OpenMed/multicare-articles huggingface dataset:
Two Sites of Obstruction with Gallstones: A Case Report of Bouveret Syndrome with a Concurrent Biliary Ileus
Authors: Eric Bergeron, Maude Pichette
Journal: Case Rep Surg (2023)
MeSH terms: Case Reports

Bouveret syndrome is a gastric outlet obstruction, and biliary ileus is an obstruction of the small bowel, and both are caused by a gallstone that escaped the gallbladder through a bilio-enteric fistula. The concurrent occurrence of obstruction at both sites is encountered very rarely, and only two such cases associated with Bouveret syndrome were reported before. We now present a case involving a 78-year-old female with simultaneous obstruction at both the duodenum and jejunum. The literature is reviewed to evaluate the incidence of such a situation and to discuss the management of the case.
Insulin Autoimmune Syndrome in a 25-Year-Old, Previously Healthy Kuwaiti Man
Authors: Einas Alrashidi, Thamer Alessa
Journal: Case Rep Endocrinol (2019)
MeSH terms: Case Reports

Insulin autoimmune syndrome (IAS) is a disease characterized by hyperinsulinaemic hypoglycaemia associated with autoantibodies against endogenous insulin. We have described a case of a 25-year-old, previously healthy Kuwaiti man who was admitted to the Mubarak Al-Kabeer hospital with a history of recurrent hypoglycaemia. The patient revealed that he had taken several different injectable anabolic steroids and growth hormone with oral amino acids and other tablets (fat burners) for bodybuilding in the last two months. He denied knowingly using insulin or insulin analogues. The patient had elevated fasting insulin level (>301 uIU/mL) and elevated insulin autoantibodies (>100.0 IU/mL). After appropriate work-up, he was diagnosed with IAS. After treatment with prednisolone (1 mg/kg/day), the patient had complete recovery. In patients with repeated hypoglycaemia, IAS should be considered in the differential diagnosis. Glucocorticoid therapy can be effective for the treatment of hypoglycaemia in patients with IAS.
TFG::ALK fusion in ALK positive large B-cell lymphoma: a case report and review of literature
Authors: Andrew Xiao, Nahid Shahmarvand, Alexandra Nagy, Jyoti Kumar, Jessica Van Ziffle, Patrick Devine, Franklin Huang, Lhara Lezama, Peng Li, Robert S Ohgami
Journal: Front Oncol (2023)
Keywords: alk, alk fusion, alk translocation, alk+ large b-cell lymphoma, tfg
MeSH terms: Case Reports

Anaplastic lymphoma kinase (ALK) positive large B-cell lymphoma (ALK+ LBCL) is an aggressive and rare subtype of B-cell lymphoma. Patients typically present with advanced clinical stage disease and do not respond to conventional chemotherapy; the median overall survival is 1.8 years. The genetic landscape of this entity remains poorly understood. Here we report a unique case of ALK+ LBCL harbouring a rare TFG::ALK fusion. Targeted next-generation sequencing showed no significant single nucleotide variants, insertions/deletions, or other structural variants beyond the TFG::ALK fusion; deep deletions of FOXO1, PRKCA, and the MYB locus were also detected. Our case report draws attention to this rare disease, highlights a need for larger genetic profiling studies, and focuses on the pathogenesis and potential therapeutic targets of this aggressive disease. To our knowledge, this is the first report of a TFG::ALK fusion in ALK+ LBCL.
Complex psychiatric comorbidities in Thai trans women: A case series
Authors: Sorawit Wainipitapong, Soravit Burakitpachai, Thanapob Bumphenkiatikul
Journal: F1000Res (2022)
Keywords: case study, gender dysphoria, gender identity disorder (gid), mental health, trans, transgender, transwomen, gender dysphoria, mental illness, psychiatric disorder
MeSH terms: Mental Health, Transgender Persons / psychology, Transsexualism / epidemiology, Transsexualism / psychology, Case Reports, Comorbidity, Female, Humans, Male, Southeast Asian People

Trans women (TW) have a high prevalence of poor mental health. Gender-affirming treatments could reduce distress regarding their gender incongruity. However, psychiatric comorbidities might complicate the management or even confirmation of being transgender. We reported three TW with complex mental illnesses, including anxiety disorder with cultural explanation, neurodevelopmental disorders with cross-dressing, and severe personality disorder accompanied by major depression. All cases received both psychiatric and gender-affirming treatments, which demonstrated promising outcomes. Along with gender dysphoria (GD), psychiatric comorbidities also altered these TW's identity and manifestations. Recognition of such conditions would be beneficial in providing care for all TW, both with and without GD.
Case report: Generalized lymphatic anomaly of multiple abdominal organs in a young dog
Authors: So-Hyeon Park, Jung-Ha Lee, Elisa N Salas, Myeongsu Kim, Jae-Ik Han, Kichang Lee, Hakyoung Yoon
Journal: Front Vet Sci (2023)
Keywords: canine, cystic lesions, lymphangioma, lymphangiomatosis, lymphatic malformation, multi-organs
MeSH terms: Case Reports

A 9-month-old, female Pomeranian dog presented with vomiting and lethargy. Ultrasonography revealed multilobulated anechoic round shape structures at the ovarian and uterine locations. Through computed tomography scan, an extensive non-contrast multilobulated fluid-filled mass suspected of originating from the walls of the ovary, uterus, urinary bladder and rectum was observed. Ovariohysterectomy and urinary bladder biopsy were performed. Histopathological examination revealed numerous cystic lesions lined by plump cuboidal cells believed to be of epithelial origin. Immunohistochemical staining showed that the cyst-like lesions lining cells were strongly positive for lymphatic vessel endothelial hyaluronan receptor 1. Based on these results, lesions were identified as generalized lymphatic anomaly (GLA), in which lymphangiomas develop in multiple organs. After 6 months follow-up, the size of the cysts remaining in the region of the bladder did not undergo much change. GLA should be included in the differential diagnosis when multiple cystic lesions are interspersed in multiple organs.
Management of massive diffuse alveolar hemorrhage in a child with systemic lupus erythematosus
Authors: Dai Kimura, Samir Shah, Mario Briceno-Medina, Shyam Sathanandam, Brent Haberman, Jie Zhang, Linda Myers, Tk Susheel Kumar, Christopher Knott-Craig
Journal: J Intensive Care (2015)
Keywords: diffuse alveolar hemorrhage (dah), extracorporeal membrane oxygenation (ecmo), hemoptysis, lobectomy, plasmapheresis, systemic lupus erythematosus (sle)
MeSH terms: Case Reports

Diffuse alveolar hemorrhage (DAH) from systemic lupus erythematosus (SLE) is a rare but potentially life-threatening condition. We report the case of a 14-year-old female with SLE who developed hypoxia and shock secondary to severe alveolar hemorrhage. She was successfully managed by placement on extracorporeal membrane oxygenation (ECMO) followed by emergent pulmonary lobectomy and medical treatment including high-dose methylprednisolone, cyclophosphamide, intravenous immunoglobulin, and plasmapheresis.
Tubular colonic duplication in an adult patient with long-standing history of constipation and tenesmus
Authors: Hisham F Bahmad, Luis E Rosario Alvarado, Kiranmayi P Muddasani, Ana Maria Medina
Journal: Autops Case Rep (2021)
Keywords: case reports, congenital abnormalities, constipation, diverticulum, colon
MeSH terms: Case Reports

Background:
Intestinal duplications are rare congenital developmental anomalies with an incidence of 0.005-0.025% of births. They are usually identified before 2 years of age and commonly affect the foregut or mid-/hindgut. However, it is very uncommon for these anomalies, to arise in the colon or present during adulthood.
Case presentation:
Herein, we present a case of a 28-year-old woman with a long-standing history of constipation, tenesmus, and rectal prolapse. Colonoscopy results were normal. An abdominal computed tomography (CT) revealed a diffusely mildly dilated redundant colon, which was prominently stool-filled. The gastrografin enema showed ahaustral mucosal appearance of the sigmoid and descending colon with findings suggestive of tricompartmental pelvic floor prolapse, moderate-size anterior rectocele, and grade 2 sigmoidocele. A laparoscopic exploration was performed, revealing a tubular duplicated colon at the sigmoid level. A sigmoid resection rectopexy was performed. Pathologic examination supported the diagnosis. At 1-month follow-up, the patient was doing well without constipation or rectal prolapse.
Conclusions:
Tubular colonic duplications are very rare in adults but should be considered in the differential diagnosis of chronic constipation refractory to medical therapy. Due to the non-specific manifestations of this entity, it is rather challenging to make an accurate diagnosis pre-operatively. Surgery remains the mainstay of treatment. Some reports suggest that carcinomas are more prone to develop in colonic/rectal duplications than in other GI tract duplications.
Thigh Abscess Caused by Yersinia enterocolitica in an Immunocompetent Host
Authors: Purva Gumaste, V Subbarao Boppana, Amarinder Singh Garcha, Donald Blair
Journal: Case Rep Med (2012)
MeSH terms: Case Reports

Yersinia enterocolitica is primarily a gastrointestinal tract pathogen known to cause gastroenteritis, although it may produce extra-intestinal infections like sepsis and its sequelae. However, primary cutaneous infections are extremely rare. We present a case of Y. enterocolitica thigh abscess in an immunocompetent adult. The portal of entry is unclear in this case. He did many outdoor activities that involved skin injuries and exposure to soil and contaminated water. Hence, direct inoculation as a result of exposure to contaminated water is postulated in the absence of evidence for a gastrointestinal route of infection.
Electronic and manual registration of Manchester System: reliability, accuracy, and time evaluation
Authors: Emilia Aparecida Cicolo, Heloísa Helena Ciqueto Peres
Journal: Rev Lat Am Enfermagem (2019)
MeSH terms: Emergency Nursing / standards, Triage / methods, Adult, Data Accuracy, Emergency Nursing / methods, Emergency Service, Hospital / organization & administration, Emergency Service, Hospital / statistics & numerical data, Female, Humans, Male, Medical Informatics, Middle Aged, Reproducibility of Results

Objective:
to evaluate the degree of reliability, accuracy and timing to perform the Manchester Triage System in electronic and manual records.
Method:
exploratory-descriptive research. Case series corresponded to a total of 20 validated simulated clinical cases applied to a sample of 10 nurses. For data collection each participant received 4 clinical cases in 2 different phases of the study, using manual and electronic registration. The variables related to the triage were: incomplete data filling, discriminator, flowchart, priority level, vital signs and triage timing.
Results:
moderate reliability for choosing flowcharts and substantial reliability for determining discriminators in both records; substantial and moderate, for priority, respectively, in manual and electronic registration. For vital signs, it was weak in manual recording and substantial in electronic. Accuracy showed a statistically significant difference related to vital signs. The average timing on triage was shorter with the use of electronic registration.
Conclusion:
the use of electronic registration has advantages regarding reliability, accuracy and timing to perform the triage, pointing to the importance of adopting technologies in the management and care work process in health services.
The pathology of severe dengue in multiple organs of human fatal cases: histopathology, ultrastructure and virus replication
Authors: Tiago F Póvoa, Ada M B Alves, Carlos A B Oliveira, Gerard J Nuovo, Vera L A Chagas, Marciano V Paes
Journal: PLoS One (2014)
MeSH terms: Dengue Virus, Severe Dengue / pathology, Severe Dengue / virology, Case Reports, Research Support, Non-U.S. Gov't, Adult, Fatal Outcome, Female, Heart / virology, Humans, Kidney / pathology, Kidney / ultrastructure, Kidney / virology, Liver / pathology, Liver / ultrastructure, Liver / virology, Lung / pathology, Lung / ultrastructure, Lung / virology, Male, Middle Aged, Myocardium / pathology, Myocardium / ultrastructure, Severe Dengue / diagnosis, Spleen / pathology, Spleen / ultrastructure, Spleen / virology, Virus Replication, Young Adult

Dengue is a public health problem, with several gaps in understanding its pathogenesis. Studies based on human fatal cases are extremely important and may clarify some of these gaps. In this work, we analyzed lesions in different organs of four dengue fatal cases, occurred in Brazil. Tissues were prepared for visualization in optical and electron microscopy, with damages quantification. As expected, we observed in all studied organ lesions characteristic of severe dengue, such as hemorrhage and edema, although other injuries were also detected. Cases presented necrotic areas in the liver and diffuse macro and microsteatosis, which were more accentuated in case 1, who also had obesity. The lung was the most affected organ, with hyaline membrane formation associated with mononuclear infiltrates in patients with pre-existing diseases such as diabetes and obesity (cases 1 and 2, respectively). These cases had also extensive acute tubular necrosis in the kidney. Infection induced destruction of cardiac fibers in most cases, with absence of nucleus and loss of striations, suggesting myocarditis. Spleens revealed significant destruction of the germinal centers and atrophy of lymphoid follicles, which may be associated to decrease of T cell number. Circulatory disturbs were reinforced by the presence of megakaryocytes in alveolar spaces, thrombus formation in glomerular capillaries and loss of endothelium in several tissues. Besides histopathological and ultrastructural observations, virus replication were investigated by detection of dengue antigens, especially the non-structural 3 protein (NS3), and confirmed by the presence of virus RNA negative strand (in situ hybridization), with second staining for identification of some cells. Results showed that dengue had broader tropism comparing to what was described before in literature, replicating in hepatocytes, type II pneumocytes and cardiac fibers, as well as in resident and circulating monocytes/macrophages and endothelial cells.
Brain-Computer Interface Priming for Cervical Transcutaneous Spinal Cord Stimulation Therapy: An Exploratory Case Study
Authors: Ciarán McGeady, Aleksandra Vučković, Niraj Singh Tharu, Yong-Ping Zheng, Monzurul Alam
Journal: Front Rehabil Sci (2022)
Keywords: brain-computer interface, motor priming, neuromodulation, rehabilitation, spinal cord injury, transcutaneous spinal cord stimulation

Loss of arm and hand function is one of the most devastating consequences of cervical spinal cord injury (SCI). Although some residual functional neurons often pass the site of injury, recovery after SCI is extremely limited. Recent efforts have aimed to augment traditional rehabilitation by combining exercise-based training with techniques such as transcutaneous spinal cord stimulation (tSCS), and movement priming. Such methods have been linked with elevated corticospinal excitability, and enhanced neuroplastic effects following activity-based therapy. In the present study, we investigated the potential for facilitating tSCS-based exercise-training with brain-computer interface (BCI) motor priming. An individual with chronic AIS A cervical SCI with both sensory and motor complete tetraplegia participated in a two-phase cross-over intervention whereby they engaged in 15 sessions of intensive tSCS-mediated hand training for 1 h, 3 times/week, followed by a two week washout period, and a further 15 sessions of tSCS training with bimanual BCI motor priming preceding each session. We found using the Graded Redefined Assessment for Strength, Sensibility, and Prehension that the participant's arm and hand function improved considerably across each phase of the study: from 96/232 points at baseline, to 117/232 after tSCS training alone, and to 131/232 points after BCI priming with tSCS training, reflecting improved strength, sensation, and gross and fine motor skills. Improved motor scores and heightened perception to sharp sensations improved the neurological level of injury from C4 to C5 following training and improvements were generally maintained four weeks after the final training session. Although functional improvements were similar regardless of the presence of BCI priming, there was a moderate improvement of bilateral strength only when priming preceded tSCS training, perhaps suggesting a benefit of motor priming for tSCS training.
The Serious Impact of Comorbidities on Methemoglobinemia: A Case Report
Authors: Antonio Eliseu, Carolina Palma, Margarida Agudo, Miguel Rodrigues, Francisca Santos
Journal: Cureus (2023)
Keywords: altered mental status, comorbidities, methemoglobinemia, respiratory failure, status epilecticus
MeSH terms: Case Reports

Methemoglobinemia is a rare, life-threatening condition that occurs when the body is exposed to oxidative stress. We present the case of a 72-year-old female with a past medical history of hypertension, obesity, dyslipidemia, and heart failure who was admitted to the emergency department with altered mental status and respiratory failure. After admission, we also identified an atrioventricular block 2:1, anemia, and skin discoloration. We performed endotracheal intubation and started mechanical ventilation due to respiratory failure; however, the patient retained an oxygen "saturation gap" despite adequate ventilation. In the initial laboratory evaluation, methemoglobinemia was found to be 13%, reaching a maximum level of 16%. An electroencephalogram revealed status epilepticus after her admission to the intensive care unit. Despite all efforts and supportive care, methylene blue therapy was never attempted, and the patient died. Our case emphasizes the importance of a high index of suspicion for methemoglobinemia, especially in the presence of an oxygen "saturation gap," and that despite relatively low levels of methemoglobinemia, it can have a more severe clinical presentation in patients with comorbidities. In these patients, a reduced threshold for administering methylene blue should be taken into account.
18q22.1-qter deletion and 4p16.3 microduplication in a boy with speech delay and mental retardation: case report and review of the literature
Authors: Chunjing Wang, Huanhuan Ren, Huaifu Dong, Meng Liang, Qi Wu, Yaping Liao
Journal: Mol Cytogenet (2018)
Keywords: 18q221 deletion, 4p163 duplication, facial dysmorphisms, mental retardation, speech delay
MeSH terms: Case Reports

Background:
Deletions involving the long arm of chromosome 18 have been associated with a highly variable phenotypic spectrum that is related to the extent of the deleted region. Duplications in chromosomal region 4p16.3 have also been shown to cause 4p16.3 microduplication syndrome. Most reported patients of trisomy 4p16.3 have more duplications, including the Wolf-Hirschhorn critical region (WHSCR). Here, we present a patient with speech delay and mental retardation caused by a deletion of 18q (18q22.1-qter) and terminal microduplication of 4p (4p16.3-pter) distal to WHSCR.
Case presentation:
The patient was a 23-month-old boy with moderate growth retardation, severe speech delay, mental retardation, and dysmorphic features. Single nucleotide polymorphism (SNP) array analysis confirmed an 11.2-Mb terminal deletion at 18q22.1 and revealed a 1.8-Mb terminal duplication of 4p16.3. Our patient showed clinical overlap with these two syndromes, although his overall features were milder than what had been previously described. Some dosage-sensitive genes on the 18q terminal deleted region and 4p16.3 duplicated region of the present case may have contributed to his phenotype.
Conclusions:
This is the first report of a patient with combined terminal deletion of 18q22.1 and duplication of 4p16.3. In this report, we provide clinical and molecular evidence supporting that the microduplication in 4p16.3, distal to WHSCR, is pathogenic. The coexistence of two chromosome aberrations complicates the clinical picture and creates a chimeric phenotype. This report provides further information on the genotype-phenotype correlation of 18q terminal deletion and 4p microduplication.
Case Report: Therapeutic Strategy With Delayed Debridement for Culture-Negative Invasive Group A Streptococcal Infections Diagnosed by Metagenomic Next-Generation Sequencing
Authors: Wenfang He, Chenfang Wu, Yanjun Zhong, Jinxiu Li, Guyi Wang, Bo Yu, Ping Xu, Yiwen Xiao, Tiantian Tang
Journal: Front Public Health (2022)
Keywords: clindamycin, intravenous immunoglobulin, invasive group a streptococcal infections, next-generation sequencing, streptococcal toxic shock syndrome
MeSH terms: Shock, Septic / diagnosis, Shock, Septic / microbiology, Shock, Septic / therapy, Streptococcal Infections / drug therapy, Streptococcal Infections / therapy, Case Reports, Research Support, Non-U.S. Gov't, Adult, Anti-Bacterial Agents / therapeutic use, Clindamycin / therapeutic use, Debridement, High-Throughput Nucleotide Sequencing, Humans, Immunoglobulins, Intravenous / therapeutic use, Male, Streptococcus pyogenes, Anti-Bacterial Agents, Immunoglobulins, Intravenous, Clindamycin

Streptococcal toxic shock syndrome (STSS) caused by group A streptococcus is a rare condition that rapidly developed to multiple organ failure even death. Therefore, prompt diagnosis, initiate appropriate antibiotics and other supportive treatments are critical. Here we reported a case of STSS caused by group A streptococcus infection. A healthy 39-year-old man presented a sudden pain in the left lower extremity, followed by a high fever (40.0 °C) with dizziness, nausea, and shortness of breath. Twenty-four hours before the visit, the patient showed anuria. The patient was then admitted to the intensive care unit. Blood examination revealed elevated levels of inflammatory markers and creatinine. He suffered from septic shock, dysfunction of coagulation, acute kidney dysfunction, acute respiratory distress syndrome, and acute liver function injury. The diagnosis was obtained through clinical manifestation and metagenomic next-generation sequencing (mNGS) drawn from the pustule and deep soft tissue (lower limb) samples while all bacterial cultures came back negative. The pustule mNGS report detected a total of 132 unique group A streptococcus sequence reads, representing 96.3% of microbial reads while the soft tissue mNGS report identified a total of 142474 unique group A streptococcus sequence reads, representing 100% of microbial reads. The patient was treated with aggressive fluid resuscitation, antibiotics comprising piperacillin/tazobactam and clindamycin, respiratory support, following the delayed surgical debridement. Intravenous immunoglobulin was also used for 5 days. On the 14th day after admission, he was transferred to the general ward for follow-up treatment. Our case highlighted, for the first time, the key role of mNGS in the early diagnosis of culture-negative invasive group A streptococcal infection. The case also suggested that clindamycin combined with beta-lactam antibiotics and adjunction of intravenous immunoglobulin therapy with delayed debridement performed well in the management of unstable STSS patients.