OpenMed/multicare-articles huggingface dataset:
Profound Metabolic Acidosis due to Metformin Intoxication Requiring Dialysis
Authors: Klodia Hermez, Carla Dudash-Mion
Journal: Case Rep Nephrol (2021)
MeSH terms: Case Reports

Metformin-associated lactic acidosis (MALA) is a rare but life-threatening condition with often high mortality rates. Despite this, metformin continues to be one of the most commonly prescribed antihyperglycemic agents in the market. We present a unique case of a 61-year-old female with severe acidosis of pH = 6.72 and lactic acid of 26 mmol/L who presented obtunded after ingestion of an unknown amount of metformin. She was subsequently intubated, became hypotensive, and was initiated on vasopressors. She was swiftly started on a combination of intermittent hemodialysis (IHD) and bicarbonate therapy 7 hours after admission followed by continuous renal replacement therapy (CRRT) as she became more hemodynamically unstable. The patient's renal function improved, and she was discharged 7 days after admission with favorable sequelae. Dialysis is often reported in cases of severe MALA; however, it remains unclear how quickly dialysis should be initiated. This case aims to explore the benefits of quick initiation of extracorporeal measures in the forms of IHD and CRRT with concurrent bicarbonate supplementation. Furthermore, this case demonstrates the importance of clinical suspicion in metabolic acidosis in a patient on metformin therapy.
Thymic papillary adenocarcinoma coexisting with type A thymoma: A case report
Authors: Soichi Oka, Masaaki Inoue, Yohei Honda, Yasuhiro Chikaishi, Junichi Yoshida, Daisei Yasuda, Masao Tanaka
Journal: Int J Surg Case Rep (2019)
Keywords: mediastinal tumor, thymic carcinoma, thymoma

Introduction:
Thymic papillary adenocarcinoma is rare. Further, thymic papillary adenocarcinoma coexisting with type A thymoma is extremely rare. Surgery remains the only effective treatment for this disease.
Presentation of case:
An 84-year-old Japanese woman presented to our institute due to abnormal chest computed tomography (CT) findings showing a 45 × 40 × 40-mm tumor located in the anterior mediastinum. A malignant tumor was suspected based on the CT findings and high serum levels of carcinoembryonic antigen. Mediastinal tumor resection was performed via video-assisted thoracic surgery through the left thoracic approach. This patient was discharged from our institute without any problems at six days post-operation.
Discussion:
This report has three major implications. First, one of the tumors was papillary adenocarcinoma. Primary papillary adenocarcinoma of the thymus is exceedingly rare. Second, papillary adenocarcinoma and type A thymoma coexisted in this tumor. Third, epithelial thymic tumor should be resected completely, since complete resection has been reported to be associated with an improved prognosis.
Conclusion:
We encountered a rare case of thymic papillary adenocarcinoma coexisting with type A thymoma.
First case report of spontaneous biliary pleural fistula diagnosed using near infrared region I/II fluorescence of indocyanine green
Authors: Yisheng Peng, Jun Fan, Gang Zhu, Cheng Fang, Fangyi Peng, Zeyu Zhang, Jie Tian, Song Su, Xiaoli Yang, Bo Li
Journal: Front Oncol (2022)
Keywords: icg, nir fluorescence, biliary pleural fistula, case report, diagnosis
MeSH terms: Case Reports

We report a rare case of spontaneous biliary pleural fistula in a patient whose diagnosis was aided by the use of near-infrared I/II fluorescence imaging. When both 99mTc-mebrofenin hepatobiliary scintigraphy and CT examination were diagnostically difficult, we found strong fluorescent signals in the patient's pleural drainage fluid and sputum using NIR I/II fluorescence imaging, and therefore diagnosed the patient with a biliary pleural fistula. This provides a safe and effective test for diagnosing biliary pleural fistulas.
Surgical Treatment of Double-Layered Lateral Meniscus
Authors: Masataka Ota, Hiroshi Takagi, Shin Kato, Fumiyoshi Kawashima, Koji Kanzaki
Journal: Case Rep Orthop (2021)
MeSH terms: Case Reports

This is a rare case of a patient with a double-layered lateral meniscus, undergoing surgical treatment. A 17-year-old woman who was a member of a volleyball club had a two-year history of right knee pain with episodes of locking, although she had no history of trauma. She was referred to our hospital because her condition did not improve after conservative treatment. On presentation to the hospital, she had full range of motion in the right knee. McMurray's test revealed no clicks; however, it produced pain in the lateral part. Plain radiography revealed no abnormal findings, whereas magnetic resonance imaging showed high signal in the posterior segment of the lateral meniscus and an increase in its volume. Arthroscopic findings showed an accessory meniscus with a flat surface overlying a normal-sized lateral meniscus. It was firmly connected to the posterior root and middle segment of the lower normal meniscus. The accessory meniscus was markedly mobile as revealed by probing. The patient was diagnosed with double-layered lateral meniscus and underwent resection of the accessory meniscus. Postoperatively, she initiated strengthening of muscles and range of motion training without weight-bearing restrictions. Two months postoperatively, she had completely recovered and participated in volleyball practices. In the last follow-up at 18 months, she had no restrictions in daily or sports activities.
Proxy Users Enable Older People Creative Writing on the Web
Authors: Piotr Toczyski, Jarosław Kowalski, Cezary Biele
Journal: Front Sociol (2019)
Keywords: artificial intelligence, creative writing, digital wisdom, gray digital divide, participatory action research, social inclusion, technology and older people, voice assistants

This paper presents several state-of-the-art concepts within Internet studies and applies them to the creative writing of older people using the Internet. For more than 10 years two creative Web users aged 80+, assisted by younger proxy users, were involved in preliminary action research. It was aimed at finding patterns of inducing older people's creativity and sharing their wisdom with the general Internet audience. The effectiveness of conducted action research in transferring wisdom using silver digital content is high. It is demonstrated with (a) qualitative participants' insights, (b) the quantitative description of statistics of blog visits, and (c) the social significance of the topics covered in the created content. Lasting for more than a decade and located within the space of socio-technological solutions in Central and Eastern Europe, the results delivered patterns of emerging technologies aimed at enhancing older people's creativity on the Web. The insights from those two action-based case studies enabled the development of new hypotheses. New directions of further, more advanced research of older users' activity are based on interdisciplinary studies at the crossroads of public health, sociological theory, gerontology, and human-computer interaction studies. New research questions are presented, to be explored within the social scientific studies of the next-generation Internet. Departing from the established concepts and preliminary research, the authors hypothesize that: (1) in order to optimize non-human technology-based assistants, human proxy users should be researched; (2) voice assistant technology could become the primary proxy for a production of silver digital content; and (3) interactive and intelligent technology will be the substitute for social actors that prevent exclusion and disengagement. The remaining research question also refers to the conditions under which the technology can be a viable substitute for proxy users.
Compulsory Psychiatric Admission in a Patient With Metastatic Breast Cancer: From Palliative Care to Assisted Suicide
Authors: Felix Noppes, Egemen Savaskan, Florian Riese
Journal: Front Psychiatry (2020)
Keywords: assisted suicide, coercion, compulsory commitment, concealed medication, covert medication, involuntary admission, palliative care, psycho-oncology
MeSH terms: Case Reports

The provision of palliative care in psychiatry and the use of coercion in palliative care are underexplored areas. We report the case of a 65-year-old woman with cerebral metastatic breast cancer who was compulsorily admitted from a specialized palliative care ward to a psychiatric inpatient ward in Zurich, Switzerland. While in specialized inpatient palliative care, the patient had resisted palliative care but was found to lack decision-making capacity for her treatment due to disordered thought process and paranoid delusions. Under our care, which involved coercive treatment in the form of concealed administration of an antipsychotic, the patient's psychiatric symptoms improved. She regained decision-making capacity, was granted discharge from hospital, and ended her life by assisted suicide on the day of discharge.
Case Report: An Unusual Case of Biventricular Thrombosis in a COVID-19 Patient With Ischemic Dilated Cardiomyopathy: Assessment of Mass Mobility and Embolic Risk by Tissue Doppler Imaging
Authors: Andrea Sonaglioni, Adriana Albini, Gian Luigi Nicolosi, Elisabetta Rigamonti, Douglas M Noonan, Michele Lombardo
Journal: Front Cardiovasc Med (2021)
Keywords: ace2, covid-19, biventricular thrombosis, dilated cardiomyopathy, pulsed wave tissue doppler imaging
MeSH terms: Case Reports

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spike protein binds to angiotensin-converting enzyme 2 (ACE2) receptor on vascular cells. As a consequence, patients with COVID-19 have an increased incidence of thromboembolic complications of the SARS-CoV-2 infection and subsequent endothelial cell damage with consequence of development of systemic vasculitis and diffuse intravascular coagulation. The present case describes a COVID-19 female patient with ischemic dilated cardiomyopathy, who presented with congestive heart failure and echocardiographic evidence of biventricular apical thrombi. The peak antegrade longitudinal velocity (Va) of each thrombotic mass was measured by pulsed wave tissue Doppler imaging (PW-TDI). Both left ventricular and right ventricular apical thrombi were found with a TDI-derived mass peak Va < 10 cm/s. There was no clinical evidence of neither systemic nor pulmonary embolization, probably due to the hypomobility of both left and right ventricular masses.
Periampullary Metastases from Breast Cancer: A Case Report and Literature Review
Authors: Yi Lin, Sio In Wong, Yuzhou Wang, Chileong Lam, Xianghong Peng
Journal: Case Rep Oncol Med (2019)
MeSH terms: Case Reports

We presented a metastatic breast cancer case who was afflicted with obstructive jaundice caused by an ampullary neoplasm. Since jaundice due to periampullary metastasis from breast cancer was a rare entity, a literature review of similar cases through the PubMed database was done. A total of 23 additional cases were found. Among these 24 cases, 5 presented with periampullary metastasis synchronously with the diagnosis of breast cancer, while 19 had metachronous periampullary metastasis with an interval ranging between 1.3 and 23 years from the initial diagnosis of breast cancer to the emergence of jaundice. It is intriguing to establish a differential diagnosis for common bile tract stricture prior to tissue biopsy, even with diagnostic workups including serum tumor markers, MRI plus MRCP, ERCP with intraductal brushing, and endoscopic ultrasound, in that the clinical, radiological, and endoscopic findings of metastatic lesions overlapped extensively with those found with primary periampullary malignancies. An immunohistochemical portfolio including cytokeratin7/20 (CK7/20), homeobox protein CDX2, human epidermal growth factor receptor 2 (HER2/neu), estrogen receptor alfa (ERα), progesterone receptor (PgR), mammaglobin, gross cystic disease fluid protein-15 (GCDFP-15), and transacting T-cell-specific transcription factor (GATA-3) was helpful for differential diagnosis among cases with ambiguous microscopic features.
Folie à Deux in the Setting of COVID-19 Quarantine
Authors: Maxsaya Baez Nuñez, Ezequiel Rodriguez, Matthew DeLuca, Krishan Chirimunj, Monica Dhingra
Journal: Case Rep Psychiatry (2022)
MeSH terms: Case Reports

We relay the case of a middle-aged male and his mother, an elderly female, who presented with folie à deux in the context of shared delusions of persecution and somatization during the COVID-19 quarantine period. The delusions were described as electric microwave shocks being transmitted to their internal organs by neighbors, followed by somatic symptoms of palpitations, headaches, and a shock-like perception. To the best of our knowledge, there have not been any reports that describe the development of folie à deux in the setting of the COVID-19 quarantine. Folie à deux may be defined as delusions affecting two or more individuals, usually first-degree relatives. Delusions classically transmit from one person, coined the inducer, to one or several individuals, the induced, who share and may expand on the communicated delusions. The preconditions that must exist for folie à deux to develop are an intimate emotional association between the inducer and the induced and a genetic predisposition to psychosis, such as blood relations with primary relatives. Isolation from society has also been considered a potential risk factor for shared psychosis in the recent literature. Given that to the best of our knowledge, there have not been any reports describing the development of folie à deux in the setting of the COVID-19 quarantine, the authors aim to dissect how extended periods of shared isolation from society during such a significant time in history may have served as a significant precipitating factor in the onset of shared psychotic disorder, while simultaneously illustrating a parallel relation to how such conditions may predispose certain subgroups to similarly dynamic-based mental health disorders. In addition, an evaluation of the origins and multifactorial etiology of folie à deux, along with that of existing treatment modalities, and the emphasis on advancement toward more effective treatment approaches will be provided.
Case of rheumatic mitral stenosis with bilateral coronary artery fistula to pulmonary artery: A rare entity
Authors: Manish Jawarkar, Pratik Manek, Mausam Shah, Vivek Wadhawa, Chirag Doshi, Divyesh Rathod
Journal: J Cardiovasc Thorac Res (2021)
Keywords: coronary arteriovenous fistula, mitral stenosis
MeSH terms: Case Reports

Coronary to pulmonary artery fistula is a rare form of congenital coronary artery anomaly. Majority of coronary arteriovenous fistula detected incidentally on coronary angiography. Although, most of these patients are asymptomatic, larger fistulae can produce symptoms of heart failure. Here we present a rare case of 61-year-old female who presented primarily for mitral valve replacement for severe mitral stenosis. On screening angiography, there were two fistula arising from both right and left coronary artery and draining in to the main pulmonary artery. The patient was operated and mitral valve replacement with closure of the fistula. Patient had an uneventful post-operative period and was discharged on 7 the post-operative day.
Case Report: Diagnostic and Therapeutic Challenges in Severe Mechanobullous Epidermolysis Bullosa Acquisita
Authors: Franziska Schauer, Alexander Nyström, Manfred Kunz, Stefanie Hübner, Sarah Scholl, Ioannis Athanasiou, Svenja Alter, Judith Fischer, Cristina Has, Dimitra Kiritsi
Journal: Front Immunol (2022)
Keywords: col7a1, collagen vii, immunoglobulin, rituximab, skin blistering, skin fragility
MeSH terms: Epidermolysis Bullosa Acquisita, Epidermolysis Bullosa Dystrophica / diagnosis, Epidermolysis Bullosa Dystrophica / genetics, Epidermolysis Bullosa Dystrophica / therapy, Case Reports, Research Support, Non-U.S. Gov't, Autoantibodies, Collagen Type VII / genetics, Female, Humans, Skin, Autoantibodies, COL7A1 protein, human, Collagen Type VII

Collagen VII is the main constituent of the anchoring fibrils, important adhesive structures that attach the epidermis to the dermal extracellular matrix. Two disorders are caused by dysfunction of collagen VII, both characterized by skin and mucosa fragility, epidermolysis bullosa acquisita (EBA) and dystrophic epidermolysis bullosa (DEB). EBA and DEB share high clinical similarities with significant difference in patients' age of onset and pathogenesis. Our patients presented with severe and recalcitrant mechanobullous EBA with characteristic DIF, IIF and ELISA diagnostics. But in both women recessive COL7A1 variants were also found, in a monoallelic state. Collagen VII from EBA keratinocytes of our cases was significantly more vulnerable to proteolytic degradation than control keratinocytes, hinting that the heterozygous pathogenic variants were sufficient to destabilize the molecule in vitro. Thus, even if the amount and functionality of mutant and normal type VII collagen polypeptides is sufficient to assure dermal-epidermal adhesion in healthy individuals, the functionally-impaired proteins are probably more prone to development of autoantibodies against them. Our work suggests that testing for COL7A1 genetic variants should be considered in patients with EBA, which either have a patient history hinting towards underlying dystrophic epidermolysis bullosa or pose therapeutic challenges.
Bilateral Lipid Keratopathy in the Setting of Brimonidine Tartrate Use
Authors: Majid Moshirfar, Melody Ziari, Carter J Payne, Seth R Stapley, Briana K Ply, Yasmyne C Ronquillo, Phillip C Hoopes
Journal: Case Rep Ophthalmol Med (2023)
MeSH terms: Case Reports

Lipid keratopathy (LK) is a rare disease involving lipid deposition in the cornea resulting in corneal opacification. Primary LK can arise sporadically while secondary LK is seen in patients with a history of ocular trauma, medication exposure, infection, inflammation, or disorders resulting in derangements of lipid metabolism. Secondary LK is more common and occurs due to neovascularization. Use of precipitating medications should be considered in LK workup, particularly for patients in whom other etiologies have been ruled out. Brimonidine, an ocular hypotensive medication, can be associated with LK. We present a case of bilateral secondary LK in a patient with a history of prolonged brimonidine use, without additional contributing factors.
Remarkable Response of Metastatic Gallbladder Carcinoma to Apatinib After Failed Multiline Chemotherapies: A Case Report and Literature Review
Authors: Mengxi Zhang, Pengfei Zhang, Kexun Zhou, Qiu Li
Journal: Front Oncol (2019)
Keywords: anti-angiogenesis, apatinib, chemotherapy, metastatic gallbladder cancer, targeted therapy
MeSH terms: Case Reports

Gallbladder carcinoma (GBC) is a relatively rare and aggressive malignant tumor with a poor prognosis. A systematic review of current clinical studies illustrates an extreme paucity of second-line therapeutic options following the failure of standard-of-care cisplatin-gemcitabine chemotherapy. The efficacy of apatinib, an highly potent and selective oral inhibitor of VEGFR-2 tyrosine kinase, for refractory advanced GBC has not yet been clarified. Herein, we report a case of advanced GBC that presented a durable partial response to apatinib used as monotherapy after the failure of multiline chemotherapies including S-1 monotherapy, capecitabine monotherapy, gemcitabine plus capecitabine, and irinotecan plus oxaliplatin. The patient achieved an efficacy of partial response within 2 months. By September 23, 2019, the duration of treatment had extended for almost 1 year with a satisfactory quality of life, and the administration of apatinib was continued. Dose reduction of apatinib occurred at week four due to grade 2 hypertension and hand-foot skin reaction (HFSR). No fatigue, proteinuria, mucositis, or thrombocytopenia occurred. To the best of our knowledge, this is the first case of a successful use of apatinib monotherapy for heavily pretreated GBC. Further prospective studies are warranted to confirm the efficacy and safety of apatinib in GBC.
Cataract surgery with implantation of a high-add intraocular lens LENTIS® MAX LS-313 MF80 in end-stage, age-related macular degeneration: A case report of magnifying surgery
Authors: Andreas F Borkenstein, Eva-Maria Borkenstein
Journal: Clin Case Rep (2018)
Keywords: amd, armd, mags, cataract surgery, high‐add intraocular lens, magnifying surgery
MeSH terms: Case Reports

A new treatment option for cataracts and advanced ARMD: the simultaneous intravitreal injection of anti-vascular endothelial growth factor and implantation of a high-add IOL. We believe major opportunities arise from a new subcategory in cataract surgery-called magnifying surgery (MAGS). Our case proves the potential of this brand-new technology.
A case of enoxaparin-induced thrombocytopaenia during treatment of acute myocardial infarction
Authors: Snag Yup Lim, Se Ryeon Lee, Yong Hyun Kim, Jin Seok Kim, Seong Hwan Kim, Jeong Chun Ahn, Woo Hyuk Song
Journal: Cardiovasc J Afr (2016)
MeSH terms: Angioplasty, Balloon, Coronary, Anticoagulants / adverse effects, Coronary Occlusion / therapy, Coronary Thrombosis / drug therapy, Enoxaparin / adverse effects, Inferior Wall Myocardial Infarction / therapy, ST Elevation Myocardial Infarction / therapy, Thrombectomy, Thrombocytopenia / chemically induced, Case Reports, Aged, Coronary Angiography, Coronary Occlusion / diagnostic imaging, Coronary Occlusion / etiology, Coronary Thrombosis / complications, Coronary Thrombosis / diagnostic imaging, Female, Humans, Inferior Wall Myocardial Infarction / diagnostic imaging, Inferior Wall Myocardial Infarction / etiology, Platelet Aggregation Inhibitors / therapeutic use, ST Elevation Myocardial Infarction / diagnostic imaging, ST Elevation Myocardial Infarction / etiology, Thrombocytopenia / blood, Thrombocytopenia / diagnosis, Treatment Outcome, Ultrasonography, Interventional, Anticoagulants, Enoxaparin, Platelet Aggregation Inhibitors

Heparin-induced thrombocytopaenia is a life-threatening complication, affecting the morbidity and mortality of the patient if not properly treated. We report a case of a 75-year-old female patient who experienced enoxaparininduced thrombocytopaenia during medical treatment of acute ST-segment elevation myocardial infarction due to thrombotic total occlusion in the large right coronary artery.
Case report: Characterization of a rare pathogenic variant associated with loss of COL3A1 expression in vascular Ehlers Danlos syndrome
Authors: Janvie Manhas, Lov Raj Lohani, Ashikh Seethy, Uma Kumar, Shivanand Gamanagatti, Sudip Sen
Journal: Front Cardiovasc Med (2022)
Keywords: col3a1 pathogenic variant, clinical fibroblast testing, exome sequencing, hepatic artery dissection, stroke, vascular ehlers danlos syndrome
MeSH terms: Case Reports

The vascular subtype of Ehlers Danlos Syndrome (vEDS) is a rare connective tissue disorder characterized by spontaneous arterial, bowel or organ rupture. The diagnosis of vEDS is established in a proband by identification of a heterozygous pathogenic variant in the alpha-1 gene of type III collagen (COL3A1) by molecular analysis. In this report, we present a case of vEDS with life threatening, spontaneous arterial dissections in association with an uncharacterized rare variant of COL3A1, exon19:c.1340G > A. Primary culture of patient skin fibroblasts followed by immunofluorescence revealed a complete absence of COL3A1 protein expression as well as altered morphology. Electron microscopy of the cultured fibroblasts showed abnormal vacuoles in the cytoplasm suggestive of a secretory defect. In this study, we have performed functional characterization of the COL3A1 exon19:c.1340G > A variant for the first time and this may now be classified as likely pathogenic in vEDS. *Both JM and LRL contributed equally in the manuscript and should both be considered as the first author.