Case Reports in Medicine最新文献

Background: Canes are used by patients with hemiplegia to improve gait and ambulation, but the effects of different types of canes remain unclear. Therefore, this study compared the effectiveness of a newly developed carbon-curved cane (CC-C) with that of a conventional cane using gait analysis of patients with chronic stroke-induced hemiplegia. Case: A 41-year-old male was diagnosed with cardiogenic cerebral infarction 3 years ago. The patient is independent in his activities of daily living and participates alone in the community using a single-point cane (SP-C). This study utilized an AB design with two conditions: the use of an SP-C and a CC-C. Gait evaluation included a three-dimensional gait analysis and analysis of the ground reaction force (GRF) applied to the cane using a force plate. The main outcomes were the spatiotemporal gait characteristics, and the suboutcomes were range of motion (ROM), center of mass (COM) trajectory, and GRF applied to the cane. Wilcoxon rank-sum test was performed to clarify the difference between SP-C and CC-C use with a significance level of p=0.05. Gait velocity, paretic and nonparetic step length, stride length, cadence, and single-stance time tended to be higher, and the preswing time was lower with CC-C than with SP-C use (p < 0.05). Differences were observed in limb ROM and COM trajectory (p < 0.05) with GRF tending to have a higher propulsion force in CC-C and SP-C having higher braking and medial forces. Conclusion: CC-C improved gait and demonstrated different GRF values than SP-C.

Background: E-cigarette use has become increasingly prevalent among young adults, raising concerns about its potential health impact and susceptibility to infections. Blastomyces dematitidis, the causative agent of blastomycosis, is a dimorphic fungus endemic to certain regions of the United States. We present a rare presentation of pulmonary blastomycosis in a young, immunocompetent male with chronic e-cigarette use, highlighting the need to consider fungal infections in the differential diagnosis of pneumonia of unknown etiology in patients with risk factors for respiratory illness. Presentation: A 20-year-old male with a 4-year history of daily e-cigarette use and gutter cleaner by occupation presented with a 10-day history of worsening cough, bloody sputum, shortness of breath, night sweats, fever, and weight loss. He was hemodynamically stable, required minimal oxygen support, and was admitted for chest X-ray showing right upper lobe pneumonia and cavitary lesion. The patient was tested for community-acquired pneumonia, atypical pneumonia, granulomatous diseases, and immunosuppressive and viral lymphoproliferative disorders. A diagnostic bronchoscopy ultimately confirmed blastomycosis, leading to treatment with amphotericin B and itraconazole, resulting in significant clinical improvement. Conclusion: Pulmonary blastomycosis often presents asymptomatically, with severe cases more common in the elderly or those with comorbidities and immune dysfunction. Physicians tend to overlook it as a differential diagnosis for primary lung infections, focusing on bacterial pneumonia and tuberculosis in younger individuals. This case underscores the need for further investigation into the impact of e-cigarette use on immune function. This case also highlights the importance of making blastomycosis a reportable disease in Georgia, considering its increasing incidence and the widespread construction and soil disturbance occurring throughout the state.

This case report presents a rare instance of synchronous adrenal ganglioneuroma and an ipsilateral retroperitoneal mass in a 51-year-old woman with episodic hypertensive crises and increased symptom frequency. Imaging revealed a hypodense mass near the right kidney and an additional adrenal mass, which led to surgical intervention. Laboratory findings indicated hypercortisolism, and both masses were surgically removed by the laparoscopy approach. Postoperative pathology identified both masses as maturing-type ganglioneuroma, with no signs of malignancy or complications. This case highlights the diagnostic and therapeutic challenges of such rare presentations and emphasizes the importance of detailed imaging, surgical excision, and histopathological analysis. The potential link between elevated cortisol levels and ganglioneuroma, as observed here, underscores the need for further research into these benign tumors.

Background: Classic Kaposi's sarcoma (CKS) is distinguished by nodules and clustered papules over the extremities with persistent edema. Aim: This report examine the results of neodymium-doped yttrium-aluminum-garnet (Nd:YAG) laser for the treatment of numerous nodular symptomatic nodules in CKS patients' lower extremities that are ineligible for systemic therapy. Methods: Each lesion received two sessions Nd:YAG laser treatment performed at 1-month intervals. Pretreatment and follow-up visit (after 3 months) were accompanied by clinical photographs and improvement was assessed by a skilled medical professional by comparing before- and after-treatment photos as well as by looking at patients directly. Videodermoscopy was performed on all lesions. Results: Just one session with long-pulsed Nd:YAG laser proved to be successful, with the immediate coagulation of the lesions and the disappearance of most of them. Every single lesion healed in two to 4 weeks. Only one lesion, the largest one, presented a water blister after treatment, which resolved within a few days. At 2 months follow up, the patient reported total pain relief and full recovery after the symptomatic nodules vanished. Conclusion: Nd:YAG laser could represent a rapid and advantageous therapeutic approach for both early- and advanced-stage CKS patients.

Malaria is one of the vector-borne diseases with major public health problems to date, especially in endemic areas. Malaria is usually associated with various degrees of reduced red blood counts, and thrombocytopenia is a common association of malaria, but it is rarely associated with hemorrhagic manifestations. This case report presents two Sudanese patients, who presented to a private clinic in North Bahri. The patients were infected with Plasmodium falciparum; they developed thrombocytopenia and were presented clinically with epistaxis. A 36-year-old male and a 41-year-old male presented with the clinical features of malaria and epistaxis and were diagnosed with P. falciparum malaria. Both patients had significant thrombocytopenia in complete blood count (CBC). They showed clinical and laboratory improvement of thrombocytopenia after successful treatment of malaria. Although bleeding is a rare complication of malaria associated with thrombocytopenia, it should be considered even if it presents as a minor bleeding such as epistaxis or bleeding from gum.

We report a case of a stone in inguinal hernia sac. A 41-year-old male patient presented to Hakim Hospital in Neyshabur city, Iran, with complaints of pain and swelling in the right abdominal region. After initial evaluations, a diagnosis of right inguinal hernia was made, and the patient was scheduled for hernioplasty. He had no history of previous surgeries, hospital admissions, underlying diseases, or kidney and gallbladder stones. The surgery was performed. The hernia sac was exposed. Inside the hernia sac, a stone measuring approximately 2 cm in diameter, with a hard consistency and yellow color, was found. The stone was not adherent to the sac and was mobile. The hernia sac was opened, the stone was removed, and sent to the pathology lab. The patient was discharged 24 h later in good general condition. According to the pathology report, the components of the stone were identified as calcium oxalate.

Background: Cerebral metastases from soft tissue and bone sarcoma are uncommon. Metastatic sarcoma of the brain is a highly aggressive disease with a poor prognosis. There is no consensus regarding the management of cerebral metastases from bone sarcomas. Clinical Presentation: The patient is a 60-year-old, right-handed male, who presented with a right frontal scalp swelling that was hard in consistency. On examination, he had pain and tenderness over the swelling. The neurological examination was normal. Investigations: Initial CTH revealed a right frontal skull lesion with characteristic expansion and sunburst appearance with a degree of cortical destruction. MRI brain with contrast showed features suggestive of skull osteosarcoma. Management: He underwent a subtotal tumor resection. He was diagnosed with high-grade chondroblastoma-like osteosarcoma of the skull. Subsequently, he received three cycles of neoadjuvant chemotherapy in the form of Adriamycin and cisplatin. One year later, he underwent further surgical intervention with an additional skull resection and reconstruction using mesh and scalp reconstruction. Follow-Up: MRI brain with contrast showed a distant metastasis in the right transverse sinus and other distant brain areas and were treated with Gamma Knife radiosurgery (GKRS) 6 months after the primary surgery. Conclusion: Skull calvarium primary osteosarcoma is a rare pathology. Cerebral metastasis from skull bone osteosarcoma is a challenging clinical situation that requires a multidisciplinary therapeutic approach that includes neurosurgery, plastic surgery, chemotherapy, and radiosurgery.

Infantile reversible cytochrome c oxidase (COX) deficiency myopathy is a mitochondrial rare disease with onset age of first day to three months with symptoms of generalized muscle weakness and severe hypotonia. Despite its initial serious conditions, the symptoms may improve spontaneously later in their life, with the so-called "benign" myopathy accordingly. This benign mitochondrial myopathy might be improved in their later life, which is different from most mitochondrial myopathies with progression by age. Therefore, we depicted the rare case of her clinical course during our medical practice, anticipating to provide more information of this rare disease.

A 55-year-old male patient with diffuse cutaneous systemic sclerosis (dcSSC) since 2018 presented with a history of arrhythmia. He had been stable for 5 years with pantoprazole, diltiazem, and mycophenolate mofetil (MMF); vitamin E; and vitamin D until he developed arrhythmia. Different evaluations revealed left bundle branch block, wall motion abnormality, mildly reduced systolic function, diffused interstitial fibrosis, and lesions in the left circumflex artery (LCX) and left anterior descending artery (LAD) and stenosis in LCX, without significant improvement following percutaneous coronary intervention for LCX stenosis. Holter monitoring demonstrated persistent ventricular premature beats and couplets. Arrhythmia was not responsive to bisoprolol therapy, and it was not feasible to perform cardiac ablation. Suspecting MMF-induced arrhythmia, MMF was discontinued, which led to a reduction in arrhythmia and symptom improvement after 9 months. This case report emphasized a possible heart-related complication of MMF, which healthcare providers should consider when prescribing medication to patients.

Helicobacter pylori (H. pylori) is a urease-producing bacterium that has a tendency to colonize the gastric mucosa. H. pylori can cause atrophic gastritis and gastric intestinal metaplasia (GIM). H. pylori has also been associated with MALT lymphoma, which is an extranodal marginal zone lymphoma. The gold standard for the diagnosis of H. pylori is histopathological analysis from biopsied gastric mucosa. MALT lymhoma can have a wide range of clinical manifestations, such as epigastric pain, iron-deficiency anemia, and overt upper gastrointestinal (GI) bleeding. MALT lymphoma has been rarely associated with headaches. We describe a case of H. pylori-positive MALToma manifesting as epigastric pain occurring concomitantly with throbbing headaches; hence, headache can be a heralding symptom for the diagnosis of MALToma.