Cases journal最新文献

Seborrheic keratoses, a benign growth lesion, is a very common cutaneous lesion encountered in white races in the fourth and fifth decade. The occurrence of this lesion on the vulva is rare, as an isolated lesion or in association with lesions elsewhere. A 34-year-old woman reported with a hyperpigmented palpable lesion, approximately 5-10 mm in diameter, was found on the patient's left labium majus. The clinical differential diagnosis of the pigmented lesions of the vulva is difficult often need a biopsy.

Introduction: Approximately 15% (more than 2 million individuals, based on these estimates) of all people with diabetes will develop a lower-extremity ulcer during the course of the disease. Ultimately, between 14% and 20% of patients with lower-extremity diabetic ulcers will require amputation of the affected limb. Analysis of the 1995 Medicare claims revealed that lower-extremity ulcer care accounted for $1.45 billion in Medicare costs. Therapies that promote rapid and complete healing and reduce the need for expensive surgical procedures would impact these costs substantially. One such example is the electrotherapeutic modality utilizing the H-Wave(R) device therapy and program.It has been recently shown in acute animal experiments that the H-Wave(R) device stimulation induces a nitric oxide-dependent increase in microcirculation of the rat Cremaster skeletal muscle. Moreover, chronic H-wave(R) device stimulation of rat hind limbs not only increases blood flow but induces measured angiogenesis. Coupling these findings strongly suggests that H-Wave(R) device stimulation promotes rapid and complete healing without need of expensive surgical procedures.

Case presentation: We decided to do a preliminary evaluation of the H-Wave(R) device therapy and program in three seriously afflicted diabetic patients. Patient 1 had chronic venous stasis for 6 years. Patient 2 had chronic recurrent leg ulcerations. Patient 3 had a chronic venous stasis ulcer for 2 years. All were dispensed a home H-Wave(R) unit. Patient 1 had no other treatment, patient 2 had H-Wave(R) therapy along with traditional compressive therapy, and patient 3 had no other therapy.For patient 1, following treatment the ulcer completely healed with the H-Wave(R) device and program after 3 months. For patient 2, by one month complete ulcer closure occurred. Patient 3 had a completely healed ulcer after 9 months.

Conclusions: While most diabetic ulcers can be treated successfully on an outpatient basis, a significant proportion will persist and become infected. Based on this preliminary case series investigation we found that three patients prescribed H-Wave(R) home treatment demonstrate accelerated healing with excellent results. While these results are encouraging, additional large scale investigation is warranted before any interpretation is given to these interesting outcomes.

Patients with spontaneous lens dislocation and glaucoma can be challenging to manage. We present a forty-six year old Caucasian lady who was referred with bilateral high intraocular pressure, and was subsequently diagnosed with glaucoma in association with lens dislocation and Marfan syndrome. Baerveldt glaucoma drainage device tubes were inserted in both eyes due to poor response to medical therapy. However, this was complicated by recurrent vitreous occlusion of both glaucoma drainage tubes requiring further multiple surgical interventions. There have not been any further recurrences of vitreous incarceration or posterior segment complications since, but the patient remains under close follow-up.

Cancer survivors have a higher risk of new primary cancer, in the same or in another organ, than the general population. We report a 78-year-old women who has metachronous quadruple adenocarcinoma, includes bilateral breast cancer, ovarian cancer and retroperitoneal neuroendocrine carcinoma. The development of second cancer in cancer survivors can be expected but third or higher order malignancies are rare.

Introduction: In 1% of Rhesus negative women sensitisation occurs without any overt sensitising event during pregnancy. This accounts for late immunisation during a first pregnancy and is responsible for 18-27% of cases of alloimmunisation. The incidence of congenital uterine anomalies in a fertile population is 3.2% of which 5% are bicornuate uterus. Bicornuate uterus can lead to early miscarriages, preterm labor, fetal growth retardation and congenital malformations.

Case presentation: A 23-year-old lady in her first pregnancy developed Anti-D antibodies at 28 weeks of gestation without any known sensitising event. In view of increasing anti-D titres, at 36 weeks she was delivered. Incidentally during caesarean section she was found to have bicornuate uterus. The neonate was treated with phototherapy and blood transfusion following delivery.

Conclusion: Rhesus antibodies when managed by close monitoring and timely delivery can lead to favourable outcome. Bicornuate uterus does not always lead to complications like miscarriage, growth retardation or preterm labour and does not need any special intervention.

Introduction: Leiomyosarcomas are rare tumors. The most common site for head and neck leiomyosarcomas is the oral cavity, followed by sinonasal tract and skin. Subcutaneous leiomyosarcomas are thought to arise from small to medium-sized blood vessels in the subcutaneous tissue.

Case presentation: A 67-year-old female patient underwent excision of a slow growing neck mass of the left posterior neck triangle after a thorough clinical and laboratory examination. The lesion was located in the subcutis and fine needle aspiration biopsy revealed malignant features. Histology revealed subcutaneous leiomyosarcoma and the patient is free from local recurrence and distant metastases 3 years after wide excision of the lesion.

Conclusions: The primary modality of therapy of subcutaneous leiomyosarcoma is surgery, adjuvant radiotherapy or chemotherapy may be used for control of local recurrence, in case of positive surgical margins, high-grade or large tumors.

Introduction: Drug-induced esophageal ulcers most commonly cause heartburn, midsternal pain and dysphagia. In our clinic azithromycin is a relative widely used antibiotic for respiratory tract infections and otitis media because of its activity against Haemophilus influenzae and atypical pathogens, and its ease of administration. After a thorough search in Pubmed the present case is the first one to report azithromycin-induced esophageal ulcer and associated symptoms in the literature.

Case presentation: A 61-year-old Caucasian man was admitted to our endoscopy unit for the investigation of odynophagia and retrosternal pain of new onset. His past medical history was unremarkable but had used azithromycin 500 mg/d for three days in the previous week. An upper endoscopy revealed an extensive serpiginous midesophageal ulcer in the presence of a normal squamocolumnar junction and biopsies from the edges and center of the lesion disclosed no neoplasia or infectious causes but a dense acute inflammatory infiltrate. The patient was put on a liquid diet, sucralfate proton pump inhibitor treatment and was symptom-free within two weeks. After four weeks on therapy a repeated upper endoscopic control examination demonstrated normal findings.

Conclusion: To our knowledge this is the first such a case of azithromycin -induced esophageal ulceration. We think that a little time taken by the physician to warn the patients for taking every oral drug with sufficient amount of water might prevent this kind of complications.

Introduction: Giant cell tumor (GCT) is an aggressive, but usually benign bone neoplasm most commonly arising in the metaphysis/epiphyses of long bones. While they are categorized as benign tumors, they can be locally aggressive and clinically have metastatic potential. The most common locations of this tumor include the distal femur, proximal tibia, and distal radius. We report a GCT arising in an atypical location and mimicking a breast mass.

Case presentation: This case was diagnosed at a large cancer center in Florida. Pertinent clinical findings were obtained from chart review and inter-departmental consultation. Radiologically, the initial impression included a deep-seated breast cancer with local chest wall invasion. Further evaluation revealed the mass to be an expansile rib lesion with extraosseous soft tissue invasion. Histological examination of the biopsy specimen showed bland multi-nucleated giant cells and mononuclear cells whose nuclei were morphologically similar. No necrosis, pleomorphism or mitotic activity was identified. No chondroid or osseous elements were present.

Conclusion: The histological features of bland mononuclear and multinucleated giant cells along with the lack of any additional mesenchymal elements led to the diagnosis of giant cell tumor. Resection of tumor was performed. The patient is disease free as of the last follow-up visit. This case is important as it shows where the physician must keep this diagnosis in mind whenever a deeply located breast mast is present.

Background: The primary mucinous adenocarcinoma of the bladder is an extremely rare urologic entity, which is found in less than 2% of all urinary bladder tumours and is often presented as metastatic.

Case presentation: A 69-year old male patient was diagnosed with a primary mucinous adenocarcinoma of the bladder after undergoing a transurethral resection of a bladder tumour and complete examination of the entire gastrointestinal tract to rule out other primary cites. Immunohistochemistry confirmed the nature of the tumour. The patient underwent a radical cystoprostatectomy with en block bilateral pelvic lymphadenectomy and urinary diversion with a Bricker ileostomy.

Conclusion: The primary adenocarcinoma creates a diagnostic dilemma, since it cannot be easily differentiated by the adenocarcinoma that originates from the colon and the prostate. We advocate the radical surgical management, after exclusion of any primary malignant sites related to the gastrointestinal tract. The immunohistochemistry has a leading role, assisting with the differential diagnosis.

Introduction: The diagnosis of Parkinson's disease is mainly clinical. DaT SCAN may help in difficult cases. Depression is also a clinical diagnosis and is common and persistent symptom in Parkinson's disease. Dementia is very often in Parkinson's disease, but usually not at the first stages. The treatment of each of the above symptoms is difficult and a lot of times individualized.

Case presentation: Female 64 years old patient with history of hypothyroidism, depression and anxiety disorder was examined at outpatient Memory and Dementia clinic of 3rd Department of Neurology. The patient's major problems were functional and cognitive decline, severe extrapyramidal symptoms and depression. According to UKPDS Brain Bank criteria the patient had bradykinesia, muscular rigidity, postural instability and rest tremor present with unilateral onset of the symptoms affecting left side most and progressive course. The modified Hoehn and Yahr scale was 3: mild to moderate bilateral disease; some postural instability; physically independent. The symptoms remained during nine months follow up, despite the pharmaceutical treatment. Nine months later, the patient made an attempt to suicide. Firstly, she was transferred to intensive care department with 2nd degree burns and respiratory problems, then she was hospitalized at the Burn Unit and afterwards at the Psychiatric clinic. One month later the patient had no depression, a clear reduction of the extrapyramidal symptoms, functional and cognitive improvement.

Conclusion: An astonishing improvement occurred after the threat of life. Two years after the attempt to suicide, the depressive symptoms remain in remission and functional and cognitive status is normal. The extrapyramidal symptoms have disappeared.