OpenMed/multicare-articles huggingface dataset:
Early Surgical Intervention following Inguinal Hernia Repair with Severe Postoperative Pain
Authors: Ferdinand Köckerling, Christine Schug-Pass
Journal: Front Surg (2017)
Keywords: chronic pain, inguinal hernia, postoperative pain, re-intervention, tack fixation
MeSH terms: Case Reports

Introduction:
Severe postoperative pain is an important risk factor for onset of chronic inguinal pain following inguinal hernia repair. All measures must be taken to eliminate postoperative pain.
Materials and methods:
This case report highlights the problems of severe postoperative pain following transabdominal preperitoneal patch plasty (TAPP) inguinal hernia repair and describes a systematic treatment path that may include surgical intervention.
Results:
Following TAPP operation for lateral inguinal hernia, this patient who had been operated on in an external hospital still experienced intense, stabbing inguinal pain on postoperative day 7 during movement, despite optimal pain treatment. Diagnostic examination did not reveal any findings of note. The surgical report documented that the surgeon had used metallic tacks for mesh fixation, i.e., at the pectineal line of the pubic bone, pubic symphysis, upper margin of the mesh, and for closure of the peritoneum. During surgical revision on postoperative day 7, eight tacks and the mesh were removed and, following further dissection, a new mesh was placed and fixed with glue. The patient's intense stabbing pain resolved immediately after surgery.
Conclusion:
Since the results of late intervention for chronic inguinal pain are anything but satisfactory, early surgical intervention should be considered for patients with severe postoperative pain >3 days of suspected surgical origin.
VHL-Associated Optic Nerve Hemangioblastoma Treated with Stereotactic Radiosurgery
Authors: Hiroshi Kanno, Seiki Osano, Masamichi Shinonaga
Journal: J Kidney Cancer VHL (2018)
Keywords: vhl, optic nerve hemangioblastoma, stereotactic radiosurgery, von hippel-lindau disease
MeSH terms: Case Reports

Central nervous system hemangioblastomas are generally restricted to the cerebellum, spinal cord, and brainstem. Supratentorial hemangioblastomas are uncommon, and optic nerve hemangioblastomas are extremely rare, with fewer than 25 reports including this case. In this report, we present the case of a 36-year-old woman with von Hippel-Lindau (VHL) disease who presented with progressive diminution of vision in the left eye due to a retrobulbar optic nerve hemangioblastoma. The patient had a history of cerebellar/spinal hemangioblastomas and pancreatic cysts, and her father and brother were patients with VHL disease. Gadolinium-enhanced magnetic resonance imaging showed intraorbital retrobulbar-enhanced mass on the left optic nerve. The optic nerve hemangioblastoma was treated with fractionated stereotactic radiosurgery using Novalis. Eighteen months after the stereotactic radiosurgery, the tumor volume decreased although the patient lost vision. This report presents an extremely rare case of optic nerve hemangioblastoma, which is the first case treated with stereotactic radiosurgery.
Electrochemotherapy as a new therapeutic strategy in advanced Merkel cell carcinoma of head and neck region
Authors: Daniele Scelsi, Niccolò Mevio, Giulia Bertino, Antonio Occhini, Valeria Brazzelli, Patrizia Morbini, Marco Benazzo
Journal: Radiol Oncol (2013)
Keywords: merkel cell carcinoma, electrochemotherapy, head and neck cancer, palliative treatment

Background:
Merkel Cell Carcinoma (MCC) is a rare and aggressive tumour, arising from a cutaneous mechanoceptor cell located in the basal layer of epidermis, with poor prognosis. The treatment of choice for the initial stage of the disease is surgery and/or radiotherapy. The treatment of recurrent or advanced disease is still controversial.
Case report:
We report a case of 84 years old woman with a recurrent MCC of the chin treated with electrochemotherapy (ECT). During the period of 20 months, four sessions of ECT were employed, which resulted in an objective response of the tumour and good quality of residual life.
Conclusions:
Our case shows the effectiveness of ECT in the treatment of locally advanced MCC of the head and neck region in a patient not suitable for standard therapeutic options.
Malignant rhabdoid tumor of the lung in the young adult: a case report
Authors: Adel Attia, Moosa Suleman, Hesham Mosleh
Journal: Case Rep Pulmonol (2011)
MeSH terms: Case Reports

Malignant rhabdoid tumor (MRT) is one of the most aggressive and lethal malignancies in pediatric oncology. Malignant rhabdoid tumor was initially described in 1978 as a rhabdomyosarcomatoid variant of a Wilms tumor because of its occurrence in the kidney and because of the resemblance of its cells to rhabdomyoblasts. The absence of muscular differentiation led Haas and colleagues to coin the term rhabdoid tumor of the kidney in 1981, Haas et al..
Successful repair of injury to the eyelid, lacrimal passage, and extraocular muscle
Authors: Shreya Mehul Shah, Mehul Ashvin Shah, Prerna D Shah, Kashyap B Patel
Journal: GMS Ophthalmol Cases (2016)
Keywords: extraocular muscle rupture repair, lacrimal canalicular injury repair, lid laceration repair
MeSH terms: Case Reports

Introduction:
Injury is a known cause of monocular blindness. Ocular trauma may affect lacrimal canaliculi and the extraocular muscle. We report this case as it includes injury to lid, lacrimal canaliculi and inferior rectus.
Case description:
A 25-year-old male presented with an injury caused by a sharp object that resulted in a conjunctival tear, lid tear involving the lacrimal canal, and rupture of the inferior rectus muscle. All of the structures were repaired successfully during a single procedure.
Conclusion:
An extraocular injury involving the conjunctiva, lid, lacrimal passages, and extraocular muscles can be repaired successfully during a single procedure.
Unusual Case of Severe Lactic Acidosis in a Liver Transplant Patient
Authors: Shweta Yemul Golhar, Michael S Green, Stephen Guy
Journal: Case Rep Transplant (2017)
MeSH terms: Case Reports

Lactic acidosis is a standard indicator for oxygen debt and some other very significant causes. We describe a case of liver transplant patient presenting with vague abdominal pain and lactic acidosis without any liver dysfunction/failure/ischemia/rejection or sepsis. The imaging studies showed vague bowel edema and normal hepatic perfusion. The patient continued to deteriorate with rising lactic acidosis when a repeat CT abdomen eventually showed signs of lymphomatosis peritonei. Biopsy revealed the unusual diagnosis of posttransplant lymphoproliferative disorder. Immediate discontinuation of immunosuppression and initiation of chemotherapy led to clinical improvement. Our intention of presenting this case is to increase awareness of posttransplant lymphoma and propose lactic acidosis as not only an indicator of liver dysfunction or rejection but also an aid for diagnosis of this unusual but fatal and potentially curable condition.
Hematochezia: An Uncommon Presentation of Colonic Tuberculosis
Authors: Fares Ayoub, Vikas Khullar, Harry Powers, Angela Pham, Shehla Islam, Amitabh Suman
Journal: Case Rep Gastrointest Med (2017)
MeSH terms: Case Reports

Abdominal tuberculosis (TB) is an uncommon entity in the United States. Colonic TB is reported in 2-3% of patients with abdominal TB. It is frequently misdiagnosed as Crohn's disease or carcinoma of the colon due to their shared clinical, radiographic, and endoscopic presentations. We present a case of a 72-year-old male with colonic tuberculosis presenting as hematochezia. Our patient presented with shortness of breath and weight loss. Chest X-ray demonstrated ill-defined bilateral parenchymal opacities in the perihilar, mid, and lower lung zones. The patient was diagnosed and treated for community acquired pneumonia, with no improvement. Hematochezia complicated by symptomatic hypotension developed later in the course of admission. Colonoscopy revealed multiple ulcers at the anus and transverse and ascending colon as well as the cecum with stigmata of bleeding. Biopsy of a sigmoid ulcer was consistent with colonic tuberculosis. Antitubercular therapy was initiated, but the patient passed away secondary to multiorgan failure 29 days into admission.
Myasthenia gravis development and crisis subsequent to multiple sclerosis
Authors: Kurosh Gharagozli, Maziar Shojaei, Ali Amini Harandi, Nayyereh Akbari, Manouchehr Ilkhani
Journal: Case Rep Med (2011)
MeSH terms: Case Reports

During the last decade, sporadic combination of multiple sclerosis (MS) and myasthenia gravis (MG) has been reported repeatedly. Although these are anecdotal, they are important enough to raise concerns about co-occurrence of MG and MS. Here, we present a case of an MS patient who developed an MG crisis. She had received interferon for relapsing remitting MS. Interestingly, she developed an MG crisis 4 years after the diagnosis of MS. MS and MG have relatively the same distribution for age, corresponding to the younger peak of the bimodal age distribution in MG. They also share some HLA typing characteristics. Furthermore, some evidences support the role of systemic immune dysregulation due to a genetic susceptibility that is common to these two diseases. The association may be underdiagnosed because of the possible overlap of symptoms especially bulbar manifestations in which either MG or MS can mimic each other, leading to underestimating incidence of the combination. The evidence warrants physicians, especially neurologists, to always consider the possibility of the other disease when encountering any patients either with MS or MG. Anecdotal and sporadic reports of combination of multiple sclerosis (MS) and myasthenia gravis (MG) have been raised concerns about co-occurrence of them.
Treatment of unusually large acrochordon by shave excision and electrodesiccation
Authors: Sudesh T Choudhary
Journal: J Cutan Aesthet Surg (2008)
Keywords: acrochordon, electrodessication, giant
MeSH terms: Case Reports

Acrochordons are usually small in size and are easily treated with electrofulguration under local anaesthesia. Here is a report of a giant acrochordon which posed problems in management. A technique to manage it under local anaesthesia in an office setting is described.
Nasal alar necrosis following hyaluronic Acid injection into nasolabial folds: a case report
Authors: Ali Manafi, Behrooz Barikbin, Amir Manafi, Zahra Sadat Hamedi, Shokoofeh Ahmadi Moghadam
Journal: World J Plast Surg (2015)
Keywords: alar necrosis, hyaluronic acid, injection, soft tissue
MeSH terms: Case Reports

Injection of synthetic fillers for soft tissue augmentation is increasing over the last decade. One of the most common materials used is hyaluronic acid (HA) that is safe and temporary filler for soft tissue augmentation. We present a case of 54-year-old female who experienced vascular occlusion and nasal alar necrosis following HA injection to the nasolabial folds. She suffered from pain, necrosis, infection, and alar loss that finally required a reconstructive surgery for cosmetic appearance of the nose. The case highlights the importance of proper injection technique by an anesthesiologist, as well as the need for immediate recognition and treatment of vascular occlusion.
Q Fever Presented as a Large Retroperitoneal Pseudotumoral Mass
Authors: Behdokht Nowroozizadeh, Negar Haghighi Mehmandari, Nicolas Gallegos, Mari Perez-Rosendahl, Di Lu
Journal: Case Rep Pathol (2017)
MeSH terms: Case Reports

Background:
Q fever is an infection caused by Coxiella burnetii, an intracellular organism. Acute infection is most often a benign and asymptomatic process; however, some individuals may go on to develop subacute and persistent localized symptomatic Q fever. As such, the clinical and histopathologic findings of Q fever are widely variable and may be missed if clinical suspicion is not high.
Case presentation:
Herein we report the first case of C. burnetii infection presenting as an isolated retroperitoneal mass. A 61-year-old male underwent axillary-bifemoral bypass surgery. His postoperative course was complicated by the discovery of a large retroperitoneal mass.
Conclusion:
Clinical and histopathologic findings of Coxiella burnetii infection are variable and can be deceiving. These are often nonspecific, especially in its persistent localized infectious stages.
Case Report: Pulmonary sarcomatoid carcinoma in a female patient from Nepal
Authors: Anirudra Devkota, Amrit Paudel, Simit Sapkota, Subash Pandit, Aashish Baniya
Journal: F1000Res (2021)
Keywords: aggressive, carcinoma, chemotherapy, diagnosis, pulmonary sarcomatoid
MeSH terms: Carcinoma, Carcinoma, Non-Small-Cell Lung, Lung Neoplasms, Case Reports, Aged, Female, Humans, Lung, Nepal

Sarcomatoid carcinoma of the lung is an uncommon subtype of non-small-cell lung cancer (NSCLC). Even in the early stages, pulmonary sarcomatoid carcinoma (PSC) has a dismal prognosis when compared to other kinds of NSCLC with a mean survival of 9-12 months and a five-year survival rate of around 20%. We present the case of a 68-year-old woman with a two-month history of shortness of breath and cough. Initial computed tomography (CT) scan showed features of interstitial lung disease with chronic obstructive airway changes. After 34 months, the patient's condition worsened with newer complaints of sore throat and hemoptysis. A repeat CT scan showed a ∼49x38x59mm size lesion in the superior segment of the left lower lobe. A core needle biopsy was performed, which revealed tumor cells consisting of irregular tubules and sarcomatoid components. The patient was started on chemotherapy. Unfortunately, she succumbed to her disease. Our case highlights the aggressiveness of PSC.
Case Report: Stent Retriever Thrombectomy of Acute Basilar Artery Occlusion via the Type 1 Proatlantal Intersegmental Artery
Authors: Lei Zhao, Lijun Yang, Xiaosong Liu, Xiaoliang Wang, Gengshen Zhang, Jianliang Wu
Journal: Front Neurol (2022)
Keywords: acute basilar artery occlusion, case report, proatlantal intersegmental artery, stroke, thrombectomy
MeSH terms: Case Reports

Stent retriever thrombectomy (SRT) is one of the most effective methods for the recanalization of acute basilar artery occlusion (ABAO). The proatlantal intersegmental artery (PIA) is a rare carotid-vertebrobasilar anastomosis. Recognition of this rare form of anastomosis is particularly important for the rapid establishment of positive blood flow in patients with ABAO. In this case, the patient had a rare, left type 1 PIA. The right vertebral artery (VA) was tenuous and did not enter the cranium. We performed a thrombectomy of the ABAO by inserting a catheter via the type 1 PIA. The complete recanalization of basilar artery (BA) flow was achieved following two stent retractions; however, the patient eventually died of brain stem hemorrhage.
Concomitant dislocation of the tarsometatarsal and metatarsophalangeal joints of the second toe (floating second metatarsal): a case report
Authors: Mahmood Karimi Mobarake, Alireza Saied, Elisabeth Baron
Journal: Cases J (2009)

When examining patients with injuries of the tarsometatarsal joint, the physician must pay attention to the foot as a whole. An extremely rare foot injury has been described in which axial and compressive forces cause simultaneous dislocation of the tarsometatarsal joint and the metatarsophalangeal joint of the same or adjacent ray. The following is a report of one of these rare injuries.We will also discuss probable mechanism and diagnosis of this rare traumatic injury.
Multimodal Images of Acute Central Retinal Artery Occlusion
Authors: Parth Shah, Stephen G Schwartz, Harry W Flynn Jr
Journal: Case Rep Ophthalmol Med (2017)
MeSH terms: Case Reports

Two illustrative cases of acute central retinal artery occlusion (CRAO) are presented with multimodal imaging, including fluorescein angiography (FA) and commercially available optical coherence tomography angiography (OCT-A). In both patients, retinal ischemia was imaged well using both FA and OCT-A, and the two imaging studies provided comparable pictures. OCT-A provides useful information for the diagnosis and management of patients with acute CRAO, without the need for dye injection.
Diagnosis by metagenomic next-generation sequencing of a Talaromyces marneffei bloodstream infection in an HIV-negative child: A case report
Authors: Aimei Yang, Yan Hu, Peiling Chen, Guilang Zheng, Xuejiao Hu, Jingwen Zhang, Jing Wang, Chun Wang, Zijian Huang, Yuxin Zhang, Yuxiong Guo
Journal: Front Pediatr (2022)
Keywords: hiv negative, talaromyces marneffei, bloodstream infection, case report, metagenomic next-generation sequencing
MeSH terms: Case Reports

Background:

Talaromyces marneffei (TM) bloodstream infections are life- threatening in immunocompromised individuals. The lack of specific clinical features for these infections and poor sensitivity associated with routine examination procedures make diagnosis challenging. Untimely diagnosis and delayed antifungal treatment threatens the life of such patients.
Case description:
We report a case of a TM bloodstream infection, confirmed by the results of blood culture, of a child who was HIV negative and possessed a CD40LG gene mutation. A diagnosis of TM was established by blood metagenomic next-generation sequencing (mNGS) of the patient's blood, which was confirmed by microbiological culture of blood. On admission, this previously healthy male patient was 8-months of age, who presented with recurrent fever and a cough of 6-days in duration. His condition did not improve after antibacterial treatment for 5-days, with significant and recurrent fever and worsening spirit. He was referred to the Department of Pediatrics in our tertiary medical institution with a white blood cell count of 21.5*10∧9/L, C-reactive protein of 47.98 mg/L, and procalcitonin of 0.28 ng/mL. A bloodstream infection was not excluded and blood was collected for microbial culture. The patient received a 1-day treatment of cefoperazone sulbactam and 6-days of imipenem cilastatin. Symptoms did not improve and fever persisted. Blood was submitted for mNGS analysis and within 14-h, 14,352 TM reads were detected with a relative abundance of 98.09%. Antibiotic treatment was immediately changed to intravenous amphotericin B combined with oral itraconazole. The condition of the child gradually improved. Blood culture showed TM on the 7th day after hospitalization, confirming bloodstream infection. After the 13th day of hospital admission, the patient's body temperature dropped close to 38°C and was discharged on the 30th day of hospitalization. Oral itraconazole was prescribed with follow up at the outpatient clinic.
Conclusions:
HIV-negative patients with CD40LG mutations may be potential hosts for TM. TM infections are rare in children and their detection by conventional microbial culture methods are inadequate for an early diagnosis. mNGS is a rapid detection method that permits early diagnosis of uncommon infectious agents, such as TM, allowing for improved patient outcomes.
A rare but important adverse event associated with adult voluntary medical male circumcision: prolonged bleeding
Authors: Moses Galukande, Carol Kahendehe, Eria Buuza, Denis Bbaale Sekavuga
Journal: Int J Emerg Med (2015)
Keywords: adverse events, hemophilia, prolonged bleeding, voluntary medical male circumcision

Background:
The majority of bleeding disorders worldwide are undiagnosed. Their moderate or severe forms are associated with considerable morbidity and mortality. In the advent of mass male circumcision for the partial prevention of HIV, undiagnosed and diagnosed cases of bleeding disorders are likely to be increasingly encountered. The ability to screen, diagnose, and manage these cases appropriately will mitigate associated adverse events. We describe three cases of prolonged bleeding after adult voluntary medical male circumcision (VMMC) and propose program measures.
Methods:
A descriptive case series at tertiary urban hospital serving a VMMC program. The cases were recruited consecutively over a 3-year period. Standard laboratory tests were used to confirm diagnosis. Written informed consent was obtained from each subject.
Results:
Three cases were described of previously undiagnosed hemophilia A males circumcised during routine VMMC service delivery. They had presented with complaints of prolonged (non-stop or recurring) bleeding. They were aged 16, 22, and 24 years, of low socioeconomic background, with limited formal education. Whereas two of the three were aware of a tendency to prolonged bleeding from minor cuts, they did not volunteer these histories. The patients were referred to a hospital with the resources to test and administer recombinant factor VIII in Kampala (the capital city) 3, 9, and 16 days after circumcision. Two had received whole blood transfusions enroute to this hospital. All three were diagnosed with mild or moderate hemophilia A. Factor IX levels were all within normal range. In all three cases, the bleeding stopped within hours of the initial factor VIII infusion, and two to three maintenance doses were given over the subsequent 2 to 3 days for each patient.
Conclusions:
Sensitization of health workers in safe male circumcision (SMC) programs for pre-operative diagnosis and appropriate referral is highly recommended.
Hemobilia caused by a ruptured hepatic cyst: a case report
Authors: Viplove Senadhi, Deepika Arora, Manish Arora, Sudhir Dutta
Journal: J Med Case Rep (2011)

Introduction:
Hemobilia is a rare cause of upper gastrointestinal bleeding. More than 50% of hemobilia cases are related to iatrogenic trauma from hepatobiliary procedures, and needle biopsy of the liver represents the most common cause. A minority of hemobilia cases are due to hepatobiliary disorders such as cholangitis, hepatobiliary cancers, choledocholithiasis, and vascular abnormalities in the liver. The classic presentation of hemobilia is the triad of right upper quadrant (biliary) pain, obstructive jaundice, and upper gastrointestinal bleeding. We report a rare case of hemobilia caused by a spontaneous hepatic cyst rupture, where our patient presented without the classical symptoms, in the absence of therapeutic or pathological coagulopathy, and in the absence of spontaneous or iatrogenic trauma.
Case presentation:
A 91-year-old African-American woman was referred to our out-patient gastroenterology clinic for evaluation of mild epigastric pain and intermittent melena. An abdominal computed tomography scan was remarkable for multiple hepatic cysts. Esophagogastroduodenoscopy revealed multiple blood clots at the ampulla of Vater. Endoscopic retrograde cholangiopancreatography showed a single 18 mm-sized filling defect in the common hepatic duct wall at the junction of the right and left hepatic duct, adjacent to one of the hepatic cysts. The ruptured hepatic cyst communicated to the bile ducts and was the cause of hemobilia with an atypical clinical presentation.
Conclusion:
Hemobilia is an infrequent cause of upper gastrointestinal bleeding and rarely occurs due to hepatic cyst rupture. To the best of our knowledge, this is only the second case report in the literature that describes hemobilia due to hepatic cyst rupture. However, it is the first case in the literature of hemobilia due to hepatic cyst rupture in the absence of iatrogenic or spontaneous trauma, and in the absence of a spontaneous or pathological coagulopathy.