http://www.hindawi.com The latest articles from Hindawi Publishing Corporation © 2013 , Hindawi Publishing Corporation . All rights reserved. Thu, 23 May 2013 18:51:38 +0000 http://www.hindawi.com/crim/medicine/2013/396401/ We report a dramatic case of a 19-year-old man with crack cocaine overdose with important clinical complications as cardiac arrest due to ventricular fibrillation and epileptics status. During this intoxication, electrocardiographic abnormalities similar to those found in tricyclic antidepressant poisoning were observed, and they were reversed by intravenous sodium bicarbonate infusion. Carlos Henrique Miranda and Antônio Pazin-Filho Copyright © 2013 Carlos Henrique Miranda and Antônio Pazin-Filho. All rights reserved. Thu, 23 May 2013 18:49:30 +0000 http://www.hindawi.com/crim/medicine/2013/468376/ Occult spinal dysraphism is defined as a group of dystrophic conditions below an intact cover of dermis and epidermis. Ultrasonography using linear transducers is a fast, inexpensive, and effective method that makes it possible to view the content of the vertebral canal and bone structures. Magnetic resonance imaging (MRI) is reserved for elucidating the type of dysraphism and for planning corrective surgery. We present a case of a five-day-old female neonate who presented cutaneous stigmas (in the lumbar region, hands, and feet), in whom ultrasonography demonstrated dysraphism in the lumbar region. MRI confirmed the type of dysraphism and enabled surgical planning. Claudio Rodrigues Pires, Jane Marília Matos de Medeiros, Edward Araujo Júnior, Adriano Czapkowski, and Sebastião Marques Zanforlin Filho Copyright © 2013 Claudio Rodrigues Pires et al. All rights reserved. Thu, 23 May 2013 18:41:59 +0000 http://www.hindawi.com/crim/medicine/2013/985310/ Sacral fatigue fractures represent a frequently overlooked cause of low-back and buttock pain in athletes. A high index of clinical suspicion and MRI utilization can provide the accurate diagnosis. A 38-year-old male amateur, midfielder, soccer player presented to our department with aggravating right buttock pain during the previous month, following an increase in training intensity and frequency on an artificial turf field. A point of maximal tenderness was demonstrated over the area of the right sacroiliac joint. No radiographic abnormalities were observed. MRI of the pelvis revealed the presence of a stress fracture in the right sacral ala. The patient underwent conservative treatment and resumed playing soccer 12 weeks later, with no residual or recurrent clinical complaints. Apart from the recent change in training regimen, decreased shock absorption related to the physical properties of old generation artificial turf may have also been involved in this case. Georgios Tzoanos, Nikolaos Tsavalas, Nikolaos Manidakis, and Apostolos Karantanas Copyright © 2013 Georgios Tzoanos et al. All rights reserved. Wed, 22 May 2013 15:21:56 +0000 http://www.hindawi.com/crim/medicine/2013/512416/ We report the case of a 12-year-old girl, who consulted us with one-year history of an 8 mm nose lesion that was painless and firm upon palpation. The lesion was resected conservatively. Immunohistochemistry was in favor of a primitive neuroectodermal tumor (PNET)/Ewing’s sarcoma lesion, excluding epithelial, lymphoid, and other tumors. After a second resection, our patient was referred to chemotherapy and has already undergone 9 cycles out of 14. The patient is to date with no evidence of persistent or recurrent disease. To our knowledge, this is the first description of a PNET arising in the nose. Habib Rizk, Aline Khazzaka, Amer Sebaaly, Maguy Cherfan, Roland Tomb, and Riad Sarkis Copyright © 2013 Habib Rizk et al. All rights reserved. Mon, 20 May 2013 19:04:44 +0000 http://www.hindawi.com/crim/medicine/2013/935172/ Although clinical presentation of fibrillary glomerulonephritis is similar to most forms of glomerulonephritis, it is usually difficult to make the diagnosis. Clinical manifestations include proteinuria, microscopic haematuria, nephrotic syndrome, and impairment of renal function. A diagnosis of fibrillary glomerulonephritis is only confirmed by renal biopsy and it must comprise electronmicroscopy-verified ultrastructural findings. We report four cases between 45–50 years old with documented type 2 diabetes mellitus (T2DM) and arterial hypertension. All patients were found to have fibrils on kidney biopsy. The differential diagnosis of fibrils in the setting of diabetes mellitus is also discussed. Fayna González-Cabrera, Fernando Henríquez-Palop, Ana Ramírez-Puga, Raquel Santana-Estupiñán, Celia Plaza-Toledano, Gloria Antón-Pérez, Silvia Marrero-Robayna, Davinia Ramírez-Medina, Roberto Gallego-Samper, Nicanor Vega-Díaz, Rafael Camacho-Galan, and José C. Rodríguez-Pérez Copyright © 2013 Fayna González-Cabrera et al. All rights reserved. Mon, 20 May 2013 10:54:24 +0000 http://www.hindawi.com/crim/medicine/2013/923129/ Introduction. DiGeorge syndrome is a developmental defect commonly caused by a microdeletion on the long arm of chromosome 22 or less frequently by a deletion of the short arm of chromosome 10. Case report. We report a case of a gentleman with mild dysmorphic features who presented with hypocalcaemia-induced seizures and an associated thyroid mass with a background of learning difficulties and abnormal immune function. Discussion. DiGeorge syndrome was initially described in 1967 by Angelo DiGeorge. The majority of cases are due to a novel mutation. The resulting learning difficulties, congenital heart disease, palatal abnormalities, hypoplasia/aplasia of the parathyroid and thymus glands, and immune deficiency generally lead to diagnosis in childhood. Presentation in adulthood is rare but must be borne in mind when dealing with cases of hypocalcaemia even in the absence of florid phenotypic features. A link with malignant disease has also been reported and should lead to prompt investigation of concerning masses. Adrian Zammit, Deborah Grech Marguerat, Josephine Psaila, and Alexander Attard Copyright © 2013 Adrian Zammit et al. All rights reserved. Thu, 16 May 2013 11:01:36 +0000 http://www.hindawi.com/crim/medicine/2013/867650/ Night eating syndrome (NES) is a nosographic entity included among the forms not otherwise specified (EDNOS) in eating disorders (ED) of the DSM IV. It is characterized by a reduced food intake during the day, evening hyperphagia, and nocturnal awakenings associated with conscious episodes of compulsive ingestion of food. Frequently, NES patients show significant psychopathology comorbidity with affective disorders. This paper describes a case report of an NES patient treated with agomelatine, an antidepressant analogue of melatonin, which acts by improving not only the mood but also by regulating sleep cycles and appetite. After three months of observation, the use of Agomelatine not only improved the mood of our NES patient (assessed in the HAM-D scores) but it was also able to reduce the night eating questionnaire, by both reducing the number of nocturnal awakenings with food intake, the time of snoring, the minutes of movement during night sleep (assessed at polysomnography), and the weight (−5.5 kg) and optimizing blood glucose and lipid profile. In our clinical case report, agomelatine was able both to reduce the NES symptoms and to significantly improve the mood of our NES patient without adverse side effects during the duration of treatment. Therefore, our case report supports the rationale for further studies on the use of Agomelatine in the NES treatment. Walter Milano, Michele De Rosa, Luca Milano, and Anna Capasso Copyright © 2013 Walter Milano et al. All rights reserved. Thu, 16 May 2013 09:06:59 +0000 http://www.hindawi.com/crim/medicine/2013/904952/ Atrial myxoma is the most common primary cardiac tumor. Its clinical presentation spreads from asymptomatic incidental mass to serious life-threatening cardiovascular complications. We report the case of a 44-year-old man with evening fever and worsening dyspnea in the last weeks, admitted to our hospital for acute pulmonary edema. The cardiac auscultation was very suspicious for mitral valve stenosis, but the echocardiography revealed a huge atrial mass with a diastolic prolapse into mitral valve orifice causing an extremely high transmitral gradient pressure. Awareness of this uncommon acute presentation of atrial myxoma is necessary for timely diagnosis and prompt surgical intervention. Andrea Fisicaro, Massimo Slavich, Eustachio Agricola, Claudia Marini, and Alberto Margonato Copyright © 2013 Andrea Fisicaro et al. All rights reserved. Wed, 15 May 2013 14:25:29 +0000 http://www.hindawi.com/crim/medicine/2013/149656/ Background. Extrarenal pathologies may be associated with renal position and fusion anomalies. According to the literature, our patient is the first horseshoe kidney case that had mega cisterna magna, arachnodactyly, and mild mental retardation. Case Report. A 9-year-old boy admitted because of the myoclonic jerks. He had a dysmorphic face, low-set and cup-shaped ears, arachnodactyly, and mild mental retardation. The patient’s laboratory findings were normal except for a mild leucocytosis and hypochromic microcytic anemia. His cerebrospinal fluid was cytologically and biochemically normal. Cranial MRI revealed 1.5 cm diametered mega cisterna magna in the retrocerebellar region. Although there were no significant epileptical discharges in the electroencephalography, there were slow wave discharges arising from the anterior regions of both hemispheres. Because he had stomachache, abdominal ultrasonography was performed, and horseshoe kidney was determined. Abdominal CT did not reveal any abnormalities except the horseshoe kidney. There were not any cardiac pathologies in echocardiography. He had normal 46XY karyotype and there were no repeated chromosomal derangements, but we could not evaluate for molecular and submicroscopic somatic changes. He was treated with valproic acid and myoclonic jerks did not repeat. Conclusion. We suggest that the presence of these novel findings may represent a newly recognized, separate syndrome. Çapan Konca, Bahar Caliskan, and Mehmet Ali Tas Copyright © 2013 Çapan Konca et al. All rights reserved. Mon, 13 May 2013 08:26:06 +0000 http://www.hindawi.com/crim/medicine/2013/735058/ Tracheobronchomalacia (TBM) is defined as the condition where the airway lumen narrows more than 50 percent. The acquired TBM usually occurs in adults; however, the prevalence of TBM in asthma is unknown. We report two cases of severe asthma in elderly patients that could not be controlled with higher medication use. Case 1 was a 70-year-old woman with sever persistent asthma for 10 years, presented with uncontrolled symptoms for 4 months. A CT of the chest showed collapse of the trachea at the posterior wall. Case 2 involved a 72-year-old woman with partly controlled asthma presenting with uncontrolled symptoms for 3 months. A CT of the chest showed normal distal tracheal anteroposterior diameter. However, bronchoscopy showed bronchomalacia at the right and left bronchus of the lower lungs. Patients who have severe asthma, despite adequate treatment with medication, should be further investigated to exclude other diseases that have clinical features similar to asthma such as tracheobronchomalacia, particularly in the elderly. Sawad Boonpiyathad and Atik Sangasapaviliya Copyright © 2013 Sawad Boonpiyathad and Atik Sangasapaviliya. All rights reserved. Mon, 13 May 2013 08:19:15 +0000 http://www.hindawi.com/crim/medicine/2013/280628/ Gastroesophageal reflux disease (GERD) is a common entity in the United States. Surgical fundoplication can be performed safely with well-established long-term results. In selected patients with GERD, endoluminal therapy has a potential role. We report on a patient with recurrent GERD after two prior fundoplications who wished to pursue endoscopic treatment. The presence of a gastrostomy tube allowed for the performance of a transgastric-assisted endoluminal fundoplication using the EndoCinch (TM) device and standard pediatric laparoscopic instruments. Symptomatic relief of GERD with EndoCinch (TM) is common but the long-term outcomes are limited. Nevertheless, the EndoCinch (TM) device remains a method for endoscopic suturing in certain settings. In patients with gastrostomy access, the use of laparoscopic instruments may further enable the performance of advanced endoscopic therapies. Konstantinos Spaniolas, Richard I. Rothstein, and Thadeus L. Trus Copyright © 2013 Konstantinos Spaniolas et al. All rights reserved. Sun, 12 May 2013 16:39:09 +0000 http://www.hindawi.com/crim/medicine/2013/430862/ Left ventricular noncompaction (LVNC) is a rare disease caused by intrauterine failure of the myocardium to compact. The major clinical manifestations of LVNC include heart failure, ventricular tachyarrhythmia, thromboembolic event, and sudden deaths. Atrial arrhythmia usually seen is atrial fibrillation. We report a rare case of focal left atrial tachycardia in an 18-year-old patient who presented for evaluation of persistent tachycardia. Transthoracic echocardiogram showed severe systolic dysfunction and evidence of noncompaction of the left ventricle. A detailed review of ECG revealed the possibility of ectopic atrial tachycardia, most likely originating from the left side. Electrophysiology study showed sustained atrial tachycardia originating on the ridge anterior to the left sided pulmonary veins. A successful radiofrequency catheter ablation was performed at this site without any complications. Shailendra Singh, Gulam Parihar, Rohit Rao, and Vishal Goyal Copyright © 2013 Shailendra Singh et al. All rights reserved. Thu, 09 May 2013 18:41:35 +0000 http://www.hindawi.com/crim/medicine/2013/489362/ Diagnosis and management of a systemic vasculitis are among the most demanding challenges in clinical medicine. A patient with a past history of cryptogenic organizing pneumonia presents with new bilateral lung lesions, unilateral pleural effusion, and significant proteinuria. The patient tested p-ANCA and anti-MPO positive but c-ANCA negative. A diagnosis of granulomatosis with polyangiitis GPA was reached after performing both renal and lung biopsies. Step-by-step differential diagnosis and management are discussed. Katerina D. Samara, Giorgos Papadogiannis, Andrew G. Nicholson, Eleutherios Magkanas, Konstantinos Stylianou, Nikolaos Siafakas, and Katerina M. Antoniou Copyright © 2013 Katerina D. Samara et al. All rights reserved. Wed, 08 May 2013 18:27:33 +0000 http://www.hindawi.com/crim/medicine/2013/189326/ Haemoptysis is rarely reported following coitus, and cardiac decompensation has been mostly implicated in the aetiology. We present a 53-year-old Nigerian, known hypertensive diabetic woman with background ischaemic heart disease who presented with postcoital haemoptysis of one-year duration. Echocardiography revealed combined ischaemic and mitral valvular heart disease, probably of rheumatic aetiology. There has been no previous report in an African population. This case illustrates the need to rule out coitus as a rare but potential cause of haemoptysis in middle aged patients with underlying cardiac pathologies and the need for an extensive cardiac workup in a population with predominantly pulmonary causes of haemoptysis. Emeka B. Kesieme, Browne C. Okonkwo, Peter O. Okokhere, Georgi Prisadov, Eghosa Aigbe, and Christopher Affusim Copyright © 2013 Emeka B. Kesieme et al. All rights reserved. Tue, 07 May 2013 11:16:35 +0000 http://www.hindawi.com/crim/medicine/2013/371387/ We describe an unusual case of renal cell carcinoma (RCC) involving the entire upper urinary tract. A 51-year-old female was referred to us because of macroscopic hematuria. Computed tomography revealed a renal tumor filling renal pelvis and ureter, which turned to be a clear cell RCC after nephroureterectomy. Shigenori Kakutani, Haruki Kume, Yoshikazu Hirano, Toshihiko Wakita, and Yukio Homma Copyright © 2013 Shigenori Kakutani et al. All rights reserved. Tue, 30 Apr 2013 15:26:18 +0000 http://www.hindawi.com/crim/medicine/2013/953240/ Solid pseudopapillary tumor (SPT) is an uncommon neoplasm of the pancreas. A rare case of spontaneous rupture of SPT is reported. A 13-year-old female felt acute abdominal pain without blunt abdominal trauma. Enhanced computed tomography (CT) revealed a tumor in the pancreas tail with fluid collection around it. The tumor was diagnosed as SPT with hemoperitoneum associated with spontaneous rupture. The bleeding was stopped conservatively and she was referred for surgery at three months after the rupture. At that time, CT revealed a tumor 4 cm in diameter, which protruded from pancreas tail without distant metastases. Since peritoneal dissemination was not seen on intraoperative exploration, laparoscopic enucleation was performed. Pathologically, the tumor was diagnosed as SPT with rupture of the capsule of tumor, and complete resection was confirmed. The patient has been followed up for two years, and she is alive without recurrence. Susumu Takamatsu, Hiroto Nagano, Shunroh Ohtsukasa, Yasuyuki Kawachi, and Hiroshi Maruyama Copyright © 2013 Susumu Takamatsu et al. All rights reserved. Tue, 30 Apr 2013 11:46:32 +0000 http://www.hindawi.com/crim/medicine/2013/659078/ Spondylolysis of the lumbar spine has traditionally been treated using a variety of techniques ranging from conservative care to fusion. Direct repair of the defect may be utilized in young adult patients without significant disc degeneration and lumbar instability. We used minimally invasive techniques to place pars interarticularis screws with the use of an intraoperative CT scanner in three young adults, including two athletes. This technique is a modification of the original procedure in 1970 by Buck, and it offers the advantage of minimal muscle dissection and optimal screw trajectory. There were no intra- or postoperative complications. The detailed operative procedure and the postoperative course along with a brief review of pars interarticularis defect treatment are discussed. Gabriel A. Widi, Seth K. Williams, and Allan D. Levi Copyright © 2013 Gabriel A. Widi et al. All rights reserved. Mon, 29 Apr 2013 08:31:32 +0000 http://www.hindawi.com/crim/medicine/2013/401359/ The authors describe the combination of awake craniotomy and minimally invasive endoscopic port surgery to resect a high-grade glioma located near eloquent structures of the temporal lobe. Combined minimally invasive techniques such as these may facilitate deep tumor resection within eloquent regions of the brain, allowing minimum white matter dissection. Technical aspects of this procedure, a case outcome involving this technique, and the direction of further investigations for the utility of these techniques are discussed. Lance Bodily, Arlan H. Mintz, and Johnathan Engh Copyright © 2013 Lance Bodily et al. All rights reserved. Sun, 28 Apr 2013 09:48:19 +0000 http://www.hindawi.com/crim/medicine/2013/353798/ Though commonly encountered, extrapulmonary tuberculosis (TB) can sometimes present with variable clinical picture intricating the diagnosis (Avasthi et al., 2010). The nonspecific symptoms include pyrexia of unknown origin, hepatosplenomegaly, lymphadenopathy, meningitis, and, rarely, variety of hematological abnormalities, namely, anemia, pancytopenia, and leukemoid reaction (Avasthi et al., 2010). When it presents with bone marrow (BM) involvement, prognosis is usually poor (Avasthi et al., 2010, Qasim et al., 2003, and Singh et al., 2001). We, hereby, report a case of extra-pulmonary TB with a six-month history of fever associated with dizziness, fatigability, and cough. During the hospital stay, the patient showed a spectrum of interesting hematological findings, including severe pancytopenia on peripheral smear, necrotizing caseating granulomas consistent with TB on bone marrow examination. The patient showed a good clinical as well as hematological response to antituberculosis treatment. This paper highlights the significance of a hematological picture in the final confirmation of TB, which may otherwise be passed off as nutritional or other unrelated causes. Aisha A. Alghamdi, Faiza S. Awan, Iqbal H. Maniyar, and Naif A. Alghamdi Copyright © 2013 Aisha A. Alghamdi et al. All rights reserved. Wed, 24 Apr 2013 10:00:51 +0000 http://www.hindawi.com/crim/medicine/2013/325127/ A 77-year-old woman visited our institution complaining of general fatigue. Chest radiography revealed masses in the upper and middle lung fields. Pathological findings for an endoscopic biopsy specimen revealed squamous cell carcinoma. High-grade fever developed and blood analyses revealed sustained elevated white blood cell count and C-reactive protein levels. Cytokine production by tumor cells was suspected; both serum granulocyte colony-stimulating factor (117 pg/mL; normal: <57.5 pg/mL) and interleukin-6 (83.5 pg/mL; normal: <2.41 pg/mL) levels were high. Immunohistochemical examination of biopsy specimens showed positive staining with antigranulocyte colony-stimulating factor and anti-interleukin-6 monoclonal antibodies. Diagnosis of a tumor that produced granulocyte colony-stimulating factor and interleukin-6 was established. The patient was administered best supportive therapy since she was not eligible for surgical treatment because of her poor respiratory function. She died from interstitial pneumonia exacerbation two months after this diagnosis. We present a female with squamous cell carcinoma of the lung that produced granulocyte colony-stimulating factor and interleukin-6. Nobuhiro Takeuchi, Kento Yamamoto, and Kazuyoshi Naba Copyright © 2013 Nobuhiro Takeuchi et al. All rights reserved. Tue, 23 Apr 2013 16:21:21 +0000 http://www.hindawi.com/crim/medicine/2013/972684/ We present the case of a 90-year-old diabetic male and medically managed three-vessel coronary artery disease with evidence of an oval, nonmobile echo-density located on the posterior mitral valve annulus measuring two centimeters in diameter without significant impingement of the mitral valve on initial screening echocardiogram which was initially thought to be prominent mitral annular calcification which was later confirmed to be a rare case of caseoma as confirmed by both cardiac magnetic resonance (CMR) as well as coronary computed tomographic angiography (CCTA). William L. Pomeroy, Brian Markelz, Kevin Steel, and Ahmad M. Slim Copyright © 2013 William L. Pomeroy et al. All rights reserved. Tue, 23 Apr 2013 14:27:22 +0000 http://www.hindawi.com/crim/medicine/2013/675372/ Spontaneous spleen rupture is a rare complication of infectious diseases and it can become a potentially life-threatening condition if not diagnosed in time. A 17-year-old Greek female presented to the ER due to acute abdominal pain, mainly of the left upper quadrant. She had no recent report of trauma. The patient was pale, her blood pressure was 90/70 mmHg, and her pulse was 120 b/min. Clinical examination of the abdomen revealed muscle contraction and resistance. The patient was submitted to an ultrasound of the upper abdomen and to a CT scanning of the abdomen that revealed an extended intraperitoneal hemorrhage due to spleen rupture. Due to the patient’s hemodynamic instability, she was taken to the operation room and splenectomy was performed. Following a series of laboratory examinations, the patient was diagnosed to be positive for current cytomegalovirus infection. The postoperative course was uneventful, and in a two year follow-up the patient is symptom-free. Spontaneous spleen rupture due to Cytomegalovirus infection is a rare clinical entity, described in few case reports in the world literature and should always be taken into consideration in differential diagnosis of acute abdomen, especially in adolescents with no recent report of trauma. Verroiotou Maria, Al Mogrampi Saad, and Ioannis Fardellas Copyright © 2013 Verroiotou Maria et al. All rights reserved. Mon, 22 Apr 2013 11:04:04 +0000 http://www.hindawi.com/crim/medicine/2013/730549/ We present a case of persistent pneumaturia of one-year duration in a fifty-five-year-old male with a history of spinal cord injury. The evaluation demonstrated gas throughout the collecting system attributable to a urinary tract infection with a gas-forming organism, Klebsiella pneumoniae. Youssef S. Tanagho, Jonathan M. Mobley, Brian M. Benway, and Alana C. Desai Copyright © 2013 Youssef S. Tanagho et al. All rights reserved. Sun, 21 Apr 2013 15:38:20 +0000 http://www.hindawi.com/crim/medicine/2013/310495/ In children, flexor pollicis longus (FPL) tendon injuries are uncommon. In delayed diagnosed cases, CT and MRI are hard to perform, even though to confirm the location of the lacerated proximal tendon end is preferable for the planning of operation procedure. In such condition, ultrasonography is suitable because of its characteristic feature of easy-to-perform procedure even in children. In this report, preoperative ultrasonography was practical in the delayed diagnosis of FPL tendon in a 2-year-old child to schedule the primary repair because the precise location of both FPL proximal and distal ends was identified. In addition, routine postoperative ultrasonography was also useful to track its healing process without concern about mutual communication due to the patient’s age, which helped to promote active motion. Issei Nagura, Takako Kanatani, and Masatoshi Sumi Copyright © 2013 Issei Nagura et al. All rights reserved. Tue, 16 Apr 2013 17:27:41 +0000 http://www.hindawi.com/crim/medicine/2013/368637/ Nocardia farcinica is a Gram-positive weakly acid-fast filamentous saprophytic bacterium, an uncommon cause of human infections, acquired usually through the respiratory tract, often life-threatening, and associated with different clinical presentations. Predisposing conditions for N. farcinica infections include hematologic malignancies, treatment with corticosteroids, and any other condition of immunosuppression. Clinical and microbiological diagnoses of N. farcinica infections are troublesome, and the isolation and identification of the etiologic agent are difficult and time-consuming processes. We describe a case of fatal disseminated infection in a patient with myelodysplastic syndrome, treated with corticosteroids, in which N. farcinica has been isolated from blood culture and identified by Matrix-Assisted Laser Desorption-Ionization Time of Flight Mass Spectrometry. The patient died after 18 days of hospitalization in spite of triple antimicrobial therapy. Nocardia farcinica infection should be suspected in patients with history of malignancy, under corticosteroid therapy, suffering from subacute pulmonary infection,and who do not respondto conventional antimicrobial therapy. Matrix-Assisted Laser Desorption-Ionization Time of Flight Mass Spectrometry can be a valuable tool for rapid diagnosis of nocardiosis. Christian Leli, Amedeo Moretti, Francesco Guercini, Angela Cardaccia, Leone Furbetta, Giancarlo Agnelli, Francesco Bistoni, and Antonella Mencacci Copyright © 2013 Christian Leli et al. All rights reserved. Wed, 10 Apr 2013 16:04:57 +0000 http://www.hindawi.com/crim/medicine/2013/197561/ A spigelian hernia is a protrusion through an anterior abdominal wall defect along the linea semilunaris. The traditional method of repair consists of an open surgical technique requiring a lengthy abdominal incision to allow visualization of the defect. However, with the emergence and availability of laparoscopic techniques, a minimally invasive approach is feasible. Only eight prior case reports have documented emergent laparoscopic repair of a spigelian hernia. We describe the first successful laparoscopic repair of a spigelian hernia in an emergent setting at our institution. Reid Barker, Richdeep S. Gill, Avneet S. Brar, Daniel W. Birch, and Shahzeer Karmali Copyright © 2013 Reid Barker et al. All rights reserved. Wed, 10 Apr 2013 09:44:28 +0000 http://www.hindawi.com/crim/medicine/2013/461409/ Herein, we report an unusual case of a 78-year-old woman with synchronous presentation of sigmoid cancer and a nonfunctioning primary adrenal cortex carcinoma, who developed superior vena cava syndrome due to metastatic lymphadenopathy from the latter malignancy. Our case suggests that adrenal incidentalomas during initial staging evaluation after cancer diagnosis are not always “innocent” and should not be “a priori” considered incidental findings attributed to hyperplasia, adenoma or even a non life-threatening metastasis from the primary tumor. It also emphasizes the importance of a continuous assessment of patients with synchronous primary malignancies, in order to timely evaluate changes in clinical or biological behavior and administrate the appropriate treatment. Panagiota Economopoulou, Giannis Mountzios, Ioannis Kotsantis, Marios Bakogeorgos, Vassilios Ramfidis, Ioannis Kapiris, Efstratios Patsouris, and Nikolaos Kentepozidis Copyright © 2013 Panagiota Economopoulou et al. All rights reserved. Tue, 09 Apr 2013 13:08:57 +0000 http://www.hindawi.com/crim/medicine/2013/461485/ Microscopic Colitis (MC) is characterized by chronic watery diarrhea, grossly normal appearing colonic mucosa during conventional white light endoscopy, and biopsy showing microscopic inflammation. We report a case of collagenous colitis with gross endoscopic findings. Atif Saleem, Parag A. Brahmbhatt, Sarah Khan, Mark Young, and Gene D. LeSage Copyright © 2013 Atif Saleem et al. All rights reserved. Thu, 04 Apr 2013 18:36:52 +0000 http://www.hindawi.com/crim/medicine/2013/804136/ Large cell neuroendocrine carcinoma (LCNEC) of the urinary bladder is very rare. Definite treatment strategy has not been established and prognosis of the disease is not clear yet. We report a case of primary LCNEC of the urinary bladder here with some review of the literature. The patient was a 84-year-old man. He underwent transurethral resection of bladder tumor (TURBT). Histological examination revealed a rosette arrangement of the tumor cells by HE staining and immunohistochemical study revealed positive CD 56, synaptophysin, and chromogranin A (LCNEC). After TURBT, he has no sign of recurrence for 8 months. We have to strictly observe the progress because LCNEC is very aggressive. Shinro Hata and Yoshihisa Tasaki Copyright © 2013 Shinro Hata and Yoshihisa Tasaki. All rights reserved. Thu, 04 Apr 2013 16:11:10 +0000 http://www.hindawi.com/crim/medicine/2013/751329/ Puerperal group A streptococcal infections, a major postpartum killer during the late 19th and early 20th centuries, have become (fortunately) rare. We describe a cluster of 4 serious peripartum group A streptococcal infections occurring within the past five years at a single medical center. These cases were not epidemiologically linked and serve to illustrate the continuing risk of these potentially fulminant infections. Mary T. Busowski, Melissa Lee, John D. Busowski, Kauser Akhter, and Mark R. Wallace Copyright © 2013 Mary T. Busowski et al. All rights reserved.