OpenMed/multicare-articles huggingface dataset:
Quality optimisation in colonoscopy: a function of time of colonoscopy or bowel preparation
Authors: Haytham Abudeeb, Khurram Khan, Min Maung, Lee Malcomson, Alistair Brown
Journal: Pan Afr Med J (2019)
Keywords: colonoscopy, bowel preparation, incomplete, poor bowel preparation
MeSH terms: Cathartics / administration & dosage, Colonoscopy / methods, Polyethylene Glycols / administration & dosage, Case Reports, Adult, Aged, Aged, 80 and over, Drug Administration Schedule, Female, Humans, Male, Middle Aged, Preoperative Care / methods, Retrospective Studies, Time Factors, Treatment Failure, Young Adult, Cathartics, MoviPrep, Polyethylene Glycols

To test the hypothesis claimed in recent studies that quality of bowel preparation for colonoscopy could be influenced by the time of the day colonoscopy is performed. Do patients in morning list have better bowel preparation than those on the afternoon list? Retrospective analysis of 736 consecutive patients who had colonoscopy from 1st August to 31st December 2012. Patients with poor bowel preparation (Boston Bowel Prep Score 6 or less) were identified (n = 242). Colonoscopy reports of these patients analysed. Patients were stratified into two groups (am and pm) and results compared. Mean patient age 63.9 years (range 19-89). Male to female ratio 1:1. 92% of patients were given Moviprep. for bowel preparation. 32.9% (242/736) of patients were identified as having inadequate bowel preparation. 37.7% of morning list patients had poor bowel preparation. 26.7% of afternoon list patients had poor bowel preparation. 14.7% (108/736) had incomplete colonoscopy, of which 26.9% (29/108) were due to poor bowel preparation. The commonest reasons for incomplete examination were patient discomfort & bowel looping. Our study demonstrates that morning session patients had poorer bowel preparation than the afternoon session patients in contrast to published evidence in recent literature. This implies that timing of bowel preparation is probably more important than timing of colonoscopy. Poor bowel preparation does not seem to have a significant impact on the colonoscopy failure rate in this series.
Disseminated Granulomatous Disease from Intravesical Instillation of Bacillus Calmette-Guerin
Authors: Sayed Ab Reshad Ghafouri, Alexander Brun, Rohit Bhalla, Craig Margulies, Kevin Skole
Journal: Case Rep Oncol Med (2018)
MeSH terms: Case Reports

Intravesical instillation of Bacillus Calmette-Guerin is one of the standard treatment options for superficial bladder cancer. While Bacillus Calmette-Guerin therapy is usually well tolerated with most patients experiencing only cystitis, in rare cases, it can lead to disseminated granulomatous disease. We present a case of a 72-year-old man with disseminated granulomatous disease from intravesical BCG instillation whose treatment was complicated by antimycobacterial drug toxicity.
Myeloma cells with asurophilic granules--an unusual morphological variant--case presentation
Authors: Ana Maria Vlădăreanu, Diana Cîşleanu, Mihaela Derveşteanu, Minodora Onisâi, Horia Bumbea, Sînziana Radeşi, Mădălina Begu, Băluţă Cristina
Journal: J Med Life (2008)
MeSH terms: Bone Marrow Cells / pathology, Multiple Myeloma / pathology, Plasma Cells / pathology, Case Reports, Aged, 80 and over, Cytoplasmic Granules / pathology, Fractures, Spontaneous / pathology, Humans, Inclusion Bodies / pathology, Magnetic Resonance Imaging, Male, Multiple Myeloma / diagnostic imaging, Radiography, Spinal Fractures / pathology

We present the case of an 80-year-old man who was admitted for anemia, back pain and progressive weakness. After a workup of clinical and laboratory data, the final diagnosis was multiple myeloma. The bone marrow aspirate revealed 53% myeloma cells with peculiar and rare morphological features: numerous large asurophilic--bright red granules--mucopolizaccharides and immunoglobulins secreted and accumulated in the endoplasmic reticulum, typically known as Russel bodies.
ECMELLA as a bridge to heart transplantation in refractory ventricular fibrillation: A case report
Authors: Raphaël Giraud, Benjamin Assouline, Haran Burri, Dipen Shah, Philippe Meyer, Sophie Degrauwe, Matthias Kirsch, Karim Bendjelid
Journal: Front Cardiovasc Med (2023)
Keywords: ecmella, impella, va-ecmo, cardiac arrest, heart transplantation, refractory ventricular fibrillation
MeSH terms: Case Reports

Background:
Extracorporeal membrane oxygenation (ECMO) is an effective cardiorespiratory support technique in refractory cardiac arrest (CA). In patients under veno-arterial ECMO, the use of an Impella device, a microaxial pump inserted percutaneously, is a valuable strategy through a left ventricular unloading approach. ECMELLA, a combination of ECMO with Impella, seems to be a promising method to support end-organ perfusion while unloading the left ventricle.
Case summary:
The present case report describes the clinical course of a patient with ischemic and dilated cardiomyopathy who presented with refractory ventricular fibrillation (VF) leading to CA in the late postmyocardial infarction (MI) period, and who was successfully treated with ECMO and IMPELLA as a bridge to heart transplantation.
Discussion:
In the case of CA on VF refractory to conventional resuscitation maneuvers, early extracorporeal cardiopulmonary resuscitation (ECPR) associated with an Impella seems to be the best strategy. It provides organ perfusion, left ventricular unloading, and ability for neurological evaluation and VF catheter ablation before allowing heart transplantation. It is the treatment of choice in cases of end-stage ischaemic cardiomyopathy and recurrent malignant arrhythmias.
Mechanisms Underlying Improvement in Obstructive Sleep Apnea Syndrome by Uvulopalatopharyngoplasty
Authors: Takahisa Yamamoto, Naoko Fujii, Yoichi Nishimura, Noboru Iwata, Seiichi Nakata
Journal: Case Rep Otolaryngol (2017)
MeSH terms: Case Reports

In a previous case report, we determined for the first time that uvulopalatopharyngoplasty (UPPP) does not change the volume of the upper airway but causes morphological changes in the entire upper airway. The objective of this study is to elucidate the mechanisms underlying the improvement in obstructive sleep apnea syndrome (OSAS) by UPPP. We present an additional case involving a patient with OSAS treated using UPPP. Morphological and numerical parameter changes after surgery were compared with the corresponding preoperative values. Anatomically accurate upper airway computational models were reconstructed from computed tomographic imaging data. In addition, computed fluid dynamics analysis was performed to reveal inhalation flow characteristics before and after UPPP and clearly assess the effect of UPPP on airflow patterns in the patient's upper airway. An important benefit of UPPP is the morphological changes in the entire upper airway, in addition to widening the restricted area. These morphological changes induce laminarization of the pharyngeal jet. To obtain sufficient efficacy of UPPP in OSAS, the morphological changes in the upper airway and the airflow pattern after the surgery must be controlled.
Newborn with Gastroschisis associated with Limb Anomalies
Authors: Phyu Phyu Win
Journal: J Neonatal Surg (2017)
Keywords: gastroschisis, limb anomalies, maternal age, newborn
MeSH terms: Case Reports

Gastroschisis is often found together with other extra intestinal conditions such as limb, spine, cardiac, central nervous system and genitourinary abnormalities. There are reports of its association with young maternal age. The cases presented here highlight the association of gastroschisis with limbs anomalies and young maternal age.
Pulmonary Langerhans Cell Histiocytosis with Lytic Bone Involvement in an Adult Smoker: Regression following Smoking Cessation
Authors: B Routy, J Hoang, J Gruber
Journal: Case Rep Hematol (2015)

Langerhans cell histiocytosis (LCH) is a rare myeloid neoplasm characterized by the proliferation and dissemination of histiocytes. These in turn may cause symptoms ranging from isolated, infiltrative lesions to severe multisystem disease. Pulmonary Langerhans cell histiocytosis (PLCH) presents as a localized polyclonal proliferation of Langerhans cells in the lungs causing bilateral cysts and fibrosis. In adults, this rare condition is considered a reactive process associated with cigarette smoking. Recently, clonal proliferation has been reported with the presence of BRAF V600E oncogenic mutation in a subset of PLCH patients. Spontaneous resolution was described; however, based on case series, smoking cessation remains the most effective way to achieve complete remission and prevent long term complications related to tobacco. Herein, we report the case of an adult woman with biopsy-proven PLCH presenting with thoracic (T8) vertebral bone destruction. Both the lung and the bone diseases regressed following smoking cessation, representing a rare case of synchronous disseminated PCLH with bone localization. This observation underscores the contribution of cigarette smoking as a systemic trigger of both pulmonary and extrapulmonary bone lesions. A review of similar cases in the literature is also presented.
A patient with features of albright hereditory osteodystrophy and unusual neuropsychiatric findings without coding Gsalpha mutations
Authors: Shirin Hasani-Ranjbar, Zahra Jouyandeh, Mahsa Mohammad Amoli, Akbar Soltani, Seyed Masoud Arzaghi
Journal: J Diabetes Metab Disord (2014)
Keywords: albright hereditory osteodystrophy, gnas mutation, pseudohypoparathyroidism, pseudopseudohypoparathyroidism
MeSH terms: Case Reports

Background:
Pseudohypoparathyroidism(PHP) is a heterogeneous group of rare metabolic disorders characterized by hypocalcemia and hyperphosphatemia resulting from PTH resistance. Different forms of PHP have been reported based on biochemical and clinical manifestation and genetic findings. Most of these forms are caused by defects in GNAS, an imprinted gene locus with multiple subunits. We reported a 12- year- old girl with unusual clinical manifestations of Pseudopseudohypoparathyroidism(PPHP).
Methods:
After clinical and biochemical evaluations, the patients' genomic DNA was isolated from peripheral blood leukocytes using salting out method. The whole coding sequences of GNAS gene including 13 exons were amplified by PCR. Quantitative PCR reactions were performed too.
Findings:
We described a 12- year- old girl with Albright Hereditory osteodystrophy (AHO) phenotype, poor school performance, some abnormal movements, TSH resistance with normal serum calcium and phosphorus levels and normal Gsα bioactivity with no mutation in GNAS exons. Unusual neuropsychiatric findings in this patient were compatible with Asperger syndrome.
Conclusions:
According to our findings this patient could not be categorized in any of PHP subgroups. Identifying of such individuals may be useful to discover different genetic patterns in pseudohypoparathyroidism and pseudopseudohypoparathyroidism. It is important to identify patients in whom PHP is caused by novel GNAS mutations, as careful investigations of these findings will likely further our knowledge of this complex and this unique disorder. In addition this case presented with unusual neuropsychiatric findings which has not been reported up to now.
Gout in a 15-year-old boy with juvenile idiopathic arthritis: a case study
Authors: Hallie Morris, Kristen Grant, Geetika Khanna, Andrew J White
Journal: Pediatr Rheumatol Online J (2014)
MeSH terms: Allopurinol / administration & dosage, Ankle Joint / pathology, Ankle Joint / physiopathology, Arthritis, Gouty / blood, Arthritis, Gouty / complications, Arthritis, Gouty / diagnosis, Arthritis, Gouty / physiopathology, Arthritis, Gouty / therapy, Arthritis, Juvenile / diagnosis, Colchicine / administration & dosage, Obesity / complications, Osteochondritis Dissecans / diagnosis, Osteochondritis Dissecans / therapy, Uric Acid / blood, Case Reports, Adolescent, Delayed Diagnosis, Diagnosis, Differential, Gout Suppressants / administration & dosage, Humans, Magnetic Resonance Imaging, Male, Orthopedic Procedures / methods, Severity of Illness Index, Time-to-Treatment, Treatment Failure, Gout Suppressants, Uric Acid, Allopurinol, Colchicine

Joint pain is a common complaint in pediatrics and is most often attributed to overuse or injury. In the face of persistent, severe, or recurrent symptoms, the differential typically expands to include bony or structural causes versus rheumatologic conditions. Rarely, a child has two distinct causes for joint pain. In this case, an obese 15-year-old male was diagnosed with gout, a disease common in adults but virtually ignored in the field of pediatrics. The presence of juvenile idiopathic arthritis (JIA) complicated and delayed the consideration of this second diagnosis. Indeed, the absence of gout from this patient's differential diagnosis resulted in a greater than two-year delay in receiving treatment. The patients' BMI was 47.4, and he was also mis-diagnosed with osteochondritis dissecans and underwent medical treatment for JIA, assorted imaging studies, and multiple surgical procedures before the key history of increased pain with red meat ingestion, noticed by the patient, and a subsequent elevated uric acid confirmed his ultimate diagnosis. With the increased prevalence of obesity in the adolescent population, the diagnosis of gout should be an important consideration in the differential diagnosis for an arthritic joint in an overweight patient, regardless of age.
Myxoid Plexiform Fibrohistiocytic Tumor Masquerading as Ganglion Cyst: A Case Report and Literature Review
Authors: Chih-Yi Liu, Jui Lan, Hsuan-Ying Huang
Journal: Case Rep Pathol (2017)
MeSH terms: Case Reports

Background. Plexiform fibrohistiocytic tumor is a distinctive mesenchymal neoplasm of low-grade malignancy, with the capacity for biphasic differentiation toward a fibroblastic or histiocyte-like morphology. Clinically, these lesions affect different areas of the body and appear as painless, slowly growing, dermal or subcutaneous masses. To date, only three cases of myxoid variant have been reported in the English literature. Case Presentation. A 45-year-old female patient presented with a subcutaneous nodule in the right popliteal fossa. The initial impression was a benign ganglion cyst. The soft tissue tumor has been treated by local excision. The histopathological and the immunohistochemical findings supported the diagnosis of myxoid plexiform fibrohistiocytic tumor. The postoperative course was uneventful, and the patient received regular follow-up examination. She is alive without any recurrence. Conclusions. This case demonstrates how to distinguish this distinctive plexiform fibrohistiocytic tumor from other problematic soft tissue tumors. It is also remarkable for its rarely reported extensive myxoid change. Currently, there is no clear-cut correlation between the clinicopathologic findings and the behavior of this unusual variant.
Xanthogranulomatous Salpingooophoritis: The Youngest Documented Case Report
Authors: Harshawardhan Tanwar, Avinash Joshi, Vinayak Wagaskar, Siddharth Kini, Manoj Bachhav
Journal: Case Rep Obstet Gynecol (2015)

Background. Xanthogranulomatous inflammation is an uncommon affection of the female genital tract. The youngest case reported of xanthogranulomatous salpingooophoritis in literature was by Shilpa et al. in 2013 in an eighteen-year-old female. Case Report. We report a case of 2-year-old female child with right-sided xanthogranulomatous salpingooophoritis presented as mass in abdomen. This is a case report of the youngest documented case of xanthogranulomatous salpingooophoritis in literature. As per abdominal examination, there was generalized distention of abdomen and a mass was palpable which was arising out of pelvis more on the right side. The ultrasonography (USG) abdomen and pelvis revealed a thick-walled mass measuring 9.2 cm × 6.0 cm × 7.6 cm in pelvis. We did right salpingooophorectomy of the patient. On histopathology, the diagnosis of xanthogranulomatous salpingooophoritis was confirmed. Conclusion. Clinical presentation, radiological appearance, and gross features of xanthogranulomatous lesions of ovary can mimic neoplastic lesions and lead to misdiagnosis. Though, it is very rare in pediatric age group, xanthogranulomatous salpingooophoritis as one of the differential diagnoses should be kept in mind while dealing with tuboovarian masses in this age group.
Metastatic renal cell carcinoma in an ovarian benign mixed mucinous cystadenoma and brenner tumour: a case report
Authors: Amar Ibrahim, Mohammad Salih Al-Jafari
Journal: Case Rep Pathol (2012)

This is a case of a 71-year-old woman, who presented with a large abdominal mass. Microscopic examination revealed metastatic renal cell carcinoma in an otherwise massively enlarged benign ovarian tumour of mixed mucinous cystadenoma and Brenner tumour. Clinicopathological and radiological assessment together with a thorough evaluation of gross and histological features, including the use of immunohistochemical stains, is essential to confirm the diagnosis and rule out the possibility of primary clear cell carcinoma of ovary, as this has important prognostic and therapeutic implications.
Gastrointestinal bleeding after endoscopic mucosal resection in a case of Peutz-Jeghers syndrome with hypofibrinogenemia: A case report
Authors: Toshihiko Kakiuchi, Hironobu Takedomi, Takashi Akutagawa, Nanae Tsuruoka, Yasuhisa Sakata, Muneaki Matsuo
Journal: Front Pediatr (2022)
Keywords: peutz–jeghers syndrome, complications, endoscopic mucosal resection, gastrointestinal hemorrhage, hypofibrinogenemia
MeSH terms: Case Reports

Backgroud:
Peutz-Jegers syndrome (PJS) is an autosomal dominant hereditary disorder characterized by hamartomatous polyposis of the entire gastrointestinal tract. Fibrinogen (Fbg) is synthesized by the liver, and hypofibrinogenemia is often asymptomatic and manifests with bleeding after trauma or invasive surgical procedures. Here, we present a case of a pediatric patient with PJS and hypofibrinogenemia who manifested with gastrointestinal bleeding after endoscopic mucosal resection (EMR) of small intestinal polyps.
Case presentation:
An 11-year-old boy with PJS was referred to our hospital. Since his mother was diagnosed with PJS, with black pigments being observed on his lips, mouth, and limbs, he underwent upper and lower gastrointestinal endoscopy at the age of 8 years at a previous hospital. EMR for duodenal polyp was performed, and the pathological findings were consistent with hamartoma. His Fbg level was 117 mg/dl at the time, with no post-bleeding being detected after EMR. The small intestine was not assessed at the prior facility and was left neglected for three years. At our hospital, small intestine fluoroscopy was performed and revealed a polyp in the jejunum, and abdominal computed tomography showed two polyps and intussusception. On double-balloon enteroscopy, the resected polyps were hamartoma with diameters of 20 and 30 mm. The patient's Fbg level was 107 mg/dl. The day after EMR, he had melena and black stools. He was diagnosed with post-EMR bleeding and started to stop eating, and hemostatic agents were given. His hemoglobin level dropped to 9.2 g/dl the next day. Genetic testing for congenital Fbg deficiency revealed a heterozygous pathogenic variant in fibrinogen gamma chain Exon 10. Therefore, he was diagnosed with concurrent hypofibrinogenemia and PJS.
Conclusion:
To the best of our knowledge, this is the first reported case with concurrent PJS and hypofibrinogenemia. In patients with PJS, hypofibrinogenemia should be considered as one of the risk factors of postoperative bleeding during polypectomy, and appropriate prophylactic measures should be taken.
Multifocal Arterial Thrombosis during Thalidomide Therapy: Case Report and Review of the Literature
Authors: Monica Ferri, Gianluca Faggioli, Francesca Fratesi, Andrea Stella
Journal: Case Rep Med (2009)
MeSH terms: Case Reports

Introduction. Thalidomide has been associated with both venous and arterial thrombotic events. Case Presentation. A 66-years old man during thalidomide therapy for myeloma experienced acute right arm ischemia, emergently treated with thrombectomy and, on postoperative day one left side weakness with right internal carotid thrombosis. Discussion. Because of the increased risk of arterial thrombosis complication, prophylactic therapy with ASA or anticoagulation during thalidomide administration is mandatory.
Mixed adenoneuroendocrine carcinoma of the gastric stump following Billroth II gastrectomy: case report and review of the literature
Authors: Everton Cazzo, Helena Paes de Almeida de Saito
Journal: Sao Paulo Med J (2016)
MeSH terms: Adenocarcinoma / surgery, Carcinoma, Neuroendocrine / surgery, Gastric Stump / surgery, Mixed Tumor, Malignant / surgery, Stomach Neoplasms / surgery, Case Reports, Review, Adenocarcinoma / therapy, Aged, 80 and over, Carcinoma, Neuroendocrine / therapy, Chemoradiotherapy, Adjuvant / methods, Female, Gastroenterostomy, Humans, Mixed Tumor, Malignant / therapy, Stomach Neoplasms / therapy

Context:
Gastric stump cancer after gastric resection is a well-known disease. It may be a newly developed cancer after resection due to benign disease, or recurrent or residual disease after oncological surgery. The predominant histological type is usually adenocarcinoma. This study aimed to report on a rare occurrence of a mixed adenoneuroendocrine carcinoma (MANEC) on the gastric stump.
Case report:
The case of an 83-year-old female who presented a locally aggressive gastric stump MANEC, 35 years after Billroth II gastrectomy to treat a peptic ulcer, is reported. The patient underwent resection and adjuvant therapy. She has been followed up for one year without signs of recurrence.
Conclusion:
MANEC is a rare type of gastrointestinal neoplasm. The classification, histopathology, clinical features, treatment issues and prognosis are discussed along with a brief review of the literature.
Gastric Kaposi sarcoma presenting as an upper gastrointestinal bleeding in a non-AIDS patient
Authors: Elahe Zanganeh, Seyed Ashkan Hosseini, Mehdi Alimadadi, Mohammadreza Seyyedmajidi
Journal: Caspian J Intern Med (2021)
Keywords: kaposi sarcoma, non-aids, upper gastrointestinal bleeding
MeSH terms: Case Reports

Background:
Majority of the patients affected by Kaposi sarcoma (KS) have human immunodeficiency virus (HIV). Highly active antiretroviral therapy (HAART) lessened the incidence of AIDS (acquired immunodeficiency syndrome)- related KS. Cutaneous signs are the most common, but involving the gastrointestinal (GI) tract is very important and dangerous because of serious complications including perforation and bleeding.
Case presentation:
This report is a rare case of gastric-KS presenting as melena in a non-AIDS 67-year-old woman. We describe the diagnosis and management of this rare complication.
Conclusion:
GI-KS is often asymptomatic with different endoscopic appearances, and maybe present without cutaneous lesions. Thus, a high diagnostic suspicion is needed and we should attend these GI complications.