New Horizons in Clinical Case Reports最新文献

{"title":"Partial Priapisim: A rare presentation of sickle cell anemia","authors":"M. Malallah, Hussain Al Rashed, Abdullatif Al Terki, 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":"","PeriodicalId":100954,"journal":{"name":"New Horizons in Clinical Case Reports","volume":"1 1","pages":"9-10"},"PeriodicalIF":0.0,"publicationDate":"2017-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87779140","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":"Clippers syndrome in a young patient with ataxia and dizziness","authors":"Eibtihal Abd Elmoneim Hassan *","doi":"10.1016/j.nhccr.2017.06.162","DOIUrl":"10.1016/j.nhccr.2017.06.162","url":null,"abstract":"<div><h3>Introduction</h3><p>Chronic lymphocytic inflammation with pontine perivascular enhancement responsive to steroids: A rare central nervous system inflammatory disorder involving predominantly the pons as a distinct form of brainstem encephalitis centered on the pons, and/or the spinal cord. Usually presented with symptoms/signs referable to brainstem, cranial nerve-and/or cerebellar dysfunction. Symptoms related to long tract affections and/or spinal cord syndrome. Paresis, spasticity, plantar response, hyperreflexia, altered sensation of the extremities, decrease vibration sense, neurogenic bladder and cognitive deficits. Responsive to steroids and long term immunosuppression. MRI with contrast is a useful tool to help for early diagnosis of such cases.</p></div><div><h3>Case description</h3><p>Here we are going to report a case of a 28-year-old, previously healthy female presented to the ED with a history of blurring of vision, dizziness, headache, and parasthesia of lower limbs, not alcoholic or smoker, no H/O drug intake. No family history of chronic disease. On examination the patient had normal vital signs (Temp. 37.2, RR 18 and SpO2 100%) her ENT examination is unremarkable. Her neck movements are unrestricted. Cardiovascular, respiratory and abdominal examinations are unremarkable. Her pupils are equal and reactive; fundoscopy is normal. She is orientated and follows commands, horizontal Nystagmus, DTRS exaggerated symmetrically, planter reflex down going on the left equivocal on the right, positive Romberg sign to the left and dysdiadochokinesis.</p></div><div><h3>Results and conclusions</h3><p>Non contrast CT head showed left periventricular parenchyma calcification suspicious of hemorrhagic spots. MRI brain showed multiple punctuate and curvilinear enhancing foci, B/L cerebral scattered ovoid bright signal intensity ring enhancement small nodules workup was done to exclude Meningitis, TB encephalitis, CNS lymphoma, Toxoplasmosis, HIV, Vasculitis and Demyelination. Results were negative. Steroids started and the patient improved.</p></div><div><h3>Take-home message</h3><p>Careful history taking and a high index of suspicion of central causes of vertigo is needed when a patient presents with dizziness.</p></div>","PeriodicalId":100954,"journal":{"name":"New Horizons in Clinical Case Reports","volume":"1 ","pages":"Page 13"},"PeriodicalIF":0.0,"publicationDate":"2017-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.nhccr.2017.06.162","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85139133","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":"Advanced concepts for medical robotic systems","authors":"Gernot Kronreif *","doi":"10.1016/j.nhccr.2017.06.146","DOIUrl":"10.1016/j.nhccr.2017.06.146","url":null,"abstract":"&lt;div&gt;&lt;p&gt;With the first recorded medical application of a robot - a CT-based orientation of a needle guide for biopsy of the brain - occurring in 1985, a number of research groups in Asia, Europe, and the USA began investigating other medical applications of robotics. Beside of a big number of research prototypes and scientific outcome, a relatively small number of commercial ventures were resulting from these efforts.&lt;/p&gt;&lt;p&gt;Now, after more than 30 years of activities and compared to many other fields of medical technology, medical robotics still can be considered as of being in its infant state. The number of commercially available setups actually could be increased, but only few of them really have created significant impact. Many research questions have been addressed in order to improve the technology, but the gap between research in laboratories and real use in surgical routine seems to get even bigger. If one looks to the main reasons for this slow adoptation of new technology, it turns out to mostly not being related to technical functioning, but to other factors such as:&lt;/p&gt;&lt;p&gt;&lt;/p&gt;&lt;ul&gt;&lt;li&gt;&lt;span&gt;•&lt;/span&gt;&lt;span&gt;&lt;p&gt;cumbersome use of robots (complexity, size, missing integration into clinical workflow) which hinders application in clinical routine,&lt;/p&gt;&lt;/span&gt;&lt;/li&gt;&lt;/ul&gt;&lt;p&gt;&lt;/p&gt;&lt;ul&gt;&lt;li&gt;&lt;span&gt;•&lt;/span&gt;&lt;span&gt;&lt;p&gt;high cost for robot system and operational cost (i.e. cost/benefit ratio is not satisfactory in most cases),&lt;/p&gt;&lt;/span&gt;&lt;/li&gt;&lt;/ul&gt;&lt;p&gt;&lt;/p&gt;&lt;ul&gt;&lt;li&gt;&lt;span&gt;•&lt;/span&gt;&lt;span&gt;&lt;p&gt;high setup time and effort (e.g. additional person for operating robot system),&lt;/p&gt;&lt;/span&gt;&lt;/li&gt;&lt;/ul&gt;&lt;p&gt;&lt;/p&gt;&lt;ul&gt;&lt;li&gt;&lt;span&gt;•&lt;/span&gt;&lt;span&gt;&lt;p&gt;limitation in portability and/or mobility,&lt;/p&gt;&lt;/span&gt;&lt;/li&gt;&lt;/ul&gt;&lt;p&gt;&lt;/p&gt;&lt;ul&gt;&lt;li&gt;&lt;span&gt;•&lt;/span&gt;&lt;span&gt;&lt;p&gt;unsolved safety issues.&lt;/p&gt;&lt;/span&gt;&lt;/li&gt;&lt;/ul&gt;&lt;p&gt;The presentation will include a short introduction into medical robot systems for surgical applications. Topics include issues such as kinematic configurations, interfaces to existing surgical equipment, but also matters related to standards and regulations. One key aspect for (future) medical robots is related to its main operation principle. Current commercial robot systems are either directly controlled by a human operator or strictly follow a pre-defined path. Automated systems are limited to setups where no direct contact between robot and/or the guided tool takes place, e.g. to compensate (to a certain degree) breathing motion in external radiotherapy or for imaging purposes. On the cognitive side, a long thought-after feature is to estimate what the surgeon would like to do next. This could be taken into account when planning and executing the next movement of the robotized tool or camera. Addition of cognitive capabilities to the robot also has the potential to take a further step toward surgical automation, e.g. for the awareness of the current medical situation and the ability to react in a suitable way. Concrete robot applications - such as for percutaneous placement of needles for tumor ","PeriodicalId":100954,"journal":{"name":"New Horizons in Clinical Case Reports","volume":"1 ","pages":"Page 5"},"PeriodicalIF":0.0,"publicationDate":"2017-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.nhccr.2017.06.146","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84851024","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":"Neurocysticercosis presenting with psychosis","authors":"Aml ElemamaliI *,&nbsp;Shafa Talyb,&nbsp;Abobaker Awad","doi":"10.1016/j.nhccr.2017.06.188","DOIUrl":"https://doi.org/10.1016/j.nhccr.2017.06.188","url":null,"abstract":"<div><h3>Introduction</h3><p>Neurocysticercosis, the infection caused by the larval form of the tape worm Taenia Solium is the most common parasitic disease of the central nervous system. The disease presents it with spectrum of clinical manifestations like seizure, headache, neurological deficit and psychiatric symptoms such as psychosis. Even though most commonly patients present with seizure, rarely it may produce symptoms of neuropsychiatric disorder such as psychosis.</p></div><div><h3>Case description</h3><p>Here we are going to report a case of a patient 31-year-old Nepali male who presented to our emergency department with features of acute psychosis. Later on with diagnostic imaging like CT head and MRI brain was discovered to have multiple neurosysticercosis one in the right frontal region and the other in the right inferior cerebellar region. Patient was admitted to the inpatient and was managed with anthelminthic, antipsychotic and steroids.</p></div><div><h3>Results and conclusions</h3><p>Patient condition improved and he is on regular follow up in psychiatry and neurology clinic.</p></div><div><h3>Take-home message</h3><p>Although it is rare for neurocysticercosis to present with psychosis, always keep a high index of suspicion especially in patients from endemic areas.</p></div>","PeriodicalId":100954,"journal":{"name":"New Horizons in Clinical Case Reports","volume":"1 ","pages":"Page 23"},"PeriodicalIF":0.0,"publicationDate":"2017-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.nhccr.2017.06.188","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91723178","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":"Gastrointestinal metastases from breast cancer: A case report","authors":"Begoña Peinado,&nbsp;Estibaliz Álvarez,&nbsp;Isabel Pascual,&nbsp;Ines Rubio,&nbsp;Mario Alvarez,&nbsp;Jose Luis Marijuan,&nbsp;Joaquin Diaz","doi":"10.1016/j.nhccr.2017.06.199","DOIUrl":"https://doi.org/10.1016/j.nhccr.2017.06.199","url":null,"abstract":"<div><h3>Background</h3><p>Breast cancer is the most common type of cancer in women nowadays. According to published major studies, the most common sites of metastases of breast cancer are bone, lung, liver and brain. However, it can also metastasize rarely to the gastrointestinal tract. Among the different subtypes of breast cancer, gastrointestinal spread has been associated to infiltrating lobular carcinoma. We present a case of perforated acute diverticulitis that underwent surgery, in which the pathological exam informed of colonic metastasis of lobular breast carcinoma.</p></div><div><h3>Case report</h3><p>A 78-year-old woman, with medical history of high blood pressure, diabetes and left mastectomy performed 14 years ago for infiltrating lobular carcinoma (Stage T2N2M0), with positive estrogenic receptors. Oncological controls showed pleural and bone progression in the last year, so hormonal therapy was indicated. She was admitted to the emergency department due to 72 hours of left lower-quadrant abdominal pain associated with constipation and nausea. On examination she presented tenderness and a palpable mass in the left lower quadrant. Blood tests showed an increased leukocyte count of 13.5x103/µL with neutrophilia, a CRP of 356mg/L and high lactate levels (4.5mmol/L). An abdominal computed tomography (CT) scan showed a left inguinal abscess (6x8x7cm) communicating with an inflammatory mass involving the sigmoid colon, as well as extensive bone metastases, not visualized in previous CTs. An emergency Hartmann's procedure was performed. The postoperative period was uneventful. The pathological report of the surgical specimen informed of infiltration in multiple diverticula by a carcinoma, with morphological pattern and immunohistochemistry compatible with a lobular breast carcinoma. The patient was derived to the Department of Oncology to continue follow-up and hormonal therapy.</p></div><div><h3>Conclusions</h3><p>Gastrointestinal breast metastases are uncommon, however, we should consider this diagnosis in patients with tumoral progression presenting with abdominal symptoms. Metastatic patients should receive medical treatment, reserving surgery for complications like obstruction or perforation, as in the case presented.</p></div>","PeriodicalId":100954,"journal":{"name":"New Horizons in Clinical Case Reports","volume":"1 ","pages":"Pages 27-28"},"PeriodicalIF":0.0,"publicationDate":"2017-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.nhccr.2017.06.199","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91723181","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":"Dasatinib related pericardial effusion requiring pericardial drainage","authors":"Kyriacos Mouyis *,&nbsp;Sofia Metaxa,&nbsp;Constantinos Missouris","doi":"10.1016/j.nhccr.2017.06.179","DOIUrl":"https://doi.org/10.1016/j.nhccr.2017.06.179","url":null,"abstract":"<div><h3>Introduction</h3><p>Dasatinib is an oral Bcr-Abl and Src family tyrosine kinase inhibitor approved for use in patients with chronic myelogenous leukaemia (CML) and Philadelphia chromosome positive acute lymphoblastic leukaemia (ALL). Its common side effects include myelosuppression, oedema, diarrhea and nausea. It has also been associated with the formation of pleural and pericardial effusions. As a result, Dasatinib is to be avoided in patients with pre-existing effusions or predisposition to respiratory or cardiovascular disease.</p></div><div><h3>Case description</h3><p>A fit 62-year-old pilot with no relevant medical history was diagnosed with CML in 2014, and commenced on Dasatinib therapy (100mg OD). A subsequent trans-thoracic echocardiogram (TTE) revealed normal ventricles and cardiac valves. There was however a mild to moderate global pericardial effusion, without haemodynamic compromise. This was regularly monitored with TTEs and remained stable until May 2016, where it measured 2.1cm posteriorly around the LV and 1.0 cm around the RV. Due restrictions imposed by the Civil Aviation Authority in the UK, the patient was referred for pericardial window procedure, prior to being considered fit for flying.</p></div><div><h3>Conclusions</h3><p>Dasatinib is known to cause pleural and pericardial effusions. This has been reported in patients without any predisposing factors.(1) The link with pericardial effusions has been proven with robust statistical analysis.(2) No specific mechanism has been proposed but an immune mediated reaction or off target inhibition of growth factors may be involved.(3) Management includes dose interruption or reduction, and/or treatment with steroids.(3) Our case report re-enforces that Dasatinib is an important cause of pericardial effusion and TTE is the modality of choice for follow-up. Pericardial window and drainage may be needed in patients where this prohibits them from undertaking employment.</p></div><div><h3>Take-home message</h3><p>Dasatinib related pericardial effusions are a documented side effect of therapy. One should be vigilant in monitoring patients on the drug as effusions may progress over time and require intervention. TTE is the monitoring modality of choice. As far as we are aware this is the first case report for surgical intervention in a patient with Dasatinib induced pericardial effusion.</p></div>","PeriodicalId":100954,"journal":{"name":"New Horizons in Clinical Case Reports","volume":"1 ","pages":"Pages 19-20"},"PeriodicalIF":0.0,"publicationDate":"2017-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.nhccr.2017.06.179","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91723660","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":"Acute renal failure and severe lactic acidosis due to metformin","authors":"Sirmpilantze Tamta * ,&nbsp;Kordali Christina ,&nbsp;Poulas Andreas ,&nbsp;Charalambous Natasa ,&nbsp;Lambas Vaggelis ,&nbsp;Rozi Fotini ,&nbsp;Mavras Georgios ,&nbsp;Lampropoulos E Christos","doi":"10.1016/j.nhccr.2017.06.167","DOIUrl":"https://doi.org/10.1016/j.nhccr.2017.06.167","url":null,"abstract":"<div><h3>Introduction</h3><p>Metformin may rarely cause lactic acidosis in patients with predisposing factors of acidosis or tissue hypoxia, like acute renal or heart failure, liver failure, dehydration, alcohol consumption or serious infection. Mortality may approach 50% in these cases.</p></div><div><h3>Case description</h3><p>A 70-year-old lady came to the emergency unit because of vomits and diffuse abdominal pain. Five days ago, she had visited our hospital for the same reason, with normal findings on physical and laboratory examination. Her medical history included diabetes mellitus under metformin/vildagliptin and dementia. The patient was confused and disoriented, afebrile, oliguric, with tachypnea and diffuse abdominal tenderness. Pressure was 130/70mmHg. Blood gases revealed severe lactic acidosis (lactate&gt;15mmol/L), pH=6.84, PCO₂=7mmHg, pO2=133mmHg, glucose=57mg/dL, HCO3&lt;3mmol/L. Abnormal laboratory tests included creatinine=5.3mg/dL, urea=152mg/dL, WBC=17000/µL, hemoglobin=12.3gr/dL, sodium=133mmol/L, potassium=4.4mmol/L, ESR=43mm/h. Chest x-ray, abdominal ultrasound (to exclude obstructive nephropathy) and echocardiography were normal.</p></div><div><h3>Results and conclusions</h3><p>The patient received 400mL bicarbonate 4.8%, aggressive hydration, dopamine (diuretic dose) and 160mg furosemide. Because of clinical deterioration she underwent hemodialysis. She was treated, according to guidelines, as for severe sepsis with meropenem. Blood and urine cultures were negative. On 1^st day, ECG showed ischemic lesions, which resolved with nitrates. Abdominal CT was normal. She remained afebrile after the 1^st day (low grade fever). Overall, the patient underwent three hemodialysis sessions (resistant severe lactic acidosis, low bicarbonates). On 2^nd day, she was well oriented. She was discharged 8 days later with urea=59mg/dL and creatinine=1.6mg/dL. After 20 days, creatinine was 1mg/dL.</p></div><div><h3>Take-home message</h3><p>Metformin may be a cause of severe lactic acidosis, disproportionate to the degree of renal failure, in patients with previous normal renal function and acute dysregulation. Hemodialysis is a lifesaving therapeutic intervention in these patients.</p></div>","PeriodicalId":100954,"journal":{"name":"New Horizons in Clinical Case Reports","volume":"1 ","pages":"Page 15"},"PeriodicalIF":0.0,"publicationDate":"2017-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.nhccr.2017.06.167","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91723666","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":"Post-infarction left ventricular pseudoaneurysm","authors":"Rienzi Diaz *","doi":"10.1016/j.nhccr.2017.06.194","DOIUrl":"https://doi.org/10.1016/j.nhccr.2017.06.194","url":null,"abstract":"<div><h3>Introduction</h3><p>Pseudoaneurysm of the left ventricle is a severe complication of myocardial infarction that results from a free cardiac wall rupture that is contained by the pericardium, thrombus, or adhesions. Most patients with a cardiac pseudoaneurysm will display symptoms of dyspnea or chest pain, but 10% of patients can be asymptomatic. Transthoracic Doppler color flow imaging is a suitable starting diagnostic method for diagnosing a pseudoaneurysm of the left ventricle. Cardiac magnetic resonance is an excellent complementary method for identifying this cardiac entity.</p></div><div><h3>Case description</h3><p>A patient in heart failure was admitted to receive intensive care therapy. An electrocardiogram showed anterolateral ST elevation and two-dimensional echocardiogram [2DE] posterolateral akinesis of the left ventricle. After a satisfactory in-hospital course he was discharged without any apparent complication. Six months later he was referred for new evaluation due to heart failure symptoms. A 2DE revealed a pseudoaneurysm along the left ventricular lateral wall. A cardiac magnetic resonance confirmed a pseudoaneurysm contained by the pericardium. Late gadolinium-enhanced imaging demonstrated a transmural lateral myocardial infarction with marked delayed enhancement of the pericardium that forms the wall of the pseudoaneurysm.</p></div><div><h3>Results and conclusions</h3><p>Early surgical intervention is recommended for a pseudoaneurysm of the left ventricle because of its tendency to rupture. Most patients do well after surgical repair, except for that requiring concomitant mitral valve replacement. However, the long-term outcomes of patients with a pseudoaneurysm not treated with surgery appear to be relatively benign, with a very low risk of fatal rupture. Therefore, a conservative approach may be considered in these patients that should include chronic anticoagulation therapy because of a high risk of ischemic stroke.</p></div><div><h3>Take-home message</h3><p>Transthoracic echocardiography is an acceptable starting diagnostic method in patients having a pseudoaneurysm. Cardiac magnetic resonance has been increasingly used as a non-invasive diagnostic method.</p></div>","PeriodicalId":100954,"journal":{"name":"New Horizons in Clinical Case Reports","volume":"1 ","pages":"Page 26"},"PeriodicalIF":0.0,"publicationDate":"2017-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.nhccr.2017.06.194","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91723072","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":"Tracheoesophageal fistula in sibilings - A rare occurence","authors":"Hind Zaidan *,&nbsp;Hussein Hamdy,&nbsp;Martin Corbally","doi":"10.1016/j.nhccr.2017.06.153","DOIUrl":"10.1016/j.nhccr.2017.06.153","url":null,"abstract":"<div><h3>Introduction</h3><p>Esophageal atresia is one of the most common congenital malformations occurring in 1 in every 2000-4000 live births. Previously considered to be a fatal condition, it has now become an eminently treatable condition with survival limited only by the presence or absence of major cardiac malformations. For the majority of families, the condition is unique to one child which in itself is challenging. It is extremely rare to affect more than one sibling in any family. The risk of recurrence is 0.5-2% and rises to 20% if another sibling is affected.</p></div><div><h3>Case description</h3><p>We report on two siblings, born two years apart with Type C TOF who were treated at King Hamad University Hospital, Bahrain. The first sibling was born with a short gap esophageal atresia with a distal fistula and repaired shortly after birth in another institution. The second sibling was born with a more challenging long gap esophageal atresia also with a distal fistula. The fistula was ligated on the second day of life and a gastrostomy tube put in place for feeding; repair of the atresia took place 2 months later. Both patients underwent serial dilatations to overcome strictures but are both tolerating oral diets. The third sibling in the family was unaffected with TOF or any VACTREL association.</p></div><div><h3>Conclusion</h3><p>The etiology of TOF is multifactorial with genetic, environmental and unknown components. There were no known environmental factors which could have contributed to this rare occurrence, but the only factor of significance is consanguinity of the parents who are first cousins. On the other hand, genetic factors are responsible for 12% of cases, these are classified as Chromosomal mutations, Syndromic or Isolated. These siblings do not fall into any of the mentioned categories and it is therefore speculated that this occurrence is due to a sporadic mutation.</p></div><div><h3>Take-home message</h3><p>Esophageal atresia with or without fistula is a fairly common condition encountered by paediatric surgeons on a daily basis. Despite increased experience and advancements in management of complex cases, the etiology remains a mystery. Future research should focus on more in-depth genetic studies on the impact of co-sanguinity on sibling TOFs.</p></div>","PeriodicalId":100954,"journal":{"name":"New Horizons in Clinical Case Reports","volume":"1 ","pages":"Page 8"},"PeriodicalIF":0.0,"publicationDate":"2017-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.nhccr.2017.06.153","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81999887","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":"Stevens Johnson syndrome during postoperative period. A case report","authors":"Begoña Peinado,&nbsp;Estibaliz Álvarez *,&nbsp;Ana Verón,&nbsp;Jose Castell,&nbsp;Anais Acevedo,&nbsp;Jenny Guevara,&nbsp;Susana Ayuela,&nbsp;Alberto Mata,&nbsp;Joaquín Díaz Domínguez","doi":"10.1016/j.nhccr.2017.06.145","DOIUrl":"10.1016/j.nhccr.2017.06.145","url":null,"abstract":"<div><h3>Introduction</h3><p>The Stevens Johnson syndrome is a rare and potentially fatal cutaneous reaction to medicaments or infections. The most common drugs linked to this syndrome are antibiotics (such as sulfonamides, cephalosporines and quinolones), anticonvulsivant drugs (carbamazepine, phenytoin) and nonsteroidal anti-inflammatory drugs (NSAIDs). It is characterized by extensive necrosis with detachment of the epidermis, and the mortality rate rises up to 30%. We present a case of Stevens Johnson syndrome associated with drugs administration during postoperative period.</p></div><div><h3>Case description</h3><p>A 73-year-old female reported to Department of Hepatic Surgery for a hepatectomy due to colorectal liver metastases. Her oncological history initiated 5 months ago with a colorectal obstructive tumor and liver metastases in both lobes. An emergency Hartmann procedure was performed following adjuvant chemotherapy, with good response. The surgical team decided to perform a two stage hepatectomy. The postoperative period was torpid and a reintervention for bowel obstruction was required, as well as two long stays in the Intensive Care Unit. A month after the first surgery, the patient presented with a reddish maculopapular lesion on the neck that rapidly extended to the back and forearms. An intra-oral erythema and conjunctival ulcerations were also noted. The diagnosis of syndrome was confirmed by the Department of Dermatology with a skin biopsy. Pharmacology and Allergy Departments completed the study and proposed that the syndrome was possibly due to peniciline and NSAIDs. Despite the efforts of the multidisciplinary team, the supportive care, and the early retreat of the possible causing drugs and ciclosporine plus corticosteroids treatment, the patient presented with severe liver failure and finally died after 2 months of hospitalization.</p></div><div><h3>Conclusions</h3><p>Cutaneous reactions are a very common condition during the postoperative period, most of them are related to habitual drugs regimens. Considering this, it is of paramount importance to keep in mind that the Stevens Johnson syndrome is a rare but severe dermatological pathology in which early diagnosis and treatment is vital.</p></div>","PeriodicalId":100954,"journal":{"name":"New Horizons in Clinical Case Reports","volume":"1 ","pages":"Page 5"},"PeriodicalIF":0.0,"publicationDate":"2017-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.nhccr.2017.06.145","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77637788","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}