Journal of Clinical Case Reports

Case report is an important kind of medical article published in many journals. The case report can contribute to the medical society and it becomes the useful source for future referencing. Case report usually deals with special, uncommon and valuable situation.

In the past, no systemic therapies have consistently impacted the overall survival of this kind of patients, and surgery has been considered the best therapy in patients with solitary metastases, especially confined to the subcutaneous tissues, non-regional lymph nodes or lung, when carefully selection of patients indicated a favorable biology of the disease.

We aimed to describe the effects of whole body vibration training on serum creatine kinase and motor function in two brothers with Duchenne muscular dystrophy using standardized measurements. Whole body vibration was delivered using a side-alternating vibration platform at a starting frequency of 7.5 Hz, increasing up to 20 Hz for 5 minutes three times weekly for three months. The baseline serum creatine kinase of the 7 and 10 years old boys was 33,105 U/L and 14,984 U/L. After vibration training, their levels dropped significantly, reaching a nadir of 7,383 U/L and 536 U/L respectively during treatment. There was a modest increase in their 6-minute walk distance but their overall North Star Ambulatory Assessment scores were unchanged. Whole body vibration appeared to be safe and well-tolerated. The reduction in serum creatine kinase as observed in these two boys suggests a potential benefit of brief high frequency vibration on muscle function.

We present, for the first time to our knowledge, a patient with Systemic Lupus Erythematosus (SLE) with pulmonary Bronchial-Associated Lymphoid Tissue (BALT) lymphoma, refractory to chemotherapy but after a single four-week course of rituximab experienced significant regression of pulmonary lesions and remained progressionfree six months post- treatment. This case report demonstrates the promising role for rituximab in refractory BALT lymphoma.

The mortality rate from cardiogenic shock after acute myocardialinfarction (MI) is high without reperfusion (70%-80%) [1]. Early revascularization is the basis of treatment of acute MI complicated by cardiogenic shock. Mechanical circulatory devices provide additional support for patients with refractory cardiogenic shock after revascularization alone has failed. These devices have been shown in the literature to improve outcomes in contrast to pharmacologic agents and/or intra-aortic balloon pump (IABP) demonstrated in the literature [2]. Short-term ventricular assists devices (VADs) can be initiated quickly and do not necessarily require a sternotomy. The Impella devices are minimally invasively placed, catheter mounted microaxial flow pumps. They are designed to directly unload the left ventricle, reduce myocardial workload and oxygen consumption while increasing cardiac output, coronary and end-organ perfusion. The purpose of our study is to review a patient who presented with acute cardiogenic shock and was treated with an Impella 5.0 device for temporarymechanical support.

We report a case of diffuse large B-cell lymphoma involving the thigh skin and tongue in an 85-year-old woman. No systemic symptoms or other lesions were observed at diagnosis. Local radiotherapy was effective, but cutaneous recurrence occurred 6 months after the treatment. The patient died of old age with no macroscopically distinguishable nodal or systemic lesions. A postmortem examination revealed intravascular invasion into the tongue, lung, and lymph nodes around the pancreas. To our knowledge, this is the first report of primary cutaneous diffuse large B-cell lymphoma with tongue involvement.

Group “G” Streptococcus is an ubiquitous non-pathogenic commensal organism found in the skin, throat, gut, appendix and the female genital tract. As per our review of the available literature we present the first reported case of localized intra-abdominal abscess caused by Group g streptoccoccus (GGS) also seen first time in our institution which is a rare but an important cause when after the requisite Surgical procedure-drainage and antibiotic regimens the post-operative pyrexia/symptoms do not settle down with rising counts then one should start thinking about upgrading the antibiotics to meropenem+ciprofloxacin/vancomycin/teichoplanin along-with the existing anaerobic cover. In our case blood cultures were negative, only the pus culture-liquid subcultures grew large colony gram positive cocci on the 1st postoperative day with further identification as Group G Streptococcus (GGS) with the sensitivity pattern on the 3rd postoperative day identified the organism as large-so a very good microbiology department team is necessary which in our case was instrumental in the management of our patient with a very high index of suspicion. This case is being reported for the reason of its rarity. Especially reported in patients who are diabetics/malignancies/respiratory infections/immunosuppressed/chronic leg ulcers/pet dogs at home it is gaining importance as an organism for causing deep-seated abscesses in the body especially the abdomen which are usually multiple or as peritonitis. Another important reason mentioned in literature for immediate and urgent drainage of abscess caused by GGS infections is that this may lead to a very serious streptococcal toxic shock syndrome having a very fulminant and rapid downhill course with GGS bacteremia having a high 30 days mortality rate of to 15%.

Fat embolismsyndrome is a rare complication following a long bone fracture. It is believed to be caused by the toxic effects of free fatty acids and is clinically characterized by the triad of dyspnea, petechiae and mental confusion. Ocular fat embolism syndrome in the complete absence of any cardiac defects is a rare phenomenon which is not commonly encountered in ophthalmic practice. The authors present a case of fat embolism syndrome with the uncommon finding of bilateral embolism of the central retinal artery after a single femoral fracture without evidence of cardiac defect.

Central retinal artery occlusion (CRAO) following cosmetic surgery seems to be rare and disastrous disease inducing sudden visual loss. Even if tough treatment is prescribed initially, the prognosis of visual recovery is more regretable. In this paper, we report one case of CRAO combined with ptosis resulting from simultaneous autologous fat injection and BoNT/A treatment in theglabellar area for cosmetic problems. We confirmed CRAO by fluorescein angiography. There are many possible causes of visual loss following cosmetic surgery; however, the commonest form is autologous fat injection up to now. To our knowledge, there have been little reports of CRAO combined with ptosis in autologous fat injection procedures. These facts must be kept in mind by all cosmetic plastic surgeons and ophthalmologists of the importance of careful measures and immediate treatment of iatrogenically induced ocular complications.

Introduction: Cytomegalovirus is the most common cause of intrauterine infection in developed countries. Between 10% and 15% of infants infected with congenital cytomegalovirus exhibits the clinically apparent or symptomatic form of the disease. Exchange transfusion is an established therapy for hyperbilirubinemia and severe anemia. However, to the best of our knowledge, the viral load of cytomegalovirus before and after exchange transfusion has not been previously reported.

Case report: A Japanese female was delivered at 36 weeks of gestation to a 29-year-old gravida 3 para 3 by emergency Cesarean section because of non-reassuring fetal status. Hepatomegaly, splenomegaly, generalized petechiae, leptocephaly, and jaundice were noted at birth. On admission, her total bilirubin was 14.2 mg/dL, cytomegalovirus immunoglobulin M was positive (4.63 mg/dL), and her head ultrasound and computed tomography showed left intraventricular calcification and bilateral ventriculomegaly. Toxoplasma, rubella, and herpes simplex virus serologies were negative. The exchange transfusion was performed for the treatment of early onset hyperbilirubinemia, not for the treatment of congenital cytomegalovirus infection. The cytomegalovirus viral load before and after exchange transfusion was investigated by real-time polymerase chain reaction, and the plasma viral
load of cytomegalovirus was not significantly decreased from before (8.7×105/mL) to after (4.3×105/mL) exchange transfusion.

Conclusion: Exchange transfusion did not reduce the viral load of cytomegalovirus in severe congenital
cytomegalovirus infection.