OpenMed/multicare-articles huggingface dataset:
Asystole following Reintubation during Suspension Laryngoscopy
Authors: Sheryl H Glassman, Michael S Green, Melissa Brodsky
Journal: Case Rep Anesthesiol (2012)
MeSH terms: Case Reports

Transient increase in heart rate and mean arterial pressure commonly occur during manipulation of the airway via direct laryngoscopy. This phenomenon is understood to be due to a sympathetic nervous system reflex causing an increase in plasma catecholamines. Rarely, severe bradycardia and possible asystole can occur following laryngoscopy. One previous report described asystole during suspension laryngoscopy after uneventful direct laryngoscopy. Here we report a case of asystole occurring at the time of reinsertion and cuff inflation of an endotracheal tube in a patient who had been hemodynamically stable during initial direct laryngoscopy and the ensuing suspension laryngoscopy. The asystole was immediately recognized and successful cardiopulmonary resuscitation was performed with the patient returning to baseline sinus rhythm. Cardiac arrest following laryngoscopy is rare. This case highlights the importance of continued vigilance even after the initial manipulations of the airway by both direct laryngoscopy and suspension laryngoscopy are to be performed. Identifying patients who may benefit from premedication with a vagolytic drug may prevent adversity. Preoperative heart rate analysis can identify patients with strong vagal tone.
A patient with metastatic melanoma presenting with gastrointestinal perforation after dacarbazine infusion: a case report
Authors: Sjoukje F Oosting, Frans Tm Peters, Geke Ap Hospers, Nanno H Mulder
Journal: J Med Case Rep (2010)

Introduction:
We report a rare case of gastrointestinal perforation following dacarbazine infusion for metastatic melanoma. The condition is attributed to a responding malignant melanoma in the gastrointestinal tract.
Case presentation:
A 52-year-old Caucasian man presented with abdominal pain and distension, malaise, night sweats, dysphagia and early satiety. A computed tomography scan showed massive ascites, lymphadenopathy and liver lesions suspect for metastases. An upper gastrointestinal endoscopy was performed and revealed multiple dark lesions of 5 mm to 10 mm in his stomach and duodenum.When his skin was re-examined, an irregular pigmented lesion over the left clavicle measuring 15 mm x 8 mm with partial depigmentation was found. Histological examination of a duodenal lesion was consistent with a diagnosis of metastatic melanoma. The patient deteriorated and his level of lactate dehydrogenase rapidly increased. The patient was started on systemic treatment with dacarbazine 800 mg/m2 every three weeks and he was discharged one day after the first dose. On the sixth day he was readmitted with severe abdominal pain. A chest X-ray showed the presence of free intraperitoneal air that was consistent with gastrointestinal perforation. His lactate dehydrogenase level had fallen from 6969U/L to 1827U/L, supporting the conclusion that the response of gastrointestinal metastases to dacarbazine had resulted in the perforation of the patient's bowel wall. A laparotomy was discussed with the patient and his family but he decided to go home with symptomatic treatment. He died 11 days later.
Conclusion:
Melanoma can originate in, as well as metastasize to, the gastrointestinal tract. Gastrointestinal perforations due to responding tumors are a well-known complication of systemic treatment of gastrointestinal lymphomas. However, as the response rate of metastatic melanoma to dacarbazine is only 10% to 20%, and responses are usually only partial, perforation due to treatment response in metastatic melanoma is rare.Medical oncologists should be aware of the risk of bowel perforation after starting cytotoxic chemotherapy on patients with gastrointestinal metastases.
Pulmonary Vasculitis and a Horseshoe Kidney in Noonan Syndrome
Authors: Surasak Puvabanditsin, Rosanna Abellar, Adaora Madubuko, Rajeev Mehta, Lauren Walzer
Journal: Case Rep Pathol (2018)
MeSH terms: Case Reports

We report a term male neonate with congenital myeloproliferative disorder, thrombocytopenia, a horseshoe kidney, feeding difficulty secondary to dysphagia/foregut dysmotility, and respiratory failure. Prenatal molecular genetic analysis revealed a fetus carrying c.184T>G (p.Tyr62Asp) pathogenic variant in PTPN11. The infant eventually succumbed to respiratory failure. Bacterial and viral cultures/studies were all no growth/negative. Pulmonary capillaritis and vasculitis were noted at autopsy. This report presents a new case of Noonan syndrome with unusual associated disorders and a review of the literature.
Prolonged Intestinal Mucosal Barium Coating due to Ischemic Necrosis
Authors: Vincent H S Low
Journal: Case Rep Radiol (2011)
MeSH terms: Case Reports

A case of a 63-year-old man with small bowel ischemia six weeks after transplantation surgery is presented. Plain abdominal radiograph obtained several days after ingestion of barium shows the sign of prolonged barium coating indicating severe mucosal damage. Abdominal CT scan demonstrates small bowel wall thickening as well as pockets of peritoneal fluid collections. Most critically, CT allows visualization of subtle traces of dense barium within the dependent portions of this fluid indicating bowel perforation.
Bladder mucinous adenocarcinoma as a diagnostic challenge: a case report
Authors: Sofronievska Glavinov Maja, Kostadinova Kunovska Slavica, Abdiu Suad, Jovanovic Rubens
Journal: Pan Afr Med J (2022)
Keywords: mucinous adenocarcinoma, bladder, case report, diagnosis
MeSH terms: Adenocarcinoma / diagnosis, Adenocarcinoma / surgery, Adenocarcinoma, Mucinous / diagnosis, Adenocarcinoma, Mucinous / pathology, Adenocarcinoma, Mucinous / surgery, Colonic Neoplasms, Urinary Bladder Neoplasms / diagnosis, Urinary Bladder Neoplasms / pathology, Urinary Bladder Neoplasms / surgery, Case Reports, Aged, Female, Humans, Urinary Bladder / pathology

Primary bladder adenocarcinoma (PBA), especially the mucinous subtype, is a rare cancer that represents less than 2% of all bladder malignancies. Overlapping histopathological and immunohistochemical (IHC) features of PBA with metastatic colonic adenocarcinomas (MCA) make the final diagnosis very hard. We presented a 75-year-old woman presenting with hematuria and severe anaemia in the last two weeks. The abdominal computed tomography scan showed a tumor-sized 2x2 cm right to the bladder dome. The patient underwent partial cystectomy without postoperative complication. The histopathologic and IHC showed mucinous adenocarcinoma and could not distinguish between the PBA from MCA. Investigations to exclude MCA revealed no other primary malignant site and suggested PBA. In conclusion, mucinous PBA requires ruling out any possibility of a metastatic lesion that could arise from other organs. Treatment should be considered an individual approach based on the tumour location and size, the patient´s age, general condition, and comorbidities.
Use of daptomycin for the treatment of methicillin-resistant coagulase-negative staphylococcal ventriculitis
Authors: Mohamed Erritouni, Nessrine Ktaich, James J Rahal, Deborah Figueroa, Jaime Nieto, Carl Urban, Noriel Mariano, Frank Eisinger, Jonathan Abayev, David Nicolau, David Rubin, Murisiku Raifu, Sorana Segal-Maurer
Journal: Case Rep Med (2012)
MeSH terms: Case Reports

Coagulase-negative staphylococci (CoNS) are the main pathogens causing hospital-acquired external-ventricular-drain- (EVD-) and lumbar-drain- (LD-) associated meningitis and ventriculitis. The treatment of these infections can be challenging and may require combination of intraventricular and intravenous administration of antibiotics. Limited animal data demonstrate rapid daptomycin bactericidal activity, adequate penetration in the setting of inflamed meninges, and extended half-life in the ventricles Steenbergen et al. (2009). There are limited clinical data using daptomycin intravenously and/or intraventricularly for the treatment of central nervous system infections (CNS) Elvy et al. (2008), Stucki et al. (2007), Lee et al. (2008) and Wallace et al. (2009). We report here our experience in the treatment of an EVD-related infection.
Haemoptysis in pregnancy caused by a well-differentiated fetal adenocarcinoma: a case report
Authors: Rebecca J Thompson, Philip S Hasleton, Paul M Taylor, Mark Woodhead, Louise M Byrd
Journal: J Med Case Rep (2010)

Introduction:
Haemoptysis in pregnancy is frequently assumed to be caused by a pulmonary embolism. However, it can also be an indicator of serious pathology.
Case presentation:
We report the case of a 27-year-old Caucasian woman who presented with haemoptysis in pregnancy that was discovered to be caused by a well-differentiated fetal adenocarcinoma of the lung.
Conclusion:
This case demonstrates the importance of establishing an accurate diagnosis when a pregnant woman presents with haemoptysis and that more serious pathology should be considered if the clinical symptoms persist and/or the presumed diagnosis of pulmonary embolism is not confirmed.
Prolonged Hypophosphatemia and Intensive Care After Curative Surgery of Tumor Induced Osteomalacia: A Case Report
Authors: Eeva M Ryhänen, Camilla Schalin-Jäntti, Niina Matikainen
Journal: Front Endocrinol (Lausanne) (2021)
Keywords: fibroblast growth factor 23, intensive care, oncogenic osteomalacia, perioperative hypophosphatemia, surgical complications, tumor-induced hypophosphatemia, tumor-induced osteomalacia
MeSH terms: Hypophosphatemia / etiology, Mandibular Neoplasms / surgery, Osteomalacia / surgery, Paraneoplastic Syndromes / surgery, Phosphates / blood, Case Reports, Research Support, Non-U.S. Gov't, Female, Fibroblast Growth Factors / blood, Humans, Hypophosphatemia / blood, Hypophosphatemia / pathology, Mandibular Neoplasms / blood, Mandibular Neoplasms / complications, Mandibular Neoplasms / pathology, Middle Aged, Osteomalacia / blood, Osteomalacia / pathology, Paraneoplastic Syndromes / blood, Phosphates, Fibroblast Growth Factors

Introduction:
Rare FGF23-producing mesenchymal tumors lead to paraneoplastic tumor-induced osteomalacia (TIO) presenting with phosphate wasting, hypophosphatemia, chronic hypomineralization of the bone, fragility fractures and muscle weakness. Diagnosis of TIO requires exclusion of other etiologies and careful search for a mesenchymal tumor that often is very small and can appear anywhere in the body. Surgical removal of the tumor is the only definitive treatment of TIO. Surgical complications due to chronic hypophosphatemia are not well recognized.
Case description:
The current case describes severe fragility fractures in a 58-year-old woman, who lost her ability to walk and was bedridden for two years. First, the initial diagnostic laboratory work-up did not include serum phosphorus measurements, second, the suspicion of adverse effects of pioglitazone as an underlying cause delayed correct diagnosis for at least two years. After biochemical discovery of hyperphosphaturic hypophosphatemia at a tertiary referral centre, a FGF23-producing tumor of the mandible was discovered on physical examination, and then surgically removed. Postoperatively, severe hypophosphatemia and muscle weakness prolonged the need for ventilation support, intensive care and phosphate supplementation. After two years of rehabilitation, the patient was able to walk short distances. The tumor has not recurred, and serum phosphate concentration has remained within normal limits during 3.5 years of follow-up.
Conclusions:
The case report illustrates knowledge gaps in the diagnostic work-up of rare causes of low bone mass and fragility fractures. Compared to other low phosphate conditions, surgical recovery from TIO-induced hypophosphatemia warrants special attention. Increased alkaline phosphatase concentration may indicate impaired postsurgical recovery due to prolonged hypophosphatemia, underlining the need for proactive perioperative correction of hypophosphatemia.
Laparoscopic Partial Splenectomy Assisted by Fluorescence in a 13-Year-Old Girl
Authors: Isabel Bada-Bosch, David Peláez Mata, Manuel de la Torre, Javier Ordóñez, María Dolores Blanco, Juan de Agustin
Journal: European J Pediatr Surg Rep (2020)
Keywords: fluorescence, indocyanine green, laparoscopy, partial splenectomy, pediatric
MeSH terms: Case Reports

Partial splenectomy allows preserving immune function in benign splenic lesions such as epidermoid cysts. Determining the plane of resection and perfusion of the spleen remnant can be difficult, especially in centrally located lesions. We present a 13-year-old girl with a symptomatic splenic cyst of 6 cm in diameter located next to the splenic hilum. Laparoscopic partial splenectomy was performed through a 10-mm umbilical approach and three accessory 5-mm ports. Intraoperative intravenous injection of indocyanine green (ICG) at 0.2 mg/kg guided the careful dissection of the splenic hilum and checked the spleen perfusion once the upper arterial branch was clamped. The subsequent wash-out of the ICG allowed inspection of the peripheral vascular return of the splenic remnant through polar veins. Surgery was uneventful with minimal blood loss. Follow-up ultrasound scan revealed a well-perfused small splenic remnant with no signs of recurrence. Laparoscopic partial splenectomy is feasible in benign splenic tumors, especially in those cases of peripheral location. Fluorescence facilitates the safe dissection of the splenic hilum, the visualization of the transection plane of the spleen and the perfusion of the remnant in cases of anatomically and technically complicated partial splenectomies.
Massive Malignant Epithelioid Angiomyolipoma of the Kidney
Authors: Isaac M Tessone, Benjamin Lichtbroun, Arnav Srivastava, Alexandra L Tabakin, Charles F Polotti, Roman Groisberg, Evita Sadimin, Eric A Singer, Miral S Grandhi
Journal: J Kidney Cancer VHL (2022)
Keywords: pecoma, epithelioid angiomyolipoma, mtor inhibitor, renal tumor, tuberous sclerosis
MeSH terms: Case Reports

Renal angiomyolipomas (AMLs) are a subset of perivascular epithelioid cell neoplasms (PEComas) that are associated with tuberous sclerosis complex (TSC). Epithelioid angiomyolipomas (EAMLs) are a rare variant of AML with more aggressive propensities. EAMLs with malignant potential can be difficult to distinguish from relatively benign AMLs and other renal tumors. Although there are no established criteria for predicting EAML malignancy, there are proposed histologic parameters that are associated with higher tumor risk. EAML can be treated with surgical resection as well as mTOR inhibitors. Here, we present a unique case of a patient with a 36-cm renal EAML metastatic to the lungs that was treated with complete surgical resection of the primary lesion and mTOR inhibition.
Myonecrosis in a Sickle Cell-Diseased Patient: A Case Report and Literature Review
Authors: Ali Wasel Almomen, Yaser Mansour Tawfeeq, Ahmed Khalid Almuhaisin, Abdulraheem Ayman Altalib
Journal: Case Rep Orthop (2020)
MeSH terms: Case Reports

Myonecrosis is a condition that results in muscle tissue necrosis, and it is rarely seen in sickle cell patients and often missed because more common manifestations of sickle cell can overlap like vaso-occlusive crises (VOC), which results in pain in the extremities or spine; also osteomyelitis is commonly seen in sickle cell patients. In this article, we present a case of myonecrosis in a sickle cell-diseased patient who presented with left acute atraumatic left foot pain and MRI with contrast showing characteristic image of muscle infarction supportive therapy initiated, and 2-year follow-up did not reveal any physical disabilities; further study and follow-up are needed to know the nature of the disease and avoid improper management of those patients.
Use of Fluphenazine in Bipolar Disorder With a History of Substance Abuse: A Report of Two Cases
Authors: Samira Khan, Sira Diakite, Aishwarya Kumar
Journal: Cureus (2023)
Keywords: anti-psychotics, bipolar, compliance, injectables, treatment-resistant
MeSH terms: Case Reports

One of the major mental health problems with an increased rate of medication failures and treatment resistance arises with the combination of substance use and mood disorders. The purpose of this report is to discuss the off-label use of fluphenazine in managing bipolar disorder in patients with a history of substance abuse, its efficacy, and the importance of having community resources such as assertive community treatment in monitoring treatment progress and improving overall health outcomes. First-generation antipsychotics, like fluphenazine, should be used cautiously with the risks and benefits weighed against possible side effects. This report shows how fluphenazine can successfully be used as an off-label maintenance option in challenging cases.
Entecavir-Associated Thrombocytopenia: A Case Report and Review of the Pathophysiology, Diagnosis, and Treatment of a Rare but Reversible Cause of Thrombocytopenia
Authors: Binoy Yohannan, Dai Chu N Luu, Mark Feldman
Journal: Case Rep Hematol (2019)
MeSH terms: Case Reports

Drug-associated thrombocytopenia is often unrecognized. We report a 76-year-old female with lymphoma who presented with easy bruising and oral bleeding. She had undergone screening for hepatitis B virus (HBV) prior to starting rituximab and was found to have hepatitis B core serum antibody (IgG anti-HBc). She was therefore treated with prophylactic entecavir 0.5 mg daily to prevent reactivation of HBV. Her initial platelet count was 136,000/mm3. Five days after starting entecavir, she presented with bruising and oral bleeding and was found to have a platelet count of 7,000/mm3. A coagulation profile and the rest of the blood parameters (RBC and WBC counts) were normal. Entecavir was stopped, and she was given 3 units of apheresed platelets followed by intravenous immunoglobulin (1 g/kg) for 5 consecutive days. Her platelet counts improved and normalized in one week. She was diagnosed with entecavir-induced thrombocytopenia based on the temporal relationship and after carefully excluding alternate causes of thrombocytopenia. This case highlights the importance of recognizing drug-induced thrombocytopenia (DITP) as a reversible cause of thrombocytopenia.
Primary meningococcal polyarthritis in an adult woman
Authors: José Celso Giordan Cavalcanti Sarinho, Marília Soares E Silva Arcadipane, Graziela Tavares Miola Menezes, Danilo Fernando Costa Duarte, Waldenise Cossermelli, Ivan Aprahamian
Journal: Case Rep Med (2015)

Primary joint infection caused by the Gram-negative bacteria Neisseria meningitidis is rare. Normally, joint involvement comes secondary to meningitis or severe sepsis caused by this agent. When primary arthritis is seen, monoarthritis is the most common presentation. A meningococcal polyarthritis is described in less than 10 case reports according to current literature. This case report aims to briefly review this rare clinical event in an adult woman with no previous history of rheumatological disease. Early diagnosis of polyarthritis caused by meningococcal bacteria usually present a good prognosis when properly treated.
Delayed migration of embolized coil with large renal stone formation: a rare presentation
Authors: Santosh Kumar, Kumar Jayant, Shrawan K Singh, Kalpesh M Parmar, Sudheer K Devana, Gautam R Choudhari, Ankur Mittal
Journal: Case Rep Urol (2014)

Delayed bleeding following percutaneous nephrolithotomy (PCNL) usually occurs due to development of the pseudoaneurysm which can be successfully managed with coil embolization. However very few cases of such complications have been reported in the literature. Here we are reporting a case of delayed post-PCNL bleeding that occurred in a 53-year-old diabetic patient operated on for renal stone. Computed tomography scan revealed a presence of the pseudoaneurysm in the segmental branch of right renal artery, which was successfully managed with coiling. Patient remained asymptomatic for the next 9 years after which he again presented with similar complaints. X-ray KUB was done which revealed a 2.7 cms renal pelvic calculus with the migrated coil in its center and a left upper ureteric calculus. His routine haemogram, coagulogram, serum electrolytes, and liver function tests, renal function tests, vitamin D3, and PTH (parathyroid hormone) were within normal limits. He underwent left laparoscopic ureterolithotomy and right percutaneous nephrolithotomy (PCNL). Intraoperatively the migrated stainless steel embolization coil was seen engulfed all around by the multiple stones in the right renal pelvis. Postoperative period was uneventful. Later he was followed in the outpatient department and was doing well. To conclude, this is the only case report of development of a large calculus around a migrated embolization coil which was successfully managed with PCNL. PCNL offers better stone clearance in cases of stones being formed over foreign bodies like fragmented double J stents, fragmented nephrostomies, or migrated embolization coil.
Necrotizing fasciitis of the neck and head complicated with chronic osteomyelitis: Case report presentation
Authors: Rosa María Wong-Chew, Antonio H Angel-Ambrocio, Sheila Yadira Gomez-Murillo, Angel Puente-Sanchez, Gerardo Fernandez-Sobrino, Alfonso Marhx-Bracho, María de Lourdes Marroquín-Yañez
Journal: Int J Surg Case Rep (2019)
Keywords: case report, children, multidrug resistant organisms, necrotizing fasciitis, osteomyelitis

Introduction:
Necrotizing fasciitis (NF) is a severe infectious condition associated with significant morbidity and mortality and characteristically has a higher incidence in adults; pediatric cases are very rare. In this case report we describe, the clinical presentation, management and outcome of a patient with necrotizing fasciitis of the neck and head complicated with chronic osteomyelitis.
Presentation of the case:
An 18 month-old, latin, male, diagnosed with rickets and Crouzon syndrome, twenty-four hours post- craniofacial remodeling surgery presented tissue edema, indurated skin and violaceous and well delimited lesions in the neck and head. The patient developed septic shock, acute osteomyelitis and infection of the cranial grafts. Multiple surgical lavages, debridation of the necrotic tissue and resection of the affected bone, in combination with multiple antibiotics, laboratory test methods, VAC therapy and hyperbaric oxygen were required for successful treatment and full recovery of the patient.
Discussion:
Although early antibiotic therapy and critical care are basic for the treatment of patients with NF, early aggressive surgical treatment is crucial for an adequate outcome. Adjuvant treatment for NF such as the Vacuum-assisted closure and the hyperbaric oxygen therapy are very useful to accelerate wound healing. Moreover, special laboratory test methods such as the checkerboard can be used to determine the adequate antimicrobial combination of drugs in the case of multi resistant organisms.
Conclusions:
Early diagnosis, adequate antibiotic therapy and aggressive surgical debridement of the necrotic tissue combined with VAC and hyperbaric oxygen therapy played an important role in the successful treatment of NF.