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Clinical Medicine Insights. Case Reports

Donald D Stevenson, Jennifer L Gasko
Opioid addiction is a world-wide tragedy, with severe consequences for both the victims and the society that must care for them. The pathways to addiction are multiple but postoperative opioid prescriptions for pain management are a major contributor to this crisis. This case report describes the differences in pain management during 2 different arthroplasties of the knees in the same person. After the first arthroplasty of the right knee 10 years ago, postoperative opioids were used, but after the second arthroplasty of the left knee in 2007, anti-inflammatory drugs took the place of opioids...
2018: Clinical Medicine Insights. Case Reports
Marc Darrow, Brent Shaw, Brittany Darrow, Stevie Wisz
The use of mesenchymal stem cells from bone marrow concentrate (BMC) has become an increasingly popular option as an alternative to total joint replacement. Although there is evidence to support the use of BMC injections to improve quality of life for patients with knee osteoarthritis (OA), there is limited evidence to support its use in patients with hip OA. This case series provides the short-term outcomes of 4 hip OA patients who each underwent 4 BMC injections. On average, the last follow-up was administered 3...
2018: Clinical Medicine Insights. Case Reports
Yusuke Takasaki, Atsushi Irisawa, Goro Shibukawa, Ai Sato, Yoko Abe, Akane Yamabe, Noriyuki Arakawa, Takumi Maki, Yoshitsugu Yoshida, Ryo Igarashi, Shogo Yamamoto, Tsunehiko Ikeda, Nobutoshi Soeta, Takuro Saito, Hiroshi Hojo
Ovarian cancer often occurs distant metastasis to the peritoneum, liver, lungs, and lymph nodes. However, there has been no reported case of direct metastasis to the duodenal major papilla. We herein reported 72-year-old woman with history of ovarian cancer surgery 11 years ago presenting with obstructive jaundice. Abdominal CT showed a small mass in the distal bile duct. Forceps biopsy from the small mass was done under endoscopic retrograde cholangiography, and histologic examination revealed adenocarcinoma...
2018: Clinical Medicine Insights. Case Reports
Takuya Murakami, Tetsu Akimoto, Tomoyuki Yamazaki, Hiromichi Yoshizawa, Mari Okada, Atsushi Miki, Saki Nakagawa, Ken Ohara, Taro Sugase, Takahiro Masuda, Takahisa Kobayashi, Osamu Saito, Shigeaki Muto, Daisuke Nagata
A 28-year-old man was referred and admitted to our hospital due to Escherichia coli O157-mediated hemorrhagic colitis with severe thrombocytopenia. A systemic workup concluded that the patient had acute pancreatitis as well as hemolytic uremic syndrome. The patient was ultimately discharged, with his platelet count having recovered. Our case serves an illustrative example of potentially serious complications of an increasingly recognized public health problem. Systemic studies on this topic are insufficient, and we strongly recommend the further accumulation of more experiences like ours...
2018: Clinical Medicine Insights. Case Reports
Yuko Mutsuyoshi, Shohei Kaneko, Saori Minato, Katsunori Yanai, Hiroki Ishii, Taisuke Kitano, Mitsutoshi Shindo, Haruhisa Miyazawa, Kiyonori Ito, Yuichiro Ueda, Keiji Hirai, Taro Hoshino, Susumu Ookawara, Yoshiyuki Morishita
We herein report a case of ureter rupture with severe oliguric acute renal injury due to benign prostatic hypertrophy. After insertion of an indwelling urinary catheter, the patient's urine output immediately increased. His symptoms and renal function also rapidly improved to the normal range without a surgical operation. Clinicians should note this complication in patients with oliguria.
2018: Clinical Medicine Insights. Case Reports
Laurence Pincet, François Gorostidi
Background: Graves disease or other causes of thyrotoxicosis are frequently associated with cytopenia. Although anemia is the most common, other cell lineage can be affected. Pancytopenia is a rare complication of thyrotoxicosis. Case presentation: We report a case of a 33-year-old Chinese man who presented a nonsevere pancytopenia in the context of a newly diagnosed Graves disease. Restauration of euthyroid state led to progressive correction of pancytopenia. Conclusions: Literature review shows other rare cases of pancytopenia...
2018: Clinical Medicine Insights. Case Reports
Mahmoud Jabalameli, Abolfazl Bagherifard, Hosseinali Hadi, Alireza Askari, Salman Ghaffari
Background: The occurrence of chronic knee dislocation is rare. To the best of our knowledge, total knee arthroplasty for treatment of chronic anterior knee dislocation has not been reported. Method: This report describes 3 cases of chronic anterior knee dislocation treated by total knee arthroplasty. Results: Three female patients with chronic anterior knee dislocation were treated by hinged prosthesis total knee arthroplasty using the Insall rectus snip approach...
2018: Clinical Medicine Insights. Case Reports
Oriol Plans Galván, Hipólito Pérez Moltó, Ariadna Fabià-Mayans, Blanca Xicoy, José Luis Mate, Pilar Ricart Martí
Hydroxyurea (HU) is a drug frequently used in the treatment of chronic myeloproliferative neoplasms. The most common side effects of this drug are pancytopenia, digestive and skin disorders. Respiratory complications are rare and there are less than 20 cases described, only 5 of which underwent an anatomopathological study. We present the case of a patient with chronic myeloproliferative neoplasm who developed interstitial pneumonitis probably due to HU according to histological study.
2018: Clinical Medicine Insights. Case Reports
Noriyuki Arakawa, Atsushi Irisawa, Goro Shibukawa, Ai Sato, Yoko Abe, Akane Yamabe, Yusuke Takasakia, Yoshitsugu Yoshida, Takumi Maki, Ryo Igarashi, Shogo Yamamoto, Tsunehiko Ikeda, Hiroshi Hojo
While some reports are available regarding metachronous gastric metastasis from renal cell carcinoma after treatment, there are few reports of primary lesion detection based on the diagnosis of a gastric metastatic lesion. The patient in this case was an 80-year-old woman who underwent upper gastrointestinal endoscopy after having developed anorexia 2 months earlier. A submucosal tumor with central umbilication was found in the gastric greater curvature. Endoscopic ultrasonography revealed a solid and hypoechoic mass with hypervascularity on color Doppler imaging that proliferated mainly within the submucosal layer...
2018: Clinical Medicine Insights. Case Reports
Abdel Rahman Al Manasra, Mohammed Bani Hani, Haitham Qandeel, Samer Al Asmar, Mohammad Alqudah, Nabil Al-Zoubi, Satish Nadig, Shadi Hamouri, Khaled Obeidat, Nada Al-Muqaimi
Background and Study Aims: The prevalence of gallbladder cancer (GBC) varies between different parts of the world. This study is a review of literature and an update of a previously published study conducted in our university and aims to reassess the incidence of GBC over the past 2 decades. Patients and Methods: We conducted a retrospective study between 2002 and 2016. Data regarding demographics, clinical presentation, risk factors, histopathology, investigations, and treatments were obtained...
2018: Clinical Medicine Insights. Case Reports
Roberta Aliotta, Luca Zanoli, Itria Lauretta, Rosa Giunta, Silvia Ferrario, Stefania Rastelli, Sebastiano Rapisarda, Elnaz Rahbari, Francesco Rapisarda
Until 2018, 236 cases of acute pancreatitis have been reported in patients who underwent peritoneal dialysis. Here, we presented a patient with double renal transplantation with chronic renal failure, under renal replacement therapy by peritoneal dialysis, who developed acute pancreatitis with abdominal pain, nausea, vomiting, leukocytosis with neutrophil left shift which is complicated by pancreatic pseudocyst, candida peritonitis, fungal sepsis, overlapping of Acinetobacter baumannii sepsis, and pneumonitis...
2018: Clinical Medicine Insights. Case Reports
Takumi Minezumi, Shin-Ichi Takeda, Yusuke Igarashi, Kentaro Sato, Yoshiaki Murakami, Daisuke Nagata
Blood glucose management in patients undergoing dialysis is clinically challenging. In this population, most conventional oral hypoglycemic agents are contraindicated, especially from the perspective of pharmacokinetics. Dipeptidyl peptidase-4 inhibitors exert unique pharmacologic actions via glucose-dependent mechanism and have an excellent tolerability profile with a very low risk of hypoglycemia. Furthermore, the literature reports that some dipeptidyl peptidase-4 inhibitors such as teneligliptin can be administered at the usual dose, regardless of a patient's level of renal impairment...
2018: Clinical Medicine Insights. Case Reports
Taro Sugase, Tetsu Akimoto, Takaaki Kimura, Takashi Yagisawa, Eiji Kusano, Daisuke Nagata
Acquired von Willebrand syndrome (AVWS) is a rare clinical entity presenting with heterogeneous hemorrhagic manifestations, although some subsets of patients with AVWS may be asymptomatic until they are exposed to major trauma, an invasive procedure, or surgery. We herein report one such case in a 73-year-old male patient with nephrotic syndrome with a prolonged active partial thromboplastin time. We initially did not deal with this distinct abnormal clotting profile seriously, but persistent bleeding after a retroperitoneoscopic-assisted renal biopsy that allowed us to ascribe his nephrotic syndrome to membranous nephropathy fortuitously led to the discovery of concurrent AVWS...
2018: Clinical Medicine Insights. Case Reports
Anthony A Odubanjo, Rohini Kalisetti, Robert Adrah, Adeniyi Ajenifuja, Blessey Joseph, Mohammed Zaman
Uncontrolled diabetes and acute coronary syndrome share a complex dynamic that results in significant ambiguity when interpreting biomarker elevations in this setting. This is concerning because myocardial infarction has been shown to be the most common cause of death in the first 24 hours of admission for uncontrolled diabetes. Literature shows that elevation in cardiac biomarkers in patients with uncontrolled diabetes could be from viral myopericarditis, although a clear clinical significance is still lacking...
2018: 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
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