OpenMed/multicare-articles huggingface dataset:
Experience with successful treatment of severe recurrent vulvar adhesions: A case report
Authors: Yingying Bi, Yuhang Chen, Wu Li, Huici Jiang, Jinlong Qin, Jiajing Cheng
Journal: Front Surg (2023)
Keywords: basic fibroblast growth factor, case report, oestrogen, postmenopausal women, vulvar adhesions
MeSH terms: Case Reports

Vulvar adhesions are defined as partial or complete adherence of the labia minora and/or labia majora. Vulvar adhesions are rare, especially in postmenopausal women.This article describes a case of postmenopausal recurrent vulvar adhesions successfully treated with surgery. The patient was a 52-year-old woman who had undergone manual separation and surgical adhesion release due to vulvar adhesions, which recurred soon after treatment. The patient then came to our hospital for treatment because of complete dense adhesions to the vulva and laboured urination. The patient received surgical treatment, the anatomical structure of the vulva recovered well, and the symptoms affecting the urinary system disappeared. There was no readhesion during the 3-month follow-up.
Case report: Post-thoracic surgery acquired venous thoracic outlet syndrome
Authors: Mohamed Amine Mansouri, Jon Andri Lutz
Journal: Front Surg (2023)
Keywords: etiology, management, postoperative, thoracic outlet syndrome, thoracic surgery
MeSH terms: Case Reports

Thoracic outlet syndrome (TOS) is a rare entity responsible for the vascular and/or nervous symptoms of the upper limbs. Unlike the congenital anatomical anomalies that cause TOS, acquired etiologies are even less common. Here, we report the case of a 41-year-old male with iatrogenic acquired TOS secondary to complex chest wall surgery for chondrosarcoma of the manubrium sterni; he was diagnosed with chondrosarcoma of the manubrium sterni in November, 2021. After staging was completed, primary surgery was performed. The operation was complex, with en-bloc resection of the manubrium sterni; the upper part of the corpus sterni; the first, second, and third bilateral parasternal ribs; and the medial clavicles, whose stumps were fixed on the first ribs. We reconstructed the defect using a double Prolene mesh, and bridged the second and third ribs on each side using two screwed plates. Finally, the wound was covered with pediculated musculocutaneous flaps. A few days after the operation, the patient presented with swelling in the left upper limb. Doppler ultrasound revealed slowing-down of the left subclavian vein flow, which was confirmed via thoracic computed tomography angiography. Systemic anticoagulation was initiated, and the patient began rehabilitation physiotherapy six weeks postoperatively. Symptoms had resolved by the 8-week outpatient follow-up, and anticoagulation therapy was stopped at three months; radiological follow-up demonstrated an improvement in subclavian vein flow without thrombosis. To the best of our knowledge, this is the first description of acquired venous TOS after thoracic surgery. Conservative treatment was found to sufficiently avoid the need for more invasive methods.
Progressive Back Pain due to Aspergillus nidulans Vertebral Osteomyelitis in an Immunocompetent Patient: Surgical and Antifungal Management
Authors: Mark K Lyons, Matthew T Neal, Naresh P Patel, Holenarasipur R Vikram
Journal: Case Rep Orthop (2019)
MeSH terms: Case Reports

Case report:

Aspergillus osteomyelitis is a destructive and progressive infection that has been described both in immunosuppressed and in immunocompetent hosts. We describe a case of lumbar vertebral osteomyelitis in a 61-year-old immunocompetent patient due to Aspergillus nidulans that was successfully treated with a combination of extensive surgical debridement, spinal stabilization, and a prolonged course of antifungal therapy. Imaging demonstrated findings consistent with L3 discitis. The biopsy grew Aspergillus fungus and was treated with vorconizole. Imaging showed progressive destructive osteomyelitis at L3-L4. Patient underwent anterior L3 and L4 partial corpectomies, anterior interbody fusion L3-L5, and posterior T11-S2 pedicle screw and rod fixation. Antifungal treatment resulted in resolution of infection. Aspergillus markers remain negative. One year following definitive treatment, the patient's back pain remains resolved.
Conclusion:
Definitive surgical resection of the infection, spinal stabilization, and aggressive antifungal therapy were required to eradicate the infection.
Giant gastrointestinal stromal tumor presenting as a palpable abdominal mass: an unusual presentation
Authors: Sachin Patil, Sudhir Jain, R C M Kaza, Ronald S Chamberlain
Journal: ISRN Surg (2011)
MeSH terms: Case Reports

Gastrointestinal stromal tumors (GIST-) account for the majority of mesenchymal tumors arising within the gastrointestinal tract. GIST presenting as a palpable abdominal mass is extremely rare. We report four additional cases of a GIST presenting as an abdominal mass along with a pertinent review of the literature. Twenty five cases of GISTs presenting with an abdominal mass, including 4 cases discussed here, have been reported in the world literature since 2001. The mean duration of symptoms was 152.7 days. Twenty one of 25 (84%) patients received surgical resection. The mean tumor size was 17.2 cm, with an average mitotic index of 7.6 per 50 high power fields. Thirteen of 14 (92.9%) patients had a high-risk tumor. Five patients were disease-free at a mean followup of 11 months, 2 patients had stable disease and 2 patients had progressive disease, and one patient had a partial response. In conclusion, symptomatic patents have an increased incidence of high-risk tumors and metastases at presentation. Adjuvant therapy with imatinib improves disease-free survival in patients with large abdominal GIST tumors, but no change in overall survival was noted. Finally, GISTs should be considered in the differential diagnosis of an abdominal mass in an elderly patient.
Case report: Trigeminal neuralgia misdiagnosed as glossopharyngeal neuralgia
Authors: Liangzhe Wu, Jinbiao Xiong, Ying Huang, Kunning Han, Kunhao Cai, Xuejun Fu
Journal: Front Neurol (2023)
Keywords: glossopharyngeal neuralgia, magnetic resonance imaging, microvascular decompression, misdiagnosed, trigeminal neuralgia
MeSH terms: Case Reports

Background:
Trigeminal neuralgia (TN) and glossopharyngeal neuralgia (GPN) are cranial nerve neuralgias with the same clinical manifestations, pathological features, and trigger factors; their affected sites are adjacent. Performing a magnetic resonance imaging (MRI) examination alone can easily lead to a misdiagnosis.
Case presentation:
A 72-year-old man had visited another hospital with severe left-sided tongue pain. On MRI, vascular compression of the glossopharyngeal nerve had been visible, with unclear evidence of trigeminal nerve involvement. He had been diagnosed with left-sided GPN and underwent microvascular decompression (MVD) of the left glossopharyngeal nerve. However, no improvement was observed after surgery. During a second surgery at our hospital, MVD of the trigeminal nerve was performed, and the trigeminal nerve was fully explored and separated. The patient's pain resolved after surgery. Ultimately, the patient was definitively diagnosed with left-sided TN.
Discussion and conclusion:
MVD is currently the most efficacious surgical option for treating cranial nerve neuralgia. To select patients for MVD, having an MRI criteria for identifying true neurovascular compression will be helpful. However, clinicians should focus more on a patient's clinical symptoms and not rely solely on MRI findings. This patient's case can help clinicians distinguish between TN and GPN, improve the understanding of these diseases, avoid misdiagnosis, and reduce the possibility of secondary damage.
Pleomorphic adenomas of the parapharyngeal space
Authors: Istemihan Akın, Tuğba Karagöz, Murad Mutlu, Mehmet Sahan, Evrim Onder
Journal: Case Rep Otolaryngol (2014)

Background. Parapharyngeal space is one of potential facial planes for neoplasms and infections and represents less than 1% of all head and neck tumours. Occurrence of the pleomorphic adenoma in the parapharyngeal space is a rarity. Case Presentation. Here, three giant pleomorphic adenomas of different sizes occupying the parapharyngeal space in three patients are reported. Extensive preoperative diagnostic workup was done in order to verify the nature and size of the tumour and the proximity to the large vessels. Review of the literature, clinical features, pathology, radiological findings, and treatment of these tumours are discussed. Conclusion. The excision of the tumor through submandibular transcervical approach, without cutting the mandible, turned out to be a safe and radical approach in all three cases.
An Unusual Presentation of Insert Dislocation and MCL Rupture in Unicompartmental Knee Replacement with 2 Years Postoperative Results: Does It Functional?
Authors: Ali Asma, Mehmet Erduran, Musa Eymir
Journal: Case Rep Orthop (2019)
MeSH terms: Case Reports

According to our knowledge, there is no prior article that reports functional results of medial collateral ligament (MCL) primary repair and insert change after MCL rupture and mobile-bearing dislocation as a late complication of unicompartmental knee replacement (UKR). Firstly, 63-year-old woman was treated with UKR due to anteromedial knee osteoarthritis of the right knee joint. 1 year after UKR surgery, she suffered from MCL rupture and mobile-bearing dislocation because of falls while getting on a public bus, and therefore, secondly, she was operated with MCL primary repair and mobile-bearing change and followed up for 2 years. The patient was evaluated regarding functional capacity, pain intensity, range of motion (RoM), and quality of life. Our case showed an improvement in the functional level and the other outcomes (pain intensity and quality of life) at postoperative 2nd year when compared to the preoperative period. The wellbeing of our case in about the postop 2nd year functional capacity and also other outcomes after revision surgery prompted us to continue to this surgery approach in the surgical management of similar cases that may arise thereafter.
Management of Chronic Disseminated Intravascular Coagulation Associated with Aortic Aneurysm/Dissection
Authors: Shigeru Koba, Tomoya Yamaguchi, Kenji Miki, Hiroshi Makihara, Shinsaku Imashuku
Journal: Case Rep Hematol (2019)
MeSH terms: Case Reports

Disseminated intravascular coagulation (DIC) is a systemic life-threatening process that can cause thrombosis and hemorrhage. Chronic DIC has been associated with aortic aneurysm/dissection. Aortic aneurysm/dissection should be included in the differential diagnosis of elderly patients with hemorrhagic diathesis due to DIC of uncertain etiology. Treatment depends on various factors, including the severity of underlying disease, extent of DIC, and patient comorbidities, as well as the ability of the patient to maintain activities of daily living once discharged from the hospital. This report describes the clinical characteristics of four elderly patients with chronic DIC associated with aortic aneurysm/dissection who were treated in our institution. We also offer the recommendations around most appropriate nonsurgical treatment of these patients.
Effectiveness and safety of botulinum toxin type a in children with musculoskeletal conditions: what is the current state of evidence?
Authors: Noémi Dahan-Oliel, Bahar Kasaai, Kathleen Montpetit, Reggie Hamdy
Journal: Int J Pediatr (2012)

Children with musculoskeletal conditions experience muscle weakness, difficulty walking and limitations in physical activities. Standard treatment includes physiotherapy, casting, and surgery. The use of botulinum toxins appears as a promising treatment on its own, but usually as an adjunct to other treatment modalities and as an alternative to surgery. The objectives were to establish the evidence on the effectiveness, safety and functional outcome of BTX-A in children with musculoskeletal conditions. A literature search using five electronic databases identified 24 studies that met our inclusion criteria. Two randomized clinical trials were included; most studies were case studies with small sample sizes and no control group. Improvements in gait pattern, function, range of motion, reduction of co-contractions, and avoidance of surgical procedures were found following BTX-A injections. Adverse events were not reported in 10 studies, minor adverse events were reported in 13 children and there were no severe adverse events. Additional doses appear safe. BTX-A is a promising treatment adjunct in improving functional outcomes in children with musculoskeletal conditions. Future studies including larger samples, longer follow-up periods and a comparison group are required to provide evidence on the effectiveness and safety of this drug in children with musculoskeletal conditions.
Transvesicoscopic Bipolar Sealing of Vesicovaginal Fistula
Authors: Ali Akkoç, Cemil Aydın, Murat Uçar, Aykut Buğra Şentürk, Murat Topçuoğlu, Ahmet Metin
Journal: J Endourol Case Rep (2018)
Keywords: bipolar, sealing, vesicoscopic, vesicovaginal fistula
MeSH terms: Case Reports

Introduction: Vesicovaginal fistula (VVF) is a problem that physically and psychologically debilitates the patient. Options for treatment of VVF include transabdominal, transvaginal, transvesical, laparoscopic, and robotic repair or minimally invasive methods such as fulguration. We describe a novel minimally invasive technique: transvesicoscopic bipolar sealing of the vesicovaginal fistula (TBSF). Case Presentation: We carried out the transvesicoscopic sealing of VVF with 5 mm of diameter on a 46-year-old woman, who had a failed conservative treatment with a Foley catheter placement. The patient was informed about the modified surgical procedure before operation. The fistula tract was sealed by using an electrothermal bipolar vessel sealer through a 5-mm transvesical ports. The patient was discharged on the first postoperative day and was on anticholinergic medications after the operation. The patient remained dry after the removal of the catheter at the third postoperative week. Conclusion: In select cases of VVF, TBSF may be effectively used for closure of the fistula tract.
Primary pituitary stalk mucosa-associated lymphoid tissue lymphoma: a case report and literature review
Authors: Shihao Cai, Juexian Xiao, Peng Chen, Haitao Luo, Zujue Cheng
Journal: Front Neurol (2023)
Keywords: malt lymphoma, hormone replacement therapy, pituitary stalk mass, primary cns lymphoma, surgery
MeSH terms: Case Reports

Background:
Primary extranodal mucosa-associated lymphoid tissue (MALT) lymphoma in the sellar region is a rare indolent B-cell lymphoma.
Case presentation:
A newly diagnosed patient with MALT lymphoma originating from the pituitary stalk is reported. A space-occupying lesion in the sellar region was found in a 24 year-old man who had no clinical symptoms except for those relating to a sex hormone disorder (rising estrogen and falling androgen) identified during a pre-employment physical examination. MALT lymphoma was diagnosed pathologically. Radiotherapy and chemotherapy were proposed after surgery. However, the patient selected androgen replacement therapy only rather than chemoradiotherapy. Over the next 3 months, no visual disturbance, headache, cranial nerve abnormality, or other symptoms occurred.
Conclusion:
Primary sellar region MALT lymphoma is an extremely rare disease. The differential diagnosis of sellar and parasellar masses should include primary sellar region MALT lymphoma. Early detection and treatment of this lymphoma can effectively improve the prognosis.
Total Knee Arthroplasty in Severe Valgus Osteoarthritis Excellent Early Results in a 90-Year-Old Patient with a Valgus Deformity of 47°
Authors: Petros Ismailidis, Rolf Kernen, Sebastian Andreas Mueller
Journal: Case Rep Orthop (2017)
MeSH terms: Case Reports

Grade III valgus deformity (tibiofemoral alignment > 20°) is present in only 0.5% of patients receiving total knee arthroplasty. Furthermore, cases with a valgus deformity exceeding 40° are even rarer. Since they mostly affect elderly, polymorbid patients, successful outcome means a great challenge. We report on a case of a 90-year-old patient with a valgus deformity of 47°. The patient was preoperatively restricted to a wheel chair, unable to walk, and only able to stand for a few seconds. The maximal knee flexion was 100°, and there was an extension deficit of 15°. The WOMAC score was 91; the EQ-5D-5L Index was 0.048. She was treated with a constrained hinged prosthesis. Postoperatively, the axis was 6° valgus. After 3 months of rehabilitation, she was independent using a wheeled walker. The maximal flexion of the knee was 110° and there was no extension deficit. The WOMAC score was 45; the EQ-5D-5L Index was 0.813. This case demonstrates the possibility of a satisfactory result and an improvement in quality of life and mobility with a plausible timetable and with reasonable use of resources even in advanced age and severe valgus deformity.
Homicides Disguised as Fire Deaths
Authors: Gabrielė Žiūkaitė, Marta Jasaitė, Sigitas Chmieliauskas, Diana Vasiljevaitė, Sigitas Laima, Dalius Banionis, Jurgita Stasiūnienė
Journal: Acta Med Litu (2023)
Keywords: antemortem burning, burned bodies, forensic science, homicide, postmortem burning
MeSH terms: Case Reports

Background:
When conducting a forensic examination of burnt bodies, it is important to determine whether the victim was exposed to fire while alive or after death. The differential diagnosis between antemortem and postmortem burning is difficult and often cannot be made based on information obtained solely from the autopsy. The aim of the study is to review current literature on this topic and present clinical cases that illustrate how challenging the determination of vitality during the fire and manner of death can be.
Materials and methods:
We present four cases of burnt homicide victims, illustrating the complexity of forensic determination of the cause of death in the fire and the importance of differential diagnosis of antemortem and postmortem exposure to flames.
Results:
In the forensic assessment autopsy is a fundamental to determine the cause of death. When death is related to fire, particular findings during autopsy can help to suspect that the victim was alive. One of the main antemortem signs is the deposition of soot in the respiratory tract. Another important test is the toxicological analysis, which determines the level of carboxyhaemoglobin in the blood: a concentration of more than 50% indicates that the person died in the fire.
Conclusions:
Forensic examination of burnt bodies requires a comprehensive and detailed assessment of all available data. The autopsy, together with additional diagnostic forensic methods, including histological examination, toxicological analysis and postmortem computed tomography, allows the exact cause of death to be determined.
A Medical Resident with a History of Alcohol Abuse and Suicidal Ideation: A Challenge for Both Psychiatry and Occupational Medicine in the Context of the First Wave of the COVID-19 Pandemic
Authors: Martina Corsi, Antonello Veltri, Salvio Perretta, Riccardo Marino, Gabriele Necciari, Fabrizio Caldi, Rudy Foddis, Alfonso Cristaudo, Rodolfo Buselli, Giovanni Guglielmi
Journal: Case Rep Psychiatry (2022)
MeSH terms: Case Reports

This case study draws attention to the hazards of physicians with a history of alcohol addiction and a particular psychopathology framework in the context of occupational health surveillance, particularly during the challenging working conditions brought about by the COVID-19 pandemic. The case involves a hospital resident in her thirties, with a previous history of addiction and attempts at suicide, who was assigned to a COVID-19 unit of an Italian hospital. In this case study, we discuss the preventive intervention put in place in order to protect physicians' health and work. What emerges is the key role that rapid substantive communications between specialists play in formulating an effective strategy for dealing with these conditions. We believe this case is noteworthy for the lessons that can be learned for tailoring prevention and treatment pathways for health care workers with addiction.
Primary Small-Cell Carcinoma of the Palate with Cushing's Syndrome: A Case Report
Authors: Yingqiu Song, Zhenyu Lin, Lingjuan Chen, Gang Wu
Journal: Case Rep Oncol Med (2012)

We report a 24-year-old woman presenting with a relapsed soy-bean-size tender mass at the junction of the soft and hard palate and a history of palatine tumor of small cell carcinoma. Reexcision surgery was performed and histopathological features were consistent. The patient was treated with six cycles of chemotherapy consisting of etoposide and cisplatin. After one year, the patient developed bone metastases and Cushing's syndrome, and successfully recovered with subsequent chemotherapy with irinotecan and cisplatin plus radiotherapy. There was no evidence of recurrence or metastasis for more than three years. Small cell carcinoma originating in the head and neck region has been reported to be highly aggressive and has a poor prognosis. This is the first case report of a patient with relapsed primary small cell carcinoma of the palate and successfully treated with second-line chemotherapy and local radiotherapy.
Challenges in the Management of Home-Based Care Experienced by a Caregiver with Autism Spectrum Disorder
Authors: Sayaka Ohsawa, Hisashi Yoshimoto, Ryo Ohsawa, Satoko Takahashi, Shoji Yokoya
Journal: Palliat Med Rep (2021)
Keywords: autism spectrum disorder, communication supports, family caregiver, home care services, interprofessional team, palliative care
MeSH terms: Case Reports

We describe the case of a 37-year-old woman with autism spectrum disorder (ASD) who lived with a mother with end-stage breast cancer and a visually impaired father. She was the main caregiver for her mother, who was receiving home-based palliative care. The caregiver needed training on communication and task management so that she could manage the communication with home care staff and perform more house chores. It was also necessary to share information with home care staff about ASD and how to treat her with understanding and respect. Although most support for people with ASD focuses on schools and workplaces, to offer successful end-of-life care at home, medical and home staff need to understand and communicate well with people with ASD and provide multiple types of support. Research, guidebooks, and visuals about main caregivers who have ASD and improving the inclusivity among staff members are necessary for providing successful home care and meeting caregivers' and patients' needs and expectations.