OpenMed/multicare-articles huggingface dataset:
Combined Chylothorax and Chylous Ascites Complicating Liver Transplantation: A Report of a Case and Review of the Literature
Authors: Tommy Ivanics, Semeret Munie, Hassan Nasser, Shravan Leonard-Murali, Atsushi Yoshida, Shunji Nagai, Kelly Collins, Marwan Abouljoud, Michael Rizzari
Journal: Case Rep Transplant (2019)
MeSH terms: Case Reports

Chyle leaks may occur as a result of surgical intervention. Chyloperitoneum, or chylous ascites after liver transplantation, is rare and the development of chylothorax after abdominal surgery is even more rare. With increasingly aggressive surgical resections, particularly in the retroperitoneum, the incidence of chyle leaks is expected to increase in the future. Here we present a unique case of a combined chylothorax and chyloperitoneum following liver transplantation successfully managed conservatively. Risk factors for chylous ascites include para-aortic manipulation, extensive retroperitoneal dissection, use of a Ligasure device, and early enteral feeding as well as early enteral feeding. The clinical presentation is typically insidious and may include painless abdominal distension. Diagnosis can be made by noting characteristic milky white drainage which on laboratory examination has a total fluid triglyceride level >110 mg/dl, an ascites/serum triglyceride ratio of >1 and a leukocyte count in fluid >1000/uL with a lymphocyte predominance. Chyle leaks may lead to significant morbidity and mortality. Numerous management options exist, with conservative nonoperative measurements leading to the most consistent and successful outcomes. This includes a step-up approach beginning with dietary modifications to a low-fat or medium chain triglyceride diet followed by nil per os with addition of total parenteral nutrition and somatostatin analogues such as octreotide. Rarely do patients require more invasive treatment. Early recognition and appropriate management are imperative to mitigate this complication.
A case of haemoptysis in a girl with Noonan syndrome
Authors: R K Mopeli, M Lebea, C Verwey
Journal: Afr J Thorac Crit Care Med (2020)
Keywords: noonan syndrome, bronchial artery, haemoptysis, polyps
MeSH terms: Case Reports

Noonan syndrome (NS) is an autosomal dominant condition affecting 1 in 2 000 live births. It is characterised by distinctive physical features, congenital heart disease and multiple other comorbidities including haematological abnormalities. Haemoptysis is the expectoration of blood originating from the lower respiratory tract. It is uncommon in children but can be life threatening.Perfusion of the lower respiratory system arises from the pulmonary arterial circulation and the bronchial circulation, or bleeding may arise from either. In children, the most common causes of haemoptysis are respiratory tract infections, aspirated foreign bodies and bronchiectasis. We present a 7-year-old girl with recurrent haemoptysis.
Repeated bouts of pulmonary tuberculosis in a hunting cat: reinfection or recrudescence?
Authors: Carolina Sc Albuquerque, Petra Černá, Danièlle A Gunn-Moore
Journal: JFMS Open Rep (2021)
Keywords: m microti, mycobacteria, mycobacteriumtuberculosis complex, hypercalcaemia, pyogranulomatous, tuberculosis
MeSH terms: Case Reports

Case summary:
A 7-year-old neutered male Siamese cat was referred for investigation of weight loss and hypercalcaemia (3.3 mmol/l; reference interval 2-3 mmol/l). Haematology, serum biochemistry, thoracic imaging, bronchoalveolar lavage (BAL), Ziehl-Neelsen staining of the BAL fluid and interferon gamma release assay (IGRA) were compatible with pneumonia caused by the less pathogenic member of the Mycobacterium tuberculosis complex, that is, M microti (the 'vole bacillus'), which is common in cats in the UK. Treatment with azithromycin, rifampicin and marbofloxacin was given for 2 months, followed by 4 months of azithromycin and marbofloxacin. Treatment recommendations for tuberculous pneumonia have since changed. The cat remained asymptomatic for 1 year but went on to develop M microti pneumonia on five other occasions, and was treated for 6-12 months on each occasion. The patient's clinical signs, hypercalcaemia and radiographic/CT pulmonary pathology always resolved completely, and the IGRA became negative, before antimycobacterial treatment was stopped. This suggests cure followed by reinfection owing to avid hunting behaviour. Alternatively, this could represent recrudescence of dormant disease. This case has previously been included in a study that described a series of cases of feline tuberculosis.
Relevance and novel information:
This case shows that M microti infection in cats can present as recurrent episodes of pneumonia, even after prolonged treatment courses.
A 17 year-old girl with a demyelinating disease requiring mechanical ventilation: a case report
Authors: Chrysostomos Katsenos, Despoina Androulaki, Stavroula Lyra, Theodoros Tsoutsouras, Costas Mandragos
Journal: BMC Res Notes (2013)
MeSH terms: Demyelinating Diseases / physiopathology, Respiration, Artificial, Respiratory Insufficiency / therapy, Case Reports, Adolescent, Demyelinating Diseases / complications, Female, Humans, Magnetic Resonance Imaging, Respiratory Insufficiency / etiology

Background:
Demyelinating diseases cause destruction of the myelin sheath, while axons are relatively spared. Pathologically, demyelination can be the result of an inflammatory process, viral infection, acquired metabolic derangement and ischemic insult. Three diseases that can cause inflammatory demyelination of the CNS are: Multiple sclerosis (MS), Acute disseminated encephalomyelitis (ADEM) and Acute hemorrhagic leucoencephalitis. Differentiation is not always easy and there is considerable overlaping. Data about adults with acute demyelination requiring ICU admission is limited.
Case presentation:
A 17 year old Greek female was hospitalised in the ICU because of acute respiratory failure requiring mechanical ventilation. She had a history of febrile disease one month before, acute onset of paraplegia, diplopia, progressive arm weakness and dyspnea. Her consciousness was not impaired. A demyelinating central nervous system (CNS) disease, possibly post infectious encephalomyelitis (ADEM) was the underlying condition. The MRI of the brain disclosed diffused expanded cerebral lesions involving the optic nerve, basal ganglia cerebellum, pons and medulla oblongata. There was also extended involvement of the cervical and thoracic part of the spinal cord. CSF leukocyte count was elevated with lymphocyte predominance. The patient required mechanical ventilation for two months. Then she was transferred to a rehabilitation centre. Three years later she remains paraplegic. Since then she has not suffered any other demyelination attack.
Conclusions:
Demyelinating diseases can cause acute respiratory failure when the spinal cord is affected. Severe forms of these diseases, making necessary ICU admission, is less frequently reported. Intensivists should be aware of the features of these rare diseases.
Management of Neonatal Diabetes due to a KCNJ11 Mutation with Automated Insulin Delivery System and Remote Patient Monitoring
Authors: Ming Yeh Lee, Anna L Gloyn, David M Maahs, Priya Prahalad
Journal: Case Rep Endocrinol (2023)
MeSH terms: Case Reports

Neonatal diabetes mellitus (NDM) is a monogenic form of diabetes. Management of hyperglycemia in neonates with subcutaneous insulin is challenging because of frequent feeding, variable quantity of milk intake with each feed, low insulin dose requirements, and high risk for hypoglycemia and associated complications in this population. We present a case of NDM in a proband initially presenting with focal seizures and diabetic ketoacidosis due to a pathologic mutation in the beta cell potassium ATP channel gene KCNJ11 c.679G > A (p.E227K). We describe the use of continuous glucose monitoring (CGM), insulin pump, automated insulin delivery system, and remote patient monitoring technologies to facilitate rapid and safe outpatient cross-titration from insulin to oral sulfonylurea. Our case highlights the safety and efficacy of these technologies for infants with diabetes, including improvements in glycemia, quality of life, and cost-effectiveness by shortening hospital stay.
Deep Parotid Lobe Abscess Presenting with Dysphagia and Trismus
Authors: Madison Grinnell, Andrew Logeman, Timothy Knudsen, Zafar Sayed
Journal: Case Rep Otolaryngol (2019)
MeSH terms: Case Reports

An abscess of the deep parotid lobe is an uncommon complication of acute parotitis. Characterized by warm erythematous facial skin and ipsilateral cheek swelling, parotid abscesses have often been associated with decreased saliva production and immunodeficiency. We offer a case of a large deep parotid lobe abscess presenting similarly to a peritonsillar mass, causing significant odynophagia and difficulty swallowing. Computed tomography scan revealed an infected deep parotid lobe sialocele which was surgically drained transorally and treated expectantly with antibiotics.
Management of a Pregnancy with a Solid Pseudopapillary Neoplasm of the Pancreas
Authors: Atakan Tanacan, Gokcen Orgul, Ahmet Bülent Dogrul, Fatih Aktoz, Osman Abbasoglu, M Sinan Beksac
Journal: Case Rep Obstet Gynecol (2018)
MeSH terms: Case Reports

A 26-year-old primigravid patient, at 35 weeks and 2 days of gestation, was referred to Hacettepe University Hospital for pancreatic mass, giant cervical myoma, maternal systemic lupus erythematosus, thrombocytopenia, and onset of preterm labor. At 36 weeks and 1 day of gestation (6 days after admission to the hospital), regular uterine contractions started and cervical dilatation with effacement was observed. Because of breech presentation and giant cervical myoma, a cesarean section was performed on the primigravid patient under general anesthesia. Four months after the birth, subtotal pancreatectomy, partial gastrectomy, duodenectomy, cholecystectomy, and omentectomy (Whipple procedure) were performed. The pathologic diagnosis was of a solid pseudopapillary neoplasm of the pancreas; the patient was discharged from hospital after ten days.
Genotype 1 hepatitis E virus infection with acute acalculous cholecystitis as an extrahepatic symptom: a case report
Authors: Ken Fujioka, Toshiki Nishimura, Masayuki Seki, Masanori Kinoshita, Nobuyuki Mishima, Shigeo Irimajiri, Masaya Yamato
Journal: Trop Med Health (2016)
Keywords: acalculous cholecystitis, case report, genotype 1, hepatitis e virus
MeSH terms: Case Reports

Background:
Hepatitis E virus (HEV) causes an acute viral hepatitis that is transmitted enterically. It is epidemic in Africa, Asia, the Middle East, and Central America. It is known that HEV can cause extrahepatic manifestations. Here, we report the first case of acalculous cholecystitis as an extrahepatic symptom of HEV.
Case presentation:
A 24-year-old Japanese woman with no notable past medical history presented with complaints of fever and nausea while she was traveling in Australia; within the previous 2 months, she had also traveled to India and Africa. She visited a local hospital in Australia, and the laboratory tests showed significantly elevated levels of transaminase, so she was checked for viral hepatitis. After excluding hepatitis A, B, and C, as well as other causes of hepatitis, it was revealed that the patient was positive for HEV-IgM. Since she was a visitor to Australia, she was sent back to Japan and was transferred to our hospital. On day 4, the patient complained of right upper quadrant pain. Ultrasonography of the abdomen showed a thickened gallbladder wall without calculi. Acalculous cholecystitis was diagnosed from her course. No antibiotics were administered against it because there was no evidence of bacterial infection. The edematous wall showed significant improvement on day 11 and had returned to normal by day 14. The patient was discharged on day 16 because all of the symptoms had disappeared.
Conclusions:
We found that HEV can cause acalculous cholecystitis as an extrahepatic manifestation. In addition, the cholecystitis could be resolved without any antibiotics.
COVID-19 in 28-Week Triplets Caused by Intrauterine Transmission of SARS-CoV-2-Case Report
Authors: Sigrid C Disse, Tatiana Manuylova, Klaus Adam, Annette Lechler, Robert Zant, Karin Klingel, Christian Aepinus, Thomas Finkenzeller, Sven Wellmann, Fritz Schneble
Journal: Front Pediatr (2021)
Keywords: covid-19, sars-cov-2, case report, neonate, preterm, triplets, vertical transmission
MeSH terms: Case Reports

Since the beginning of the COVID-19 pandemic, in-utero transmission of SARS-CoV-2 remains a rarity and only very few cases have been proven across the world. Here we depict the clinical, laboratory and radiologic findings of preterm triplets born at 28 6/7 weeks to a mother who contracted COVID-19 just 1 week before delivery. The triplets showed SARS-CoV-2 positivity right after birth, developed significant leukopenia and early-onset pulmonary interstitial emphysema. The most severely affected triplet I required 10 days of high-frequency oscillatory ventilation due to failure of conventional invasive ventilation, and circulatory support for 4 days. Despite a severe clinical course in two triplets (triplet I and II), clinical management without experimental, targeted antiviral drugs was successful. At discharge home, the triplets showed no signs of neurologic or pulmonary sequelae. Placental immunohistology with SARS-CoV-2 N-protein localized strongly to syncytiotrophoblast cells and, to a lesser extent, to fetal Hofbauer cells, proving intrauterine virus transmission. We discuss the role of maternal viremia as a potential risk factor for vertical transmission. To the best of our knowledge, our report presents the earliest unequivocally confirmed prenatal virus transmission in long-term surviving children, i.e., at the beginning of the third trimester.
Ultrasound Diagnosis of a Cervical Rib with Pseudarthrosis
Authors: Douglas Lacomblez, Dana Dumitriu
Journal: J Belg Soc Radiol (2021)
Keywords: cervical rib, lump, neck, pseudarthrosis, ultrasound
MeSH terms: Case Reports

Teaching Point: Ultrasound is the first-line examination for neck mass and may offer a reliable method to identify cervical ribs.
Skin Hyperpigmentation as the Presenting Symptom of Subacute Combined Degeneration of the Spinal Cord
Authors: Abdulhameed Alhazmi, Abdulrahman Almalki, Safieeldin Ghazala
Journal: Case Rep Neurol Med (2017)
MeSH terms: Case Reports

Vitamin B12 deficiency results in hematological, neurological, and rarely dermatological complications. Subacute combined degeneration of the cord is one of the neurological complications, and usually the presenting symptom is paresthesia. Herein, we report a case of a 46-year-old man with subacute combined degeneration presenting with knuckle hyperpigmentation.
Large B cell lymphoma presenting as an adnexal mass in an HIV positive patient: a case report
Authors: Misai Hukuimwe, Asaph Ziruma, Muchabayiwa Francis Gidiri, Marshall Manase
Journal: Pan Afr Med J (2019)
Keywords: hiv, non-hodgkins lymphoma, ovarian
MeSH terms: Adnexal Diseases / diagnosis, HIV Infections / drug therapy, Lymphoma, Large B-Cell, Diffuse / diagnosis, Ovarian Neoplasms / diagnosis, Case Reports, Adnexal Diseases / pathology, Adult, Anti-HIV Agents / administration & dosage, CD4 Lymphocyte Count, Female, Humans, Hysterectomy / methods, Lymphoma, Large B-Cell, Diffuse / therapy, Ovarian Neoplasms / pathology, Ovarian Neoplasms / therapy, Anti-HIV Agents

We present a 34-year-old HIV positive woman who presented with a 2-month history of abdominal pain, abdominal distension, night sweats and fever. She had a firm, immobile and irregular abdominopelvic mass of about 30 weeks uterine size. Investigations showed a haemoglobin of 6.5g/dl, (NR 12-14) cancer antigen 125 of 44U/ml (NR 0-35), serum beta human chorionic gonadotropin (HCG) of 0.258mIU/ml (NR 0-5) and alpha fetoprotein of 7ng/ml (NR <10). Her CD4 count was 63cells/mm3. At laparotomy there was a left ovarian mass and the rest of the abdomen and omentum looked grossly normal, leading to the conclusion that the primary was in the ovaries. A total abdominal hysterectomy, bilateral adnexectomy and infracolic omentectomy were done. Sigmoidectomy and Hartmann's procedure were also performed. Histology of the specimens showed a large B cell lymphoma. She has since been commenced on chemotherapy and antiretroviral therapy and has been doing well.
Case report: Unilateral transnasal endoscopic marsupialization of nasopalatine duct cyst
Authors: Ryoji Kagoya, Tomoko Iwanami, Makoto Mochizuki, Kenji Kondo, Ken Ito
Journal: Front Surg (2022)
Keywords: endoscopic marsupialization, nasopalatine duct cyst, nasopalatine nerve, oronasal fistula, paresthesia
MeSH terms: Case Reports

Nasopalatine duct cyst (NPDC) is the most common type of non-odontogenic cysts of the jaw. It has been treated with complete surgical resection using a sublabial or palatine approach. However, complete removal of the cyst can be accompanied by postoperative complications including oronasal fistula. Recently, endoscopic marsupialization for the disease has been advocated, but there are still few reports regarding the surgery. Herein, we report a case of NPDC that was treated with unilateral transnasal endoscopic marsupialization. A 43-year-old man with no relevant previous medical history was referred to our hospital for the treatment of lesion occupying the right nasal cavity. A computerized tomography scan of the sinus revealed an egg-shaped lesion with a well-defined border centered on the lower half of the nasal cavity and hard palate. Based on the site of the lesion, it was considered to be NPDC. Transnasal endoscopic marsupialization was performed to diagnose and improve nasal obstruction. Histopathological examination revealed stratified squamous epithelium without atypia, which was consistent with NPDC. Although the patient noticed paresthesia of the right upper incisor area, symptoms improved 3 months after surgery. Written informed consent was obtained from the patient for the publication of any potentially identifiable images or data included in this article. Transnasal endoscopic marsupialization for NPDC is minimally invasive and useful; however, it is necessary to build evidence for an appropriate excision range based on the position and size of the lesion.
Effect of Hemoadsorption for Cytokine Removal in Pneumococcal and Meningococcal Sepsis
Authors: Francesca Leonardis, Viviana De Angelis, Francesca Frisardi, Chiara Pietrafitta, Ivano Riva, Tino Martino Valetti, Valentina Broletti, Gianmariano Marchesi, Lorenza Menato, Roberto Nani, Franco Marson, Mirca Fabbris, Luca Cabrini, Sergio Colombo, Alberto Zangrillo, Carlo Coniglio, Giovanni Gordini, Lucia Stalteri, Giovanni Giuliani, Vittorio Dalmastri, Gaetano La Manna
Journal: Case Rep Crit Care (2018)
MeSH terms: Case Reports

Bacterial meningitis and septicemia are invasive bacterial diseases, representing a significant cause of morbidity and mortality worldwide. Both conditions are characterized by an impressive inflammatory response, resulting rapidly in cerebral edema, infarction, hydrocephalus, and septic shock with multiple organ failure. Despite advances in critical care, outcome and prognosis remain critical. Available adjunctive treatments to control the inflammatory response have shown encouraging results in the evolution of patients with sepsis and systemic inflammation, but meningococcal or pneumococcal infection has not been investigated. We herein report five patients with similar critical pathological conditions, characterized by pneumococcal or meningococcal sepsis and treated with hemoadsorption for cytokine removal. All patients showed a progressive stabilization in hemodynamics along with a rapid and marked reduction of catecholamine dosages, a stabilization in metabolic disorders, and less-than-expected loss of extremities. Therapy proved to be safe and well tolerated. From this first experience, extracorporeal cytokine removal seems to be a valid and safe therapy in the management of meningococcal and pneumococcal diseases and may contribute to the patient stabilization and prevention of severe sequelae. Further studies are required to confirm efficacy in a larger context.
Pleomorphic Adenoma Originating from Heterotopic Salivary Tissue of the Upper Neck: A Diagnostic Pitfall
Authors: Riccardo La Macchia, Salvatore Stefanelli, Vincent Lenoir, Nicolas Dulguerov, Jean-Claude Pache, Minerva Becker
Journal: Case Rep Otolaryngol (2017)
MeSH terms: Case Reports

Pleomorphic adenoma directly arising in the neck is thought to originate from heterotopic salivary gland tissue. In this article, we present the case of a 55-year-old female patient with a histologically proven pleomorphic adenoma located at the left mandibular angle, anteriorly to the sternocleidomastoid muscle and posteroinferiorly to the submandibular gland. As the patient also had an ipsilateral thyroid nodule with coarse calcifications, clinical and radiological features suggested a possible level II metastatic lymph node. However, ultrasound-guided fine needle aspiration cytology and postsurgery histopathological examination revealed a pleomorphic adenoma arising from heterotopic salivary gland tissue unrelated to a benign thyroid nodule. In this article, we provide a review of the existing literature on heterotopic salivary gland tissue and related neoplasms and discuss their imaging presentation.
Access to school-based eye health programs: a qualitative case study, Bogotá, Colombia
Authors: Aryati Yashadhana, Nina Serova, Ling Lee, Luisa Casas Luque, Leonardo Ramirez, Juan Carlos Silva, Anthea M Burnett
Journal: Rev Panam Salud Publica (2021)
Keywords: colombia, eye health, equity, schools, vision screening

Objectives:
To identify barriers and enablers to accessing school-based eye health programs in Bogotá, Colombia.
Methods:
We undertook a qualitative case study that explored how structural factors, and social and cultural norms influence access to school-based eye health programs. We conducted focus groups discussions and interviews with a purposive sample of 37 participants: government stakeholders (n = 4), representatives from nongovernmental organizations (n = 3), and an eye-care practitioner, as well as teachers (n = 7), a school nurse, parents (n = 7), and children (n = 14) from private and public schools. Data were analyzed using a priori themes from the availability, accessibility, acceptability and quality framework.
Results:
Routine vision screening in schools is not currently provided nor is there a budget to support it. Lack of collaboration between the health and education ministries and the absence of national planning affected the delivery of eye care in schools. Factors related to acceptability of school-based eye health programs included: poor acceptance of training teachers as vision screeners; stigma related to wearing spectacles; and distrust of health services. The cost of spectacles and poor access to eye health information were identified as barriers to positive child eye health outcomes by socioeconomically disadvantaged parents and children.
Conclusion:
Our findings suggest the need for a national school eye health plan and improved cooperation between health and education ministries. Interventions to improve trust in health services, tackle the lack of human resources while respecting professional qualifications, and raise awareness of the importance of eye health are recommended.