein report a 75-year-old woman with minimal change disease who developed pains in the right back, groin, and thigh because of retroperitoneal bleeding during prophylactic anticoagulation with unfractionated heparin. Although this procedure has not been accepted as the standard of care for patients with nephrosis, pharmacologic prophylaxis may already be practiced empirically, as in the present patient...
2017: Clinical Medicine Insights. Case Reports
https://www.readbyqxmd.com/read/28811742/respiratory-t-wave-inversion-in-a-patient-with-chest-pain
#5
Himani Sharma, Abhinav Tiwari
T-wave inversion on electrocardiogram (ECG) is always a concerning finding as it is often associated with myocardial ischemia or ventricular strain. Respiratory variation in the T-wave morphology has been reported in the literature; however, the frequency of this observation remains unknown as this is not routinely evaluated. Although the exact physiological mechanisms underlying this ECG change are unclear, it is proposed to be due to the respiratory variation of the heart position resulting in an alteration in T-wave polarity...
2017: Clinical Medicine Insights. Case Reports
https://www.readbyqxmd.com/read/28680269/baclofen-related-neurotoxicity-implication-in-a-fatality-associated-with-hepatorenal-syndrome
#6
Larry K Golightly, Lauren E Grecheck, Ike I Kim
No abstract text is available yet for this article.
2017: Clinical Medicine Insights. Case Reports
https://www.readbyqxmd.com/read/28579861/cryptogenic-organizing-pneumonia-with-lung-nodules-secondary-to-pulmonary-manifestation-of-crohn-disease
#7
Taufiq Zaman, Joseph Watson, Mohammad Zaman
Crohn disease is an immune-mediated inflammatory condition with gastrointestinal and extraintestinal manifestations in patients. Pulmonary involvement of Crohn disease is one manifestation. There have been case reports which have shown Crohn disease and lung nodules which were noted to be histopathological as cryptogenic organizing pneumonia (COP). In our case, a 22-year-old woman with Crohn disease was seen with complaints of chest pain and cough. Computed tomographic scan of chest showed multiple bilateral lung nodules, for which biopsy was done, which showed COP...
2017: Clinical Medicine Insights. Case Reports
https://www.readbyqxmd.com/read/28579860/distinguishing-motor-weakness-from-impaired-spatial-awareness-a-helping-hand
#8
Suneil A Raju, Charles R Swift, Karna Dev Bardhan
Our patient, aged 73 years, had background peripheral neuropathy of unknown cause, stable for several years, which caused some difficulty in walking on uneven ground. He attended for a teaching session but now staggered in, a new development. He had apparent weakness of his right arm, but there was difficulty in distinguishing motor weakness from impaired spatial awareness suggestive of parietal lobe dysfunction. With the patient seated, eyes closed, and left arm outstretched, S.A.R. lifted the patient's right arm and asked him to indicate when both were level...
2017: Clinical Medicine Insights. Case Reports
https://www.readbyqxmd.com/read/28579859/clot-in-lung-clot-in-heart-a-case-report-of-tumor-like-thrombus-in-right-atrium
#9
Roshanak Habibi, Alvaro J Altamirano, Shahriar Dadkhah
Tumor-like formation of thrombus in the right atrial cavity is rare. It may be mistaken for a myxoma. The exact pathophysiology of an isolated thrombus in the heart is still unclear. Management to prevent complications such as pulmonary thromboembolism depends on the clinical judgment of a cardiologist. This report describes a 76-year-old woman with right atrial thrombus causing subsequent pulmonary thromboembolism in right lung. She initially presented to us with pulmonary embolism, and later, an incidental finding of a mass in her right atrium revealed an association of thrombus in heart with thrombus in lung...
2017: Clinical Medicine Insights. Case Reports
https://www.readbyqxmd.com/read/28469502/false-positive-cases-of-fluorodeoxyglucose-positron-emission-tomography-computed-tomographic-scans-in-metastasis-of-esophageal-cancer
#10
Tomoki Yamatsuji, Naomasa Ishida, Munenori Takaoka, Jiro Hayashi, Kazuhiro Yoshida, Kaori Shigemitsu, Atsushi Urakami, Minoru Haisa, Yoshio Naomoto
Of 129 esophagectomies at our institute from June 2010 to March 2015, we experienced three preoperative positron emission tomography-computed tomographic (PET/CT) false positives. Bone metastasis was originally suspected in 2 cases, but they were later found to be bone metastasis negative after a preoperative bone biopsy and clinical course observation. The other cases suspected of mediastinal lymph node metastasis were diagnosed as inflammatory lymphadenopathy by a pathological examination of the removed lymph nodes...
2017: Clinical Medicine Insights. Case Reports
https://www.readbyqxmd.com/read/28469501/an-autopsy-case-of-sudden-unexpected-death-of-a-young-adult-in-a-hot-bath-molecular-analysis-using-next-generation-dna-sequencing
#11
Yukiko Hata, Koshi Kinoshita, Naoki Nishida
We report a case of sudden unexpected death of a young woman who was found in a bathtub of hot water. The autopsy concluded that all possible causes of sudden loss of consciousness, except cardiac origin, could be excluded. However, the heart did not show any obvious pathological changes. We used next-generation DNA sequencing (NGS) to examine 73 genes and detected 3 rare, potentially pathogenic variants with minor allele frequencies ⩽1.0%. The pathogenicity of these variants was evaluated using 8 in silico predictive algorithms, and SCN5A_p...
2017: Clinical Medicine Insights. Case Reports
https://www.readbyqxmd.com/read/28469500/lung-adenocarcinoma-presenting-as-worsening-of-chronic-neck-pain-a-cautionary-tale
#12
Neeka N Akhavan, Tony S Brar, Edlira Maska
INTRODUCTION: Neck pain is a common musculoskeletal problem that up to 70% of the world population will experience at some point in their lives. Intramedullary spinal cord metastasis is an exceedingly rare complication of malignancy that affects less than 1% of all patients with cancer. CASE REPORT: We report a case of a 61-year-old man who presented to primary care clinic with 1-month history of worsening neck pain with associated neurologic deficits. Despite initial conservative management, the patient continued to have progressive worsening of sensory and motor deficits...
2017: Clinical Medicine Insights. Case Reports
https://www.readbyqxmd.com/read/28469499/a-case-of-statin-associated-autoimmune-myopathy
#13
Alexander J Sweidan, Anthony Leung, Cassandra J Kaiser, Sarah J Strube, Andrei N Dokukin, Stephen Romansky, Sassan Farjami
A 70-year-old previously independent man developed progressive proximal leg weakness resulting in a fall at home suffering traumatic brain injury. He was prescribed a statin medication two years prior, but this was discontinued on admission to the hospital due to concern for statin myopathy. His weakness continued to progress while in acute rehabilitation, along with the development of dysphagia requiring placement of gastrostomy tube and respiratory failure requiring tracheostomy. Corticosteroids and intravenous immunoglobulin were administered without response...
2017: Clinical Medicine Insights. Case Reports
https://www.readbyqxmd.com/read/28469498/twenty-five-years-of-chronic-strongyloidiasis-in-an-immigrant
#14
Kalambay N Junior, Rehana Zaman, Mohammed H Zaman, Taufiq Zaman
Chronic strongyloidiasis is an infection of the tropical regions, caused by the nematode Strongyloides stercoralis. In the United States, patients are typically immigrants. The very long asymptomatic phase followed by the clinical presentation of the disease mimics asthma, chronic obstructive pulmonary disease (COPD), or inflammatory bowel disease (IBD) as in this case report. The inconsistency of eosinophilia and the low sensitivity of microscopic stool examination make chronic strongyloidiasis a disease that is frequently misdiagnosed in the United States...
2017: Clinical Medicine Insights. Case Reports
https://www.readbyqxmd.com/read/28469497/performing-anticoagulation-a-puzzling-case-of-cholesterol-embolization-syndrome
#15
Yusuke Igarashi, Tetsu Akimoto, Takahisa Kobayashi, Yoshitaka Iwazu, Takuya Miki, Naoko Otani-Takei, Toshimi Imai, Taro Sugase, Takahiro Masuda, Shin-Ichi Takeda, Shigeaki Muto, Daisuke Nagata
The avoidance of any form of anticoagulation is advised in cases of cholesterol embolization syndrome (CES). We herein describe a case of CES in a man with a history of unprovoked pulmonary embolism for which warfarinization was performed. Despite anecdotal reports of successful anticoagulation in CES patients with certain indications, irreversible renal failure, which was sufficiently severe to require chronic hemodialysis, eventually developed in our patient. Our results emphasize the pitfalls of this procedure, which imply its limited feasibility and safety...
2017: Clinical Medicine Insights. Case Reports
https://www.readbyqxmd.com/read/28096700/sequential-combination-chemotherapy-of-dacarbazine-dtic-with-carboplatin-and-paclitaxel-for-patients-with-metastatic-mucosal-melanoma-of-nasal-cavity-and-paranasal-sinuses
#16
W Omata, A Tsutsumida, K Namikawa, A Takahashi, K Oashi, N Yamazaki
By the recent introduction of molecular targeting drugs against BRAF mutation and immune checkpoint inhibitors, the prognosis of patients with melanoma in advanced stage is now improving, but still in the minority. Mucosal melanoma lacks the BRAF mutations, and hence conventional chemotherapeutic regimens must be improved. We have conventionally used dacarbazine (DTIC) for patients with metastatic mucosal melanoma. However, the efficacy of DTIC in patients with metastatic mucosal melanoma has been limited. Therefore, we explored other possibilities to improve the prognosis of patients suffering from metastatic mucosal melanoma...
2017: Clinical Medicine Insights. Case Reports
https://www.readbyqxmd.com/read/28096701/metreleptin-treatment-in-three-patients-with-generalized-lipodystrophy
#17
Carla Musso, Maria Laura Major, Eugenia Andres, Vinaya Simha
Generalized lipodystrophy (GL) is a rare inherited or acquired disease characterized by widespread loss of subcutaneous fat, leading to leptin deficiency, ectopic fat deposition, and severe metabolic abnormalities. Previous studies have shown the benefit of leptin replacement (metreleptin) in ameliorating metabolic complications, but little is known about the experience of metreleptin treatment outside of a research setting. We report on post-marketing clinical experience with metreleptin therapy in three patients with GL and marked hypoleptinemia, uncontrolled diabetes, and hypertriglyceridemia...
2016: Clinical Medicine Insights. Case Reports
https://www.readbyqxmd.com/read/28008298/severe-protracted-spasm-of-urinary-bladder-and-autonomic-dysreflexia-caused-by-changing-the-suprapubic-catheter-in-a-cervical-spinal-cord-injury-patient-treatment-by-a-bolus-dose-and-increased-total-daily-dose-of-intrathecal-baclofen
#18
Subramanian Vaidyanathan, Tun Oo, Bakul M Soni, Peter L Hughes, Gurpreet Singh
BACKGROUND: Intrathecal administration of baclofen by implanted pump reduces rigidity and muscle spasms. Its use specifically to control bladder spasms has not been reported. CASE REPORT: A tetraplegic patient developed severe, protracted, bladder spasms, abdominal muscles spasms, and high blood pressure after change of suprapubic catheter; nifedipine, diazepam, and paracetamol did not control spasms; bolus dose of baclofen intrathecally produced prompt relief via baclofen pump...
2016: Clinical Medicine Insights. Case Reports
https://www.readbyqxmd.com/read/27980443/lujan-fryns-syndrome-lfs-a-unique-combination-of-hypernasality-marfanoid-body-habitus-and-neuropsychiatric-issues-presenting-as-acute-onset-dysphagia
#19
Abidullah Khan, Mohammad Humayun, Iqbal Haider, Maimoona Ayub
BACKGROUND: Lujan-Fryns syndrome (LFS) is an extremely rare, X-linked disorder, for which the full clinical spectrum is still unknown. Usually, it presents with neuropsychiatric problems such as learning disabilities and behavioral issues in a typical combination with marfanoid features. Often, there is a positive family history for the disorder. However, sporadic cases have also been reported in males. More interestingly, there is no case of LFS presenting with acute-onset dysphagia in the English language medical literature...
2016: Clinical Medicine Insights. Case Reports
https://www.readbyqxmd.com/read/27920592/left-main-coronary-ostial-stenosis-after-aortic-valve-replacement-a-case-report
#20
Munish Sharma, Daniel Mascarenhas
Coronary ostial stenosis is a rare but potentially life-threatening complication of aortic valve replacement (AVR). It can present potential complications such as acute coronary syndrome, left ventricular failure, ventricular arrhythmias, or sudden death. Exact pathogenetic mechanism is not known, but a few hypotheses have been proposed. We present a case of left main coronary stenosis 11 months after AVR was done for symptomatic critical aortic stenosis. High index of clinical suspicion and timely coronary angiography helped to determine the exact etiology...
2016: Clinical Medicine Insights. Case Reports
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