Archives of Clinical and Medical Case Reports
EISSN : 2575-9655
Current Publisher: Fortune Journals (10.26502)
Total articles ≅ 349
Latest articles in this journal
Archives of Clinical and Medical Case Reports, Volume 05, pp 342-354; doi:10.26502/acmcr.96550365
Recently, we proposed the third entity of microscopic colitis (MC), termed colitis nucleomigrans (CN). The present review describes clinicopathological features of CN. CN shares clinical and endoscopic features of MC with collagenous colitis and lymphocytic colitis. We analyzed endoscopic biopsy specimens of nonspecific colitis clinically manifesting chronic watery diarrhea or inflammatory bowel disease (IBD)-like symptoms, but with minor endoscopic abnormality. The histopathological criteria of CN are as follows: a) chained nuclear migration to the middle part of the surface-lining columnar epithelia, b) apoptotic nuclear debris scattered below the nuclei, and c) mild to moderate chronic inflammation in the lamina propria. Thirty-three patients (M: F=20:13, median 63 years; range 17-88) fulfilled the above criteria. Seven cases accompanied MC-like clinical/endoscopic features. Mucosal reddening with or without erosions/aphthae was endoscopically observed in the remaining 26 cases with IBD-like clinical features: occult/gross hematochezia (n=19), abdominal pain (n=2) and mucin secretion (n=2). Apoptotic debris immunoreactive for cleaved caspase-3 appeared more frequently in IBD-like CN than in MC-like CN. CD8-positive intraepithelial lymphocytes were comparable in both types. Proton pump inhibitors (PPIs) were administered in five (71%) CN cases with MC-like features, and the diarrhea improved after cessation of PPIs in three. In IBD-like CN cases, eight (31%) received PPIs. Altered apoptotic processes in the colorectal surface-lining epithelia, predominantly with a debris pattern of apoptosis, may be involved in the pathogenesis. Mechanisms of nuclear migration to the unusual position and the impairment of nuclear anchoring to the basal situation in the surface-lining epithelia remain to be established.
Archives of Clinical and Medical Case Reports, Volume 05, pp 355-360; doi:10.26502/acmcr.96550366
Acral syringotropic melanoma with eccrine duct hyperplasia (ASMEDH) is rare. We describe ASMEDH arising in the right sole of a Japanese woman aged 80’s. On a 15 x 10 mm-sized, irregular-shaped pigmented macule, the dermoscopy indicated pararrel ridges. The lesion was removed surgically. No nodal swelling was noted. Microscopically, the pigmented melanoma cells were distributed not only in the basal epidermis but also in the cutaneous sweat gland duct. The melanoma cells were positive for HMB45, melan A, S-100 protein, bcl-2, vimentin, CD5 and SOX10, but negative for CKs and adipophilin. Ki-67 labeling was around 10%. In the dermis, basal cells immunoreactive for cytokeratin (CK) 34βE12, CK5/6 and p40 surrounded the intraductally spreading melanoma cells and ductal lumina were frequently located in the center. Invasive growth was absent. The surgical margins were negative. The patient did not receive adjuvant chemotherapy, and she is doing well eight months after surgery. Our final diagnosis was ASMEDH, melanoma in situ, the third case in the world.
Archives of Clinical and Medical Case Reports, Volume 05, pp 325-341; doi:10.26502/acmcr.96550364
Objectives: In this single-subject experimental design study, we investigated the effect of late-phase stroke rehabilitation on gait pattern. Methods: A subgroup from a previous clinical study, four men in the chronic phase after stroke, received 3 weeks of enriched and task-specific therapy (ETT) consisting of task-specific exercise, socialization, sensory and cognitive stimulation in a Mediterranean climate. Spatiotemporal gait variables, kinematics and symmetry were measured before and after the intervention in an advanced gait laboratory. Statistical significance was determined with the two-standard deviation band method. Results: Subject 1 had kinematic improvements (increased knee flexion during swing and dorsiflexion during stance) and spatiotemporal gains (increased speed, double-limb support, stride length and cadence) after ETT. Subject 2 had improved swing time symmetry ratio but no spatiotemporal or kinematic improvements. Subject 3 had gains in speed, stride width and length, and knee flexion during swing. Subject 4 had a change in cadence but no gain in kinematics, nor symmetry. Conclusions: Two of the four participants had significant improvements in gait kinematics, symmetry, and spatiotemporal variables after the intervention. Future research should consider the potential effects of ETT with the aim of validating the conclusions that can be drawn from this study.
Archives of Clinical and Medical Case Reports, Volume 05, pp 314-324; doi:10.26502/acmcr.96550363
Introduction: Influenza A (H1N1) virus have been a serious problem in 2009, which was considered as a pandemic and caused the death of more than 12000 people. Pneumonia is the most common complication of influenza infection and can be seen as viral pneumonia and/or bacterial coinfection. However, since November 2019, the world has been exposed to a new pneumonia agent named SARS - CoV - 2 from the Coronavirus family. In this case series, we aimed to re-evaluate the cases we followed up in the intensive care unit due to severe pandemic Influenza A infection between November 2019 and March 2020 from the Covid-19 perspective. Cases: There were five cases diagnosed with pandemic influenza A (H1N1) pneumonia in intensive care between November 2019 and March 2020, and the average age was 50. Given the risk factors two patients had immunosuppression and two patients had diabetes. Fever, respiratory distress and cough were the most prominent symptoms, and involvement in both lungs was detected in all patients on radiological imaging. Unfortunately, all patients had died despite antiviral therapy, antibiotic treatment against secondary bacterial infection, hemodynamic and respiratory support treatments. Discussion: Considering the literature, covid-19 and influenza co-infections have been detected in 34 cases since November 2019. In general terms, covid-19 and influenza tables are similar, with slight differences. In this case we look back to our findings, similar cases are considered as covid-19 under current conditions.
Archives of Clinical and Medical Case Reports, Volume 5, pp 182-192; doi:10.26502/acmcr.96550345
Introduction: Patent ductus arteriosus (PDA) is common in preterm neonates. Indomethacin and ibuprofen are commonly used for medical closure of patent ductus arteriosus. This study aims to evaluate the safety and efficacy of ibuprofen for treatment of PDA in very low birth weight (VLBW) infants. Methods: A retrospective audit of VLBW infants who received ibuprofen for treatment of PDA in a single centre between March 2010 and December 2014 was conducted. Infants with hemodynamically significant PDA were treated with intravenous or oral ibuprofen after echocardiographic evaluation. Response to treatment was documented with follow up echocardiography. The baseline patient characteristics, the ductal closure rate, adverse effects and need for PDA ligation were analysed. Results: Total of 138 VLBW infants received ibuprofen. 108 infants with birth weight ranging from 430-1500g received intravenous ibuprofen (group 1) and 30 infants with birth weight ranging from 661-1483g received oral ibuprofen (group 2). The closure rate of PDA was 50.9% (55/108) in-group 1 and 43.3% (13/30) in-group 2. Necrotizing enterocolitis or spontaneous intestinal perforation was observed in 11.1% (12/108) of group 1 and 10% (3/30) of group 2 infants. PDA ligation rate was 20.4% (22/108) in-group 1 and 6.7% (2/30) in-group 2. Conclusion: The closure rate of PDA following intravenous ibuprofen was 50.9% in VLBW infants. Serious gastrointestinal adverse effects occurred in 10-11% of infants treated with ibuprofen. Relatively lower closure rates and serious gastrointestinal adverse effects should be considered when treatment decisions are made for closure of PDA with ibuprofen.
Archives of Clinical and Medical Case Reports, Volume 5, pp 193-203; doi:10.26502/acmcr.96550346
FAM20A is a Protein Coding gene. It acts as an allosteric activator of the Golgi serine/threonine protein kinase FAM20C and is involved in biomineralization of teeth. A novel homozygous deletion mutation in exon 11 of FAM20A has been described in five members from a large consanguineous Bedouin family, all five with hypoplastic-hypocalcified AI and unerupted and crown resorbed permanent molars, a very rare phenotype. Deciduous mandibular canines and first molar, and maxillary first and second molars of an affected girl were compared to normal pair-matched teeth. Slices of the teeth were examined using SEM, and the ion content of enamel and dentine was determined using Energy Dispersive X-ray Spectrometer (EDS). The deciduous teeth showed missing enamel and the dentin was hypercalcified with very few open tubuli. Calcium and phosphorous percentages were reduced by 45 % in the enamel, and extensive apposition of secondary dentin and calcification of the pulps was observed. The permanent dentition showed impacted molars, premolars and canines with hypoplastic enamel and reduced dimensions of the erupted teeth. The mutation of FAM20A caused a peculiar type of AI with very thin amorphic enamel, infraoccluded deciduous teeth and impacted permanent canines, premolars and molars.
Archives of Clinical and Medical Case Reports, Volume 5, pp 129-136; doi:10.26502/acmcr.96550337
Herein, we first reported a case of undifferentiated sarcoma with epithelioid features harboring TFE3 amplification. A 66-year-old woman with a history of chronic lymphocytic leukemia and chemotherapy presented with a 4 cm palpable nodule in the left lower leg. Microscopically, the large epithelioid tumor cells with remarkable pleomorphism and the small round tumor cells intermingled with each other in a diffuse sheet or a hemangiopericytoma-like vascular growth pattern. Atypical mitotic figures and lymph node metastasis were found while tumor necrosis was absent. Immunohistochemically, the tumor was positive for vimentin, TFE3, and CD34. TFE3 gene amplification was identified by fluorescence in situ hybridization. The patient was alive and well without recurrence or metastasis for 12 months after tumor resection. The tumor should differentiate from PEComa, alveolar soft part sarcoma, epithelioid sarcoma, epithelioid angiosarcoma, and epithelioid rhabdomyosarcoma.
Archives of Clinical and Medical Case Reports, Volume 5, pp 96-100; doi:10.26502/acmcr.96550332
Hemophagocytic lymphohistiocytosis (HLH) is a rare and severe condition of immune dysregulation characterized by severe organ damage induced by a hyperinflammatory response and uncontrolled T-cell and macrophage activation. Secondary HLH, also known as macrophage activation syndrome, commonly presents in adulthood and characterized by acquired immune dysfunction in response to infections, malignancies, or autoinflammatory/autoimmune disorders. Secondary HLH induced by regorafenib has not been yet described. Here we report a case of HLH induced by regorafenib, confirmed by clinical, laboratory and histopathological findings, with typical results on bone marrow aspiration.
Archives of Clinical and Medical Case Reports, Volume 5, pp 118-128; doi:10.26502/acmcr.96550336
Natural products are able to inhibit radiation effects and exert an antitumor effect with fewer adverse reactions; however, their antitumor effects are less than those of widely-used synthetic drugs. Flavonoid is a natural material that has attracting attention, and we extracted this material with alcohol and investigated the effect of continuous flavonoid administration on radioactivity-induced reduction of hemocytes, in addition to the antioxidant and antitum or effects of flavonoid. Following a 1-week adjustment period, flavonoid was administered intraperitoneally to male ICR mice at a dose of 100 mg/kg every other day for 2 weeks. Following administration, 2 Gy whole-body irradiation was performed and the counts of leukocytes, lymphocytes, and granulocytes and monocytes in the peripheral blood were determined 1, 3, 7, 15 and 30 days after irradiation. These cells were considered since they are closely associated with immunity to radioactivity. In a second experiment, flavonoid was similarly administered to the mice for 2 weeks after a 1-week adjustment period, and 2 Gy whole-body irradiation was performed. The antioxidant effects in hemocytes were then investigated using 2,2'-azobis (2-amidinopropane) dihydrochloride (AAPH), a radical generator. In a third experiment, 1×106 Sarcoma-180 cells were inoculated into the right thigh of mice, which were divided into four groups: control, flavonoid-treated, 6 Gy irradiated and Flavonoid-treated + 6 Gy irradiated groups, and changes in tumor size were measured for 20 days. Statistical analysis was conducted using ANOVA for multiple groups. In the three experiments, administration of Flavonoid inhibited the reduction of hemocytes caused by whole-body irradiation, showed antioxidant effects against radioactivity, and inhibited tumor growth, respectively. In conclusion, our data suggest that the antioxidant effect of Flavonoid inhibits hemocyte reduction caused by whole-body irradiation and enhances immunological inhibition of tumor growth.
Archives of Clinical and Medical Case Reports, Volume 5, pp 143-147; doi:10.26502/acmcr.96550339