OpenMed/multicare-articles huggingface dataset:
A Case of Xanthogranulomatous Pyelonephritis Associated with Renoduodenal Fistula
Authors: R Conor Holton-Burke, Mini Varughese
Journal: Case Rep Med (2017)
MeSH terms: Case Reports

Xanthogranulomatous pyelonephritis (XGP) is a rare form of pyelonephritis associated with repeated infection, chronic inflammation, and obstruction. Various fistulas, including those to the intestine, are a known association with XGP. Here, a 55-year-old woman with a history of multiple previous renal calculi presented with dysuria and back pain. Contrast-enhanced computed tomography (CT) revealed a soft tissue density in her renal pelvis and perirenal space consistent with XGP along with a tract connecting the upper pole of her right kidney to the second portion of the duodenum. This finding was subsequently confirmed during percutaneous nephrostomy placement, stent placement, a small bowel follow-through study, and upper endoscopy. She was diagnosed with XGP with associated renoduodenal fistula, eventually treated by open nephrectomy with fistula takedown. Histopathologic analysis was consistent with the diagnosis of XGP with no malignant or infectious cause of the fistula. XGP should be considered in the diagnosis of patients with dysuria and back pain, especially when a history of obstruction or chronic inflammation. Associated fistulas should also be considered prior to surgical management to prevent complications.
Primary Hyperparathyroidism in a Post-total Thyroidectomy Patient: An Unexpected Diagnosis
Authors: Ana F Batista, Sara Fontaínhas, Sónia C Pereira
Journal: Cureus (2023)
Keywords: case-report, chronic kidney disease (ckd), hypercalcemia, parathyroid adenoma, primary hyperparathyroidism, total thyrodectomy
MeSH terms: Case Reports

Hypercalcemia is commonly encountered in the clinical setting. Although primary hyperparathyroidism resulting from a single parathyroid adenoma is the most common cause, in patients who undergo total thyroidectomy, especially when there is no history of radiation exposure nor parathyroid autotransplantation, it becomes an even more unexpected diagnosis. Because the majority of patients are asymptomatic, the diagnosis often is made incidentally. However, with long-standing disease, as parathyroid hormone and blood calcium levels rise, symptoms become more noticeable, and its clinical manifestations can affect nearly every organ system in the body. We present the case of a 79-year-old woman with a history of surgical hypothyroidism secondary to total thyroidectomy, hypertension and chronic kidney disease, who was admitted to the Emergency Department after an episode of syncope. She mentioned abdominal pain and vomiting in the previous week and paresthesia of both hands and feet over the last months. The initial testing identified a first-degree auriculoventricular block, a worsened renal function and severe hypercalcemia caused by primary hyperparathyroidism. The mainstay of treatment was aggressive fluid therapy, intravenous bisphosphonate and calcimimetic. Definitive treatment was achieved by the surgical removal of a mass located in the left thyroidectomy bed, compatible with a parathyroid adenoma. No further therapy was needed, as calcium levels gradually returned to normal.
Bilateral kidney matrix stones: a rare case
Authors: Mounir Lahyani, Yassine Rhannam, Amine Slaoui, Alae Touzani, Tarik Karmouni, Khalid Elkhader, Abdellatif Koutani, Ahmed Ibn Attya Andaloussi
Journal: Pan Afr Med J (2016)
Keywords: kidney stone, pcnl, matrix, open surgery
MeSH terms: Kidney Calculi / diagnosis, Nephrostomy, Percutaneous / methods, Ureteral Calculi / diagnosis, Case Reports, Humans, Kidney Calculi / pathology, Kidney Calculi / surgery, Male, Middle Aged, Treatment Outcome, Ureteral Calculi / pathology, Ureteral Calculi / surgery, Ureteroscopy / methods, Urinary Tract Infections / etiology

Kedney matrix stones are a rare form of calculi. Flank pain and urinary tract infections (UTI) are the most common presentations of matrix calculi. The diagnosis is usually made at surgery, but some preoperative radiographic findings might be suggestive. Open surgery was the method of choice for treatment. However, combination of ureterorenoscopy and percutaneous nephrolithotomy (PCNL) was found to be safe and effective. We report a rare case of renal and ureteral matrix stones that were diagnosed and treated by open surgery. We also describe its clinical, radiological and therapeutic features through a review of the literature.
Primary rectal melanoma in an African female: a case report
Authors: Werimo Pascal Kuka, Joseph Gatheru, Sitna Mwanzi, Nelson Onyango, Allan Rajula
Journal: Pan Afr Med J (2022)
Keywords: kenya, rectal, case report, malignant melanoma, rectal cancer
MeSH terms: Melanoma / pathology, Rectal Neoplasms / pathology, Skin Neoplasms / pathology, Case Reports, Female, Humans, Kenya, Middle Aged, Positron Emission Tomography Computed Tomography

Primary malignant melanoma occurs frequently on the skin and is rare in people of African ancestry. The rectal region is an unusual site for non-cutaneous melanoma. We report a case of a 58-year- old African woman presenting to a Kenyan hospital with lower abdominal pain and per rectal bleeding for three months, who underwent a colonoscopy that showed a rectal polypoid mass at the anorectal region. Histology of the mass showed pigmented pleomorphic cells which had positive stains for melanoma markers. Staging workup performed, including magnetic resonance imaging (MRI) of the pelvis and positron emission tomography (PET) - computed tomography (CT), showed regional lymph node involvement but no evidence of distant metastases. Surgery was recommended to the patient but she died eight months after the diagnosis. The case illustrates that primary rectal melanoma, though rare in Africans, is an aggressive disease which can be easily misdiagnosed as hemorrhoids or rectal adenocarcinoma.
Axillary schwannoma, preoperative diagnosis on a tru-cut biopsy: Case report and literature review
Authors: Hager Aref, Georges A Abizeid
Journal: Int J Surg Case Rep (2018)
Keywords: axillary schwannoma, case report, preoperative diagnosis, schwannoma, tru-cut biopsy

Introduction:
Schwannoma is a benign encapsulated tumor of the peripheral nervous system which is mainly located in the head and neck. However, axillary Schwannoma is rare. In this article, the author presents an interesting case of a right axillary Schwannoma, where the diagnosis was preoperatively made on a Tru-cut biopsy.
Case presentation:
We report a case of an enlarged right axillary swelling in a sixty-year-old male. Proper radiologic workup was performed. Furthermore, a Tru-cut biopsy was taken which revealed evidence of schwannoma. Having such symptomatic lesion, operative excision was done with the use of a nerve stimulator, which aided in preserving nerve function.
Conclusion:
With such non-specific presentation, axillary Schwannoma may be easily missed and mismanaged. A Tru-cut biopsy may provide great help in expert hands, aiding operative planning; likewise in the case we are presenting. Furthermore, utilizing an intraoperative nerve stimulator will facilitate nerve preservation.
Measuring Maternal Mortality: Three Case Studies Using Verbal Autopsy with Different Platforms
Authors: Siân L Curtis, Robert G Mswia, Emily H Weaver
Journal: PLoS One (2015)
MeSH terms: Autopsy / methods, Cause of Death / trends, Maternal Mortality, Research Support, N.I.H., Extramural, Adolescent, Adult, Bangladesh, Family Characteristics, Female, Humans, Middle Aged, Mozambique, Pregnancy, Surveys and Questionnaires, Zambia

Background:
Accurate measurement of maternal mortality is needed to develop a greater understanding of the scale of the problem, to increase effectiveness of program planning and targeting, and to track progress. In the absence of good quality vital statistics, interim methods are used to measure maternal mortality. The purpose of this study is to document experience with three community-based interim methods that measure maternal mortality using verbal autopsy.
Methods:
This study uses a post-census mortality survey, a sample vital registration with verbal autopsy, and a large-scale household survey to summarize the measures of maternal mortality obtained from these three platforms, compares and contrasts the different methodologies employed, and evaluates strengths and weaknesses of each approach. Included is also a discussion of issues related to death identification and classification, estimating maternal mortality ratios and rates, sample sizes and periodicity of estimates, data quality, and cost.
Results:
The sample sizes vary considerably between the three data sources and the number of maternal deaths identified through each platform was small. The proportion of deaths to women of reproductive age that are maternal deaths ranged from 8.8% to 17.3%. The maternal mortality rate was estimable using two of the platforms while obtaining an estimate of the maternal mortality ratio was only possible using one of the platforms. The percentage of maternal deaths due to direct obstetric causes ranged from 45.2% to 80.4%.
Conclusions:
This study documents experiences applying standard verbal autopsy methods to estimate maternal mortality and confirms that verbal autopsy is a feasible method for collecting maternal mortality data. None of these interim methods are likely to be suitable for detecting short term changes in mortality due to prohibitive sample size requirements, and thus, comprehensive and continuous civil registration systems to provide high quality vital statistics are essential in the long-term.
Reversible methotrexate-associated lymphoma of the liver in rheumatoid arthritis: a unique case of primary hepatic lymphoma
Authors: Ai Kawahara, Junichi Tsukada, Takahiro Yamaguchi, Takefumi Katsuragi, Takehiro Higashi
Journal: Biomark Res (2015)
Keywords: immunodeficiency, methotrexate, primary hepatic lymphoma
MeSH terms: Case Reports

Primary hepatic lymphoma (PHL) is an extremely rare disease, frequently associated with viruses such as hepatitis B virus (HBV), hepatitis C virus (HCV), and human immune deficiency virus (HIV). On the other hand, an increased risk of lymphoproliferative disorders (LPD) has been demonstrated in patients treated with immunosuppressive drugs such as methotrexate (MTX) for rheumatoid arthritis (RA). The role of Epstein-Barr virus (EBV) has been discussed in the pathogenesis of the immunodeficiency-associated LPDs. We here describe a RA patient, who developed PHL during RA treatment. The patient was a 64 year-old Japanese male with a 2-year history of RA, who had been treated with MTX at weekly dose of 8-14 mg for 2 years and infliximab (IFX) for 7 months. He presented with a 2 month history of generalized malaise, right hypochondrium pain and fever. Contrast-enhanced computed tomography (CECT) of the abdomen showed multiple irregular and nodular liver masses with a maximum of 13 cm in diameter on the right liver. Biopsy specimens demonstrated CD20-positve diffuse large B-cell lymphoma (DLBCL), but EBV was not identified by EBV-encoded RNA in situ hybridization. Serology for HBV, HCV, human T-cell leukemia virus I (HTLV-I), and HIV was negative. His symptoms disappeared following discontinuation of RA treatment including MTX. A drastic regression of the tumor masses was further obtained without cytotoxic chemotherapy. In addition, although the patient had no past history of liver dysfunction before MTX therapy, persistent elevation of liver enzymes has been observed during MTX treatment. These findings show a causative role of MTX in the development of reversible PHL in the patient.
Emergency Valve-in-Valve Transcatheter Aortic Valve Implantation for the Treatment of Acute Stentless Bioprosthetic Aortic Insufficiency and Cardiogenic Shock
Authors: Ivan D Hanson, Pratik K Dalal, Brian M Renard, George S Hanzel, Alessandro Vivacqua
Journal: Case Rep Cardiol (2018)
MeSH terms: Case Reports

Bioprosthetic aortic valve degeneration may present as acute, severe aortic regurgitation and cardiogenic shock. Such patients may be unsuitable for emergency valve replacement surgery due to excessive risk of operative mortality but could be treatable with transfemoral valve-in-valve transcatheter aortic valve implantation (TAVI). There is a paucity of data regarding the feasibility of valve-in-valve TAVI in patients presenting with cardiogenic shock due to acute aortic insufficiency from stentless bioprosthetic valve degeneration. We present one such case, highlighting the unique aspects of valve-in-valve TAVI for this challenging patient subset.
Improving Social Cognition in People with Schizophrenia with RC2S: Two Single-Case Studies
Authors: Elodie Peyroux, Nicolas Franck
Journal: Front Psychiatry (2016)
Keywords: cognitive remediation, schizophrenia, simulation techniques, single-case design, social cognition

Difficulties in social interactions are a central characteristic of people with schizophrenia, and can be partly explained by impairments of social cognitive processes. New strategies of cognitive remediation have been recently developed to target these deficits. The RC2S therapy is an individualized and partly computerized program through which patients practice social interactions and develop social cognitive abilities with simulation techniques in a realistic environment. Here, we present the results of two case-studies involving two patients with schizophrenia presenting with specific profiles of impaired social cognition. Each patient completed three baseline sessions, 14 treatment sessions, and 3 follow-up sessions at the end of the therapy - and for 1 patient, another 3 sessions 9 months later. We used a multiple baseline design to assess specific components of social cognition according to the patients' profiles. Functioning and symptomatology were also assessed at the end of the treatment and 6 months later. Results highlight significant improvements in the targeted social cognitive processes and positive changes in functioning in the long term. The RC2S program seems, thus, to be a new useful program for social cognitive remediation in schizophrenia.
Newly Emerging Feeding Difficulties in a 33-Year-Old Adult With CHARGE Syndrome
Authors: Alexandra Hudson, Kim Blake
Journal: J Clin Med Res (2016)
Keywords: charge syndrome, feeding difficulties, mouth over-stuffing
MeSH terms: Case Reports

Feeding and swallowing difficulties are common among individuals with CHARGE syndrome. Many children require gastrostomy tube feeding in their early years and often undergo a delay in feeding and oral-motor skill development. There is little information available on adults with CHARGE syndrome, and the feeding difficulties they face. The present case describes newly emerging mouth over-stuffing feeding behaviors and feeding difficulties in a 33-year-old adult with CHARGE syndrome who had not undergone feeding therapy since childhood.
Traumatic deep vein thrombosis in a soccer player: A case study
Authors: Paul S Echlin, Ross Eg Upshur, Douglas B McKeag, Harsha P Jayatilake
Journal: Thromb J (2004)

A 42 year-old male former semi-professional soccer player sustained a right lower extremity popliteal contusion during a soccer game. He was clinically diagnosed with a possible traumatic deep vein thrombosis (DVT), and sent for confirmatory tests. A duplex doppler ultrasound was positive for DVT, and the patient was admitted to hospital for anticoagulation (unfractionated heparin, warfarin). Upon discharge from hospital the patient continued oral warfarin anticoagulation (six months), and the use of compression stockings (nine months). He followed up with his family doctor at regular intervals for serial coagulation measurements, and ultrasound examinations. The patient's only identified major thrombotic risk factor was the traumatic injury. One year after the initial deep vein thrombosis (DVT) the patient returned to contact sport, however he continued to have intermittent symptoms of right lower leg pain and right knee effusion.Athletes can develop vascular injuries in a variety of contact and non-contact sports. Trauma is one of the most common causes of lower extremity deep vein thrombosis (DVT), however athletic injuries involving lower extremity traumatic DVT are seldom reported. This diagnosis and the associated risk factors must be considered during the initial physical examination. The primary method of radiological diagnosis of lower extremity DVT is a complete bilateral duplex sonography, which can be augmented by other methods such as evidence-based risk factor analysis. Antithrombotic medication is the current standard of treatment for DVT. Acute thrombolytic treatment has demonstrated an improved therapeutic efficacy, and a decrease in post-DVT symptoms.There is a lack of scientific literature concerning the return to sport protocol following a DVT event. Athletic individuals who desire to return to sport after a DVT need to be fully informed about their treatment and risk of reoccurrence, so that appropriate decisions can be made.
First successful birth of twins in India following the transfer of vitrified oocytes
Authors: Priya Selvaraj, Kamala Selvaraj, Kalaichelvi Srinivasan
Journal: J Hum Reprod Sci (2010)
Keywords: donor oocyte program, icsi, embryo transfer, oocyte cryopreservation, vitrification
MeSH terms: Case Reports

We report the first twin pregnancy and birth in India after the transfer of embryos generated from vitrified and thawed oocytes to a 41-year-old woman who was in a donor program. Embryos were generated from the microinjection of pre-prepared sperms into vitrified oocytes. Twin male babies weighing 750 and 860 g were born by emergency cesarean section. Vitrification is one of the most promising options in cryopreservation and preservation of embryos and oocytes.
A Giant Primary Retroperitoneal Serous Cystadenoma: Case Report and Review of Retroperitoneal Cysts
Authors: Amit Mori, Kinesh Changela, Dhuha Alhankawi, Alexander Itskovich, Ahmar Butt, Madhavi Reddy
Journal: Surg J (N Y) (2017)
Keywords: cystadenomas, cystic, primary, retroperitoneal, serous
MeSH terms: Review

Primary retroperitoneal serous cystadenomas (PRSCs) are rare cystic lesions whose pathogenesis is currently not well understood. Although the vast majority of tumors are benign, early recognition and resection is necessary to avoid malignant transformation, rupture, and secondary infection. Here we present the case of a 79-year-old woman who presented with confusion, visual hallucinations, and a history of fall. As part of the work-up for abdominal distension, computed tomography scan of the abdomen and pelvis was performed, which revealed a right-sided retroperitoneal cystic lesion measuring 26.6 × 16.7 cm in size. The lesion was resected laparoscopically, and the surgical specimen measured 28 × 17 cm. Histology revealed a serous cystadenoma. The postsurgical course was uneventful, and no radiological recurrence was noted on 3 months follow-up. Very few primary retroperitoneal cystic lesions have been reported in the literature. Most lesions are benign and predominantly occur in females. They may remain asymptomatic for long periods of time and are usually discovered when they reach very large in size. In rare cases, these lesions may have malignant potential. Diagnosis of PRSC should be considered in the differential diagnosis of all retroperitoneal cysts.
Total and Subtotal Parathyroidectomy in Young Patients With Multiple Endocrine Neoplasia Type 1-Related Primary Hyperparathyroidism: Potential Post-surgical Benefits and Complications
Authors: Francesco Tonelli, Francesca Marini, Francesca Giusti, Maria Luisa Brandi
Journal: Front Endocrinol (Lausanne) (2018)
Keywords: multiple endocrine neoplasia type 1, parathyroid adenoma, parathyroidectomy, primary hyperparathyroidism, young men1 patients

Background: The choice of surgical treatment for patients with Multiple Endocrine Neoplasia type 1 (MEN1)-related primary hyperparathyroidism (PHPT) remains controversial and it has not been specifically addressed in young patients. Methods: This is a retrospective case series study. The study includes the surgical data and the follow-up of 38 patients younger than 30 years of age, all diagnosed with MEN1, collected and followed-up between 1991 and 2017 at the Regional Referral Center for Inherited Endocrine Tumors of the Tuscany Region, and operated by parathyroidectomy. Genetic and/or clinical MEN1 diagnosis was made before surgery in all patients. Subtotal (9/38 patients) or total parathyroidectomy with auto-transplantation (28/38 patients) were performed in all patients but one, in whom a single mediastinal adenoma was excised from the aorto-pulmonary window. All patients but one, who was operated in 2017, had a post-operatory follow-up of at least 12 months. Results: Total parathyroidectomy (TPTX), with auto-transplantation, was the most frequently adopted operation both as primary (20/38 patients) and secondary (8/38 patients) surgery, followed by subtotal parathyroidectomy (SPTX; 9/38 patients) and limited parathyroidectomy (1/38 patient). At follow-up, lasting a mean of 11.8 ± 6.6 years (range 0-23 years), no persistent PHPT was observed. PHPT recurred in 4/28 TPTX (14%) and in 2/9 SPTX (22%). Permanent hypoparathyroidism showed no statistically significant difference between the procedures (2/9 in SPTX and 5/28 in TPTX). Conclusions: Data from this retrospective study showed the efficacy of TPTX for the treatment of MEN1-PHPT, also in adolescent and young patients, showing, in our series, no risk of PHPT permanence and a longer disease-free period and, subsequently, the possibility to postpone re-intervention with respect to both limited PTX and SPTX. The risk of permanent hypoparathyroidism in TPTX was comparable to STPX, and could be mitigated over the years.
Spontaneous Septostomy in a Twin Pregnancy Causing Fatal Amniotic Band Syndrome
Authors: Carolina Hvelplund, Kasper Pihl, Simon Trautner, Pernille Pedersen, Lisa Leth Maroun
Journal: Case Rep Pediatr (2018)
MeSH terms: Case Reports

Complications due to spontaneous septostomy of the dividing membrane in monochorionic diamniotic pregnancies are rarely described. Herein, we report the case of a preterm female neonate from a monochorionic diamniotic twin pregnancy delivered by caesarean section at 32 weeks of gestation. She was born with a broad band of a transparent membrane-like material firmly attached to her lower abdomen. Postnatally, she developed respiratory distress syndrome and persistent pulmonary hypertension, complicated by bilateral pneumothorax. She died due to respiratory failure when she was 1 day old. Her twin sister survived with no malformations. At postmortem examination, the neonate had severe lung hypoplasia, and the attached material was diagnosed as the dividing septum. We hypothesize that the lung hypoplasia was secondary to local oligohydramnios, which developed as a consequence of the twin being firmly stuck in the defect of the dividing membrane. To our best knowledge, spontaneous septostomy causing an ultimately fatal amniotic band syndrome has not previously been described.
Hyperandrogenism in a Postmenopausal Woman Secondary to Testosterone Secreting Ovarian Stromal Tumor with Acoustic Schwannoma
Authors: Bindu Gandrapu, Preeyanka Sundar, Brian Phillips
Journal: Case Rep Endocrinol (2018)
MeSH terms: Case Reports

Androgen-secreting ovarian neoplasms are rare ovarian tumors that present with hirsutism and virilization which may manifest as severe alopecia, deepening of voice, and clitoromegaly. Most often, ovarian tumors are found to be very small or even undetectable. In such cases, bilateral salpingo-oophorectomy should be performed after ruling out other causes of high androgens. We present a 63-year-old postmenopausal woman with clinically and radiologically undetectable testosterone-secreting ovarian tumor, which was later on detected on biopsy.