Schwannoma of the breast presenting as a painful lump: A case report

Rationale:Schwannoma in the breast parenchyma is very unusual. It usually develops on the head, neck, and extensor surfaces of the upper and lower extremities.Patient concerns:We report a case of a 60-year-old woman with a palpable and painful mass. Clinically, she experienced neuropathic pain at the mass site.Diagnoses:The tumor was a 1 cm, well-circumscribed mass, and revealed schwannoma on core needle biopsyInterventions:The patient underwent wide excision.Outcomes:No postoperative complications were observed. A six-month follow-up revealed no recurrenceLessons subsections:Although breast schwannoma is a very rare tumor, it is a very important consideration in case of a Breast Imaging-Report and Data System 4A lesion with a painful and palpable mass.     

Treatment for a eumycetoma infection caused by Aspergillus in an immunocompromised host: a case report

Eumycetoma is a chronic infection of the skin and subcutaneous tissue caused by filamentous fungi, which usually occurs in tropical or subtropical countries. We report a case of an immunocompromised patient presenting with presumed eumycetoma in the United States and his subsequent treatment with voriconazole. The use of voriconazole and liposomal amphotericin B halted the progression and allowed gradual resolution of the infection. The patient will require close monitoring and long‐term therapy with voriconazole to obtain a clinical cure. Voriconazole and liposomal amphotericin B are potential initial treatment options, with long‐term voriconazole maintenance therapy, for an Aspergillus‐induced eumycetoma.     

Ultrasound imaging for the rheumatologist XXXIV. Sonographic assessment of the painful foot

The foot is increasingly the focus of attention for rheumatologists when assessing patients presenting to a clinic and may represent underlying intra-articular inflammatory pathology or involvement of the surrounding soft tissues. This study describes the correlation between clinical and ultrasound (US) findings in patients presenting with a variety of rheumatic disorders linked with foot pain. Poor correlation was found between conventional clinical examination and US in cases with joint inflammation, tendonitis and, more particularly, those cases with enthesopathy.     

A systematic approach to medical decision-making of uncommon clinical pictures: a case of ulcerative skin lesions by palm tree thorn injury and a one-year follow-up

In clinical practice, the clinician is challenged with symptoms and/or signs at times apparently insoluble by diagnostic and/or therapeutic means. We propose that in these cases, we have to use an EBM approach in which evidence may be looked up in every available clinical report and bibliographic databases are used for searching that evidence. We report on a case of ulcerative skin lesions apparently insoluble by expert dermatologists following a conventional diagnostic and therapeutic process. We use this case report for illustrating a systematic approach to resolve diagnostic and therapeutic questions using a bibliographic database search (like MEDLINE and EMBASE). Both a systematic approach to bibliographic databases and a critically appraised topic on case reports (or case series) are needed to 'rehabilitate' low-level evidences (that is a case report or case series) to a higher level when we approach decision-making of uncommon clinical pictures. We demonstrate the possibility of using bibliographic databases to search and retrieve useful information for decision-making of uncommon clinical pictures. The method we have proposed can be applied in every area of the world, especially in rural areas. Finally, an Internet-shared database of uncommon clinical pictures with critically appraised topics could be useful in saving more time.     

A case of painful progressive peripheral neuropathy after successful pancreas transplantation

A 30-year-old female with diabetes type 1 of 26 years underwent simultaneous pancreas and kidney transplantation. In spite of good function of both organs she developed a pseudotabetic polyneuropathy of a diabetic type.     

糖尿病足混合感染1例及文献复习

在糖尿病足形成的三大病理(缺血、神经病变和感染)中,感染被认为是最重要的环节。通常,轻度的局灶性浅表溃疡是由革兰阳性需氧球菌(如金黄色葡萄球菌或链球菌)引起;而深部溃疡则由多种细菌混合感染所致,病原菌除了革兰阳性球菌外,还包括革兰阴性杆菌(大肠埃希菌、克雷伯菌、产气肠杆菌、奇异变形杆菌和铜绿假单孢菌等)和厌氧菌(脆弱类杆菌和消化链球菌)等[1]。临床上,由于创面感染无法控制,最终导致截肢的病例屡见不鲜(约90%的糖尿病性截肢与感染相关[2]),给患者带来了巨大的身心痛苦和负担。由此,控制感染在糖尿病足患者的治疗中至关重要,而早期准确分离并确定致病菌对感染控制非常重要,有助于指导临床医师精准使用敏感抗生素,从而降低中远期并发症,提高临床治疗效果。     

Neuropathic diabetic foot ulcers treated with cerium dioxide nanoparticles: A case report

Wound healing in diabetes is frequently impaired and its treatment remains a challenge. The ability of topical application of cerium (Ce) dioxide nanoparticles (CNPs) to accelerate wound healing in an animal model provides a rationale to develop this technology for use in humans affected by traumatic injury, diabetes and burns. We first described a case report of successful topical treatment of neuropathic diabetic foot ulcers with novel gel containing CNPs. The CNPs has bacteriostatic activity, anti-inflammatory properties and can penetrated into the wound tissue and reduced oxidative damage therefore protect regenerative tissue, suggesting a therapeutic potential for topical treatment of diabetic foot ulcers.     

Plant thorn synovitis: an uncommon cause of monoarthritis

Plant thorn synovitis (PTS) is an uncommon cause of monoarthritis. Seven cases of PTS were identified at our institution from January 1979 to July 1990, six of whom were men. Mean age was 27 years (range, 7 to 56 years). Symptoms included pain, swelling, and stiffness. Synovitis was present on examination along with decreased range of motion of affected joints in all patients. Roentgenograms were unremarkable in five patients, but disclosed demineralization in two others. Initial conservative treatment with nonsteroidal antiinflammatory drugs (NSAIDs), antibiotics, or splinting was usually unsuccessful; surgery was necessary in six patients. Findings included marked inflammatory synovial reactions with evidence of retained thorn in all patients. One patient had a positive operative wound culture (Enterobacter agglomerans) without evidence of osteomyelitis. All patients improved after surgery without sequelae. Despite a history suggesting thorn injury in many cases, diagnosis was often delayed; mean time to diagnosis was 10 weeks (range, 2 weeks to 9 months). PTS must be included in the differential diagnosis of monoarthritis. Histologically, PTS can mimic sarcoidosis, tuberculosis, or fungal infection. Optimal treatment of PTS is arthrotomy, foreign body removal, and extensive synovectomy.