New Horizons in Clinical Case Reports最新文献

{"title":"Nocardia cyriacigeorgica pneumonia in ulcerative colitis patient receiving infliximab despite TMP/SMX prophylaxis","authors":"Dharma Sunjaya * ,&nbsp;Jennifer Toy ,&nbsp;Seth Sweetser","doi":"10.1016/j.nhccr.2017.06.184","DOIUrl":"https://doi.org/10.1016/j.nhccr.2017.06.184","url":null,"abstract":"<div><h3>Introduction</h3><p>Infliximab is an effective therapy for induction and maintenance of remission in patients with refractory ulcerative colitis (UC). Treatment with TNF-alpha inhibitors is associated with an increased risk of infection. In this case, we will discuss an uncommon cause of infection associated with infliximab therapy despite antibiotic prophylaxis.</p></div><div><h3>Case description</h3><p>78-year-old man with history of UC maintained on infliximab infusion every 8-weeks was found to have pulmonary infiltrates on chest computed tomography (CT). His UC history was notable for recent <em>Pneumocystis jiroveci</em> pneumonia while on infliximab requiring intravenous Trimethoprim/Sulfamethoxazole (TMP/SMX) treatment for 21 days followed by single strength oral TMP/SMX for secondary prophylaxis. On evaluation, the patient endorsed weakness, generalized fatigue, and shortness of breath with activities. His lab was notable for mild anemia in the absence of leukocytosis.</p></div><div><h3>Result and conclusion</h3><p>Bronchoscopy was performed and bronchoalveolar lavage fluid was sent to the microbiology laboratory for culture. After 30 days of incubation, the culture returned partially acid fast, branching, Gram-positive rod shaped bacteria consistent with <em>Nocardia cyriacigeorgica</em>. The isolate was susceptible to TMP/SMX (0.25/4.75μg/Ml). Patient was started on therapeutic dose of oral TMP/SMX at 5 mg/kg of the trimethoprim component for 6 months. Infliximab was subsequently held. Repeat chest CT scan at 6 months showed resolution of patchy ground glass and nodular infiltrates.</p></div><div><h3>Take-home message</h3><p>This case highlights the importance of considering <em>Nocardia</em> infection in ulcerative colitis patients receiving infliximab therapy presenting with shortness of breath and new infiltrates on chest imaging. In addition, patients receiving prophylaxis with TMP/SMX are still at risk for this infection because the effectiveness of prophylactic doses of TMP/SMX in preventing disease remains unclear.</p></div>","PeriodicalId":100954,"journal":{"name":"New Horizons in Clinical Case Reports","volume":"1 ","pages":"Page 22"},"PeriodicalIF":0.0,"publicationDate":"2017-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.nhccr.2017.06.184","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91723180","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Partial Priapisim: A rare presentation of sickle cell anemia","authors":"Mariam Malallah * ,&nbsp;Hussain Al Rashed ,&nbsp;Abdullatif Al Terki ,&nbsp;Tariq Al Shaiji","doi":"10.1016/j.nhccr.2017.06.156","DOIUrl":"https://doi.org/10.1016/j.nhccr.2017.06.156","url":null,"abstract":"<div><h3>Introduction</h3><p>Partial segmental thrombosis of the corpus cavernosum (PSTCC); known as partial priapism; is an uncommon urological condition which predominantly affects young men in which the proximal part of one corpus cavernosum is thrombosed. Many risk factors are described in the literature, the exact etiology of penile thrombosis and its pathogenesis remains unclear. Several treatment options are available ranging from conservative medical treatment with NSAIDs, antibiotics, analgesics, low molecular weight heparin, acetylsalicylic acid and antibiotics, surgical or to a follow-up observation without treatment. In this study we presented a sickle cell patient who presented with pain and perineal swelling and diagnosed with PSTCC using MRI and was treated conservatively.</p></div><div><h3>Case description</h3><p>A 23-year-old male, known case of sickle cell anemia, presented to casualty with a 1-day history of perineal pain of a sudden onset, increasing in severity, no aggravating or relieving factors. It was associated with perineal swelling, decrease in urine output and vomiting, not associated with urethral discharge, erectile dysfunction, trauma, sexual contact, fever, abdominal pain, lower urinary tract symptoms, change in bowel habits, or bleeding per rectum. He had a past history of left pyeloplasty in childhood. He was a smoker, non-alcohol consumer with a family history of liver malignancy. Examination revealed a stable vitals, abdomen was soft and non-tender, genitourinary exam findings confirmed the absence of priapism. There was a normal circumcised penis, normal bilateral testis and epididymis, separated perineal mass slightly hard in consistency, fixed and tender at the proximal part of the penis. Digital rectal examination was unremarkable. The complete blood count showed mild leukocytosis, electrolytes, coagulation profile, urine analysis and urine culture were unremarkable. MRI perineal and penis showed the right intratunical corpus cavernosum with altered signal intensity involving the root, proximal and mid third sparing the distal third of corpus cavernosum, maximum width of 26mm (predominantly hyposignal intensity with few areas of hypersignal intensity). Visualized Buck’s fascia and tunica albuginea were intact. Features mostly suggestive of right corpus cavernosum hematoma. Conservative treatment was initiated with 6 hourly IV paracetamol and the response was observed with gradually disappearing pain, reduction in swelling size and leukocytic count. On follow up patient was pain free, reduction in swelling size with a recovery of painless erection. A follow up ultrasound of the scrotum and a hematologist referral were arranged.</p></div><div><h3>Results and conclusions</h3><p>PSTCC is not an urological crisis and has an excellent prognosis. Conservative treatment appears to be a reliable therapeutic option. Surgery is reserved for patients in whom conservative management fails.</p></div>","PeriodicalId":100954,"journal":{"name":"New Horizons in Clinical Case Reports","volume":"1 ","pages":"Pages 9-10"},"PeriodicalIF":0.0,"publicationDate":"2017-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.nhccr.2017.06.156","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91723915","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Physical plasma in palliative cancer care: Introduction and perspectives","authors":"C. Seebauer, S. Kindler, T. Woedtke, H. Metelmann","doi":"10.1016/J.NHCCR.2017.06.200","DOIUrl":"https://doi.org/10.1016/J.NHCCR.2017.06.200","url":null,"abstract":"","PeriodicalId":100954,"journal":{"name":"New Horizons in Clinical Case Reports","volume":"23 1","pages":"28"},"PeriodicalIF":0.0,"publicationDate":"2017-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79872488","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}

{"title":"Marcus Gunn Syndrome and implications for Oral and Maxillofacial surgery (OMFS)","authors":"Claire Graham * ,&nbsp;Nathalie Gallichan ,&nbsp;Katharine Fleming ,&nbsp;Kathryn Taylor","doi":"10.1016/j.nhccr.2017.06.143","DOIUrl":"10.1016/j.nhccr.2017.06.143","url":null,"abstract":"<div><h3>Introduction</h3><p>Marcus Gunn Syndrome, also known as Jaw Wink Syndrome or trigemino-oculomotor synkinesis, was first reported in 1883. It typically presents at birth with unilateral ptosis and eyelid elevation on jaw opening. Pathophysiology is explained by an oculofacial synkinesis. There is an aberrant connection of the oculomotor nerve and the mandibular branch of the trigeminal nerve resulting in eyelid elevation on mouth opening. The typically congenital syndrome is exceptionally rare. It is often diagnosed in infancy with complete ophthalmic examination and ptosis evaluation. This syndrome does not often require surgical intervention but it may still have an impact in clinical management.</p></div><div><h3>Case description</h3><p>A 32-year-old male presented in the OMFS outpatient clinic in Countess of Chester Hospital for extraction of his lower third molars. His past medical history included a known diagnosis of Marcus Gunn Syndrome but he was otherwise fit and well. He had resting ptosis of the left and elevation of the left eyelid on jaw protrusion.</p></div><div><h3>Results and conclusions</h3><p>Third molars were removed uneventfully under local anesthesia and no further treatment was required. Literature suggests that patients with Marcus Gunn Syndrome may have an atypical oculocardiac reflex during their surgical procedure and patients are at increased risk of malignant hypothermia. In this case, the procedure was performed under local anesthesia but this condition may impact on surgical planning if general anesthesia was to be considered.</p></div>","PeriodicalId":100954,"journal":{"name":"New Horizons in Clinical Case Reports","volume":"1 ","pages":"Page 4"},"PeriodicalIF":0.0,"publicationDate":"2017-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.nhccr.2017.06.143","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82344405","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Right sided reconstruction of the heart for invasive angiosarcoma of the right atrium","authors":"E. Brouwers, M. Herregods, E. Verbeken, P. Herijgers, W. Oosterlinck","doi":"10.1016/J.NHCCR.2017.06.161","DOIUrl":"https://doi.org/10.1016/J.NHCCR.2017.06.161","url":null,"abstract":"","PeriodicalId":100954,"journal":{"name":"New Horizons in Clinical Case Reports","volume":"11 1","pages":"12-13"},"PeriodicalIF":0.0,"publicationDate":"2017-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78109129","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}

{"title":"Return to Pre-Injury Level of Sport in an Elite Age-Group Triathlete after Non-Operative Treatment of Combined Complete Obturator Internus and Partial Hamstring Tendon Tears","authors":"T. Greenhalgh, Adnan Saithna, K. Iyengar, S. Ramteke","doi":"10.1016/j.nhccr.2017.06.201","DOIUrl":"https://doi.org/10.1016/j.nhccr.2017.06.201","url":null,"abstract":"","PeriodicalId":100954,"journal":{"name":"New Horizons in Clinical Case Reports","volume":"62 1","pages":"28"},"PeriodicalIF":0.0,"publicationDate":"2017-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89450353","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}

{"title":"Usefulness of repetitive transcranial magnetic stimulation for the recovery of central cord syndrome","authors":"Jung Keun Hyun *,&nbsp;Seo Young Kim,&nbsp;Tae Uk Kim","doi":"10.1016/j.nhccr.2017.06.177","DOIUrl":"https://doi.org/10.1016/j.nhccr.2017.06.177","url":null,"abstract":"<div><h3>Objectives</h3><p>Repetitive transcranial magnetic stimulation (rTMS) can modulate neuronal circuits and also enhance spinal cord plasticity. Our aim of this study was to delineate the effect of rTMS on the functional recovery of upper extremity in patients with incomplete spinal cord injury, especially central cord syndrome (CCS), and detect the changes of spinal cord tracts crossing the lesion by diffusion tensor imaging (DTI).</p></div><div><h3>Method</h3><p>Fourteen patients with CCS, which level of injury was between C4 to C6, were performed rTMS with high frequency (20Hz) over the unilateral motor cortex for 5 days as well as the conventional occupational therapy. The non-treated side of each subject was used as control. We assessed the neurological status using International Standard for Neurological Classification of Spinal Cord Injury (ISNCSCI), and functional status of upper extremities using the Jebsen hand function and O'conner finger dexterity tests twice; before treatment, and 1 month after treatment. DTI was performed on the injured cervical spinal cord, obtained fractional anisotrophy (FA), apparent diffusion coefficient (ADC) at each level, and calculate imaginary spinal cord tracts of each subject.</p></div><div><h3>Results</h3><p>The neurological status of the upper extremity motor score in the treated side using ISNCSCI was improved in all subjects otherwise only 10 of 14 subjects (71.4%) showed some improvements of non-treated side at 1 month after treatment. The functional status including the writing score of Jebsen hand function test were also significantly improved more in treated side in comparison with non-treated side at 1 month. The FA values and the number of imaginary spinal cord tracts of treated side at the injured level were also increased more than those of non-treated side in the same subjects. Any side effects such as seizure, severe headache, nausea or vision problem was not observed during rTMS treatment and follow-up period.</p></div><div><h3>Conclusions</h3><p>The high frequency rTMS was effective to improve the neurological and functional status of CCS patients and might increase the spinal cord plasticity without any serious side effects.</p></div>","PeriodicalId":100954,"journal":{"name":"New Horizons in Clinical Case Reports","volume":"1 ","pages":"Pages 18-19"},"PeriodicalIF":0.0,"publicationDate":"2017-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.nhccr.2017.06.177","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91723704","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Physical plasma in palliative cancer care: Introduction and perspectives","authors":"Christian Seebauer * ,&nbsp;Stefan Kindler ,&nbsp;Thomas von Woedtke ,&nbsp;Hans-Robert Metelmann","doi":"10.1016/j.nhccr.2017.06.200","DOIUrl":"https://doi.org/10.1016/j.nhccr.2017.06.200","url":null,"abstract":"<div><h3>Background</h3><p>Patients suffering from advanced head and neck tumors frequently suffer from superinfected chronic wounds caused by necrotic tissue due to progressive tumor growth, weak systemic and local immunological response and various accompanying illnesses. Due to strong wound vulnerability, local antiseptic wound care of microbial contaminated tumor areas is frequently complicated by bleeding, pain and patient dissatisfaction. As Cold Atmospheric Plasma (CAP) has been proven to be anti-microbial and anti-cancerous, CAP could occupy an important role in palliative cancer care.</p></div><div><h3>Material and methods</h3><p>After a curably intended surgical cancer treatment of a well-differentiated squamous cell carcinoma of the left cheek at the beginning of 2015, the 51-year-old patient noticed a rapidly progressive swelling on the left neck in June. CT scan indicated a large contrast enhancing mass, which was suspected to be tumor recurrence. Operative findings revealed inoperability due to infiltrating the vascular wall of the external carotid. After a palliative intended combined radio-chemotherapy, the tumor was characterized by progressive growth with exulceration. Due to the vulnerability of the extended bacterially contaminated wound and the underlying carotid artery, wound care was difficult. Since October, a supportive palliative cancer treatment using CAP has been started with the patients' written consent. The exulcerative tumor growth region received treatment with the kINPenMED (Neoplas GmbH, Greifswald, Germany) for near 5 minutes in a meandering manner. Plasma treatment was continued to be performed every 3 days. Wound care was implemented in conjunction with an antiseptic wound dressing.</p></div><div><h3>Results</h3><p>The superinfected necrotic tumor areas appeared to be clean of cell detritus and bacteria. Microbiological examination revealed a reduction of bacterial colonization which led to decrease of wound odour, too. Due to the decrease of inflammation, vulnerability and wound algesia have been reduced significantly. Upon CAP therapy a partial tumor response with tumor mass reduction were observed. The ulcerated tumor area has been reduced to one-quarter of its original size. The underlying carotid artery is still intact and ultrasound investigation revealed a regular blood flow. Histological examinations revealed an increased amount of apoptotic tumor cells and a local increase of immune defense. Furthermore, a desmoplastic reaction of the conjunctive tissue represented by a higher proliferation rate of fibroblasts could be depicted. No plasma relevant systemic side effects have occurred.</p></div><div><h3>Conclusion</h3><p>By a sufficient reduction of bacterial colonization, decrease of inflammation, wound vulnerability and algesia, CAP constitutes an innovative and valuable treatment option in palliative cancer care. Local tumor mass reduction is an unexpected and promising response during CAP treatment","PeriodicalId":100954,"journal":{"name":"New Horizons in Clinical Case Reports","volume":"1 ","pages":"Page 28"},"PeriodicalIF":0.0,"publicationDate":"2017-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.nhccr.2017.06.200","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91723182","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unusual presentation of tuberculous meningitis: Two case reports","authors":"Shafa Kadhim Tlayib *,&nbsp;Zainab Abdelramman,&nbsp;Fawzia Munir","doi":"10.1016/j.nhccr.2017.06.164","DOIUrl":"10.1016/j.nhccr.2017.06.164","url":null,"abstract":"<div><h3>Introduction</h3><p>Central nervous system tuberculosis is a serious health problem worldwide and accounts for more than 7% of all cases of tuberculosis especially in developing countries with high prevalence of tuberculosis and also should be considered in high risk patients or in patient emigrated from regions with a high prevalence of tuberculosis. Tuberculous radiculomylitis is a complication of tuberculous meningitis which has been infrequently reported in medical literature.</p></div><div><h3>Case description</h3><p><em>Case I:</em> A 49-year-old previously healthy Filipino female with 5 days history of fever, back pain radiating to both legs followed by acute onset of lower limb weakness and urine retention one day prior to presentation. Physical examination revealed pyrexia, alert patient, no sign of meningeal irritation and lower limb power decrease (3/5) normal exam of upper limb. Investigation showed elevated WBC in Cerebral Spinal Fluid (60% lymphocyte). Positive PPD and positive quantiferon test. MRI showed extensive enhancement around nerve roots extending cranially to lower thoracic. Patient started on antituberculous treatment, steroid and physiotherapy. Six month post treatment did not show significant neurological improvement, but fever respond after start of treatment.</p><p><em>Case II:</em> A 27-year-old healthy Filipino female, presented with history of fever, headache, neck and back pain with vomiting, three weeks prior to presentation and was treated as case of otitis media with two different antibiotic given during two primary health care visits. Presented with one day lower abdominal pain with urinary retention and body weakness. Physical exam showed lethargic patient afebrile with spastic quadriparesis power of upper limb 4/5 and lower limb 3/5. Investigation showed cerebrospinal fluid, high WBC (90% lymphocyte), high CSF protein and low glucose. High serum ESR. MRI showed increase leptomeningeal enhancement of spinal cord extending to the pons. Patient also started on steroid and antituberclous drugs. Patient made good clinical recovery and discharged.</p></div><div><h3>Results and conclusions</h3><p>In patient with tuberculous meningitis, an early diagnosis and initiation of therapy plays a major role in preventing unnecessary morbidity and mortality. In several series, use of the steroid has been considered beneficial and should be given for secondary neurological complications, associated with tuberculous meningitis. Emergency clinician must be aware of unusual presentation of tuberculous meningitis and other different causes of lower limb weakness. Neuroimaging with MRI with and without contrast and lumber puncture is critical for diagnosis.</p></div>","PeriodicalId":100954,"journal":{"name":"New Horizons in Clinical Case Reports","volume":"1 ","pages":"Pages 13-14"},"PeriodicalIF":0.0,"publicationDate":"2017-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.nhccr.2017.06.164","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91425860","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implantation of Penile Prosthesis (3-piece Inflatable) for Erectile Dysfucntion in a Patient with Left Orchiectomy for Left Undescended Testis: A Cosmetic Approach","authors":"Ahmad Al-Tawari, Said M. Yaiesh, Tariq F. Al-Shaiji","doi":"10.1016/J.NHCCR.2017.06.183","DOIUrl":"https://doi.org/10.1016/J.NHCCR.2017.06.183","url":null,"abstract":"","PeriodicalId":100954,"journal":{"name":"New Horizons in Clinical Case Reports","volume":"63 1","pages":"21-22"},"PeriodicalIF":0.0,"publicationDate":"2017-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89932708","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}