Advancements in Case Studies最新文献

{"title":"We Need to Review the Medical Care Model Based on Emergency Situations","authors":"I. Braga, Laila Zelkcovicz Ertler, W. Waissman, Bruno de Avilla da Fonseca e Silva","doi":"10.31031/AICS.2019.01.000524","DOIUrl":"https://doi.org/10.31031/AICS.2019.01.000524","url":null,"abstract":"Medical urgency is defined as the unforeseen occurrence of a health problem with or without a potential risk of death. Medical emergency is the condition that implies an imminent risk of death or intense suffering. In both cases, need for medical care is immediate [1]. Efficient care in the above situations in the emergency room is of paramount importance for life and death situations. Nevertheless, problems in these establishments generate disorders in various spheres of human well-being. Incidence of errors in situations requiring fast thinking is highly dependent on the experience of the emergency physician [2], but the analysis of this professional in this type of situation lacks the history of the patient and information that may be essential for the correct diagnosis [3]. Emergency situations, due to their very nature, have been presented with a wide range of errors and have been linked to a large contingent of cases due to medical error, both in the civil and criminal spheres [4]. It is allied to the fact that the search for these places of care is not always done by individuals in a condition of emergency and in fact urgent, with a large contingent of situations in these places that could be solved in an outpatient way.","PeriodicalId":148950,"journal":{"name":"Advancements in Case Studies","volume":"13 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129096004","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":"Metastatic Breast Carcinoma with Treatment- Resistant Hypocalcemia","authors":"S. Ozçelik, F. Ferhatoğlu, M. Çelik, M. Ozcelik, Süleyman Baş, H. Cengiz, H. Gozu","doi":"10.31031/AICS.2019.01.000523","DOIUrl":"https://doi.org/10.31031/AICS.2019.01.000523","url":null,"abstract":"Introduction: Hypocalcemia is a condition that can occur in malignant diseases due to tumor lysis syndrome or chemotherapy agents. Hypocalcemia due to hypoparathyroidism accompanying malignancy is very rare. We, in this report are sharing a case of metastatıc breast carcinoma with treatment -resistant hypocalcaemia. Case Report: A 37-year-old woman who was diagnosed and followed-up with panhypopituitarism and contractions throughout the body after a recent child delivery. On the basis of the positive chvostek and trausseu findings on the physical examination of the patient we did hypocalcemia work-up and found plasma calcium: 5.4mg/dl, phosphorus: 7.8mg/dl, albumin: 4g/dl, 25-OH vitamin D3: 18.7ng/ml and parathormone as <3pg/ml. Considering primary hypoparathyroidism, calcium carbonate and calcitriol treatments were applied. However, ca-gluconate infusion was initiated on the basis that calcium levels remained at 6.5mg/dl. In the cranial-pituitary MRI examination there were multiple millimetric nodular lesions of in cerebral and cerebellar hemispheres. PET/CT revealed a hypermetabolic area of malignant character in the lower quadrant of the left breast which can represent the primary tumor and multiple hipermetabolic areas in axial skeleton showing the most prominent activity in C2 and T6 vertebra. The biopsy result from the mass in the breast was reported as invasive lobular carcinoma and the patient was referred to the oncology department. Discussion: Hypoparathyroidism may develop due to surgery, autoimmune or destruction in the parathyroid gland. The cause of hypoparathyroidism, which further complicated the treatment of hypocalcemia in our patient, may be due to metastasis or to the possible autoimmune mechanisms or PTHrP. Osteoblastic metastasis and PTHrP may have been found at the same time, and this cycle may have shifted towards osteoblastic activity. We can’t find any association between breast cancer and autoimmune hypoparathyroidism in the literature. Conclusion: Although there are other reasons that complicate the clinical status in treatment-resistant hypocalcemia patients, it should be considered that there may be an underlying malignancy.","PeriodicalId":148950,"journal":{"name":"Advancements in Case Studies","volume":"5 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124508227","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":"Autoimmune Encephalitis a Mini Review","authors":"F. Lui","doi":"10.31031/aics.2019.01.000522","DOIUrl":"https://doi.org/10.31031/aics.2019.01.000522","url":null,"abstract":"","PeriodicalId":148950,"journal":{"name":"Advancements in Case Studies","volume":"9 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128900750","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":"Compression Impression Technique for Fixed Prosthodontics: the Iskaros Technique","authors":"Maged Iskaros","doi":"10.31031/aics.2019.01.000521","DOIUrl":"https://doi.org/10.31031/aics.2019.01.000521","url":null,"abstract":"","PeriodicalId":148950,"journal":{"name":"Advancements in Case Studies","volume":"12 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133431158","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":"Gastrojejuno-Colic Fistula: Case Report","authors":"M. Stošić, Marko Gmijović, I. Stojanović, K. Zdravković","doi":"10.31031/AICS.2019.01.000520","DOIUrl":"https://doi.org/10.31031/AICS.2019.01.000520","url":null,"abstract":"Introduction: Since the beginning of the 1990s, surgical procedures for peptic ulcer disease have been very rare as a result of administering medical treatments such as proton pump inhibitors and anti-Helicobacter Pylori therapy. The postsurgical complications may be noticed presently, i.e. 10, 20 or more years after the initial surgical treatment. Gastrojejunocolic fistula (GJCF) is one of the complications. The symptoms include chronic diarrhea and weight loss. Ingested food passes through the fistula, bypassing all of the small intestine and a part of the colon. Contrast examination is the most sensitive diagnostic tool. The treatment is surgical, preceded by suitable protein-electrolyte preparation. Unlike previous years, surgical approach is now a single-stage procedure. Case report: A 60year old man was admitted to hospital, complaining of progressive weight loss, chronic diarrhoea, and feculent breath. The clinical examination took a few months, including rare disease diagnostics (APUD tumours). Endoscopic examinations were performed repeatedly, but none showed a minor fistula, as it had been at the beginning. The diagnosis was made by contrast examination of the gastro duodenum. After electrolyte imbalance and nutritional deficiencies were resuscitated, a re-resection of the stomach, anastomotic ulcer, proximal jejunum and transverse colon was performed in a single-stage procedure. The reconstruction of the gastro-jejunum was performed by Rouxen-Y technique, and colocolic anastomosis was performed during a single-stage procedure. The patient was discharged from the hospital on the 11th postoperative day, but he continued treatment for R-y stasis syndrome. The weight gain after 6 months was 15 kg, and the patient did not report diarrhea or feculent breath. Conclusion: The modern diagnostic methods might have unjustly challenged the importance of contrast examination of the digestive tract. In our case, contrast radiography was used to make a diagnosis. Chronic diarrhea symptom is present in infectious enterocolitis, while Crohn’s disease or a malignancy may also be suspected. In case when more frequent diseases are excluded, the mentioned fistula should be considered. Nowadays, GJCF surgery is performed as a single-stage procedure after providing adequate protein-electrolyte preparation.","PeriodicalId":148950,"journal":{"name":"Advancements in Case Studies","volume":"426 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116053826","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":"Dermatofibrosarcoma Protuberans Of the Vulva Treated with Mohs Micrographic Surgery","authors":"Miguel Olmos Pérez","doi":"10.31031/aics.2019.01.000519","DOIUrl":"https://doi.org/10.31031/aics.2019.01.000519","url":null,"abstract":"Dermatofibrosarcoma protuberans (DFSP) of the vulva is extremely rare conditions. It has been published approximately 43 case reports in medical literature; most tumors arise on the labia majora. We present a 57-year-old woman with DFSP in vulva that was removed by Mohs Micrographic Surgery technique. The wound exhibited a satisfying functional and cosmetic appearance, with no evidence of deformity of the vulva","PeriodicalId":148950,"journal":{"name":"Advancements in Case Studies","volume":"98 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115155992","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":"Autoimmune Buerger’s Disease Joining Polymyalgia Rheumatica: A Case Report","authors":"M. A. Naafs","doi":"10.31031/aics.2019.01.000518","DOIUrl":"https://doi.org/10.31031/aics.2019.01.000518","url":null,"abstract":"In this case report a patient is described with Buerger’s disease joining polymyalgia rheumatica (PMR), a combination reported never. A rapidly evolving cascade of autoimmune reactions led to debilitating disease within 3 years. Much research in Buerger’s disease Is needed to improve the outlook of these patients.","PeriodicalId":148950,"journal":{"name":"Advancements in Case Studies","volume":"112 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131495852","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":"Disseminated Mycobacterium Avium Complex Mimicking Multi-Organ Sarcoidosis in a Patient with Systemic Lupus Erythematosus Treated with Rituximab","authors":"Tabata Mm, Brian Abe, Shah Ns","doi":"10.31031/aics.2019.02.000531","DOIUrl":"https://doi.org/10.31031/aics.2019.02.000531","url":null,"abstract":"A 38-year old female with a history of systemic lupus erythematosus on rituximab therapy, bipolar dis-order, renal dysfunction, and recurrent nephrolithiasis, presented to the hospital with fevers, flank pain, 40-pound weight loss, odynophagia, and dysphagia. She was found to have new pancytopenia, pulmonary nodules and ground glass opacities on chest CT, and low-grade disseminated intravascular coagulation. She was treated with broad spectrum anti-microbials without improvement, and when her respiratory status rapidly declined, she was empirically started on steroids and quickly improved. After extensive workup, her overall clinical picture supported the diagnosis of sarcoidosis with pulmonary nodules, alkaline phosphatase elevation, hypercalcemia, elevated angiotensin converting enzyme and soluble IL-2 receptor level, and non-necrotizing granulomas on liver biopsy. Shortly after discharge, polymerase chain reaction of respiratory tract and blood cultures taken during hospitalization resulted positive for mycobacterium avium complex, consistent with disseminated Mycobacterium avium complex infection mimicking multi-organ system sarcoidosis. biopsy in cellularity atypical lymphoid granulomas. aspirate histiocytes ingested red blood cells no increase in hemophagocytosis of nucleated cells. Liver biopsy showed macro-vesicular steatosis and non-necrotizing portal and lobular granulomas. Soluble IL-2 was elevated at 27,600 (reference <1,000).","PeriodicalId":148950,"journal":{"name":"Advancements in Case Studies","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121336403","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":"The Great Masquerader: Pulmonary Embolism","authors":"S. Alam, Syed Ahsan","doi":"10.31031/aics.2019.02.000529","DOIUrl":"https://doi.org/10.31031/aics.2019.02.000529","url":null,"abstract":"Acute pulmonary embolism (PE) and Acute Coronary Syndrome (ACS) are considered to be potentially life threatening. Prompt identification of etiology of symptoms can significantly reduce morbidity and mortality. Both the have signs and symptoms that are common to either presentations such as dyspnea, chest discomfort and hemodynamic instability. Electrocardiography (ECG) has been traditionally used to differentiate in the initial stages of work between ACS and PE. More recently T wave inversion has been identified as possible sign of underlying PE. We would like to report a 49-year-old gentleman who presented with chest pain and was initially diagnosed and treated ACS. In this case presentation we would like to present the clinical findings and briefly discuss the salient difference between the two presentations.","PeriodicalId":148950,"journal":{"name":"Advancements in Case Studies","volume":"25 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129949778","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":"Giant Glioblastoma in a Patient with Previous Prostate Adenocarcinoma","authors":"A. Parés, A. Santoyo, P. C. Rebollo, R. Riba","doi":"10.31031/AICS.2018.01.000515","DOIUrl":"https://doi.org/10.31031/AICS.2018.01.000515","url":null,"abstract":"Introduction: Malignant gliomas (GBM) are the most common primary malignant brain tumors. Clinical presentation is variable, being headache the most common symptom. Diagnosis is usually suspected by magnetic resonance (MRI) and in most of cases the treatment consists in neurosurgery followed by co-adjuvant radiotherapy and temozolomide. Case presentation: A 57-year-old male presented to the Emergency Department with a 48-hour history of progressive holocraneal headache, vomiting, gait instability and bilateral hearing loss. He underwent brain Computed Tomography (CT) scan and MRI, with results compatible with GBM. Complete mass excision was performed without complications and he was discharged with co-adjuvant treatment with radiotherapy and temozolomide. Conclusion: Despite optimal treatment and important advances in our understanding of molecular pathogenesis, GBM are still associated with high morbidity and mortality.","PeriodicalId":148950,"journal":{"name":"Advancements in Case Studies","volume":"154 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123253031","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}