http://www.casesjournal.com The most accessed research articles published by Cases Journal 2010-04-06T00:00:00Z This is an RSS newsfeed from BioMed Central It is intended to be used with an RSS reader. For more information about RSS newsfeeds from BioMed Central, visit http://www.biomedcentral.com/info/about/rss/ IntroductionAn epileptic child had been long treated with valproic acid and lamotrigine. After a few years of treatment, he manifested severe clinical signs of hypocalcemia. We retain that valproic acid could have caused such metabolic dysfunction.Case presentationWe report here the involvement of valproic acid in symptomatic hypocalcemia in an 11-year-old epileptic white patient in treatment with valproic acid and lamotrigine. During the treatment the patient developed hypocalcemia associated with high plasma levels of valproic acid, parathyroid hormone and alkaline phosphatase, indicating increased bone turnover. Plasma levels of Vitamin D were normal. Plasma calcium values significantly correlated with valproic acid haematic levels; reduction of valproic acid dose was accompanied by prompt normalization of calcemia.The specific mechanism through which valproic acid causes hypocalcemia is unknown, although the relationship between valproic acid dose and haematic levels of calcium appears very likely. Conclusions: It seems necessary, during long term therapy with valproic acid, to monitor plasma calcium and alkaline phosphatase plasma levels. Also, these patients should undergo treatment and perhaps prescribe vitamin D and calcium treatment. http://www.casesjournal.com/content/2/1/7394 Cases Journal 2009, 2:7394 2009-06-17T00:00:00Z doi:10.4076/1757-1626-2-7394 Cases Journal 1757-1626 2 7394 2009-06-17T00:00:00Z 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, 3:77 2010-03-23T00:00:00Z doi:10.1186/1757-1626-3-77 Cases Journal 1757-1626 3 77 2010-03-23T00:00:00Z XML Background: Self-induced injections of liquid substances mainly for penis enlargement is a well-documented but still rather uncommon practice in the western world.Case presentationHerein we present the case of a 30-year-old male who self-inflicted, twice in a six-month-period, intra-urethral liquid paraffin and tied up his penis with a cord in order to achieve both enlargement and elongation. He arrived in our emergency department suffering from suprapubic pain; physical examination revealed a rather unique deformity of the penis. He finally refused any treatment and absconded. Conclusion: Side effects after paraffin administration are various and sometimes severe. Most of the times surgical treatment is needed and radical excision together with follow-up seems the best modality. Such practices emphasize on the public's misbelieves and that some aspects of sexual medicine are yet covered with the veil of misconception. http://www.casesjournal.com/content/1/1/223 Ioannis Kokkonouzis Georgios Antoniou Athanasios Droulias Cases Journal 2008, 1:223 2008-10-07T00:00:00Z doi:10.1186/1757-1626-1-223 Cases Journal 1757-1626 1 223 2008-10-07T00:00:00Z XML IntroductionStress cardiomyopathy is a condition of chest pain, breathlessness, abnormal heart rhythms and sometimes congestive heart failure or shock precipitated by intense mental or physical stress.Case presentationA 64-year-old male with a known diagnosis of moderate-to-severe aortic stenosis and advised that valve replacement was not urgent, presented with acute pulmonary edema following extraordinary mental distress. The patient was misdiagnosed as having a "massive heart attack" and died when managed by a traditional protocol for acute myocardial infarction/coronary artery disease, irrespective of his known aortic stenosis. Conclusion: Intense mental stress poses a considerable risk, particularly to patients with significant aortic stenosis. As described here, it can precipitate acute pulmonary edema. Importantly, effective management of acute pulmonary edema due to stress cardiomyopathy in patients with known aortic stenosis requires its distinction from acute pulmonary edema caused by an acute myocardial infarction. Treatment options include primarily urgent rhythm and/or rate control, as well as cautious vasodilation. http://www.casesjournal.com/content/2/1/9128 Monika Bayer Cases Journal 2009, 2:9128 2009-12-02T00:00:00Z doi:10.1186/1757-1626-2-9128 Cases Journal 1757-1626 2 9128 2009-12-02T00:00:00Z 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, 1:421 2008-12-29T00:00:00Z doi:10.1186/1757-1626-1-421 Cases Journal 1757-1626 1 421 2008-12-29T00:00:00Z XML 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, 3:79 2010-04-06T00:00:00Z doi:10.1186/1757-1626-3-79 Cases Journal 1757-1626 3 79 2010-04-06T00:00:00Z 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, 1:43 2008-07-17T00:00:00Z doi:10.1186/1757-1626-1-43 Cases Journal 1757-1626 1 43 2008-07-17T00:00:00Z XML A 15 year and 1 month old Chinese female with palatally impacted upper left canine was successfully treated with an upper removable appliance with a magnet incorporated to provide orthodontic traction force. This case report indicates the possibility of using magnetic force as a safe, effective and comfortable way for orthodontic traction. http://www.casesjournal.com/content/1/1/382 Larry Li Ricky Wong Nigel King Cases Journal 2008, 1:382 2008-12-10T00:00:00Z doi:10.1186/1757-1626-1-382 Cases Journal 1757-1626 1 382 2008-12-10T00:00:00Z 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, 3:73 2010-02-25T00:00:00Z doi:10.1186/1757-1626-3-73 Cases Journal 1757-1626 3 73 2010-02-25T00:00:00Z 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, 3:76 2010-03-09T00:00:00Z doi:10.1186/1757-1626-3-76 Cases Journal 1757-1626 3 76 2010-03-09T00:00:00Z XML