http://www.casesjournal.com The latest research articles published by Cases Journal 2010-04-06T00:00:00Z IntroductionWe describe a rare case of small bowel infarction due to fibro muscular dysplasia in superior mesenteric artery in a young patient.Case presentationA 28 year old Asian female presented with acute onset left sided abdominal pain and watery diarrhea. She had a laparotomy due to further deterioration. It showed infracted small intestine, gall bladder and parts of liver. Abdomen had to be closed without any therapeutic procedure. She died in early post operative period. Autopsy showed fibro muscular dysplasia of superior mesenteric artery. Conclusion: Fibro muscular dysplasia of SMA is rare, is treatable but has a high mortality. http://www.casesjournal.com/content/3/1/79 Sanjay Dalmia Amir Hussain Cases Journal 2010, null:79 2010-04-06T00:00:00Z doi:10.1186/1757-1626-3-79 /content/figures/1757-1626-3-79-toc.gif Cases Journal 1757-1626 ${item.volume} 79 2010-04-06T00:00:00Z XML IntroductionHypoparathyroidism is a chronic condition which requires a lifelong substitution with vitamin D analogues and careful monitoring. This is especially true for older patients and older compounds as dihydrotachysterol with longer half-life that might lead to long-lasting hypercalcemic episodes.Case presentationA 74-year old male patient with postsurgical hypoparathyroidism who has been successfully supplemented with dihydrotachysterol (1.7 ml/day) for over 50 years presented with neuropsychiatric disturbances, constipation, renal insufficiency and polyuria. Laboratory investigation demonstrated serum calcium 3.7 mmol/L, serum creatinine 180 micromol/L, urine calcium excretion 1.1 mmol/mmol of the creatinine, normal 25 OH vitamin D3 and low parathormone and 1,25 di OH vitamin D3. Careful history revealed that he has been erroneously taking 2.5 ml of dihydrotachysterol per day for at least 6 to 8 weeks that caused vitamin D intoxication and symptomatic hypercalcemia. He was treated with intravenous saline infusion, prednisolone and 60 mg of intravenous sodium pamidronate. On the fourth day after admission serum calcium dropped rapidly within the reference range. The treatment for hypoparathyroidism had to be reinstituted 10 days after dihydrotachysterol had been discontinued when the patient was switched to shorter acting calcitriol. Conclusions: Here we reported that the immediate use of pamidronate in addition to classic treatment of dihydrotachysterol intoxication with intravenous saline, diuretics and glucocorticoids is an effective treatment choice that leads to rapid resolution of hypercalcemia. http://www.casesjournal.com/content/3/1/78 Mojca Jensterle Marija Pfeifer Matjaz Sever Tomaz Kocjan Cases Journal 2010, null:78 2010-03-26T00:00:00Z doi:10.1186/1757-1626-3-78 /content/figures/1757-1626-3-78-toc.gif Cases Journal 1757-1626 ${item.volume} 78 2010-03-26T00:00:00Z XML IntroductionCirrhosis of the liver commonly leads to a state of chronic hypervolemic hyponatremia. Profound exacerbation of the hyponatremic state may occur in patients with decompensated cirrhosis in conjunction with acute stressors such as infection or binge alcohol ingestion.Case presentationA 47 year old man with a history of alcoholic cirrhosis presented to the hospital with symptomatic profound hyponatremia (serum sodium concentration of 105 meq/L) due to a recent infection and binge drinking. The patient was treated with antibiotics, diuretics and hypertonic saline and was placed on a fluid restricted diet. The serum sodium level corrected slowly over four days with symptomatic improvement occurring after two days. A brief discussion of the symptoms and treatment of acute and chronic hyponatremia in the setting of cirrhosis is included. Conclusion: In patients with cirrhosis, it is important to recognize the symptoms of hyponatremia, identify and treat any exacerbating conditions early in their course, and correct the serum sodium concentration slowly with frequent monitoring. http://www.casesjournal.com/content/3/1/77 Aaron Lindsay Cases Journal 2010, null:77 2010-03-23T00:00:00Z doi:10.1186/1757-1626-3-77 /content/figures/1757-1626-3-77-toc.gif Cases Journal 1757-1626 ${item.volume} 77 2010-03-23T00:00:00Z XML We present the contrast-enhanced spiral CT findings in a case of acute celiac artery occlusion with gastric perforation and total splenic infarction. Spiral CT depicted thrombus in the celiac axis and its branches, stenosis of the superior mesenteric artery, splenic infarction and lack of enhancement of the gastric wall with a large necrotic gap. Spiral CT enabled prompt diagnosis and therapy in this rare condition in a patient with suspicion of acute mesenteric ischemia. http://www.casesjournal.com/content/3/1/82 Cases Journal 2010, null:82 2010-03-22T00:00:00Z doi:10.1186/1757-1626-3-82 /content/figures/1757-1626-3-82-toc.gif Cases Journal 1757-1626 ${item.volume} 82 2010-03-22T00:00:00Z XML IntroductionProliferating trichilemmal tumour defined with more than one terms by many author, after well documentated series reported as "proliferating epidermoid cysts" by Wilson-Jones, firstly in 1966. They are rare, slowly growing, lobular masses inherited autosomal dominantly and localized on scalps of older women and believed to arising as a complication of a trauma and inflammation and effect 5-10% of people.Case presentationWe intented to present the case of a 62 years old Turkish woman with a history of slowly growing scalp mass after the trauma, especially during last 15 years. After surgical evaluation, histopathological slides exhibited the characteristic structures of proliferating trichilemmal tumour. The patient was lost to follow-up and no recurrens or distance metastasis detected during 40 months follow-up. Conclusion: In our opinion, widely surgical excision with long-term surveillance is the best choice for both diagnosis and treatment still today. http://www.casesjournal.com/content/3/1/80 Cases Journal 2010, null:80 2010-03-20T00:00:00Z doi:10.1186/1757-1626-3-80 /content/figures/1757-1626-3-80-toc.gif Cases Journal 1757-1626 ${item.volume} 80 2010-03-20T00:00:00Z XML Although the advanced stages of neoplasms have a risk of superior mesenteric venous thrombosis (MVT), an initial clinical diagnosis of MVT is sometimes difficult and it can be treated as a cancer-related pain using NSAIDs and/or opioids.We herein present a case of palliative stage of cancer with acute MVT, which was successfully treated with immediate anticoagulant therapy. We believe this case provides an important clinical lesson, which is that we should remember that MVT is one of the potential causes of abdominal pain with cancer patients and the thrombosis can be easily identified by US and CT. http://www.casesjournal.com/content/3/1/76 Fuminori Goda Hiroyuki Okuyama Ayumu Yamagami Hiromi Nakata Michio Inukai Eiji Ohashi Takeaki Takashima Takashi Himoto Hisashi Masugata Shoichi Senda Cases Journal 2010, null:76 2010-03-09T00:00:00Z doi:10.1186/1757-1626-3-76 /content/figures/1757-1626-3-76-toc.gif Cases Journal 1757-1626 ${item.volume} 76 2010-03-09T00:00:00Z XML Hematogones are the normal bone marrow constituents of bone marrow in children and their number decreases with age. As hematogones can resemble malignant lymphoblasts by their morphologic features and by expression of an immature B-cell phenotype, an accurate distinction of hematogone-rich lymphoid regeneration from leukemic lymphoblasts is critical for patient care. The increased number of hematogones had been reported in the bone marrow of children recovering from chemotherapy, aplastic conditions, other forms of bone marrow injury, infections like Cytomegalovirus, HIV and immune thrombocytopenia disorders. We describe here a case of one and half month old male infant with bicytopenia and leucocytosis associated with increased hematogones in the bone marrow due to an unknown probable viral infection. http://www.casesjournal.com/content/3/1/75 Kiran Agarwal Meenu Aggarwal Vikas Kumar Aggarwal Meenu Pujani Manupriya Nain Cases Journal 2010, null:75 2010-03-04T00:00:00Z doi:10.1186/1757-1626-3-75 /content/figures/1757-1626-3-75-toc.gif Cases Journal 1757-1626 ${item.volume} 75 2010-03-04T00:00:00Z XML Background: Castleman's disease or angiofollicular lymphoid hyperplasia is a rare benign lymph node hyperplasia usually presenting as an asymptomatic mediastinal mass in children. The disease can present at any extra thoracic site with lymphoid tissue such as retroperitoneal, mesentery, axilla, and pelvis. Hepatic localization castleman disease is very rare in children. Herein, we reported a case of Castleman's disease arising from the lymph node in hilum of liver.Case presentationA 5 -year-old girl with chief complaint of abdominal pain for two months which exaggerated in last three days was referred to the hospital. On routine physical examination, only a generalized abdominal pain was noticed. Routine laboratory investigations and Chest X-Ray were normal. Abdominal Sonography revealed a 3.7 × 3.1 cm solid mass in the hilum of the liver. On the MRI images, a lobulated mass in the portal hepatic associated with mass effect on the portal vein was visible. Histological examination revealed expansion of mantle zone in lymphatic nodules accompanied by burnt out germinal centers. This pattern was matched with the diagnosis of the hyaline-vascular type of Castleman disease. The patient underwent a laparotomy. The patient had an uneventful postoperative course. Conclusion: This pattern was matched with the diagnosis of the hyaline-vascular type of Castleman disease. http://www.casesjournal.com/content/3/1/74 Hossein Karami Alireza Alam Sahebpour Maryam Ghasemi Hasan Karami Mojdeh Dabirian Kurosh Vahidshahi Farzad Masiha Soheila Shahmohammadi Cases Journal 2010, null:74 2010-03-01T00:00:00Z doi:10.1186/1757-1626-3-74 /content/figures/1757-1626-3-74-toc.gif Cases Journal 1757-1626 ${item.volume} 74 2010-03-01T00:00:00Z XML Pseudohyperkalemia can appear in a variety of settings and should be recognized early. Treatment of pseudohyperkalemia can lead to an inappropriate decrease of actual serum potassium levels which may lead to life threatening conditions. In the case presented, an 81-year-old male presented with massive leucocytosis and an extremely elevated potassium level. This case report emphasizes the importance of recognizing pseudohyperkalemia in a patient with a severely increased potassium and WBC level; such patients may be clinically asymptomatic or may have a normal ECG. http://www.casesjournal.com/content/3/1/73 Alice Kim Benjamin Biteman Umer Malik Shahzad Siddique Mersadies Martin Syed Ali Nadeem Maboud Sabiya Raja Alison Zachry Ahmed Mahmoud Cases Journal 2010, null:73 2010-02-25T00:00:00Z doi:10.1186/1757-1626-3-73 /content/figures/1757-1626-3-73-toc.gif Cases Journal 1757-1626 ${item.volume} 73 2010-02-25T00:00:00Z XML We report a rare case of late knee locking after an open knee injury in a polytrauma patient with a pelvic fracture and a contralateral femoral artery injury. Once the life and limb threatening injuries were addressed, debridement and washout of the knee wound was performed. X-rays and subsequent CT revealed only an undisplaced patella fracture. The patient presented 6 months later to a knee surgeon with recurrent locking. An arthroscopy was performed and a 10 mm plastic soft drink bottle cap was retrieved leading to the immediate resolution of symptoms without complications.Open knee injuries require thorough debridement washout and joint assessment. Late locking should raise the suspicion of an intra-articular loose or foreign body. Arthroscopy is an excellent first line tool in the diagnosis and late management of this unusual problem. http://www.casesjournal.com/content/3/1/72 Simon Boyle Joseph Talbot Quamar Bismil Ernest Schilders Cases Journal 2010, null:72 2010-02-24T00:00:00Z doi:10.1186/1757-1626-3-72 /content/figures/1757-1626-3-72-toc.gif Cases Journal 1757-1626 ${item.volume} 72 2010-02-24T00:00:00Z XML