http://www.casesjournal.com The most accessed research articles published by Cases Journal 2009-12-18T00:00:00Z Background: A 40-years-old female presented with intermittent chest pain and dyspnea on exertion.Case PresentationElectrocardiography showed sinus rhythm with ST-depression in inferior and lateral leads. Subsequent exercise treadmill testing revealed significant ST-depression in V4–V5 and V6 leads. Coronary angiography later showed a single left coronary artery with right coronary artery arising from left circumflex artery, a rare anomaly of coronary arteries. No atheromatous lesion was seen during angiography. Conclusion: The dignosis of this anomaly is importsnt because the symptoms cannot be differentiated from atherosclerotic coronary artery disease. http://www.casesjournal.com/content/1/1/355 Mohammad Shojaie Ahad Eshraghian Cases Journal 2008, null:355 2008-11-27T00:00:00Z doi:10.1186/1757-1626-1-355 /content/figures/1757-1626-1-355-toc.gif Cases Journal 1757-1626 ${item.volume} 355 2008-11-27T00:00:00Z XML IntroductionGastric polyps exist in a wide variety of types, most of which are small and often benign. Discovery of gastric polyps during Endoscopy necessitates biopsies.Case presentationWe present a case report of an isolated diffuse hyperplastic gastric polyposis in a 26 years old Hispanic female when she was investigated for profound anemia. The Esophagogastroduodenoscopy revealed numerous gastric polyps filling the entire stomach. She was treated with near-total gastrectomy and her anemia resolved Conclusion: Isolated diffuse hyperplasic gastric polyposis with normal gastrin level is a rare entity and can present with severe anemia. http://www.casesjournal.com/content/1/1/130 Suriya Jayawardena Dharshan Anandacoomaraswamy Olga Burzyantseva Muhammad Abdullah Cases Journal 2008, null:130 2008-08-28T00:00:00Z doi:10.1186/1757-1626-1-130 /content/figures/1757-1626-1-130-toc.gif Cases Journal 1757-1626 ${item.volume} 130 2008-08-28T00:00:00Z XML Application of constricting devices on the external male genitalia for increasing sexual performance is an unusual practice that can potentially lead to penile strangulation with severe consequences. In this case report we describe a case of a 48 year old male who presented in our hospital with a steel ring on his external genitalia which led to penile strangulation and a short review of the literature. The foreign body was successfully removed by an angle grinder which was not immediately available in the operating theatre. The patient had an uneventful recovery. http://www.casesjournal.com/content/1/1/45 Ioannis Efthimiou Savas Kazoulis Ioannis Christoulakis Cases Journal 2008, null:45 2008-07-18T00:00:00Z doi:10.1186/1757-1626-1-45 /content/figures/1757-1626-1-45-toc.gif Cases Journal 1757-1626 ${item.volume} 45 2008-07-18T00:00:00Z XML Necrotizing fasciitis is a rapidly progressive, life-threatening soft tissue bacterial infection. We present a serious case of a 43-year-old male who suffered from necrotizing fasciitis of the left leg in whom a delayed diagnosis caused multiorgan dysfunction.Early recognition of important symptoms is essential in the management and surgical debridement of necrotizing fasciitis. Treatment should include comprehensive supportive measures (early goal-directed therapy, adequate ventilation strategy, activated protein C dosage, tight glucose control, steroids, renal replacement therapy) and early antibiotic therapy based on microbiologic monitoring. The pathophysiology and etiologic factors of necrotizing fasciitis are discussed. http://www.casesjournal.com/content/1/1/125 Piotr Smuszkiewicz Iwona Trojanowska Hanna Tomczak Cases Journal 2008, null:125 2008-08-23T00:00:00Z doi:10.1186/1757-1626-1-125 /content/figures/1757-1626-1-125-toc.gif Cases Journal 1757-1626 ${item.volume} 125 2008-08-23T00:00:00Z XML Basaloid squamous cell carcinoma (BSCC) is a rare and aggressive variant of squamous cell carcinoma (SCC) that occurs preferentially in the upper aerodigestive tract. We present two cases of BSCC, one arising in the conjunctiva and the other arising in a paranasal sinus. Clinical and pathological findings in these two cases, including immunohistochemistry is presented along with brief discussion of literature. To the best of our knowledge, this is the first report of BSCC of the conjunctiva. BSCC of the head and neck should be distinguished from adenoid cystic carcinoma, small cell neuroendocrine carcinoma, basal cell adenocarcinoma, adenosquamous carcinoma, squamous cell carcinoma, spindle cell squamous carcinoma, mucoepidermoid carcinoma, and adenoid cystic carcinoma. http://www.casesjournal.com/content/2/1/9351 Pooja Vasudev Odette Boutross-Tadross Jasim Radhi Cases Journal 2009, null:9351 2009-12-18T00:00:00Z doi:10.1186/1757-1626-2-9351 /content/figures/1757-1626-2-9351-toc.gif Cases Journal 1757-1626 ${item.volume} 9351 2009-12-18T00:00:00Z XML Subdural empyema is an unusual complication of meningococcal meningitis, and in acute cases can be rapidly fatal. We present a case of an 8 week old infant who presented with atypical Neisseria meningitis with bifrontal subdural empyema formation. Through the utilisation of modern polymerise chain reaction tests on cerebrospinal fluid samples, we were able to confirm the diagnosis and institute appropriate treatment. Early surgical intervention and appropriate intravenous antibiotics meant that the patient fully recovered. In summary, early treatment of meningitis without adequate microbiological investigations can complicate later diagnosis of subdural empyema. Early suspicion of empyema should be considered when patient fails to improve after 48 hrs, seizures are a late sign and gives a poorer prognosis. Computed tomography scanning is still the modality of choice although in this case, magnetic resonance imaging had its benefits. Polymerase chain reaction of cerebrospinal fluid testing may also provide an important confirmatory test in future. http://www.casesjournal.com/content/2/1/6335 Cases Journal 2009, null:6335 2009-09-17T00:00:00Z doi:10.4076/1757-1626-2-6335 /content/figures/1757-1626-0002-0000006335-toc.gif Cases Journal 1757-1626 ${item.volume} 6335 2009-09-17T00:00:00Z XML IntroductionIndwelling urethral catheter is often used in male spinal cord injury patients to provide drainage to neuropathic bladder. If the balloon of a Foley catheter is inflated in urethra or, when a properly inserted Foley catheter is later pulled and thereby, the Foley balloon comes to lie in urethra, an excessive length of catheter will remain outside the penis. This sign is termed "long catheter sign". Long catheter sign will also be positive when Foley catheter slips out of urinary bladder in situations where Foley balloon is ruptured by a spiky vesical calculus or deflated due to a defective valve.Case PresentationA fifty-year-old Caucasian male with paraplegia at T-5 level had been managing neuropathic bladder by long-term indwelling urethral catheter. During his stay in spinal unit, the patient felt that there had been a tug on the drainage tube when he was being turned during night as part of the routine care for relief of pressure. Next morning, a health professional noticed that a long segment of catheter was lying outside penis. There was no bleeding from urethral meatus. Catheter continued to drain urine, which was yellowish in colour. Urine output was satisfactory. This patient did not develop any clinical feature of autonomic dysreflexia nor was he feeling unwell. In view of positive long catheter sign, radiological studies were performed to check the position of Foley catheter, which confirmed the clinical impression of incorrectly positioned Foley catheter. The catheter was removed; flexible cystoscopy was performed. A 16 Fr, 20 ml balloon Foley catheter was inserted over a 0.032" guide wire. Following this procedure, a considerably shorter length of Foley catheter remained outside the penis. Conclusion: Positive long catheter sign indicates that the Foley catheter is placed incorrectly and needs repositioning urgently. Prompt recognition of long catheter sign and immediate repositioning of Foley catheter will help to prevent complications such as chronic distension of urinary bladder, urine infection, and pressure necrosis of urethra especially if Foley balloon remains inflated within urethra for a long period. In this patient, use of a Foley catheter with 20 ml balloon, and securing the drainage tube to thigh with two straps, helped to prevent inadvertent pull of Foley balloon into the urethra. http://www.casesjournal.com/content/1/1/43 Subramanian Vaidyanathan Peter Hughes Tun Oo Bakul Soni Cases Journal 2008, null:43 2008-07-17T00:00:00Z doi:10.1186/1757-1626-1-43 /content/figures/1757-1626-1-43-toc.gif Cases Journal 1757-1626 ${item.volume} 43 2008-07-17T00:00:00Z XML Total Knee Arthroplasty operations are increasing in frequency, and knee flexion contracture is a common pathology, both pre-existing and post-operative. A 61-year-old male presented with knee flexion contracture following a total knee arthroplasty. Physical therapy alone did not fully reduce the contracture and dynamic splinting was then prescribed for daily low-load, prolonged-duration stretch. After 28 physical therapy sessions, the active range of motion improved from -20° to -12° (stiff knee still lacking full extension), and after eight additional weeks with nightly wear of dynamic splint, the patient regained full knee extension, (active extension improved from -12° to 0°). http://www.casesjournal.com/content/1/1/421 Eric Finger F Willis Cases Journal 2008, null:421 2008-12-29T00:00:00Z doi:10.1186/1757-1626-1-421 /content/figures/1757-1626-1-421-toc.gif Cases Journal 1757-1626 ${item.volume} 421 2008-12-29T00:00:00Z XML Background: Today, gas gangrene is rare, but still many of the patients die, despite having received timely treatment.Case presentationThis report highlights the cases of three different patients, who were transferred to our surgical department in 2006. The first patient (Patient_A), with the suspected diagnosis "femoral hematoma", a second patient (Patient_B) because of an "acute abdomen" and the third patient (Patient_C) with suspected gas gangrene of the right leg. Conclusion: The first two cases demonstrate gas gangrene should always be kept in mind, especially in high-risk-patients. Though, the third case shows that severe consequences because of a precipitate diagnosis can be avoided by careful evaluation. http://www.casesjournal.com/content/1/1/252 Engelbert Schropfer Stephan Rauthe Thomas Meyer Cases Journal 2008, null:252 2008-10-20T00:00:00Z doi:10.1186/1757-1626-1-252 /content/figures/1757-1626-1-252-toc.gif Cases Journal 1757-1626 ${item.volume} 252 2008-10-20T00:00:00Z XML Giant tonsillolith is a rare clinical entity. Commonly, it occurs between 20–77 years of age. We had a twelve years old female patient, who had odynophagia due to a giant tonsillolith. The stone was removed and tonsillectomy was performed. We reviewed the literature on this rare clinical entity and found that this is the fourth case of giant tonsillolith in a child and largest ever tonsillolith to be reported in English literature. http://www.casesjournal.com/content/1/1/50 Jagdeep Thakur Ravinder Minhas Anamika Thakur Dev Sharma Narinder Mohindroo Cases Journal 2008, null:50 2008-07-18T00:00:00Z doi:10.1186/1757-1626-1-50 /content/figures/1757-1626-1-50-toc.gif Cases Journal 1757-1626 ${item.volume} 50 2008-07-18T00:00:00Z XML