Journal of Clinical Case Reports

Abdominal cerclage may be recommended in women with a shortened or absent cervix or after failure of a previous vaginal cerclage. If the abdominal cerclage has to be removed prior to delivery of a non-viable fetus, hysterotomy is not necessary. In that case a laparoscopic removal should be considered. We will discuss laparoscopic placement and removal of an abdominal cerclage placed in a 27-year old woman, gravida 10, para 2, abortus 7, who presented at 16 weeks and 6 days gestational age with abdominal cramps and protruding membranes.

Filariasis is an endemic disease in many countries of Asia and Africa. It results in disfiguring lymphedema. A young gentleman presented with dizziness and found to have pancytopenia; an RBC count of 1.2 × 106/μl, Hemoglobin (Hb) of 3.6 g/dl, Total Leucocyte Count (TLC) of 3.9 × 103/ μl and platelet count of 7.0 × 103/μl. Examination of the peripheral smear, revealed the presence of microfilaria which was identified as Wuchereria bancrofti with the characteristic sheath and tail devoid of nuclei. Bone marrow revealed a picture of hypoplastic marrow with no evidence of microflaira parasite. He was started on Ivermectin 9 mg stat dose and Doxycycline 100 mg orally twice daily. His hemoglobin became stable after transfusion and platelets continued to drop. The patient continued to receive platelets transfusion till he decided to travel back to his home country and lost follow up after that. This is one of the few case reports demonstrating the rare association of pancytopenia and microfilariasis and it adds to the previous reports that it raises the awareness of both the physicians and the laboratory staff to the occurrence of this important association in a non-endemic area.

The Scoliosis Research Society defines scoliosis as a deformity in the frontal plane with a Cobb angle greater than 10°. Our case report shows a seven year’s old patient suffering from idiopathic scoliosis related to a myogenic torticollis from birth by hematoma of Sternocleidomastoid (SCM) dx. The patient through the rehabilitation treatment with the Global Postural Re-education (GPR) with frequency of a weekly session of 60 minutes, for a period of 14 months, showed a significant improvement of the postural, the reduction in Cobb degrees of scoliosis and lordosis and quality of life. However, it appears necessary to continue studying conservative rehabilitation methods effective for idiopathic scoliosis.

Perforations of any part of the gastrointestinal tract can occur in transplant patients, although the colon may be the most common site. We analyze the case of a 39-year-old patient after kidney transplantation who suffered perforation of terminal ileum with peritonitis on the 7th day after transplantation. We histologically confirmed presence of a foreign body in the intestinal wall – a rare cause of intestinal perforation in a patient after kidney transplantation. We have not noticed a significant worsening of graft function or development of sepsis mainly because of quick evaluation of the patient’s clinical state, prompt surgical intervention and a combined antibiotic treatment. Gastrointestinal perforations have rarely been noted in large studies involving transplant recipients.

Torsion of an accessory spleen is a very rare entity that causes an acute abdomen in children, and it is difficult to accurately diagnose preoperatively. We herein report a case of acute abdominal pain in a 5-year-old boy caused by torsion of an accessory spleen. In this case, abdominal US detected the whorl of the twisted pedicle, which may be a hallmark to diagnose torsion of an accessory spleen. We must consider torsion of an accessory spleen as a differential diagnosis when encountering acute abdomen in children with a palpable mass.

Background: Marantic endocarditis is a rare paraneoplastic syndrome which results from an hypercoagulate state. It can be associated with several tumors, particularly gastric cancer, and histology of adenocarcinoma. Mucines secreted by adenocarcinoma contribute to the activation of the coagulation pathway. Case presentation: We present the case of a patient with a marantic endocarditis complicating a metastatic gastric adenocarcinoma. He was hospitalised for a thoracic pain. At the physical examination, we found swelling, redness, and warmth of the right lower limb, suspected for a deep vein thrombosis that was confirmed at the echo doppler ultrasound. CT scan documented a severe bilateral pulmonary embolism, a splenic infarction, and multiple liver metastases. Laboratory tests were normal. Despite a Low-Molecular Weight Heparin (LMWH) treatment, the patient presented a cerebral stroke, confirmed at the MRI. Trans-thoracic echocardiography found a small vegetation of the mobile end of the mitral valve with a normal left ventricular contractile function. LMWH was switched by continuous intravenous Unfractionated Heparin (UFH). PET scan showed multiple liver metastases and a pathological gastric hypermetabolism. Liver biopsy confirmed a metastasis of a HER-2 negative gastric adenocarcinoma. Because of the stop of heparin treatment during this procedure, the patient presented a new brain stroke. A systemic palliative chemotherapy was started by FOLFOX-4 regimen and it is now ongoing. Conclusion: The particularity of this case relies on the impossibility to initially switch UFH by another anticoagulant treatment. Chemotherapy represents the only possibility to decrease mucine production and thrombi formation.

Neuroblastoma is the most common extra cranial solid tumour in childhood and in infancy, but it is a rare fetal tumour, especially on neck region. Approximately, two thirds of the cases arise from adrenal gland and presentation of other localizations is extremely rare. Here, we report a case of cervical Neuroblastoma suspected at 20th gestational week. This is the fourth case detected on prenatal ultrasound on neck region and these cases that is identified in the second trimester fetal anatomy screening.

We report the case of a 72-year-old female who was admitted to our hospital because of obstructive colitis. Blood analysis showed her serum carcinoembryonic antigen (CEA) level to be 156.0 ng/mL. A sigmoidectomy and descending colostomy were performed for obstructive colitis due to colonic diverticulitis. Histopathological examination revealed active inflammation of the sigmoid colon without neoplasia. Her serum CEA level decreased within normal limits immediately after surgery.

Surgical removal of a broken instrument can be a difficult procedure due to proximity of vital anatomical structures of the region. In the mandibular posterior lingual region the difficult access to the area adds to this difficulty. The main concern in such cases is localization of the foreign body. Here we present a case report of such a case, with its complete management and a careful technique of retrieval. The main aim of this study was to highlight the use of CBCT in such cases

A 13-month-old female presented to the emergency department with acute neurological deficit. Her parents stated that she had awoken that morning at approximately 6:30 am only looking to the right, with left-sided mouth droop, and weakness on the left side. They reported that the child hit her head earlier that same evening after falling backwards against the wall. She did not lose consciousness and was acting normal after the incident, until bed-time, around 8:30 PM. She was recovering from an upper respiratory infection (URI) and had appeared very pale over the previous couple of weeks.

One of the salient aims of orthodontic treatment is to acquire a well-established functional bite. This could be reached through having what is called a “canine guided occlusion”. In this type of occlusion the upper and lower canines guide the bite of the rest of the teeth especially during lateral movements. This aids to attain robust masticatory functions and to secure a convenient environment for the health of the Temporo-mandibular joint. In this study a case with early extraction of a permanent lower canine is presented. The recreation of a “canine guided occlusion” was done by orthodontic treatment. Orthodontic mini-screws were placed in the upper arch and some frictionless mechanics in the lower arch. The canine guided occlusion was finally re-established by moving the lower 1st premolar in place of the lower canine with some modifications in its angulation and vertical position. The creation of a harmonious canine guided occlusion was checked and confirmed before the removal of the orthodontic appliance. The orthodontic treatment of the current case not only aided in establishing “canine guided occlusion” but also helped to enhance the facial appearance of the patient in terms of reducing facial convexity, aligning the teeth and reducing the incisal show at rest.

Introduction: Penicillium (Talaromyces) marneffei is a dimorphic fungus that is endemic in Southeast Asia and South China, but rarely seen the United States except in immunosuppressed patients who have had travel-related exposure. Case Presentation: A 28 year-old man with advanced HIV/AIDS presented with dyspnea, cough and fever two weeks after returning from Shenzhen, South China. He was treated for presumptive Pneumocystis jiroveci pneumonia with improvement in his symptoms and was then started on antiretroviral therapy. Three weeks later he developed rash and fever, and blood culture grew Penicillium (Talaromyces) marneffei. Conclusion: This case highlights the importance of obtaining a detailed travel history in order to incorporate travel-related diseases in a differential diagnosis.

Knowing growth and pubertal development in Down Syndrome (DS) is very important to early detect catch down growth/weight or pubertal delay that can be suggestive of disorders such as autoimmune diseases, endocrinophaties or oncological pathologies.

Klinefelter syndrome is a chromosomal condition that affects male physical and cognitive development. The symptoms associated with KS vary greatly and many males with KS are never diagnosed or treated. Affected individuals typically have small testes that do not produce as much testosterone as usual. Reduced testosterone can impact reproductive maturation greatly and can lead to delayed or incomplete puberty, breast enlargement (gynecomastia), reduced facial and body hair, and an inability to have biological children (infertility). Puberty is a time of rapid physical and psychological change, and hormone replacement treatment can successfully limit and reduce the symptoms of KS. This case report encompasses a routine fertility evaluation in which a 38 year old Caucasian male was diagnosed with Klinefelter Syndrome (KS) and pronounced infertile. The case highlights the relative lack of awareness surrounding KS and the options which may enable KS males to produce healthy offspring.

Autotransplantation provides the possibility of a natural tooth rather than a prothesis or an osseointegrated implant to replace a missing tooth. The indications for autotransplantation are wide, but careful patient selection coupled with an appropriate technique is a prerequisite for a good functional and esthetic outcome. Autogenous tooth transplantation is the surgical movement of a tooth from one location in the mouth to another in the same individual. It has achieved high success rates and is an excellent option for tooth replacement. This paper describes the review on autogenous tooth transplantation and also highlights the advantages of autotransplantation using a case report as an example.

A case report of a forty-six-year old female patient with the duplication of the posterior cerebral artery (PCA) and concomitant vascular malformation. We try to explain the development of this variant and diagnostic approach in this particular case.

Diaphragmatic Hernia (DH) after adult Orthotopic Liver Transplantation (OLT) is a rare event with only two cases reported in English literature. It is not clear if this complication is related to surgery or to immunosuppression therapy or both. We describe a well-resolved case of left-sided DH in a 43-year-old man taking Tacrolimus and mycophenolate mofetil (MMF) as immunosuppressants, 27 months after OLT. Authors from previously reported cases considered that ascites and incisional hernia, as well as Mammalian Target Of Rapamycin (mTOR) inhibitors therapy, as predisposing factors for DH development. In the case presented here, none of the possible surgical triggering factors described before were present. MMF is associated to impaired wound healing and incisional hernias, like mTOR inhibitors. Maybe minor and not evident diaphragmatic injury during hepatectomy associated to immunosuppression with mTOR inhibitors and/or MMF have an important role in DH occurrence after OLT in adults.

Pulmonary alveolar proteinosis is a rare disease of alveolar surfactant accumulation. Primary, autoimmune etiology accounts for 90% of cases. This report presents a case of secondary alveolar proteinosis, a metal worker with a pulmonary infection who was subsequently diagnosed with alveolar proteinosis based on the results of bronchoalveolar lavage and lung biopsy. He underwent complete resolution of the alveolar proteinosis after whole lung lavage and change of his workplace. Long term follow-up hasn’t shown any sequelae and he has suffered no relapse. This favorable disease course is representative of secondary alveolar proteinosis with a reversible causative agent.

Pyoderma Vegetans (PV) is a chronic inflammatory disease that usually presents as verrucose plaques. It belongs to the group of neutrophilic dermatoses and it is diagnosed right after other inflammatory and infectious diseases are excluded. It shows no association to systemic disorders and has great response to oral corticosteroids. We hereby report a patient presenting PV of lower limbs.

Introduction: Brain Natriuretic Peptide (BNP) is secreted from cardiac myocytes in response to the wall stress. BNP is eliminated via Natriuretic Peptide Receptor C (NPR-C) and degradation by extracellular proteases including neprilysin (NEP). Obesity and insulin resistance predispose to lower circulating natriuretic peptide levels. Raised NEP activity and an elevated NPR-C gene expression have been described in obese individuals with insulin resistance and lower circulating levels of natriuretic peptide. Methods: We assessed the relationship between markers of peptide production and pulmonary clearance with indices of insulin resistance and body weight. The cardiac, peripheral and pulmonary Extraction Ratio (ER) has been quantified to assess BNP synthesis and clearance. Twenty one individuals admitted for EP study were consented. Simultaneous sampling of serum BNP level was performed from femoral artery and vein, coronary sinus and femoral artery and pulmonary artery and pulmonary wedge position. Results: The mean serum BNP level was 37 ng/L. The mean cardiac ER was 1.20, pulmonary and peripheral ER was 0.13. There was a tendency for lower cardiac and pulmonary ER in males. Pulmonary ER correlated with age (r=0.495, p=0.023) and systolic BP (r=0.58, p=0.006) only. However there was no correlation between cardiac and pulmonary ER with BMI, waist circumference and HOMA-IR. Conclusions: We found no correlation between the marker of BNP pulmonary clearance with body size and insulin resistance. Induction of the adipose tissue specific NPR-C pathway (rather than NEP clearance) is more likely the cause of the lower level of BNP in patients with obesity and insulin resistance.

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Background: The aim of the current study was to assess the hematological and biochemical variations in the serum of myocardial infarction patients and healthy controls. Method: The case-control study included 200 samples collected from Myocardial infarction patients and controls for the analysis the variations of hematological and biochemical. Result: WBC and ESR were increased, whereas, hemoglobin and platelet was decreased in patients as compared with the controls. Serum triglyceride, total cholesterol, LDL increased and decreased HDL in patients as compared with the controls. Copper and potassium showed increased levels whereas, decreased serum albumin, and zinc in patients as compared with the controls. Conclusion: Further detailed investigations on the role of hematological, biochemical, variations in the pathogenesis of acute myocardial infarction are needed.

Background: Many patients with relapsing-remitting MS (RRMS) show a suboptimal response to first-line disease-modifying drugs. In these patients treatment with natalizumab is highly effective, however its use has been limited due to safety concerns. Objective: To evaluate the consistency between the eligibility to natalizumab according to Italian Drug Agency (AIFA), European Medicines Agency (EMA) and Food and Drug Administration (FDA) criteria, and its use in clinical practice. Methods: Medical records of 402 patients from four Italian MS Centres were reviewed to identify patients eligible to natalizumab according to AIFA, EMA, and FDA criteria and verify how many of them were currently treated or had been previously treated in practice. Results: Of 316 RRMS patients, 13.3% were currently or had been previously treated with natalizumab, while additional 7.0%, 14.2%, and 27.2% were not receiving the drug although they were eligible according to AIFA, EMA, and FDA criteria, respectively. Compared to patients treated with natalizumab, subject who were eligible but remained untreated were older and with shorter education. Conclusion: In a cohort of RRMS patients, 20.3%, 27.5%, and 40.5% were eligible to natalizumab according to AIFA, EMA, and FDA, respectively, although only part of them were actually treated.

Introduction: A precise transfer of planned procedures to a real operative field can be provided by surgical robots. This technology, still unique, is increasingly applied in new medical specialties. The aim of this paper was to describe the clinical application of an active navigation in the dental implant treatment. Case Report: The patient was imaged by CBCT computed tomography Gendex GXCB-500/i-CAT while wearing an individually fitted interfacing acrylic splint. Thereafter, CT data were imported to the Image Guided Implantology System and precise 3-dimensional implant treatment plan was contemplated. This system allows real-time interactive carrying out of implantological procedures with three-dimensional visualization of the anatomical structures during the procedure. Conclusions: The system of active navigation ensures the coordination of prosthetic and surgical treatment which guarantees optimal surgical and prosthetic effect of the therapy, including both anatomical structures and prosthetic requirements.

Case Report: A 28-year-old man complained acute low-back pain three-day post-appendectomy. Computed tomography revealed thrombosis of both iliac veins and ascending lumbar vein in a patient with chronic occlusion of infra-renal inferior vein cava. Consequent lumbar and intraspinal epidural venous engorgements caused nerve root and thecal sac compression that simulated a spinal stenosis. Complete symptoms resolution was achieved after thrombectomy using a rotational catheter.

Melioidosis caused by Burkholderia pseudomallei, a gram negative soil saprophyte was first described by Whitmore and Krishnaswami in 1912. The term melioidosis was coined in 1921 by Stanton and Fletcher and is derived from the Greek word “melis” meaning “a distemper of assess” and “eidos”, resemblance. This was because the disease clinically and pathophysiologically resembled glanders, a chronic and debilitating disease of equines caused by Pseudomonas mallei.