Instructions for creating the basic narrative used to describe a case study. Please refer to the Research Guide at www.grmerc.net/research/resources/guide.html for detailed information about these topics.

Title
Descriptive title of the case report/series

Introduction
The introduction should be brief, tell why the case is important and why it is being reported (for example, because it adds to the understanding of a clinical problem). For the sake of brevity, you should cite a few recent review articles when possible rather than many individual studies. Case studies usually respond to one of the following generic topics but use specific information from the case being presented.

1. An unexpected association between diseases or symptoms. (For example, AIDS came to be recognized, in part, because Kaposi's sarcoma and Pneumocystis carinii pneumonia were reported in homosexual men in 1981.)
2. An unexpected event in the course of observing or treating a patient. (The transdermal absorption of nitroglycerin and its dilating effect on blood vessels came to be understood after a physician reported headache in a patient who handled TNT powder in his daily work.)
3. Findings that shed new light on the possible pathogenesis of a disease or an adverse effect.
4. Unique or rare features of a disease.
5. Unique therapeutic approaches.

Significance/Uniqueness of Case
Using the literature, establish any previous work that is related to your research question. Also, use the literature to ask the really important question of, "Who cares, so what?" The essential characteristic of a publishable case report is educational value. It is not true that a report must tell of a unique finding. Some case reports are published because they support the findings in previously published cases or because they are useful reminders of an important point in diagnosis or treatment

Methods
Describe your literature search methods and results (search engine & key words). Refer to information in the literature that bears on the case, tell what changes, if any, in patient care the case suggests, and point out what questions deserve further research. If you say that you found no other cases in the literature, the reader would like to know how you did the literature search. For example, how far back in time did your search go, and did you limit your search to reports only in Japanese or English?

Patient Description
Describe the patient include social history, such as tobacco and alcohol use, use of illegal substances, medication being used, notable results of physical examination and laboratory tests, differential diagnosis or diagnoses considered. For legal and ethical reasons, a patient should not be referred to by his or her initials. Use "Patient A" or some other designator that does not hint at the person's identity. Do not use case when referring to a person-a case is an instance of disease, a patient is a person. Intervention Describe all therapeutic interventions conducted during the course of treatment include any recommendations/indications from the literature.

Results
Describe the outcome of treatment including final diagnosis. Provide the results of only the relevant examinations and laboratory tests, usually only those with positive results. Some reviewers of case studies want the results of all tests and procedures presented, so that the reader can follow along in detective fashion, eliminating unlikely diagnoses and "solving" the case at the end of the report with the author. List the laboratory's ranges of normal values for any unusual tests performed.

Conclusions/Implications
The purpose of the discussion is to explain anything that isn't clear in the case description and to offer interpretations of findings. Make clear any important point that isn't explained in the case descriptions. For example, if you reported that liver enzymes were elevated but no significant liver dysfunction was found, tell the reader in the discussion section why the enzymes were elevated. Also discuss implications for the field.