Prolonged disturbance of consciousness caused by severe hypophosphatemia: a report of two cases.

PubMed

Murakami, Takaaki; Yoshida, Masanori; Funazo, Tomoko; Matsuda, Yuki; Matsuo, Koji; Nambu, Takuo; Yonemitsu, Shin; Muro, Seiji; Oki, Shogo

2014-01-01

We herein describe two patients with a prolonged disturbance of consciousness due to severe hypophosphatemia. Case one presented with pneumococcal infection and acute exacerbation of chronic obstructive pulmonary disease and asthma. Case two presented with diabetic foot infections and diabetic ketoacidosis. Both patients responded to initial therapy for their primary diseases, but consciousness became worse in both cases. Their test results for impaired consciousness revealed severe hypophosphatemia; therefore, phosphate replacement therapy was administered, thus resulting in complete alertness. These cases demonstrate that we should consider the possibility of hypophosphatemia in critically ill patients with an altered consciousness.

Guillain-Barré syndrome. Review and presentation of a case with pedal manifestations.

PubMed

Viegas, G V

1997-05-01

Guillan-Barré syndrome is an acute, symmetrical polyneuropathy with distinctive features. The early clinical course involves painful paresthesia that is usually followed by proximal motor weakness. Albuminocytologic dissociation in the cerebrospinal fluid is considered diagnostically important. Therapy ranges from supportive measures including physical therapy to surgical intervention for residual deformities. A case with pedal manifestations is presented.

A Treatment-Refractory Case of Social Anxiety Disorder: Lessons Learned from a Failed Course of Cognitive-Behavioral Therapy

ERIC Educational Resources Information Center

Brozovich, Faith A.; Heimberg, Richard G.

2011-01-01

Over the past 25 years researchers have made enormous strides in the implementation of cognitive-behavioral therapy (CBT) for social anxiety disorder (SAD), although considerable work remains to be done. The present paper discusses a treatment refractory case seen in our clinic. The young man presented numerous interrelated obstacles, such as low…

Mode Deactivation Therapy (MDT): A Theoretical Case Analysis on a Suicidal Adolescent

ERIC Educational Resources Information Center

Apsche, Jack A.; Siv, Alexander M.

2005-01-01

This case study presents a case study of the effectiveness of Mode deactivation therapy (MDT) (Apsche, Bass, Jennings, Murphy, Hunter, and Siv, 2005) with an adolescent male, with reactive conduct disorder, PTSD and 8 lethal suicide attempts. The youngster was hospitalized four times for suicide attempts, three previous placements in residential…

Necrotizing Infundibular Crystalline Folliculitis (NICF) Induced by Anti-Tumoral Therapies: Report of 2 Cases.

PubMed

Fattouh, Kinda; Collet-Benzaquen, Diane; Provensal, Anne M; Desseigne, Françoise; Castillo, Christine; Combemale, Patrick; de la Fouchardière, Arnaud

2017-10-01

Necrotizing Infundibular Crystalline Folliculitis (NICF) is rare entity of unknown pathogenesis presenting as follicular crystalline papules arising in seborrheic areas. We report 2 cases of NICF in patients under targeted therapy for metastatic adenocarcinoma. In one case, the lesions reappeared cyclically every 3 weeks after each injection and in the other case, lesions persisted until disruption of the continuous oral therapy. Punch-biopsies demonstrated folliculitis with a plugging crystalline material associated with either bacteria or yeast. These are the first descriptions of drug-induced NICF.

Family Therapy Approach to Incapacitating Migraine.

ERIC Educational Resources Information Center

Rosenstock, Harvey A.; And Others

1979-01-01

The case of a nine-year-old boy suffering from psycosomatic migraine headaches is discussed. The main article presents the case study and discusses the family systems approach which was successfully used in therapy. The following discussion deals with the psychosomatic personality. (HMV)

Use of continuous renal replacement therapy in acute aluminum phosphide poisoning: a novel therapy.

PubMed

Nasa, Prashant; Gupta, Ankur; Mangal, Kishore; Nagrani, S K; Raina, Sanjay; Yadav, Rohit

2013-09-01

Aluminum phosphide is most common cause of poisoning in northern India. There is no specific antidote available and management of such cases is mainly supportive with high mortality. We present two cases of severe acute aluminium phosphide poisoning where continuous renal replacement therapy (CRRT) was started early along with other resuscitative measures and both the patients survived.

Chronic inflammatory gingival enlargement associated with orthodontic therapy--a case report.

PubMed

Jadhav, Tanya; Bhat, K Mahalinga; Bhat, G Subraya; Varghese, Jothi M

2013-02-01

Gingival enlargement, also synonymous with the terms gingival hyperplasia or hypertrophy, is defined as an abnormal overgrowth of gingival tissues. A case of a 19-year-old male presenting with maxillary and mandibular chronic inflammatory gingival enlargement associated with prolonged orthodontic therapy is reported here. Surgical therapy was carried out to provide a good aesthetic outcome. No recurrence was reported at the end of 1 year. The importance of patient motivation and compliance during and after therapy as a critical factor in the success of treatment has also been highlighted through this case report.

Case study of first episode schizophrenia in pregnancy and postpartum.

PubMed

Kast, Kristopher A; Agarkar, Smita

2017-08-01

Patients with first-episode psychosis of peripartum onset commonly prove to have a mood-disorder diathesis; however, a proportion of cases represent first-episode schizophrenia. We present such a case and discuss the clinical relevance of recognizing this small but important population of new mothers. These patients are at considerable risk of misdiagnosis, resulting in ineffective maintenance therapy, poorer recovery of function, and development of treatment resistance. Accurate diagnosis in the peripartum period will impact treatment decisions and long-term therapy. Clinicians need to be vigilant, especially during maintenance therapy, to identify these patients and ensure appropriate antipsychotic therapy is provided.

Radiation therapy for primary breast lymphoma in male gynecomastia: a rare case report and review of the literature.

PubMed

Ishibashi, Naoya; Hata, Masaharu; Mochizuki, Takao; Ogawa, Kogi; Sugiura, Hiroaki; Takekawa, Yoshinori; Maebayashi, Toshiya; Aizawa, Takuya; Sakaguchi, Masakuni; Abe, Osamu

2016-10-01

Primary breast lymphoma is a rare type of non-Hodgkin lymphoma and usually affects women, although a few cases have been reported in men. Chemotherapy and radiation therapy, or a combination of both, are frequently administered for treatment of primary breast lymphoma, as local control by surgical resection is poor. No standard therapy has been established, and the optimal radiation dose and irradiation field for male patients are unknown. The present report describes a 75-year-old man with bilateral cirrhosis-induced gynecomastia who was diagnosed with primary breast lymphoma; specifically, diffuse large B-cell lymphoma. Because of his hepatic dysfunction, he was treated with radiation therapy alone. Radiation therapy was followed by eight cycles of rituximab monotherapy. Clinical response was good, with no signs of relapse. Clinicians may benefit from knowledge regarding effective treatment of primary breast lymphoma in male patients, which has been rarely reported owing to the low incidence of this condition. The outcome in the present case may help to establish effective treatment guidelines in similar cases.

Assessment of the Evolution of Cancer Treatment Therapies

PubMed Central

Arruebo, Manuel; Vilaboa, Nuria; Sáez-Gutierrez, Berta; Lambea, Julio; Tres, Alejandro; Valladares, Mónica; González-Fernández, África

2011-01-01

Cancer therapy has been characterized throughout history by ups and downs, not only due to the ineffectiveness of treatments and side effects, but also by hope and the reality of complete remission and cure in many cases. Within the therapeutic arsenal, alongside surgery in the case of solid tumors, are the antitumor drugs and radiation that have been the treatment of choice in some instances. In recent years, immunotherapy has become an important therapeutic alternative, and is now the first choice in many cases. Nanotechnology has recently arrived on the scene, offering nanostructures as new therapeutic alternatives for controlled drug delivery, for combining imaging and treatment, applying hyperthermia, and providing directed target therapy, among others. These therapies can be applied either alone or in combination with other components (antibodies, peptides, folic acid, etc.). In addition, gene therapy is also offering promising new methods for treatment. Here, we present a review of the evolution of cancer treatments, starting with chemotherapy, surgery, radiation and immunotherapy, and moving on to the most promising cutting-edge therapies (gene therapy and nanomedicine). We offer an historical point of view that covers the arrival of these therapies to clinical practice and the market, and the promises and challenges they present. PMID:24212956

Cybernetics of Brief Family Therapy.

ERIC Educational Resources Information Center

Keeney, Bradford P.; Ross, Jeffrey M.

1983-01-01

Presents a cybernetic view of brief family therapy. Includes a historical discussion of the key ideas underlying brief family therapy, a cybernetic model of therapeutic change, and a clinical case for exemplification. (Author/JAC)

A Case of Premature Termination in a Treatment for Generalized Anxiety Disorder

ERIC Educational Resources Information Center

Boswell, James F.; Llera, Sandra J.; Newman, Michelle G.; Castonguay, Louis G.

2011-01-01

In this paper we present a case of failure in an integrative treatment for generalized anxiety disorder (GAD) combining cognitive-behavioral therapy, an empirically supported treatment for GAD, and interpersonal-emotional processing therapy. The client of focus dropped out of treatment after the 8th session. Based on our analysis of this case, we…

Therapeutic Suggestions for Chronic Subdural Hematoma Associated with Idiopathic Thrombocytopenic Purpura: A Case Report and Literature Review

PubMed Central

Takase, Hajime; Tatezuki, Junya; Ikegaya, Naoki; Yamamoto, Daisuke; Hashimoto, Mizuki; Takagi, Makoto; Mochimatsu, Yasuhiko; Kawahara, Nobutaka

2015-01-01

A 66-year-old woman who was previously diagnosed with idiopathic thrombocytopenic purpura (ITP) presented with mild right-sided hemiparesis and drowsiness. Head computed tomography (CT) imaging demonstrated a massive left chronic subdural hematoma (CSDH) with a midline shift. Because initial laboratory data showed a significantly decreased blood platelet count (0.3 × 104/mm3), medical treatments such as platelet transfusion, intravenous immunoglobulin (IVIG), and high-dose corticosteroid therapy, were initiated. She clinically and radiologically responded well to these treatments without any surgical intervention. In addition to presenting our case, we searched the PubMed and Ichushi Web databases to comprehensively illustrate clinical characteristics and treatment outcomes of similar cases. Including the present case, we found 19 reports and 23 cases of CSDH associated with ITP in the literature, and assessed 17 reports and 21 cases that were written in English and Japanese. None or mild neurological symptom were seen in 13 cases, and severe, such as coma and hemiparesis, were described in the younger 8 cases with significant difference. All except one were first treated with medical therapies. Most cases of the former group responded well to conservative therapy. On the other hand, most in the latter eventually needed surgical treatment in addition except recent two cases including the present case. CSDH associated with ITP is rarely described, and its management remains controversial. However, this report highlights multiple continuous medical treatments under strict observation and general care might be a useful alternative to avoid surgery in cases presenting with severe neurological deficits and extremely low platelet counts. PMID:28663980

A rare case of laryngotracheal chondrosarcoma in a patient with past history of radioiodine therapy for thyroid cancer.

PubMed

Mohajeri, Gholamreza; Hekmatnia, Ali; Ahrar, Hossein; Hekmatnia, Farzane; Nia, Reza Basirat; Afsharmoghadam, Nushin; Eftekhari, Mehdi; Jafarpishe, Saleh

2013-01-01

Tracheal chondrosarcoma is a rare malignant mesenchymal tumor and there are less than 15 reports in the literature. We report a rare case of laryngotracheal chondrosarcoma in a 74-year-old man. He gave a history of radioiodine therapy for thyroid papillary carcinoma about 24 years ago. Diagnostic steps, histological presentation, and therapy are described in detail.

Morrie: A Case Study.

ERIC Educational Resources Information Center

Wheeler, Eugenie G.; Knight, Bob

1981-01-01

Presents a case study demonstrating successful behavioral treatment of a depressed older man using group and conjoint therapy. Two major issues in dealing with the aged are addressed: dealing with resistance to therapy, and distinguishing between disability due to organic brain syndrome and that due to depression. (Author/RC)

[Successful electroconvulsive therapy of Cotard syndrome with bitemporal hypoperfusion].

PubMed

Lohmann, T; Nishimura, K; Sabri, O; Klosterkötter, J

1996-05-01

A case study is presented to illustrate a rare condition described by Cotard as "délire de négation". The central symptom is a nihilistic delusion with denial of one's own existence of oneself and that of the external world. In the present case, the syndrome became manifest as an escalation of a recurrent depressive disorder late in life. After initial resistance to therapy, the syndrome was successfully treated with electroconvulsive therapy. For the first time, we report the regional cerebral blood flow measured by 99mTc-HMPAO-SPECT before and after therapy. Before treatment, significant bitemporal hypoperfusion relative to the cerebellum was found, which was no longer demonstrable on remission.

Maintenance therapy with electroconvulsive therapy in a patient with a codiagnosis of bipolar disorder and obsessive-compulsive disorder.

PubMed

Bülbül, Feridun; Copoglu, Umit Sertan; Alpak, Gokay; Unal, Ahmet; Tastan, Mehmet Fatih; Savas, Haluk Asuman

2013-06-01

Obsessive-compulsive disorder (OCD) is defined as the most commonly seen anxiety disorder accompanying the bipolar disorder, and this concomitance causes the difficulties in the therapy. Although electroconvulsive therapy (ECT) is efficient in both manic and depressive episodes of the bipolar disorder, it is considered as a therapeutic option in cases of OCD with depression comorbidity. In this article, we aimed to present a case in which depressive episode of bipolar disorder and OCD comorbidity were present; both depressive and OCD symptoms were resolved using ECT. Symptoms of both diseases recurred after the discontinuation of ECT, and well-being sustained with maintenance ECT.

Cord blood-derived cytokine-induced killer cellular therapy plus radiation therapy for esophageal cancer: a case report.

PubMed

Wang, Liming; Huang, Shigao; Dang, Yazheng; Li, Ming; Bai, Wen; Zhong, Zhanqiang; Zhao, Hongliang; Li, Yang; Liu, Yongjun; Wu, Mingyuan

2014-12-01

Esophageal cancer is a serious malignancy with regards to mortality and prognosis. Current treatment options include multimodality therapy mainstays of current treatment including surgery, radiation, and chemotherapy. Cell therapy for esophageal cancer is an advancing area of research. We report a case of esophageal cancer following cord blood-derived cytokine-induced killer cell infusion and adjuvant radiotherapy. Initially, she presented with poor spirit, full liquid diets, and upper abdominal pain. Through cell therapy plus adjuvant radiotherapy, the patient remitted and was self-reliant. Recognition of this curative effect of sequent therapy for esophageal cancer is important to enable appropriate treatment. This case highlights cord blood-derived cytokine-induced killer cell therapy significantly alleviates the adverse reaction of radiation and improves the curative effect. Cell therapy plus adjuvant radiotherapy can be a safe and effective treatment for esophageal cancer.

Varicella zoster meningitis complicating combined anti-tumor necrosis factor and corticosteroid therapy in Crohn's disease.

PubMed

Ma, Christopher; Walters, Brennan; Fedorak, Richard N

2013-06-07

Opportunistic viral infections are a well-recognized complication of anti-tumor necrosis factor (TNF) therapy for inflammatory bowel disease (IBD). Cases of severe or atypical varicella zoster virus infection, both primary and latent reactivation, have been described in association with immunosuppression of Crohn's disease (CD) patients. However, central nervous system varicella zoster virus infections have been rarely described, and there are no previous reports of varicella zoster virus meningitis associated with anti-TNF therapy among the CD population. Here, we present the case of a 40-year-old male with severe ileocecal-CD who developed a reactivation of dermatomal herpes zoster after treatment with prednisone and adalimumab. The reactivation presented as debilitating varicella zoster virus meningitis, which was not completely resolved despite aggressive antiviral therapy with prolonged intravenous acyclovir and subsequent oral valacyclovir. This is the first reported case of opportunistic central nervous system varicella zoster infection complicating anti-TNF therapy in the CD population. This paper also reviews the literature on varicella zoster virus infections of immunosuppressed IBD patients and the importance of vaccination prior to initiation of anti-TNF therapy.

[BCG infection of the glans penis after intravesical BCG therapy].

PubMed

Michelet, N; Spenatto, N; Viraben, R; Cuny, J-F; Mazet, J; Trechot, P; Barbaud, A; Schmutz, J-L

2008-01-01

BCG therapy is an effective adjuvant treatment for superficial bladder tumors. Therapy involves intravesical instillation of live attenuated Calmette-Guérin bacilli. BCG infection of the glans is a rare local complication associated with this treatment, two cases of which are reported below. Case 1: A 77-year-old man presented relapsing urothelial bladder carcinoma treated by endoscopic resection and BCG therapy. One week after the seventh instillation, severe balanitis developed. Three months later, examination revealed massive painful perimeatal ulceration with yellowish papules in the peripheral regions. Histology revealed epithelioid giant-cell granulomas. Ziehl-Neelsen staining was positive. Slow cure of the lesions was achieved within 12months using double antitubercular antibiotic therapy. Case 2: In a 61-year-old man receiving BCG therapy for relapsing bladder carcinoma in situ, the sixth instillation was considered traumatic since it was highly painful. One week later, papular nodules appeared on the glans with a sclerosing lesion of the balanopreputial sac, dark purple perimeatal papules and a mass beneath the mucosa of the glans. Antibiotic treatment comprising ofloxacin followed by rifampicin for two months proved ineffective. Histology revealed granulomatous dermal lesions with eosinophilic necrosis. Triple antitubercular antibiotic therapy was initiated. The first reported case of BCG infection of the glans in patients undergoing intravesical BCG therapy was published in 1992. Since then, there have been nine other reports. There is no stereotypical clinical presentation. In most cases, an infiltrated erythematosus plaque is seen together with yellowish papules in certain patients. Diagnosis is based upon history and histological examination.

Cognitive therapy for antisocial and borderline personality disorders: single case study series.

PubMed

Davidson, K M; Tyrer, P

1996-09-01

Cognitive therapy for affective disorders has been recently adapted and developed for the treatment of personality disorders. In the present study, a specific and detailed cognitive therapy treatment manual for borderline and antisocial personality disorders was evaluated in a pilot study. The results of a single case series demonstrate that important clinical changes in dysfunctional behaviour and attitudes can be achieved with short-term cognitive therapy in patients with antisocial and borderline personality disorders, although these were not, on the whole, statistically significant.

Breast cancer and HIV in the era of highly active antiretroviral therapy: two case reports and review of the literature.

PubMed

Latif, Naeem; Rana, Fauzia; Guthrie, Troy

2011-01-01

The incidence of human immunodeficiency virus (HIV) infection is rising in US women; however its impact on breast cancer incidence, stage at presentation, response and treatment toxicity remains unknown. To address the impact of HIV infection and use of highly active antiretroviral therapy (HAART) on the natural history of breast cancer we present two cases of breast cancer in HIV-infected women and also review the literature. A literature search was done on Medline using the key words HIV/AIDS, breast cancer, and HAART therapy, restricted to English language. There were mostly case reports and one large series of 20 cases reported by Hurley et al. Data concerning the impact of HIV infection and HAART therapy regarding pathogenesis, stage at presentation, tumor type, response, and toxicity associated with treatment were reviewed. The literature review shows that the breast cancer incidence is either same or less in HIV-infected patients compared to the general population. However, the patients with HIV infection present with more advanced stage and aggressive disease, and they also have poor chemotherapy tolerance. The impact of HAART on breast cancer incidence in HIV-infected patients is still unclear. © 2010 Wiley Periodicals, Inc.

Laser CO2 treatment for vulvar lymphedema secondary to gynecological cancer therapy: A report of two cases and review of the literature.

PubMed

Sopracordevole, Francesco; Mancioli, Francesca; Canzonieri, Vincenzo; Buttignol, Monica; Giorda, Giorgio; Ciavattini, Andrea

2015-04-01

Vulvar lymphedema is an uncommon and disabling side-effect of pelvic lymphadenectomy and pelvic radiotherapeutic treatment for invasive genital cancer. Lymphorrhea, a complication of lymphedema, may be extremely distressing for patients due to the requirement to wear sanitary towels and as the pain and loss of elasticity of the vulvar skin and mucosa can cause discomfort during coitus. Surgical treatments of lymphorrhea and vulvar lymphedema secondary to gynecological cancer treatments remain controversial and are not currently considered to be the standard therapy. The present study reports two cases of vulvar lymphedema complicated by vulvar lymphorrhea in females who had undergone treatment for cervical and endometrial cancer, respectively; a review of the literature is also included. In the two present cases, vulvar lymphedemas were refractory to standard treatments, including decongestive therapy, manual lymph drainage, elastic bandaging, low-stretch bandaging, exercises and skin care. Laser CO 2 excision and vaporization of the whole skin and mucosal tissue of the vulva was successfully performed to treat the lymphorrhea and improve quality of life. Thus, the present two cases indicated that laser CO 2 surgery may present an additional therapy for the treatment of genital lymphedema that is refractory to other treatments.

Treatment of Medial Tibial Stress Syndrome With Radial Soundwave Therapy in Elite Athletes: Current Evidence, Report on Two Cases, and Proposed Treatment Regimen.

PubMed

Saxena, Amol; Fullem, Brian; Gerdesmeyer, Ludger

Two case reports of high-level athletes with medial tibial stress syndrome (MTSS), 1 an Olympian with an actual stress fracture, are presented. Successful treatment included radial soundwave therapy, pneumatic leg braces, relative rest using an antigravity treadmill, and temporary foot orthoses. Radial soundwave therapy has a high level of evidence for treatment of MTSS. We also present recent evidence of the value of vitamin D assessment. Both patients had a successful outcome with minimal downtime. Finally, a suggested treatment regimen for MTSS is presented. Copyright © 2017 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

Menstruation angina: a case report

PubMed Central

2009-01-01

Introduction Menstruation is commonly associated with migraine and irritable bowel but is rarely correlated with angina or myocardial ischaemia. Only a small number of cases have been reported suggesting a link between menstruation and myocardial ischaemic events. Case presentation A case of menstruation angina is reported in order to raise awareness of this association. A 47-year-old South Asian woman presented with recurrent chest pains in a monthly fashion coinciding with her menstruations. Each presentation was associated with troponin elevation. Angioplasty failed to resolve her symptoms but she eventually responded to hormonal therapy. Conclusions The possibility of menstruation angina should always be taken into account in any female patients from puberty to menopause presenting with recurrent chest pains. This can allow an earlier introduction of hormonal therapy to arrest further myocardial damage. PMID:19830114

Electroconvulsive therapy for lycanthropy and Cotard syndrome: a case report.

PubMed

Grover, Sandeep; Shah, Ruchita; Ghosh, Abhishek

2010-12-01

We present a case of psychotic depression presenting with lycanthropy (being converted to a pig) and Cotard syndrome simultaneously and treated with electroconvulsive therapy. A 37-year-old female patient developed psychotic depression after a stressor (a possibility of having a malignancy). As her depression worsened, she developed delusional belief of self being metamorphosed to a pig and her children also being metamorphosed into pig. In addition, she had the delusional belief that her own body and body of her children was rotting away. She was treated with electroconvulsive therapy along with venlafaxine and olanzapine, with which she improved completely.

The use of electroconvulsive therapy in atypical psychotic presentations: a case review.

PubMed

Montgomery, John H; Vasu, Devi

2007-10-01

Convulsive therapy and its progeny, electroconvulsive therapy (ECT), were originally used for the treatment of catatonic schizophrenia, and there is little doubt that ECT remains an effective intervention for the treatment of schizophrenia. However, current practice tends to favor the use of ECT in severe or treatment refractory affective disorders, and its use in schizophrenia and other nonaffective (atypical) psychotic disorders has become controversial.CASE REPORTS HAVE SUGGESTED A ROLE FOR ECT IN TWO SPECIFIC ATYPICAL PSYCHOTIC DISORDERS: Cotard's syndrome and cycloid psychosis. In this article, we review the atypical psychotic disorders and report a series of five case examples that signify the role of ECT in atypical psychotic presentations, particularly when the symptoms resemble those found in Cotard's syndrome and cycloid psychosis.

Targeted Approaches Applied to Uncommon Diseases: A Case of Salivary Duct Carcinoma Metastatic to the Brain Treated with the Multikinase Inhibitor Neratinib

PubMed Central

Sorenson, Karl R.; Piovezani Ramos, Guilherme; Villasboas Bisneto, Jose Caetano; Price, Katharine

2017-01-01

Salivary duct carcinoma is a rare malignancy associated with hormone receptor and human epidermal growth factor receptor 2 (HER2) overexpression. Local surgical control is the cornerstone of therapy, but a subset of patients develops metastatic disease portending a poor prognosis and limited management options. Intracranial metastases are an uncommon manifestation and present a therapeutic challenge. We report the case of a 31-year-old male who presented with facial pain and swelling subsequently diagnosed with salivary duct carcinoma. Our patient underwent extensive locoregional resection and analysis of the tumor tissue demonstrated evidence of androgen receptor expression and HER2 overexpression. His course was complicated by metastatic extra- and intracranial recurrence despite combined modality treatment with radiation and chemotherapy followed by anti-HER2 monoclonal antibody therapy and androgen deprivation therapy. After exhausting standard treatment options, he received experimental therapy with a new small-molecule tyrosine kinase inhibitor, neratinib, with evidence of a transient clinical response and no significant adverse effects. This case exemplifies the potential and limitations of targeted therapy, particularly when applied to patients with rare diseases and presentations. PMID:28878657

Targeted Approaches Applied to Uncommon Diseases: A Case of Salivary Duct Carcinoma Metastatic to the Brain Treated with the Multikinase Inhibitor Neratinib.

PubMed

Sorenson, Karl R; Piovezani Ramos, Guilherme; Villasboas Bisneto, Jose Caetano; Price, Katharine

2017-01-01

Salivary duct carcinoma is a rare malignancy associated with hormone receptor and human epidermal growth factor receptor 2 (HER2) overexpression. Local surgical control is the cornerstone of therapy, but a subset of patients develops metastatic disease portending a poor prognosis and limited management options. Intracranial metastases are an uncommon manifestation and present a therapeutic challenge. We report the case of a 31-year-old male who presented with facial pain and swelling subsequently diagnosed with salivary duct carcinoma. Our patient underwent extensive locoregional resection and analysis of the tumor tissue demonstrated evidence of androgen receptor expression and HER2 overexpression. His course was complicated by metastatic extra- and intracranial recurrence despite combined modality treatment with radiation and chemotherapy followed by anti-HER2 monoclonal antibody therapy and androgen deprivation therapy. After exhausting standard treatment options, he received experimental therapy with a new small-molecule tyrosine kinase inhibitor, neratinib, with evidence of a transient clinical response and no significant adverse effects. This case exemplifies the potential and limitations of targeted therapy, particularly when applied to patients with rare diseases and presentations.

The Morphometrical and Histopathological Changes which were Observed after Topical Ozone Therapy on an Exophytic Fibrous Gingival Lesion: A Case Report.

PubMed

Patel, Punit Vaibhav; Gujjari, Sheela Kumar

2013-06-01

We are presenting 2 cases where ozone therapy was used in the form of ozonated oil on an exophytic fibrous gingival lesion. A 42-years female patient was selected, who presented with a mild to moderately painful, exophytic, fibrous lesion on the upper anterior gingiva. This gingival lesion was treated with 2ml of ozonated oil, thrice daily for one week. After the ozone therapy, the postoperative outcomes were measured and analyzed. Finally, the lesion was subjected to an excisional biopsy and a histopathological evaluation. After the ozone therapy, the patient revealed that there was less pain. On examination of the lesion, an improvement was observed in the clinical sign of the inflammation and also a reduction in the surface ulceration. During the final biopsy, less bleeding was observed. The morphometrical analysis showed a reduction in the size of the lesion. The histopathological analysis showed a reduction in the collagen fibres and in the inflammatory cells in the connective tissue stroma. Topical ozone therapy provides potential benefits for the treatment of exophytic gingival lesions. The observed benefits in present case report needs to be verified in future with well-controlled clinical trials.

CENTRAL SEROUS CHORIORETINOPATHY IN POSTMENOPAUSAL WOMEN RECEIVING EXOGENOUS TESTOSTERONE.

PubMed

Conway, Mandi D; Noble, Jason A; Peyman, Gholam A

2017-01-01

Central serous chorioretinopathy (CSR) is a serous detachment of the neurosensory retina commonly associated with male sex, Type-A personality and corticosteroid use. Exogenous administration of androgens and development of CSR in men has been reported. Only one case of CSR in a postmenopausal woman receiving exogenous androgen therapy has been reported. The authors describe three cases of chronic CSR in postmenopausal women receiving exogenous testosterone therapy. Diagnosis was based on characteristic clinical, fluorescein angiographic, and optical coherence tomography findings. The three women were being treated with exogenous testosterone and progesterone therapy for symptoms of menopause and libido loss. Average age at presentation was 54.7 years (53-56 years), average duration of exogenous androgen use was 61 months (36-87 months), with average 19.7-month follow-up. Resolution of symptoms seemed correlated with cessation of androgen use despite treatment with oscillatory photodynamic therapy and intravitreal pharmacotherapy with antivascular endothelial growth factor agents. Exogenous testosterone is increasingly prescribed for menopausal symptoms and libido loss. Treatment with oscillatory photodynamic therapy, supplemental bevacizumab intravitreal pharmacotherapy, and cessation of exogenous androgen therapy was successful in three cases of chronic, therapy-resistant CSR. Ophthalmologists should inquire about androgen usage in patients who present with CSR, especially in the setting of therapy resistance.

Individual Multimodal Therapy for Weight Loss: A Case Example.

ERIC Educational Resources Information Center

Kilmartin, Christopher; Robbins, Steven

1987-01-01

Presents a case study highlighting a treatment model based on a multimodal conceptualization. Suggests that individual multimodal therapy provides a comprehensive approach to the treatment of overeating, helping to target social and emotional issues related to eating disorders as well as the eating behaviors themselves. (Author/ABB)

Light and Laser Modalities in the Treatment of Cutaneous Sarcoidosis: A Systematic Review.

PubMed

Lima, Ana Luiza; Goetze, Steven; Illing, Tanja; Elsner, Peter

2018-04-27

Sarcoidosis is a systemic non-caseating granulomatous disease of unknown aetiology. Cutaneous manifestations are present in approximately 10-30% of the patients with the systemic form. Therapy is indicated in case of disabling symptoms, organ dysfunction or cosmetically distressing manifestation. Despite different therapeutic possibilities, cutaneous sarcoidosis remains exceptionally difficult to treat. Light and laser therapy may be a promising alternative. In this systematic review, we summarised the available treatments according to the literature concerning light and laser therapy for cutaneous sarcoidosis. Publications written in English and German, published between January 1990 and July 2016 in the database PubMed, MEDLINE, Embase, and Scopus were analysed. Light therapy with intense pulsed light, photodynamic therapy, and ultraviolet A light therapy, as well as laser therapy with pulsed dye laser, YAG laser, and Q-switched ruby laser were described. The results are based on individual case reports and small case series. Randomised controlled studies are lacking.

[Outpatient treatment of selective mutism: long-standing selective mutism in a 17-year-old male].

PubMed

Herdener-Pinnekamp, Katharina; Gundelfinger, Ronnie; Steinhausen, Hans-Christoph

2010-01-01

The present case report describes the successful treatment of a 17 year old male adolescent suffering for 10 years from selective mutism. Following a summary review of recent publications on therapy approaches, the report describes the treatment concept in the present case, including detailed assessment of co-morbid disorders, motivation for change, behaviour therapy with supporting drug intervention, and intensive co-operation with parents and other caretakers.

Transient anosmia during acute phase electroconvulsive therapy: a report of 2 cases.

PubMed

Upshaw, William N; Hubbard, Jacqueline D; Ali, Sadia; Fernandez, Jamie Winderbaum

2013-12-01

Treatment-resistant psychiatric illness poses a clinical challenge to psychiatrists in both inpatient and outpatient settings. Although electroconvulsive therapy is a relatively safe option for the treatment of these patients, initiation of this treatment requires a conscientious discussion of the risks and benefits of the procedure to obtain informed consent. The 2 cases presented here describe transient anosmia, a seldom reported but potentially significant adverse effect of electroconvulsive therapy.

Sibling Group Play Therapy: An Effective Alternative with an Elective Mute Child.

ERIC Educational Resources Information Center

Barlow, Karen; And Others

1986-01-01

Presents the case study of an elective mute child. Describes the effects of sibling play therapy and lists implications for school counselors who might use group or sibling play therapy in their developmental guidance programs. (ABB)

Protothecal bursitis after simultaneous kidney/liver transplantation: a case report and review.

PubMed

Ramírez, I; Nieto-Ríos, J F; Ocampo-Kohn, C; Aristizábal-Alzate, A; Zuluaga-Valencia, G; Muñoz Maya, O; Pérez, J C

2016-04-01

Solid organ transplantation is an accepted therapy for end-stage diseases of the kidneys, liver, heart, and lungs. Unfortunately, transplantation is associated with infectious complications. Here, we present a case report of Prototheca wickerhamii olecranon bursitis and review all of the cases in solid organ transplant (SOT) recipients published in the literature to date. In our patient, the infection resolved with surgical therapy and limited antifungal therapy, and no symptoms have recurred over 24 months of follow-up. A review of the literature suggests that 50% of SOT recipients with Prototheca infection present with disseminated infection, and the overall mortality is 75%. More studies are required to determine the optimal management of protothecosis in this population. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Presentation and Treatment of Histoplasmosis in Pediatric Oncology Patients: Case Series and Review of the Literature.

PubMed

Hess, Jennifer; Fondell, Andrew; Fustino, Nicholas; Malik, Jeff; Rokes, Christopher

2017-03-01

Histoplasmosis is an endemic fungus in several regions of the United States. The diagnosis and treatment of this infection can be challenging in pediatric oncology patients. We present 5 patients diagnosed with histoplasmosis while receiving treatment at a midsize pediatric oncology center in Iowa. Two cases occurred in patients with acute lymphoblastic leukemia and 3 cases in patients with solid tumors. All patients were treated with antifungal therapy and demonstrated excellent clinical response. Histoplasmosis should be considered as a potential cause of nonspecific febrile illness, pulmonary masses, and bone marrow suppression in immunocompromised patients in endemic regions. Prompt and accurate diagnosis can facilitate timely antifungal therapy and avoidance of prolonged hospital stays, invasive testing, unnecessary antibiotics, and unwarranted anticancer therapies.

Cognitive Behavioural Relating Therapy (CBRT) for voice hearers: a case study.

PubMed

Paulik, Georgie; Hayward, Mark; Birchwood, Max

2013-10-01

There has been a recent focus on the interpersonal nature of the voice hearing experience, with studies showing that similar patterns of relating exist between voice hearer and voice as between voice hearer and social others. Two recent therapeutic approaches to voices, Cognitive Therapy for Command Hallucinations and Relating Therapy, have been developed to address patterns of relating and power imbalances between voice hearer and voice. This paper presents a novel intervention that combines elements of these two therapies, named Cognitive Behavioural Relating Therapy (CBRT). The application of CBRT is illustrated through a clinical case study. The clinical case study showed changes in patterns of relating, improved self-esteem and reductions in voice-related distress. The outcomes provide preliminary support for the utility of CBRT when working with voice hearers.

Crusted scabies-associated immune reconstitution inflammatory syndrome

PubMed Central

2012-01-01

Background Despite the widely accepted association between crusted scabies and human immunodeficiency virus (HIV)-infection, crusted scabies has not been included in the spectrum of infections associated with immune reconstitution inflammatory syndrome in HIV-infected patients initiating antiretroviral therapy. Case presentation We report a case of a 28-year-old Mexican individual with late HIV-infection, who had no apparent skin lesions but soon after initiation of antiretroviral therapy, he developed an aggressive form of crusted scabies with rapid progression of lesions. Severe infestation by Sarcoptes scabiei was confirmed by microscopic examination of the scale and skin biopsy. Due to the atypical presentation of scabies in a patient responding to antiretroviral therapy, preceded by no apparent skin lesions at initiation of antiretroviral therapy, the episode was interpreted for the first time as “unmasking crusted scabies-associated immune reconstitution inflammatory syndrome”. Conclusion This case illustrates that when crusted scabies is observed in HIV-infected patients responding to antiretroviral therapy, it might as well be considered as a possible manifestation of immune reconstitution inflammatory syndrome. Patient context should be considered for adequate diagnosis and treatment of conditions exacerbated by antiretroviral therapy-induced immune reconstitution. PMID:23181485

Evaluating the effect of metronidazole plus amoxicillin-clavulanate versus amoxicillin-clavulanate alone in canine haemorrhagic diarrhoea: a randomised controlled trial in primary care practice.

PubMed

Ortiz, V; Klein, L; Channell, S; Simpson, B; Wright, B; Edwards, C; Gilbert, R; Day, R; Caddy, S L

2018-06-07

To investigate the benefit of supplementing amoxicillin-clavulanic acid therapy with metronidazole in dogs presenting to a primary care veterinary practice with severe haemorrhagic diarrhoea. Prospective randomised blinded trial on dogs presenting with haemorrhagic diarrhoea of less than 3 days duration to a primary care veterinary hospital and also requiring intravenous fluid therapy. Cases were randomised to receive either metronidazole or saline, in addition to standard supportive therapy consisting of amoxicillin-clavulanic acid, intravenous fluid therapy, buprenorphine and omeprazole. Treatment efficacy was measured by duration of hospitalisation and daily scoring of disease severity. Thirty-four cases successfully completed the trial. There was no significant difference in hospitalisation time between treatment groups (mean for dogs receiving metronidazole was 29.6 hours and for controls was 26.3 hours) nor in daily clinical scores. This study strongly suggests that addition of metronidazole is not an essential addition to amoxicillin-clavulanic acid therapy for treatment of severe cases of haemorrhagic diarrhoea in dogs. © 2018 British Small Animal Veterinary Association.

Gestalt Therapy with Females Involved in Intimate Violence.

ERIC Educational Resources Information Center

Little, Linda F.

This paper notes recent evidence suggesting that couples characterized by violent interactions respond best to therapy when seen first in individual therapy sessions. Clinicians are then presented with a Gestalt therapy approach to intervening in cases of intimate violence that goes beyond crisis intervention. The focus is on the female's roles in…

Integrating Hypnosis with Other Therapies for Treating Specific Phobias: A Case Series.

PubMed

Hirsch, Joseph A

2018-04-01

There is a high prevalence of anxiety disorders including specific phobias and panic disorder in the United States and Europe. A variety of therapeutic modalities including pharmacotherapy, cognitive behavioral therapy, systematic desensitization, hypnosis, in vivo exposure, and virtual reality exposure therapy have been applied. No one modality has been entirely successful. There has been only a limited attempt to combine psychological therapies in the treatment of specific phobias and panic disorder and what has been done has been primarily with systematic desensitization or cognitive behavioral therapy along with hypnotherapy. I present two cases of multiple specific phobias that were successfully treated with hypnotherapy combined with virtual reality exposure therapy or in vivo exposure therapy. The rationale for this integrative therapy and the neurobiological constructs are considered.

[Differential diagnosis and therapy of acute abdomen in sickle cell crisis. A rare case in visceral surgery].

PubMed

Zülke, C; Graeb, C; Rüschhoff, J; Wagner, H; Jauch, K W

2000-01-01

Surgical therapy of the acute abdomen often allows only limited time for differential diagnosis to confirm the indication for surgery. Under consideration of clinical aspects and case history both common and rare causes of an acute abdomen should be investigated without undue loss of time. Differential diagnostic considerations and eventual therapy are presented in the following case of a 25-year-old Afro-american who developed multiorgan failure after an initial course of lower-back pain. In addition to the clinical setting of an acute abdomen the patient presented with acute respiratory failure and laboratory signs of severe hemolysis in combination with newly detected splenomegaly. The indication for splenectomy was made following CT-proven complete splenic infarction due to repeated acute squestration. Histologic examination of the spleen together with hemoglobin electrophoresis confirmed the clinical assumption of unusually late primary manifestation of a sickle cell crisis. In the underlying case, the hemoglobinopathy was in fact the less common form of combined sickle-cell-beta-thalassemia. A ten-day course of intensive care therapy was necessary to treat ongoing multiorgan failure due to persistent sickle cell crisis. Current diagnostic and therapeutic procedures in connection with sickle cell crisis as a rare cause of an acute abdomen with the necessity for surgical intervention are presented.

Pencil Beam Scanning Proton Therapy for Rhabdomyosarcoma of the Biliary Tract.

PubMed

Pater, Luke; Turpin, Brian; Mascia, Anthony

2017-10-05

Rhabdomyosarcoma (RMS) is the most common soft tissue sarcoma of childhood with 250-350 cases diagnosed annually in the United States. Biliary tract rhabdomyosarcoma is rare, representing <1% of the RMS cases. Due to its location, resection is clinically challenging, and functional complications exist and persist from biliary obstruction. The anatomical location of this tumor presents both opportunities and challenges for pencil beam scanning proton therapy. Proton therapy offers a dosimetric and clinical advantage by sparing the healthy liver, stomach, contra-lateral kidney and bowel. Motion management and anatomical variations, such as intestinal filling or weight loss, requiring routine dosimetric evaluation and possible adaptive treatment planning, present challenges for the use of proton therapy. By taking advantage of the superior dose distribution of proton radiation, assessing the impact of tumor and anatomy motion, and performing regular dose evaluations, biliary tract RMS is an ideal diagnosis for pencil beam scanning proton therapy.

Play therapy: a case-based example of a nondirective approach.

PubMed

Lawver, Timothy; Blankenship, Kelly

2008-10-01

Play therapy is a treatment modality in which the therapist engages in play with the child. Its use has been documented in a variety of settings and with a variety of diagnoses. Treating within the context of play brings the therapist and the therapy to the level of the child. By way of an introduction to this approach, a case is presented of a six-year-old boy with oppositional defiant disorder. The presentation focuses on the events and interactions of a typical session with an established patient. The primary issues of the session are aggression, self worth, and self efficacy. These themes manifest themselves through the content of the child's play and narration of his actions. The therapist then reflects these back to the child while gently encouraging the child toward more positive play. Though the example is one of nondirective play therapy, a wide range of variation exists under the heading of play therapy.

Localized severe aggressive periodontitis. Disease progression and tooth preservation: a short case report over 14 years.

PubMed

Pelka, Matthias; Petschelt, Anselm

2009-04-01

A case of a 31-year-old female with aggressive periodontitis over 14 years is presented. From 1993 to 2000, no periodontal therapy occurred; disease development and progression could be reconstructed upon radiographic findings. In 2000, full-mouth disinfection therapy and antibiotic therapy was performed, as well as regenerative surgical treatments. Seven years after surgical treatment, stable periodontal conditions and clear bone regeneration in the surgical areas was evident.

An adult case of mumps brainstem encephalitis.

PubMed

Koyama, S; Morita, K; Yamaguchi, S; Fujikane, T; Sasaki, N; Aizawa, H; Kikuchi, K

2000-06-01

We present an adult case of mumps brainstem encephalitis. He was successfully treated with steroid pulse therapy and recovered completely except for persistent dysuria. He had not been vaccinated and had no history of acute mumps infection. We consider that encephalitis in this case was caused by a reversible autoimmune process triggered by mumps infection. We emphasize the usefulness of pulse therapy for the treatment of some cases of mumps brainstem encephalitis in addition to the importance of mumps vaccination to prevent such a severe complication as encephalitis.

Alphabet Soup: ERP, CT, and ACT for OCD

ERIC Educational Resources Information Center

Tolin, David F.

2009-01-01

The present article comments on the case conference presented in this issue, namely, Himle and Franklin's (Himle & Franklin, 2009) exposure and response prevention (ERP); Chosak and colleagues' (Chosak, Marques, Fama, Renaud, & Wilhelm, 2009) cognitive therapy (CT); and (Twohig, 2009) Acceptance and Commitment Therapy (ACT). Two questions are…

Combined mirror visual and auditory feedback therapy for upper limb phantom pain: a case report

PubMed Central

2011-01-01

Introduction Phantom limb sensation and phantom limb pain is a very common issue after amputations. In recent years there has been accumulating data implicating 'mirror visual feedback' or 'mirror therapy' as helpful in the treatment of phantom limb sensation and phantom limb pain. Case presentation We present the case of a 24-year-old Caucasian man, a left upper limb amputee, treated with mirror visual feedback combined with auditory feedback with improved pain relief. Conclusion This case may suggest that auditory feedback might enhance the effectiveness of mirror visual feedback and serve as a valuable addition to the complex multi-sensory processing of body perception in patients who are amputees. PMID:21272334

C-shaped maxillary permanent first molar: a case report and literature review.

PubMed

Martins, Jorge N R; Quaresma, Sérgio; Quaresma, Maria Carlos; Frisbie-Teel, Jared

2013-12-01

The C-shaped configuration is rare in the upper first molar.The purpose of this article is to present 2 cases diagnosed during endodontic therapy and perform a literature review of this anatomy in the upper first molar. Endodontic therapy was performed by using a dental operating microscope and a cone-beam computed tomography analysis for better understanding of this anatomy. A literature search was conducted to identify and compare all the published cases of C-shaped upper first molar. Before the cases reported in this article, only 5 cases were available in the published literature. Three different types of C-shaped configurations in the upper first molar have been presented. The C-shaped maxillary first molar is a rare anatomic configuration. The use of the dental operating microscope may help in the endodontic therapy of these cases. Three types of C-shaped configurations have been reported; the fusion of the distobuccal root with the palatal root appears to be the most usual one. Copyright © 2013 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

Extreme metabolic alkalosis with fludrocortisone therapy.

PubMed Central

Burns, A.; Brown, T. M.; Semple, P.

1983-01-01

We present an unusual case of extreme metabolic alkalosis resulting from severe hypokalaemia caused by unmonitored fludrocortisone therapy. Biochemical aspects of the disorder are discussed, as is the successful treatment with diuretics and potassium replacement. Some dangers of this therapy and necessary precautions are emphasized. PMID:6622340

Phobic postural vertigo treated with autogenic training: a case report

PubMed Central

Goto, Fumiyuki; Nakai, Kimiko; Kunihiro, Takanobu; Ogawa, Kaoru

2008-01-01

Background Patients suffering from dizziness due to vertigo are commonly encountered in the department of otolaryngology. If various clinical examinations do not reveal any objective findings, then the patients are referred to the department of internal medicine or psychiatry. In many cases, the diagnosis is psychological dizziness. Phobic postural vertigo, which was first reported by Brandt T et al in 1994, is supposed to be a type of psychological dizziness. The diagnosis is based on 6 characteristics proposed by Brandt et al. Patients are usually treated with conventional medical therapy, but some cases may be refractory to such a therapy. Psychotherapy is recommended in some cases; however, psychotherapy including autogenic training, which can be used for general relaxation, is not widely accepted. This paper describes the successful administration of autogenic training in a patient suffering from phobic postural vertigo. Case presentation We present a case of a patient who suffered from phobic postural vertigo. A 37-year-old female complained of dizziness. She had started experiencing dizziness almost 3 years She was intractable to many sort of conventional therapy. In the end, her symptom disappeared after introduction of autogenic training. Conclusion Autogenic training can be a viable and acceptable treatment option for phobic postural vertigo patients who fail to respond to other therapies. This case emphasizes the importance of autogenic training as a method to control symptom of phobic postural vertigo. PMID:18826607

Guillain-Barre syndrome associated with peginterferon alfa-2a for chronic hepatitis C: A case report

PubMed Central

Niazi, Mumtaz A; Azhar, Ashaur; Tufail, Kashif; Feyssa, Eyob L; Penny, Stephen F; McGregory, Marlene; Araya, Victor; Ortiz, Jorge A

2010-01-01

The recommended therapy for chronic hepatitis C (CHC) infection is the combination of a Pegylated interferon and Ribavirin. Almost all such patients on combination therapy experience one or more adverse events during the course of treatment. Significant neurological side effects are rare. A few cases of Bell’s Palsy, chronic inflammatory demyelinating polyneuropathy and even one case of acute demyelinating polyneuropathy with atypical features for Guillain-Barre syndrome (GBS) associated with Interferon therapy have been reported but no report of GBS with typical features has been published. We present a case report of typical GBS associated with Peginterferon alfa-2a and Ribavirin used for treatment of CHC infection. PMID:21160989

A case study from a nursing and occupational therapy perspective - Providing care for a patient with a traumatic brachial plexus injury.

PubMed

Wellington, Beverley; McGeehan, Claire

2015-02-01

This paper presents a case study that demonstrates how collaborative working between professionals enhanced the holistic care for a patient following a traumatic brachial plexus injury. The paper will describe the patient's journey of care from initial presentation, diagnosis and assessment, acute care provision, discharge & rehabilitation to ongoing supportive counselling. The care encompasses input from both a nursing and occupational therapy perspective. Copyright © 2014 Elsevier Ltd. All rights reserved.

Use of Hemadsorption in a Case of Pediatric Toxic Shock Syndrome

PubMed Central

Berkes, Andrea; Szikszay, Edit; Kerényi, Adrienne; Szabó, Tamás; Ujhelyi, László; Bari, Krisztina; Balla, György

2017-01-01

Background Toxic shock syndrome is a potentially fatal toxin-mediated disease. The role of toxins in this clinical entity made us hypothesize that extracorporeal blood purification with CytoSorb® could play a beneficial role in the clinical management of toxic shock syndrome. This case report describes the successful treatment of toxic shock syndrome using a combination of renal replacement therapy and hemadsorption in a pediatric patient. Case Presentation A 5-year-old girl with Down's syndrome presented with an inflamed area surrounding an insect bite, signs of systemic inflammation, and multiple organ failure. As previous attempts of immune modulation therapy were unsuccessful, renal replacement therapy was supplemented by the cytokine absorber CytoSorb. Treatment using this combination was associated with a rapid and significant stabilization in the hemodynamic situation and a decrease in inflammatory mediators within hours after the initiation of therapy. The application of CytoSorb therapy was simple and safe. Conclusion The use of extracorporeal blood purification with CytoSorb proved potentially beneficial by removing toxins and inflammatory mediators in this case and could therefore play a role in the clinical management of toxic shock syndrome. Whether CytoSorb has the potential to even positively influence mortality in patients with toxic shock syndrome still needs to be confirmed. PMID:28791185

Behavioral Experiments in the Treatment of Paranoid Schizophrenia: A Single Case Study

ERIC Educational Resources Information Center

Hagen, Roger; Nordahl, Hans M.

2008-01-01

Since the first description of cognitive therapy of paranoid delusions appeared in the literature, the empirical support for cognitive behavioral therapy in treating psychotic symptoms has been widely established. The aim of the present case study is to show how the behavioral experiment can be used as a powerful tool to change delusional thinking…

Repairing Discordant Student--Teacher Relationships: A Case Study Using Emotion-Focused Therapy

ERIC Educational Resources Information Center

Lander, Itzhak

2009-01-01

This article describes the use of emotion-focused therapy (EFT) to reduce conflict in the student-teacher relationship. A case study of a homeroom teacher and a sixth-grade student is presented. This innovative family treatment model is demonstrated to be a useful tool for improving the student-teacher relational system, resulting in amelioration…

Assessing Outcome in Cognitive Behavior Therapy for Child Depression: An Illustrative Case Series

ERIC Educational Resources Information Center

Eckshtain, Dikla; Gaynor, Scott T.

2009-01-01

Recent meta-analytic data suggest a need for ongoing evaluation of treatments for youth depression. The present article calls attention to a number of issues relevant to the empirical evaluation of if and how cognitive behavior therapy for child depression works. A case series of 6 children and a primary caregiver received treatment--individual…

The Effect of Tomatis Therapy on Children with Autism: Eleven Case Studies

ERIC Educational Resources Information Center

Gerritsen, Jan

2010-01-01

This article presents a reanalysis of a previously reported study on the impact of the Tomatis Method of auditory stimulation on subjects with autism. When analyzed as individual case studies, the data showed that six of the 11 subjects with autism demonstrated significant improvement from 90 hours of Tomatis Therapy. Five subjects did not benefit…

Exploring barriers to remaining physically active: a case report of a person with multiple sclerosis.

PubMed

Zalewski, Kathryn

2007-03-01

Physical therapy intervention for those with chronic disabling conditions typically follows an episode of care approach: therapists provide services when a decrement in functional performance occurs such that individuals require intervention to return to baseline performance. Attention to the psychosocial supports required for successful transition can be unintentionally minimized when the focus of an episode of care follows a change in physical function. The purpose of this case report is to present and discuss the challenges to successful community reintegration following physical therapy intervention with an emphasis on developing independent exercise habits in management of a person with multiple sclerosis. RW, presented in this case study, is a 52-year-old man diagnosed with progressive multiple sclerosis five years before self-referral to a pro bono physical therapy clinic.

Fast Food Art, Talk Show Therapy: The Impact of Mass Media on Adolescent Art Therapy

ERIC Educational Resources Information Center

Potash, Jordan S.

2009-01-01

Electronic media provides rapid delivery and unlimited access to pictures, sounds, and information. The ubiquitous presence of techno-digital culture in the lives of today's adolescents may influence or contaminate the art therapy process. This article presents two case studies that illustrate how cyberspace entered into art therapy sessions and…

Therapeutic uses of the WebCam in child psychiatry.

PubMed

Chlebowski, Susan; Fremont, Wanda

2011-01-01

The authors provide examples for the use of the WebCam as a therapeutic tool in child psychiatry, discussing cases to demonstrate the application of the WebCam, which is most often used in psychiatry training programs during resident supervision and for case presentations. Six cases illustrate the use of the WebCam in individual and family therapy. The WebCam, used during individual sessions, can facilitate the development of prosocial skills. Comparing individual WebCam video sessions can help to evaluate the effectiveness of medication and progress in therapy. The WebCam has proven to be useful in psycho-education, facilitating communication, and treating children and families. The applications of this technology may include cognitive-behavioral therapy, dialectical-behavioral, and group therapy.

Laser induced thermal therapy (LITT) for pediatric brain tumors: case-based review

PubMed Central

Riordan, Margaret

2014-01-01

Integration of Laser induced thermal therapy (LITT) to magnetic resonance imaging (MRI) have created new options for treating surgically challenging tumors in locations that would otherwise have represented an intrinsic comorbidity by the approach itself. As new applications and variations of the use are discussed, we present a case-based review of the history, development, and subsequent updates of minimally invasive MRI-guided laser interstitial thermal therapy (MRgLITT) ablation in pediatric brain tumors. PMID:26835340

The case for therapeutic positivism in head and neck malignancy.

PubMed

Woods, J E

1980-10-01

A negative attitude toward the treatment of advanced malignancy of the head and neck is frequently encountered. Aggressive therapy, at least for certain patients, is reasonable, and the assessment of certain factors in choosing candidates for such therapy is important. Illustrative case presentations demonstrate that a meaningful number of patients receive palliation or even cure with radical therapy. In view of the grim choices, it seems appropriate to take a positive, if radical, approach when the patient is highly motivated.

Rescue of Graves Thyrotoxicosis-Induced Cholestatic Liver Disease Without Antithyroid Drugs: A Case Report.

PubMed

Yan, Lily D; Thomas, Dylan; Schwartz, Michael; Reich, Jason; Steenkamp, Devin

2017-03-01

Graves thyrotoxicosis rarely presents with painless jaundice resulting from hyperthyroidism-associated hepatotoxicity, without preexisting liver disease. Management in patients with this presentation is challenging, given that the thionamides, methimazole and propylthiouracil, have both been associated with drug-induced liver injury. Radioactive iodine ablation and thyroidectomy are well-established alternatives, but each have their associated risks and contraindications. We present an unusual case of severe hyperthyroidism-associated hepatotoxicity, in which adjuvant therapies, including glucocorticoids, saturated solution of potassium iodide, and cholestyramine, were used as a bridge to definitive therapy with thyroidectomy.

An unusual pathogen in ambulatory care: two cases of Scedosporium soft tissue infections presenting as "unresponsive cellulitis".

PubMed

Misselbrook, Gary Peter; Lillie, Patrick; Thomas, Claire P

2016-01-01

Soft tissue infections with Scedosporium spp. are an uncommon but serious and emerging cause of infection in immunocompromised patients. Acute Medical Units (AMUs) in the UK are increasingly managing patients with cellulitis in an outpatient setting, therefore acute physicians should be aware of some of the more uncommon causes of soft tissue infection, particularly in patients not responding to initial antibiotic therapy. We present two cases of Scedosporium presenting to the AMU as cellulitis not responding to initial antibiotic therapy and outline the assessment and management of this important condition.

Case Series of an Intraoral Balancing Appliance Therapy on Subjective Symptom Severity and Cervical Spine Alignment

PubMed Central

Lee, Young Jun; Lee, Joo Kang; Jung, Soo Chang; Lee, Hwang-woo; Yin, Chang Shik; Lee, Young Jin

2013-01-01

Objective. The objective of this study was to investigate the effect of a holistic intraoral appliance (OA) on cervical spine alignment and subjective symptom severity. Design. An observational study on case series with holistic OA therapy. Setting. An outpatient clinic for holistic temporomandibular joint (TMJ) therapy under the supervision of the Pain Center, CHA Biomedical center, CHA University. Subjects. Ambulatory patients presenting with diverse chief complaints in the holistic TMJ clinic. Main Measures. Any immediate change in the curvature of cervical spine and the degree of atlantoaxial rotation was investigated in the images of simple X-ray and computed tomography of cervical spine with or without OA. Changes of subjective symptom severity were also analyzed for the holistic OA therapy cases. Results. A total of 59 cases were reviewed. Alignment of upper cervical spine rotation showed an immediate improvement (P < 0.001). Changes of subjective symptom severity also showed significant improvement (P < 0.05). Conclusion. These cases revealed rudimentary clinical evidence that holistic OA therapy may be related to an alleviated symptom severity and an improved cervical spinal alignment. These results show that further researches may warrant for the holistic TMJ therapy. PMID:23935655

Antitumor Necrosis Factor-α Therapy Associated with Inflammatory Bowel Disease: Three Cases and a Systematic Literature Review.

PubMed

Bieber, Amir; Fawaz, Abdallah; Novofastovski, Irina; Mader, Reuven

2017-07-01

Antitumor necrosis factor-α (anti-TNF-α) therapy is the most prescribed biologic agent therapy in rheumatology and gastroenterology. However, a number of serious side effects have been reported with these drugs. Only a handful of cases of new-onset inflammatory bowel disease (IBD), mostly in children diagnosed with juvenile idiopathic arthritis (JIA), have been reported during anti-TNF-α therapy. We present 3 cases of adult IBD following anti-TNF-α therapy and a literature review on this topic. We searched PubMed MESH for all relevant terms, papers were reviewed, and patient-specific data were extracted. Relevant clinical data were calculated and presented. The PubMed search resulted in 137 articles, of which 11 articles and 4 cited publications were included in our analysis. We found 53 cases of IBD after anti-TNF-α therapy reported in the literature; most of them were case series collected retrospectively from national databases or studies. Almost all the patients developed IBD after the introduction of etanercept (ETN); 2 patients with rheumatoid arthritis were also included. The average age at IBD onset was 17.3 years and the average time from ETN introduction to IBD onset was 27 months (± 24). Gastrointestinal symptoms have been reported as improving or subsiding in most of the patients after discontinuing ETN. Although this manifestation is not common, it should be taken into consideration as an adverse effect of ETN. Rheumatologists, and in particular rheumatologists treating adult patients, should be aware of this possible complication. Further investigation about the pathogenic process underlying this phenomenon is warranted.

Safety and Efficacy of Endoscopic Therapy for Nonmalignant Duodenal Duplication Cysts: Case Report and Comprehensive Review of 28 Cases Reported in the Literature.

PubMed

Gjeorgjievski, Mihajlo; Manickam, Palaniappan; Ghaith, Gehad; Cappell, Mitchell S

2016-05-01

Analyze efficacy, safety of endoscopic therapy for duodenal duplication cysts (DDC) by comprehensively reviewing case reports.Tandem, independent, systematic, computerized, literature searches were performed via PubMed using medical subject headings or Keywords "cyst" and "duodenal" and "duplication"; or "cyst", and "endoscopy" or "endoscopic", and "therapy" or "decompression"; with reconciliation of generated references by two experts. Case report followed CARE guidelines.Literature review revealed 28 cases (mean = 1.3 ± 1.2 cases/report). Endoscopic therapy is increasingly reported recently (1984-1999: 3 cases, 2000-2015: 25 cases, P = 0.003, OR = 8.33, 95%-CI: 1.77-44.5). Fourteen (54%) of 26 patients were men (unknown-sex = 2). Mean age = 32.2 ± 18.3 years old. Procedure indications: acute pancreatitis-16, abdominal pain-8, jaundice-2, gastrointestinal (GI) obstruction-1, asymptomatic cyst-1. Mean maximal DDC dimension = 3.20 ± 1.53 cm (range, 1-6.5 cm). Endoscopic techniques included cyst puncture via needle knife papillotomy (NKP)/papillotome-18, snare resection of cyst-7, cystotome-2, and cyst needle aspiration/ligation-1. Endoscopic therapy was successful in all cases. Among 24 initially symptomatic patients, all remained asymptomatic post-therapy without relapses (mean follow-up = 36.5 ± 48.6 months, 3 others reported asymptomatic at follow-up of unknown duration; 1 initially asymptomatic patient remained asymptomatic 3 years post-therapy). Two complications occurred: mild intraprocedural duodenal bleeding related to NKP and treated locally endoscopically.A patient is reported who presented with vomiting, 15-kg-weight-loss, and profound dehydration for 1 month from extrinsic compression of duodenum by 14 × 6 cm DDC, underwent successful endosonographic cyst decompression with large fenestration of cyst and endoscopic aspiration of 1 L of fluid from cyst with rapid relief of symptoms. At endoscopy the DDC was intubated and visualized and random endoscopic mucosal biopsies were obtained to help exclude malignant or dysplastic DDC.Study limitations include retrospective literature review, potential reporting bias, limited patient number, variable follow-up.In conclusion, endoscopic therapy for DDC was efficacious in all 29 reported patients including current case, including patients presenting acutely with acute pancreatitis, or GI obstruction. Complications were rare and minor, suggesting that endoscopic therapy may be a useful alternative to surgery for nonmalignant DDC when performed by expert endoscopists.

The use of child-centered play therapy and filial therapy with Head Start families: a brief report.

PubMed

Johnson, L; Bruhn, R; Winek, J; Krepps, J; Wiley, K

1999-04-01

Play therapy and filial therapy show promise as effective ways to provide direct services to Head Start, addressing the needs of the children, the families, and the Head Start teachers and staff. This paper examines the utility of play and filial therapies for the Head Start population, presents a systemic explanation for the benefit of filial therapy, and provides a case example for illustration.

Hyperbaric oxygen therapy as treatment for bilateral arm compartment syndrome after CrossFit: case report and literature review.

PubMed

Mendes, Adriano Fernando; Neto, José da Mota; Heringer, Erica Maciel; de Simoni, Leandro Furtado; Pires, Diego Demolinari; Labronici, Pedro José

2018-01-01

CrossFit is a physical fitness program characterized by high-intensity workouts that can be associated with serious injury. Acute compartment syndrome in the upper limbs is a rare occurrence. It may occur after intense physical exercise, and its usual treatment is surgical. Hyperbaric oxygen therapy is a treatment described as adjunctive in cases of compartmental syndrome. We describe the case of a CrossFit practitioner who, after intense training, developed progressive symptoms of rhabdomyolysis and acute bilateral arm compartment syndrome, who was successfully treated with hyperbaric oxygen therapy and required no fasciotomy as surgical treatment. Acute compartment syndrome in the arms after intense physical exercise is a rare occurrence that should be suspected by practitioners of physical activity experiencing intense, disproportionate and progressive pain. In the case presented, hyperbaric oxygen therapy was successfully used in the treatment of the disorder, with satisfactory progress, and without the need for a surgical fasciotomy as therapy. Copyright© Undersea and Hyperbaric Medical Society.

Pain therapy with oxycodone/naloxone prolonged-release combination: case report.

PubMed

Błaszczyk, Feliks; Droń, Aleksandra

2013-01-01

Pain afflicts patients suffering from many chronic diseases and is present in 80% of cases of patients with advanced cancer who suffer from persistent pain. The aim of the pain treatment is to achieve the maximum analgesic effect while minimizing side effects. The main analgesic agent - morphine is unfortunately a therapy associated with gastrointestinal side effects. It appears that the combination of oxycodone and naloxone available as Targin(®) (Mundipharma) is an alternative. The paper presents a case of a 45-year-old patient who was treated effectively with oxycodone/naloxone prolonged-release tablets. This treatment has proven to be effective in providing pain and constipation control.

Clinical feature and management of immune thrombocytopenic purpura in a tertiary hospital in Northwest Nigeria

PubMed Central

Hassan, Abdulaziz; Adebayo, Adeshola; Musa, Abubakar Umar; Suleiman, Aishatu Maude; Ibrahim, Ismaila Nda; Kusfa, Ibrahim Usman; Aminu, Mohammed Sirajo

2017-01-01

Background: Immune thrombocytopenic purpura (ITP) is a rare bleeding disorder that may remit spontaneously. Life-threatening bleeding may require transfusion support, steroids, and other immunosuppressive therapy or splenectomy. Objective: To review the clinical presentation and laboratory features of ITP at Ahmadu Bello University Teaching Hospital (ABUTH), Zaria, Nigeria. Subjects and Methods: A retrospective analytic study of case notes and bone marrow (BM) records of patients diagnosed with ITP at Haematology Department, ABUTH, Zaria, from January 1, 2004, to December 31, 2012. Results: There were nine cases (six females, three males), aged 6–20 (mean 11.11) years. The presentations were epistaxis 8 (88.9%), purpura 4 (44.4%), gum bleeding 4 (44.4%), menorrhagia 2 (22.2%), and intracranial hemorrhage (ICH) 1 (11.1%). Only 1 (11.1%) had clinical splenomegaly. Platelet count of <20 × 109/L was found in 4 (44.4%) while 6 (66.7%) had packed cell volume of <25%. All the nine cases had BM megakaryocytic hyperplasia. Six patients had blood transfusion support while 7 (77.8%) patients received oral prednisolone therapy with time to cessation of bleeding of 12–16 (mean of 8) weeks. One case had spontaneous remission while another had anti-D due to relapse after steroid therapy; this resulted in transient rise in platelet counts. None had other immunosuppressive therapy or splenectomy. Six (66.7%) cases were lost to follow-up after achieving remission and one died of ICH. Conclusion: ITP is not common in our center though its clinical presentations are varied. However, prednisolone and blood transfusion therapy are central to the management of these patients with favorable outcome. PMID:29269984

Medicinal Leech Therapy for Glans Penis Congestion After Primary Bladder Exstrophy-Epispadias Repair in an Infant: A Case Report.

PubMed

Wagenheim, Gavin N; Au, Jason; Gargollo, Patricio C

2016-01-01

Many postoperative complications have been reported after repair of classic bladder exstrophy. We present a case of medicinal leech therapy for glans penis congestion following exstrophy repair in an infant. A 2-week-old male with classic bladder exstrophy underwent complete primary repair. On postoperative day 1, he developed rapidly worsening glans penis venous congestion. Medicinal leech therapy was instituted with antibiotics and blood transfusions to maintain a hematocrit >30%. After 24 hours, venous congestion improved and therapy was discontinued. The patient's remaining hospital course was uncomplicated. Medicinal leeches are an effective therapy to relieve glans penis venous congestion. Copyright © 2015 Elsevier Inc. All rights reserved.

ELECTRO CONVULSIVE THERAPY IN PRE-PUBERTAL CATATONIA: A CASE STUDY

PubMed Central

Thakur, Anupam; Dutta, S.; Jagadheesan, K.; Sinha, Vinod Kumar

2001-01-01

Depression in prepubertal age group is a relatively rare condition. The presence of life threatening catatonic features call for aggressive treatment. Electro convulsive therapy (ECT) has been described to be effective in these circumstances; however, doubts have been raised about its safety profile. This present case study illustrates the efficacy and safety of ECT in prepubertal catatonia. PMID:21407888

L-DOPA therapy interferes with urine catecholamine analysis in children with suspected neuroblastoma: a case series.

PubMed

Kelly, Alison U; Srivastava, Rajeev; Dow, Ellie; Davidson, D Fraser

2017-09-01

Neuroblastoma is the most common solid extracranial malignancy diagnosed in childhood. Clinical presentation is variable, and metastatic disease is common at diagnosis. Analyses of urinary catecholamines and their metabolites are commonly requested as a first-line investigation when clinical suspicion exists. Levodopa (L-Dopa) therapy is utilized as a treatment for a number of disorders in childhood, including Dopa-responsive dystonia. Neuroblastoma may mimic some of the clinical features of this disorder. L-Dopa can interfere with analysis of urinary catecholamines and their metabolites and complicate the interpretation of results. We present the cases of three children who were prescribed L-dopa at the time of analysis of urinary catecholamines and metabolites as a screen for neuroblastoma, but who did not have the disease. Comparison of their results with those from cases with true neuroblastoma reveal that it is impossible to reliably distinguish true neuroblastoma from L-Dopa therapy using these tests. We recommend that patients should be off L-dopa therapy, if possible when these tests are performed. These cases illustrate the importance of providing clinical details and drug history to the laboratory in order to avoid diagnostic confusion.

Chronic cutaneous lupus erythematosus presenting as periorbital edema and erythema.

PubMed

Cyran, S; Douglass, M C; Silverstein, J L

1992-02-01

We report two unusual cases of cutaneous lupus erythematosus presenting as dramatic eyelid edema and erythema. Neither patient had evidence of systemic or other significant cutaneous involvement. The eyelid edema and erythema were unilateral in one case and bilateral in the other. Both cases responded to therapy with antimalarial drugs.

A Bold Perspective on Counseling with Couples and Families: An Interview with Arnold A. Lazarus.

ERIC Educational Resources Information Center

Christensen, Teresa M.

2001-01-01

Illuminates a collaborative effort between the author and Dr. Arnold A. Lazarus, an internationally known presenter, author, and therapist. Many consider Lazarus to be a pioneer of behavior therapy and brief psychotherapy. Presents details about his unique perspective regarding therapy with couples and families. Provides case examples that…

The Use of Music Therapy During the Treatment of Cancer Patients: A Collection of Evidence

PubMed Central

Boyde, Constance; Linden, Ulrike; Boehm, Katja

2012-01-01

Background: Music therapy is one of the oldest forms of creative art therapy and has been shown to have effects in different clinical and therapeutic settings, such as schizophrenia, pain, cardiovascular parameters, and dementia. This article provides an overview of some of the recent findings in this field and also reports two single case vignettes that offer insight into day-to-day applications of clinical music therapy. Material and Methods: For the collection of clinical studies of music therapy in oncology, the databases AMED, CAIRSS, EMBASE, MEDLINE, PsychINFO, and PSYNDEX were searched with the terms “Study OR Trial” AND “Music Therapy” AND “Cancer OR Oncolog$.” Studies were analyzed with respect to their design, setting and interventions, indications, patients, and outcomes. In addition, two case vignettes present the application of music therapy for a child with leukemia and an adult patient with breast cancer. Results: We found a total of 12 clinical studies conducted between 2001 and 2011 comprised of a total of 922 patients. Eight studies had a randomized controlled design, and four studies were conducted in the field of pediatric oncology. Studies reported heterogeneous results on short-term improvements in patients' mood and relaxation and reduced exhaustion and anxiety as well as in coping with the disease and cancer-related pain. Case descriptions showed similar effects in expressing emotions, opening up new goals, and turning the mind toward a healthy process and away form a disease-centered focus. Conclusion: The use of music therapy in the integrative treatment of cancer patients is a therapeutic option whose salutogenetic potential is shown in many case studies such as those presented here. Study results, however, did not draw a conclusive picture of the overall effect of music therapy. In addition to further clinical trials, the evidence mosaic should be complemented with qualitative studies, single case descriptions, and basic research. PMID:27257528

Carcinoma of penis. Review of cases treated by surgery and radiation therapy 1960-1977

DOE Office of Scientific and Technical Information (OSTI.GOV)

Krieg, R.M.; Luk, K.H.

1981-08-01

Cases of squamous cell carcinoma of the penis treated by surgery and radiation therapy at Moffitt Hospital, University of California, and Mount Zion Hospital and Medical Center are reviewed. Only cases followed for more than three years or with autopsy findings are presented. For the primary lesion, over-all surgical control rate locally was 15/17 or 88 per cent. Over-all control rate with radiation therapy alone was 9/12 (75 per cent), and with surgical salvage 11/12 (92 per cent). Radiation therapy appears to be the treatment of choice for early stage lesions, reserving surgery for salvage. Prophylactic ilioinguinal lymph node dissectionmore » for N0 lesions is not warranted. The role of chemotherapy needs further investigation.« less

Treating a Sex Addict Through Marital Sex Therapy.

ERIC Educational Resources Information Center

Sprenkle, Douglas H.

1987-01-01

Views treatment of sexual addiction within context of addiction and family therapy. Presents a case of sexual addiction and explicates an intervention model which emphasizes the importance of family participation in the treatment. (Author/NB)

Staphylococcus aureus Prostatic abscess: a clinical case report and a review of the literature.

PubMed

Carroll, David E; Marr, Ian; Huang, G Khai Lin; Holt, Deborah C; Tong, Steven Y C; Boutlis, Craig S

2017-07-21

Prostatic abscess is a rare complication of acute bacterial prostatitis and is most commonly caused by Enterobacteriaceae. We report on a case of prostatic abscess caused by Staphylococcus aureus and conduct a review of the literature. We present a case of S. aureus prostatic abscess that was successfully treated with a combination of antibiotic and surgical therapy. The isolate was non–multidrug-resistant, methicillin-resistant Staphylococcus aureus and was genotyped as clonal complex 5, an emerging regional clone that is trimethoprim resistant and Panton-Valentine leukocidin positive. This current case report is the first to describe the use of clindamycin step-down therapy. A literature review identified a further 39 cases of S. aureus prostatic abscesses, of which 26 were methicillin resistant. S. aureus is an uncommon cause of prostatic abscess. Optimal management includes both antibiotic therapy and surgical drainage. Our use of clindamycin as step-down therapy was guided by its excellent prostatic penetration.

Reversible Hypokalemia and Bartter-Like Syndrome during Prolonged Systemic Therapy with Colistimethate Sodium in an Adult Patient.

PubMed

Kamal Eldin, Tarek; Tosone, Grazia; Capuano, Alfredo; Orlando, Raffaele

2017-12-01

We present the case of a 58-year-old woman who developed hypokalaemia and metabolic alkalosis 2 weeks after therapy with colistimethate sodium for the treatment of chronic lower limb ulcer infection by extensively drug-resistant (XDR) Pseudomonas aeruginosa. The metabolic changes observed resembled Bartter syndrome, a group of congenital disorders affecting the distal segments of the renal tubules. The metabolic abnormalities reversed spontaneously 6 days after drug discontinuation. Acquired forms of Bartter syndrome have been reported during courses of antibiotic therapy; however, to our knowledge, this is the first documented case associated with colistimethate therapy in an adult.

Radiofrequency-induced thermotherapy of nasopharyngeal angiofibroma and immunohistochemical analysis of vessel proliferation: a case report

PubMed Central

Krstulja, Mira; Kujundžić, Milodar; Halaj, Adelaida; Braut, Tamara; Cvjetković, Niko

2008-01-01

Introduction Nasopharyngeal angiofibroma presents with symptoms of nasal obstruction and epistaxis. The treatment of choice is embolization followed by surgery. Case presentation A 52-year-old man underwent surgery for nasopharyngeal angiofibroma after adjuvant radiofrequency-induced thermotherapy. To the best of the authors' knowledge, this is the first case of angiofibroma with clinical follow-up after thermocoagulation therapy supported by quantitative, double immunohistochemistry. We found this case of angiofibroma to be of interest owing to the presentation of symptoms leading to biopsy, the pathohistological observations obtained with synchronous Ki67/cluster of differentiation 34 and Ki67/smooth muscle actin immunohistochemistry and high pericyte proliferation. Conclusion Coagulation of angiofibroma vessels followed by acquisition of a thick mantle of pericytes in a patient with a nasopharyngeal growth suggests that radiofrequency-induced thermotherapy could be a useful, palliative therapy for bleeding nasopharyngeal angiofibroma, supporting vessel maturation prior to surgical tumor removal. PMID:18706100

The Use of Electroconvulsive Therapy in Atypical Psychotic Presentations

PubMed Central

Vasu, Devi

2007-01-01

Convulsive therapy and its progeny, electroconvulsive therapy (ECT), were originally used for the treatment of catatonic schizophrenia, and there is little doubt that ECT remains an effective intervention for the treatment of schizophrenia. However, current practice tends to favor the use of ECT in severe or treatment refractory affective disorders, and its use in schizophrenia and other nonaffective (atypical) psychotic disorders has become controversial. Case reports have suggested a role for ECT in two specific atypical psychotic disorders: Cotard's syndrome and cycloid psychosis. In this article, we review the atypical psychotic disorders and report a series of five case examples that signify the role of ECT in atypical psychotic presentations, particularly when the symptoms resemble those found in Cotard's syndrome and cycloid psychosis. PMID:20428309

DOE Office of Scientific and Technical Information (OSTI.GOV)

Kozaki, T.; Iwama, M.; Mori, M.

Method of radiotherapy, dose, clinical symptoms, peripheral blood findings, and results of serum biochemical examination for nine infantile patients are discussed. Nine cases were composed of three cases of embryonal cell carcinoma, two of Wilm's tumor, and each one case of bone metastasis of neuroblastoma, histocytosis X, lymphosarcoma, and hepatoblastoma. High-voltsge roentgen therapy of 100 KVP was carried out in two cases, and Linac x-ray therapy In eight cases. Dose ranged from 1000 to 4000 R and days of irradiation ranged from 5 to 54 days. rt was dffficult to distinguish between radiotoxemia and side effect due to irradiation becausemore » there were many relatively severe cases although there was not any case that needed discontinuation of rodiotherapy. After irradiation, fatigue was recognized in four cases, anorexia in four cases, nausea and vomiting in three cases, and weight loss in two cases, but an attack of fever, diarrhea, and proteinuria were not recognized in any case. Peripheral blood finding and serum biochemical examination were carried out before radiotherapy, in two weeks after beginning of radiotherapy and in two weeks after finishlng of radiotherapy. The greater port of cases showed a slight decrease of leukocyte count. Although there was a case in which neutrophils out of leukocyte tended to increase after finishing of therapy, lymphocyte count had a tendency to decrease since beginning of therapy and its recovery was not recognized for a short time after finishing of irradiatlon. With respect to serum biochemical examination, only a little elevation of GOT and GPT was recognized in one case of bone metastasis of neuroblastoma treated with high voltage roentgen therspy in two weeks after beginning of irradiation. Two cases of Wilm's tumor showed eosinophilia in response to enforcement of irradiation. Diagnosis, chief complaints, past medical history, present illness, present condition, and physical examination results on admission of each case were also added. (JA)« less

A case of catatonia in a 14-year-old girl with schizophrenia treated with electroconvulsive therapy.

PubMed

Häßler, Frank; Reis, Olaf; Weirich, Steffen; Höppner, Jacqueline; Pohl, Birgit; Buchmann, Johannes

2013-01-01

This article presents a case of a 14-year-old female twin with schizophrenia who developed severe catatonia following treatment with olanzapine. Under a combined treatment with amantadine, electroconvulsive therapy (ECT), and (currently) ziprasidone alone she improved markedly. Severity and course of catatonia including treatment response were evaluated with the Bush-Francis Catatonia Rating Scale (BFCRS). This case report emphasizes the benefit of ECT in the treatment of catatonic symptoms in an adolescent patient with schizophrenic illness.

Innovative Moments in Grief Therapy: Reconstructing Meaning Following Perinatal Death

ERIC Educational Resources Information Center

Alves, Daniela; Mendes, Ines; Goncalves, Miguel M.; Neimeyer, Robert A.

2012-01-01

This article presents an intensive analysis of a good outcome case of constructivist grief therapy with a bereaved mother, using the Innovative Moments Coding System (IMCS). Inspired by M. White and D. Epston's narrative therapy, the IMCS conceptualizes therapeutic change as resulting from the elaboration and expansion of unique outcomes (or as we…

Secondary prevention of cervical cancer part 3: evidence-based management of women with cervical intraepithelial neoplasia.

PubMed

Guido, Richard; Lonky, Neal M; Diedrich, Justin

2014-06-01

The management of cervical intraepithelial neoplasia has evolved over the last 20 years. Observation has replaced aggressive therapy in many cases. Evidence based guidelines now guide therapy. This chapter presents an overview of various treatment options, as well as the most recent guidelines of therapy.

[The modern therapy of lyme disease].

PubMed

Garlicki, Aleksander

2007-01-01

The modern therapy of Lyme disease, including newest Guidelines of the Infectious Diseases Society of America has been presented. Poland is endemic region for borreliosis and number of reported cases have been increasing rapidly. Newest guidelines should help doctors, not only infectious disease specialist, but especially General Practicioners, solve problems assiciated with therapy of Lyme disease.

DRESS syndrome due to antibiotic therapy of osteoarticular infections in children: two case reports.

PubMed

Ramírez, A; Abril, J C; Cano, J

2015-01-01

Osteoarticular infection in children frequently occurs before 10 years of age. Surgical drainage is sometimes required, whereas acute osteomyelitis can be treated with antibiotic therapy alone. The duration of antibiotic therapy varies, 2 weeks is sufficient for septic arthritis, whereas 6 weeks is often required for complicated cases. Some of these antibiotic drugs present direct complications with low clinical impact in certain individuals. Hypersensitivity to these drugs causes different reactions in children. DRESS syndrome (Drug Reaction with Eosinophilia and Systemic Symptoms) is a severe and potentially life-threatening drug reaction. It is characterised by high fever, malaise, lymphadenopathy and skin rash. From a clinical perspective, these symptoms can lead to an exacerbation of the initial infectious process for which treatment was commenced. The liver is the organ most often affected in DRESS syndrome associated with haematological changes, potentially similar to sepsis. We present two cases of children with osteoarticular infections who developed DRESS syndrome after antibiotic therapy. Both patients made a complete recovery after cessation of the antibiotic drugs used. Copyright © 2014 SECOT. Published by Elsevier Espana. All rights reserved.

The surgical treatment of chronic pancreatitis: a clinical series of 17 cases.

PubMed

Vasile, D; Ilco, A; Popa, D; Belega, A; Pana, S

2013-01-01

Despite the fact that in the last few years, new invasive non-surgical therapies were introduced, surgical treatment of chronic pancreatitis still plays an important part.The aim of the study is to evaluate pain remission and quality of life after surgical approach. We present 17 cases of chronic pancreatitis that were operated between 2007-2011. Surgical treatment was decided for after the failure of pain control therapy (14 cases)and by the suspicion of cancer in the head of the pancreas (3 cases). Imaging data for all the cases, CT-CE and ERCP, guided us in choosing the right therapy. Surgical techniques performed were pancreatico-jejunostomy (PJ) in eleven cases and duodenopancreatectomy(DP) in six cases. Good pain control was achieved in 10 patients: 6-PJ and 4-DP. Moderate results were observed in 4 cases: 2-PJ and 2-DP. In 3 patients symptoms remained the same. There is no consensus over the surgical treatment in chronic pancreatitis. Surgical approach, strongly motivated and personalised for each patient is followed by good results. It is possible that in the future, limited resections become the therapy of choice, replacing classic ones. Celsius.

Central nervous system vasculitis caused by propylthiouracil therapy: a case report and literature review.

PubMed

Vanek, C; Samuels, M H

2005-01-01

Antineutrophil cytoplasmic antibodies (ANCA) are associated with vasculitis, including vasculitis induced by drugs such as the thionamides. The affected organ systems in thionamide-induced vasculitis have been primarily renal, musculoskeletal, and dermatologic. We describe the first case of thionamide-induced central nervous system vasculitis presenting as confusion, with complete resolution after discontinuation of propylthiouracil. We review the literature and summarize 42 additional cases of thionamide-induced ANCA-positive vasculitis since 1992. Propylthiouracil was responsible in 93% of cases and the predominant ANCA pattern on immunofluorescent staining was perinuclear (p-ANCA). Clinical improvement occurred after drug discontinuation in 93%, steroid therapy was used in some cases. The mean duration of treatment with thionamides was 35 months prior to presentation. Long-term medical treatment with thionamides for hyperthyroidism may increase the risk of this severe side effect.

Vocal fold hemorrhage associated with coumadin therapy in an opera singer.

PubMed

Neely, J L; Rosen, C

2000-06-01

Vocal fold hemorrhage can represent a disastrous and potentially career ending injury to a singer or professional voice user. The risk factors of vocal fold hemorrhage, including laryngeal trauma, phonotrauma, aspirin and nonsteroidal antiinflammatories, and hormonal imbalances are well known. We present a case of an opera singer who developed recurrent vocal fold hemorrhage associated with coumadin anticoagulation therapy. This case highlights the importance of the risk of vocal fold hemorrhage to professional singers and professional voice users and offers an alternative to long-term coumadin therapy in this select population.

Topic-Focused Analysis of Verbal Interaction in a Case of Integrative Therapy with a Young Woman Presenting with Symptoms of Depression

ERIC Educational Resources Information Center

Reichelt, Sissel; Skjerve, Jan; McLeod, John

2017-01-01

It is increasingly recognised that single-case analysis makes a valuable contribution to the evidence base for psychotherapy, alongside other methodologies. Such analyses make it possible to investigate the unfolding process of change in therapy, and develop an understanding of change factors that contribute to outcome. One of the key challenges…

Histologically-Proven Efficacy of Bland Embolization in a Patient with Net Liver Metastasis

DOE Office of Scientific and Technical Information (OSTI.GOV)

Monfardini, Lorenzo, E-mail: lorenzo.monfardini@poliambulanza.it, E-mail: lorenzo.monfardini@ieo.it; Varano, Gianluca Maria; Foà, Riccardo

2016-06-15

We present a case of 57-year-old patient with three liver metastases from a primary neuroendocrine duodenal tumor, who underwent bland embolization with excellent response to therapy, followed by surgical resection. The purpose of our case report is to describe the histological characteristics of tumoral response to therapy after bland embolization focusing on intralesional necrosis and microsphere distribution.

Parent-Child Interaction Therapy for Children Born Premature: A Case Study and Illustration of Vagal Tone as a Physiological Measure of Treatment Outcome

ERIC Educational Resources Information Center

Bagner, Daniel M.; Sheinkopf, Stephen J.; Miller-Loncar, Cynthia L.; Vohr, Betty R.; Hinckley, Matthew; Eyberg, Sheila M.; Lester, Barry M.

2009-01-01

Evidence-based psychosocial interventions for externalizing behavior problems in children born premature have not been reported in the literature. This single-case study describes Parent-Child Interaction Therapy (PCIT) with a 23-month-old child born at 29 weeks gestation weighing 1,020 grams, who presented with significant externalizing behavior…

[Ego-state Therapy: Psychotherapy for Multiple Personality Disorders].

PubMed

Sugiyama, Toshiro

2018-01-01

The author describes ego-state therapy. This psychotherapy is used for treating multiple personality disorders. The author mentions the theoretical background of this method, and practical points. Initially, ego-state therapy was developed as a type of hypnotherapy, but it evolved as a safe therapeutic method in combination with trauma processing therapies. The author presents a case study, and discusses the clinical significance of this treatment.

Pain therapy with oxycodone/naloxone prolonged-release combination: case report

PubMed Central

Droń, Aleksandra

2013-01-01

Pain afflicts patients suffering from many chronic diseases and is present in 80% of cases of patients with advanced cancer who suffer from persistent pain. The aim of the pain treatment is to achieve the maximum analgesic effect while minimizing side effects. The main analgesic agent – morphine is unfortunately a therapy associated with gastrointestinal side effects. It appears that the combination of oxycodone and naloxone available as Targin® (Mundipharma) is an alternative. The paper presents a case of a 45-year-old patient who was treated effectively with oxycodone/naloxone prolonged-release tablets. This treatment has proven to be effective in providing pain and constipation control. PMID:24592131

Multimodal Counseling of Childhood Encopresis: A Case Example.

ERIC Educational Resources Information Center

Gumaer, Jim

1990-01-01

Provides information regarding childhood disorder of encopresis and presents multimodal therapy techniques for school counselors who cannot successfully refer clients. Presents a case study of a teenage boy suffering from encopresis who was referred for counseling. Suggests specific treatment strategies including behavior modification, nutrition…

[The clinical effect of combination therapy for oral cancer with S-1, superselective intra-arterial chemotherapy, and radiation therapy].

PubMed

Yamamoto, Chika; Yoshikawa, Hiromasa; Fukumoto, Shunsuke; Higuchi, Takashi; Yoshida, Masanori; Horinouchi, Yasufumi; Uehara, Satoru; Yasumori, Koutarou

2011-12-01

Combination therapy with S-1, superselective intra-arterial infusion of CBDCA and radiation therapy has been used to treat patients with oral cancer since 2005. In this study, the histopathological effects and toxicities following concurrent chemoradiotherapy were examined. The subjects consisted of 15 patients (10 men and 5 women) who were treated with S-1 (60-80 mg/day, 4 weeks), superselective intra-arterial infusion of CBDCA (300 mg/body) and radiation therapy (total dose 30-36 Gy) in our department from 2005 to 2009. Nine patients, showed T2 disease, 3 showed T3 disease, and another 3 showed T4 diseases. The primary cancer sites were the tongue (6 cases), buccal mucosa (4 cases), mandible gingival (3 cases), maxillary gingiva (1 case), and the floor of the mouth (1 case). The histopathological effects were evaluated according to Oboshi-Shimosato classification. Grade IV was shown in 10 cases (66. 7%), grade III in 1 case (6. 7%), II bin 3 cases (20. 0%), and II a in 1 case (6. 7%). All patients completed the treatment. The pathological response of the resected tumor was grade IIbor higher in 14 cases (93. 3%). While good histological effects were noted, there was one patient for whom viable tumor cells remained in the central part of the tumor. The present study indicates that further investigation is needed to determine the best dosing and dosing schedule.

Isolated avulsion of the vastus lateralis tendon insertion in a weightlifter: a case report

PubMed Central

Trikha, Paul S; Wood, David G

2009-01-01

Introduction We report a case of isolated, unilateral avulsion of the vastus lateralis tendon from its insertion at the patella. This was diagnosed by magnetic resonance imaging, and underwent successful surgical repair. Case presentation A healthy 32-year-old national level power lifter presented with an isolated avulsion of the vastus lateralis tendon. After a failed course of conservative therapy he underwent surgical repair and a graded physical therapy programme. One year later he returned to full training with no evidence of re-rupture. Conclusion This is the first reported case of an isolated vastus lateralis avulsion. Our experience suggests that magnetic resonance imaging is invaluable in the diagnosis of this condition and that surgical repair provides a good outcome in high demand patients. PMID:19918436

Trajectory and outcomes of speech language therapy in the Prader-Willi syndrome (PWS): case report.

PubMed

Misquiatti, Andréa Regina Nunes; Cristovão, Melina Pavini; Brito, Maria Claudia

2011-03-01

The aim of this study was to describe the trajectory and the outcomes of speech-language therapy in Prader-Willi syndrome through a longitudinal study of the case of an 8 year-old boy, along four years of speech-language therapy follow-up. The therapy sessions were filmed and documental analysis of information from the child's records regarding anamnesis, evaluation and speech-language therapy reports and multidisciplinary evaluations were carried out. The child presented typical characteristics of Prader-Willi syndrome, such as obesity, hyperfagia, anxiety, behavioral problems and self aggression episodes. Speech-language pathology evaluation showed orofacial hypotony, sialorrhea, hypernasal voice, cognitive deficits, oral comprehension difficulties, communication using gestures and unintelligible isolated words. Initially, speech-language therapy had the aim to promote the language development emphasizing social interaction through recreational activities. With the evolution of the case, the main focus became the development of conversation and narrative abilities. It were observed improvements in attention, symbolic play, social contact and behavior. Moreover, there was an increase in vocabulary, and evolution in oral comprehension and the development of narrative abilities. Hence, speech-language pathology intervention in the case described was effective in different linguistic levels, regarding phonological, syntactic, lexical and pragmatic abilities.

Introduction of vertical integration and case-based learning in anatomy for undergraduate physical therapy and occupational therapy students.

PubMed

Parmar, Suresh K; Rathinam, Bertha A D

2011-01-01

The purpose of the present pilot study was to evaluate the benefits of innovative teaching methodologies introduced to final year occupational and physical therapy students in Christian Medical College in India. Students' satisfactions along the long-term retention of knowledge and clinical application of the respiratory anatomy have been assessed. The final year undergraduate physical therapy and occupational therapy students had respiratory anatomy teaching over two sessions. The teaching involved case-based learning and integrated anatomy lectures (vertical integration) with the Anatomy department. Pretest and immediate and follow-up post-tests were conducted to assess the effectiveness of the innovative methods. A feedback questionnaire was marked to grade case-based learning. The method of integrated and case-based teaching was appreciated and found to be useful in imparting knowledge to the students. Students retained the gained knowledge adequately and the same was inferred by statistically significant improvement in both post-test scores. Vertical integration of anatomy in the final year reinforces their existing knowledge of anatomy. Case-based learning may facilitate the development of effective and clinically sound therapists. Copyright © 2011 American Association of Anatomists.

CANCER OF THE PERINEAL SKIN ARISING AFTER X-RAY THERAPY OF ECZEMA

DOE Office of Scientific and Technical Information (OSTI.GOV)

Mel'nikov, R.A.; Yaritsyn, S.S.

1961-11-01

The history is presented for a case of cancer of the perineal skin which developed after extensive x-ray therapy administered for a benign condition. The cancer was removed successfully by electrosurgical excision. (C.H.)

Transmyocardial revascularization by a 1000-watt CO2 laser: sole therapy (Abstract Only)

NASA Astrophysics Data System (ADS)

Crew, John R.; Dean, Marilyn; Jones, Reinold; Fisher, John C.

1993-05-01

The concept of transmyocardial revascularization (TMR) providing blood flow to the left heart muscle based on the reptilian heart model has now been extended from an adjunctive procedure with coronary artery bypass to sole therapy. At Seton Hospital and Medical Center TMR is now being performed for the first time in clinical trials with patients who have no other mechanism of perfusion and a history of either failed PTCA or coronary artery bypass, with angina already under maximum medical therapy with a demonstrable ischemic muscle target. Longevity and reperfusion by tomographic thallium of these laser-drilled holes has been previously demonstrated but effectiveness of these channels for primary perfusion (sole therapy) apart from normal coronary bypass collateral supply is under investigation. Phase I of the FDA study has been completed with 15 cases and now Phase II includes three other beta test sites along with alternative therapy in marginal cases as the investigational format for the next 50 cases. More than 2 year followup in the first 15 cases is presented.

Music therapy in the treatment of multiple sclerosis: a comprehensive literature review.

PubMed

Ostermann, Thomas; Schmid, Wolfgang

2006-04-01

Coping with multiple sclerosis symptoms still remains a challenge for each patient suffering from this chronic inflammatory disease. Therefore, patients often turn to using complementary and alternative medicine (CAM). In this review, the authors aimed to investigate the current state of literature of music therapy in the treatment of multiple sclerosis (MS). Medline, PubMed, Embase, AMED, CAMbase and the Music Therapy World Journal Index were searched for the terms MS and 'music therapy'. In addition, an internet search using Google Scholar was performed. The authors found seven case-reports/series and seven studies on music therapy for MS-patients. Both the case reports and studies presented here are pioneer work. Most of the studies are naturally predominated by the use of qualitative and uncontrolled research designs. Nevertheless, the results of the studies as well as the case reports demonstrate patients' improvement in the domains of self-acceptance, anxiety and depression. The results of the studies as well as the case reports define a sufficient basis for further music therapeutical work as they show a variety of psychosocial and emotional benefits for MS patients.

Nivolumab-induced vitiligo in a metastatic melanoma patient: A case report.

PubMed

Edmondson, Lindsay A; Smith, Leticia V; Mallik, Alka

2017-12-01

The programmed-death-1 inhibitors selectively block programmed-death-1 interaction with its receptor, which restores active T-cell response directed at tumor cells, inducing an anti-tumor effect. This nonspecific activation of the immune system can also lead to a wide spectrum of side effects. Nivolumab has been used effectively to prolong survival in patients with metastatic melanoma and is recommended as a category 1 agent for systemic therapy in metastatic or unresectable melanoma per the National Comprehensive Cancer Network guidelines. We present a case of a 64-year-old woman who began nivolumab therapy for metastatic melanoma. After six doses of nivolumab therapy, the patient experienced generalized hypopigmentation on her face, chest, back, arms, and lower extremities. Although vitiligo has been reported in as many as 10.7% of patients undergoing nivolumab therapy in some clinical trials, we believe this is the first case to describe the progression of nivolumab-induced vitiligo in a metastatic melanoma patient. This case provides significant insight into the onset, symptoms, development, and treatment options for patients experiencing vitiligo as a result of nivolumab therapy.

Amiodarone induced pneumonitis and hyperthyroidism: case report.

PubMed

Grabczak, Elzbieta Magdalena; Zielonka, Tadeusz M; Wiwała, Joanna; Bareła, Anna Dagmara; Opuchlik, Andrzej; Potulska, Anna; Ambroziak, Urszula; Chazan, Ryszarda

2008-09-01

Amiodarone is a highly effective antiarrhythmic agent used in life-threatening ventricular and supraventricular arrhythmias. Its long-term use may however lead to several adverse effects, including corneal deposits, liver and thyroid gland dysfunction, lung lesions, bone marrow injury, skin lesions, or neurological abnormalities. The article presents the case of a 56-year-old man with a history of a stroke, who after a few days of amiodarone therapy for an episode of atrial fibrillation was diagnosed with amiodarone-induced hyperthyroidism and interstitial pulmonary lesions. Clinical and laboratory symptoms of hyperthyroidism and radiographic signs of pulmonary involvement did not occur until several weeks after discontinuation of amiodarone therapy. Differential diagnosis of causes of hyperthyroidism and diseases causing nodular pulmonary lesions did not demonstrate any other pathologies. Empirical antibiotic therapy and administration of thiamazole and high doses of propranolol failed to improve the patient's clinical status. It was not until thiamazole was given in combination with glucocorticosteroids, when a slow relief of hyperthyroidism symptoms and resolution of radiographic pulmonary signs were observed. Based on the presented case, the risk of appearance of 2 serious concomitant adverse effects was demonstrated, even following a short-term amiodarone therapy. This paper also contains an overview of adverse effects which may be encountered during or after therapy with this effective antiarrhythmic agent. It was emphasized how important it is to select patients appropriately, and to monitor potential adverse effects during amiodarone therapy.

Cognitive-Behavioral Treatment of Hoarding in Youth: A Case Illustration.

PubMed

McKay, Dean

2016-11-01

Hoarding in children is associated with more severe ancillary psychopathology, and has poor treatment outcome. At present, there are no empirically established procedures for treating hoarding in youth. The present case illustration is of a 10-year old child ("Grace") who presented for treatment with significant hoarding related to academic concerns and additional unrelated symptoms of obsessive-compulsive disorder (OCD). Grace was treated with cognitive behavior therapy (CBT) primarily comprising exposure with response prevention, behavioral experiments, and cognitive therapy, along with a program of reinforcement delivered by her parents to maintain her motivation for therapy. After 23 sessions and one booster session, Grace's symptoms improved significantly, with gains maintained at 1-year follow-up. In addition to the benefits of the specific interventions chosen, the role of therapist-patient/parent alliance as a contributory factor for good outcome is emphasized. As hoarding is underinvestigated in youth, suggestions for further investigation are offered. © 2016 Wiley Periodicals, Inc.

Acute respiratory failure secondary to mesalamine-induced interstitial pneumonitis

PubMed Central

Abraham, Albin; Karakurum, Ali

2013-01-01

Interstitial pneumonitis as an adverse effect of mesalamine therapy is a rare but potentially serious complication. Patients typically have a mild disease course with no documented cases of respiratory failure in published literature. Given its variable latent period and non-specific signs and symptoms, it may be difficult to diagnose. We present the case of a 65-year-old man who presented with symptoms of fever, shortness of breath and a non-productive cough, 2 weeks after initiation of therapy with mesalamine. His hospital course was complicated by acute respiratory failure requiring intubation and mechanical ventilation. Radiographic studies revealed bilateral lower lobe infiltrates and bronchosopy with bronchoalveolar lavage and transbronchial biopsy were consistent with a diagnosis of drug-induced interstitial pneumonitis. The aim of this paper is to highlight the importance of considering a diagnosis of mesalamine-induced lung injury in patients presenting with respiratory symptoms while on mesalamine therapy and to review relevant literature. PMID:23964037

Acute respiratory failure secondary to mesalamine-induced interstitial pneumonitis.

PubMed

Abraham, Albin; Karakurum, Ali

2013-08-20

Interstitial pneumonitis as an adverse effect of mesalamine therapy is a rare but potentially serious complication. Patients typically have a mild disease course with no documented cases of respiratory failure in published literature. Given its variable latent period and non-specific signs and symptoms, it may be difficult to diagnose. We present the case of a 65-year-old man who presented with symptoms of fever, shortness of breath and a non-productive cough, 2 weeks after initiation of therapy with mesalamine. His hospital course was complicated by acute respiratory failure requiring intubation and mechanical ventilation. Radiographic studies revealed bilateral lower lobe infiltrates and bronchosopy with bronchoalveolar lavage and transbronchial biopsy were consistent with a diagnosis of drug-induced interstitial pneumonitis. The aim of this paper is to highlight the importance of considering a diagnosis of mesalamine-induced lung injury in patients presenting with respiratory symptoms while on mesalamine therapy and to review relevant literature.

Nonsurgical periodontal therapy to treat a case of severe periodontitis: A 12-year follow-up.

PubMed

Carnio, João; Moreira, Ana Karina; Jenny, Todd; Camargo, Paulo M; Pirih, Flavia Q

2015-08-01

This case report describes the successful treatment of a severe chronic periodontitis case by nonsurgical therapy and a strict maintenance program over a 12-year period. A 38-year-old man concerned about the protrusion of his maxillary incisors was referred for periodontal treatment. The teeth in the maxillary arch had generalized severe chronic periodontitis. Several treatment options were presented to the patient including the most aggressive, extraction of all maxillary teeth, and the most conservative, scaling and root planing. The patient opted to having the most conservative approach, even though the prognoses for the maxillary teeth were unfavorable. Therefore, he received nonsurgical therapy via scaling and root planing combined with systemic antibiotics before referral to an orthodontist to address the esthetic concerns. The maxillary dentition was treated with orthodontic therapy to retract and align the maxillary anterior segment. Periodontal maintenance (1-hour session), including subgingival instrumentation, was performed 4 times per year until the end of the 12-year follow-up period. The patient only missed 2 appointments in 12 years. Twelve years later, the results revealed that all but 1 maxillary tooth were maintained in a state of acceptable health, function, and esthetics. Although most would agree with the initial poor prognosis of this patient's case, nonsurgical periodontal therapy was utilized with a 3-month periodontal maintenance program and demonstrated long-term success. The outcome presented in this case report may only have been possible because of patient compliance, professional experience, skill, and supervision throughout the course of treatment. Copyright © 2015 American Dental Association. Published by Elsevier Inc. All rights reserved.

Outcome-Based Evaluation of a Social Skills Program Using Art Therapy and Group Therapy for Children on the Autism Spectrum

ERIC Educational Resources Information Center

Epp, Kathleen Marie

2008-01-01

There is a paucity of literature on social skills therapy for students on the autism spectrum, revealing an urgent need for additional research. Past research has focused on the use of small groups or single-case study designs. The present study examines the effectiveness of a social skills therapy program for school-age children ages 11 through…

BEHAVIOR THERAPY FOR TRANSSEXUALISM

PubMed Central

Andrade, A. Chitra; Kumaraiah, V.; Mishra, H.; Chatterji, S.; Andrade, Chittaranjan

1995-01-01

Transsexualism is a rare disorder, and there is little literature available on its treatment. A case is presented of transsexualism with homosexual orientation in a 24 year old male. Since the disorder appeared to have behavioral antecedents, it was treated with a behavior therapy package comprising relaxation, aversion therapy with aversion relief, modelling, hypnosis, orgasmic reconditioning, behavioral counselling and sex education. Therapy resulted in normalization of gender identity, but the homosexual orientation persisted. PMID:21743738

CBT for Medication Adherence and Depression (CBT-AD) in HIV-Infected Patients Receiving Methadone Maintenance Therapy

ERIC Educational Resources Information Center

Soroudi, Nafisseh; Perez, Giselle K.; Gonzalez, Jeffrey S.; Greer, Joseph A.; Pollack, Mark H.; Otto, Michael W.; Safren, Steven A.

2008-01-01

For individuals with HIV who are current or former injection drug users, depression is a common, distressing condition that can interfere with a critical self-care behavior--adherence to antiretroviral therapy. The present study describes the feasibility and outcome, in a case series approach, of cognitive behavioral therapy to improve adherence…

Introduction of Vertical Integration and Case-Based Learning in Anatomy for Undergraduate Physical Therapy and Occupational Therapy Students

ERIC Educational Resources Information Center

Parmar, Suresh K.; Rathinam, Bertha A. D.

2011-01-01

The purpose of the present pilot study was to evaluate the benefits of innovative teaching methodologies introduced to final year occupational and physical therapy students in Christian Medical College in India. Students' satisfactions along the long-term retention of knowledge and clinical application of the respiratory anatomy have been…

Very late stent thrombosis in a bare-metal stent, 9 years after implantation.

PubMed

Almasswary, Adel A

2009-06-01

Very late bare-metal stent thrombosis occurring beyond one year after stenting is uncommon. We report a case of bare-metal stent thrombosis presenting as acute myocardial infarction. The patient's stent was implanted 9 years ago, however, he was not adherent to his antiplatelet therapy (aspirin). This case highlights the importance of antiplatelet therapy in patients with stents even many years after implantation.

Superior vena cava syndrome with central venous catheter for chemotherapy treated successfully with fibrinolysis.

PubMed

Guijarro Escribano, J F; Antón, R F; Colmenarejo Rubio, A; Sáenz Cascos, L; Sainz González, F; Alguacil Rodríguez, R

2007-03-01

Recently, there has been an increase in the number of cases of superior vena cava (SVC) syndrome associated with chronic indwelling central venous catheters. Fibrinolytic therapy and endovascular treatment are currently achieving good results. We present a case history of a patient with SVC with a catheter used for chemotherapy, which was successfully treated with catheter-directed (intraclot) infusion thrombolytic therapy with urokinase.

A case of phytodermatitis due to the Ceratocephalus falcatus.

PubMed

Gönül, Müzeyyen; Cakmak, Seray Külcü

2014-03-01

Many people widely use herbal therapies for health problems in the world. Although these herbal therapies sometimes may be useful for some disorders they are not risk free. Ceratocephalus falcatus is an annual, wild plant which is a member of Ranunculaceae family. There are few case reports of phytodermatitis due to the Ranunculaceae family. We present a 58-year-old woman with irritant phytodermatitis due to C. falcatus.

Emotional Processing, Interaction Process, and Outcome in Clarification-Oriented Psychotherapy for Personality Disorders: A Process-Outcome Analysis.

PubMed

Kramer, Ueli; Pascual-Leone, Antonio; Rohde, Kristina B; Sachse, Rainer

2016-06-01

It is important to understand the change processes involved in psychotherapies for patients with personality disorders (PDs). One patient process that promises to be useful in relation to the outcome of psychotherapy is emotional processing. In the present process-outcome analysis, we examine this question by using a sequential model of emotional processing and by additionally taking into account a therapist's appropriate responsiveness to a patient's presentation in clarification-oriented psychotherapy (COP), a humanistic-experiential form of therapy. The present study involved 39 patients with a range of PDs undergoing COP. Session 25 was assessed as part of the working phase of each therapy by external raters in terms of emotional processing using the Classification of Affective-Meaning States (CAMS) and in terms of the overall quality of therapist-patient interaction using the Process-Content-Relationship Scale (BIBS). Treatment outcome was assessed pre- and post-therapy using the Global Severity Index (GSI) of the SCL-90-R and the BDI. Results indicate that the good outcome cases showed more self-compassion, more rejecting anger, and a higher quality of therapist-patient interaction compared to poorer outcome cases. For good outcome cases, emotional processing predicted 18% of symptom change at the end of treatment, which was not found for poor outcome cases. These results are discussed within the framework of an integrative understanding of emotional processing as an underlying mechanism of change in COP, and perhaps in other effective therapy approaches for PDs.

Pericarditis and pericardial effusion: management update.

PubMed

Sparano, Dina M; Ward, R Parker

2011-12-01

Prompt recognition of the signs and symptoms of pericardial disease is critical so that appropriate treatments can be initiated. Acute pericarditis has a classical presentation, including symptoms, physical examination findings, and electrocardiography abnormalities. Early recognition of acute pericarditis will avoid unnecessary invasive testing and prompt therapies that provide rapid symptom relief. Non-steroidal anti-inflammatory drugs (NSAIDs) remain first-line therapy for uncomplicated acute pericarditis, although colchicine can be used concomitantly with NSAIDS as the first-line approach, particularly in severely symptomatic cases. Colchicine should be used in all refractory cases and as initial therapy in all recurrences. Aspirin should replace NSAIDS in pericarditis complicating acute myocardial infarction. Systemic corticosteroids can be used in refractory cases or in those with immune-mediated etiologies, although generally should be avoided due to a higher risk of recurrence. Pericardial effusions have many etiologies and the approach to diagnosis and therapy depends on clinical presentation. Pericardial tamponade is a life-threatening clinical diagnosis made on physical examination and supported by characteristic findings on diagnostic testing. Prompt diagnosis and management is critical. Treatment consists of urgent pericardial fluid drainage with a pericardial drain left in place for several days to help prevent acute recurrence. Analysis of pericardial fluid should be performed in all cases as it may provide clues to etiology. Consultation of cardiac surgery for pericardial window should be considered in recurrent cases and may be the first-line approach to malignant effusions, although acute relief of hemodynamic compromise must not be delayed. Constrictive pericarditis is associated with symptoms that mimic many other cardiac conditions. Thus, correct diagnosis is critical and involves identification of pericardial thickening or calcification in association with characteristic hemodynamic alterations using noninvasive and invasive diagnostic approaches. Constrictive physiology may occur transiently and resolve with medical therapy. In chronic cases, definitive therapy requires referral to an experienced surgeon for pericardiectomy.

Enhanced Cognitive Behavioral Therapy for an Adolescent with Purging Disorder: A Case Report

PubMed Central

Sysko, Robyn; Hildebrandt, Tom

2012-01-01

Objective To present a case report detailing the use of an enhanced form of cognitive behavior therapy (CBT). The treatment was provided to an adolescent with an eating disorder not otherwise specified (EDNOS) diagnosis, and included a focus on the additional maintaining mechanisms of mood intolerance and interpersonal problems. Case This case began as an unsuccessful attempt at family therapy, where the underlying dysfunction exacerbated symptoms and demoralized the family. The therapist subsequently chose to utilize an enhanced version of CBT to simultaneously address the patient's symptoms and try to effect change across multiple domains. A description of the patient's eating disorder pathology, the 29-session treatment, and outcome, are provided. Conclusion This case study illustrates that it is possible to successfully use enhanced CBT with developmentally appropriate adaptations in the treatment of a young patient with an EDNOS diagnosis, as suggested by Cooper and Stewart (2008). PMID:20859990

Extensive intramuscular manifestation of sarcoidosis with initially missed diagnosis and delayed therapy: a case report.

PubMed

Meyer, Niklaus; Sutter, Reto; Schirp, Udo; Gutzeit, Andreas

2017-08-24

Sarcoidosis is a multisystemic granulomatous disorder, which in nearly all cases involves the lungs and other organs. Isolated forms of sarcoidosis within the muscles, but without lung involvement, are extremely rare and can lead to delayed or even false diagnosis. A 52-year-old white, Swiss man presented with painful arm cramps and a history of symptoms over the previous 3 years. In the initial clinical investigation, our patient also showed edema in both legs without any other complaints. After performing an magnetic resonance imaging scan of his extremities and a positron emission tomography/computed tomography scan, diffuse myositis was described. The subsequent muscle biopsy provided the surprising diagnosis of muscle sarcoidosis, without involvement of the lungs or any other organ. After starting therapy with glucocorticoids, his symptoms improved immediately. Sarcoidosis is a common disorder, which in most cases affects the lungs. In this case report an isolated sarcoidosis is described without lung involvement, but with involvement of the muscles of the extremities and the trunk. Reported cases of sarcoidosis only involving skeletal muscle and without lung involvement are extremely rare. Radiologists should consider this presentation of sarcoidosis to avoid delayed diagnosis and therapy.

Managing a case of extensively drug-resistant (XDR) pulmonary tuberculosis in Singapore.

PubMed

Phua, Chee Kiang; Chee, Cynthia B E; Chua, Angeline P G; Gan, Suay Hong; Ahmed, Aneez D B; Wang, Yee Tang

2011-03-01

Extensively drug-resistant tuberculosis (XDR-TB) is an emerging global health risk. We present the first case report of XDR-TB in Singapore. A 41-year-old Indonesian lady with previously treated pulmonary tuberculosis presented with chronic cough. Her sputum was strongly acid-fast bacilli positive and grew Mycobacterium tuberculosis complex resistant to first and second-line TB medications. She received 5 months of intensive multidrug treatment without sputum smear conversion. She then underwent resection of the diseased lung. The total cost incurred amounted to over S$100,000. She achieved sputum smear/culture conversion post-surgery, but will require further medical therapy for at least 18 months. XDRTB is poorly responsive to therapy and extremely expensive to manage. Its prevention by strict compliance to therapy is paramount.

Fatal hypertriglyceridaemia, acute pancreatitis and diabetic ketoacidosis possibly induced by quetiapine.

PubMed

Madsen, Kristian Roerbaek

2014-01-08

A 27-year-old man treated with quetiapine for anxiety disorder developed hypertriglyceridaemia-induced acute pancreatitis and diabetic ketoacidosis. He was otherwise physically healthy with no family history of hyperlipidaemia. Despite aggressive intensive therapy he died of multiorgan failure within 36 h from initial presentation. While second-generation antipsychotics are well known to be causally linked to diabetes and hyperlipidaemia, this is to my knowledge the first-described case of a fatal triad of extreme hypertriglyceridaemia, acute pancreatitis and diabetic ketoacidosis possibly induced by quetiapine. Clinicians should be aware of this rare clinical presentation since rapid progression to multiorgan failure can occur. Early supportive therapy should be initiated. Lactescent serum and ketoacidosis in severe acute pancreatitis should not be overlooked-initiate insulin therapy and possibly plasmapheresis in case of extreme hypertriglyceridaemia.

Multifocal avascular necrosis after liver transplantation: an unusual presentation of the antiphospholipid syndrome.

PubMed

Mundo, J; Peris, P; Monegal, A; Navasa, M; Cervera, R; Guañiabens, N

2006-01-01

We describe the case of a 31-year-old man who presented with an antiphospholipid syndrome (APS), which manifested as multifocal avascular necrosis (AVN) one year after orthotopic liver transplantation. The patient developed multiple AVN affecting hips, left knee, humerus and tarsal bones just after withdrawal of corticosteroid therapy. Three years later when lupus anticoagulant was detected, he began anticoagulant treatment and no further AVN episodes were observed. It is important to be aware of this clinical manifestation of APS, especially in these cases where it can be easily overlooked because of corticosteroid therapy.

Clinical Use of the Marital Satisfaction Inventory: Two Case Studies.

ERIC Educational Resources Information Center

Wills, Robert M.; Snyder, Douglas K.

1982-01-01

Describes the clinical use of the Marital Satisfaction Inventory (MSI), a multidimensional self-report measure of marital interaction. Two case studies of couples in marital therapy are presented. The MSI is presented as a cost-efficient procedure, permitting objective assessment across multiple areas of a couple's relationship. (Author/JAC)

Metastatic clear cell eccrine hidradenocarcinoma of the vulva: survival after primary surgical resection.

PubMed

Massad, L S; Bitterman, P; Clarke-Pearson, D L

1996-05-01

A case of clear cell eccrine hidradenocarcinoma of the vulva metastatic to regional lymph nodes with long survival after surgical resection is presented. Like the only other case reported to date, this suggests that surgical therapy alone may be adequate, even when metastasis is present.

Cognitive Behavioral Therapy as a Treatment for Electroconvulsive Therapy Phobia: Case Report and Review of Literature.

PubMed

Wo, Nolan King Hop; Guyitt, Brendan; Owen, Richard

2015-12-01

Electroconvulsive therapy (ECT) can raise feelings of fear and anxiety in our patients. No documented cases of phobia regarding ECT or its treatment were found in the literature. We present a patient who developed anxiety regarding ECT that was severe enough to be classified as a phobia. She was successfully treated with cognitive behavioral therapy (CBT) for her phobia and was subsequently able to tolerate ECT. We conducted a literature review of ECT phobia, fear, and anxiety using MEDLINE, PsycINFO, and EMBASE. We outlined how CBT, in our specific case, was helpful in treating extreme and unrealistic fears concerning ECT. We could not find a case of phobia related to ECT in the literature; however, both qualitative and quantitative studies illustrate that ECT causes anxiety and fear. Although cases of ECT phobia are rare, feelings of fear and anxiety surrounding ECT are common. The experience of ECT is individualized for each patient, and CBT can be a successful treatment in those who have anxiety related to ECT.

Successful treatment of young infants presenting neonatal diabetes mellitus with continuous subcutaneous insulin infusion before genetic diagnosis.

PubMed

Rabbone, Ivana; Barbetti, Fabrizio; Marigliano, Marco; Bonfanti, Riccardo; Piccinno, Elvira; Ortolani, Federica; Ignaccolo, Giovanna; Maffeis, Claudio; Confetto, Santino; Cerutti, Franco; Zanfardino, Angela; Iafusco, Dario

2016-08-01

Neonatal diabetes mellitus (NDM) is defined as hyperglycemia and impaired insulin secretion with onset within 6 months of birth. While rare, NDM presents complex challenges regarding the management of glycemic control. The availability of continuous subcutaneous insulin infusion pumps (CSII) in combination with continuous glucose monitoring systems (CGM) provides an opportunity to monitor glucose levels more closely and deliver insulin more safely. We report four cases of young infants with NDM successfully treated with CSII and CGM. Moreover, in two cases with Kir 6.2 mutation, we describe the use of CSII in switching therapy from insulin to sulfonylurea treatment. Insulin pump requirement for the 4 neonatal diabetes cases was the same regardless of disease pathogenesis and c-peptide levels. No dilution of insulin was needed. The use of an integrated CGM system helped in a more precise control of BG levels with the possibility of several modifications of insulin basal rates. Moreover, as showed in the first two case-reports, when the treatment was switched from insulin to glibenclamide, according to identification of Kir 6.2 mutation and diagnosis of NPDM, the CSII therapy demonstrated to be helpful in allowing gradual insulin suspension and progressive introduction of sulfonylurea. During the neonatal period, the use of CSII therapy is safe, more physiological, accurate and easier for the insulin administration management. Furthermore, CSII therapy is safe during the switch of therapy from insulin to glibenclamide for infants with permanent neonatal diabetes mellitus.

Genetic characterization drives personalized therapy for early-stage non-small-cell lung cancer (NSCLC) patients and survivors with metachronous second primary tumor (MST): A case report.

PubMed

Ding, Xingchen; Wang, Linlin; Liu, Xijun; Sun, Xindong; Yu, Jinming; Meng, Xue

2017-03-01

The pathogenesis and progression of lung cancer is a complicated process in which many genes take part. But molecular gene testing is typically only performed in advanced-stage non-squamous non-small-cell lung cancer (NSCLC). The value of tyrosine kinase inhibitors (TKI) administration is not widely recognized with respect to early-stage NSCLC. Here, we present a case of a man, heavy smoker who initially presented with stage IA lung adenocarcinoma (LADC). Three years after a lung lobectomy, he was diagnosed with advanced lung squamous cell carcinoma (SCC), according to laboratory, imaging, and pathological examinations. The case initially had an early-stage LADC with an L858R epidermal growth factor receptor (EGFR) mutation. A subsequent advanced SCC bearing EGFR L858R/T790M mutations occurred 3 years after surgery. The comprehensive therapy we utilized, including surgical resection for the early-stage lesion and GP chemotherapy and local radiotherapy as the first line therapy along with gefitinib maintenance treatment for the advanced metachronous second primary tumors (MST). The synthetical therapy, have resulted in our patient with remaining alive and progression free for 4.5 years. This case suggests that changes in molecular pathology should be monitored closely throughout cancer progression to guide personalized therapy and improve prognosis. We further review administration of TKI to early-stage NSCLC and to the metachronous second primary tumors (MST) in survivors.

De novo development of a cerebral arteriovenous malformation following radiation therapy: Case report and an update to classical arteriovenous malformation nomenclature.

PubMed

Koch, Matthew J; Agarwalla, Pankaj K; Stapleton, Christopher J; Ogilvy, Christopher S; Loeffler, Jay S

2016-06-01

Cerebral arteriovenous malformations (AVM) are traditionally considered primary congenital lesions that result from embryological aberrations in vasculogenesis. Recent insights, however, suggest that these lesions may be secondary to a vascular insult such as ischemia or trauma. Herein, the authors present a rare case of a secondary cerebral AVM, occurring in a young girl who received prior cranial radiation therapy. At age 3years, she underwent surgical resection, chemotherapy, and photon radiation therapy for treatment of a fourth ventricular ependymoma. At age 19years, she developed new onset seizures and was found to have a left medial temporal lobe AVM. Her seizures were managed successfully with anti-epileptic medications and the AVM was treated with proton radiation therapy. This case highlights a rare but possible vascular sequela of radiation therapy and adds to the growing body of evidence that cerebral AVM may arise as secondary lesions. Copyright © 2015 Elsevier Ltd. All rights reserved.

Teaching ethical analysis in occupational therapy.

PubMed

Haddad, A M

1988-05-01

Ethical decision making is a cognitive skill requiring education in ethical principles and an understanding of specific ethical issues. It is also a psychodynamic process involving personalities, values, opinions, and perceptions. This article proposes the use of case studies and role-playing techniques in teaching ethics in occupational therapy to supplement conventional methods of presenting ethical theories and principles. These two approaches invite students to discuss and analyze crucial issues in occupational therapy from a variety of viewpoints. Methodology of developing case studies and role-playing exercises are discussed. The techniques are evaluated and their application to the teaching of ethics is examined.

Application of photodynamic therapy, laser therapy, and a cellulose membrane for calcaneal pressure ulcer treatment in a diabetic patient: A case report.

PubMed

Rosa, Luciano Pereira; da Silva, Francine Cristina; Vieira, Regiane Lima; Tanajura, Beatriz Rocha; da Silva Gusmão, Alana Gonçalves; de Oliveira, Janeide Muritiba; Dos Santos, Nathalia Aparecida Campanário; Bagnato, Vanderlei Salvador

2017-09-01

Diabetes mellitus is a metabolic disorder in which a person has high blood glucose levels due to inadequate insulin production by the pancreas. Wounds in these individuals cannot heal properly over time due to circulatory changes that hinder and stagnate the healing process. We report the case of an 82-year-old female type 2 diabetes mellitus carrier, presenting to clinical-dermatological examination pressure ulcer (PU) in the right calcaneus region. The patient was treated with photodynamic therapy using curcumin and blue light-emitting diodes (LEDs), laser therapy, and the application of a cellulose membrane in order to promote ulcer decontamination by local action, accelerate wound healing, and maintain favorable conditions of asepsis and moisture, respectively. The ulcer healing occurred after 30days of treatment and total epithelialization was observed. From the results obtained in this case report, we conclude that the combination of photodynamic therapy, laser therapy, and coating with a cellulose membrane is a promising treatment for the healing of PU in diabetic patients. Copyright © 2017 Elsevier B.V. All rights reserved.

Demodex Folliculitis of the Scalp: Clinicopathological Study of an Uncommon Entity.

PubMed

Helou, Wissam; Avitan-Hersh, Emily; Bergman, Reuven

2016-09-01

Demodex is a saprophytic mite in humans commonly present in the pilosebaceous units, which has been implicated as a pathogen in several skin conditions. The clinical presentation and histopathology of Demodex folliculitis of the scalp have been described in only a few case reports. This study was performed to further elucidate the clinicopathological features of this entity. We have studied 333 consecutively submitted scalp biopsies performed for hair loss and alopecia. All specimens were completely step-sectioned. Biopsies with Demodex mites were further studied histopathologically, and the patients' clinical files were reviewed. There were 17 biopsies (5.1%) with Demodex in at least 1 pilosebaceous unit. Based on the clinical presentation, histopathology, and response to therapy, Demodex was considered to be nonpathogenic in 13 cases. The remaining 4 cases were characterized by hair loss, scalp erythema, scales, and pustules. There were 2 or more pilosebaceous units with Demodex along mononuclear and/or neutrophilic infiltrates around and in the involved follicles and occasionally granulomas. All 4 cases responded completely to metronidazole therapy. In conclusion, Demodex is infrequently found in scalp biopsies for hair loss and alopecia, and, in most cases, it does not seem to be pathogenic. Occasionally, however, it is associated with folliculitis characterized by hair loss, erythema, scales, and pustules clinically; neutrophilic and/or mononuclear-cell folliculitis with occasional granulomas histopathologically; and a prompt response to anti-Demodex therapy.

Play Therapy

PubMed Central

Kool, Ritesh

2010-01-01

Play therapy represents a unique form of treatment that is not only geared toward young children, but is translated into a language children can comprehend and utilize—the language of play. For the referring provider or practitioner, questions may remain regarding the nature, course, and efficacy of play therapy. This article reviews the theoretical underpinnings of play therapy, some practical considerations, and finally a summary of the current state of research in regard to play therapy. The authors present the practicing psychiatrist with a road map for referring a patient to play therapy or initiating it in appropriate cases. PMID:21103141

The Verbotonal Method of Aural Rehabilitation: A Case Study

ERIC Educational Resources Information Center

Eisenberg, Diane; Santore, Frances

1976-01-01

A case study is presented of a 12-year-old child with a congenital profound bilateral sensori-neural hearing loss, who received rehabilitative audio-therapy according to the verbotonal method. (Author/LS)

Gastric Outlet Obstruction--An Unexpected Complication during Coca-Cola Therapy for a Gastric Bezoar: A Case Report and Literature Review.

PubMed

Lu, Lei; Zhang, Xiao-Feng

2016-01-01

Gastric bezoars are concretions of undigested material, and Coca-Cola therapy is an easy, efficacious and safe approach for bezoar treatment. Gastric outlet obstruction due to a migratory gastric bezoar during Coca-Cola therapy is an uncommon presentation and, to the best of our knowledge, no cases have been previously reported. We herein describe one such case with no known predisposing factors that recovered via the endoscopic technique. A thorough literature search was performed, which yielded eight relevant patients from seven publications, all of who developed gastrointestinal obstruction during dissolution treatment and recovered uneventfully after surgical intervention. In conclusion, this potential complication should be kept in mind in the event that alternative treatment is necessary.

Multidisciplinary approach to non-surgical management of inguinal disruption in a professional hockey player treated with platelet-rich plasma, manual therapy and exercise: a case report.

PubMed

St-Onge, Eric; MacIntyre, Ian G; Galea, Anthony M

2015-12-01

To present the clinical management of inguinal disruption in a professional hockey player and highlight the importance of a multidisciplinary approach to diagnosis and management. A professional hockey player with recurrent groin pain presented to the clinic after an acute exacerbation of pain while playing hockey. The patient received a clinical diagnosis of inguinal disruption. Imaging revealed a tear in the rectus abdominis. Management included two platelet-rich plasma (PRP) injections to the injured tissue, and subsequent manual therapy and exercise. The patient returned to his prior level of performance in 3.5 weeks. This case demonstrated the importance of a multidisciplinary team and the need for advanced imaging in athletes with groin pain. Research quality concerning the non-surgical management of inguinal disruption remains low. This case adds evidence that PRP, with the addition of manual therapy and exercise may serve as a relatively quick and effective non-surgical management strategy.

Endometriosis: Survey of Current Diagnostic and Therapeutic Options and Latest Research Work

PubMed Central

Juhasz-Böss, I.; Laschke, M. W.; Müller, F.; Rosenbaum, P.; Baum, S.; Solomayer, E. F.; Ulrich, U.

2014-01-01

Endometriosis is one of the most frequent benign diseases in women of child-bearing age. The main symptoms are chronic upper abdominal pain and infertility. However, the aetiology and pathogenesis of endometriosis are as yet insufficiently clarified. Thus, therapy is mainly symptomatic with laparoscopic surgery being the gold standard. The aim of drug therapy is to achieve a hypo-oestrogenic condition. In cases of severe endometriosis and a desire to have children there is often an indication for assisted reproduction. The present article illustrates almost all current aspects on the diagnosis of and therapy of endometriosis. From the clinical viewpoint, emphasis is placed on the rare cases of deeply infiltrating endometriosis that are, however, accompanied with a high morbidity. Current therapeutic options in cases of infertility are also presented in more detail. Furthermore, special attention is paid to the latest research results from both clinical and basic research fields in order to demonstrate our current knowledge on the pathogenesis and, where possible, potentially related therapeutic options. PMID:25221341

BRCA2 Mutation as a Possible Cause of Poor Response to 177Lu-PSMA Therapy.

PubMed

Ahmadzadehfar, Hojjat; Gaertner, Florian; Lossin, Philipp S; Schwarz, Bettina; Essler, Markus

2018-05-14

We present the case of a 66-year-old man with castration-resistant prostate cancer, with an increasing prostate-specific antigen level, and a progressive disease during Lu-PSMA radionuclide therapy. Because the patient had a BRCA2 mutation, poly-ADP ribose polymerase inhibitor therapy was started. The patient showed a dramatic subjective and biological response to this therapy with a progression-free survival of 5 months.

Filicide as a part of extended suicide: An experience of psychotherapy with the survivor.

PubMed

Manjula, M; Chandrashekar, C R

2014-04-01

The tragedy of maternal filicide and extended suicides has occurred throughout history. Maternal filicide-suicide perpetrators most often suffer from depression, suicidality, or psychosis. Interventions in such cases are not commonly reported in the psychiatric settings, and the components of psychotherapeutic approach and its efficacy are also not known. Here we present a long-term therapy carried out with a 36-year-old married lady, with the complaints of low mood, suicidal ideation, severe guilt feelings, and depressive cognitions. There was positive family history of depression, past history of dysthymia, suicidal attempt, and severe marital discord. Therapy was carried out for a period of 9 months with follow-up for 4 years and addressed existential issues and grief with the components of existential therapy, grief therapy, narratives, religious beliefs, and interpersonal acceptance. The case highlights the need for blending of multiple approaches to meet the challenges such cases can pose.

Mucormycosis of the head and neck.

PubMed

Dan, Michael

2011-04-01

Mucormycosis of the head and neck is the most common form of infection by the order Mucorales, accounting for up to half of all cases. About 70% of rhinocerebral cases develop in diabetic patients. Less often, rhinocerebral mucormycosis occurs in solid organ transplant recipients, those with prolonged neutropenia, and those on deferoxamine therapy. Recently, rhinocerebral disease has been increasingly recognized in patients undergoing hematopoietic stem cell transplantation. A growing number of cases have presented as breakthrough infection in patients receiving voriconazole. The mortality rate of rhinocerebral mucormycosis has remained at 30% to 70% despite aggressive therapy. Early initiation of treatment substantially improves outcome, underscoring the need to maintain a high index of suspicion and promptly biopsy potential lesions. Surgical excision of necrotic tissue is essential. Lipid formulations of amphotericin B have become the standard treatment for mucormycosis. Posaconazole is useful as salvage therapy, but cannot be recommended yet as primary therapy.

Treating the sibling subsystem: an adjunct of divorce therapy.

PubMed

Schibuk, M

1989-04-01

Sibling therapy, frequently overlooked as a method of treatment, is particularly appropriate in situations that require a deliberate focus on the "unit of continuity," or the subsystem that remains intact during a process of family reorganization. For this and other reasons it can be an effective tool in treating children of divorce. A case illustrating this use of sibling therapy is presented.

Male Cross-Dressers in Therapy: A Solution-Focused Perspective for Marriage and Family Therapists.

ERIC Educational Resources Information Center

Dzelme, Kristina; Jones, Rene A.

2001-01-01

Offers techniques on how to work with male cross-dressers using solution focused therapy. Solution focused therapy is discussed as a way to work with male cross dressers and their partners. A case study of a male cross dresser and his wife is presented and possible directions are suggested for marriage and family therapists. (BF)

Occupational Therapy Interventions for People With Alzheimer's Disease.

PubMed

Piersol, Catherine Verrier; Jensen, Lou; Lieberman, Deborah; Arbesman, Marian

Evidence Connection articles provide a clinical application of systematic reviews developed in conjunction with the American Occupational Therapy Association's (AOTA's) Evidence-Based Practice Project. In this Evidence Connection article, we describe a case report of a person with Alzheimer's disease. The occupational therapy assessment and intervention process in the home setting is described. Findings from the systematic reviews on this topic were published in the November/December 2017 issue of the American Journal of Occupational Therapy and in AOTA's Occupational Therapy Practice Guidelines for Adults With Alzheimer's Disease and Related Major Neurocognitive Disorders. Each article in this series summarizes the evidence from the published reviews on a given topic and presents an application of the evidence to a related clinical case. Evidence Connection articles illustrate how the research evidence from the reviews can be used to inform and guide clinical reasoning. Copyright © 2018 by the American Occupational Therapy Association, Inc.

Clinical outcomes of gastrointestinal stromal tumor in southern Thailand

PubMed Central

Pornsuksiri, Kittima; Chewatanakornkul, Siripong; Kanngurn, Samornmas; Maneechay, Wanwisa; Chaiyapan, Walawee; Sangkhathat, Surasak

2012-01-01

AIM: To review a single institutional experience in clinical management of gastrointestinal stromal tumors (GIST) and analyze for factors determining treatment outcome. METHODS: Clinicopathological data of patients with a diagnosis of GIST who were treated at our institute during November 2004 to September 2009 were retrospectively reviewed. RESULTS: Ninety-nine cases were included in the analysis. Primary tumor sites were at the stomach in and small bowel in 44% and 33%, respectively. Thirty-one cases already had metastasis at presentation and the most common metastatic site was the liver. Sixty-four cases (65%) were in the high-risk category. Surgical treatment was performed in 77 cases (78%), 3 of whom received upfront targeted therapy. Complete resection was achieved in 56 cases (73% of operative cases) and of whom 27 developed local recurrence or distant metastasis at a median duration of 2 years. Imatinib was given as a primary therapy in unresectable cases (25 cases) and as an adjuvant in cases with residual tumor (21 cases). Targeted therapy gave partial response in 7 cases (15%), stable disease in 27 cases (57%) and progressive disease in 13 cases (28%). Four-year overall survival was 74% (95% CI: 61%-83%). Univariate survival analysis found that low-risk tumor, gastric site, complete resection and response to imatinib were associated with better survival. CONCLUSION: The overall outcomes of GIST can be predicted by risk-categorization. Surgery alone may not be a curative treatment for GIST. Response to targeted therapy is a crucial survival determinant in these patients. PMID:23444235

The effect of group play therapy on social-emotional skills in pre-school children.

PubMed

Chinekesh, Ahdieh; Kamalian, Mehrnoush; Eltemasi, Masoumeh; Chinekesh, Shirin; Alavi, Manijeh

2013-12-24

Childhood is important and critical period in human life. The foundation of ego is shaped in childhood. Play therapy is one of the successful strategies to help children with inner conflicts problems. This method of psychotherapy is base on the normal learning processes of children, provides solutions to relieve feelings of stress, and expands self-expression. Group play therapy can enhance the self-awareness, self- regulation, social communication, empathy and adoptability in children. Present study investigated the effects of play therapy on relational and emotional skills of pre-school children. For this purpose, the total numbers of 372 pre-school children were randomly selected, and divided into two equal groups (case and control). In next step, the BUSSE-SR methodology was used for evaluation and comparison of self-awareness, self-regulation, social interaction, empathy, adoptability, and control groups. Pre-test were performed for both groups and case group was involved in-group play therapy. According to the results of post-test, correlation of variables between case-control groups was examined by multivariate analysis of covariance. Frequency of boys and girls in our sample were 51.3 and 48.7 percent, respectively. The mean age of children was 5.1±0.6 year. According to the results of present study, play therapy significantly enhanced the social-emotional skills (P< 0.001). Our findings are consistent with the results of previous studies in other nations with different environmental and cultural properties. In conclusion, it seems that play therapy can be used in pre-school centers to help children learn problem-solving skills and communicate with others.

Filgrastim as a Rescue Therapy for Persistent Neutropenia in a Case of Dengue Hemorrhagic Fever with Acute Respiratory Distress Syndrome and Myocarditis

PubMed Central

Deepak, Desh; Garg, Rakesh; Pawar, Mridula; Banerjee, Neerja; Solanki, Rakesh; Maurya, Indubala

2011-01-01

Pathogenesis of dengue involves suppression of immune system leading to development of characteristic presentation of haematological picture of thrombocytopenia and leucopenia. Sometimes, this suppression in immune response is responsible for deterioration in clinical status of the patient in spite of all specific and supportive therapy. Certain drugs like steroids are used for rescue therapy in conditions like sepsis. We present a novel use of filgrastim as a rescue therapy in a patient with dengue hemorrhagic fever (DHF) with acute respiratory distress syndrome (ARDS), myocarditis, and febrile neutropenia and not responding to standard management. PMID:22606398

How collaboration in therapy becomes therapeutic: the therapeutic collaboration coding system.

PubMed

Ribeiro, Eugénia; Ribeiro, António P; Gonçalves, Miguel M; Horvath, Adam O; Stiles, William B

2013-09-01

The quality and strength of the therapeutic collaboration, the core of the alliance, is reliably associated with positive therapy outcomes. The urgent challenge for clinicians and researchers is constructing a conceptual framework to integrate the dialectical work that fosters collaboration, with a model of how clients make progress in therapy. We propose a conceptual account of how collaboration in therapy becomes therapeutic. In addition, we report on the construction of a coding system - the therapeutic collaboration coding system (TCCS) - designed to analyse and track on a moment-by-moment basis the interaction between therapist and client. Preliminary evidence is presented regarding the coding system's psychometric properties. The TCCS evaluates each speaking turn and assesses whether and how therapists are working within the client's therapeutic zone of proximal development, defined as the space between the client's actual therapeutic developmental level and their potential developmental level that can be reached in collaboration with the therapist. We applied the TCCS to five cases: a good and a poor outcome case of narrative therapy, a good and a poor outcome case of cognitive-behavioural therapy, and a dropout case of narrative therapy. The TCCS offers markers that may help researchers better understand the therapeutic collaboration on a moment-to-moment basis and may help therapists better regulate the relationship. © 2012 The British Psychological Society.

A microbiological hazard of rural living: Clostridium septicum brain abscess in a child with E coli 0157 associated haemolytic uraemic syndrome

PubMed Central

Williams, Eleri J; Mitchell, Patrick; Mitra, Dipayan; Clark, Julia E

2012-01-01

Clostridium septicum infection in humans is rare and this is the second case report of focal C septicum brain abscesses associated with Escherichia coli 0157 haemolytic uraemic syndrome (HUS). The case presented in a child who lived on a rural farm. The abscesses initially progressed despite 7 months of appropriate antibiotic therapy and repeated image-guided aspiration. After definitive resection and prolonged antibiotic therapy, there was no recurrence. This case reminds us of this rare but important neurological complication of HUS and supports consideration of early definitive neurosurgical intervention in similar unusual cases. PMID:22736786

Primary Spinal Cord Melanoma: A Case Report and a Systemic Review of Overall Survival.

PubMed

Zhang, Mingzhe; Liu, Raynald; Xiang, Yi; Mao, Jianhui; Li, Guangjie; Ma, Ronghua; Sun, Zhaosheng

2018-06-01

The incidence of primary spinal cord melanoma (PSCM) is rare. Several case series and case reports have been published in the literature. However, the predictive factors of PSCM survival and management options are not discussed in detail. We present a case of PSCM; total resection was achieved and chemotherapy was given postoperatively. A comprehensive search was performed on PubMed's electronic database using the words "primary spinal cord melanoma." Survival rates with various gender, location, treatment, and metastasis condition were collected from the published articles and analyzed. Fifty nine cases were eligible for the survival analysis; 54% were male and 46% were female. Patient sex did not influence overall survival. The most common location was the thorax. Patient sex and tumor location did not influence overall survival. The major presenting symptoms were weakness and paresthesia of the extremities. Metastasis or dissemination was noted in 45.16% of 31 patients. In the Kaplan-Meier survival analysis, patients who had metastasis had the worst prognosis. Extent of resection was not related to mortality. Patients who received surgery and surgery with adjuvant therapy had a better median survival than did those who had adjuvant therapy alone. Prognosis was worst in those patients who underwent only adjuvant therapy without surgery (5 months). Surgery is the first treatment of choice in treating PSCM. The goal of tumor resection is to reduce symptoms. Adjuvant therapy after surgery had a beneficial effect on limiting the metastasis. Copyright © 2018 Elsevier Inc. All rights reserved.

Lesson of the month 2: The limitations of steroid therapy in bradykinin-mediated angioedema attacks.

PubMed

Ismail, Sharif; Cheng, Leo; Grigoriadou, Sofia; Laffan, James; Menon, Manoj

2015-02-01

Acute angioedema attacks are conventionally treated with antihistamines and steroids, in line with a presumed mechanism of disease involving overwhelming mast-cell degranulation. This approach overlooks a small but important minority of cases in which attacks are bradykinin driven and exhibit poor responsiveness to steroid or anti-histamine therapy. These patients may have a family history of angioedema (hereditary angioedema), or a past medical history including B-cell lymphoproliferative disorders or autoimmune disease (acquired angioedema). Rather than steroid therapy, they respond to administration of a bradykinin inhibitor, or more commonly, a C1 esterase inhibitor substitute, to control acute symptoms and reduce the probability of invasive airway insertion. In the long-term, they require C1 esterase inhibitor sparing therapy and a treat-the-cause approach to reduce the risk of recurrent attacks. We present here a case of a middle-aged woman who presented with recurrent angioedema of initially uncertain aetiology. © 2015 Royal College of Physicians.

Constrictive Pericarditis 5 Months after Radiation Therapy in a 62-Year-Old Woman with Esophageal Cancer.

PubMed

Yeneneh, Beeletsega T; Allen, Sorcha; Panse, Prasad; Mookadam, Farouk; Rule, William

2017-12-01

Most pericardial changes appear within a few weeks in patients who have undergone radiation therapy for thoracic neoplasms. Chronic pericardial constriction typically occurs decades later, consequent to fibrosis. Early constrictive pericarditis after chest irradiation is quite rare. We report the case of a 62-year-old woman who underwent radiation therapy for esophageal cancer and presented with constrictive pericarditis 5 months later. We searched the English-language medical literature from January 1986 through December 2015 for reports of early constrictive pericarditis after irradiation for thoracic malignancies. We defined "early" as a diagnosis within one year after radiation therapy. Five cases fit our criteria, and we summarize the findings here. To our knowledge, ours is the first definitive report of a patient with esophageal cancer to present with early radiation-induced constrictive pericarditis. We conclude that constrictive pericarditis can occur early after radiation for thoracic malignancies, albeit rarely. When planning care for cancer patients, awareness of this sequela is helpful.

Aikido: a model for brief strategic therapy.

PubMed

Saposnek, D T

1980-09-01

Building on Watzlawick's observations of certain similarities between judo and brief strategic therapy, this paper develops theoretic and pragmatic parallels between brief strategic therapy and a sophisticated martial art system, Aikido. After presenting the contextual similarities of the two conceptual systems as parallel "challenges" to the therapist and Aikidoist to effect change, the similarities in basic principles of practice are presented. The similarities in the philosophical and attitudinal positions of these conceptual systems are then delineated, followed by a case example that integrates the various concepts in the paper.

Dissociative identity disorder and the process of couple therapy.

PubMed

Macintosh, Heather B

2013-01-01

Couple therapy in the context of dissociative identity disorder (DID) has been neglected as an area of exploration and development in the couple therapy and trauma literature. What little discussion exists focuses primarily on couple therapy as an adjunct to individual therapy rather than as a primary treatment for couple distress and trauma. Couple therapy researchers have begun to develop adaptations to provide effective support to couples dealing with the impact of childhood trauma in their relationships, but little attention has been paid to the specific and complex needs of DID patients in couple therapy (H. B. MacIntosh & S. Johnson, 2008 ). This review and case presentation explores the case of "Lisa," a woman diagnosed with DID, and "Don," her partner, and illustrates the themes of learning to communicate, handling conflicting needs, responding to child alters, and addressing sexuality and education through their therapy process. It is the hope of the author that this discussion will renew interest in the field of couple therapy in the context of DID, with the eventual goal of developing an empirically testable model of treatment for couples.

Chronic catatonic schizophrenia treated successfully with right unilateral ultrabrief pulse electroconvulsive therapy: case report.

PubMed

Cupina, Denise; Patil, Sachin; Loo, Colleen

2013-06-01

Catatonia is a syndrome with prominent motor and behavioral symptoms commonly seen in acutely ill psychiatric patients. Catatonic symptoms have been considered as positive predictors of response to electroconvulsive therapy (ECT); however, few studies so far have addressed the role of ECT treatment technique in schizophrenia. We present the case of a 41-year-old woman with chronic catatonic schizophrenia who was treated successfully with a course of ultrabrief right unilateral ECT.

Effect of periodontal therapy on metabolic control and an inflammatory mediator in type 2 diabetic subjects: a report on 17 consecutive cases.

PubMed

Serrano, Carlos; Pérez, Clara; Sabogal, Diego

2012-04-01

A reciprocal relationship between diabetes mellitus and chronic periodontitis has been described, whereby chronic periodontal infection could affect diabetic metabolic control. Therefore, periodontal therapy could influence metabolic control or systemic inflammation leading to diabetic complications. This case report series presents the effect of therapy on periodontal indices, glycated hemoglobin (HbA1c) and high-sensitivity C-reactive protein (hs-CRP) in a group of type 2 diabetic patients. Seventeen diabetic patients diagnosed with moderate to severe chronic periodontitis received periodontal therapy. All patients received a hygienic phase of treatment and were re-examined 3 months later. At re-examination, subjects judged to need periodontal surgery were treated and re-examined after a further 3 months. A complete clinical examination and measurements of HbA1c and hs-CRP were evaluated. Periodontal treatment led to a significant improvement in periodontal indices; only five patients required periodontal surgery. The percentage of bleeding on probing was reduced by nearly 40%; percentage of pockets > or = 5 mm was less than half baseline values; mean pocket depth reduction was 1.21 mm (0.58) and attachment level gain was 0.74 mm (0.69). Nevertheless, no changes were present for HbA1c; a reduction in hs-CRP of 1.37 mg/L (2.67) was present. Periodontal therapy in this case series group produced a significant improvement in the clinical condition, butdid not affect metabolic control. It led to a decrease in hs-CRP.

Laser therapy in general dental practice

NASA Astrophysics Data System (ADS)

Darbar, Arun A.

2006-02-01

This is a clinical presentation on the use of laser therapy in a private dental practice using a 810nm diode. A wide range of conditions involving pain management, treatment and as an adjunct to procedures to enhance patient comfort and experience. This will include cases treated for TMD (Temporo mandibular dysfunction), apthous ulcers, angular chelitis, cold sores, gingival retraction, periodontal treatment and management of failing dental implants. The case presentation will include the protocols used and some long term reviews. The results have been very positive and will be shared to enable this form of treatment to be used more frequently and with confidence within dental practice.

Cooking and oxygen. An explosive recipe.

PubMed

Burns, H L; Ralston, D; Muller, M; Pegg, S

2001-02-01

Home oxygen therapy is commonly prescribed for the treatment of chronic obstructive pulmonary disease (COPD). The risks of smoking while using this therapy have been well described. To discuss the Royal Brisbane Hospital Burns Unit's experience and present case studies which illustrate the danger of alternative ignition sources while using home oxygen. The dangers of home oxygen therapy can be minimised by careful patient selection, education and ongoing monitoring.

Rivaroxaban as an effective alternative to warfarin in a patient with atrial fibrillation, thrombophilia, and left atrial appendage thrombus: a case report.

PubMed

Scarano, Michele; Casale, Matteo; Mantini, Cesare; Imbalzano, Egidio; Consorti, Cristiana; Clemente, Daniela; Dattilo, Giuseppe

2017-04-09

Atrial fibrillation is the most common cardiac arrhythmia. It is responsible for up to 20% of all ischemic strokes. Rate control and anticoagulation are crucial for atrial fibrillation management and stroke prevention. We present the case of an 84-year-old Italian woman with a left atrial appendage thrombus that developed despite her use of anticoagulant therapy with warfarin for a previous pulmonary embolism. She had atrial fibrillation and heterozygosity for both factor V Leiden and methylenetetrahydrofolate reductase C677T mutation, thus creating resistance to activated protein C. Anticoagulant therapy was switched to heparin for 1 week and then to rivaroxaban. After 3 months of rivaroxaban use, the thrombus disappeared. This case raises the issue of the ineffectiveness of warfarin therapy in complex cases involving particular thrombophilic conditions and the possibility of using rivaroxaban as a safe and effective alternative.

A rare variant of internal anatomy of a third mandibular molar: a case report.

PubMed

Nimigean, V; Nimigean, Vanda Roxana; Sălăvăstru, D I

2011-01-01

The several anatomical variations existing in the root canal system may contribute to failure of the root canal therapy. Knowledge of the internal dental morphology is a complex and extremely important point for planning and performing endodontic therapy. This paper reports the case of a left mandibular third molar that presented only one dental conical root and only one aberrant radicular canal with an initial annular portion situated in the coronar third of the root and a linear portion at the level of the other two thirds of the dental root, which opened through an apical foramen. Root canal therapy and case management are described. Features like wide crown access, adequate illumination and use of exploring files where important for successful completion of the endodontic treatment. The treatment was performed through conventional methods. This clinical case constitutes a rare anatomical variant of internal radicular morphology.

Juvenile dermatomyositis presenting with periorbital edema.

PubMed

Taban, Mehryar; Perry, Julian D

2006-01-01

Juvenile dermatomyositis is a rare disease that affects the skin and muscles. It often presents with a classic heliotrope eyelid rash. We present a case of juvenile dermatomyositis presenting with significant bilateral periorbital edema, with its complete resolution after systemic antiinflammatory therapy.

A case of keratosis lichenoid chronica.

PubMed

Baczewski, Natasha; Albano, Brian

2012-01-01

Keratosis lichenoid chronica is a rare dermatologic anomaly believed to be a variant of lichen planus. It presents as violaceous, nodular lesions usually on the dorsal aspects of the extremities and the trunk. The disease is refractory to treatment although psoralen ultraviolet A therapy and oral retinoids have been proven useful in some cases. Here we present the case of a 58-year-old male diagnosed with keratosis lichenoid chronica.

Otic Langerhans' Cell Histiocytosis in an Adult: A Case Report and Review of the Literature

PubMed Central

Gungadeen, Anil; Kullar, Peter; Yates, Philip

2013-01-01

Objective. To present a case of otic Langerhans' cell histiocytosis in an adult. Also included the diagnosis and management of the condition and a review of the relevant literature. Case Report. We report a case of a 41-year-old man with a history of persistent unilateral ear discharge associated with an aural polyp. Radiological imaging showed bony lesions of the skull and a soft-tissue mass within the middle ear. Histological analysis of the polyp demonstrated Langerhans' cell histiocytosis. His otological symptoms were completely resolved with the systemic therapy. Conclusions. Otic Langerhans' cell histiocytosis can present in adults. Persistent ear symptoms along with evidence of soft-tissue masses within the ear and bony lesions of the skull or elsewhere should prompt the otolaryngologists to include Langerhans' cell histiocytosis in their differential diagnosis. Management should be with systemic therapy rather than local surgical treatment. PMID:23762704

Lactobacillus as a rare cause of an infected total knee replacement: a case report

PubMed Central

2009-01-01

Introduction We report a rare case of an infected revision total knee replacement as a result of a Lactobacillus species infection. Lactobacillus infections have been associated with prolonged broad-spectrum antibiotic use. This can have implications in revision surgery, especially when patients have been on previous long-term suppressive antibiotic therapy. Case presentation An 81-year-old British man with a previous history of complex revision knee arthroplasty for infection presented with a hot, swollen knee joint. He had previously been on long-term suppressive antibiotic therapy. Aspiration of the knee joint yielded a culture of Lactobacillus species. Conclusion In patients undergoing revision joint arthroplasty, especially for previous infection, the presence of common and uncommon bacterial species must be excluded and eradicated before further surgical intervention. PMID:19830207

Endodontic management of permanent mandibular molars with 6 root canals: report of 3 cases.

PubMed

Malhotra, Amit; Ahlawat, Jyoti; Bansal, Chirag; Tahiliani, Divya

2016-01-01

Aberrations in the internal dental anatomy present challenges for clinicians performing endodontic therapy. These challenges have been partly resolved in recent years by a more comprehensive knowledge of root canal anatomy as well as advancements in the endodontic armamentarium. The aim of this case series is to describe successful root canal treatment, under magnification, in 3 cases of mandibular first molars with 6 root canals. Two of these teeth had 2 roots (mesial and distal) with 3 canals in each root; the third tooth had 3 root canals located mesially and 3 present distally as well as a radix entomolaris. A distal root with 3 canals is rare; however, it is important to look for such anatomical variations to ensure successful endodontic therapy.

Successful Treatment of Endometriosis-Related Hemorrhagic Ascites: A Report of Three Cases.

PubMed

Mendes, Sofia; Carvalho, Catarina; Rodrigues, GonÇalo; Barata, Sónia; Calhaz-Jorge, Carlos; Osório, Filipa

2018-06-01

Endometriosis-related ascites is rare and is frequently confused with an ovarian malignancy. Since it affects women in reproductive age, its diagnosis and therapy are even more challenging. These patients usually present with abdominal distension, pelvic pain, and weight loss, but a careful questioning usually reveals the typical endometriosis symptoms-such as dysmenorrhea and dyspareunia. We present three cases of endometriosis-related ascites, one of them with pleural effusion. All cases were associated with extensive disease and required laborious laparoscopic surgery, medical therapy with gonadotropin releasing hormone analogs, and long-term follow-up. One of the patients delivered twins following an in vitro fertilization (IVF) cycle without recurrence of ascites. We aim to raise awareness toward the importance of considering endometriosis in a patient with ascites of unknown origin.

Play therapy: considerations and applications for the practitioner.

PubMed

Kool, Ritesh; Lawver, Timothy

2010-10-01

Play therapy represents a unique form of treatment that is not only geared toward young children, but is translated into a language children can comprehend and utilize-the language of play. For the referring provider or practitioner, questions may remain regarding the nature, course, and efficacy of play therapy. This article reviews the theoretical underpinnings of play therapy, some practical considerations, and finally a summary of the current state of research in regard to play therapy. The authors present the practicing psychiatrist with a road map for referring a patient to play therapy or initiating it in appropriate cases.

Episodic epileptic verbal auditory agnosia in Landau Kleffner syndrome treated with combination diazepam and corticosteroids.

PubMed

Devinsky, Orrin; Goldberg, Rina; Miles, Daniel; Bojko, Aviva; Riviello, James

2014-10-01

We report 2 pediatric patients who presented initially with seizures followed by subacute language regression characterized by a verbal auditory agnosia. These previously normal children had no evidence of expressive aphasia during their symptomatic periods. Further, in both cases, auditory agnosia was associated with sleep-activated electroencephalographic (EEG) epileptiform activity, consistent with Landau-Kleffner syndrome. However, both cases are unique since the episodic auditory agnosia and sleep-activated EEG epileptiform activity rapidly responded to combination therapy with pulse benzodiazepine and corticosteroids. Further, in each case, recurrences were characterized by similar symptoms, EEG findings, and beneficial responses to the pulse benzodiazepine and corticosteroid therapy. These observations suggest that pulse combination high-dose corticosteroid and benzodiazepine therapy may be especially effective in Landau-Kleffner syndrome. © The Author(s) 2014.

[Methemoglobinemia after inhalation of poppers].

PubMed

Janssens, U; Hillen, S; Janssens, T; Grafe, J

2018-04-17

This case report presents a case of symptomatic methemoglobinemia (MetHb 31.6%) after inhalation of volatile nitrites (poppers). The patient's medical history and symptoms are discussed together with pathophysiology of methemoglobinemia, diagnostics, and antidote therapy. Pulse oxymetry, arterial blood gas analysis, and CO-oximetry receive particular attention as well as antidote therapy with methylene blue. The patient was treated successfully with intravenous methylene blue. Within 60 min methemoglobinemia returned to normal values (MetHb 0.6%). Stimulating compounds such as volatile nitrites (poppers) may lead to potentially fatal methemoglobinemia. Swift and accurate diagnosis and targeted therapy with methylene blue can lead to rapid recovery.

[Erythromycin in therapy of cyclic vomiting syndrome].

PubMed

Pavlović, Momcilo; Radlović, Nedeljko; Leković, Zoran; Berenji, Karolina

2007-01-01

Cyclic vomiting syndrome is an insufficiently understood disorder which manifests itself in stereotypical episodes of vomiting with no detectable organic cause. Considering its unknown aetiology, drugs borrowed from various medication classes are applied in the therapy of this disorder, with variable success. Among other medicaments, erythromycin is also used in treatment of cyclic vomiting syndrome. This is a case study in which the application of erythromycin led to the prevention of attacks of cyclic vomiting syndrome. Our case report presents how periodical erythromycin therapy in two-week intervals at expected attack periods in a girl led to disappearance of cyclic vomiting. Adverse effects of erythromycin did not show up.

[Hepatoxic effect of a noni juice consumption--a case report].

PubMed

Waldman, Wojciech; Piotrowicz, Grazyna; Sein Anand, Jacek

2013-01-01

Noni juice of an Indian mulberry fruit has recently become a very popular remedy for several diseases. The paper presents the case of hepatotoxic action of Noni juice in a previously healthy 55-years old female patient. After symptomatic therapy and cessation of exposure to the juice all symptoms dissapeared. 1. Indian mulberry formulations may, in some cases, lead to liver toxicity. 2. Treatment consists of cessation of exposure to preparations containing Indian mulberry fruits and a symptomatic therapy. 3 There is an urgent need to examine the therapeutic and toxic effects of commonly used herbal specifics.

A case of incomplete atypical femoral fracture with histomorphometrical evidence of osteomalacia.

PubMed

Tsuchie, Hiroyuki; Miyakoshi, Naohisa; Nishi, Tomio; Abe, Hidekazu; Segawa, Toyohito; Shimada, Yoichi

2015-01-01

Roughly half of the femoral fracture patients diagnosed with AFF according to the criteria suggested by a task force of the American Society for Bone and Mineral Research (ASBMR) have not undergone bisphosphonate (BP) therapy. One suspected cause of such fractures is severe bone loss due to osteomalacia, but the pathogenesis remains unknown. We report a case of an 84-year-old woman with AFF not treated by BP therapy, in whom underlying osteomalacia was histologically diagnosed. The involvement of femoral curvature and spino-pelvic malaligment in the fracture in the present case was considered.

Bilateral Mastectomy as Radical Treatment of Gynecomastia Secondary to Antiretroviral Therapy in a Low-Income Setting: A Case Report.

PubMed

Antunes, Mario; Schiavone, Marcella; Pizzol, Damiano; Di Gennaro, Francesco; Ludovico, Rossana; De Palma, Angela

2018-05-11

Gynecomastia is a common finding in males, with an incidence that varies widely globally. In 10-25% of cases, it is caused by drugs. Its pathophysiologic mechanism includes exposure to exogenous estrogens and medications that cause hypogonadism, antiandrogenic effects and hyperprolactinemia. Gynecomastia is associated with exposure to antiretroviral therapy (ART), particularly efavirenz. Sometimes surgery may be required as treatment. We report a case of a 46-year-old man receiving ART presenting with a marked bilateral breast enlargement who underwent bilateral mastectomy as the only successful treatment in a low-income setting.

Chronicle of a death foretold: a case of catastrophic vascular Behcet's disease.

PubMed

Planer, David; Leibowitz, David; Elitzur, Yair; Korach, Amit; Hiller, Nurith; Chajek-Shaul, Tova

2007-03-01

A 20-year-old man with Behcet's disease characterized by recurrent arterial aneurysms presented with a new aortic root aneurysm. This patient previously had aneurysms of the coronary arteries and vein, as well as ruptured renal artery aneurysm. Chronic maintenance immunosuppressive therapy was recommended due to the catastrophic nature of the disease, which the patient refused to take. The patient died shortly after admission. This case demonstrates the unique catastrophic natural history of vascular Behcet's disease with recurrent life-threatening arterial events, and this case stresses the therapeutic dilemma of maintenance immunosuppressive therapy in selected patients.

Delayed cerebral radiation necrosis following treatment for a plasmacytoma of the skull.

PubMed

Chambless, Lola B; Angel, Federica B; Abel, Ty W; Xia, Fen; Weaver, Kyle D

2010-10-25

Cerebral radiation necrosis is a relatively common complication of radiation therapy for intracranial malignancies which can also rarely be encountered after radiation of extracranial lesions of the head and neck. We present the first reported case of cerebral radiation necrosis in a patient who underwent radiation therapy for a plasmacytoma of the skull. A 68-year-old male with multiple myeloma presented with an enhancing right frontal mass, 8 years after receiving radiation therapy for a plasmacytoma of the left frontal skull. The patient underwent a diagnostic and therapeutic craniotomy for a presumed neoplastic lesion. The pathologic diagnosis made in this case was delayed radiation necrosis. The patient was followed for over a year during which this process continued to evolve before the ultimate resolution of his clinical symptoms and radiographic abnormality. This case highlights the importance of considering radiation necrosis in the differential diagnosis of any patient with an intracranial mass and a history of radiation for an extracranial head and neck malignancy, regardless of timing and laterality. This case also provides unique insights into the ongoing debate regarding the role of the aberrant immune response in the pathogenesis of delayed cerebral radiation necrosis.

Management of refractory anti-phospholipid syndrome.

PubMed

Scoble, Tina; Wijetilleka, Sonali; Khamashta, Munther A

2011-09-01

Anti-phospholipid syndrome (APS) is an autoimmune prothrombotic disorder characterised by the predisposition to venous and/or arterial thrombosis and obstetric morbidity. Management of APS centres on attenuating the procoagulant state whilst balancing the risks of anticoagulant therapy. Cases of recurrent thromboses and obstetric complications occur despite optimum therapy. Alternative therapies for refractory cases are subject to disparity among clinicians due to the current lack of clinical evidence present. This review aims to address the current management strategies for refractory thrombotic and obstetric cases and future therapeutic interventions. The role and current clinical evidence of using long term low molecular weight heparin (LMWH) as an alternative to warfarin therapy for refractory thromboses is evaluated. Potential alternatives for thromboses including statins, hydroxychloroquine, Rituximab are reviewed as well as the additional avenues to target in the future as the pathogenic mechanisms of APS are unveiled. The optimal management for refractory obstetric APS cases is subject to controversy. This review focuses and assesses the current evidence for the uses of low dose prednisolone, intravenous immunoglobulin and hydroxycholoroquine in obstetric cases. The treatment modalities for the management of refractory APS require further clinical evidence. Copyright © 2011 Elsevier B.V. All rights reserved.

[Dermatomyositis associated with anti-MDA5 antibodies and pneumocystis pneumonia: Two lethal cases].

PubMed

Aymonier, M; Abed, S; Boyé, T; Barazzutti, H; Fournier, B; Morand, J-J

2017-04-01

Dermatomyositis associated with anti-MDA-5 autoantibodies is a recently-described clinical entity. Herein we report two lethal cases involving pneumocystis pneumonia. Case n o  1. A 56-year-old male patient developed cutaneous symptoms consistent with dermatomyositis without muscular involvement. Antinuclear antibodies were present and anti-MDA5 auto-antibodies were identified. The scan showed interstitial lung disease without infection. Significant improvement was obtained with corticosteroids. One month later, the patient presented acute respiratory illness (hypoxemia: PaO 2 60mmHg, exacerbation of lung disease evidenced by a scan, and diagnosis of pneumocystis pneumonia on bronchoalveolar lavage). He died despite appropriate antibiotic therapy and immunosuppressant therapy. Case n o  2. The second case concerned a 52-year-old Vietnamese man who developed more atypical cutaneous symptoms of dermatomyositis without muscular involvement. ANAb responses were positive (1/400) and MDA5 was present. The patient was treated with corticosteroids (40mg/d), hydroxychloroquine, and intravenous immunoglobulin. After significant improvement, the patient developed an acute respiratory illness due to superinfection with pneumocystis and he died despite specific treatment and cyclophosphamide bolus. In dermatomyositis, anti-MDA5 antibody screening is essential for the prognosis since the disease carries a risk of complication with severe lung disease. Bronchial fibroscopy with bronchoalveolar lavage should be considered at the time of diagnosis. Our two cases suggest the need for early screening for pneumocystis pneumonia in the event of respiratory distress and possibly for prophylactic treatment at the start of immunosuppressant therapy. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

Clinical Application of Liquid Biopsy in Targeted Therapy of Metastatic Colorectal Cancer

PubMed Central

Trojan, Jörg; Klein-Scory, Susanne; Koch, Christine; Schmiegel, Wolff

2017-01-01

Background. Colorectal cancers (CRC) shed DNA into blood circulation. There is growing evidence that the analysis of circulating tumor DNA can be effectively used for monitoring of disease, to track tumor heterogeneity and to evaluate response to treatment. Case Presentation. Here, we describe two cases of patients with advanced CRC. The first case is about a patient with no available tissue for analysis of RAS mutation status. Liquid biopsy revealed RAS-wild-type and the therapy with anti-EGFR (epidermal growth factor receptor) monoclonal antibody cetuximab could be initiated. In the second case, the mutational profile of a patient with initial wild-type RAS-status was continually tracked during the course of treatment. An acquired KRAS exon 3 mutation was detected. The number of KRAS mutated fragments decreased continuously after the discontinuation of the therapy with EGFR-specific antibodies. Conclusion. Liquid biopsy provides a rapid genotype result, which accurately reproduces the current mutation status of tumor tissue. Furthermore, liquid biopsy enables close monitoring of the onset of secondary resistance to anti-EGFR therapy. PMID:28232873

Clinical Application of Liquid Biopsy in Targeted Therapy of Metastatic Colorectal Cancer.

PubMed

Trojan, Jörg; Klein-Scory, Susanne; Koch, Christine; Schmiegel, Wolff; Baraniskin, Alexander

2017-01-01

Background. Colorectal cancers (CRC) shed DNA into blood circulation. There is growing evidence that the analysis of circulating tumor DNA can be effectively used for monitoring of disease, to track tumor heterogeneity and to evaluate response to treatment. Case Presentation. Here, we describe two cases of patients with advanced CRC. The first case is about a patient with no available tissue for analysis of RAS mutation status. Liquid biopsy revealed RAS-wild-type and the therapy with anti-EGFR (epidermal growth factor receptor) monoclonal antibody cetuximab could be initiated. In the second case, the mutational profile of a patient with initial wild-type RAS-status was continually tracked during the course of treatment. An acquired KRAS exon 3 mutation was detected. The number of KRAS mutated fragments decreased continuously after the discontinuation of the therapy with EGFR-specific antibodies. Conclusion . Liquid biopsy provides a rapid genotype result, which accurately reproduces the current mutation status of tumor tissue. Furthermore, liquid biopsy enables close monitoring of the onset of secondary resistance to anti-EGFR therapy.

Cognitive behavioral therapy for insomnia as a preparatory treatment for exposure therapy for posttraumatic stress disorder.

PubMed

Baddeley, Jenna L; Gros, Daniel F

2013-01-01

Insomnia is present in a majority of individuals with posttraumatic stress disorder (PTSD). However, when both disorders are present, disagreements exist about whether to provide exposure therapy for PTSD before insomnia treatment, or vice versa. The current case study describes the psychological treatment of a psychotherapy-naive veteran with comorbid insomnia and PTSD. The patient initially refused exposure therapy for PTSD; thus, cognitive-behavioral therapy for insomnia (CBTi) was a first-step treatment. Cognitive Behavior Therapy for Insomnia provided insomnia symptom relief psychoeducation and self-monitoring of PTSD symptoms prepared the patient to enter exposure therapy. After six CBTi sessions, the patient completed seven sessions of trauma-specific exposure therapy. At the conclusion of treatment and at 90-day follow up, the patient demonstrated significant reductions in insomnia and PTSD symptoms. Findings support the safe and effective use of CBTi in patients with comorbid insomnia and PTSD to improve sleep and facilitate entry into exposure therapy for PTSD.

Use of dimethyl sulfoxide (DMSO) in radiation therapy (in German)

DOE Office of Scientific and Technical Information (OSTI.GOV)

Glaser, F.H.

1973-01-01

The present clinical examinstion deals with the possible use of DMSO in rsdiation therapy. DMSO was applied to 30 patients, 8 times in radiogenic subcutaneous fibroses, 13 times in contracted scars and keloids, 3 times in cases of induratio penis plastica, and 6 times as vehicle substsnce for tamor cell sensitization with vitamin A in the radiation therapy of skin metastases sfter mamma carcinoma. The results confirm the value of a DMSO treatment of subcutaneous fibroses following highly dosed percutaneous radiation therapy, especially in cases with a radiological ulcer. In keloids of scars a clear effect could be achieved withoutmore » exceptions also in those csses showing only insufficient regression tendency to a preceded rsdiation therapy. The results of irradiation in cases with I.p.p., however, did not show any convincing improvement by a DMSO treatment. A new field of application is opened for the indiation therapy of recurrences and metastases in the area of the skin by sensitization of these cutaneous tumor infiltrates by vitamin A in connection with DMSO as vehicle substance so that a curative regression can be locally obtained by relatively low radiation doses. (auth)« less

Bloodstream infections in patients with solid tumors: epidemiology, antibiotic therapy, and outcomes in 528 episodes in a single cancer center.

PubMed

Marín, Mar; Gudiol, Carlota; Garcia-Vidal, Carol; Ardanuy, Carmen; Carratalà, Jordi

2014-05-01

Current information regarding bloodstream infection (BSI) in patients with solid tumors is scarce. We assessed the epidemiology, antibiotic therapy, and outcomes of BSI in these patients. We also compared patients who died with those who survived to identify risk factors associated with mortality. From January 2006 to July 2012 all episodes of BSI in patients with solid tumors at a cancer center were prospectively recorded and analyzed. A total of 528 episodes of BSI were documented in 489 patients. The most frequent neoplasms were hepatobiliary tumors (19%), followed by lung cancer (18%) and lower gastrointestinal malignancies (16%). Many patients had received corticosteroid therapy (41%), and 15% had neutropenia (<500 neutrophils/μL) at the time of BSI. The most common source of BSI was cholangitis (21%), followed by other abdominal (19.5%) and urinary tract infections (17%). Gram-negative BSI occurred in 55% of cases, mainly due to Escherichia coli (55%), Pseudomonas aeruginosa (18%), and Klebsiella pneumoniae (16%). Among gram-positive BSI (35%), viridans group streptococci were the most frequent causative organisms (22%), followed by Staphylococcus aureus (21%) and Enterococcus species (18%). We identified 61 multidrug-resistant (MDR) organisms (13%), mainly extended-spectrum β-lactamase-producing Enterobacteriaceae (n = 20) and AmpC-producing Enterobacteriaceae (n = 13). The majority of patients with BSI caused by MDR organisms had received antibiotics (70%), and they had been previously hospitalized (61.4%) more frequently than patients with BSI caused by susceptible strains. Inadequate empirical antibiotic therapy was given to 23% of patients, with a higher proportion in those with BSI due to a MDR strain (69%). Early (<48 h) and overall (30 d) case-fatality rates were 7% and 32%, respectively. The overall case-fatality rate was higher among cases caused by MDR organisms (39.3%). The only independent risk factors for the early case-fatality rate were the endogenous source of BSI (odds ratio [OR], 3.57; 95% confidence interval [CI], 1.06-12.02), shock at presentation (OR, 3.63; 95% CI, 1.63-8.09), and corticosteroid therapy (OR, 3.245; 95% CI, 1.43-7.32). The independent risk factors for overall case-fatality rate were the presence of a chronic advanced cancer (OR, 35.39; 95% CI, 2.48-504.91), shock at presentation (OR, 25.84; 95% CI, 3.73-179.0), and corticosteroid therapy (OR, 6.98; 95% CI, 1.61-30.21).BSI in patients with solid tumors occurred mainly among those with hepatobiliary cancer, and cholangitis was the most frequent source; gram-negative bacilli were the most frequent causative agents. MDR organisms were relatively common, particularly in patients who had previously received antibiotics and had been hospitalized; these patients were frequently treated with inadequate empirical antibiotic therapy and had a poorer outcome. The case-fatality rate of patients with solid tumors and BSI was high and was associated with chronic advanced cancer, corticosteroid therapy, and shock at presentation.

Adaptive Counseling and Therapy: An Integrative, Eclectic Model.

ERIC Educational Resources Information Center

Howard, George S.; And Others

1986-01-01

Presents an integrative model, Adaptive Counseling and Therapy (ACT), for selecting a progression of therapist styles as clients move through developmental stages during the course of counseling and psychotherapy. ACT is intended to be useful to practitioners in case conceptualization and in the application of effective treatment planning.…

Tooth extraction by orthodontic force after radiation therapy: report of case

DOE Office of Scientific and Technical Information (OSTI.GOV)

Rodu, B.; Filler, S.J.; Woodfin, G.K.

1985-12-01

This report presents a therapeutic approach to orthodontic tooth extraction in a patient at high risk for the development of osteoradionecrosis with conventional techniques. The rationale for this procedure is discussed in detail, combining principles of radiation biology, clinical radiation therapy, and biomechanics of tooth movement.

Tuberculosis: Art Therapy with Patients in Isolation.

ERIC Educational Resources Information Center

Rosner-David, Irene; Ilusorio, Shereen

1995-01-01

Tuberculosis is reappearing with increasing prevalence and presenting new treatment challenges. Art therapy, which partly originated in a tuberculosis sanatoria, again serves to assist patients in coping with their illness and confinement. Case examples illustrate aspects of the disease and related emotions and highlight the potential for such an…

Conversion Therapy: Ethical Considerations in Family Counseling.

ERIC Educational Resources Information Center

Steigerwald, Fran; Janson, Gregory R.

2003-01-01

Explores the ethical and practical considerations of conversion therapy when counseling families and individuals within families with gay, lesbian, bisexual, and transsexual concerns. Emphasis is placed on the need for counselors to assess personal biases in the area of working with sexual minorities. Presents a reflective exercise and case study…

DOE Office of Scientific and Technical Information (OSTI.GOV)

Novelli, Luigi, E-mail: luigi.novelli@egp.aphp.fr; Raynaud, Alain; Pellerin, Olivier

We report the case of a 50-year-old man who presented to our institution with septic thrombosis of the renal vein which had not resolved despite several days of antibiotic therapy. Optimal restoration of renal vein flow was obtained by percutaneous manual aspiration embolectomy (PMAE) in this patient with contraindication to fibrinolytic therapy and surgery.

[A mandibular second molar with three mesial roots: report of one case].

PubMed

Zhang, Ping

2010-02-01

A case of unusual root canal morphology was presented to demonstrate anatomic variations in mandibular second molars. This case report presented the endodontic therapy of a mandibular second molar with three canals in the mesial root. A mesial middle canal was found between the mesiobuccal and mesiolingual canals. This report indicated the importance of looking for additional canals and unusual canal morphology, because knowledge of their existence might occasionally enable clinicians to treat a case successfully that otherwise to fail.

The nasogastric tube syndrome: two case reports and review of the literature.

PubMed

Apostolakis, L W; Funk, G F; Urdaneta, L F; McCulloch, T M; Jeyapalan, M M

2001-01-01

The nasogastric tube syndrome is a potentially life-threatening complication of an indwelling nasogastric (NG) tube. The syndrome is thought to result from ulceration and infection of the posterior cricoid region with subsequent dysfunction of vocal cord abduction. This dysfunction may present as complete loss of vocal cord abduction manifested as serious airway compromise. Reports of this syndrome are infrequent, with only 29 cases published to date. Two additional cases of nasogastric tube syndrome diagnosed at the University of Iowa Hospitals and Clinics over a 2-year period are presented. A search of MEDLINE (1966 through February 1999), including review of those articles' references identified seven previous publications, including 29 case reports. These 29 cases are reviewed and the findings summarized. Twenty-nine cases of NG tube syndrome are identified, with 16 of these occurring in the preantibiotic period. Including the two cases presented here, 15 contemporary patients are examined. Among these 15 cases, 10 required tracheostomy, on average 8.5 days after NG tube placement. Although the fully manifested syndrome presents quite dramatically, we suspect that a clinical spectrum of severity exists with less severe cases going unrecognized. Consistent with previous reports, we found that direct visualization of the postcricoid region is required to rule out the diagnosis and recommend such action be taken whenever the diagnosis is suspected. Treatment should include establishment of a safe airway, removal of the tube whenever possible, antibiotic therapy, and antireflux therapy.

The neuropsychiatric aspect of Addison's disease: a case report.

PubMed

Abdel-Motleb, Mohamed

2012-10-01

Chronic adrenal insufficiency, known as Addison's disease, presents with a constellation of symptoms and signs. The neuropsychiatric aspect of this condition is not fully understood and not much has been documented about it in the English literature. This article presents a case of a 41-year old male patient who presented initially with depression after a recent life stressor. After his condition escalated and therapy continued to fail, the medical team revised its diagnosis to Addison's disease. Neuropsychiatric symptoms could be the first presentation of Addison's disease, and thus should be kept in mind whenever such a case presents to the physician.

Report on Hyperbaric Oxygen Therapy: An Overlooked Therapeutic Option in Stroke Recovery and a Potential Source of Health Sector Revenue and Health Tourism.

PubMed

Lowe, S; Le Mercier du Quesnay, D R; Gayle, Pmh; Henry-Pinnock, F; Wedderburn-Buddo, T

2015-06-30

This is a special case report on Jamaica's first use of hyperbaric oxygen therapy (HBOT) in stroke recovery, presented at the 56 th Annual Conference of the Association of Surgeons in Jamaica, Kingston, Jamaica. The literature and story behind the trial ‒ covering case history, diagnosis and discussion of outcome ‒ technical issues, costing, insurance and possibilities for income earning and health tourism are explored.

Cystic echinococcosis of lung and heart coupled with repeated echinococcosis of brain--a case report.

PubMed

Busić, Zeljko; Bradarić, Nikola; Ledenko, Vlatko; Pavlek, Goran

2011-12-01

Echinococcosis is rarely encountered as a cystic brain disease. In this article we are presenting a case of a young woman repeatedly operated due to echinococcosis of lung, heart and brain. Recurrent brain ecchinococcosis developed despite preoperative and postoperative albendazol therapy after first and combined therapy with albendazol and praziquantel after the second brain surgery. The mechanism of recurrence remains unclear (primary infestation, dissemination after spontaneous or intraoperative cyst rupture or new infestation).

Human Gongylonema pulchrum Infection: Esophageal Symptoms and Need for Prolonged Albendazole Therapy.

PubMed

Libertin, Claudia R; Reza, Mohammed; Peterson, Joy H; Lewis, Jason; Hata, D Jane

2017-04-01

AbstractWe describe a case of human infection with Gongylonema pulchrum acquired in southeast Georgia. The patient presented with intermittent yet persistent nausea and vomiting for months. This case describes the need for extraction of worms on two occasions each followed by courses of albendazole treatment. Gongylonema pulchrum infections with high worm burden may relapse after extraction of the worm and a 3-day short course of albendazole therapy. Longer courses of albendazole may be indicated in selected circumstances.

[Aneurysms of the deep femoral artery: a systematic review of literature].

PubMed

Tsilimparis, N; Faber, E; Zindler, K; Mohammad, W; Hanack, U; Yousefi, S; Rückert, R I

2012-10-01

True aneurysms of the deep femoral artery (APFA) are rare and are usually presented as case reports. Recommendations for diagnostics and therapy of APFAs are based on low-level evidence only. The purpose of this paper was to summarise the existing world experience with APFA. On the occasion of our own case a systematic review of the literature was performed for diagnostics and therapy for true APFA. Publications retrieved from PubMed, EMBASE, and the Cochrane Collaboration as well as by hand search from their references were reviewed. From 2002 onwards 25 papers on true APFAs were published in the English and German literature. Apart from two retrospective studies over a longer period of time these were exclusively case reports. A total of 55 true APFAs were reported in 47 patients with a mean age of 63 years. Therapeutic intervention was due to a rupture in 10 cases (18 %). The mean maximal diameter of APFA at presentation was 5.4 cm (2-18 cm). APFAs that were not ruptured presented frequently as a painful pulsatile mass in the groin and thigh. Therapeutic options for APFA included, apart from surgical resection with or without reconstruction of the deep femoral artery, the endovascular repair. Symptoms of swelling and pain in the presence of a mass at the proximal thigh should raise the suspicion of an APFA. Surgical therapy should be performed electively in APFAs with a diameter of more than 2 cm or in cases of rapid progression as well as in all symptomatic or ruptured cases. The endovascular approach should be considered as an alternative option in all cases. Georg Thieme Verlag KG Stuttgart · New York.

[Therapeutic factors affecting the healing process in patients with gangrene of the perineum].

PubMed

Baraket, Oussama; Triki, Wissem; Ayed, Karim; Hmida, Sonia Ben; Lahmidi, Mohamed Amine; Baccar, Abdelamjid; Bouchoucha, Samy

2018-01-01

Fournier gangrene is a rare and severe necrotizing fasciitis. It is burdened with high morbi-mortality, requiring early and massive medical and surgical management. Initial treatment is based on patient's resuscitation associated with surgical debridement. Subsequently, the main challenge is the healing process and its possible sequelae. Several therapeutic approaches are currently available to improve and accelerate the healing process. We conducted a retrospective study of 20 cases. The median age of our patients was 56 years. The study included 16 men and 7 women. Comorbidity was present in 15 patients. Antibiotic therapy was administered in all cases, with a median duration of 15 days. All patients underwent surgery. Iterative reviews were necessary in all patients, who needed, on average, 3 dressing changes. Colostomy was performed in 6 cases. Hyperbaric oxygen therapy was performed in 4 cases. Vacuum assisted closure was performed in 1 case. Soft tissue coverage was necessary in 2 cases. The mean duration of healing was 15 days with oxygen therapy versus 24 days in the absence of this treatment. The mean duration of hospitalization was 20 days. Four patients died. Healing process without sequelae is a therapeutic challenge. Despite the addition of new therapeutic approaches, outcomes are not satisfactory. However, multidisciplinary approach associated with oxygen therapy and vacuum assisted closure might improve patients outcomes.

Severe Refractory Anemia in Primary Intestinal Lymphangiectasia. A Case Report.

PubMed

Balaban, Vasile Daniel; Popp, Alina; Grasu, Mugur; Vasilescu, Florina; Jinga, Mariana

2015-09-01

Primary intestinal lymphangiectasia (Waldmann's disease) is a rare disease characterized by dilated lymphatics in the small bowel leading to an exudative enteropathy with lymphopenia, hypoalbuminemia and hypogammaglobulinemia. We report the case of a 23 year-old male who presented with chronic anemia and in whom primary intestinal lymphangiectasia was diagnosed. A low-fat diet along with nutritional therapy with medium-chain triglyceride supplementation improved the protein-losing enteropathy, but did not solve the anemia. Octreotide was also unsuccessful, and after attempting angiographic embolization therapy, limited small bowel resection together with antiplasmin therapy managed to correct the anemia and control the exudative enteropathy. Although primary intestinal lymphangiectasia is usually adequately managed by nutritional therapy, complications such as anemia can occur and can prove to be a therapeutic challenge.

Cotard's syndrome with schizophreniform disorder can be successfully treated with electroconvulsive therapy: case report

PubMed Central

Caliyurt, Okan; Vardar, Erdal; Tuglu, Cengiz

2004-01-01

We report a case of Cotard's syndrome associated with psychotic symptoms. A 27-year-old man was admitted to hospital with the diagnosis of schizophreniform disorder. His presenting symptoms, which had started 1 month before hospital admission, were somatic delusions of gastrointestinal and cardiovascular malfunction and the absence of a stomach, which resulted in a decrease in weight from 75 kg to 63 kg in 1 month. Cranial computed tomographic images showed dilatation of the lateral and third ventricles, whereas magnetic resonance imaging revealed central atrophy and lateral ventricle dilatation. Single- photon emission computed tomography demonstrated left temporal, left frontal and left parietal hypoperfusion. The patient did not respond to antipsychotic therapies, but he was successfully treated with electroconvulsive therapy. This report emphasizes that Cotard's syndrome may be accompanied by lesions of the left hemisphere and that electroconvulsive therapy could be the first-line therapy in such patients with psychotic disorder. PMID:15069468

[Clinical aspects of coping with tinnitus].

PubMed

Nieschalk, M; Winter, B; Stoll, W

1995-10-01

Forty-two patients suffering form chronic tinnitus participated in our psychologically oriented treatment last year. The following study presents the results of the psychological management of chronic tinnitus combining counselling with relaxation training. Furthermore individual therapy is compared with group therapy. The therapeutical efficiency can be tested using visual analog scales. The individual estimated loudness and annoyance of tinnitus are registered. A quantitative assessment of complaints is made via questionnaires (adapted to Back Depression Inventory). In most cases a reduction of tinnitus loudness and annoyance after individual and group therapy is seen directly. But a constant therapeutical effect is only found is individual therapy. In group therapy, many of our patients reported an increase in the pretherapeutical estimation of tinnitus loudness and annoyance. We believe that permanent confrontation with the tinnitus problem may advance the psychological conflict in many cases. Therefore, psychological management of tinnitus should be concentrated on temporary limited support aimed at overcoming tinnitus sensation.

Safe and effective administration of T-VEC in a patient with heart transplantation and recurrent locally advanced melanoma.

PubMed

Schvartsman, Gustavo; Perez, Kristen; Flynn, Jill E; Myers, Jeffrey N; Tawbi, Hussein

2017-01-01

Immunotherapy plays a key role in the treatment of metastatic melanoma. Patients with autoimmune conditions and/or on immunosuppressive therapy due to orthotropic transplants, however, are systematically excluded from clinical trials. Talimogene laherparepvec (T-VEC) is the first oncolytic virus to be approved by the FDA for cancer therapy. To our knowledge, this is the first report of T-VEC being administered in the setting of an organ transplant recipient. Here we present the case of a patient with recurrent locally advanced cutaneous melanoma receiving salvage T-VEC therapy in the setting of orthotropic heart transplantation. After 5 cycles of therapy, no evidence of graft rejection has been observed to date, and the patient achieved a complete remission, and is currently off therapy. This case advocates for further investigation on the safety and efficacy of immunotherapeutic approaches, such as T-VEC, in solid organ transplant recipients.

Treatment of psoriasis and long-term maintenance using 308 nm excimer laser, clobetasol spray, and calcitriol ointment: a case series.

PubMed

Wong, Jillian W; Nguyen, Tien V; Bhutani, Tina; Koo, John Y M

2012-08-01

Psoriasis is a chronic inflammatory skin disease that is characterized by thickened red plaques covered with silvery scales. Excimer laser therapy is a cutting-edge advancement in UVB phototherapy. In contrast to traditional phototherapy, the 308 nm excimer laser only targets psoriasis plaques, while it spares uninvolved skin. It allows for treatment with a supra-erythmogenic dose of UVB irradiation. Targeted UVB therapy is a possible treatment especially for many who have failed topical treatments, systemic therapy, and traditional phototherapy. For safe and effective psoriasis treatment, a combination of therapies may be used, including a combination of laser treatment with topical medications. We present two cases demonstrating effective treatment with excimer laser in conjunction with clobetasol spray and calcitriol ointment for 12 weeks. Long-term near-clearance of psoriasis was sustained after 6 months and one-year follow up periods without further therapy.

The Effect of Group Play Therapy on Social-Emotional Skills in Pre-School Children

PubMed Central

Chinekesh, Ahdieh; Kamalian, Mehrnoush; Eltemasi, Masoumeh; Chinekesh, Shirin; Alavi, Manijeh

2014-01-01

Background: Childhood is important and critical period in human life. The foundation of ego is shaped in childhood. Play therapy is one of the successful strategies to help children with inner conflicts problems. This method of psychotherapy is base on the normal learning processes of children, provides solutions to relieve feelings of stress, and expands self-expression. Group play therapy can enhance the self-awareness, self- regulation, social communication, empathy and adoptability in children. Methods: Present study investigated the effects of play therapy on relational and emotional skills of pre-school children. For this purpose, the total numbers of 372 pre-school children were randomly selected, and divided into two equal groups (case and control). In next step, the BUSSE-SR methodology was used for evaluation and comparison of self-awareness, self-regulation, social interaction, empathy, adoptability, and control groups. Pre-test were performed for both groups and case group was involved in-group play therapy. According to the results of post-test, correlation of variables between case-control groups was examined by multivariate analysis of covariance. Results: Frequency of boys and girls in our sample were 51.3 and 48.7 percent, respectively. The mean age of children was 5.1±0.6 year. According to the results of present study, play therapy significantly enhanced the social-emotional skills (P< 0.001). Our findings are consistent with the results of previous studies in other nations with different environmental and cultural properties. In conclusion, it seems that play therapy can be used in pre-school centers to help children learn problem-solving skills and communicate with others. PMID:24576376

Severe myositis of the hip flexors after pre-operative chemoradiation therapy for locally advanced rectal cancer: case report.

PubMed

Florczynski, Matthew M; Sanatani, Michael S; Mai, Lauren; Fisher, Barbara; Moulin, Dwight E; Cao, Jeffrey; Louie, Alexander V; Pope, Janet E; Leung, Eric

2016-03-22

The use of neoadjuvant radiation therapy and chemotherapy in the treatment of locally advanced rectal adenocarcinoma has been shown to reduce disease recurrence when combined with surgery and adjuvant chemotherapy. We report a case of a patient who developed a debilitating bilateral myopathy of the hip flexors after successful treatment for rectal cancer. To the best of our knowledge, this is the first such complication from radiation therapy reported in a patient with colorectal cancer. The disproportionate severity of our patient's myopathy relative to the dose of radiation used also makes this case unique among reports of neuromuscular complications from radiation therapy. The patient is a 65-year-old male with node negative, high-grade adenocarcinoma of the rectum penetrating through the distal rectal wall. He underwent neoadjuvant concurrent pelvic radiation therapy and capecitabine-based chemotherapy, followed by abdominoperineal resection and post-operative FOLFOX chemotherapy. Five months post-completion of pelvic radiotherapy and 2 months after the completion of adjuvant chemotherapy, he presented with bilateral weakness of the iliopsoas muscles and severe pain radiating to the groin. The patient improved with 40 mg/d of prednisone, which was gradually tapered to 2 mg/d over 6 months, with substantial recovery of muscle strength and elimination of pain. The timing, presentation and response of our patient's symptoms to corticosteroids are most consistent with a radiation recall reaction. Radiation recall is a phenomenon whereby previously irradiated tissue becomes vulnerable to toxicity by subsequent systemic therapy and is rarely associated with myopathies. Radiation recall should be considered a potential complication of neoadjuvant radiation therapy for rectal cancer, and for ongoing research into the optimization of treatment for these patients. Severe myopathies caused by radiation recall may be fully reversible with corticosteroid treatment.

A Case of Therapy-Resistant Folliculitis due to Adrenal Insufficiency?

PubMed Central

Stausholm, Kirsten Rønholt; Spaun, Eva; Koppelhus, Uffe

2016-01-01

A report on a 40-year-old patient with recalcitrant, suppurative folliculitis is presented. After years of unsuccessful treatment with conventional therapies, the patient was diagnosed with adrenal insufficiency with a low level of circulating cortisol. A few weeks after the patient was subjected to substitution therapy with hydrocortisone, his folliculitis resolved. We discuss the role of plasma cortisol level in the pathogenesis of folliculitis. PMID:28101019

A multimodal physical therapy approach to the management of a patient with temporomandibular dysfunction and head and neck lymphedema: a case report

PubMed Central

Crane, Patricia; Feinberg, Lauren; Morris, John

2015-01-01

Objective and importance: There is a paucity of research that investigates therapeutic interventions of patients with concurrent head and neck lymphedema and temporomandibular dysfunction (TMD). The purpose of this case report is to describe the management and outcomes of a patient with head and neck lymphedema and TMD using a multimodal physical therapy approach. Clinical presentation: A 74-year-old male with a past medical history of head and neck lymphedema and TMD was referred to physical therapy with chief complaints of inability to open his mouth in order to eat solid food, increased neck lymphedema, temporomadibular joint pain, and inability to speak for prolonged periods of time. Interventions: The patient was treated for three visits over 4 weeks. Treatment included complete decongestive therapy (CDT), manual therapy, therapeutic exercise, and a home exercise program. Upon discharge, the patient had improved mandibular depression, decreased head and neck lymphedema, improved deep neck flexor endurance, decreased pain, and improved function on the Patient Specific Functional Scale (PSFS). Conclusion: Utilization of a multimodal physical therapy approach to treat a patient with a complex presentation yielded positive outcomes. Further research on outcomes and treatment approaches in patients with TMD and head and neck lymphedema is warranted. PMID:26309380

Insulin oedema in a child with newly diagnosed diabetes mellitus.

PubMed

Aravamudhan, Avinash; Gardner, Chris; Smith, Claire; Senniappan, Senthil

2014-05-01

Insulin oedema is a rare complication of insulin therapy for diabetes mellitus. It has been reported in type 1 diabetes mellitus, in poorly controlled type 2 diabetes mellitus following either the initiation or intensification of insulin therapy and in underweight patients on large doses of insulin. There are only a few case reports since it was first described in 1928, showing that it is an uncommon and probably an under-reported complication. The majority of those reports have been in the adult population. The generalised oedema tends to develop shortly after initiation or intensification of insulin therapy and resolves spontaneously within few weeks. We present one of the youngest patients reported in the literature, a 9-year-old boy who developed insulin oedema within few days of presenting with diabetic ketoacidosis. The case highlights the importance of recognising this generally transient and self-resolving complication and differentiating it from other serious causes of oedema.

Thinking and working relationally: interviewing and constructing hypotheses to create compassionate understanding.

PubMed

Sheinberg, Marcia; Brewster, Mary Kim

2014-12-01

In the initial interviews of family therapy sessions, the therapist faces the challenge of obtaining and organizing the information that is most relevant toward understanding the essential concerns that families and couples bring to therapy. This article describes the process of clinical interviewing and case conceptualization used in training family therapists at the Ackerman Institute for the Family. This approach helps the therapist bring forward, and organize, specific information into relational hypotheses, or systemic-relational conceptualizations, that allow both family members and the therapist to understand presenting problems within their relational contexts. While always provisional, relational hypotheses help anchor the therapist in a systemic-relational frame and provide a conceptual through-line to guide the ongoing work of the therapy. The process of interviewing and the construction of clear and complex conceptualizations of presenting problems are illustrated through case examples. © 2014 Family Process Institute.

Diagnostic and therapeutic challenges of EBV-positive mucocutaneous ulcer: a case report and systematic review of the literature.

PubMed

Roberts, Toni K; Chen, Xueyan; Liao, Jay Justin

2015-01-01

Epstein-Barr virus-positive mucocutaneous ulcer (EBVMCU) is a recently recognized B cell lymphoproliferative disorder that is driven by latent EBV infection and causes discrete ulcerations in the oropharynx, gastrointestinal tract, and skin. Local attenuation of immunosurveillance associated with iatrogenic immunosuppressant use, primary immunodeficiency, or age-associated immunosenescence has been implicated as a predisposing factor. This disorder is likely under reported, as it was only first defined in 2010 and shares histological features with other B-cell proliferative neoplasms. The first case series that described EBVMCU suggested that EBVMCU is generally self-limited and is likely to resolve without treatment. Since that publication, additional cases have been reported that describe a more heterogeneous clinical course, often requiring aggressive therapy. We now systematically review all published cases of EBVMCU and detail a case of aggressive and progressive EBVMCU, including diagnostic and management challenges, as well as successful treatment with radiation therapy. A forty-nine year old woman presented with painful and debilitating multifocal oral EBVMCU that initially responded to four weekly doses of rituximab. Her disease relapsed within 3 months and continued to progress and cause significant morbidity. She was successfully treated with local external beam radiation therapy of 30 Gy in 15 fractions, with duration of response of at least 6 months. We suggest that although many patients with EBVMCU experience a self-limited course, for others EBVMCU can be a debilitating, persistent disorder that requires aggressive therapy to prevent disease progression. CD20- and CD30-directed antibody therapy, local radiation therapy, local surgical excision, systemic chemotherapy, and a combination of these therapies have all been successfully used to treat EBVMCU with high rates of durable clinical remission. As EBVMCU is not currently included in the 2008 WHO classification of lymphoproliferative disorders and no evidence-based guidelines or expert opinions have been proposed to guide therapy, this case report and systematic review provides a foundation on which to guide therapeutic decisions.

Severe angioedema in myxedema coma: a difficult airway in a rare endocrine emergency.

PubMed

Lee, Christopher H; Wira, Charles R

2009-10-01

Myxedema coma is the most lethal manifestation of hypothyroidism. It is a true medical emergency and can result in profound hemodynamic instability and airway compromise. Myxedema coma currently remains a diagnostic challenge due to the rarity of cases seen today, and failure to promptly initiate therapy with replacement thyroid hormone can be fatal. As thyroid hormone therapy can take days or weeks to reverse the manifestations of myxedema coma, interim supportive therapy is critical while awaiting clinical improvement. Some patients will require endotracheal intubation in the emergency department (ED), and physicians should be aware that unanticipated posterior pharyngeal edema in myxedema coma could severely complicate airway management. Although mechanical ventilation is a well-described adjunctive therapy for myxedema coma, reports of the potential difficulty in securing a definitive airway in these patients are rare. We describe a case of an unidentified woman who presented to the ED with myxedema coma requiring urgent endotracheal intubation and was found to have extensive posterior pharyngeal angioedema inconsistent with her relatively benign external examination. This case highlights the typical features of myxedema coma and discusses our necessity for a rescue device in definitive endotracheal tube placement. Emergency physicians should anticipate a potentially difficult airway in all myxedema coma patients regardless of the degree of external facial edema present.

Shoshin beriberi induced by long-term administration of diuretics: a case report.

PubMed

Misumida, Naoki; Umeda, Hisashi; Iwase, Mitsunori

2014-01-01

Previous studies have suggested that diuretic therapy for heart failure may lead to thiamine deficiency due to the increased urinary thiamine excretion. Herein, we present the case of a 61-year-old man with shoshin beriberi, a fulminant form of wet beriberi, induced by long-term diuretic therapy. The patient had a history of heart failure with preserved ejection fraction and was receiving furosemide and trichlormethiazide therapy. He presented with worsening exertional dyspnea and was admitted for heart failure exacerbation. His condition failed to improve even after intensive treatment. A hemodynamic evaluation with the Swan-Ganz catheter revealed high-output heart failure with low peripheral vascular resistance. Thiamine was administered for suspected shoshin beriberi; his hemodynamic status improved dramatically within the next six hours. The serum thiamine level was below the normal range; the patient was therefore diagnosed with shoshin beriberi. The common causes of thiamine deficiency were not identified. Long-term diuretic therapy with furosemide and thiazide was thought to have played a major role in the development of thiamine deficiency. This case illustrates the importance of considering wet beriberi as a possible cause of heart failure exacerbation in patients taking diuretics, even when the common thiamine deficiency causes are not identified with history-taking.

Re-imagining occupational therapy clients as communities: Presenting the community-centred practice framework.

PubMed

Hyett, Nerida; Kenny, Amanda; Dickson-Swift, Virginia

2018-01-09

Occupational therapists' are increasingly working with communities and providing services at the community level. There is, however, a lack of conceptual frameworks to guide this work. The aim of this article is to present a new conceptual framework for community-centered practice in occupational therapy. The conceptual framework was developed from qualitative multi-case research on exemplars of community participation. The first was, a network of Canadian food security programs, and the second, a rural Australian community banking initiative. Key themes were identified from across the case studies, and cross-case findings interpreted using occupational therapy and occupational science knowledge, and relevant social theory. The outcome is a four-stage, occupation-focused, community-centered practice framework. The Community-Centred Practice Framework can be used by occupational therapists to understand and apply a community-centered practice approach. The four stages are: (1) Community Identity, (2) Community Occupations, (3) Community Resources and Barriers, and (4) Participation Enablement. Further research is needed to trial and critically evaluate the framework, to assess its usefulness as a robust, occupation-focused, frame of reference to guide community-centered practice in occupational therapy. The proposed framework should assist occupational therapists to conceptualize community-centered practice, and to utilize and apply theory.

Herbal therapy is equivalent to rifaximin for the treatment of small intestinal bacterial overgrowth.

PubMed

Chedid, Victor; Dhalla, Sameer; Clarke, John O; Roland, Bani Chander; Dunbar, Kerry B; Koh, Joyce; Justino, Edmundo; Tomakin, Eric; Mullin, Gerard E

2014-05-01

Patients with small intestine bacterial overgrowth (SIBO) have chronic intestinal and extraintestinal symptomatology which adversely affects their quality of life. Present treatment of SIBO is limited to oral antibiotics with variable success. A growing number of patients are interested in using complementary and alternative therapies for their gastrointestinal health. The objective was to determine the remission rate of SIBO using either the antibiotic rifaximin or herbals in a tertiary care referral gastroenterology practice. One hundred and four patients who tested positive for newly diagnosed SIBO by lactulose breath testing (LBT) were offered either rifaximin 1200 mg daily vs herbal therapy for 4 weeks with repeat LBT post-treatment. Three hundred ninety-six patients underwent LBT for suspected SIBO, of which 251 (63.4%) were positive 165 underwent treatment and 104 had a follow-up LBT. Of the 37 patients who received herbal therapy, 17 (46%) had a negative follow-up LBT compared to 23/67 (34%) of rifaximin users (P=.24). The odds ratio of having a negative LBT after taking herbal therapy as compared to rifaximin was 1.85 (CI=0.77-4.41, P=.17) once adjusted for age, gender, SIBO risk factors and IBS status. Fourteen of the 44 (31.8%) rifaximin non-responders were offered herbal rescue therapy, with 8 of the 14 (57.1%) having a negative LBT after completing the rescue herbal therapy, while 10 non-responders were offered triple antibiotics with 6 responding (60%, P=.89). Adverse effects were reported among the rifaximin treated arm including 1 case of anaphylaxis, 2 cases of hives, 2 cases of diarrhea and 1 case of Clostridium difficile. Only one case of diarrhea was reported in the herbal therapy arm, which did not reach statistical significance (P=.22). SIBO is widely prevalent in a tertiary referral gastroenterology practice. Herbal therapies are at least as effective as rifaximin for resolution of SIBO by LBT. Herbals also appear to be as effective as triple antibiotic therapy for SIBO rescue therapy for rifaximin non-responders. Further, prospective studies are needed to validate these findings and explore additional alternative therapies in patients with refractory SIBO.

Herbal Therapy Is Equivalent to Rifaximin for the Treatment of Small Intestinal Bacterial Overgrowth

PubMed Central

Chedid, Victor; Dhalla, Sameer; Clarke, John O.; Roland, Bani Chander; Dunbar, Kerry B.; Koh, Joyce; Justino, Edmundo; Tomakin, Eric

2014-01-01

Objective: Patients with small intestine bacterial overgrowth (SIBO) have chronic intestinal and extraintestinal symptomatology which adversely affects their quality of life. Present treatment of SIBO is limited to oral antibiotics with variable success. A growing number of patients are interested in using complementary and alternative therapies for their gastrointestinal health. The objective was to determine the remission rate of SIBO using either the antibiotic rifaximin or herbals in a tertiary care referral gastroenterology practice. Design: One hundred and four patients who tested positive for newly diagnosed SIBO by lactulose breath testing (LBT) were offered either rifaximin 1200 mg daily vs herbal therapy for 4 weeks with repeat LBT post-treatment. Results: Three hundred ninety-six patients underwent LBT for suspected SIBO, of which 251 (63.4%) were positive 165 underwent treatment and 104 had a follow-up LBT. Of the 37 patients who received herbal therapy, 17 (46%) had a negative follow-up LBT compared to 23/67 (34%) of rifaximin users (P=.24). The odds ratio of having a negative LBT after taking herbal therapy as compared to rifaximin was 1.85 (CI=0.77-4.41, P=.17) once adjusted for age, gender, SIBO risk factors and IBS status. Fourteen of the 44 (31.8%) rifaximin non-responders were offered herbal rescue therapy, with 8 of the 14 (57.1%) having a negative LBT after completing the rescue herbal therapy, while 10 non-responders were offered triple antibiotics with 6 responding (60%, P=.89). Adverse effects were reported among the rifaximin treated arm including 1 case of anaphylaxis, 2 cases of hives, 2 cases of diarrhea and 1 case of Clostridium difficile. Only one case of diarrhea was reported in the herbal therapy arm, which did not reach statistical significance (P=.22). Conclusion: SIBO is widely prevalent in a tertiary referral gastroenterology practice. Herbal therapies are at least as effective as rifaximin for resolution of SIBO by LBT. Herbals also appear to be as effective as triple antibiotic therapy for SIBO rescue therapy for rifaximin non-responders. Further, prospective studies are needed to validate these findings and explore additional alternative therapies in patients with refractory SIBO. PMID:24891990

Multidisciplinary approach to non-surgical management of inguinal disruption in a professional hockey player treated with platelet-rich plasma, manual therapy and exercise: a case report

PubMed Central

St-Onge, Eric; MacIntyre, Ian G.; Galea, Anthony M.

2015-01-01

Objective: To present the clinical management of inguinal disruption in a professional hockey player and highlight the importance of a multidisciplinary approach to diagnosis and management. Clinical Features: A professional hockey player with recurrent groin pain presented to the clinic after an acute exacerbation of pain while playing hockey. Intervention: The patient received a clinical diagnosis of inguinal disruption. Imaging revealed a tear in the rectus abdominis. Management included two platelet-rich plasma (PRP) injections to the injured tissue, and subsequent manual therapy and exercise. The patient returned to his prior level of performance in 3.5 weeks. Discussion: This case demonstrated the importance of a multidisciplinary team and the need for advanced imaging in athletes with groin pain. Summary: Research quality concerning the non-surgical management of inguinal disruption remains low. This case adds evidence that PRP, with the addition of manual therapy and exercise may serve as a relatively quick and effective non-surgical management strategy. PMID:26816415

[A case of brucellosis presenting with suppurative parotitis involvement].

PubMed

Kanmaz, Lutfi; Karakeçili, Faruk; Çıkman, Aytekin; Özçiçek, Fatih; Karavaş, Erdal

2016-01-01

Brucellosis is a common zoonotic infection caused by Brucella bacteria. Brucella infections are usually presented with various clinical manifestations, and often accompanied by multiple organ involvements. In this article, we present a case of brucellosis with suppurative parotitis involvement accompanied by parotid abscess and fistula in a 60-year-old male patient. According to the literature review we conducted regarding complications of brucellosis, our case is the first case reported in the literature. Significant improvement in patient's suppurative parotitis and clinical findings was observed at the fifth week of combination antibiotic therapy. Patient's complaints resolved completely after eight weeks of treatment.

Progressive alveolar echinococcosis after discontinuation of anthelmintic therapy

PubMed Central

2013-01-01

We report a case of a female patient with alveolar echinococcosis (AE) who presented with progressive pulmonary and hepatic lesions and had a fatal outcome. AE affecting the liver, the lungs and the brain had been diagnosed 20 years ago and treated successfully with albendazole and stereotactic gamma knife therapy. Due to severe hair loss albendazole was stopped 14 years before presentation. Lesions had remained stable in imaging studies for at least 11 years, but then had started to progress. Lifelong anthelmintic maintenance therapy and regular follow-up may therefore be crucial in order to prevent such a dramatic clinical course. PMID:24289745

First Experiences in Intensity Modulated Radiation Surgery at the National Institute of Neurology and Neurosurgery: A Dosimetric Point of View

NASA Astrophysics Data System (ADS)

Lárraga-Gutiérrez, José M.; Celis-López, Miguel A.

2003-09-01

The National Institute of Neurology and Neurosurgery in Mexico City has acquired a Novalis® shaped beam radiosurgery unit. The institute is pioneer in the use of new technologies for neuroscience. The Novalis® unit allows the use of conformal beam radiosurgery/therapy and the more advanced modality of conformal therapy: Intensity Modulated Radiation Therapy (IMRT). In the present work we present the first cases of treatments that use the IMRT technique and show its ability to protect organs at risk, such as brainstem and optical vias.

Manual therapy and therapeutic exercise in patient with symptomatic cervical spondylotic myelopathy: a case report.

PubMed

Almeida, Gabriel Peixoto Leão; Carneiro, Kysia Karine Almeida; Marques, Amélia Pasqual

2013-10-01

Cervical spondylotic myelopathy (CSM) is caused by narrowing of the cervical spinal canal, although surgical decompression is an obvious indication for spinal cord stenosis, there are not enough data to determine that surgery is the most indicated intervention for milder forms. The purpose of the present case report was to describe the outcomes results of the physical therapy treatment with emphasis on manual therapy and therapeutic exercise for a patient with CSM. A 58-year-old male patient attended the physical therapy clinic due to pain and paresthesia in the upper and lower limbs. The magnetic resonance imaging was compatible with spondylotic myelopathy. Following physical therapy treatment, the patient exhibited an improvement in functional capacity (triangle step test and timed 10-m walk), pain, paresthesia, mJOA scale and Neck Disability Index. Based on the lack of rapid evolution of neurological impairment, physical therapy treatment was indicated, which achieved satisfactory results. Copyright © 2013 Elsevier Ltd. All rights reserved.

Facial nerve palsy: analysis of cases reported in children in a suburban hospital in Nigeria.

PubMed

Folayan, M O; Arobieke, R I; Eziyi, E; Oyetola, E O; Elusiyan, J

2014-01-01

The study describes the epidemiology, treatment, and treatment outcomes of the 10 cases of facial nerve palsy seen in children managed at the Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife over a 10 year period. It also compares findings with report from developed countries. This was a retrospective cohort review of pediatric cases of facial nerve palsy encountered in all the clinics run by specialists in the above named hospital. A diagnosis of facial palsy was based on International Classification of Diseases, Ninth Revision, Clinical Modification codes. Information retrieved from the case note included sex, age, number of days with lesion prior to presentation in the clinic, diagnosis, treatment, treatment outcome, and referral clinic. Only 10 cases of facial nerve palsy were diagnosed in the institution during the study period. Prevalence of facial nerve palsy in this hospital was 0.01%. The lesion more commonly affected males and the right side of the face. All cases were associated with infections: Mainly mumps (70% of cases). Case management include the use of steroids and eye pads for cases that presented within 7 days; and steroids, eye pad, and physical therapy for cases that presented later. All cases of facial nerve palsy associated with mumps and malaria infection fully recovered. The two cases of facial nerve palsy associated with otitis media only partially recovered. Facial nerve palsy in pediatric patients is more commonly associated with mumps in the study environment. Successes are recorded with steroid therapy.

Personalized assessment and management of women at risk for breast cancer in North America.

PubMed

Pruthi, Sandhya; Heisey, Ruth; Bevers, Therese

2015-03-01

Many women at increased risk for breast cancer would benefit from referral for genetic testing, enhanced screening, preventive therapy or risk-reducing surgery. We present a visual model and a step-wise approach to assist with a personalized risk stratification and management of these women. We present current recommendations with respect to lifestyle behaviors and mammographic screening, and we review the current evidence regarding enhanced screening and risk-reducing therapies. We discuss the usefulness of three risk-assessment tools in determining whether a woman qualifies for genetic testing, enhanced screening or preventive therapy and present four cases to demonstrate the usefulness of this approach in the clinical setting.

THERAPY-RELATED T/MYELOID MIXED PHENOTYPE ACUTE LEUKEMIA IN A PATIENT TREATED WITH CHEMOTHERAPY FOR CUTANEOUS DIFFUSE LARGE B CELL LYMPHOMA.

PubMed

Roberts, Evans; Oncale, Melody; Safah, Hana; Schmieg, John

2016-01-01

Mixed-phenotype acute leukemia is a rare form of leukemia that is associated with a poor prognosis. Most cases of mixed-phenotype acute leukemia are de novo. However, therapy-related mixed-phenotype acute leukemia can occur, and are often associated with exposure to topoisomerase-II inhibitors and alkylating agents. There are no known treatment guidelines for therapy-related mixed-phenotype acute leukemia. We present a patient with T/myeloid mixed-phenotype acute leukemia secondary to rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone R-CHOP chemotherapy for primary cutaneous diffuse large B-cell lymphoma. The patient's leukemic cells express CD34, an immaturity marker, CD3, a T-cell marker, and myeloperoxidase, a myeloid marker, and her history of chemotherapy for previous lymphoma supports the diagnosis of therapy-related T/myeloid mixed phenotype acute leukemia. Clinicians should be aware that this entity could be associated with R-CHOP chemotherapy. Given the complexity in diagnosis, and lack of treatment guidelines, a further understanding of the pathological and genetic principles of therapy-related mixed-phenotype acute leukemia will assist in future efforts to treat and categorize these patients. Mixed phenotype acute leukemia is a rare entity that accounts for two to five percent of all acute leukemias. Therapy- related mixed phenotype acute leukemia is an exceedingly rare hematological neoplasm that accounts for less than one percent of acute leukemias. We describe a case of therapy-related T/myeloid mixed phenotype acute leukemia following rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone R-CHOP chemotherapy for primary cutaneous diffuse large B-cell lymphoma DLBCL. The patient is a 63-year-old female who presented with several cutaneous nodules diagnosed as primary cutaneous DLBCL. The patient received R-CHOP chemotherapy and achieved remission. She remained in remission for four years until she presented with dyspnea, night sweats, weakness, and diffuse lymphadenopathy. Her presentation was initially concerning for recurrent lymphoma; however, a bone marrow biopsy and aspirate and a lymph node biopsy revealed a distinct blast population consistent with T/myeloid mixed phenotype acute leukemia T/M-MPAL. Given the patient's history of previous chemotherapy exposure, our patient represents a case of therapy-related T/myeloid mixed phenotype acute leukemia t-MPAL.

Cognitive therapy for punishment paranoia: a single case experiment.

PubMed

Chadwick, P; Trower, P

1996-04-01

There is growing agreement that at least certain kinds of delusions defend against negative self-evaluation, and in consequence that cognitive therapy for delusions needs to address issues of self-evaluation more explicitly. However, in practice it can be difficult to enable clients to see the connection between delusions and self-esteem. The present single-case study exemplifies the conceptual and practical application of cognitive therapy for individuals who are both paranoid and have strong negative self-evaluative beliefs. A multiple-baseline approach is used, whereby one man's negative self-evaluative belief and two paranoid delusions are challenged sequentially. Conviction in two of the three beliefs changes at the point of intervention; conviction in the third changes prior to intervention. We discuss the details of the case, as well as the wider implications for cognitive approaches to delusions.

Rapid Improvement of thyroid storm-related hemodynamic collapse by aggressive anti-thyroid therapy including steroid pulse: A case report.

PubMed

Kiriyama, Hiroyuki; Amiya, Eisuke; Hatano, Masaru; Hosoya, Yumiko; Maki, Hisataka; Nitta, Daisuke; Saito, Akihito; Shiraishi, Yasuyuki; Minatsuki, Shun; Sato, Tatsuyuki; Murakami, Haruka; Uehara, Masae; Manaka, Katsunori; Makita, Noriko; Watanabe, Masafumi; Komuro, Issei

2017-06-01

Heart failure is relatively common in patients with hyperthyroidism, but thyrotoxic cardiomyopathy with poor left ventricular (LV) systolic function is very rare. We experienced a representative case of a patient who presented with severe LV dysfunction related to thyroid storm and needed extracorporeal membrane oxygenation (ECMO) temporally. Thyrotoxic cardiomyopathy. Aggressive antithyroid therapy, including steroid pulse to hyperthyroidism, leads to the dramatic improvement of cardiac function and she was successfully weaned from ECMO. The most outstanding feature of the current case was the rapid decrease of cardiac injury and improvement of cardiac function by strengthening antithyroid therapy, including steroid pulse, without thyroid hormone level normalization. In thyroid storm, various systemic inflammatory reactions have different time courses and among them, the cardiac phenotype emerges in most striking and critical ways.

Endodontic treatment of a maxillary central incisor with two roots.

PubMed

Maghsoudlou, Amir; Jafarzadeh, Hamid; Forghani, Maryam

2013-03-01

This clinical report presents a rare case of maxillary central incisor with two separate roots. Unusual morphology of the roots and root canals may exist in any tooth. Recognition of the dental anatomy and its variations is necessary for successful endodontic therapy. It is well known that maxillary incisors are usually single-rooted teeth. The root canals were instrumented with conventional hand files and Gates Glidden and obturated by using the lateral technique. Recall radiograph after 1 year shows the healing process of the preoperative apical periodontitis. Clinicians should be aware of unexpected root canal morphology when performing root canal therapy. The present case demonstrated the importance of accurate preoperative radiograph and adequate access preparation.

Laser ablation in temporomandibular joint disorders and a case report involving an ossifying fibroma: how optics could potentially advance treatments in oral and maxillofacial surgery

NASA Astrophysics Data System (ADS)

Tandon, Rahul; Stevens, Timothy W.; Stringer, Dale E.; Dean, Jeff S.; Herford, Alan S.

2013-03-01

Introduction: In the field of oral and maxillofacial surgery, there are many applications for lasers and optics. The first part of this manuscript is to discuss laser therapy and garner suggestions on how it can be improved. The second part is to present a case in which complications of a bone graft delayed healing and a return to normalcy for the patient. It is the goal of this paper to utilize the new advancements in optics so that patient care can be improved. Laser Therapy: Laser ablation and low-level laser therapy have been used in a variety of joint adhesion cases, including arthritis of the hand and foot. In the field of oral and maxillofacial surgery, this method has been used to treat pain and mobility dysfunction in patients with temporomandibular joint disease. While the outcomes have been promising, lack of familiarity with the device or doubt about its effects have reduced its use. This reduction in use has left the actual process of laser therapy relatively unchanged. Case Presentation: A 28 year-old female presented for a mandibular resection due to an ossifying fibroma. In the next several months her reconstructed area displayed significant signs of infection, as well as graft failure. X-rays, unfortunately, did not display the actual metabolic activity. Although the patient was reconstructed successfully thereafter, with more advanced technology available the patient could have endured a more comfortable treatment. Conclusion: While there are many more areas of oral and maxillofacial surgery that could potentially benefit from advances in optical technology, we have chosen to highlight these two areas due to their prevalence within our community.

Treatment of Bell's Palsy Using Monochromatic Infrared Energy: A Report of 2 Cases.

PubMed

Ng, Shu Yan; Chu, Ming Him E

2014-06-01

The purpose of the study is to describe the use of monochromatic infrared energy (MIRE) therapy in the management of 2 patients with Bell's palsy. Two patients presented to a chiropractic clinic with Bell's palsy that was diagnosed by a medical physician. Both patients were treated using MIRE. The acute patient was a 32-year-old male. He presented with left facial palsy 1 day before the consultation. He was unable to puff the left cheek and close the left eyelid. He had difficulty raising the left eyebrow. The chronic case was a 46-year-old lady. Prior to the first consultation, she was treated with corticosteroid and electro-acupuncture for one and a half years, with incomplete recovery. When first seen, the left corner of mouth drooped and she had difficulty raising her left eyebrow. Monochromatic infrared energy therapy, emitting 890 nm infrared light, was placed on the post-auricular area, pre-auricular area, the temple and mandibular area of the affected side. Each treatment lasted 30 minutes. Photographs were taken every week to document changes. The acute case received 19 treatments in 6 weeks. He reported an improvement of 95%. The chronic case received a total of 45 treatments in 9 months. She rated an improvement of 50%. At the conclusion of treatment, she was able to close her left eyelid and puff her left cheek but still could not raise her left eyebrow. These 2 patients seemed to respond to a different degree to the MIRE therapy. As 71% of patients with Bell's palsy recover uneventfully without any treatment, the present study describes the course of care but cannot confirm the effectiveness of MIRE therapy in the management of Bell's palsy.

Treatment of Bell's Palsy Using Monochromatic Infrared Energy: A Report of 2 Cases

PubMed Central

Ng, Shu Yan; Chu, Ming Him E.

2014-01-01

Objective The purpose of the study is to describe the use of monochromatic infrared energy (MIRE) therapy in the management of 2 patients with Bell's palsy. Clinical features Two patients presented to a chiropractic clinic with Bell's palsy that was diagnosed by a medical physician. Both patients were treated using MIRE. The acute patient was a 32-year-old male. He presented with left facial palsy 1 day before the consultation. He was unable to puff the left cheek and close the left eyelid. He had difficulty raising the left eyebrow. The chronic case was a 46-year-old lady. Prior to the first consultation, she was treated with corticosteroid and electro-acupuncture for one and a half years, with incomplete recovery. When first seen, the left corner of mouth drooped and she had difficulty raising her left eyebrow. Intervention and outcome Monochromatic infrared energy therapy, emitting 890 nm infrared light, was placed on the post-auricular area, pre-auricular area, the temple and mandibular area of the affected side. Each treatment lasted 30 minutes. Photographs were taken every week to document changes. The acute case received 19 treatments in 6 weeks. He reported an improvement of 95%. The chronic case received a total of 45 treatments in 9 months. She rated an improvement of 50%. At the conclusion of treatment, she was able to close her left eyelid and puff her left cheek but still could not raise her left eyebrow. Conclusion These 2 patients seemed to respond to a different degree to the MIRE therapy. As 71% of patients with Bell's palsy recover uneventfully without any treatment, the present study describes the course of care but cannot confirm the effectiveness of MIRE therapy in the management of Bell's palsy. PMID:25685117

School-Based Cognitive-Behavioral Therapy for an Adolescent Presenting with ADHD and Explosive Anger: A Case Study

ERIC Educational Resources Information Center

Parker, Janise; Zaboski, Brian; Joyce-Beaulieu, Diana

2016-01-01

This case demonstrates the efficacy of utilizing an intensive, multi-faceted behavioral intervention paradigm. A comprehensive, integrative, school-based service model was applied to address attention deficit hyperactivity disorder symptomology, oppositional behaviors, and explosive anger at the secondary level. The case reviews a multi-modal…

A case of Graves' ophthalmopathy associated with pembrolizumab (Keytruda) therapy.

PubMed

Park, Ella S Y; Rabinowits, Guilherme; Hamnvik, Ole-Petter R; Dagi, Linda R

2018-04-04

We present the first reported case of Graves' orbitopathy induced by pembrolizumab, a new FDA-approved drug used for the treatment of multiple refractory solid tumors and classic Hodgkin lymphoma. Pembrolizumab elicits T-lymphocyte proliferation; we suspect that thyroid eye disease may result in some cases. Copyright © 2018. Published by Elsevier Inc.

Intensive (Daily) Behavior Therapy for School Refusal: A Multiple Baseline Case Series

ERIC Educational Resources Information Center

Tolin, David F.; Whiting, Sara; Maltby, Nicholas; Diefenbach, Gretchen J.; Lothstein, Mary Anne; Hardcastle, Surrey; Catalano, Amy; Gray, Krista

2009-01-01

The following multiple baseline case series examines school refusal behavior in 4 male adolescents. School refusal symptom presentation was ascertained utilizing a functional analysis from the School Refusal Assessment Scale (Kearney, 2002). For the majority of cases, treatment was conducted within a 15-session intensive format over a 3-week…

Peritonitis as the First Presentation of Disseminated Listeriosis in a Patient on Peritoneal Dialysis-a Case Report.

PubMed

Beckerleg, Weiwei; Keskar, Vaibhav; Karpinski, Jolanta

2017-01-01

Infections with Listeria monocytogenes are uncommon but serious, with mortality rate approaching 30% in cases of systemic involvement despite first-line therapy. They are usually caused by ingestion of contaminated foods, but spontaneous infections have also been described. Listeria monocytogenes is a rare cause of peritonitis, and most of the published cases are in patients with cirrhosis and ascites. There are a few reported cases of Listeria peritonitis associated with peritoneal dialysis (PD), primarily isolated peritonitis.If detected early, Listeria peritonitis can be successfully treated with ampicillin, alone or in combination with gentamicin. Vancomycin has been listed as a second-line agent. However, it has been associated with treatment failure.In this case report, we present a patient who developed disseminated listeriosis, with peritonitis as the first manifestation of disseminated infection. This case illustrates the importance of having a high index of suspicion for L. monocytogenes if patients deteriorate despite empiric therapy for PD-associated peritonitis and serves as a further example demonstrating the inadequate coverage of vancomycin for L. monocytogenes . Copyright © 2017 International Society for Peritoneal Dialysis.

Different treatment modalities for refractory vaginismus in western Saudi Arabia.

PubMed

Fageeh, Wafa M K

2011-06-01

Although vaginismus is a common sexual dysfunction in Saudi Arabia, there are limited data concerning the treatment modalities associated with patients with symptoms of vaginismus. This study is aimed to evaluate the presentation and different modalities of management in patients with severe refractory vaginismus in western Saudi Arabia. Successful penetrative sexual intercourse suggesting that common elements of the therapies used were successful. A retrospective study of patients presenting with severe refractory vaginismus treated in Jeddah, Saudi Arabia. The subjects were 15 women with third to fourth degree vaginismus who presented to King Abdulazziz University Hospital between January 1, 2008 and January 1, 2009. The mean age of the participants was 23 years. The mean duration of marriage before seeking medical advice was 12 months. Six patients had undergone conventional therapy successfully. The other six cases, four of which had a previous history of treatment failure, and two who were unresponsive to 4 months of conventional therapy were offered botulinum toxin type A. Five patients who received the Botox therapy had satisfactory intercourse on the same day of the treatment. One patient required a repeat injection after 2 months for recurrent vaginismus. Three of the 15 patients refused the treatment as they were already divorced and had only come in to exclude organic causes for their condition. Vaginismus is an overlooked topic in conservative societies such as Saudi Arabia. For most patients, not knowing who to confide in or where to turn to plays a major role in the under diagnosis of vaginismus. Conventional therapy proved effective in mild and moderate cases, while botulinum toxin has a more rapid effect and was thus more effective in severe cases. © 2011 International Society for Sexual Medicine.

[New aspects of tuberculosis therapy].

PubMed

Haegi, V

1975-02-22

The introduction of ethambutol and rifampicin has modified the therapy of tuberculosis. Therapy in hospitals or sanatoria can be shortened, and intermittent regimens (once or twice weekly under supervision) are possible. Better knowledge of the side effects of particular drugs, particularly rifampicin, (such as allergic reactions in intermittent administration and reduced effect of oral contraceptives) has been gained. Instead of mere supervision, preventive chemotherapy is given in many cases such as in recently discovered fibrotic lesions and in high risk cases (silicosis, treatment with corticosteroids and immunosuppressive agents)minadequate treatment may lead to functional impairment such as fibrosis and cor pulmonale. These aspects are discussed and the resultant guidelines for the treatment of tuberculosis are presented.

Treatment of insomnia by concomitant therapy with Zopiclone and Aniracetam in patients with cerebral infarction, cerebroatrophy, Alzheimer's disease and Parkinson's disease.

PubMed

Katsunuma, H; Shimizu, T; Ogawa, K; Kubo, H; Ishida, H; Yoshihama, A

1998-04-01

For insomniac patients, sleeping drugs are used: in addition, concomitant therapy with other drugs has been tried in an effort to prevent a decrease in the effects due to long-term continuous use. This report presents the results of a study on the sleeping effects in nine aged patients with insomnia associated with cerebrovascular and noncerebrovascular disorders who received concomitant therapy with Zopiclone and Aniracetam. The treatment in 7/9 cases (78%) was found to be effective, showing more than 50% prolongation of sleeping time, and in two cases (22%) was found to be ineffective. We discuss the mechanism of action referring to the literature.

Multidisciplinary therapy for the treatment of malocclusion in a patient with chronic periodontitis with a five-year follow-up: A case report.

PubMed

Zhang, Dongmei; Lin, Li; Tang, Xiaoling; Li, Chen; Liu, Jingbo; Wang, Hongyang; Pan, Yaping

2017-10-01

Multidisciplinary therapy is essential in dental practice to achieve optimized outcomes. The present case report describes the application of periodontal surgery with a five-year follow-up in a patient with malocclusion and chronic periodontitis. In the presence of periodontal inflammation, orthodontic therapy may result in further periodontal breakdown due to plaque accumulation. In order to prevent this progression, scaling and root planning with a periodontal endoscope was applied, and continuous clinical monitoring and risk assessment was performed every 3 months using a Florida Probe. This combined treatment supports the long-term maintenance of periodontal conditions, functional occlusion and harmony of the facial profile.

Switching Therapy from Intravenous Landiolol to Transdermal Bisoprolol in a Patient with Thyroid Storm Complicated by Decompensated Heart Failure and Gastrointestinal Dysfunction.

PubMed

Godo, Shigeo; Kawazoe, Yu; Ozaki, Hiroshi; Fujita, Motoo; Kudo, Daisuke; Nomura, Ryosuke; Shimokawa, Hiroaki; Kushimoto, Shigeki

2017-10-01

Thyroid storm is a life-threatening disorder that remains a therapeutic challenge. Although β-blockers are the mainstay for treatment, their use can be challenging in cases complicated by rapid atrial fibrillation and decompensated heart failure. We present a case of thyroid storm-associated atrial fibrillation and decompensated heart failure complicated by gastrointestinal dysfunction secondary to diffuse peritonitis that was successfully managed by a switching therapy, in which the continuous intravenous administration of landiolol was changed to bisoprolol via transdermal patch, in the acute phase treatment. This switching therapy may offer a promising therapeutic option for this potentially lethal disorder.

Fungal osteomyelitis with vertebral re-ossification

PubMed Central

O′Guinn, Devon J.; Serletis, Demitre; Kazemi, Noojan

2015-01-01

Introduction We present a rare case of thoracic vertebral osteomyelitis secondary to pulmonary Blastomyces dermatitides. Presentation of case A 27-year-old male presented with three months of chest pains and non-productive cough. Examination revealed diminished breath sounds on the right. CT/MR imaging confirmed a right-sided pre-/paravertebral soft tissue mass and destructive lytic lesions from T2 to T6. CT-guided needle biopsy confirmed granulomatous pulmonary Blastomycosis. Conservative management with antifungal therapy was initiated. Neurosurgical review confirmed no clinical or profound radiographic instability, and the patient was stabilized with TLSO bracing. Serial imaging 3 months later revealed near-resolution of the thoracic soft tissue mass, with vertebral re-ossification from T2 to T6. Discussion Fungal osteomyelitis presents a rare entity in the spectrum of spinal infections. In such cases, lytic spinal lesions are classically seen in association with a large paraspinous mass. Fungal infections of the spinal column may be treated conservatively, with surgical intervention reserved for progressive cases manifesting with neurological compromise and/or spinal column instability. Here, we found unexpected evidence for vertebral re-ossification across the affected thoracic levels (T2-6) in response to IV antibiotic therapy and conservative bracing, nearly 3 months later. PMID:26692163

Late reversal reaction after 10 years of adequately treated leprosy.

PubMed Central

Thacker, A. K.; Kumar, P.; Mukhija, R. D.; Sharma, S. P.

1997-01-01

Differentiation between a relapse or late reversal reaction following completion of regular drug therapy in patients with leprosy is often difficult, though it has definite therapeutic implications. The present case documents a late reversal reaction occurring an unusually long time after the completion of multi-drug therapy. Images Figure PMID:9519194

Integrative Solution-Focused Brief Therapy with a Chinese Female College Student Dealing with Relationship Loss

ERIC Educational Resources Information Center

Ng, Kok-Mun; Parikh, Sejal; Guo, Lan

2012-01-01

Through case presentation, this article illustrates the integration of person-centered skills and guided imagery into Solution-Focused Brief Therapy (SFBT) with a Chinese female college student who was experiencing emotional distress due to relationship loss. Transcripts from select portions of actual counseling sessions further demonstrate the…

Lower extremity thrust and non-thrust joint mobilization for patellofemoral pain syndrome: a case report.

PubMed

Simpson, Brad G; Simon, Corey B

2014-05-01

A 40-year old female presented to physical therapy with a one-year history of insidious right anteromedial and anterolateral knee pain. Additionally, the patient had a history of multiple lateral ankle sprains bilaterally, the last sprain occurring on the right ankle 1 year prior to the onset of knee pain. The patient was evaluated and given a physical therapy diagnosis of patellofemoral pain syndrome (PFPS), with associated talocrural and tibiofemoral joint hypomobility limiting ankle dorsiflexion and knee extension, respectively. Treatment included a high-velocity low amplitude thrust manipulation to the talocrural joint, which helped restore normal ankle dorsiflexion range of motion. The patient also received tibiofemoral joint non-thrust manual therapy to regain normal knee extension mobility prior to implementing further functional progression exercises to her home program (HEP). This case report highlights the importance of a detailed evaluation of knee and ankle joint mobility in patients presenting with anterior knee pain. Further, manual physical therapy to the lower extremity was found to be successful in restoring normal movement patterns and pain-free function in a patient with chronic anterior knee pain.

Topical Calendula officinalis L. successfully treated exfoliative cheilitis: a case report

PubMed Central

2009-01-01

Authors describe a case of recurrent exfoliative cheilitis that responded to treatment with a standardized topical preparation of Calendula officinalis L. An eighteen-year-old man was referred to UNESP - São Paulo State University, Department of Biosciences and Oral Diagnosis, São José dos Campos Dental School to investigate a chronic dry scaling lesion on his lips. The patient's main chief was aesthetic compromising. Corticoid therapy was suspended and Calendula officinalis ointment 10% for ad libitum use has been prescribed. The results presented allow the authors to consider Calendula officinalis L. as a potential therapy in cases of cheilitis exfoliative. PMID:20062714

A case of septic arthritis caused by a Mycoplasma salivarium strain resistant towards Ciprofloxacin and Clarithromycin in a patient with chronic lymphatic leukemia.

PubMed

Büchsel, Martin; Pletschen, Lars; Fleiner, Michael; Häcker, Georg; Serr, Annerose

2016-09-01

Mycoplasma salivarium is a rare agent of septic arthritis in immunocompromised patients. We report a case of septic arthritis due to Mycoplasma salivarium in a patient with B-cell chronic lymphocytic leukemia who underwent chemotherapy with rituximab and bendamustin. Therapy of arthritis due to Mycoplasma salivarium is difficult because there are almost no susceptibility data available. The present case illustrates that antimicrobial susceptibility of Mycoplasma strains is not necessarily predictable and that antibiotic therapy should therefore be guided by in vitro susceptibility testing. Copyright © 2016 Elsevier Inc. All rights reserved.

Chemodectomas: review and report of nine cases.

PubMed

Poster, D S; Schapiro, H; Woronoff, R

1979-01-01

We have reviewed the broad spectrum of disease caused by chemodectomas. This spectrum extends from the benign to the aggressively malignant with many graduations in-between. Our analyses included cases from the literature and nine new cases seen over the past twenty-five years. Surgery as the primary and most definitive form of therapy, is recommended if feasible, with total excision as the goal, in both benign and malignant histologies. An excellent outcome is to be expected in benign cases. At present, no predictor exists to foretell the behavior of malignant lesions, which can range from the aggressive to the slowly progressive. Both radiotherapy and chemotherapy have been tried in malignant cases. No consistent good result has occurred from the use of either. The future will hopefully bring us more effective therapy.

The feminist/emotionally focused therapy practice model: an integrated approach for couple therapy.

PubMed

Vatcher, C A; Bogo, M

2001-01-01

Emotionally focused therapy (EFT) is a well-developed, empirically tested practice model for couple therapy that integrates systems, experiential, and attachment theories. Feminist family therapy theory has provided a critique of biased assumptions about gender at play in traditional family therapy practice and the historical absence of discussions of power in family therapy theory. This article presents an integrated feminist/EFT practice model for use in couple therapy, using a case from practice to illustrate key concepts. Broadly, the integrated model addresses gender roles and individual emotional experience using a systemic framework for understanding couple interaction. The model provides practitioners with a sophisticated, comprehensive, and relevant practice approach for working with the issues and challenges emerging for contemporary heterosexual couples.

Tinea Capitis in the form of Concentric Rings in an HIV Positive Adult on Antiretroviral Treatment

PubMed Central

Narang, Kirti; Pahwa, Manish; Ramesh, V

2012-01-01

Dermatophyte infection may present in the form of concentric rings caused by Trichophyton concentricum, known as Tinea Imbricata. In immunosuppressed patients, there are reports of lesions in the form of concentric rings caused by dermatophytes other than Trichophyton concentricum too, mostly by Trichophyton tonsurans, known as Tinea indesiciva or Tinea pseudoimbricata. We report a case of tinea capitis in a HIV-positive adult woman on antiretroviral therapy, who presented with concentric rings of papules and pustules with slight scaling on the scalp along with diffuse thinning of hair. Both Potassium hydroxide mount and culture showed the presence of Dermatophytes. Tinea capitis is considered rare in adults, but new cases are being reported in immunocompromised as well as in immunocompetent patients. The pertinent features of this case are: HIV-positive adult female on antiretroviral therapy, presenting with tinea capitis in the form of concentric rings; culture from the lesion grew Microsporum audouinii; responding to oral Terbinafine. PMID:22837564

Evaluation of reach and grasp robot-assisted therapy suggests similar functional recovery patterns on proximal and distal arm segments in sub-acute hemiplegia.

PubMed

Loureiro, Rui C V; Harwin, William S; Lamperd, Robert; Collin, Christine

2014-05-01

This paper provides some additional evidence in support of the hypothesis that robot therapies are clinically beneficial in neurorehabilitation. Although only four subjects were included in the study, the design of the intervention and the measures were done so as to minimize bias. The results are presented as single case studies, and can only be interpreted as such due to the study size. The intensity of intervention was 16 h and the therapy philosophy (based on Carr and Shepherd) was that coordinated movements are preferable to joint based therapies, and that coordinating distal movements (in this case grasps) helps not only to recover function in these areas, but has greater value since the results are immediately transferable to daily skills such as reach and grasp movements.

Hyperbaric oxygen therapy with topical negative pressure: an alternative treatment for the refractory sternal wound infection.

PubMed

Sun, I-Feng; Lee, Su-Shin; Chiu, Chaw-Chi; Lin, Sin-Daw; Lai, Chung-Sheng

2008-01-01

Sternal osteomyelitis is a potentially lethal complication after cardiac surgery. It may be the cause of postoperative morbidity and mortality. We present a case of deep sternal wound infection after sternotomy. The patient received three treatments of surgical debridement, irrigation, topical negative pressure (TNP) dressing, and hyperbaric oxygen (HBO) therapy. Forty-five HBO therapy sessions were administered. After nine weeks, the sternal wound was healed and completely epithelialized. This conservative therapy can be an alternative and inexpensive method for the difficult sternal wound infection patient.

Attachment-Based Family Therapy With a 13-Year-Old Girl Presenting With High Risk for Suicide.

PubMed

Krauthamer Ewing, E Stephanie; Levy, Suzanne A; Boamah-Wiafe, Linda; Kobak, Roger; Diamond, Guy

2016-01-01

This article describes the application of Attachment-Based Family Therapy (ABFT) to the treatment of a 13-year-old female adolescent presenting with high risk of suicide, complicated by a history of depression and sexual trauma. The article begins with an overview of ABFT, including (a) how attachment theory guides treatment; (b) the structure of the clinical model; and (c) the data that provide empirical support. A case example is then presented that exemplifies the primary clinical procedures used to reach therapeutic goals in ABFT, including attachment repair and autonomy/competence promotion. Weekly changes in suicide ideation and depression scores are presented. The article concludes with a discussion about implications for family-based treatment of suicidal youth. © 2015 American Association for Marriage and Family Therapy.

Graves' disease in a 3 year-old patient with agranulocytosis due to anti-thyroid drugs: Radioiodine ablation therapy as an effective alternative.

PubMed

Espinosa-Muñoz, E; Ramírez-Ocaña, D; Martín-García, A M; Ruiz-García, F J; Puentes-Zarzuela, C

The case is presented of a 3 year-old girl with mitochondrial disease (subacute necrotizing encephalomyelopathy of Leigh syndrome), v-stage chronic kidney disease of a diffuse mesangial sclerosis, as well as developmental disorders, and diagnosed with hyperthyroidism Graves-Basedow disease. Six weeks after starting the treatment with neo-carbimazole, the patient reported a serious case of agranulocytosis. This led to stopping the anti-thyroid drugs, and was treated successfully with 131 I ablation therapy. The relevance of the article is that Graves' disease is uncommon in the paediatric age range (especially in children younger than 6 years old), and developing complications due to a possible late diagnosis. Agranulocytosis as a potentially serious adverse effect following the use of anti-thyroid drugs, and the few reported cases of ablation therapy with 131 I at this age, makes this case unique. Copyright © 2017 Elsevier España, S.L.U. y SEMNIM. All rights reserved.

Dynamic Target Definition: a novel approach for PTV definition in ion beam therapy.

PubMed

Cabal, Gonzalo A; Jäkel, Oliver

2013-05-01

To present a beam arrangement specific approach for PTV definition in ion beam therapy. By means of a Monte Carlo error propagation analysis a criteria is formulated to assess whether a voxel is safely treated. Based on this a non-isotropical expansion rule is proposed aiming to minimize the impact of uncertainties on the dose delivered. The method is exemplified in two cases: a Head and Neck case and a Prostate case. In both cases the modality used is proton beam irradiation and the sources of uncertainties taken into account are positioning (set up) errors and range uncertainties. It is shown how different beam arrangements have an impact on plan robustness which leads to different target expansions necessary to assure a predefined level of plan robustness. The relevance of appropriate beam angle arrangements as a way to minimize uncertainties is demonstrated. A novel method for PTV definition in on beam therapy is presented. The method show promising results by improving the probability of correct dose CTV coverage while reducing the size of the PTV volume. In a clinical scenario this translates into an enhanced tumor control probability while reducing the volume of healthy tissue being irradiated. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Microbial keratitis following vegetative matter injury.

PubMed

Taneja, Mukesh; Ashar, Jatin N; Mathur, Anurag; Nalamada, Suma; Garg, Prashant

2013-04-01

The purpose of the present study was to analyze the microbiological profile of cases of keratitis following trauma with vegetative matter in a tertiary care center. A retrospective review of the medical records of 49 patients with keratitis following vegetative matter injury over a 3-month period was performed. All patients underwent corneal scraping for smears and inoculation onto various culture media. The microbiological profile was based on the smear and culture reports. For patients who were culture-negative, outcome after standard empirical antibacterial therapy as per hospital protocol was analyzed. Thirteen patients with corneal ulcers had fungal etiology, eight had bacterial etiology, and two had protozoal etiology, while 13 patients were polymicrobial and 13 were culture-negative. Polymicrobial infections were mainly bacterial (eight cases), and the remaining five cases had coexistent fungal and bacterial etiology. The treatment was directed to the specific organism and patients improved with medical or surgical therapy. Only a third of culture-negative cases showed fungal etiology on biopsy or histopathology after keratoplasty while a third showed improvement with therapy. Corneal infections following vegetative matter trauma show a varied etiological profile; however, bacterial and polymicrobial infections are more prevalent. Empirical anti-fungal therapy, as commonly practiced, must be avoided in cases with vegetative matter injury.

Three case reports of radiation-induced glioblastoma after complete remission of acute lymphoblastic leukemia.

PubMed

Kajitani, Takumi; Kanamori, Masayuki; Saito, Ryuta; Watanabe, Yuko; Suzuki, Hiroyoshi; Watanabe, Mika; Kure, Shigeo; Tominaga, Teiji

2018-04-01

Radiation therapy is sometimes performed to control intracranial acute lymphoblastic leukemia (ALL), but may lead to radiation-induced malignant glioma. The clinical, radiological, histological, and molecular findings are described of three cases of radiation-induced glioblastoma after the treatment for ALL. They received radiation therapy at age 6-8 years. The latency from radiation therapy to the onset of radiation-induced glioblastoma was 5-10 years. Magnetic resonance imaging demonstrated diffuse lesions with multiple small enhanced lesions in all cases. Histological examination showed that the tumors consisted of mainly small round astrocytic atypical cells in one case, and astrocytic atypical cells with elongated cytoplasm and nuclear pleomorphism with small cell component in two cases. Microvascular proliferation was present in all cases. Immunohistochemical analysis for B-Raf V600E, and mutational analysis for the isocitrate dehydrogenase (IDH) 1, IDH2, and H3F3A gene revealed the wild-type alleles in all three cases. The integrated diagnoses were IDH wild-type glioblastoma, and local irradiation and concomitant temozolomide were performed. After the initial treatment, significant shrinkage of the diffuse lesion and enhanced lesion was found in all cases. Radiation-induced glioblastoma occurring after the treatment for ALL had unique clinical, radiological, histological, and molecular characteristics in our three cases.

Bloodstream Infections in Patients With Solid Tumors

PubMed Central

Marín, Mar; Gudiol, Carlota; Garcia-Vidal, Carol; Ardanuy, Carmen; Carratalà, Jordi

2014-01-01

Abstract Current information regarding bloodstream infection (BSI) in patients with solid tumors is scarce. We assessed the epidemiology, antibiotic therapy, and outcomes of BSI in these patients. We also compared patients who died with those who survived to identify risk factors associated with mortality. From January 2006 to July 2012 all episodes of BSI in patients with solid tumors at a cancer center were prospectively recorded and analyzed. A total of 528 episodes of BSI were documented in 489 patients. The most frequent neoplasms were hepatobiliary tumors (19%), followed by lung cancer (18%) and lower gastrointestinal malignancies (16%). Many patients had received corticosteroid therapy (41%), and 15% had neutropenia (<500 neutrophils/μL) at the time of BSI. The most common source of BSI was cholangitis (21%), followed by other abdominal (19.5%) and urinary tract infections (17%). Gram-negative BSI occurred in 55% of cases, mainly due to Escherichia coli (55%), Pseudomonas aeruginosa (18%), and Klebsiella pneumoniae (16%). Among gram-positive BSI (35%), viridans group streptococci were the most frequent causative organisms (22%), followed by Staphylococcus aureus (21%) and Enterococcus species (18%). We identified 61 multidrug-resistant (MDR) organisms (13%), mainly extended-spectrum β-lactamase-producing Enterobacteriaceae (n = 20) and AmpC-producing Enterobacteriaceae (n = 13). The majority of patients with BSI caused by MDR organisms had received antibiotics (70%), and they had been previously hospitalized (61.4%) more frequently than patients with BSI caused by susceptible strains. Inadequate empirical antibiotic therapy was given to 23% of patients, with a higher proportion in those with BSI due to a MDR strain (69%). Early (<48 h) and overall (30 d) case-fatality rates were 7% and 32%, respectively. The overall case-fatality rate was higher among cases caused by MDR organisms (39.3%). The only independent risk factors for the early case-fatality rate were the endogenous source of BSI (odds ratio [OR], 3.57; 95% confidence interval [CI], 1.06–12.02), shock at presentation (OR, 3.63; 95% CI, 1.63–8.09), and corticosteroid therapy (OR, 3.245; 95% CI, 1.43–7.32). The independent risk factors for overall case-fatality rate were the presence of a chronic advanced cancer (OR, 35.39; 95% CI, 2.48–504.91), shock at presentation (OR, 25.84; 95% CI, 3.73–179.0), and corticosteroid therapy (OR, 6.98; 95% CI, 1.61–30.21). BSI in patients with solid tumors occurred mainly among those with hepatobiliary cancer, and cholangitis was the most frequent source; gram-negative bacilli were the most frequent causative agents. MDR organisms were relatively common, particularly in patients who had previously received antibiotics and had been hospitalized; these patients were frequently treated with inadequate empirical antibiotic therapy and had a poorer outcome. The case-fatality rate of patients with solid tumors and BSI was high and was associated with chronic advanced cancer, corticosteroid therapy, and shock at presentation. PMID:24797169

A Specialized Approach to the Case of Randall.

ERIC Educational Resources Information Center

Preston, Brian K.

1993-01-01

Responds to case of head-injured former engineering college student who presented for career counseling following automobile accident, three months in coma, and four years of rehabilitation therapy. Recommends vocational evaluation concentrating on a detailed work history, neuropsychological data, work samples, independent living skills…

A rare case of unilateral gynecomastia during antituberculous chemotherapy with isoniazid.

PubMed

Goud, B K Manjunatha; Devi, Oinam Sarsina; Nayal, Bhavna; Devaki, R N

2012-01-01

Gynecomastia refers to enlargement of male breast (s) due to benign proliferation of glandular tissue and is caused by excessive estrogen. The etiology may be pathological, pharmacological, or idiopathic reasons. The present report describes a case of gynecomastia due to isoniazid therapy.

Condyloma acuminata in child end laser therapy: a case report

PubMed Central

2009-01-01

Background Condyloma acuminata are soft, skin colored, fleshy warts that are caused by the Human Papilloma Virus (HPV). The disease is highly contagious, can appear singly or in groups, small or large. The incubation period may be from 1–6 months. Although anogenital warts are considered to be sexually transmitted in adults, this may not be the case for children. Genital warts in children may result from several modes of transmission: from the maternal genital tract autoinoculation, from finger warts and nonsexual transmission from members/careers. Case presentation The presented case is a 13-month-old girl. She was hospitalized at the Clinic of Dermatovenerology in 2001 due to papillomatosis changes on the genital area. The changes had started to appear in the sixth month of life, light purple in color, smooth and combined in a tumorous mass, in the vulva and anal areas. Conclusion From this case we can come to the conclusion that condyloma acuminate are not only transmitted sexually but through nonsexual ways as well, such is this case, from the infected mother to the infant. Laser therapy is preferred when multiple warts are spread over a large area as though in our case. PMID:19193210

[Morphea or juvenile localised scleroderma: Case report].

PubMed

Strickler, Alexis; Gallo, Silvanna; Jaramillo, Pedro; de Toro, Gonzalo

2016-01-01

Morphea or juvenile localised scleroderma (JLS) is an autoimmune, inflammatory, chronic, slowly progressive connective tissue disease of unknown cause that preferably affects skin and underlying tissues. To report a case of Juvenil Localised scleroderma in an 8-year old girl, contributing to an early diagnosis and treatment. The case is presented of an 8 year-old girl who presented with indurated hypopigmented plaques, of linear distribution in the right upper extremity of two years onset, together with papery texture hyperpigmented indurated plaques with whitish areas of thinned skin in right lower extremity, and leg and ankle swelling. The clinical features and diagnostic tests, including histology were compatible with linear and pansclerotic JLS. She started with immunosuppressive therapy, physiotherapy, and occupational therapy. We report a case of linear and pansclerotic ELJ type, in which there was a 2 year delay in diagnosis, however the response to treatment was positive as expected. Copyright © 2016 Sociedad Chilena de Pediatría. Publicado por Elsevier España, S.L.U. All rights reserved.

Breast hematoma complicating anticoagulant therapy: management and literature review.

PubMed

Salemis, Nikolaos S

2012-01-01

Anticoagulant-induced spontaneous breast hematoma is a very rare clinical entity with only a few cases reported in the literature so far. We describe a case of a spontaneous breast hematoma in a female patient under combined oral anticoagulant and antiplatelet therapy. Physicians should be aware of this possibility in patients under anticoagulant treatment presenting with sudden onset of breast pain and a palpable mass. Repeat imaging is mandatory until complete clinical and imaging resolution of the hematoma. If an abnormality persists, further investigation is needed to exclude an underlying malignancy.

[Intramedullary toxoplasmosis in HIV-tuberculosis co-infected patient].

PubMed

Pérez-Lazo, Giancarlo; Castillo-Córdova, Raúl; Maquera-Afaray, Julio

2017-02-01

The most common clinical presentation of Toxoplasma gondii in HIV patients is encephalitis; however, the intramedullary involvement has been reported in a few cases. We report a case of intramedullary toxoplasmosis in a female patient diagnosed with HIV/tuberculosis co-infection, and history of poor adherence to antiretroviral therapy. The patient developed subacute paraparesis with compromise of sensory function and urinary sphincter. The nuclear magnetic resonance evaluation showed a single intramedullary ring-enhanced lesion at the T-8 level which was solved after an anti-Toxoplasma therapy with trimethoprim/sulfamethoxazole.

[Within the boundaries of music. Case report: Music therapy with a pre-psychotic adolescent. Importance of music in psychotherapeutic processes].

PubMed

Niedecken, D

1991-02-01

In presenting the case of a 12-15 year old boy with severe learning difficulties and antisocial tendencies the author reflects upon the process of musical enculturation in music therapy. The deployment of symbolical meaning through the therapeutic use of sound and music is described - from music as a self object up to the point where music is fully acknowledged as a cultural object. It is shown, how this process goes with the unfolding and working through of the transference relationship.

Widespread Skin Necrosis Secondary to Gemcitabine Therapy.

PubMed

Zito, Patrick M; Gonzalez, Adrianna M; Fox, Joshua D; Cronin, Megan; Mackrides, Nicholas; Kirsner, Robert S; Nichols, Anna J

2018-05-01

Gemcitabine, a pyrimidine nucleoside analogue, is an oncologic agent used in the treatment of cutaneous T-cell lymphoma (CTCL). Common dermatologic reactions associated with gemcitabine include alopecia, mild skin rash, and mucositis but skin necrosis is exceptional. Herein we present an unusual case of widespread skin necrosis mimicking toxic epidermal necrolysis in a 45-year-old woman receiving gemcitabine therapy for stage IIIA cutaneous T-cell lymphoma. This is the first reported case of a TEN-like reaction subsequent to gemcitabine treatment. J Drugs Dermatol. 2018;17(5):582-585.

Case Report: Coinfection with Hymenolepis nana, Hymenolepis diminuta, Giardia intestinalis, and Human Immunodeficiency Virus: A Case Report with Complex Immunologic Interactions

PubMed Central

Pérez-Chacón, Gladymar; Pocaterra, Leonor A.; Rojas, Elsy; Hernán, Aurora; Jiménez, Juan Carlos; Núñez, Luz

2017-01-01

We describe the case of a 43-year-old human immunodeficiency virus–infected man receiving combined antiretroviral therapy and coinfected with Hymenolepis nana, Hymenolepis diminuta, and Giardia intestinalis, presenting as chronic diarrhea and critical weight loss. Immunological aspects of these interactions are reviewed. PMID:28219994

A Spectrum of Nerve Injury after Thermal Ablation: A Report of Four Cases and Review of the Literature

DOE Office of Scientific and Technical Information (OSTI.GOV)

Philip, Asher; Gupta, Sanjay, E-mail: sgupta@mdanderson.org; Ahrar, Kamran, E-mail: kahrar@mdanderson.org

2013-10-15

Thermal ablation is an accepted alternative for the palliation of pain from bone metastases. Although rare, neurologic complications after thermal ablation have been reported. We present four cases, including two cases of rapid reversal of postcryoablation neurapraxia after the administration of steroid therapy, and review the literature.

A unique complication of radiofrequency therapy to the tongue base

PubMed Central

Tornari, Chrysostomos; Wong, Gentle; Arora, Asit; Kotecha, Bhik

2015-01-01

Introduction Radiofrequency ablation treatment of the tongue base can be used either alone or as part of a multilevel approach in the treatment of snoring. This involves the generation of thermal energy around the circumvallate papillae of the tongue. Potential complications include ulceration, dysphagia, haematoma and abscess formation. Presentation of case We present the case of a 50-year-old patient who developed an anterior neck swelling following a second application of radiofrequency ablation therapy to the tongue base for snoring. This was secondary to an infection of a previously undiagnosed thyroglossal cyst. The patient made a full recovery following intravenous antibiotic therapy and ultrasound-guided needle aspiration. Discussion Thyroglossal tract remnants are thought to be present in seven percent of the adult population. An infection in a thyroglossal tract cyst has not previously been reported following radiofrequency ablation of the tongue base. Given the relatively high complication rate of tongue base radiofrequency ablation in some series, this complication may be under-recognised. Conclusion An infected thyroglossal tract cyst should be suspected in patients with anterior neck swellings following radiofrequency ablation therapy to the tongue base. We advise caution when performing this procedure on patients with known thyroglossal tract remnants though there is insufficient evidence to suggest that this procedure is contraindicated. PMID:25603484

Phobic postural vertigo treated with autogenic training: a case report.

PubMed

Goto, Fumiyuki; Nakai, Kimiko; Kunihiro, Takanobu; Ogawa, Kaoru

2008-09-30

Patients suffering from dizziness due to vertigo are commonly encountered in the department of otolaryngology. If various clinical examinations do not reveal any objective findings, then the patients are referred to the department of internal medicine or psychiatry. In many cases, the diagnosis is psychological dizziness. Phobic postural vertigo, which was first reported by Brandt T et al in 1994, is supposed to be a type of psychological dizziness. The diagnosis is based on 6 characteristics proposed by Brandt et al. Patients are usually treated with conventional medical therapy, but some cases may be refractory to such a therapy. Psychotherapy is recommended in some cases; however, psychotherapy including autogenic training, which can be used for general relaxation, is not widely accepted. This paper describes the successful administration of autogenic training in a patient suffering from phobic postural vertigo. We present a case of a patient who suffered from phobic postural vertigo. A 37-year-old female complained of dizziness. She had started experiencing dizziness almost 3 years She was intractable to many sort of conventional therapy. In the end, her symptom disappeared after introduction of autogenic training. Autogenic training can be a viable and acceptable treatment option for phobic postural vertigo patients who fail to respond to other therapies. This case emphasizes the importance of autogenic training as a method to control symptom of phobic postural vertigo.

A case of severe chlorite poisoning successfully treated with early administration of methylene blue, renal replacement therapy, and red blood cell transfusion: case report.

PubMed

Gebhardtova, Andrea; Vavrinec, Peter; Vavrincova-Yaghi, Diana; Seelen, Mark; Dobisova, Anna; Flassikova, Zora; Cikova, Andrea; Henning, Robert H; Yaghi, Aktham

2014-08-01

The case of a 55-year-old man who attempted suicide by ingesting <100 mL of 28% sodium chlorite solution is presented. On arrival in the intensive care unit, the patient appeared cyanotic with lowered consciousness and displayed anuria and chocolate brown serum.Initial laboratory tests revealed 40% of methemoglobin. The formation of methemoglobin was effectively treated with methylene blue (10% after 29 hours).To remove the toxin, and because of the anuric acute renal failure, the patient received renal replacement therapy. Despite these therapeutic measures, the patient developed hemolytic anemia and disseminated intravascular coagulation, which were treated with red blood cell transfusion and intermittent hemodialysis. These interventions led to the improvement of his condition and the patient eventually fully recovered. Patient gave written informed consent.This is the third known case of chlorite poisoning that has been reported. Based upon this case, we suggest the management of sodium chlorite poisoning to comprise the early administration of methylene blue, in addition to renal replacement therapy and transfusion of red blood cells.

Is electroconvulsive therapy safe in the presence of an intracranial metallic object?: case report and review of the literature.

PubMed

Mortier, Philippe; Sienaert, Pascal; Bouckaert, Filip

2013-09-01

Little is known about the use of electroconvulsive therapy (ECT) in patients with intracranial metallic objects. Theoretically, electric current might cause heating of the metal and damage of the surrounding brain tissue. Moreover, intracranial foreign objects increase the risk for epileptic phenomena and could thus complicate the treatment course. The case of a man with intracranial bullet fragments as a result of a headshot, treated with ECT for mania, is presented. We conducted a PubMed literature search for other relevant cases. In our patient, ECT was completed without complication. Electroconvulsive therapy was safely administered in 22 published cases of patients with intracranial metallic objects. After carefully weighing benefits and risks in each individual case, psychiatrists should not be reluctant to use ECT in patients with intracranial metallic objects. Apart from avoiding empirical dosage titration to minimize the exposure to current, positioning the electrodes to avoid the electric current of heating the metal, and continuing antiepileptic agents in high-risk patients, no precautions need to be considered.

Case report of exercise and statin-fibrate combination therapy-caused myopathy in a patient with metabolic syndrome: contradictions between the two main therapeutic pathways.

PubMed

László, Andrea; Kalabay, László; Nemcsik, János

2013-02-06

Lifestyle modifications including exercise are beneficial and fundamentally part of the therapy of metabolic syndrome, although in most of the cases medical interventions are also required to reach the target values in the laboratory parameters. Statin and fibrate combination therapy is considered to be safe and effective in dyslipidaemia and metabolic syndrome. However, increased physical activity can enhance the statin and fibrate-associated myopathy. Myositis and the rare but life-threatening rhabdomyolysis are causing a conflict between exercise and statin-fibrate therapy, which is yet to be resolved. We present a case of a 43-year-old Caucasian man with metabolic syndrome who had the side-effect of exercise and drug-associated myositis. The patient had only transient moderate complaints and rhabdomyolysis could be avoided with the one-month creatine kinase control, a test which is not recommended routinely by the new guidelines. We would like to turn the spotlight on the possible complications of statin-fibrate therapy and exercise, when strict follow-up is recommended. In this condition high number of patients can be affected and the responsibility of general practitioners is accentuated.

Correction to hill (2005).

PubMed

Hill, Clara E

2006-01-01

Reports an error in "Therapist Techniques, Client Involvement, and the Therapeutic Relationship: Inextricably Intertwined in the Therapy Process" by Clara E. Hill (Psychotherapy: Theory, Research, Practice, Training, 2005 Win, Vol 42(4), 431-442). An author's name was incorrectly spelled in a reference. The correct reference is presented. (The following abstract of the original article appeared in record 2006-03309-003.) I propose that therapist techniques, client involvement, and the therapeutic relationship are inextricably intertwined and need to be considered together in any discussion of the therapy process. Furthermore, I present a pantheoretical model of how these three variables evolve over four stages of successful therapy: initial impression formation, beginning the therapy (involves the components of facilitating client exploration and developing case conceptualization and treatment strategies), the core work of therapy (involves the components of theory-relevant tasks and overcoming obstacles), and termination. Theoretical propositions as well as implications for training and research are presented. (PsycINFO Database Record (c) 2010 APA, all rights reserved).

Boron neutron capture therapy for malignant melanoma: first clinical case report in China

PubMed Central

Yong, Zhong; Song, Zewen; Zhou, Yongmao; Liu, Tong; Zhang, Zizhu; Zhao, Yanzhong; Chen, Yang; Jin, Congjun; Chen, Xiang; Lu, Jianyun; Han, Rui; Li, Pengzhou; Sun, Xulong; Wang, Guohui; Shi, Guangqing; Zhu, Shaihong

2016-01-01

A phase I/II clinical trial for treating malignant melanoma by boron neutron capture therapy (BNCT) was designed to evaluate whether the world’s first in-hospital neutron irradiator (IHNI) was qualified for BNCT. In this clinical trial planning to enroll 30 patients, the first case was treated on August 19, 2014. We present the protocol of this clinical trial, the treating procedure, and the clinical outcome of this first case. Only grade 2 acute radiation injury was observed during the first four weeks after BNCT and the injury healed after treatment. No late radiation injury was found during the 24-month follow-up. Based on positron emission tomography-computed tomography (PET/CT) scan, pathological analysis and gross examination, the patient showed a complete response to BNCT, indicating that BNCT is a potent therapy against malignant melanoma and IHNI has the potential to enable the delivery of BNCT in hospitals. PMID:28174492

Prepubertal Gynecomastia Due to Indirect Exposure to Nonformulary Bioidentical Hormonal Replacement Therapy: A Case Report.

PubMed

De Pinho, Joao Correia; Aghajanova, Lusine; Herndon, Christopher N

2016-01-01

Gynecomastia is a disorder of the endocrine system characterized by an abnormal presence of a palpable unilateral or bilateral enlargement and proliferation of glandular ductal benign breast tissue in male individuals. This case discusses the medical implications of an unregulated, indirect exposure to nonformulary, bioidentical hormone replacement therapy in male children. An 8-year-old boy presented with prepubertal gynecomastia secondary to estrogen exposure from maternal use of bioidentical hormonal replacement therapy (the Wiley protocol). We review the literature on prepubertal gynecomastia secondary to exogenous estrogen exposure, evaluation, clinical surveillance of the pubertal development, and relevant short- and long-term implications. Indirect exposure to nonformulary hormonal replacement in our case report was an etiologic factor in the development of prepubertal gynecomastia. This novel estrogen exposure source has important implications in the differential diagnosis of prepubertal gynecomastia and potential adverse effects secondary to precocious hormonal exposure.

Case report of meningiomatosis with aspiration of a dental bridge improved by comprehensive rehabilitation therapy

PubMed Central

Suh, Min Ji; Han, Eun Young; Kim, Bo Ryun; Lee, Jong Hoo

2016-01-01

[Purpose] The aim of this study was to ascertain the effect of comprehensive rehabilitation therapy on a quadriplegic patient with meningiomatosis and severe dysphagia. [Subject and Methods] Meningiomatosis is defined as multiple meningiomas involved in several intracranial regions, which occurs more frequently in elderly patients. The prognosis of meningiomatosis is mostly reported as benign, but the prognosis for some malignant cases can be poor. Furthermore, dysphagia in elderly patients with brain lesions may lead to foreign body aspiration, which can be fatal. The removable type of dental prosthesis is a common cause of aspiration, but aspiration is rare with the fixed type. [Results] This report presents a rare case of bronchial aspiration involving a fixed dental prosthesis in an elderly meningiomatosis patient that was improved following comprehensive rehabilitation therapy. [Conclusion] Thorough evaluation and individualized assessment of rehabilitation goals is recommended for the care of severe comorbid elderly patients. PMID:28174477

[Ulcerating Herpes simplex infections in intensive care patients].

PubMed

Fischer, M; Wohlrab, J; Radke, J; Marsch, W C; Soukup, J

2002-11-01

Herpes simplex infections are potentially a life-threatening situation for immunocompromised as well as critically ill patients. The correct diagnosis is made more difficult in comatose patients by the fact that the characteristic symptom of extreme pain cannot be registered. The clinical dermatological findings (polycyclic configuration, easily bleeding ulcers) are thus especially important in patients under intensive care conditions. As examples, the cases of 3 critically ill patients (subarachnoid bleeding or head injury) developing therapy-resistant, flat sacral or perioral skin ulcers with peripheral blisters are presented. Herpes simplex virus was confirmed immunohistologically and in the smear test. All patients subsequently died. These cases emphasize that patients in the intensive care unit are in danger of developing a chronic persistent Herpes simplex infection due to latent immunosuppression. Chronic persistent Herpes infections may be underrated in intensive therapy, and must always be ruled out in case of therapy-resistant erosions or ulcerations.

Use of stereotactic intensity-modulated radiotherapy in thyroid-related ophthalmopathy. Case report.

PubMed

Espinoza, Salvador; Saboori, Mehran; Forman, Scott; Moorthy, Chitti R; Benzil, Deborah L

2004-11-01

Thyroid-related ophthalmopathy (TRO), a debilitating condition involving a range of visual and orbital symptoms, occurs in up to 40% of patients with Graves disease. The goals of treatment include correcting thyroid dysfunction, relieving ocular pain, preserving vision, and improving cosmetic appearance. Options for therapy include symptomatic treatment, glucocorticoid medication, radiation therapy, and surgery. Traditional radiation treatment uses small opposed bilateral fields consisting of retrobulbar volumes and customized blocks to shield periorbital structures. The combination of intensity-modulated radiotherapy (IMRT) and stereotactic technology facilitates the administration of radiation to patients suffering from TRO and provides greater safety and efficacy than traditional treatment. The authors present the case of a patient with severe TRO whose symptoms resolved rapidly after treatment with stereotactic IMRT. The outcome in this case supports stereotactic IMRT as an effective treatment option for patients with TRO who also undergo radiation therapy.

The postmodern turn in group therapy.

PubMed

O'Leary, J V

2001-10-01

The postmodern critique, often referred to as social constructionism, has influenced nearly all disciplines, including recently the domain of psychology--and most particularly psychoanalysis. This article presents an exposition of the "postmodern turn," including some historical perspective, a description of its theoretical elements as related to psychological practice, as well as standard objections to its theories. This author believes that many of the concepts inherent to a social constructionist approach are compelling for theory and practice in group therapy. Clinical case studies are cited in describing how postmodern theories present a natural fit for group therapy. Furthermore, specific implications of this model are delineated for the arduous task of leading groups.

Hyperbaric oxygen therapy in the treatment of osteonecrosis of the femoral head: a review of the current literature.

PubMed

Uzun, Gunalp; Mutluoglu, Mesut; Ersen, Omer; Yildiz, Senol

2016-01-01

To review the current literature on the use of hyperbaric oxygen (HBO₂) therapy in the treatment of osteonecrosis of the femoral head (ONFH). We searched PubMed, Directory of Open Access Journals (DOAJ), EMBASE, Web of Science, Academic Search Complete, CINAHL and MEDLINE through April 2015. We hand-searched relevant textbooks, conference proceedings and the reference lists of review articles and clinical studies Randomized controlled trials (RCT) and observational studies (cohort study, case-control study, case series) that reported the outcome of patients who received HBO₂therapy for ONFH were included. Only English-language articles were included. Study quality was not used as an exclusion criterion. Two authors independently assessed trials for inclusion, extracted data and presented to other authors. Disagreements were resolved by consensus. We identified eight clinical studies; two randomized controlled trials (RCTs); one historically controlled study; and five case series. The majority of the studies were small-scale, heterogeneous and methodologically weak. In four of the studies HBO₂therapy was combined with other treatment modalities, making it impossible to draw firm conclusions on the specific effects of HBO₂therapy. Hip survivorship in studies wherein HBO₂therapy was used alone was 95.5% in Steinberg Stage I lesions, 89% in Steinberg Stage II lesions and 100% in Ficat Stage II lesions. There is a room for HBO₂therapy in the management ONFH. Further RCTs, however, are required to better elucidate the role of HBO₂therapy in the treatment of ONFH.

Fiducial marker placement via conventional or electromagnetic navigation bronchoscopy (ENB): an interdisciplinary approach to the curative management of lung cancer.

PubMed

Hagmeyer, Lars; Priegnitz, Christina; Kocher, Martin; Schilcher, Burkhart; Budach, Wilfried; Treml, Marcel; Stieglitz, Sven; Randerath, Winfried

2016-05-01

Conventional and electromagnetic navigation bronchoscopy (ENB) is generally used as a diagnostic tool in suspicious pulmonary nodules. The use of this technique for the placement of fiducial markers in patients with inoperable but early-stage lung cancer could present an innovative approach enabling risk-reduced therapy. We present seven clinical cases where conventional bronchoscopy and ENB were used as part of an experimental interdisciplinary approach to clinical management and therapy planning. In each case, we analyzed the clinical indication, endoscopic procedures and post-interventional outcome. In six patients (three females, three males) with peripheral non-small cell lung cancer (NSCLC), stage cT1cN0cM0, surgery and conventional stereotactic radiation therapy was not possible because of end-stage chronic obstructive pulmonary disease. ENB was used for fiducial marker placement prior to cyberknife radiotherapy. No procedure-related complications were observed. Complete remission could be achieved in four cases, partial remission in two cases and no relevant complications induced by radiotherapy were observed. In one male patient, an endoluminal relapse in the right lower lobe was diagnosed following a right upper lobe resection for a NSCLC. The tumor could not be clearly identified by computerized tomography, so that the bronchoscopic placement of a fiducial marker in the tumor was performed in order to allow stereotactic radiochemotherapy, by which complete remission could be achieved. Fiducial marker placement may be an interesting bronchoscopic technique in the interdisciplinary therapeutic approach to inoperable early-stage lung cancer. In the described cases, therapy planning was successful and no procedure-related complications were observed. © 2014 John Wiley & Sons Ltd.

Effective induction therapy for anti-SRP associated myositis in childhood: A small case series and review of the literature.

PubMed

Binns, E L; Moraitis, E; Maillard, S; Tansley, S; McHugh, N; Jacques, T S; Wedderburn, L R; Pilkington, C; Yasin, S A; Nistala, K

2017-10-31

Anti-Signal Recognition Particle associated myopathy is a clinically and histopathologically distinct subgroup of Juvenile Idiopathic Inflammatory Myositis, which is under-recognised in children and fails to respond to conventional first line therapies. We present three cases where remission was successfully induced using combination therapy with intensive rehabilitation. Three new patients are reported. All 3 cases presented with profound, rapid-onset, proximal myopathy and markedly raised CK, but no rash. Histology revealed a destructive myopathy characterized by scattered atrophic and necrotic fibres with little or no inflammatory infiltrate. All 3 patients responded to induction with cyclophosphamide, IVIG and rituximab, in conjunction with intensive physiotherapy and methotrexate as the maintenance agent. Our patients regained near-normal strength (MMT > 70/80), in contrast with the current literature where >50% of cases reported severe residual weakness. A literature search on paediatric anti-SRP myositis was performed to June 2016; PubMed was screened using a combination of the following terms: signal recognition particle, autoantibodies, antibodies, myositis, muscular diseases, skeletal muscle, childhood, paediatric, juvenile. Articles in a foreign language were excluded. Nine case studies were found. This paper supports the hypothesis that anti-SRP myositis is distinct from other JIIM. It is an important differential to JDM and should be considered where there is severe weakness without rash or if highly elevated muscle enzymes (CK > 10,000 U/l) are found. Early identification is essential to initiate aggressive medical and physical therapy. Greater international collaboration and long-term follow-up data is needed to establish the most effective treatment strategy for this rare group of patients.

Necrotizing fasciitis in a patient receiving tocilizumab for rheumatoid arthritis - Case report.

PubMed

Rosa-Gonçalves, Diana; Bernardes, Miguel; Costa, Lúcia

We present a case of necrotizing fasciitis in a 66-year-old Caucasian woman with rheumatoid arthritis receiving tocilizumab, and provide a review of published cases. The patient exhibited no systemic symptoms and discreet cutaneous inflammatory signals at presentation. She was successfully treated with broad-spectrum empiric antibiotic therapy and surgical debridement. Copyright © 2016 Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología. All rights reserved.

Successful Treatment of Olfactory Reference Syndrome with Cognitive Behavioral Therapy: A Case Study

ERIC Educational Resources Information Center

Martin-Pichora, Andrea L.; Antony, Martin M.

2011-01-01

Olfactory reference syndrome (ORS) is characterized by a preoccupation with the belief that one's body emits a foul odor. Cognitive behavioral therapy (CBT) was used to treat a woman in her 50s who presented in our outpatient anxiety disorders specialty clinic with ORS, accompanied by embarrassment, shame, distress, avoidance behavior, and social…

Terminal Stage Leukemia: Integrating Art Therapy and Family Process.

ERIC Educational Resources Information Center

Teufel, Emily Scudder

1995-01-01

Through art therapy, children express symbolically what they will not or cannot express emotionally to those close to them, and some children have the added stress of family problems that are magnified due to the situation. Presents the case history of a nine-year-old girl in the terminal stages of leukemia whose artwork symbolized family unity.…

When Sexual and Religious Orientation Collide: Considerations in Working with Conflicted Same-Sex Attracted Male Clients

ERIC Educational Resources Information Center

Haldeman, Douglas C.

2004-01-01

The debate among scholars and gay activists and religious/political activists about the appropriateness and efficacy of conversion therapy has left out a number of individuals for whom neither gay-affirmative nor conversion therapy may be indicated. The present discussion, through the use of case material, offers considerations for the…

The epidemiology and clinical features of melioidosis in Far North Queensland: Implications for patient management.

PubMed

Stewart, James D; Smith, Simon; Binotto, Enzo; McBride, William J; Currie, Bart J; Hanson, Josh

2017-03-01

The epidemiology, clinical presentation and management of melioidosis vary around the world. It is essential to define the disease's local features to optimise its management. Between 1998 and 2016 there were 197 cases of culture confirmed melioidosis in Far North Queensland; 154 (78%) presented in the December-April wet season. 145 (74%) patients were bacteraemic, 58 (29%) were admitted to the Intensive Care Unit and 27 (14%) died; nine (33%) of these deaths occurred within 48 hours of presentation. Pneumonia was the most frequent clinical finding, present in 101 (61%) of the 166 with available imaging. A recognised risk factor for melioidosis (diabetes, hazardous alcohol use, chronic renal disease, chronic lung disease, immunosuppression or malignancy) was present in 148 (91%) of 162 patients with complete comorbidity data. Despite representing only 9% of the region's population, Aboriginal and Torres Strait Island (ATSI) people comprised 59% of the cases. ATSI patients were younger than non-ATSI patients (median (interquartile range): 46 (38-56) years versus 59 (43-69) years (p<0.001) and had a higher case-fatality rate (22/117 (19%) versus 5/80 (6.3%) (p = 0.01)). In the 155 patients surviving the initial intensive intravenous phase of treatment, eleven (7.1%) had disease recurrence, despite the fact that nine (82%) of these patients had received prolonged intravenous therapy. Recurrence was usually due to inadequate source control or poor adherence to oral eradication therapy. The case fatality rate declined from 12/44 (27%) in the first five years of the study to 7/76 (9%) in the last five (p = 0.009), reflecting national improvements in sepsis management. Melioidosis in Far North Queensland is a seasonal, opportunistic infection of patients with specific comorbidities. The ATSI population bear the greatest burden of disease. Although the case-fatality rate is declining, deaths frequently occur early after hospitalisation, reinforcing the importance of prompt, targeted therapy in high-risk patients.

Posttraumatic gastric wall hematoma in a patient under anticoagulant therapy. Case report and literature review.

PubMed

Mânzat Saplacan, Roberta Maria; Catinean, Adrian; Manole, Simona; Valean, Simona Doina; Chira, Romeo Ioan; Mircea, Petru Adrian

2011-06-01

We report the clinical observation of a 58-year old patient who presented with upper abdominal pain and a small ecchymosis located in the umbilical area. Personal history of the patient revealed ischemic heart disease and chronic atrial fibrillation. He was under treatment with oral anticoagulants (coumarins). The clinical data and especially the imaging investigations led to a diagnosis of gastric wall hematoma, possibly occurring post-traumatically in a patient under anticoagulant treatment. A conservative therapeutic approach was adopted and ultrasound surveillance. After 6 months the gastric parietal collection manifested complete resorption, spontaneously. In relation to the case presentation, we also discuss some issues on the frequency, diagnosis and therapeutic attitude in this rare complication of anticoagulant therapy.

Sarcoidosis as an adverse effect of tumor necrosis factor inhibitors.

PubMed

Cathcart, Shelley; Sami, Naveed; Elewski, Boni

2012-05-01

Tumor necrosis factor inhibitors are valuable tools for dermatologists. As their use increases, rare adverse events are more likely to be encountered. We describe one patient who developed sarcoidosis while being treated for psoriasis with etanercept. We sought to review to previously reported cases and further characterize the nature of this reaction. A literature search was performed with the key words "sarcoidosis, sarcoid, etanercept, infliximab, adalimumab, granulomatous, and drug reaction." All relevant cases in the English language were included and evaluated for demographic data, duration of therapy prior to developing sarcoid, duration of sarcoid signs/symptoms, treatments used and time to resolution after discontinuation of the drug. Including the present case, there are 34 cases of sarcoidosis developing during anti-tumor necrosis factor therapy. All previously reported cases were patients with a primarily rheumatologic diagnosis. In all but one case, discontinuation of the drug resulted in complete resolution of symptoms. The lung and surrounding lymph nodes were the areas most commonly affected. The average amount of time between initiation of therapy and onset of symptoms was 22 months. The average time to resolution of symptoms after discontinuation of the drug was 5.2 months. This is a retrospective case review. These data indicated that sarcoid is a possible adverse effect of tumor necrosis factor inhibitor therapy that should be noted by dermatologists using these drugs. While it has been reported in the rheumatology literature, it may be under-recognized by dermatologists.

Early and Severe Radiation Toxicity Associated with Concurrent Sirolimus in an Organ Transplant Recipient with Head and Neck Cutaneous Squamous Cell Carcinoma: A Case Report.

PubMed

Manyam, Bindu V; Nwizu, Tobenna I; Rahe, Melissa L; Harr, Bridgett A; Koyfman, Shlomo A

2015-10-01

We present a case of a 71-year-old man with a history of liver transplantation who was treated with adjuvant radiotherapy with concurrent cisplatin for recurrent cutaneous squamous cell carcinoma of the head and neck. The patient was transitioned from tacrolimus to sirolimus for immunosuppression immediately prior to the start of radiation therapy, with the goal of reducing the risk for further skin cancer recurrence. The patient developed severe normal tissue toxicity, disproportionate to the dose delivered. He was diagnosed with Grade 4 esophagitis and mucositis after just 2,400 cGy in 12 fractions (planned 6,400 cGy in 32 fractions), requiring cessation of therapy. Six months later, the patient was diagnosed with local recurrence and distant metastases in the lung, and unfortunately passed away one month later. Randomized data have demonstrated the anti-neoplastic benefit of sirolimus. Pre-clinical studies and animal models have suggested that sirolimus may be a radiation sensitizer; however, the literature is limited regarding the clinical translation of these biologic findings. The case we presented reflects that concurrent radiation therapy with sirolimus may enhance the cytotoxic effects of radiation therapy and contribute to dose-limiting toxicity. Certainly, further study is necessary to explore this observation. Copyright© 2015 International Institute of Anticancer Research (Dr. John G. Delinassios), All rights reserved.

A case of mixed connective tissue disease with pseudo-pseudo Meigs' syndrome (PPMS)-like features.

PubMed

Cheah, C K; Ramanujam, S; Mohd Noor, N; Gandhi, C; D Souza, Beryl A; Gun, S C

2016-02-01

Pseudo-pseudo Meigs' syndrome (PPMS) has been reported to be a rare presentation of patients with systemic lupus erythematosus (SLE). However, such a presentation is not common in other forms of connective tissue disease. We presented a case of gross ascites, pleural effusion, and marked elevation of CA-125 level (PPMS-like features) that led to a diagnosis of MCTD. The patient responded to systemic steroid therapy. © The Author(s) 2015.

Orthodontic Treatment in Adult Patient with Reduced Periodontium: A Case Report.

PubMed

Shintcovsk, Ricardo Lima; Knop, Luegya Amorim Henriques; Pinto, Ary Santos; Gandini, Luiz Gonzaga; Martins, Lídia Parsekian

2015-01-01

Patients presenting reduced periodontium represent a major concern for orthodontists. The purpose of this article is to present the clinical case of an adult patient who presented sequel of periodontal disease (diastemas) compromising her dental aesthetics. She was subjected to an orthodontic treatment with the application of light forces distant from the teeth with reduced periodontium. A periodontal support therapy was successfully implemented. The final stage of the treatment indicated satisfactory occlusal and periodontal characteristics.

[Body dysmorphic disorder].

PubMed

Grau, Katharina; Fegert, Jörg Michael; Allroggen, Marc

2015-01-01

Body dysmorphic disorder (BDD) is a relatively common disorder with a point prevalence of 0.7-2.4 %. BDD is characterized by the patient's excessive concern with an imagined or slight defect in physical appearance. BDD usually begins in adolescence. Comorbidity rates and also suicidality rates are high. The course of BDD tends to be chronic. According to the present state of knowledge, cognitive-behavioral therapy and pharmacotherapy with selective serotonin reuptake inhibitors are valuable options in the therapy of BDD. The case report describes a recent case of BDD with typical clinical and therapy-related characteristics. The aim of this work is to strengthen the awareness of BDD in clinical practice of child and adolescent psychiatry, facilitating an adequate diagnosis and treatment of the affected individuals.

Difficult to control atopic dermatitis

PubMed Central

2013-01-01

Difficult to control atopic dermatitis (AD) presents a therapeutic challenge and often requires combinations of topical and systemic treatment. Anti-inflammatory treatment of severe AD most commonly includes topical glucocorticosteroids and topical calcineurin antagonists used for exacerbation management and more recently for proactive therapy in selected cases. Topical corticosteroids remain the mainstay of therapy, the topical calcineurin inhibitors tacrolimus and pimecrolimus are preferred in certain locations. Systemic anti-inflammatory treatment is an option for severe refractory cases. Microbial colonization and superinfection contribute to disease exacerbation and thus justify additional antimicrobial / antiseptic treatment. Systemic antihistamines (H1) may relieve pruritus but do not have sufficient effect on eczema. Adjuvant therapy includes UV irradiation preferably of UVA1 wavelength. “Eczema school” educational programs have been proven to be helpful. PMID:23663504

[Metabolic alkalosis despite hyperlactatemia and hypercapnia. Interpretation and therapy with help of the Stewart concept].

PubMed

Chappell, D; Hofmann-Kiefer, K; Jacob, M; Conzen, P; Rehm, M

2008-02-01

Acid-base disturbances are commonly found in critically ill patients and are often associated with fatal complications. The basis of a successful treatment is a thorough understanding of the causes of these disorders. The "classical methods" to explain acid-base disorders--pH, base excess and bicarbonate concentration--mostly do not provide a causal correlation to the underlying pathology. An unusual case of a combined respiratory-metabolic disorder with hyperlactatemia and hypercapnia is presented. An acidosis masked by hypochloremic and hypoalbuminemic alkalosis was identified with the help of Stewart's concept and finally permitted a successful therapy. The modern Stewart concept provides enhanced information, enabling an exact diagnosis and causal therapy even in complex cases.

A rare case of unilateral gynecomastia during antituberculous chemotherapy with isoniazid

PubMed Central

Goud, B. K. Manjunatha; Devi, Oinam Sarsina; Nayal, Bhavna; Devaki, R. N.

2012-01-01

Gynecomastia refers to enlargement of male breast (s) due to benign proliferation of glandular tissue and is caused by excessive estrogen. The etiology may be pathological, pharmacological, or idiopathic reasons. The present report describes a case of gynecomastia due to isoniazid therapy. PMID:23087519

Acute renal failure as a form of presentation of sarcoidosis in a young adult: a case report

PubMed Central

2014-01-01

Introduction Sarcoidosis is a systemic granulomatous disease. Renal involvement is a rare initial presentation of this disease. Few articles on renal involvement as an initial presentation of sarcoidosis have been published in the literature. Case presentation A 26-year-old Caucasian woman presented with acute renal failure as an initial manifestation of sarcoidosis. Conclusions Renal involvement is an uncommon feature of sarcoidosis and it is essential to establish a fast and correct diagnosis because early therapy avoids progression to terminal renal failure. PMID:25124289

Severe, childhood-onset, idiopathic, life-long insomnia responding selectively to opiate therapy: case report with 19 year follow-up.

PubMed

Schenck, C H; Mahowald, M W

2001-11-01

Idiopathic (primary) insomnia can be difficult to treat; only two prior cases responsive to opiate therapy have been reported. A case is now presented of severe, idiopathic, childhood-onset, familial insomnia, with increased libido, absence of psychopathology, tardive emergence of restless legs syndrome (RLS), and selective response to opiate therapy. A 39-year-old woman was referred in 1981 by her physician who had discovered 3 years earlier that propoxyphene treatment of migraines also controlled her chronic insomnia. She had experienced severe insomnia since childhood, and during early adulthood the insomnia intensified, as she would sleep 0-3 h nightly and never napped. Daily generalized motor restlessness resulted in her frequently walking around the house while feeling exhausted. The quality of her life was considerably compromised by her insomnia, motor restlessness, and by an increased libido that was present since puberty and that was only partially relieved by having sex repeatedly with her husband. Nightly opiate therapy for 19 years has controlled the insomnia, motor restlessness, and excessive libido without affecting her normal libido. The insomnia had not responded to treatment with >25 agents covering >10 pharmacologic categories. During her first (unmedicated) polysomnographic (PSG) study in 1981, she slept 0 min while spending 436 min in bed. In 1984, four consecutive PSG studies were conducted in a design that confirmed the efficacy of propoxyphene therapy of her insomnia. In 1990, an ambulatory PSG revealed two runs of EEG rhythmic paroxysmal activity arising from sleep and wakefulness, without clinical correlate. Neurologic history was negative for seizures, but positive for complete right carotid artery occlusion and three transient ischemic attacks. At age 55 years, typical RLS emerged that was controlled with levodopa therapy, and a concurrent relapse of insomnia was controlled with oxycodone replacing propoxyphene. Nightly opiate therapy of severe idiopathic (primary) insomnia can remain effective during very long-term clinical follow-up. Guidelines are provided for when to consider such an unusual treatment in other cases of severe, chronic insomnia.

Acute myocardial infarction during l-thyroxine therapy in a patient with intermittent changing axis deviation, permanent atrial fibrillation and without significant coronary stenoses.

PubMed

Patanè, Salvatore; Marte, Filippo

2010-01-07

It has been rarely reported intermittent changing axis deviation also occurs during atrial fibrillation. Intermittent changing axis deviation during acute myocardial infarction and changing axis deviation associated with atrial fibrillation and acute myocardial infarction too have been also rarely reported. It has also been reported acute myocardial infarction during l-thyroxine substitution therapy in a patient with elevated levels of free triiodothyronine and without significant coronary artery stenoses. An acute myocardial infarction due to coronary spasm associated with l-thyroxine therapy has also been reported too. We present a case of changing axis deviation during acute myocardial infarction in a 56-year-old Italian woman with permanent atrial fibrillation and l-thyroxine therapy and without significant coronary stenoses. Also this case focuses attention on changing axis deviation in the presence of atrial fibrillation during acute myocardial infarction and on the possible development of acute myocardial infarction without significant coronary stenoses associated with l-thyroxine therapy.

Acute renal failure induced by markedly decreased appetite secondary to a depressive episode after discontinuation of long-term lithium therapy in an elderly patient with bipolar disorder.

PubMed

Okada, Akira

2014-05-16

Some elderly patients on chronic lithium therapy for bipolar disorder and their doctors may be faced with a therapeutic dilemma over whether or not to continue prescribing/taking lithium given their increased risk of reduced renal function. We present the case of a 78-year-old woman with bipolar disorder who discontinued lithium therapy due to increased risk factors for renal injury. After discontinuation, she experienced markedly decreased appetite secondary to a depressive episode, and developed acute renal failure, which subsequently progressed to a more advanced stage of chronic kidney disease. This case suggests that extreme care must be taken to prevent the recurrence of depression in elderly patients with bipolar disorder who discontinue lithium therapy, even when they had been emotionally stable for a long time while receiving lithium. Medications other than lithium for bipolar disorder may be needed at the time lithium therapy is discontinued. 2014 BMJ Publishing Group Ltd.

Panic attacks. Psychologic response or medical illness?

PubMed

Katerndahl, D A

1984-06-01

Panic attacks are surprisingly common in the United States, costing our economy more than $100 million per year in disability benefits and health care expenses. However, diagnosis is difficult and consequently many patients are treated for other conditions. When an underlying disorder is determined to be present, treatment of that disorder may ameliorate attacks. If none is present, panic symptoms will respond to a variety of drugs. Behavioral therapy may be necessary in severe cases or as adjunctive therapy after attacks abate.

The cumulative effect of bisphosphonates and statins on stress fractures. Is it a failure of steroid biosynthesis? Case Report.

PubMed

Dzugan, Sergey S; Dzugan, Sergey A

2016-01-01

Osteoporosis related fractures pose a significant economic and healthcare problem. There is a growing concern about increased numbers of stress or low energy fractures after bisphosphonates therapy. A 65-year-old woman is presented with a stress fracture of the left femur. From our point of view, this fracture was associated with a long-term statin and bisphosphonate therapy. We did not find a similar presentation in medical literature.

Somatic symptom disorder treated with electroconvulsive therapy.

PubMed

Borisovskaya, Anna; Augsburger, Jay Alan

2017-05-01

Somatic symptom disorder (SSD) is a challenging condition to treat with chronic pain, a common and disabling symptom. We present a patient who received electroconvulsive therapy (ECT) for SSD with significant improvement in pain and gastrointestinal symptoms. We also present a brief literature review of similar cases treated with ECT. Preliminary evidence suggests that ECT should be considered for treatment of SSD comorbid with major depressive disorder, when standard treatments fail. Further research is needed to clarify whether ECT can be used for SSD without associated depression.

Hyperthyroidism as a reversible cause of right ventricular overload and congestive heart failure

PubMed Central

Di Giovambattista, Raniero

2008-01-01

We describe a case of severe congestive heart failure and right ventricular overload associated with overt hyperthyroidism, completely reversed with antithyroid therapy in a few week. It represents a very unusual presentation of overt hyperthyroidism because of the severity of right heart failure. The impressive right ventricular volume overload made mandatory to perform transesophageal echo and angio-TC examination to exclude the coexistence of ASD or anomalous pulmonary venous return. Only a few cases of reversible right heart failure, with or without pulmonary hypertension, have been reported worldwide. In our case the most striking feature has been the normalization of the cardiovascular findings after six weeks of tiamazole therapy. PMID:18549503

Monte Carlo simulation for light propagation in 3D tooth model

NASA Astrophysics Data System (ADS)

Fu, Yongji; Jacques, Steven L.

2011-03-01

Monte Carlo (MC) simulation was implemented in a three dimensional tooth model to simulate the light propagation in the tooth for antibiotic photodynamic therapy and other laser therapy. The goal of this research is to estimate the light energy deposition in the target region of tooth with given light source information, tooth optical properties and tooth structure. Two use cases were presented to demonstrate the practical application of this model. One case was comparing the isotropic point source and narrow beam dosage distribution and the other case was comparing different incident points for the same light source. This model will help the doctor for PDT design in the tooth.

[Epilepsy, vertigo, dizziness, headache, emesis as neurological manifestation in a Giteleman's Sindrome case].

PubMed

Delsere, Mirco; Campogiani, Vincenzo; Carletti, Vincenzo; Mancini, Stefania; Piccinini, Nadia; Castelli, Paolo; Sopranzi, Franco

2015-01-01

We report the case of a woman presenting the recent onset of multiple seizure and epilepsy episodes combined with other neurological symptoms (e.g. vertigo, dizziness, vomiting, headache). She was resistant to antiepileptic and symptomatic therapy, having been first admitted to the neurology ward and subsequently to the general medicine ward. In this case, several patient assessments and imaging exams were not conclusive evidence of specific etiopathogenesis, or definitive neurological illness; however, the patient showed laboratory indexes compatible with Gitelmans Syndrome. The correction of the electrolytic imbalances of tubulopathy (including low magnesium and potassium levels) led to the progressive improvement of clinical manifestations and the eventual interruption of the antiepileptic therapy.

[Postsurgical chylous ascites: case report and literature review].

PubMed

Olivar Roldán, J; Fernández Martínez, A; Martínez Sancho, E; Díaz Gómez, J; Martín Borge, V; Gómez Candela, C

2009-01-01

Chylous ascites derives from chyle leakage into the peritoneal cavity, either due to rupture or obstruction of abdominal lymphatic vessels. The main clinical sign is abdominal distention, while diagnosis requires the presence of triglycerides in ascitic fluid. Neoplasms are the most common cause of chylous ascites, although less common causes, such as abdominal surgery, should also be considered. The mainstay of therapy is hyperproteic diet with fat restriction and middle-chain triglycerides. Parenteral nutrition is reserved for cases in which dietary treatment fails to restore an optimal nutritional status or is contraindicated, whereas surgery is considered for patients that are deemed refractory to conservative therapy. We present a case of chylous ascites secondary to retroperitoneal lymphadenectomy.

ROENTGEN: case-based reasoning and radiation therapy planning.

PubMed Central

Berger, J.

1992-01-01

ROENTGEN is a design assistant for radiation therapy planning which uses case-based reasoning, an artificial intelligence technique. It learns both from specific problem-solving experiences and from direct instruction from the user. The first sort of learning is the normal case-based method of storing problem solutions so that they can be reused. The second sort is necessary because ROENTGEN does not, initially, have an internal model of the physics of its problem domain. This dependence on explicit user instruction brings to the forefront representational questions regarding indexing, failure definition, failure explanation and repair. This paper presents the techniques used by ROENTGEN in its knowledge acquisition and design activities. PMID:1482869

[One-shot therapy and transcatheter arterial embolization (TAE) therapy of unresectable hepatocellular carcinoma].

PubMed

Tanikawa, K; Hirai, K; Kawazoe, Y; Yamashita, K; Kumagai, M; Abe, M

1985-10-01

407 cases of unresectable hepatocellular carcinoma (HCC) occurring from 1970 to March 1985, including 107 cases receiving conservative therapy, 176 cases receiving one-shot therapy and 124 cases receiving transcatheter arterial embolization (TAE) therapy, were studied and the efficacy of chemotherapy was compared with that of TAE therapy. The results were as follows; One-year survival rate was 2.8% with a median survival time of 1.3 months in conservative therapy. In the 176 cases of one-shot therapy, one-year survival rate was 21.0%, two-year 6.8% and three-year 2.3% and the median survival time was 4.8% months. In 120 cases of one-shot therapy which were compatible with criteria for one-shot injection of anticancer drugs via the hepatic artery for HCC, one-year survival rate was 30%. However the rate was 1.8% in 56 cases which were not compatible with the criteria. In 37 cases in which Mitomycin C (MMC) and Adriamycin (ADR) were administered alternately, one-year survival rate was 41.7%, two-year 16.1% and three-year 4.3%. The highest survival rate was obtained by TAE therapy. One-year survival rate was 66.9%, two-year 33.8% and three-year 28.9%. Decrease of AFP after therapy was noted in 42.4% of cases given one-shot therapy and in 95.2% of cases given TEA therapy. The results suggest that alternate administration of anticancer agents produces good chemotherapeutic effects and that the best life-prolongation is obtained by TAE therapy.

A Case of Treatment- resistant Depression and Body Dysmorphic Disorder: The Role of Electroconvulsive Therapy Revisited.

PubMed

Mahato, Ram S; San Gabriel, Maria Chona P; Longshore, Carrol T; Schnur, David B

2016-01-01

Body dysmorphic disorder is a common, often disabling condition, and is frequently comorbid with major depressive disorder. Selective serotonin reuptake inhibitors constitute first line set of somatic interventions but the management of refractory patients remains challenging. Electroconvulsive therapy, an often highly beneficial treatment for medication resistant-depression, is not considered an effective therapeutic alternative for treatment refractory body dysmorphic disorder. Here we present a 50-year-old woman with body dysmorphic disorder and comorbid major depressive disorder who remained incapacitated and suicidal despite several trials with selective serotonin reuptake inhibitors and antipsychotic medication. Depressive and dysmorphic symptoms appeared to resolve with electroconvulsive therapy, and remission was sustained for two months. Electroconvulsive therapy has an important place in the management of treatment- resistant depression associated with body dysmorphic disorder, and, in select cases, may be effective for dysmorphic symptoms as well.

Management of ganciclovir-resistant cytomegalovirus retinitis in HIV infection in the era of antiretroviral therapy.

PubMed

Adler, Hugh; De Gascun, Cillian F; McSweeney, Fionnuala; Acheson, Robert W; Brannigan, Eimear T; Duffy, Margaret; Keegan, David J; Lambert, John S

2014-10-01

The incidence of cytomegalovirus retinitis has decreased significantly since the advent of antiretroviral therapy. However, it remains an important problem in both the developed and developing worlds. Furthermore, long-term antiviral suppression is associated with a significant increase in viral resistance. We present the case of a 46-year-old man who developed cytomegalovirus retinitis one year after being diagnosed with HIV. While he initially demonstrated an excellent clinical response to ganciclovir, his cytomegalovirus viral load remained persistently elevated. Over the subsequent years, his virus developed ganciclovir resistance with a concomitant deterioration in his visual acuity. He responded poorly to salvage therapy with foscarnet and cidofovir. This case highlights the ongoing difficulty of managing cytomegalovirus disease nearly two decades into the era of antiretroviral therapy and underlines the need to develop new treatment strategies. © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

[The use of auto mode switching in patients with sick sinus syndrome].

PubMed

Vlasínová, J

2005-01-01

At present the dual chamber pacing, originally developed for patients with AV blockades, is widely used also for patients with Sick sinus syndrome (tachycardic-bradycardic type). But these patients often cause therapeutical problems to their physicians. In these cases either antiarrhythmic therapy is necessary to prevent recurrent supraventricular tachycardias (which are cause of rapid ventricular pacing) or in the case of failure of AA therapy the pacing mode has to be changed to DDI/R, which excludes physiological VAT pacing. The Auto Mode Switching (AMS) function ensures adequate ventricular pacing rate in the time of SV arrhythmias. Effects of dual chamber pacemakers equipped with AMS were studied in a group of patients with paroxysmal atrial fibrilation and/or atrial flutter. Therapy brings effects in lower of expenses due to less frequent visits at the physician, lower rate of rehospitalizations and lower need for powerful AA therapy.

Bisphosphonate therapy and osteonecrosis of the jaw complicated with a temporal abscess in an elderly woman with rheumatoid arthritis: a case report

PubMed Central

Manzon, Licia; Ettorre, Evaristo; Viscogliosi, Giovanni; Ippoliti, Stefano; Filiaci, Fabio; Ungari, Claudio; Fratto, Giovanni; Agrillo, Alessandro

2014-01-01

Bisphosphonate-related osteonecrosis of the jaw (BRONJ) is an adverse drug reaction described as the progressive destruction and death of bone tissue of the mandible or maxilla, in the course of bisphosphonate therapy. Orally administered bisphosphonates, widely used for the treatment of osteoporosis, are rarely associated with BRONJ. Instead, the risk greatly increases whether the patient is concomitantly taking steroid and/or immunosuppressant agents. The aims of this paper are to briefly discuss the evidence of the associations between bisphosphonate therapy and BRONJ, and the effects of co-occurring factors such as the presence of rheumatoid arthritis, dental surgery, and concomitant corticosteroid therapy. In particular, we present the case of an elderly woman with BRONJ suffering from rheumatoid arthritis, with a recent dental extraction and with a very unusual complication: a temporal abscess, who was successfully treated. PMID:25187700

Endodontic management of radix paramolaris with six canals: a clinical case report.

PubMed

Acharya, N; Singh, A; Samant, P S; Gautam, V

2013-01-01

Endodontic therapy of mandibular molars is a challenging task due to its varied root canal morphology. A mandibular first molar with additional buccal root (Radix paramolaris) and additional distolingual root (Radix Entomolaris) is an example of its varied anatomy. A successful management of atypical root canal configurations is an important aspect in determining the success rate of root canal therapy. The detail knowledge of the root morphology and canal anatomy allows the clinician for accurate location of the extra roots and canals and accordingly the refinement of the access cavity for the stress free entry of complex anatomy. Hence, for a successful root canal therapy, clinician must be aware of the external and internal anatomic variations .The aim of this clinical case report is to present and describe the unusual presence of two separate mesial roots and six root canals in mandibular first molar, detected during routine endodontic therapy.

Medium voltage therapy for preventing and treating asystole and PEA in ICDs.

PubMed

Gilman, Byron L; Brewer, James E; Kroll, Kai; Kroll, Mark W

2009-01-01

Sudden cardiac death (SCD) takes up to 500,000 lives each year before a victim can even be treated. To address this the implantable cardioverter defibrillator (ICD) was developed to treat those identified at high risk of SCD. Unfortunately, there are a significant number of cases in which the ICD does not successfully return a victim to normal rhythm and effective perfusion of the blood. The vast majority of cases that are not responsive to the ICD therapy require cardio-pulmonary resuscitation (CPR) according to current resuscitation guidelines. A novel electrical stimulus called medium voltage therapy (MVT) has shown efficacy in producing coronary and carotid blood flow during ventricular fibrillation. This report presents the case that the same stimulus may be effective and feasible for use in ICD patients that do not respond to their ICD therapy, or do not have a rhythm in which, an ICD shock is indicated. The inclusion of MVT technology in implantable devices may be effective in preparing the heart for successful defibrillation or in improving the metabolic condition of the heart to the extent that a pulsatile rhythm may spontaneously develop.

Paracentric Inversion of Chromosome 21 Leading to Disruption of the HLCS Gene in a Family with Holocarboxylase Synthetase Deficiency.

PubMed

Quinonez, Shane C; Seeley, Andrea H; Lam, Cindy; Glover, Thomas W; Barshop, Bruce A; Keegan, Catherine E

2017-01-01

Holocarboxylase synthetase (HLCS) deficiency is a rare autosomal recessive disorder that presents with multiple life-threatening metabolic derangements including metabolic acidosis, ketosis, and hyperammonemia. A majority of HLCS deficiency patients respond to biotin therapy; however, some patients show only a partial or no response to biotin therapy. Here, we report a neonatal presentation of HLCS deficiency with partial response to biotin therapy. Sequencing of HLCS showed a novel heterozygous mutation in exon 5, c.996G>C (p.Gln332His), which likely abolishes the normal intron 6 splice donor site. Cytogenetic analysis revealed that the defect of the other allele is a paracentric inversion on chromosome 21 that disrupts HLCS. This case illustrates that in addition to facilitating necessary family testing, a molecular diagnosis can optimize management by providing a better explanation of the enzyme's underlying defect. It also emphasizes the potential benefit of a karyotype in cases in which molecular genetic testing fails to provide an explanation.

Pneumocystis jirovecii Pneumonia in Pediatric Inflammatory Bowel Disease: A Case Report and Literature Review

PubMed Central

Lawrence, Sally J.; Sadarangani, Manish; Jacobson, Kevan

2017-01-01

Immunosuppressive therapy is a known risk factor for opportunistic infections. We report the first case of severe Pneumocystis jirovecii infection requiring intensive care in a pediatric patient with inflammatory bowel disease (IBD). The literature was reviewed and there were 92 reported cases of Pneumocystis pneumonia (PCP) in patients with IBD. Most sources were case reports and there was likely reporting bias toward patients receiving immunomodulators, anti-tumor necrosis factor (anti-TNF) therapy, and those who died. Overall, 56% of patients were males and 58% had Crohn’s disease. The median age was 45 years (interquartile range 30–68, range 8–78) and 86% of patients were lymphopenic. The case-fatality rate was 23%. Corticosteroids were used as IBD treatment in 88% of patients who subsequently developed PCP, 42% received thiopurines, 44% used anti-TNF therapy, and 15% received either cyclosporine or tacrolimus. Rates of mono, dual, triple, and quadruple immunosuppression therapy were 35, 35, 29, and 2%, respectively. This report highlights the importance of considering PCP in immunosuppressed lymphopenic pediatric IBD patients who present with unusual symptoms. Moreover, it should give gastroenterologists the impetus to limit immunosuppressive therapy to its minimal effective dose and consider options such as exclusive enteral nutrition wherever possible. Although there is no place for global PCP prophylaxis in IBD given the low incidence, in an era when there is increasing use of biologic agents with combination immunosuppressive therapy, the risk-benefit profile of PCP chemoprophylaxis should be revisited in selected cohorts such as patients on triple immunosuppression with corticosteroids, thiopurines, and a biological agent or calcineurin inhibitor, especially in lymphopenic individuals. PMID:28791279

Management of Metastatic Apocrine Hidradenocarcinoma with Chemotherapy and Radiation.

PubMed

Miller, Daniel H; Peterson, Jennifer L; Buskirk, Steven J; Vallow, Laura A; Ta, Randy; Joseph, Richard; Krishna, Murli; Ko, Stephen J; Tzou, Katherine S

2015-09-07

Hidradenocarcinoma is a rare aggressive form of cutaneous adnexal skin carcinoma originating from the sweat gland. Due to its low incidence, prognostic and treatment strategies are still being explored both for primary and advanced disease. This tumor most often presents as either solid or cystic appearing subcutaneous nodules, which may be associated with pruritus or ulceration. To date the mainstay of treatment for local disease has been surgical excision; however, the paucity of historical data available has shown that these tumors often behave aggressively with high rates of local recurrence, metastasis, and poor overall outcomes. There are few case reports describing the utility of radiation therapy in the treatment of hidradenocarcinoma. Herein, we present a case of metastatic apocrine hidradenocarcinoma in a 32-year-old Caucasian male. The patient initially underwent excisional biopsy which confirmed the diagnosis of poorly differentiated, highly infiltrative, apocrine hidradenocarcinoma. He received systemic chemotherapy for metastatic disease, followed by radiation therapy to areas of grossly palpable adenopathy. Prior to radiation therapy the patient had an enlarged hypermetabolic conglomerate of lymph nodes in the right axilla, and borderline enlarged low activity nodes within the left axilla. He received 3 cycles of chemotherapy followed by tamoxifen and radiation therapy (50.4 Gy in 28 fractions) to areas of progressive disease in the bilateral axilla, lower neck, and axillary skin. Following treatment, the patient had complete resolution of skin nodules and improvement of his pruritus. While the role of radiation therapy in the treatment of hidradenocarcinoma has not been well established, this case report demonstrated the potential benefit of external beam radiotherapy in the management of this rare disease.

Play Therapy

PubMed Central

Lawver, Timothy; Blankenship, Kelly

2008-01-01

Play therapy is a treatment modality in which the therapist engages in play with the child. Its use has been documented in a variety of settings and with a variety of diagnoses. Treating within the context of play brings the therapist and the therapy to the level of the child. By way of an introduction to this approach, a case is presented of a six-year-old boy with oppositional defiant disorder. The presentation focuses on the events and interactions of a typical session with an established patient. The primary issues of the session are aggression, self worth, and self efficacy. These themes manifest themselves through the content of the child’s play and narration of his actions. The therapist then reflects these back to the child while gently encouraging the child toward more positive play. Though the example is one of nondirective play therapy, a wide range of variation exists under the heading of play therapy. PMID:19724720

Reemergence of Plasmodium vivax malaria in the republic of Korea.

PubMed Central

Feighner, B. H.; Pak, S. I.; Novakoski, W. L.; Kelsey, L. L.; Strickman, D.

1998-01-01

Plasmodium vivax malaria reemerged in the Republic of Korea in 1993. The number of cases has tripled each year since, with more than 1,600 cases reported in 1997. All 27 cases in U.S. troops resolved uneventfully with chloroquine/primaquine therapy. Disease is localized along the western Demilitarized Zone and presents minimal risk to tourists. PMID:9621202

Use of Video-Based Cases as a Medium to Develop Critical Thinking Skills in Health Science Students

ERIC Educational Resources Information Center

Zipp, Genevieve Pinto; Maher, Cathy

2010-01-01

One learning strategy that, at present, has not been widely used in graduate Physical Therapy education is "video based cases". The use of visually unfolding case-base experience provides students a unique opportunity to experience real patient scenarios in their classroom environment. The purpose of this paper is to provide data on student…

Application of vincristine-loaded platelet therapy in three dogs with refractory immune-mediated thrombocytopenia.

PubMed

Park, Hyung-Jin; Kim, Ja-Won; Song, Kun-Ho; Seo, Kyoung-Won

2015-01-01

Three dogs presented with refractory immune-mediated thrombocytopenia (IMT). All patients failed to respond to prednisone, which is considered a mainstay of immunosuppressive therapy. Vincristine-loaded platelets (VLPs), which act selectively on mononuclear phagocytes,were introduced. After the VLPs were transfused, two dogs responded quickly with improved clinical signs while the third dog with recurrent IMT was euthanized due to its deteriorating condition. This case report describes the efficacy of VLP therapy in refractory IMT patients.

Application of vincristine-loaded platelet therapy in three dogs with refractory immune-mediated thrombocytopenia

PubMed Central

Park, Hyung-Jin; Kim, Ja-Won; Song, Kun-Ho

2015-01-01

Three dogs presented with refractory immune-mediated thrombocytopenia (IMT). All patients failed to respond to prednisone, which is considered a mainstay of immunosuppressive therapy. Vincristine-loaded platelets (VLPs), which act selectively on mononuclear phagocytes,were introduced. After the VLPs were transfused, two dogs responded quickly withimproved clinical signs while the third dogwith recurrent IMT was euthanized due to its deteriorating condition. This case report describesthe efficacy of VLP therapy in refractory IMT patients. PMID:25269722

A case of pulmonary carcinoid tumour in a pregnant woman successfully treated with bronchoscopic (electrocautery) therapy

PubMed Central

Binesh, Fariba; Samet, Mohammad; Bovanlu, Taghi Roshan

2013-01-01

We present an uncommon case of a carcinoid tumour of the bronchus that was diagnosed during pregnancy in a 28-year-old woman. The patient was admitted at the emergency department with massive haemoptysis. Owing to the patient's critical condition, she underwent urgent flexible bronchoscopy. Bleeding was controlled by local injection of 500 mg tranexamic acid and electrocautery. After the bleeding has stopped, multiple specimens were taken. Histological examination confirmed typical carcinoid tumour. Owing to repeated haemoptysis, she was treated with bronchoscopic (electrocautery) therapy, and, after delivery, she underwent pulmonary lobectomy. Only a few similar cases were found in the literature reporting bronchopulmonary carcinoid tumour during pregnancy and we could not find any similar case which was treated by electrocautery. PMID:23608865

Attention Training with Auditory Hallucinations: A Case Study

ERIC Educational Resources Information Center

Valmaggia, Lucia R.; Bouman, Theo K.; Schuurman, Laura

2007-01-01

The case presented in this paper illustrates how Attention Training (ATT; [Wells, A. (1990). "Panic disorder in association with relaxation induced anxiety: An attentional training approach to treatment." "Behavior Therapy," 21, 273-280.]) can be applied in an outpatient setting in the treatment of auditory hallucinations. The 25-year-old male…

Crystalline maculopathy: a rare complication of tamoxifen therapy.

PubMed

Srikantia, Nirmala; Mukesh, S; Krishnaswamy, Malavika

2010-01-01

Tamoxifen is a selective estrogen receptor modulator widely used in the treatment of hormone-responsive breast cancer. Tamoxifen-induced ocular complications are very rare. A post-menopausal woman, diagnosed and treated case of carcinoma of left breast, on follow-up presented with history of gradual diminution of vision in both eyes of 3 months duration. Patient was on tamoxifen therapy 20 mg daily for the last 2 years. Fundus examination showed crystalline maculopathy. Fluorescein angiography, ocular coherence tomography confirmed the diagnosis. Tamoxifen therapy was discontinued. Although ocular toxicity is rare, careful evaluation of patients with visual symptoms on tamoxifen therapy is required.

Pulmonary sporotrichosis: case series and systematic analysis of literature on clinico-radiological patterns and management outcomes.

PubMed

Aung, Ar Kar; Teh, Bing Mei; McGrath, Christopher; Thompson, Philip J

2013-07-01

Pulmonary infections by Sporothrix spp. manifest radiologically as cavitary or non-cavitary disease depending on whether the infection is primary pulmonary or multifocal sporotrichosis. Despite current guidelines, the optimal management for pulmonary sporotrichosis remains unclear. In order to clarify this, we present two cases of pulmonary sporotrichosis, as well as the results of a comprehensive literature review of treatment outcomes based on clinico-radiological presentation patterns of the disease. A literature search of all case reports in English language over the last 50 years (1960-2010) was conducted. Data on patient characteristics, risk factors, clinico-radiological patterns, treatment modalities and outcomes were collected and analyzed. A total of 86 cases were identified, i.e., 64 (74.4%) primary pulmonary and 22 (25.6%) multifocal sporotrichosis. Radiologically, primary pulmonary disease was commonly characterized by cavity formation which was lacking in multifocal infections (P = 0.0001). Immunosuppressant use was more common in multifocal sporotrichosis (P = 0.0001), while hemoptysis was more common in primary pulmonary form (P = 0.01). No other differences in patient characteristics or risk factors were noted. Extra-pulmonary multifocal sporotrichosis most commonly involved skin (81.8%) and joints (45.4%). For patients with cavitary primary pulmonary sporotrichosis, outcomes from medical therapy alone were inferior to surgical intervention (P = 0.02). However, for both primary pulmonary and multifocal sporotrichosis with non-cavitary disease, medical therapy alone provided good outcomes. Only 12 (16.7%) cases were treated with itraconazole. Treatment of pulmonary sporotrichosis should be guided by the clinico-radiological patterns of presentation. Medical therapy alone is likely sufficient for non-cavitary disease while early surgery should be considered for cavitary primary pulmonary sporotrichosis. The experience in treating cavitary disease with itraconazole alone is limited and further data are required.

A Case of Tranexamic Acid as Adjunctive Treatment for Chronic Subdural Hematoma with Multiple Recurrences

PubMed Central

Mikkelsen, Ronni; Anker-Møller, Thorkil; Hvas, Anne-Mette; Sunde, Niels

2017-01-01

Patient: Male, 64 Final Diagnosis: Chronic subdural hematoma Symptoms: Aphasia • headache • paresis Medication: — Clinical Procedure: Burr hole evacuation • Tranexamic acid Specialty: Neurosurgery Objective: Unusual clinical course Background: Chronic subdural hematoma (CSDH) is a common neurosurgical condition that is treated using a cranial burr hole evacuation procedure, but recurrence is common. The use of anticoagulant therapy can increase the risk of developing a recurrent subdural hematoma. We present a challenging case of a patient on long-term anticoagulant therapy following previous aortic and aortic valve surgery who had CSDH with multiple recurrences and was ultimately treated with tranexamic acid as an adjunct to surgery. Case Report: A male patient in his mid-sixties presented with a headache and bilateral CSDH. Apart from a mechanical heart valve, he was otherwise healthy. A standard burr hole evacuation was performed, but the left hematoma and symptoms recurred after three months, and he presented with additional symptoms of aphasia and right-hand weakness. He had an additional three procedures followed by recurrences over a period of six weeks. Following his fifth and final surgical procedure, he was given postoperative intravenous tranexamic acid 10 mg/kg four times during the first 24 hours with dalteparin sodium 9,500 international units (IU) twice daily. His symptoms resolved, and after nine months he had no residual hematoma, and no thromboembolic complications occurred. Conclusions: This case has demonstrated that tranexamic acid can be used as an adjunctive treatment to surgery when dealing with recurring CSDH, even in patients who require concomitant anticoagulant therapy. Although clinical trials are underway to evaluate tranexamic acid as a medical treatment for CSDH, this case report may support further studies that include patients with risk factors for thromboembolic disease. PMID:28912416

Antiviral therapy for HCV-associated cryoglobulinemic glomerulonephritis: case report and review of the literature.

PubMed

Fabrizi, Fabrizio; Fogazzi, Giovanni Battista; Cresseri, Donata; Passerini, Patrizia; Martin, Paul; Donato, Maria Francesca; Rumi, Maria Grazia; Messa, Piergiorgio

2012-01-01

We describe the case of a 51-year-old woman with HCV-associated cryoglobulinemic glomerulonephritis (GN). She presented mild deterioration of kidney function, non-nephrotic proteinuria, and active urinary sediment. Kidney biopsy showed features of membranoproliferative changes with some sclerosis. Sustained viral response (SVR) was obtained by 6 months of antiviral therapy (peg-IFN-α2a plus ribavirin). SVR was linked with improvement of kidney function and remission of proteinuria. Clinical and virological remission persists over a 25-month follow-up. This case report emphasizes efficacy and safety of antiviral treatment of HCV-associated glomerulonephritis--preliminary but encouraging results exist. We identified by systematic review of the literature 9 studies (156 unique patients); the pooled estimate of frequency of sustained virological response after IFN-based therapy was 0.49 (95% confidence interval, CI: 0.21, 0.77; p < 0.0005; random effects model). Heterogeneity was found (I(2) = 98.9%, p < 0.0001). Two possible regimens should be considered for the treatment of HCV-associated cryoglobulinemic GN according to the clinical presentation. Immunosuppressive therapy is recommended for HCV-related kidney disease having aggressive course, and recent evidence supports rituximab (RTX) use with a reduced exposure to corticosteroids. We identified six studies (66 unique patients) on RTX therapy for HCV-associated kidney disease; at the end of RTX therapy, the pooled estimate of the mean decrease in proteinuria was 1.4 g/24 h (95% CI: 0.75, 2.05, p < 0.001); The p test for heterogeneity gave a value of 0.94 (I(2) = 0). Several questions related to RTX use remain. HCV-induced GN is uncommon among CKD patients of developed countries, and this clearly hampers prospective controlled clinical trials aimed to evaluate efficacy and safety of antiviral or immunosuppressive therapy in this population. Copyright © 2013 S. Karger AG, Basel.

Importance of Regular and Maintenance Therapy Adherence in Neuromyelitis Optica (NMO): Lessons from a Repeating Relapse Case

PubMed Central

Miao, Jing; Aboagye, Doreen E.; Chulpayev, Boris; Liu, Lin; Ishkanian, Gary; Kolanuvada, Bangaruraju; Alaie, Dariush; Petrillo, Richard L.

2018-01-01

Patient: Female, 58 Final Diagnosis: NMO Symptoms: New-onset right leg weakness and pain Medication: — Clinical Procedure: Progressive and recurring Specialty: Neurology Objective: Rare disease Background: Neuromyelitis optica (NMO) is a rare demyelinating disease of the central nervous system; NMO predominantly affects the spinal cord and optic nerves. The diagnosis is based on history, clinical presentation, seropositive NMO-IgG antibody, and notably, exclusion of other diseases. Despite the absence of definitive therapeutic strategies for NMO, methylprednisolone pulse therapy and plasma exchange are used for acute phase treatment, while immunosuppressive agent(s) are recommended to prevent relapses and improve prognosis. Here, we report a repeating relapse NMO case due to lack of regular and maintenance therapy. Case Report: A 58-year-old female with chronic NMO presented with a three-day history of new-onset right leg weakness and pain. The patient was diagnosed with NMO three years ago and presented with her fourth attacks. During her initial diagnosis, she was initiated on steroids. One year later, she developed the first relapse and was treated with steroids and rituximab, leading to 1.5-year remission. After the second relapse, steroids and rituximab was still given as maintenance therapy, but was not followed. Thus, the third relapse occurred in five months. During this hospitalization, she received initially high-dose solumedrol (1 g daily for five days) in addition to gabapentin 100 mg (gradually increased to 300 mg) three times a day for muscle spasms. Due to worsening of paresthesia and hemiparesis, it was decided to place her on plasma exchange treatment. After two plasma exchanges, the patient’s condition was improved and she regained strength in her lower extremity. She completed five more cycles of plasma exchange, and was then discharged on steroid therapy (prednisone 20 mg daily for 10 days then taper) as maintenance therapy and with follow-up in neurology clinic. Conclusions: Over the span of three years, the patient has had three relapses since her NMO diagnosis where her symptoms have worsened. Steroid therapy alone seemed not insufficient in managing her more recent relapses. Nonadherence to NMO treatment likely increased her risk for recurrence, thus regular and long-term maintenance therapy is imperative to delay the progression and prevent relapse in NMO. PMID:29321467

Delayed presentation of severe rhabdomyolysis leading to acute kidney injury following atorvastatin-gemfibrozil combination therapy: a case report.

PubMed

Dalugama, Chamara; Pathirage, Manoji; Kularatne, S A M

2018-05-22

Rhabdomyolysis is a rare but serious complication of lipid-lowering therapy. Statin and fibrate combination increases the risk of rhabdomyolysis possibly by pharmacodynamic interactions. Advanced age, diabetes, hypothyroidism, polypharmacy, and renal impairment are known to increase the risk of rhabdomyolysis. Management strategies include fluid resuscitation and urine alkalinization. Renal indications such as refractory hyperkalemia, acidosis, fluid overload, or uremic complications mandate renal replacement therapy in rhabdomyolysis. We report the case of a 62-year-old Sri Lankan Sinhalese man with dyslipidemia, type 2 diabetes mellitus with renal impairment, and hypothyroidism who was on atorvastatin; he was started on gemfibrozil and developed muscle symptoms. Although gemfibrozil was discontinued soon after, he presented with rhabdomyolysis with acute kidney injury 1 month later. He needed hemodialysis due to refractory hyperkalemia, metabolic acidosis, and fluid overload. Rhabdomyolysis is a rare but serious complication due to lipid-lowering therapy with statins and fibrates. Treating physicians should be aware and patients should be warned to report about muscle symptoms after starting statins or fibrates. Rhabdomyolysis may occur with mild symptoms and signs and may occur later, even after discontinuation of the drug.

[Skin necrosis during long-term fluindione treatment revealing protein C deficiency].

PubMed

Merklen-Djafri, C; Mazurier, I; Samama, M-M; Alhenc-Gelas, M; Tortel, M-C; Cribier, B; Roth, B; Batard, M-L

2012-03-01

Cutaneous necrosis is a rare complication of vitamin K antagonist therapy. It presents as cutaneous hemorrhagic necrosis and usually occurs at the start of treatment. We describe an atypical case of recurrent skin necrosis after two years of treatment with fluindione. A 70-year old woman with a history of venous thromboembolism and obesity presented with a large haemorrhagic necrosis of the abdominal wall. She had been treated with fluindione for two years. Genetic protein C deficiency was discovered. Resumption of vitamin K antagonist therapy was followed by recurrence of skin necrosis despite concomitant administration of heparin. Treatment with vitamin K antagonists could not be continued. This observation is unusual due to the late onset of skin necrosis. The condition usually begins shortly after initiation of vitamin K antagonist therapy, generally between the third and the sixth day of treatment. It is due to a transient hypercoagulable state in patients with protein C deficiency or, in rare cases, protein S deficiency. This late-onset skin necrosis, occurring many years after initiation of anticoagulant therapy, may be explained by a sudden worsening of pre-existing protein C deficiency due to infectious and iatrogenic factors. Copyright © 2011 Elsevier Masson SAS. All rights reserved.

Lower extremity thrust and non-thrust joint mobilization for patellofemoral pain syndrome: a case report

PubMed Central

Simpson, Brad G; Simon, Corey B

2014-01-01

A 40-year old female presented to physical therapy with a one-year history of insidious right anteromedial and anterolateral knee pain. Additionally, the patient had a history of multiple lateral ankle sprains bilaterally, the last sprain occurring on the right ankle 1 year prior to the onset of knee pain. The patient was evaluated and given a physical therapy diagnosis of patellofemoral pain syndrome (PFPS), with associated talocrural and tibiofemoral joint hypomobility limiting ankle dorsiflexion and knee extension, respectively. Treatment included a high-velocity low amplitude thrust manipulation to the talocrural joint, which helped restore normal ankle dorsiflexion range of motion. The patient also received tibiofemoral joint non-thrust manual therapy to regain normal knee extension mobility prior to implementing further functional progression exercises to her home program (HEP). This case report highlights the importance of a detailed evaluation of knee and ankle joint mobility in patients presenting with anterior knee pain. Further, manual physical therapy to the lower extremity was found to be successful in restoring normal movement patterns and pain-free function in a patient with chronic anterior knee pain. PMID:24976753

Diagnostic challenges in tuberculous otitis media.

PubMed

Tang, I P; Prepageran, N; Ong, C A; Puraviappan, P

2010-08-01

To demonstrate the different clinical presentations of tuberculous otitis media and the management of selected cases. We report four cases of tuberculous otitis media with different clinical presentations, encountered between 1998 and 2002. None of the cases showed improvement with local or systemic antibiotics. The diagnosis, complications and management of these cases are discussed. A high index of clinical suspicion of tuberculous otitis media is required in patients who do not respond to standard antibiotic therapy for (nontuberculous) chronic middle-ear infection. Early diagnosis and treatment of tuberculous otitis media is important to avoid irreversible complications, surgical intervention and propagation of the disease.

An Unusual Presentation of Addison's Disease-A Case Report.

PubMed

Choudhary, Sandeep; Alam, Anwer; Dewan, Vivek; Yadav, Dinesh; Dubey, N K

2011-07-01

Addison's disease is most commonly due to autoimmune adrenalitis and tuberculosis and refers to primary hypoadrenalism caused by a total or near total destruction or dysfunction of both adrenal cortices. Usual manifestations involve chronic fatigue, muscle weakness, loss of appetite, nausea, vomiting, diarrhea, hypotension and hyperpigmentation of skin. We herein report a case of primary adrenal insufficiency presenting with fever and seizures in an 11-yr-old boy. His symptoms resolved after starting specific therapy. This kind of presentation of Addison's disease is rather unusual.

Massage Therapy Treatment and Outcomes for a Patient with Parkinson’s Disease: a Case Report

PubMed Central

Casciaro, Yolanda

2016-01-01

Introduction Parkinson’s disease (PD) is a complex neurological disorder. The disease is progressive and, in time, results in severe disability. Many patients turn to massage in an attempt to alleviate symptoms of pain and rigidity, though the effects of massage with respect to PD are not well studied. This case adds one more instance in which massage therapy has provided temporary respite from resting tremor, one unrelenting symptom of PD. Objective To determine if massage therapy can produce favorable outcomes with respect to the severity of rigidity and tremor in a patient with PD. Case Presentation A 63-year-old female patient with idiopathic, long-standing, Hoehn-Yahr Stage 4 PD was treated with massage therapy five times over the course of six weeks. A SPES/SCOPA Motor Impairments rating scale was used to measure rigidity and tremor pre- and post-treatment, to gauge treatment effectiveness. The massage treatments consisted of deep longitudinal stroking, muscle squeezing techniques, passive range of motion movements, and general relaxation techniques to encourage a soothing environment while promoting a decrease in muscular tone and hyperactivity. Massage therapy administration was by a student near the end of her two-year diploma. Results The results obtained indicated that massage therapy treatment had a positive effect on reducing resting and postural tremor in a patient with long-standing PD. The treatment was also effective in temporarily reducing rigidity during treatment, but did not produce a lasting effect. Conclusion Further study is required; however, the results of this case were consistent with the limited research available on the subject of massage therapy and Parkinson’s disease, in that positive change with respect to tremor—and to a lesser degree, rigidity—were achieved with focused, intentional treatment. PMID:26977216

Paracoccidioidomycosis: case report and review.

PubMed

Manns, B J; Baylis, B W; Urbanski, S J; Gibb, A P; Rabin, H R

1996-11-01

A previously well 59-year-old man presented with paracoccidioidomycosis, more than 15 years after leaving South America. He failed to respond to conventional therapies, first with oral itraconazole and then with amphotericin B plus sulfadiazine, and eventually died of recurrent arterial emboli possibly due to paracoccidioidomycotic aortitis. This patient's presentation demonstrates the difficulties that may be encountered in diagnosing and managing this disease. Paracoccidioidomycosis should be suspected in patients with an appropriate travel history who experience weight loss and have pulmonary, mucosal, and cutaneous lesions. This article comprehensively reviews the literature, with emphasis on epidemiology, clinical presentation, diagnosis, and therapy with imidazole antifungal medications.

Bilateral exudative retinal detachment associated with central serous chorioretinopathy in a patient treated with corticosteroids.

PubMed

Rueda-Rueda, T; Sánchez-Vicente, J L; Llerena-Manzorro, L; Medina-Tapia, A; González-García, L; Alfaro-Juárez, A; Vital-Berral, C; López-Herrero, F; Muñoz-Morales, A; Ortega, L S; Herrador-Montiel, Á

2017-10-01

The case is presented on a 54-year-old woman with a central serous chorioretinopathy, misdiagnosed as Vogt-Koyanagi-Harada disease, and treated with systemic corticosteroids. The patient presented with a bilateral bullous exudative retinal detachment. Discontinuation of corticosteroid therapy, surgical drainage of subretinal fluid, and photodynamic therapy, led to anatomical and functional improvement. The recognition of an atypical presentation of central serous chorioretinopathy may avoid complications of the inappropriate treatment with corticosteroids. Copyright © 2017 Sociedad Española de Oftalmología. Publicado por Elsevier España, S.L.U. All rights reserved.

Precocious puberty and large multicystic ovaries in young girls with primary hypothyroidism.

PubMed

Sanjeevaiah, Aravind Raj; Sanjay, Subbarayappa; Deepak, Tejesweni; Sharada, Ardanareshwaran; Srikanta, Sri S

2007-10-01

To describe 2 cases of primary hypothyroidism, precocious puberty, large multicystic ovaries, possible diagnostic dilemma, unilateral oophorectomies, and subsequent response to levothyroxine replacement therapy. We present the clinical, biochemical, radiologic, and histopathologic findings in 2 patients with rare cases of Van Wyk-Grumbach syndrome and megaovaries, who underwent unilateral oophorectomy. Two patients, an 8-year-old girl and a 3-year-old girl (cases 1 and 2, respectively), were referred to our center. Both patients presented with precocious puberty and vaginal bleeding and had undergone unilateral oophorectomy before referral. In the first patient (case 1), the surgical intervention was a consequence of torsion of the left megaovary, necessitating emergency oophorectomy. Oophorectomy in the second patient (case 2) was a result of initial diagnostic confusion, inasmuch as a sexcord stromal tumor was suspected. A detailed history, physical examination, and laboratory results pointed toward primary hypothyroidism due to Hashimoto's thyroiditis and thyroid dysgenesis, respectively. Serial ultrasound studies of the abdomen and pelvis revealed large multicystic ovaries, with progressive enlargement (including regrowth from an apparent ovarian "postsurgical remnant"). Both patients responded dramatically after initiation of levothyroxine replacement therapy, with no further vaginal bleeding and reversal of megaovary to normal size (in case 1). In a highly selected minority of children with untreated primary hypothyroidism, there is development of precocious puberty and progressively enlarging multicystic ovaries. The precise endocrine, neuroanatomic, and neurophysiologic bases for this phenomenon are unclear. Nevertheless, the entire clinicopathologic picture, including giant ovaries, dramatically reverts to normal status with the restoration of a euthyroid state by means of simple levothyroxine replacement therapy.

Primary intestinal and thoracic lymphangiectasia: a response to antiplasmin therapy.

PubMed

MacLean, Joanna E; Cohen, Eyal; Weinstein, Michael

2002-06-01

Lymphangiectasia is a congenital or acquired disorder characterized by abnormal, dilated lymphatics with a variable age of presentation. We describe a case of lymphangiectasia with intestinal and pulmonary involvement in an adolescent female, who presented with many of the classic features including chylous pleural effusions, lymphopenia, hypogammaglobinemia, and a protein-losing enteropathy. She also presented with recurrent lower gastrointestinal bleeding, which is infrequently described. The patient did not improve with bowel rest and a low-fat medium-chain triglyceride diet and had little improvement with octreotide acetate therapy. However, she had a clinical response to antiplasmin therapy, trans-4-aminothylcyclohexamine carboxylic acid (tranexamic acid) in terms of serum albumin and gastrointestinal bleeding. She continues to have exacerbations of her condition, as well as persistent lymphopenia and chronic pleural effusions.

Candida Osteomyelitis: Analysis of 207 Pediatric and Adult Cases (1970–2011)

PubMed Central

Gamaletsou, Maria N.; Kontoyiannis, Dimitrios P.; Sipsas, Nikolaos V.; Moriyama, Brad; Alexander, Elizabeth; Roilides, Emmanuel; Brause, Barry; Walsh, Thomas J.

2012-01-01

Background. The epidemiology, pathogenesis, clinical manifestations, management, and outcome of Candida osteomyelitis are not well understood. Methods. Cases of Candida osteomyelitis from 1970 through 2011 were reviewed. Underlying conditions, microbiology, mechanisms of infection, clinical manifestations, antifungal therapy, and outcome were studied in 207 evaluable cases. Results. Median age was 30 years (range, ≤ 1 month to 88 years) with a >2:1 male:female ratio. Most patients (90%) were not neutropenic. Localizing pain, tenderness, and/or edema were present in 90% of patients. Mechanisms of bone infection followed a pattern of hematogenous dissemination (67%), direct inoculation (25%), and contiguous infection (9%). Coinciding with hematogenous infection, most patients had ≥2 infected bones. When analyzed by age, the most common distribution of infected sites for adults was vertebra (odds ratio [OR], 0.09; 95% confidence interval [CI], .04–.25), rib, and sternum; for pediatric patients (≤18 years) the pattern was femur (OR, 20.6; 95% CI, 8.4–48.1), humerus, then vertebra/ribs. Non-albicans Candida species caused 35% of cases. Bacteria were recovered concomitantly from 12% of cases, underscoring the need for biopsy and/or culture. Candida septic arthritis occurred concomitantly in 21%. Combined surgery and antifungal therapy were used in 48% of cases. The overall complete response rate of Candida osteomyelitis of 32% reflects the difficulty in treating this infection. Relapsed infection, possibly related to inadequate duration of therapy, occurred among 32% who ultimately achieved complete response. Conclusions. Candida osteomyelitis is being reported with increasing frequency. Localizing symptoms are usually present. Vertebrae are the most common sites in adults vs femora in children. Timely diagnosis of Candida osteomyelitis with extended courses of 6–12 months of antifungal therapy, and surgical intervention, when indicated, may improve outcome. PMID:22911646

Tracheomalacia treatment using a large-diameter, custom-made airway stent in a case with mounier-kuhn syndrome.

PubMed

Ozdemir, Cengiz; Sökücü, Sinem Nedime; Karasulu, Levent; Altın, Sedat; Dalar, Levent

2014-01-01

Mounier-Kuhn Syndrome (MKS) is a rare congenital disease that presents with abnormal enlargement in the central airways. In MKS, tracheomegaly is accompanied by difficulty in expelling recurrent lung infections and bronchiectasia. We presented a patient with MKS where commercially made stents were inadequate for stabilization and a custom-made, self-expandable metallic stent with a diameter of 28 mm and length of 100 mm was used. Chest pain that was thought to develop due to the stent and that disappeared after stent removal may be considered the main complication leading to stent removal. Continuous positive airway pressure therapy (CPAP) therapy was planned for the control of symptoms, which re-emerged after stent removal. This case is presented as an example that complications developing due to the stent as well as patient noncompliance may lead to stent removal, even when useful results are obtained from treatment of MKS.

"Am I Becoming a Serial Killer?" A Case Study of Cognitive Behavioral Therapy for Mental Illness Anxiety.

PubMed

Gelinas, Bethany L; Hadjistavropoulos, Heather

2016-05-01

Although mental illness anxiety is described in the literature, there is very little information on which to draw when treating individuals who present with fears and worries about mental health. In fact, we identified no previous case descriptions focused on this form of anxiety and treated from a cognitive behavioral perspective. The current case study aims to advance the understanding of the clinical picture of mental illness anxiety, and facilitate the understanding of how cognitive behavioral techniques for health anxiety can be effectively adapted and implemented for such a case. A case study approach was adopted in which a baseline condition and repeated assessments were conducted during an 8-week treatment and 2-month follow-up period. In the current case study, we discuss the assessment, conceptualization, and cognitive behavioral treatment of a 24-year old woman who presented with mental illness anxiety. Several common health anxiety assessment tools and cognitive behavioural techniques were adapted for her particular clinical presentation. Consistent with research evidence for health anxiety, significant improvements in health anxiety and anxiety sensitivity were seen after eight sessions of therapy and maintained at 2-month follow-up. The results provide preliminary evidence that cognitive behavioral techniques for health anxiety can be effectively and efficiently adapted for mental illness anxiety. However, the lack of available research pertaining to mental illness anxiety contributes to challenges in conceptualization, assessment and treatment.

Group B Streptococcal Cellulitis and Necrotizing Fasciitis in Infants: A Systematic Review.

PubMed

Wojtera, Monika; Cheng, Horace; Fiorini, Kyle; Coughlin, Kevin; Barton, Michelle; Strychowsky, Julie

2018-02-07

There is no consensus regarding approaches to infantile group B streptococcal (GBS) head and neck cellulitis and necrotizing fasciitis. We present a case of GBS necrotizing cellulitis and summarizes the literature regarding the presentation and management of infantile head and neck GBS cellulitis and necrotizing fasciitis. The literature was searched using PubMed, Web of Science, EMBASE, and Medline (inception to April 2017) by two independent review authors. Inclusion criteria encompassed case reports or case series of infants less than 12 months of age with GBS cellulitis of the head and neck, or with GBS necrotizing fasciitis without restriction to the head and neck. Data were extracted using tables developed a priori by two independent review authors, and discrepancies were resolved by consensus. An infant presenting at 33 days of age with GBS facial necrotizing fasciitis was successfully treated conservatively with antibiotics. Our literature search identified 40 infants with GBS head and neck cellulitis. Late-onset (98%), male gender (65%), and prematurity (58%) predominated. Penicillins were the main therapy used (97%). The 12 identified cases of necrotizing fasciitis were associated with polymicrobial etiology (36%) and broad-spectrum antibiotic use. Seventy-five percent required debridement, including four of five (80%) cases involving the head and neck. Skin and soft tissue involvement is an uncommon manifestation of late-onset GBS infection which requires antibiotic therapy and possibly surgical debridement cases with necrotizing fasciitis.

Idiopathic burning mouth syndrome: a common treatment-refractory somatoform condition responsive to ECT.

PubMed

McGirr, Alexander; Davis, Lindsay; Vila-Rodriguez, Fidel

2014-04-30

Somatic symptom disorders are common causes of disability and suffering, and can pose significant management challenges. Idiopathic burning mouth syndrome is a challenging somatic symptom disorder with relatively high prevalence, particularly among post-menopausal women. Here, we present the case of a woman with severe treatment refractory idiopathic burning mouth syndrome and comorbid major depressive disorder, who was successfully treated with bitemporal electroconvulsive therapy. This case highlights the potential effectiveness of electroconvulsive therapy in idiopathic burning mouth syndrome when other treatment options have been exhausted. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

[Long-Term Multidisciplinary Therapy for Multiple Liver Metastases from Colorectal Cancer with Biliary Drainage for Occlusive Jaundice--A Case Report].

PubMed

Okamura, Shu; Mikami, Koji; Murata, Kohei; Nushijima, Yoichirou; Okada, Kazuyuki; Yanagisawa, Tetsu; Fukuchi, Nariaki; Ebisui, Chikara; Yokouchi, Hideoki; Kinuta, Masakatsu

2015-11-01

Here, we report the case of a 43-year-old man who was diagnosed with sigmoid colon cancer with synchronous multiple liver metastases following resection of a primary lesion. Subsequent mFOLFOX+BV therapy elicited a marked response in the liver metastases, which led to the patient undergoing hepatic (S7) radiofrequency ablation (RFA), hepatic resection (lateral segmentectomy and partial [S5] resection), and cholecystectomy. Six months later, transluminal RFA was repeated because liver (S7) metastasis recurred, and 8 courses of XELOX plus BV therapy were administered. As obstructive jaundice due to recurrence of the liver metastases developed after a 6 months hiatus in chemotherapy, we endoscopically inserted a biliary stent. Despite reducing IRIS plus BV therapy, obstructive jaundice developed again, and 3 intrahepatic biliary stents were inserted with percutaneous transhepatic biliary drainage. To date, the patient has been alive for 4 years since the initial resection of the primary lesion after undergoing consecutive systemic chemotherapy with different regimens. Some studies have shown that in cases of obstructive jaundice caused by advanced gastrointestinal cancer, longer survival could be expected by reducing the severity of jaundice, suggesting that resuming chemotherapy as well as improving the severity of jaundice could contribute to better outcomes. The patient in the present case was successfully treated twice with biliary drainage for occlusive jaundice and chemotherapy, suggesting that a combination of multidisciplinary therapy and adequate local therapy such as biliary drainage could be important for the treatment of metastatic liver cancer.

A case of functional growth hormone deficiency and early growth retardation in a child with IFT172 mutations.

PubMed

Lucas-Herald, Angela K; Kinning, Esther; Iida, Aritoshi; Wang, Zheng; Miyake, Noriko; Ikegawa, Shiro; McNeilly, Jane; Ahmed, S Faisal

2015-04-01

Ciliopathies are a group of rare conditions that present through a wide range of manifestations. Given the relative common occurrence of defects of the GH/IGF-I axis in children with short stature and growth retardation, the association between ciliopathies and these defects needs further attention. Our patient is a boy who was born at term and noted to have early growth retardation and weight gain within the first 18 months of life. Biochemical tests demonstrated low IGF-I but a normal peak GH on stimulation and an adequate increase in IGF-I on administration of recombinant human growth hormone (rhGH). A magnetic resonance imaging scan revealed pituitary hypoplasia and an ectopic posterior pituitary. His growth responded well to rhGH therapy. Subsequently he also developed a retinopathy of his rods and cones, metaphyseal dysplasia, and hypertension with renal failure requiring renal replacement therapy. Whole-exome sequencing demonstrated compound heterozygous mutations of IFT172, thus consistent with a ciliopathy. This is the first reported case of a child with a mutation in IFT172 who presented with growth retardation in early childhood and was initially managed as a case of functional GH deficiency that responded to rhGH therapy. This case highlights the importance of ciliary function in pituitary development and the link between early onset growth failure and ciliopathies.

[Chronic recurrent multifocal osteomyelitis of the mandible: report of three cases].

PubMed

Paim, Luciana B; Liphaus, Bernadete Lourdes; Rocha, André C; Castellanos, Aura Ligia Z; Silva, Clovis Artur A

2003-01-01

To report three cases of chronic recurrent multifocal osteomyelitis of the mandible, an inflammatory disease affecting one or more bones with absence of isolated microorganisms in affected areas. The first case is a 13 year-old female presenting with pain and fever after dental treatment. The patient received antibiotic treatment for osteomyelitis, but developed progressive enlargement of the mandible and palmoplantar pustulosis. Bone scintigraphy showed intense and diffuse uptake in the mandible. The swelling decreased after indomethacin and hyperbaric oxygen therapy. Case 2 is a 9 year-old female patient with recurrent pain and edema of the right mandible for three years. The diagnosis of osteomyelitis was established and amoxicillin introduced. After three months, tomography showed diffuse mandible osteolysis. Indomethacin and hyperbaric oxygen therapy were introduced, however the patient presented a relapse and was treated with prednisone, rofecoxib and methotrexate. Patient 3, a 10 year-old male, had palmoplantar pustulosis and recurrent enlargement of the mandible. Tomography showed diffuse mandible osteolysis and scintigraphy revealed intense and diffuse uptake in the mandible. The patient was treated with prednisone. Rofecoxib was replaced after two relapses. Chronic recurrent multifocal osteomyelitis of the mandible is often associated with prolonged pain periods and periods of activity and remission of the inflammatory process. Its recognition is important to prevent the patient from being submitted to prolonged antibiotic therapy and unnecessary invasive procedures.

[Leptospirosis in a family after whitewater rafting in Thailand].

PubMed

Gallardo, C; Williams-Smith, J; Jaton, K; Asner, S; Cheseaux, J-J; Troillet, N; Manuel, O; Berthod, D

2015-04-15

Leptospirosis is a zoonosis found worldwide, with an incidence that is approximately 10 times higher in the tropics than in temperate regions. The main reservoir of leptospirosis is the rat and human infection usually results from exposure to infected animal urine or tissues. Only 10% of cases are symptomatic. We present here two confirmed and two probable cases of leptospirosis in a family returning from whitewater rafting in Thailand, illustrating the wide variety of the clinical manifestations of this infection. Two of the patients were hospitalized and presented a probable Jarisch-Herxheimer reaction after initiation of beta-lactam therapy. The two others patients were treated empirically with doxycycline. We discuss here some relevant aspects of the epidemiology, clinical manifestations, therapy and the challenge of an early diagnosis of leptospirosis.

Pulmonary Sarcoidosis Activation following Neoadjuvant Pembrolizumab plus Chemotherapy Combination Therapy in a Patient with Non-Small Cell Lung Cancer: A Case Report

PubMed Central

Fakhri, Ghina; Akel, Reem; Salem, Ziad; Tawil, Ayman; Tfayli, Arafat

2017-01-01

Background Pembrolizumab is a humanized monoclonal antibody which serves to enhance the antitumor immune response by targeting programmed cell death 1 receptor. The use of pembrolizumab plus carboplatin/pemetrexed combination therapy results in improvement in overall survival and progression-free survival rates for non-small cell lung cancer (NSCLC) patients as compared to chemotherapy alone. However, numerous immune-mediated toxicities of pembrolizumab have been reported. Case Presentation We report the case of a 74-year-old male patient diagnosed with stage IIIA programmed death-ligand 1-positive non-small cell lung adenocarcinoma treated with 4 cycles of carboplatin/pemetrexed plus pembrolizumab combination therapy followed by 2 cycles of pembrolizumab treatment. Follow-up PET-CT scanning showed a very good response at the level of the tumor but new-onset activity in bilateral hilar and mediastinal lymph nodes. Biopsy of these lymph nodes revealed a benign pathology with noncaseating granulomas consistent with immune-mediated sarcoidosis. Conclusion The pathogenesis of immunotherapy-induced sarcoidosis is not yet known but has been reported in different cancers and using different checkpoint inhibitors. To our knowledge, this case is the first in the literature displaying pulmonary sarcoidosis in a patient with NSCLC 4 months after having initiated chemotherapy plus pembrolizumab combination therapy. PMID:29515398

Noninfectious interstitial lung disease during infliximab therapy: Case report and literature review

PubMed Central

Caccaro, Roberta; Savarino, Edoardo; D’Incà, Renata; Sturniolo, Giacomo Carlo

2013-01-01

Pulmonary abnormalities are not frequently encountered in patients with inflammatory bowel diseases. However, lung toxicity can be induced by conventional medications used to maintain remission, and similar evidence is also emerging for biologics. We present the case of a young woman affected by colonic Crohn’s disease who was treated with oral mesalamine and became steroid-dependent and refractory to azathioprine and adalimumab. She was referred to our clinic with a severe relapse and was treated with infliximab, an anti-tumor necrosis factor α (TNF-α) antibody, to induce remission. After an initial benefit, with decreases in bowel movements, rectal bleeding and C-reactive protein levels, she experienced shortness of breath after the 5th infusion. Noninfectious interstitial lung disease was diagnosed. Both mesalamine and infliximab were discontinued, and steroids were introduced with slow but progressive improvement of symptoms, radiology and functional tests. This represents a rare case of interstitial lung disease associated with infliximab therapy and the effect of drug withdrawal on these lung alterations. Given the increasing use of anti-TNF-α therapies and the increasing reports of pulmonary abnormalities in patients with inflammatory bowel diseases, this case underlines the importance of a careful evaluation of respiratory symptoms in patients undergoing infliximab therapy. PMID:23983443

SU-C-210-02: Impact of Intrafractional Motion On TomoTherapy Stereotactic Body Radiotherapy (SBRT) 4D Dosimetry

DOE Office of Scientific and Technical Information (OSTI.GOV)

Lian, J; Matney, J; Chao, E

2015-06-15

Purpose: TomoTherapy treatment has unique challenges in handling intrafractional motion compared to conventional LINAC. This study is aimed to gain a realistic and quantitative understanding of motion impact on TomoTherapy SBRT treatment of lung and prostate cancer patients. Methods: A 4D dose engine utilizing GPUs and including motion during treatment was developed for the efficient simulation of TomoTherapy delivered dosimetry. Two clinical CyberKnife lung cases with respiratory motion tracking and two prostate cases with a slower non-periodical organ motion treated by LINAC plus Calypso tracking were used in the study. For each disease site, one selected case has an averagemore » motion (6mm); the other has a large motion (10mm for lung and 15mm for prostate). SBRT of lung and prostate cases were re-planned on TomoTherapy with 12 Gyx4 fractions and 7Gyx5 fractions, respectively, all with 95% PTV coverage. Each case was planned with 4 jaw settings: 1) conventional 1cm static, 2) 2.5cm static, 3) 2.5cm dynamic, and 4) 5cm dynamic. The intrafractional rigid motion of the target was applied in the dose calculation of individual fractions of each plan and total dose was accumulated from multiple fractions. Results: For 1cm static jaw plans with motions applied, PTV coverage is related to motion type and amplitude. For SBRT patients with average motion (6mm), the PTV coverage remains > 95% for lung case and 74% for prostate case. For cases with large motion, PTV coverage drops to 61% for lung SBRT and 49% for prostate SBRT. Plans with other jaws improve uniformity of moving target, but still suffer from poor PTV coverage (< 70%). Conclusion: TomoTherapy lung SBRT is less motion-impacted when average amplitude of respiratory-induced intrafractional motion is present (6mm). When motion is large and/or non-periodic (prostate), all studied plans lead to significantly decreased target coverage in actual delivered dosimetry.« less

Ocular and orbital porcupine quills in the dog: a review and case series.

PubMed Central

Grahn, B H; Szentimrey, D; Pharr, J W; Farrow, C S; Fowler, D

1995-01-01

A retrospective evaluation of 5 cases of orbital or intraocular porcupine quills in the dog and a literature review from MEDLINE (1983-1995) is presented. This paper reviews the diagnosis, therapy, and visual prognosis of ocular and orbital quills in the dog. Distinguishing penetration and perforation of the eye and intraocular structures is paramount in establishing a visual prognosis and appropriate therapy. Perforation of the cornea or sclera, lens, or the uvea and retina necessitates prompt specialized surgical therapy to save vision. The diagnosis of orbital quills can be readily confirmed with ultrasonography. The characteristic sonographic appearance of a double-banded, linear, hyperechoic object allows accurate localization of the quill, which aids surgical removal. Images Figure 1. Figure 2. Figure 3. Figure 4. Figure 5. Figure 6. PMID:7585434

[Progressive course of hypophosphatemic osteomalacia during 25-year follow up].

PubMed

Bojović, Jaroslav; Pavlica, Ljiljana

2010-01-01

Hypophosphatemic osteomalacia is defined as mineralization of the newly formed bone matrix (osteoids) in adults as a consequence of the phosphate deficiency. A female from Belgrade, aged 62 years fell ill in 1982. when she was 36. She first felt pains in bones associated with chronic fatigue. In 1986. during her hospitalization the presence of neoplastic hematologic, endocrinologic, urogenital and gastroenterologic system deseases was excluded. Hypophosphatemic osteomalacia was diagnosed on the basis of the history, clinical presentation, physical examination, radiologic finding and laboratory analyses (lower serum phosphorus level). The initial therapy included a mixture of phosphates, vitamin D and calcium. The doses were several times corrected over the following four years. In 1990 she had a mild clinical deterioration requiring recorrection of the mentioned therapy. In 1993 bilateral femoral neck fractures occurred and subsequent osetosynthe as was performed. The disease had a progressive character in spite of the administered drug therapy so that multiple fractures occurred in 2000. During the last hospitalization in 2008. neither new pseudo fractures nor fractures were found although biochemical profile of the hypophosphatemic osteomalacia was still present. The aim of this study was to emphasize the complexity in both diagnostic and therapeutic approach in the case of hypophosphatemic osteomalacia. In the presented case the patient showed a complicated and progressive course. In our opinion such course was a consequence of impossible etiologic treatment and discontinued therapy

TH-D-BRC-01: Panel Member

DOE Office of Scientific and Technical Information (OSTI.GOV)

Aydogan, B.

Interest in proton therapy has increased dramatically in the past couple of years, especially in the United States. There certainly is an important place for proton therapy in the arsenal of cancer treatments. Its dosimetric advantage and potential for low toxicity makes it the perfect partner for photons and other cancer treatment modalities. Often there is a belief that the new technology ought to be better but many believe that they should be widely adopted in the clinic only after evidence has shown that they are at least as safe and efficacious as existing technologies, which are often less expensive.more » This is the case for proton radiotherapy. This session being both educational and debate will provide a good review of basics and technological advancement as well as a comprehensive clinical update for both proton and photon therapy. Future technology developments and how they will impact the potential dosimetric advantage of proton therapy will be discussed. Particularly the debate will focus on whether these developments will close or widen the gap between photon and proton therapy. Learning Objectives: To review challenges, limitations, and recent and future developments in proton therapy. To review challenges, limitations, recent and future developments in photon radiotherapy. To review current clinical trials and challenging clinical cases. C. Yu, No company or organization that my presentation mentions provided me with financial support. I am the Founder and CEO of Xcision Medical Systems, LLC. However, my presentation will not mention any product or technology developed by Xcision.« less

TH-D-BRC-02: Panel Member

DOE Office of Scientific and Technical Information (OSTI.GOV)

Hahn, S.

Interest in proton therapy has increased dramatically in the past couple of years, especially in the United States. There certainly is an important place for proton therapy in the arsenal of cancer treatments. Its dosimetric advantage and potential for low toxicity makes it the perfect partner for photons and other cancer treatment modalities. Often there is a belief that the new technology ought to be better but many believe that they should be widely adopted in the clinic only after evidence has shown that they are at least as safe and efficacious as existing technologies, which are often less expensive.more » This is the case for proton radiotherapy. This session being both educational and debate will provide a good review of basics and technological advancement as well as a comprehensive clinical update for both proton and photon therapy. Future technology developments and how they will impact the potential dosimetric advantage of proton therapy will be discussed. Particularly the debate will focus on whether these developments will close or widen the gap between photon and proton therapy. Learning Objectives: To review challenges, limitations, and recent and future developments in proton therapy. To review challenges, limitations, recent and future developments in photon radiotherapy. To review current clinical trials and challenging clinical cases. C. Yu, No company or organization that my presentation mentions provided me with financial support. I am the Founder and CEO of Xcision Medical Systems, LLC. However, my presentation will not mention any product or technology developed by Xcision.« less

TH-D-BRC-04: Panel Member

DOE Office of Scientific and Technical Information (OSTI.GOV)

Yu, C.

Interest in proton therapy has increased dramatically in the past couple of years, especially in the United States. There certainly is an important place for proton therapy in the arsenal of cancer treatments. Its dosimetric advantage and potential for low toxicity makes it the perfect partner for photons and other cancer treatment modalities. Often there is a belief that the new technology ought to be better but many believe that they should be widely adopted in the clinic only after evidence has shown that they are at least as safe and efficacious as existing technologies, which are often less expensive.more » This is the case for proton radiotherapy. This session being both educational and debate will provide a good review of basics and technological advancement as well as a comprehensive clinical update for both proton and photon therapy. Future technology developments and how they will impact the potential dosimetric advantage of proton therapy will be discussed. Particularly the debate will focus on whether these developments will close or widen the gap between photon and proton therapy. Learning Objectives: To review challenges, limitations, and recent and future developments in proton therapy. To review challenges, limitations, recent and future developments in photon radiotherapy. To review current clinical trials and challenging clinical cases. C. Yu, No company or organization that my presentation mentions provided me with financial support. I am the Founder and CEO of Xcision Medical Systems, LLC. However, my presentation will not mention any product or technology developed by Xcision.« less

TH-D-BRC-03: Panel Member

DOE Office of Scientific and Technical Information (OSTI.GOV)

Paganetti, H.

Interest in proton therapy has increased dramatically in the past couple of years, especially in the United States. There certainly is an important place for proton therapy in the arsenal of cancer treatments. Its dosimetric advantage and potential for low toxicity makes it the perfect partner for photons and other cancer treatment modalities. Often there is a belief that the new technology ought to be better but many believe that they should be widely adopted in the clinic only after evidence has shown that they are at least as safe and efficacious as existing technologies, which are often less expensive.more » This is the case for proton radiotherapy. This session being both educational and debate will provide a good review of basics and technological advancement as well as a comprehensive clinical update for both proton and photon therapy. Future technology developments and how they will impact the potential dosimetric advantage of proton therapy will be discussed. Particularly the debate will focus on whether these developments will close or widen the gap between photon and proton therapy. Learning Objectives: To review challenges, limitations, and recent and future developments in proton therapy. To review challenges, limitations, recent and future developments in photon radiotherapy. To review current clinical trials and challenging clinical cases. C. Yu, No company or organization that my presentation mentions provided me with financial support. I am the Founder and CEO of Xcision Medical Systems, LLC. However, my presentation will not mention any product or technology developed by Xcision.« less

Use of Hemadsorption in a Case of Pediatric Toxic Shock Syndrome.

PubMed

Berkes, Andrea; Szikszay, Edit; Kappelmayer, János; Kerényi, Adrienne; Szabó, Tamás; Ujhelyi, László; Bari, Krisztina; Balla, György; Balla, József

2017-01-01

Toxic shock syndrome is a potentially fatal toxin-mediated disease. The role of toxins in this clinical entity made us hypothesize that extracorporeal blood purification with CytoSorb® could play a beneficial role in the clinical management of toxic shock syndrome. This case report describes the successful treatment of toxic shock syndrome using a combination of renal replacement therapy and hemadsorption in a pediatric patient. A 5-year-old girl with Down's syndrome presented with an inflamed area surrounding an insect bite, signs of systemic inflammation, and multiple organ failure. As previous attempts of immune modulation therapy were unsuccessful, renal replacement therapy was supplemented by the cytokine absorber CytoSorb. Treatment using this combination was associated with a rapid and significant stabilization in the hemodynamic situation and a decrease in inflammatory mediators within hours after the initiation of therapy. The application of CytoSorb therapy was simple and safe. The use of extracorporeal blood purification with CytoSorb proved potentially beneficial by removing toxins and inflammatory mediators in this case and could therefore play a role in the clinical management of toxic shock syndrome. Whether CytoSorb has the potential to even positively influence mortality in patients with toxic shock syndrome still needs to be confirmed.

Interim prostacyclin therapy for an isolated disconnected pulmonary artery: a case report

PubMed Central

2010-01-01

Introduction Disconnected pulmonary arteries are unusual and may result in pulmonary hypertension with acute right heart failure. Case presentation We report a case of a three-month-old Asian girl who presented with heart failure and severe pulmonary hypertension due to a disconnected right pulmonary artery. An epoprostenol (prostacyclin) infusion was instrumental in lowering pulmonary artery pressures and stabilizing the child prior to surgery. Conclusions This is, to the best of our knowledge, the first report of successful prostacyclin usage in such a situation. PMID:20525186

A Case of Severe Chlorite Poisoning Successfully Treated With Early Administration of Methylene Blue, Renal Replacement Therapy, and Red Blood Cell Transfusion

PubMed Central

Gebhardtova, Andrea; Vavrinec, Peter; Vavrincova-Yaghi, Diana; Seelen, Mark; Dobisova, Anna; Flassikova, Zora; Cikova, Andrea; Henning, Robert H.; Yaghi, Aktham

2014-01-01

Abstract The case of a 55-year-old man who attempted suicide by ingesting <100 mL of 28% sodium chlorite solution is presented. On arrival in the intensive care unit, the patient appeared cyanotic with lowered consciousness and displayed anuria and chocolate brown serum. Initial laboratory tests revealed 40% of methemoglobin. The formation of methemoglobin was effectively treated with methylene blue (10% after 29 hours). To remove the toxin, and because of the anuric acute renal failure, the patient received renal replacement therapy. Despite these therapeutic measures, the patient developed hemolytic anemia and disseminated intravascular coagulation, which were treated with red blood cell transfusion and intermittent hemodialysis. These interventions led to the improvement of his condition and the patient eventually fully recovered. Patient gave written informed consent. This is the third known case of chlorite poisoning that has been reported. Based upon this case, we suggest the management of sodium chlorite poisoning to comprise the early administration of methylene blue, in addition to renal replacement therapy and transfusion of red blood cells. PMID:25144325

Using Videoconferencing to Deliver Individual Therapy and Pediatric Psychology Interventions with Children and Adolescents

PubMed Central

Patton, Susana

2016-01-01

Abstract Background: Because of the widening access gap between need for individual and pediatric psychology services and child specialist availability, secure videoconferencing options are more needed than ever to address access challenges across underserved settings. Methods: The authors summarize real-time videoconferencing evidence to date across individual therapy with children and pediatric psychology interventions using videoconferencing. The authors summarize emerging guidelines that inform best practices for individual child therapy over videoconferencing. Results: The authors present three case examples to illustrate best practices. The first behavioral pediatrics case summarizes evidence-based approaches in treating a rural young adolescent with attention-deficit/hyperactivity disorder (ADHD), oppositional defiant disorder (ODD), and hearing impairment. The second pediatric psychology case describes similarities and difference between on-site and videoconferencing services in treating a rural child with toileting concerns. The third adolescent case describes treatment of an urban honors student with depression. Conclusions: Videoconferencing is an effective approach to improving access to individual and pediatric psychology interventions for children and adolescents. Videoconferencing approaches are well accepted by families and show promise for disseminating evidence-based treatments to underserved communities. PMID:26745607

Using Videoconferencing to Deliver Individual Therapy and Pediatric Psychology Interventions with Children and Adolescents.

PubMed

Nelson, Eve-Lynn; Patton, Susana

2016-04-01

Because of the widening access gap between need for individual and pediatric psychology services and child specialist availability, secure videoconferencing options are more needed than ever to address access challenges across underserved settings. The authors summarize real-time videoconferencing evidence to date across individual therapy with children and pediatric psychology interventions using videoconferencing. The authors summarize emerging guidelines that inform best practices for individual child therapy over videoconferencing. The authors present three case examples to illustrate best practices. The first behavioral pediatrics case summarizes evidence-based approaches in treating a rural young adolescent with attention-deficit/hyperactivity disorder (ADHD), oppositional defiant disorder (ODD), and hearing impairment. The second pediatric psychology case describes similarities and difference between on-site and videoconferencing services in treating a rural child with toileting concerns. The third adolescent case describes treatment of an urban honors student with depression. Videoconferencing is an effective approach to improving access to individual and pediatric psychology interventions for children and adolescents. Videoconferencing approaches are well accepted by families and show promise for disseminating evidence-based treatments to underserved communities.

Gastrointestinal histoplasmosis in the acquired immunodeficiency syndrome: report of 18 cases and literature review.

PubMed

Assi, Maha; McKinsey, David S; Driks, Michael R; O'Connor, Mary C; Bonacini, Maurizio; Graham, Bruce; Manian, Farrin

2006-07-01

No large case series of gastrointestinal histoplasmosis (GIH) in patients with AIDS has been published. We report 18 cases and review 34 published cases in the medical literature. We did a retrospective chart review from patients seen in our medical practices between 1989 and 2004. Most of our patients were men who had sex with men and who were not receiving highly active antiretroviral therapy. Median CD4 count was 34/muL. The most common presenting symptoms were diarrhea, fever, abdominal pain, and weight loss. The most commonly involved site was the colon or cecum. Biopsies revealed visible Histoplasma capsulatum organisms in 89%. Cultures from any site were positive in 76.9%. Four patients died from GIH. Gastrointestinal histoplasmosis occurs in severely immunocompromised patients with AIDS not receiving highly active antiretroviral therapy. Typical manifestations include diarrhea, fever, abdominal pain, and weight loss. Diagnosis is confirmed by blood or gastrointestinal tissue culture. Improvements in antiretroviral and antifungal therapies appear to have reduced the incidence of GIH and may improve the prognosis of this disease.

First Experience of Intraoperative Radiation Therapy in Cerebral High Grade Glioma in Iran: A Report of Three Cases and Literature Review

PubMed Central

Seddighi, Afsoun; Esmaeil Akbari, Mohammad; Seddighi, Amir Saied; Rakhsha, Afshin; Vaezi, Marjan; Zohrevand, Amir Hossein

2015-01-01

Introduction: Among the high grade cerebral gliomas, Glioblastoma multiform for instance, would be the main pattern of local recurrence causes clinical deterioration and deaths. This has observed 2 - 3 cm upon the initial lesion. During the period of 2 - 4 weeks post-surgery, remaining tumor cells have re-grown until radiochemotherapy has initiated. So it has seemed clear that improved local control could hopefully translate into improved survival. As a matter of fact, mass reduction has insufficiently achieved in almost every case of GBM as that the tumor cell number has not fallen below a “threshold” that tumor control might achieve by the host immune system. Intraoperative Radiation therapy has been one of those add-on therapies, which has performed during or directly after resection and cleared the tumor cavity from microscopically remaining cells. Although IORT has presented a novel and feasible principle, the method faced a number of technical and geometrical errors and limitations, which has decreased its potential in the reports of previous studies. Examples could be mentioned as incomplete target volume coverage that seemed as the greatest influence on survival, due to irradiation with an inadequate electron cone size, due to angle errors, or inadequately low energies. In contrast to the previously used forward-beaming electron cones, spherical irradiation sources were specifically attractive in brain tumor IORT, even in post resection cavities with normal complex shapes. Case Presentation: We have been reporting 3 cases of high grade gliomas, one recurrent GBM, one primary glioma grade III, and the last one recurrent Rhabdoid GBM, which have been fulfilling our entrance criteria of IORT procedure, by using spherical applicators, which has been increasingly discussed in recent studies. Conclusions: It was the first experience of intraoperative radiation therapy for cerebral malignant tumours in Iran. Finally, we had a brief overview on the past and present IORT strategies in the treatment of GBM. PMID:26634108

Corticosteroid Treatment for Prolonged Fever in Hepatosplenic Cat-Scratch Disease: A Case Study.

PubMed

Phan, Amanda; Castagnini, Luis A

2017-12-01

Hepatosplenic cat-scratch disease (CSD) may cause prolonged fever. We present the case of a 4-year-old boy with confirmed hepatosplenic CSD with fever lasting 3 months despite use of multiple different antimicrobial agents. The patient became afebrile soon after corticosteroid therapy was started. Our case indicates corticosteroids may be useful in patients with hepatosplenic CSD and prolonged fever.

Stage Presentation, Care Patterns, and Treatment Outcomes for Squamous Cell Carcinoma of the Penis

DOE Office of Scientific and Technical Information (OSTI.GOV)

Burt, Lindsay M.; Shrieve, Dennis C.; Tward, Jonathan D., E-mail: Jonathan.Tward@hci.utah.edu

Purpose: Penile squamous cell carcinoma (SCC) is a rare entity, with few published series on outcomes. We evaluated the stage distributions and outcomes for surgery and radiation therapy in a U.S. population database. Methods and Materials: Subjects with SCC of the penis were identified using the National Cancer Institute Surveillance, Epidemiology and End Results (SEER) Program database between 1988 and 2006. Descriptive statistics were performed, and cause-specific survival (CSS) was estimated using Kaplan-Meier analysis. Comparisons of treatment modalities were analyzed using multivariate Cox regression. Subjects were staged using American Joint Committee on Cancer, sixth edition, criteria. Results: There were 2458more » subjects identified. The median age was 66.8 years (range, 17-102 years). Grade 2 disease was present in 94.5% of cases. T1, T2, T3, T4, and Tx disease was present in 64.8%, 17.1%, 9.5%, 2.1%, and 6.5% of cases, respectively. N0, N1, N2, N3, and Nx disease was noted in 61.6%, 6.9%, 4.0%, 3.7%, and 23.8% of cases, respectively. M1 disease was noted in 2.5% of subjects. Individuals of white ethnicity accounted for 85.1% of cases. Lymphadenectomy was performed in 16.7% of cases. The CSS for all patients at 5 and 10 years was 80.8% and 78.6%. By multivariable analysis grades 2 and 3 disease, T3 stage, and positive lymph nodes were adverse prognostic factors for CSS. Conclusion: SCC of the penis often presents as early-stage T1, N0, M0, grade 1, or grade 2 disease. The majority of patients identified were treated with surgery, and only a small fraction of patients received radiation therapy alone or as adjuvant therapy.« less

Thoracic spinal cord intramedullary aspergillus invasion and abscess.

PubMed

McCaslin, Addason F; Lall, Rishi R; Wong, Albert P; Lall, Rohan R; Sugrue, Patrick A; Koski, Tyler R

2015-02-01

Invasive central nervous system aspergillosis is a rare form of fungal infection that presents most commonly in immunocompromised individuals. There have been multiple previous reports of aspergillus vertebral osteomyelitis and spinal epidural aspergillus abscess; however to our knowledge there are no reports of intramedullary aspergillus infection. We present a 19-year-old woman with active acute lymphoblastic leukemia who presented with several weeks of fevers and bilateral lower extremity weakness. She was found to have an intramedullary aspergillus abscess at T12-L1 resulting from adjacent vertebral osteomyelitis and underwent surgical debridement with ultra-sound guided aspiration and aggressive intravenous voriconazole therapy. To our knowledge this is the first reported case of spinal aspergillosis invading the intramedullary cavity. Though rare, this entity should be included in the differential for immunocompromised patients presenting with fevers and neurologic deficit. Early recognition with aggressive neurosurgical intervention and antifungal therapy may improve outcomes in future cases. Copyright © 2014 Elsevier Ltd. All rights reserved.

Bacteremia caused by Achromobacter species in an immunocompromised host.

PubMed Central

Kish, M A; Buggy, B P; Forbes, B A

1984-01-01

A case of bacteremia caused by Achromobacter species in an immunocompromised patient is described. The patient responded to antibiotic therapy. Detailed antibiotic susceptibility data are presented. PMID:6332118

Non-Hodgkin’s Lymphomas, Version 4.2014

PubMed Central

Zelenetz, Andrew D.; Gordon, Leo I.; Wierda, William G.; Abramson, Jeremy S.; Advani, Ranjana H.; Andreadis, C. Babis; Bartlett, Nancy; Byrd, John C.; Czuczman, Myron S.; Fayad, Luis E.; Fisher, Richard I.; Glenn, Martha J.; Harris, Nancy Lee; Hoppe, Richard T.; Horwitz, Steven M.; Kelsey, Christopher R.; Kim, Youn H.; Krivacic, Susan; LaCasce, Ann S.; Nademanee, Auayporn; Porcu, Pierluigi; Press, Oliver; Rabinovitch, Rachel; Reddy, Nishitha; Reid, Erin; Saad, Ayman A.; Sokol, Lubomir; Swinnen, Lode J.; Tsien, Christina; Vose, Julie M.; Yahalom, Joachim; Zafar, Nadeem; Dwyer, Mary; Sundar, Hema

2016-01-01

Non-Hodgkin’s lymphomas (NHL) are a heterogeneous group of lymphoproliferative disorders originating in B lymphocytes, T lymphocytes, or natural killer cells. Mantle cell lymphoma (MCL) accounts for approximately 6% of all newly diagnosed NHL cases. Radiation therapy with or without systemic therapy is a reasonable approach for the few patients who present with early-stage disease. Rituximab-based chemoimmunotherapy followed by high-dose therapy and autologous stem cell rescue (HDT/ASCR) is recommended for patients presenting with advanced-stage disease. Induction therapy followed by rituximab maintenance may provide extended disease control for those who are not candidates for HDT/ASCR. Ibrutinib, a Bruton tyrosine kinase inhibitor, was recently approved for the treatment of relapsed or refractory disease. This manuscript discusses the recommendations outlined in the NCCN Guidelines for NHL regarding the diagnosis and management of patients with MCL. PMID:25190696

68Ga-DOTA-TATE PET/CT for Molecular Imaging of Somatostatin Receptor Expression in Extra-adrenal Paraganglioma in a Case of Complete Carney Triad.

PubMed

Derlin, Thorsten; Hartung, Dagmar; Hueper, Katja

2017-12-01

Carney triad is a very rare syndrome characterized by the synchronous or metachronous occurrence of gastrointestinal stromal tumors, pulmonary chondroma, and extra-adrenal paraganglioma. We present the case of a 36-year-old woman with complete Carney triad who underwent a Ga-DOTA-TATE PET/CT scan for restaging of metastasizing extra-adrenal paraganglioma and for evaluation of targeted radionuclide therapy potential. On the Ga-DOTA-TATE PET scan, increased tracer accumulation was observed in paraganglioma metastases. This case highlights the usefulness of Ga-DOTA-TATE PET/CT for restaging of metastasizing paraganglioma in Carney triad and the option of targeted radionuclide therapy in this entity.

Halo naevi, vitiligo and diffuse alopecia areata associated with tocilizumab therapy

PubMed Central

Nadesalingam, Kavitha; Goodfield, Mark; Emery, Paul

2016-01-01

We present a follow-up case report of a 33-year-old lady with juvenile onset arthritis who developed halo naevi while on treatment with tocilizumab. This case report describes the development of halo naevi, vitiligo and diffuse alopecia areata associated with tocilizumab therapy following infection with Methicillin-resistant Staphylococcus aureus (MRSA) and Panton–Valentine leukocidin positivity. This is the first case that describes these events and supports previous theories on cellular and humoral immunity as causative factors. The regression of melanocytes during treatment with tocilizumab could also implicate IL-6 and sIL-6R as future targets in the treatment of melanoma through its direct effect of melanocytic cytotoxicity, which supports previous studies. PMID:27516894

Facing fears and sadness: cognitive-behavioral therapy for childhood traumatic grief.

PubMed

Brown, Elissa J; Pearlman, Michelle Y; Goodman, Robin F

2004-01-01

The term childhood traumatic grief (CTG) is being increasingly used to refer to the particular reaction in children that may follow the death of a loved one during a traumatic event. The goal of this case study is to describe the theoretical argument and framework for, as well as a clinical example of, cognitive-behavioral therapy (CBT) for CTG. We present a case of a five-year-old boy whose father, a firefighter, died in the line of duty at the World Trade Center on September 11, 2001. This specific case will highlight the steps of CBT for CTG, the value of assessment during the therapeutic process, and the need to consider developmental and family factors in treatment.

Isolated avulsion of the vastus lateralis tendon insertion in a weightlifter: a case report.

PubMed

Phadnis, Joideep; Trikha, Paul S; Wood, David G

2009-08-25

We report a case of isolated, unilateral avulsion of the vastus lateralis tendon from its insertion at the patella. This was diagnosed by magnetic resonance imaging, and underwent successful surgical repair. A healthy 32-year-old national level power lifter presented with an isolated avulsion of the vastus lateralis tendon. After a failed course of conservative therapy he underwent surgical repair and a graded physical therapy programme. One year later he returned to full training with no evidence of re-rupture. This is the first reported case of an isolated vastus lateralis avulsion. Our experience suggests that magnetic resonance imaging is invaluable in the diagnosis of this condition and that surgical repair provides a good outcome in high demand patients.

Combining Sedation and Cognitive Behavioural Therapy (CBT) to Overcome Dental Phobia: a Case Report.

PubMed

Hare, Jennifer S J

2017-01-01

This case report presents a Cognitive Behavioural Therapy (CBT) intervention provided for a 63-year-old male, who had experienced dental phobia for over 50-years. This gentleman initially received intravenous sedation (IVS) for 5-years within a Specialist Sedation and Special Care dental department, before being referred for the long-term management of his dental phobia, within the embedded specialist Dental Health Psychology Service in a London Dental Hospital. This brief report will consider aspects of the CBT intervention delivered in relation to assessment, case conceptualisation, course of treatment and outcomes; reflecting on the complementary aspects of sedation and CBT. Learning points will be identified for the role of CBT or CBT-based techniques within dental anxiety management settings.

Starting Life Over--Working with the Head Injured: The Case of Randall.

ERIC Educational Resources Information Center

Bostwick, Tracy

1993-01-01

Presents case of engineering college student who, after automobile accident, three months in coma, and four years of rehabilitation therapy, is seeking career counseling due to his frustrations with obtaining full-time professional employment. Notes that client had difficulty remembering new information; was physically slow; was mentally slower…

Understanding and Treating Health Anxiety: A Cognitive-Behavioral Approach

ERIC Educational Resources Information Center

Taylor, Steven

2004-01-01

Mrs. A. presents with a textbook case of hypochondriasis. An additional diagnosis of OCD does not enhance our understanding or treatment of her problems, and is not indicated according to "DSM-IV." Cognitive-behavior therapy (CBT) is effective in treating hypochondriasis, although it is necessary to devise a case formulation for each patient to…

Coinfection with Hymenolepis nana, Hymenolepis diminuta, Giardia intestinalis, and Human Immunodeficiency Virus: A Case Report with Complex Immunologic Interactions.

PubMed

Pérez-Chacón, Gladymar; Pocaterra, Leonor A; Rojas, Elsy; Hernán, Aurora; Jiménez, Juan Carlos; Núñez, Luz

2017-05-01

AbstractWe describe the case of a 43-year-old human immunodeficiency virus-infected man receiving combined antiretroviral therapy and coinfected with Hymenolepis nana , Hymenolepis diminuta , and Giardia intestinalis , presenting as chronic diarrhea and critical weight loss. Immunological aspects of these interactions are reviewed.

Pragmatic Language Impairment: Case Studies of Social and Pragmatic Language Therapy

ERIC Educational Resources Information Center

Adams, Catherine; Baxendale, Janet; Lloyd, Julian; Aldred, Catherine

2005-01-01

The current position on speech and language intervention for children who have pragmatic language impairment (PLI) is limited by a lack of evidence to support practice. Two intervention outcome case studies of children with PLI, aimed at establishing efficacy, are presented in this paper. Standardized language tests and conversational sampling…

Intracranial evaluation and laser ablation for epilepsy with periventricular nodular heterotopia.

PubMed

Thompson, Stephen A; Kalamangalam, Giridhar P; Tandon, Nitin

2016-10-01

Surgical treatment of focal epilepsy in the presence of periventricular nodular heterotopia (PVNH) poses a challenge, as the relative roles of the nodular tissue and the overlying cortex in the generation of seizures can be complex and variable. Here, we review the literature on chronic invasive EEG recordings in humans with this substrate and present two illustrative cases from our practice. We found that while inter-ictal spiking from nodules is common, clinical seizures rarely arise solely from nodular tissue. More typically, ictal onset is simultaneous with overlying neocortex or mesial temporal structures. Surgical outcome is more favorable in cases with unilateral (as opposed to bilateral) PVNH, and when a substantial or complete ablation of PVNH is performed. In rare cases, nodular ablation alone may be sufficient, as may be completed by MRI-guided laser interstitial thermal therapy. The mechanism(s) by which PNVH interacts with overlying cortex are not fully understood, but we suggest that PVNH either orchestrates or amplifies local network epileptogenicity. At present, invasive recordings with penetrating depth electrodes are required prior to surgical therapy, as illustrated in our cases. Published by Elsevier Ltd.

Selenium: a brief review and a case report of selenium responsive cardiomyopathy

PubMed Central

2013-01-01

Background The authors review the role of selenium and highlight possible low selenium levels in soil that may result in deficient states in Saudi Arabia. Case presentation The authors report a case of selenium-responsive cardiomyopathy in a 15-month old Saudi Arabian boy. This case of selenium deficiency causing dilated cardiomyopathy is presented with failure to thrive, prolonged fever and respiratory distress. The investigations revealed selenium deficiency. Selenium supplementation along with anti-failure therapy [Furosimide, Captopril] was administered for 6 months. Following therapy the cardiac function, hair, skin and the general health of the patient improved significantly. Conclusion The patient with dilated cardiomyopathy of unknown etiology, not responding to usual medication may be deficient in selenium. Serum selenium measurements should be included in the diagnostic work-up to ensure early detection and treatment of the disease. The selenium level in the Saudi population needs be determined. Vulnerable populations have to undergo regular selenium measurements and supplementation if indicated. Dependence on processed foods suggests that the Saudi population fortify themselves with nutrient and micronutrient supplements in accordance to the RDA. PMID:23530936

The transition of renal histopathology after immunosuppressive therapy in a woman with renal limited ANCA-associated vasculitis: a case report and literature review.

PubMed

Li, Xiang-Yang; Liang, Ying-Shan; Pai, Pearl

2016-01-01

The kidneys are frequently involved in antineutrophil cytoplasmic autoantibody (ANCA) associated small-vessel vasculitis (AASVV). The pathological hallmark of ANCA-associated glomerulonephritis (AAGN) is a pauci-immune necrotising crescentic glomerulonephritis. The histopathology of AAGN may change during the course of the disease as a consequence of immunosuppressive therapy. Herein, we report the pathological evolution of a case of AAGN. We report a female presented with renal-limited AASVV, hypocomplementemia and nephrotic syndrome. The first renal biopsy revealed "crescentic" changes at presentation, but after treatment with immunosuppressive treatment, a second renal biopsy four years later showed "mixed" changes of AAGN and immune complex deposition mimicking a mesangial proliferative glomerulonephritis. A literature review was undertaken in order to understand these transformations and factors which determine the pathological transitions. AAGN is commonly described as a pauci-immune necrotising crescentic glomerulonephritis, but immune complex depositions have been frequently identified under electronic microscopy and is associated with greater levels of proteinuria. Acute lesions such as fibrinoid necrosis or glomerular crescent may completely disappear or reduce significantly after immunosuppressive therapy, but chronic changes may increase over time. Based on our review and the illustration of this case, the initial histopathology of an AAGN and its active fibrinoid necrosis and cellular glomerular crescent may disappear or resolve after immunosuppressive therapy with resulting non-distinctive feature. Understanding the transition may facilitate the clinical diagnosis and provide further insight into this disease.

A multimodal physical therapy approach utilizing the Maitland concept in the management of a patient with cervical and lumbar radiculitis and Ehlers-Danlos syndrome-hypermobility type: A case report.

PubMed

Pennetti, Adelina

2018-07-01

The purpose of this case report is to present a multimodal approach for patient management using the Maitland concept framework for cervical and lumbar radiculitis with an underlying diagnosis of Ehlers-Danlos Syndrome-Hypermobility Type (EDS-HT). This case presents care guided by evidence, patient values, and rationale for the selected course of physical therapy treatment provided by therapist experience. A 35-year-old female with a 2-year history of worsening lumbar and cervical pain was referred to physical therapy to address these musculoskeletal issues concurrent with diagnostic testing for EDS. A multimodal approach including manual therapy, therapeutic exercise, postural and body mechanics education, and a home exercise program was used. The patient specific functional scale (PSFS) was used to gauge patient's perceived improvements which were demonstrated by increased scores at reevaluation and at discharge. Following the Maitland concept framework, the physical therapist was able to make sound clinical decisions by tracking the logical flow of constant patient assessment. A 10-month course of treatment designed to maximize recovery of function was successful with a chronic history of pain and the EDS-HT diagnosis. The role of education and empowering the patient is shown to be of utmost importance. Optimizing therapeutic outcomes long-term for this patient population requires maintaining a home exercise program, adaptation and modifications of work and lifestyle activities.

Vemurafenib beyond progression in a patient with metastatic melanoma: a case report.

PubMed

Grimaldi, Antonio M; Simeone, Ester; Palla, Marco; Festino, Lucia; Caracò, Corrado; Mozzillo, Nicola; Petrillo, Antonella; Muto, Paolo; Ascierto, Paolo A

2015-04-01

The prognosis of metastatic melanoma has changed markedly in recent years because of the advent of newer targeted therapies such as BRAF inhibitors. However, the response to BRAF inhibitor therapy is frequently nondurable in patients with advanced melanoma. Novel approaches are thus needed to overcome resistance to these agents and to improve the management of advanced melanoma patients after disease progression. Here, we present the case of a 44-year-old man diagnosed with advanced melanoma in July 2010, harboring a BRAF mutation. Melanoma progressed during first-line chemotherapy with dacarbazine, but showed significant benefit after the initiation of vemurafenib on August 2011. Six months later, the patient experienced disease progression in left-obturator lymphadenopathy; still, anti-BRAF treatment was continued together with stereotactic radiotherapy, and was interrupted only shortly for intestinal occlusion secondary to melanoma metastasis of the bowel. When his conditions were stable, after 1 month of vemurafenib treatment discontinuation, anti-BRAF therapy was reinitiated, with a positive outcome. Vemurafenib treatment was definitively discontinued for disease progression in the brain, peritoneum, lymph node, intestine, and skin in March 2013, after about 20 months from initiation, and the patient died a few weeks later. The clinical case presented here shows that treatment beyond progression with vemurafenib can yield a survival benefit in melanoma patients whose disease progresses in a few sites, which can be treated with locoregional therapies. This clinical strategy needs further validation in prospective clinical trials.

A conservative approach to perineal Fournier's gangrene.

PubMed

Milanese, Giulio; Quaresima, Luigi; Dellabella, Marco; Scalise, Alessandro; Di Benedetto, Giovanni Maria; Muzzonigro, Giovanni; Minardi, Daniele

2015-03-31

Fournier's gangrene (FG) is a disease involving necrosis of perineum and external genitalia; in 95% of cases it is possible to diagnose the Fournier's gangrene just by physical examination. The clinical presentation of FG varies from an initial localized infection to large areas with necrotizing infection. The disease typically affect elderly men (6°-7° decade) with important systemic comorbidities; women are less frequently affected. Despite improvements in diagnosis and management, the mortality rate nowadays is between 20% and 43%. The severity and mortality of the disease is dependent upon the general condition of the patient at presentation and upon the rate of spread of the infection. Treatment involves a multidisciplinary approach: intensive systematic management, broad-spectrum antibiotic therapy, early surgical debridement (wide abscission of necrotic tissues and surgical drainage of peritoneum, scrotum, penis, and inguinal areas), hyperbaric oxygen therapy; surgery can eventually be repeated if necessary; reconstructive surgery has an important role in the final treatment of the disease. The technical difficulties frequently encountered and the inability to make a complete removal of the necrotizing tissues at the time of surgery in some cases has led to the application of combined techniques, in view of the enhancement effect of specific advanced medications, targeted antibiotic therapy and hyperbaric medicine. We have considered 6 patients affected by Fournier's gangrene treated at our institution; all the patients received treatment with the help of plastic surgeons of the same institution. After debridement, all the patients were treated with advanced specific dressings consisting of plates and strips made of calcium alginate, hydrogels and polyurethane and twodimensional cavity foams. Reconstructive surgery was necessary in one case. Hyperbaric oxygen therapy (HBO) has been performed in all cases. The multidisciplinary approach, the combined use of HBO therapy and the adoption of advanced specific dressings, have made possible the complete healing of the lesions in a shorter period, avoiding further surgery in 5 out of 6 patients.

History of physical and 'moral' treatment of hysteria.

PubMed

Broussolle, Emmanuel; Gobert, Florent; Danaila, Teodor; Thobois, Stéphane; Walusinski, Olivier; Bogousslavsky, Julien

2014-01-01

This historical review presents the advances made mostly during the last 200 years on the description, concepts, theories, and (more specifically) cure of patients suffering from hysteria, a still obscure entity. The denomination of the syndrome has changed over time, from hysteria (reinvestigated by Paul Briquet and Jean-Martin Charcot) to pithiatism (Joseph Babinski), then to conversion neurosis (Sigmund Freud), and today functional neurological disorders according to the 2013 American Neurological Association DSM-5 classification. The treatment was renewed in the second half of the 19th century in Paris by Paul Briquet and then by Jean-Martin Charcot. Hysterical women, who represented the great majority of cases, were cured by physical therapy (notably physio-, hydro-, and electrotherapy, and in some cases ovary compression) and 'moral' therapies (general, causal therapy, rest, isolation, hypnosis, and suggestion). At the turn of the 19th and 20th centuries, psychotherapy, psychoanalysis, and persuasion were established respectively by Pierre Janet, Sigmund Freud, and Joseph Babinski. During World War I, military forces faced a large number of posttrauma neurosis cases among soldiers (named the 'Babinski-Froment war neurosis' and Myers 'shell shock', in the French and English literature, respectively). This led to the use of more brutal therapies in military hospitals, combining electrical shock and persuasion, particularly in France with Clovis Vincent and Gustave Roussy, but also in Great Britain and Germany. After World War I, this method was abandoned and there was a marked decrease in interest in hysteria for a long period of time. Today, the current treatment comprises (if possible intensive) physiotherapy, together with psychotherapy, and in some cases psychoanalysis. Antidepressants and anxiolytics may be required, and more recently cognitive and behavioral therapy. Repetitive transcranial magnetic stimulation is a new technique under investigation which may be promising in patients presenting with motor conversion syndrome (motor deficit or movement disorder). Functional neurological disorders remain a difficult problem to manage with frequent failures and chronic handicapping evolution. This emphasizes the need for therapeutic innovations in the future.

Compromised breast flap treated with leech therapy, hyperbaric oxygen, pentoxifylline and topical nitroglycerin: A case report.

PubMed

Moffat, Andrew D; Weaver, Lindell K; Tettelbach, William H

2015-01-01

Hyperbaric oxygen (HBO2) is often indicated in compromised surgical flaps. Although limited to animal models and human case reports, the utilization of leech therapy (Hirudo medicinalis) with HBO2 provides better outcomes than each modality alone. Topical nitroglycerin and pentoxifylline are also frequently used adjunctively for compromised flaps. We present a case of successful breast flap salvage utilizing a combination of leech therapy, HBO2, topical nitroglycerin and pentoxifylline. A 34-year-old female, one day post-status cosmetic breast reduction mammoplasty developed a dusky discoloration of the left nipple areolar complex, indicating imminent flap failure. The patient was immediately treated with topical nitroglycerin, oral pentoxifylline, and referred for HBO2. After her first HBO2 treatment, there was clinical improvement to the superior portion of the areolar flap, with little improvement inferiorly where the discoloration had remained essentially unchanged. To address this, we added leech therapy and discontinued the topical nitroglycerin. Ceftriaxone for Aeromonas prophylaxis was started, and leeches were attached two at a time and removed from the area once feeding had ceased. These were applied three times per day for three days while receiving HBO2 twice per day for six days. The patient's flap improved and completely healed by Week 8 without need for further surgery. This is the first case to our knowledge of successful breast flap salvage using a combination of leech therapy, HBO2, topical nitroglycerin and pentoxifylline.

Trends of breast cancer treatment in Sabah, Malaysia: a problem with lack of awareness.

PubMed

Leong, B D K; Chuah, J A; Kumar, V M; Rohamini, S; Siti, Z S; Yip, C H

2009-08-01

Sabah, formerly known as North Borneo, is part of East Malaysia. 52.2 percent of patients with breast cancer in Sabah presented at advanced stages and up to 20.4 percent of patients defaulted proper treatment, opting for traditional therapy. We performed a two-year prospective study looking at the treatment trends of breast cancer in Sabah. Our subjects were all newly-diagnosed breast cancer cases seen at the hospital in 2005 and 2006. Type of surgery, chemotherapy, radiotherapy, hormonal therapy and surgical complication for each patient were studied. Out of 186 newly-diagnosed cases, 152 (81.7 percent) had surgery, 126 (67.7 percent) had chemotherapy, 118 (63.4 percent) had radiotherapy and 92 (49.5 percent) had hormonal therapy. 18.3 percent did not have surgery either due to refusal of treatment or advanced disease. They were more likely to be non-Chinese (91.1 percent, p-value is 0.02). Only 15.8 percent had breast-conserving surgery. The most frequent surgical complication was seroma formation (15.0 percent) . The commonest chemotherapy regime and hormonal therapy were anthracycline-based regime (88.1 percent) and tamoxifen (95.8 percent), respectively. The proportion of breast-conserving surgery and usage of modern adjuvant therapies are low in Sabah. This can be attributed to lack of breast cancer awareness leading to late presentation and refusal of treatment, coupled with insufficient health service funding.

Acute-on-chronic liver failure due to thiamazole in a patient with hyperthyroidism and trilogy of Fallot: case report

PubMed Central

2010-01-01

Background Thiamazole is a widely used antithyroid agent that has been approved for the treatment of hyperthyroidism. Although thiamazole-induced hepatotoxicity is a main side effect, it may progress to liver failure in a very few cases. Case Presentation We described a 24-year-old patient with hyperthyroidism and trilogy of Fallot, who developed liver failure due to thiamazole. Liver biopsy showed intrahepatic cholestasis, mild inflammatory infiltrates, as well as significant fibrosis, indicating both acute and chronic liver injuries. Although a series of potent therapies were given, the patient deceased due to severe liver decompensation. Conclusions This case suggests that thiamazole-induced hepatotoxicity in the setting of advanced fibrosis increases the risk of poor outcome. Regular liver function monitoring during thiamazole therapy is therefore important. PMID:20707932

Familial tularaemia.

PubMed

Peker, E; Ayaydin, A; Duran, N

2009-01-01

Tularaemia is a zoonotic disease caused by Francisella tularensis . In this report, we have presented an early stage case of tularemia with fever and pharyngitis and two cases from the same non-endemic region with typical lymphadenitis. All three patients were treated with non-specific medications in healthcare centres, the treatment being directed towards symptoms resembling those of upper respiratory tract infections. However, there was no regression in their complaints. Because the first case had been treated earlier, his lymphadenopaties regressed and there was no suppuration. The other two cases, which had been suspected to be exposed to the same pathogen based on their histories, were at a mild acute phase and presented to our clinic with typical lymphadenitis. The diagnoses of each of the three patients were made serologically. An early clinical recovery was achieved in the first patient with streptomycin (1 x 1 g/day im) and doxycyline (2 x 100 mg/day peroral) therapy. The therapy was prolonged to 4 weeks in the other two cases according to lymph node response and no complications occurring in their follow-ups. It can be concluded that tularaemia should be considered in the differential diagnosis of patients with fever, pharyngitis, conjunctivitis and cervical lymphadenopathies that do not respond to beta-lactam antibiotics.

Ovarian stimulation in young adult cancer survivors on targeted cancer therapies

PubMed Central

Su, H. Irene; Connell, Meghan W.; Bazhenova, Lyudmila A.

2016-01-01

Objective To describe a clinical approach to and outcomes of in vitro fertilization in reproductive-aged cancer survivors on targeted cancer therapies. Design Case report Setting Academic fertility preservation program Patients The first case is of a female patient with metastatic lung cancer on long-term crizotinib, an ALK inhibitor. The second case is of a female patient with metastatic colon cancer on long-term denosumab, a RANKL antibody. Both patients presented desiring fertility. Interventions In vitro fertilization Main outcome measures Live birth and embryo banking Results The potential impact of targeted therapy on oocytes and pregnancy was investigated via literature review and pharmaceutical company inquiries. Following oncologic, fertility and psychological counseling, both survivors underwent ovarian stimulation, in vitro fertilization and preimplantation genetic screening. One couple achieved live births of dizygotic twins via gestational surrogacy. The second couple froze one euploid blastocyst for future fertility. Both survivors are stable from their cancer standpoints. Conclusion Successful fertility treatments are possible in the context of exposure to crizotinib, and denosumab. PMID:27565250

Corticosteroid treatment in Sydenham's chorea.

PubMed

Fusco, C; Spagnoli, C

2018-03-01

Sydenham's chorea (SC) is an immune-mediated hyperkinetic movement disorder, developing after group A Beta-hemolytic streptococcal (GABHS) infection. Aside from conventional symptomatic treatment (carbamazepine, valproate, neuroleptics), the use of steroids has also been advocated, mainly in severe, drug-resistant cases or if clinically disabling side effects develop with first line therapies. Based on the description of 5 cases followed in the Child Neurology Unit of Santa Maria Nuova Hospital in Reggio Emilia and on the available medical literature on this topic, we propose considering the use of corticosteroids therapy in children with SC, with the administration of IV methyl-prednisolone followed by oral deflazacort in severe cases and of oral deflazacort alone in mild and moderate degrees of involvement. In our experience this therapy is effective both in the short and long-term period, in different clinical presentations (chorea paralytica, distal chorea, hemichorea, "classic" chorea, association with mood disorder or dyspraxia) and very well tolerated (no significant side effects were recorded). Copyright © 2017. Published by Elsevier Ltd.

Continuous amnioinfusion via an epidural catheter following spontaneous membrane rupture: A case report.

PubMed

Turgut, Abdulkadir; Katar, Selahattin; Sak, Muhammet Erdal; Turgut, Fethiye Gülden; Sahin, Alparslan; Başaranoğlu, Serdar; Yalınkaya, Ahmet

2013-01-01

Preterm premature rupture of membranes (PPROM) is seen in 3% of all pregnancies, and is a frequent cause of preterm birth, neonatal mortality and morbidity. The most important complications are maternal and foetal infection, prematurity, umbilical cord compression, hypoxia or asphyxia due to cord prolapse, pulmonary hypoplasia and extremity deformities. The basic approach to PPROM therapy aims to prevent premature birth and the development of foetal distress, and decrease the risk of maternal and foetal infection, and amniotic fluid loss. In compliance with these objectives, alternatives of PPROM therapy demonstrate a wide spectrum, including watchful waiting, amniopatch application, recurrent amnioinfusions and emergency birth. However, repeated amnioinfusions in cases of fluid loss, especially within 6 hours of therapy, provides only minimal benefit. In this case presentation, we attempted to describe a different and cost-effective continuous amnioinfusion technique performed to confer survival benefit for an immature anhydramniotic foetus affected by PPROM at the border of viability.

Continuous amnioinfusion via an epidural catheter following spontaneous membrane rupture: A case report

PubMed Central

Turgut, Abdulkadir; Katar, Selahattin; Sak, Muhammet Erdal; Turgut, Fethiye Gülden; Şahin, Alparslan; Başaranoğlu, Serdar; Yalınkaya, Ahmet

2013-01-01

Preterm premature rupture of membranes (PPROM) is seen in 3% of all pregnancies, and is a frequent cause of preterm birth, neonatal mortality and morbidity. The most important complications are maternal and foetal infection, prematurity, umbilical cord compression, hypoxia or asphyxia due to cord prolapse, pulmonary hypoplasia and extremity deformities. The basic approach to PPROM therapy aims to prevent premature birth and the development of foetal distress, and decrease the risk of maternal and foetal infection, and amniotic fluid loss. In compliance with these objectives, alternatives of PPROM therapy demonstrate a wide spectrum, including watchful waiting, amniopatch application, recurrent amnioinfusions and emergency birth. However, repeated amnioinfusions in cases of fluid loss, especially within 6 hours of therapy, provides only minimal benefit. In this case presentation, we attempted to describe a different and cost-effective continuous amnioinfusion technique performed to confer survival benefit for an immature anhydramniotic foetus affected by PPROM at the border of viability. PMID:24592114

Primary tuberculosis of the glans penis.

PubMed

Jimenez Parra, Jose David; Alvarez Bandres, Silvia; Garcia Garcia, Diego; Torres Varas, Lorena; Sotil Arrieta, Amaia; Jimenez Calvo, Jesus

2014-03-01

Tuberculosis of the penis is an extremely rare disease with few cases reported in the literature. We present the case of a 64 year-old man with a whitish papular-ampullary eruption in the glans penis. After antibiotic/antimycotic therapy and several topical ointments for 3 months without response he was referred to our Department. Biopsy of the ulceration edge was performed and pathology result showed a chronic granulomatous inflammatory necrotizing lesion with granulomatous vasculitis lesions, without tumor infiltration. Systemic examination to rule out other tuberculosis foci was negative. With de suspicion of primary tuberculosis of the glans penis, anti tuberculosis therapy with Isoniazid and Piridoxine was started. Within a period of five months the ulceration healed significantly. Currently, the patient is still asymptomatic without glans penis lesions. Primary glans penis tuberculosis is a rare disease, but we must consider it (both primary and secondary forms) to try to avoid diagnostic delays that may cause prejudice for the patient. This condition promptly responds to anti tuberculosis therapy as evidenced by our case and many other reports.

Successful Concomitant Therapy with Pirfenidone and Nintedanib in Idiopathic Pulmonary Fibrosis: A Case Report.

PubMed

Hagmeyer, Lars; Treml, Marcel; Priegnitz, Christina; Randerath, Winfried J

2016-01-01

Pirfenidone and nintedanib are both pleiotropic anti-fibrotic agents approved for the treatment of idiopathic pulmonary fibrosis (IPF) as monotherapy. To date, evidence supporting their efficacy as concomitant therapy has not been reported. Here, we present the first case of a Caucasian male patient with IPF treated with both pirfenidone and nintedanib following 2 years of treatment with pirfenidone monotherapy. Over a 24-month period, there was a clear decline in the patient's forced vital capacity from 3.5 liter before initiation of treatment to 2.5 liter after 24 months. Concomitant nintedanib treatment was initiated in March 2015. Lung function stabilized, and the two treatments were well tolerated. Treatment with pirfenidone and nintedanib has currently been ongoing for nearly 12 months. This is the first report of a successful long-term treatment with pirfenidone and nintedanib and suggests that in selected cases, concomitant anti-fibrotic therapy may represent a safe and therapeutically valuable escalation option after pirfenidone monotherapy. © 2016 S. Karger AG, Basel.

[A case of interstitial pneumonia complicating RS3PE syndrome in which soluble interleukin-2 receptor (sIL-2R) proved useful for assessing symptoms].

PubMed

Okuda, Miyuki; Kashio, Makoto; Aitani, Masakazu; Nakanishi, Daisuke; Tanaka, Nobuya; Kimura, Kentaro

2009-07-01

The patient was a 70-year-old man who had been given a diagnosis of remitting seronegative symmetrical synovitis with pitting edema (RS3PE) syndrome and had been placed on low-dose steroid therapy in the Department of Orthopedics. During treatment, sudden fever, hypoxemia and chest radiography-confirmed interstitial shadows throughout the lung fields were noted, and the patient was referred to the Department of Internal Medicine. RS3PE complicated by interstitial pneumonia was diagnosed, and steroid pulse therapy and immunosuppressant therapy were initiated. In the present case, soluble interleukin-2 receptor (sIL-2R) proved useful for assessing symptoms. To the best of our knowledge, RS3PE syndrome complicated by pulmonary lesions and accompanied by severe acute respiratory failure requiring noninvasive positive-pressure ventilation has not previously been reported, and this rare case is discussed with reference to the literature.

Failure of isotretinoin and interferon-alpha combination therapy for HPV-linked severe vulvar dysplasia. A report of two cases.

PubMed

Vilmer, C; Havard, S; Cavelier-Balloy, B; Pelisse, M; Dubertret, L; Leibowitch, M

1998-08-01

Retinoids (RA) and interferon (IFN) have been reported to be active against a variety of tumors and human papillomavirus (HPV)-related lesions. Because chronic and recurrent HPV-linked vulvar intraepithelial neoplasia 3 (VIN 3) have a high risk of invasion, we evaluated combined therapy of IFN-alpha with 13-cis-retinoic acid (13 cRA) in the treatment of two VIN 3 cases of this type. Two patients with chronic and recurrent VIN 3 were treated with combined therapy of IFN-alpha (4.5 x 10(6) five times a week) and 13 cRA (1 mg/kg/d) for six months. Clinical regression was observed at the end of treatment in both cases, but histologic features of VIN 3 were still present. These data demonstrate the ineffectiveness of the combined regimen of IFN-alpha and 13 cRA with this schedule for a period of six months in recurrent and chronic VIN 3.

A Sound Therapy-Based Intervention to Expand the Auditory Dynamic Range for Loudness among Persons with Sensorineural Hearing Losses: Case Evidence Showcasing Treatment Efficacy

PubMed Central

Formby, Craig; Sherlock, LaGuinn P.; Hawley, Monica L.; Gold, Susan L.

2017-01-01

Case evidence is presented that highlights the clinical relevance and significance of a novel sound therapy-based treatment. This intervention has been shown to be efficacious in a randomized controlled trial for promoting expansion of the dynamic range for loudness and increased sound tolerance among persons with sensorineural hearing losses. Prior to treatment, these individuals were unable to use aided sound effectively because of their limited dynamic ranges. These promising treatment effects are shown in this article to be functionally significant, giving rise to improved speech understanding and enhanced hearing aid benefit and satisfaction, and, in turn, to enhanced quality of life posttreatment. These posttreatment sound therapy effects also are shown to be sustained, in whole or part, with aided environmental sound and to be dependent on specialized counseling to maximize treatment benefit. Importantly, the treatment appears to be efficacious for hearing-impaired persons with primary hyperacusis (i.e., abnormally reduced loudness discomfort levels [LDLs]) and for persons with loudness recruitment (i.e., LDLs within the typical range), which suggests the intervention should generalize across most individuals with reduced dynamic ranges owing to sensorineural hearing loss. An exception presented in this article is for a person describing the perceptual experience of pronounced loudness adaptation, which apparently rendered the sound therapy inaudible and ineffectual for this individual. Ultimately, these case examples showcase the enormous potential of a surprisingly simple sound therapy intervention, which has utility for virtually all audiologists to master and empower the adaptive plasticity of the auditory system to achieve remarkable treatment benefits for large numbers of individuals with sensorineural hearing losses. PMID:28286368

Management of Metastatic Apocrine Hidradenocarcinoma with Chemotherapy and Radiation

PubMed Central

Miller, Daniel H.; Peterson, Jennifer L.; Buskirk, Steven J.; Vallow, Laura A.; Ta, Randy; Joseph, Richard; Krishna, Murli; Ko, Stephen J.; Tzou, Katherine S.

2015-01-01

Hidradenocarcinoma is a rare aggressive form of cutaneous adnexal skin carcinoma originating from the sweat gland. Due to its low incidence, prognostic and treatment strategies are still being explored both for primary and advanced disease. This tumor most often presents as either solid or cystic appearing subcutaneous nodules, which may be associated with pruritus or ulceration. To date the mainstay of treatment for local disease has been surgical excision; however, the paucity of historical data available has shown that these tumors often behave aggressively with high rates of local recurrence, metastasis, and poor overall outcomes. There are few case reports describing the utility of radiation therapy in the treatment of hidradenocarcinoma. Herein, we present a case of metastatic apocrine hidradenocarcinoma in a 32-year-old Caucasian male. The patient initially underwent excisional biopsy which confirmed the diagnosis of poorly differentiated, highly infiltrative, apocrine hidradenocarcinoma. He received systemic chemotherapy for metastatic disease, followed by radiation therapy to areas of grossly palpable adenopathy. Prior to radiation therapy the patient had an enlarged hypermetabolic conglomerate of lymph nodes in the right axilla, and borderline enlarged low activity nodes within the left axilla. He received 3 cycles of chemotherapy followed by tamoxifen and radiation therapy (50.4 Gy in 28 fractions) to areas of progressive disease in the bilateral axilla, lower neck, and axillary skin. Following treatment, the patient had complete resolution of skin nodules and improvement of his pruritus. While the role of radiation therapy in the treatment of hidradenocarcinoma has not been well established, this case report demonstrated the potential benefit of external beam radiotherapy in the management of this rare disease. PMID:26500736

[Vaginismus--a psychiatric perspective, "secrets" and other psychodynamic causes].

PubMed

Sheinfeld, H; Roshka, P; Finkelshtein, I; Davis, H

2001-09-01

Vaginismus is a disorder involving both psychiatry and gynecology. Psychiatric help is sought in only a small proportion of cases, although it is probable that the psychological etiology of the disorder is more frequent than generally recognized. This article deals with the causes and psychological circumstances of the disorder. Five cases are presented. In the first three cases, primary vaginismus caused unconsummated marriage in young women of religious or traditional background. In these cases a "secret" was revealed relating to a previous sexually related experience. This provides the basis for therapy. The other cases describe secondary vaginismus which appeared in older women who developed the symptom after a number of years of marriage. This article discusses the different psychotherapeutic approaches for the two types of cases. In the former cases, therapy may be brief and the prognosis is favorable. In the second case type, there is often more significant personality or marital pathology requiring prolonged and extensive psychotherapy. The authors stress the need for physicians to be mindful of cases of vaginismus requiring psychiatric intervention rather than gynecological treatment.

True Precocious Puberty Following Treatment of a Leydig Cell Tumor: Two Case Reports and Literature Review.

PubMed

Verrotti, Alberto; Penta, Laura; Zenzeri, Letizia; Lucchetti, Laura; Giovenali, Paolo; De Feo, Pierpaolo

2015-01-01

Leydig cell testicular tumors are a rare cause of precocious pseudopuberty in boys. Surgery is the main therapy and shows good overall prognosis. The physical signs of precocious puberty are expected to disappear shortly after surgical removal of the mass. We report two children, 7.5 and 7.7 year-old boys, who underwent testis-sparing surgery for a Leydig cell testicular tumor causing precocious pseudopuberty. During follow-up, after an immediate clinical and laboratory regression, both boys presented signs of precocious puberty and ultimately developed central precocious puberty. They were successfully treated with gonadotropin-releasing hormone (GnRH) analogs. Only six other cases have been described regarding the development of central precocious puberty after successful treatment of a Leydig cell tumor causing precocious pseudopuberty. Gonadotropin-dependent precocious puberty should be considered in children treated for a Leydig cell tumor presenting persistent or recurrent physical signs of puberty activation. In such cases, therapy with GnRH analogs appears to be the most effective medical treatment.

Definitive treatment of androgen receptor-positive salivary duct carcinoma with androgen deprivation therapy and external beam radiotherapy.

PubMed

Soper, Margaret S; Iganej, Shawn; Thompson, Lester D R

2014-01-01

Salivary duct carcinoma (SDC) is an aggressive malignancy with high recurrence rates. Standard management includes surgical resection followed by adjuvant radiation. Androgen receptor positivity has been described to be present in 40% to 90% of SDCs, and a recent case series showed a benefit to androgen deprivation therapy (ADT) in recurrent or metastatic disease. We present the case of an 87-year-old woman with a locally advanced androgen receptor-positive parotid SDC treated definitively with ADT and external beam radiotherapy, a regimen modeled after the treatment of prostate cancer. She had a complete response on positron emission tomography (PET)/CT scan and had no evidence of disease 24 months after the completion of treatment. To our knowledge, this case report is the first to describe the use of ADT plus radiation to definitively treat SDC. This regimen could be considered in patients with androgen receptor-positive SDCs who are considered unresectable or who refuse surgery. Copyright © 2013 Wiley Periodicals, Inc.

Primary breast tuberculosis: diagnostic and therapeutic dilemmas.

PubMed

Hiremath, Bharati V; Subramaniam, Narayana

2015-01-01

To review the diagnostic and therapeutic challenges associated with treating isolated primary breast tuberculosis through discussion of our series of seven cases. Although breast is an uncommon site of occurrence of tuberculosis and isolated primary breast tuberculosis is an even rarer entity, its importance lies in distinguishing it from more common pathologies like abscesses or malignancy and avoiding unnecessary erroneous surgical intervention. The spectrum and presentation is wide and varied and we present our experience in managing seven such cases. A retrospective analysis of all the cases of histopathologically proven primary breast tuberculosis in the last three years at M.S. Ramaiah Hospital (2012-2014) was done. Analysis was in terms of mode of presentation, clinical features, diagnostic modalities used for evaluation and confirmation of the diagnosis, medical treatment and surgical intervention, if any. Special emphasis was placed on dilemmas in diagnosis and difficulties encountered during treatment. All cases were followed up till cure. Patients most commonly presented with a breast abscess, painful breast lumps and recurrent abscesses. Other foci of tuberculosis were ruled out in all of these patients. Majority were treated exclusively with anti-tubercular therapy (although regimens varied), but those with abscesses underwent incision and drainage. All cases were treated and followed up till cure. The challenges associated with primary breast tuberculosis are multiple, including which anti-tubercular therapy regimen to use, when to surgically intervene (as the breast is a cosmetically important area) and treating atypical mycobacteria. We provide a detailed discussion of the challenges we faced and review of literature.

Prostate carcinoma mimicking a sphenoid wing meningioma

PubMed Central

Bradley, Lucas H.; Burton, Matthew; Gokden, Murat; Serletis, Demitre

2015-01-01

Introduction We report here on a rare case of a large, lateral sphenoid wing tumor with radiographic and intraoperative findings highly suggestive of meningioma, yet pathology was in fact consistent with metastatic prostate adenocarcinoma. Presentation of case An 81 year-old male presented with expressive dysphasia, right-sided weakness and headaches. Imaging revealed a heterogeneously-enhancing lesion based on the left lateral sphenoid wing. The presumed diagnosis was strongly in favor of meningioma, and the patient underwent complete resection of the dural-based lesion. Final pathology confirmed the unexpected finding of a metastatic prostate adenocarcinoma. Although he tolerated surgery well, the patient was subsequently referred for palliative therapy given findings of widespread systemic disease. Discussion Intracranial metastases may involve the dura, at times presenting with rare radiographic features highly suggestive for meningioma, as in our case here. This makes differentiation, at least based on imaging, a challenge. Elderly patients presenting with neurological deficits secondary to a newly-diagnosed, dural-based lesion should thus be considered for metastasis, prompting additional imaging studies (including body CT, MRI or PET) to rule out a primary lesion elsewhere. In some cases, this may affect the overall decision to proceed with surgical resection, or alternatively, to proceed directly to palliative therapy (the latter decision made in the context of widespread metastatic disease). Conclusion We conclude that dural-based metastatic lesions may mimic meningiomas, warranting thorough pre-operative work-up to exclude the possibility of metastasis. In certain cases, identification of widespread disease might preclude surgery and favor palliation, instead. PMID:26318129

Methyl - aminolevulinic acid photodynamic therapy and topical tretinoin in a patient with vulvar extramammary Paget's disease.

PubMed

Magnano, Michela; Loi, Camilla; Bardazzi, Federico; Burtica, Elena Cleopatra; Patrizi, Annalisa

2013-01-01

Extramammary Paget's disease is a rare neoplasm of apocrine gland-bearing areas of the skin. The most common site of presentation is the vulva. Surgery is the most frequently reported therapy so far; however, it is invasive and it is complicated by a high rate of recurrence. For this reason, several less-invasive treatments have been recently proposed, including photodynamic therapy. We describe in this article the case of an 84-year-old patient with a noninvasive vulvar extramammary Paget's disease successfully treated with methyl-aminolevulinic acid photodynamic therapy associated with topical tretinoin. © 2013 Wiley Periodicals, Inc.

Surgical and radiological effects upon the development of speech after total laryngectomy

DOE Office of Scientific and Technical Information (OSTI.GOV)

Richardson, J.L.

1981-01-01

The data presented examine the relationship between postlaryngectomy communication method, and the extent of total laryngectomy and the use of radiation therapy. The expectations of speech therapy providers were also examined. The author interviewed 60 laryngectomy patients who were six months to 3 1/2 years postsurgery. Surgeries were grouped into four categories and correlated with communication method. The relationship was statistically significant with the most apparent deterrent effect exhibited only for the most extreme surgical excisions. There was no relationship with the use of radiation therapy. In many cases speech therapy providers' expectations were not supported by the data.

Onset of Type 1 Diabetes Mellitus During Pegylated-interferon Alfa and Ribavirin Therapy for Chronic Hepatitis C Virus Infection

PubMed Central

Ranganathan, Raghini; Janarthanan, Krishnaveni; Rajasekaran, Senthilkumar

2012-01-01

A 16-year-old female was treated with pegylated-interferon (PEG-IFN) alfa (a)-2b and ribavirin combination therapy for chronic hepatitis C virus (HCV) infection. She attained rapid virological response. She presented with diabetic ketoacidosis after 41 weeks of therapy. Anti-glutamic acid decarboxylase antibodies and islet cell antibodies were negative. Her fasting serum C-peptide level was <0.1 ng/mL, and the treatment course was completed. This case underlines the importance of periodic plasma glucose monitoring in patients during and after PEG-IFN and ribavirin therapy. PMID:25755410

Battling illness with wellness: a qualitative case study of a young rapper’s experiences with music therapy

PubMed Central

Solli, Hans Petter

2015-01-01

Mental health difficulties are connected with major interpersonal and social challenges. Recent qualitative research indicates that music therapy can facilitate many of the core elements found to promote social recovery and social inclusion, findings also reflected in results from a growing body of effect studies. The objective of this study was to explore how music therapy might afford possibilities for social recovery to one man with psychosis admitted to a psychiatric intensive care unit. This was achieved by means of a qualitative case study featuring a description of the music therapeutic process alongside first-hand accounts of the participant’s subjective experiences. The data were analysed using interpretative phenomenological analysis (IPA). The findings are presented in a narrative form reflecting processes and activities considered particularly important for the process of social recovery. Theoretical perspectives from the recovery literature and current perspectives in music therapy are discussed with a view to the possible use of music therapy for strengthening agency, (re)building identity, developing positive relationships, and expanding social networks. PMID:26246669

Tics as signs of catatonia: electroconvulsive therapy response in 2 men.

PubMed

Dhossche, Dirk M; Reti, Irving M; Shettar, Shashidhar M; Wachtel, Lee E

2010-12-01

Tics have rarely been described in catatonia although tics are sudden and nonrhythmic variants of stereotypic or repetitive movement abnormalities that are considered cardinal symptoms of catatonia. We describe 2 men with tics and self-injurious behavior, who met criteria for catatonia. One patient met criteria for autism. We reported 2 new cases and performed a literature review using PubMed to identify other cases of tics that were treated with electroconvulsive therapy. Tics along with other catatonic symptoms and self-injurious behavior responded to electroconvulsive therapy in 2 men. Eight other patients with tics that were treated with electroconvulsive therapy were found in the literature. Catatonia was recognized in 4 of the 8 patients. Two patients met criteria for autism. Tics, with or without self-injurious behavior, may be signs of catatonia. Patients with tics or Tourette syndrome warrant assessment for catatonia. If catatonia is present, electroconvulsive therapy provides a safe but rarely used alternative to pharmacotherapy, psychosurgery, or invasive brain stimulation in the treatment of tics and Tourette syndrome. © 2010 Lippincott Williams & Wilkins, Inc.

[Remission of acquired hemophilia A following radiation therapy for esophageal cancer].

PubMed

Yanagisawa, Kunio; Ogawa, Yoshiyuki; Mitsui, Takeki; Noguchi, Hiroyuki; Shimizu, Hiroaki; Ishizaki, Takuma; Handa, Hiroshi; Ieko, Masahiro; Ichinose, Akitada; Nojima, Yoshihisa

2016-04-01

Although acquired hemophilia A (AHA) often develops in patients with neoplasms, there are few reports on the efficacy of radiation therapy during the bleeding phase of AHA in the prior literature. We herein present a case of AHA experiencing remission soon after radiation therapy for esophageal cancer. A man in his seventies, who had a history of radical nephrectomy for left renal cell carcinoma, received a diagnosis of esophageal cancer. Three months later, he noticed a right thigh hematoma, and was transferred to our hospital. Laboratory data revealed a marked reduction of coagulation factor VIII (FVIII) activity at 0.9% and the inhibitor to FVIII was detected in his serum at 21.8 BU/ml. Under a diagnosis of AHA, the patient received high-dose oral prednisolone, which failed to achieve disease remission. He then underwent radiation therapy to eradicate the underlying esophageal cancer. Despite tapering of the prednisolone dosage, FVIII inhibitor declined to undetectable levels. In this case, radiation therapy for the underlying cancer was associated with achieving complete remission of AHA.

Effective anti-PD-1 therapy in a SUFU-mutated patient with Gorlin-Goltz syndrome.

PubMed

Moreira, A; Kirchberger, M C; Toussaint, F; Erdmann, M; Schuler, G; Heinzerling, L

2018-03-30

We present a case of a 77-year-old male patient with more than 50 basal cell carcinomas on the head and upper trunk. The patient did not respond to several lines of treatment, including surgery, imiquimod, retinoids, itraconazole and therapy with the hedgehog inhibitor vismodegib. The patient responded well to an off-label therapy with the anti-PD-1 antibody pembrolizumab after 4 infusions. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

[Autoimmune hepatitis].

PubMed

Färkkilä, Martti

2013-01-01

Autoimmune hepatitis is chronic liver disease with two subtypes, type 1 with anti nuclear or smooth muscle antibodies and type 2 with LKM1 or LC1 antibodies, and both with hypergammaglobulinemia and typical histology. Prevalence of AIH is between 10 to 17 per 100000 in Europe. Up to 20-40 % of cases present with acute hepatitis. Budesonide can be used as a first line induction therapy in non-cirrhotic patients, and tiopurines, mercaptopurine or mycophenolic acid as maintenance therapies. Patients not responding to conventional therapy can be treated with ciclosporin, tacrolimus or rituximab or finally with liver transplantation.

[Conversion Therapy Using Etoposide and Cisplatin Chemotherapy for Liver Metastases from Advanced Gastric Mixed Adenoneuroendocrine Carcinoma - A Case Report].

PubMed

Inaba, Yoko; Fujita, Maiko; Ninomiya, Riki; Hashimoto, Daijo

2017-11-01

Gastric mixed adenoneuroendocrine carcinoma(MANEC)with multiple liver metastases is a rare condition with most data being derived from case reports. We present a case with liver metastases from gastric MANEC that respond remarkably to chemotherapy. Sixty-one-year-old male with severe anemia referred to surgical consultation due to advanced gastric cancer with multiple liver metastases. To relieve uncontrollable tumor bleeding, simple distal gastrectomy for symptom palliation was performed. Based on the tentative diagnosis with gastric poorly differentiated adenocarcinoma, a course of TS-1 and oxaliplatin therapy was administrated. Thereafter final diagnosis with neuroendocrine carcinoma with tubular adenocarcinoma was made, and the chemotherapy was switched to etoposide and cisplatin. Follow up abdominal CT scan after the third course of the therapy showed remarkable tumor shrinkages(PR). In anticipation of the chemotherapy effects in the adjuvant setting, we performed liver metastasectomy for curative intent. Two of 6 resected liver specimens showed no viable cancer cells at all (pCR). However, immediately after the surgery, multiple liver metastases developed, and the recurrent masses had kept growing up rapidly. The third line carboplatin and etoposide chemotherapy was given once but was withdrawn because of bone marrow suppression. At the present, the patient is alive with recurrent diseases for 18 months after initial diagnosis.

Successful management of Churg-Strauss syndrome using omalizumab as adjuvant immunomodulatory therapy: first documented pediatric case.

PubMed

Iglesias, E; Camacho Lovillo, M; Delgado Pecellín, I; Lirola Cruz, M J; Falcón Neyra, M D; Salazar Quero, J C; Bernabeu-Wittel, J; González Valencia, J P; Neth, O

2014-03-01

Churg-Strauss syndrome (CSS) is an anti-neutrophil cytoplasmic antibody (ANCA) associated vasculitis; it is extremely rare in childhood and defined according to the Chapel-Hill Consensus as an eosinophil-rich and granulomatous inflammation involving the respiratory tract and necrotizing vasculitis affecting small to medium-sized vessels. Children commonly have a history of asthma and sinusitis whilst clinical presentation typically involves pulmonary tract and less frequently skin, heart, gastrointestinal tract, and peripheral nerves. Cardiopulmonary disease is higher in children and prognosis is worse. It is associated with significant eosinophilia and raised serum IgE-levels. ANCA are only found in 25% of childhood cases. Here we report the case of a 10-year-old girl who presented to us with vomiting, abdominal pain, and weight loss, paresthesias of lower extremities and breathlessness as well as a history of asthma, sinusitis and allergic rhinitis. She was treated with corticosteroids, cyclophosphamide, intravenous immunoglobulin, mycophenolate mofetil (MMF), and rituximab. However, remission was only achieved after initiation of omalizumab therapy, a recombinant humanized anti-IgE antibody. To the best of our knowledge this is the first pediatric patient suffering from CSS successfully managed with adjuvant anti-IgE therapy resulting in the control of respiratory as well as gastrointestinal symptoms. © 2013 Wiley Periodicals, Inc.

Voriconazole-Induced Periostitis & Enthesopathy in Solid Organ Transplant Patients: Case Reports

PubMed Central

Sircar, Monica; Kotton, Camille; Wojciechowski, David; Safa, Kassem; Gilligan, Hannah; Heher, Eliot; Williams, Winfred; Thadhani, Ravi; Tolkoff-Rubin, Nina

2016-01-01

Background Voriconazole is frequently used to treat fungal infections in solid organ transplant patients. Recently, there have been reports suggesting that prolonged voriconazole therapy may lead to periostitis. Aim Here we present two cases of voriconazole-induced periostitis in solid organ transplant patients. Case Presentation Voriconazole was given to two transplant patients-one with a liver transplant and the second with a heart transplant, to treat their fungal infections. Both developed voriconazole-induced toxicity. While undergoing voriconazole therapy, they had incapacitating bone pain. The liver transplant patient had to be taken off voriconazole, and the heart transplant patient succumbed to non-voriconazole related causes. Conclusions Voriconazole therapy in two solid organ transplant patients resulted in periostitis. We provide potential etiologies underlying voriconazole-induced periostitis, including fluoride toxicity, abnormalities in the pulmonary vascular bed leading to the production of downstream inflammatory mediators, and abnormal pharmacokinetics of hepatic drug metabolism. In addition to monitoring blood voriconazole trough levels, we suggest careful assessment for musculoskeletal pain in patients undergoing voriconazole treatment for two months or more, particularly if their daily dosages of voriconazole exceed 500 mg per day. Appropriate workup should include measurement of alkaline phosphatase, voriconazole trough and fluoride levels as well as a bone scan. Overall, early recognition of voriconazole-induced musculoskeletal toxicity is important for better morbidity outcomes. PMID:27990445

Videoteleconferencing Early Child Anxiety Treatment: A Case Study of the Internet-Delivered PCIT CALM (I-CALM) Program

PubMed Central

Cooper-Vince, Christine E.; Chou, Tommy; Furr, Jami M.; Puliafico, Anthony C.; Comer, Jonathan S.

2017-01-01

Anxiety disorders are one of the most prevalent and impairing classes of mental health difficulties affecting young children. Though the vast majority of supported programs for child anxiety focus on youth ages 7 years and up, preliminary support has emerged for exposure-based adaptations of parent-coaching interventions, i.e., the Parent Child Interaction Therapy (PCIT) CALM Program, to address anxiety disorders in early childhood. Despite these advances, low rates of community service use and accessibility persist. The increased ubiquity of Internet access has positioned videoteleconferencing (VTC) as a powerful tool to overcome traditional barriers to care. The present case study details the VTC delivery of the PCIT CALM Program in the treatment of a 6 year-old boy presenting with generalized anxiety disorder and separation anxiety disorder. This case provides qualitative support for the feasibility of delivering integrated real-time parent coaching and exposure therapy to address early childhood anxiety disorders via VTC. The remission of the patient’s anxiety across treatment sessions suggests that the telehealth format may be a useful modality for the delivery of early childhood anxiety treatment. The technical considerations for the delivery of VTC therapy as well as the implications for treatment are discussed. PMID:29104931

Collaboration in Culturally Responsive Therapy: Establishing A Strong Therapeutic Alliance Across Cultural Lines

PubMed Central

Asnaani, Anu; Hofmann, Stefan G.

2012-01-01

Achieving effectiveness of therapeutic interventions across a diversity of patients continues to be a foremost concern of clinicians and clinical researchers alike. Further, across theoretical orientations and in all treatment modalities, therapy alliance remains a critical component to determine such favorable outcome from therapy. Yet, there remains a scarcity of empirical data testing specific features that most readily facilitate effective collaboration in a multi-cultural therapy relationship. This article reviews the literature on terminology, empirical findings, and features to enhance collaboration in multi-cultural therapy, suggesting guidelines for achieving this goal in therapy with patients (and therapists) of various cultural/racial backgrounds. This is followed by a multi-cultural case study presenting with several co-morbid Axis I disorders, to exemplify the application of these guidelines over the course of therapy. PMID:23616299

[Topical therapy of ulcerative colitis].

PubMed

Rogler, G; Beglinger, C; Mottet, C; Seibold, F; Gross, V

2011-11-16

The availability of new topical preparations for the treatment of left sided ulcerative colitis ulcerosa offers a therapy optimization for many patients. Rectal application of steroids and 5-aminosalicylic acid (5-ASA) is associated with fewer side effects and has a higher therapeutic efficacy in mild to moderate-active left-sided colitis as compared to a systemic therapy. Often it is argued that the patients' compliance is insufficient with a rectal therapy. However, with sufficient information on the proven advantages this is usually not the case. The rectal application of drugs in distal ulcerative colitis is suitable also for the maintenance of remission. Therefore the new therapy guidelines recommend topical therapy more than in former times. Subsequently, these manuscripts focussed specifically on the topical therapy of distal colitis, to elucidate that clear treatment advantages are present in daily practice.

[Ectopic breast fibroadenoma. Case report].

PubMed

Senatore, G; Zanotti, S; Cambrini, P; Montroni, I; Pellegrini, A; Montanari, E; Santini, D; Taffurelli, M

2010-03-01

Among the rare anomalies of the breast development, polythelia is the most common, between 1% and 5% of women and men present supernumerary nipples. Polymastia, usually presenting as ectopic breast tissue without areola-nipple complex, is seen mostly along the milk line, extending from the axilla to the pubic region. Ectopic breast tissue is functionally analogous to mammary gland and it is subjected to the same alterations and diseases, whether benign or malignant, that affect normal breast tissue. We report the case of a 21 years-old female evaluated by the medical staff after founding a solid nodular mass by suspect axillary lymphadenopathy. Differential diagnosis with lymphoma is the major problem in these cases. The mass was removed and the intraoperative histological examination showed fibroadenoma in axillary supernumerary breast. Presence of ectopic breast tissue is a rare condition; development of benign mass or malignant degeneration is possible, but it is very unusual. In case of polymastia diagnosis is simple; in case of isolated nodule, without local inflammation or infection, there are greater difficulties. Ultrasonography is diagnostic in case of breast fibroadenoma, but it might be inadequate in ectopic localizations owing to the shortage of mammary tissue around the mass. Preoperative diagnosis is important to plan an adequate surgical treatment; lumpectomy is indicated in case of benign tissue; in case of malignancy, therapy is based on the standard treatment used for breast cancer (surgery, chemotherapy and radiation therapy).

Compatible Transfusion Therapy for Paroxysmal Cold Hemoglobinuria

ERIC Educational Resources Information Center

Rausen, Aaron R.; And Others

1975-01-01

Presented are case histories of two children, ages 2 and 4 years, with paroxysmal cold hemoglobinuria (PCH, a syndrome characterized by acute intravascular hemoglobin dissolution and hemoglobin in the urine). (Author/CL)

Kocuria varians infection associated with brain abscess: A case report

PubMed Central

2010-01-01

Background Kocuria, established by Stackebrandt et al., previously was classified into Micrococcus. Only two species, K. rosea and K. kristinae are reported to be associated as pathogenic and found with catheter-related bacteremia and acute cholecystitis. Case presentation We herein report the first case of brain abscess caused by Kocuria varians, a gram-positive microorganism, in a 52-year-old man. Hematogenous spread is the probable pathogenesis. Conclusions This report presents a case of Kocuria varians brain abscess successfully treated with surgical excision combined with antimicrobial therapy. In addition, Vitek 2 system has been used to identify and differentiate between coagulase-negative staphylococcus. PMID:20423506

[A rare case of diencephalic cachexia in an adult female with cranio-pharyngioma].

PubMed

Klochkova, I S; Astaf'eva, L I; Konovalov, A N; Kadashev, B A; Kalinin, P L; Sharipov, O I; Kutin, M A; Sidneva, Yu G; Shishkina, L V; Pronin, I N

Diencephalic cachexia (DС) is progressive weight loss despite a normal caloric intake and a satisfactory state of health, which is caused by hypothalamic lesions. This is a rare (about 100 cases were reported) and potentially fatal disorder of unknown pathogenesis. At present, there is no effective pharmacological therapy for the disorder. Cachexia may regress only if the tumor reduces in size, therefore the timely diagnosis and treatment are of vital importance for the patient. DС is typical of early childhood, and only a few cases have been reported in adults. We present a rare case of DС in a 24-year-old female with papillary craniopharyngioma.

Idiopathic granulomatous mastitis masquerading as carcinoma of the breast: a case report and review of the literature

PubMed Central

Tuli, Richard; O'Hara, Brian J; Hines, Janet; Rosenberg, Anne L

2007-01-01

Background Idiopathic granulomatous mastitis is an uncommon, benign entity with a diagnosis of exclusion. The typical clinical presentation of idiopathic granulomatous mastitis often mimics infection or malignancy. As a result, histopathological confirmation of idiopathic granulomatous mastitis combined with exclusion of infection, malignancy and other causes of granulomatous disease is absolutely necessary. Case Presentation We present a case of a young woman with idiopathic granulomatous mastitis, initially mistaken for mastitis as well as breast carcinoma, and successfully treated with a course of corticosteroids. Conclusion There is no clear clinical consensus regarding the ideal therapeutic management of idiopathic granulomatous mastitis. Treatment options include expectant management with spontaneous remission, corticosteroid therapy, immunosuppressive agents and extensive surgery for refractory cases. PMID:17662130

The Infection Returns: A Case of Pulmonary Sporotrichosis Relapse after Chemotherapy

PubMed Central

2018-01-01

Background Pulmonary sporotrichosis is a rare disease caused by a dimorphic fungus, Sporothrix schenckii. It is rarely found in association with malignancy. We present a case of pulmonary sporotrichosis recurrence after chemotherapy. Case Presentation A 44-year-old man, treated for pulmonary sporotrichosis in the past, presented with dysphagia and was found to have squamous cell carcinoma of the esophagus. After undergoing chemotherapy, extensive cavitary lesions were observed on thoracic computed tomography scan. A bronchoalveolar lavage revealed the presence of Sporothrix schenckii sensu lato. Despite treatment with itraconazole, he eventually required a left pneumonectomy for progressive destructive cavitary lesions involving the left lung. Conclusion This case highlights the importance of considering past fungal infections, albeit cured, in patients initiating immunosuppressive therapy. PMID:29559998

Reversible hemispheric hypoperfusion in two cases of SMART syndrome.

PubMed

Wai, Karmen; Balabanski, Anna; Chia, Nicholas; Kleinig, Timothy

2017-09-01

Stroke-like migraine attacks after radiation therapy (SMART) syndrome manifests as prolonged episodes of cortical dysfunction, years after cranial irradiation. We present two cases demonstrating reversible hemispheric hypoperfusion. Case 1 presented with left hemispheric symptoms following previous similar episodes. CT perfusion (CTP) demonstrated reversible hemispheric hypoperfusion; subsequent investigations were consistent with SMART syndrome. Case 2 presented following the third episode of a hemispheric syndrome with near-identical CTP abnormalities. L-arginine was administered with rapid reversal of clinical and CTP abnormalities. We conclude that SMART syndrome may demonstrate significant hypoperfusion on hyperacute CTP without subsequent infarction. Impaired cerebrovascular autoregulation probably contributes to cortical dysfunction in SMART syndrome. L-arginine warrants investigation as a potential treatment. Copyright © 2017 Elsevier Ltd. All rights reserved.

Aspergillus Osteomyelitis of the Ribs in Immunocompetent Hosts: Report of Two Rare Cases

PubMed Central

Menon, Aditya; Rodrigues, Camilla; Soman, Rajeev; Sunavala, Ayesha; Agashe, Vikas M

2017-01-01

Introduction: Osteomyelitis is rarely caused by fungi, most common among them being Candida. Aspergillus is a rare cause of fungal osteomyelitis mimics tuberculous osteomyelitis. Aspergillus osteomyelitis (AO) of the ribs is relatively uncommon, with an incidence rate of only 9% among all reported cases of AO. With mortality rates of almost 25%, AO is on the rise attributed to increasing numbers of immunocompromised individuals. There are very few case reports of AO of ribs in immunocompetent individuals. We report two such cases. Case Report: Case 1: A 51-year-old male developed spontaneous chest pain along right costal margin with a low-grade fever. High-resolution computed tomography chest revealed osteomyelitis of anterolateral chest wall. He did not improve with empirical antitubercular therapy, and subsequent debridement showed polymicrobial pyogenic infection which was managed with appropriate antibiotics elsewhere. Samples were not sent for fungal culture. He presented to us 3 months later, and surgical debridement showed growth of Aspergillus flavus which was managed with oral voriconazole. The lesion healed with no recurrence at 24-month follow-up. Case 2: A 40-year-old male presented to our institute with left-sided chest pain, low-grade fever, and loss of appetite. There was a history of injury with a sharp piece of wood 2 years earlier. Magnetic resonance imaging defined the lesion which was biopsied under ultrasound guidance. Cultures grew A. flavus which was treated with oral voriconazole. He had complete clinical improvement at 16-month follow-up. Conclusion: More number of AO cases are being reported in immunocompetent individuals. Variability in clinical picture, rarity, misdiagnosis, empirical therapy, and failure to send deep tissue samples for fungal cultures are some of the reasons for the high mortality rates. It is paramount in today’s scenario of atypical presentations, to obtain deep tissue for all cultures including fungal culture and histopathology, either surgically or under image guidance to achieve good clinical outcomes. Our study highlights that following the strict protocol of obtaining tissue for fungal culture, systemic antifungal therapy, and surgical debridement where necessary can help to diagnose and treat this rare pathology and ensure the good clinical outcome. PMID:29181357

Cytomegalovirus Retinitis in Three Pediatric Cases with Acute Lymphoblastic Leukemia: Case Series and Review of the Literature.

PubMed

Demir, Sevliya Öcal; Çeliker, Hande; Karaaslan, Ayşe; Kadayifci, Eda Kepenekli; Akkoç, Gülşen; Atıcı, Serkan; Yakut, Nurhayat; Şenay, Emel; Kazokoğlu, Haluk; Koç, Ahmet; Bakır, Mustafa; Soysal, Ahmet

2016-11-22

Cytomegalovirus (CMV) retinitis is typically diagnosed in patient with AIDS and those who underwent allogeneic hematopoietic cell transplant. However, it may develop in patients with acute lymphoblastic leukemia (ALL) who have not undergone hematopoietic cell transplantation. To increase awareness of CMV retinitis in this group, we describe 3 patients ages 3, 9, and 12, with ALL who developed CMV retinitis. The diagnosis of CMV retinitis was made on the basis of ophthalmological findings suggesting typical retinal lesions. In 2 cases, CMV DNAemia was present, while in 1 patient CMV DNA was detected only in vitreous fluid using the PCR technique. All cases were treated with intravenous ganciclovir for 2 or 3 weeks as induction therapy, followed by oral valganciclovir prophylaxis. Initially, active retinitis lesions resolved in all cases; however, in 1 patient CMV retinitis relapsed 3 times during follow-up. In this case, by using foscarnet therapy, satisfactory responses were achieved and the progression of CMV retinitis lesions stopped and eventually regressed.

Bleeding Diathesis or Fabrication: Munchausen Syndrome

PubMed Central

Asadullah Khan, Raad; Rupareliya, Chintan; Hanif, Rida; Ali, Zeeshan; Farooq, Faiza

2017-01-01

A case history of an 18-year-old female with a diagnosis of Munchausen syndrome is presented with a literature review of this rare syndrome. We present this case because of the young age and the patient's overwhelming response to cognitive behavioral therapy. We recommend collateral history taking, exclusion of all possible etiologies and detailed briefing of family members as it plays a vital role to reduce the mental and financial suffering of the patient. PMID:28951819

Long-term remission of folliculitis decalvans after treatment with the long-pulsed Nd:YAG laser.

PubMed

Meesters, Arne A; Van der Veen, J P Wietze; Wolkerstorfer, Albert

2014-04-01

Folliculitis decalvans (FD) is a rare inflammatory scalp disorder presenting with tufted folliculitis, follicular papules and pustules, progressing to cicatricial alopecia. Current treatments mainly consist of antibiotic and immunomodulatory therapies and are often disappointing. FD has previously shown to respond to treatment with neodymium:yttrium aluminium garnet (Nd:YAG) laser in one case. We present a case of recalcitrant FD, successfully treated with a long-pulsed Nd:YAG laser.

Metastatic hidradenocarcinoma: Surgery and chemotherapy

PubMed Central

Amel, Trabelsi; Olfa, Gharbi; Faten, Hammedi; Makrem, Hochlef; Slim, Ben Ahmed; Moncef, Mokni

2009-01-01

Context: Hidradenocarcinoma is a rare carcinoma of high malignant potential. It most metastasizes to regional lymph nodes and distant viscera. Case report: We report a case of 52-year-old woman who presented with an invasive hidradenocarcinoma of the finger, treated with surgical excision. The patient presented with skin and lymph node metastases four years after, treated by chemotherapy. Conclusion: Hidradenocarcinoma is an aggressive tumor. It seems important to use adjuvant therapies particularly for recurrent and metastatic forms. PMID:22666726

Immunoglobulin G4-related acquired hemophilia: A case report

PubMed Central

Li, Xiaoyan; Duan, Wei; Zhu, Xiang; Xu, Jianying

2016-01-01

Acquired hemophilia A (AHA) is a relatively rare and life-threatening bleeding disorder whose pathogenesis is not completely understood. The present study reports a rare case of immunogubulin (IgG)4-related AHA with multisystemic involvement. A 55-year old male patient presented with symptoms of bronchial asthma and multiple subdermal hematomas. Chest computed tomography showed multiple diffuse nodular lesions with thickening of bronchovascular bundles, and scattered high-density spots in both lung lobes. Laboratory investigations showed increased activated partial prothrombin time (120.0 sec), a markedly decreased factor VIII (FVIII) activity (0.5%), a high-titer of FVIII inhibitor (27.2 Bethesda units/ml) and a marked increase in serum IgG4 (>4.03 g/l) level. Left inguinal lymph node biopsy revealed capsular thickening with marked lymphoplasmacytic infiltration, occlusive phlebitis and irregular fibrosis. Immunostaining revealed numerous IgG4-positive plasma cells (>100 cells/human plasma fibronectin) in the nodular lesions, with an IgG4/IgG ratio of >40%. The symptoms were markedly alleviated following corticosteroid therapy. The current study presents the first reported case of a rare IgG4-related AHA that presented with unusual clinical features and multisystemic involvement. The patient responded well to corticosteroid therapy. Documentation of such rare cases will help in characterizing the pathogenesis, and prompt recognition and timely treatment of this rare disorder. PMID:28105131

[Botulism in infancy - survey of literature based on a case report].

PubMed

Berkes, Andrea; Szegedi, István; Szikszay, Edit; Gulyás, Márta; Oláh, Eva

2007-06-17

The authors have drawn attention to a rare disease called infant botulism, which raises some difficulties with regard to differential diagnosis. In the case of the six-month-old infant portrayed, infant botulism and food-born botulism appeared together. As a result of the severity of the disease and due to its rapid course observed in the presented case as well, the diagnosis has to be raised relying on the accurate patient's history and on the clinical examination, then it should be confirmed by appropriate examinations. In relation to presenting a case, the authors examine the microbiological background of the disease, its symptomatology, its epidemiological characteristics, the appropriate methods of electrophysiological examination and laboratory analysis as recommended in current literature, together with the difficulties that arise in differential diagnosis and also the possibilities of treatment. They pay special attention to the particular characteristics of the infant form of the disease, to the difficulties of making a diagnosis due to the characteristics of the age group and also to the questions in relation to the guiding principles of therapy. The rapid and fatal process observed in the presented case warns us that serious complications can occur even when up-to-date therapy is used. Therefore, despite the improvement in prognosis we have to strive to prevent the disease by spreading the proper regulations of nutritional hygiene.

A case of metastatic follicular thyroid carcinoma complicated with Graves' disease after total thyroidectomy.

PubMed

Aoyama, Mariko; Takizawa, Hiromitsu; Tsuboi, Mitsuhiro; Nakagawa, Yasushi; Tangoku, Akira

2017-12-28

Thyroid cancer and Graves' disease may present simultaneously in one patient. The incidence of the development of hyperthyroidism from metastatic differentiated thyroid carcinoma is rare. We herein report a case of metastatic follicular carcinoma complicated with Graves' disease after total thyroidectomy. A 57-year-old woman underwent right hemithyroidectomy for follicular carcinoma. Metastatic lesions appeared in the lungs and skull two years after the first surgery, and remnant thyroidectomy was performed for radioactive iodine-131 (RAI) therapy, during which the TSH receptor antibody (TRAb) was found to be negative. The patient was treated with RAI therapy four times for four years and was receiving levothyroxine suppressive therapy. Although radioiodine uptake was observed in the lesions after the fourth course of RAI therapy, metastatic lesions had progressed. Four years after the second surgery, she had heart palpitations and tremors. Laboratory data revealed hyperthyroidism and positive TRAb. She was diagnosed with Graves' disease and received a fifth course of RAI therapy. 131I scintigraphy after RAI therapy showed strong radioiodine uptake in the metastatic lesions. As a result, the sizes and numbers of metastatic lesions decreased, and thyroid function improved. Metastatic lesions produced thyroid hormone and caused hyperthyroidism. RAI therapy was effective for Graves' disease and thyroid carcinoma.

Utilization of Liposuction for Delayed Morel-Lavallée Lesion: A Case Report and Review.

PubMed

Gardner, Preston; Flis, Diana; Chaiyasate, Kongkrit

2017-01-01

Morel-Lavallée lesions are irregularly occurring and often overlooked results of traumatic injuries, resulting in potential long-term encapsulation of fluid between soft-tissue layers. The objective in this review was to discuss the delayed presentation of a Morel-Lavallée lesion and operative utility of liposuction in the patient's treatment and review literature with particular focus on diagnosis and therapeutic interventions. The reviewed case demonstrates the presentation and successful therapy of a young female presenting with a MLL and contour deformity.

Oral Effects and Early Implant Survival Results After Imatinib Discontinuation Therapy for Chronic Myelogenous Leukemia: A Case Report.

PubMed

Dixon, Douglas R; Yassin, Alaa

2017-08-01

Little is known regarding the success, failure, or complication rates of advanced implant procedures in patients after discontinuation therapy of long-term medications for the treatment of chronic myelogenous leukemia (CML). This case report presents initial results of a case involving implant placement in the mandible and maxilla as well as reduction of palatal oral pigmentation in a patient discontinuing long-term tyrosine kinase inhibitor (TKI) therapy for CML. A 57-year-old male was referred to the Department of Periodontics, University of Washington, Seattle, Washington, for an assessment of edentulous areas (tooth sites #3 and #14) and failing tooth #19. Previous medical treatment included oral administration (>10 years) of TKI for the treatment of CML. Systemic complications arising from long-term TKI therapy were treated with discontinuation of this medication. Concurrently, after multispecialty dental and medical consultation, extraction of tooth #19 with immediate implant placement and bilateral sinus augmentation with simultaneous implant placement were successfully performed during three separate surgical appointments. Additionally, marked reduction of oral palatal pigmentation was observed during the surgical and restorative phases after TKI discontinuation. Patients with a history of long-term TKIs for CML are at risk for developing complications that result in discontinuation of therapy. Long-term benefits of therapy may allow these patients to enjoy remission with an extended and improved quality of life. Patients undergoing discontinuation therapy may seek dental care. Therefore, dental providers need to understand these systemic interactions and, with multispecialty consultation, may help effectively treat these individuals.

Proposed algorithm for the management of athletes with athletic pubalgia (sports hernia): a case series.

PubMed

Kachingwe, Aimie F; Grech, Steven

2008-12-01

A case series of 6 athletes with a suspected sports hernia. Groin pain in athletes is common, and 1 source of groin pain is athletic pubalgia, or a sports hernia. Description of this condition and its management is scarce in the physical therapy literature. The purpose of this case series is to describe a conservative approach to treating athletes with a likely sports hernia and to provide physical therapists with an algorithm for managing athletes with this dysfunction. Six collegiate athletes (age range, 19-22 years; 4 males, 2 females) with a physician diagnosis of groin pain secondary to possible/probable sports hernia were referred to physical therapy. A method of evaluation was constructed and a cluster of 5 key findings indicative of a sports hernia is presented. The athletes were managed according to a proposed algorithm and received physical therapy consisting of soft tissue and joint mobilization/manipulation, neuromuscular re-education, manual stretching, and therapeutic exercise. Three of the athletes received conservative intervention and were able to fully return to sport after a mean of 7.7 sessions of physical therapy. The other 3 athletes reached this outcome after surgical repair and a mean of 6.7 sessions of physical therapy. Conservative management including manual therapy appears to be a viable option in the management of athletes with a sports hernia. Follow-up randomized clinical trials should be performed to further investigate the effectiveness of conservative rehabilitation compared to a homogeneous group of patients undergoing surgical repair for this condition. Therapy, level 4.

Effect of non-surgical periodontal therapy on insulin resistance in patients with type II diabetes mellitus and chronic periodontitis, as assessed by C-peptide and the Homeostasis Assessment Index.

PubMed

Mammen, Jerry; Vadakkekuttical, Rosamma Joseph; George, Joseraj Manaloor; Kaziyarakath, Jaishid Ahadal; Radhakrishnan, Chandni

2017-08-01

A bidirectional relationship exists between diabetes and periodontitis. In the present clinical trial, we evaluated the effects of non-surgical periodontal therapy (NSPT) on insulin resistance in patients with type II diabetes mellitus (DM) and chronic periodontitis. Forty chronic periodontitis patients with type II DM were selected and equally allocated to case and control groups. All patients were assessed for periodontal parameters and systemic parameters. The case group received NSPT, and both groups were re-evaluated after 3 months. All periodontal parameters were found to be significantly improved in the case group compared to the control group 3 months after NSPT. The mean differences in systemic parameters, such as fasting serum C-peptide, Homeostasis Assessment (HOMA) Index-insulin resistance, and HOMA-insulin sensitivity, from baseline to 3 months for the case group were 0.544 ± 0.73, 0.54 ± 0.63, and -25.44 ± 36.81, respectively; for the control group, they were significant at -1.66 ± 1.89, -1.48 ± 1.86, and 31.42 ± 38.82 respectively (P < 0.05). There was a significant decrease in fasting blood glucose and glycosylated hemoglobin A1c from baseline to 3 months in the case group (P < 0.05). The present study showed that periodontal inflammation could affect glycemic control and insulin resistance. Effective periodontal therapy reduced insulin resistance and improved periodontal health status and insulin sensitivity in patients with type II DM and chronic periodontitis. © 2016 John Wiley & Sons Australia, Ltd.

The results of therapeutic plasma exchange in patients with severe hyperthyroidism: a retrospective multicenter study.

PubMed

Keklik, Muzaffer; Kaynar, Leylagul; Yilmaz, Mehmet; Sivgin, Serdar; Solmaz, Musa; Pala, Cigdem; Aribas, Sulbiye; Akyol, Gulsah; Unluhizarci, Kursat; Cetin, Mustafa; Eser, Bulent; Unal, Ali

2013-06-01

Hyperthyroidism characterized by elevated serum levels of circulating thyroid hormones. The aim of hyperthyroidism treatment is to achieve a euthyroid state as soon as possible and to maintain euthyroid status. However, drug withdrawal and utilization of alternative therapies are needed in cases in which leucopenia or impairment in liver functions is observed during medical therapy. In the present study, we aimed to present our cases which underwent therapeutic plasma exchange (TPE) due to severe hyperthyroidism. The results of 22 patients who underwent therapeutic plasma exchange due to hyperthyroidism in Apheresis Units of Erciyes University and Gaziantep University, between 2006 and 2012, were retrospectively reviewed. These cases had severe thyrotoxic values despite anti-thyroid drug use. After TPE, we observed a significant decrease in free thyroxin (FT4) (p<0.001) and free triiodotyhronin (FT3) (p<0.004) levels. There was statistically significant increase in the mean values of TSH levels after TPE (p<0.001). Clinical improvement was achieved in hyperthyroidism by TPE in 20 cases (91%). Both FT3 and FT4 levels remained above the normal limits in two of 22 patients. TPE should be considered as an effective and safe therapeutic option to achieve euthyroid state before surgery or radioactive iodine treatment. TPE is a useful option in cases with severe hyperthyroidism unresponsive to anti-thyroid agents and in those with clinical manifestations of cardiac failure and in patients with severe adverse events during anti-thyroid therapy. Copyright © 2013 Elsevier Ltd. All rights reserved.

[Cases of suspected poisoning in small animal practice - a retrospective and prospective survey].

PubMed

Allkämper, Svenja; Kösters, Sarah; Campe, Amely; Kietzmann, Manfred; Kreienbrock, Lothar

2018-06-01

Systematic survey of data from cases of suspected poisoning in small animal practices. In 11 exemplary selected small animal practices, patient files from cases of suspected poisoning over 2006/2007, data entry forms of poisonings 2009-2010 and the contact group, which are all patients with at least one visit in 2007, were analysed. In 2007, approximately 1 in 200 dog and 1 in 500 cat patients were presented with poisoning. More than 70 % of cases concerned dogs. Some breeds of hunting dogs were more frequently affected than expected from their percentage in the practice population. Suspicion of poisoning was retrospective mainly founded in neutered dogs. In addition to numerous unspecific symptoms, bleeding was frequently observed. With central nervous system symptoms or a critical general condition a founded suspicion was observed more frequently. In cases of unfounded suspicion, inflammation of the gastrointestinal tract was mostly present. Other frequently seen diseases were infections, tumours and autoimmune diseases. The main toxins in the retrospective evaluation were coumarin derivatives (37 %), drugs (10 %) and chocolate (7 %). The prospective survey yielded a higher percentage of poisoning with drugs and plants. The diagnosis was mainly based on case history and clinical signs. Therapy was predominantly symptomatic. Poisoning with coumarin derivatives is the most frequent intoxication in dogs, but also cats. The risk from permethrin for cats remains current. In daily practice, therapy is mostly symptomatic without any specific toxicological evidence. Consequently, the causative toxin is frequently unknown. Therefore, additional methods for elimination (stomach/rectal lavage, medical coal, lipid therapy) should be included as therapeutical options. For a successful systematic prospective survey in daily practice a good collaboration between practice and investigator is necessary. Schattauer GmbH.

Male breast cancer is rare: an initial presentation may be as an abscess.

PubMed

Ventham, N T; Hussien, M I

2010-08-06

Breast cancer in men is rare. Breast cancer presenting initially as an abscess has been described only a handful of times in the literature. We present the first described case of invasive adenocarcinoma presenting as an abscess in a man. An 80-year-old diabetic man presented with symptoms typical of a breast abscess. The abscess failed to respond to percutaneous therapy and excision of breast abscess was performed. Histology revealed an invasive carcinoma. He went on to have a mastectomy. Histology should be obtained from breast abscesses not resolving within 2 months of initial percutaneous therapy. Histology could be obtained by ultrasound-guided fine-needle aspiration (FNA), core or vacuum assisted biopsy, or by formal incision and drainage.

Male breast cancer is rare: an initial presentation may be as an abscess

PubMed Central

Ventham, N T; Hussien, M I

2010-01-01

Breast cancer in men is rare. Breast cancer presenting initially as an abscess has been described only a handful of times in the literature. We present the first described case of invasive adenocarcinoma presenting as an abscess in a man. An 80-year-old diabetic man presented with symptoms typical of a breast abscess. The abscess failed to respond to percutaneous therapy and excision of breast abscess was performed. Histology revealed an invasive carcinoma. He went on to have a mastectomy. Histology should be obtained from breast abscesses not resolving within 2 months of initial percutaneous therapy. Histology could be obtained by ultrasound-guided fine-needle aspiration (FNA), core or vacuum assisted biopsy, or by formal incision and drainage. PMID:22767683

Is mindfulness-based therapy an effective intervention for obsessive-intrusive thoughts: a case series.

PubMed

Wilkinson-Tough, Megan; Bocci, Laura; Thorne, Kirsty; Herlihy, Jane

2010-01-01

Despite the efficacy of cognitive-behavioural interventions in improving the experience of obsessions and compulsions, some people do not benefit from this approach. The present research uses a case series design to establish whether mindfulness-based therapy could benefit those experiencing obsessive-intrusive thoughts by targeting thought-action fusion and thought suppression. Three participants received a relaxation control intervention followed by a six-session mindfulness-based intervention which emphasized daily practice. Following therapy all participants demonstrated reductions in Yale-Brown Obsessive-Compulsive Scale scores to below clinical levels, with two participants maintaining this at follow-up. Qualitative analysis of post-therapy feedback suggested that mindfulness skills such as observation, awareness and acceptance were seen as helpful in managing thought-action fusion and suppression. Despite being limited by small participant numbers, these results suggest that mindfulness may be beneficial to some people experiencing intrusive unwanted thoughts and that further research could establish the possible efficacy of this approach in larger samples. Copyright (c) 2009 John Wiley & Sons, Ltd.

Paradoxical reaction to antituberculosis therapy in a patient with lupus vulgaris.

PubMed

Santesteban, R; Bonaut, B; Córdoba, A; Yanguas, I

2015-03-01

Patients receiving treatment for tuberculosis may experience an unexpected deterioration of their disease; this is known as a paradoxical reaction. We present the case of a 59-year-old man with lupus vulgaris who experienced a paradoxical deterioration of cutaneous lesions after starting antituberculosis therapy. The reaction was self-limiting; the lesions gradually improved, and the final outcome was very good. Paradoxical reactions are well-known in patients with human immunodeficiency virus (HIV) infection who start antiretroviral therapy, but they can also occur in non-HIV-infected patients with tuberculosis who start antituberculosis therapy. In the literature reviewed, paradoxical reactions involving skin lesions were described in patients with miliary tuberculosis. The case we report is the first of a paradoxical reaction in lupus vulgaris. The increasing frequency of tuberculosis in Spain could lead to a rise in the number of paradoxical reactions. Copyright © 2014 Elsevier España, S.L.U. y AEDV. All rights reserved.

Hypotrichosis and juvenile macular dystrophy caused by CDH3 mutation: A candidate disease for retinal gene therapy.

PubMed

Singh, Mandeep S; Broadgate, Suzanne; Mathur, Ranjana; Holt, Richard; Halford, Stephanie; MacLaren, Robert E

2016-05-09

Hypotrichosis with juvenile macular dystrophy (HJMD) is an autosomal recessive disorder that causes childhood visual impairment. HJMD is caused by mutations in CDH3 which encodes cadherin-3, a protein expressed in retinal pigment epithelium (RPE) cells that may have a key role in intercellular adhesion. We present a case of HJMD and analyse its phenotypic and molecular characteristics to assess the potential for retinal gene therapy as a means of preventing severe visual loss in this condition. Longitudinal in vivo imaging of the retina showed the relative anatomical preservation of the macula, which suggested the presence of a therapeutic window for gene augmentation therapy to preserve visual acuity. The coding sequence of CDH3 fits within the packaging limit of recombinant adeno-associated virus vectors that have been shown to be safe in clinical trials and can efficiently target RPE cells. This report expands the number of reported cases of HJMD and highlights the phenotypic characteristics to consider when selecting candidates for retinal gene therapy.

Infection-associated hemophagocytic syndrome complicated by infectious lymphoproliferation: a case report.

PubMed

Syrůcková, Z; Starý, J; Sedlácek, P; Smísek, P; Vavrinec, J; Komrska, V; Roubalová, K; Vandasová, J; Sintáková, B; Housková, J; Hassan, M

1996-01-01

The case of a 7-year-old boy with virus-associated hemophagocytic syndrome (VAHS) and serologically proven parvovirus B-19 infection is described. The patient with VAHS presented with fever, hepatosplenomegaly, pancytopenia, and hyperlipidemia type IV. After induction therapy with VP-16 and prednisone, partial remission was achieved. Despite maintenance therapy, reinductions, and the addition of cyclosporine A for 3 months, several relapses occurred. The therapy was stopped because of life-threatening complications (Klebsiella sepsis, neutropenic enterocolitis, and stercoral peritonitis). The complications were treated successfully. The patient status was stabilized after splenectomy. However, hepatomegaly progressed slowly and the hyperlipidemia endured. Ten months after the diagnosis leukocytosis with absolute T lymphocytosis appeared. Reactivation of VAHS was suspected and intravenous immunoglobin and then antilymphocyte immunoglobulin ALG therapy were started. The resultant decrease in leukocytosis was prompt, but lymphopenia did not occur. Virostatic treatment with foscarnet was introduced based on human herpesvirus-6 seroconversion. Twenty-six months after the diagnosis, the patient is well, without any sign of VAHS or lymphoproliferation.

[Sexual delinquency and Parkinson's disease].

PubMed

Berger, Ch; Mehrhoff, F W; Beier, K M; Meinck, H-M

2003-04-01

The risk of aberrant sexual behaviour such as hypersexuality, exhibitionism, or pederasty may be underestimated in Parkinson's disease and its therapy with high-dosage L-dopa or dopamine agonists. We describe two legal cases which are representative of the forensic assessment of these side effects. The first case brought to court was a 45-year-old man suffering for 20 years from Parkinson's disease who developed hypersexuality and exhibitionism under high-dose therapy with ropinirol. The second patient, a 57-year-old man with an 11-year history of Parkinson's disease, developed increased libido and pederasty under therapy with L-dopa and bromocriptine. We discuss the present literature concerning hypersexuality and sexually deviant behaviour in Parkinson's disease and dopaminergic therapy in the German legal context. Doctors treating Parkinson patients should be aware of increased sexual impulses or reduced behavioural control and ask specifically about them during anamnesis, and counteractive therapeutic strategies should be considered to prevent the occurrence of illegal sexually aberrant behavioural disorders.

Direct Surgery of Previously Coiled Large Internal Carotid Ophthalmic Aneurysm for the Purpose of Optic Nerve Decompression

PubMed Central

Kawabata, Shuhei; Toyota, Shingo; Kumagai, Tetsuya; Goto, Tetsu; Mori, Kanji; Taki, Takuyu

2017-01-01

Background Progressive visual loss after coil embolization of a large internal carotid ophthalmic aneurysm has been widely reported. It is generally accepted that the primary strategy for this complication should be conservative, including steroid therapy; however, it is not well known as to what approach to take when the conservative therapy is not effective. Case Presentation We report a case of a 55-year-old female presenting with progressive visual loss after the coiling of a ruptured large internal carotid ophthalmic aneurysm. As the conservative therapy had not been effective, we performed neck clipping of the aneurysm with optic canal unroofing, anterior clinoidectomy, and partial removal of the embolized coils for the purpose of optic nerve decompression. After the surgery, the visual symptom was improved markedly. Conclusions It is suggested that direct surgery for the purpose of optic nerve decompression may be one of the options when conservative therapy is not effective for progressive visual disturbance after coil embolization. PMID:28229036

Systematic review of sensory integration therapy for individuals with disabilities: Single case design studies.

PubMed

Leong, H M; Carter, Mark; Stephenson, Jennifer

2015-12-01

Sensory integration therapy (SIT) is a controversial intervention that is widely used for people with disabilities. Systematic analysis was conducted on the outcomes of 17 single case design studies on sensory integration therapy for people with, or at-risk of, a developmental or learning disability, disorder or delay. An assessment of the quality of methodology of the studies found most used weak designs and poor methodology, with a tendency for higher quality studies to produce negative results. Based on limited comparative evidence, functional analysis-based interventions for challenging behavior were more effective that SIT. Overall the studies do not provide convincing evidence for the efficacy of sensory integration therapy. Given the findings of the present review and other recent analyses it is advised that the use of SIT be limited to experimental contexts. Issues with the studies and possible improvements for future research are discussed including the need to employ designs that allow for adequate demonstration of experimental control. Copyright © 2015 Elsevier Ltd. All rights reserved.

[Intrauterine fetal therapy of NIHF with massive pleural effusion - a case study].

PubMed

Sobczuk, Kamila; Wojtera, Justyna; Celewicz, Zbigniew; Szaflik, Krzysztof

2013-05-01

Hydrops fetalis (fetal hydrops) is a serious fetal condition defined as abnormal accumulation of fluid in two or more extravascular compartments, including ascites, pleural effusion, pericardial effusion, and skin edema. Edema is classified as immune or non-immune. Today more than 90% of fetal edema has non-immune cause. This paper presents a case of a pregnant woman who was admitted to the Obstetrics and Gynecology Department because of fetal hydrops with massive pleural effusion and polyhydramnios at 34 weeks gestation. The intrauterine therapy consisted of two treatments. During the first surgery amnioreduction, evacuation of fluid from the pleural cavity of the fetus, and shunts to both pleural cavities were performed. During the second surgery amnioreduction, cordocentesis with albumin administration and pleural shunt were performed. Intrauterine therapy led to a reduction of swelling of the fetus from 7mm up to 1-2 mm and the total evacuation of fluid from the pleural cavity and the fetal lung expansion. We also present the condition of the neonate after birth and after 12 months of life.

A suspected case of lymphogranuloma venereum (LGV) suggests underdiagnosed LGV infection among Slovenian men who have sex with men.

PubMed

Mlakar, Boštjan; Ramšak, Ana

2016-06-01

Lymphogranuloma venereum (LGV) is sexually transmitted infection caused by serovars of Chlamydia trachomatis, mostly seen among HIV-positive men who have sex with men. The first three reports of possible LGV in Slovenia were from April to June 2015, followed by a confirmed case of LGV in August 2015. We present the case of an HIV-positive MSM that presented with an anorectal abscess, discharge, lymphadenopathy, and unusual perianal plaque. Gonococcal proctitis was assumed and he received empirical antibiotic treatment, after which only intermittent improvement occurred. After a positive test result for chlamydial infection, but without a response to azithromycin treatment, LGV was suspected. Treatment according to the guidelines was introduced. When doxycycline therapy started, rapid improvement was observed, and it was therefore assumed that the LGV infection had been successfully treated. Two similar cases with an unusual anorectal presentation and an excellent response to antibiotic therapy for LGV were observed at the same center shortly thereafter. While pointing out possible delays and limitations in diagnostic procedures at self-pay facilities, the need for better access to high quality STI management in public and in private services is emphasized. Enhanced surveillance and testing guidelines could reveal a hidden LGV epidemic among MSM in Slovenia.

Premature Craniosynostosis: A Complication of Thyroid Replacement Therapy

ERIC Educational Resources Information Center

Penfold, James L.; Simpson, Donald A.

1975-01-01

Presented are case studies of 3 children, infancy to 9-years-old, whose premature skull ossification (craniosynostosis) is traced to iatrogenic hyperthyroidism from the administration of excessive amounts of thyroid hormone. (CL)

Stability of Programmable Shunt Valve Settings with Simultaneous Use of the Optune Transducer Array: A Case Report.

PubMed

Chan, Andrew K; Birk, Harjus S; Winkler, Ethan A; Viner, Jennifer A; Taylor, Jennie W; McDermott, Michael W

2016-07-07

The Optune® transducer array (Novocure Ltd., Haifa, Israel) is an FDA-approved noninvasive regional therapy that aims to inhibit the growth of glioblastoma multiforme (GBM) cells via utilization of alternating electric fields. Some patients with GBM may develop hydrocephalus and benefit from subsequent shunt placement, but special attention must be paid to patients in whom programmable valves are utilized, given the potential effect of the magnetic fields on valve settings. We present the first case report illustrating the stability of programmable shunt valve settings in a neurosurgical patient undergoing therapy with the Optune device. In this study, shunt valve settings were stable over a period of five days despite Optune therapy. This is reassuring for patients with GBM who require simultaneous treatment with both the Optune device and a programmable shunt system.

Refractory Mycoplasma pneumoniae pneumonia with concomitant acute cerebral infarction in a child: A case report and literature review.

PubMed

Jin, Xingnan; Zou, Yingxue; Zhai, Jia; Liu, Jie; Huang, Bing

2018-03-01

Mycoplasma pneumoniae pneumonia, a common cause of community-acquired pneumonia in children, is rarely complicated with acute cerebral infarction. We present a 7-year-old boy with severe M pneumoniae pneumonia who developed impaired consciousness, aphasia, and reduced limb muscle power 7 days postadmission. Mycoplasma pneumoniae pneumonia with concomitant acute cerebral infarction. The patient recovered with aggressive antibiotic therapy, antiinflammation therapy with methylprednisolone, and gamma immunoglobulin and anticoagulation therapy with aspirin and low molecular weight heparin along with rehabilitation training. At 8 days postadmission, his consciousness was improved and at the 6-month follow-up visit, his muscle power of bilateral upper and lower limbs was normal except still poor right handgrip power. Stroke or cerebral infarction should be considered and promptly managed in rare cases of M pneumoniae pneumonia with neurologic manifestations.

Genital Warts

PubMed Central

Yanofsky, Valerie R.; Patel, Rita V.

2012-01-01

External genital warts, also known as condylomata acuminata, are extremely common, with between 500,000 to one million new cases diagnosed each year in the United States alone. To date, more than 120 distinct subtypes of human papillomavirus have been identified. Human papillomavirus types 6 and 11 rarely give rise to cervical cancers, but are responsible for 90 percent of the cases of genital warts. The current treatment options are largely centered upon removal of the warts rather than elimination of the underlying viral infection. A wide range of therapies are presently in use, which are highly variable and can differ dramatically with respect to cost, side-effect profiles, dosing schedules, duration of treatment, and overall effectiveness. As of yet, no definitive therapy has emerged as the ideal standard of care in the treatment of genital warts, and therapy selection generally occurs in a patient-specific manner. PMID:22768354

Methotrexate-induced pneumonitis in Crohn's disease. Case report and review of the literature

PubMed Central

2010-01-01

Methotrexate (MTX) is a folate-antagonist used in several neoplastic and inflammatory diseases. Reports of pulmonary complications in patients given low-dose MTX therapy are increasing. Pulmonary toxicity from MTX has a variable frequency and can present with different forms. Most often MTX-induced pneumonia in patients affected by rheumatoid arthritis (RA) is reported. In this paper we describe a case of MTX-related pneumonitis in a relatively young woman affected by Crohn's disease who presented non-productive cough, fever and dyspnea on exercise. Chest X-ray demonstrated bilateral interstitial infiltrates and at computed tomography (CT) ground-glass opacities appeared in both lungs. At spirometry an obstructive defect was demonstrated. A rapid improvement of symptoms and the regression of radiographic and spirometric alterations was achieved through MTX withdrawal and the introduction of corticosteroid therapy. PMID:22958737

Utilization of mechanical diagnosis and therapy (MDT) for the treatment of lumbar pain in the presence of known lumbar transverse process fractures: a case study

PubMed Central

Elenburg, J. L.; Foley, B. S.; Roberts, K.; Bayliss, A. J.

2016-01-01

Background Spinal fractures are typically considered a contraindication to mechanical diagnosis and therapy (MDT). Objective and importance The purpose of this case study is to illustrate how MDT was used safely and effectively to treat lumbar pain in a patient with multiple lumbar transverse process fractures. Clinical presentation The subject was a 24-year-old female with left L2-5 transverse process fractures, sustained 10 weeks prior in a pedestrian versus motor vehicle accident. Intervention (and technique) After collaboration with her physiatrist, an MDT examination revealed a presentation consistent with the lumbar derangement syndrome. Conclusion After three visits, utilizing patient generated forces with the extension principle of treatment, her pain, Oswestry disability index (ODI) score, and function all improved. PMID:27559276

Virginal Breast Hypertrophy: Different Presentations of 2 Cases and the Role of Tamoxifen as an Adjuvant Therapy.

PubMed

Karagüzel, Gülay; Bilen, Sevcan; Karaçal, Naci; Yıldız, Kadriye; Livaoğlu, Murat

2016-10-01

Virginal breast hypertrophy is a rapid and massive enlargement of one or both breasts. There are several proposed causes and treatment options for virginal breast hypertrophy, but the investigations to support these theories are lacking. We report two premenarchal girls with virginal breast hypertrophy who presented as different clinical cases. After their surgical interventions, their clinical courses were followed for more than 2 years with tamoxifen as an adjuvant therapy. Breast size and shape disorders can be a disturbing cosmetic problem for adolescents who worry about their body image. A combination treatment of breast reduction surgery and tamoxifen is reasonable and can eliminate the need for repeated surgeries for girls with virginal breast hypertrophy. Copyright © 2016 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.

Imitating the Great Imitator The Intersection of Sarcoidosis and Hodgkin's Lymphoma A Report of Two Cases.

PubMed

Outlaw, Darryl; Mehta, Amitkumar; Dalvi, Sam R

2018-06-01

Sarcoidosis and Hodgkin's lymphoma represent two distinct diseases with different pathogenic mechanisms, therapeutic interventions, and prognoses. Nevertheless, both diseases can have overlapping presentations, thus blurring the line between successful identification and treatment. A propensity to develop one of these diseases following diagnosis of the other has long been appreciated. Here we review two cases of presumed sarcoidosis that were ultimately diagnosed as Hodgkin's lymphoma. Both patients initially presented with non-specific symptoms and underwent a thorough workup, including histological evaluation demonstrating non-caseating granulomas without evidence of malignancy. Both patients started sarcoid-directed therapies with relapse of symptoms. Repeat imaging and tissue biopsy eventually led to the diagnosis of stage IVB Hodgkin's lymphoma. After the initiation of Hodgkin's-directed therapies, both patients showed marked clinical responses, and entered complete remission.

[Liver Atrophy and Failure Associated with Paclitaxel and Bevacizumab Combination Therapy for Metastatic Breast Cancer].

PubMed

Yamamoto, Mari; Ikeda, Masahiko; Kubo, Shinichiro; Tsukioki, Takahiro; Nakamoto, Shougo

2016-07-01

We managed 6 cases of severe liver atrophy and failure associated with paclitaxel and bevacizumab combination therapy (PB therapy)for HER2-negative metastatic breast cancer. In this case-controlstudy, we examined the records of these 6 patients to investigate past treatment, medication history, and degree of atrophy, and compared their data with that of 67 patients without liver atrophy. The degree of the liver atrophy used SYNAPSE VINCENT®of the image analysis software. The results showed that patients with liver atrophy had a longer pretreatment period than those without liver atrophy(33.5 months vs 15.5 months), and they also experienced a longer median time to treatment failure with PB therapy than other patients(11 months vs 6 months). The ratio of individuals presenting with diffuse liver metastasis among patients with liver metastasis was 80% with liver atrophy, compared to 8% without liver atrophy. The degree of liver atrophy was an average of 67%in terms of volume ratio before/after PB therapy(57-82%). The individualwith the greatest extent of liver atrophy died of liver failure, not as a result of breast cancer progression. The direct causal link between bevacizumab and liver atrophy and failure is unclear, but the individuals in this study had a long previous history of treatment, and diffuse liver metastases may develop in patients undergoing long periods of PB therapy, which may also cause liver atrophy; therefore, the possibility of liver failure should be considered in such cases.

Pulmonary co-infection with nocardia species and nontuberculous mycobacteria mimicking miliary tuberculosis in a patient with Crohn's disease under combined immunosuppressive therapy.

PubMed

Weber, Marko; Rüddel, Jessica; Bruns, Tony; Pletz, Mathias W; Stallmach, Andreas

2018-06-01

Nocardiosis is a rare infection caused by ubiquitous soil-born, acid-resistant, Gram-positive bacteria that can be life-threatening in immunocompromised patients. Originally usually diagnosed in HIV-positive patients, only few cases have been reported in patients on immunosuppressive therapy for inflammatory bowel disease or rheumatologic disorders. We present a case of a 32-year-old man who was treated with infliximab, prednisolone, and azathioprine for severe terminal ileitis. Although the clinical status improved under triple immunosuppressive therapy, weight loss, weakness, and fatigue persisted. Laboratory studies revealed iron deficiency anemia, hypalbuminemia and raised inflammatory markers. Chest computed tomography scan showed multiple pulmonary nodules and a large cavity in the left upper lobe (segment 3a). Empiric tuberculostatic therapy was introduced for suspected miliary tuberculosis but stopped for lack of clinical improvement and negative tuberculosis tests (interferon-gamma release assay, microscopy, polymerase chain reaction). Finally, the diagnosis of pulmonary nocardiosis with concomitant pulmonary Mycobacterium avium infection was confirmed microbiologically, and the patient was treated with high-dose co-trimoxazole, clarithromycin, ethambutol, and rifampicin for 12 months.This case report underlines the increased risk of severe and rare infections like nocardiosis with combination immunosuppressive therapy and the necessity for thorough diagnostic screening for opportunistic infection. Although long-term antibiotic treatment for nocardiosis is mandatory, the optimal timing to restart immunosuppressive therapy remains ambiguous. © Georg Thieme Verlag KG Stuttgart · New York.

Depression in Patients with Mastocytosis: Prevalence, Features and Effects of Masitinib Therapy

PubMed Central

Moura, Daniela Silva; Sultan, Serge; Georgin-Lavialle, Sophie; Pillet, Nathalie; Montestruc, François; Gineste, Paul; Barete, Stéphane; Damaj, Gandhi; Moussy, Alain; Lortholary, Olivier; Hermine, Olivier

2011-01-01

Depression in patients with mastocytosis is often reported but its prevalence and characteristics are not precisely described. In addition, the impact of therapies targeting mast cells proliferation, differentiation and degranulation on psychic symptoms of depression have never been investigated. Our objective was to determine the prevalence and to describe features of depression in a large cohort of mastocytosis patients (n = 288) and to investigate the therapeutic impact of the protein kinase inhibitor masitinib in depression symptoms. The description of depression was based on the analysis of a database with Hamilton scores using Principal Component Analysis (PCA). Efficacy of masitinib therapy was evaluated using non parametric Wilcoxon test for paired data within a three months period (n = 35). Our results show that patients with indolent mastocytosis present an elevated prevalence of depression (64%). Depression was moderate in 56% but severe in 8% of cases. Core symptoms (such as psychic anxiety, depressed mood, work and interests) characterized depression in mastocytosis patients. Masitinib therapy was associated with significant improvement (67% of the cases) of overall depression, with 75% of recovery cases. Global Quality of Life slightly improved after masitinib therapy and did not predicted depression improvement. In conclusion, depression is very frequent in mastocytosis patients and masitinib therapy is associated with the reduction its psychic experiences. We conclude that depression in mastocytosis may originate from processes related to mast cells activation. Masitinib could therefore be a useful treatment for mastocytosis patients with depression and anxiety symptoms. PMID:22031830

Role of Ketamine and Methadone as Adjunctive Therapy in Complex Pain Management: A Case Report and Literature Review

PubMed Central

Faisal, Wasek; Jacques, Judith

2017-01-01

Assessment and management of complex cancer pain always remains a major challenge for any palliative care team, given its heterogeneity of underlying pathophysiology and limitations of any pharmacotherapy. Here, we present a case of complex pain management in a young patient with a life-limiting illness, highlighting the issues of organic and nonorganic contributors of pain and provide some insight into the role of ketamine and methadone as adjunctive therapy to opioid analgesics. A brief literature review is also done to provide the context of use of these adjunctive drugs in this setting. PMID:28216871

A case of gas gangrene in an immunosuppressed Crohn's patient.

PubMed

Kiel, Natalie; Ho, Vincent; Pascoe, Andrew

2011-09-07

Clostridium septicum (C. septicum) gas gangrene is well documented in the literature, typically in the setting of trauma or immunosuppression. In this paper, we report a unique case of spontaneous clostridial myonecrosis in a patient with Crohn's disease and sulfasalazine-induced neutropenia. The patient presented with left thigh pain, vomiting and diarrhea. Blood tests demonstrated a profound neutropenia, and magnetic resonance imaging of the thigh confirmed extensive myonecrosis. The patient underwent emergency hip disarticulation, followed by hemicolectomy. C. septicum was cultured from the blood. Following completion of antibiotic therapy, the patient developed myonecrosis of the right pectoral muscle necessitating further debridement, and remains on lifelong prophylactic antibiotic therapy.

Propylthiouracil-induced cutaneous vasculitis. Case presentation and review of the literature.

PubMed

Vasily, D B; Tyler, W B

1980-02-01

A patient had cutaneous vasculitis, leukopenia, and splenomegaly caused by the antithyroid drug, propylthiouracil. Histopathologic changes of acute vasculitis of the superficial and deep dermal blood vessels accompanied by fibrin thrombi formation were found in biopsy specimens of the cutaneous lesions. Direct immunofluorescence studies demonstrated IgM and C3 of the vessel walls suggesting immune complex deposition. The literature disclosed five cases with similar features associated with propylthiouracil therapy. Characteristic cutaneous findings include a recurrent, self-limited, symmetrical purpuric eruption that can involve the face or earlobes. Clinicians should recognize these changes as a cutaneous sign of a vasculitis associated with propylthiouracil therapy.

[Septic cavernous sinus thrombosis following ethmoiditis: a case report].

PubMed

Ben Abdallah Chabchoub, R; Kmiha, S; Turki, F; Trabelsi, L; Maalej, B; Ben Salah, M; Abdelhédi Gargouri, L; Boukédi, A; Ben Halima, N; Mahfoudh, A

2014-01-01

Acute ethmoiditis is a rare infection of ethmoidal cells. The pathognomonic sign is an edema of the internal corner of the eye. Imaging may be necessary to verify the absence of orbital or endocranial complications. Thrombophlebitis of the cavernous sinus is a serious complication of this infectious process. We report the case of an 11-year-old boy who presented with ethmoiditis complicated with thrombophlebitis of the cavernous sinus, with right hemiplegia and left Bell palsy sequelae. Early diagnosis of this disorder and urgent therapy are essential. Treatment is based on the antibiotic therapy. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

Photodynamic therapy influence on anti-cancer immunity

NASA Astrophysics Data System (ADS)

Isaeva, O. G.; Osipov, V. A.

2010-02-01

The system of partial differential equations describing tumor-immune dynamics with angiogenesis taken into account is presented. For spatially homogeneous case, the steady state analysis of the model is carried out. The effects of single photodynamic impact are numerically simulated. In the case of strong immune response we found that the photodynamic therapy (PDT) gives rise to the substantial shrinkage of tumor size which is accompanied by the increase of IL-2 concentration. On the contrary, the photodynamic stimulation of weak immune response is shown to be insufficient to reduce the tumor. These findings indicate the important role of anti-cancer immune response in the long-term tumor control after PDT.

Photodynamic therapy influence on anti-cancer immunity

NASA Astrophysics Data System (ADS)

Isaeva, O. G.; Osipov, V. A.

2009-10-01

The system of partial differential equations describing tumor-immune dynamics with angiogenesis taken into account is presented. For spatially homogeneous case, the steady state analysis of the model is carried out. The effects of single photodynamic impact are numerically simulated. In the case of strong immune response we found that the photodynamic therapy (PDT) gives rise to the substantial shrinkage of tumor size which is accompanied by the increase of IL-2 concentration. On the contrary, the photodynamic stimulation of weak immune response is shown to be insufficient to reduce the tumor. These findings indicate the important role of anti-cancer immune response in the long-term tumor control after PDT.

Adult acute megakaryoblastic leukemia: rare association with cytopenias of undetermined significance and p210 and p190 BCR–ABL transcripts

PubMed Central

Trifa, Adrian; Selicean, Cristina; Moisoiu, Vlad; Frinc, Ioana; Zdrenghea, Mihnea; Tomuleasa, Ciprian

2017-01-01

Acute megakaryocytic leukemia (M7-AML) is a rare form of acute myeloid leukemia (AML), which is associated with poor prognosis. The case presented in the current report is a statement for the difficult diagnosis and clinical management of M7-AML in the context of a previous hematologic disorder of undetermined significance and associated genetic abnormalities. Probably, following the complete hematologic remission and further with induction chemotherapy plus tyrosine kinase inhibitor therapy, the clinical management of this case will be followed by a allogeneic bone marrow transplantation, the only proven therapy to improve overall survival. PMID:29089774

Chronic suppurative otitis media due to nontuberculous mycobacteria: A case of successful treatment with topical boric acid.

PubMed

Lefebvre, Marie-Astrid; Quach, Caroline; Daniel, Sam J

2015-07-01

Nontuberculous mycobacteria (NTM) are an increasingly recognized cause of chronic suppurative otitis media in children with tympanostomy tubes. Treatment of this condition is difficult and typically requires a combination of systemic antibiotics and surgical debridement. We present the first case of a 2-year-old male with chronic suppurative otitis media due to NTM who failed systemic antibiotic therapy and was successfully managed with topical boric acid powder. This report highlights the challenges involved in treating this infection, and introduces boric acid as a potentially valuable component of therapy. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Psychosis and concurrent impulse control disorder in Parkinson's disease: A review based on a case report.

PubMed

Guedes, Bruno Fukelmann; Gonçalves, Marcia Rubia; Cury, Rubens Gisbert

2016-01-01

Psychosis, impulse control disorders (e.g., pathological gambling and hypersexuality) and repetitive behaviors such as punding are known psychiatric complications of Parkinson's disease (PD). Impulsive, compulsive and repetitive behaviors are strongly associated with dopamine-replacement therapy. We present the case of a 58-year-old man with PD and a myriad of psychiatric symptoms. Concurrent psychosis, punding and pathological gambling developed more than six years after the introduction of pramipexole and ceased shortly after the addition of quetiapine and discontinuation of pramipexole. This report emphasizes the importance of monitoring for a wide array of psychiatric symptoms in patients on dopamine replacement therapy.

Endometrial Adenocarcinoma Presenting in a Premenopausal Patient with Tuberous Sclerosis

ERIC Educational Resources Information Center

Jaffe, J. S.; Chambers, J. T.

2005-01-01

Background: Endometrial adenocarcinoma is very uncommon in women under 40 years of age. Case: A 39-year-old woman with tuberous sclerosis and severe intellectual disability presented with irregular bleeding unresponsive to oral contraceptive therapy. She was subsequently found to have a deeply invasive endometrial adenocarcinoma. Conclusion:…

The Use of Music in Counseling Addictive Clients.

ERIC Educational Resources Information Center

Gallant, Wilfred; Siegel, Sammi; Holosko, Michael

1997-01-01

Explores a broad range of music interventions appropriate for addictive clients so as to fill a void in the music therapy and addictions counseling literature. Presents a rationale for the use of music intervention and presents case examples. Describes a social work intervention approach tested over a 10-year period. (RJM)

Resolving Relationship Problems in Communication Disorders Treatment: A Systems Approach.

ERIC Educational Resources Information Center

Stone, Judith R.

1992-01-01

Systems concepts from general systems theory and family therapy literature are presented as analytical tools to help professionals understand and change interactions with their clients having communication disorders. Two case examples that illustrate relationship problems are presented, and approaches taken to their resolution are described.…

Second-Degree Interatrial Block in Hemodialysis Patients

PubMed Central

Enriquez, Andres; D'Amato, Anna; de Luna, Antoni Bayes; Baranchuk, Adrian

2015-01-01

Interatrial conduction delays manifest as a prolonged P-wave duration on surface ECG and the term interatrial block (IAB) has been coined. They are usually fixed, but cases of intermittent IAB have been described, suggesting functional conduction block at the Bachmann bundle region. We report 2 cases of patients on chronic hemodialysis therapy presenting with intermittent IAB. PMID:25755895

A Single-Case Experimental Demonstration of Functional Analytic Psychotherapy with Two Clients with Severe Interpersonal Problems

ERIC Educational Resources Information Center

Oshiro, Claudia Kami Bastos; Kanter, Jonathan; Meyer, Sonia Beatriz

2012-01-01

Functional Analytic Psychotherapy (FAP) is emerging as an effective psychotherapy for psychiatric clinical cases. However, there is little research demonstrating the process of change of FAP. The present study evaluated the introduction and withdrawal of FAP interventions on therapy-interfering verbal behaviors of two participants who were in…

Use of musculoskeletal ultrasonography in the diagnosis of pes anserine tendinitis: a case report.

PubMed

Valley, V T; Shermer, C D

2001-01-01

A 45-year-old woman presented to the Emergency Department with a chief complaint of acute, nontraumatic medial knee pain. Musculoskeletal ultrasonography was performed, and the diagnosis of pes anserine tendinitis was elucidated. A discussion of this clinical entity, the characteristic ultrasonographic findings, and therapy follow in this case report.

MRI-Guided Laser Interstitial Thermal Therapy for Epilepsy.

PubMed

North, Robert Y; Raskin, Jeffrey S; Curry, Daniel J

2017-10-01

MRI-guided laser interstitial thermal therapy for epilepsy (LITT-E) has become an established, minimally invasive alternative to traditional epilepsy surgery. LITT-E is particularly valuable in cases in which open surgery poses unacceptably high morbidity or patient preference precludes craniotomy. Here we present a focused review of technical details and application of LITT to both focal and generalized epilepsy. Copyright © 2017 Elsevier Inc. All rights reserved.

Tapering chronic opioid therapy in neuropathic facial pain: an interdisciplinary approach.

PubMed

Chandwani, Brijesh P; Kulich, Ronald J; Andrew, Lainie; Scrivani, Steven

2008-01-01

This case report presents a patient with chronic orofacial pain who was considered to be an appropriate candidate for chronic opioid therapy, a treatment uncommonly considered at most facial pain centers. Her opioid treatment proved ineffectual, and conservative approaches were addressed. She was successfully tapered off the use of a long-acting opioid within a relatively short time, using an interdisciplinary approach involving an aggressive biobehavioral approach.

Response to apatinib in chemotherapy-failed advanced spindle cell breast carcinoma.

PubMed

Zhou, Na; Liu, Congmin; Hou, Helei; Zhang, Chuantao; Liu, Dong; Wang, Guanqun; Liu, Kewei; Zhu, Jingjuan; Lv, Hongying; Li, Tianjun; Zhang, Xiaochun

2016-11-01

Spindle cell carcinoma of the breast is a rare subtype of metaplastic carcinoma, and no effective chemotherapy special for metaplastic carcinoma exists until now. As spindle cell carcinomas of the breast are typically "Triple Negative", endocrine therapy and molecular therapy targeted to Her2 might not be favorable, resulting in poor prognosis. Apatinib is currently being tested in patients with breast or lung cancers. Here we report a successful case using Apatinib to treat spindle cell carcinoma of breast.A 52- year- old woman presented with a gradually enlarged lump in left breast, which was revealed to be a triple-negative spindle cell carcinoma, underwent a modified radical mastectomy. After the first line chemotherapy with Cyclophosphamide and Epirubicin, multiple metastases in bilateral lung and left anterior thoracic wall appeared. After disease progressed with therapy of Bevacizumab combined with Albumin-bound Paclitaxel and Cisplatin, we treated the patient with Apatinib according to her VEGFR expression, which showed nearly complete response and controllable and tolerated side effects. Next-generation sequencing analysis of the tumor specimen and real time ctDNA was performed to observe the mutated gene numbers matched with therapeutic effect. The present case can help to provide a new and effective therapy strategy to treat advanced spindle cell carcinoma.