臨床症例報告ジャーナル

We report a case of Renal Vein Thrombosis (RVT) thought to be a complication of actue pyelonephritis in a 44 year old female presenting to the acute medical take. The most common cause of RVT is nephrotic syndrome, due to a hyper-coaguable state. RVT is also seen in renal cell carcinoma due to tumour invasion. A possible theory relating RVT to acute pyelonephritis may relate to concomitant thrombophlebitis of the renal vein in pyelonephritis, which then predisposes to thrombosis. The patient was subsequently investigated for possible causes of this thrombotic event and anticoagulated. The management of RVT is also discussed. We hope this case highlights the importance of keeping an open mind and adding to the original management when a new, but unexpected finding is made.

We present the operating photograph of a young men who presented a chronic distressful right sciatic pain exacerbated by internal rotation of the extended leg and by abduction and external rotation of the thigh (Pace’s sign, elicited by the contraction of piriformis muscle).

The number of paraneoplastic encephalitis cases has been gradually rising. The most common one being anti- N -methyl-D-aspartate (NMDAR) encephalitis (over 120 cases reported in literature) [1]. Various other synaptic antibodies have also been associated with autoimmune encephalitis. These include: anti-leucine-rich glioma- inactivated protein (LGI1), anti-α-amino-3-hydroxy-5-methyl-4- isoxazolepropionic acid (AMPAR), anti-gamma-aminobutyric acid (GABA-B) receptor, and anti-contactin-associated protein 2 (CASPR-2).

In our Chinese cohort of 27 Non-Small Cell Lung Cancer (NSCLC) patients with mediastinal nodal involvement who underwent EBUS-TBNA, we showed no role of SUV from PET-CT scans in determining EGFR mutation status. Nonetheless, we showed that patients with high SUV (>9.6) as well as number of passes could predict inadequacy of cellular material in obtaining EGFR mutation status in EBUS-TBNA.

Opioids represent the main treatment for moderate to severe chronic pain both oncological than neuropathic one. They are assuredly effective drugs to relieve the pain symptoms but are burdened in chronic use by adverse events that may limit their use (tolerance, nausea, vomiting, itching, sleepiness). The strategy of switching opioids is a response to this. Rotation from one opioid to another, regulated by conversion tables, is useful to ensure a better balance of analgesia and toxicity. Tapentadol is a novel, centrally acting analgesic with dual mechanism of action, combining mu-opioid receptor agonism with noradrenaline reuptake inhibition in the same molecule. It has an improved side effect profile when compared to opioids and nonsteroidal anti-inflammatory drugs. The dual mechanism of action makes Tapentadol a useful analgesic to treat acute, chronic, and neuropathic pain. As the Pain Treatment Service of the Second University of Naples, we present two clinical cases of patients being treated with high dose opioids who we rotated to tapentadol.

We present a case of fulminant neonatal sepsis caused by nontypable Haemophilus influenzae and discuss some potential prevention measures. A 33-year-old pregnant woman delivered a 1,166 g male neonate at 27 weeks and 2 days of gestation. He died 5 hours after birth. Haemophilus influenzae was isolated from the amniotic fluid, maternal vaginal discharge, placenta, neonatal oral cavity, neonatal skin, and neonatal stool. These isolates were found to be nontypable by polymerase chain reaction and sensitive to ampicillin. Placental histopathology revealed acute chorioamnionitis without cord phlebitis or arteritis. An autopsy found no colonization of gram-negative cocobacilli in the organs including the lungs. These results suggest that acute intrapartum nontypable Haemophilus influenzae infection can cause fulminant and invasive neonatal sepsis. Intrapartum antibiotic prophylaxis may be useful for prevention.

We are reporting on a rare case of woman who developed broad ligament hematoma 24 hours after normal vaginal delivery. The patient had no history of congenital or acquired bleeding disorder, and the course of her pregnancy and labour were uneventful.

It is sometimes quite difficult to distinguish between severe spasticity and contracture formation. To decide on an appropriate anti-spastic treatment and determine realistic expectations, in some cases, this distinction is very important.

Tuberculous dactylitis is an unusual form of bone tuberculosis characterized by non-specific clinical and imaging features. Tissue pathological and microbiological examination represent the hallmark of diagnosis. This is the case of a woman on tumour necrosis alpha blocker presenting with chronic osteomyelitis and arthritis of a finger caused by Mycobacterium tuberculosis

Introduction: Osteitis pubis has been known as a noninfectious inflammation of the pubis symphysis. It is poorly understood and is rarely seen in the immediate postpartum period following spontaneous delivery. Case report: A 25 year old primigravida had a spontaneous delivery at 37 weeks of gestation. 5 days following the delivery she complained of dull aching pain the in lower abdominal and pubic region. Pain was continuous and increased on activity and subsided on rest. Pain increased in severity and the she consulted local doctors who treated her with analgesics and antibiotics. The Pain did not subside and she presented to us a week following the onset of symptoms. A plain radiography of the pelvis was done which showed irregular bony lesion at the level of pubic symphysis. MRI scan of the pelvis was done and Osteitis pubis was diagnosed. She was managed with bed rest, anti inflammatory and physiotherapy. Pain subsided over a period of ten days and patient was discharged subsequently. She is engaging in all her activities of daily living with no complaints presently. Discussion: Osteitis Pubis is a rapidly progressive, nonsuppurative osteonecrosis of the symphysis pubis is frequently confused with other entities. Because the prognosis for recovery is invariably good, acute intervention is directed at relieving pain by immobility and anti-inflammatory agents. We present a rarely described case of osteitis pubis occurring in the postpartum period following spontaneous delivery.

Angiosarcoma of the posterior mediastinum is a rare neoplasm of soft tissues and its location in the mediastinum is extremely uncommon. According to the papers of other cases reported on angiosarcoma in mediastinum, invasive biological behavior exist, such as ill-defined margin, heterogeneous density and local involvement of lung and ribs or vertebra. This case showed a well-defined, homogeneous mass. So, confusion is possible with other benign tumor in mediastinum.

First degree Atrio Ventricular (AV) block is a common manifestation of acute Rheumatic Fever (RF) and is included in the Jones criteria but Wenckebacks phenomena and complete heart block are rarely described in the RF. Presyncope occurring in RF was rarely reported. We report the case of a young 14 years old boy with rheumatic heart disease revealed by presyncope due to an third degree AV block. Rapid improvement was obtained under corticosteroids.

A male child, three years old, with primitive neuroectodermal tumor (PNET) was admitted to our department because of episodes of apnea with syncope. Twenty four hr ambulatory electrocardiographic monitoring revealed extremely long sinus pauses, the longest being thirty four seconds, followed by sinus tachycardia. Permanent pacing reduced the frequency, duration and severity of episodes.

We report the case of dual pulmonary venous drainage, normal to left atrium and abnormal to left innominate vein, as a very rare cause of right ventricular dilatation in an otherwise normal and asymptomatic child.

We report the case of Left Ascending artery thrombosis after cannabis abuse confirmed by optical coherence tomography, treated successfully by thromboaspiration without stent implantation