OpenMed/multicare-articles huggingface dataset:
Takotsubo Cardiomyopathy after Spinal Anesthesia for a Minimally Invasive Urologic Procedure
Authors: Emmanuel Lilitsis, Despina Dermitzaki, Georgios Avgenakis, Ioannis Heretis, Charalampos Mpelantis, Charalampos Mamoulakis
Journal: Case Rep Anesthesiol (2017)
MeSH terms: Case Reports

We present the case of a patient who suffered from Takotsubo cardiomyopathy (TCM) immediately after the initiation of subarachnoid anesthesia for a minimally invasive urologic procedure (tension-free vaginal tape (TVT) surgery for stress urine incontinence). TCM mimics acute coronary syndrome and is caused by an exaggerated sympathetic reaction to significant emotional or physical stress. Our patient suffered from chest pain, palpitations, dyspnea, and hemodynamic instability immediately following subarachnoid anesthesia and later in the postanesthesia care unit. Blood troponin was elevated and new electrocardiographic changes appeared indicative of cardiac ischemia. Cardiac ultrasound indicated left ventricular apical akinesia and ballooning with severely affected contractility. The patient was admitted to coronary intensive care for the proper care and finally was discharged. TCM was attributed to high emotional preoperative stress for which no premedication had been administered to the patient. In conclusion, adequate premedication and anxiety management are not only a measure to alleviate psychological stress of surgical patients, but, more importantly, an imperative mean to suppress sympathetic nerve system response and its cardiovascular consequences.
Recurrence of extramedullary plasmacytoma of the breast
Authors: Khaled Majadob, Wesam Al-Sakkaf, Farouk Rezk, Kris Zegocki, Faris Al-Refaie
Journal: Ecancermedicalscience (2013)
Keywords: aggressive plasmacytoma, breast plasmacytoma, extramedullary plasmacytoma
MeSH terms: Case Reports

We present a rare case of a multiple recurrent extramedullary plasmacytoma of the breast and spine that showed aggressive behaviour without bone marrow involvement. A 29-year-old woman initially presented with extramedullary plasmacytoma of the left breast that was treated with radiotherapy. Shortly after, a recurrence appeared in the right breast, spine, and in both breasts, despite treatment with local and systemic therapy.
A Rare Presentation of Possible Disseminated Histoplasmosis with Adrenal Insufficiency Leading to Adrenal Crisis in an Immunocompetent Adult: A Case Report
Authors: Wanasinghe Arachchilage Praneeth Prabash Jayathilake, Kulatunga Wijekoon Mudiyanselage Pramitha Prabhashini Kumarihamy, Dissanayake Mudiyanselage Priyantha Udaya Kumara Ralapanawa, Widana Arachchilage Thilak Ananda Jayalath
Journal: Case Rep Med (2020)
MeSH terms: Case Reports

Histoplasmosis is caused by Histoplasma capsulatum, and commonly it causes an asymptomatic illness. Although Histoplasma is the commonest organism to infect adrenal glands, disseminated histoplasmosis in an immune-competent host leading to adrenal insufficiency is rare in current literature. Here, we report a case of possible disseminated histoplasmosis leading to adrenal crisis in a young Asian immunocompetent male. A 42-year-old Sri Lankan male with noninsulin-dependent diabetes mellitus presented with constitutional symptoms and feverishness for three weeks' duration. He was found to have hepatosplenomegaly with bilateral adrenal masses and pancytopenia. One week later, he developed severe vomiting and hemodynamic collapse and was found to have suppressed adrenal functions. Ultrasound-guided biopsy of adrenals showed fungal spores morphologically similar to Histoplasma. He was started on oral itraconazole and adrenal replacement therapy. He improved symptomatically with treatment and currently is on regular clinic follow-up with a plan to continue antifungal therapy for at least one year to prevent a relapse. Fungal infections, especially histoplasmosis, need to be considered in all immunocompetent patients with compatible history and bilateral adrenal masses. Adrenal insufficiency needs to be promptly diagnosed and treated to prevent Addisonian crisis in these patients.
Low-Grade Fibromyxoid Sarcoma of the Lateral Skull Base: Presentation of Two Cases
Authors: Evgenia Chetverikova, Priit Kasenõmm
Journal: Case Rep Otolaryngol (2019)
MeSH terms: Case Reports

Low-grade fibromyxoid sarcoma (LGFMS) is a rare slow-growing malignant tumour with a deceptively benign histologic appearance. Herein, we report two cases of LGFMS with variable clinical presentations. The first case was a 17-year-old female who referred to our department due to deaf ear on the right together with ipsilateral gag reflex impairment and globus sensation in the pharynx. The second case was a 35-year-old female with recurrent LGFMS, suffering from headaches, vertigo, and episodes of loss of consciousness. LGFMS of the temporal bone is a rare pathology, and to the best of our knowledge, no such cases have been reported before.
Unusual combination of acute aortic dissection, Mayer-Rokitansky-Küster-Hauser syndrome, and 46,XX gonadal dysgenesis: A case report
Authors: Yifan Zeng, Yerong Hu, Bo Jiang, Ling Tan, Hao Tang
Journal: Front Cardiovasc Med (2022)
Keywords: 46,xx gonadal dysgenesis, mrkh syndrome, aortic dissection, frozen elephant trunk, total aortic arch replacement, whole-exome sequencing
MeSH terms: Case Reports

Background:
Acute Stanford type A aortic dissection (ATAAD) is a life-threatening disease. Elderly patients are the high-risk population for aortic dissection (AD). Young patients with AD usually have heritable connective tissue diseases such as Marfan syndrome and Loeys-Dietz syndrome. However, young AD patients without heritable connective tissue disease are relatively rare.
Case presentation:
Herein, we report a case of a 25-year-old female diagnosed with ATAAD accompanied by undeveloped secondary sexual characteristics. Computed tomography angiography (CTA) showed that her AD involved the ascending and abdominal aorta. She had undergone thoracic endovascular aortic stent graft implantation in a local hospital due to acute Stanford type B aortic dissection at age 19. No uterus or ovaries were found on CTA and transabdominal ultrasonography. Sex hormone detection revealed a low estrogen level. G-banded karyotyping analyses revealed a normal 46,XX karyotype. Finally, her abnormalities in the reproductive system were diagnosed as MRKH syndrome and 46,XX gonadal dysgenesis. Whole-exome sequencing (WES) in the patient found an SNP variant of ACTA2 c.773G>A and MYH11 c.5081A>G. MYH11 c.5081A>G was also found in her mother and younger brother. Copy number variations sequencing (CNV-seq) found an approximately 109.30 Kb duplication at chromosome 6p22.3 (Chr 6: g.24920238-25029535) with a copy number of 3. We performed emergent total aortic arch replacement with frozen elephant trunk surgery, and the patient recovered well after surgery. However, her abdominal AD was stilling progression during 6 months of follow-up.
Conclusion:
To our knowledge, we report the world's first case of early-onset recurrent AD combined with MRKH syndrome and 46,XX gonadal dysgenesis.
Treatment of Severe Refractory Hematuria due to Radiation-Induced Hemorrhagic Cystitis with Dexamethasone
Authors: José Carlos Rodrigues Nascimento, Márcio Wilker Soares Campelo, Iuri Arruda Aragão, José Fernando Bastos de Moura, Lúcio Flávio Gonzaga Silva, Reinaldo Barreto Oriá
Journal: Case Rep Med (2017)
MeSH terms: Case Reports

Treatment of pelvic neoplasms with radiotherapy may develop sequelae, especially RHC. An 85-year-old male patient was admitted to a hospital emergency with gross hematuria leading to urinary retention and was diagnosed with RHC. The urinary bladder was probed, unobstructed, and maintained in continuous three-way saline irrigation. During 45 days of hospitalization, the patient underwent two cystoscopic procedures for urinary bladder flocculation, whole blood transfusions, and one platelet apheresis. None of these interventions led to clinical resolution. As the patient hematological condition was deteriorating, dexamethasone (4 mg i.v., bolus of 6/6, 12/12, and 24 h during five days) and epoetin alpha (1000 IU, 1 ml, s.c., for four weeks) were administered which led to the remission of the urinary bleeding. Dexamethasone therapy may be considered for RHC, when conventional treatments are not effective or are not possible, avoiding more aggressive interventions such as cystectomy.
Sinking Skin Flap Syndrome, a Rare Complication of Craniectomy
Authors: Martin Cassagne, Anne-Sophie Claes
Journal: J Belg Soc Radiol (2022)
Keywords: sinking skin flap syndrome, craniectomy, paradoxical herniation, syndrome of the trephined
MeSH terms: Case Reports

Teaching point: Sinking skin flap syndrome is a medical emergency that rarely complicates large craniectomy. It results from an intracerebral hypotension and requires the replacement of the cranial flap.
Purple Urine Bag Syndrome: A Rare Spot Diagnosis
Authors: Dilraj S Kalsi, Joel Ward, Regent Lee, Ashok Handa
Journal: Dis Markers (2017)
MeSH terms: Proteus Infections / urine, Urinary Tract Infections / urine, Review, Diagnosis, Differential, Humans, Proteus Infections / diagnosis, Proteus Infections / drug therapy, Proteus Infections / epidemiology, Urinary Tract Infections / diagnosis, Urinary Tract Infections / drug therapy, Urinary Tract Infections / epidemiology

Purple urine bag syndrome (PUBS) is a complication of urinary tract infections (UTIs) where catheter bags and tubing turn purple. It is alarming for patients, families, and clinicians; however, it is in itself a benign phenomenon. PUBS is the result of UTIs with specific bacteria that produce sulphatases and phosphatases which lead tryptophan metabolism to produce indigo (blue) and indirubin (red) pigments, a mixture of which becomes purple. Risk factors include female gender, immobility, constipation, chronic catheterisation, and renal disease. Management involves reassurance, antibiotics, and regular changing of catheters, although there are debates regarding how aggressively to treat and no official guidelines. Prognosis is good, but PUBS is associated with high morbidity and mortality due to the backgrounds of patients. Here, we review the literature available on PUBS, present a summary of case studies from the last five years, and propose the Oxford Urine Chart as a tool to aid such diagnoses.
clusterBMA: Bayesian model averaging for clustering
Authors: Owen Forbes, Edgar Santos-Fernandez, Paul Pao-Yen Wu, Hong-Bo Xie, Paul E Schwenn, Jim Lagopoulos, Lia Mills, Dashiell D Sacks, Daniel F Hermens, Kerrie Mengersen
Journal: PLoS One (2023)
MeSH terms: Algorithms, Benchmarking, Research Support, Non-U.S. Gov't, Bayes Theorem, Clinical Relevance, Cluster Analysis, Humans

Various methods have been developed to combine inference across multiple sets of results for unsupervised clustering, within the ensemble clustering literature. The approach of reporting results from one 'best' model out of several candidate clustering models generally ignores the uncertainty that arises from model selection, and results in inferences that are sensitive to the particular model and parameters chosen. Bayesian model averaging (BMA) is a popular approach for combining results across multiple models that offers some attractive benefits in this setting, including probabilistic interpretation of the combined cluster structure and quantification of model-based uncertainty. In this work we introduce clusterBMA, a method that enables weighted model averaging across results from multiple unsupervised clustering algorithms. We use clustering internal validation criteria to develop an approximation of the posterior model probability, used for weighting the results from each model. From a combined posterior similarity matrix representing a weighted average of the clustering solutions across models, we apply symmetric simplex matrix factorisation to calculate final probabilistic cluster allocations. In addition to outperforming other ensemble clustering methods on simulated data, clusterBMA offers unique features including probabilistic allocation to averaged clusters, combining allocation probabilities from 'hard' and 'soft' clustering algorithms, and measuring model-based uncertainty in averaged cluster allocation. This method is implemented in an accompanying R package of the same name. We use simulated datasets to explore the ability of the proposed technique to identify robust integrated clusters with varying levels of separation between subgroups, and with varying numbers of clusters between models. Benchmarking accuracy against four other ensemble methods previously demonstrated to be highly effective in the literature, clusterBMA matches or exceeds the performance of competing approaches under various conditions of dimensionality and cluster separation. clusterBMA substantially outperformed other ensemble methods for high dimensional simulated data with low cluster separation, with 1.16 to 7.12 times better performance as measured by the Adjusted Rand Index. We also explore the performance of this approach through a case study that aims to identify probabilistic clusters of individuals based on electroencephalography (EEG) data. In applied settings for clustering individuals based on health data, the features of probabilistic allocation and measurement of model-based uncertainty in averaged clusters are useful for clinical relevance and statistical communication.
Successful glycemic control using a flash glucose monitoring system for a pregnant woman with diabetes: a case report
Authors: Miyako Kishimoto, Saori Tamada, Yoko Oshiba
Journal: J Diabetes Metab Disord (2017)
Keywords: flash glucose monitoring system, gestational diabetes mellitus, impaired glucose tolerance, insulin
MeSH terms: Case Reports

Background:
Glucose control for pregnant women with glucose intolerance is important, as hyperglycemia may adversely affect the mother and the fetus.
Case presentation:
We report the case of a pregnant Japanese woman who experienced gestational diabetes mellitus during her first pregnancy and developed impaired glucose tolerance after the delivery. During her second pregnancy with twins, she required up to 75 units of injected insulin to control her postprandial hyperglycemia and occasionally experienced hypoglycemia. We used a newly developed flash glucose monitoring system, which allowed her to successfully achieve ideal glycemic control and experience an uncomplicated delivery.
Conclusion:
We suggest that this flash glucose monitoring system may be clinically effective for similar cases that involve pregnant women with abnormal glucose tolerance.
Recurrent urinary tract infection associated with SGLT-2 inhibitor in type 2 diabetes mellitus patient: A case report
Authors: Mohammad Hazique, Arihant Surana, Mehul Sinha, Ayush Anand
Journal: Clin Case Rep (2023)
Keywords: case report, diabetes mellitus, empagliflozin, urinary tract infection
MeSH terms: Case Reports

A high index of clinical suspicion of urinary tract infections due to empagliflozin use should be maintained in T2DM patients to avoid progression to life-threatening condition.
C1-C2 instability in psoriatic arthritis
Authors: Teka Maher, Zaier Akram Yassine, Ben Hnia Majdi, Naouar Nader
Journal: Pan Afr Med J (2020)
Keywords: arthritis psoriatic, arthrodesis, spondyloarthropathies
MeSH terms: Arthritis, Psoriatic / complications, Cervical Vertebrae / pathology, Joint Instability / etiology, Case Reports, Humans, Middle Aged, Paresthesia / etiology, Radiography

Cervical spine damage is common in psoriatic arthritis especially in older forms and it is rarely initiated by symptomatic atloid-axoid instability. Spinal involvement is frequently associated with sacroiliac dysfunction, the cervical spine involvement is observed in 35%-75% of cases with two types of radiological lesion. Upper cervical spine localization often manifests as C1-C2 arthritis, lower cervical spine involvement is manifested by syndesmophytes, ossification of the anterior longitudinal ligament and posterior inter apophyseal osteoarthritis. Our case is about a late onset upper cervical spine instability in a 45-year-old patient who has been treated for 20 years for rheumatism and has checked for paraesthesia's of the four limbs and gait difficulty that have been evolving over the last 3 months and the outcome of this case is that a C1-C2 instability must be systematically checked for in view of the appearance of deficient signs.
Structural Failure of a Modern Knee Tumor Megaendoprosthesis
Authors: Katrin Koch, Dieter Kohn, Konstantinos Anagnostakos
Journal: Case Rep Orthop (2017)
MeSH terms: Case Reports

Modular knee megaendoprotheses are commonly used devices for distal femur or proximal tibia replacement in tumor surgery as well as for treatment of some periprosthetic fractures around a loose or failed total knee arthroplasty. Structural failures of the prosthesis are well-known postoperative complications and have been reported for various prosthesis types. In the majority of the cases, the polyethylene parts fail. We would like to present an unusual case of a broken femoral component of an MRH® endoprosthesis four years after implantation.
Missed signs of autonomic dysreflexia in a tetraplegic patient after incorrect placement of urethral Foley catheter: a case report
Authors: Subramanian Vaidyanathan, Bakul M Soni, Tun Oo, Peter L Hughes, Gurpreet Singh
Journal: Patient Saf Surg (2014)
Keywords: autonomic dysreflexia, spinal cord injury, tetraplegia, urethra, urinary catheter
MeSH terms: Case Reports

Background:
Autonomic dysreflexia is poorly recognised outside of spinal cord injury centres, and may result in adverse outcomes including mortality from delayed diagnosis and treatment. We present a spinal cord injury patient, who developed autonomic dysreflexia following incorrect placement of urethral Foley catheter. Health professionals failed to recognise signs and symptoms of autonomic dysreflexia as well as its significance in this tetraplegic patient.
Case presentation:
A tetraplegic patient started sweating profusely following insertion of a Foley catheter per urethra. The catheter was draining urine; there was no bypassing, no bleeding per urethra, and no haematuria. Patient's wife, who had been looking after her tetraplegic husband for more than forty years, told the health professionals that the catheter might have been placed incorrectly but her concerns were ignored. Ultrasound scan of urinary tract revealed no urinary calculi, no hydronephrosis. The balloon of Foley catheter was not seen in urinary bladder but this finding was not recognised by radiologist and spinal cord physician. Patient continued to sweat profusely; therefore, CT of pelvis was performed, but there was a delay of ten days. CT revealed the balloon of Foley catheter in the over-stretched prostate-membranous urethra; the tip of catheter was not located within the urinary bladder but was lying distal to bladder neck. Flexible cystoscopy was performed and Foley catheter was inserted into the bladder over a guide wire. The intensity of sweating decreased; noxious stimuli arising from traumatised urethra might take a long while to settle.
Conclusion:
Inserting a catheter in a tetraplegic patient should be carried out by a senior health professional, who is familiar with spasm of bladder neck which occurs frequently in tetraplegic patients. Facilities for urgent CT scan should be available to check the position of Foley catheter in spinal cord injury patients when a patient manifests signs and symptoms of autonomic dysreflexia following insertion of a urethral catheter. When an isolated symptom such as flushing or sweating is noticed in a tetraplegic patient, doctors should seek out other signs/symptoms of autonomic dysreflexia.
Antiangiogenic therapy in the treatment of recurrent medulloblastoma in the adult: case report and review of the literature
Authors: Giuseppe Privitera, Grazia Acquaviva, Giovanni Carlo Ettorre, Corrado Spatola
Journal: J Oncol (2009)
MeSH terms: Case Reports

Medulloblastoma is a rare tumor in central nervous system, with an even rarer occurrence in adulthood. The management of a recurrent disease is a medical challenge; chemotherapy has been used as the treatment of choice, while reirradiation has been employed in selected cases. We report the case of a 51-year-old man with recurrent medulloblastoma. He was treated with local reirradiation, chemotherapy, and antiangiogenic drug, with the latter giving the longer progression-free interval. The aim of this report is to show that recurrent medulloblastoma in adults can be approached with a multimodality treatment and that antiangiogenic therapy should have a role in the management of this disease.
Primary B Cell Lymphoma of the CNS Mimicking Anti-LGI1 Limbic Encephalitis
Authors: Christian Thomas, Christoph Lehrich, Catharina C Gross, Heinz Wiendl, Sven G Meuth, Nico Melzer
Journal: Front Neurol (2018)
Keywords: le, mri, pcnsl, antibodies, diagnostic criteria
MeSH terms: Case Reports

Limbic encephalitis is a potentially paraneoplastic type of encephalitis mainly involving the limbic system. Recently, diagnostic criteria comprising clinical presentation as well as imaging, laboratory and electrophysiological findings have been established. Here, we show that incipient primary central nervous system lymphoma can closely resemble limbic encephalitis including positive testing for anti-LGI1 antibodies illustrating the need for thorough interpretation of initial laboratory and radiologic findings and tight follow-up examinations.
Esthetic Rehabilitation of Anterior Teeth with Copy-Milled Restorations: A Report of Two Cases
Authors: Sapna Rani, Jyoti Devi, Chandan Jain, Parul Mutneja, Mahesh Verma
Journal: Case Rep Dent (2017)
MeSH terms: Case Reports

Digitalization has become part and parcel of contemporary prosthodontics with the probability of most of the procedures being based on the digital techniques in the near future. This digital revolution started in the latter half of the 20th century by converting analog objects/signals into digital bits and bytes. Recent developments in all-ceramic materials and systems of computer-aided designing and computer-aided manufacturing (CAD/CAM), copy milling, and so forth offer excellent esthetics and superb biocompatibility. Copy milling system for ceramics enables milling of the zirconia cores of all-ceramic restorations precisely and also if this system is properly used the procedure for fabricating all-ceramic restorations can be substantially simplified. This case report presents fabrication of all-ceramic Maryland Bridge and post-core with a copy milling system for esthetics and preservation of integrity of tooth. For both of the patients, the use of biologic, all-ceramic, copy-milled restorations resulted in clinical success and recovered function and esthetics.