臨床症例報告ジャーナル

Introduction: Painful Leg and Moving Toes (PLMT) is a rare disorder of unknown etiology. It is characterized by pain and abnormal movement of toes. These symptoms are troublesome to patients but not life-threatening. There is no curative treatment; however, supportive therapy and symptomatic therapy somewhat ameliorate the conditions. Thus, also to avoid extensive or invasive examinations, physicians should be aware this condition.

Case presentation: The first patient had sensory symptoms that began in both legs, and gradually involuntary movements appeared in the toes of one leg, which spread to the other leg. The second had no leg pain, but involuntary movement of the toes was the sole clinical presentation. Diagnosing these conditions as PLMT, we prescribed pregabalin, clonazepam, baclofen, local corticosteroid injections, epidural blocks and warmwater soaks, which led to partial improvement of these symptoms.

Conclusion: PLMT presents in different forms, symptoms usually do not worsen over time and not life-threatening, and thus, in this sense, benign condition. We, presenting these two cases, wish to update the clinical presentation, electrophysiological findings, pathophysiology, associated diseases, treatment and management of PLMT

Background: Mycotic aneurysms are a rare subset of intracranial aneurysms caused by bacterial, viral or fungal sources. Rupture of an intracranial mycotic aneurysm is a life-threatening event untreated with a mortality range up to 80%.

Case description: Here, we report the case of a 21-year-old second year female medical student who suffered from a ruptured mycotic aneurysm of the middle cerebral artery with subarachnoid haemorrhage. After surgical resection of the aneurysm, intensive monitoring and treatment of cerebral vasospasm were performed. Further diagnostics for the focus of infection, including laboratory parameters, transoesophageal echocardiography and otolaryngoscopic diagnostic, showed normal findings without any sign of endocarditis, vasculitis or otolaryngitis. After 3 weeks, the patient was discharged in a very well condition.

Conclusion: Aseptic mycotic aneurysm is a rare subtype with posing significant therapeutic challenge. Surgical resection of those aneurysms might be safe and effective treatment

In late state gastric cancer, combination chemotherapy with targeted therapy has been employed, which may control the tumor growth and recurrence. We here report two patients diagnosed with advanced gastric cancer which were treated with SOX regimen combined with apatinib for conversion therapy. After three cycles of this combination treatment, the lymph node metastases and tumor decreased in size, which enabled the surgery (R0 resection), with no recurrence for more than 1 year. We believe that apatinib combined with SOX regimen can increase the possibility of successful surgical resection, and thereby prolonging the progression-free survival of patients with advanced gastric cancer

The clinical course of our patient highlights an atypical presentation of thromboembolic disease related to pregnancy, a thrombophlebitis of the right ovarian vein with endocaval floating thrombus. The diagnosis remains difficult since it is a rare entity with an atypical presentation but with serious medical consequences.

Background: It is recognized in the medical community the world over that intervertebral disc tissue degenerates over the course of life and cannot be regenerated endogenously. But as all living tissue, intervertebral disc cells should be able to absorb and metabolize nutrients and replicate, thereby enabling regeneration. By this logic, disc regeneration should be possible by improving nutrient absorption, which is dependent on correct biomechanics. The role of the autonomic nervous system is critical in understanding function of tissue, including intervertebral discs.

Case report: In this case study, a man 45-year of age with disc degeneration of the lower lumbar spine between L5 and S1 and pain during exercise was treated with a series of full spine chiropractic adjustments in order to correct biomechanics and improve nutrient absorption of the intervertebral discs. This resulted in the growth of the degenerated disc, which increased the lateral angle between L5 and S1 by 80% coinciding with freedom of pain, free range of motion and an improvement of autonomic balance. This was documented by full spine X-rays and a pre- and post-scan of the autonomic nervous system.

Conclusion: This study shows that growth of intervertebral disc tissue is possible without the use of medication, surgery or cell transplantation and should be the beginning of rethinking functional physiology and the importance of translational medicine.

Coronary sinus ostial atresia is a rare encounter in the intervention laboratory and is often linked with several congenital cardiac anomalies such as persistent left superior vena cava among others. Over the course of Cardiac Resynchronization Therapy (CRT), our case had the coronary sinus directly communicating with the superior vena cava through an anomalous bridging vein in the absence of a persistent left superior vena cava, along with an atretic right atrial ostium. Also, of interest was the minimal amount of technical challenge offered by such an anomaly for CRT lead implantation provided an otherwise favorable coronary anatomy.