Volume 3 Issue 1

2019-12-23 Case Report

Orgasmic coitus triggered stillbirth via placental abruption: A case report


Sexual activity during healthy pregnancy is safe. There are little data on how coital activity affects outcome of the high-risk pregnancies. Hereby we report a case demonstrating that orgasmic coitus triggered placental abruption resulting in preterm stillbirth.

A 38-year-old 8-para, 12-gravida woman lived unmarriedly with a constant partner in low socioeconomic conditions. Her previous pregnancies included 7 deliveries without complication, two early miscarriages and two pregnancy terminations. Her present pregnancy was complicated with gestational hypertension successfully treated with nifedipine. She had coitus 2 to 4 times a month, mostly without orgasm. The last coitus which happened in side-by-side position was accompanied by orgasm which continued in uterine hypertonicity and massive vaginal bleeding at 29 weeks gestation. Two hours subsequently, on admission to hospital, placental abruption and fetal demise were diagnosed. At the emergency cesarean section, a dead female infant weighing 1,510 g was born. Fetal pathology was not discovered. Placental histopathology showed retroplacental hematoma, intervillous and decidual hemorrhages, focal distal villous hypoplasia and avascular villuses. Patient’s recovery rapidly occurred after intensive care.

Placental abruption complicates 0.4% - 1.0% of deliveries. It is known that most cases of abruption cannot be predicted and prevented. Our report suggests that orgasmic coitus may be a trigger for placental abruption in those women who have gestational hypertension and multiple risks for placental abruption. We infer from the above case that sexual intercourse is advised to avoid during pregnancy of such women in order to prevent placental abruption.

Abstract Read Full Article HTML DOI: 10.29328/journal.acr.1001026 Cite this Article

2019-12-06 Letter to the Editor

Achievement of cure following allogeneic HSCT with Flu-Bu regimen in a patient with severe mycosis fungoides and Sezary Syndrome

Letter to Editor

Experience with allogeneic hematopoietic stem cell transplantation (HSCT) in mycosis fungoides/Sezary syndrome (MF/SS) is limited to a small number of case reports and case series [1,2]. The advantage of allogeneic HSCT has been indicated in progressive disease in the review of CIBMTR study groups [3]. A consensus is still not available about the intensity and the content of the conditioning regimen due to the rarity of the disease and heterogeneous patient groups.

Abstract Read Full Article HTML DOI: 10.29328/journal.acr.1001025 Cite this Article

2019-12-06 Case Report

Scraping cytology and scanning electron microscopy in diagnosis and therapy of corneal ulcer by mycobacterium infection


Purpose: This work is aimed at demonstrating that scraping cytology and scanning electron microscopy can successfully assist in the diagnosis of nontuberculous mycobacteria infection. For this purpose, we report the use of both these techniques in the diagnosis of cornel ulcer in a previously healthy young man.

Methods: Cytological samples were achieved by scraping technique on the mucosa, both sub palpebral and temporal area of the eye tarsal conjunctiva. The obtained sample was affixed to a sanded rectangular slide, stained with the Pappenheim method, washed in bidistilled water, treated in Giemsa solution, washed again and subsequently dried on a hot plate and observed with a microscope at various magnifications.

Results: After a therapy based on a 500 mg clarithromycin tablet administered every 12 hours for 30 days as systemic therapy, a complete recovery of the patient from left eye inflammation was observed and SEM cytology showed that NTM colonies had disappeared.

Conclusion: Conjunctival cytology scraping and SEM technologies can be therefore exploited as new tools in diagnosis and fast identification of these newly discovered mycobacteria. In fact, they have a new way for studying ocular pathology, because of the simple execution and remarkable accuracy in the diagnosis. In fact, this technique allows to gather valuable information about all pathogens expression and the cellular action involved in pathology. As a further plus, this technique provides clinicians with the opportunity to repeat the SEM cytology for monitoring patients during therapy, hence leading to evaluate the efficacy of the pharmaceutical regimen in real time.

Abstract Read Full Article HTML DOI: 10.29328/journal.acr.1001024 Cite this Article

2019-11-20 Case Report

Foley catheter balloon tamponade as a method of controlling iatrogenic pulmonary artery bleeding in redo thoracic surgery


Background: Pulmonary artery bleeding secondary to iatrogenic injury is a troublesome intraoperative complication. The likelihood of encountering this complication is significantly higher in redo surgery for a number of reasons, including distortion of anatomical structures, adhesions and loss of tissue planes. Significant blood loss, although rare, remains a concern, and can occasionally be life-threatening. When significant bleeding from the pulmonary artery occurs, it can be a challenging situation to manage.

Case Report: A 65 year old female was undergoing redo thoracic surgery in the setting of a completion lobectomy for biopsy-proven primary adenocarcinoma of the lung. Iatrogenic injury to the pulmonary artery resulted in significant bleeding that could not be managed by gaining proximal control due to dense adhesions. The novel decision to utilize a Foley catheter for balloon tamponade was taken, in order to provide sufficient haemostasis for definitive surgical repair of the defect to be undertaken.

Conclusion: The increased technical difficulties of redo thoracic surgery are well recognised. We describe the first case of Foley catheter balloon tamponade being utilized in the context of iatrogenic pulmonary artery bleeding during thoracic surgery.

Abstract Read Full Article HTML DOI: 10.29328/journal.acr.1001023 Cite this Article

2019-11-20 Case Report

Treatment of autoimmune hemolytic anemia with erythropoietin: A case report

In this article, we describe the case of a fifty-year-old patient with autoimmune hemolytic anemia (AIHA) with constitutional symptoms, jaundice, unquantified fever and progressive dyspnea. The patient had history of smoking and Hepatitis A and following a physical exam she was found in a regular condition, icteric but with no other further signs. Her laboratory tests revealed hemolytic anemia with a hemoglobin of 8.5 g/dL, an increase of total and indirect bilirubin, an elevated ferritin, a decreased transferrin and haptoglobin and a positive result for direct Coomb’s test. Considering this, an immune profile was ordered finding a negative result of ANAs and ENAs and a decrease of complement C3 and C4. The patient was diagnosed with AIHA and as an initial step a corticosteroid treatment was administrated however the patient showed no clinical nor chemical improvement. At her third day of hospitalization, she was unstable hemodynamically requiring transfer to Intensive Care Unit (ICU) to optimize management. After 24 hours on ICU, due to persistence of deterioration of the patient, it was decided to manage with erythropoietin (EPO). In the following days, the patient showed a rise in her hemoglobin and an overall improvement made possible the transfer to hospitalization service. The AIHA is an uncommon disease and is not the first option that comes to mind with these symptoms, currently there are not controlled studies to the treatment due to its complexity and the heterogeneity of the results. We strongly support the use of EPO in refractory cases of this pathology.

Abstract Read Full Article HTML DOI: 10.29328/journal.acr.1001022 Cite this Article

2019-10-16 Case Report

Intestinal malrotation presenting with midgut volvulus in an adult

A 36-year-old man without previous medical history presented to the emergency department with abdominal pain and vomiting of acute onset. His vital signs were stable and he had no fever. Abdominal exploration revealed distention with pain at palpation. Laboratory tests were normal. Abdominal X-Ray showed gastric and small intestine distention.A nasogastric tube was placed and fluid therapy started. Computed tomography showed an intestinal malrotation, without the duodenum crossing the midline and with the colic frame arranged in the left hemiabdomen (Figure 1), complicated with a midgut volvulus as demonstrated by the whirlpool sign (Figure 2, arrow). Ladd’s procedure was performed using a midline open approach. Mesenteric lymphadenopathy and chylous ascites was found (Figure 3). The volvulus was reduced by counter-clockwise detorsion without need of intestinal resection and Ladd’s bands division along with an extended Kocher manoeuvre (Figure 4) allowed a good position of the mesentery. Appendectomy was also conducted. Postoperative course was uneventful with the patient being discharged the fifth day, after resumption of bowel function. No alterations were detected at follow up one month later.

Abstract Read Full Article HTML DOI: 10.29328/journal.acr.1001020 Cite this Article

2019-10-02 Case Report

Fatal agranulocytosis associated with Metamizole treatment in a 16-year-old girl

Agranulocytosis is one of the common reasons of consultation in hematology. It’s life-threatening because of an infection risk. The metamizole is a drug, known for its potential rare danger of inducing a severe agranulocytosis. However, it remains widely used because of its beneficial effect analgesic and antipyretic. We report in this study, a case of a girl who was 16 years old, referred for severe agranulocytosis, and appeared two weeks after treatment with Novalgin. The clinico-biological symptoms were dominated by Streptococcal septicemia with an infectious pulmonary and digestive focus. The blood cell count confirmed a severe agranulocytosis with total disappearance of neutrophils. Despite broad-spectrum antibiotic therapy and stimulation with hematopoietic growth factor, the clinical evolution was fatal in the short term. What motivates us to add this case to those of the literature in order to remind practitioners about the danger of this drug, and to promote has doubled of vigilance during use.

Abstract Read Full Article HTML DOI: 10.29328/journal.acr.1001019 Cite this Article

2019-09-30 Case Report

Automatic heartbeat monitoring system

The proliferation and popularity of open source hardware and software, such as Arduino and Raspberry PI, together with IoT and Embedded System, has brought the health industry to rapid evolution, creating portable and low-cost medical devices for monitoring vital signals. Electrocardiographic (ECG) equipment plays a vital role for diagnosis of cardiac disease. However, the cost of this equipment is huge and the operation is too much complex which cannot offer better services to a large population in developing countries. In this paper, I have designed and implemented a low cost fully portable ECG monitoring system using android smartphone and Arduino. The results obtained by the device were tested comparing them with those obtained from a traditional ECG used in clinical practice on 70 people, in resting and under-activity conditions. The values of beats per minute (BPM), ECG waveform and ECG parameters were identical, and presented a sensitivity of 97.8% and a specificity of 78.52%.

Abstract Read Full Article HTML DOI: 10.29328/journal.acr.1001018 Cite this Article

2019-09-24 Case Report

A rare case of recurrent urinary tract infection due to Trichosporon species in an immune-competent diabetic female patient

Trichosporonosis is a disease caused by Trichosporon spp. which are ubiquitous anamorphic yeast that commonly inhabit the soil. In human they are found in the skin, gastrointestinal tract and respiratory tract. Globally, Trichosporon spp. infection is rare and remains scantily reported in urinary tract infections and disseminated invasive infection amongst immunocompromised and cancer patients with neutropenia. Trichosporon asahii is the most commonly reported species. Virulence factors like proteinases, lipases, and phospholipases may be responsible for disease manifestation. We report a case of recurrent urinary tract infection due to Trichosporon spp. in a 62-year-old immunocompetent diabetic female which remained misdiagnosed for a long period of time. The patient was subsequently treated successfully by oral fluconazole drug.

Abstract Read Full Article HTML DOI: 10.29328/journal.acr.1001017 Cite this Article

2019-08-05 Case Report

Clinical, histopathological and surgical evaluations of persistent oropharyngeal membrane case in a calf

A male, 4 days old and 20 kg Simmental calf was evaluated for regurgitation and hyper salivation since birth. The mother became pregnant by artificial insemination and the pregnancy was the second of the mother. A membrane closed the pharynx and a diverticulum on dorsal of this membrane was seen during oropharyngeal examination through inspection. Membrane was also viewed by endoscopy under general anaesthesia. Larynx and oesophagus were imaged by bronchoscopy through the back side of the membrane. After these applications, it was decided that soft palate adhered firmly to the root of tongue causing congenital atresia. Surgical treatment of oropharyngeal membrane was carried out under general anaesthesia. Firstly, tracheotomy was performed for to ease breathing and membrane removed by electrocautery application. Intensive fluid accumulation and oedema formation at the incision area were detected by endoscopic examination following operation and the calf had severe dyspnoea two days after operation and died due to respiratory insufficiency. At necropsy, severe inflammatory reaction, laryngeal oedema and intensive salivation at the surgical side was determined. Direct imaging techniques should be used to determine in the closed oropharyngeal lumen. Moreover, nasopharyngoscopy should be considered to image larynx and oesophageal way. Present case is the first report with concern to pharyngeal membrane formation together with direct imaging and surgical procedures. Therefore, it was considered that this case report could be useful for colleagues and literatures.

Abstract Read Full Article HTML DOI: 10.29328/journal.acr.1001016 Cite this Article

2019-08-02 Case Report

Type II myocardial infarction and latent LVOT obstruction due to Systolic Anterior Motion of mitral valve

Left ventricular outflow tract obstruction is a well-recognized feature in hypertrophic cardiomyopathy but can occur in other clinical scenarios when anatomically susceptible heart is subjected to permissive physiological conditions that provoke systolic anterior motion of the mitral valve (SAM): ie, reduced preload, increased inotropic state, and decreased afterload.

This report describes a case of hemodynamically significant latent LVOTO that was associated with hypotension, syncope, acute myocardial ischemic ECG changes, and an increase in cardiac enzymes. (Type II myocardial infarction) in a non HCM patient with excessive anterior mitral valve tissue.

Abstract Read Full Article HTML DOI: 10.29328/journal.acr.1001015 Cite this Article

2019-07-17 Case Report

Anasarca in a 35 year old man- A diagnostic dilemma

Anasarca is generalized swelling of the body following accumulation of fluid in the extracellular compartments. It may result from multiple aetiology mainly of renal, hepatic or cardiovascular origin. 

The aim of this case report is to highlight the challenges encountered in making diagnosis in a patient with anarsaca.

We report a case of a 34 year old transporter who presented with anasarca. He had clinical features and risk factors suggestive of renal, hepatic and cardiovascular disease. However investigations ruled out renal, hepatic or cardiovascular diseases as the aetiology of the anarsaca. The anarsarca was also noted to be unresponsive to diuretics. The diagnosis of the disease causing the anarsaca was therefore a dilemma.

Abstract Read Full Article HTML DOI: 10.29328/journal.acr.1001014 Cite this Article

2019-06-04 Case Report

Brachial pseudoaneurysm associated with median nerve injury as a complication of peripherally inserted central catheter: A case report

Introduction: Peripherally inserted central venous catheters (PICCs) have been increasingly used as an alternative to conventional central venous catheters for long-term administration of chemotherapy, antibiotics, parenteral nutrition, and hydration in patients with difficult venous access. Traumatic complications to arteries and nerves adjacent to veins selected for PICC placement have been rarely described.

Case presentation: We report the case of a PICC placement in the brachial vein of the right upper limb of a 78-year-old woman that resulted in brachial artery pseudoaneurysm and median nerve lesion.

Discussion: The pseudoaneurysm was successfully repaired with thrombin injection, but neurological deficits to the hand resulting from nerve injury persisted even four months after the procedure.

Abstract Read Full Article HTML DOI: 10.29328/journal.acr.1001013 Cite this Article

2019-04-05 Case Report

Local recurrence after enlarged total nephrectomy

Local isolated recurrence of kidney cancer in the renal lodge after radical nephrectomy is rare and has a poor prognosis. Surgical excision, sometimes even extended to neighboring organs, is currently the only effective treatment for local recurrence of kidney cancer. The interest of new medical therapies remains to be defined. We report a case of local recurrence in a patient with radical nephrectomy.

Abstract Read Full Article HTML DOI: 10.29328/journal.acr.1001012 Cite this Article

2019-03-08 Case Report

A Case of Acute Peripheral Vertigo: Using the HINTS Exam to guide diagnostic workup

Acute dizziness/vertigo is among the most common causes for visiting the emergency department or primary care physician. Although the majority of these presentations represent an acute peripheral vestibulopathy (APV), lateral medullary, lateral pontine, and inferior cerebellar infarctions can mimic APV very closely. We present an atypical presentation of an aggressive APV and outline how a well-constructed bedside neurotologic evaluation can distinguish central from peripheral vertigo in the acute setting.

Abstract Read Full Article HTML DOI: 10.29328/journal.acr.1001011 Cite this Article

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Abstract Read Full Article HTML DOI: 10.29328/journal.acr.1001051 Citation

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Abstract Read Full Article HTML DOI: 10.29328/journal.acr.1001050 Citation

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Abstract Read Full Article HTML DOI: 10.29328/journal.acr.1001049 Citation

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Abstract Read Full Article HTML DOI: 10.29328/journal.acr.1001048 Citation

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Abstract Read Full Article HTML DOI: 10.29328/journal.acr.1001045 Citation

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Abstract Read Full Article HTML DOI: 10.29328/journal.acr.1001043 Citation

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Abstract Read Full Article HTML DOI: 10.29328/journal.acr.1001042 Citation