http://www.jmedicalcasereports.com The most accessed research articles published by Journal of Medical Case Reports 2010-03-02T00:00:00Z This is an RSS newsfeed from BioMed Central It is intended to be used with an RSS reader. For more information about RSS newsfeeds from BioMed Central, visit http://www.biomedcentral.com/info/about/rss/ IntroductionA cutaneous horn is a conical projection of hyperkeratotic epidermis. Though grossly resembling an animal horn, it lacks a bony core. These lesions have been well described in Caucasian patients, as well as in a number of Arabic and Asian patients.Case presentationA young female presented with a large 'horn' of five-year duration, arising from a burn scar. Excision and scalp reconstruction were performed. Histology was reported as verrucoid epidermal hyperplasia with cutaneous horn. Conclusion: This may be the first documentation of this lesion in a black African. Although likely rare, it should be considered in the differential diagnosis of dermatologic lesions. Up to 40% of cutaneous horns occur as part of a premalignant or malignant lesion, and surgical extirpation with histological examination is thus more important than the curiosity surrounding these lesions. http://www.jmedicalcasereports.com/content/1/1/170 Peter Nthumba Journal of Medical Case Reports 2007, 1:170 2007-12-05T00:00:00Z doi:10.1186/1752-1947-1-170 Journal of Medical Case Reports 1752-1947 1 170 2007-12-05T00:00:00Z XML IntroductionThoracoabdominal aortic aneurysms usually present in elderly patients with serious renal, pulmonary, cerebral, or cardiac comorbidities that pose a great challenge to the attending surgeon. Endovascular techniques for the treatment of thoracoabdominal aneurysms are not yet widely used due to limitations associated with them, such as spinal and visceral ischemia.Case presentationAn 87-year-old Caucasian man with a symptomatic Crawford type I thoracoabdominal aortic aneurysm was treated successfully with a long tube stent graft using endovascular techniques and without any complication in follow-up examinations. The stent was placed distal to the left subclavian artery, and proximal to the celiac axis. Conclusion: The use of endovascular stents for long segment thoracoabdominal aortic aneurysms needs to undergo clinical investigation to determine whether this procedure decreases morbidity and mortality rates. http://www.jmedicalcasereports.com/content/4/1/37 Arash Mohammadi Tofigh Massoud Ghasemi Babak Heidari Aghdam Mersedeh Karvandi Afsoon Kaboli Journal of Medical Case Reports 2010, 4:37 2010-02-02T00:00:00Z doi:10.1186/1752-1947-4-37 Journal of Medical Case Reports 1752-1947 4 37 2010-02-02T00:00:00Z XML IntroductionIdiopathic intracranial hypertension can rarely be associated with an underlying endocrine disorder such as Cushing's syndrome, hyperthyroidism, or with administration of thyroxine or growth hormone. Though cases of idiopathic intracranial hypertension associated with Addison's disease in children have been reported, there is only one documented case report of this association in adults. We describe a case of an acute adrenal insufficiency precipitated by idiopathic intracranial hypertension in a Caucasian female.Case presentationA 24-year-old Caucasian woman was acutely unwell with a background of several months of generalised fatigue and intermittent headaches. She had unremarkable neurological and systemic examination with a normal computerised tomography and magnetic resonance imaging of the brain. Normal cerebrospinal fluid but increased opening pressure at lumbar puncture suggested intracranial hypertension. A flat short synacthen test and raised level of adrenocorticotrophic hormone were consistent with primary adrenal failure. Conclusion: Addison's disease can remain unrecognised until precipitated by acute stress. This case suggests that idiopathic intracranial hypertension can rarely be associated with Addison's disease and present as an acute illness. Idiopathic intracranial hypertension is possibly related to an increase in the levels of arginine vasopressin peptide in serum and cerebrospinal fluid secondary to a glucocorticoid deficient state. http://www.jmedicalcasereports.com/content/4/1/60 Dushyant Sharma Rohini Mukherjee Peter Moore Daniel Cuthbertson Journal of Medical Case Reports 2010, 4:60 2010-02-19T00:00:00Z doi:10.1186/1752-1947-4-60 Journal of Medical Case Reports 1752-1947 4 60 2010-02-19T00:00:00Z PDF IntroductionThe spinal cord is a target for many neurosurgical procedures used to treat chronic severe pain. Neuromodulation and neuroablation are surgical techniques based on well known specific anatomical structures. However, anatomical and electrophysical changes related to the tethered spinal cord make it more difficult to use these procedures.Case presentationWe report a 37-year-old Caucasian female patient who had several surgical interventions for a tethered cord syndrome, resulting in severe neuropathic pain in the lower back and right leg. This pain had been treated by spinal cord stimulation, using intra-operative sensory mapping, allowing the optimal placement in a more caudal position. Conclusion: The little more caudally-placed electrodes with low voltage use are specific remarks for this treatment in tethered cord syndrome. http://www.jmedicalcasereports.com/content/4/1/74 Maarten Moens Ann De Smedt Jan D'Haese Steven Droogmans Cristo Chaskis Journal of Medical Case Reports 2010, 4:74 2010-02-25T00:00:00Z doi:10.1186/1752-1947-4-74 Journal of Medical Case Reports 1752-1947 4 74 2010-02-25T00:00:00Z PDF IntroductionThe sensation of palpitations may either be the initial or the only symptom of cardiac arrhythmia. We describe a case of an apparent clear temporal relationship between standard ibuprofen dosing and palpitations. A review of the medical literature revealed this to be, to the best of our knowledge, the first reported case of this type.Case presentationA 13-year-old Caucasian girl initially presented to our clinic with hamstring tendinitis. She was commenced on a medication regimen of paracetamol and ibuprofen. After the third ibuprofen dose, she experienced palpitations. These were associated with lower chest and/or upper abdominal discomfort, and a feeling of being hot and sweaty. Her symptoms ceased upon the cessation of ibuprofen therapy. Conclusion: Cardiac arrhythmia is a potentially fatal disorder that may exhibit heart palpitations as its initial (or only) symptom. The prompt recognition of the cause of the symptom can reduce mortality and morbidity associated with any underlying pathological processes. There is a need to investigate cases of recurrent palpitations so as to exclude underlying structural cardiac pathology and/or abnormal cardiac rhythm. http://www.jmedicalcasereports.com/content/4/1/76 Robert Douglas Journal of Medical Case Reports 2010, 4:76 2010-03-02T00:00:00Z doi:10.1186/1752-1947-4-76 Journal of Medical Case Reports 1752-1947 4 76 2010-03-02T00:00:00Z PDF IntroductionThe occurrence of intussusception in adults is rare. The condition is found in 1 in 1300 abdominal operations and 1 in 100 patients operated for intestinal obstruction. The child to adult ratio is 20:1.Case presentationA 52-year-old Irish Caucasian woman was investigated for a 3-month history of intermittent episodes of colicky midgut pain and associated constipation. Ileocolonoscopy revealed a pedunculated lesion in the terminal ileum prolapsing into the caecum. Computed tomography confirmed a smooth-walled, nonobstructing, low density intramural lesion in the terminal ileum with secondary intussusception. A laparoscopic small bowel resection was performed. Histology revealed a large pedunculated polypoidal mass measuring 4 × 2.5 × 2 cm consistent with a submucosal lipoma. She had complete resolution of her symptoms and remained well at 12-month follow-up. Conclusion: This case highlights an unusual cause of incomplete small bowel obstruction successfully treated through interdisciplinary cooperation. Ileal lipomas are not typically amenable to endoscopic removal and require resection. This can be successfully achieved via a laparoscopic approach with early restoration of premorbid functioning. http://www.jmedicalcasereports.com/content/4/1/51 Noormuhammad Abbasakoor Dara Kavanagh Diarmaid Moran Barbara Ryan Paul Neary Journal of Medical Case Reports 2010, 4:51 2010-02-11T00:00:00Z doi:10.1186/1752-1947-4-51 Journal of Medical Case Reports 1752-1947 4 51 2010-02-11T00:00:00Z XML IntroductionMyasthenia gravis is a commonly undiagnosed condition in the elderly. Statin medications can cause weakness and are linked to the development and deterioration of several autoimmune conditions, including myasthenia gravis.Case presentationWe report the case of a 60-year-old Caucasian man who presented with acute onset of dysarthria and dysphagia initially attributed to a brain stem stroke. Oculobulbar and limb weakness progressed until myasthenia gravis was diagnosed and treated, and until statin therapy was finally withdrawn. Conclusion: Myasthenia gravis may be underappreciated as a cause of acute bulbar weakness among the elderly. Statin therapy appeared to have contributed to the weakness in our patient who was diagnosed with myasthenia gravis. http://www.jmedicalcasereports.com/content/4/1/61 Michael Keogh John Findlay Simon Leach John Bowen Journal of Medical Case Reports 2010, 4:61 2010-02-20T00:00:00Z doi:10.1186/1752-1947-4-61 Journal of Medical Case Reports 1752-1947 4 61 2010-02-20T00:00:00Z XML IntroductionHenoch-Schönlein purpura is a systemic disease with frequent renal involvement, characterized by IgA mesangial deposits. Streptococcal infection can induce an abnormal IgA immune response like Henoch-Schönlein purpura, quite similar to typical acute post-infectious glomerulonephritis. Indeed, hypocomplementemia that is typical of acute glomerulonephritis has also been described in Henoch-Schönlein purpura.Case presentationWe describe a 14-year-old Caucasian Spanish girl who developed urinary abnormalities and cutaneous purpura after streptococcal infection. Renal biopsy showed typical findings from Henoch-Schönlein purpura nephritis. In addition, she had low serum levels of complement (C4 fraction) that persisted during follow-up, in spite of her clinical evolution. She responded to treatment with enalapril and steroids. Conclusion: The case described has, at least, three points of interest in Henoch-Schönlein purpura: 1) Initial presentation was preceded by streptococcal infection; 2) There was a persistence of low serum levels of complement; and 3) There was response to steroids and angiotensin-converting enzyme inhibitor in the presence of nephrotic syndrome. There are not many cases described in the literature with these characteristics. We conclude that Henoch-Schönlein purpura could appear after streptococcal infection in patients with abnormal complement levels, and that steroids and angiotensin-converting enzyme inhibitor could be successful treatment for the disease. http://www.jmedicalcasereports.com/content/4/1/50 Francisco Rivera Sara Anaya Javier Perez-Alvarez M Sanchez de la Nieta M Vozmediano Julia Blanco Journal of Medical Case Reports 2010, 4:50 2010-02-11T00:00:00Z doi:10.1186/1752-1947-4-50 Journal of Medical Case Reports 1752-1947 4 50 2010-02-11T00:00:00Z XML Penile fracture is a rare condition. Primarily it is a rupture of the corpus cavernosum that occurs when the penis is erect. The rupture can also affect the corpus spongiosum and the urethra.We report a case of a 37 year old man who presented with acute penile pain, penile swelling and the inability to pass urine after a blunt trauma during sexual intercourse. In emergency surgery we found bilateral partial rupture of the corpus cavernosum with complete urethral and corpus spongiosum disruption. In the one year follow up the patient presented with normal erectile and voiding function.Emergency surgical repair in penile fracture can preserve erectile and voiding function. http://www.jmedicalcasereports.com/content/1/1/14 Klemen Jagodic Marko Erklavec Igor Bizjak Sandi Poteko Helena Korosec Jagodic Journal of Medical Case Reports 2007, 1:14 2007-05-02T00:00:00Z doi:10.1186/1752-1947-1-14 Journal of Medical Case Reports 1752-1947 1 14 2007-05-02T00:00:00Z XML IntroductionPurple Glove Syndrome is a devastating complication of intravenous phenytoin administration. Adequate analgesia and preservation of limb movement for physiotherapy are the two essential components of management.Case presentationA 26-year-old Tamil woman from India developed Purple Glove Syndrome after intravenous administration of phenytoin. She was managed conservatively by limb elevation, physiotherapy and oral antibiotics. A 20G intravenous cannula was inserted into the sheath of her brachial plexus and a continuous infusion of bupivacaine at a low concentration (0.1%) with fentanyl (2 μg/ml) at a rate of 1 to 2 ml/hr was given. She had adequate analgesia with preserved motor function which helped in physiotherapy and functional recovery of the hand in a month. Conclusion: A continuous blockade of the brachial plexus with a low concentration of bupivacaine and fentanyl helps to alleviate the vasospasm and the pain while preserving the motor function for the patient to perform active movements of the finger and hand. http://www.jmedicalcasereports.com/content/4/1/48 Georgene Singh Verghese Cherian Binu Thomas Journal of Medical Case Reports 2010, 4:48 2010-02-10T00:00:00Z doi:10.1186/1752-1947-4-48 Journal of Medical Case Reports 1752-1947 4 48 2010-02-10T00:00:00Z XML