Masatomo Maeda, Akihiro Fukuda, Kouki Shinoda, M. Tamura, M. Yamada, Hidemitsu Nakagawa
{"title":"A case of idiopathic middle cerebral artery occlusion and perforating branch aneurysm in an unusual location","authors":"Masatomo Maeda, Akihiro Fukuda, Kouki Shinoda, M. Tamura, M. Yamada, Hidemitsu Nakagawa","doi":"10.15761/ccsr.1000172","DOIUrl":"https://doi.org/10.15761/ccsr.1000172","url":null,"abstract":"","PeriodicalId":10345,"journal":{"name":"Clinical Case Studies and Reports","volume":"33 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80591489","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M. Kallela, M. Nissila, P. Keski-Santti, M. Sumelahti, Mikko Karppa, M. Ilmavirta, M. Farkkila, L. Paloheimo, M. Maki, K. Syrjanen, O. Suovaniemi
Background & Study Design: Endorsements from migraine patients testifying that L-cysteine effectively prevented their headache attacks, prompted us to design a double-blind, randomized placebo-controlled, multi-centre trial (with 218 patients) comparing Acetium® capsules (100mg L-cysteine, inactivating acetaldehyde in the stomach) and placebo in prevention of migraine attacks during a 3-month trial period. Methods: Migraine diaries were evaluated at monthly intervals for study compliance. The primary study endpoint was reduction in the number of migraine days (NMD), assessed at 4 cut-offs: ≥50%, ≥30%, ≥25% and ≥20%. Results : Altogether, 146 patients had completed the study per protocol. Using the most stringent cut-off (≥50%) for reduction of NMD, the success rate in the Acetium® arm was 26.0% and in the placebo arm 25.4%; OR=1.027 (95%CI 0.589-1.79) (p=NS). Among the patients with a potential acetaldehyde-associated trigger (alcohol, smoking, dietary), Acetium® was up to 50% more effective than placebo in NMD reduction by various cut-offs, with the highest OR=1.569 (95%CI 0.743-3.312). Conclusions : Although Acetium® was not more effective than placebo in reducing the NMD in the global analysis, certain sub-groups might benefit from Acetium® intervention considerably more than migraine patients collectively.
背景与研究设计:偏头痛患者证实l -半胱氨酸有效地预防了头痛发作，这促使我们设计了一项双盲、随机安慰剂对照、多中心试验(218例患者)，比较Acetium®胶囊(100mg l -半胱氨酸，胃中乙醛失活)和安慰剂在3个月的试验期间预防偏头痛发作的效果。方法:偏头痛日记每隔一个月评估一次研究依从性。主要研究终点是偏头痛天数(NMD)的减少，有4个临界值:≥50%、≥30%、≥25%和≥20%。结果:共有146名患者完成了每个方案的研究。使用最严格的临界值(≥50%)来降低NMD, Acetium®组的成功率为26.0%，安慰剂组为25.4%;OR=1.027 (95%CI 0.589-1.79) (p=NS)。在具有潜在乙醛相关触发因素(酒精、吸烟、饮食)的患者中，通过各种截断值，Acetium®在减少NMD方面比安慰剂有效高达50%，最高OR=1.569 (95%CI 0.743-3.312)。结论:尽管在整体分析中，Acetium®在降低NMD方面并不比安慰剂更有效，但某些亚组可能比偏头痛患者总体上更受益于Acetium®干预。
{"title":"Elimination of histamine liberator (acetaldehyde) by L-cysteine in prevention of migraine attacks: Randomized controlled trial with a medical device (Acetium® Capsules)","authors":"M. Kallela, M. Nissila, P. Keski-Santti, M. Sumelahti, Mikko Karppa, M. Ilmavirta, M. Farkkila, L. Paloheimo, M. Maki, K. Syrjanen, O. Suovaniemi","doi":"10.15761/ccsr.1000167","DOIUrl":"https://doi.org/10.15761/ccsr.1000167","url":null,"abstract":"Background & Study Design: Endorsements from migraine patients testifying that L-cysteine effectively prevented their headache attacks, prompted us to design a double-blind, randomized placebo-controlled, multi-centre trial (with 218 patients) comparing Acetium® capsules (100mg L-cysteine, inactivating acetaldehyde in the stomach) and placebo in prevention of migraine attacks during a 3-month trial period. Methods: Migraine diaries were evaluated at monthly intervals for study compliance. The primary study endpoint was reduction in the number of migraine days (NMD), assessed at 4 cut-offs: ≥50%, ≥30%, ≥25% and ≥20%. Results : Altogether, 146 patients had completed the study per protocol. Using the most stringent cut-off (≥50%) for reduction of NMD, the success rate in the Acetium® arm was 26.0% and in the placebo arm 25.4%; OR=1.027 (95%CI 0.589-1.79) (p=NS). Among the patients with a potential acetaldehyde-associated trigger (alcohol, smoking, dietary), Acetium® was up to 50% more effective than placebo in NMD reduction by various cut-offs, with the highest OR=1.569 (95%CI 0.743-3.312). Conclusions : Although Acetium® was not more effective than placebo in reducing the NMD in the global analysis, certain sub-groups might benefit from Acetium® intervention considerably more than migraine patients collectively.","PeriodicalId":10345,"journal":{"name":"Clinical Case Studies and Reports","volume":"86 2 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91115128","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jatin Agrawal, Praveen Kumar, A. Arora, Ashish Kumar
Extra hepatic recurrence of hepatocellular carcinoma (HCC) after liver transplant is seen only in 10- 15% cases. Usual site for recurrence is lung, bones and lymph nodes. Adrenal metastasis is rare and usually seen along with other organs recurrence. Isolated adrenal metastasis from HCC after liver transplant is rare entity. Surgical resection of isolated adrenal recurrence is described in few case reports with variable outcome. Here, we also report a case of isolated adrenal recurrence of HCC after liver transplant. Patient was successfully treated him with adrenalectomy. Post adrenalectomy 3 years follow up showed good overall survival without recurrence.
{"title":"Isolated adrenal metastasis of hepatocellular carcinoma (HCC) post liver transplantation: a rare entity","authors":"Jatin Agrawal, Praveen Kumar, A. Arora, Ashish Kumar","doi":"10.15761/ccsr.1000166","DOIUrl":"https://doi.org/10.15761/ccsr.1000166","url":null,"abstract":"Extra hepatic recurrence of hepatocellular carcinoma (HCC) after liver transplant is seen only in 10- 15% cases. Usual site for recurrence is lung, bones and lymph nodes. Adrenal metastasis is rare and usually seen along with other organs recurrence. Isolated adrenal metastasis from HCC after liver transplant is rare entity. Surgical resection of isolated adrenal recurrence is described in few case reports with variable outcome. Here, we also report a case of isolated adrenal recurrence of HCC after liver transplant. Patient was successfully treated him with adrenalectomy. Post adrenalectomy 3 years follow up showed good overall survival without recurrence.","PeriodicalId":10345,"journal":{"name":"Clinical Case Studies and Reports","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83009466","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Weimer Le, G. Cattari, A. Binelli, E. Fanales‐Belasio, Poddighe Af, F. Sensi
The SARS-CoV-2 pandemic has already infected more than 98 million people worldwide and resulted in 2.1 million deaths. Though originally described as a respiratory virus, SARS-CoV-2 has now been shown to have multiorgan involvement. Chronic kidney disease (CKD) has emerged as a risk factor for adverse outcomes. The virus can cause renal involvement, and severe renal dysfunction is more common among patients with chronic comorbid conditions, especially patients with chronic kidney disease. Angiotensin-converting enzyme 2 (ACE2) has been proven to be the major receptor of SARS-CoV-2 in kidneys, suggesting that ACE2-related changes may be involved in renal injury during the infection. For patients with SARS-CoV-2 infection, renal injury by either direct infection or systemic effects, including host immune clearance and immune tolerance disorders, endothelium-mediated vasculitis, thrombus formation, glucose and lipid metabolism disorder, increased serum creatinine, variable degrees of proteinuria, hematuria, and radiographic abnormalities of the kidneys and hypoxia. Here, we report an Italian patient with Chronic kidney diseases, hypertension and sarcomatous endothelial carcinoma responding to alternative therapy with regression of pneumonia caused by Sars-Cov-2 without Remdesivir for nefrotoxicity.
{"title":"Characteristic and management of Sars-Cov-2 pneumonia without Remdesivir in patient with chronic kidney diseases and sarcomatous endothelial carcinoma","authors":"Weimer Le, G. Cattari, A. Binelli, E. Fanales‐Belasio, Poddighe Af, F. Sensi","doi":"10.15761/ccsr.1000162","DOIUrl":"https://doi.org/10.15761/ccsr.1000162","url":null,"abstract":"The SARS-CoV-2 pandemic has already infected more than 98 million people worldwide and resulted in 2.1 million deaths. Though originally described as a respiratory virus, SARS-CoV-2 has now been shown to have multiorgan involvement. Chronic kidney disease (CKD) has emerged as a risk factor for adverse outcomes. The virus can cause renal involvement, and severe renal dysfunction is more common among patients with chronic comorbid conditions, especially patients with chronic kidney disease. Angiotensin-converting enzyme 2 (ACE2) has been proven to be the major receptor of SARS-CoV-2 in kidneys, suggesting that ACE2-related changes may be involved in renal injury during the infection. For patients with SARS-CoV-2 infection, renal injury by either direct infection or systemic effects, including host immune clearance and immune tolerance disorders, endothelium-mediated vasculitis, thrombus formation, glucose and lipid metabolism disorder, increased serum creatinine, variable degrees of proteinuria, hematuria, and radiographic abnormalities of the kidneys and hypoxia. Here, we report an Italian patient with Chronic kidney diseases, hypertension and sarcomatous endothelial carcinoma responding to alternative therapy with regression of pneumonia caused by Sars-Cov-2 without Remdesivir for nefrotoxicity.","PeriodicalId":10345,"journal":{"name":"Clinical Case Studies and Reports","volume":"27 17 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85275927","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The diagnostic assessment with DSM-5 or ICD-10 of patients is necessary in psychiatry and psychotherapy, but there are also other important concepts that are necessary the indication and treatment planning. The following article describes the diagnosis based on the OPD-CA, in which, among other things, allows to assess intrapsychic conflicts that impede development and need to be dealt with in therapy. Two cases are presented that have the same diagnosis, F93, but have very different psychodynamic conflicts and also different therapy requirements. The consequences for the subsequent therapy are discussed.
{"title":"One ICD-10 diagnosis- different conflicts: Using the OPD-CA as tool for treatment planning","authors":"I. Seiffge-Krenke","doi":"10.15761/ccsr.1000150","DOIUrl":"https://doi.org/10.15761/ccsr.1000150","url":null,"abstract":"The diagnostic assessment with DSM-5 or ICD-10 of patients is necessary in psychiatry and psychotherapy, but there are also other important concepts that are necessary the indication and treatment planning. The following article describes the diagnosis based on the OPD-CA, in which, among other things, allows to assess intrapsychic conflicts that impede development and need to be dealt with in therapy. Two cases are presented that have the same diagnosis, F93, but have very different psychodynamic conflicts and also different therapy requirements. The consequences for the subsequent therapy are discussed.","PeriodicalId":10345,"journal":{"name":"Clinical Case Studies and Reports","volume":"23 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73997959","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Patients with End-stage Kidney Disease (ESKD) on renal replacement therapy (RRT) are at high risk of extraosseous metastatic calcifications at multiple sites, which includes widespread arterial calcification, cardiac valvular calcification, and soft tissues calcium deposits. Tumoral calcinosis (TC) and calciphylaxis are two dreaded consequences of metastatic soft tissues calcium phosphate complex deposits in patients with ESKD with very poor outcome [1]. A 71-year-old female patient with ESKD secondary to systemic sclerosis on hemodialysis (HD) for last four years, presents with progressively increasing soft tissue swellings involving, both her buttocks over last one year. The swellings were non-tender and firm in consistency. Her X- rays revealed TC in both her buttocks and upper thigh, showing marked progression since the last study done 6 months prior. Vascular calcification was also noted in the pelvis [2] (Figure 1). She is on 4 hours 3 times a week HD with dialysis clearance within the target range. Her serum calcium was 2.8 mmol/L, serum phosphate of 2 mmol/L and parathyroid hormone level of 60-90 pmol/L. She did not improve with treatment with phosphate binders; Vitamin D. There were no improvements in the swellings with further treatment with sodium thiosulfate and Cinacalcet and aggressive dialysis. Parathyroidectomy was declined
{"title":"Tumoral calcinosis of buttock in a patient with end stage kidney disease on haemodialysis","authors":"A. Hayat","doi":"10.15761/ccsr.1000151","DOIUrl":"https://doi.org/10.15761/ccsr.1000151","url":null,"abstract":"Patients with End-stage Kidney Disease (ESKD) on renal replacement therapy (RRT) are at high risk of extraosseous metastatic calcifications at multiple sites, which includes widespread arterial calcification, cardiac valvular calcification, and soft tissues calcium deposits. Tumoral calcinosis (TC) and calciphylaxis are two dreaded consequences of metastatic soft tissues calcium phosphate complex deposits in patients with ESKD with very poor outcome [1]. A 71-year-old female patient with ESKD secondary to systemic sclerosis on hemodialysis (HD) for last four years, presents with progressively increasing soft tissue swellings involving, both her buttocks over last one year. The swellings were non-tender and firm in consistency. Her X- rays revealed TC in both her buttocks and upper thigh, showing marked progression since the last study done 6 months prior. Vascular calcification was also noted in the pelvis [2] (Figure 1). She is on 4 hours 3 times a week HD with dialysis clearance within the target range. Her serum calcium was 2.8 mmol/L, serum phosphate of 2 mmol/L and parathyroid hormone level of 60-90 pmol/L. She did not improve with treatment with phosphate binders; Vitamin D. There were no improvements in the swellings with further treatment with sodium thiosulfate and Cinacalcet and aggressive dialysis. Parathyroidectomy was declined","PeriodicalId":10345,"journal":{"name":"Clinical Case Studies and Reports","volume":"24 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74362870","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Intracerebral hemorrhage (ICH) is a rare phenomenon for which 10% occur in the cerebellum. They occur in older adults and are associated with hypertension in the majority of cases. They have been reported in adolescents and young adults in association with arteriovenous malformations and angiomas. Spontaneous cerebellar hemorrhaging, in the absence of trauma or any identifiable well-established risk factors, is an exceedingly rare occurrence, with a mortality ranging from 25-57%. A case of a 26-year-old male with a spontaneous cerebellar hemorrhage is presented. He is a healthy young adult without identifiable risk factors for cerebrovascular accident (CVA) apart from marijuana use, which has not definitively been established as a risk factor. Several possible etiology’s are explored, and after nine years his post-event status is assessed.
{"title":"A case of spontaneous cerebellar hemorrhage","authors":"Arash Lashani, R. Hage","doi":"10.15761/ccsr.1000142","DOIUrl":"https://doi.org/10.15761/ccsr.1000142","url":null,"abstract":"Intracerebral hemorrhage (ICH) is a rare phenomenon for which 10% occur in the cerebellum. They occur in older adults and are associated with hypertension in the majority of cases. They have been reported in adolescents and young adults in association with arteriovenous malformations and angiomas. Spontaneous cerebellar hemorrhaging, in the absence of trauma or any identifiable well-established risk factors, is an exceedingly rare occurrence, with a mortality ranging from 25-57%. A case of a 26-year-old male with a spontaneous cerebellar hemorrhage is presented. He is a healthy young adult without identifiable risk factors for cerebrovascular accident (CVA) apart from marijuana use, which has not definitively been established as a risk factor. Several possible etiology’s are explored, and after nine years his post-event status is assessed.","PeriodicalId":10345,"journal":{"name":"Clinical Case Studies and Reports","volume":"29 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88137933","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A 57 yo woman underwent bilateral nephrectomy for autosomal dominant adult polycystic disease with massive organ enlargement. Despite severe pre-operative hypertension, her postoperative course was complicated by very severe debilitating hypotension, especially on dialysis, and refractory to multiple attempted interventions. Carefully planned deceased donor renal transplantation resulted in immediate post-operative normalisation of blood pressure, sustained improvement to quality of life and excellent graft function eight years later.
{"title":"Refractory hypotension in an anephric patient: Immediate response to renal transplantation","authors":"Tony Bose, K. Nicholls","doi":"10.15761/ccsr.1000145","DOIUrl":"https://doi.org/10.15761/ccsr.1000145","url":null,"abstract":"A 57 yo woman underwent bilateral nephrectomy for autosomal dominant adult polycystic disease with massive organ enlargement. Despite severe pre-operative hypertension, her postoperative course was complicated by very severe debilitating hypotension, especially on dialysis, and refractory to multiple attempted interventions. Carefully planned deceased donor renal transplantation resulted in immediate post-operative normalisation of blood pressure, sustained improvement to quality of life and excellent graft function eight years later.","PeriodicalId":10345,"journal":{"name":"Clinical Case Studies and Reports","volume":"175 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85881977","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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