OpenMed/multicare-articles huggingface dataset:
Case Report: Revisiting the Internal Mammary Artery Perforator Flap: Salvage Option for Circumferential Pharyngo-Esophageal Defects
Authors: Nicholas Marsden, Lipi Shukla, Damien Grinsell
Journal: Front Surg (2021)
Keywords: imap flap, fistula, pharyngo-esophageal reconstruction, radiotherapy, stricture
MeSH terms: Case Reports

Patients that present with pharyngeal strictures and pharyngocutaneous fistulas in the context of previous reconstruction and post-operative radiotherapy often report significant morbidity and reduction in quality of life. Reconstruction of such defects present a substantial clinical challenge requiring the importation of unirradiated vascularized tissue to facilitate healing in a friable, fibrotic, and vessel depleted tissue bed. The authors present a case report demonstrating an adaptation of the internal mammary artery perforator (IMAP) flap for reliable reconstruction of circumferential pharyngeal defects with primary tension free closure of the donor site. This technique avoids the use of free tissue transfer in a hostile, irradiated neck. The tubed IMAP flap is an excellent option, serving the purposes of reconstruction as well as addressing the patient's presenting issues of a chronic sinus and pharyngeal stricture inhibiting oral intake.
Isolated cortical blindness without simultaneous neurological involvement in progressive multifocal leukoencephalopathy in a patient with human immune deficiency virus infection
Authors: Vijay Ananth Jeyaraman, Sridharan Sudharshan, Ambika Selvakumar, Shika Bassi, Olma Veena Noronha, Poongulali Selvamuthu, Nagalingeshwaran Kumarasamy, Jyotirmay Biswas
Journal: J Ophthalmic Inflamm Infect (2013)

Background:
This is a case report of cortical blindness in a HIV-positive patient with progressive multifocal leukoencephalopathy (PML) without any other associated neurological dysfunction.
Findings:
Young HIV-positive patient presented to us with sudden profound visual loss. On examination and further investigation, we have diagnosed cortical blindness without any other focal neurological deficit due to PML.
Conclusion:
Our case highlights the fact that PML needs to be suspected in patients with HIV, presenting with cortical blindness even without any other focal neurological defect.
Adrenal Hemangioma: A Case of Retroperitoneal Tumor
Authors: Genta Iwamoto, Kota Shimokihara, Takashi Kawahara, Daiji Takamoto, Masahiro Yao, Jun-Ichi Teranishi, Masako Otani, Hiroji Uemura
Journal: Case Rep Med (2018)
MeSH terms: Case Reports

Introduction:
Adrenal hemangioma is a rare disease, with only some 60 cases reported previously. Due to the difficulty of the preoperative diagnosis of adrenal hemangioma, almost all of the cases were diagnosed by a histopathological analysis of surgical specimens.
Case presentation:
A 52-year-old man was referred to our department for further examination of his left retroperitoneal tumor. He had received hemodialysis due to chronic renal failure resulting from membranous nephropathy. Computed tomography revealed a mass around his left hilum. Magnetic resonance imaging (MRI) and positron-emission tomography (PET)-CT were unable to confirm or deny malignancy, and tumor markers, including CEA and CA19-9, showed slight elevation. His tumor grew from 38 mm to 54 mm in diameter in 7 months of follow-up. We therefore planned retroperitoneal tumor resection with left nephrectomy. Histopathologically, hyperplastic small vessels with hemorrhaging and denaturation were seen. The endothelial cells showed no variants or division of the nucleus. Based on this diagnosis, no further therapy was performed. He has had no recurrence in the eight months since the surgery.
Conclusion:
We herein report a rare case of adrenal hemangioma.
Managing Feline Idiopathic Hypercalcemia With Chia Seeds ( Salvia hispanica L.): A Case Series
Authors: Marco Fantinati, Nathalie Priymenko
Journal: Front Vet Sci (2020)
Keywords: salvia hispanica, cats, chia seeds, hypercalcemia, nutrition
MeSH terms: Case Reports

Background: We describe for the first time the use of chia seeds (Salvia hispanica L.) as a non-pharmacological solution in managing feline idiopathic hypercalcemia when dietary change alone fails. Case Summary: Over a 2-year period of time, three female spayed, middle-aged, Domestic Shorthair cats were diagnosed with idiopathic hypercalcemia. Reason for consultation were lethargy and dysorexia, with a single episode of vomiting described in one cat and dysuria in another. Thorough diagnostic work-up included complete blood count, serum biochemistry, urinalysis, ionized calcium, calcemic hormones, parathyroid hormone-related protein, and imaging of chest and abdomen. Based on different nutritional reasons, each cat was switched to a different high-moisture pet food as first-step in managing the disorder: a high-fiber diet, a diet formulated for chronic kidney disease management and a diet designed to prevent calcium oxalate urolithiasis. In the three cats, 6 weeks of dietary change alone did not result in normocalcemia. Before resorting to any pharmacological solution, supplementation to the diet of chia seeds (2 g/cat/day) was started. After 4 weeks from the introduction of Salvia hispanica L., all cats achieved normalization of ionized calcium concentration. Conclusion: Chia seeds (Salvia hispanica L.) supplementation could be a useful tool in managing feline idiopathic hypercalcemia.
A case report of diffuse hyperplastic gastropathy with multiple polypoid formations in a patient with pernicious anemia, Helicobacter pylori infection, hypergastrinemia and hypoalbuminaemia: Do not forget of Ménétrier's disease
Authors: Daniel Reis Waisberg, Evandro Sobroza de Mello, Francisco Tustumi, Daniel José Szor, Amir Zeide Charruf, Felipe Emanuel Fuhro, Jaques Waisberg, André Roncon Dias
Journal: Int J Surg Case Rep (2020)
Keywords: case report, gastrectomy, hypertrophic gastritis
MeSH terms: Case Reports

Introduction:
Ménétrier's disease is a rare condition, frequently associated with Helicobacter pylori infection, hypergastrinemia and hypoalbuminaemia.
Presentation of the case:
A case of a 55 years-old female patient with a previous diagnosis of pernicious anemia complaining of epigastric discomfort, hyporexia, vomiting, and weight loss is reported. Endoscopy showed multiple gastric polyploid formations and Helicobacter pylori infection was detected. Laboratory tests showed elevated gastrin serum levels and presence of antibodies antiparietal cells, as well as microcytic hypochromic anemia compatible with chronic iron deficiency. Albumin serum level was slightly decreased. Full thickness biopsy performed via echoendoscopy reported gastritis cystica/polyposa profunda. Given the association of diffuse involvement of the entire stomach, the possibility of developing malignant disease and the clinical symptoms, the patient underwent laparoscopic total gastrectomy with Roux-en-Y reconstruction. The surgical specimen showed the mucosa hyperemic and swollen, with prominent gastric folds. Hyperplastic elongation of gastric foveolas associated with disappearance of oxyntic glands was compatible with Ménétrier's disease.
Discussion:
The Ménétrier's disease diagnosis may be tricky, especially when an unusual endoscopic presentation is associated with other conditions that may mislead the diagnostic evaluation. The differential diagnoses were gastric malignancies, Zollinger-Ellison syndrome, massive gastric polyposis and gastritis cystica/polyposa profunda.
Conclusion:
Clinical, laboratory, endoscopic and histopathological findings are paramount for reaching the diagnosis of Ménétrier's disease, but it should be suspected in all cases of upper gastrointestinal symptoms and hypertrophied gastric mucosa.
ATLAS2030 Pediatric Gait Exoskeleton: Changes on Range of Motion, Strength and Spasticity in Children With Cerebral Palsy. A Case Series Study
Authors: Elena Delgado, Carlos Cumplido, Jaime Ramos, Elena Garcés, Gonzalo Puyuelo, Alberto Plaza, Mar Hernández, Alba Gutiérrez, Thomas Taverner, Marie André Destarac, Mercedes Martínez, Elena García
Journal: Front Pediatr (2021)
Keywords: atlas exoskeleton, cerebral palsy, children, range of motion, rehabilitation, robot-assisted gait training, spasticity, strength

Background: Cerebral Palsy (CP), the most common motor disability in childhood, affects individual's motor skills, movement and posture. This results in limited activity and a low social participation. The ATLAS2030 exoskeleton is a pediatric device that enables gait rehabilitation for children with neurological or neuromuscular pathologies with gait pathology. Purpose: To study changes in relation to range of motion (ROM), strength and spasticity in children with CP after using the ATLAS2030 gait exoskeleton. Methods and Participants: Three children (mean age 8.0 ± 2.0), two girls and one boy, two of them with GMFCS IV and one with GMFCS III, received robot-assisted gait training (RAGT) with ATLAS2030 for one month. Results: The average time of exoskeleton use was 54.7 ± 10.4 min in all sessions, and all participants were able to perform all exercises. The strength of all muscle groups was increased after the 10 sessions for the participants assessed and the limited ROM in the sagittal plane (hip and knee extension and ankle dorsiflexion) decreased after the use of the exoskeleton compared to the initial state. Spasticity was reduced at the end of the sessions after the use of the exoskeleton compared to their initial state. Conclusion: The ROM, spasticity and strength were improved after RAGT with ATLAS2030 exoskeleton in these children with CP. However, further studies with larger samples should be carried out to confirm our findings.
Peripheral primitive neuroectodermal tumor associated with paraneoplastic Cushing's syndrome: The rare case
Authors: Mahtab Rahbar, Maryam Rahbar, Gholamreza Bahoush
Journal: Ann Med Surg (Lond) (2018)
Keywords: cushing's disease, paraneoplastic syndrome, peripheral primitive neuroectodermal tumor
MeSH terms: Case Reports

Introduction:
Primitive neuroectodermal tumors (PNET) form a group of tumors defined by their appearance that are thought to develop from primitive (undifferentiated) nerve cells in the brain. They are rare tumors and their incidence is not well defined.
Case presentation:
An 18-month-old male presenting with typical Cushingoid appearance (moon face, central obesity, hirsutism and growth arrest) was admitted for evaluation of endocrine problems. Subsequent laboratory studies revealed markedly elevated adrenocorticotropic (ACTH) and cortisol levels, as well as a hypokalemic metabolic alkalosis, these data are consistent with the diagnosis of Cushing's disease. He was treated with metyrapone to control hypercortisolemia. One month and a half later, a mass was detected in the abdomen by ultrasonography. An abdominal Computed tomography confirmed a large heterogeneous retroperitoneal mass with a significant amount of extension into surrounding structures which was removed by laparoscopic abdominal surgery. The patient's symptoms completely resolved and the ACTH and cortisol levels were also greatly reduced. Histologically, the tumor tissue consistent with the diagnosis of the retroperitoneal primitive neuroectodermal tumor which was confirmed immunohistochemically. This case demonstrates the successful diagnosis and treatment of a rare neoplasm.
Conclusion:
This is the first rare case with ectopic ACTH syndrome caused by the peripheral primitive neuroectodermal tumor.
Cerebral Venous Sinus Thrombosis due to Iron Deficiency Anemia in an Adolescent Girl
Authors: Hussein N Matlik, Nivargi Sagar
Journal: Case Rep Pediatr (2021)
MeSH terms: Case Reports

Cerebral venous sinus thrombosis (CVST) is rare but now increasingly diagnosed in children. Early diagnosis is of prime importance as any delay leads to significant mortality and morbidity. It requires a high index of suspicion to diagnose CVST early as, often, the symptoms are vague and the signs are nonspecific. Varieties of aetiologies are described for generation of cerebral venous sinus thrombus. Iron deficiency anemia is one of the most important preventable causes of CVST. The most proposed mechanism in development of CVST in iron deficiency is secondary thrombocytosis. However, we describe a case of CVST due to iron deficiency in the absence of thrombocytosis.
Catamenial pneumothorax in Ghana: case report and literature review
Authors: Isaac Okyere, Paul Sedem Komla Glover, Paa Kobina Forson, Perditer Okyere, Delali Blood-Dzraku
Journal: Pan Afr Med J (2019)
Keywords: catamenial, catamenial pneumothorax, haemoperitoneum, oral contraceptives, pleurodesis, pneumothorax
MeSH terms: Endometriosis / diagnosis, Pleurodesis / methods, Pneumothorax / diagnosis, Case Reports, Review, Adult, Chest Pain / etiology, Drainage / methods, Female, Ghana, Humans, Menstruation / physiology, Pneumothorax / therapy, Catamenial pneumothorax

Catamenial pneumothorax is a rare condition that is often misdiagnosed. It is defined as spontaneous pneumothorax occurring within 72 hours before or after onset of menstruation. Etiology is unknown but could be linked to endometriosis. Pleural ablation via thoracoscopy and hormonal therapy are mainstay treatment options to avoid recurrence. We present a case of a young adult female who experienced gradual painless abdominal distention that resolved spontaneously after each menses twelve years post menarche. She was first seen at a peripheral facility where laparotomy undertaken was negative for suspected ectopic pregnancy. However, a bleeding omental mass was noticed and a biopsy taken. Histopathology reported it as an endometriotic tissue. The patient subsequently had recurrent cyclical chest pains and breathlessness leading to the diagnosis of catamenial pneumothorax. She had chemical pleurodesis done with sterile talc after chest tube drainage and has been well over two years now.
Bilateral Iris Atrophy after the Femtosecond Assisted Laser In Situ Keratomileusis Surgery
Authors: Kenan Olcay, Akin Cakir, Sercan Koray Sagdic, Eyup Duzgun, Yildiray Yildirim
Journal: Case Rep Ophthalmol Med (2015)

Purpose. To report an unknown complication of laser in situ keratomileusis (LASIK) surgery. Case Presentation. A 28-year-old female presented with photophobia and glare to our eye service. She stated in her medical history that she had undergone femtosecond assisted LASIK surgery in both eyes 15 months ago and her symptoms started just after this surgery. On admission, her best-corrected visual acuity was 10/10 in both eyes. She had mydriatic pupils with no direct light reflex. Examination of the anterior segment revealed bilateral iris atrophy projecting within the LASIK ablation zone and a transillumination defect was remarkable on the slit lamp examination. Conclusion. We hypothesized that this condition may have been caused by the abnormally increased IOP that resulted in ischemia in the iris vascular plexus during the suction process of surgery.
Stroke as an Unusual First Presentation of Lyme Disease
Authors: Mohamad Almoussa, Angelika Goertzen, Barbara Fauser, Christoph W Zimmermann
Journal: Case Rep Neurol Med (2015)

Introduction. Lyme neuroborreliosis is a nervous system infection caused by spirochete Borrelia burgdorferi with diverse neurological complications. Stroke due to cerebral vasculitis is a rare consequence of neuroborreliosis and has been described in just a few case reports. Case Presentation. Here, we report the case of a 43-year-old patient who presented with discrete left-sided hemiparesis and amnestic cognitive impairment. Brain magnetic resonance imaging showed a thalamic infarct, and serological and cerebrospinal fluid (CSF) tests confirmed the diagnosis of active neuroborreliosis. The antibiotic treatment with intravenous ceftriaxone for three weeks led to an improvement of the symptoms and remarkable regression of radiological findings, but not to full recovery of the amnestic cognitive disorder. Conclusion. Lyme neuroborreliosis should be suspected in patients with cerebrovascular events without obvious risk factors, especially those living in endemic areas such as northern Europe or those who have been exposed to ticks and those with clinical or radiological findings suggesting Lyme neuroborreliosis, in order to establish the diagnosis and start a proper antibiotic therapy.
Surgical Management for Refractory Bleb Dysesthesia
Authors: Agnieszka Dyrda, Alfonso Anton, Juan Pablo Figueroa-Vercellino, Marta Pazos
Journal: J Ophthalmol (2020)

Purpose:
To present long-term results of modified bleb-limiting conjunctivoplasty as a successful treatment for intractable bleb dysesthesia and to review the literature on the surgical management of dysesthetic bleb.
Methods:
Consecutive case series and literature review. We present four cases of surgically reduced painful blebs. Our technique consisted of the following steps: (1) conjunctival, radial incision to the bare sclera in the desired limit of the bleb; (2) suturing with buried, interrupted sutures at the nearest edge of the filtering bleb; (3) lower limbal peritomy including unwanted area of the extended bleb; (4) dissection and removal of the underlying fibrous tissue when present; (5) conjunctival and resorbable sutures. In addition, a systematic literature review was performed. Only reports presenting outcomes of surgical treatment of bleb dysesthesia after filtering procedure were included in review.
Results:
Four eyes were included consecutively in the study in a period of 4 years. On average, they developed circumferential bleb dysesthesia 9.3 ± 4.7 months after uneventful combined phacotrabeculectomy with Mitomycin C as primary procedure. Surgical reduction was decided after failure of lubricants in controlling ocular discomfort. Two cases showed a dense fibrous tissue beneath the conjunctiva that was excised to ensure filtration. In all cases, a rapid disappearance of symptoms with very good aesthetic and functional outcome was observed. After 12-month follow-up, patients remained asymptomatic and maintained intraocular pressure of 10.7 ± 1.2 mmHg without treatment. A systematic review of the literature obtained 15 eligible case series (n = 123) with rates of success within 46-100%, favoring less aggressive approaches to reduce bleb size.
Conclusion:
Bleb dysesthesia is a rare complication of filtering glaucoma surgery. This modified bleb-limiting conjunctivoplasty technique (with removal of subjacent fibrous tissue if present) is able to target the underlying etiology providing ocular discomfort relief while maintaining bleb function and may be considered as first-choice surgical treatment.
Diagnosis, management and outcome of Spinal Cord Injury without Radiographic Abnormalities (SCIWORA) in adult patients with trauma: a case series
Authors: Suhail Yaqoob Hakim, Lubna Gamal Altawil, Ahmed Faidh Ramzee, Mohammad Asim, Khalid Ahmed, Motasem Awwad, Ahmed El-Faramawy, Monira Mollazehi, Ayman El-Menyar, Mohamed Ellabib, Hassan Al-Thani
Journal: Qatar Med J (2021)
Keywords: computed tomography, spinal cord injury without radiographic abnormality, magnetic resonance imaging, management, outcomes, trauma

Background:
Spinal cord injury without radiographic abnormality (SCIWORA) in adults causes diagnostic and prognostic dilemma as radiography and/or computed tomography does not clearly detect bone lesions during the initial assessment. Herein, we report our experience on 11 spinal cord injury cases without radiographic abnormality, regarding the clinicoradiological features, management, and outcomes.
Methods:
We conducted a case series of adult patients with SCIWORA who were admitted at the level 1 trauma center at Hamad General Hospital from January 2008 to July 2018. All patients underwent initial head and spine X-ray imaging, computed tomography, magnetic resonance imaging, and 12 months of clinical follow-up.
Results:
Eleven patients (mean age, 46.5 ± 14.4 years) met the criteria of SCIWORA. The neurologic status on admission and 12 months after hospital discharge were classified according to the American Spinal Injury Association (ASIA) impairment scale (AIS). On admission, 6 (54.5%) patients had ASIA grade C: 2 (18.2%) each had AIS grade D and B and 1 (9.1%) had AIS grade A. Five cases were treated conservatively with rehabilitation and physiotherapy, and five were treated surgically by anterior cervical discectomy with fusion. One patient who declined surgery was managed with a sternal occipital mandibular immobilizer brace and underwent rehabilitation.
Conclusion:
SCIWORA requires higher clinical suspicion and thorough neurological and radiologic assessment to prevent secondary spinal cord injuries and complications.
Acute Hepatitis B and Acute HIV Coinfection in an Adult Patient: A Rare Case Report
Authors: Raghav Bansal, Maurice Policar, Chinar Mehta
Journal: Case Rep Med (2010)
MeSH terms: Case Reports

Acute HIV and acute hepatitis B coinfection is extremely rare. A 23-year-old homosexual man was admitted to our hospital with 5-day history of fever, malaise, and back pain with initial laboratory values showing severe transaminitis. The clinical picture was initially suggestive of acute viral hepatitis, which on further testing revealed acute hepatitis B and acute HIV coinfection. Although the patient was asymptomatic, a decision was made to start antiretroviral therapy. At 2-month followup, liver function tests were normal with undetectable viral loads. The early treatment of acute HIV/HBV coinfections likely contributed to eventual seroconversion with immunity to HBV in a severely immunocompromised host. To the best of our knowledge, this is the first case report of acute Hepatitis B and acute HIV coinfection and its management. In conclusion, early treatment of acute hepatitis B in immunocompromised patients may be beneficial.
Adenoid cystic carcinoma of the parotid metastasizing to liver: case report
Authors: K Harish, S R Mangala Gouri
Journal: BMC Cancer (2004)
MeSH terms: Carcinoma, Adenoid Cystic / secondary, Liver Neoplasms / secondary, Parotid Neoplasms / radiotherapy, Parotid Neoplasms / surgery, Case Reports, Carcinoma, Adenoid Cystic / pathology, Carcinoma, Adenoid Cystic / radiotherapy, Carcinoma, Adenoid Cystic / surgery, Fatal Outcome, Female, Follow-Up Studies, Humans, Middle Aged, Parotid Neoplasms / pathology, Radiotherapy, Adjuvant

Background:
Adenoid cystic carcinoma is a rare malignant parotid tumor. Metastasis can occur even a decade or more after initial treatment of the primary.
Case presentation:
We report a 60 year old female patient who presented with adenoid cystic carcinoma of the parotid gland. She underwent a total conservative parotidectomy followed by adjuvant radiotherapy. While on follow up, patient developed multiple liver metastases which manifested three years later. Patient lived for another two years before she died of her disease.
Conclusions:
Although distant metastases of adenoid cystic carcinoma develop frequently, isolated metastasis to liver is unusual. Even after manifestation of distant metastasis, patients can be expected to live for a number of years. Palliative chemotherapy can be considered in symptomatic cases while the usefulness of metastasectomy is controversial.