OpenMed/multicare-articles huggingface dataset:
Long-Term Outcomes of Osteochondral Allograft with Osteogenic Protein-1 Augmentation: A Twelve-Year Follow-Up
Authors: Eric Assid, Andrew Renshaw, Mawadah Samad, Richard Tupler, Deryk Jones
Journal: Case Rep Orthop (2023)
MeSH terms: Case Reports

Background:
Osteochondral lesions (OCLs) can significantly impact functional status and activities of daily living. Weightbearing joints are disproportionately affected due to considerable biomechanical forces in these areas. Various biologic reconstructive procedures such as microfracture, osteochondral autograft transfer (OATS) or allograft transplantation (OCA), and matrix-induced autologous chondrocyte implantation (MACI) are utilized by surgeons to treat OCLs. The integration of osteochondral allografts can restore knee function and maintain the integrity of adjacent joint surfaces. Bone incorporation has been linked to successful outcomes following OCA. Pulse lavage and carbon dioxide have been used to remove marrow elements from the superficial, middle, and deep layers of the allograft; this has been combined with the use of various biologics such as bone marrow aspirate or whole blood to augment donor bone incorporation into the host bone. We present an innovative augmentation approach in OCA transplantation demonstrating excellent incorporation of an osteogenic protein-1 (OP-1) implant (Stryker, Kalamazoo, MI) to treat a large fresh osteoarticular allograft. Case Presentation. We present a 51-year-old male who received OCA augmented with an OP-1 implant (Stryker, Kalamazoo, MI) in 2011. Due to subsequent ACL reconstruction for two years and medial meniscal repair four years following OCA transplantation, we were able to arthroscopically evaluate graft status at short- and intermediate-term follow-ups. Positive findings were further verified with radiographic imaging and patient-reported outcome measures (PROMs).
Conclusion:
OP-1 implants aided in the bone incorporation of a large osteochondral allograft, restoring a high functional level in a demanding sport.
Delayed Anaphylactic Reaction to Midazolam in the Absence of Immediate Respiratory or Skin Manifestations
Authors: Andrew Winegarner, Mark C Kendall, Mekhala Stephen, Afreen Siddiqui
Journal: Case Rep Anesthesiol (2023)
MeSH terms: Case Reports

Anaphylaxis, a type 1 hypersensitivity reaction, is a feared but uncommon complication of medications administered in the perioperative period. The incidence of perioperative hypersensitivity reactions has been reported to range from 1 in 20,000 to 1 in 1,361. Anesthesiologists are well aware of common causes of hypersensitivity such as paralytics and antibiotics; however, less common triggers of anaphylaxis need to be considered as well. Midazolam, a short acting benzodiazepine metabolized by cytochrome P450 enzymes, is considered very safe with a minimal risk profile. Previous reports have described adverse reactions to occur within seconds to minutes following the administration of midazolam. We describe a patient with no known history of asthma or allergies who underwent elective hydrocelectomy with spinal analgesia without incident until 42 minutes later at the conclusion of the procedure, when they experienced circulatory collapse necessitating immediate emergency treatment. This case emphasizes the necessity to improve knowledge and awareness of delayed hypersensitivity reactions following the administration of perioperative medications such as midazolam.
Early Recovery of Physical Function After Total Hip Arthroplasty in a Patient With Osteopetrosis: A Case Report
Authors: Shusuke Nojiri, Azusa Kayamoto, Chiaki Terai, Yusuke Osawa, Yasuhiko Takegami
Journal: Cureus (2024)
Keywords: hip abductor muscle strength, marble bone disease, osteopetrosis, physical function, rehabilitation, total hip arthroplasty, walking speed
MeSH terms: Case Reports

Osteopetrosis is an uncommon and inherited disorder. Some disease-specific characteristics, such as diffuse osteosclerosis and a high incidence of fractures, may potentially affect postoperative rehabilitation. This report presents a case of successful rehabilitation early after total hip arthroplasty for osteopetrosis. A 56-year-old Japanese man, who was diagnosed with osteopetrosis at the age of 11, underwent total hip arthroplasty in the right hip. Full weight-bearing was allowed on the day after the operation; the postoperative rehabilitation program was proceeded based on a standard program as done after total hip arthroplasty for osteoarthritis. A shoe lift in the left leg was used in supervised walking training to correct the imbalanced alignment due to leg length discrepancy. The patient could walk independently with a cane 17 days after the operation. Three weeks after the operation, the patient demonstrated comfortable and maximal walking speed of 1.11 and 1.34 m/s, respectively, and maximal hip abductor muscle strength of 3.96 kgf･m, both of which were better than those before the operation. There were no adverse events during the postoperative rehabilitation course. These findings suggest the safety and efficacy of standard rehabilitation programs after total hip arthroplasty even in individuals with osteopetrosis. In addition, it may be important to consider the whole-body condition in the rehabilitation of individuals with osteopetrosis.
Case Report: First attempt by off-label use of tenecteplase to treat acute extensive portal venous system thrombosis
Authors: Qianqian Li, Ying Piao, Yongguo Zhang, Xingshun Qi
Journal: Front Cardiovasc Med (2024)
Keywords: bleeding, case report, portal venous system thrombosis, tenecteplase, thrombolysis
MeSH terms: Case Reports

Acute extensive portal venous system thrombosis (PVST) can cause lethal complications. Herein, we have for the first time reported the use of anticoagulation combined with systemic thrombolysis by tenecteplase in a male patient with a diagnosis of acute extensive PVST but without liver cirrhosis. After thrombolytic therapy, abdominal pain obviously alleviated. However, urinary bleeding developed, which was reversible by stopping thrombolytic drugs. Finally, this case developed cavernous transformation of the portal vein without portal venous recanalization. In future, the efficacy and safety of tenecteplase should be explored in acute extensive PVST cases.
Effects of steroids on super-refractory status epilepticus in tick-borne meningoencephalitis
Authors: Christine Heuer, Claudio Togni, Marian Galovic, Anna Czernuszenko, Giovanna Brandi, Ignazio de Trizio
Journal: Epilepsy Behav Rep (2024)
Keywords: status epilepticus, steroids, tick-borne encephalitis
MeSH terms: Case Reports

We report a unique case of super-refractory status epilepticus (SRSE) secondary to tick-borne encephalitis (TBE) to evaluate the therapeutic challenges and potential benefits of steroid treatment in this context. A previously healthy 31-year-old woman was admitted to the hospital with fever, headache, vertigo, and meningismus, ultimately diagnosed with TBE. Despite empirical antimicrobial treatment, the patient's condition deteriorated, leading to coma and SRSE. Various antiseizure medications and sedatives were administered without sustained success. Steroid treatment was initiated due to elevated intracranial pressure and persistent seizure activity. Following the administration of dexamethasone, electrographic status epilepticus resolved, though the patient developed clinical signs of increased intracranial pressure necessitating decompressive craniectomy. The patient's condition stabilized with a combination of antiseizure medicazions. Despite cessation of SRSE, the patient remained in a minimally conscious state at discharge, showing only gradual improvement over time. The use of steroids in TBE is controversial, with limited reports of potential benefits. In this case, steroid administration coincided with the cessation of SRSE, and authors explore its potential benefit considering its immunomodulatory effects.
Catatonia Induced by First-Time Use of Synthetic Cannabinoids: A Case Report
Authors: Avanti Puri, Filippo Costanzo, Janny Rivera, Jean Bujdos
Journal: Cureus (2024)
Keywords: cannabinoids, cannabis-induced catatonia, case report, catatonia, synthetic cannabis
MeSH terms: Case Reports

We present the case of a 32-year-old woman who developed life-threatening catatonia in the setting of synthetic cannabis use. She was treated with high doses of lorazepam (up to 26 mg) and eventually transferred to receive electroconvulsive therapy (ECT). Synthetic cannabis poses a unique risk as it is widely available, difficult to regulate, and with adverse effects that are not well understood due to the presence of ever-changing chemical compounds. In this case report, we present one of the first cases of catatonia induced by first-time synthetic cannabinoids with no previous history of cannabis use disorder.
CPX-351 and allogeneic stem cell transplant for a therapy-related acute myeloid leukemia that developed after treatment of acute promyelocytic leukemia: a case report and review of the literature
Authors: Alessandra Sperotto, Maria Teresa Lupo Stanghellini, Jacopo Peccatori, Roberta De Marchi, Simona Piemontese, Giulia Ciotti, Marco Basso, Elisabetta Pierdomenico, Paolo Fiore, Fabio Ciceri, Michele Gottardi
Journal: Front Oncol (2024)
Keywords: cpx-351, acute myeloid leukemia, acute promyelocytic leukemia, allogeneic hematopoietic stem cell transplantation, therapy-related myeloid neoplasm
MeSH terms: Case Reports

Therapy-related myeloid neoplasms (t-MNs), which develop after cytotoxic, radiation, or immunosuppressive therapy for an unrelated disease, account for 7%-8% of acute myeloid leukemia (AML). Worse outcomes and consequently shortened survival are associated with t-MNs as compared with de novo AML. Therapy-related MNs are being reported with increasing frequency in successfully treated acute promyelocytic leukemia (APL), in particular, before the introduction of all-trans retinoic acid (ATRA) plus arsenic trioxide (ATO). Considering the high curability of APL, t-MNs represent one of the prognosis-limiting factors in this setting of leukemia. We report our experience with a patient who developed t-AML 15 years after treatment for APL. Treatment included three cycles of chemotherapy with CPX-351 (Vyxeos, Jazz Pharmaceuticals) followed, as in remission, by an allogeneic hematopoietic stem cell transplant. A review of available literature was also included.
Pancreatic diffuse large B-cell lymphoma: a case report and literature review
Authors: Lijun Shi, Juan Wang, Li Wei, Zhongrui Ma, Xaiohu Liu
Journal: Front Oncol (2023)
Keywords: diagnosis, diffuse large b-cell lymphoma, jaundice, jaundice pancreatic tumor, non-hodgkin’s lymphoma, pancreatic tumor
MeSH terms: Case Reports

Primary pancreatic lymphoma is an extremely rare malignant tumor that accounts for 1% and 0.5% of all extranodal malignant lymphomas and pancreatic tumors, respectively. The clinical and radiographic characteristics of primary pancreatic lymphoma are non-specific, and it is often misdiagnosed as pancreatic cancer or pancreatic tuberculosis, delaying treatment. The most common histological subtype of primary pancreatic lymphoma is diffuse large B-cell lymphoma. Herein, we report a case of a 48-year-old female patient who was hospitalized for complaints of lower back pain, jaundice, dark brown urine, nausea, and ascites. Radiological evaluation revealed a pancreatic head mass that was diagnosed as diffuse large B-cell lymphoma following ultrasound-guided percutaneous fine-needle biopsy. During hospitalization, the patient's jaundice worsened, and percutaneous transhepatic drainage was performed. However, hemorrhagic ascites and disorders of consciousness occurred after surgery, and the patient died due to multiple organ failure. Considering the outcome of this case, we reviewed the existing relevant literature on primary pancreatic lymphoma to better understand the disease to facilitate timely diagnosis and initiation of treatment.
Successful Laparoscopic Resection of Biliary Cystadenoma: A Case Report
Authors: Hadeel Alosaimi, Rana Alotaibi, Razan Almuwallad, Maha Aljohani, Ahmad Abdulfatah
Journal: Cureus (2024)
Keywords: abdominal pain, biliary cystadenoma, computed tomography, hepatic lesion, laparoscopy
MeSH terms: Case Reports

Biliary cystadenomas are rare hepatic lesions originating from the biliary epithelium. We present the case of a 32-year-old female who presented with persistent right upper quadrant abdominal pain, prompting a thorough investigation. Mildly elevated liver enzymes were noted on laboratory testing. Imaging studies, including a contrast-enhanced CT scan, revealed a 14 cm multiloculated cystic lesion in the right lobe of the liver. A biliary cystadenoma was confirmed, leading to a collaborative decision for laparoscopic resection. Intraoperative findings and histopathological examination supported the diagnosis, and the patient had an uneventful recovery postoperatively. This case report underscores the clinical complexity of biliary cystadenomas and highlights the successful multidisciplinary management of a young patient through laparoscopic resection. The case contributes valuable insights into the diagnostic and therapeutic challenges associated with these uncommon hepatic lesions.
Case report of atypical undernutrition of hypoproteinemia type
Authors: Qun-Ru Wang, Jun Long, Chen-Cheng Wang, Ji-Lei Hu, Ning Lin, Shan-Hong Tang
Journal: Open Life Sci (2023)
Keywords: cavernous transformation of the portal vein, hypoproteinemia, portal thrombosis, undernutrition
MeSH terms: Case Reports

Albumin and prealbumin serve as vital markers reflecting hepatic synthesis activity and overall body nutrient status. Hypoproteinemia can result from various etiological factors, with reduced blood inflow into the liver due to portal vein thrombosis being one such cause. However, literature addressing this specific association remains limited. This report presents an atypical case of malnutrition involving a patient who experienced prolonged hypoproteinemia attributable to a gradual decline in hepatic blood perfusion caused by progressive portal thrombosis and cavernous transformation of the portal vein (CTPV). The case encompasses an in-depth analysis of the factors contributing to undernutrition, the etiology and diagnosis of hypoproteinemia, and its clinical implications. Vigilance for the presence of hypoproteinemia is essential in the management of patients afflicted by progressive portal vein thrombosis complicated by CTPV. Timely and effective interventions aimed at rectifying hypoproteinemia can significantly enhance clinical outcomes. Moreover, reduced hepatic blood flow should be considered a plausible underlying cause in cases of unexplained hypoproteinemia, warranting thorough evaluation. This case underscores the importance of recognizing the intricate interplay between hepatic vascular pathology and protein homeostasis in clinical practice.
Point of Care Ultrasound Identification and Aspiration of a Neck Lymph Node
Authors: Andrew Moore, Ali Mrad, Leonard Riley, Sonia M Castillo
Journal: POCUS J (2024)
Keywords: fna, lung cancer, pocus, supraclavicular lymph node
MeSH terms: Case Reports

The tissue diagnosis and staging of all types of lung cancer is foundational for prognosis and establishing the optimal treatment plan. In order to appropriately stage lung cancer, the highest stage should be established using the 8th edition TNM criteria, where tumor size (T), nodal involvement (N), and metastasis (M) are all taken into account. Establishing a tissue diagnosis may involve the use of CT guided biopsy, navigational bronchoscopy, endobronchial biopsy, EBUS, percutaneous lymph node biopsy and/or excisional biopsy of supraclavicular nodes. It is recommended to proceed with the method that is considered least invasive and provides the highest staging. We present a case of recurrent lung adenocarcinoma diagnosed with real time ultrasound-guided fine needle aspiration of a neck lymph node.
A Case Report of a Patient with Soaring Clozapine Levels after Developing a Urinary Tract Infection
Authors: Adesh Kumar Agrawal, Soumitra Das, Lorenzo Abednego B Adre, Nakka Raghuma, Sharanya Kaushik, Adarsha Adhikari
Journal: Case Rep Psychiatry (2024)
MeSH terms: Case Reports

Clozapine is an antipsychotic medicine used to treat mental illnesses that is resistant to therapy. It can induce dose-dependent adverse effects such as increased susceptibility to infections and hematological irregularities. In this case report, we present a 37-year-old woman with schizoaffective disorder who experienced clozapine side effects following a moderate urinary tract infection (UTI). Her serum clozapine levels and side effects were increased throughout her UTI but resolved once the UTI was managed conservatively. We reviewed clozapine's pharmacokinetic properties to understand why serum levels rose during infection. While we could not definitely explain the mechanism of elevation, we emphasize the importance of monitoring serum clozapine levels and keeping watchful for adverse effects, as well as heightened scrutiny, evaluation for recent infections, and regular monitoring of patients.
Thyroid metastasis from renal cell carcinoma presenting as a solid mass with rapid enlargement
Authors: Isabella Chiardi, Priska Gaffuri, Andrea Leoncini, Pierpaolo Trimboli
Journal: Endocrinol Diabetes Metab Case Rep (2024)

Summary:
Thyroid metastases from nonthyroidal malignancies (NTMs) represent a diagnostic challenge, often displaying heterogeneous clinical manifestations. These metastases are rare but significant, accounting for approximately 2% of thyroid malignancies. Distinguishing them from primary thyroid malignancies is challenging due to the lack of specific ultrasound features, and the ultrasound-based risk stratification systems offer limited utility in such cases. Fine needle aspiration cytology is crucial for definitive diagnosis, yet it may not always provide accurate results. In this case report, we describe a unique instance of thyroid metastases originating from renal cell carcinoma, emphasizing the complexities in diagnosis and the importance of considering oncological conditions when assessing thyroid masses. Awareness of thyroid metastasis from NTMs, particularly in cases of diffuse thyroid hypoechogenicity and hypothyroidism, is essential for clinicians in their diagnostic approach.
Learning points:
Thyroid metastases from nonthyroidal malignancies are diagnostic challenges due to their heterogeneous clinical presentations, often mimicking primary thyroid malignancies. Thyroid metastases from nonthyroidal malignancies are relatively rare, but they still account for approximately 2% of thyroid malignancies. It is fundamental to consider oncological conditions when assessing thyroid masses, especially in cases of diffuse thyroid hypoechogenicity, hypothyroidism, and history of other tumors. Thyroid presentation is quite similar to that of autoimmune hypothyroidism, endocrinologists must be aware of the possibility of thyroid hypofunction due to the massive invasion of the parenchyma.
Feasibility and safety of combined laparoscopic and transvaginal oocyte retrieval in a woman with vaginal recurrence of cervical adenocarcinoma: a case report
Authors: Caroline Ingold, Paula Andrea Navarro, Renato de Oliveira, Caio Parente Barbosa, José Carlos Sadalla, Giuliano Bedoschi
Journal: Front Reprod Health (2024)
Keywords: cryopreservation, fertility preservation, laparoscopy, oocyte retrieval, uterine cervical neoplasms
MeSH terms: Case Reports

Introduction:
Oocyte cryopreservation is an established technique for fertility preservation in women diagnosed with cancer. However, some clinical scenarios may preclude the commonly used transvaginal approach to oocyte retrieval. In such cases, a laparoscopic approach may be required. Here, we report the feasibility and safety of a combined laparoscopic and transvaginal approach for oocyte retrieval in a woman with vaginal recurrence of cervical adenocarcinoma. This approach allowed for oocyte cryopreservation prior to cancer treatment, representing a novel application in this clinical context.
Methods:
A 31-year-old woman with endocervical adenocarcinoma underwent laparoscopic radical hysterectomy and pelvic lymph node dissection. She presented with vaginal recurrence and was referred for fertility preservation by oocyte cryopreservation before chemotherapy and radiotherapy/brachytherapy. Ovarian stimulation was initiated with a gonadotropin antagonist protocol combined with aromatase inhibitors, and oocyte retrieval was performed with a combined laparoscopic and transvaginal approach.
Results:
A total of 18 oocytes were retrieved and 10 mature oocytes were cryopreserved. Peritoneal fluid cytology was negative for malignancy. The patient underwent chemotherapy and radiotherapy/brachytherapy and was disease-free after oocyte retrieval.
Conclusion:
The combined laparoscopic and transvaginal approach for oocyte retrieval emerges as a practical and efficacious method for fertility preservation in cases of cervical adenocarcinoma with vaginal recurrence. Further comprehensive studies are warranted to establish the reproducibility, safety, and long-term outcomes associated with this innovative approach.
Multimodal imaging shows acute multilayered retinal hemorrhages in heatstroke-a rare case report
Authors: Yi Zhang, Chunyan Lei, Xi Huang, Meixia Zhang
Journal: Front Med (Lausanne) (2024)
Keywords: heatstroke, intraretinal hemorrhage, multilayered retinal hemorrhage, multimodal imaging, preretinal hemorrhage
MeSH terms: Case Reports

Background:
Heatstroke is a life-threatening disease clinically characterized by central nervous system dysfunction, multiorgan failure, and extreme hyperthermia. There are no reports about eye involvement in heat stroke. Here, we report a rare case of multilayered retinal hemorrhages in a patient with heatstroke.
Case presentation:
A 55-year-old male with a one-month history of blurry vision in both eyes presented at our department after suffering from heatstroke. His visual acuity was 5/20 OD and 10/20 OS. Fundus examination revealed retinal hemorrhages in both eyes. Fundus autofluorescence images and near-infrared reflectance images revealed well-defined retinal lesions. Optical coherence tomography helped to accurately locate the different layers of the lesions, including the nerve fiber layer, sub-inner limiting membrane, outer plexiform layer, ellipsoid zone and Henle fiber layer hemorrhages. We followed up with the patient for 8 months. At the last follow-up, his visual acuity was 20/20 in both eyes, and fundus examination showed that retinal hemorrhages were almost completely absorbed.
Conclusion:
To our knowledge, this is the first report on multilayered retinal hemorrhages secondary to heat stroke. Intraretinal and preretinal hemorrhages can gradually resolve, and the patient's vision will improve with the absorption of the retinal hemorrhages. Multimodal imaging may help to reveal additional details about retinal lesions and monitor the course of the disease.