OpenMed/multicare-articles huggingface dataset:
New solution for old challenge: Device closure of non-centrally positioned atrial septal defect
Authors: Shamsi Ghaffari, Akbar Molaei, Ahmad Jamei Khosroshahi, Rezvaniyeh Salehi, Mehrnoush Toufan Tabrizi, Mahmood Samadi
Journal: J Cardiovasc Thorac Res (2020)
Keywords: multiple asds, peripheral asd, transcatheter closure
MeSH terms: Case Reports

Multiple interatrial defects, termed fenestrated ASDs that require closure are not uncommon. The problem arises when a centrally located defect or a patent foramen oval (PFO) is associated with another peripherally located defect. In cases like this, all attempts at crossing the true defect might totally fail or might be difficult because the wire or the catheter crosses the central defect repeatedly despite the use of a sizing balloon. In order to overcome such an issue, we introduce a new technique by which not only the procedure and the fluoroscopy time will be reduced, but also it ceases the mistakes about the number of defects, their size and location.
Optical coherence tomography angiography findings of choroidal neovascularization in pseudoxanthoma elasticum
Authors: Orly Gal-Or, Chandrakumar Balaratnasingam, K Bailey Freund
Journal: Int J Retina Vitreous (2015)
Keywords: angioid streaks, bruch’s membrane, choroidal neovasculariztion, multimodal imaging, optical coherence tomography angiography
MeSH terms: Case Reports

Angioid streaks (AS) are the most common ocular manifestation in patients with pseudoxanthoma elasticum (PXE). The major cause of severe visual loss in patients with AS is choroidal neovascularization (CNV). We report the optical coherence tomography angiography (OCTA) findings of CNV in a patient with PXE and angioid streaks. A 51-year-old man with PXE presented with visual disturbance in his right eye. Best corrected visual acuity was 20/30 OD and 20/30 OS. Funduscopic examination revealed angioid streaks and type 1 NV in his right eye. Multimodal imaging including OCTA demonstrated CNV nasal to the fovea. The morphology and configuration of CNV followed the path of the AS. OCTA combined with other multimodal imaging modalities may be a useful tool for diagnosing CNV secondary to angioid streaks in patients with pseudoxanthoma elasticum. The configuration of CNV in these may follow the path of angioid streaks implicating Bruch's membrane disruption as an important anatomical change in the pathogenesis of CNV.
HOSPITAL PHYSICAL THERAPY MANAGEMENT IN PEDIATRIC PATIENTS WITH COVID-19: CASE REPORTS
Authors: Camila Wohlgemuth Schaan, Vanessa de Souza Vieira, Cristina Miller, Ana Paula Dattein Peiter, Taciana Piccoli, Gabriela Cavion, Janice Luisa Lukrafka, Renata Salatti Ferrari
Journal: Rev Paul Pediatr (2020)
MeSH terms: Coronavirus Infections / rehabilitation, Patient-Centered Care / methods, Physical Therapy Modalities / nursing, Pneumonia, Viral / rehabilitation, Case Reports, Brazil, COVID-19, Child, Coronavirus Infections / nursing, Female, Humans, Infant, Male, Pandemics, Pneumonia, Viral / nursing, Range of Motion, Articular

Objective:
To report the physiotherapeutic management of two pediatric cases with COVID-19 admitted in a reference state hospital to treat the disease in Porto Alegre, Southern Brazil.
Cases description:
Case 1, female, 10-month-old child, pre-existing chronic disease, hospitalized since birth, mechanical ventilation dependency via tracheotomy, progressed with hypoxemia, requiring oxygen therapy, and increased ventilator parameters, and a diagnosis of COVID-19 was confirmed. Airway clearance and pulmonary expansion maintenance therapies were performed. During hospitalization, the child acquired cephalic control, sitting without support, rolling, holding, and reaching objects. Recommendations were provided to a family member to maintain motor development milestones. Case 2, male, nine years old, previous psychiatric disease and obesity, showed worsening of the sensory state, requiring intensive care and invasive mechanical ventilation, with the diagnosis of SARS-Cov-2 infection. The physical therapy was performed to maintain airway clearance, pulmonary expansion, and early mobilization, showing ventilatory improvement during the intensive care hospitalization and successfully extubated after 17 days. The physical therapy evolved from passive to resistive exercises during the hospitalization, and the patient was able to walk without assistance at discharge, with the same previous functional status.
Comments:
The COVID-19 showed different manifestations in both cases. Physical therapy treatment was essential to maintain and to recover the functional status of the patients. Future studies are needed to improve the understanding of disease course and its functional consequences to offer an efficient treatment to pediatric patients with COVID-19.
Acute Complex Type A Dissection associated with peripheral malperfusion syndrome treated with a staged approach guided by lactate levels
Authors: Amna Suliman, Michael Dialynas, Hutan Ashrafian, Colin Bicknell, Maziar Mireskandari, Mohamad Hamady, Thanos Athanasiou
Journal: J Cardiothorac Surg (2010)
MeSH terms: Aortic Aneurysm, Thoracic / surgery, Aortic Dissection / surgery, Femoral Artery / surgery, Case Reports, Aortic Aneurysm, Thoracic / complications, Aortic Aneurysm, Thoracic / diagnostic imaging, Aortic Dissection / complications, Aortic Dissection / diagnostic imaging, Biomarkers / blood, Clinical Protocols, Humans, Ischemia / diagnosis, Ischemia / etiology, Lactic Acid / blood, Leg / blood supply, Male, Middle Aged, Radiography, Stents, Syndrome, Treatment Outcome, Biomarkers, Lactic Acid

Acute type A aortic dissection can be complicated by visceral malperfusion and is associated with a significant surgical morbidity and mortality. We describe a case of successful management of a complex acute type A dissection with mesenteric and lower limb ischemia treated with endovascular thoracic stenting and femoro-femoral crossover bypass grafting followed by aortic arch repair. To accomplish this, we applied a staged therapeutic approach using serial lactate measurements to assess the adequacy of peripheral perfusion and metabolic status prior to surgical repair of the proximal dissection.
Combined Effect of a Locking Plate and Teriparatide for Incomplete Atypical Femoral Fracture: Two Case Reports of Curved Femurs
Authors: Hiroyuki Tsuchie, Naohisa Miyakoshi, Tomio Nishi, Hidekazu Abe, Toyohito Segawa, Yoichi Shimada
Journal: Case Rep Orthop (2015)

In surgical treatment for atypical femoral fractures (AFFs), reconstruction nail fixation is recommended for both complete and incomplete fractures. Although it has been reported that AFF is affected by many factors, The ASBMR Task Force 2013 Revised Case Definition of AFFs states that a curved femur is often seen in Asian patients. It is sometimes difficult to insert a nail into a femur in incomplete AFF patients with severely curved femurs. We report two incomplete bisphosphonate-related AFF patients with marked femoral curvatures treated by locking plates and teriparatide, showing early bone unions and favorable long-term outcomes.
Spontaneous hemoperitoneum caused by meckel's diverticulum in an elder patient
Authors: Adriá Rosat, Eduardo Pérez, Hanna Hernández Oaknin, Javier Mendiz, Guillermo Hernández, Manuel Barrera
Journal: Pan Afr Med J (2016)
Keywords: meckel´s diverticulum, old patient, spontaneous hemoperitoneum
MeSH terms: Hemoperitoneum / etiology, Meckel Diverticulum / complications, Case Reports, Review, Aged, 80 and over, Hemoperitoneum / pathology, Humans, Male, Meckel Diverticulum / diagnosis

Symptomatic Meckel's Diverticulum is a rare entity in old patients. The most common complications are gastrointestinal bleeding, intestinal obstruction, acute inflammation, and perforation. Usually those complications occur on the first two decades of life and mostly before the fifth decade. We report an extremely unusual debut of Meckel's Diverticulum, presented as massive spontaneous hemoperitoneum in an 82-year-old man without gastrointestinal bleeding. A literature review of atraumatic hemoperitoneum as presentation of Meckel's diverticulum was made.
Correction of severe valgus deformity of knee osteoarthritis with non-constrained total knee arthroplasty implant: A case report
Authors: Dwikora Novembri Utomo, Ferdiansyah Mahyudin, Andre Yanuar, Lukas Widhiyanto, Kukuh Dwiputra Hernugrahanto
Journal: Int J Surg Case Rep (2018)
Keywords: case report, mcl shift, no consensus, non-constrained implant, severe valgus deformity

Introduction:
Knee osteoarthritis with valgus deformity presents a surgical challenge that must be solved during total knee arthroplasty (TKA). In some case whereby ligament imbalance is found, constrained implant should be used. Unfortunately, the implant is not always readily accessible in some developing countries. The objective of this paper is to provide alternative solution to such case.
Presentation of case:
We reported a 71-year-old female patient with a painful and fixed valgus deformity of her right knee. Preoperatively, the patient's right knee range of motion (ROM) was 10-145° of flexion with a 32° fixed valgus deformity. A constrained implant was not accessible. To balance the ligament, Medial Collateral Ligament (MCL) origin was shifted to superior and anterior. A non-constrained implant was used. The valgus deformity was corrected intraoperatively and ROM achieved 0-140° of flexion.
Discussion:
It is crucial that attention is given not only to the restoration of proper bony alignment but even more importantly to soft tissue balancing. By using the non-constrained implant, the cost can also be reduced and suitable for developing countries with limited coverage of state insurance.
Conclusion:
Three months after the surgery, the patient achieved stable and painless knee with 10-90° of flexion and complete correction of her valgus deformity.
Ribociclib in newly diagnosed hepatitis B infection: A case report
Authors: Fabrizio Di Costanzo, Simone Carrano, Gennaro Iengo, Amedeo Cefaliello, Valentina Cossiga, Filomena Morisco, Mario Giuliano, Carmine De Angelis, Grazia Arpino
Journal: Front Oncol (2023)
Keywords: cdk4/6 inhibitors, ribociclib, hepatitis b, luminal breast cancer, tenofovir disoproxil fumarate
MeSH terms: Case Reports

Breast cancer is the most frequently diagnosed cancer in women worldwide. Actually CDK4/6 inhibitor Ribociclib is approved for the treatment of metastatic hormone-positive and human epidermal growth factor receptor 2 (HER 2)-negative breast cancer, but comorbidities like infectious or cardiovascular diseases may limit its use.
Case report:
A 45-year-old woman was diagnosed with metastatic breast cancer in September 2021; also, her hepatitis screening resulted positive for hepatitis B infection. Patient assumed eradicative therapy for hepatitis and bit after started oncological therapy with Ribociclib.
Outcome:
Frequent check of hepatological function was observed since start of eradicative therapy; liver transaminases and bilirubin kept to not rise despite start of oncological treatment with Ribociclib. Patient's Performance Status was also not compromised and revaluation at 4, 9 and 13 months showed partial response and then stable disease.
Discussion:
hepatotoxicity of Ribociclib is reported as a possible side effect, and often positivity for hepatitis is cause of exclusion from therapy; in our case, no hepatotoxicity was noted and patient obtained response in terms of control of both infectious and oncological diseases.
IgA/kappa-restricted crystal storing histiocytosis involving the central nervous system characterized by proteomic analysis
Authors: Brent A Orr, Gary L Gallia, Ahmet Dogan, Fausto J Rodriguez
Journal: Clin Neuropathol (2014)
MeSH terms: Brain Diseases / pathology, Histiocytosis / etiology, Histiocytosis / pathology, Immunoglobulin A / metabolism, Paraproteinemias / complications, Paraproteinemias / diagnosis, Case Reports, Research Support, N.I.H., Extramural, Adult, Brain Diseases / etiology, Brain Diseases / metabolism, Female, Histiocytosis / metabolism, Humans, Immunoglobulin A

Crystal storing histiocytosis (CSH) is a rare disorder characterized by the accumulation of crystalline material in the cytoplasm of histiocytes. Involvement of the central nervous system (CNS) with CSH is extremely rare. Herein, we report a case of crystal storing histiocytosis involving the CNS. Using immunohistochemistry and mass spectrometry we demonstrate that the disease resulted from an IgA-κ restricted plasma cell dyscrasia. CNS-CSH represents a rare clinicopathologic entity with an indolent course, usually lacking systemic manifestations.
A case report of primary orbital non-Hodgkin's lymphoma causing complete vision loss
Authors: Neerav Lamba, Douglas P Dworak, Shyam A Patel, Rohini Chennuri
Journal: GMS Ophthalmol Cases (2016)
Keywords: nhl, non-hodgkin’s, lymphoma, orbital, primary orbital lymphoma
MeSH terms: Case Reports

A 29-year-old male with acquired immunodeficiency syndrome presented with a week of left eye blurriness, which then progressed to complete vision loss. On exam, the left pupil was nonreactive to light, and fundoscopy showed significant optic nerve edema. CT and MRI of the left orbit showed a mass lesion compressing the posterior aspect of the sclera with diffuse thickening and contrast enhancement of the retrobulbar portion of the left optic nerve. The lesion demonstrated low T1 and intermediate T2 intensities and heterogeneous contrast enhancement and measured 17.4 mm x 15 mm x 10.6 mm. Anterior orbitotomy with exploration and biopsy were performed. Immunohistochemical studies confirmed diffuse large B-cell lymphoma and a workup showed no systemic involvement. Plans for treatment with chemotherapy and radiation were initiated. Even though rare, primary orbital NHL should be in the differential for relatively acute blindness without other symptoms, especially in patients with AIDS.
Anti-IgLON5 Disease with Isolated Hemichorea: A Case Report and Review of the Literature
Authors: Anna Grossauer, Anna Hussl, Philipp Mahlknecht, Marina Peball, Anna Heidbreder, Florian Deisenhammer, Atbin Djamshidian, Klaus Seppi, Beatrice Heim
Journal: Mov Disord Clin Pract (2022)
Keywords: iglon5, autoimmune encephalitis, chorea, hemichorea, movement disorder
MeSH terms: Review

Background:
Anti-IgLON5 disease is an autoimmune encephalopathy with sleep disturbances as a hallmark in the majority of reported cases. Additional clinical symptoms are heterogenous and include movement disorders, bulbar dysfunction, autonomic disorders, and neurocognitive impairment.
Case:
Here, we report the case of an 87-year-old woman presenting with isolated progressive hemichorea. An extensive diagnostic work-up revealed antibodies against IgLON5 in the serum. Neither history nor polysomnography (PSG) unveiled signs and features of sleep dysfunction typically reported in anti-IgLON5 disease.
Literature review:
In an extensive literature review we identified twelve other studies reporting about patients with confirmed anti-IgLON5 disease and chorea as extrapyramidal movement disorder in their clinical phenotype. Subsequently, clinical characteristics of these patients were carefully evaluated.
Conclusions:
Our results support the diversity of clinical phenotypes in anti-IgLON5 disease, adding isolated hemichorea to the spectrum of presenting symptoms. As sleep-related disorders are often not the leading reason for consultation and only revealed by PSG examination, we suggest that screening for antibodies against IgLON5 should be considered in patients presenting with unexplained movement disorders, including isolated hemichorea.
Overlap syndrome with Sjögren's syndrome and systemic sclerosis in a steel rolling mill worker: a case report
Authors: Min-Kee Yi, Won-Jun Choi, Sung-Woo Han, Seng-Ho Song, Dong-Hoon Lee, Sun Young Kyung, Sang-Hwan Han
Journal: Ann Occup Environ Med (2016)
Keywords: overlap syndrome, silica, sjögren's syndrome, systemic sclerosis
MeSH terms: Case Reports

Background:
There are few reports about work-related factors associated with Sjögren's syndrome. We report a case of overlap syndrome with Sjögren's syndrome and systemic sclerosis.
Case presentation:
A 54-year-old man was admitted due to dyspnea on exertion. The results of physical examination and laboratory findings were compatible with Sjögren's syndrome with systemic sclerosis. The patient had no pre-existing autoimmune disease, and denied family history of autoimmune disease. The patient worked in the large-scale rolling department of a steel manufacturing company for 25 years. Hot rolling is a rolling process performed at between 1100 °C and 1200 °C, generating a high temperature and a large amount of fumes, involving jet-spraying of water throughout the process to remove the instantaneously generated oxide film and prevent the high generation of fumes. In this process, workers could be exposed to silica produced by thermal oxidation. Other potential toxic substances including nickel and manganese seemed to be less likely associated with the patient's clinical manifestations.
Conclusions:
Occupational exposure to silica seemed to be associated with the patient's clinical manifestations of overlap syndrome with Sjögren's syndrome and systemic sclerosis. Although the underlying mechanism is still unclear, autoimmune disease including Sjögren's syndrome affects women more often than men and there was no family history of autoimmune disease. These suggested that there was an association between occupational silica exposure and the disease of the patient. Future research about the association between long-term low dose exposure to silica and the development of autoimmune diseases should be encouraged.
A case of a jejunal gastrointestinal stromal tumor with significantly elevated CA19-9 levels
Authors: Koichi Mohri, Kazuhiro Hiramatsu, Yoshihisa Shibata, Taro Aoba, Masahiro Fujii, Atsuki Arimoto, Akira Ito, Takehito Kato
Journal: Int J Surg Case Rep (2020)
Keywords: carbohydrate antigen 19-9, gastrointestinal stromal tumour, tumor marker
MeSH terms: Case Reports

Introduction:
A gastrointestinal stromal tumor (GIST) with an elevated serum tumor marker level is very rare. We report a case of jejunal GIST associated with extremely elevated levels of serum carbohydrate antigen 19-9 (CA19-9).
Presentation of case:
A 61-year-old woman was referred to our hospital for examination of an abdominal tumor. Laboratory tests revealed extremely elevated CA19-9 levels (13,498 U/mL). Enhanced abdominal computed tomography demonstrated a well-enhanced, round 40 mm tumor. The patient underwent a jejunectomy and lymph node dissection. Based on the postoperative pathological findings, the tumor was diagnosed as a GIST. Microscopically, a solid region of the resected tumor showed negative staining for CA19-9. The serum CA19-9 level drastically decreased postoperatively.
Discussion:
Increased proliferation of epithelial cells secondary to inflammation and ulceration of epithelia may lead to increased secretion and accumulation of CA19-9, which is consequently released into the blood circulation.
Conclusion:
In cases of GIST, an isolated increase of serum CA19-9 is extremely rare; but they are not necessarily associated with malignant transformation.
Recent dating of extinct Atlantic gray whale fossils, (Eschrichtius robustus), Georgia Bight and Florida, western Atlantic Ocean
Authors: Ervan G Garrison, Gary S Morgan, Krista McGrath, Camilla Speller, Alexander Cherkinsky
Journal: PeerJ (2019)
Keywords: gray whale, paleontology, radiocarbon dating, stable isotopes, western atlantic basin, zooms

The Atlantic gray whale (Eschrichtius robustus) presents an interesting case study of climate related dispersal and extinction. While (limited) fossil records confirm its presence in the Atlantic up until the 18th Century, its abundance and distribution within the Eastern and Western basins are still not well understood. The discovery of presumed gray whale fossil remains from the Georgia Bight and the Atlantic coast of Florida, from the mid-1980s to late-2000s, provides a new opportunity to recover additional data regarding their chronology within the Western basin. Here, we apply accelerator mass spectrometry radiocarbon techniques to six fossil whale finds, identifying dates within marine isotope stage 3 (59-24 ka) and the late Holocene, ∼2,000 yr BP. We additionally confirm the taxonomic identification of two fossil bone samples as E. robustus using collagen peptide mass fingerprinting (ZooMS). The obtained dates, when combined with a larger corpus of previously published Atlantic gray whale fossil dates, support the hypothesis for the decline of the Atlantic gray whale in the late Pleistocene and the late Holocene. These new data augment the findings of the Eastern Atlantic Basin and better incorporate the Western Atlantic Basin into a pan-ocean understanding for the species.
Case report: Intranasal esketamine for severe major depressive disorder with psychotic features
Authors: Maximilian Carter, Kassandra Solsrud, Nicholas Mischel
Journal: Front Psychiatry (2022)
Keywords: case report, depression, esketamine, intranasal, psychotic
MeSH terms: Case Reports

Introduction:
About one third of patients with major depressive disorder (MDD) have treatment resistant depression (TRD). The difficulty of treating TRD especially in those with suicidal ideation and psychotic features demands treatments that are fast-acting, safe, and effective. Limited access, lack of viable options, and incomplete characterization of rapid-acting antidepressants has prevented widespread incorporation into treatment of patients with TRD. However, ketamine and its variations have shown promise of being effective treatment options for patients with TRD with psychotic features.
Case description:
This 28-year-old patient with TRD with psychotic features received 14 treatments of intranasal esketamine over a 3-month period. This patient initially presented with anhedonia, difficulty sleeping, suicidal thoughts, and auditory hallucinations. The Quick Inventory of Depressive Symptomology (QIDS) was used to assess depression before each session.
Results:
After her first two treatment sessions within a week, this patient experienced a reduction in depression from severe to moderate according to the QIDS. Over 14 sessions, she had no significant adverse effects, including no psychotic symptoms during esketamine treatment, and was stabilized to mild depression without suicidal ideations. One year after treatment, she continues to be stable. She has not had auditory hallucinations since the esketamine treatment.
Conclusions:
This case report provides an example of a patient with severe TRD with psychotic features that showed significant improvement after treatment with intranasal esketamine. Larger studies are indicated to further elucidate the effectiveness and safety of intranasal esketamine, so it can be more widely used for patients with TRD with psychotic features.
A tale of two sit-bones: The cyclist's ischial hygroma (Perineal nodular induration)
Authors: J Swart, R V P de Villiers, F Roux, F Rademan, G Thom
Journal: S Afr J Sports Med (2019)
Keywords: cycling, perineal injury
MeSH terms: Case Reports

The ischial hygroma, also known as a perineal nodular induration, is a relatively rare and mostly cycling-specific injury that is often incorrectly diagnosed and managed. Here two cases with divergent managements are described to highlight the spectrum of treatment available to manage this condition. The presentation, assessment and management of two cases of perineal nodular induration are discussed. The management options, namely surgical excision vs conservative management, with saddle pressure mapping highlight that there is no single optimal method and that a multidisciplinary approach should be applied to treat these injuries successfully. Perineal nodular induration should be investigated appropriately to exclude less benign causes of perineal masses. Conservative management and surgical excision can both be successful. Clinicians should be familiar with the assessment and management of this relatively rare but debilitating condition in competitive cyclists.