OpenMed/multicare-articles huggingface dataset:
Single-site laparoscopic colectomy for rectosigmoid cancer with middle aortic syndrome: report of a case
Authors: Koki Tamai, Ichiro Takemasa, Mamoru Uemura, Junichi Nishimura, Taishi Hata, Hiroki Higashihara, Keigo Osuga, Tsunekazu Mizushima, Hirofumi Yamamoto, Yuichiro Doki, Masaki Mori
Journal: Surg Case Rep (2015)
Keywords: colorectal cancer, middle aortic syndrome, single-site laparoscopic colectomy

Introduction:
Single-site laparoscopic colectomy (SLC) is a promising minimally invasive and safe treatment for colorectal cancer. Improvements of the working instruments and procedures for SLC have helped to overcome challenges regarding the difficulty of operation, supporting the gradual acceptance of this technique. In contrast, narrow working space of the abdominal cavity sometimes prevents securing an adequate surgical view. To obtain precise anatomical information and enable complete mesocolic excision (CME), we routinely perform three-dimensional computed tomography prior to SLC.
Case presentation:
A 69-year-old Japanese woman was clinically diagnosed with rectosigmoid cancer. Unexpectedly, preoperative examination revealed asymptomatic stenosis of the great artery, which was diagnosed as middle aortic syndrome. Because radical colectomy requires dissection of vessels that supply blood flow to the legs, a vascular stent was inserted prior to operation. We chose SLC due to the reduced risk of damaging epigastric arteries, which may eventually become collaterals in the event of stent re-stenosis. We accomplished SLC with CME, and the patient was discharged on the tenth day after operation without complications.
Conclusion:
The present case is the first to proceed by SLC for colorectal cancer complicated by vascular obstructive disease. Preoperative imaging enabled us to identify an unexpected rare disease and to still accomplish SLC with CME, thus reinforcing the importance of preoperative imaging to optimize the use of SLC. In addition, SLC may become one of the most adequate procedures for patients complicated by vascular obstructive disease.
Inflammatory myoglandular polyps: a case series of four patients and review of the literature
Authors: Shoji Hirasaki, Hiromitsu Kanzaki, Minoru Matsubara, Seiyuu Suzuki
Journal: Gastroenterol Res Pract (2010)
MeSH terms: Case Reports

Background:
Inflammatory myoglandular polyp (IMGP) is a nonneoplastic colorectal polyp. Only a small number of cases have been reported, and the pathogenesis remains unclear.
Methods:
We analyzed colonoscopy and histologic findings in 4 patients with IMGP. Histologic confirmation of the inflammatory granulation tissue in the lamina propria, proliferation of smooth muscle, and hyperplastic glands with variable cystic changes formed the criteria for the selection of patients.
Results:
We treated four cases of IMGP and reviewed the literature on this disease. Three cases were located in the sigmoid colon or descending colon. All 4 polyps were identified as red, pedunculated lesions. All 4 cases had no symptoms. In two cases, endoscopic findings of polyps were necessary to be differentiated from juvenile polyps.
Conclusions:
Pedunculated lesions are the main pattern of IMGP. An analysis of endoscopic and histologic features in IMGP of the colorectum revealed that colonic IMGPs resembled juvenile polyps. On colonoscopy, IMGP should generally be taken into consideration as a differential diagnosis of peduncular polyp.
Acquired Elliptocytosis as a Manifestation of Myelodysplastic Syndrome Associated with Deletion of Chromosome 20q
Authors: Sukesh Manthri, Naresh K Vasireddy, Sindhura Bandaru, Swati Pathak
Journal: Case Rep Hematol (2018)
MeSH terms: Case Reports

Elliptocytosis is commonly seen as a hereditary condition. We present a case of myelodysplastic syndrome (MDS) del(q20) variant with concomitant acquired elliptocytosis. A 73-year-old male with a history of prostate cancer presented to the hospital for evaluation of bleeding gums. Initial evaluation showed Hgb of 9.3 gm/dl, hematocrit of 28%, platelet count of 36,000 K/cmm, and WBC of 1.8 K/cmm with an ANC of 0.8 K/cmm. A slightly elevated bilirubin of 1.2 mg/dl spurred a hemolytic workup. Peripheral smear showed frequent elliptocytes, teardrop cells, schistocytes, and occasional spherocytes. Bone marrow biopsy did not show significant fibrosis to explain the elliptocytosis. Cytogenetics showed 20q deletion, and later, he was started on therapy for intermediate risk MDS. Bone marrow biopsy after completion of 6 cycles showed complete cytogenetic remission with significant improvement in elliptocytosis. Elliptocytosis in the setting of MDS has rarely been reported, and association with 20q deletion is even rarer. Animal studies have shown that haploinsufficiency of L3MBTL1 contributes to some (20q-) myeloproliferative neoplasms and myelodysplastic syndromes by affecting erythroid differentiation. Our case report raises interesting questions: Does MDS with rarely reported elliptocytosis indicate a disease process that is different from the usual 20q deletion? Is haploinsufficiency of L3MBTL1 responsible for this manifestation?
A case report of autoimmune necrotizing myositis presenting as dysphagia and neck swelling
Authors: Linh Q Ngo, Andrew G Wu, Matthew A Nguyen, Lauren E McPherson, Elie Gertner
Journal: BMC Ear Nose Throat Disord (2016)
Keywords: anti-3-hydroxy-3-methylglutaryl-coenzyme a reductase, dysphagia, hmgcr, inflammatory myositis, necrotizing myositis
MeSH terms: Case Reports

Background:
Severe dysphagia may occur in the immune mediated necrotizing myopathies (IMNM). Neck swelling and severe dysphagia as the initial symptoms upon presentation has not been previously described.
Case presentation:
A 55-year-old male with a 4 week history of neck swelling, fatigue, dysphagia, myalgias, night sweats, and cough was admitted for an elevated CK. He underwent extensive infectious and inflammatory evaluation including neck imaging and muscle biopsy. Neck CT and MRI showed inflammation throughout his strap muscles, retropharyngeal soft tissues and deltoids. Infectious work up was negative. Deltoid muscle biopsy demonstrated evidence of IMNM. Lab tests revealed anti-3-hydroxy-3-methylglutaryl-coenzyme A reductase (HMGCR) antibodies confirming the diagnosis of HMGCR IMNM.
Conclusions:
HMGCR IMNM is a rare and incompletely understood disease process. Awareness of HMGCR IMNM could potentially lead to earlier diagnosis, treatment and improved clinical outcomes as disease progression can be rapid and severe.
Using pCO2 Gap in the Differential Diagnosis of Hyperlactatemia Outside the Context of Sepsis: A Physiological Review and Case Series
Authors: Petr Waldauf, Katerina Jiroutkova, Frantisek Duska
Journal: Crit Care Res Pract (2019)

Introduction:
There is an inverse relationship between cardiac output and the central venous-arterial difference of partial pressures of carbon dioxide (pCO2 gap), and pCO2 gap has been used to guide early resuscitation of septic shock. It can be hypothesized that pCO2 gap can be used outside the context of sepsis to distinguish type A and type B lactic acidosis and thereby avoid unnecessary fluid resuscitation in patients with high lactate, but without organ hypoperfusion.
Methods:
We performed a structured review of the literature enlightening the physiological background. Next, we retrospectively selected a series of case reports of nonseptic critically ill patients with elevated lactate, in whom both arterial and central venous blood gases were simultaneously measured and the diagnosis of either type A or type B hyperlactataemia was conclusively known. In these cases, we calculated venous-arterial CO2 and O2 content differences and pCO2 gap.
Results:
Based on available physiological data, pCO2 can be considered as an acceptable surrogate of venous-arterial CO2 content difference, and it should better reflect cardiac output than central venous saturation or indices based on venous-arterial O2 content difference. In our case report of nonseptic patients, we observed that if global hypoperfusion was present (i.e., in type A lactic acidosis), pCO2 gap was elevated (>1 kPa), whilst in the absence of it (i.e., in type B lactic acidosis), pCO2 gap was low (<0.5 kPa).
Conclusion:
Physiological rationale and a small case series are consistent with the hypothesis that low pCO2 gap in nonseptic critically ill is suggestive of the absence of tissue hypoperfusion, mandating the search for the cause of type B lactic acidosis rather than administration of fluids or other drugs aimed at increasing cardiac output.
Laparotomy enables retrograde dilatation and stent placement for malignant esophago-respiratory fistula
Authors: Alexander Rehders, Kenko Cupisti, Marcus Schmitt, Marc A Renter, Patrick Kröpil, Ozcan Iskender, Wolfram T Knoefel
Journal: World J Surg Oncol (2008)
MeSH terms: Dilatation, Pathologic, Esophageal Diseases / surgery, Laparotomy, Respiratory Tract Infections / surgery, Stents, Tracheoesophageal Fistula / surgery, Case Reports, Aged, Esophageal Diseases / diagnostic imaging, Esophageal Diseases / therapy, Humans, Male, Radiography, Respiratory Tract Infections / therapy, Tracheoesophageal Fistula / therapy

Background:
Malignant esophageal stenosis with complete obstruction and esophagorespiratory fistula (ERF) is difficult to treat with standard endoscopic techniques.
Case presentation:
We report a patient in whom with local recurrence of esophageal carcinoma an esophagotracheal fistula occurred. Initially the patient had undergone esophageal resection with interposition of a gastric tube. Due to complete obstruction of the lumen by recurrent tumor conventional transoral stent placement failed. For retrograde dilatation a laparotomy was performed. Via a duodenal incision endoscopic access to the gastric tube was achieved. Using a guidewire the esophageal obstruction was traversed and dilated. Then it was possible to place an esophageal stent via an antegrade approach.
Conclusion:
Open surgery enables a safe access for retrograde endoscopic therapy in patients who had undergone esophageal resection with gastric interposition.
SARS-CoV-2 and Subacute Thyroiditis: A Case Report and Literature Review
Authors: Amir Mohammad Salehi, Hossain Salehi, Hossein Ali Mohammadi, Jamileh Afsar
Journal: Case Rep Med (2022)
MeSH terms: Case Reports

Introduction:
Subacute thyroiditis (SAT) is an inflammatory disorder of the thyroid gland, usually triggered by a recent viral or bacterial infection of upper respiratory tracts. The disease is characterized by neck pain radiating to the ears and thyroid gland tenderness. In most cases, it is associated with a transient episode of hyperthyroidism, which is followed by euthyroidism. However, sometimes, it manifests itself with hypothyroidism. Case Presentation. The present report described a case of SAT who was a 55-year-old man presenting to an endocrine clinic with tachycardia, tremor, and neck pain radiating to the jaw and ears. His thyroid function test revealed thyrotoxicosis, and thyroid ultrasound findings were consistent with SAT. The patient reported a history of COVID-19 about 15 days before presentation, which was confirmed by a positive PCR test for SARS-CoV-2.
Conclusions:
It is of great importance for physicians to note that thyrotoxicosis in a patient with a recent history of COVID-19 can be due to SAT. Therefore, they should not begin antithyroid drugs without ordering proper investigations.
Case Report: Severe Complement-Mediated Thrombotic Microangiopathy in IgG4-Related Disease Secondary to Anti-Factor H IgG4 Autoantibodies
Authors: Gautier Breville, Ido Zamberg, Salima Sadallah, Caroline Stephan, Belen Ponte, Jörg D Seebach
Journal: Front Immunol (2021)
Keywords: igg4-related disease, sars cov2, anti-factor h auto-antibodies, antibodies, atypical hemolytic uremic syndrome, complement factor h, complement factor h-related protein, thrombotic microangiopathy
MeSH terms: Apolipoproteins / genetics, Atypical Hemolytic Uremic Syndrome / genetics, Autoantibodies / immunology, Complement C3b Inactivator Proteins / genetics, Complement Factor H / immunology, Immunoglobulin G4-Related Disease / genetics, Case Reports, Atypical Hemolytic Uremic Syndrome / immunology, Atypical Hemolytic Uremic Syndrome / pathology, Female, Gene Deletion, Genetic Predisposition to Disease / genetics, Humans, Immunoglobulin G / immunology, Immunoglobulin G4-Related Disease / immunology, Immunoglobulin G4-Related Disease / pathology, Middle Aged, Thrombotic Microangiopathies / immunology, Thrombotic Microangiopathies / pathology, Apolipoproteins, Autoantibodies, CFHR1 protein, human, CFHR4 protein, human, Complement C3b Inactivator Proteins, Immunoglobulin G, Complement Factor H

Objective:
To first describe and estimate the potential pathogenic role of Ig4 autoantibodies in complement-mediated thrombotic microangiopathy (TMA) in a patient with IgG4-related disease (IgG4-RD).
Methods:
This study is a case report presenting a retrospective review of the patient's medical chart. Plasma complement C3 and C4 levels, immunoglobulin isotypes and subclasses were determined by nephelometry, the complement pathways' activity (CH50, AP50, MBL) using WIESLAB® Complement System assays. Human complement factor H levels, anti-complement factor H auto-antibodies were analyzed by ELISA, using HRP-labeled secondary antibodies specific for human IgG, IgG4, and IgA, respectively. Genetic analyses were performed by exome sequencing of 14 gens implicated in complement disorders, as well as multiplex ligation-dependent probe amplification looking specifically for CFH, CFHR1-2-3, and 5.
Results:
Our brief report presents the first case of IgG4-RD with complement-mediated TMA originating from both pathogenic CFHR 1 and CFHR 4 genes deletions, and inhibitory anti-complement factor H autoantibodies of the IgG4 subclass. Remission was achieved with plasmaphereses, corticosteroids, and cyclophosphamide. Following remission, the patient was diagnosed with lymphocytic meningitis and SARS-CoV-2 pneumonia with an uneventful recovery.
Conclusion:
IgG4-RD can be associated with pathogenic IgG4 autoantibodies. Genetic predisposition such as CFHR1 and CFHR4 gene deletions enhance the susceptibility to the formation of inhibitory anti-Factor H IgG4 antibodies.
The emperor's new clothes: hypersensitivity of the new cardiac isoenzymes
Authors: Ma Ai Thanda Han, Vivek Cherian, R Dobbin Chow
Journal: J Community Hosp Intern Med Perspect (2013)
Keywords: cardiac troponins, conventional troponin assays, highly sensitive troponin assays, pulmonary embolism, right ventricular myocardial infarction
MeSH terms: Case Reports

Right ventricular (RV) myocardial infarction (MI) and pulmonary embolism (PE) are commonly recognized as two of the most challenging and vexing entities in clinical practice. When either is considered in a differential diagnosis, they warrant close consideration because of the life-threatening nature of these conditions. Their signs and symptoms overlap and, on rare occasions, they both can be simultaneously present in a single patient. Cardiac troponins are considered reliable markers of myocardial injury and are critical to the diagnosis of acute coronary syndromes. However, they can also be elevated in cases of PE. We herewith present a case of a woman who initially presented with syncope and then subsequently dyspnea. She manifested elevated cardiac isoenzymes, right-sided electrocardiogram abnormalities, and RV hypokinesis on echocardiography. She was initially diagnosed with RV infarct and managed with an interventional cardiology approach. However, her symptom of dyspnea persisted and the patient was eventually diagnosed with PE. Clinicians should entertain the diagnosis of PE in patients with elevated troponin I and evidence of right-sided cardiac compromise.
Clinical, Histological, and Radiological Outcomes of Sinus Floor Elevation Using a New Approach before Extraction of Periodontally Hopeless Maxillary Molars: A Case Report with 3-year Follow-Up
Authors: Zhaoguo Yue, Qi Liu, Haidong Zhang, Jingwen Yang, Lili Miao, Jianxia Hou
Journal: Case Rep Dent (2022)
MeSH terms: Case Reports

Introduction. This report is the first to present a case with 3-year follow-up, in which sinus floor elevation was performed before extraction of periodontally hopeless teeth, in order to shorten the edentulous interval between extraction and loading of implants and improve the patient's quality of life. Case Presentation. After a series of initial and supportive periodontal therapies, the lateral window was created at the apices of the hopeless teeth, followed by grafting of bone substitute and membrane material at the sinus floor. The tooth was preserved for 13 months prior to extraction followed by immediate implant placement. The patient is satisfied with the oral function partially retained during the treatment period. Predominance of new bone was detected by histologic analysis. The available bone height was augmented from 1-2 to 12-14 mm with little resorption (less than 2 mm of height) after 3 years of follow-up. The dental implant is in good condition without obvious signs of peri-implantitis or mobility after 3 years of loading. Discussion. The feasibility of modified sinus floor elevation (MSFE) could be seen in the current case. The potential benefit of MSFE may include shortening the edentulous interval, facilitating bone regeneration, and providing a chance for immediate implant placement. However, further clinical case evaluations and controlled studies are required to determine indications, effectiveness, and safety of such augmentation procedures.
Exploring a Third Confirmed Case of Hemoperitoneum following Open Inguinal Hernia Repair Caused by Sampson Artery Hemorrhage
Authors: Jordan Hebert, Manoj Jagtiani, Alexander Hsu, David Schmelzer, Fred Wolodiger
Journal: Case Rep Surg (2017)
MeSH terms: Case Reports

Hemoperitoneum is a rare complication of open inguinal hernia repair. This is the third reported case of this complication attributed to the same bleeding source: Sampson's artery. Sampson's artery courses along the round ligament of the uterus in the inguinal canal of females, originating from the arcade formed between the uterine and ovarian arteries. Usually obliterated in postembryonic development, this artery can persist in some adult female patients. Disruption of Sampson's artery can lead to hemoperitoneum following ligation of the uterine round ligament during open inguinal hernia repair in females. This case report describes a third confirmed case of hemoperitoneum complicating an open inguinal hernia repair. We review all three reported cases to date and discuss the recurring signs, symptoms, epidemiologic factors, and diagnostic findings associated. Our review suggests that females of childbearing age, particularly those in the peripartum period, are most at risk of developing this rare complication.
Cervical Spine Ischemic Stroke Complicated by Spastic Quadriparesis and Ogilvie Syndrome: A Case Report and Literature Review
Authors: Salman Assad, Justin Nolte, Dharampreet Singh, Samrina Hanif, Paul Ferguson
Journal: Case Rep Neurol Med (2020)
MeSH terms: Case Reports

Infarction or ischemia of the spinal cord is a rare entity and is often misdiagnosed as inflammatory myelopathy in acute settings. Atherosclerotic disease can affect spinal arteries, leading to cord ischemia with clinical presentation mixed with myelopathy. We present a case of a 66-year-old male who came to the hospital with unsteady gait and numbness of all extremities without associated pain for the past 48 hours. The neurological examination on admission directed the diagnosis towards myelopathy of the cervical spine. However, the initial magnetic resonance imaging (MRI) of the cervical spine demonstrated gliosis and restricted diffusion of the cord with multilevel neuroforaminal stenosis but without central canal stenosis or cord compression. The MRI brain, cerebrospinal fluid analysis, and rheumatologic evaluation were unremarkable. Four days into the clinical course, the patient developed weakness and spasticity of all extremities prompting further evaluation. Computed tomography angiography (CTA) scan of the head and neck revealed right vertebral artery occlusion and intracranial atherosclerotic disease. He was started on aspirin and clopidogrel for secondary risk reduction. The hospital course was further complicated by Ogilvie syndrome (OS), and the patient underwent uncomplicated cecostomy.
Respiratory Syncytial Virus Associated Myocarditis Requiring Venoarterial Extracorporeal Membrane Oxygenation
Authors: Anamaria Milas, Aditya Shah, Neesha Anand, Meghan Saunders-Kurban, Samir Patel
Journal: Case Rep Infect Dis (2017)
MeSH terms: Case Reports

Severe fulminant myocarditis causing cardiogenic shock can be a rapidly progressing, life threatening condition. Respiratory syncytial virus (RSV) is a very rare infectious culprit infrequently described in medical literature as a cause of myocarditis, particularly in adults. We present a case of acute fulminant myocarditis in a patient with PCR positive RSV infection requiring venoarterial extracorporeal membrane oxygenation (VA-ECMO).
Case Report: Superficial Circumflex Iliac Artery Perforator Flap for Tongue Reconstruction Following the Hemiglossectomy
Authors: Yihong Fang, Qiming Ouyang, Zhi Zheng, Jin Wang
Journal: Front Surg (2021)
Keywords: hemiglossectomy, oral maxillofacial reconstruction, superficial circumflex iliac artery perforator flap, tongue cancer, tongue reconstruction
MeSH terms: Case Reports

Objective: Therapeutic evaluation of applying superficial circumflex iliac artery perforator (SCIP) flap in tongue reconstruction after hemiglossectomy. Methods: We retrospectively collected a total number of 14 patients who received SCIP flap reconstruction for tongue defects at the Fujian Medical University affiliated Union Hospital, between November 2016 and November 2020. We evaluated the clinical features of the flap, analyzed the postoperative functions and esthetic effects after 6 months of the tongue reconstruction. Results: All the SCIP flaps survived successfully after the operation, the recipient site tongue bodies were well reconstructed 6 months after the surgery. Patient speech and swallowing functions were well recovered during the follow-up. The scars in the donor site were concealed with limited numbness. Conclusions: With the advantages of the hidden donor site and aesthetic benefits, the SCIP flap is a reliable option for the reconstruction of the tongue defect after hemiglossectomy.