OpenMed/multicare-articles huggingface dataset:
Case Report: Arthroscopic "Debridement Antibiotics and Implant Retention" With Local Injection of Personalized Phage Therapy to Salvage a Relapsing Pseudomonas Aeruginosa Prosthetic Knee Infection
Authors: Tristan Ferry, Camille Kolenda, Cécile Batailler, Romain Gaillard, Claude-Alexandre Gustave, Sébastien Lustig, Cindy Fevre, Charlotte Petitjean, Gilles Leboucher, Frédéric Laurent, Lyon BJI Study group
Journal: Front Med (Lausanne) (2021)
Keywords: p aeruginosa, bacteriophages, phage therapy, phagotherapy, prosthetic-joint infection
MeSH terms: Case Reports

Bacteriophages are viruses that specifically target bacteria. They are considered to have a high potential in patients with prosthetic joint infection (PJI), as they have a synergistic anti-biofilm activity with antibiotics. We report here the case of an 88-year-old man (63 kg) with relapsing Pseudomonas aeruginosa prosthetic knee infection. The patient had severe alteration of the general status and was bedridden with congestive heart failure. As prosthesis explantation and/or exchange was not feasible, we proposed to this patient the use of phage therapy to try to control the disease in accordance with the local ethics committee and the French National Agency for Medicines and Health Products Safety (ANSM). Three phages, targeting P. aeruginosa, were selected based on their lytic activity on the patient's strain (phagogram). Hospital pharmacist mixed extemporaneously the active phages (initial concentration 1 ml of 1 × 1010 PFU/ml for each phage) to obtain a cocktail of phages in a suspension form (final dilution 1 × 109 PFU/ml for both phages). Conventional arthroscopy was performed and 30 cc of the magistral preparation was injected through the arthroscope (PhagoDAIR procedure). The patient received intravenous ceftazidime and then oral ciprofloxacin as suppressive antimicrobial therapy. Under this treatment, the patient rapidly improved with disappearance of signs of heart failure and pain of the left knee. During the follow-up of 1 year, the local status of the left knee was normal, and its motion and walking were unpainful. The present case suggests that the PhagoDAIR procedure by arthroscopy has the potential to be used as salvage therapy for patients with P. aeruginosa relapsing PJI, in combination with suppressive antimicrobial therapy. A Phase II clinical study deserves to be performed to confirm this hypothesis.
A Novel SPAST/SPG4 Splice-Site Variant in a Family with Dominant Hereditary Spastic Paraplegia
Authors: Nathaniel M Robbins, Jillian R Ozmore, Thomas L Winder, Pedro Gonzalez-Alegre, Tanya M Bardakjian
Journal: Case Rep Neurol Med (2020)
MeSH terms: Case Reports

Some causes of spastic paraplegia are treatable and many are not. Diagnostic work-up to determine the etiology can be costly and invasive. Here we report the case of a man with slowly progressive spastic paraparesis. Using a multigene next-generation sequencing (NGS) panel, we identified a novel variant in the consensus splice site of the SPAST gene (exon 13, c.1536G>A, heterozygous), affecting codon 512 of the SPAST mRNA. The observed variant segregated with the disease in four tested family members. In this case, genetic confirmation obviated the need for additional testing such as MRI and lumbar puncture and helped the patient and his family understand his condition and prognosis. We conclude with a brief discussion of the SPG4/SPAST gene and the role of multigene panels in the diagnosis and management of hereditary spastic paraplegia.
Evaluation of canine teeth crown reduction technique in macaques
Authors: Su-Mi Kim, Jong-Min Kim
Journal: Lab Anim Res (2020)
Keywords: canine teeth reduction, macaque, personnel protection
MeSH terms: Case Reports

Background:
The reduction of canine teeth in adult males in whom permanent canine teeth eruption occurs should be considered due to the safety of humans or other monkeys. The objective of this study was to evaluate the complications of canine teeth reduction in macaques. Case presentation: Canine teeth reductions were performed in 8 rhesus and 2 cynomolgus macaques. Complications related to canine teeth reduction were evaluated at one to three week intervals during the experimental period by gross examination, CBC, and monitoring of appetite. One monkey showed a fistula due to periapical abscess and neutrophilia more than 2 years after canine teeth reduction, and extraction of the diseased canine tooth was performed; the other 9 monkeys showed no complications during the observation period. This report shows the effectiveness of canine teeth reduction with few complications.
Conclusion:
Canine teeth reduction in male macaques is an acceptable procedure for reducing the severity of injury to humans or other monkeys.
Sympathetic Ophthalmia - case report
Authors: Sorin Simion Macarie, Diana Huțu
Journal: Rom J Ophthalmol (2022)
Keywords: enucleation, ocular trauma, sympathetic ophthalmia, vision loss
MeSH terms: Ophthalmia, Sympathetic / diagnosis, Ophthalmia, Sympathetic / etiology, Ophthalmia, Sympathetic / therapy, Case Reports, Adult, Humans, Male, Tomography, Optical Coherence, Visual Acuity, Young Adult

Purpose. To present the case of a 22-year-old man with a history of trauma on the right eye, followed by a sudden decrease of visual acuity on the left eye, but with a good recovery after surgical treatment. Material and methods. We reported a case of a 22-year-old patient with a sudden and painless decrease of visual acuity on the left eye, a month after a car accident, which led to the laceration of the right globe. At first, the patient received only medical treatment because he refused any surgical intervention. He had a favorable evolution during hospitalization, but he returned after a month with the same visual acuity as at his first admission. The patient accepted the medical treatment and the enucleation of the right eye, thus having a fast improvement in his visual acuity on the left eye. Conclusions. Although the enucleation was overdue, it had a strong favorable influence on the evolution of the disease. As a result of the surgery, the visual acuity has improved significantly in just a few days. Abbreviations: OCT = optical coherence tomography.
Case Report: Long-Term Tolvaptan Treatment in a Child With SIADH and Suprasellar Arachnoid Cyst
Authors: Andrea Puma, Milena Brugnara, Paolo Cavarzere, Marco Zaffanello, Giorgio Piacentini, Rossella Gaudino
Journal: Front Pediatr (2021)
Keywords: hyponatriemia, pediatric treatment, suprasellar arachnoid cysts, syndrome of inappropriate antidiuresis, tolvaptan, vaptans
MeSH terms: Case Reports

Suprasellar arachnoid cysts represent a rare occurrence in the pediatric population and usually cause symptoms related to mass effect and can occasionally cause endocrine dysfunctions. The association between SAC and the syndrome of inappropriate antidiuretic hormone (SIADH) in the pediatric population has rarely been described previously. In most cases, SIADH is temporary and resolves by treating the underlying cause. The first-line treatment consists of fluid restriction in asymptomatic children. Oral urea and demeclocycline are other effective treatment options. Vaptans are a new class of medication for the management of SIADH. These agents are a nonpeptide vasopressin V2 receptor antagonist that selectively antagonizes the antidiuretic effect of AVP, resulting in excretion of diluted urine or "aquaresis." Their efficacy has been shown in adult patients with euvolemic or hypervolemic hyponatremia. However, evidence is lacking in pediatric patients with SIADH. We report the case of a 9-year-old female child with a SAC, who underwent endoscopic fenestration at the age of 2 years. After surgery she developed chronic hyponatremia due to SIADH. Hyponatremia was refractory to treatment with fluid restriction, oral sodium, and urea. In order to normalize serum sodium levels, tolvaptan treatment was started on a compassionate-use basis; 24-48 h later serum sodium levels returned to normal. To date, tolvaptan has been used regularly for 6 years with no side effects occurring during the treatment period. This is the first case of a child with chronic SIADH secondary to SAC successfully treated with tolvaptan. Further studies are needed to demonstrate its usefulness on a broader case series.
Ventilator integrated polygraphy for patients using non-invasive ventilation; Case report
Authors: Helena López-Brull, Estefanía Mira-Padilla, Sarah Hussein, Antoine Guerder, Estelle Wozniak, Violeta Esteban-Ronda, Jésus Gonzalez-Bermejo
Journal: Front Med (Lausanne) (2022)
Keywords: copd, niv, case report, monitoring, patient ventilator asynchrony
MeSH terms: Case Reports

The COVID-19 pandemic has meant that home respiratory services have needed to be reviewed. As a result, new solutions have been developed and implemented. The Vivo 45™ (Breas, Mölnlycke, Sweden) is a ventilator that offers clinicians the ability to attach effort belts to the device. This allows the clinician to review ventilator traces with the addition of thoracic and abdominal activity. This allows more flexibility for the monitoring of patients at home and in the hospital, with detection of patient ventilator asynchrony (PVA). Decreasing PVA may improve ventilator adherence and increased ventilator usage improves survival. We report three cases of patients undergoing overnight monitoring with the Vivo 45™, highlighting the benefit of ventilator integrated polygraphy. In our three cases we demonstrate a simple safe tool to optimize NIV treatment over one or two-night recordings using ventilator downloaded software with the addition of effort belts and pulse oximetry without involving more than one machine and without hospitalization in a sleep unit.
Oil, you're kidding me!
Authors: James Austin, Channa Vasanth Nadarajah
Journal: GMS Ophthalmol Cases (2019)
MeSH terms: Case Reports

A 47-year-old female collapses with loss of consciousness secondary to septic shock and is found to have a left orbital fracture and a right orbital mass that was not seen on imaging two years ago. The mass is reported as a possible ocular melanoma. She is free of any eye pain, ophthalmoplegia or deterioration of vision but has pre-existing extensive diabetic proliferative retinopathy. One year ago, she underwent delamination and segmentation with silicone oil injected as a tamponade agent into the right eye. She is seen promptly in the ophthalmological clinic where fundoscopy reveals this mass to be the silicone oil and no further action is required.
Spontaneous regression of a metastatic carcinoma transmitted by a kidney graft
Authors: Mikhail V Kiselevskiy, Elena G Gromova, Nikolay A Kozlov, Svetlana D Bezhanova, Irina Zh Shubina
Journal: Explor Target Antitumor Ther (2023)
Keywords: cancer, immunosuppressive therapy, kidney graft, spontaneous regressions
MeSH terms: Case Reports

Transmission of a malignancy from a donor's organ to the recipient of the graft is a rare event, though it is a severe complication that can result in a poor outcome. Usually, immunosuppressive therapy is discontinued and the allograft is removed. However, treatment of patients with the disseminated cancers implies that after the graft removal and cessation of the immunosuppression, radiotherapy, chemotherapy, or immunotherapy with alpha-interferon (INF-α) or interleukin-2 (IL-2) are required. The case report presents a clinical case of a transmitted kidney graft with multiple metastases (MTS) in a 31-year-old woman with the spontaneous regression of the metastatic cancer after transplantectomy and cancellation of the immunosuppressive therapy. Obviously, the determining factor is the recognition of the tumor by the effectors of the antitumor immunity due to the human leukocyte antigen (HLA) mismatch between the donor and the recipient. Therefore, cancellation of the immunosuppressive therapy in cases of transferal of a malignancy with a transplanted organ allows the effectors of the immune system to distinguish the tumor as a foreign tissue and effectively eliminate this neoplasm.
Unsuccessful percutaneous mechanical thrombectomy in fibrin-rich high-risk pulmonary thromboembolism
Authors: Jernej Vidmar, Igor Serša, Eduard Kralj, Peter Popovič
Journal: Thromb J (2015)
Keywords: fibrin-rich thromboemboli, high-risk pulmonary thromboembolism, open embolectomy, percutaneous mechanical thrombectomy
MeSH terms: Case Reports

Background:
We report a case of unsuccessful percutaneous mechanical thrombectomy in treatment of a high-risk pulmonary embolism (PE). Pulmonary thromboemboli are commonly expected as a homogenous mass, rich with red blood cell content, which respond well to percutaneous mechanical thrombectomy (PMT). Catheter-based approach or surgical embolectomy are two treatment options that are usually considered for treatment of high-risk PE when the thrombolytic therapy fails or it is contraindicated due to a patient's persisting hemodynamic compromise. Currently, selection criteria for PE treatment options are based mostly on the assessment of patient's history. The aim of this report is to highlight a possible treatment complication in PMT of structurally heterogeneous thrombotic mass due to PMT inadequacy.
Case presentation:
A 32 year-old male with polytrauma was admitted to an intensive care unit after a right-sided nephrectomy and evacuation of retroperitoneal hematoma. The patient initial haemostatic disorder was improved by administration of blood preparations, an anti-fibrinolytic agent and concentrates of fibrinogen. On the third day he presented sudden onset of hemodynamic instability and was incapable of standard CTA diagnostic procedure. Urgent and relevant investigations including transthoracic and transesophageal echocardiogram confirmed a high-risk PE. PMT was performed due to contraindications for systemic thrombolysis. Long-term PMT was attempted using aspiration with several devices. No major improvement was achieved in any of the treatments and the patient died. Autopsy confirmed a large heterogeneous thrombotic mass in the pulmonary trunk folding to the right main artery. Additional histological analysis revealed a high fibrin-rich content in the peripheral surroundings of the thrombus.
Conclusion:
In the case, it was confirmed that the outcome of PMT was directly influenced by mechanical and histological features of the thromboembolus in high-risk PE. Formation of a rather complex thromboembolus in high-risk PE favors surgical embolectomy as the only life-saving treatment option. Current diagnostic imaging techniques do not enable precise assessment of thrombi structure and are therefore unable to identify patients who might benefit from PMT or open surgical embolectomy. Surgical backup treatment should be considered if there are no contraindications in the event of a failed catheter intervention.
A Lip Lump: An Unexpected Histological Diagnosis of a Lip Schwannoma
Authors: Thomas Haigh, John Raad Glore, David Gouldesbrough, Winson Wong
Journal: Case Rep Otolaryngol (2017)
MeSH terms: Case Reports

Schwannomas are benign nerve sheath tumours arising from Schwann cells. They comprise 1% of all benign tumours. In the 2016 World Health Organisation Classification of Central Nervous System, they are classified as a tumour of the cranial and paraspinal nerves, Schwannoma 9560/0. A 23-year-old Caucasian lady presented with a seven-month history of a painless right upper lip lump. Examination revealed a small cystic 0.5 cm diameter lesion within the right upper lip. The clinical impression was that of a mucocele. Excision of the lip lesion was performed under local anaesthetic. Histological examination of the excised lesion demonstrated a circumscribed nodule consisting of spindle cells mixed with vascular spaces containing red blood cells and fibrin. Immunohistochemistry for S100 was strongly positive. The findings were consistent with that of a small benign schwannoma. The current consensus is for surgical excision of a conservative nature with no need for margins. If recurrence does occur one needs to consider whether complete enucleation was achieved or whether malignant transformation has occurred.
Joint preservation of the wrist using articulated distraction arthroplasty: a case report of a novel technique
Authors: Matt D A Fletcher
Journal: Case Rep Orthop (2015)

Distraction arthroplasty of the ankle, elbow, and hip has become widely accepted and used within the orthopaedic community with excellent initial results which appear sustained. To date it has not been applied to the wrist in the same manner. A novel technique, drawn upon past success of articulated ankle distraction and static wrist distraction, was devised and evaluated by application of articulated wrist distraction performed over a 12-week period in a patient with poor functional outcome following limited wrist fusion. Posttreatment results showed improvement in range of motion (100-degree arc), subjective pain, and functional outcome measures (DASH 21.7, Mayo Wrist Score 80) comparable or better than either limited wrist fusion or proximal row carpectomy. Articulated wrist distraction initially appears to be a promising therapeutic option for the management of the stiff and painful wrist to maintain maximal function for which formal wrist arthrodesis may be the only alternative.
Cecal Volvulus
Authors: Kelly Di Dier, Adelard De Backer, Filip Vanhoenacker
Journal: J Belg Soc Radiol (2022)
Keywords: abdominal computed tomography, bird’s beak sign, cecal volvulus, coffee bean sign, whirl sign
MeSH terms: Case Reports

Teaching Point: The coffee bean sign, the whirl sign, and the bird's beak sign are the key findings on abdominal CT of cecal volvulus.
Late-Onset Metastatic Malignant Spindle Cell Tumour Presenting with Massive Intra-Abdominal Haemorrhage
Authors: Pamathy Gnanaselvam, Malintha Lahiru, Mariathas Priatharshan, Umesh Jayarajah, Kathirvetpillai Kopinath
Journal: Case Rep Surg (2020)
MeSH terms: Case Reports

Primary spindle cell sarcoma is a rare tumour. The presentation of acute intra-abdominal bleeding from a metastatic spindle cell tumour has not been previously reported. We report a case of a 40-year-old woman with a history of curative resection of the medial compartment of the right thigh for spindle cell sarcoma presenting with an acute onset abdominal pain and haemorrhagic shock after 5 uneventful years. Emergency exploratory laparotomy was conducted that revealed a retropancreatic mass which had ruptured along its inferior border. Histological evaluation revealed a metastatic deposit of the spindle cell sarcoma. In cases of spontaneous abdominal haemorrhage, it is important to consider the possibility of a ruptured metastatic deposit among the differentials especially in patients with a history of malignancies. Moreover, this is the first reported case of metastatic malignant spindle cell sarcoma presenting with intra-abdominal haemorrhage.
Inappropriate Protocol of Implant Placement in Contact with Impacted Teeth Leading to Failure
Authors: Imed Ouni, Lamia Mansour
Journal: Case Rep Dent (2023)
MeSH terms: Case Reports

Tooth impaction is a frequent phenomenon in patients with craniofacial syndrome, and the oral rehabilitation of such cases is considered a therapeutic challenge for the clinician. Placing implants in contact with impacted teeth may provide an alternative treatment for patients who refuse invasive surgery, and for whom orthodontic traction and surgery are not possible. However, the absence of evidence-based guideline protocols may sometimes lead to inappropriate execution by the clinician. This study aims to describe a case of early failure of an implant placed in contact with dental tissue and to identify the factors associated with implant failure to uncover and prevent their causative mechanisms.
Dysphagia Due to an Extremely Long Styloid Process: A Case Report of Eagle Syndrome
Authors: Ali Albayat, Ali Al Habeeb, Mahdi Jawad
Journal: Cureus (2023)
Keywords: case report, computed tomography, dysphagia, eagle's syndrome, neck pain, styloid process
MeSH terms: Case Reports

Dysphagia is a relatively common condition in the general population and has a wide range of underlying etiologies. We present the case of a 58-year-old male who presented with a complaint of progressive difficulty swallowing for two years in duration associated with unintentional weight loss. He has been using a proton pump inhibitor therapy for more than one year, but he had only mild improvement in his symptoms. Recently, the patient started to experience neck pain during swallowing and he underwent a head and neck computed tomography scan, which demonstrated an extensive elongation of the left styloid process that measured 14.9 cm. The clinical and imaging findings were consistent with Eagle syndrome and the decision was made to perform a resection of the left styloid process. Excision of the left styloid process was made using the external cervical approach. At the follow-up visit, the patient reported a near-complete resolution of his complaints. Eagle syndrome is a very rare etiology of dysphagia. The case highlights an example of Eagle syndrome with an extremely long styloid process. This diagnosis should be considered when encountering a patient with dysphagia and neck pain.
Case report: contradictory genetics and imaging in focal congenital hyperinsulinism reinforces the need for pancreatic biopsy
Authors: Daphne Yau, Ria Marwaha, Klaus Mohnike, Rakesh Sajjan, Susann Empting, Ross J Craigie, Mark J Dunne, Maria Salomon-Estebanez, Indraneel Banerjee
Journal: Int J Pediatr Endocrinol (2020)
Keywords: fluorodopa f 18, focal congenital hyperinsulinism, katp channels, kir62 channel, positron emission tomography computed tomography
MeSH terms: Case Reports

Background:
Congenital Hyperinsulinism (CHI) is an important cause of severe hypoglycaemia in infancy due to excessive, dysregulated insulin secretion. In focal CHI, a localised lesion within the pancreas hypersecretes insulin and, importantly, hypoglycaemia resolution is possible through limited surgical resection of the lesion. Diagnosis of focal CHI is based on a crucial combination of compatible genetics and specialised imaging. Specifically, a focal lesion arises due to a paternal mutation in one of the ATP-sensitive potassium channel genes, KCNJ11 or ABCC8, in combination with post-zygotic loss of maternal heterozygosity within the affected pancreatic tissue. 6-[18F]Fluoro-L-3,4-dihydroxyphenylalanine (18F-DOPA) positron emission tomography (PET)/computed tomography (CT) imaging is used to detect and localise the lesion prior to surgery. However, its accuracy is imperfect and needs recognition in individual case management.
Case presentation:
We report the case of an infant with hypoglycaemia due to CHI and a paternally inherited KCNJ11 mutation, c.286G > A (p.Ala96Thr), leading to a high probability of focal CHI. However,18F-DOPA PET/CT scanning demonstrated diffuse uptake and failed to conclusively identify a focal lesion. Due to unresponsiveness to medical therapy and ongoing significant hypoglycaemia, surgery was undertaken and a small 4.9 × 1.7 mm focal lesion was discovered at the pancreatic neck. This is the second case where this particular KCNJ11 mutation has been incorrectly associated with diffuse 18F-DOPA uptake, in contrast to the correct diagnosis of focal CHI confirmed by pancreatic biopsy.
Conclusions:
Identifying discrepancies between genetic and imaging investigations is crucial as this may negatively impact upon the diagnosis and surgical treatment of focal CHI. This case highlights the need for pancreatic biopsy when a strong suspicion of focal CHI is present even if 18F-DOPA imaging fails to demonstrate a discrete lesion.