OpenMed/multicare-articles huggingface dataset:
From Trauma to Recovery: A Comprehensive Management of Achilles Tendon Injury in a Young Female
Authors: Neha Arya, Anam Sasun, Ghanishtha Burile, Pallavi Harjpal, Rakesh K Kovela
Journal: Cureus (2024)
Keywords: achilles tendon, balance, case report, physiotherapy, rehabilitation, strength
MeSH terms: Case Reports

The incidence of the Achilles tendon getting injured has recently increased by 18 in 100,000. Compared to non-surgical treatment, surgical results are superior. The Achilles tendon repaired with surgery has a re-rupture rate of only 5%, while if treated non-operatively, it has a rupture rate of 40%. This case report analyses the traumatic Achilles tendon rupture and subsequent surgical repair in a young woman. In this case study, a 19-year-old female patient's severe Achilles tendon injury was successfully managed by integrating prompt surgical intervention and structure. After rehabilitation, the patient's range of motion (ROM), muscle strength, and gait patterns all significantly improved. Scores on the Lower Extremity Functional Scale (LEFS) and the Dynamic Gait Index (DGI) both significantly improved. This case study reiterates the significance of an integrated healthcare strategy for Achilles tendon injuries. An immediate surgical procedure followed by a specific rehabilitation programme accelerates healing and the return to optimal function. The results emphasize the critical role of physical therapy in assisting surgical interventions and underline the necessity of comprehensive patient care in the treatment of complex orthopaedic problems.
Pembrolizumab-Induced Isolated Adrenocorticotropic Hormone (ACTH) Deficiency
Authors: Khalid Alfares, Hye Jeong Han
Journal: Cureus (2024)
Keywords: acth deficiency, adrenal insufficiency, chemotherapy-related toxicity, low cortisol, pd-1 inhibitors, pembrolizumab, pituitary hormones
MeSH terms: Case Reports

Pembrolizumab is a programmed death 1 receptor (PD-1) inhibitor. It is used as immunotherapy in various cancers, including metastatic melanoma, non-small cell lung cancer, and, notably, high-risk triple-negative breast cancer. We discuss a case of a 44-year-old female with a past medical history of triple-negative breast cancer who presented with a chief complaint of poor oral intake and fatigue after her fourth cycle of pembrolizumab therapy. The patient was diagnosed with pembrolizumab-induced isolated secondary adrenal insufficiency (AI) and was treated with corticosteroids with improvement in her symptoms. Secondary AI due to pembrolizumab use is a rare yet potentially life-threatening complication. If initial serum cortisol is borderline low, as observed in our patient, repeated testing within shorter intervals should be considered to optimize patient outcomes.
Residual Medial Ankle Pain After the Delayed Union of a Lateral Malleolus Fracture: A Case Report
Authors: Akinobu Minagawa, Tadashi Kimura, Nori Yamashita, Mitsuru Saito, Makoto Kubota
Journal: Cureus (2024)
Keywords: ankle instability, ankle pain, delayed union, lateral malleolus fracture, osteochondral lesion
MeSH terms: Case Reports

A 17-year-old girl sprained her left ankle and was diagnosed with a lateral malleolar fracture. She was treated conservatively for six months but had medial ankle pain with activity. Imaging revealed an oblique lateral malleolar fracture, with posterolateral displacement and partial fusion of the bone fragments, and bone marrow edema on the medial articular surface of the talus and medial malleolus. We diagnosed ankle instability due to delayed union with a displacement of the lateral malleolus, which caused an osteochondral lesion. We performed arthroscopic and open surgery eight months after the injury, reducted the lateral malleolus anatomically, and fixed it with a plate. Postoperatively, the pain improved rapidly, and the bone marrow edema had almost disappeared on an MRI. In this case, we think rotational instability of the ankle mortise caused abnormal pressure and continuous stress on the medial malleolus after injury, which may have contributed to persistent medial ankle pain.
Asystole in a young child with tetrahydrocannabinol overdose: a case report and review of literature
Authors: Mats Steffi Jennifer Masilamani, Rebecca Leff, Yu Kawai
Journal: Front Toxicol (2024)
Keywords: case report, thc overdose, asystole, children, edibles
MeSH terms: Case Reports

Introduction:
The association between Δ8-tetrahydrocannabinol (THC) and cardiac dysrhythmia has not been well described in children. Asystole, while consistent with reports of severe bradycardia and apnea in children, is uncommonly described in the current literature. We present the first pediatric case of asystole and apnea following THC ingestion.
Case:
A 7-year-old male presented to the emergency department (ED) after his mother noticed he was lethargic 3-4 h after accidental ingestion of five 15 mg (total of 75 mg) Δ8-THC gummies. Upon arrival, he was vitally stable and well-appearing. He received maintenance intravenous fluids. Approximately 7 h after initial ingestion, he experienced a >15-s episode of asystole and apnea on telemetry requiring sternal rub to awaken. This was followed by bradycardia (60 beats per minute range) which resolved with 0.1 mg glycopyrrolate. He was admitted to the PICU, drowsy but arousable with stable vitals. After an uneventful 24-h (post-ingestion) PICU observation, he was discharged home in stable condition.
Discussion:
To our knowledge, this is the first reported pediatric case of THC-induced asystole. The etiology of asystole may be attributed to direct vagal stimulation of THC or respiratory depression. The typical recommended observation time after potential toxicity is 3-6 h after children have returned to their physiological and behavioral baseline. Our patient was clinically stable with no concern for respiratory depression or cardiac dysrhythmia yet experienced an asystolic pause with apnea 7 h after initial ingestion.
Conclusion:
Our case demonstrates that asystole and apnea may occur in pediatric patients following large THC ingestions and those symptoms can appear late outside of the currently recommended observation period.
Case Report: two cases of anti-neutrophil cytoplasmic antibody-associated vasculitis involving large vessels
Authors: Hanyu Zhang, Dingfang Yan, Yuehua Wei, Yun He, Junjie Chang, Wenjun Zhang
Journal: Front Cardiovasc Med (2024)
Keywords: anti-neutrophil cytoplasmic antibodies, computed tomography, echocardiography, large vessels, vasculitis
MeSH terms: Case Reports

Anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is a group of systemic diseases caused by a combination of many factors, including genetics, environment, and immunity. AAV is characterized by predominantly small-vessel involvement and has a variety of clinical manifestations. Small-vessel lesions of the kidneys and lungs are common, and lesions of medium-sized arteries may also present, but the involvement of large arteries and their primary branches is very rare. This report delineates two instances of AAV with large arterial involvement, one case presenting with lesions of the aortic valve and the other with lesions of the pulmonary artery. The first case involved a 57-year-old man with no underlying diseases. Transthoracic echocardiography showed thickening of the left and right coronary valves of the aortic valve with enhanced echogenicity, moderate echogenic masses were seen on both valve leaflets, and the leaflets had restricted opening and poor closure. Blood tests showed positive perinuclear anti-neutrophil cytoplasmic antibodies (p-ANCA) and anti-myeloperoxidase (MPO) antibodies. The patient's aortic valve thickening virtually disappeared after treatment with hormones combined with immunosuppressive agents. The second case involved a 60-year-old woman whose transthoracic echocardiography and CT (computed tomography) angiography of the pulmonary arteries showed wall thickening of the main pulmonary artery and the proximal left and right pulmonary arteries, leading to luminal stenosis. Blood tests showed positive cytoplasmic anti-neutrophil cytoplasmic antibodies (c-ANCA) and anti-proteinase 3 (PR 3) antibodies. The patient's pulmonary artery wall thickening reduced after receiving hormones in combination with immunosuppression but she died of heart failure during subsequent treatment. The patient had been diagnosed with tuberculosis six months earlier and had been poorly treated with anti-tuberculosis therapy. The involvement of large arteries in AAV is a rare and critical condition with rapid progression and a high mortality rate. Early recognition of this type of AAV and aggressive immunosuppressive therapy may facilitate the reversal of the vascular lesion and a reduction in the risk of patient death.
Thrombosis of portal, superior mesenteric, and splenic veins: a case report
Authors: N Soghomonyan, H Khachatryan, G Soghomonyan, Q Fleming
Journal: Front Pharmacol (2023)
Keywords: anticoagulation, deep vein thrombosis (dvt), intestinal ischaemia, portal venous thrombosis (pvt), systemic inflammation
MeSH terms: Case Reports

Patients with venous thrombosis of splanchnic circulation represent a group of high risk with significant morbidity and mortality, if treatment is delayed. We present a patient with thrombosis of portal vein and its tributaries combined with deep venous thrombosis (DVT) of the lower extremities who was successfully treated with conservative management. This patient case highlights the importance of early empiric anti-inflammatory therapy along with systemic anticoagulation to reduce the intestinal inflammation and enteritis and break the vicious circuit resulting in secondary progressive thrombosis of the splanchnic veins, fluid shifts, and functional ileus. Case presentation: A previously healthy 61-years-old female patient with no significant medical history was admitted with progressive upper abdominal pain, nausea and vomiting, low-grade fever, mild signs of ileus, and malaise. Imaging studies revealed portal venous dilation reaching ∼20 mm with near-total obliteration of the lumen by a thrombus. In addition, thrombosis of superior mesenteric and splenic veins with thrombophlebitis was found. Imaging studies also confirmed the presence of DVT of lower extremities including thrombus propagation into the iliac veins. An immediate therapy was started with parenteral antibiotics, anti-inflammatory medications, systemic anticoagulants, and intravenous fluid infusions to restore the circulating volume deficit and treat electrolyte disbalance. With such therapy, the patient's symptoms resolved within a month, and she was discharged from the hospital with full recovery. Heparin infusion was started to reach systemic anticoagulation. With resolution of symptoms, anticoagulation was continued with warfarin. We used non-steroidal anti-inflammatory drugs (NSAIDs) as a component in management of intestinal and systemic inflammation and multifocal thrombosis when the antiphospholipid syndrome was also on the list of differential diagnoses. Conclusion: We present a previously asymptomatic patient with progressive portal venous thrombosis and ascending DVT. Early establishment of diagnosis and initiation of therapy with systemic anticoagulants, anti-inflammatory and antibacterial drugs helped to stop thrombus progression, prevent irreversible intestinal ischemia, and allow for re-canalization of the occluded veins. This case highlights the importance of early interventions to improve the treatment outcome.
EVALUATION OF ARTHROGRYPOTIC FOOT TREATMENT: MINIMUM 10 YEARS FOLLOW-UP
Authors: Monica Paschoal Nogueira, Jordana Brandão Caiafa, Alessandra Porto Pereira Galdez, Rodrigo Pastick Fujino, Fernando Farcetta
Journal: Acta Ortop Bras (2024)
Keywords: arthrogryposis, clubfoot, operative, quality of life, surgical procedures

Objective:
To evaluate patients with arthrogryposis submitted to extensive surgical treatment with a minimum of 10 years of follow-up regarding the clinical and radiological aspects and the quality of life, using the 36-Item Short Form (SF-36) and the Disease-Specific Instrument (DSI).
Methods:
A retrospective study selected 33 patients, totaling 64 operated feet.
Results:
The mean age of the patients was 17.9 years (12-39 years), and the mean follow-up time was 14.8 years (11-17). Amyoplasia represented 78.7% of syndromic diagnoses. Isolated posteromedial lateral release (PMLR) was performed in 21.8% of the feet, 27.2% of which required additional bone surgery, and about 50 feet (78.1%) were submitted to PMLR, lateral column shortening, and/or talectomy. In total, 46 talectomies were performed (71.8% of the feet), out of which 44 were the first procedure of choice. SF-36 questionnaire was evaluated and showed that 93.9% of the patients did not have restrictive and disabling pain, and the same percentage considered themselves as healthy and had good expectations for the future.
Conclusion:
Arthrogrypotic feet are difficult to treat, require many recurrent surgical procedures, and relapses are the rule. Stiffness is a common feature of these feet, and residual deformities were frequent. Level of Evidence IV; Case Series, Therapeutic Studies.
Postoperative Chylous Ascites in Gynecological Malignancies: Two Case Reports and a Literature Review
Authors: Xin Tan, GuoLin Luo, Guangdong Liao, Hong Liao
Journal: Obstet Gynecol Int (2024)

Aim:
To explore the potential factors that influence the presentation and recovery of postoperative chylous ascites (CA) in gynecological malignancies.
Methods:
We reported two cases of postoperative CA following gynecological surgery and reviewed the clinical features of 140 patients from 16 relevant papers. Patients' clinicopathological characteristics, surgical approach, and management were summarized. The onset and resolution times of postoperative CA in different groups were analyzed separately.
Results:
The two patients in our report had recovery after conservative treatments. According to the literature review, the median time of onset of postoperative CA was 5 days (range, 0-75 days) after surgery. The median resolution time was 9 days (range, 2-90 days). Among patients, 87.14% of them had lymphadenectomy during gynecological surgeries, while 92.86% of the patients had resolution after conservative treatments.
Conclusions:
Lymphadenectomy during surgery may be relevant to the postoperative CA. Conservative management could be the initial choice for postoperative CA treatment.
Idiopathic Megaduodenum in a Teenager: A Case Report
Authors: Anthony N Eze, Akachukwu N Eze, Chinecherem M Chime, Fengming Chen, Dimitrios Moris, Robin Schmitz, Tamara N Fitzgerald
Journal: Cureus (2024)
Keywords: duodenal volvulus, idiopathic, malnutrition, megaduodenum, small bowel obstruction, superior mesenteric artery syndrome
MeSH terms: Case Reports

Megaduodenum is a rare clinical syndrome characterized by significant duodenal dilation, elongation, and hypertrophy. Given its rarity and nonspecific clinical manifestations, megaduodenum may be misdiagnosed, leading to delays in surgical care and increased morbidity. We describe a case of idiopathic megaduodenum in a teenage Caucasian female, who presented with a five-year history of halitosis, recurrent belching, bloating, nausea and vomiting, and postprandial epigastric abdominal pain. She was diagnosed with megaduodenum by dramatic findings on contrast radiography. She developed a duodenal volvulus necessitating emergency exploratory laparotomy, during which a duodenal plication and a side-to-side duodenojejunostomy were performed. Exploratory laparotomy and histopathological analysis were unrevealing of any definitive abnormalities to explain her megaduodenum. Postoperatively, she developed two early small bowel obstructions, both from subsequent adhesions requiring repeat laparotomy with adhesiolysis. She has subsequently recovered without incident. Diagnosis and accurate classification of megaduodenum requires surgical exploration with a full-thickness biopsy and subsequent histopathologic analysis to rule out obstructive or functional disorders of the duodenum. Treatment of megaduodenum depends on the underlying cause and degree of duodenal distention. It is crucial that clinicians are knowledgeable of the various surgical options, their indications, and the potential postoperative complications that may arise.
Recurrent Graves' Disease Following Near-Total Thyroidectomy: A Case Report and Literature Review
Authors: Lakshmi P Menon, Syeda Naqvi, Jhansi Maradana, Dinesh Edem
Journal: Cureus (2024)
Keywords: graves’ disease, thyroglobulin, thyroid eye disease, thyroid surgery, tsh receptor antibody
MeSH terms: Case Reports

Recurrent Graves' disease due to regrowth of thyroid tissue is a rare complication of near-total thyroidectomy, which can be challenging to recognize and manage. Here, we present the case of a 30-year-old woman with Graves' disease and thyroid eye disease who underwent near-total thyroidectomy with resultant hypothyroidism. Her levothyroxine dose requirement gradually decreased and thyroglobulin level increased, which led to the diagnosis of recurrent Graves' disease. A neck ultrasound showed regrowth of thyroid tissue. The treatment options in such cases are repeat thyroid surgery and radioactive iodine ablation. The patient had moderate-severe active thyroid eye disease, so radioactive iodine ablation was contraindicated. Repeat surgery was deemed high risk due to the location of the residual thyroid tissue near the recurrent laryngeal nerve. Watchful waiting with serial thyrotropin (TSH) receptor antibody monitoring was chosen, and her levothyroxine dose was adjusted based on her thyroid function tests. There was a normalization of her TSH receptor antibody level over the next two and half years and stabilization of levothyroxine dose requirement. Recurrent Graves' disease must be considered when there is an ongoing decrease in the levothyroxine dose requirement associated with a rise in the serum thyroglobulin level following near-total thyroidectomy. Conservative management with medical therapy can induce remission in the case of recurrent Graves' disease following near-total thyroidectomy, without the need for radioactive iodine ablation or repeat thyroid surgery.
Case report: Successful treatment of advanced colon cancer in an eighty-year-old man with long-term and multi-stage endoscopic minimally invasive therapy
Authors: Nana Zhang, Lulu Zhu, Yan Liu, Xiaolong Chen, Bifang Zhang, Chunhong Wen, Huayu Zhang, Qinglin Tang, Mingqing Zhang
Journal: Front Oncol (2024)
Keywords: aged, argon plasma coagulation, colonic neoplasms, endoscopy, surgery
MeSH terms: Case Reports

Background:
No previous studies have reported on the use of minimally invasive endoscopic therapy for colon cancer in older patients.
Case presentation:
An 80-year-old man was admitted to our hospital with haematochezia and diagnosed with advanced colon cancer in 2018. Traditional surgical care was rejected by his family. We successfully treated the patient with multiple minimally invasive endoscopic therapies, such as argon plasma coagulation, from 2018 to 2021.
Conclusion:
Invasive endoscopic therapy is a feasible way to treat colon cancer in older patients.
Case Report: Identification of microduplication in the chromosomal 2p16.1p15 region in an infant suffering from pulmonary arterial hypertension
Authors: Xun Wang, Zeying Zhang, Wanyun Zuo, Dan Wang, Fan Yang, Qiming Liu, Yunbin Xiao
Journal: Front Cardiovasc Med (2023)
Keywords: 2p161p15, copy number mutation, developmental delay, microduplication, pulmonary arterial hypertension
MeSH terms: Case Reports

This study reports the first case of a patient with chromosomal 2p16.1p15 microduplication syndrome complicated by pulmonary arterial hypertension (PAH). A female infant was admitted to the hospital suffering from dyskinesia and developmental delay, and conventional echocardiography revealed an atrial septal defect (ASD), which was not taken seriously or treated at that time. Two years later, preoperative right heart catheterization for ASD closure revealed a mean pulmonary artery pressure (mPAP) of 45 mmHg. The mPAP was reduced, and the condition was stabilized after drug therapy. A genomic copy number duplication (3×) of at least 2.58 Mb in the 2p16.1p15 region on the paternal chromosome was revealed. Multiple Online Mendelian Inheritance in Man (OMIM) genes are involved in this genomic region, such as BCL11A, EHBP1, FAM161A, PEX13, and REL. EHBP1 promotes a molecular phenotypic transformation of pulmonary vascular endothelial cells and is thought to be involved in the rapidly developing PAH of this infant. Collectively, our findings contribute to the knowledge of the genes involved and the clinical manifestations of the 2p16.1p15 microduplication syndrome. Moreover, clinicians should be alert to the possibility of PAH and take early drug intervention when facing patients with 2p16.1p15 microduplications.
Avoiding stoma creation due to super-morbid obesity: A report of two surgical cases of colorectal cancer
Authors: Naoto Fujimoto, Takayuki Ogino, Norikatsu Miyoshi, Mamoru Uemura, Yuichiro Doki, Hidetoshi Eguchi
Journal: Int J Surg Case Rep (2024)
Keywords: chemotherapy, colorectal cancer, obesity, stoma
MeSH terms: Case Reports

Introduction:
A stoma is commonly created in patients with a high risk of anastomotic leakage. However, patients with obesity have a higher incidence of stoma-related complications, and the decision to create a stoma should be carefully considered. We report two cases of patients with colorectal cancer and super-morbid obesity wherein stoma creation was avoided.
Presentation of cases:
Case 1 involved a 52-year-old male patient with a body mass index (BMI) of 41.8 kg/m2 who underwent a robotic-assisted laparoscopic low anterior resection after neoadjuvant chemotherapy for lower rectal cancer. Although temporary diverting ileostomy was initially considered, stoma creation was skipped intraoperatively, considering the complication risk-benefit ratio. Case 2 involved a 42-year-old female patient with a BMI of 64 kg/m2 who underwent open partial non-curative colon resection for descending colon cancer complicated by colonic perforation and abscess formation. The patient was considered to be at high risk of stoma-related complications due to high mobility of the subcutaneous fat of abdominal wall; therefore, we decided not to create a stoma preoperatively.
Discussion:
Considering the high risk of stoma-associated complications, avoiding stoma creation and implementing preventive measures against potential complications are alternative options for patients with super-morbid obesity.
Conclusion:
We present our experience two cases in which stoma creation was avoided for super-morbid obese patients with BMI over 40.
Iatrogenic Pseudoaneurysm of the Lateral Femoral Circumflex Artery Following Antegrade Intramedullary Femur Nailing: A Case Report
Authors: Nur Ayuni Khirul Ashar, Imma Isniza Ismail, Rahul Lingam
Journal: Cureus (2024)
Keywords: iatrogenic pseudoaneurysm, intramedullary femur nailing, lateral femoral circumflex artery, trauma, vascular injury
MeSH terms: Case Reports

Few cases of femoral artery pseudoaneurysm or its branches have been reported following intramedullary nailing of femur fractures. The occurrence of a false aneurysm of the lateral femoral circumflex artery (LFCA) for such a fracture has never been reported so far. We report a case of a young male with a delayed presentation of right thigh swelling following an antegrade interlocking nail femur. Ultrasonography and CT angiography of the right thigh confirmed a pseudoaneurysm communicating with LFCA. After unsuccessful ultrasound-guided compression therapy, the patient underwent embolization of the right LFCA pseudoaneurysm by an interventional radiologist. Although intramedullary nailing is considered a safe procedure, a pseudoaneurysm should be suspected when the patient presents with a painful swelling after the surgery. Glue embolization of the artery should be considered as one of the treatment options, as it yields favorable outcomes with less morbidity.