Journal of Clinical Case Reports

Many studies have been conducted to cultivate and utilize patients’ own adipose-derived stem cells for the treatment of various incurable diseases and for regenerative medicine that can prolong lifespan. Despite the significant achievements made thus far, the lack of confidence with regard to safety, particularly the concern about Tumorigenicity, has made researchers hesitant to actively apply cultured human autologous adipose-derived cells in clinical trials. Therefore, studies on the Tumorigenicity of cultured adipose-derived stem cells are very important for expanding the field of stem cell–utilizing regenerative medicine. It is also important to study their effect on tumor biomarker levels. Long-term follow-up studies of Tumorigenicity after multiple intravenous administrations of cultured human autologous adipose-derived stem cells have not been reported worldwide. Therefore, the authors have examined about 500 Koreans who were administered more than 1 billion cultured autologous adipose-derived stem cells multiple times from 2010 to 2013 at a medical institution in Japan. We then conducted the first retrospective research in the world on the changes in eight types of tumor biomarkers over three–six years. According to the results of our analysis, there were no significant changes in the observed tumor biomarkers, irrespective of gender and age. These results suggest that multiple administrations of autologous adipose-derived stem cells cultured in accordance with the authors’ method do not affect Tumorigenicity.

Canalicular Adenoma (CA) is an uncommon, benign salivary gland tumor that was described by the World Health Organization classification in 1991. CA has a significant predilection for occurrence in the minor salivary glands, with most cases occurring in the upper lip, followed by the buccal mucosa and palate. Rarely, CA can involve the major salivary glands, for example the parotid gland. A small number of cases of CA of the parotid gland have been reported in the literature. We report a rare case of CA on the left parotid gland of an 81-year-old man with review of literature.

An 80-year-old woman suffered from acute chest pain and then exhibited cardiogenic shock. Transthoracic echocardiography revealed severe aortic regurgitation due to the intussusception of the intima. Computed tomography also showed the intussusception of the intima into the left ventricular outflow tract over the aortic valve and dissection involving the aortic root, aortic arch, and descending thoracic aorta. During surgery, echocardiography-guided central aortic cannulation was performed for the prompt establishment of cardiopulmonary bypass. The complete intimal tear was circumferentially located in the middle level of the ascending aorta. The proximal flap was inverted into the left ventricle, and the distal flap had been pushed into the aortic arch. Graft replacement of the ascending aorta was performed successfully, and the patient had an uneventful postoperative course.

A rare case of refractory ascites caused by benign portal vein stenosis after pancreatoduodenectomy (PD) is reported. A dogma claims that ascites is found in portal hypertension with an intrahepatic block only. However, in the postoperative state, the pathophysiologic condition is altered, which made diagnosis difficult.

A 69-year-old man who had undergone PD for lower bile duct carcinoma in situ, developed in postoperative course a pseudoaneurysm of the common hepatic artery successfully treated by stent graft. Six months later, the patient developed refractory ascites. CT scan revealed a severe stricture in the main trunk of the portal vein, probably due to extrinsic compression by the stent in the hepatic artery. Percutaneous transhepatic portography was performed and stent-graft was placed over the stenotic segment. Portal blood flow was corrected immediately. One week after the stenting procedure the patient was free of ascites and control physical and biochemical examination three years later is completely normal.

We present a case of a follicular variant of papillary thyroid carcinoma (PTC) with an uncommon sonographic feature– hyperechoic rim. A 24-year old female was referred to our department for an incidentally discovered nodule in the left lobe of the thyroid gland with an accompanying neck lymphadenomegaly. Ultrasound revealed a 1-cm hypoechoic nodule with a hyperechoic periphery with peripheral vascularity. The cytological finding was suspicious for PTC. Histology confirmed the suspected diagnosis. Hyperechoic rim is an uncommon ultrasound feature of thyroid nodules. A potential association with follicular variant of PTC needs to be explored.

The use of novel adhesive patch electrocardiographic monitoring for extended time periods has the potential to improve our detection and pathophysiologic understanding of ambient arrhythmias. Here we present a case of torsade de pointes in an HIV-infected individual highlighting the multiple mechanisms that may contribute to increased ventricular arrhythmia susceptibility and sudden cardiac death risk in such people.

Mummification is a postmortem process consisting in the loss of water from the soft tissues of the body and the body’s diminishing in size as a result of drying. The term “precocious mummification” is the process of rapid mummification usually observed in extreme weather conditions, with high temperature and low humidity. We present a case of precociously mummified corpse found in the city of Plovdiv, Bulgaria, sixteen days after the individual’s disappearance. The case is interesting because of the atypical precocious mummification that occurred in a very short period of time, in climate conditions that are not typical for the process of mummification-high humidity, medium temperature amplitudes and low ventilation. Such conditions are not typical for Bulgaria, especially in the fall.

Introduction: Situs inversus is a rare autosomal disorder with transposition of abdominal and thoracic organs. The prevelance is low upto 0.04%. Investigating the disease and performing surgical procedure is difficult because of difficult anatomy. We hereby report a case of symptomatic gallstones in 86 years old patient incidentally diagnosed as case of situs inversus after appropriate investigations. We also include a review of literature.

Method: Case report and literature review.

Case: An 86-year-old male patient with pain in left hypochondrium and vomiting after meal intake. He was diagnosed as case of situs inversus after 86 years. This patient successfully underwent open cholecystectomy and prophylactic appendectomy. The recovery was smooth and diagnosed without complications on painkillers.

Conclusion: Therefore, meticulous attention is needed to diagnose and operate the disease. Ability to deal with anatomical variations and hands on surgery by skilled surgeon decreases complications and successful recovery.

A Broncho Biliary Fistula (BBF) is a rare complication of echinococcosis. This occurs from rupture of a hydatid cyst located at the upper surface of the liver into the bronchial tree. Fistulisation, results in biliopytsis, which is expectoration of bile-tinged greenish-yellow sputum, a pathognomonic feature of BBF. Bilopytsis may also occur in other conditions such as hepatectomies, liver abscesses or trauma. Surgical fistula closure is the definitive management of these patients, however downstream biliary obstruction should be ruled out first. Almost all cases can be approached through a right postero-lateral thoracotomy followed by phrenotomy. However, if there are multiple cysts in the liver, a thoraco-abdominal incision may be necessary.

Primary malignant mediastinal germ cell tumors are the most common extragonadal germ cell tumors in young adults (PMMGCT). We review in our report the clinical features and therapeutic strategies and outcome of three patients diagnosed with PMMGCT at the department of medical oncology at Hassan II University Hospital of Fez, Morocco and we review briefly the existing literature data.

Acromegaly in commonly caused by GH secreting pituitary adenoma, which are a nearly always identifiable in conventional magnetic resonance (MRI). Rarely encountered, a patient with normal pituitary MRI, pose a diagnostic and therapeutic challenge. In this case a work up for ectopic acromegalic source of GH/GHRH should be considered. We herein report the case of a 60-year-old woman in whom we confirmed the GH excess. However, the imaging studies failed to identify the source of this pathology. Pituitary MRI failed to find an identifiable adenoma in MRI. The work up of ectopic GH/GHRH tumor was negative. In the lack of standard guidelines, our case is added to those reported in the literature to review the diagnostic challenge and management in such acromegalic patients.

Background: Hypertriglyceridemia (HTG) is postulated to be a rare cause of acute pancreatitis accounting for approximately 4% of causes. A serum triglyceride (TG) level above 1,000 mg/dl in the setting of pancreatitis and absent of other major causes is necessary to describe hypertriglyceridemia as a cause of acute pancreatitis. The mechanism involves the degradation of triglycerides by pancreatic lipase to release free fatty acids that induces free radical damage to the tissues. The major cornerstone in management is by reducing the triglyceride level to below 1000 mg/dL to achieve both the subsidal of the ongoing attack and the effective prevention of further episodes of pancreatitis. This can be achieved by a spectrum of treatment modalities ranging from includes dietary restriction of fat, administration of lipid-lowering agents to Experiences with plasmapheresis and effective lipid pharesis however, the latter modality hasn’t been sufficiently discussed regarding therapeutic effects.
Case presentation: This case reports a young female, 22-year-old female patient non-alcoholic, non-diabetic, non-obese with negative history for gall stones or significant drug use diagnosed with hypertriglyceridemic acute pancreatitis associated with acute kidney injury, and received one session of hemodialysis then plasmapharesis was initiated and she received 8 sessions with full dose of hypolipidemics, and responded only to plasmapharesis.