Journal of Clinical Case Reports

Metastasis to small bones (Acrometastasis) alone is uncommon and is usually a sign of occult/ manifest advanced disease, therefore warrants active search for other sites of spread. Carcinoma urinary bladder is among the rare primary sources for acrometastasis, only three (3) cases being reported so far in the literature. We report a case of carcinoma urinary bladder with metastasis to small bone of hand (metacarpal) in a 65 year Asian male to add a case to this list.

Cellular therapy has been viewed as a novel therapeutic modality for many neurological disorders. Autologous Bone Marrow Mononuclear Cells (BMMNCs) used in many studies, have a safe and ethical profile. These cells have been studied in great depth and have shown angiogenetic and immunomodulatory properties in addition to other neuroprotective effects. These peculiar mechanisms may serve to be beneficial in autism. Recently, hypoperfusion and immune alteration are identified as major underlying pathogenetic mechanisms in autism. We present a case of autism with comorbid mental retardation; treated with intrathecal administration of autologous BMMNCs. Results were documented objectively on Indian Scale for Assessment of Autism (ISAA) and Positron Emission Tomography Computed Tomography (PET CT) scan. On regular follow up assessment of the patient over 18 months, there was significant clinical improvement in social relationship, communication and behavior. On outcome measure, ISAA score improved from 111 (Moderate autism) to 73 (Mild Autism). PET CT scans comparison of pre and post therapy showed balancing effect on brain metabolism. This case provides a great insight into the clinical effects of autologous BMMNCs in autism. Though a case study, the improvements guide us to plan future studies to explore different options of cellular therapy in autism.

Congenital Chloride Diarrhoea (CCD) is a form of autosomal recessive disorder which is presented by persistent chloride rich watery diarrhea from birth. Diagnosis of CCD is simple but it needs early prediction and clinical and laboratory evaluation. It can be tentatively made from the typical history of polyhydramnios in antenatal period, prematurity, and watery diarrhea from the beginning and then confirmed by the high fecal concentration of Cl-. Serum electrolyte and pH changes are not reliable diagnostic criteria. Without early intervention most of the children will die in infancy, rest will achieve failure to thrive, and psychomotor developmental delay. .Although congenital chloride diarrhoea has been reported worldwide, but in Bangladesh, we have no reported cases. Here we have discussed two cases of CCD with their diagnostic and management outcome and also discuses about captopril and its effectiveness. Early diagnosis and treatment are essential for normal growth, development, and prevention of other severe complications of congenital chloride diarrhea.

Congenital Chloride Diarrhoea (CCD) is a form of autosomal recessive disorder which is presented by persistent chloride rich watery diarrhea from birth. Diagnosis of CCD is simple but it needs early prediction and clinical and laboratory evaluation. It can be tentatively made from the typical history of polyhydramnios in antenatal period, prematurity, and watery diarrhea from the beginning and then confirmed by the high fecal concentration of Cl-. Serum electrolyte and pH changes are not reliable diagnostic criteria. Without early intervention most of the children will die in infancy, rest will achieve failure to thrive, and psychomotor developmental delay. .Although congenital chloride diarrhoea has been reported worldwide, but in Bangladesh, we have no reported cases. Here we have discussed two cases of CCD with their diagnostic and management outcome and also discuses about captopril and its effectiveness. Early diagnosis and treatment are essential for normal growth, development, and prevention of other severe complications of congenital chloride diarrhea.

Erythema Multiforme (EM) is an acute, immune–mediated condition characterized by the appearance of distinctive target like lesions on the skin. The lesions are often accompanied by erosions or bullae involving the oral, genital and/or ocular mucosa. We report a case of Erythema Multiforme minor (EMm) who initially presented with a non healing bleeding target like lesions over the upper lip and latter developed target lesions on both hands.

Cardiobacterium hominis is a gram-negative rod and is an uncommon cause of infective endocarditis. Here we report the first published case description of C. hominis endocarditis of the pulmonic valve homograft in a patient who had previously undergone the Ross procedure.

Pyogenic Spondylodiscitis (PS) is an uncommon infection representing approximately 3-5% of all osteomyelitis cases, male-tofemale ratio 3:1. PS occurs commonly from hematogenous speeding. It typically involves disc and anterior corners of the adjacent vertebral bodies. Staphylococcus aureus is the most frequent microorganism accounting for half of the cases. Gram-negative rods account for 7-33% and coagulase-negative staphylococci were reported in 5-16% of cases. The incidence has increased recently due to a more elderly population, chronic use of steroids and other comorbidities. The disease is characterized by unremitting back pain. When the clinical presentation is suggestive, blood cultures should be performed. Magnetic resonance imaging is the modality of choice due to its high sensitivity and specificity.

We report a 40-year-old woman who developed a fatal acute cardiac tamponade after balloon angioplasty for central venous stenosis (CVS) related to hemodialysis. Retrograde and antegrade recanalization followed by balloon angioplasty was carried out through the right-femoral and left internal jugular vein approach. The interventional procedure of recanalization and balloon angioplasty was uneventful with satisfactory angiographic result of the central venous. However, the patient suffered sudden-onset shortness of breath and tachycardia, followed by bradycardia and cardiac arrest, apneic and coma immediately after the procedure. Acute cardiac tamponade was suspected and confirmed by emergency echocardiography. Urgent pericardiocentesis and indwelling catheter placement was performed with 200 ml hemorrhagic pericardial effusion aspirated. However, resuscitation was only successful in relatively stablity of blood pressure and heart rate. The patient remained in a coma and was admitted to the Intensive Care Unit (ICU) for further rescue, but still died two days later. Death was determined to be due to cardiac tamponade secondary to perforation of the right atrium by balloon dilation of the stenotic cava-atrial junction. It is an under-reported case of fatal acute cardiac tamponade happened during the balloon angioplasty for CVS in hemodialysis patients.

Idiopathic Spontaneous Intraperitoneal Hemorrhage (ISIH) is a rare and often life threatening condition, traditionally referred as abdominal apoplexy. A 32-year-old man with diffuse abdominal pain, nausea, vomiting, weakness and loss of appetite was referred to the hospital. This man had the history of alcohol consumption. The patient was kept Nil per Os (NPO) and received serum therapy. Six hours after the admission, his abdominal pain gradually increased and he developed hypotension, tachycardia and dizziness. Abdominal ultrasonography was immediately performed which showed intraperitoneal fluid. No evidence of spleen, liver or other internal organ abnormality was seen. The presence of blood was confirmed in abdominal cavity using ultrasound guided puncture. The patient was immediately transferred to operating room. Exploratory laparotomy was carried out and hemoperitoneum was conï¬Ârmed. Examination of the spleen, liver, bowel, kidneys and mesentery revealed no source of bleeding or existence of subcapsular hematoma. The patient made a fast recovery in the intensive care unit and was discharged in a stable condition after seven days. He was closely followed up for six months without any recurrence or complications related to ISH. This case is the first report of ISIH in a patient in Iran.