OpenMed/multicare-articles huggingface dataset:
Anomalous origin of the left circumflex coronary artery from the pulmonary artery. A very rare congenital anomaly in an adult patient diagnosed by cardiovascular magnetic resonance
Authors: Grigorios Korosoglou, Gerd Ringwald, Evangelos Giannitsis, Hugo A Katus
Journal: J Cardiovasc Magn Reson (2008)
MeSH terms: Coronary Vessel Anomalies / diagnosis, Magnetic Resonance Imaging / methods, Pulmonary Artery / abnormalities, Case Reports, Coronary Angiography, Electrocardiography, Female, Humans, Middle Aged

Here we report for the first time on the diagnostic potential of cardiovascular magnetic resonance (CMR) to delineate the proximal course of an anomalous left circumflex coronary artery (LCX) originating from the right pulmonary artery in an adult patient with no other form of congenital heart disease. The patient was referred to our institution due to exertional chest discomfort. X-Ray coronary angiography showed a normal left anterior descending coronary artery (LAD) and right coronary artery (RCA), while the LCX was filled retrograde by collateral flow through the LAD and the RCA. The origin of the LCX was postulated to be the pulmonary artery, but the exact origin of the anomalous artery could not be depicted on conventional angiograms. CMR provided the unambiguous depiction of the origin of the anomalous LCX from the right pulmonary artery and the delineation of its proximal course in this case of a very rare coronary anomaly in adults.
Sevoflurane-Induced Thrombocytopenia in Post-Robotic-Assisted Paraesophageal Hernia Repair
Authors: Sara Alhaj, James Tran, Muhammad Nazim, Praveen Tumula, Hassan Ahmed
Journal: Case Rep Hematol (2020)
MeSH terms: Case Reports

Background:
Transient transaminitis is an expected outcome from liver retraction after foregut surgeries. However, severe thrombocytopenia is usually not a sequela of that. We present a case in which sevoflurane is suspected of inducing thrombocytopenia as it was the only newly introduced medication to the patient during the hospital course. Thrombocytopenia may present in a variety of settings in hospitalized patients. However, managing this occurrence requires deep exploration of pathophysiology that can cause decreased platelets, which may be a challenging task in certain circumstances. The liver plays an important role in thrombopoiesis by releasing megakaryocyte growth factors. Therefore, liver dysfunction can present as thrombocytopenia or other platelet dysfunctions.
Objective:
To describe a presentation of thrombocytopenia possibly associated with anesthesia-induced transaminitis after a robotic paraesophageal hernia repair with mesh and fundoplasty with intraoperative esophagogastroduodenoscopy (EGD).
Methods:
A 55-year-old presented to the ED with abdominal pain and was found to have a large type IV paraesophageal hernia that was surgically treated with a robotic paraesophageal hernia repair with mesh. However, on the first postoperative day (POD) (#1), the patient developed new onset thrombocytopenia with transaminitis. Workup for thrombocytopenia failed to determine an etiology. With platelet transfusion, platelet count showed an upward trend. The patient was then evaluated and cleared for discharge by POD#5.
Results:
The patient's POD#1 daily labs showed elevated values for liver function tests and a low platelet count of 10,000 platelets per microliter with an international normalized value (INR) of 1.3. She had received two doses of intravenous acetaminophen just prior to surgery. Her platelet count responded to two units of platelets but decreased again immediately after. She continued to have transaminitis with down-trending liver enzymes. Peripheral smear on review showed no evidence of schistocytes. A heparin-induced thrombocytopenia (HIT) screening was negative. The patient was regularly evaluated, and the platelets stabilized and slowly started to trend up. The patient recovered by the morning of her POD#5 and was cleared for discharge.
Conclusion:
We are reporting on a case of acute postoperative thrombocytopenia that was associated with transaminitis and elevated liver enzymes. We are linking the role of the liver dysfunction in noncirrhotic patients with surgical abdominal procedures. Although liver retraction transaminitis possibly played a role in the laboratory findings in the patient, the acute drop in her platelet count could be closely related to the use of sevoflurane anesthetic considering its potential hepatotoxic side effects. We also cannot rule out the sevoflurane directly affecting the platelet count.
Carpal tunnel syndrome caused by tophi deposited under the epineurium of the median nerve: A case report
Authors: Wenzhong Zhang, Qingbo Feng, Jiaxiang Gu, Hongjun Liu
Journal: Front Surg (2023)
Keywords: carpal tunnel syndrome, case report, gout, hyperuricemia, surgery, tophi
MeSH terms: Case Reports

Introduction:
Usually caused by compression of the wrist's median nerve, carpal tunnel syndrome (CTS) is one of the most common types of peripheral neuropathy. Tophi deposited under the epineurium of the median nerve compress the median nerve, leading to CTS, which is very rare.
Case presentation:
We report a 64-year-old man with a history of tophaceous gout who presented with typical CTS symptoms and was admitted to our hospital. A physical examination revealed swelling over the right volar aspect of the carpal region, and he was unable to flex due to subcutaneous rigidity. Tinel's sign and Phalen's maneuver were positive. Electrophysiological studies confirmed the diagnosis of CTS. A carpal tunnel release and surgery to remove the gouty tophus of the right wrist were performed when serum uric acid levels were within normal limits (5.8 mg/dl). During the operation, tophi deposited under the epineurium of the median nerve were found, and the tophi were completely removed. Operative findings confirmed the diagnosis of CTS due to gout. The patient recovered uneventfully without signs of recurrence of gout and CTS symptoms during a 1-year follow-up period.
Conclusion:
A gouty tophus is an uncommon cause of CTS, and CTS may be caused by gouty tophi if there is evidence of extrinsic compression of the median nerve or symptoms emanating from the carpal tunnel.
A rare lymphoplasmacyte-rich meningioma involving the dura of the skull base and cervical spinal cord: A case report
Authors: Siyao Zhu, Yuting Zou, Ya Wang, Gongxun Xie, Shengying Xiao, Furen Zeng, Yichen Lu
Journal: Transl Neurosci (2022)
Keywords: differential diagnosis, diffuse growth, lymphoplasmacyte-rich meningioma, magnetic resonance imaging, treatment
MeSH terms: Case Reports

Lymphoplasmacyte-rich meningioma (LPRM) is a rare subtype of meningioma, the specific pathogenesis of which remains unclear. Herein, we report the case of a 48-year-old Asian man who experienced progressive deafness and limb weakness. Magnetic resonance imaging revealed extramedullary masses diffusely growing, wrapping, and compressing the cervical spinal cord. The dural lesion was partially excised by surgery, and postoperative pathological examination confirmed the diagnosis of LPRM. Diffuse LPRM is extremely rare, and its treatment is challenging owing to difficulties associated with surgery and the uncertain efficacy of traditional therapies. Therefore, further clinical practice and basic research are needed to improve the prognosis of diffuse LPRM.
Profiling COVID-19 Vaccine Adverse Events by Statistical and Ontological Analysis of VAERS Case Reports
Authors: Wenxin Guo, Jessica Deguise, Yujia Tian, Philip Chi-En Huang, Rohit Goru, Qiuyue Yang, Suyuan Peng, Luxia Zhang, Lili Zhao, Jiangan Xie, Yongqun He
Journal: Front Pharmacol (2022)
Keywords: covid-19, covid-19 vaccine, cov19vaxkb, sars-cov-2, vaers, adverse events, ontology, ontology of adverse events

Since the beginning of the COVID-19 pandemic, vaccines have been developed to mitigate the spread of SARS-CoV-2, the virus that causes COVID-19. These vaccines have been effective in reducing the rate and severity of COVID-19 infection but also have been associated with various adverse events (AEs). In this study, data from the Vaccine Adverse Event Reporting System (VAERS) was queried and analyzed via the Cov19VaxKB vaccine safety statistical analysis tool to identify statistically significant (i.e., enriched) AEs for the three currently FDA-authorized or approved COVID-19 vaccines. An ontology-based classification and literature review were conducted for these enriched AEs. Using VAERS data as of 31 December 2021, 96 AEs were found to be statistically significantly associated with the Pfizer-BioNTech, Moderna, and/or Janssen COVID-19 vaccines. The Janssen COVID-19 vaccine had a higher crude reporting rate of AEs compared to the Moderna and Pfizer COVID-19 vaccines. Females appeared to have a higher case report frequency for top adverse events compared to males. Using the Ontology of Adverse Event (OAE), these 96 adverse events were classified to different categories such as behavioral and neurological AEs, cardiovascular AEs, female reproductive system AEs, and immune system AEs. Further statistical comparison between different ages, doses, and sexes was also performed for three notable AEs: myocarditis, GBS, and thrombosis. The Pfizer vaccine was found to have a closer association with myocarditis than the other two COVID-19 vaccines in VAERS, while the Janssen vaccine was more likely to be associated with thrombosis and GBS AEs. To support standard AE representation and study, we have also modeled and classified the newly identified thrombosis with thrombocytopenia syndrome (TTS) AE and its subclasses in the OAE by incorporating the Brighton Collaboration definition. Notably, severe COVID-19 vaccine AEs (including myocarditis, GBS, and TTS) rarely occur in comparison to the large number of COVID-19 vaccinations administered in the United States, affirming the overall safety of these COVID-19 vaccines.
Incarcerated femoral hernia containing ipsilateral fallopian tube
Authors: Stefanos Atmatzidis, Grigorios Chatzimavroudis, Dimitrios Dragoumis, Konstantinos Atmatzidis
Journal: Case Rep Med (2010)
MeSH terms: Case Reports

Femoral hernias are more common in women and lead to a substantial higher rate for an emergency operation, due to strangulation. Incarcerated femoral hernia with fallopian tube as a content is an extremely rare condition. A 20-year-old woman presented to the emergency department complaining of a 6-day right groin swelling, which became painful and tender to palpation during the last 48 hours. Preoperative ultrasonography detected an oedematous hernia sac, above the femoral vessels, suggesting the presence of an incarcerated femoral hernia. The patient eventually underwent emergency surgery and the diagnosis of a strangulated femoral hernia sac, containing fallopian tube, was established. No resection of the uterine tube was performed and the hernia was repaired with polypropylene plug. The postoperative period was uneventful and the woman was discharged on the second postoperative day.
Immune thrombocytopenia in a challenging case of disseminated tuberculosis: a case report and review of the literature
Authors: Ankur Kalra, Ankit Kalra, Chandrasekar Palaniswamy, Naval Vikram, G C Khilnani, Rita Sood
Journal: Case Rep Med (2010)
MeSH terms: Case Reports

Mycobacterium tuberculosis (MTB) continues to predominate the cause of morbidity, and mortality in the developing world. The disease affects all the organ systems, and presents in various pathologic disease states. We report an uncommon manifestation of this rather common infectious disease in a 19-year-old male. Immune-mediated thrombocytopenia occurring as a consequence of the tuberculosis infection itself is an exceedingly rare occurrence, and at the time of writing of this paper, only 15 such published reports exist in the English literature so far.
Acute severe mitral regurgitation: consideration of papillary muscle architecture
Authors: Andrew Czarnecki, Amar Thakrar, Tielan Fang, Matthew Lytwyn, Roien Ahmadie, Edward Pascoe, Davinder S Jassal
Journal: Cardiovasc Ultrasound (2008)
MeSH terms: Mitral Valve Insufficiency / diagnostic imaging, Mitral Valve Insufficiency / etiology, Muscular Diseases / complications, Muscular Diseases / diagnostic imaging, Papillary Muscles / diagnostic imaging, Case Reports, Acute Disease, Diagnosis, Differential, Female, Humans, Middle Aged, Rupture, Spontaneous / diagnostic imaging, Ultrasonography

We present a case of an individual who presented with acute severe mitral regurgitation in the setting of an inferior ST elevation myocardial infarction. Both transthoracic and transesophageal echocardiography demonstrated a posteriorly directed eccentric jet of severe mitral regurgitation with flail anterior mitral valve leaflet attached presumably to the anterior papillary muscle. Intraoperative findings demonstrated rupture of the postero-medial papillary muscle attached via chords to the anterior mitral valve leaflet. This case serves to remind us that both the anterior and posterior leaflets of the mitral valve are attached to both papillary muscle heads. The direction and eccentricity of the mitral regurgitant jet on echocardiography helps to locate the leaflet involved, but not necessarily the coexisting papillary muscle pathology.
Phalangeal Intra-Articular Osteochondroma Caused a Rare Clinodactyly Deformity in Children: Case Series and Literature Review
Authors: Yun Hao, Jia-Chao Guo, Xiao-Lin Wang, Jing-Fan Shao, Jie-Xiong Feng, Jin-Peng He
Journal: Front Endocrinol (Lausanne) (2021)
Keywords: angulation, children, clinodactyly deformity, osteochondroma, treatment
MeSH terms: Bone Neoplasms / complications, Finger Phalanges / abnormalities, Hand Deformities, Acquired / etiology, Osteochondroma / complications, Case Reports, Research Support, Non-U.S. Gov't, Review, Bone Neoplasms / pathology, Child, Child, Preschool, Female, Finger Phalanges / pathology, Hand Deformities, Acquired / pathology, Humans, Male, Osteochondroma / pathology, Retrospective Studies

Background:
Various factors are discovered in the development of clinodactyly. The purpose of this retrospective study was to present a group of children with a rare clinodactyly deformity caused by phalangeal intra-articular osteochondroma and evaluate the efficacy of various treatment methods.
Methods:
All child patients that were treated for finger problems in our center between Jan 2017 and Dec 2020 were reviewed. A detailed analysis was made of the diagnosis and treatment methods in eight rare cases. X-rays and histopathology were applied.
Results:
A preliminary analysis of 405 patients in total was performed, and we included eight cases in our final analysis. This cohort consisted of 2 girls and 6 boys, with a mean age of 5.74 ± 3.22 years (range: 2y5m to 11y). Overall, four patients had their right hand affected and four patients had their left hand affected. One patient was diagnosed as having hereditary multiple osteochondroma (HMO) while the other seven patients were all grouped into solitary osteochondroma. Osteochondroma was proven in all of them by histopathology examination. Preoperative X-rays were used to allow identification and surgery planning in all cases. All osteochondromas were intra-articular and in the distal end of the phalanges, which is located opposite the epiphyseal growth area. All of the osteochondromas developed in half side of the phalanges. The angulation in the finger long axis was measured, and resulted in a mean angulation of 34.63 ± 24.93 degree (range: 10.16-88.91 degree). All of them received surgery, resulting in good appearance and fingers straightening. No recurrence was recorded.
Conclusions:
This retrospective analysis indicates that 10 degrees can be selected as the angulation level for diagnosis of clinodactyly deformities. What's more important, the abnormal mass proven by X-rays should be included as the classical direct sign for diagnosis. The first choice of treatment is surgery in symptomatic osteochondromas.
Case report: Isolated tubular basement membrane deposits in a patient with systemic lupus erythematosus - A diagnostic challenge
Authors: Orlando Vieira Gomes, Leonardo Fernandes E Santana, Rita Marina Soares de Castro Duarte, Mateus de Sousa Rodrigues, Jandir Mendonça Nicacio, Dyego José de Araújo Brito, Monique Pereira Rêgo Muniz, Natalino Salgado-Filho, Precil Diego Miranda de Menezes Neves, Gyl Eanes Barros Silva
Journal: Front Med (Lausanne) (2022)
Keywords: lupus nephritis, pathology, systemic lupus erythematosus, treatment, tubulointerstitial nephritis
MeSH terms: Case Reports

Lupus nephritis is one of the most serious and frequent manifestations of systemic lupus erythematosus. It usually presents in the first years of the disease, which suspicion should be raised in cases of elevated serum creatinine, presence of proteinuria above 500 mg/day or active urinary sediment, in the absence of other apparent causes such as urinary tract infection and use of nephrotoxic drugs. In most cases, it affects the glomerulus, and its presentation is rare in the form of isolated tubulo-interstitial disease. In this report, we describe a case of lupus nephritis diagnosed after 2 years of illness, in the form of atypical isolated tubular disease, characterized by massive deposits in the tubular basement membrane. Clinically, there were altered renal function, subnephrotic proteinuria, and evolution to a complete clinical response after immunosuppressive treatment.
B.P.F.C.® Bio-Plasma® with Pure Growth Factors (BioPlasma®) Used for the Treatment of a Persistent Great Periapical Lesion of an Endodontically Treated Tooth: A New Therapeutic Option
Authors: Raffaello Viganò, Mirko Disconzi, Edoardo Bertini, Luca Viganò, Cinzia Casu
Journal: Case Rep Dent (2020)
MeSH terms: Case Reports

The aim of this case report was to evaluate the efficacy of a new platelet-rich plasma preparation and its regenerative capacity of bone periapical tissue for the treatment of a very compromised endodontic treated tooth, with a periapical lesion of 1.5 cm in diameter, using a pure platelet concentrate. This is made without the use of anticoagulant or any type of activator, e.g., bovine thrombin, calcium chloride. For this reason, it has been called "Pure"; it is the B.P.F.C.® Bio-Plasma® with Pure Growth Factors (BioPlasma®) designed and developed by Dr. Raffaello Viganò. The patient has read and signed a written consent form. The study protocol was approved by the Ethics Committee for Human Studies, University of Varese. X-ray at 2 and 6 months and 4 years after endodontic surgery demonstrated the success of the treatment.
Case Report: A Severe Paediatric Presentation of COVID-19 in APDS2 Immunodeficiency
Authors: Nuria Sanchez Clemente, Justin Penner, Judith Breuer, Winnie Ip, Claire Booth
Journal: Front Immunol (2022)
Keywords: apds2, covid-19, sars-cov-2, case report, primary immunodeficiency
MeSH terms: COVID-19, Immunologic Deficiency Syndromes, Case Reports, Research Support, Non-U.S. Gov't, Adrenal Cortex Hormones, Child, Child, Preschool, Humans, Immunocompromised Host, Male, SARS-CoV-2, Adrenal Cortex Hormones

Critical respiratory manifestations of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) are rare in children, and little is known about how immunocompromised children respond to the infection. We report a case of a 4-year-old boy with activated PI3K delta syndrome type 2 (APDS2) with a protracted and severe COVID-19 course with both inflammatory and acute respiratory features. He was treated with remdesivir, nitazoxanide, high-dose corticosteroids, and tocilizumab and made a full recovery. We propose that remdesivir may be used in combination with nitazoxanide to improve viral clearance and reduce the chance of resistance in treating acute SARS-CoV-2 infection.
Hemorrhagic Renal Angiomyolipoma in Pregnancy Effectively Managed by Immediate Cesarean Section and Elective Transcatheter Arterial Embolization: A Case Report
Authors: Satoru Kira, Norifumi Sawada, Tatsuya Miyamoto, Takahiko Mitsui, Hidenori Zakoji, Masayuki Takeda
Journal: J Endourol Case Rep (2016)
MeSH terms: Case Reports

Renal angiomyolipoma (AML) is a benign renal tumor with a risk of rupture in intratumoral aneurysms. Although renal AML in pregnancy is rare, risk of rupture is greater. Management for AML and childbirth is important during pregnancy; however, it is undefined yet. We present a case of hemorrhagic angiomyolipoma in pregnancy that is effectively managed by immediate cesarean section and elective transcatheter arterial embolization.
Thyrotoxic Periodic Paralysis with Thyroid Storm as the First Presentation of Graves' disease; a Case Report
Authors: Tejaswee Banavathu, Swapnil Tripathi, Pankaj Sukhadiya, Kamlesh Ahari, Durga Shankar Meena, Mahendra Kumar Garg
Journal: Arch Acad Emerg Med (2021)
Keywords: graves disease, hypokalemic periodic paralysis, quadriplegia, thyroid crisis, thyrotoxicosis
MeSH terms: Case Reports

Thyrotoxic periodic paralysis is a rare endocrine emergency that manifests as acute onset muscle weakness and hypokalaemia secondary to thyrotoxicosis. It mainly occurs due to rapid and dramatic intracellular shift of potassium resulting in hypokalaemia and acute flaccid paralysis. This condition predominantly affects males of Asian descent, and presentation can range from mild generalized weakness to complete quadriplegia, as seen in our case. We herein report a case of a 40-year-old female, who presented to us with acute onset flaccid quadriplegia and thyroid storm, which is the first ever manifestation of previously undiagnosed Grave's disease. Liver abscess was found to be the underlying trigger for thyrotoxic paralysis and thyroid storm.
Case Report: ALCAPA syndrome: successful repair with an anatomical and physiological alternative surgical technique
Authors: Luis Gustavo Vilá Mollinedo, Andrés Jaime Uribe, José Luis Aceves Chimal, Roberto Pablo Martínez-Rubio, Karen Patricia Hernández-Romero
Journal: F1000Res (2016)
Keywords: alcapa syndrome, adults with alcapa, bland-white-garland syndrome, coronary extension technique, coronary vessel anomalies

Anomalous left coronary artery from the pulmonary artery, or ALCAPA syndrome, is a rare congenital cardiac disease that can cause myocardial infarction, heart failure and even death in paediatric patients. Only few untreated patients survive until adult age. Here we present the case of a 33-year-old female patient with paroxysmal tachycardia, syncope and mild exertional dyspnoea. She was diagnosed with ALCAPA syndrome and underwent surgical correction with an alternative technique of left main coronary artery extension to the aorta.