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The place of case reports in medical literature

The value of case reports

16 Dec, 14 | by Dr Dean Jenkins

Can case reports reveal the clinical value of radiology?

An odd question I know but a team of researchers from Germany asked very much that in a recently published paper. They concluded with the following answer:

“In case reports published in a prominent general medical journal radiological imaging is an important key player in the diagnostic process. In many cases, it is also the diagnostic tool which ultimately leads to determining the final diagnosis.” (1)

We are glad to see the prominent journal being our very own BMJ Case Reports. One aim – of pulling nearly 10,000 case reports into one place – has been to explore what additional value can be found in the collection. Data mining to look at the diagnostic value of radiology in challenging cases is one of them and the authors of this paper argue the case for that.

Please feel free to use BMJ Case Reports in your methods section. It is one of the most prestigious places to be in a paper. What data mining would you look for?

1 Wiesinger I, Scharf G, Platz N, et al. Evaluation of the contribution of radiological imaging to the final diagnosis in medical case reports. Eur Radiol 2014;:1–6. doi:10.1007/s00330-014-3537-7

Data visualisation

Data mining – another use for Case Reports?

Germany adopts rare disease strategy

2 Oct, 13 | by Dr Dean Jenkins

Following a three year consultation the German plan Measures to Improve the Health Situation of Persons with Rare Diseases in Germany has been published.

“[it] contains 52 distinct proposals for action. Nationally recognised centres of excellence for diseases or groups of diseases that collaborate nationally and internationally are a cornerstone of the German plan in order to provide patients with the best, targeted care available. Providing current, validated information for professionals and patients, improving diagnostics, and supporting research are other key features of the German plan.”

http://www.eurordis.org/content/germany-adopts-rare-disease-strategy-after-participative-3-year-process

achse

The plan (currently only available in German) aims to build expertise, networks, and to gain from the experience of people with rare diseases.

One of the categories of report accepted for BMJ Case Reports is “rare diseases” – the aim being to learn from new discoveries and insights. We watch this development of national strategies for rare diseases with great interest.

Atypical rabies with MRI findings: clue to the diagnosis

4 Jan, 12 | by Emma

Interesting Medicine

Rabies is well known as a fatal infectious disease transmitted through the bites of rabid mammals. When it presents with paralysis, however, it may be clinically indistinguishable from Guillain- Barre syndrome. Here the authors describe this fascinating disease with some spectacular images.

Seema Biswas
Editor-in-Chief

Atypical rabies with MRI findings: clue to the diagnosis

Ulceronodular syphilis (lues maligna praecox) in a person newly diagnosed with HIV infection

14 Dec, 11 | by Emma

An education in pathology

The authors present a case of secondary syphilis complicated by HIV infection. The pictures and description of disease process form an engrossing lesson in pathology.

Seema Biswas
Editor-in-Chief

Ulceronodular syphilis (lues maligna praecox) in a person newly diagnosed with HIV infection

Problems with the new born screen for galactosaemia

7 Dec, 11 | by Emma

Adverse events

A newborn screening test for galactosaemia is designed to identify affected infants and avert clinical effects with the prompt withdrawal of lactose and galactose from the diet. Failure of this test to detect the disease may have catastrophic effects. Here we learn from the factors that affect the effectiveness of the test in order to avoid instances of failure of diagnosis in the future.

Seema Biswas
Editor-in-Chief

Problems with the new born screen for galactosaemia

Concomitant axillary mycobacteriosis and neuro-sarcoidosis: diagnostic pitfalls

30 Nov, 11 | by Emma

Diagnostic pitfalls

Here the authors discuss the difficulties in differentiating microbial (in particular tuberculous) causes of intrathoracic lymphadenopathy and sarcoidosis; indeed, sarcoidosis may occur in patients with previous microbial infection just as TB occurs in patients who are HLA B27 positive. Case reports are an excellent platform for diagnostic debate and the discussion of pitfalls.

Seema Biswas
Editor-in-Chief

Concomitant axillary mycobacteriosis and neuro-sarcoidosis: diagnostic pitfalls

Unilateral onycholysis in a patient taking erlotinib (Tarceva)

23 Nov, 11 | by Emma

Rare side effect of treatment

Here the authors present a case of unilateral onycholysis in a patient receiving an EGFR tyrosine kinase inhibitor. In addition to describing a possible mechanism for this side effect, the authors also highlight the benefits of targeted therapy.

Seema Biswas
Editor-in-Chief

Unilateral onycholysis in a patient taking erlotinib (Tarceva)

The use of intraoperative PET probe to resect metastatic melanoma

16 Nov, 11 | by Emma

Introducing novel methods of investigation and treatment

Here the authors report two cases of metastatic melanoma resected with the assistance of an intraoperative handheld positron emission tomography (PET) probe. The probe was used to identify hypermetabolic lymph nodes and after resection the probe reading returned to background levels. At follow up the patients remained disease free.

Seema Biswas
Editor-in-Chief

The use of intraoperative PET probe to resect metastatic melanoma

The place of case reports in medical literature: Periorbital cellulits – a mistaken diagnosis!

9 Nov, 11 | by Emma

Case reports offer level IV evidence ranked well below randomised control trials and meta-analyses.

http://healthpolicyandreform.nejm.org/?p=14876&query=TOC

What role do case reports have then in the medical literature? Certainly, the report of adverse events, the opportunity to discuss diagnostic pitfalls, present novel methods of investigation and treatment and, of course, present cases of enormous interest and concern.

Over the next few weeks we hope to present a series of reports that illustrate these examples of the relevance of case reports in modern evidence based medicine. Here is the first…

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A near miss

A 12 year old healthy girl presents with unilateral periorbital swelling, purulent discharge, pain in her jaw and palpable cervical lymphadenopthy. An initial diagnosis of preseptal cellulitis is made, but, in spite of a course of conventional broad spectrum antibiotics, the symptoms progress. A careful history and further investigation leads to a diagnosis of cat scratch disease and treatment is adjusted.

Seema Biswas
Editor-in-Chief

Periorbital cellulits – a mistaken diagnosis!

BMJ Case Reports: publishing, sharing and learning through experience

BMJ Case Reports

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