Case Series Research Articles

A case series report of three patients with borderline personality disorder who received eye movement desensitization and reprocessing therapy.

A case series report of three patients with borderline personality disorder who received eye movement desensitization and reprocessing therapy.

Neosporosis in 21 adult dogs, 2010-2023.

Limited information is available regarding the clinical features, treatment, and prognosis of neosporosis in adult dogs. Describe the clinical signs, laboratory findings, magnetic resonance imaging (MRI) findings, treatment and outcome in adult dogs (>6 months) diagnosed with neosporosis based on consistent clinical signs and positive serology (titer ≥1 : 800) at a referral hospital in Sydney, Australia. Twenty-one client-owned dogs. Retrospective case series of affected dogs between 2010 and 2023. Survival times were determined from onset of clinical signs to date of death or censoring. Clinical signs varied, and were indicative of generalized myopathy (6 dogs), multifocal intracranial disease (7 dogs), myelopathy (4 dogs), polyneuropathy (2 dogs) and single cases of focal myopathy and cerebellar disease. Serum creatine kinase activity was markedly increased (median, 3369 U/L) in most dogs. The most common MRI abnormalities were multifocal intracranial abnormalities (7/13 dogs) and muscle changes (5/13 dogs) whereas T2-weighted cerebellar abnormalities (2/13 dogs) and cerebellar atrophy (1/13) were less common. Treatment response was complete (resolution to normal) in 8 dogs, incomplete (persistent neurological deficits) in 6 dogs, but there was minimal response in 7 dogs. Thirteen dogs (62%) were alive after 6 months and 12 dogs (57%) alive after 1 year. Relapse was common, with 4 dogs experiencing at least 1 relapse event during the follow-up period. Adult-onset neosporosis is uncommon and has variable clinical presentations. Treatment response also is variable, and relapse can occur, even among patients that respond completely to initial treatment.

"Revolutionizing auricular seroma treatment: exploring diverse surgical strategies with a comprehensive case study".

Auricular seromas present a significant therapeutic challenge due to their propensity for recurrence and potential for cosmetic deformity. This case series illustrates the effective management of post-traumatic auricular seromas through diverse surgical approaches in two patients. Each case highlights the use of different splinting materials post-surgery, detailing the clinical presentations, surgical interventions, and follow-up outcomes. Additionally, the study reviews alternative treatment modalities reported in the literature, providing a comprehensive overview of current strategies for managing auricular seromas. By exploring these cases, the study enhances understanding of the surgical strategies and their outcomes, emphasizing the importance of tailored treatments for auricular seromas.

Clinical features and surgical outcomes of membranous subaortic stenosis in three siblings: a case series and literature review

Introduction: Subvalvular aortic stenosis (SAS) is a rare heart condition that can cause LVOT obstruction and lead to serious complications. While surgery is the main treatment, recurrence is a concern. This case series highlights the challenges in managing SAS in young patients. Case Series: Three young brothers presented with symptoms of shortness of breath and chest tightness. All were diagnosed with membranous SAS through echocardiography and Doppler ultrasound. Surgical intervention was performed to remove the obstruction, but all three patients experienced recurrence within two years. Discussion: This case series of three brothers suggests a genetic predisposition. Symptoms included exertional dyspnea and chest tightness, diagnosed via echocardiography. Surgical intervention is the primary treatment, but its timing is debated due to recurrence risks and complications. Conclusions: This case series suggests a possible genetic predisposition to SAS. Despite successful initial surgery, the high recurrence rate highlights the need for improved management strategies and long-term follow-up. Further research is crucial to understand the causes of recurrence and optimize treatment for children with SAS.

Reduction of high-grade spondylolisthesis using minimally invasive spine surgery-transforaminal lumbar interbody fusion "trial-in-situ" technique: a technical note with case series.

This retrospective case series evaluated the effectiveness of minimally invasive spine surgery-transforaminal lumbar interbody fusion (MIS-TLIF) using the "trial-in-situ " technique for reducing high-grade spondylolisthesis. The surgical management of grade ≥III spondylolisthesis has been controversial, with various methods documented in the literature, including in-situ fusion, in-situ trans-sacral delta fixation, distraction techniques, and external reduction techniques. Recently, MIS techniques have gained popularity. This study analyzed 18 cases of high-grade spondylolisthesis treated with MIS-TLIF using the "trial-in-situ " technique. The clinical outcomes were assessed using the Visual Analog Scale (VAS) and the modified Oswestry Disability Index (mODI) scores. The spinopelvic parameters and sagittal balance were also analyzed. Preoperatively, the spinopelvic parameters were deranged, with a mean pelvic tilt of 28.31°, which improved to 13.91° postoperatively. Similarly, the sacral slope improved from 45.65° to 38.01°. VAS and mODI scores improved postoperatively, indicating the effectiveness of the "trial-in-situ " technique in reducing high-grade spondylolisthesis and achieving a better sagittal profile and spinopelvic parameters. The findings indicate that MIS-TLIF using the "trial-in-situ " technique is a viable and effective method for treating high-grade spondylolisthesis.

The Impact of Nusinersen Treatment on Respiratory Function in Patients with Spinal Muscular Atrophy: A Systematic Review

Background/Objectives: This systematic review evaluated the impact of nusinersen therapy on respiratory health and function in individuals with spinal muscular atrophy (SMA) and determined whether nusinersen improves pulmonary function, focusing on differences based on patient age and the timing of treatment initiation. Methods: A systematic search of PubMed, Ovid Medline, ScienceDirect, and Web of Science databases was conducted up to January 2024 in accordance with the PRISMA guidelines. Thirteen studies were included, comprising clinical trials, observational studies, and case series that focused on respiratory outcomes in SMA patients treated with nusinersen. The data on study design, participant characteristics, nusinersen intervention, respiratory outcomes, and adverse events were extracted. The Joanna Briggs Institute Critical Appraisal Tool was used to assess study quality. A narrative synthesis was conducted to address the heterogeneity of the studies. Results: This review found a general trend of improvement in pulmonary function, specifically in forced vital capacity (FVC), although the extent and duration of improvement varied across the studies. Peak cough flow (PCF) and peak expiratory flow (PEF) showed positive trends in some studies, although the results were not consistently significant. Respiratory function improvements were frequently observed, particularly in younger patients and those treated earlier. Conclusions: Nusinersen appears to enhance respiratory function and improve motor outcomes in SMA patients, especially with early treatment. However, further research is needed to fully understand its mechanisms and long-term effects on respiratory health in SMA.

Manifestations of Hydralazine-Induced Vasculitis: A Case Series

Manifestations of Hydralazine-Induced Vasculitis: A Case Series

Dentigerous cysts in horses: A retrospective study

SummaryBackgroundDentigerous cysts are well‐known congenital defects in horses, and the literature on this condition is extensive. Recently, a third type of dentigerous cyst, associated with an exostosis arising from the temporal bone, has been described. Today, computed tomography (CT) is often available and provides detailed information about the exact location and extent of dentigerous cysts, allowing for the description of new findings.Study designThis is a case series outlining the clinical, radiographic and computed tomographic features of dentigerous cysts in seven horses presented to the Equine Clinic at the Vetsuisse Faculty, University of Zurich, Switzerland.ObjectivesThe aim of this case series was to describe the radiographic and computed tomographic findings, and the occurrence of exostoses arising from the temporal bone, in horses with dentigerous cysts.MethodsThe medical records of the Equine Hospital at the University of Zurich were reviewed for horses admitted with dentigerous cysts between 2007 and 2023. Data collected and analysed included patient signalment, clinical history, clinical signs and their duration prior to referral, diagnostic imaging results, treatment and outcomes.ResultsThe most common location for the cysts was the base of the ear, although in one case, the maxillary sinus was involved. Of the seven cases, four were Icelandic horses. CT proved superior to standard radiography for determining the extent and precise location of the cysts, as well as for identifying dental material and exostoses in the temporal region. CT also facilitated detailed surgical planning. All cysts were surgically removed with good long‐term outcomes.Main limitationsOverall, the incidence of dentigerous cysts in horses was low. The relatively high occurrence of dentigerous cysts in Icelandic horses in this study is an interesting finding, though the small sample size calls for further research.ConclusionsTwo of the cases in this series were similar to a recently described variant of a ‘temporal dentigerous cyst associated with an exostosis in the temporal region’ and were closely connected to the bony structure and draining tract.

Combination Dornase and Alteplase for Intra-abdominal Drain, Abscess, and Hematoma Clearance: A Retrospective Case Series

Background: Since the advent of the MIST2 trial, the combined instillation of dornase and alteplase has become an effective nonsurgical treatment option for empyema and pleural fluid collection. Percutaneous drainage of abdominal abscesses and fluid collections, rather than open surgical treatment, also has become commonplace. The are several case reports and studies on the use of fibrinolytics to drain abdominal fluid collections but no literature reporting use of both alteplase and dornase for abdominal administration. Objective: We present a case series from an academic medical center where dornase therapy was added to fibrinolytic therapy to treat intra-abdominal fluid collections, hematoma, and abdominal drainage catheters with low output. Methods: This is an institutional review board-approved retrospective case series of 13 patients who underwent combination use of alteplase and dornase via intra-abdominal route. The primary objective was to assess for increased drain output, reduction in size of the fluid collection, and adverse events. Results: Many patients had improved drain output after dornase-alteplase therapy. One patient had significant bleeding complications. Conclusions: All patients were discharged alive from the hospital. Clinical success was difficult to define due to variable goals of therapy. Further data are needed to establish the safety and efficacy of this practice, especially compared with intra-abdominal alteplase alone. Patients in our series generally received larger doses of alteplase than in prior studies due to use of dosing modeled on the MIST2 trial. Based on the limited experience of our study, we recommend holding therapeutic anticoagulation during the administration of intra-abdominal dornase-alteplase.

Post-COVID-19 Vaccination Meningitis and Meningoencephalitis: A Systematic Review of Case Series and Case Reports.

Meningitis and meningoencephalitis, as inflammatory diseases of the brain parenchyma, are serious events reported sporadically after coronavirus disease 2019 (COVID-19) vaccination. However, there is a lack of systematic reviews consolidating these reported cases. By using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a comprehensive search was conducted across PubMed, Scopus, Embase, and Web of Science databases. All case reports and series discussing the emergence of meningitis and meningoencephalitis after COVID-19 vaccination were included and evaluated using the Joanna Briggs Institute critical appraisal tool. Out of 967 records, 27 studies with 31 patients were eventually included. The most commonly reported symptoms were headaches and fever. About one-third of the patients exhibited positive meningeal signs. Most of the findings in the computed tomography scans and magnetic resonance images revealed no significant changes or enhancement in the leptomeninges. Cerebrospinal fluid analysis dominantly suggested aseptic meningitis, and about 80.6% of the patients experienced a full recovery. After a detailed review of the reported cases, further research is needed to establish a definitive correlation between meningitis and COVID-19 vaccination on a larger scale.

Cutting-Edge Technology Without Cutting: Treating Skin Cancer in This Era—A Case Series

Background: Traditional treatment methods for non-melanoma skin cancer (NMSC) include surgical excision with histological evaluation, yet advancements such as reflectance confocal microscopy (RCM) and superficial radiation therapy (SRT) offer non-invasive management alternatives. This study aims to evaluate the use of RCM for the evaluation of treatment outcomes after SRT in managing localized NMSC. Methods: A prospective interventional case series study was conducted on patients treated for NMSC with SRT between March 2020 and December 2023. Suspected NMSC lesions were initially evaluated with a handheld dermoscope and then imaged at multiple depths using a VivaScope 1500 RCM. Two dermatologists trained in RCM reviewed the images. Confirmed NMSC lesions were biopsied and treated with SRT, followed by RCM imaging at six months post-treatment to assess cancer clearance, scarring, and inflammation. Results: Of the 38 lesions (composed of SCC (24) and BCC (14)) treated affecting the 29 patients, all lesions showed no residual tumor activity upon conducting follow-up RCM (100% clearance). Scarring and mild erythema were noted clinically. Six lesions demonstrated moderate to severe inflammation at a 6-month follow-up. Conclusions: This study demonstrates successful non-invasive management of localized NMSC using RCM and SRT. RCM was able to non-invasively demonstrate complete tumor clearance achieved by SRT with minimal adverse effects. These findings support considering the use of RCM and SRT as primary diagnostic, monitoring, and treatment options for NMSC without the need for biopsies, especially for elderly patients or those unsuitable for surgery due to medical conditions.

The Clinical Profile of Heatstroke Patients Admitted to the Intensive Care Unit: A Case Series From a Tertiary Care Center in New Delhi, India

The Clinical Profile of Heatstroke Patients Admitted to the Intensive Care Unit: A Case Series From a Tertiary Care Center in New Delhi, India

Nutrition and Training Recommendations for Transgender and Gender-Diverse Athletes Involved in Strength Sports and Resistance Training: A Case Series of Nine Athletes Assigned Female at Birth.

Transgender and gender diverse (TGGD) athletes have distinct nutrition and training considerations. Guidance for nutrition and sport professionals working with TGGD athletes is lacking, especially when addressing sex-specific data. The purpose of this case series was to depict nutrition and training assessment approaches and recommendations for TGGD athletes involved in strength sports or resistance training. Six types of data informed each case presentation, including: demographic, anthropometric, health history, and survey data (Eating Competence Scale, Exercise Benefits and Barriers Scale); a 3-day food and physical activity record; and an in-depth interview. Nine TGGD athletes assigned female at birth (AFAB) presented with a range of gender identities, experiences, sport involvement, and transition journeys. Most athletes consumed inadequate energy and fiber, adequate or marginally high levels of saturated fat and added sugars, and high levels of sodium. Most athletes scored low on the Eating Competence Scale and high on the Exercise Benefits and Barriers Scale. Nutrition and sports professionals can individualize the care they provide for TGGD athletes when addressing sex-specific data and help athletes ensure they are meeting their nutrient needs.

Pregnancy After Beating Thyroid Cancer: A Case Series

Pregnancy After Beating Thyroid Cancer: A Case Series

Giant cell interstitial pneumonia: case series with comprehensive ultrastructural analyses of "not only" hard metal pneumoconiosis.

Giant cell interstitial pneumonia (GIP) is a fibrosing lung disease histologically characterized by centrilobular pulmonary fibrosis and cannibalistic intra-alveolar multinucleated giant cells. It is considered a form of pneumoconiosis caused particularly by secondary exposure to hard metals (cemented carbide or tungsten carbide). Hard metals are commonly used in various industrial applications, such as cutting tools, drilling tools, machine inserts, and other wear-resistant components. However, cases with unknown exposure that recurred in transplanted lungs have been described. This has led to the hypothesis of a complex etiopathogenesis, likely multifactorial, involving the coparticipation of immune mechanisms. We aimed to identify all the elements present in a series of GIP lung samples to better understand the pathogenic mechanisms of the disease. We describe five cases of histologically diagnosed GIP in patients with occupational exposure to metallic dust using ultrastructural characterization to identify metal dust and to quantify asbestos fibres. We found that tungsten was present in three cases, albeit in trace amounts in two of them. Numerous elements were identified in all samples, including asbestos fibres in patients with endstage pulmonary fibrosis. Furthermore, in one of the described cases the recurrence of the disease was also observed in transplanted lungs. These findings support the hypothesis that GIP may be due to elements other than hard metals, with asbestos possibly representing a contributory factor in the expression of a more severe fibrotic disease. The recurrence of GIP observed in transplanted organs strengthens the hypothesis of the existence of a not yet fully understood etiopathogenic immune mechanism.

Topical Timolol for Treatment of Spider Angiomas in Children: A Case Series.

We report five cases of spider angiomas in children treated topically with timolol 0.5% (ophthalmic solution or gel-forming solution), for 6 months. Parents and patients were advised to apply one drop twice daily. Four of them showed either partial (2) or complete response (2) and only one patient had no clinical change. No adverse effects were reported. This pilot case series shows that topical timolol may prove useful as a noninvasive, available and well-tolerated treatment option for spider angiomas in children who seek a treatment alternative to pulsed dye laser.

Clinical Applications and Outcomes of the Supraclavicular Osteocutaneous Flap for Head and Neck Reconstruction.

This study evaluates the clinical applications of the supraclavicular osteocutaneous (SOC) flap in complex head and neck reconstruction and its impact on shoulder function following clavicle resection. Case series with a planned chart review. Single-institution tertiary care center. We reviewed patients with complex mandibular and maxillary defects who underwent SOC flap reconstruction from 2016 to 2020. We detailed flap harvesting techniques, patient characteristics, diagnoses, defect sites, bone dimensions, skin paddle size, vascular supply, and donor site management. Complications and outcomes were also documented. The study included 7 patients with diverse clinical conditions and diagnoses. Reconstruction techniques varied, leading to different clavicle thicknesses and skin paddle sizes. Two cases had flap necrosis due to infection, and 1 experienced chronic shoulder discomfort following partial-thickness clavicle flap surgery. Full-thickness clavicle harvesting resulted in better outcomes and simplified the procedure. Notably, there were no significant long-term complications affecting shoulder function. The SOC flap is a promising option for complex head and neck reconstruction, adaptable to specific case requirements and providing reliable vascular supply. It offers favorable clinical outcomes both functionally and aesthetically. Full-thickness clavicle harvesting, with joint preservation, effectively maintains shoulder function.

Pharmacotherapy of persistent genital arousal disorder/genito-pelvic dysesthesia: an updated review and data from a registry.

Persistent genital arousal disorder/genitopelvic dysesthesia (PGAD/GPD) is a rare, yet debilitating disease, which has been included into ICD-11. Pharmacotherapy in PGAD/GPD is a mixed blessing - drugs may either alleviate symptoms or worsen/induce them. Therefore, we aim at offering both an overview of pharmacological approaches to treat this disorder including treatment failures and to highlight drugs that may induce or worsen symptoms. We include all available data published so far as well as data from an own registry. The international registries have not recorded any completed or ongoing trials on pharmacotherapy of PGAD/GPD. We refer to case reports, case series, online surveys and data from our own registry that includes 90 subjects with PGAD/GPD. There is weak evidence (level 4) that some drugs such as SSRIs, SNRIs, cannabinoids and anticonvulsants (pregabalin and gapabentin) may alleviate symptoms in PGAD/GPD. However, serotonergic drugs may also induce or worsen PGAD/GPD during administration or termination as observed in 28% of cases. In conclusion, the pharmacotherapy of PGAD/GPD is still in its infancy just like the etiopathological understanding of the disease. Clinicians should be aware of PGAD/GPD, conduct careful diagnostics and discuss an individual treatment plan with the patient.

Cervical kyphoscoliosis due to substance abuse: a case series on introduction and neurosurgical treatment.

A prospective case series. To investigate the possible associations of multi-directional cervical kyphoscoliosis (CKS) with substance abuse and evaluate treatment outcomes. CKS is a rare medical situation without a well-established pathology. Still there are many obscurities in treatment paradigms and outcomes. To our knowledge, there is no published report on the association between CKS with addiction. Besides the novel report of such a rare etiology for CSK, the complexity of the neurosurgical treatment makes this report the first of its kind. In this series, we presented three patients with a history of crack cocaine addiction who suffered CKS due to prolonged hand-over-neck posture and treated all of them with a complex neurosurgical protocol. All cases were operated on and restored their normal spine alignment. Their long-term outcomes showed independent neurological status with no major surgical complications. Crack cocaine addiction might be associated with CKS in long-term cocaine abuse. A complex neurosurgical approach can achieve a sustainable clinical outcome.

Arthroscopic treatment for femoroacetabular impingement yields favourable patient-reported outcomes and method survivorship at 10-year follow-up.

To compare the outcomes of hip arthroscopy for femoroacetabular impingement syndrome (FAIS) preoperatively and at minimum 10-year follow-up using patient-reported outcome measures (PROMs). A total of 128 patients with FAIS were prospectively included. The patients underwent arthroscopic surgery for FAIS between 2011 and 2013 and had a minimum of 10-year follow-up. The International Hip Outcome Tool short version (iHOT-12) was the primary outcome. Secondary outcomes were the Copenhagen Hip and Groin Outcome Score (HAGOS), the European Quality of Life-5 Dimensions Questionnaire (EQ-5D), the European Quality visual analogue scale (EQ VAS), the Hip Sports Activity Scale (HSAS) for physical activity level, the Visual Analogue Scale (VAS) for overall hip function and a single question regarding overall satisfaction with the surgery. The Wilcoxon signed rank test was used to compare pre- and postoperative PROMs. There was a significant improvement (p < 0.001) of iHOT-12, HAGOS subscales, EQ-5D, EQ VAS and VAS for overall hip function. A total of 83% of the patients were satisfied with their surgery. The survivorship of hip arthroscopy, defined as nonconversion to total hip arthroplasty (THA), at the end of the follow-up period was 77%. Patients undergoing arthroscopic treatment for FAIS reported statistically significant and clinically relevant improved outcomes at 10-year follow-up. Case series, level IV.