OpenMed/multicare-articles huggingface dataset:
Encephalopathy and COVID-19: a case report
Authors: Mohamed Lazraq, Sabah Benhamza, Soufiane Saadaoui, Salah Hayar, Mounir Louardi, Hind Moujahid, Abdelhak Bensaid, Youssef Miloudi, Najib El Harrar
Journal: Pan Afr Med J (2021)
Keywords: encephalopathy, sars-cov-2, case report, without respiratory distress
MeSH terms: Brain Diseases / virology, COVID-19 / complications, SARS-CoV-2 / isolation & purification, Case Reports, Aged, Brain Diseases / diagnosis, COVID-19 / diagnosis, Humans, Male

Case numbers reported in literature with neurological manifestations potentially linked to COVID-19 is constantly increasing. Most often it is sudden anosmia, headache, encephalopathy or stroke. Pathophysiology of this neurological involvement is still poorly understood. While viral genome is very rarely detected in cerebrospinal fluid, inflammatory involvement is often very significant. We report a case of SARS-CoV-2 encephalopathy without respiratory distress or cytokine storm.
Femtosecond laser refractive surgery after descemet stripping-automated endothelial keratoplasty
Authors: Simon Sheung Man Fung, Alfonso Iovieno, Vijay Shanmuganathan, Vicenzo Maurino
Journal: Case Rep Ophthalmol Med (2012)
MeSH terms: Case Reports

Purpose. To report the use of femtosecond laser-assisted in situ keratomileusis (LASIK) in the treatment of hyperopia subsequent to Descemet stripping-automated endothelial keratoplasty (DSAEK). Methods. Interventional case report. Results. A 66-year-old woman with Fuchs endothelial dystrophy developed bullous keratopathy after cataract surgery in her right eye. She underwent DSAEK with a significant postoperative hyperopic shift in her refraction. Thirteen months after DSAEK, she underwent wavefront-guided, femtosecond laser-assisted LASIK (IntraLase, Inc., Irvine, CA/AMO, Inc., IL, USA). Pretreatment unaided visual acuity was 20/120, and best-corrected visual acuity was 20/20 with a refraction of +3.25/-0.50 × 170. One year after laser refractive correction, unaided visual acuity was 20/20 with a refraction of +0.25/-0.75 × 160. Conclusion. To our knowledge, this is the first paper on the successful treatment of hyperopic shift related to DSAEK with wavefront-guided, femtosecond laser-assisted LASIK.
Case report: Different mechanisms of drug resistance in a synchronous multiple primary lung cancer patient after EGFR-TKI treatment
Authors: Shaonan Xie, Qingyi Liu
Journal: Front Oncol (2022)
Keywords: met amplification, t790 m mutation, epidermal growth factor receptor-tyrosine kinase inhibitors (egfr-tkis), resistance mechanism, synchronous multiple primary lung cancer (smplc)
MeSH terms: Case Reports

Non-small-cell lung cancer (NSCLC) is the most common cancer in the world. In recent years, the incidence of synchronous multiple primary lung cancer (SMPLC) has gradually increased. Surgery is the preferred method to treat these patients. The management of SMPLC patients who cannot tolerate surgical treatment is controversial. We report a rare case in which a 70-year-old Chinese woman with no history of smoking had three primary lung adenocarcinoma lesions. Two lesions had epidermal growth factor receptor (EGFR) exon 19 deletion mutations, and one lesion had the L858R mutation. After first-generation EGFR-tyrosine kinase inhibitor (TKI) treatment, the three lesions all showed a good response until disease progression. After the corresponding drug treatments were given based on the different drug resistance mechanisms, good responsiveness was shown in each lessions. This case suggests that in the treatment of SMPLC, it is necessary to learn the molecular-biological information of each lesion due to the differences thereof, and a targeted treatment regimen should be developed on this basis.
Partnering with Palliative Care: A Case Report of Severe Pain in Critical Limb Ischemia Treated Successfully with a Continuous Popliteal Nerve Catheter
Authors: Ryan S D'Souza, Stephanie Shen, Frederick Ojukwu, Halena M Gazelka, Bridget P Pulos
Journal: Case Rep Anesthesiol (2020)
MeSH terms: Case Reports

Background:
Critical limb ischemia (CLI) is limb pain occurring at rest or impending limb loss as a result of lack of blood flow to the affected extremity. CLI pain is challenging to control despite multimodal pharmacologic analgesia and surgical intervention. We described the successful use of a continuous local anesthetic infusion via a popliteal nerve catheter to control severe refractory ischemic lower limb pain in a patient who failed surgical intervention and performed a brief narrative literature review on regional anesthesia for ischemic pain. Case Presentation. A 74-year-old female with acute myelogenous leukemia presented with CLI after experiencing left popliteal artery occlusion. Palliative medicine service was consulted for pain management in the setting of escalating narcotic dose requirements. She experienced a complicated hospital course with several failed attempts at surgical revascularization due to arterial rethrombosis. In accordance with the patient's goals of care, a continuous popliteal nerve catheter was placed, despite the high risk nature of an intervention in an immunocompromised patient with thrombocytopenia (platelet count of 30,000 platelets/microliter) and ongoing therapeutic anticoagulation. The patient experienced immediate relief while transitioning to comfort care.
Conclusion:
This is the first report of successful analgesia for CLI via a continuous popliteal catheter in a patient with rethrombosis and failed surgical revascularization. Based on our collaborative experience, we recommend the development of partnerships between the acute pain service and palliative care service to facilitate the early evaluation and decision to utilize regional anesthesia for treatment of CLI.
Adrenocorticotrophic hormone secreting pheochromocytoma
Authors: Meyyappan M Ramasamy, Rajaraman Thiagarajan, Pravin S Dass
Journal: Indian J Urol (2010)
Keywords: adrenocorticotrophic hormone, cushing syndrome, pheochromocytoma
MeSH terms: Case Reports

We report a rare case of pheochromocytoma of the adrenal gland presenting as Cushing syndrome. A 30 year old woman presented with pain in the left loin and classical Cushingoid features. She was a diabetic and hypertensive on treatment. Magnetic resonance imaging of the abdomen revealed a 3.5×3 cm mass in the left adrenal gland. Urine analysis revealed an elevated 24 hr urinary cortisol level. Clinical diagnosis was Cushing syndrome due to functioning left adrenal tumor, and hence left adrenalectomy was performed laparoscopically. Histopathological examination revealed adrenal pheochromocytoma. Immunohistochemical analysis of the tumor was positive for adrenocorticotrophic hormone and chromogranin.
Case Report: MR-Guided Adaptive Radiotherapy, Some Room to Maneuver
Authors: Winnie Li, Jeff Winter, Jerusha Padayachee, Jennifer Dang, Vickie Kong, Peter Chung
Journal: Front Oncol (2022)
Keywords: mr-linac, adaptive radiotherapy, inter-fraction motion, prostate cancer, ultrahypofractionation
MeSH terms: Case Reports

Background:
A magnetic resonance linear accelerator (MR-Linac) provides superior soft tissue contrast to evaluate inter- and intra-fraction motion and facilitate online adaptive radiation therapy (ART). We present here an unusual case of locally advanced castrate-resistant prostate cancer treated with high-dose palliative ultra-hypofractionated radiation therapy on the MR-Linac with significant inter-fraction tumor regression.
Case presentation:
The patient was a 65-year-old man diagnosed with metastatic prostate cancer to bone and pelvic lymph nodes 7 years prior. At diagnosis, he presented with a PSA of 23 ng/ml and was commenced on a luteinizing hormone-releasing hormone agonist, achieving a PSA nadir of 4.68 ng/ml at 12 months. The patient subsequently had progressive lower urinary tract symptoms, his PSA increased to 47 ng/ml, and there was a markedly enlarged pelvic mass involving the prostate with gross extra-capsular disease and invasion into the posterior bladder wall. The patient was referred for palliative radiation to the pelvic mass due to urinary symptoms, pain, and lower limb paraesthesia. Treatment was planned to be delivered on the MR-Linac with a schedule of 36 Gy over 6 weekly factions allowing for maximal target dose delivery while minimizing surrounding organs at risk (OARs) radiation exposure. Unexpectedly, the target volume had a marked 49% (453 cc to 233 cc) reduction that was accounted for in the online adaptive process. A new reference plan was generated after 3 fractions to add sacral plexus as an OAR, previously not visible due to mass encroachment. The patient reported ongoing reduction in urinary symptoms, pelvic pain, and lower limb paresthesia by the end of treatment.
Conclusion:
Using daily MR-guided ART, improved visualization of the changing target and OARs ensured safe dose escalation. The unexpected positive response of the target and improved patient outcomes demonstrated the added value of the MR-Linac for online adaptive radiotherapy in this setting.
Treatment of Down Syndrome-Associated Arthritis with JAK Inhibition
Authors: Jordan T Jones
Journal: Case Rep Rheumatol (2022)
MeSH terms: Case Reports

Down syndrome (DS) results from a trisomy of chromosome 21, which causes immune dysregulation that leads to hyperactivation of interferon and Janus kinase (JAK) signaling. This results in complex medical abnormalities in the immune system and an increase in autoimmune and autoinflammatory conditions such as down syndrome-associated arthritis (DA). DA is an aggressive, destructive, inflammatory arthritis that is easily misdiagnosed and difficult to treat. Treatment commonly includes immunosuppressive therapy, but these are often associated with adverse effects and ineffectiveness. This case report outlines a 6-year-old male with DA that was successfully treated with the JAK inhibitor tofacitinib. Due to the aggressive nature of DA and poor response to many immunosuppressive therapies, this case report was created to increase awareness of JAK inhibition as an effective, well-tolerated treatment for DA.
Direct Anastomosis of the Donor Hepatic Artery to the Supraceliac Aorta without Extension Graft during Adult Liver Transplant in the Era of Extended Criteria Donors: Report of a Case
Authors: Jeffrey Campsen, Paul Russ, Igal Kam
Journal: Case Rep Med (2010)
MeSH terms: Case Reports

Arguably, one of the most challenging aspects of liver transplant surgery is the hepatic artery reconstruction. When the donor and recipient arteries are normal, this anastomosis can still be difficult. However, when the recipient artery has been dissected or is small other alternative reconstructions must be considered. Routinely, the donor surgery includes removing the iliac artery and vein specifically to aid in alternative reconstruction techniques. With the increase use of extended criteria donors (i.e., specifically age >55) the iliac vessel may be unusable because of atherosclerotic disease. This paper describes revisiting an alternative technique for hepatic artery reconstruction during cadaveric liver transplant when the recipient artery has been dissected and the iliac vessels were unusable secondary to arterial plaque from a 75 yo donor. Herein, we describe the successful anastomosis of the celiac artery with aortic patch from the donor directly to the supraceliac aorta of the adult recipient.
Postoperative Heart Failure with Preserved Ejection Fraction Induced by Flumazenil Administered for Remimazolam Antagonism
Authors: Keito Koh, Takeshi Omae, Sonoko Sakuraba, Masateru Kumemura, Sho Yamazaki, Hiroshi Yunoki
Journal: Case Rep Anesthesiol (2022)
MeSH terms: Case Reports

Remimazolam is an ultrashort-acting benzodiazepine intravenous anesthetic characterized by rapid awakening after anesthesia. However, the method for administering remimazolam in clinical practice remains unclear. Here, we report a case of postoperative heart failure with preserved ejection fraction (HFpEF) after antagonizing remimazolam with flumazenil. An 82-year-old woman was scheduled to undergo lumbar laminectomy for lumbar spinal canal stenosis. Preoperative echocardiography revealed normal left ventricular systolic function, left atrial enlargement, and impaired left ventricular diastolic function. General anesthesia was induced with 10 mg/kg/h remimazolam and maintained with 0.8 mg/kg/h remimazolam intraoperatively. Before extubation, a total of 1.0 mg of flumazenil was administered. After extubation, the patient developed pulmonary edema due to HFpEF. When remimazolam is administered in elderly patients with cardiac dysfunction, the maintenance dose should be customized according to the patient's general condition to minimize the dosage of flumazenil.
Successful radiofrequency catheter ablation of Wolff-Parkinson-White syndrome in a patient with dextrocardia: A case report
Authors: Lei Zhao, Ruibin Li, Long Bai, Dong Wang, Jidong Zhang, Xiaohong Yang
Journal: Front Cardiovasc Med (2022)
Keywords: wolff-parkinson-white (wpw) syndrome, congenital heart malformation, dextrocardia, radiofrequency catheter ablation, tachycardia
MeSH terms: Case Reports

Background:
Dextrocardia is a congenital heart malformation with a low incidence that occurs in only 1 in 10,000-12,000 people. Wolff-Parkinson-White (WPW) syndrome is a congenital condition with additional accessory pathways between the atria and the ventricle, which affects up to three in 1,000 people worldwide. Experience of radiofrequency catheter ablation in patients with WPW syndrome and dextrocardia is scarce due to its rare incidence.
Case presentation:
A 39-year-old female was hospitalized due to two episodes of palpitations in the latest 2 months. The morphology of the P-QRS-T complex of lead aVR and aVL, II, and III were presented invertedly as common conditions, and shortened P-R interval and a characteristic "delta" wave were shown on the electrocardiogram (EGM). The patient with dextrocardia and situs invertus malposition was confirmed by chest-X ray, cardiac color Doppler echocardiography. The patient was diagnosed with WPW syndrome with dextrocardia and underwent radiofrequency catheter ablation (RFCA) successfully. In this case, the key to the success of RFCA is to understand the anatomical structure of the heart and the great vessels before the operation and make a personalized operative plan.
Conclusion:
Catheter ablation for tachycardia patients with dextrocardia is efficient and safe. For patients with dextrocardia, the key to successful ablation was adjusting for projection angulation and different catheter manipulation compared with a standard case because of the mirror image of a normal heart.
Median Nerve-Neurophysiological Index Correlates With the Survival of Patients With Amyotrophic Lateral Sclerosis
Authors: Liu-Qing Xu, Wei Hu, Qi-Fu Guo, Lu-Lu Lai, Guo-Rong Xu, Wan-Jin Chen, Ning Wang, Qi-Jie Zhang
Journal: Front Neurol (2020)
Keywords: amyotrophic lateral sclerosis, median nerve, neurophysiological index, prognosis, survival

Objective: This study aims to explore the association between median nerve-neurophysiological index (NI) and survival of patients with amyotrophic lateral sclerosis (ALS). Methods: A retrospective case series with a prospective follow-up study was performed in 238 patients with ALS. Their clinical profiles and NI were recorded. Kaplan-Meier curves and Cox regression were adopted to perform survival analysis. Results: The median survival time of all ALS cases was 33.0 months. Multivariate analysis showed that older age of onset, shorter diagnostic delay, higher ΔALSFRS-R, and faster progression {NI ≤ 2.15; hazard ratio [HR] = 1.543 [95% confidence interval (CI), 1.136-2.094]} were associated with short survival. NI was correlated with ALSFRS-R at baseline (r s = 0.3153; p < 0.0001) and ALSFRS-R at different time points of follow-up (r s = 0.5127; p < 0.0001). The higher NI slope of decline (> 0.25) showed shorter survival compared with the lower group (≤ 0.25; 34.0 vs. 52.0 months; p = 0.0003). A predictive model was constructed based on the age of onset, diagnostic delay, median nerve NI, and ΔALSFRS-R. The higher predictive score (> 14) showed significantly shorter survival compared with the lower group (≤ 14; HR = 3.907, 95% CI, 2.857-5.342). Conclusion: Median nerve NI and its slope of decline were predictive of survival of ALS.
Percutaneous Coronary Intervention (PCI) Strategies under Hemodynamic Support for Cardiogenic Shock: A Single-Center Experience with Two Patients
Authors: Talha Ahmed, Diljon Chahal, Ronson J Madathil, David Kaczorowski, Anuj Gupta
Journal: Case Rep Cardiol (2020)
MeSH terms: Case Reports

We describe two cases of profound cardiogenic shock complicating acute myocardial infarction (CSAMI) requiring mechanical circulatory support (MCS) with venoarterial extracorporeal membrane oxygenation (VA-ECMO) allowing complex, high-risk, and staged percutaneous interventions with successful decannulation but with unfortunate outcomes.
Synthetic augmented suture anchor reconstruction for a complete traumatic distal triceps tendon rupture in a male professional bodybuilder with postoperative biomechanical assessment
Authors: Maria-Elissavet Nikolaidou, Ingo J Banke, Thomas Laios, Konstantinos Petsogiannis, Anastasios Mourikis
Journal: Case Rep Orthop (2014)

Bodybuilding is a high-risk sport for distal triceps tendon ruptures. Management, especially in high-demanding athletes, is operative with suture anchor refixation technique being frequently used. However, the rate of rerupture is high due to underlying poor tendon quality. Thus, additional augmentation could be useful. This case report presents a reconstruction technique for a complete traumatic distal triceps tendon rupture in a bodybuilder with postoperative biomechanical assessment. A 28-year-old male professional bodybuilder was treated with a synthetic augmented suture anchor reconstruction for a complete triceps tendon rupture of his right dominant elbow. Postoperative biomechanical assessment included isokinetic elbow strength and endurance testing by using multiple angular velocities to simulate the "off-season" and "precompetition" phases of training. Eighteen months postoperatively and after full return to training, the biomechanical assessment indicated that the strength and endurance of the operated elbow joint was fully restored with even higher ratings compared to the contralateral healthy arm. The described reconstruction technique can be considered as an advisable option in high-performance athletes with underlying poor tendon quality due to high tensile strength and lack of donor site morbidity, thus enabling them to restore preinjury status and achieve safe return to sports.
A boy with amblyopia and familial exudative vitreoretinopathy harboring a new mutation of LRP5 and OPA1: A case report
Authors: Chunli Chen, Sitong Guo, Rui Zhao, Shoubin Liu, Jingjing Wu, Yuanyuan Xiao, Simeng Hou, Libin Jiang
Journal: Front Genet (2022)
Keywords: fevr, opa1, case report, fraternal twin, new mutation of lrp5
MeSH terms: Case Reports

Background: The study aimed to report a boy with familial exudative vitreoretinopathy and amblyopia harboring a new mutation of the LRP5 and OPA1 gene abnormality. Case presentation: A 9-year-old boy presented with a 2-year history of deteriorating visual acuity in the right eye. His best-corrected visual acuity was -7.00/-1.75 × 100 = 0.3 in the right eye and -2.50/-1.50 × 170 = 0.8 in the left eye. Two autosomal dominant gene mutation sites were identified in the patient: LRP5 (c.2551C > T, p.His851Tyr) from his father and OPA1 (c.565G > A, p.Glu189Lys) from his mother. Interestingly, his fraternal twin brother harbored no abnormal gene mutations, and his eye tests were normal. Conclusion: This case expands the spectrum of LRP5 gene mutations among Chinese patients with familial exudative vitreoretinopathy, and it is the first time to report a patient harboring both LRP5 and OPA1 gene mutations having anisometropic amblyopia and strabismus as the primary manifestations. These four family members exhibited individual heterogeneity of phenotypes and genotypes associated with hereditary ophthalmopathy. A comprehensive analysis of clinical phenotypes and genotypes provides clinical clues for improving the level of clinical and genetic diagnoses and a deeper understanding of the disease.
Delayed Iatrogenic Bladder Rupture Diagnosed by POCUS in the Emergency Department
Authors: Helen J Lu, Edward H Lee, Stephen Alerhand
Journal: POCUS J (2023)
Keywords: pocus, bladder rupture, point-of-care ultrasound
MeSH terms: Case Reports

Bladder rupture is an uncommon injury that leads to significant morbidity and mortality. Though occurring mostly due to trauma, this life-threatening pathology may also occur spontaneously or after a procedure such as transurethral resection of bladder tumor (TURBT). Computed tomography (CT) cystography is the standard imaging modality for diagnosis. However, this test is unlikely to be ordered in a patient with undifferentiated abdominal pain unless there is specific suspicion for this diagnosis. In our emergency department, a 48 year-old male with history of bladder cancer and TURBT two weeks prior to arrival presented with severe abdominal pain and difficulty urinating for 3 days. Point of care ultrasound (POCUS) revealed an irregularly shaped bladder, likely site of bladder rupture, and large amount of abdominal free fluid with sediment. These findings prompted an expedited diagnostic CT scan with cystography. Emergent exploratory laparotomy ultimately confirmed a small bladder defect with 2.5 L of urinary ascites. The diagnosis of non-traumatic bladder rupture can be overlooked in patients presenting with a peritonitic abdominen. The typically ordered test for such patients is standard CT, which carries a high false-negative rate for bladder rupture. This case highlights the utility of POCUS in facilitating a rapid diagnosis.
A rare complication of a vaginal breech delivery
Authors: H C Vergers-Spooren, J W de Leeuw
Journal: Case Rep Obstet Gynecol (2011)
MeSH terms: Case Reports

Rectal lesions without anal sphincter trauma in childbirth are only sporadically described in literature. We describe the case of a 29-year-old primigravida who delivered a child in frank breech presentation. During the second stage of labour a foot presented transanally through a rectal laceration with intact anal sphincters. The laceration was repaired immediately after delivery in theatre. Follow-up visits showed a properly cured laceration and no complaints of incontinence or foul discharge.
Streptococcus parasanguinis: An emerging pathogen causing neonatal endocarditis: A case report
Authors: Twishi Shrimali, Shikhir Malhotra, Nidhi Relhan, Vibhor Tak, Sushil Kumar Choudhary, Neeraj Gupta, Arun Kumarendu Singh
Journal: Access Microbiol (2023)
Keywords: streptococcus parasanguinis, infective endocarditis, neonatal sepsis
MeSH terms: Case Reports

Background. The microbial infection of the endocardium, popularly known as Infective Endocarditis (IE), is typically classified on the basis of anatomy, valve nativity and its associated microbiology. As per the associated microbiology, Staphylococcus aureus is the most common microorganism responsible for the cause of IE. Even though, the Streptococcus group accounts for a smaller percentage of IE, however this doesn't give us the liberty of ignoring the high mortality and morbidity associated with this pathogen. Case presentation. We report an unusual case of neonatal sepsis, complicated with endocarditis, caused by penicillin resistant Streptococcus parasanguinis . The neonate however died of the same despite all efforts. The said baby was given birth by a mother with gestational diabetes mellitus.
Conclusion:
High index of clinical suspicion and prompt diagnosis are the most important factors of patient management, especially in cases of life threatening neonatal infections. In such conditions a coordinated interdepartmental approach is very much needed.