OpenMed/multicare-articles huggingface dataset:
A New User-Friendly and Affordable Method in Descemet Stripping Endothelial Keratoplasty
Authors: Mohammad Soleimani, Seyed Ali Tabatabaei, Reza Mirshahi
Journal: Open Ophthalmol J (2018)
Keywords: dsaek, ecd, endothelial keratoplasty, lenticule, pbk, technique
MeSH terms: Case Reports

Aims:
To describe a new technique in Descemet Stripping Automated Endothelial Keratoplasty (DSAEK).
Materials and methods:
In this technique, we use easily available materials (mainly a Nelaton tube) to make an injector for loading DSAEK lenticule and also easily pulling it (using a gauge 23 needle) into the eye. In this paper, we report outcomes of this technique in four cases.
Results:
Using these available instruments could easily lead to a clear postoperative cornea. Mean Endothelial Cell Density (ECD) loss at sixth postoperative month was 26%.
Conclusion:
We proposed a novel effective user-friendly and affordable technique to perform DSAEK.
The Impact of Repeating Endosonography with Confocal Endomicroscopy for the Diagnosis of Cystic Neuroendocrine Tumor
Authors: Iqra Haq, Somashekar G Krishna, Bhaveshkumar Patel, Thavam Thambi-Pillai, Chencheng Xie, Karah Odegaard, Kimberlee Buohy, Muslim Atiq
Journal: Case Rep Gastrointest Med (2019)
MeSH terms: Case Reports

Cystic pancreatic neuroendocrine tumors represent around 13% of all neuroendocrine tumors (Hurtado-Pardo 2017). There has been an increase in the incidence of cases due to improvement in imaging modalities. This is a case of a 68-year-old male with the incidental finding of a pancreatic cyst on CT. Initial Endoscopic Ultrasound with Fine Needle Aspiration (EUS-FNA) showed sonographic and cytology features suggestive of a pancreatic pseudocyst. However the cyst persisted with no change in size after aspiration leading to a follow-up EUS- FNA, which was combined with needle based confocal laser endomicroscopy (nCLE). The nCLE features were consistent with a cystic pancreatic neuroendocrine tumor, which was later confirmed on histology after surgical resection.
Can ACE-I Be a Silent Killer While Normal Renal Functions Falsely Secure Us?
Authors: Ahmed Abdelaal Ahmed Mahmoud, Mark Campbell, Margarita Blajeva
Journal: Case Rep Anesthesiol (2018)
MeSH terms: Case Reports

The current case report represents a warning against serious hyperkalaemia and acidosis induced by ACE-I during surgical stress while normal renal function could deceive the attending anaesthetist. Arterial gas analysis for follow-up of haemoglobin loss accidentally discovered hyperkalaemia and acidosis. Glucose-insulin and furosemide successfully corrected hyperkalaemia after 25 minutes and acidosis after 3 hours. These complications could be explained by a deficient steroid stress response to surgery secondary to suppression by ACE-I. Event analysis and database search found that ACE-I induced aldosterone deficiency aggravated by surgical stress response with an inadequate increase in aldosterone secretion due to angiotensin II deficiency as a sequel of ACE-I leading to defective secretion of H+ and K+. Furosemide is recommended to secrete H+ and K+ compensating for aldosterone deficiency in addition to other antihyperkalaemia measures. Anaesthetising an ACE-I treated patient requires considering ACE-I as a potential cause of hyperkalaemia and acidosis.
46,XY disorder of sex development due to 17-beta hydroxysteroid dehydrogenase type 3 deficiency: a plea for timely genetic testing
Authors: Chelsey Grimbly, Oana Caluseriu, Peter Metcalfe, Mary M Jetha, Elizabeth T Rosolowsky
Journal: Int J Pediatr Endocrinol (2016)
Keywords: 17β-hydroxysteroid dehydrogenase type 3 deficiency, 46,xy undervirilization, disorders of sex development
MeSH terms: Case Reports

Background:
17β-hydroxysteroid dehydrogenase type 3 (17βHSD3) deficiency is a rare cause of disorder of sex development (DSD) due to impaired conversion of androstenedione to testosterone. Traditionally, the diagnosis was determined by βHCG-stimulated ratios of testosterone:androstenedione < 0.8.
Case presentation:
An otherwise phenotypically female infant presented with bilateral inguinal masses and a 46,XY karyotype. βHCG stimulation (1500 IU IM for 2 days) suggested 17βHSD3 deficiency although androstenedione was only minimally stimulated (4.5 nmol/L to 5.4 nmol/L). Expedient genetic testing for the HSD17B3 gene provided the unequivocal diagnosis.
Conclusion:
We advocate for urgent genetic testing in rare causes of DSD as indeterminate hormone results can delay diagnosis and prolong intervention.
Immune-related keratitis is a rare complication associated with nivolumab treatment in a patient with advanced colorectal cancer: A case report
Authors: Yuqi Su, Guoquan Li, Jiaxin Xu, Jiale Zheng, Jiapeng Jiao, Jianhui Zhang, Xiaokang Gu, Zhai Cai, Hongyu Luo, Zhou Li, Shuai Han
Journal: Front Oncol (2022)
Keywords: corneal ulceration, immune checkpoint inhibitors, immune-related keratitis, maspin, matrix metalloproteinases, metastatic colorectal cancer, nivolumab
MeSH terms: Case Reports

Background:
Immunotherapy has been widely used to treat Colorectal cancer but has also observe some immune-related adverse effects. With proper treatment, most irAE can be solved and the effect of immunotherapy will not be affected by temporary immunosuppression. However, there are few reports about corneal irAE, and the current understanding of irAE is incomplete. Here we report a metastatic colorectal cancer case of immune-related keratitis caused by nivolumab and to explore the occurrence of immune-related keratitis.
Case description:
Here we report the case of a 49-year-old man with mCRC who had no previous ocular disease but developed immune-related ulcerative keratitis after treatment with nivolumab. We summarize a large amount of literature to discuss the mechanism of immune-related keratitis. In addition, we conclude a method that may be used to detect the occurrence of immune keratitis, by monitoring MMPs and maspin in patients treated with nivolumab. We believe immune-related keratitis may be a rare complication of nivolumab in the treatment of mCRC. The effect of simple anti-infective therapy and repair-promoting drugs was not obvious, but the effect of glucocorticoid combined with autologous serum was significant.
Conclusion:
The mechanism of immune-related keratitis is that nivolumab destroys the immune microenvironment and ACAID, and affects corneal healing. Patients who use nivolumab can prevent immune keratitis by testing MMPs and maspin. The occurrence of immune keratitis may be a good indicator of the efficacy of ICI, and further study can be done in the follow-up.
Successful Treatment of Methampyrone-Induced Toxic Epidermal Necrolysis with Therapeutic Plasma Exchange
Authors: Santosa, A Rumbiana, Z Wahab, S P Kurniawan, R M Naibaho, P Yogyartono
Journal: Case Rep Med (2018)
MeSH terms: Case Reports

The toxic epidermal necrolysis (TEN) is a severe cutaneous adverse reaction frequently caused by drug exposure. A 58-year-old male was admitted to the hospital after administration of methampyrone. He developed sloughing of the total epidermis which rapidly extended over the trunk and limbs. The presumptive diagnosis was drug-induced TEN. Despite the treatment with pulsed glucocorticoid and cyclosporine, the skin lesions extended over the entire body. Strikingly, the progression of blistering was stopped by therapeutic plasma exchange (TPE). TPE was discontinued after the signs of skin inflammation had been overcome. He recovered in 8 days of hospitalization. We present here a case of a methampyrone-induced TEN which was successfully treated with TPE.
Successful bronchoscopic cryorecanalization in a case of endobronchial lipoma
Authors: B Lamprecht, G Hutarew, P Porsch, B Wegleitner, M Studnicka
Journal: Diagn Ther Endosc (2011)
MeSH terms: Case Reports

Endobronchial lipomas are rare benign tumors; less than 150 cases have been reported so far. Bronchial occlusion usually leads to a misdiagnosis of asthma/COPD or malignancy. We report the case of a 67-year-old man with a history of heavy smoking (100 pack years), dyspnea on exertion, cough, and malaise who was treated for pneumonia for three weeks. Due to nonresolving atelectasis of the superior segment of the right lower lobe, a malignant endobronchial tumor was suspected. Rigid bronchoscopy with cryorecanalization led to both the definite histopathological diagnosis of endobronchial lipoma and the reopening of an endoluminal airway obstruction during one procedure.
Minimally guided bone regeneration procedure for immediate implant placement and provisionalization of a maxillary lateral incisor: A case report
Authors: Abdulreza Fattahian, Farzaneh Poursafar, Siamak Yaghobee
Journal: J Adv Periodontol Implant Dent (2020)
Keywords: bone regeneration, dental implants, dental restoration, immediate dentalimplant loading, single tooth, temporary
MeSH terms: Case Reports

Immediate implant placement has some advantages, such as time-saving, optimal soft tissue architecture preservation, and patient acceptance. In this case, prior to implant placement, minimally guided bone regeneration was performed to augment the concavity on the apico-labial aspect of a fractured maxillary right lateral incisor. After eight months, the tooth was extracted, and an implant was immediately inserted, and a provisional composite-based crown was delivered in the same appointment. After four months, well molded mid-facial gingiva and interproximal papilla were obtained, and a final metal-ceramic crown was fabricated.
Sprain of the Subaxial Cervical Spine in Childhood
Authors: Rebecca F Lyons, Kevin McSorely, Mutaz Jadaan, J P McCabe, Colin G Murphy
Journal: Case Rep Orthop (2018)
MeSH terms: Case Reports

Posterior atlantoaxial ligament disruption in children is a rare diagnosis. We present a case of a young girl with cervical spine posterior atlantoaxial ligament disruption post a fall from a climbing frame. Presenting with minimal symptoms other than neck pain, this case highlights the diagnostic difficulty and need for further radiological imaging in paediatric patients with neck pain post trauma.
Optimized beamforming for simultaneous MEG and intracranial local field potential recordings in deep brain stimulation patients
Authors: Vladimir Litvak, Alexandre Eusebio, Ashwani Jha, Robert Oostenveld, Gareth R Barnes, William D Penny, Ludvic Zrinzo, Marwan I Hariz, Patricia Limousin, Karl J Friston, Peter Brown
Journal: Neuroimage (2010)
MeSH terms: Brain / physiopathology, Electrodes, Implanted, Magnetoencephalography / methods, Signal Processing, Computer-Assisted, Subthalamic Nucleus / physiopathology, Case Reports, Research Support, Non-U.S. Gov't, Adult, Artifacts, Cerebral Cortex, Deep Brain Stimulation / instrumentation, Fingers / physiology, Heart / physiology, Humans, Male, Middle Aged, Motor Activity / physiology, Parkinson Disease / physiopathology, Parkinson Disease / therapy

Insight into how brain structures interact is critical for understanding the principles of functional brain architectures and may lead to better diagnosis and therapy for neuropsychiatric disorders. We recorded, simultaneously, magnetoencephalographic (MEG) signals and subcortical local field potentials (LFP) in a Parkinson's disease (PD) patient with bilateral deep brain stimulation (DBS) electrodes in the subthalamic nucleus (STN). These recordings offer a unique opportunity to characterize interactions between the subcortical structures and the neocortex. However, high-amplitude artefacts appeared in the MEG. These artefacts originated from the percutaneous extension wire, rather than from the actual DBS electrode and were locked to the heart beat. In this work, we show that MEG beamforming is capable of suppressing these artefacts and quantify the optimal regularization required. We demonstrate how beamforming makes it possible to localize cortical regions whose activity is coherent with the STN-LFP, extract artefact-free virtual electrode time-series from regions of interest and localize cortical areas exhibiting specific task-related power changes. This furnishes results that are consistent with previously reported results using artefact-free MEG data. Our findings demonstrate that physiologically meaningful information can be extracted from heavily contaminated MEG signals and pave the way for further analysis of combined MEG-LFP recordings in DBS patients.
Da Vinci robot-assisted laparoscopic retroperitoneal debridement for lumbar septic spondylodiscitis: A two-case report
Authors: Jichao Ye, Hao Liu, Xumin Hu, Jinteng Li, Liangbin Gao, Yong Tang
Journal: Front Surg (2022)
Keywords: da vinci surgical system®, laparoscopy, lumbar spine, pyogenic spondylodiscitis, robotics
MeSH terms: Case Reports

The anterior approach is one of the widely used surgical treatments for lumbar spondylodiscitis, but it has the disadvantages of large trauma and a high incidence of complications. Our experiences suggested that the laparoscopic retroperitoneal approach could be effective to overcome those disadvantages of the anterior approach. Herein, we report two cases of successfully treated lumbar pyogenic spondylodiscitis using a robot-assisted laparoscopic retroperitoneal approach. The technique utilizes a robot that allows a laparoscopic retroperitoneal approach while offering excellent high-definition images of three-dimensional vision. After the operation, both patients achieved good formation and fusion of the vertebrae. Preliminary evidence suggests that the robot-assisted laparoscopic retroperitoneal approach may be feasible for the treatment of lumbar spondylodiscitis.
Rehabilitation of Post-Cerebral Venous Thrombosis
Authors: Nadiah M Almutairi, Abdulaziz A Albuhayjani
Journal: Cureus (2023)
Keywords: cerebral venous thrombosis (cvt), cerebral venous thrombosis cvt, occupational therapy, occupational therapy program, physical medicine and rehabilitation, physical therapy rehabilitation, rehabilitation medicine, speech and swallowing therapy, stroke
MeSH terms: Case Reports

Cerebral venous thrombosis (CVT) is rare and only accounts for 0.5% of all reported stroke cases. CVT includes severe headaches with neurological deficits, but the vague presentation of symptoms necessitates efficient clinical examination and imaging for a proper diagnosis. Here, we present a case of this rare type of stroke. Our patient exhibited continuous headaches, further complicated by other neurological deficits. We documented this case to aid in the diagnosis and rehabilitation management of CVT. We aim to demonstrate to physicians the importance of early rehabilitation in such stroke cases and improve the outcome for patients.
Fatal Myelotoxicity Following Palliative Chemotherapy With Cisplatin and Gemcitabine in a Patient With Stage IV Cholangiocarcinoma Linked to Post Mortem Diagnosis of Fanconi Anemia
Authors: Nils W Engel, Simon Schliffke, Ulrich Schüller, Christian Frenzel, Carsten Bokemeyer, Christian Kubisch, Davor Lessel
Journal: Front Oncol (2019)
Keywords: fanca, cholangiocarcinoma, fanconi anemia, genomic instability, myelotoxicity
MeSH terms: Case Reports

Unrecognized genome instability syndromes can potentially impede the rational treatment of cancer in rare patients. Identification of cancer patients with a hereditary condition is a compelling necessity for oncologists, giving varying hypersensitivities to various chemotherapeutic agents or radiation, depending on the underlying genetic cause. Omission of genetic testing in the setting of an overlooked hereditary syndrome may lead to unexpected and unbearable toxicity from oncological standard approaches. We present a case of a 33-year-old man with an early-onset stage IV intrahepatic cholangiocarcinoma, who experienced unusual bone marrow failure and neutropenic fever syndrome as a consequence of palliative chemotherapy containing cisplatin and gemcitabine, leading to a fatal outcome on day 25 of his first chemotherapeutic cycle. The constellation of bone marrow failure after exposure to the platinum-based agent cisplatin, the presence of an early-onset solid malignancy and the critical appraisal of further phenotypical features raised suspicion of a hereditary genome instability syndrome. Whole-exome sequencing from buccal swab DNA enabled the post mortem diagnosis of Fanconi anemia, most likely linked to the fatal outcome due to utilization of the DNA crosslinking agent cisplatin. The patient's phenotype was exceptional, as he never displayed significant hematologic abnormalities, which is the hallmark of Fanconi anemia. As such, this case stresses the importance to at least question the possibility of a hereditary basis in cases of relatively early-onset malignancy before defining an oncological treatment strategy.
Case report: Ponatinib as a bridge to CAR-T cells and subsequent maintenance in a patient with relapsed/refractory Philadelphia-like acute lymphoblastic leukemia
Authors: Fabio Giglio, Edoardo Campodonico, Francesca Lorentino, Maddalena Noviello, Elisabetta Xue, Raffaella Greco, Lorenzo Lazzari, Alessandro Bruno, Maria Teresa Lupo Stanghellini, Matteo Giovanni Carrabba, Roberta La Starza, Monica Casucci, Chiara Bonini, Sabina Chiaretti, Jacopo Peccatori, Robin Foà, Fabio Ciceri
Journal: Front Oncol (2023)
Keywords: car-t, philadelphia-like all, bridge therapy, maintenance therapy, ponatinib
MeSH terms: Case Reports

Philadelphia (Ph)-like acute lymphoblastic leukemia (ALL) constitutes a heterogeneous subset of ALL with a uniformly unfavorable prognosis. The identification of mutations amenable to treatment with tyrosine kinase-inhibitors (TKIs) represents a promising field of investigation. We report the case of a young patient affected by relapsed/refractory Ph-like ALL treated with chimeric antigen receptor T (CAR-T) cells after successful bridging with compassionate-use ponatinib and low-dose prednisone. We restarted low-dose ponatinib maintenance three months later. Twenty months later, measurable residual disease negativity and B-cell aplasia persist. To the best of our knowledge, this is the first case reporting the use of ponatinib in Ph-like ALL as a bridge to and maintenance after CAR-T cell therapy.
Validation and updating of risk models based on multinomial logistic regression
Authors: Ben Van Calster, Kirsten Van Hoorde, Yvonne Vergouwe, Shabnam Bobdiwala, George Condous, Emma Kirk, Tom Bourne, Ewout W Steyerberg
Journal: Diagn Progn Res (2017)
Keywords: calibration, discrimination, model updating, multicategory outcome, multinomial logistic regression, prediction models, risk models

Background:
Risk models often perform poorly at external validation in terms of discrimination or calibration. Updating methods are needed to improve performance of multinomial logistic regression models for risk prediction.
Methods:
We consider simple and more refined updating approaches to extend previously proposed methods for dichotomous outcomes. These include model recalibration (adjustment of intercept and/or slope), revision (re-estimation of individual model coefficients), and extension (revision with additional markers). We suggest a closed testing procedure to assist in deciding on the updating complexity. These methods are demonstrated on a case study of women with pregnancies of unknown location (PUL). A previously developed risk model predicts the probability that a PUL is a failed, intra-uterine, or ectopic pregnancy. We validated and updated this model on more recent patients from the development setting (temporal updating; n = 1422) and on patients from a different hospital (geographical updating; n = 873). Internal validation of updated models was performed through bootstrap resampling.
Results:
Contrary to dichotomous models, we noted that recalibration can also affect discrimination for multinomial risk models. If the number of outcome categories is higher than the number of variables, logistic recalibration is obsolete because straightforward model refitting does not require the estimation of more parameters. Although recalibration strongly improved performance in the case study, the closed testing procedure selected model revision. Further, revision of functional form of continuous predictors had a positive effect on discrimination, whereas penalized estimation of changes in model coefficients was beneficial for calibration.
Conclusions:
Methods for updating of multinomial risk models are now available to improve predictions in new settings. A closed testing procedure is helpful to decide whether revision is preferred over recalibration. Because multicategory outcomes increase the number of parameters to be estimated, we recommend full model revision only when the sample size for each outcome category is large.
Rectal endometriosis presenting as toxic megacolon
Authors: Luis Enrique Rosario Alvarado, Hisham Bahmad, Odille Mejia, Heather Hollembeak, Robert Poppiti, Lydia Howard, Kiranmayi Muddasani
Journal: Autops Case Rep (2021)
Keywords: case reports, colon, endometriosis, megacolon, toxic
MeSH terms: Case Reports

Background:
The bowel is the most common site of extragenital endometriosis, with involvement of the locoregional sigmoid colon and anterior rectum seen most often. The clinical presentation varies depending on how soon patients seek medical care, thus requiring changes in management strategies. Endometriosis can cause a life-threatening surgical emergency with progressive obliteration of the bowel lumen leading to obstruction and late complications including toxic megacolon and transmural necrosis.
Case presentation:
We report the case of a 41-year-old woman presenting with an acute abdomen and complete large bowel obstruction complicated by sepsis and toxic megacolon. The patient underwent emergency total colectomy with ileostomy. Medical history was significant for chronic, vague, and episodic lower abdominal pain self-medicated with herbal tea and laxatives. Pathologic examination demonstrated colonic endometriosis within the bowel wall as the cause of obstruction, ischemia, and transmural necrosis.
Conclusions:
Although a rare clinical entity, this case highlights two important points. First, it demonstrates the value of performing proper and complete clinical work up to rule out or in all possible causes of colonic obstruction, including intestinal endometriosis. Second, it suggests a potential benefit of a formalized multidisciplinary approach, including surgery, in the management of medically unresponsive endometriosis. In conclusion, this case shows that endometriosis can cause life-threatening colonic obstruction in women of childbearing age. Prompt early intervention is warranted, particularly when obstruction is only partial and ischemia has not supervened, to conceivably prevent the development of a toxic megacolon requiring colectomy and avoid late complications.