OpenMed/multicare-articles huggingface dataset:
Multimodal Imaging of Choroidal Structural in Torpedo Maculopathy
Authors: Hao Yuan, Hongliang Dou, Xuemin Li
Journal: Front Med (Lausanne) (2023)
Keywords: edi-oct, choroid vascularity index, classification, multimodal imaging, torpedo maculopathy
MeSH terms: Case Reports

Objective:
To report a case of torpedo maculopathy with multimodal fundus imaging methods, and apply the choroid vascularity index to quantitatively describe the choroidal structural changes in torpedo maculopathy.
Case presentation:
An asymptomatic 41-year-old Chinese woman with an incidentally found yellowish-white macular lesion in her left eye was referred to our hospital. She was unaware of any prior medical conditions. The best corrected visual acuity (BCVA) was 20/20 OD and 20/25 OS, respectively. Fundus exam of her left eye revealed a well-circumscribed torpedo-like hypopigmented lesion in the macula region, and the tapered edge directed toward the fovea. Pigment deposition could be seen in the inferotemporal portion of the torpedo lesion. Fluorescein angiography showed the corresponding window defect without leakage and fundus autofluorescence demonstrated low signal throughout the lesion. Enhanced depth imaging optical coherence tomography revealed outer retinal attenuation, subretinal cavitation, subtle inner choroidal excavation and thinning of outer nuclear layer. The diagnosis of torpedo maculopathy was clinically made. Choroidal vascularity index (CVI) and sub-foveal choroidal thickness (SFCT) were applied to display changes of choroidal structure. The results implied that both subfoveal CVI and SFCT of the affected eye seemed relatively lower when compared with the fellow eye. Optical coherence tomography angiography showed reduced density of the choriocapillaris in the temporal area of the lesion and increased capillary density in the nasal area. Functional examinations, including microperimetry, multifocal electroretinogram and static perimetry also revealed reduced retinal sensitivity, decreased stimulated amplitude and suspected scotoma in the lesion area. After 12 months of follow-up, the patient's visual acuity and the clinical appearance of the lesion were unchanged.
Conclusion:
The torpedo maculopathy may be identified by abnormal appearance with multimodal imaging. Decreased choroidal vascularity in the lesion area measured quantitatively by choroid vascularity index may play a role in pathogenesis of torpedo maculopathy.
Mimicry of surgical site infection - Case report
Authors: H Bretschneider, S Helbig, C Kleber, K de With, M Stiehler
Journal: Int J Surg Case Rep (2020)
Keywords: calciphylaxis, case report, periprosthetic joint infection, soft tissue complications, total joint arthroplasty
MeSH terms: Case Reports

Background context:
Calciphylaxis is a rare complication of secondary hyperparathyroidism caused by calcifications of small blood vessels in the skin and soft tissue. The disease occurs almost exclusively in patients with chronic kidney disease and has an incidence of approximately 50 cases per year in Germany [1].
Purpose:
We present a case of a 61-year-old woman with calciphylaxis in connection with a primary knee endoprosthesis implantation.
Study design:
Case report.
Methods:
A review of the medical records since the time of initial hospital admission throughout the entire hospitalization until the death of the patient was performed.
Results:
Calciphylaxis caused severe soft tissue complications after total joint arthroplasty. Despite interdisciplinary therapy, including revision and plastic surgery as well as intensive care, the patient died 4 months after primary total knee arthroplasty due to septic multi-organ failure.
Conclusion:
Calciphylaxis may cause severe soft tissue complications after total joint arthroplasty and should be considered as potential differential diagnosis to surgical site infection. This is the first case report on calciphylaxis as direct complication of total joint replacement surgery.
Open Fracture of the Acromion: An Isolated Injury with Oblique-Type Fracture
Authors: Mohammad O Alawad, Saleh Alharthi, Jameel Mahmoud, Basam Alanazi, Saad Surur
Journal: Case Rep Orthop (2018)
MeSH terms: Case Reports

Open acromial fractures are a rare set of fractures. We report a case of Gustilo IIIA open acromial fracture (14A2 as per OTA scapular fracture classification) that was isolated from any other injury. Our patient had a good recovery and showed excellent clinical outcome after irrigation and screw fixation of the acromial fracture. We also reviewed the literature for other cases of open acromial fracture.
Ramping Position to Aid Non-invasive Ventilation (NIV) in Obese Patients in the ICU
Authors: Mohamed Shirazy, Christopher Gowers, Padraig Headley
Journal: J Crit Care Med (Targu Mures) (2023)
Keywords: non-invasive ventilation, obese, ramping

Introduction:
The ramping position is recommended to facilitate pre-oxygenation and mask ventilation of obese patients in anaesthetics via improving the airway alignment.
Presentation of case series:
Two cases of obese patients admitted to the intensive care unit (ICU) with type 2 respiratory failure. Both cases showed obstructive breathing patterns on non-invasive ventilation (NIV) and failed resolution of hypercapnia. Ramping position alleviated the obstructive breathing pattern and hypercapnia was subsequently resolved.
Conclusion:
There are no available studies on the rule of the ramping position in aiding NIV in obese patients in the ICU. Accordingly, this case series is significantly important in highlighting the possible benefits of the ramping position for obese patients in settings other than anaesthesia.
A Case of Gitelman Syndrome with Hypercalcemia Secondary to Primary Hyperparathyroidism
Authors: Zeinab Alnahas, Marko Markov, Mohamad H Horani
Journal: Case Rep Endocrinol (2022)
MeSH terms: Case Reports

Gitelman syndrome is a rare autosomal recessive salt-losing tubulopathy characterized by hypokalemia, hypomagnesemia, hypocalciuria, and secondary hyperaldosteronism. However, hypercalcemia secondary to hypocalciuria is extremely rare during the disease. A 36-year-old normotensive man who suffered a motor vehicle accident was presented with hypokalemia, hypomagnesemia, and mild hypercalcemia. He had a past medical history significant for bipolar depression disorder and a history of chronic atrial fibrillation. He was diagnosed with Gitelman syndrome. However, he was noncompliant with his medications. A laboratory workup revealed hypokalemia, hypomagnesemia, hypercalcemia, and a high parathyroid hormone level. Thorough investigations identified primary hyperparathyroidism as the primary cause of hypercalcemia. To our knowledge, Gitelman syndrome and primary hyperparathyroidism are an extremely rare association that is present in our case.
Replacing Missing Maxillary Lateral Incisors by CAD/CAM PMMA Cantilever Bridges
Authors: Shayma Karray, Yosra Gassara, Emna Boudabous, Sarra Nasri, Zohra Nouira, Hayet Hajjami
Journal: Case Rep Dent (2023)
MeSH terms: Case Reports

Introduction:
Management of missing maxillary lateral incisors can be a challenging endeavour for dentists. Whether from agenesis or tooth loss, several treatment modalities are currently present to tackle this task to ensure satisfactory aesthetics. Most patients, especially younger patients are more likely to prefer fixed prosthodontic rehabilitation. Among these options is the computer-aided design and computer-aided manufacturing polymethyl methacrylate (CAD/CAM PMMA) cantilever bridge. Case Descriptions. These two clinical cases describe the management of missing lateral maxillary incisors in two Tunisian female patients with different etiologies, using CAD/CAM PMMA cantilever bridge.
Conclusions:
CAD/CAM technologies allow for a fairly quick and simple try-in thanks to their high accuracy as well as being predictable, minimally invasive, and affordable treatment options. This type of restoration can be put to use for mid- to long-term solutions to missing maxillary lateral incisors. However, its success depends mainly on patient selection regarding age, general health, occlusal context, and proper indication.
Simulation-based prediction of bone healing and treatment recommendations for lower leg fractures: Effects of motion, weight-bearing and fibular mechanics
Authors: Marcel Orth, Bergita Ganse, Annchristin Andres, Kerstin Wickert, Elke Warmerdam, Max Müller, Stefan Diebels, Michael Roland, Tim Pohlemann
Journal: Front Bioeng Biotechnol (2023)
Keywords: biomechanics, fibula, finite element analysis, gait analysis, lower leg injury, motion, prognosis of bone healing, tibial fracture

Despite recent experimental and clinical progress in the treatment of tibial and fibular fractures, in clinical practice rates of delayed bone healing and non-union remain high. The aim of this study was to simulate and compare different mechanical conditions after lower leg fractures to assess the effects of postoperative motion, weight-bearing restrictions and fibular mechanics on the strain distribution and the clinical course. Based on the computed tomography (CT) data set of a real clinical case with a distal diaphyseal tibial fracture, a proximal and a distal fibular fracture, finite element simulations were run. Early postoperative motion data, recorded via an inertial measuring unit system and pressure insoles were recorded and processed to study strain. The simulations were used to compute interfragmentary strain and the von Mises stress distribution of the intramedullary nail for different treatments of the fibula, as well as several walking velocities (1.0 km/h; 1.5 km/h; 2.0 km/h) and levels of weight-bearing restriction. The simulation of the real treatment was compared to the clinical course. The results show that a high postoperative walking speed was associated with higher loads in the fracture zone. In addition, a larger number of areas in the fracture gap with forces that exceeded beneficial mechanical properties longer was observed. Moreover, the simulations showed that surgical treatment of the distal fibular fracture had an impact on the healing course, whereas the proximal fibular fracture barely mattered. Weight-bearing restrictions were beneficial in reducing excessive mechanical conditions, while it is known that it is difficult for patients to adhere to partial weight-bearing recommendations. In conclusion, it is likely that motion, weight bearing and fibular mechanics influence the biomechanical milieu in the fracture gap. Simulations may improve decisions on the choice and location of surgical implants, as well as give recommendations for loading in the postoperative course of the individual patient.
Ipilimumab- and Nivolumab-Induced Colitis Causing Severe Hypokalemia and QTc Prolongation
Authors: David Anson, Joseph Norton, Benjamin Chaucer, Saurabh Bansal
Journal: Case Rep Oncol Med (2019)
MeSH terms: Case Reports

Immune-mediated colitis is an uncommon but well-documented adverse event in patients receiving nivolumab or ipilimumab therapy. In this report, we present a 69-year-old man who developed severe hypokalemia and colitis with significant corrected Q-T segment (QTc) prolongation as a result of combination nivolumab-ipilimumab immunotherapy for clear cell renal cell carcinoma.
Analysis of the epidemiological status, microbiology, treatment methods and financial burden of hematogenous osteomyelitis based on 259 patients in Northwest China
Authors: Shuaikun Lu, Linhu Wang, Wen Luo, Guoliang Wang, Zhenfeng Zhu, Yunyan Liu, Hao Gao, Congxiao Fu, Jun Ren, Yunfei Zhang, Yong Zhang
Journal: Front Endocrinol (Lausanne) (2023)
Keywords: staphylococcus aureus, calcium sulfate/calcium phosphate bone cement, epidemiological, financial burden, hematogenous osteomyelitis
MeSH terms: Bone Cements, Osteomyelitis / epidemiology, Osteomyelitis / therapy, Anti-Bacterial Agents / therapeutic use, Calcium Sulfate, Female, Financial Stress, Humans, Male, Retrospective Studies, Bone Cements, Calcium Sulfate, Anti-Bacterial Agents

Background:
The incidence of hematogenous osteomyelitis is on the rise, and the prognosis is poor. There has been no large-scale epidemiological analysis of hematogenous osteomyelitis in the world, and the treatment method is still controversial.
Methods:
A retrospective case study method was used to collect and analyze clinical data obtained from patients with hematogenous osteomyelitis in a tertiary hospital in Northwest China from January 1, 2011, to December 31, 2020. The aim of this study was to investigate the epidemiological status, microbiological characteristics, treatment and financial burden of hematogenous osteomyelitis in Northwest China to explore the therapeutic effects of different treatment methods, elucidate the epidemiological characteristics of hematogenous osteomyelitis and to provide a basis for the choice of treatment.
Results:
We included 259 patients with hematogenous osteomyelitis, including 96 patients with acute hematogenous osteomyelitis and 163 patients with chronic hematogenous osteomyelitis. The cause of the disease was not obvious in most patients, the sex ratio of males to females was 1.98, and the three most common infected sites were the tibia, femur and phalanx. Regarding preoperative serum inflammatory markers, the rate of positivity for ESR was the highest at 67.58%. Among pathogenic microorganisms, Staphylococcus aureus was the most common. Regarding the financial burden, the median total cost per patient was 25,754 RMB, and medications accounted for the largest proportion of the main costs.
Conclusions:
The most common pathogen associated with HO infection was MSSA. Oxacillin has good PK and PD and is recommended as the first-line drug. Some blood-borne bone infections may lead to complications, such as pulmonary infection through bacteremia, which requires early detection to avoid a missed diagnosis. Regarding surgical intervention, debridement plus absorbable calcium sulfate bone cement and calcium sulfate calcium phosphate bone cement exclusion have achieved good therapeutic effects, but they are worthy of further in-depth research. Regarding the financial burden, the median total cost per patient was 25,754 RMB. The financial burden of blood-borne osteomyelitis was lower than that of traumatic osteomyelitis. Among the main costs, drugs accounted for the largest proportion.
Acute Gastric Volvulus Causing Splenic Avulsion and Hemoperitoneum
Authors: Yana Cavanagh, Neal Carlin, Ruhin Yuridullah, Sohail Shaikh
Journal: Case Rep Gastrointest Med (2018)
MeSH terms: Case Reports

Gastric volvulus is an abnormal, potentially life-threatening, torsion of the stomach. The presence of complications such as hemoperitoneum increases the diagnostic urgency; however it can also mask the presentation of gastric volvulus. We encountered a 66-year-old female who presented with symptomatic gastric outlet obstruction and was found to have hemoperitoneum and splenic avulsion on imaging. In our case, hemoperitoneum was a clinical red herring as initial imaging concentrated on the presence of hemoperitoneum and was nondiagnostic of gastric volvulus. Interestingly, our patient experienced complete resolution of her presenting symptomatology following placement of a nasogastric tube. Furthermore, endoscopic evaluation revealed no overt pathology to explain outlet obstruction. In light of these findings, gastric torsion was strongly suspected. A repeat CT scan was confirmatory, elucidated reduction of the stomach to its anatomic position, retroactively diagnosing a gastric volvulus. This case is unusual in its presentation and setting. The patient presented with two rare complications of gastric volvulus, hemoperitoneum and splenic avulsion. Additionally, ten years prior to this presentation the patient had a temporary gastrostomy tube. Gastropexy with a gastrostomy is the treatment for gastric volvulus and should have been preventative of her presentation with torsion. Furthermore, the gastric volvulus was not initially recognized radiographically due to the presence of masking radiographic findings. This case serves to highlight the utility of clinical acumen and maintain a high index of suspicion for gastric volvulus in all cases presenting with Borchardt's triad.
Bilateral Femoral Neuropathy: A Rare Complication of Drug Overdose due to Prolonged Posturing in Lithotomy Position
Authors: D Tsiptsios, D Daud, K Tsamakis, E Rizos, A Anastadiadis, A Cassidy
Journal: Case Rep Neurol Med (2020)
MeSH terms: Case Reports

Background:
Bilateral femoral neuropathy is an uncommon complication of various surgical and nonsurgical procedures, such as pelvic/abdominal surgery or vaginal delivery. Case Report. We report a case of a 41-year-old male who was found unresponsive against the wall in a "lithotomy-type" position with both knees flexed at approximately 90 degrees and both hips flexed and externally rotated at approximately 90 and 60 degrees, respectively, 24-48 hours after a drug overdose (combination of dihydrocodeine, paracetamol, diazepam, and amitriptyline). During his recovery, he complained of severe bilateral proximal lower limb weakness and bilateral distal lower limb pain and allodynia. His symptoms were initially attributed to critical illness myopathy/neuropathy (CIMN). However, thorough clinical and neurophysiological evaluation revealed that his symptoms were due to severe bilateral femoral neuropathies.
Conclusions:
To our knowledge, this is the first reported case of bilateral femoral nerve palsy due to prolonged posturing in a "lithotomy-type" position in the context of a drug overdose.
Case Report: Infantile-Onset Fulminant Type 1 Diabetes Mellitus Caused by Novel Compound Heterozygous LRBA Variants
Authors: Eriko Totsune, Tomohiro Nakano, Kunihiko Moriya, Daichi Sato, Dai Suzuki, Akinobu Miura, Saori Katayama, Hidetaka Niizuma, Junko Kanno, Menno C van Zelm, Kohsuke Imai, Hirokazu Kanegane, Yoji Sasahara, Shigeo Kure
Journal: Front Immunol (2021)
Keywords: ctla-4 deficiency, lrba deficiency, infantile-onset fulminant type 1 diabetes mellitus, refractory autoimmune cytopenia, transposable elements (te)
MeSH terms: Adaptor Proteins, Signal Transducing / deficiency, Adaptor Proteins, Signal Transducing / genetics, Common Variable Immunodeficiency / diagnosis, Diabetes Mellitus, Type 1 / diagnosis, Diabetes Mellitus, Type 1 / genetics, Gene Deletion, Heterozygote, Primary Immunodeficiency Diseases / diagnosis, Case Reports, Research Support, Non-U.S. Gov't, Autoimmunity, Common Variable Immunodeficiency / genetics, Diabetes Mellitus, Type 1 / immunology, Diagnosis, Differential, Female, High-Throughput Nucleotide Sequencing / methods, Humans, Infant, Pedigree, Phenotype, Primary Immunodeficiency Diseases / genetics, Adaptor Proteins, Signal Transducing, LRBA protein, human

Lipopolysaccharide-responsive beige-like anchor (LRBA) deficiency is a subtype of common variable immune deficiency (CVID). Numerous case reports and cohort studies have described a broad spectrum of clinical manifestations and variable disease phenotypes, including immune dysregulation, enteropathy, and recurrent infections. Although LRBA deficiency is an autosomal recessive primary immunodeficiency resulting in a phenotype similar to CVID, it is a monogenic disease and separate from CVID. Recently, in a report of monogenic primary immunodeficiency disorder associated with CVID and autoimmunity, the most common mutated gene was LRBA. We report the case of a girl who presented with fulminant type 1 diabetes at age 7 months. She later experienced recurrent bacterial infections with neutropenia and idiopathic thrombocytopenic purpura. Clinical genome sequencing revealed compound heterozygosity of the LRBA gene, which bore two novel mutations. A genetic basis should be considered in the differential diagnosis for very young patients with fulminant autoimmunity, and the diagnostic work-up should include evaluation of markers of immunodeficiency.
22q13.32 deletion and duplication and inversion in the same family: a rare occurrence
Authors: Farooqua Jafri, James Fink, Rodney R Higgins, Raymond Tervo
Journal: ISRN Pediatr (2011)
MeSH terms: Case Reports

Chromosome 22q13.3 deletion syndrome is a well-recognized cause of global developmental delay, while duplication of the same chromosome is a rare occurrence. The presence of both abnormalities in the same family has never been reported, to our knowledge. We report a rare occurrence of 22q13.3 duplication and 22q13.3 deletion in siblings, as a consequence of a mother's inversion on her 22nd chromosome (p13;q13.32). A 6 year old male was noted in infancy to have mild global developmental delay without dysmorphic features. His genetic testing revealed he had 22q13.3 duplication to the terminus. His 4 year old brother was noted in early infancy to have severe global developmental delay and dysmorphic features related to 22q13.3 deletion to the terminus. Their mother had a long inversion on her 22nd chromosome. Genetic tests for their father and eldest brother were unremarkable. The mother's inversion may rearrange to form 22q duplication or deletion when passed on to children. The chance of a child born with a chromosome imbalance is as high as 50%.
Management of impacted maxillary central incisor and abnormality of labial frenulum in children: case report
Authors: Tiarisna Hidayatun Nisa, Prawati Nuraini, Sindy Cornelia Nelwan, Seno Pradopo, Soegeng Wahluyo, Betadion, Udijanto Tedjosasongko, Ilvana Adiwirastuti, Barnabas Bonardo
Journal: Pan Afr Med J (2022)
Keywords: impacted incisor, case report, frenectomy, surgical exposure
MeSH terms: Tooth, Impacted / surgery, Case Reports, Child, Humans, Incisor / surgery, Labial Frenum, Male, Maxilla

Deposition of the maxillary permanent central incisor is a rare occurrence in dental practice. It is a difficult condition to treat due to its importance to facial esthetics. If complications are to be avoided, early detection of such teeth is important. The present case report of impacted maxillary central incisor encased within an abnormally thickened labial frenulum. A 9-year-old boy, came with his parents to the Pediatric Dentistry Specialist, Dental and Oral Hospital, Airlangga University (UNAIR) with a chief complaint that his left maxillary front teeth did not grow while his right front teeth had grown perfectly. From the anamnesis, the patient had experienced a falling trauma when he was young, which caused the deciduous tooth to fall out. Good general health, no history of allergies, and no medical history of case management. This is a fixed orthodontic treatment with surgical exposure of impacted teeth and frenectomy of labial frenulum. After the crown of the impacted incisor was surgically exposed, eruption ball chain was bonded to traction the incisor. The left maxillary incisor fully erupted and normally to percussion, mobility, and sensitivity testing with good attached gingiva in the next 9 months. Management abnormality of labial frenulum in this case with frenectomy by using electrocautery for minimalized trauma in children. Fixed orthodontic therapy was continued to achieve proper alignment leading to good esthetic and functional rehabilitation. The treatment of an unerupted tooth will depend on its state, position, and presence of enough space in the dental arch to accommodate.