OpenMed/multicare-articles huggingface dataset:
From Silos to Solidarity: Case Study of a Patient-Centered, Integrative Approach to Opioid Tapering and Chronic Pain Mitigation in a Multidisciplinary AIDS Clinic
Authors: S Pullen, V C Marconi, C Del Rio, C Head, M Nimmo, J O'Neil, M Ziebart
Journal: J AIDS HIV Treat (2021)
Keywords: aids, chronic pain, hiv, opioids, physical therapy

Background:
People with HIV (PWH) are at a disproportionate risk for experiencing both chronic pain and opioid use disorder (OUD). Prescription opioid tapering is typically addressed within the "silo model" of medical care, whereby attention is focused solely on opioid addiction rather than also addressing chronic pain management, and limited communication occurs between patient and providers.
Objective:
This descriptive case study examined an integrative, collaborative care model consisting of Provider, Physical Therapist (PT), and Patient aimed at decreasing chronic pain and opioid use within a multidisciplinary HIV/AIDS clinic.
Method:
A physical-therapy based model of chronic pain mitigation and physician-driven opioid tapering was implemented. The Provider, PT, and Patient worked collaboratively to address physiological pain, pain coping skills and opioid tapering. A patient case example was used to illustrate the implementation of the model for a future, larger study in the same patient population.
Results:
This model was feasible in this case example in terms of clinic workflow and acceptability to both the Patient and Providers in this clinic. After the intervention, the Patient's pain was fully eliminated, and he had ceased all opioid use.
Conclusion:
Results of this case study suggest that utilizing an integrative, patient-centered approach to both chronic pain management and opioid tapering may be feasible within the context of a multidisciplinary HIV/AIDS clinic. Generalizability is limited by case study model; however, this gives insight into the value of a collaborative alternative compared to a "silo" model of opioid tapering and chronic pain management in preparation for a larger study.
A rare case and review of pulmonary ossification
Authors: Alexander J Sweidan, Justin H Shiu, Mohammed Y El Naggar, Bahman Saatian
Journal: Respir Med Case Rep (2022)
Keywords: dendriform pulmonary ossification, nodular pulmonary ossification, pulmonary calcification, pulmonary ossification
MeSH terms: Case Reports

Pulmonary ossification (PO) is a rare metastatic disease characterized by the formation of diffuse heterotopic bone units in the lung parenchyma. Herein, we describe a 45-year-old Filipino male with dendriform pulmonary ossification in combination with gastroesophageal reflux disease and chronic dust exposure, a notably unique association. Radiographic imaging and pathology findings are examined with discussion of various pulmonary disease entities from current literature. Further recognition of PO will facilitate appropriate treatment and better outcomes for patients diagnosed with this enigmatic condition.
Extraskeletal chondroma: another diagnostic possibility for a soft tissue axillary mass in an adolescent
Authors: Ibrahim Adaletli, Tal Laor, Hong Yin, Daniel J Podberesky
Journal: Case Rep Orthop (2011)
MeSH terms: Case Reports

Extraskeletal chondroma is a benign cartilaginous tumor that occurs predominantly in the soft tissues near small joints of the hands and feet. There are rare reports of the lesion in other sites, such as the head, neck, trunk, oral cavity, larynx, and pharynx. We present a case of an axillary mass in a 15-year-old girl who underwent MRI examination and resection, with the ultimate diagnosis of an extraskeletal chondroma, in order to expand the differential diagnosis of an axillary soft tissue mass in an adolescent.
CT-guided percutaneous drilling is a safe and reliable method of treating osteoid osteomas
Authors: Edgard Eduard Engel, Nelson Fabrício Gava, Marcello Henrique Nogueira-Barbosa, Filipe Almeida Botter
Journal: Springerplus (2013)
Keywords: bone neoplasms, bone remodeling, interventional radiography, osteoid osteoma, treatment outcome

Computed tomography (CT)-guided percutaneous drilling is an alternative for osteoid osteoma treatment. This study aims to evaluate the remodeling of the drill orifice. The success rate and complications were also recorded and compared with other treatment methods. Fifteen patients with an average age of fourteen years (ranging from 4 to 25) submitted to CT-guided percutaneous drilling between 2003 and 2009 were retrospectively analyzed according to clinical and radiological criteria. Fourteen cases showed complete alleviation of pain one week after surgery. No relapse was detected even in the subject who continued complaining of pain. All patients were treated with a day-hospital regimen and were discharged with partial weight bearing. Total weight bearing was allowed after one month, and sports were allowed after consolidation, which occurred in all but one case after the third month. One patient, who did not follow our medical advice, returned to sports activities after two weeks and experienced a fracture as a result. Atrophy of the vastus lateralis muscle developed after the procedure in another patient. Our case series suggests that this method is reliable and safe. The level of complexity is comparable with other minimally invasive percutaneous procedures. The cost is low because there is no need to buy probes or other equipment. The negative points include weakening of the bone and the logistical problem of assembling the orthopedic surgeon, radiologist, and anesthesiologist in the tomography room.
Systemic lymphadenopathy as the initial presentation of malignant mesothelioma: a report of three cases
Authors: Yaxia Zhang, Zohreh M Taheri, Merce Jorda
Journal: Patholog Res Int (2010)
MeSH terms: Case Reports

Systemic lymph node metastasis is a rare event in malignant mesothelioma. It is even more exceptional when systemic lymph node metastasis is the initial clinical presentation. Review of literature discloses only four cases in which metastatic lymphadenopathy was the only symptom of malignant mesothelioma. We, herewith, report three cases where the initial diagnosis of malignant mesothelioma was made by biopsy of enlarged lymph nodes, which were the only clinical presentation. Immunohistochemistry played a pivotal role in elucidating the mesothelial origin of their unusual systemic lymph node metastasis.
Unusual presentation of the germinoma: A 26-year-old female
Authors: Zahra Davoudi, Arezoo Chouhdari, Adineh Taherkhani, Farahnaz Bidari Zerehpoosh, Mohammad Samadian
Journal: Caspian J Intern Med (2021)
Keywords: germinoma, presentation, unusual
MeSH terms: Case Reports

Background:
Germinoma is a rare lesion found commonly in the pineal and suprasellar regions of the brain. Clinical presentation mainly involves the location and size of the tumor and the patient age. Endocrine abnormalities are the most common symptom.
Case presentation:
The patient was a 26-year-old Iranian female who suffered from germinoma for a long time and was referred to Loghman Hakim Hospital for amenorrhea, polyuria, and polydipsia. Despite diagnostic challenges, she was finally diagnosed with suprasellar germinoma after endoscopic transsphenoidal surgery, followed by radiotherapy and medical interventions to complement the surgery.
Conclusion:
It is important to be able to diagnose the patient's problem at an early stage based on their history, hormonal profile, laboratory results and radiological view.
Central Precocious Puberty in a Child With Metachromatic Leukodystrophy
Authors: Gilda Belli, Emanuele Bartolini, Andrea Bianchi, Mario Mascalchi, Stefano Stagi
Journal: Front Endocrinol (Lausanne) (2018)
Keywords: central precocious puberty, metabolic disease, metachromatic leucodystrophy, precocious puberty, white matter disease
MeSH terms: Case Reports

Metachromatic leucodystrophy (MLD) is a rare inherited lysosomal disorder caused by reduced activity of the enzyme arylsulfatase A with accumulation of sulfatides in the nervous system. We report a female child affected by MLD who developed central precocious puberty (CPP). This association has not been described so far. The proposita, after normal growth and psychomotor development, at age of 30 months presented with a rapidly progressive gait disturbance with frequent falls and with loss of acquired language skills. Magnetic resonance imaging showed leukoencephalopathy. Biochemical blood essays showed a 91% reduction in the arylsulfatase A activity and genetic analysis revealed compound heterozygous mutations of the Arylsulfatase A gene, enabling diagnosis of MLD. Subsequently, the patient had further rapid deterioration of motor and cognitive functions and developed drug-resistant epilepsy. At 4 years and 7 months of age bilateral thelarche occurred. Magnetic resonance imaging showed a small pituitary gland, extensive signal changes of the brain white matter, increased choline, decreased N-acetyl-aspartate and presence of lactate on 1HMR spectroscopy. Pelvic ultrasound demonstrated a slightly augmented uterine longitudinal diameter (42 mm). The gonadotropin-releasing hormone stimulation test revealed a pubertal LH peak of 12.9 UI/l. A diagnosis of CPP was made and treatment with gonadotropin-releasing hormone agonists was initiated, with good response. In conclusion, a CPP may occur in MLD as in other metabolic diseases with white matter involvement. We hypothesize that brain accumulation of sulfatides could have interfered with the complex network regulating with the hypothalamic-pituitary axis and thus triggering CPP in our patient.
Fatal tumor lysis syndrome in a patient with metastatic gastric adenocarcinoma
Authors: Robin Moiseff, Cameron Felty, Xiaoying Liu
Journal: Autops Case Rep (2020)
Keywords: stomach, stomach neoplasms, tumor lysis syndrome
MeSH terms: Case Reports

Tumor lysis syndrome is a well-characterized and potentially deadly complication of spontaneous or treatment-related tumor destruction, and it is most commonly associated with hematologic malignancies. Our case illustrates a rare example of fatal tumor lysis syndrome in the setting of metastatic gastric adenocarcinoma treated with radiation therapy. This case highlights the critical importance of identifying patients with solid organ malignancies at risk for tumor lysis syndrome and of early recognition and treatment of this syndrome.
Surgical removal of coronal fragment of tooth embedded in lower lip and esthetic management of fractured crown segment
Authors: Alok Avinash, Alok Dubey, Rajeev Kumar Singh, Swati Prasad
Journal: Int J Clin Pediatr Dent (2014)
Keywords: composite resin reconstruction, lower lip, tooth fragment retrieval
MeSH terms: Case Reports

Dental fractures of the permanent maxillary anterior teeth are relatively frequent accidents during childhood. The Efficient diagnosis and treatment of dental injury are important elements in clinical dentistry. This article describes a case of trauma in permanent right central maxillary incisors with tooth fragments embedded in the lower lip. Thorough clinical examination followed by soft tissue radiographs confirmed the presence of a fractured incisal fragment, which was surgically retrieved under local anesthesia. Direct composite restoration was placed. After finishing and polishing, an esthetic and natural-looking restoration was achieved; this completely satisfied the functional and esthetic expectation of the patient and dental team. How to cite this article: Avinash A, Dubey A, Singh RK, Prasad S. Surgical Removal of Coronal Fragment of Tooth Embedded in Lower Lip and Esthetic Management of Fractured Crown Segment. Int J Clin Pediatr Dent 2014;7(1):65-68.
A Severe Case of Drug-Induced Liver Injury after Gemcitabine Administration: A Highly Probable Causality Grading as Assessed by the Updated RUCAM Diagnostic Scoring System
Authors: Ilenia Mascherona, Caterina Maggioli, Maira Biggiogero, Oreste Mora, Lucia Marelli
Journal: Case Reports Hepatol (2020)
MeSH terms: Case Reports

Gemcitabine is an antineoplastic drug used in several forms of advanced pancreatic, lung, breast, ovarian, and bladder cancer. Common side effects include bone marrow suppression, fatigue, diarrhea, nausea, gastrointestinal upset, rash, alopecia, and stomatitis. Transient serum enzyme elevations could be observed during therapy, but clinically significant acute liver injury has been rarely associated with its use. Few cases of acute liver injury have been reported in the literature. We reported the clinical case of a 73--year-old man who developed clinically significant acute hepatic injury after using gemcitabine. Possible causes, clinical presentation, and treatments are discussed. According to the updated RUCAM score, the case was rated 10 points and became a suspected drug-induced liver injury. Moreover, on the liver biopsy, there were histological findings of mild-to-moderate portal hepatitis, eosinophilia, bile duct injury, and mild perisinusoidal fibrosis, suggesting drug damage.
Traumatic spigelian hernia complicated by caecal perforation and retroperitoneal haematoma-an unusual concurrence in blunt trauma
Authors: Faisal Syed, Gaik Si Quah, Angelina Di Re
Journal: J Surg Case Rep (2023)
MeSH terms: Case Reports

Blunt abdominal injury can be a cause of significant morbidity and mortality in patients who have sustained trauma even at low velocity. We report on an unusual case of a 50-year-old male who developed a traumatic spigelian hernia and caecal perforation after falling off a pushbike and impacting on the handlebar. We have also discussed some of the considerations taken in the assessment and surgical management of this case.
Case Report-Secondary Antibody Deficiency Due to Endogenous Hypercortisolism
Authors: Jelena Sarcevic, Claudia Cavelti-Weder, Christoph T Berger, Marten Trendelenburg
Journal: Front Immunol (2020)
Keywords: endogenous hypercortisolism, hypogammaglobulinemia, immune deficiency, lymphocytopenia, secondary antibody deficiency
MeSH terms: Adrenocorticotropic Hormone / metabolism, Agammaglobulinemia / diagnosis, B-Lymphocytes / physiology, Cushing Syndrome / diagnosis, T-Lymphocytes / physiology, Thymus Neoplasms / diagnosis, Case Reports, Agammaglobulinemia / etiology, Cushing Syndrome / complications, Humans, Lymphopenia, Male, Thymectomy, Thymus Neoplasms / etiology, Adrenocorticotropic Hormone

Therapeutic corticosteroids have an immunosuppressive function involving several pathways, including lymphocytopenia and hypogammaglobulinemia. While these effects have been well-described in patients that received corticosteroids for therapeutic reasons, the effects of endogenous corticosteroids on the immune system are less well-understood. Here, we describe a 21-year old patient with hypercortisolism due to an ACTH producing thymic tumor. In this patient, we observed a decrease in some of the immunoglobulin classes, and in specific B and T cell populations that resembled effects caused by corticosteroid treatment. IgG levels were restored following treatment and normalization of the hypercortisolism.
Rotavirus prevalence and seasonal distribution post vaccine introduction in Nairobi county Kenya
Authors: Joshua Gikonyo, Betty Mbatia, Patrick Okanya, George Obiero, Carlene Sang, James Nyangao
Journal: Pan Afr Med J (2019)
Keywords: diarrhea, acute gastroenteritis, prevalence, rotavirus
MeSH terms: Diarrhea / epidemiology, Gastroenteritis / epidemiology, Rotavirus Infections / epidemiology, Rotavirus Vaccines / administration & dosage, Case Reports, Age Distribution, Child, Preschool, Diarrhea / virology, Female, Gastroenteritis / virology, Humans, Infant, Kenya / epidemiology, Male, Prevalence, Rotavirus Infections / prevention & control, Seasons, Rotavirus Vaccines

Rotaviruses are one of the leading etiological agents of gastroenteritis in young children, for which a monovalent G1P(8) vaccine has been provided for free in Kenyan since July 2014. The main objective was to estimate the post vaccine prevalence and seasonal distribution of rotavirus diarrhea in children less than 5 years in Nairobi County, Kenya. Rotavirus positive samples were collected from children below 5 years of age in two hospitals within Nairobi County where vaccination status was card-confirmed. The children were examined and the demographic and clinical profiles of the children were recorded. Fecal specimens were analyzed for rotavirus antigen using an ELISA kit, followed by characterization by PAGE. Out of the total 323 samples, 49 had detectable rotavirus infection, representing 15.2% prevalence. Age distribution of rotavirus prevalence was as follows: ≤ 6 months-8.5%, 7-12 months-27.4%, 13-24 months - 41.4%, 25-36 months - 16.4% while 36-65 months had 6.3%. Rotavirus diarrhea was more common in wet and cold months of the year, the highest prevalence being observed in August (24.5%), 12.3% in both July and March, while April scored a prevalence of 10.2%. Out of the 49 rotavirus positive children, 48 had vomiting and abdominal cramps while all had fever and watery stool. The prevalence of Rotaviral diarrhea in children less than 5 years in Nairobi County Kenya has greatly reduced following the vaccine introduction and is more common during the wet and cold seasons of the year.
Oropharyngeal CSF Leak Secondary to Anterior Cervical Discectomy and Fusion
Authors: Wyatt J Weinheimer, Justin G Rowley, Randal Otto, John Floyd, Philip G Chen
Journal: Case Rep Otolaryngol (2018)
MeSH terms: Case Reports

We present a case of an oropharyngeal cerebrospinal fluid (CSF) fistula in a patient that presented with headache, rhinorrhea, and pneumocephalus years after an anterior cervical discectomy and fusion. Imaging suggested a defect in the fovea ethmoidalis, but endoscopic surgery revealed the defect in the oropharynx. A second procedure was performed to remove the spinal hardware and repair the leak. This case is not only unique in the literature but also highlights the importance of maintaining a broad differential diagnosis to include rare complications and shows that despite dramatic improvements in imaging, locating CSF leaks still presents a challenge.
Postural Tachycardia Syndrome and Vasovagal Syncope: A Hidden Case of Obstructive Cardiomyopathy without Severe Septal Hypertrophy
Authors: Kenneth A Mayuga, Natalie Ho, Robert W Shields Jr, Paul Cremer, L Leonardo Rodriguez
Journal: Case Rep Cardiol (2018)
MeSH terms: Case Reports

A 36-year-old female with symptoms of orthostatic intolerance and syncope was diagnosed with vasovagal syncope on a tilt table test and with postural tachycardia syndrome (POTS) after a repeat tilt table test. However, an echocardiogram at our institution revealed obstructive cardiomyopathy without severe septal hypertrophy, with a striking increase in left ventricular outflow tract gradient from 7 mmHg at rest to 75 mmHg during Valsalva, with a septal thickness of only 1.3 cm. Cardiac MRI showed an apically displaced multiheaded posteromedial papillary muscle with suggestion of aberrant chordal attachments to the anterior mitral leaflet contributing to systolic anterior motion of the mitral valve. She underwent surgery with reorientation of the posterior medial papillary muscle head, resection of the tethering secondary chordae to the A1 segment of the mitral valve, chordal shortening and tacking of the chordae to the A1 and A2 segments of the mitral valve, and gentle septal myectomy. After surgery, she had significant improvement in her prior symptoms. To our knowledge, this is the first reported case of obstructive cardiomyopathy without severe septal hypertrophy with abnormalities in papillary muscle and chordal attachment, in a patient diagnosed with vasovagal syncope and POTS.
Psychotic mania as the solitary manifestation of neurosyphilis
Authors: Eun Hyun Seo, Hae Jung Yang, Sang Hoon Kim, Jung Hyun Park, Hyung-Jun Yoon
Journal: Ann Gen Psychiatry (2018)
Keywords: bipolar disorder, blonanserin, neurosyphilis, psychiatric manifestation
MeSH terms: Case Reports

Background:
Neurosyphilis remains a diagnostic challenge in current psychiatric practice because of its pleomorphic psychiatric manifestations. Although neurosyphilis can present with a wide range of psychiatric symptoms, psychotic mania as its solitary manifestation is an unusual phenomenon.
Case presentation:
A 46-year-old man, with no history of any psychiatric disorder, exhibited abruptly developed symptoms of psychotic mania. He was admitted to a psychiatric ward for further evaluation and treatment. Upon admission, his cognitive function was unimpaired, and the hyperactivity was not severe. Also, no abnormalities were found upon neurological examination and brain magnetic resonance imaging. He was initially diagnosed as bipolar disorder with psychotic features. On the 3rd day after admission, he was confirmed as having neurosyphilis by analysis of cerebrospinal fluid and treated with intravenous penicillin-in combination with blonanserin-an atypical antipsychotic drug. After 2 weeks of treatment, most of the symptoms had abated.
Conclusions:
The present case emphasizes that patients presenting with atypical psychiatric manifestation should be screened for possible syphilis, particularly in the absence of previous psychiatric history, and suggests that combination of blonanserin with antibiotic therapy may be effective in the treatment of the manic and psychotic symptoms secondary to neurosyphilis.
Corticosteroids, Plasmapheresis, Argatroban, Rituximab, and Sirolimus Provided Clinical Benefit for Catastrophic Antiphospholipid Syndrome in a Patient with a History of Heparin-Induced Thrombocytopenia
Authors: Haytham Hasan, Ivana Surjancev, Jon A Arnason, Shivani Garg, William Nicholas Rose
Journal: Case Rep Rheumatol (2023)
MeSH terms: Case Reports

We report a patient with catastrophic antiphospholipid syndrome who had significant improvement after corticosteroids, plasmapheresis, argatroban, rituximab, and sirolimus. Argatroban was used instead of heparin due to a history of heparin-induced thrombocytopenia.
Anesthetic evaluation and perioperative management in a patient with new onset mediastinal mass syndrome presenting for emergency surgery
Authors: David Shi, Christopher A J Webb, Meredith Wagner, Anis Dizdarevic
Journal: Case Rep Anesthesiol (2011)
MeSH terms: Case Reports

Mediastinal mass syndrome (MMS) is a complex case that poses many challenges to the anesthesiologist. The cornerstone of management focuses on the potential hemodynamic changes associated with this syndrome. We describe the anesthetic management of a patient with a previously undiagnosed mediastinal mass presenting for emergency neurosurgical surgery.