Case reports

Oscillococcinum is an alternative medicine prepared by serial dilution of wild duck heart and liver extracts. This preparation has been labelled as a 'non drowsy, homoeopathic medicine' that 'reduces the duration and severity of flu and flu-like symptoms'. Clinical evidence exists to support this claim and the product has not previously been reported to cause any serious adverse drug reactions. We bring to light, however, a case of angioedema in our patient who was using oscillococcinum for flu-like symptoms. Consumers must therefore exercise caution at the outset of allergy symptoms.

Arthrogryposis multiplex congenita refers to a clinical condition or syndrome characterised by multiple congenital contractures that affect two or more different areas of the body. Of the cases reported so far, an important percentage had to be terminated before pregnancy term, predominantly by caesarean section. We describe a 36 year-old woman who wanted to conceive. A multidisciplinary approach was set from the preconceptional period and special attention was given to respiratory function, potential anaesthetic difficulties and thromboembolic risks. She delivered by caesarean section at 38 weeks. This case emphasises the possibility of achieving a term delivery in these patients and points out the importance of a multidisciplinary team, specially of obstetricians and anaesthesiologists.

Time-series analysis was used to study the associations between daily weather variables and symptomatology in a man suffering from recurrent anxiety. Outcome measures were the patient's main symptoms: anxiety and energy. Wind direction appeared to be related to the patient's energy levels; these were significantly lower when the wind blew from the southeast. This effect could not be explained by other weather parameters. Decreases in energy in turn predicted increases in anxiety. The reverse effect was observed as well, with increases in anxiety predicting decreases in energy, indicating a positive feedback loop.

A pre-teenager with newly diagnosed ulcerative colitis presented to an emergency department with acute headache, altered mental status and bilateral lower extremity weakness. Head CT demonstrated acute thrombus in the vein of Galen and straight sinus, and the patient was started on a heparin infusion. The patient clinically deteriorated and became unresponsive. In view of the rapid deterioration despite anticoagulation therapy, the patient was taken for endovascular treatment. A novel endovascular approach was performed with combined use of Solitaire FR and Penumbra devices to enhance access to the straight sinus and to limit intraprocedural blood loss. The post-treatment head CT demonstrated a decrease in hyperattenuation within the vein of Galen and straight sinus. The neurologic status improved within 24 h. The patient was discharged home with a normal neurologic examination.

Conclusions CBS is a heterogeneous clinical syndrome whose differential diagnosis is extensive. CJD can occasionally present with clinical characteristics resembling CBS. MRI detection of abnormalities in some sequences (FLAIR, DWI), as previously reported, has ...

We report a baby boy with gastroschisis with left non-palpable undescended testis who had a defect on the left side of an intact and normal umbilical cord and had associated testicular atrophy and abnormalities of the ductus deferens. They were successfully managed by primary repair and had uneventful recovery. Subsequent inguinal exploration confirmed blind ending vas deferens and vanishing left undescended testis. Our case confirms vascular accidents at the narrow abdominal wall defect can lead to vanishing testis following attempts at closing gastroschisis making the defect narrow and compromising the blood supply to the testis.

We present two cases where the identities of mixed radiopaque radiolucent lesions in the lower incisor region were unclear, although the position of the lesions and positive pulp sensitivity tests were suggestive of periapical osseous dysplasia. In the first case, the lesion presented as a solitary round mixed radiopaque radiolucent periapical lesion, suggestive in some images as periapical osseous dysplasia. Cone beam CT (CBCT) provided clear images, which confirmed the diagnosis and, additionally, the images showed evidence of initial lesions associated with other anterior teeth and some destruction of the labial plate, not evident on the conventional radiographs. In the second case, radiopacities were identified within the lesion on conventional radiographs, but CBCT imaging also showed extensive and unexpected perforation of the lingual plate. Such destruction of cortical plates may be a feature of periapical osseous dysplasia, which is not visible in conventional radiography.

Angina bullosa haemorrhagica is the term used to describe benign subepithelial oral mucosal blisters filled with blood that are not attributable to a systemic disorder or haemostatic defect. It is a very rare condition. Elderly patients are usually affected and lesions heal spontaneously without scarring. The pathogenesis is unknown, although it may be a multifactorial phenomenon. Trauma seems to be the major provoking factor and long-term use of steroid inhalers has also been implicated in the disease. We present a 50-year-old patient with angina bullosa haemorrhagica. Trauma by sharp cusp of adjacent tooth and metal crown were identified as aetiological factors in this case. Lesions healed after removal of the metal crown and rounding of the cusp. Therefore, recognition of the lesion is of great importance to dentists, to avoid misdiagnosis.

The aim of this series of articles is to identify and characterize the main linguistic and structural features of medical case reports in the field of psychiatry and psychology. The series of papers is divided into to two parts: theoretical and empirical. The main purpose of the first part is to present the theoretical background of the discourse of psychiatry and psychology as well as the characteristics of case reports of these disciplines. In the paper, the present authors also demonstrate the structure of the case reporting of psychiatry and psychology, including the instruction for authors given by the American Psychological Association. Also, the narrative approach, the patient's stories appearing in these texts as well as one of the main elements of the case reports, i.e. 'case conceptualization' are discussed. The second part will be an empirical one. The main research question is whether the case reports of psychiatry and psychology are typical representatives of the microgenre or whether they are different with respect to particular levels of the texts. The case reports of psychiatry and psychology will be compared with the case reports of clinical and surgical disciplines, for instance from cardiology or otorhinolaryngology.

Traumatic ventricular septal defects (VSDs) compli-cate 1-5% of penetrating cardiac injuries and can occur from direct lacerations (i.e. stab or gunshot) or contusions [1, 2]. Although any cardiac structure can be involved, most cases of traumatic cardiac injuries involve the ventricular chambers with more than 50% occurring on the right ventricular (RV) free wall given its anterior location [3, 4]. Only 10-25% of patients with a penetrating cardiac injury survive to reach hospital care and only 20% have stable hemo-dynamics on arrival [4, 5]. At presentation, stabili-zation of penetrating cardiac injuries is the priority and sternotomy or thoracotomy with exploration should be considered when there is hemodynamic instability [6]. Immediate treatment involves repair of free wall lacerations and a thorough cardiac exami-nation is often deferred if the causative lesion is identified and repaired [7]. VSDs can be diagnosed immediately or weeks after the initial injury and may not be noted on initial surgical exploration [8]. Mana-gement of these traumatic VSDs are challenging since patients can have numerous other injuries.Although some small VSDs may close spontane-ously, they can enlarge over time as a result of remodeling and turbulent flow. This can result in significant left to right shunting with signs and symptoms of congestive heart failure that are often preceded by enlarging cardiac chambers and eleva-tion in right ventricular systolic pressure (RVSP) [9,10]. Although open surgical repair with sternotomy can be performed, transcatheter repair is less invasive and can be effective. Technical challenges include the heterogeneous nature of these defects in terms of size, location, irregularity, and potential proximity to surrounding structures. We herein present two illustr-ative cases and review of the literature.

Traumatic asphyxia is a clinical syndrome related to cervicofascial cyanosis, petechiae, subconjunctival
haemorrhages and neurological symptoms. This syndrome occurs after a transient, severe and compressive
blunt thoracic trauma. Here, we presented two cases of traumatic asphyxia. They both had prominent petechiae
on upper parts of their bodies. The prognosis was excellent in the boy. Contrary, second case was dead in
emergency department due to subarachnoid haemorrhage and intracerebral petechial haemorrhages. Traumatic
asphyxia alone does not predict morbidity and mortality. It is the concomitant cardiovascular, pulmonary
and neurologic injuries that affect the outcome. (Hong Kong j.emerg.med. 2011;18:339-342)

The patient was a right-handed, 73-year-old female. She had mild memory dysfunction, but she could live independently.
She had a past history of artificial aortic valve replacement and atrial fibrillation. However, she chose to discontinue warfarin.
She was admitted to our hospital complaining of dizziness and visual dysfunction that had lasted for eight hours. A bedside
neurological examination disclosed upper-field hemianopsia, central achromatopsia, and truncal ataxia. A cranial MRI showed
acute infarcts in the posterior circulation, including the bilateral lower posterior lobes and the cerebellar vermis. Conservative
treatment and bedside rehabilitation ameliorated her central achromatopsia and truncal ataxia. When she started gait training
in the rehabilitation room on the 8th day of hospitalization, she could not return from the rehabilitation room to her hospital
room by herself. Further examination suggested that she had developed landmark agnosia without prosopagnosia, so her
family was advised to accompany her when she went out until there was improvement in her landmark agnosia. Six months
later, she could walk around near her house by herself. Discovering landmark agnosia in a bedside check is so difficult that it
might be missed, especially in people with cognitive decline. However, caregivers can be advised to support such patients so
that they can go about their daily lives safely. When a patient has a large posterior lobe lesion, it is important to actively check
for landmark agnosia and to advise the patient and family properly.
Key words: landmark agnosia, stroke, posterior lobe, dementia, rehabilitation.

A supernumerary tooth is an additional entity to the normal series and can be seen in all quadrants of the jaw. Occurrence may be single or multiple, unilateral or bilateral, erupted or impacted in one or in both jaws. Multiple supernumeraries are rare in individuals with no other associated disease or syndromes. The conditions commonly associated with an increased prevalence of supernumerary teeth include cleft lip and palate, cleidocranial dysplasia and Gardner syndrome. The supplemental supernumerary refers to a duplication of teeth in normal series and is found at the end of a tooth series. A supplemental tooth may closely resemble the teeth of the group to which it belongs or it may bear little resemblance in size or shape to the teeth with which it is associated. This report presents a case with bilateral supplemental upper permanent lateral incisors without any symptoms of associated disorders.