Outside of Cases: News, blogs & case reports round-up

Peanut allergy lessened with early consumption: An interesting study comparing the diets of Israeli and British infants suggests that the consumption of peanuts early in life may be linked to a decreased risk of peanut allergy.

Hormone-replacement therapy linked to breast cancer risk? Data presented at a recent cancer conference in San Antonio, USA, suggests that women who have been taking the hormone replacement drug ‘Wyeth’s Prempro’ for a long period of time could have a doubled risk of breast cancer.

Amputation by text message: An incredible story of how a surgeon carried out an emergency limb amputation on a 16-year old boy in the Democratic Republic of Congo, using instructions sent via text message from a London surgeon.

Women ‘may face greater HIV risk’: Research from Northwestern University in Chicago has shown that the HIV virus can breach even healthy vaginal tissue. It was previously thought that only damaged skin inside the vagina could provide a route for infection.

Full face transplant complete: The first almost full-face transplant to be carried out in America is now complete. 80% of the female patients face was replaced with that of a deceased donor.

The right to health: Cases Journal editor-in-chief Dr Richard Smith writes a fascinating blog for BMJ on the ‘right’ to health.

New online test for depression: Researchers at UCL (University College of London) have developed a new universal online test for predicting the risks of someone succumbing to depression.

Frost bite autoamputation of toes: case report: Cases Journal reports the unusual case of a 15 year old girl who suffered autoamputation of left mid foot and four digits of the right foot following repeated application of snow to relieve the pain in her frost bitten feet.

Man roused from coma with magnetic field: case report: New Scientist recently published the case of a 26 year old male who was roused from a coma following a series of transcranial magnetic stimulation (TMS) sessions.

Top ten self-surgeries: Continuing on from the top ten lists of the last news updates, here is a list of the top ten incredible self-surgeries, (see picture left) compiled by listverse.

Steroid abuse scars young bodybuilder

Following a report published last week in Journal of Medical Case Reports on a 24-year-old man who experienced multiple organ failure after steroid abuse we thought we would share another case report on the subject. Published in The Lancet a few months ago this case describes a 21-year-old male presenting with deep, ulcerating sores on his chest and back after heavy steroid use.

After antiseptic and antibiotic treatment the wounds healed but the patient was left with permanent scars.

Dr Peter Arne Gerber, from the Department of Dermatology at Heinrich-Heine-University in Düsseldorf, Germany, warned that moderate amounts of the drug could cause big problems.The man did not stop taking the steroids once the skin problems developed because he was more concerned with losing muscle mass. He eventually stopped but by then it was found the steroid abuse had also caused a low sperm count and shrunken testicles.

Here is our round up of other interesting case reports, blogs and news features from the past week:

Brazilian boy survives rabies [22 Nov 08] – A 15-year-old boy from Brazil who contracted rabies from the bite of a vampire bat is recovering after doctors used the Milwaukee Protocol for treatment.

Stem-cell transplant seems to fend off HIV [14 Nov 08] – A bone marrow transplant using stem cells from a donor with natural genetic resistance to the AIDS virus has left an HIV patient free of infection for nearly two years

Michael Phelps and A.D.H.D: a discussion [24 Nov 08] – Did swimmer Michael Phelps succeed at the Olympics in spite of having attention deficit hyperactivity disorder — or partly because of it?

Half of primary-care doctors in survey would leave medicine [18 Nov 08] – In a survey of U.S. primary care physicians, nearly half the respondents said that they would seriously consider getting out of the medical business within the next three years if they had an alternative.

Case report of the week: bloody tears

The shocking case of a child who cries tears of blood every day was featured in newspapers a few weeks ago. The mother of the patient complained that “Every doctor tells us they’ve never seen anything like this before in all their many years of being a doctor”.

Last week, Cases Journal published a case report detailing the condition of a young girl who suffered subconjunctival hemorrhage, also leading to bloody tears.

An important lesson could be learnt from the publication of this case report. This gives us a poignant reminder of the central role that case reports can play in informing the medical community.

Read the case report in full here.

“Bloody tears and hematohidrosis in a patient of PF3 dysfunction: a case report” – Kusum L Mishra

by Lindsay Dytham – Editorial Assistant

Case report of the week: Denying blindness – a case of Anton’s syndrome

Anton’s syndrome (sometimes referred to as Anton-Babinski syndrome) is a recognised but rare condition of visual anosognosia, where patients with objective blindness deny their loss of vision.

Dr Maddula and colleagues provide an excellent, comprehensive description of the case of an 83-year-old woman who was found collapsed at her house. Following admission, she was observed “walking into objects and was clearly blind”. “When asked to comment on the doctor’s tie, she was quick with an answer, but one that was incorrect”. Although she would attempt to carry out the activities of daily living herself, “assistance was required to help her finish her meals”. Despite these symptoms, the “patient maintained she was able to ‘see’ things around her”.

The details provided in this case will be valuable to add to the limited literature available regarding this rare condition and could help doctors to correctly diagnose patients presenting with similar symptoms.

For all the clinical details, read the full case report here.

“Anton’s syndrome due to cerebrovascular disease: a case report“, September 2009 issue, Journal of Medical Case Reports.

Lindsay Dytham – Editorial assistant

Quick, dial 999!

Spotted anything unusual about today yet? Take a look at your calendar and you will see that today’s date is 9/9/9 – the ninth day of the ninth month of the ninth year!

And, so what is our 999th published article in Cases Journal? It was published in August:  Basal cell carcinoma treated successfully with combined CO2 laser and photodynamic therapy in a renal transplant patient: a case report

English ambulance

In the UK, 999 is also the  telephone number for our emergency services, so let’s remind ourselves of some great emergency medicine case reports we have published recently:

Life-threatening hyponatremia due to intravenous n-acetylcysteine treatment in an infant: a case report

Trans-arterial and trans-venous interventional radiology for an elderly patient with life-threatening pelvic injury after accidental falling due to life-threatening cardiac arrhythmia: a case report

Low pressure hyperbaric oxygen therapy and SPECT brain imaging in the treatment of blast-induced chronic traumatic brain injury (post-concussion syndrome) and post traumatic stress disorder: a case report

An unusual presentation of non pathological delayed splenic rupture: a case report

Marathon related death due to brainstem herniation in rehydration-related hyponatraemia: a case report

Neck emergency due to parathyroid adenoma bleeding: a case report

The first case report of dental floss pick-related injury presenting with massive hemoptysis: A case report

Successful resuscitation of an elderly man with deep accidental hypothermia using portable extracorporeal circulation in the emergency department: a case report

Heart rate monitored hypothermia and drowning following a kayaking accident

Published in Cases Journal this week is the report of a 48-year old male Norwegian kayaker who capsized when paddling alone around an island in a Norwegian fjord. After managing to call for help on his mobile phone the kayaker lost consciousness and was found fifty minutes later by air ambulance floating, prone with his head submerged in sea water and was suffering from profound hypothermia with cardiopulmonary arrest. The kayaker was wearing a personal heart rate monitor/pulse watch.

Following cardiopulmonary resuscitation and warming, spontaneous circulation was achieved 3h 27 m after cardiac arrest occurred. The patient spent 21 days in intensive care but was discharged from hospital 32 days after the accident with impaired short term memory and spatial planning abilities. A year after the accident the patient had returned to a normal cognitive ability.

Aside from the patients lucky escape, this report is made particularly interesting by the collection of data from the patient’s mobile phone log, GPS data from the patient, GPS used in the helicopter, the patients pulse watch and medical records, allowing the authors to provide an interesting and detailed timeline of the patients heart rate as the incident unfolds.

Heart rate data - The graph shows the complete data of recorded heart rate for the whole kayak trip

Read the case in full here.

Title: “Heart rate monitored hypothermia and drowning in a 48-year-old man. survival without sequelae: a case report”

Authors: Fredrik Koller Lund, Johan G R Torgersen and Hans Kristian Flaatten

Richard Sear – Editorial Assistant – Cases Network

Cases Network – Image of the month

Every month we select an image from Cases Journal or the Journal of Medical Case Reports (JMCR) that we feel is that little bit extra special.

Below is our choice for this month:

Photograph showing the sigmoid colonic perforation. Figure taken from Joglekar et al., "Sigmoid perforation caused by an ingested chicken bone presenting as right iliac fossa pain mimicking appendicitis: a case report"

Sigmoid colonic perforation is an acute surgical emergency.

The patient in this case presented with a 3-day history of colicky generalised abdominal pain, gradually getting worse and eventually localising to the right iliac fossa (classical symptoms of acute appendicitis).

A provisional diagnosis of acute appendicitis was made, and consent was taken for appendicectomy. During the operation, a small (2 mm) perforation was found in the distal sigmoid colon through which a chicken bone was protruding outward.

Fewer than 1% of ingested foreign bodies will perforate the bowel. Although most sharp objects pass without complications, once beyond the oesophagus, they carry an increased risk of complications.

Diagnosis of an intestinal perforation can be difficult and the authors emphasise the need for a high degree of suspicion and awareness on the part of the clinician. They stress that situations such as these highlight the importance of obtaining full consent from the patients; this is particularly important when there is a diagnostic dilemma, as this may have future medico-legal implications. It is important to inform patients about an alternative diagnosis.

Our deputy editor said: “Excellent and intreresting case, also very well written“.

For all the clinical details, read the full case report here.

Title: “Sigmoid perforation caused by an ingested chicken bone presenting as right iliac fossa pain mimicking appendicitis: a case report”

Authors: Sandeep Joglekar, Iqbal Rajput, Sachin Kamat and Sarah Downey

To see a selection of our previous ‘Image of the month’ choices, visit our facebook site here.

For your chance to nominate a case report for the ‘Image of the month’, simply email us at: info@casesnetwork.com You can even nominate your own case!

Case report of the week: A rare case of primary lung cancer

Journal of Medical Case Reports (JMCR) publishes original and interesting case reports that expand medical knowledge and the newly published case by Syed Raza and colleagues, “Primary pulmonary mucinous cystadenocarcinoma presenting as a complex bronchocele: a case report”, is a great article to exemplify our journal’s scope.

There have only been 20 described cases of pulmonary mucinous cystadenocarcinoma (PMC) since it was first reported in 1978. PMC is a distinct but rare variety of lung cancer that, as with most lung cancers, predominantly occurs in older age and with a positive smoking history.

PMC is difficult to diagnose due to the scarcity of cancer cells present within the lesion. In this case the patient presented after collapsing and was diagnosed, based on CT findings, with a complex bronchocele (a dilation of the bronchus).  The patient went on to undergo open lung biopsy and histopathological testing that confirmed the diagnosis of PMC. This case is important in highlighting the need to consider primary PMC when investigating a suspicious bronchocele.

This case report is also excellent for its presentation of imaging and histological findings. Figure 3 from the article (below) is the view from the bronchoscopy that revealed the soft tissue lesion in the bronchus. It provides us with a very interesting insight into the investigation of such conditions.

Bronchoscopic view. Figure taken from Raza et al., "Primary pulmonary mucinous cystadenocarcinoma presenting as a complex bronchocele: a case report" in the August issue of JMCR

The deputy editor described this report as “an extremely interesting and well written case, that is most suitable for JMCR” . Visit the journal to view the full article of this case and more in the August 2009 issue.

Lindsay Dytham – Editorial Assistant, Cases Network

Inquest confirms death by soup and water diet

This week, BBC news covered the case of a 26-year-old woman who died after following a strict diet of soup and water.

The woman, 26, weighed 9st 2lb at the time of her death. She had lost six stone after dieting to lose weight she put on as a side effect of medication. The result of this extreme diet was a drastic lack of sugar leading to a metabolic chemical reaction called ketoacidosis – where the body attempts to recover the sugar loss by metabolising its own fat reserves.

Coroner Terence Carney recorded a verdict of accidental death and said he was certain she had no intention to cause herself harm.

The BBC report states: Mr Carney said: “This phenomenon – this poison if you like – which developed within her body was made by her body itself.

“It arises as a result of the body reacting to a lack of sugar within itself and that was in part a consequence of the intensive diet with which Helen was attempting to balance her weight.

“The sad truth of the matter is there has been a development within her body, a natural phenomena, which has set up this poisoning of her body’s system and has led to her death.

“It is a problem which can develop very rapidly and without the individual appreciating the consequences.”

This article reminded me of the Chalasani and Fischer case report published in Journal of Medical Case Reports last year, “South Beach Diet associated ketoacidosis: a case report“. A true and clinically relevent reflection of the dangers of restricting food intake? Or an unfortunate case for us all to learn from?

Update on oral medicine: the latest dental cases

Cases Network welcomes case reports from all areas of health care, and we’re pleased with how many cases are submitted from the fields of dentistry and oral medicine.

Here is an overview of some of our recent dental cases:

• Dental erosion caused by gastroesophageal reflux disease

A great case report on treatment for severe wearing of the teeth caused by gastroesophageal reflux disease and bruxism in a 54-year-old Turkish man. Here, the authors describe how the maxillary and mandibular anterior and posterior teeth were prepared for metal-ceramic restorations.

• Interdisciplinary approach for the treatment of periodontallycompromised malpositioned anterior teeth: a case report

In many adults with periodontal disease the positioning of teeth prevents proper cleaning. This case report gives an interdisciplinary (periodontic, orthodontic, restorative) approach for treatment.

• Treatment of horizontal root fracture: a case report

Cantore et al. report the case of a rare horizontal radicular fracture located between the middle- and apical-third of the upper left-central incisors followed-up over 4 years.

• Esthetic rehabilitation of crowded maxillary anterior teeth utilizing ceramic veneers: a case report

A 23-year-old Turkish woman with malaligned anterior teeth was rehabilitated with ceramic veneers due to her rejection of orthodontic treatment. Türkaslan and Ulusoy describe how ceramic veneers can be an alternative treatment to orthodontic therapy.

If you are interested in reviewing dental case reports for either journal, please get in touch!