by Hamza Hashmi MD and Umayr Azimi MD
Case Report
Reactive thrombocytosis refers to elevated platelet count in the absence of a myeloproliferative or myelodysplastic syndrome and is secondary to a medical or surgical condition. Extreme thrombocytosis (>1000) is unlikely to be autonomous in origin and an underlying reactive process should be strongly suspected. A 22 year old apparently healthy male presented with fatigue of five months duration. Labs showed marked hypochromic microcytic anemia with hemoglobin of 5 g/dL, extremely high platelet count of 1600 x 109 and undetectable ferritin. Upper and lower GI scopes failed to reveal any source of bleeding. Ultrasound abdomen revealed mildly enlarged spleen. Besides markedly increased megakaryopoesis, erythropoesis and low iron stores; bone marrow biopsy did not reveal any myelodysplasia. Patient was transfused 4 units of Packed RBC with rapid improvement of hemoglobin and platelet count within one week. Villous atrophy on duodenal biopsy and elevated tissue transglutaminase antibody levels confirmed diagnosis of celiac disease. Patient was started on iron supplements and gluten free diet. Follow up in 3 months revealed completely normal hemoglobin, ferritin level and platelet count. Extreme thrombocytosis should raise suspicion for a secondary cause rather than a primary myeloproliferative disorder. Iron deficiency anemia, a relatively rare but benign cause should be strongly considered in work up of reactive thrombocytosis. Atypical forms of celiac disease can be relatively asymptomatic. If clinical suspicion is high serum antibody assay and intestinal biopsy should be considered. The case illustrates rare constellation of extreme thrombocytosis from iron deficiency anemia in an otherwise asymptomatic celiac disease patient.why do men cheat on their girlfriends
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American Journal of Medical Case Reports. 2015, 3(6), 184-186. DOI: 10.12691/ajmcr-3-6-10
Pub. Date: June 07, 2015
16041 Views4831 Downloads8 Likes
by Umayr Azimi and Hamza Hashmi
Case Report
Coronary arteries normally traverse the epicardium of myocardial tissue. Myocardial bridging occurs when a portion of coronary artery passes intramurally through myocardial tissue. We present a case of pulseless arrest during a bike race in an otherwise healthy individual. Coronary angiography showed extensive myocardial bridging of the mid-LAD and mild anteroapical hypokinesis. The case demonstrates situations when myocardial bridging may be of clinical significance.adult fetish stories
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American Journal of Medical Case Reports. 2015, 3(6), 181-183. DOI: 10.12691/ajmcr-3-6-9
Pub. Date: June 05, 2015
12472 Views3973 Downloads4 Likes
by Narjust Duma MD, Zhen Wang MD and Claudia Miranda MD
Case Report
Breast cancer has a predilection for spreading to the bone, brain, liver and lung, however metastasis to bone marrow resulting in bone marrow failure is considered rare. Here, we discuss a case of breast cancer presenting with bone marrow involvement and diffuse bone lytic lesions. The patient was an81 year old female presenting with back pain in the lumbar region for four months, progressively worsening despite physical therapy and oral analgesics. She was referred for magnetic resonance image which revealed diffuse bone lytic lesions. Follow up computed tomography of chest, abdomen and pelvis confirmed bone lesions but was negative for any primary malignancy. Peripheral blood studies showed white blood cell count of 4.5x 10³/µL, hemoglobin of 6.6g/dL, hematocrit of 21% and platelet count of 120.000/µL. She also had renal dysfunction with creatinine of 1.41mg/dL and calcium of 9.8mg/dL. Due to concern for a plasma cell neoplasia, the patient was referred to our oncology clinic. Physical examination was unremarkable and peripheral blood studies revealed IgG 1411mg/dL, IgA 292mg/dL, IgM 122mg/dL with undetectable serum and urine M spikes. She underwent a bone marrow biopsy which was negative for multiple myeloma but showed a neoplastic component in the marrow (approximately 5%) positive for Pan-Keratin, GATA3, ER and Cyclin D1, consistent with mammary carcinoma. During further questioning, she reported a normal screening mammogram one year prior to the onset of symptoms. Positron emission tomography (PET)was remarkable for extensive bony metastatic disease and a heterogeneous hyper-metabolic adrenal mass concerning for metastasis. She was started on endocrine therapy with a daily aromatase inhibitor and monthly Denosumab for bone metastasis. At her six month follow up, PET-scan showed stable disease. Currently, she remains on the same hormonal regimen with monthly follow up at the oncology clinic.why does my boyfriend cheat
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American Journal of Medical Case Reports. 2015, 3(6), 177-180. DOI: 10.12691/ajmcr-3-6-8
Pub. Date: May 27, 2015
13475 Views3762 Downloads3 Likes
by HAMZA HASHMI MD and UMAYR AZIMI MD
Case Report
Heparin induced thrombocytopenia is a rare complication of heparin therapy that usually occurs within initial 5 to 10 days of heparin exposure. We present a rare case of delayed onset heparin induced thrombocytopenia that occurred one week after cessation.adult fetish stories
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American Journal of Medical Case Reports. 2015, 3(6), 174-176. DOI: 10.12691/ajmcr-3-6-7
Pub. Date: May 26, 2015
12596 Views4092 Downloads5 Likes
by GUÈYE ML, TOURÉ AO, KONATÉ I, SECK M, THIAM O, CISSE M, KÂ O, DIENG M, DIA A and TOURÉ CT
Case Report
Background: The management of pancreatic pseudocyst involves several treatment options. Among them figure predominantly the surgical, endoscopic and percutaneous drainages. Conservative management is a therapeutic alternative especially for small sized pseudocysts. Larger cysts, more than 6 cm in diameter, are usually treated surgically. However, it had been reported some cases of large-sized pancreatic pseudocyst that had regressed spontaneously. It raises the question about the systematic treatment in large-sized pancreatic pseudocyst. Case presentation: A 55-year-old man who had a 40-year history of alcoholism and a medical history of acute pancreatitis 3 weeks prior to his presentation was sent for an abdominal exploration by CT scan. The CT scan showed a pancreatic pseudocyst of 13 cm in diameter. Meanwhile the patient was just complaining of epigastric pain that was well managed by analgesics. A conservative management was then decided. At the follow-up, CT scan was realized at the 1st, the 3rd and the 5th month. It showed a decreasing of the size of the cyst. Moreover, the CT scan done 3 years after the onset, showed a strictly normal pancreatic parenchyma. Conclusion: Conservative management is a feasible alternative therapy in large pancreatic pseudocysts, bearing in mind a rigorous clinical and radiological monitoring of the patient.forced sex with siblings stories
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American Journal of Medical Case Reports. 2015, 3(6), 170-173. DOI: 10.12691/ajmcr-3-6-6
Pub. Date: May 26, 2015
14174 Views3581 Downloads15 Likes
by JaeWook Jung, YuCheol Kim and Kwang Soo Kim
Case Report
A 62-year-old-male presented at our clinic with decreased vision and metamorphopsia(OD) for several days. He had received an anti-fungal treatment two months before for the treatment of endogenous candida choroiditis (OU). Fluorescein angiography and optical coherence tomography revealed subfoveal, juxtafoveal choroidal neovascularization and tractionalposterior hyaloidmembrane (OD). Pars planavitrectomy and epiretinal membrane removal was done, and twointravitrealbevacizumabinjections were administered. His visual symptoms were not improved and chorioretinal scar and fibrotic change were detected at fovea.free malayalam hot sex stories
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American Journal of Medical Case Reports. 2015, 3(6), 167-169. DOI: 10.12691/ajmcr-3-6-5
Pub. Date: May 25, 2015
10368 Views3287 Downloads3 Likes
by Narjust Duma MD, Dhruvesh Patel and Thayer Nasereddin
Case Report
Plasmacytomas located in the central nervous system are rareentities; with no pathognomonic clinical or radiologic features histology is required for a definite diagnosis. We present a case of a dural plasmacytoma as the manifestation of disease recurrence in a patient with systemic multiple myeloma. 51 year old male with history of IgG kappa myeloma, who underwent complete remission after an autologous bone marrow transplant presented to the clinic 10 months post-remission complaining of a “head mass”. On physical examination, he was found to have a large soft mass in the parietal area. On MRI the lesion was described as an extra-axial mass, 5.5 cm x5cm diameter, with diffuse enhancement of the dura. Biopsy of the mass revealed anextramedullary plasmacytoma. At that time, his M spike and immunoglobulins levels were unremarkable. Several months after the presentation of the parietal mass, the patient developed recurrence of disease. He underwent a second autologous bone marrow transplant that markedly improved the size of the plasmacytoma. Patient achieved a complete remission after the second transplant. However, 6 months later the dural plasmacytoma increased in size and once again and his myeloma markers remained within normal levels. Unfortunately, recurrence of the multiple myeloma occurred several months later and despite several cycles of chemotherapy, the patient continued to have progression of disease. He then decided for a more conservative treatment and was sent to home hospice. Central nervous system plasmacytomas can present as solitary lesions or as part of systemic multiple myeloma, these tumors tend to have a direct relationship with the activity of the disease and can present as an early sign of recurrence despite normal multiple myeloma markers on peripheral blood.catch a cheat
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American Journal of Medical Case Reports. 2015, 3(6), 163-166. DOI: 10.12691/ajmcr-3-6-4
Pub. Date: May 22, 2015
16154 Views4414 Downloads6 Likes
by Jonathan Powell and Emanuel Ebin
Case Report
Isolated cardiac sarcoidosis is a rare but life threatening sub classification of sarcoidosis. The symptomology can range from incidental asymptomatic disease to a life threatening disorder causing sudden cardiac death [3]. Conduction disorders are a well documented manifestation of cardiac sarcoid, however a lesser studied yet life threatening problem includes granulomatous involvement of the myocardium leading to heart failure and cord rupture. Early diagnosis and initiation of appropriate treatment are paramount in preventing destruction of myocardial tissue and improving the survival rate of this unique patient population. We present a case of an otherwise healthy young adult male that presented with acute decompensated heart failure with complete bi-valve failure requiring urgent cardiac surgery.why does my boyfriend cheat
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American Journal of Medical Case Reports. 2015, 3(6), 160-162. DOI: 10.12691/ajmcr-3-6-3
Pub. Date: May 22, 2015
10223 Views2911 Downloads5 Likes
by Dhrubajyoti Bandyopadhyay, Adrija Hajra, Sabyasachi Mukhopadhyay, Vijayan Ganesan, Manaslayek, Debarati Bhar, Diptak Bhowmick, Cankatikachoudhury and Partha Sarathi Karmakar
Case Report
We report a case of hemolytic anemia as an initial manifestation of hepatitis A virus infection. On admission, the patient had anemia, reticulocytosis, and direct and indirect hyperbilirubinemia. On subsequent examination, he had both glucose-6-phosphate dehydrogenase deficiency (G6PD) and autoimmune antibodies.why do men cheat on their girlfriends
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American Journal of Medical Case Reports. 2015, 3(6), 158-159. DOI: 10.12691/ajmcr-3-6-2
Pub. Date: May 22, 2015
10218 Views3282 Downloads6 Likes
by Dhrubajyoti Bandyopadhyay, Vijayan Ganesan, Debarati Bhar, Sibnarayan Sasmal, Adrija Hajra, Cankatika choudhury, Diptak Bhowmick and Partha Sarathi Karmakar
Case Report
15 years aged young girl was admitted with acute pain abdomen with distension, vomiting and fever. Patient was very sick and investigations, both blood and imaging of abdomen were suggestive of pancreatitis. This acute condition was soon followed by acute nephritis within a day or two and was established due to systemic lupus erythematosus through various investigations. Then we started treatment with high dose steroid and patient showed dramatic improvement. As a rare complication of SLE, acute pancreatitis presents as generalized flare-ups in most patients previously diagnosed with SLE. But acute pancreatitis as an initial feature of a multisystem disorder of SLE is rare and physician should remain aware of this clinical entity.catch a cheat
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American Journal of Medical Case Reports. 2015, 3(6), 155-157. DOI: 10.12691/ajmcr-3-6-1
Pub. Date: May 15, 2015
10502 Views2820 Downloads14 Likes