OpenMed/multicare-articles huggingface dataset:
Admission Decision-Making in Hospital Emergency Departments: The Role of the Accompanying Person
Authors: Susanna Rance, Debra Westlake, Heather Brant, Ingrid Holme, Ruth Endacott, Jonathan Pinkney, Richard Byng
Journal: Glob Qual Nurs Res (2020)
Keywords: united kingdom, caregivers, carers, decision-making, emergency department, emergency room, ethnography, qualitative research

In resource-stretched emergency departments, people accompanying patients play key roles in patients' care. This article presents analysis of the ways health professionals and accompanying persons talked about admission decisions and caring roles. The authors used an ethnographic case study design involving participant observation and semi-structured interviews with 13 patients, 17 accompanying persons and 26 health care professionals in four National Health Service hospitals in south-west England. Focused analysis of interactional data revealed that professionals' standardization of the patient-carer relationship contrasted with accompanying persons' varied connections with patients. Accompanying persons could directly or obliquely express willingness, ambivalence and resistance to supporting patients' care. The drive to avoid admissions can lead health professionals to deploy conversational skills to enlist accompanying persons for discharge care without exploring the meanings of their particular relationship with the patients. Taking a relationship-centered approach could improve the attention to accompanying persons as co-producers of health care and participants in decision-making.
Zygomycosis Associated with HIV Infection and Liver Transplantation
Authors: Larry Nichols, Rebecca Z Ocque, Ivonne Daly
Journal: Patholog Res Int (2011)
MeSH terms: Case Reports

Zygomycosis is an increasing threat to patients with human immunodeficiency virus (HIV) infection. Zygomycosis (formerly called mucormycosis) is the fungal infection with Mucor, Rhizopus, or other species that share a common morphology of large empty pauciseptate hyphae with rare random-angle branching and a collapsed "twisted ribbon" appearance. Morphology allows a specific diagnosis on frozen section or smear prior to growth and identification of the fungi in culture which makes it improtant because treatment is different than that for more common mycoses such as candidiasis and aspergillosis. We present an informative and illustrative case of zygomycosis in a patient with HIV infection and liver transplantation.
Diagnosis of Woolly Hair Using Trichoscopy
Authors: Mahesh Mathur, Prakash Acharya, Alina Karki, Nisha Kc, Jyoti Shah
Journal: Case Rep Dermatol Med (2019)
MeSH terms: Case Reports

Hair shaft abnormalities including woolly hair are traditionally diagnosed by clinical examination and light microscopy which involves plucking of multiple hairs for examination. This is usually an inconvenient procedure especially in children. Trichoscopy may be a useful tool allowing close visualization of multiple hairs without causing discomfort to the patients. Trichoscopic findings of woolly hair have been described only in few reports. We report all of the trichoscopic findings of this rare disorder in one case which have only been reported separately in previous reports.
Primary Malignant Melanoma of the Cervix: A Case Report and a Review of the Literature
Authors: Michail Diakosavvas, Zacharias N Fasoulakis, Maria Kouroupi, Marianna Theodora, Lola Inagamova, Georgios Tsatsaris, Panagiotis Nikolaou, Konstantina Frangia-Tsivou, Alexandra Giatromanolaki, Emmanuel N Kontomanolis
Journal: Case Rep Oncol Med (2020)
MeSH terms: Case Reports

Background:
Gynecologic melanomas are extremely rare malignancies, and primary malignant melanoma of the cervix (PMMC) is the rarest among them all, with less than 100 cases reported so far. Although some conditions have been correlated with the pathogenesis of this entity, no specific risk factor has been yet identified, with vaginal bleeding being the most common symptoms. The diagnosis is based on physical examination with speculum assessment and cytologic and histopathologic findings accompanied with immunohistochemical staining of lesion's biopsies. Case Presentation. We report a case of PMMC in a 34-year-old para-2 patient, among the youngest cases of PMMC reported, that presented to our clinic for routine examination. Gynecologic examination demonstrated a dark, heavily fully pigmented cervical growth completely covering the entire external cervical os. Biopsy obtained and showed malignant melanoma. She underwent radical hysterectomy with bilateral salpingo-oophorectomy and pelvic lymphadenectomy. The pathological diagnosis was FIGO stage IB1 PMMC. Despite 2 courses of anti-PD-1 antibody (Nivolumab) treatment, the patient passed away 13 months after diagnosis (12 months after surgery).
Conclusions:
Early diagnosis and subsequently early treatment are of high importance regarding patients' prognosis and survival. No standardized protocols or treatment guidelines specific for this rare cancer have been issued; thus, clinicians are called to assess each case individually. Current treatment options are based on surgical excision mostly with radical hysterectomy, but in advanced or recurrent state of the disease, other treatment modalities, such as chemotherapy, radiotherapy, and immunotherapy, can be employed. Prognosis for these patients is very poor, and survival rate remains extremely low, with the median OS reported being less than 2 years. Reporting and publishing of such cases are both of paramount importance for the better understanding of this uncommon cervical malignancy, and further biological and clinical investigations are required for more suitable and effective therapies to be determined. A new staging system, specific to PMMC, could be of great use for the better correlation of the disease's stage and prognosis of these patients.
The Natural History of Medial Meniscal Root Tears: A Biomechanical and Clinical Case Perspective
Authors: Edward R Floyd, Ariel N Rodriguez, Kari L Falaas, Gregory B Carlson, Jorge Chahla, Andrew G Geeslin, Robert F LaPrade
Journal: Front Bioeng Biotechnol (2021)
Keywords: meniscal extrusion, meniscus, meniscus root repair, meniscus root tear, osteoarthritis

Posterior medial meniscus root tears (PMMRTs) make up a relatively notable proportion of all meniscus pathology and have been definitively linked to the progression of osteoarthritis (OA). While known risk factors for development of OA in the knee include abnormal tibial coronal alignment, obesity and female gender, PMMRTs have emerged in recent years as another significant driver of degenerative disease. These injuries lead to an increase in average contact pressure in the medial compartment, along with increases in peak contact pressure and a decrease in contact area relative to the intact state. Loss of the root attachment impairs the function of the entire meniscus and leads to meniscal extrusion, thus impairing the force-dissipating role of the meniscus. Anatomic meniscus root repairs with a transtibial pullout technique have been shown biomechanically to restore mean and peak contact pressures in the medial compartment. However, nonanatomic root repairs have been reported to be ineffective at restoring joint pressures back to normal. Meniscal extrusion is often a consequence of nonanatomic repair and is correlated with progression of OA. In this study, the authors will describe the biomechanical basis of the natural history of medial meniscal root tears and will support the biomechanical studies with a case series including patients that either underwent non-operative treatment (5 patients) or non-anatomic repair of their medial meniscal root tears (6 patients). Using measurements derived from axial MRI, the authors will detail the distance from native root attachment center of the non-anatomic tunnels and discuss the ongoing symptoms of those patients. Imaging and OA progression among patients who were treated nonoperatively before presentation to the authors will be discussed as well. The case series thus presented will illustrate the natural history of meniscal root tears, the consequences of non-anatomic repair, and the findings of symptomatic meniscal extrusion associated with a non-anatomic repair position of the meniscus.
Treatment of Fracture Sequel in the Mandibular Angle Region
Authors: Beatriz Sobrinho Sangalette, Tiago Trevizan Levatti, Larissa Vargas Vieira, João Lopes Toledo Filho, Cláudio Maldonado Pastori, Gustavo Lopes Toledo
Journal: Case Rep Surg (2019)
MeSH terms: Case Reports

Because of the anterior disposition on the face and the fragility of the anatomy, the mandible is commonly affected in facial fractures, and the angle region represents 32% of the mandibular fractures; therefore, the objective of the paper was to present a proposal for late correction of the mandibular fracture already consolidated and with occlusal alteration. Patient J.C.P.R., 32, during anamnesis reported loss of sensibility in the mentalis region as well as unilateral posterior open bite for having been a victim of an automobile accident about 1 year and 3 months ago. Physical examination showed elevation in the right mandibular angle region due to the poor positioning of fractured stumps. It has been found that the patient suffered a simple fracture at the mandibular angle, but that had not been treated previously, and it was necessary to treat the fracture sequel. Refraction was performed with a new reduction and fixation through titanium plates and screws, showing that, even being late, the procedure to reduce the fracture sequela was effective, even with the correct functional occlusal adjustment.
Meckel's diverticulum - a congenital defect of the gastrointestinal tract underestimated in differential diagnostics. Own experience
Authors: Jolanta Pietrzak, Anna Obuchowicz, Dariusz Majda, Andrzej Kiedos
Journal: Dev Period Med (2017)
Keywords: child, intestinal obstruction, meckel’s diverticulum
MeSH terms: Meckel Diverticulum / diagnosis, Case Reports, Child, Diagnosis, Differential, Humans, Male, Meckel Diverticulum / pathology, Meckel Diverticulum / surgery

Meckel's diverticulum is a vestigial remnant of the omphalomesenteric duct. It is the most frequent defect of the gastrointestinal tract and is present in approx. 2% of the population: more often in boys than in girls, at a 3:1 ratio. Meckel's diverticulum causes clinical symptoms only in 4-6% of individuals. It is situated approximately 60-100 cm away from the Bauhin's valve. The wall of Meckel's diverticulum consists of all layers typical of the small intestine. It is usually approx. 2-3 cm long, but it can reach lengths of over 10 centimetres. It is usually set on a narrow base. Related symptoms usually occur by the 2nd-3rd year of life and have an acute character. They may occur in older children, which must be remembered in differential diagnosis. An example can be the case of an 8.5-year-old boy with symptoms indicating obstruction of the gastrointestinal tract in which a large, atypically accreted and partly twisted Meckel's diverticulum was found with strangulation of the small intestine between the diverticulum and the mesentery.
Pulmonary Hypertension and Hypocholesterolemia Secondary to Thyrotoxicosis
Authors: Narangoda Liyanage Ajantha Shyamali, Chandrike Ponnamperuma
Journal: Case Rep Endocrinol (2020)
MeSH terms: Case Reports

Background:
Thyroid disorders commonly affect the cardiovascular system. Thyrotoxicosis leading to pulmonary hypertension has been increasingly reported during recent years. Thyroid dysfunction affects the lipid metabolism, and thyrotoxicosis can be associated with low lipid levels. Thyrotoxicosis presenting with right ventricular dysfunction is rare, and only few cases had been reported. Case Presentation. A 53-year-old woman presented with progressive shortness of breath and swelling of body for four months. Examination showed generalized oedema and a systolic murmur over the left sternal border. Transthoracic echocardiography confirmed pulmonary hypertension with tricuspid regurgitation. Investigations revealed thyrotoxicosis and very low cholesterol levels. Diagnosis of Graves' disease was confirmed with detection of thyrotropin receptor antibodies. Pulmonary pressure was normalized six months after antithyroid therapy.
Conclusion:
Thyrotoxicosis is a recognized cause of reversible pulmonary hypertension and acquired hypocholesterolemia. However, most clinicians are not aware of these associations. This case illustrates the importance of assessing thyroid function in patients presenting with pulmonary hypertension.
Case Series: Abscopal Benefit of Surgery in 3 Immunotherapy-Treated Patients With Unresectable Cancer
Authors: Bryan Oronsky, Chris Larson, Tony R Reid, Corey A Carter
Journal: J Investig Med High Impact Case Rep (2018)
Keywords: cancer, immunotherapy, surgery, unresectable disease

For all of the optimism that immunotherapy has engendered, the flip side is that 7/10 patients with susceptible tumor types do not respond, while in nonsusceptible tumor types the response rates are significantly lower. In contradiction of the current orthodoxy against surgery in the setting of unresectable disease, we present 3 examples of immunotherapy-treated patients with widespread recurrence who experienced dramatic clinical improvement following debulking/metastasectomy. Taken together with examples from the literature that correlate longer survival with surgical intervention during treatment with immunotherapy, these 3 cases suggest that a new paradigm involving a wider role for surgery in the management of these patients should be explored. Possible mechanisms by which surgery may synergize with immunotherapy and improve outcomes are also discussed.
Anterior Interosseous Nerve Neuropraxia Secondary to Shoulder Arthroscopy and Open Subpectoral Long Head Biceps Tenodesis
Authors: Jeremiah T Steed, Kathlyn Drexler, Adam N Wooldridge, Matthew Ferguson
Journal: Case Rep Orthop (2017)
MeSH terms: Case Reports

Arthroscopic rotator cuff tendon repair is a common elective procedure performed by trained orthopaedic surgeons with a relatively low complication rate. Specifically, isolated neuropraxia of the anterior interosseous nerve (AIN) is a very rare complication of shoulder arthroscopy. An analysis of peer-reviewed published literature revealed only three articles reporting a total of seven cases that describe this specific complication following standard shoulder arthroscopic procedures. This article reports on three patients diagnosed with AIN neuropraxia following routine shoulder arthroscopy done by a single surgeon within a three-year period. All three patients also underwent open biceps tenodesis immediately following completion of the arthroscopic procedures. The exact causal mechanism of AIN neuropraxia following shoulder arthroscopy with biceps tenodesis is not known. This case report reviews possible mechanisms with emphasis on specific factors that make a traction injury the most likely etiology in these cases. We critically analyze our operating room setup and patient positioning practices in light of the existing biomechanical and cadaveric research to propose changes to our standard practices that may help to reduce the incidence of this specific postoperative complication in patients undergoing elective shoulder arthroscopy with biceps tenodesis.
Oesophageal pneumatosis in a case of bowel ischaemia
Authors: Milena Pasquali, Stefano Leonardo, Miria Morsiani, Maurizio Zompatori
Journal: BJR Case Rep (2017)
MeSH terms: Case Reports

Pneumatosis intestinalis (PI) is a condition in which cystic collections of gas develop within the gastrointestinal wall, forming submucosal or subserosal "bubbles". The radiologic manifestations are often dramatic and most notably are associated with life-threatening bowel ischaemia. PI may occur as a primary type but is usually secondary in nature, attributable to a wide spectrum of causes (benign and fulminant), ranging from immunosuppression to bowel infarction. Herein, we report a case of massive and extensive PI in a patient with small bowel ischaemia, having both benign and serious clinical origins.
Peritoneal Metastasis After Treated With Abemaciclib Plus Fulvestrant for Metastatic Invasive Lobular Breast Cancer: A Case Report and Review of the Literature
Authors: Hong-Fei Gao, Jun-Sheng Zhang, Qiang-Zu Zhang, Teng Zhu, Ci-Qiu Yang, Liu-Lu Zhang, Mei Yang, Fei Ji, Jie-Qing Li, Min-Yi Cheng, Gang Niu, Kun Wang
Journal: Front Endocrinol (Lausanne) (2021)
Keywords: breast, lobular carcinoma, neoplasm metastasis, peritoneum, whole exome sequencing
MeSH terms: Aminopyridines / therapeutic use, Benzimidazoles / therapeutic use, Breast Neoplasms / drug therapy, Fulvestrant / therapeutic use, Peritoneal Neoplasms / secondary, Case Reports, Research Support, Non-U.S. Gov't, Breast Neoplasms / mortality, Breast Neoplasms / pathology, Fatal Outcome, Female, Humans, Middle Aged, Neoplasm Metastasis, Peritoneal Neoplasms / genetics, Peritoneal Neoplasms / metabolism, Peritoneal Neoplasms / mortality, Aminopyridines, Benzimidazoles, Fulvestrant, abemaciclib

Peritoneal metastases from invasive lobular carcinoma (ILC) of breast are uncommon and usually related to poor prognosis due to difficulty of detection in clinical practice and drug resistance. Therefore, recognizing the entities of peritoneal metastases of ILC and the potential mechanism of drug resistance is of great significance for early detection and providing accurate management. We herein report a case of a 60-year-old female who presented with nausea and vomiting as the first manifestation after treated with abemaciclib (a CDK4/6 inhibitor) plus fulvestrant for 23 months due to bone metastasis of ILC. Exploratory laparotomy found multiple nodules in the peritoneum and omentum, and immunohistochemistry confirmed that the peritoneal metastatic lesions were consistent with ILC. Palliative therapy was initiated, but the patient died two months later due to disease progression with malignant ascites. Whole exome sequencing (WES) was used to detect the tumor samples and showed the peritoneal metastatic lesions had acquired ESR1 and PI3KCA mutations, potentially explaining the mechanism of endocrine therapy resistance. We argue that early diagnosis of peritoneal metastasis from breast cancer is crucial for prompt and adequate treatment and WES might be an effective supplementary technique for detection of potential gene mutations and providing accurate treatment for metastatic breast cancer patients.
Therapy Outcome of a T-Cell-Rich-B-Cell Lymphoma (TCRBCL) Patient with R-CHOP in Ibadan, Nigeria: a Case Report
Authors: J A Olaniyi, A O Oluwasola, A Ibijola
Journal: Mediterr J Hematol Infect Dis (2011)
MeSH terms: Case Reports

T-cell-rich B-cell lymphoma (TCRBCL) is considered a rare variant of aggressive B cell lymphoma characterized by few neoplastic B cells and a large reactive infiltrate with striking similarities to nodular lymphocyte predominant Hodgkin's lymphoma.A case of a 46 year old man referred with a 5 months history of generalized lymphadenopathy, weight loss, low grade pyrexia and two separately reported lymph node histology consistent with TCRBCL is described.The clinical course was indeed aggressive because in spite of initial treatment with four cycles of CHOP combination chemotherapy, followed by R+CHOP(x 6 cycles), signs of tumor re-growth/infiltration were frequently observed. Also, recurrent infection was frequent, troublesome and eventually became overwhelming resulting to the loss of the patient.This case, being the first case of TCRBCL diagnosed by immunohistochemical confirmation and managed at this centre with R-CHOP, is presented to highlight the dilemma in making diagnosis, clinical challenges faced and rituximab therapy outcome especially in resource poor country. It will also serve to increase our index of suspicion and the need reinforce immunohistochemistry in the diagnosis of lymphoma.
A Novel PCNT Frame Shift Variant (c.7511delA) Causing Osteodysplastic Primordial Dwarfism of Majewski Type 2 (MOPD II)
Authors: Masoud Dehghan Tezerjani, Mohammad Yahya Vahidi Mehrjardi, Hossein Hozhabri, Masoud Rahmanian
Journal: Front Pediatr (2020)
Keywords: mopd ii, pcnt gene, birth defects, high-throughput nucleotide sequencing, primordial dwarfism
MeSH terms: Case Reports

Background: Microcephalic osteodysplastic primordial dwarfism type II (MOPD II) is an autosomal recessive and skeletal disorder included wide spectrum of clinical abnormalities such as fetal growth restriction, disproportionate face, microcephaly, post-natal growth retardation, adult height under 100 cm, abnormal skin pigmentation, insulin resistance, and susceptibility to cerebrovascular and hematologic abnormalities. Due to heterogeneous feature of MOPDs diseases and common clinical features among the different subtypes, mutation analysis can be considered as fundamental in the accurate diagnosis and confirmation of the MOPD II disease. Some studies revealed that, variants of gene encoding Pericentrin protein, PCNT, were associated with MOPD II. Methods: We performed whole exome sequencing based on the next generation sequencing (Illumina platform), to perform correct diagnosis in a 17-year-old girl with an unknown disease who was referred to the Diabetes Research Center in Yazd, Iran. The clinical features of the patient were short stature, generalized brachydactyly, gradual deterioration of brain functioning, menstrual irregularity, clitoromegaly, acanthosis nigricans, diabetes mellitus, hyperinsulinemia, insulin resistance, and dyslipidemia. Accordingly, her parents were also first cousin with no background disease. After identifying the novel variant, it was confirmed in the proband and her family using bi-directional Sanger sequencing, and its pathogenicity was also checked by different online tools. Results: Our study revealed a novel frame-shift variant in PCNT gene (c.7511delA, p.K2504Sfs*27), which causes premature termination of Pericentrin protein. The result disclosed that, the proband was affected by MOPD II disease. In addition, the Sanger sequencing confirmed the novel homozygote variant in the proband and heterozygote one in her parents, and the extended family perfectly segregated among them. Online tools such as Varsome and MutationTaster also showed a high level of pathogenicity for the variant identified. Conclusion: A novel variant was identified in the proband and her extended family, which emphasized the importance of PCNT gene mutations analysis in the screening and accurate identification of MOPD II disease, especially in prenatal diagnosis.