Diligent case reports: A rich reservoir for midlife healthcare and research.

“Case reports are the heart of medicine. They are how all doctors learn, and every patient, no matter how “ordinary” his or her problem, has something to teach us… It's one way to recover some of the lost humanity of medicine.”

There is a revival of enthusiasm and interest in support of case reports in general and specialty medicine. This is reflected in the emergence of several journals dedicated to case reports.[1-3] A medical symposium highlighting the importance of case reports was organized by Cases Network at the Royal College of Physicians in London on May 15, 2009, where Sir David Weatherall emphasized the importance of case reports and patient stories.[1] Introducing the Journal of Medical Case Reports, Kidd says that since case reports are considered to have low impact value, their publications are on the decline in the high-impact journals.[3] The authors further emphasize the value of high-quality case reports in the expansion of current medical knowledge.

There are three case reports in the present issue of JMH. A case of post-salpingectomy endometriosis by Indranil Chakrabarti opens up an interesting area of peri/postmenopausal endometriosis.[4] Serious and life-threatening cases of postmenopausal endometriosis may go unnoticed. Accidental but causal bilateral paraureteric endometriosis was detected in a postmenopausal woman with bilateral hydronephrosis and renal failure.[5] The patient had previously undergone hysterectomy with bilateral oopherectomy for menometrorrhagia. There was no sign of endometriosis as was confirmed at the end of the surgery. Post surgically the patient had remained in good health and received hormone replacement therapy (HRT) for seven years. The authors caution about administration of HRT. However, there are reports of postmenopasal intestinal endometriosis or ovarian endometrioma where women have not received any HRT.[6-8] Since reported cases had not received any HRT and were estrogen-deficient for several years, the hypothesis of intestinal metaplasia was proposed. It has also been shown that endometriotic tissue itself produces estrogen. The presence of steroidogenic genes and aromatase have also been demonstrated in the endometriotic tissue.[9]

A case of de novo occurrence of pituitary prolactinoma in a 46-year-old woman with secondary amenorrhea of four years was reported in an IMS newsletter way back in 1997 by the society's member, the late Dr. Meena Shringi.[10] Subsequently, an interesting discussion about the infrequent nature or infrequent recognition of peri/postmenopausal occurrence of pituitary prolactinoma had ensued following her letter to the editor of Fertil Steril.[1112] Diligent and unusual case reports may hold secrets about the yet ill-understood pathophysiological mechanism of a known disease or describe for the first time a new disease. Finally, it has been rightly said that case reports and case series are cornerstones of medical progress as they have high sensitivity of contributing new knowledge.[13]