HHV 6–7 reactivation causing Pityriasis Rosea and labyrinthitis: A case report

Pityriasis Rosea (PR) and labyrinthitis are most commonly caused by viral infections. PR presents with a characteristic rash while labyrinthitis presents with vertigo, tinnitus and hearing loss. However, the coexistence of PR and Labyrinthitis remains an uncommon event. Human Herpes Virus (HHV) 6 and 7, are common infections in childhood, and their reactivation causes Pityriasis Rosea. But these viruses are not known to have any involvement with the inner ear or the 8th cranial nerve (CN).     

A cause for concern? Osteopoikilosis found incidentally in the emergency department: a case report

Osteopoikilosis is a rare, inherited bone disorder, which is usually found incidentally on x ray. It may be mistaken for other, more serious disorders such as bony metastases, causing undue distress to the doctor and patient.     

Can a giant cervical osteophyte cause dysphagia and airway obstruction? A case report

Cervical spondylosis is a common disorder mainly affecting elderly people. It frequently presents with excessive bone formation (osteophytes). These may lead to pain and neurological deficits due to root compression. Dysphagia and airway obstruction due to a giant anterior osteophyte of the cervical spine are extremely rare. We present the case of an 81-year-old patient suffering from dysphagia and slight dyspnoea due to a giant cervical osteophyte. Osteophyte resection was performed and the patient was relieved from symptoms. This case highlights that a large cervical osteophyte may, albeit rarely, be the cause of simultaneously presenting dysphagia and dyspnoea, and should, therefore, be included in the diagnostic workup in such cases.     

Large leiomyoma of lower esophagus diagnosed by endoscopic ultrasonography–fine needle aspiration: A case report

BACKGROUNDBenign esophageal tumors are rare accounting for < 1% of esophageal tumors; two-thirds of which are leiomyomas. Esophageal leiomyoma is a benign tumor derived from mesenchymal tissue that is completely muscularly differentiated. Most esophageal leiomyomas are < 5 cm. Esophageal leiomyomas > 5 cm are rare. We describe a case of a large esophageal leiomyoma involving the cardia and diaphragm.CASE SUMMARYA 35-year-old woman presented to the doctor because of a choking sensation after eating. Physical examination showed no positive signs. Gastroscopy indicated an uplifted change in the cardia. Enhanced computed tomography revealed space-occupying lesions in the lower part of the esophagus and cardia, which were likely to be malignant. Positron emission tomography–computed tomography showed increased metabolism of soft tissue masses in the lower esophagus and near the cardia. Malignant lesions were considered, and mesenchymal tumors were not excluded. Endoscopic ultrasonography was performed to examine a hypoechoic mass in the lower esophagus, which was unclear from the esophageal wall. Clinical evaluation suggested diagnosis of esophageal and cardiac stromal tumors. Finally, histological specimens obtained by endoscopic ultrasonography– fine needle aspiration suggested leiomyoma. The patient underwent laparoscopic local resection of the tumor. The postoperative pathological diagnosis was leiomyoma.CONCLUSIONEndoscopic ultrasonography-fine needle aspiration is necessary for the diagnosis of gastrointestinal leiomyomas. It provides a strong basis for diagnosis of gastrointestinal tumors of unknown nature and origin.     

Use of the INDEPENDENCE 3000 IBOT™ transporter at home and in the community: A case report

The INDEPENDENCE? 3000 IBOT? Transporter (IBOT), as an electronically stabilized mobility device for people with disabilities. The purpose of this study was to gain experience with the IBOT? at home and in the community using an expert wheelchair user, who used the device as his primary mobility device for 1 week. This case report is based upon observations by trained clinicians, and a diary recorded by the primary author a male manual wheelchair user with traumatic spinal cord injury at the T7/8 level. The subject was 41 years of age and 21 years post SCI at the time of the study. The participant was employed and lived in a ranch style accessible home. The subject used the devices to perform a variety of activities including holding eye-level discussions with colleagues and shopping by balancing on two wheels, going up and down steep ramps, traversing outdoor surfaces (e.g., grass, dirt trails) and climbing curbs. The balance and four-wheel drive functions were helpful and worked well. The IBOT was somewhat difficult to control in standard function. The seat height was too high for most tables and desks encountered, and transfers were notably more difficult than with other wheelchairs. It was difficult to use the IBOT in the bathroom, and the subject preferred to use his personal wheelchairs for transfers into the shower. The IBOT was a functional mobility device, its greatest strengths are outdoors and in circumstances where there is space to use balance function.     

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

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.     

Emergency department initiation of cardiopulmonary bypass: a case report and review of the literature

Background

Out-of-hospital cardiac arrest carries a dismal prognosis. Percutaneous extracorporeal membrane oxygenation (ECMO) has been used with success for in-hospital arrests, and some literature suggests improvement in long-term survival for out-of-hospital arrests as well.

Objectives

This case highlights the use of ECMO in the emergency department.

Case Report

We report a case in which emergency physician-initiated ECMO was used as a bridge to definitive care in an out-of- hospital cardiac arrest in the United States.

Conclusions

ECMO is a novel adjunct for patients in cardiac arrest in whom the usual advanced life support techniques have failed.     

Unusual complication in patient with Gardner’s syndrome: Coexistence of triple gastrointestinal perforation and lower gastrointestinal bleeding: A case report and review of literature

Gardner’s syndrome (GS) is a rare syndrome with autosomal dominant inheritance, which is characterized by multiple intestinal polyps, dental anomalies, desmoid tumors, and soft tissue tumors. All gastrointestinal symptoms seen in GS are associated with the underlying familial adenomatosis polyposis and abdominal desmoid tumors, with the most common symptoms being anemia, lower gastrointestinal bleeding, abdominal pain, diarrhea, obstruction, and mucous defecation. To our best knowledge, no case of GS that has presented with gastrointestinal perforation and bleeding has ever been reported in the English language medical literature. A 37-year-old male who had been diagnosed with GS five years earlier was referred to our clinic for lower gastrointestinal bleeding. Despite the absence of a bleeding focus on conventional angiography, the patient was operated on with laparotomy, due to the persistence of both signs and symptoms of mild peritonitis. On the laparotomy, the patient was noted to have areas of perforation in the duodenum, splenic flexura, and mid-rectum. The third and fourth part of the duodenum, the proximal 15 cm segment of the jejunum, a 10 cm segment of the terminal ileum, the whole colon, and the upper and middle rectum were resected, and duodeno-jejunal side-to-side anastomosis and terminal ileostomy were performed. The histopathological analysis of the large mass measuring 30 cm × 20 cm was reported as a desmoid tumor. The pathological examination of the tumor foci detected in the colonic specimen revealed poorly differentiated adenosquamous carcinoma.     

Oral rehabilitation of a Parkinson’s patient: A case report

Parkinson’s disease is an idiopathic disorder of the central nervous system, characterized by resting tremors, muscular rigidity, slow and decreased movements. Oral rehabilitation of these patients requires special care, especially in those cases where the patient’s socioeconomic status is not good and patient cannot come several times for fabrication of a complete denture. This clinical report presents a case of a Parkinson’s patient who was completely rehabilitated in 3 appointments using special techniques. Border molding, final impression and jaw relation procedures were done in one appointment by using a custom tray with detachable handles and occlusal rims.     

Validity and test–retest reliability of a measure of hand sensibility and manual dexterity in people with multiple sclerosis: the ReSense test

Abstract

Purpose: To evaluate the concurrent validity and reliability of the ReSense tool, a new clinical test aimed at determining sensory and functional deficits of the hand in people with multiple sclerosis (PwMS). Methods: Study participants included 90 PwMS, 58 women, characterized by significant sensory symptoms in one or both hands. Thirty healthy subjects, 19 women, served as controls. The ReSense evaluation tool measures the ability to perceive and recognize texture and spatial properties of specific elements. ReSense scores were compared with the two-point discrimination (2PD), Semmes–Weinstein monofilament (SWM), Nine-Hole Peg Test (9-HPT), Box and Block Test (BBT) and the Functional dexterity (FDT) tests. Results: The Cronbach alpha value for the ReSense test for PwMS was 0.84. The ReSense was significantly correlated with the 9-HPT; Pearson's R?=??0.44 and FDT; Pearson's R?=??0.35. Significant correlations were demonstrated between the ReSense score to SWM and 2PD. The strongest correlation was found with the 2PD performed on the dominant hand; Pearson's R?=??0.55. Conclusions: The ReSense is a valid tool developed for testing sensing properties of the hand in PwMS. We believe that the sensitivity and specificity values of this tool will assist the clinician to formulate decisions related to rehabilitation management of his/her patient.

• Implication for Rehabilitation

• The ReSense, a valid and reliable tool was developed for testing sensing properties of elements with hand manipulation in the clinic.

• The ReSense test score was significantly correlated with scores of manual dexterity and traditional sensibility tests.

• A continuous scale such as the ReSense test may provide clinicians with more precise information relating to hand performance in PwMS than traditional sensory tools.

     

Sarcomatoid carcinoma of the pancreas — a rare tumor with an uncommon presentation and course: A case report and review of literature

BACKGROUNDSarcomatoid carcinoma of the pancreas (SCP) is a rare type of pancreatic neoplasm, and only a few cases have been described in the literature. Histologically, it is composed mostly of atypical spindle cells with apparent sarcomatous features.CASE SUMMARYThis is a report of a 61-year-old Chilean woman who underwent medical investigation for acute abdominal pain. Computed tomography identified a solid tumor in the tail of the pancreas with features suspicious of malignancy. En-bloc distal pancreatectomy and splenectomy were performed to excise the tumor. Histopathology and immunohistochemistry were confirmatory of sarcomatoid carcinoma with lymphovascular invasion. After surgery, the patient did not receive chemotherapy. Previous studies indicate a poor prognosis for this type of malignancy. However, our patient has survived for 35 mo with no recurrence to date.CONCLUSIONThe case presented herein is a patient with an SCP with a rare presentation and long-term survival after surgery despite not receiving adjuvant chemotherapy.     

Does noninvasive ventilation work in ARDS? A case report and review of the current literature

The role of noninvasive positive pressure ventilation (NIPPV) in adult respiratory distress syndrome (ARDS) is controversial, in contrast to its well established benefits in other types of respiratory failure, especially acute exacerbations of chronic obstructive pulmonary disease and cardiogenic pulmonary oedema. We report a case of ARDS caused by Mycoplasma pneumoniae in a 70 year old man, treated with NIPPV in addition to standard medical therapy and analyse current evidence regarding the role of NIPPV in patients with ARDS.     

Müllerian adenosarcoma of the ovary: case report and review of the literature

Müllerian adenosarcoma is a rare neoplasm that can arise in both uterine and extrauterine locations. This report describes the ultrasound and magnetic resonance imaging findings of one case of ovarian adenosarcoma and reviews the literature as to the previously described imaging findings. Adenosarcoma should be considered in patients with a predominantly solid pelvic mass on imaging, particularly in those with a history of endometriosis or findings compatible with endometriosis on ultrasound or magnetic resonance imaging. A very low resistive index on ultrasound may also be suggestive of this diagnosis.