OpenMed/multicare-articles huggingface dataset:
Traumatic Bereavements: Rebalancing the Relationship to the Deceased and the Death Story Using the Two-Track Model of Bereavement
Authors: Simon Shimshon Rubin, Ruth Malkinson, Eliezer Witztum
Journal: Front Psychiatry (2020)
Keywords: two-track model of bereavement, bereavement, continuing bonds, posttraumatic stress disorder, prolonged grief disorder, psychotherapy, suicide, traumatic bereavement
MeSH terms: Review

Bereavements that occur under external traumatic circumstances increase the risk for dysfunction, trauma symptomatology, as well as disordered and prolonged grief. While the majority of individuals who have experienced traumatic bereavements do not meet formal criteria for posttraumatic stress disorder (PTSD), persistent complex bereavement disorder (PCBD), or prolonged grief disorder (PGD), the degree of distress and dysfunction for these bereaved can be quite significant. The assessment and intervention paradigms in use with traumatic bereavements often prioritize the trauma and bypass the centrality of the interpersonal loss. By using a bifocal approach in conceptualizing bereavement, the Two-Track Model of Bereavement (TTMB) rebalances the approach to the class of traumatic bereavements. Track I examines biopsychosocial functioning and symptoms of trauma, and track II focuses on the nature of the ongoing relationship with the deceased and the death story that may also have elements of traumatic response. The model and its application serve to identify both adaptive and maladaptive responses to loss along both axes to optimally focus interventions where needed. The story of the death, the psychological relationship with the deceased, and the presence of biopsychosocial difficulties each have a part to play in assessment and intervention. A case study of assessment and intervention following traumatic bereavement due to suicide illustrates how attention to each of these factors in the TTMB can facilitate change. Ultimately, the relational bond with the deceased is a major vector in grief and mourning. Assessment and intervention with traumatic bereavements require attention to dysfunction and symptoms of trauma as well as to the death story and the state of the relationship to the deceased.
A case report of epiploic appendagitis as a mimic of acute cholecystitis
Authors: Emily Chan, Alaa El-Banna
Journal: Int J Surg Case Rep (2018)
Keywords: case report, diagnostic mimic, epiploic appendagitis, unusual presentation

Introduction:
Epiploic appendagitis is a rare cause of acute abdominal pain. It's presentation often mimics other causes of acute abdominal pain. It is important for clinicians to be aware of an epiploic appendagitis since a delay in diagnosis can lead to unnecessary hospital stay, antibiotic usage and surgical intervention [1-4]). We present a case of epiploic appendagitis mimicking acute cholecystitis in a rural community hospital.
Case report:
A 54 Caucasian male self-presents to the emergency department on a Saturday with severe right upper quadrant pain. He was initially diagnosed as acute cholecystitis and managed with antibiotics. Due to limitations with out-of-hours radiology, an ultrasound (US) scan was performed two days after admission. This US showed no evidence of cholecystitis or gallstones. A computed tomography (CT) scan was subsequently performed which revealed a diagnosis of epiploic appendagitis. The patient was discharged with analgesia and anti-inflammatories.
Discussion:
Epiploic appendagitis can mimic common pathologies causing acute abdominal pain. Unlike its mimics, epiploic appendagitis is a self-limiting condition and its initial management remains conservative. It is diagnosed with imaging studies such as CT scans. It is important for clinicians to be aware of an epiploic appendagitis as a cause for abdominal pain since a delay in diagnosis can lead to unnecessary hospital stay, antibiotic usage and surgical intervention [1-4].
Conclusion:
A diagnosis of epiploic appendagitis should remain on the list of differential diagnosis for acute abdominal pain. A prompt diagnosis of epiploic appendagitis avoids unnecessary surgical intervention and antibiotic usage.
Three Cases of Hemiconvulsion-Hemiplegia-Epilepsy Syndrome With Focal Cortical Dysplasia Type IIId
Authors: Shinji Itamura, Tohru Okanishi, Yoshifumi Arai, Mitsuyo Nishimura, Shimpei Baba, Naoki Ichikawa, Yoshimichi Hirayama, Naoko Ishihara, Takuya Hiraide, Hidetoshi Ishigaki, Tokiko Fukuda, Yoshiro Otsuki, Hideo Enoki, Ayataka Fujimoto
Journal: Front Neurol (2019)
Keywords: cortical malformation, epilepsy surgery, focal cortical dysplasia, hemiconvulsion-hemiplegia-epilepsy syndrome, hemispherotomy, histopathology, intractable epilepsy, pathology
MeSH terms: Case Reports

Hemiconvulsion-hemiplegia-epilepsy syndrome (HHES) is a subset of acute encephalopathy characterized by infantile-onset with acute hemiconvulsive febrile status and subsequent unilateral cerebral atrophy and hemiparesis. In the chronic phase, patients with HHES develop epilepsy, typically displayed as intractable focal seizures. The patients are often intractable with antiepileptic drugs and need surgical treatment. Although viral encephalitis and genetic abnormalities are presumed to be the underlying etiology, the pathogenesis remains mostly unknown. We describe three cases of successful functional hemispherotomy for intractable epilepsy in HHES. Patients developed acute asymmetrical convulsive status following viral infections during the ages of 17-30 months. Their seizures were intractable with antiepileptic drugs and required hemispherotomy. On the basis of the pathological findings, all cases were diagnosed as focal cortical dysplasia (FCD) type IIId. The epileptogenic mild cortical malformations may be the cause of HHES.
Resection and Abdominal Wall Reconstruction for Cesarean Scar Endometriosis
Authors: Kento Takaya, Hirokazu Shido, Shun Yamazaki
Journal: Case Rep Med (2022)
MeSH terms: Case Reports

Introduction:
Currently, there are few reports describing the use of reconstructive techniques in the treatment of cesarean scar endometriosis (CSE). Here, we report a case of CSE, a rare form of endometriosis caused by scars from obstetric and gynecological surgeries. Case Report. A 50-year-old woman became aware of a painful, deep scar mass in her lower abdomen during her menstrual period 10 years after her second cesarean section. This was diagnosed as CSE after the biopsy. Under general anesthesia, the mass, a portion of the rectus abdominis, and a 1 cm tumor-free margin were resected as a whole, and the abdominal wall was reconstructed with a soft artificial mesh.
Results:
No obvious recurrence or subjective symptoms were observed postoperatively or reported in the 1-year follow-up period. Discussion. Endometriosis appearing in a cesarean scar is rare; it is chiefly triggered by intraoperative mechanical implantation. In cases of surgical scar masses with a history of gynecological surgery and associated menstrual symptoms, this syndrome should be considered during diagnosis and treatment.
Intra-Orbital Meningioma Causing Loss of Vision in Neurofibromatosis Type 2: Case Series and Management Considerations
Authors: Gregory P Lekovic, Marc S Schwartz, George Hanna, John Go
Journal: Front Surg (2018)
Keywords: gamma knife radiosurgery, neurofibromatosis type ii, optic nerve decompression, optic nerve sheath meningioma, orbital apex meningioma, vision loss

Objectives: Little evidence exists regarding the management of orbital meningioma causing vision loss in the setting of neurofibromatosis Type 2 (NF2). We review here our experience with patients at risk for blindness due to intra-orbital meningioma. Design/Setting/Participants/Main Outcome Measures: The charts of patients with NF2 presenting for evaluation of intra-orbital meningioma and vision impairment between 2008 and 2013 were retrospectively reviewed in accordance with institutional IRB policies. Patients with primarily extra-orbital tumors and minimal intra-orbital extension were excluded. Charts were analyzed for the presence and/or imaging progression of intra-orbital tumor, presence of other optic apparatus pathology, presence and/ or progression of vision impairment, and intervention performed (if any). Results: Seven patients with intra-orbital meningioma on MRI and bilateral vision loss and/or unilateral visual impairment due to tumor and contralateral blindness of any etiology were identified. Patients without salvageable vision in either eye were excluded (n = 3). Diagnosis of meningioma was obtained either by biopsy or based on imaging assessment. Conclusion: Conservative management of orbital tumors in NF2 may be preferred in asymptomatic patients but may not be acceptable in patients with progressive visual decline. Radiation is a reasonable option for meningiomas of the orbit and optic nerve sheath. Finally, although the benefit of cranial nerve decompression in NF2 for preservation of facial nerve and hearing has previously been established, the role of optic nerve decompression for preservation of vision in NF2 remains poorly defined.
Relapsed/refractory diffuse large B cell lymphoma with cardiac involvement: A case report and literature review
Authors: Yuanyuan Yang, Zixuan Li, Yuntao Li, Yue Zhao, Mingxia Shi
Journal: Front Oncol (2023)
Keywords: b-cell lymphoma, car t-cell immunotherapy, cardiac hematological malignancy, case report, secondary cardiac lymphoma
MeSH terms: Case Reports

Background:
Hematological malignancies of the heart (CHMs) are extremely rare, and include leukemia, lymphoma infiltration, and multiple myeloma with extramedullary manifestations. Cardiac lymphoma can be divided into primary cardiac lymphoma (PCL) and secondary cardiac lymphoma (SCL). Compared to PCL, SCL is relatively more common. Histologically, the most frequent SCL is diffuse large B-cell lymphoma (DLBCL). The prognosis of lymphoma in patients with cardiac involvement is extremely poor. CAR T-cell immunotherapy has been recently become a highly effective treatment for relapsed or refractory diffuse large B-cell lymphoma. To date, there are no guidelines that provide a clear consensus on the management of patients with secondary heart or pericardial involvement. We report a case of relapsed/refractory DLBCL that secondarily affected the heart.
Case presentation:
A male patient was diagnosed with double-expressor DLBCL based on biopsies of mediastinal and peripancreatic masses and fluorescence in situ hybridization. The patient received first-line chemotherapy and anti-CD19 CAR T cell immunotherapy, but developed heart metastases after 12 months. Considering his physical condition and economic situation of the patient, two cycles of multiline chemotherapies were administered, followed by CAR-NK cell immunotherapy and allogeneic hematopoietic stem cell transplantation (allo-HSCT) at another hospital. After achieving a six-month survival, the patient died of severe pneumonia.
Conclusion:
The response of our patient emphasizes the importance of early diagnosis and timely treatment to improve the prognosis of SCL and serves as an important reference for SCL treatment strategies.
Combined open revascularization and endovascular treatment of complex intracranial aneurysms: case series
Authors: Robert C Rennert, Vincent N Nguyen, Aidin Abedi, Nadia A Atai, Joseph N Carey, Matthew Tenser, Arun Amar, William J Mack, Jonathan J Russin
Journal: Front Neurol (2023)
Keywords: aneurysm, bypass, cerebral revascularization, embolization, neuroendovascular approach

Background and purpose:
The treatment of complex intracranial aneurysms can be challenging with stand-alone open or endovascular techniques, particularly after rupture. A combined open and endovascular strategy can potentially limit the risk of extensive dissections with open-only techniques, and allow for aggressive definitive endovascular treatments with minimized downstream ischemic risk.
Materials and methods:
Retrospective, single-institution review of consecutive patients undergoing combined open revascularization and endovascular embolization/occlusion for complex intracranial aneurysms from 1/2016 to 6/2022.
Results:
Ten patients (4 male [40%]; mean age 51.9 ± 8.7 years) underwent combined open revascularization and endovascular treatment of intracranial aneurysms. The majority of aneurysms, 9/10 (90%), were ruptured and 8/10 (80%) were fusiform in morphology. Aneurysms of the posterior circulation represented 8/10 (80%) of the cases (vertebral artery [VA] involving the posterior inferior cerebellar artery [PICA] origin, proximal PICA or anterior inferior cerebellar artery/PICA complex, or proximal posterior cerebral artery). Revascularization strategies included intracranial-to-intracranial (IC-IC; 7/10 [70%]) and extracranial-to-intracranial (EC-IC; 3/10 [30%]) constructs, with 100% postoperative patency. Initial endovascular procedures (consisting of aneurysm/vessel sacrifice in 9/10 patients) were performed early after surgery (0.7 ± 1.5 days). In one patient, secondary endovascular vessel sacrifice was performed after an initial sub-occlusive embolization. Treatment related strokes were diagnosed in 3/10 patients (30%), largely from involved or nearby perforators. All bypasses with follow-up were patent (median 14.0, range 4-72 months). Good outcomes (defined as a Glasgow Outcomes Scale ≥4 and modified Rankin Scale ≤2) occurred in 6/10 patients (60%).
Conclusion:
A variety of complex aneurysms not amenable to stand-alone open or endovascular techniques can be successfully treated with combined open and endovascular approaches. Recognition and preservation of perforators is critical to treatment success.
Case Report: Co-existence of a novel EXOC4-TRHDE gene fusion with PML-RARA in acute promyelocytic leukemia
Authors: Xiaodong Liu, Wanting Li, Jian Xiao, Huixiu Zhong, Kun Yang
Journal: Front Oncol (2023)
Keywords: exoc4‐trhde, acute promyelocytic leukemia, additional chromosomal abnormality, all-trans retinoic acid, arsenic trioxide
MeSH terms: Case Reports

Acute promyelocytic leukemia (APL) is a type of myeloid leukemia with a specific chromosomal translocation t(15;17)(q22; q12) forming the PML-RARA fusion gene. However, approximately one third of newly diagnosed patients with APL have additional chromosomal abnormalities. Here, we report a case of APL with co-existence of a novel translocation t(7;12)(q32;q13) involving an out-of-frame fusion between EXOC4 and TRHDE, together with PML-RARA. The patient achieved complete remission after treatment with conventional therapy with all-trans retinoic acid (ATRA) and arsenic trioxide (ATO). Although the causative link between EXOC4-TRHDE and PML-RARA has yet to be established, the patient had a good response to therapy, suggesting that the EXOC4-TRHDE fusion does not affect the efficacy of combined treatment with ATRA and ATO.
Case Report: A novel KNCH2 variant-induced fetal heart block and the advantages of fetal genomic sequencing in prenatal long-term dexamethasone exposure
Authors: Huiping Huang, Siyuan Jing, Shaoying Wu, Li Wei, Qian Zhang, Yimin Hua, Yifei Li, Haiyan Yu, Kaiyu Zhou
Journal: Front Genet (2022)
Keywords: case report, dexamethasone exposure, fetal bradycardia, kcnh2, long qt syndrome, prenatal management
MeSH terms: Case Reports

Background: Fetal bradycardia is a common but severe condition. In addition to autoimmune-mediated fetal heart block, several types of channelopathies induce high-degree atrioventricular block (AVB). Long QT syndrome (LQTS) is a major cause of non-autoimmune-mediated fetal heart block. Due to the limitations of prenatal diagnostic technologies, LQTS is seldom identified unless fetal genetic screening is performed. Thus, long-term prenatal dexamethasone (DEX) exposure can become a challenge for these patients. We report on a rare case of a novel KCNH2 variant related to LQTS and associated with high-degree fetal AVB with long-term DEX exposure. This case led us to review our prenatal administration strategy for such patients. Case Presentation: A fetus was identified with high-degree AVB (2:1 transduction at 28 + 2 gestational weeks). Typical tests of immune function in the pregnant woman were conducted including tests for thyroid function, rheumatic screening, autoimmune antibodies (such as anti-Ro/SSA and anti-La/SSB), and anti-nuclear antibodies (anti-ANA). Following the recommended protocol, the pregnant patient received DEX (0.75 mg/day) during pregnancy. Subsequently, the fetal AVB changed from 2:1 to prolonged AV intervals with ventricular tachycardia, which suggested a therapeutic benefit of DEX in some respects. However, a high-degree AVB with a significantly prolonged QTc interval was identified in the neonate following birth. Genetic testing revealed that a KCNH2 c.1868C>A variant induced LQTS. The body length remained approximately -3.2 SD from the reference value after prenatal long-term DEX exposure, which indicated a developmental restriction. Additionally, the functional validation experiments were performed to demonstrate the prolonged duration of calcium transit both in depolarization and repolarization with the KCNH2 c.1868C>A variant. Conclusion: Genetic screening should be recommended in fetuses with autoimmune antibody negative high-degree AVB, especially for 2:1 transduction AVB and in fetuses with changes in fetal heart rhythm following initial DEX treatment. Genetic screening may help identify genetic variant-related channelopathies and avoid unexpected prenatal exposure of DEX and its possible long-term adverse postnatal complications.
Enterococcal Cerebellopontine Angle Abscess in a 12-year-old Female
Authors: Alka Sonavane, Vasant Baradkar, Simit Kumar
Journal: J Glob Infect Dis (2010)
Keywords: brain abscess, computerized tomography, enterococcus species
MeSH terms: Case Reports

Despite advances in imaging and antibiotic treatment, brain abscess is still encountered occasionally. Various aerobic and anaerobic bacteria have been reported as causative agents of brain abscess but only a few cases of enterococcal brain abscesses have been reported. Here we report a case of brain abscess in a 12-year-old female patient, who presented with a history of fever, chills, headache, convulsions since seven days and history of altered sensorium and aphasia since the last two days. The patient had chronic suppurative otitis media of both ears following trauma and presented with ear discharge. The diagnosis of brain abscess was done by computerized tomography scan and the pus was aspirated by left suboccipital burr hole operation. Enterococcus species was cultured from the aspirated pus sample. The patient responded to surgical drainage and antibiotic treatment.
Primary leiomyosarcoma of the male breast: a case report
Authors: Yazan Masannat, Haytham Sumrien, Yousef Sharaiha
Journal: Case Rep Med (2010)
MeSH terms: Case Reports

Primary leiomyosarcoma of the breast is a rare tumour with only around thirty cases reported in the literature. Most of the cases reported are in females, while only a few are reported in males. We present a case of primary breast leiomyosarcoma in a 59-year-old man that presented with a subareolar lump which felt to be benign clinically and radiologically but proven to be a leiomyosarcoma on excision.
Missed Connections: Identification of Atrial Septal Defect by MRI
Authors: Timothy J O'Toole, Faisal Dadi, Patrick Kietrsunthorn, Jason Foerst, Ali Hama Amin
Journal: Case Rep Cardiol (2023)
MeSH terms: Case Reports

In this case report, we describe a 55-year-old female patient with worsening exertional dyspnea who is referred to the cardiology department, due to the appearance of worsening pulmonary vascular disease on computed tomography (CT) of the chest. Previous transthoracic echocardiograms (TTE) identified right ventricle enlargement, but no other structural abnormalities. She completed cardiac magnetic resonance (CMR) imaging, which identified a large secundum atrial septal defect (ASD). She subsequently underwent surgical planning and correction of the lesion with improvement of her symptoms. This case and a growing body of literature support the use of CMR as an alternative imaging modality for the diagnosis of congenital heart disease (CHD).
Anterior Inferior Cerebellar Aneurysm Treated by Aneurysm Resection and Intracranial Artery Anastomosis in situ: A Case Report and Literature Review
Authors: Chaojue Huang, Shixing Qin, Wei Huang, Yongjia Yu
Journal: Front Surg (2021)
Keywords: aneurysm resection, aneurysms, anterior inferior cerebellar aneurysm, arterial anastomosis in situ, complex aneurysms
MeSH terms: Case Reports

Background: Anterior inferior cerebellar artery (AICA) aneurysms are relatively rare in clinical practice, accounting for <1% of all intracranial arteries. After the diagnosis and location are confirmed by angiography, magnetic resonance, and other imaging examinations, interventional, or surgical treatment is often used, but some complex aneurysms require reconstructive surgery. Case Description: An 8-year-old male child was admitted to the hospital due to sudden disturbance of consciousness for 2 weeks. The head CT showed hematocele in the ventricular system with subarachnoid hemorrhage in the basilar cistern and annular cistern. On admission, he was conscious, answered correctly, had a soft neck, limb muscle strength was normal, and had no cranial nerves or nervous system abnormalities. A preoperative examination showed the right side of the anterior distal arteries class under the circular wide neck aneurysm, the distal anterior inferior cerebellar artery supplying a wide range of blood to the cerebellum, the ipsilateral posterior inferior cerebellar artery absent, and the aneurysm close to the VII, VIII nerves. The aneurysm was successfully treated by aneurysm resection and intracranial artery anastomosis in situ of a2 AICA-a2 AICA. Conclusions: AICA aneurysms are relatively rare; in this case, a complex wide-necked aneurysm was successfully treated by aneurysm resection and anastomosis in situ of a2 AICA-a2 AICA. This case can provide a reference for the surgical treatment of complex anterior cerebellar aneurysms.
Low-Malignant Schwannoma of the Cervix in Pregnancy: A Case Report and Literature Systematic Review
Authors: Giada M Almirante, Francesco Cantatore, Gianluca Taccagni, Massimo Candiani, Massimo Origoni
Journal: Case Rep Obstet Gynecol (2021)
MeSH terms: Case Reports

Primary cervical melanocytic schwannomas, arising from the sympathetic chain, are very rare pigmented neural sheath tumors that, both grossly and clinically, are often misdiagnosed with other more frequent lesions of the uterine cervix. Literature review accounts for seventeen published cases of schwannomas of the cervix, ten of which are malignant and seven benign. Pathological examination with immunostaining techniques is essential for the correct diagnosis of these tumors. We report a case of primary cervical schwannoma in a 32-year-old female who was referred to our department at 13 weeks of gestation with a diagnosis of malignant melanoma of the cervix. Pathological review detailed a neoplasm with a myxoid spindle cell component and a minority of small epithelioid cells, with a low-malignant potential proliferation index: morphological and immunocytochemical findings were compatible with the diagnosis of nerve sheath tumor, type schwannoma. The patient underwent a vaginal trachelectomy and a prophylactic Shirodkar's cerclage. Pregnancy was carried on without any negative event. The patient delivered by a caesarean section a healthy female newborn. Placental histology was negative. After 6 years from the first diagnosis, the patient is healthy and disease free.