by Nathaniel Moulton, Joe Devasahayam, Rohini Kannuswamy, Arul Chandran and Hunter Hofmann
Case Report
Renal Cell Carcinoma (RCC), the most lethal urological cancer has many variants. A relatively uncommon variant, sarcomatoid RCC (sRCC) is one of the most aggressive morphotypes of RCC. The complexity of this tumor is mainly due to the difficulty in its diagnosis as it can present with relatively subtle symptoms and quickly progress to very advanced stage with unusually rapid metastasis and could be fatal. We present a male patient with this rare tumor who initially presented with vague multi-system complaints. The patient rapidly deteriorated and expired following aggressive therapy and was subsequently found to have metastatic sRCC upon autopsy. We review the characteristic features of sRCC and analyze the clinical presentations, histology, prognosis as well as the atypical presentations of sRCC. This case therefore, highlights the difficulty of diagnosis prior to nephrectomy and reinforces the need for a high degree of suspicion for renal malignancies especially in the older patient.cialis coupons free
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American Journal of Medical Case Reports. 2016, 4(6), 221-223. DOI: 10.12691/ajmcr-4-6-10
Pub. Date: July 09, 2016
14789 Views3136 Downloads
by Gan Yuen Keat, Syed Shoeb Ahmad, Suresh Subramanian, Shuaibah Abdul Ghani and Amir Samsudin
Case Report
Iris cysts are uncommon ocular pathologies and their surgical excision is often difficult owing to their location and fragile nature. Herein, we report a patient who complained of progressive, painless blurring of vision in the left eye for six months. On examination, a large smooth non-transilluminant iris mass was seen extending from 11 o’clock to 5 o’clock region and touching the corneal endothelium. Surgical excision was performed and the patient’s vision improved from HM to 6/48.
American Journal of Medical Case Reports. 2016, 4(6), 218-220. DOI: 10.12691/ajmcr-4-6-9
Pub. Date: July 08, 2016
7985 Views2092 Downloads
by Haniyeh Amidfar, Heidarali Esmaeili, Mehrdad Yavarikia and Atiyeh Amidfar
Case Report
Background: Chondroblastoma is a rare benign cartilaginous neoplasm that considered for approximately 1% of all bone tumors and characteristically emerges in the epiphysis of a long bone, especially the hummeros, femurand tibia.Only rare cases have been reported in the diaphyseal region. Case Report: We report a case of diaphyseal one in a 13 years old girl that admitted ith brief pain and deformities in left leg. Radiographic examinations disclosed a multiloculated osteolytic lesion in left tibia. Conclusion: Histologicak findings revealed proliferation of polygonal cells in the cartigenous background with few Giant cells.coupons for prescription drugs
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American Journal of Medical Case Reports. 2016, 4(6), 215-217. DOI: 10.12691/ajmcr-4-6-8
Pub. Date: June 24, 2016
12369 Views2868 Downloads
by Hassan Tahir, Muhammad Ali Raza, Vistasp Daruwalla and Zeeshan Khakwani
Case Report
Neurological complications are the most frequent extra cardiac complications of infective endocarditis (IE) dominated by the stroke with a high mortality . These manifestations might be the first sign of IE in rare cases. Atrial fibrillation and infective endocarditis (IE) are two of the most common causes of cardio embolic strokes. The patients with infective endocarditis (IE) can present with variable symptoms ranging from vague complaints of fever and chills to any embolic complication. Duke’s criteria is the most common criteria used to diagnose infective endocarditis. We present a case of an acute ischemic stroke in a young patient, which was the sole presentation of subacute infective endocarditis associated with Enterococcus faecalis, thus leading to delayed diagnosis and treatment.bystolic generic name
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American Journal of Medical Case Reports. 2016, 4(6), 212-214. DOI: 10.12691/ajmcr-4-6-7
Pub. Date: June 22, 2016
12308 Views3442 Downloads24 Likes
by Felix Liauw, Windhi Kresnawati and Nastiti Kaswandani
Case Report
Immunocompromised patients are very prone to infection and sometimes result in death. Pneumocystis carinii pneumonia (PCP) is one of the opportunistic infections that affects lung. The frequency was high (80-88%). We reported 2 severe cases of PCP infection that remain survive. Case 1 is 8-year-old boy, post-liver transplantation, with PCP, pulmonary tuberculosis, cytomegalovirus infection, septic shock and severe malnutrition. Case 2 is 8-year-old girl, HIV positive, with PCP, respiratory failure, and severe malnutrition. These patients survived after adequate treatment of PCP and nutritional support. After 26 months of follow up, they are doing well with good nutritional status.coupons for prescription drugs
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American Journal of Medical Case Reports. 2016, 4(6), 208-211. DOI: 10.12691/ajmcr-4-6-6
Pub. Date: June 17, 2016
10593 Views3311 Downloads1 Likes
by M A Hannan, Imran Sarker, M. Fariduddin, Ayesha Begum, Shahadat Hossain and Nusrat Sultana
Case Report
Hashimoto’s thyroiditis (HT) is now considered as the most common autoimmune disease. Cerebellar ataxia can be a rare presentation of autoimmune (Hashimoto’s) thyroiditis. We reported a 26 year old lady presented with recurrent episodes of bilateral cerebellar ataxia without any other neurological features. She was euthyroid but having very high circulating antibodies specially anti-thyroid peroxidase (TPOAb) antibodies suggestive of Hashimoto’s thyroiditis.cialis dosage levels
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American Journal of Medical Case Reports. 2016, 4(6), 204-207. DOI: 10.12691/ajmcr-4-6-5
Pub. Date: June 17, 2016
14931 Views4213 Downloads1 Likes
by Sharmin- Jahan, Hasanat MA, Nusrat- Sultana, Shadequl-Islam AHM, Satyajit- Mallick, Saifur-Rahman M and Fariduddin M
Case Report
Primary growth hormone resistance or growth hormone insensitivity syndrome (GHIS), also known as Laron syndrome, is a hereditary disease caused by deletions or different types of mutations in the growth hormone receptor gene or by post-receptor defects. This disorder is characterized by a clinical appearance attributable to severe growth hormone deficiency with high levels of circulating growth hormone in contrast to low serum insulin-like growth factor-1 (IGF-1) and low serum insulin-like growth factor binding protein (IGFBP-3)values. It is an autosomal recessive disorder and to date, more than 70 unique growth hormone receptor (GHR) mutations have been identified in more than 250 GHIS patients. We report the case of an 8-year-old boy and his 12-year-old sister born to first cousin parent that presented with severe short stature who had the classic feature of GH deficiency. Investigations revealed high plasma GH levels in both the cases. Subsequently, IGF-1 and IGFBP-3 assay were done and the levels were found to be very low. These reports along with elevated GH level in the context of typical picture of GH deficiency confirmed the diagnosis of GHIS. Genetic testing could not be done because of unavailability in our context. Regrettably specific therapy in the form of recombinant IGF-1 could not be offered as it is not commercially available in our country.prescription transfer coupon
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American Journal of Medical Case Reports. 2016, 4(6), 198-203. DOI: 10.12691/ajmcr-4-6-4
Pub. Date: June 13, 2016
25289 Views4598 Downloads6 Likes
by Ali Mahad Musallam Al-Mashani, Neeraj Salhotra, Azmat Ali, Aziz Haris, Rashid M Khan and Naresh Kaul
Opinion Paper
Craniectomy with or without cervical laminectomy is a well-recognized treatment option for patients with symptomatic Chiari malformation. However, performing craniectomy removes the protection of the suboccipital cranial bone while laminectomy may limit cervical spine movement. We undertook a retrospective study of seventeen patients who underwent conventional craniectomy and cervical laminectomy or cranioplasty alone for correction of Chiari malformation. The objective was to present cinical outcome and complications when the Chiari malformation was corrected by conventional craniectomy/ laminectomy or craniotomy alone. In the craniotomy group with eleven patients, the inside of the suboccipital bone was resurfaced prior to replacing it thereby creating space for the cerebrospinal fluid to flow after adhesionolysis and careful resection/ shrinkage of subpial tonsils without performing laminectomy. Craniectomy and C1-C2 laminectomy was done in six patients as per standard procedure. At a variable followup period of 10 years after the surgery, we did not observe any difference in clinical outcome between the two groups. The resolution of syrinx was 54.5 % in the craniotomy group as compared to 66.7% in the craniectomy/ laminectomy group, while it persisted unchanged in one patient in each group. CSF leak was noted in 2 patients in each group. Reduction of symptoms like headache, neck pain or paresthesia showed reduction in intensity in all patients except paresthesia that persisted in 1 patient of the craniotomy group. The finding of this study suggests that performing craniotomy alone is as effective as craniectomy/ laminectomy in terms of outcome and relief of signs and symptoms of Chiari malformation.drug coupon card
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American Journal of Medical Case Reports. 2016, 4(6), 193-197. DOI: 10.12691/ajmcr-4-6-3
Pub. Date: June 07, 2016
15412 Views3606 Downloads
by Luv Sharma, Tarun Dagar and Vincent Merry
Case Report
Intravascular bullet embolism is a rare phenomenon encountered during autopsies of firearm fatalities. In cases where the victim has died due to firearm wounds, single entrance wounds without exits necessitate locating the bullet/projectile inside the body. This task gets tricky if the projectile enters a blood vessel and further embolises onwards with the flow of blood. We present a case of a firearm wound over the upper back with the projectile piercing the arch of aorta. Radiological investigations including CT–chest proved blank for locating any bullet inside the body. Emergency sternotomy was done but surgical exploration couldn’t find the missing bullet and the patient later succumbed to internal blood loss. Pre-autopsy x-ray showed a hypo-dense metallic shadow in the lower middle abdomen slightly to the left. The missing bullet was located inside the lumen of the common iliac artery during autopsy after tracing the track from the wound in the arch of aorta downwards. A brief summation of diagnostic & treatment protocol and autopsy findings is presented.prescription transfer coupon
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American Journal of Medical Case Reports. 2016, 4(6), 190-192. DOI: 10.12691/ajmcr-4-6-2
Pub. Date: June 04, 2016
12841 Views3185 Downloads
by Ali Akbar Esmailiejah, Ali Keipourfard and Yasamin Hashemi
Case Report
Background: Patellar fracture accounts for approximately 1% of all skeletal fractures. Bilateral fracture of the patella is even rarer, comprising less than 3% of all patellar injuries. Case Description: A 28 year old man presented with bilateral patellar fracture after car accident and direct dashboard injury while driving, with superficial abrasion on both fracture sites. Mentioned fracture had transverse fracture pattern which was fixed with two Kirschner wire following tension band principle. Our patient was able to squat, sit in crossed leg position and perform his household activities by the end of 2nd month. He regained his full strength and ability to perform normal daily activities by the end of 6th months, without any post-operative complaints. Discussion: A case of bilateral patellar fracture as a consequence of dashboard injury is presented and pathomechanical and operative management and follow up of such injuries is discussed.
American Journal of Medical Case Reports. 2016, 4(6), 186-189. DOI: 10.12691/ajmcr-4-6-1
Pub. Date: June 02, 2016
15879 Views4606 Downloads