OpenMed/multicare-articles huggingface dataset:
Sequential Observations of Conversion from Nonischemic to Ischemic Central Retinal Vein Occlusion Using Optical Coherence Tomography Angiography
Authors: Akira Fukutomi, Kotaro Tsuboi, Hikari Ono, Yuichiro Ishida, Motohiro Kamei
Journal: Case Rep Ophthalmol Med (2018)
MeSH terms: Case Reports

We report the sequential changes of retinal vessels observed by optical coherence tomography angiography (OCTA) in a case of nonischemic central retinal vein occlusion (CRVO) that converted to ischemic CRVO. An 81-year-old woman visited our Retina Clinic because of visual acuity loss in the left eye. Funduscopic examination showed venous tortuosity and intraretinal hemorrhage in all four quadrants of the fundus. OCT showed macular edema. Fluorescein angiography (FA) and OCTA showed loss of small capillaries. Nonischemic CRVO was diagnosed. Antivascular endothelial growth factor (VEGF) treatment resolved the edema and improved visual acuity. However, during follow-up, capillary dropout was observed on OCTA, which gradually enlarged. Eventually, FA confirmed the conversion to ischemic CRVO. In this case, sequential observations using OCTA showed that nonischemic CRVO did not convert to ischemic CRVO abruptly but occurred stepwise. Additionally, vascular changes began around the veins and blood flow changes were observed more clearly in deep capillary plexus than in superficial capillary plexus.
Prolonged Course of COVID-19-Associated Pneumonia in a B-Cell Depleted Patient After Rituximab
Authors: Igor Kos, Benedikt Balensiefer, Sophie Roth, Manfred Ahlgrimm, Martina Sester, Tina Schmidt, Lorenz Thurner, Moritz Bewarder, Robert Bals, Frank Lammert, Stephan Stilgenbauer, Dominic Kaddu-Mulindwa
Journal: Front Oncol (2020)
Keywords: b-nhl, covid-19, sars-cov-2, t-cell activation, lymphoma
MeSH terms: Case Reports

Patients with pre-existing comorbidities and immunosuppression are at greater risk for SARS-CoV-2 infection and severe manifestations of COVID-19. This also includes cancer patients, who are shown to have a poor prognosis after infection. Here, we describe the case of a 72-year old male patient with B-cell depletion after maintenance treatment with rituximab for non-Hodgkin-lymphoma who had a prolonged COVID-19 course and initial false negative test results. Our case highlights the diagnostic pitfalls in diagnosing COVID-19 in B-cell depleted patients and discuss the role of B-cell depletion in the course and treatment of COVID-19. Furthermore, we investigated peripheral blood monocytes and SARS-CoV-2 specific T cells in our patient. In conclusion, our case report can help physicians to avoid diagnostic pitfalls for COVID-19 in hemato-oncological patients under chemoimmunotherapy and tries to explain the role of B-cell depletion and SARS-CoV-2 specific T cells in this context.
Zinc Chloride Smoke Inhalation Induced Severe Acute Respiratory Distress Syndrome: First Survival in the United States with Extended Duration (Five Weeks) Therapy with High Dose Corticosteroids in Combination with Lung Protective Ventilation
Authors: Hafiz Mahboob, Robert Richeson Iii, Robert McCain
Journal: Case Rep Crit Care (2017)
MeSH terms: Case Reports

Zinc chloride smoke bomb exposure is frequently seen in military drills, combat exercises, metal industry works, and disaster simulations. Smoke exposure presents with variety of pulmonary damage based on the intensity of the exposure. Smoke induced severe acute respiratory distress syndrome (ARDS) is often fatal and there are no standard treatment guidelines. We report the first survival of smoke induced severe ARDS in the United States (US) with prolonged use of high dose steroids (five weeks) and lung protective ventilation alone. Previously reported surviving patients in China and Taiwan required extracorporeal membrane oxygenation (ECMO) and other invasive modalities. We suggest that an extended course of high dose corticosteroids should be considered for the treatment of smoke inhalation related ARDS and should be introduced as early as possible to minimize the morbidity and mortality. We further suggest that patients with smoke inhalation should be observed in the hospital for at least 48 to 72 hours before discharge, as ARDS can have a delayed onset. Being vigilant for infectious complications is important due to prolonged steroid treatment regimen. Patients must also be monitored for critical illness polyneuromyopathy. Additionally, upper airway injury should be suspected and early evaluation by otorhinolaryngology may be beneficial.
CASE REPORT Case Report and Review of the Literature: Deep Inferior Epigastric Perforator Flap for Breast Reconstruction After Abdominal Recontouring
Authors: Jonathan Bank, Lucio A Pavone, Iris A Seitz, Michelle C Roughton, Loren S Schechter
Journal: Eplasty (2012)

Objective:
The report herein presents a case of a 49-year-old woman with left breast cancer who presented seeking immediate autologous reconstruction. Surgical history included an abdominal hysterectomy and an abdominal contouring procedure. This is a first description of a deep inferior epigastric perforator flap after abdominal wall manipulation of this magnitude.
Methods:
Computed tomographic angiography identified patent medial row perforators. Doppler confirmed the location of the perforators. The flap was designed with the inferior incision at the previous lower abdominal scar. Laser-assisted indocyanine green imaging confirmed adequate flap perfusion on the basis of a single left deep inferior epigastric perforator.
Results:
The flap was harvested on one perforator and anastomosed to the internal mammary system. The postoperative course was complicated by venous anastomosis kinking, requiring revision, but otherwise unremarkable.
Conclusion:
Computed tomographic angiography confirmed presence of perforators, communication with the deep inferior epigastric system, and location acceptable for flap design. Laser-assisted indocyanine green angiography facilitated perforator selection and provided intraoperative assessment of flap perfusion. Utilization of these modalities allowed safe completion of an operation considered contraindicated by conventional algorithms and highlights their role in complex perforator flap reconstruction.
Metastasizing Malignant Granular Cell Tumor (Abrikossoff Tumor) of the Anterior Abdominal Wall, with Prolonged Survival
Authors: Yara A Alnashwan, Khaled A H Ali, Samir S Amr
Journal: Case Rep Pathol (2019)
MeSH terms: Case Reports

Malignant granular cell tumor (MGCT) is a rare high-grade mesenchymal tumor of Schwann cell origin. MGCTs commonly affect thigh, extremity, and trunk; however, involvement of the abdominal wall is quite rare. It has poor prognosis with 39% mortality rate in 3-year interval. We report a 50-year-old female who had MGCT arising in the anterior abdominal wall and developed massive metastatic deposits in both lungs and in the right inguinal lymph nodes, with prolonged survival for 11 years. A brief review of the literature is presented.
Severe anemia may not be a contraindication to debridement in a Jehovah's witness patient with necrotizng fasciitis of the lower extremity - A case report
Authors: Chinwe Ogedegbe, Jayson Fernando, Sanjeev Kaul
Journal: Int J Surg Case Rep (2019)
Keywords: case report, jehovah’s witness, necrotizing fasciitis, severe anemia

Introduction:
Necrotizing fasciitis is a severe soft tissue infection characterized by rapidly progressing necrosis involving the fascia and subcutaneous tissue. Necrotizing fasciitis of the lower extremity in a Jehovah's Witness patient in the setting of severe anemia and systemic sepsis is uncommon.
Case presentation:
A 62-year-old man of Jehovah's Witness faith with a history of alcohol use disorder and uncontrolled diabetes mellitus initially presented with a non-healing diabetic foot ulcer, subsequently developed sepsis and necrotizing fasciitis. He underwent an above the knee amputation and was transferred to our institution's Surgical Intensive Care Unit for further management. The patient presented in critical condition with a hemoglobin of 4.7 g/dL and progression of necrotizing fasciitis of the lower extremity stump. He underwent revision amputation and numerous excisional debridements along with IV antibiotics, epoetin alfa, and iron sucrose. He successfully recovered with minimal blood loss and was discharged with a hemoglobin of 8 g/dL.
Discussion:
This case highlights some of the challenges involved in managing necrotizing fasciitis. The conversation with the Jehovah's Witness patient in a life-threatening condition must be held with the upmost respect. Surgical decision making and operative technique is critical in determining the boundary of excisional debridement to perform in the absence of the ability to transfuse blood. The medical management was focused on resuscitation for sepsis, severe anemia, hyperglycemia, and wound management.
Conclusion:
Severely anemic patients in critical condition can survive necrotizing fasciitis with a well-planned interdisciplinary approach without compromising patient autonomy.
Primary omental torsion in an old woman: imaging techniques can prevent unnecessary surgical interventions
Authors: Mohhamad-Hadi Saeed Modaghegh, Reza Jafarzadeh
Journal: Case Rep Med (2011)
MeSH terms: Case Reports

Torsion and/or infarction of the greater omentum are rare but well-recognized clinical situations which present as an acute abdomen. The etiology is unknown and speculative. In most cases, the pathology is right sided and clinical presentation consists of an acute or subacute flank pain with mild peritonism usually evoking appendicitis or cholecystitis. Nevertheless, knowledge concerning these two problems can help the surgeon in proper diagnosis and treatment. Since the first report on primary torsion by Eitel in 1899, a few hundred more have been reported and some collective reviews published to date. Recently, ultra sonography and computed tomography have proved to provide sufficiently typical, consistent, and well-recognizable features to avoid unnecessary surgery. In this study, we will present a case diagnosed as primary omental torsion based on computed tomography, which underwent successful conservative management.
Fatal Necrotizing Fasciitis following Episiotomy
Authors: Faris Almarzouqi, Gerrit Grieb, Christian Klink, Dirk Bauerschlag, Paul C Fuchs, Ziyad Alharbi, Marketa Vasku, Norbert Pallua
Journal: Case Rep Surg (2015)

Introduction. Necrotizing fasciitis is an uncommon condition in general practice but one that provokes serious morbidity. It is characterized by widespread fascial necrosis with relative sparing of skin and underlying muscle. Herein, we report a fatal case of necrotizing fasciitis in a young healthy woman after episiotomy. Case Report. A 17-year-old primigravida underwent a vaginal delivery with mediolateral episiotomy. Necrotizing fasciitis was diagnosed on the 5th postpartum day, when the patient was referred to our tertiary care medical center. Surgical debridement was initiated together with antibiotics and followed by hyperbaric oxygen therapy. The patient died due to septic shock after 16 hours from the referral. Conclusion. Delay of diagnosis and consequently the surgical debridement were most likely the reasons for maternal death. In puerperal period, a physician must consider necrotizing fasciitis as a possible diagnosis in any local sings of infection especially when accompanied by fever and/or tenderness. Early diagnosis is the key for low mortality and morbidity.
Multimodal stone therapy for two forgotten and encrusted ureteral stents: a case report
Authors: Thorsten H Ecke, Steffen Hallmann, Jürgen Ruttloff
Journal: Cases J (2009)

Introduction:
Ureteral stent placement is a common procedure in daily urologic practice. To manage the problems of forgotten stents for many years needs multimodal stone therapy.
Case presentation:
We present a case of a 26-years-old Caucasian, white woman with two forgotten encrusted ureteral stents for 48 months. Multimodal stone therapy including extracorporeal shock wave (SWL), percutaneous nephrolithotomy (PCNL), ureterorenoscopy (URS), cystolithotripsy with Lithoclast, and open surgery was necessary to remove all the stones. Using the described combination of techniques, our patient was rendered stone and stent free. Urologists should bear in mind the presence of severe encrustations when they have to deal with a forgotten stent.
Conclusion:
This case shows that combined urologic techniques can achieve successful and safe management of forgotten stents, but treatment should be tailored to the volume of encrustation and associated stone.
De novo LAMP2 insertion mutation causes cardiac-only Danon disease: A case report
Authors: James Jiqi Wang, Bo Yu, Xiuli Song, Hong Wang
Journal: Front Cardiovasc Med (2022)
Keywords: danon disease, lamp2, sanger sequencing, genetic diagnosis, hypertrophy
MeSH terms: Case Reports

Danon disease is a rare disease caused by glycogen storage lysosomal disorder. It is related to the pathogenic mutation of the LAMP2 gene. In this case report, we present a patient with a novel pathogenic mutation (c.764_765insGA) with cardiac-only symptoms. Her family members do not carry the same mutation she does, suggesting this is a de novo mutation. Further tests revealed vacuoles and glycogen disposition in the patient's heart tissue and a significant decrease in LAMP2 protein expression. Protein structure remodeling of LAMP2 predicted that the mutant protein has conformational change lacking an important transmembrane domain, subsequently causing protein destabilization.
Extraction of maxillary central incisors: an orthodontic-restorative treatment
Authors: Zohreh Hedayati, Maryam Zare, Fateme Bahramnia
Journal: Case Rep Dent (2014)

Malformed central incisors with poor prognosis could be candidates for extraction especially in crowded dental arches. This case report refers to a 12-year-old boy who suffered from malformed upper central incisors associated with severe attrition. Upper lateral incisors were positioned palatally and canines were rotated and positioned in the high buccal area. The patient had class II malocclusion and space deficiency in both dental arches. Due to incisal wear and malformed short maxillary central incisors and the need for root canal therapy with a major crown build-up, these teeth were extracted. The maxillary lateral incisors were substituted. Thus the maxillary canines were substituted for lateral incisors and the first premolars were substituted for canines. In the lower dental arch the first bicuspids were extracted. Composite resin build-up was performed on the maxillary lateral incisors and canines. This allowed for the crowding and the malocclusion to be corrected. Subsequent gingivectomy improved the patient's gingival margins and smile esthetics one month after orthodontic therapy.
Step cut "V" osteotomy for acute correction in Blount's disease treatment: A case series
Authors: Faisal Miraj, Ajiantoro, I Wayan Arya Mahendra Karda
Journal: Int J Surg Case Rep (2019)
Keywords: acute correction, blount’s disease, outcomes, step cut “v” osteotomy

Introduction:
Severe Blount's disease results in progressive multiplanar deformity of the lower limb. There are varus, procurvatum, and internal tibia rotational deformity. Treatment varies for each patient, depending on age, magnitude of deformity, discrepancy, psychosocial factor, and surgeon's experience. The aim of treatment is to acutely correct deformity and realign the mechanical axis. We proposed a technique of step cut "V" Osteotomy which could achieve the aim of treatment safely and effectively.
Methods:
Twenty-seven legs from eighteen patients were underwent Step Cut "V" Osteotomy technique in our institution from 2015 to 2017 to produce overvalgus correction. Eleven patients had bilateral deformities, and seven patients had unilateral deformity. All patients had mechanical axis deviation (MAD) away medially to the center of the knee, increase of tibiofemoral angle, and Drennan angle. Outcomes were recorded postoperatively such as infection, compartment syndrome, nerve palsy, range of motion, stability of knee ligaments, union time, early weight bearing and recurrence.
Results:
From this Step Cut "V" Osteotomy, we can accurately measure the angle of correction we want to achieve preoperatively. Drennan angle and Tibiofemoral angle (TFA) of the patients improved with subsequent correction of interbal tibia rotation and procurvatum. No complication of compartment syndrome and nerve palsy were found. Patient could perform early mobilization, and weight bearing on second month after surgery because of strong fixation and good ligament stability. No significant postoperative infection occurred. Union time achieved in two to three months, but four legs from patients over 4 years old who underwent surgery experienced a recurrence.
Conclusion:
Step Cut "V" Osteotomy is a simple, safe and effective technique for acute correction of severe Blount's disease. And can produce an accurate correction, high union rate and early weight bearing with no complication as a result that would be achieved at the end of treatment.
Case report: One pediatric liver-transplant recipient with SARS-CoV-2 infection suffering unexplained mixed acidosis
Authors: Lianhu Yu, Lu Zheng, Hui Hu, Ping Wan, Yanming Lu, Libo Wang, Hui Yu, Yiwei Chen, Jianguo Zhou, Qiang Xia, Wenhao Zhou, Ting Zhang
Journal: Front Med (Lausanne) (2023)
Keywords: covid-19, immunosuppressants, liver transplant, mixed acidosis, mycophenolate mofetil
MeSH terms: Case Reports

Background:
The management of LT patients during COVID-19 pandemic is important. Immunosuppressants (IS) are key therapy agents after liver transplant. Different ISs have different side effects. Calcineurin inhibitor (CNI) may lead to metabolic acidosis while mycophenolate mofetil (MMF) showed rare nephrotoxicity. We report a post-liver transplant girl who was infected with SARS-CoV-2, developing a severe mixed acidosis 3 months after the transplantation. Her acidosis was improved after withdrawing of MMF, leading the suspicion that acidosis maybe a rare side effect of MMF.
Case presentation:
A girl was admitted to our hospital due to SARS-CoV-2 infection, 3 months before admission the patient received LT due to Niemann-Pick disease (NPD). During hospitalization, blood gas analysis showed severe mixed acidosis. To relieve mixed acidosis, the patient was given oral rehydration salt and liquid replacement therapy. Considering that immunosuppressants may cause metabolic acidosis, dose of CsA was decreased and MMF was discontinued.
Results:
However, liquid replacement therapy and decreased CsA dose cannot improve the condition. As an attempt, MMF was discontinued, and 3 days later, the girl's acidosis was relieved, the latest blood gas analysis was normal with the original dose of CsA and no use of MMF or other IS. In addition, we used Naranjo Scale to see if adverse drug reactions (ADRs) existed. The final score was 6 which means MMF contributes to acidosis probably.
Conclusion:
The girl's mixed acidosis cannot be explained by Niemann-Pick disease and SARS-CoV-2 infection. CNIs could cause metabolic acidosis but declining the dose of CsA didn't improve her acidosis while withdrawing MMF showed a good effect. Together with the Naranjo Scale result, we suspect that acidosis maybe a rare side effect of MMF.
Tongue Necrosis Secondary to Giant Cell Arteritis: A Case Report and Literature Review
Authors: Rafael Alex Barbosa de Siqueira Sobrinho, Karolina Cayres Alvino de Lima, Helena Carvalho Moura, Mônica Modesto Araújo, Christyanne Maria Rodrigues Barreto de Assis, Pedro Alves da Cruz Gouveia
Journal: Case Rep Med (2017)
MeSH terms: Case Reports

Giant cell arteritis is a form of vasculitis involving the medium- and large-sized arteries that chiefly affects older people. Clinical findings are headache, jaw claudication, fever, pain, and thickening of the temporal artery. The most feared complication is visual loss due to impairment of the ophthalmic artery and posterior ciliary arteries. This a case report of an 85-year-old male presenting with headache and jaw pain, who was admitted with tongue necrosis as an initial manifestation of giant cell arteritis. The necrotic area detached spontaneously after two weeks of therapy with corticosteroids and methotrexate. Reviewing the literature, our patient presented with clinical symptoms consistent with most reports, except for the fact of being male. Although unusual as an initial manifestation, tongue necrosis is an important alert for diagnosing giant cell arteritis. Early diagnosis and treatment of this atypical manifestation may reduce morbidity.
Case report: ISL2 is involved in malignant transformation in a patient with multiple relapsed oligodendroglioma
Authors: Shu-Na Chen, Zhongyong Wang, Di-Sheng Zhou, Xue-Qi Liu, Tao-Yi Mai, Zhao-Xia Dong, Miao Li, Xing-Ding Zhang, Lin Qi
Journal: Front Oncol (2022)
Keywords: isl2, angiogenesis, case report, malignant transformation, oligodendroglioma
MeSH terms: Case Reports

The majority of oligodendrogliomas exhibit an intrinsic tendency to develop into malignant high-grade tumors. Angiogenesis is a major factor contributing to the malignant transformation of oligodendroglioma, and its molecular regulatory mechanism needs further study. We provide a case report of an oligodendroglioma patient with two recurrences whose disease progressed from WHO grade II to grade III. We showed that the expression of insulin gene enhancer protein (ISL2) and its angiogenic ability were positively correlated with the progression of oligodendroglioma. In Low-grade glioma (LGG) patients, including oligodendroglioma patients, overexpression of ISL2 was correlated with poor prognosis, and this correlation was not affected by gender or isocitrate dehydrogenase 1(IDH1) mutation status. ISL2 expression and ISL2-mediated angiogenic pathway activity are ideal biomarkers for the malignant transformation of oligodendroglioma. Anti-ISL2 therapy is also a potential treatment option for malignantly transformed oligodendroglioma.
Bleeding Meckel's Diverticulum in a 33-Year-Old Female Diagnosed with Video Capsule Endoscopy and a Technetium-99 m Pertechnetate Scan with a Favorable Response to H2 Blocker and PPI
Authors: Gregor Krstevski, Urim Isahi, Vladimir Andreevski
Journal: Case Rep Gastrointest Med (2021)
MeSH terms: Case Reports

Meckel's diverticulum is a true diverticulum consisting of all three layers of the small intestine resulting from incomplete regression of the vitelline duct. While it is often benign, it can present with serious complications such as intussusception, ulceration, torsion, hemorrhage, obstruction, inflammation, and fistula formation. Although it typically presents in infancy and early childhood, it can also manifest much later into adulthood. We report a case of Meckel's diverticulum complicated by significant bleeding in a 33-year-old female patient. Diagnosis was accomplished with video capsule endoscopy and a technetium-99 m pertechnetate scan. The patient responded well to acid suppression, initially with an H2 blocker and later with a PPI (proton pump inhibitor), and remained asymptomatic for nearly four months in the interim to definitive surgical treatment. Microscopic examination of the resected diverticulum confirmed the presence of ectopic gastric mucosa. A PubMed literature search revealed several similar cases of Meckel's diverticulum complicated by hemorrhage with a favorable response to H2 blockers and PPIs. While surgical resection remains the mainstay of definitive treatment, medications aimed at acid suppression can delay the need for urgent surgery, allow for diagnostic assessment, and optimize conditions for elective surgical treatment.