OpenMed/multicare-articles huggingface dataset:
Toxicological and Biochemical Analyses of an Autopsy Case Involving Oral Overdose of Multiple Antidiabetic and Antihypertensive Drugs
Authors: Tomoya Ikeda, Naoto Tani, Shigeki Oritani, Alissa Shida, Yayoi Aoki, Fumiya Morioka, Takaki Ishikawa
Journal: Case Rep Med (2018)
MeSH terms: Case Reports

Oral antidiabetics can cause fatal hypoglycemia; although they can be chemically identified and quantified, biochemical investigations are important for assessing the biological consequences of an overdose. Such cases of overdose involving oral antidiabetics may involve other drugs for treating lifestyle-related diseases, particularly antihypertensives. Here, we report a toxicological and biochemical investigation of drugs and biochemical profiles in a fatal overdose involving multiple oral antidiabetics and antihypertensives. A 55-year-old woman died about 2 days after the ingestion of around 110 tablets of antidiabetics and antihypertensives that had been prescribed for her husband. A forensic autopsy and histological analysis demonstrated no evident pathology as the cause of death. A toxicological analysis suggested hypoglycemia and an overdose of antihypertensives as well as the retention of antidiabetics and diuretics in the pericardial fluid. A relatively low pericardial amlodipine concentration was observed, which may have been the result of its long half-life (slower distribution and reduction rate) and/or possible affinity with the myocardium. In addition, a biochemical analysis indicated hypoglycemia, without increased serum insulin and C-peptide, but with increased glucagon levels, as the possible influence of glibenclamide overdose. These observations suggest the usefulness of a combination of toxicological and biochemical analyses in postmortem investigations involving a fatal overdose of such drugs.
Brain metastasis in colorectal cancer presenting as refractory hypertension
Authors: Syed Moin Hassan, Ateeq Mubarik, Salman Muddassir, Furqan Haq
Journal: J Community Hosp Intern Med Perspect (2018)
Keywords: brain metastasis, colorectal cancer, hypertensive urgency, mass effect, neurosurgery, solitary lesion, stereotactic radiosurgery, whole-brain radiotherapy
MeSH terms: Case Reports

Background: Brain metastasis (BM) from colorectal cancer (CRC) is rare with the incidence ranging from 0.6% to 3.2%. There is also an increased incidence of BM with rectal primaries and is consistent with this patient's presentation. Overall, there is scarce literature on the symptoms of patients who present with CRC BMs. Objectives: We present a case of brain metastasis in colorectal cancer presenting with hypertensive urgency and severe headache. Methods and results: This case highlights that neurological deficits are not necessary for BMs in patients with CRC and summarizes and reviews the associated literature regarding BM in CRC. A 57-year-old female with a past medical history of recently diagnosed stage IV moderately differentiated distal rectal adenocarcinoma with liver and lung metastasis was admitted with the primary complaint of hypertensive urgency, severe headache, intractable nausea and vomiting, and diarrhea. Magnetic resonance imaging brain showed a left cerebellar lesion measuring 3.6 × 3.2 × 2.9 cm, ipsilateral transtentorial herniation, and obliteration of the fourth ventricle. The patient was started on steroids and transferred for an urgent neurosurgical intervention to a tertiary care center. Conclusions: Even though BMs are rare in CRC, clinicians should have a high index of suspicion with complaints like hypertensive urgency, headache, nausea, vomiting, vertigo, and blurring of vision triggering imaging studies to rule out BM. The approach to BM has become increasingly individualized as surgical and radiosurgical therapies have continued to evolve Abbreviations: CRC: Colorectal cancer; BM: Brain metastasis; FOLFOX: Folinic acid, fluorouracil and oxaliplatin; CT: Computed tomography; IV: Intravenous; PO: By mouth; BAER: Brain auditory evoked response hearing testing; SSEP's: Somatosensory evoked potentials; BMFI: Brain metastasis free interval; WBRT: Whole-brain radiation therapy; SRS: Stereotactic radiosurgery.
Rapidly fatal outcome of Covid-19 after successful emergency surgery during pandemic outbreak in Northern Italy
Authors: Filippo Montali, Gerardo Palmieri, Lorenzo Casali, Lorenzo Pagliai, Renato Costi
Journal: Int J Surg Case Rep (2020)
Keywords: covid-19, emergency surgery, fatal outcome, pandemic outbreak, sars cov-2
MeSH terms: Case Reports

Introduction:
A pandemic outbreak of novel coronavirus, named SARS-CoV-2 and responsible of Coronavirus Disease 2019 (COVID-19), has rapidly spread from China to Europe, being Northern Italy the first focus outside Asia. Little is known about the evolution of SARS-CoV-2 infection in patients undergoing surgery.
Presentation of case:
Here we report the first confirmed case of early postoperative SARS-CoV-2 infection in a patient recovering after Hartmann's procedure for acute diverticulitis. After an otherwise unevenful postoperative course, on post-operative day 8, the patient suddenly presented hyperpyrexia and cough, rapidly evolving to respiratory failure and death 36 h after symptoms onset. CT-scan identified bilateral, diffuse, interstitial pneumonitis and oropharyngeal swab test confirmed the presence of SARS-CoV-2. A previous contact with the partner, developing the same symptoms, remained unrecognized until ICU admission.
Discussion:
During a pandemic outbreak, the early identification of SARS-CoV-2 infection of an inside patient initially considered to be infection-free has a pivotal importance not only for the prompt patient's management, but also to avoid infection spreading to other patients and hospital personnel.In the reported case, a more precise information to the patient regarding the imperative necessity to inform the medical personnel of any person of his entourage presenting, at any time, any tell-tale sign, symptom or examination which may be attributed to COVID-19, may have had allowed to anticipate patient's isolation and examinations and procedures aimed at identifying such an infection.
Conclusion:
Persistent hyperleucocytosis and increased CRP serum level in spite of uneventful postoperative course were the only, aspecific markers of an ongoing SARS-CoV-2 infection before symptoms' onset, and should be considered in future clinical practice in order to adopt the prompt and appropriate patient management and limit COVID-19 contagion in surgical units.
First Robotic Hepatectomy With Middle Hepatic Vein Reconstruction Using ePTFE Graft for Hepatic Adenoma: A Case Report
Authors: Jilong Wang, Zongrui Jin, Banghao Xu, Weitao Chen, Jianyong Zhang, Hai Zhu, Tingting Lu, Ling Zhang, Ya Guo, Zhang Wen
Journal: Front Surg (2022)
Keywords: case reports, hepatectomy, hepatic veins, liver cell adenoma, robotic surgical procedures, vascular grafting
MeSH terms: Case Reports

Surgical resection remains the best choice for the treatment of liver tumors. Hepatectomy combined with artificial vascular reconstruction has been proven as an alternative to treating tumors involving the main hepatic veins. As the cutting-edge surgical technique, robotic liver surgery is a novel procedure expanding the field of minimally invasive approaches, especially in complex reconstruction. This study reports, for the first time, on a robotic hepatectomy with middle hepatic vein (MHV) reconstruction using an expanded polytetrafluoroethylene (ePTFE) graft for a patient with hepatic adenoma. The tumor, which was located in segment 8, was adjacent to the MHV. Robot-assisted resection of segment 4 and partial segment 8, and MHV reconstruction using a ePTFE graft were performed. During the post-operative examination and follow-up, the blood flow of the ePTFE graft was patent, and liver function recovered well. Thus, robotic hepatectomy with MHV reconstruction is a safe, minimally invasive, and precise surgery that may provide a novel approach for patients with liver tumors that are invading or adjacent to the main hepatic veins.
Possible causes of seizure after spine surgery
Authors: Zohreh Habibi, Farideh Nejat, Mostafa El Khashab
Journal: J Pediatr Neurosci (2010)
Keywords: lipomyelomeningocele, seizure, spinal-induced
MeSH terms: Case Reports

Seizure after laminectomy for spinal procedure is very rare and has not been reported after lipomyelomeningocele surgery beforehand. Here, two cases of seizure following laminectomy for lipomyelomeningocele are reported. The exact etiology of the event is unknown but anesthetic material, pneumocephalus, intracranial hypotension subsequent to cerebrospinal fluid leakage after spinal procedures, spinal-induced seizure and the potential toxic effect of fat molecules could be considered.
Thirty years of blackouts: a case report of swallow syncope
Authors: Irene Lambiris, Ivan Mendoza, Marcelo Helguera, Jose Baez Escudero, Cesar Bonilla
Journal: J Community Hosp Intern Med Perspect (2013)
Keywords: av block, deglutition syncope, dual chamber pacemaker, electophysiologic testing, tilt-table, vagotonic hypersensitivity
MeSH terms: Case Reports

Deglutition syncope has been demonstrated in isolated case reports, the first being described over 50 years ago. It is thought to be caused by a hypersensitive vagotonic reflex in response to esophageal dilation after swallowing. It can cause syncope due to complete atrioventricular (AV) block and acute reduction of cardiac output. Although rare, its lethality is worthy of discussion, as early recognition can offer complete treatment with placement of a pacemaker. A 54-year-old man presented with 30 years of lightheadedness and syncope, followed by disorientation and tremors, after eating sandwiches or drinking carbonated beverages. He initially was evaluated by a neurologist. Work-up included cardiac 2D transthoracic echocardiogram, electroencephalogram, swallow stud, pulmonary function tests, electrocardiogram, and cardiac stress testing. All tests were within normal limits, and it was determined that he was suffering from convulsive syncope and deglutition syncope. Referral to the cardiac electrophysiology department with tilt-table testing accompanied by swallow evaluation was then recommended. The tests demonstrated marked vagal response resulting in sinus bradycardia with second-degree AV block and pauses up to 3.5 seconds. Patient experienced near syncope. A rate-responsive, dual-chamber Boston Scientific pacemaker with DDDR programming was implanted. Patient has remained asymptomatic at follow-up.
Renal cell carcinoma in children: case report and literature review
Authors: Aissa Abdellah, Kadiri Selma, Marnouche Elamin, Touil Asmae, Rouas Lamia, Malihy Abderrahmane, El Majjaoui Sanaa, Elkacemi Hanan, Kebdani Tayeb, Benjaafar Noureddine
Journal: Pan Afr Med J (2015)
Keywords: renal cell carcinoma, children, surgical resection
MeSH terms: Carcinoma, Renal Cell / surgery, Kidney Neoplasms / surgery, Nephrectomy / methods, Case Reports, Review, Carcinoma, Renal Cell / diagnosis, Carcinoma, Renal Cell / pathology, Child, Hematuria / etiology, Humans, Kidney Neoplasms / diagnosis, Kidney Neoplasms / pathology, Male, Tomography, X-Ray Computed

Renal cell carcinoma is infrequent in children; consequently it is important to communicate its diagnosis and follow up. The behaviour of this type of tumor is better characterized in adults and in this setting the treatment of choice is surgical resection. However, the place of chemo- and radiotherapy has not been well defined. Here, we present a 9-year-old boy with renal cell carcinoma demonstrating only hematuria without any pathological physical examination findings. The mass was described by abdominal ultrasonography and computed tomography in the left kidney. After the left nephroureterectomy, the patient was given no adjuvant therapy.
Endocarditis following Consumption of Cereal Associated with Salmonella enterica Subtype Mbandaka Outbreak
Authors: Jana K Dickter, LiYing Cai, David S Snyder
Journal: Case Rep Infect Dis (2019)
MeSH terms: Case Reports

A 69-year-old immunocompromised man developed mitral valve endocarditis due to Salmonella enterica serotype Mbandaka, contracted from the cereal outbreak. The patient had a history of HLA-matched related hematopoietic stem cell transplant with persistent graft-versus-host disease (GVHD). This case report discusses prior international outbreaks that occurred due to Salmonella enterica subtype Mbandaka, the risks of developing endovascular infections from salmonellosis, and persistent infections that may develop more frequently with S. enterica serotype Mbandaka. The patient received a six-week course of intravenous antibiotics and remains on oral suppressive antibiotics, with his length of therapy to be determined based on his GVHD treatment.
Anomalous left coronary artery from the pulmonary artery presenting with aborted sudden death in an octogenarian: a case report
Authors: Ahmad Separham, Parvaneh Aliakbarzadeh
Journal: J Med Case Rep (2012)

Introduction:
We report a rare coronary anomaly presenting with aborted sudden death in an octogenarian. An anomalous left coronary artery from the pulmonary artery is a rare coronary anomaly which usually presents in the first year of life. Survival into adulthood and the elderly years is extremely rare.
Case presentation:
An 85-year-old Caucasian woman was brought to our hospital following cardiopulmonary arrest. After prolonged resuscitation and stabilization of our patient, further evaluation revealed an anomalous left coronary artery from pulmonary artery syndrome. She was discharged on medication.
Conclusion:
An anomalous left coronary artery from the pulmonary artery can present in elderly and even octogenarian patients. Careful history, physical examination and an appropriate invasive study are needed to confirm the diagnosis.
The combination of phylogenetic analysis with epidemiological and serological data to track HIV-1 transmission in a sexual transmission case
Authors: Min Chen, Yanling Ma, Chaojun Yang, Li Yang, Huichao Chen, Lijuan Dong, Jie Dai, Manhong Jia, Lin Lu
Journal: PLoS One (2015)
MeSH terms: HIV Infections / transmission, Case Reports, Research Support, Non-U.S. Gov't, Bayes Theorem, Female, HIV Infections / blood, HIV Infections / epidemiology, Humans, Male, Middle Aged, Phylogeny

Objective:
To investigate the linkage of HIV transmission from a man to a woman through unprotected sexual contact without disclosing his HIV-positive status.
Methods:
Combined with epidemiological information and serological tests, phylogenetic analysis was used to test the a priori hypothesis of HIV transmission from the man to the woman. Control subjects, infected with HIV through heterosexual intercourse, from the same location were also sampled. Phylogenetic analyses were performed using the consensus gag, pol and env sequences obtained from blood samples of the man, the woman and the local control subjects. The env quasispecies of the man, the woman, and two controls were also obtained using single genome amplification and sequencing (SGA/S) to explore the paraphyletic relationship by phylogenetic analysis.
Results:
Epidemiological information and serological tests indicated that the man was infected with HIV-1 earlier than the woman. Phylogenetic analyses of the consensus sequences showed a monophyletic cluster for the man and woman in all three genomic regions. Furthermore, gag sequences of the man and woman shared a unique recombination pattern from subtype B and C, which was different from those of CRF07_BC or CRF08_BC observed in the local samples. These indicated that the viral sequences from the two subjects display a high level of similarity. Further, viral quasispecies from the man exhibited a paraphyletic relationship with those from the woman in the Bayesian and maximum-likelihood (ML) phylogenetic trees of the env region, which supported the transmission direction from the man to the woman.
Conclusions:
In the context of epidemiological and serological evidence, the results of phylogenetic analyses support the transmission from the man to the woman.
Is It the pH That Matters? Challenging the Pathophysiology of Acidemia in a Case of Severe Hypercapnia Secondary to Intraoperative CO2 Insufflation
Authors: Evan Merle, Saad Zaatari, Rory Spiegel
Journal: Case Rep Crit Care (2020)
MeSH terms: Case Reports

Background:
Acidemia has been long thought to lead to hemodynamic compromise. While some literature to date challenges this idea, there is no consensus on this topic.
Case summary:
To our knowledge, this is the most severe case of hypercapnia and acidosis due to carbon dioxide (CO2) insufflation during laparoscopy reported in the literature. Remarkably, this patient remained hemodynamically normal despite having a blood pH below 6.81. This prompts a wider discussion about the effects of blood pH on human physiology. Most patients who present acidotic are critically ill and have confounding underlying metabolic or respiratory pathophysiology driving their illness. In this case, the patient experienced no respiratory insult leading to an increase in blood CO2 but rather had CO2 iatrogenically introduced into the circulatory system, effectively detaching the deleterious effects of CO2 from the respiratory pathologies that so often cause its accumulation.
Conclusion:
This raises the question, in patients with severe acidosis and hemodynamic compromise, is acidosis a symptom of the underlying process, or is the acidosis itself causing harm?
Rectal diverticulum in a terrier dog: A case report
Authors: Hossein Kazemi Mehrjerdi, Ali Mirshahi, Amir Afkhami
Journal: Vet Res Forum (2013)
Keywords: diverticulum, dog, perineal hernia, rectum
MeSH terms: Case Reports

Rectal diverticulum is a rare condition in dogs characterized by formation of a pouch or sac due to hernial protrusion of the mucous membranes through a defect in the muscular coat of the rectum. A 12-year-old male terrier dog was admitted with a history of a left perineal swelling, dyschezia and tenesmus during the last five months. Digital rectal examination identified a weakness in the left pelvic diaphragm and feces-filled sac within the lateral wall of the rectum. Positive contrast radiography showed a marked solitary diverticulum (3.5 × 4 × 4.5 cm) with wide-orifice neck arising from the left rectal wall. Using a lateral approach, a large rectal diverticulum was found and diverticulectomy following standard herniorrhaphy was performed. The dog recovered uneventfully with no signs of dyschezia during the next three years. Diverticulectomy by lateral approach and perineal herniorrhaphy produced excellent results.
Elbow Posterolateral Rotatory Instability due to Cubitus Varus and Overuse
Authors: Juan Martín Patiño, Alejandro Rullan Corna, Alejandro Michelini, Ignacio Abdon, Alejandro José Ramos Vertiz
Journal: Case Rep Orthop (2018)
MeSH terms: Case Reports

A malunion as a complication of distal humerus fractures has been frequently linked with aesthetic problems but less frequently with posterolateral rotatory instability. We report 2 cases of childhood posttraumatic cubitus varus with subsequent posterolateral rotatory instability and their treatment with a minimum of 2 years of follow-up. The etiology of the so-called posterolateral rotatory instability of the elbow is mostly traumatic, but iatrogenic causes have also been described such as the treatment of tennis elbow and less frequently and chronically due to overuse and overload because of distal humerus malunion.
A simple novel technique for the management of a dentoalveolar fracture in a pediatric patient using a vacuum-formed splint
Authors: Kumar Nilesh, Ashish Mahamuni, Swapnil Taur, Aaditee V Vande
Journal: J Dent Res Dent Clin Dent Prospects (2020)
Keywords: fracture, mandible, paediatric, thermoformed splint, trauma
MeSH terms: Case Reports

This paper reports a novel, minimally invasive, simple technique for the treatment of a displaced dentoalveolar fracture using a vacuum-formed splint in a 12-year-old pediatric patient. Vacuum formed splints have been reliable treatment options with limited morbidity and discomfort compared to other traditionally used procedures.
Case report: Mucous membrane pemphigoid with complicated autoantibody profile indicating the necessity of comprehensive diagnostic methods and the contribution of IgA autoantibodies
Authors: Weijun Liu, Huicheng Li, Yun Jin, Lifang Cheng, Luhuai Shi, Yangmin Gao, Zhijun Zhou, Suying Feng, Hua Qian, Takashi Hashimoto, Xiaoguang Li
Journal: Front Immunol (2023)
Keywords: bp180, iga autoantibody, bronchiolitis obliterans, integrin α6β4, laminin 332, lesions on the extremities, mucous membrane pemphigoid
MeSH terms: Autoimmune Diseases, Pemphigoid, Benign Mucous Membrane / diagnosis, Pemphigoid, Bullous, Case Reports, Research Support, Non-U.S. Gov't, Autoantibodies, Autoantigens, Female, Humans, Immunoglobulin A, Immunoglobulin G, Mucous Membrane, Non-Fibrillar Collagens, Autoantibodies, Immunoglobulin A, Non-Fibrillar Collagens, Autoantigens, Immunoglobulin G

Mucous membrane pemphigoid (MMP) is a type of subepithelial autoimmune bullous disease, affecting various mucosae, occasionally with skin lesions. Both diagnosis and treatment of MMP are difficult. Although multiple autoantigens have been identified for MMP, the pathogenesis of MMP is still unclear. In this study, we presented a female MMP case with extensive oral mucosal lesions and skin lesions, particularly on the extremities. IgG and IgA autoantibodies against multiple autoantigens including BP180, laminin 332, integrinα6β4 and desmoglein 3, and IgM autoantibodies against BP180 were identified during the disease course. Compared with IgG autoantibodies, the levels of IgA autoantibodies against various autoantigens decreased more significantly with improvement of clinical features after the initiation of treatments. Our findings indicated the importance of comprehensive autoantibody screening for different immunoglobulin types and autoantigens at multiple time points for the precise diagnosis of various autoimmune bullous diseases, and the significant involvement of IgA autoantibodies into the pathogenesis of MMP.
Diphencyprone induced vitiligo: a case report
Authors: Mohammad Ali Nilforoushzadeh, Gelavizh Keshtmand, Fariba Jaffary, Abbas Kheirkhah
Journal: Case Rep Med (2012)
MeSH terms: Case Reports

Diphencyprone (DCP) is a contact sensitizer which is used to treat dermatological disorders with an immunological origin, such as extensive alopecia areata (AA). Vitiligo is a rare but known side effect of DPCP therapy which is formed in the treatment site or remote areas. In this paper a 37-year-old man developed alopecia totalis with loss of eyebrows and eyelashes who presented some vitiligo patches on his scalp and arm distant from the location of DPCP application and a 42-year-old woman with 25 years history of hair loss and 3 months DPCP application who revealed some vitiligo patches on the scalp with distant to the site of application at the 6th week are reported. Considering the absence of personal and family history of Vitiligo in our two cases, the hypothesis of latent Vitiligo is not proved. The positive patch test in left arm of one of the patients also suggests the direct role of DPCP as the cause of Vitiligo occurrence. As the development of vitiligo by DCP is unpredictable and the depigmentation may persist indefinitely, it is important to inform all patients about this potential adverse effect before starting the treatment.