OpenMed/multicare-articles huggingface dataset:
Patient with bipolar I disorder who presented with low blood lithium levels after receiving crushed tablets via a nasogastric tube: A case report
Authors: Ryoko Fujikawa, Kumiko Fujii, Yuji Ozeki
Journal: Front Psychiatry (2022)
Keywords: bipolar disorder, crushed form, lithium, low blood level, nasogastric tube
MeSH terms: Case Reports

In clinical psychiatric cases, the placement of a nasogastric tube is occasionally considered. If a patient who presents with mania or other psychiatric conditions refuses to take drugs, they are administered via the nasogastric tube. The tablet is crushed, suspended, passed via the nasogastric line, and reaches the stomach directly. However, the effects of these processes on blood drug concentrations remain unclear. Herein, we report a patient with bipolar I disorder who presented with low blood lithium carbonate (Li) concentrations after receiving the drug via the nasogastric tube.
Case:
A 26-year-old woman developed manic symptoms with grandeur delusion. She was admitted to a psychiatric hospital three times after diagnosis. Her manic symptoms with delusion improved with Li and aripiprazole (ARP). Her condition stabilized with Li 800 mg/day and ARP 9 mg/day. After the Li dose was reduced to 600 mg/day, she maintained remission, with the blood level range of Li being 0.31 ∼ 0.42 mEq/L. After 1 year, she was admitted to our hospital due to a jaw deformity. During the perioperative period, treatment with oral Li was discontinued by the surgeons, and her manic symptoms recurred. During therapy with olanzapine 20 mg and Li 800 mg, her blood Li concentration was 0.67 mEq/L. The symptoms remained. Hence, the Li dose increased to 1,000 mg/day. However, she refused to take the medication. Thus, a nasogastric tube was used to administer medicines. Thereafter, the blood Li concentration decreased to 0.43 mEq/L, which was lesser than 800 mg/day. Each blood sample was collected approximately 18 h after the administration. Her symptoms remained. Thereafter, she agreed to take the medication, and the Li concentration reached 0.78 mEq/L. Then, the symptoms partly improved.
Conclusion:
After the administration of Li via the nasogastric tube, the Li concentration decreased, which was lower than expected. This phenomenon could be attributed to the fact that the medication was crushed, suspended, and administered via the nasogastric tube. Therefore, pulverizing and administering Li tablets via the nasogastric tube can be applied for the management of mania, however, caution should be observed because of the risk of fluctuations in blood Li levels, as in this case.
A first case of successful using of ibrutinib in treating paraneoplastic pemphigus related bronchiolitis obliterans concurrent with CLL
Authors: Can Chen, Ying Xu, Jingdi Yu, Shenxian Qian, Yaping Xie
Journal: Front Med (Lausanne) (2023)
Keywords: bronchiolitis obliterans, chronic lymphocytic leukemia, ibrutinib, mechanism, paraneoplastic pemphigus
MeSH terms: Case Reports

Paraneoplastic pemphigus (PNP) is a rare life-threatening disease which always associated with an underlying neoplasm. Tumor-related PNP most commonly precedes the detection of a hematological malignancy, with some cases seen during disease remission following cytotoxic drug therapy or radiotherapy. The lung is the most frequently-involved site in PNP, second only to the eyes, and involvement is seen in 59.2% to 92.8% of PNP cases. Bronchiolitis obliterans (BO) is the end stage of respiratory involvement and is regarded as life-threatening. The key point in treatment of PNP is to control the associated underlying hematologic neoplasia. High-dose systemic corticosteroids combined with other immunosuppressants are considered the first line of treatment. Other therapies that have shown beneficial effects include plasmapheresis, intravenous immunogloblin (IVIG), and more recently, daclizumab, alemtuzumab, and rituximab. There is no effective treatment for BO with PNP, and suppression of the cellular immune response may be necessary. Patients with PNP-BO associated with lymphoma mostly die within approximately 1 year. Herein, we reported a patient who diagnosed with PNP-BO concurrent with chronic lymphocytic leukemia. He was successful treated with ibrutinib and had achieved the longest survival which suggested that ibrutinib may be the best treatment choice for such patient.
Combined treatment by burosumab and a calcimimetic can ameliorate hypophosphatemia due to excessive actions of FGF23 and PTH in adult XLH with tertiary hyperparathyroidism: A case report
Authors: Yuichi Takashi, Kyoko Toyokawa, Naoki Oda, Yoshimi Muta, Hisashi Yokomizo, Seiji Fukumoto, Daiji Kawanami
Journal: Front Endocrinol (Lausanne) (2022)
Keywords: x-linked hypophosphatemia, burosumab, evocalcet, fibroblast growth factor 23, parathyroid hormone, tertiary hyperparathyroidism
MeSH terms: Familial Hypophosphatemic Rickets / complications, Familial Hypophosphatemic Rickets / drug therapy, Hyperparathyroidism, Hypophosphatemia / drug therapy, Hypophosphatemia / etiology, Case Reports, Adult, Fibroblast Growth Factors / metabolism, Humans, Parathyroid Hormone, Phosphates, Parathyroid Hormone, burosumab, Fibroblast Growth Factors, Phosphates

Introduction:
X-linked hypophosphatemia (XLH) is the most prevalent type of heritable fibroblast growth factor 23 (FGF23)-related hypophosphatemic rickets. Recently, anti-FGF23 antibody, burosumab, has become clinically available. We herein report a patient with adult XLH and tertiary hyperparathyroidism.
Case presentation:
The serum phosphate level and tubular maximum reabsorption of phosphate per glomerular filtration rate (TmP/GFR) remained low, despite burosumab treatment. While the influence of the relationship between FGF23 and parathyroid hormone (PTH) on the phosphaturic effect is unclear, it was considered that a high level of PTH due to tertiary hyperparathyroidism remains to suppress renal phosphate reabsorption. A calcimimetic, evocalcet, increased the serum phosphate level and TmP/GFR.
Discussion and conclusion:
Therefore, it is important to evaluate the presence of secondary-tertiary hyperparathyroidism in patients whose serum phosphate level does not increase with burosumab treatment.
Delusional Parasitosis or Morgellons Disease: A Case of an Overlap Syndrome
Authors: Fatmah Alhendi, Abdullatif Burahmah
Journal: Case Rep Dent (2023)
MeSH terms: Case Reports

Background. Delusional parasitosis (DP) is a monosymptomatic hypochondriacal psychosis where the patient has the delusion of being infested with parasites, whereas Morgellons disease (MD) is described when the patient has fixed ideation of fibers or other materials emerging from skin. Both psychological and organic causes can result into the delusion of infestation, and careful examination is required to exclude secondary causes. Oral DP can result in self-inflected mutilations of the oral mucosa. To our knowledge, oral DP is only rarely reported in the literature. Here, we describe and discuss the management of a case of overlap between oral DP and oral MD at the oral medicine (OM) clinic. Case Report. A 50-year-old male presented to the OM clinic with ulcerations of oral and perioral tissues. Patient reported inflicting wounds to himself using a shaving blade to extirpate worms and pieces of glass from underneath his oral and perioral mucosa. Clinical and laboratory investigations ruled out parasitic infestations. Self-inflected ulcers were treated with topical steroids and prophylactic antifungals, and the patient was referred for psychiatric evaluation. A diagnosis of primary DP was reached, and the patient was managed with antipsychotics. Practical Implications. Oral health care providers should be familiar with oral manifestations of psychiatric disorders and should be able to manage such patients in a multidisciplinary team of internist, dermatologist, and psychiatrist.
Prenatal diagnosis in a fetuses with a clenched hands, overlapping fingers, and clubfoot due to MED12 deficiency in three affected siblings: A case report
Authors: Huiqin Xue, Qiaoyin Tang, Yu Feng, Chenyue Zhao, Ke Xu, Weiyue Gu, Zhaoyu Xue, Xinyan Li, Jinsong Jiang, Hongyong Lu, Xiayu Sun, Jianrui Wu, Guizhi Cao
Journal: Front Genet (2023)
Keywords: med12, case report, clenched hand, clubfoot, overlapping fingers
MeSH terms: Case Reports

A fetal clenched hand with overlapping fingers is more common in aneuploidy syndrome and was not well-documented in MED12 deficiency. This study reports the clinical and genetic findings of three affected siblings from a Chinese family. The chromosome karyotype analysis diagram shows that karyotypes of the three children were normal. Trio whole-exome sequencing and Sanger sequencing verification found that there was a MED12 R296Q variant in normal mothers and their two offspring. A pattern of clenched hand with overlapping fingers (clinodactyly) and clubfoot was found in all the three affected siblings by three-dimensional ultrasound. The discovery of this case shows that even if the chromosome karyotype is normal, comprehensive prenatal genetic diagnosis is required when the ultrasound results show a clenched hand with clinodactyly and clubfoot symptoms.
Coronary Artery Dissection in a Patient with Buerger's Disease
Authors: Ali İhsan Tekin, Ümit Arslan
Journal: Braz J Cardiovasc Surg (2019)
MeSH terms: Coronary Artery Disease / etiology, Coronary Occlusion / etiology, Thromboangiitis Obliterans / complications, Case Reports, Computed Tomography Angiography / methods, Coronary Angiography / methods, Coronary Artery Bypass / methods, Coronary Artery Disease / diagnostic imaging, Coronary Artery Disease / surgery, Coronary Occlusion / diagnostic imaging, Coronary Occlusion / surgery, Humans, Male, Mammary Arteries / surgery, Middle Aged, Saphenous Vein / transplantation, Thromboangiitis Obliterans / surgery

Buerger's disease, vasculitis of small and medium-sized blood vessels, is a non-atherosclerotic and progressive occlusive condition which frequently involves the distal part of the limbs. The occlusion of coronary arteries in Buerger's disease is a rare condition; however, coronary artery dissection has not been reported previously. Therefore, this paper presents a 45-year-old man who developed coronary artery dissection associated with Buerger's disease. The patient was treated successfully with coronary artery bypass grafting with the left internal mammary artery to the left anterior descending artery, and saphenous vein graft to the right coronary artery.
Metronomics for thymic carcinoma
Authors: Jacobo Muñoz Del Toro, Patricia Cortez Castedo, Alfonso Cortés Salgado, M Eugenia Olmedo García, Pilar Garrido López
Journal: Ecancermedicalscience (2014)
Keywords: metronomics, recurrent thymic carcinoma, treatment
MeSH terms: Case Reports

Although thymomas are the most frequent primary tumours of the anterior mediastinum, thymic carcinoma is very infrequent and more aggressive. Combination chemotherapy is the first-line treatment for the advanced stages, but because of the lack of evidence from randomised trials, the management of the successive lines is a challenging field. We report a partial radiological response in the seventh line of a thymic carcinoma stage IV with an oral regimen.
Attempt of Real-Time Near-Infrared Fluorescence Imaging Using Indocyanine Green (ICG) in Radical Resection of Gallbladder Cancer: A Case Report
Authors: Yang Yu, Lin Xiang, Yuping Bai, Ewetse Paul Maswikiti, Baohong Gu, Xuemei Li, Haiyuan Li, Peng Zheng, Ying Zhang, Hao Chen
Journal: Front Surg (2021)
Keywords: case report, fluorescence laparoscope, gallbladder cancer, indocyanine green, near-infrared fluorescence
MeSH terms: Case Reports

Surgery is the mainstay of treatment for resectable gallbladder cancer. Near-infrared fluorescence (NIRF) imaging using ICG is an innovation in laparoscopic surgery, which can provide real-time navigation during the whole operation. In this article, we present a 56-year older woman with gallbladder cancer, in which we evaluated the applicability of NIRF imaging using ICG for tumor and biliary tree visualization during the operative procedure of gallbladder cancer. The tumor and biliary tree were clearly visualized by utilizing a green fluorescence dye. The patient was successfully operated radical resection of gallbladder cancer under fluorescence laparoscope, without any complications. According to this case, the utilization of ICG based NIRF imaging is feasible and beneficial in identifying tumors and the biliary tree during radical resection. It can assist in the achievement of a negative margin and lymphatic clearance around the biliary tree. However, further studies are needed to corroborate the results of this case.
Is the Left Kidney the Right One for Kidney Donation in Women Planning on Future Pregnancy?
Authors: H Kıran, G Kıran, D Arıkan, M Yüzbaşıoğlu, M Bakacak, Ö Ercan, B Köstü
Journal: Int J Organ Transplant Med (2015)
Keywords: hydronephrosis, kidney transplantation, nephrectomy, pregnancy
MeSH terms: Case Reports

The kidney transplantation surgery requires left nephrectomy because of the anatomical disadvantages. But hydroureteronephrosis is the most significant renal functional alteration of pregnancy, accounted for by both hormonal and mechanical factors. Dilatation of the ureters and renal pelvis is more prominent on the right side than the left side and is seen in up to 80% of pregnant women. A 23-year-old woman who become pregnant after 4 months from left kidney donation was admitted to our emergency department with acute right kidney injury during her 39(th) week of pregnancy. She did not response to conservative treatment and required emergency delivery because of the progressive increase in her serum creatinine levels. After delivery, progressive decrease at creatinine level had been observed and in one month, it had reached the normal level. Mother candidates should be advised they donate their kidneys after completing their childbearing if possible, or undergo right nephrectomy.
Acute renal infarction presenting with acute abdominal pain secondary to newly discovered atrial fibrillation: a case report and literature review
Authors: Sherif Ali Eltawansy, Shil Patel, Mana Rao, Samaa Hassanien, Mihir Maniar
Journal: Case Rep Emerg Med (2014)

We report an 85-year-old female with known history of recurrent diverticulitis presented with abdominal pain. It was believed that the patient again needed to be treated for another diverticulitis and was started on the routine treatment. The initial CT scan of abdomen showed renal infarcts bilaterally that were confirmed by a CT with and without intravenous contrast secondary to unknown cause. An ECG found accidentally that the patient was in atrial fibrillation, which was the attributed factor to the renal infarctions. Subsequently, the patient was started on the appropriate anticoagulation and discharged.
Ventricular Septal Rupture Complicating Silent Myocardial Infarction
Authors: Amr Telmesani, Qasim Al Abri, Mohammed Chamsi-Pasha
Journal: Methodist Debakey Cardiovasc J (2022)
Keywords: intracardiac shunting, myocardial infarction, ventricular septal rupture
MeSH terms: Myocardial Infarction / complications, Myocardial Infarction / diagnostic imaging, Ventricular Septal Rupture / diagnostic imaging, Ventricular Septal Rupture / etiology, Ventricular Septal Rupture / surgery, Case Reports, Heart, Heart Ventricles, Humans, Magnetic Resonance Imaging, Male, Middle Aged

A 55-year-old gentleman presented to the emergency department with shortness of breath for the past 3 days. Cardiac magnetic resonance imaging assessed intracardiac shunting and a mechanism of ventricular septal rupture (VSR), showing significant left-to-right shunting and Qp:Qs of 4:1. There was transmural myocardial infarction as well as an aneurysm at the diaphragmatic inferior wall of the left ventricle.
Donor-derived cytomegalovirus-cytotoxic T lymphocytes and leflunomide successfully control refractory cytomegalovirus infections and disease of multiple sites after allogeneic-hematopoietic stem cell transplantation: A case report
Authors: Nan Su, Zhenghua Liu, Peng Sun, Feng Gu, Xiaojing Yan, Dali Cai
Journal: Front Med (Lausanne) (2022)
Keywords: ctls, allo-hsct, case report, cytomegalovirus, leflunomide
MeSH terms: Case Reports

Drug-resistant cytomegalovirus (CMV) infection after hematopoietic stem cell transplantation (HSCT) often leads to morbidity and mortality. Several studies have shown that CMV-cytotoxic T lymphocytes (CTLs) can overcome drug-resistant CMV infection, but still many questions remain unanswered. Here, we present a case of refractory CMV infection after allogeneic HSCT (allo-HSCT). Donor-derived CMV-CTLs failed to eliminate the virus in unique peripheral blood on the first application, when 70 mg methylprednisolone (MP) was taken per day. After a second attempt with a combination of 8 mg MP with leflunomide, a complete and persisting clearance of all involved sites, including peripheral blood, urinary system, leptomeninges, and retina, was achieved. To summarize, intravenous infusion of CTLs can eliminate CMV in the oculi and central nervous system (CNS), and a low dosage of 8 mg MP has no interaction with CMV-CTLs.
Pathologic Femur Fracture through Osteoid Osteoma after Radiofrequency Ablation: Case Report and Review of the Literature
Authors: Nathan B Rogers, Brennan P Roper, Alfred A Mansour 3rd
Journal: Case Rep Orthop (2021)
MeSH terms: Case Reports

This is a case report of a 4-year-old girl who sustained a femoral shaft fracture 2 weeks after radiofrequency ablation of an osteoid osteoma. The fracture occurred after a relatively low-energy impact, jumping off the second to last step of a staircase. The pathologic fracture was successfully treated with closed reduction and spica casting, with full return to activities. Cases have been reported in the literature of femoral shaft fractures in older patients after radiofrequency ablation, but all are farther out than 2 weeks and none in patients as young as 4 years.
Fatal Cerebral Air Embolism: A Case Series and Literature Review
Authors: Rashmi Mishra, Pavithra Reddy, Misbahuddin Khaja
Journal: Case Rep Crit Care (2016)

Cerebral air embolism (CAE) is an infrequently reported complication of routine medical procedures. We present two cases of CAE. The first patient was a 55-year-old male presenting with vomiting and loss of consciousness one day after his hemodialysis session. Physical exam was significant for hypotension and hypoxia with no focal neurologic deficits. Computed tomography (CT) scan of head showed gas in cerebral venous circulation. The patient did not undergo any procedures prior to presentation, and his last hemodialysis session was uneventful. Retrograde rise of venous air to the cerebral circulation was the likely mechanism for venous CAE. The second patient was a 46-year-old female presenting with fever, shortness of breath, and hematemesis. She was febrile, tachypneic, and tachycardic and required intubation and mechanical ventilation. An orogastric tube inserted drained 2500 mL of bright red blood. Flexible laryngoscopy and esophagogastroduodenoscopy were performed. She also underwent central venous catheter placement. CT scan of head performed the next day due to absent brain stem reflexes revealed intravascular air within cerebral arteries. A transthoracic echocardiogram with bubble study ruled out patent foramen ovale. The patient had a paradoxical CAE in the absence of a patent foramen ovale.
Onco-testicular sperm extraction (Onco-TESE) from a single testis with metachronous bilateral testicular cancer: a case report
Authors: Itsuto Hamano, Shingo Hatakeyama, Rika Nakamura, Rie Fukuhara, Daisuke Noro, Hiroko Seino, Takahiro Yoneyama, Yasuhiro Hashimoto, Takuya Koie, Yoshihito Yokoyama, Chikara Ohyama
Journal: Basic Clin Androl (2018)
Keywords: azoospermia, intracytoplasmic sperm injection (icsi), onco-tese, testicular cancer
MeSH terms: Case Reports

Background:
Although oncologic testicular sperm extraction (onco-TESE) has been increasingly practiced, the evidence of onco-TESE performed in patients with testicular cancer is insufficient. Furthermore, in bilateral testicular cancer, accounting for 0.5%-1% of testicular cancers, onco-TESE is more challenging and has been insufficiently reported.
Case presentation:
Here we report the case of a 25-year-old man who underwent onco-TESE from his residual single testis with a nonseminomatous germ cell tumor that occurred 5 years after orchiectomy of the contralateral testis. A second orchiectomy and simultaneous TESE from the noncancerous testicular tissue were performed. The pathological diagnosis was germ cell tumors, tumors of more than one histological type (embryonal carcinoma, immature teratoma, yolk sac tumor, seminoma, and choriocarcinoma; pT1N0M0). The patient subsequently married and hoped for fatherhood 3 years later. Whereas histological diagnosis of the normal testicular tissue was Johnsen score 6 (maturation arrest), morphologically normal and motile sperms were successfully retrieved from thawed TESE samples and used for multiple cycles of intracytoplasmic sperm injection. Although the conception has not been succeeded to date, ICSI attempts have been continuing.
Conclusion:
This case demonstrates the effectiveness of onco-TESE for challenging cases such as bilateral and nonseminmatous testicular cancer.
Refractory tracheoesophageal fistula treated using multi-stage surgery: A case report
Authors: Yoichi Nakagawa, Satoshi Makita, Hiroo Uchida, Akinari Hinoki, Chiyoe Shirota, Wataru Sumida, Hizuru Amano, Masamune Okamoto, Aitaro Takimoto, Seiya Ogata, Shunya Takada, Daiki Kato, Yousuke Gohda, Yaohui Guo
Journal: Front Pediatr (2022)
Keywords: esophageal atresia, reconstruction, recurrence, thoracoscopy, tracheoesophageal fistula (tef)
MeSH terms: Case Reports

A tracheoesophageal fistula (TEF) recurs in approximately 2%-13% of cases of esophageal atresia with TEF that are treated surgically. Currently, there is no consensus on the most effective treatment to prevent recurrent TEF (RTEF). Herein, we present a patient with type C esophageal atresia who underwent thoracoscopic esophago-esophageal anastomosis and TEF repair at 2 days old. However, RTEFs were observed at ages 3, 6, and 11 months, and thoracoscopic TEF repairs using a pleural patch, fascia lata graft, and pectoralis major myocutaneous (PMMC) flap were performed, respectively. A fourth recurrence led to mediastinitis, shock liver, disseminated intravascular coagulopathy, and a compromised respiratory status. Hence, laparoscopic esophageal transection was first performed to improve the respiratory condition by preventing the regurgitation of gastric contents. Once the patient was stable, a subtotal esophageal resection with TEF closure followed by gastric tube reconstruction was performed. In conclusion, we encountered a case of refractory RTEF that was repaired four times using various techniques, including a fascia lata graft and PMMC flap. However, TEF still recurred after these four operations. The final surgical strategy involved an esophageal transection as a palliative therapy, which improved the respiratory condition, followed by closure of the TEF and subtotal esophageal resection. Finally, esophageal reconstruction using a gastric tube after the complete remission of inflammation was effective. This multi-stage surgery was considered the only choice to rescue the patient and effectively prevent another recurrence.