OpenMed/multicare-articles huggingface dataset:
Treatment of a Subacute Locked Thumb Metacarpophalangeal Joint with Sesamoid Entrapment
Authors: John J Carroll, William D McClain, Julia A V Nuelle
Journal: Case Rep Orthop (2019)
MeSH terms: Case Reports

Introduction:
Locked thumb metacarpophalangeal (MCP) joints due to entrapped radial sesamoids are rare injuries that commonly require open reduction, especially when the injury is delayed in presentation.
Case presentation:
We present a case of a 24-year-old female with a subacute thumb MCP joint subluxation due to an incarcerated radial sesamoid. She underwent successful closed reduction but had persistent pain and difficulty gripping large objects necessitating eventual open volar plate repair despite therapy. She was able to achieve full motion, with little pain and disability, after undergoing delayed volar plate repair.
Discussion:
Delayed volar plate repair may be considered for those patients who fail to improve with conservative management and occupational therapy after a successful closed reduction for thumb MCP joint subluxation due to an incarcerated radial sesamoid.
Primary cerebral malignant melanoma: A case report with literature review
Authors: Kai Tang, Xiangyi Kong, Gengsheng Mao, Ming Qiu, Haibo Zhu, Lei Zhou, Qingbin Nie, Yi Xu, Shiwei Du
Journal: Medicine (Baltimore) (2017)
MeSH terms: Brain Neoplasms / diagnosis, Melanoma / diagnosis, Case Reports, Review, Adult, Biopsy, Brain Neoplasms / pathology, Female, Humans, Magnetic Resonance Imaging, Melanoma / pathology, Temporal Lobe / diagnostic imaging, Temporal Lobe / pathology, Tomography, X-Ray Computed

Primary intracranial melanomas are uncommon and constitute approximately 1% of all melanoma cases and 0.07% of all brain tumors. In nature, these primary melanomas are very aggressive and can spread to other organs.We report an uncommon case of primary cerebral malignant melanoma-a challenging diagnosis guided by clinical presentations, radiological features, and surgical biopsy results, aiming to emphasize the importance of considering primary melanoma when making differential diagnoses of intracranial lesions.We present a rare case of a primary cerebral melanoma in the left temporal lobe. The mass appeared iso-hypodense on brain computed tomography (CT), short signal on T1-weighted magnetic resonance images (T1WI) and long signal on T2WI. It was not easy to make an accurate diagnosis before surgery. We showed the patient's disease course and reviewed related literatures, for readers' reference. Written informed consent was obtained from the patient for publication of this case report and any accompanying images. Because of this, there is no need to conduct special ethic review and the ethical approval is not necessary.After surgery, the pathological examination confirmed the diagnosis of melanoma. The patient was discharged without any complications and went on to receive adjuvant radiochemotherapy.It is difficult to diagnose primary cerebral melanoma in the absence of any cutaneous melanosis. A high index of clinical suspicion along with good pathology reporting is the key in diagnosing these extremely rare tumors.
An Unusual Case of Nonhealing Granulomatous Keratitis Caused by Mycobacterium chelonae in a Healthy Middle Aged Adult
Authors: Vipul Bhandari, Sriganesh, Kirti Relekar
Journal: Case Rep Ophthalmol Med (2015)

Purpose. To report a rare presentation of culture positive Mycobacterium chelonae (M. chelonae) corneal ulcer and its management. Case Report. We report a rare case with history of chronic pain and blurriness of vision. Examination revealed chronic nonhealing paracentral corneal ulcer inferiorly at 5 to 7 o'clock meridian with anterior chamber cells 1+ unresponsive to routine antibiotic and antifungal medications with Mantoux test (MT) positivity in a middle aged nondiabetic patient with no prior obvious history of trauma, ocular surgery, and contact lens usage. Discussion. Ziehl Neelsen (ZN) staining in nonhealing ulcer revealed acid fast bacilli typical of M. chelonae with subsequent culture positivity in Lowenstein Jensen (LJ) medium. Subsequent treatment with topical fortified amikacin and tobramycin resulted in rapid healing of corneal ulcer. Conclusion. M. chelonae presenting as a chronic nonhealing corneal ulcer spontaneously occurring in a healthy young adult with no predisposing factor draws the need to have a good index of suspicion by performing ZN stain and culture and its subsequent successful management with topical fortified amikacin and tobramycin.
Seizures and Consciousness Disorder Secondary to Intracranial Hypotension After Spinal Surgery: A Case Report and Literature Review
Authors: Yuqing Lv, Hui Xiang
Journal: Front Neurol (2022)
Keywords: cerebrospinal fluid leakage, critical care, intracranial hypotension, seizure, spinal surgery, status epilepticus
MeSH terms: Case Reports

Rationale:
Cerebrospinal fluid (CSF) leakage is a common condition after spinal surgery and is also the most common cause of intracranial hypotension. Intracranial hypotension (IH) is typically characterized by an orthostatic headache with associated nausea, vomiting, tinnitus, vertigo, hypoacusis, neck stiffness, and photophobia. There have been limited case reports describing surgery-associated IH presenting with seizures and disorder of consciousness. Due to the atypia of symptoms, these clinical manifestations are usually ignored or even misdiagnosed. As a result, clinicians face a significant challenge in detecting IH early and understanding its various clinical presentations. Meanwhile, we summarize the cases of IH presenting as seizures in recent years, including its clinical characteristics and effective treatment, which will be very helpful for the early diagnosis of IH.
Patient concerns:
A 72-year-old Chinese male patient developed status epilepticus, a disorder of consciousness, and quadriplegia when he finished spinal surgery, although he had no previous seizures or any seizure risk factors.
Diagnosis:
After MRI and CT examination, subdural hygromas were found under both sides of the skull, and combined with the clinical manifestations of the patient, intracranial hypotension due to cerebrospinal fluid leakage was diagnosed.
Interventions:
In the early stage, we carried out strict perioperative critical care for the patient. Trendelenburg position was conducted to relieve intracranial hypotension. The dural repair surgery was performed after the diagnosis of CSF leakage.
Outcomes:
Seizures in the patient were resolved. Three months after discharge, he was gradually returning to normal life.
Lessons:
One possible cause of unexplained seizures and disorder of consciousness after spinal surgery is cerebrospinal fluid leakage associated with intracranial hypotension syndrome. Trendelenburg position and dural repair surgery are effective ways to relieve intracranial hypotension and associated symptoms. Better awareness of the association between IH (intracranial hypotension) and seizures may help us improve early recognition of the syndrome.
Improvising in Endoscopy: Endoscopic Removal of Sharp Foreign Bodies in the Upper GI Tract, Using a Handmade Protective Device
Authors: Konstantinos Miltiadou, Zisimangelos Solomos, Dimitrios Lygkos, Alexandros Chatzidakis, Evripidis Rizos, Ioannis S Papanikolaou, Konstantinos Triantafyllou
Journal: Case Rep Gastrointest Med (2020)
MeSH terms: Case Reports

Introduction. Foreign body ingestion is a common problem in large-volume endoscopic departments. Several techniques and devices have been described for the safe endoscopic removal of these objects. However, these devices may not be suitable in every clinical setting or-as in our case-they may not even be available. Case Presentation. We report the case of a 34-year-old patient, presenting with sharp foreign body ingestion. The foreign bodies were safely removed using a handmade protective hood due to lack of a commercial device. In our case, improvisation proved to be of great benefit for the patient as well as for the endoscopist. Discussion. Improvised interventions can be of special interest in the setting of insufficiently funded or equipped endoscopic departments.
Case Report: Successful Management of a Compressive Intraspinal Coccidioides Species Granuloma in a Cat
Authors: Hannah Dowdy, Jason E Evans, Jared A Jaffey, Kathryn L Wycislo, Jason D Struthers, Eric T Hostnik
Journal: Front Vet Sci (2022)
Keywords: central nervous system, coccidioidomycosis, disseminated, feline, fluconazole, neurosurgery
MeSH terms: Case Reports

A 9-year-old, neutered male, domestic shorthair cat from Arizona, was presented for evaluation of a 7-day history of hind limb paraparesis that progressed to paraplegia. There was no history of respiratory abnormalities. Neurologic examination supported localization of a T3-L3 myelopathy. Computed tomography (CT) revealed an expansile widening of the spinal canal dorsal to L4 associated with a strongly contrast-enhancing mass. Moreover, CT series of the thorax revealed a diffuse miliary pulmonary pattern, as well as tracheobronchial, sternal, and cranial mediastinal lymphadenomegaly. Transthoracic lung lobe and sternal lymph node fine needle aspiration revealed pyogranulomatous inflammation with Coccidioides spp. spherules and endospores. A suspected diagnosis of spinal coccidioidomycosis was made; fluconazole (10.9 mg/kg PO q12h) treatment was initiated, and decompressive neurosurgery was performed. The granuloma was removed en bloc and histopathology revealed marked, chronic-active, pyogranulomatous myelitis with intralesional Coccidioides spp. spherules with endosporulation. Serum anti-Coccidioides spp. antibody titer results revealed a negative IgM and a positive IgG (1:4). The cat was treated with fluconazole for 445 days and examined at various time points, with the last examination 2 years after initial presentation. The cat returned to full ambulation with only mild functional deficits of the right hind limb. In conclusion, this report documents the diagnosis, treatment, and long-term follow up of a cat with a compressive Coccidioides spp. spinal cord granuloma. This case highlights the importance of including coccidioidomycosis as a differential diagnosis for cats with peracute hindlimb paraplegia that have lived in or traveled to regions where Coccidioides spp. is endemic, and demonstrates the potential for a good long-term outcome with decompressive neurosurgery and antifungal therapy.
Free-style puzzle flap as a cross-leg pedicled flap: the concept of re-using a flap in acute burns, a case report
Authors: Kevin Serror, Marc Chaouat, Golda Romano, Magali Schmidt, Alice Blet, Maurice Mimoun, David Boccara
Journal: Burns Trauma (2018)
Keywords: burns, cross-leg, free flap, pedicled flap, puzzle flap
MeSH terms: Case Reports

Background:
In well-selected cases, flaps can play a pivotal role in optimizing outcomes in the acute phase of burns. A previous redundant flap could be reused or recycled as a donor site from which a new flap could be raised.
Case presentation:
We report the case of a patient with full thickness burns on both legs, leading to the exposure of joints of the right ankle and the right foot and left patellar tendon. The right lower extremity was covered with a free musculo-cutaneous latissimus dorsi flap. Then, a musculo-cutaneous cross-leg flap pedicled on the anterior branch and centered on a perforator was harvested from the previous redundant flap to cover the controlateral knee.
Conclusion:
Sequential flap coverage can be considered in cases of extensive soft tissue defects and particularly in burns. This case illustrates that re-using a redundant part of a previous flap to cover another defect is a safe and interesting alternative in the event of a lack of donor sites or to save donor sites for later reconstruction of contracted burn scars.
Case report: Functional characterization of a novel CHD7 intronic variant in patients with CHARGE syndrome
Authors: Cesare Rossi, Sherin Ramadan, Cecilia Evangelisti, Simona Ferrari, Maria Accadia, Reha M Toydemir, Emanuele Panza
Journal: Front Genet (2023)
Keywords: charge syndrome, chd7, intronic variant, minigene, splice site mutation
MeSH terms: Case Reports

Background: Because CHARGE syndrome is characterized by high clinical variability, molecular confirmation of the clinical diagnosis is of pivotal importance. Most patients have a pathogenic variant in the CHD7 gene; however, variants are distributed throughout the gene and most cases are due to de novo mutations. Often, assessing the pathogenetic effect of a variant can be challenging, requiring the design of a unique assay for each specific case. Method: Here we describe a new CHD7 intronic variant, c.5607+17A>G, identified in two unrelated patients. In order to characterize the molecular effect of the variant, minigenes were constructed using exon trapping vectors. Results: The experimental approach pinpoints the pathogenetic effect of the variant on CHD7 gene splicing, subsequently confirmed using cDNA synthetized from RNA extracted from patient lymphocytes. Our results were further corroborated by the introduction of other substitutions at the same nucleotide position, showing that c.5607+17A>G specifically alters splicing possibly due to the generation of a recognition motif for the recruitment of a splicing effector. Conclusion: Here we identify a novel pathogenetic variant affecting splicing, and we provide a detailed molecular characterization and possible functional explanation.
Botulinum Toxin A Injection in the Bladder Neck: A Promising Treatment for Urinary Retention
Authors: Marianne Alam, Joseph Zgheib, Mohamad-Fadi Dalati, Fouad El Khoury
Journal: Case Rep Urol (2016)

Secondary to failure of optimal medical therapy and the high morbidity that accompanies surgical techniques in high risk patients, the use of de novo treatments including botulinum toxin A is emerging in the treatment of benign prostatic hyperplasia (BPH). However, the treatment of urinary retention secondary to BPH via injecting botulinum toxin into the bladder neck is not well established in the literature. This case report describes the case of a 75-year-old male patient with a chronic history of obstructive lower urinary tract symptoms (LUTS) and multiple comorbidities who was admitted to the hospital for management of recurrent urinary retention. The patient was not a surgical candidate for transurethral incision of the prostate (TUIP) or transurethral resection of the prostate (TURP). Botulinum toxin injection into the bladder neck was performed with very satisfying results. Botulinum toxin injection in the bladder neck presents a promising minimally invasive, tolerated, and cost-effective approach for the treatment of urinary retention in patients with benign prostatic obstruction who are not candidates for surgery or in whom medical treatment has failed. More research is needed to identify the efficacy of this novel approach.
Antiproteinase 3 Positive Eosinophilic Granulomatosis with Polyangiitis Presenting with Heart Failure and Intraventricular Thrombosis
Authors: Dan Zhu, Yiming Luo, Xiangyuan Liu, Lingyun Zu
Journal: Case Rep Rheumatol (2017)
MeSH terms: Case Reports

Eosinophilic granulomatosis with polyangiitis (EGPA) is a rare systemic vasculitis commonly with cardiac complications. We describe a case of anti-PR3 ANCA-positive EGPA complicated by congestive heart failure and intraventricular thrombosis. Interestingly, the thrombus was resolved rapidly with steroid and cyclophosphamide in the setting of interrupted anticoagulation. To the best of our knowledge, we report the first case of anti-PR3 positive EGPA with extensive cardiac involvement. Our patient had overlapping features with previously studied ANCA-positive and ANCA-negative EGPA cases. We also hypothesize that the thrombogenic potential of eosinophils may play a central role in thrombogenesis in EGPA and aggressive immunosuppressive therapy remains the cornerstone of treatment, and the addition of anticoagulation therapy in the setting of thrombus formation and also very high risk of bleeding needs to be considered cautiously.
Comparison between different radiographic methods for evaluating the flexibility of scoliosis curves
Authors: Luciano Miller Reis Rodrigues, Fabrício Hitoshi Ueno, Alberto Ofenhejm Gotfryd, Thiago Mattar, Edison Noboru Fujiki, Carlo Milani
Journal: Acta Ortop Bras (2014)
Keywords: preoperative care, radiography, scoliosis

Objective:
To compare different radiographic methods of spine evaluation to estimate the reducibility and flexibility of the scoliosis curves.
Methods:
Twenty one patients with Lenke types I and III adolescent idiopathic scoliosis (AIS) were included. Radiographic evaluations were made preoperatively on the orthostatic, supine decubitus with lateral inclination to the right and left and supine positions with manual reduction, with support in the apex of each curve on the X-ray table. On the day of surgery, when the patient was anesthetized, radiography was taken with longitudinal traction through divergent forces, holding under the arms and ankles, and with translational force at the apex of the deformity for curve correction. After one week, a post-operative radiography was performed in orthostatic position.
Results:
The correction and flexibility of the main thoracic and thoracic/lumbar curves were statistically different between the supine radiographs, manual reduction, modified traction under general anesthesia, lateral inclination and postoperatively. The modified maneuver for traction under general anesthesia is the one which showed greater flexibility, besides presenting higher radiographic similarity to postoperative aspects.
Conclusion:
Among the radiographic modalities evaluated the study under anesthesia with traction and reduction showed better correlation with postoperative radiographic appearance. Level of Evidence IV, Case Series.
Is the Isthmus Location an Additional Risk Factor for Indeterminate Thyroid Nodules? Case Report and Review of the Literature
Authors: Gilda Pontieri, Francesca Urselli, Livia Peschi, Alessia Liccardi, Anna Rita Ruggiero, Emilia Vergara, Claudio Bellevicine, Giancarlo Troncone, Maurizio De Palma, Bernadette Biondi
Journal: Front Endocrinol (Lausanne) (2018)
Keywords: capsular invasion, extrathyroidal extension, indeterminate thyroid lesion, isthmus nodule, isthmusectomy, lymph nodes metastasis, multifocality, total thyroidectomy
MeSH terms: Case Reports

Background: The management of indeterminate thyroid lesions is controversial. The American Thyroid Association (ATA) guidelines suggest a conservative approach for low risk indeterminate thyroid lesions (TIR3A). Case Report: We report a clinical case of a young girl who had TIR3A in a thyroid nodule located in the isthmus. After considering clinical and ultrasound (US) risk factors, we assessed literature data and guidelines to plan the extension of surgery. We found several studies supporting that the isthmus malignant lesions were associated with a higher rate of multifocality, capsular invasion, extrathyroidal extension, and central lymph node (LN) metastases. These data could predict a more aggressive behavior and a poor prognosis of the isthmus thyroid cancer compared to differentiated thyroid cancer, originating in the thyroid lobes. On the basis of these literature data and considering the familial risk for thyroid cancer of our patient, we decided to perform a total thyroidectomy. The histological examination revealed a follicular variant of papillary carcinoma located in the isthmus with capsular invasion. Conclusion: The isthmus location could be an additional risk factor to consider for a correct surgical approach in indeterminate thyroid lesions and thyroid cancer at fine-needle aspiration (FNA). We suggest that a careful ultrasonography should be carried out in patients with isthmus nodules. Total thyroidectomy should be performed in aggressive nodular disease. Prospective studies are needed to establish the best treatment for these lesions.
A de novo 2.9 Mb interstitial deletion at 13q12.11 in a child with developmental delay accompanied by mild dysmorphic characteristics
Authors: Magdalini Lagou, Ioannis Papoulidis, Sandro Orru, Vasileios Papadopoulos, George Daskalakis, Maria Kontodiou, Eleftherios Anastasakis, Michael B Petersen, George Kitsos, Loretta Thomaidis, Emmanouil Manolakos
Journal: Mol Cytogenet (2014)
Keywords: 13q1211, array-cgh, deletion, mild dysmorphic features
MeSH terms: Case Reports

Background:
Proximal deletions in the 13q12.11 region are very rare. Much larger deletions including this region have been described and are associated with complex phenotypes of mental retardation, developmental delay and various others anomalies.
Results:
We report on a 3-year-old girl with a rare 2.9 Mb interstitial deletion at 13q12.11 due to a de novo unbalanced t(13;14) translocation. She had mild mental retardation and relatively mild dysmorphic features such as microcephaly, flat nasal bridge, moderate micrognathia and clinodactyly of 5(th) finger. Molecular karyotyping revealed a deletion on the long arm of chromosome 13 as involving sub-bands 13q12.11, a deletion of about 2.9 Mb.
Discussion:
The clinical application of array-CGH has made it possible to detect submicroscopical genomic rearrangements that are associated with varying phenotypes.The description of more patients with deletions of the 13q12.11 region will allow a more precise genotype-phenotype correlation.
Primary Leiomyosarcoma of the Glans
Authors: Raimundo Nonato Gois da Costa Junior, Antonio Augusto Lima Teixeira Júnior, Thalita Moura Silva Rocha, Thaís Bastos Moraes Sobrinho, Liseana de Oliveira Barbosa, Rafael Campos Silva, Rita da Graça Carvalhal Frazão Corrêa, Antonio Machado Alencar Junior, Francisco Sergio Moura Silva Nascimento, Syomara Pereira da Costa Melo, José Ribamar Rodrigues Calixto, Gyl Eanes Barros Silva
Journal: Front Oncol (2022)
Keywords: glans, histopathological, immunohistochemistry, leiomyosarcoma, penile tumors
MeSH terms: Case Reports

Penile leiomyosarcoma isz an extremely uncommon entity that rarely occurs in the glans. Due to the limited number of cases described in literature, guidelines regarding non-surgical treatment, prognosis, and management remain equivocal. Among the mesenchymal tumors of the penis, leiomyosarcoma has the highest propensity for recurrence. It originates in the smooth muscle cells from two distinct locations: superficial and deep. The deep subtype is the most aggressive and has the highest potential for metastasis. Surgical treatment should be implemented early and must be locally aggressive. Herein, we present a rare case of a 54-year-old patient with deep localized leiomyosarcoma of the glans, albeit with superficial characteristics. A review of the main histopathological, clinical, immunohistochemical, and therapeutic aspects of this unusual entity is presented.
A case of transverse colon cancer with a large liver abscess that could be treated with a radical operation after infection control
Authors: Hideki Kogo, Kazuhito Yamamoto, Hiroshi Yoshida
Journal: Int J Surg Case Rep (2020)
Keywords: advanced colorectal cancer, case report, liver abscess, percutaneous transhepatic abscess drainage (ptad)
MeSH terms: Case Reports

Introduction:
Advanced colorectal cancer is known to be associated with liver abscesses. A strategy to treat liver abscesses as early as possible is necessary to ensure high surgical curability before the cancer progresses and to prevent worsening nutritional status of the patient during surgery.
Presentation of case:
An 82-year-old woman was hospitalized due to fever. A 10 cm in diameter liver abscess and advanced colon cancer were diagnosed. After conservative treatment of the liver abscess with antibiotics and puncture drainage, colorectal cancer surgery was performed on a standby basis.
Discussion:
We propose that empiric antibiotic therapy should be administered early in cases of liver abscesses that may require early colorectal surgery. Abscess drainage should be performed promptly if the abscess is of a size that can be punctured easily.
Conclusion:
In patients with advanced colorectal cancer complicated by liver abscesses that required early surgery, prompt drainage of the liver abscesses is mandatory.