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Importance of dysphagia examination in patient with dermatomyositis: Case report  [PDF]
Ra?kovi? Sanvila,Bolpa?i? Jasna,Tomi?-Spiri? Vesna,Stefanovi? Ljiljana
Medicinski Pregled , 2012, DOI: 10.2298/mpns1210432r
Abstract: Introduction. Polymiositis belongs to the group of inflammatory myopathies which are manifested by muscle weakness of the shoulder blade and pelvic region. The presence of typical skin manifestations is suggestive of dermatomyositis. These patients may also develop dysphagia (10-54%) as a result of involvement of the oropharyngeal and upper oesophageal striated muscles. Dermatomyositis may also be associated with another systemic disease or malignancy. Case Report. Hereby is presented the case of a 42-year-old female patient hospitalized at the Department of Allergy and Immunology, Clinical Center of Serbia for the shoulder blade and pelvic muscle weakness and pains in the small and large joints, eyelid edema, facial and neckline redness, difficult swallowing and loss of body mass. Based on the presence of proximal muscle weakness, increased enzyme serum levels (lactic acid dehydrogenase, glutamic-oxalacetic transaminase), positive electroneuromyography findings, typical skin changes and positive muscle biopsy, the patient was diagnosed to have dermatomyositis. Both radioscopy and esophagography revealed some disturbances in all phases of swallowing, absence of all primary and secondary peristaltic waves accompanied by contrast medium aspiration. Additionally, esophageal manometry proved the absence of esophageal peristalsis. Additional examinations ruled out the presence of any malignancies. The patient underwent glycocorticoid and azatioprim treatment along with specific dietary regimen, symptomatic and physical therapy, which led to favorable clinical outcome. Conclusion. Dermatomyositis-associated dysphagia may lead to severe complications such as cachexia and aspiration pneumonia. In addition to the management of underlying disease, the treatment includes special dietary regimen, rehabilitation and even interventional surgical procedures, if necessary.
Breast cancer in pregnancy; routine examination, diagnosis and management: A case report  [PDF]
Anne-Beatrice Kihara, Kiarie Gladwell, Cheserem J. Eunice, Amin Medhat, Bashir Issak, Rogena Emily, Kosgei J. Rose
Case Reports in Clinical Medicine (CRCM) , 2013, DOI: 10.4236/crcm.2013.22031

Pregnancy associated breast cancer is defined as breast cancer diagnosed during pregnancy or in the first postpartum year. The incidence is rare; however it is important to be aware of its occurrence with the increased challenges posed by delays in diagnosis, treatment and optimization of maternal and fetal outcomes. The case report presented is of a 36 years old, Para 0 + 2 known diabetic and hypertensive pregnant woman, first seen in the antenatal clinic at 14 weeks of gestation. The patient requested for a breast examination following National campaigns conducted during the International Breast Cancer Awareness month. The examination revealed a grossly enlarged right breast with “peau de orange” skin changes. The patient eventually underwent radical mastectomy. Histopathology revealed a grade 3 invasive ductal carcinoma with lymphovascular invasion (Stage TNM). This case is presented to highlight missed opportunities in antenatal clinic settings for screening, diagnosis and treatment of cancer of the breast in pregnancy. The role of a multidisciplinary approach to management has also been emphasized.

Transcranial Doppler Ultrasound Examination Of The Circulation Of Cerebral Arteries –Case Report  [PDF]
Sinisa Djuricic,Milovan Savic,Sanja Slavujevic,Cedomir Jacimovic
Aktuelnosti iz Neurologije, Psihijatrije i Grani?nih Podru?ja , 2011,
Abstract: Use of the noninvasive Doppler Ultrasound examination method for diagnostics of cerebral circulation is very common because it allows quick evaluation; it is cost efficient and easy to use. It represents the imperative in diagnostics, caretaking, monitoring and treatment of patients with different vascular disorders of the brain, as well as in the prospective treatment of patients with a risk of stroke. In this paper described is the use of Transcranial Doppler (TCD) method in the research of cerebral arteries circulation, at the department of neurology in Doboj General Hospital. A total of 114 patients was examined (66 men and 48 women), mean age 61.5 for men and 60.5 years for women. According to the diagnostics of the resident doctors, the frequency structure for neurological disorders was dizziness with or without instability, and the occurrence of tinnitus for 46 patients (40.35%), for 28 patients (24.56%) it was VB insufficiency with or without signs of the brain stem damage, for 20 of them (17.54%) the main symptom was headache, for 12 patients (10.53%) were the stroke symptoms or the consciousness disturbances, while in 8 cases (7.02%) sought answers about the nature of disorder on the basis of TCD examination. Pathology findings was found in 16 patients (11 women and 5 men), out of which four were referred for additional magnetic-resonance testing and MR angiography: three were examined completely with confirmed diagnostics of TCD examination. Presented in this paper is a patient with von Reklinghausen's disease, Arachnoid cysts on both sides and changes on extra and endocrinal brain arteries. Our initial experience with this method of testing the cerebral arteries function proved to be practically usable and very useful in diagnostics, and according to the complexity of the disorder for indicating of the additional diagnostics and determining its treatment.
Severe acute cholangitis after endoscopic sphincterotomy induced by barium examination: A case report  [cached]
Zhen-Hai Zhang,Ya-Guang Wu,Cheng-Kun Qin,Zhong-Xue Su
World Journal of Gastroenterology , 2012, DOI: 10.3748/wjg.v18.i39.5658
Abstract: Endoscopic sphincterotomy (EST) is considered as a possible etiological factor for severe cholangitis. We herein report a case of severe cholangitis after endoscopic sphincterotomy induced by barium examination. An adult male patient presented with epigastric pain was diagnosed as having choledocholithiasis by ultrasonography. EST was performed and the stone was completely cleaned. Barium examination was done 3 d after EST and severe cholangitis appeared 4 h later. The patient was recovered after treated with tienam for 4 d. Barium examination may induce severe cholangitis in patients after EST, although rare, barium examination should be chosen cautiously. Cautions should be also used when EST is performed in patients younger than 50 years to avoid the damage to the sphincter of Oddi.
Oncoplastic Surgery in Japanese Patients with Breast Cancer Close to the Areola: Partial Mastectomy Using Periareolar Mammoplasty: A Case Report
Yuko Kijima,Heiji Yoshinaka,Munetsugu Hirata,Tadao Mizoguchi,Sumiya Ishigami,Akihiro Nakajo,Hideo Arima,Shinichi Ueno,Shoji Natsugoe
Case Reports in Surgery , 2011, DOI: 10.1155/2011/121985
Abstract: We report the results of oncoplastic surgery in two Japanese patients with early breast cancer. Their breasts were large and ptotic, and their lesions, which were close to the areola, were considered to be suitable for breast conservative surgery. Oncoplastic surgery involving partial resection of the gland and a periareolar mammoplasty were performed. The technique was easy to perform, and the cosmetic outcome was excellent.
Uterine metastasis of invasive ductal breast carcinoma diagnosed by cytological examination in an asymptomatic patient: an unusual case report  [cached]
?a?da? Türky?lmaz,?brahim S. Serin,I??n Soyuer,Bülent ?z?elik
Erciyes Medical Journal , 2007,
Abstract: Uterine metastasis of malignant tumors occurs very rarely. Despite abnormal uterine bleeding is the most common symptom of metastatic uterine disease, less than 5% of patients may have not any gynecologic symptoms and diagnosis is made usually following abnormal cervical cytology. Here we present a case of uterine metastasis of invasive ductal breast carcinoma that was diagnosed by cervical cytological examination during breast cancer follow up. Even if there are not any gynecologic symptoms and findings in a patient who has breast cancer history, a detail systematic pelvic examination of these patients must be done yearly.
Patent Vitellointestinal Duct: A Close Differential Diagnosis of Umbilical Granuloma: A Case Report and Review of Literature  [PDF]
Saurabh Piparsaliya, Milind Joshi, Nitin Rajput, Priti Zade
Surgical Science (SS) , 2011, DOI: 10.4236/ss.2011.23027
Abstract: Umbilical granuloma is a very common cause of umbilical discharge. It is managed by chemical cauterization or simple thread ligation. However, it can be a differential diagnosis of patent vitello intestinal duct and this should be ruled out before managing such patients. We report a case of a 10-week-old male infant referred by his General Practitioner for silver nitrate cauterisation, with a diagnosis of suspected umbilical granuloma (UG). The child underwent subsequent exploratory laparotomy and bowel anastomosis.
A novel approach to sonographic examination in a patient with a calf muscle tear: a case report
Carl PC Chen, Simon FT Tang, Chih-Chin Hsu, Ruo Li Chen, Rex CH Hsu, Chin-Wen Wu, Max JL Chen
Journal of Medical Case Reports , 2009, DOI: 10.4076/1752-1947-3-7291
Abstract: A 60-year-old man in good health visited our rehabilitation clinic complaining of left calf muscle pain. On suspicion of a ruptured left medial head gastrocnemius muscle, a soft tissue ultrasound examination was performed. An ultrasound examination revealed symmetrical findings of bilateral calf muscles without evidence of muscle rupture. A roentgenogram of the left lower limb did not reveal any bony lesions. An ultrasound examination one week later also revealed negative sonographic findings. However, he still complained of persistent pain in his left calf area. A different ultrasound examination approach was then performed with the patient lying in the supine position with his knee flexed at 90 degrees. The transducer was then placed pointing upwards to examine the muscles and well-defined anechoic fluid collections with areas of hypoechoic surroundings were observed.For patients suffering from calf muscle area pain and suspicion of tennis leg, a soft tissue ultrasound is a simple tool to confirm the diagnosis. However, in the case of negative sonographic findings, we recommend trying a different positional approach to examine the calf muscles by ultrasound before the diagnosis of tennis leg can be ruled out.Rupture of the distal musculotendinous junction at the medial head of the gastrocnemius muscle is known as "tennis leg" [1,2]. The occurrence of tennis leg is relatively common in athletes who perform sudden acceleration and deceleration maneuvers. The classic clinical manifestation of tennis leg is that of a middle-aged person who complains of acute sports-related pain in the middle portion of the calf muscle associated with a snapping sensation [3]. Imaging tools such as computed tomography (CT), magnetic resonance imaging (MRI) and ultrasound (US) can be used for the diagnosis of tennis leg. Presently, US is most economical and has been used as the primary imaging technique for evaluating patients suffering from tennis leg and other muscle ruptures [1,4].Wh
Vacuum-assisted breast biopsy in close proximity to the skin: a case report
Flora Zagouri, Theodoros N Sergentanis, Dimitra Koulocheri, Georgia Giannakopoulou, Aphrodite Nonni, Dimitrios Dardamanis, Nikolaos V Michalopoulos, Ioannis Flessas, John Bramis, George C Zografos
Journal of Medical Case Reports , 2008, DOI: 10.1186/1752-1947-2-165
Abstract: A 53-year-old woman presented with a newly developed, non-palpable lesion in her left breast. The lesion consisted of widely spread microcalcifications located approximately 5 mm from the skin. The lesion was isoechoic on ultrasound examination. Vacuum-assisted breast biopsy was scheduled (on the Fischer's table, using 11-gauge probes, under local anaesthesia). The vacuum-assisted breast biopsy probe was inserted antidiametrically into the breast, the probe reached the lesion and effort was made to excise the microcalcifications. As only a small proportion of the microcalcifications were excised an accurate diagnosis could not be expected. However, with the probe having entered the breast antidiametrically, the probe tip underlying the skin could be palpated. Following the palpation of the tip, the exact point was marked by a pen, the probe was removed and the patient was transferred to the surgery room to have the remaining lesion removed by a spindle-form excision under local anaesthesia. The mammogram of the removed specimen confirmed the total excision of the suspicious microcalcifications.Isoechoic superficial lesions can be localized with a hook-wire and open breast biopsy under general or local anaesthesia can be performed. However, vacuum-assisted breast biopsy might offer an alternative solution and serve as an alternative approach to localize the lesion. The clinical significance of the present exploratory effort remains to be assessed in the future.Vacuum-assisted breast biopsy (VABB) is a minimally invasive technique used increasingly for the assessment of mammographically detected, non-palpable breast lesions [1,2]. The effectiveness of VABB has been demonstrated on lesions both with and without microcalcifications [3,4]. The sensitivity, specificity and fast performance of the method have contributed to its gradual establishment in the workup of suspicious breast lesions [1,2,5].The contraindications of the method are few, but they do exist. Stereotact
Importance of Close Follow-Up in the Fetus with Premature Atrial Contractions Accompanied by Atrial Septal Aneurysm: A Case Report  [PDF]
Yilmaz Yozgat,Ayhan Kilic,Cem Karadeniz,Rahmi Ozdemir,Onder Doksoz,Timur Mese,Nurettin Unal
Case Reports in Obstetrics and Gynecology , 2013, DOI: 10.1155/2013/391085
Abstract: Rhythms that derive from parts of atria other than the sinus node are called premature atrial contractions (PACs). Vast majority of fetal PACs are idiopathic. Fetal PACs usually have a good prognosis and disappear spontaneously during pregnancy or after delivery. Development of fetal tachycardia or fetal bradycardia is rarely reported during follow-up of fetuses diagnosed with PACs. To the best of our knowledge, coexistence of tachycardia and bradycardia leading to hemodynamic impairment has not yet been reported. We present a fetus diagnosed with PACs and atrial septal aneurysm (ASA) on the 23rd week of gestation proceeding to fetal bradycardia and fetal tachycardia and consequently hemodynamic impairment. We suggest closer follow-up of fetuses with PACs accompanied by ASA. 1. Introduction Rhythms originating from atrial regions other than the sinus node are defined as premature atrial contractions (PACs). Vast majority of fetal PACs are idiopathic. Fetal PACs usually have a good prognosis and disappear spontaneously during pregnancy or after delivery [1]. PACs may rarely develop secondarily to underlying structural abnormalities. Presence of an atrial septal aneurysm (ASA) is the most commonly reported structural anomaly in fetuses [2, 3]. Development of fetal tachycardia or fetal bradycardia is rarely reported during follow-up of fetuses diagnosed with PACs [2–4]. To the best of our knowledge, coexistence of fetal tachycardia and bradycardia leading to hemodynamic impairment in the same fetus possibly due to coexisting PAC and ASA has not yet been reported. We present a fetus diagnosed with PACs and ASA on the 23rd week of gestation proceeding to fetal bradycardia and fetal tachycardia and consequently hemodynamic impairment. 2. Case Report A 29-year-old woman was referred for evaluation of suspected fetal arrhythmia in the 23rd week of her pregnancy. Obstetric ultrasonography was negative for fetal anomalies. Fetal echocardiography showed an enlarged and mobile ASA extending as much as 50% into the left atrium and frequent PACs. She was scheduled for weekly hospital visits to allow for early detection of potentially serious fetal arrhythmias. Beginning from 30th week of gestation, brief but frequent (lasting for 3–5?min with 5?min intervals) episodes of fetal bradycardia due to blocked bigeminal PACs were observed, with ventricular rates varying between 80 and 100?bpm. Differential diagnosis between paradoxical bradycardia due to blocked PACs and 2?:?1 atrioventricular (AV) block seen in fetuses of women with collagen tissue disease was done using
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