OpenMed/multicare-articles huggingface dataset:
The Vestibular Implant: Hearing Preservation during Intralabyrinthine Electrode Insertion-A Case Report
Authors: Raymond van de Berg, Florence Lucieer, Nils Guinand, Joost van Tongeren, Erwin George, Jean-Philippe Guyot, Herman Kingma, Marc van Hoof, Yasin Temel, Jacobus van Overbeeke, Angelica Perez-Fornos, Robert Stokroos
Journal: Front Neurol (2017)
Keywords: bilateral vestibular areflexia, bilateral vestibulopathy, electrode design, hearing preservation, neural prosthesis, vestibular implant, vestibular prosthesis, vestibulo-ocular reflex
MeSH terms: Case Reports

Objective:
The vestibular implant seems feasible as a clinically useful device in the near future. However, hearing preservation during intralabyrinthine implantation remains a challenge. It should be preserved to be able to treat patients with bilateral vestibulopathy and (partially) intact hearing. This case study investigated the feasibility of hearing preservation during the acute phase after electrode insertion in the semicircular canals.
Methods:
A 40-year-old woman with normal hearing underwent a translabyrinthine approach for a vestibular schwannoma Koos Grade IV. Hearing was monitored using auditory brainstem response audiometry (ABR). ABR signals were recorded synchronously to video recordings of the surgery. Following the principles of soft surgery, a conventional dummy electrode was inserted in the lateral semicircular canal for several minutes and subsequently removed. The same procedure was then applied for the posterior canal. Finally, the labyrinthectomy was completed, and the schwannoma was removed.
Results:
Surgery was performed without complications. No leakage of endolymph and no significant reduction of ABR response were observed during insertion and after removal of the electrodes from the semicircular canals, indicting no damage to the peripheral auditory function. The ABR response significantly changed when the semicircular canals were completely opened during the labyrinthectomy. This was indicated by a change in the morphology and latency of peak V of the ABR signal.
Conclusion:
Electrode insertion in the semicircular canals is possible without acutely damaging the peripheral auditory function measured with ABR, as shown in this proof-of-principle clinical investigation.
Clinical Paradox: Anterior Wall Myocardial Infarction with Predominant Inferior ST Elevation and No Variation in Coronary Anatomy in a PAI-1 Homozygote
Authors: Marko Perčić, Tea Friščić, Jasna Čerkez Habek, Dean Strinić, Ninoslav Rudman, Jozica Šikić
Journal: Case Rep Cardiol (2020)
MeSH terms: Case Reports

Changes of the ST segment are commonly used as predictors of the culprit vessel during an acute myocardial infarction. In case of combined ST elevation in both inferior and anterior leads, these changes can be due to a distal occlusion of a "wrapped" left anterior descending artery (LAD) or a two-vessel disease. Our case of anterior wall myocardial infarction with inferior ST elevation and anterior ST depression shows that electrocardiographic changes during acute myocardial infarction cannot always be explained by logical sequelae of the injury current, vessel anatomy, and their irrigation territory.
Appendiceal Orifice Inflammation in Ulcerative Colitis Mimicking Mucosa-Associated Lymphoid Tissue Lymphoma in the Cecum
Authors: Masaya Iwamuro, Takahide Takahashi, Takehiro Tanaka, Tomohiro Toji, Sakiko Hiraoka, Seiji Kawano, Yoshiro Kawahara, Hiroyuki Okada
Journal: Case Rep Gastrointest Med (2020)
MeSH terms: Case Reports

A 55-year-old Japanese woman, who had been diagnosed with ulcerative colitis at 18 years of age, underwent screening endoscopy examinations. Esophagogastroduodenoscopy revealed an extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue (MALT lymphoma) of the stomach. Colonoscopy showed a slightly elevated reddish lesion with dilated microvessels but no erosions or ulcers. Although MALT lymphoma in the cecum was endoscopically suspected, flow cytometry and pathological analyses led to the diagnosis of appendiceal orifice inflammation in ulcerative colitis. This case highlights the diversity of the endoscopic appearance of appendiceal orifice inflammation in ulcerative colitis.
Anaphylactic Reactions Caused by Nafamostat Mesylate during Hemodialysis before Surgery for Carpal Tunnel Syndrome
Authors: Yuta Nakamura, Kaoru Tada, Masashi Matsuta, Atsuro Murai, Hiroyuki Tsuchiya
Journal: Case Rep Nephrol (2021)
MeSH terms: Case Reports

Nafamostat mesylate (NM) has been used to treat pancreatitis and disseminated intravascular coagulation during hemodialysis (HD). However, there have been some reports of adverse effects related to anaphylactic reactions. We present a case in which anaphylactic reactions caused by NM during preoperative HD caused repeated postponement of surgery for carpal tunnel syndrome. Symptoms including fever, shivering, chills, low blood pressure, tachycardia, nausea, and vomiting appeared during preoperative HD, and surgery was postponed thrice. Initially, the patient was misdiagnosed with sepsis because of elevated C-reactive protein and procalcitonin levels. However, since the symptoms appeared only when NM was administered and disappeared quickly after the administration of NM was terminated, the condition was diagnosed as anaphylactic reactions caused by NM. Therefore, it is essential to consider anaphylactic reactions caused by NM as differential diagnoses, when symptoms, such as fever, are observed during perioperative HD.
Successful use of cyclosporine as treatment for eosinophilic cystitis: a case report
Authors: Sohaib Aleem, Bharat Kumar, Mary Beth Fasano, Elizabeth Takacs, Antoine Emile Azar
Journal: World Allergy Organ J (2016)
Keywords: cyclosporine, eosinophilic cystitis, steroids
MeSH terms: Case Reports

Background:
Eosinophilic cystitis is a rare inflammatory disorder characterized by eosinophilic infiltration of all layers of the urinary bladder wall. Due to lack of consensus and potential for side effect from various therapeutic options, treatment of the disease is often challenging.
Case presentation:
A 64-year old woman with hypertensive nephropathy resulting in stage III chronic kidney disease, obstructive sleep apnea, and obstructive lung disease presented with a 4 month history of dysuria, urgency, frequency, and persistent hematuria. Based on eosinophilic infiltration on bladder wall biopsy in the absence of any evidence of infection, malignancy, or immune disorder, she was diagnosed with eosinophilic cystitis. Despite multiple medication regimens, her symptoms persisted, requiring high-dose prednisone with steroid-related side effects. After four months, she was started on cyclosporine, which led to symptomatic improvement and reduction in prednisone dosage. At that time, repeat urine cytology and cystoscopy did not reveal friable tissues or eosinophiluria.
Conclusion:
This case illustrates the utility of using cyclosporine to treat eosinophilic cystitis in adult patient with multiple comorbid conditions.
Granulomatosis with Polyangiitis as a Cause of Sudden-Onset Bilateral Sensorineural Hearing Loss: Case Report and Recommendations for Initial Assessment
Authors: Paul R Ratmeyer, Benjamin R Johnson, Luis P Roldan, Tania L Kraai
Journal: Case Rep Otolaryngol (2021)
MeSH terms: Case Reports

Granulomatosis with polyangiitis (GPA) is a severe systemic vasculitis that commonly affects the paranasal sinuses, upper and lower respiratory tracts, and kidneys. GPA has also been associated with sensorineural hearing loss (SNHL), through inflammation of the cochlear apparatus. Early recognition, diagnostic laboratory evaluation, and appropriate treatment are essential to improve outcomes and achieve remission for patients with GPA. Here, we present a case of bilateral sudden sensorineural hearing loss (SSNHL) and distal symmetric polyneuropathy as the first presenting signs of GPA. A specific diagnostic work-up to rule out autoimmune inner-ear disease in patients with bilateral SSNHL is not clearly stated in the clinical practice guidelines from the American Academy of Otolaryngology-Head and Neck Surgery. The aim of this paper is to delineate an appropriate diagnostic work-up for patients with bilateral SSNHL when there is concern for autoimmune disease.
Bilateral cochlear implantation in a child with Waardenburg syndrome: A case report
Authors: Xiaohui Wang, Lin Xu, Na Zhang, Ying Zhao
Journal: Front Pediatr (2022)
Keywords: waardenburg syndrome, airway, anesthesia management, cochlear implantation, rare disease
MeSH terms: Case Reports

Background:
Waardenburg syndrome (WS) is a rare genetic disorder that presents with clinical characteristics such as white forelock, congenital deafness, dystopia canthorum, and heterochromia iridis. It is mostly transmitted through an autosomal dominant mode, with a few genetic mutations. Children with WS often require surgical intervention at an early age and may have a difficult airway, which can be challenging for anesthesiologists.
Case presentation:
We report the anesthetic management during cochlear implantation in a 14-month-old girl with WS who weighed 9 kg. In addition to hearing loss and delayed speech, she presented with motor developmental delay, chewing and swallowing impairments, and dietary bucking. Resistance was encountered during tracheal intubation after anesthesia induction, and the tracheal tube was successfully intubated after rotation.
Conclusions:
We report the anesthetic management during cochlear implantation in a child with WS, briefly describe the research advances related to WS, and discuss the optimization of the perioperative management of these children, including airway management, anesthesia-related complications, and the use of anesthetics.
Treatment of puberty trichotillomania with low-dose aripiprazole
Authors: Tsuyoshi Sasaki, Masaomi Iyo
Journal: Ann Gen Psychiatry (2015)
Keywords: aripiprazole, puberty, trichotillomania
MeSH terms: Case Reports

The present case is of a 14-year-old female with trichotillomania (TTM) that was treated with a low dose of aripiprazole (ARP) 1.5 mg/day. To our knowledge, this is the first published report to show an improvement of pubertal TTM using an ultra-low dose of ARP. In this case, a 50-mg fluvoxamine monotherapy for 2 years and a subsequent 4-month comprehensive cognitive behavioral therapy (CBT) monotherapy did not improve her hair-pulling symptoms. However, the treatment with a low-dose ARP of 1.5 mg/day dramatically improved her TTM symptoms without extrapyramidal symptoms. In this regard, low-dose ARP treatment for TTM might be a safe alternative to antidepressants, which carry the risk of agitation with suicidal ideation in adolescents.
Adrenal Cavernous Hemangioma: A Rarely Perceived Pathology-Case Illustration and Review of Literature
Authors: Jad A Degheili, Nassib F Abou Heidar, Mouhammad El-Moussawi, Ayman Tawil, Rami W Nasr
Journal: Case Rep Pathol (2019)
MeSH terms: Case Reports

Cavernous hemangiomas are endothelial tumors that rarely affect the adrenal glands. Most of these tumors remain silent and are incidentally found on abdominal imaging. Hardly ever, these tumors are endocrinologically functional. They may present as vague abdominal pain. Surgical resection remains the mainstay for large masses. In this paper, we are presenting a case of adrenal cavernous hemangioma in a 83-year-old male patient who initially presented for workup of vague abdominal and bilateral flank pain. A computed tomography scan of the abdomen showed an 8 cm right adrenal adenoma which was metabolically nonfunctional. The mass was completely resected through an open subcostal incision, with no encountered postoperative complications. A highlight of all published cases of adrenal hemangiomas since 1955 is also presented and reviewed.
Case Report of Multiembolic Cerebrovascular Event Associated with Ramp Study Echocardiogram
Authors: Brian C Butera, Luanda P Grazette, Tracy Lawrence, Michael E Bowdish, Andrew J Yoon
Journal: Case Rep Cardiol (2017)
MeSH terms: Case Reports

The incidence of ramp test echocardiogram-associated embolic events in the setting of therapeutic anticoagulation is likely rare and has not been reported. We present such a case in a patient with a HeartMate II left ventricular assist device (LVAD) whose serial head computed tomography images, deteriorating clinical course, and the multiembolic nature of the event suggest causality. If the pretest probability of pump thrombosis in an individual LVAD patient is sufficiently high, the potential risks of performing a ramp study echocardiogram may not be warranted, even in the setting of adequate anticoagulation.
Acute type A aortic dissection involving the iliac and left renal arteries, misdiagnosed as myocardial infarction
Authors: Paul Nkemtendong Tolefac, Anastase Dzudie, Sidick Mouliom, Leopold Aminde, Romuald Hentchoya, Martin H Abanda, Charles Mve Mvondo, Vanina D Wanko, Henry N Luma
Journal: Cardiovasc J Afr (2018)
MeSH terms: Aneurysm, Infected / diagnostic imaging, Aortic Aneurysm / diagnostic imaging, Aortic Dissection / diagnostic imaging, Aortography / methods, Computed Tomography Angiography, Iliac Aneurysm / diagnostic imaging, Myocardial Infarction / diagnosis, Renal Artery / diagnostic imaging, Case Reports, Acute Disease, Aneurysm, Infected / complications, Aneurysm, Infected / microbiology, Aneurysm, Infected / therapy, Aortic Aneurysm / complications, Aortic Aneurysm / microbiology, Aortic Aneurysm / therapy, Aortic Dissection / complications, Aortic Dissection / microbiology, Aortic Dissection / therapy, Chest Pain / etiology, Diagnostic Errors, Echocardiography, Electrocardiography, Fatal Outcome, Humans, Iliac Aneurysm / complications, Iliac Aneurysm / microbiology, Iliac Aneurysm / therapy, Male, Middle Aged, Predictive Value of Tests, Time Factors

Acute aortic dissection is the most frequent and deadly presentation of acute aortic syndromes. Its incidence is estimated at three to four cases per 100 000 persons per year. Its clinical presentation may be misleading, with misdiagnosis ranging between 14.1 and 38% in many series. A late diagnosis or absence of early and appropriate management is associated with mortality rates as high as 50 and 80% by the third day and second week, respectively, especially in proximal lesions. We report on the case of a 53-year-old man who presented with type A aortic dissection, misdiagnosed as acute myocardial infarction, who later died on day 12 of hospitalisation. Although a relatively rare condition, poor awareness in Africa probably accounted for the initial misdiagnosis. Thorough investigation of acute chest pain and initiation of clinical registries are potential avenues to curb related morbidity and mortality.
Thrombolytic Dilemma: A Case Report of Early Puerperium Ischemic Stroke Treated With Intravenous Thrombolysis
Authors: André Santos, Maria Lima Costa, José Eduardo Sousa, Ilídia Carmezim, Ana Gomes
Journal: Cureus (2023)
Keywords: early puerperium thrombolysis, ischemic stroke, postpartum complication, thrombolytic therapy, tissue plasminogen activator
MeSH terms: Case Reports

A 25-year-old woman was admitted to the obstetrics ward when presented with a sudden onset of expressive aphasia and minor right facial palsy 48 hours after forceps-assisted delivery. The intrahospital emergency team was immediately mobilized. The patient had a blood pressure (BP) of 119/79 mmHg, heart rate of 114 bpm, O2 saturation of 97%, and blood glucose level of 136 mg/dL. Trauma and toxic exposure were ruled out. A rapid EKG was performed with no significant changes. Assuming an acute stroke, the patient immediately underwent brain CT (approximately 15 minutes after the beginning of the symptoms), which revealed no signs of hemorrhage, an ischemic area, or masses. Brain CT angiography was then performed; however, no major brain artery obstruction was found. With brain hemorrhage ruled out and persistent neurologic deficits, the case was discussed between the emergency team doctor and the patient's obstetrician, and intravenous thrombolysis (IVT) with recombinant tissue plasminogen activator (rt-PA) was started approximately 45 minutes after the onset of symptoms. After treatment completion, the patient had a complete resolution of the neurological deficits. The patient remained under strict observation at the acute stroke unit (ASU), and no secondary brain hemorrhage or post-partum-related complications were noted.
Uncoupling between cerebral perfusion and oxygenation during incremental exercise in an athlete with postconcussion syndrome: a case report
Authors: Sarah Imhoff, Simon Malenfant, Éric Nadreau, Paul Poirier, Damian M Bailey, Patrice Brassard
Journal: Physiol Rep (2017)
Keywords: cerebral oxygenation, cerebral perfusion, exercise, postconcussion syndrome
MeSH terms: Cerebral Cortex / blood supply, Cerebral Cortex / physiopathology, Exercise, Post-Concussion Syndrome / physiopathology, Case Reports, Adult, Arterial Pressure, Athletes, Blood Flow Velocity, Female, Humans, Middle Cerebral Artery / physiopathology, Respiration

High-intensity exercise may pose a risk to patients with postconcussion syndrome (PCS) when symptomatic during exertion. The case of a paralympic athlete with PCS who experienced a succession of convulsion-awakening periods and reported a marked increase in postconcussion symptoms after undergoing a graded symptom-limited aerobic exercise protocol is presented. Potential mechanisms of cerebrovascular function failure are then discussed.
A case report of a gastric perforation in a giant inguinoscrotal hernia: A two-step approach
Authors: Paul Sayad, Audrey Zhen Tan
Journal: Int J Surg Case Rep (2019)
Keywords: case report, gastric perforation, giant hernia, hernia, inguinoscrotal hernia

Introduction:
An inguinoscrotal hernia is defined as giant if descending below the midpoint of the inner thigh of a patient in upright position. It is an uncommon condition and rarely encountered in clinical practice that can lead to severe complications such as gastric perforation.
Presentation of case:
We present a case of a 50-year old male suffering from a gastric perforation in a giant inguinoscrotal hernia that was managed in a two-step approach.
Discussion:
In our patient, we opted for a two-step approach. The initial phase consisted in the release of the stomach, repair of the perforation, the control of the infection and the stabilization of the patient. The repair of the hernia was performed uneventfully three months later in the second phase.
Conclusion:
In a giant inguinal hernia with gastric perforation, delaying the hernia repair when possible can decrease the complexity of the procedure and most likely its morbidity and mortality.
Salvage of failed local and regional flaps with porcine urinary bladder extracellular matrix aided tissue regeneration
Authors: Gregory J Kruper, Zachary P Vandegriend, Ho-Sheng Lin, Giancarlo F Zuliani
Journal: Case Rep Otolaryngol (2013)

Local and regional flap failure can be a major complication in head and neck surgery, which continue to be prevalent for a number of reasons including poor flap design, improper surgical technique, and poor tissue vascularity. Dealing with these failures can be quite difficult. Surgical debridement, flap revisions, and complex wound regimens are necessitated to reestablish appropriate tissue coverage. Traditional use of wet to dry dressing to enable proper wound granulation and possible closure with additional flaps or skin grafts is a laborious process. Such treatments place great time burdens on the patient, physicians, and nurses. Because the face and neck possess a complex three-dimensional topography, wound dressings are inherently complex to design and change. Many patients also require postoperative treatments such as radiation and chemotherapy to treat aggressive malignancies, and delay in wound healing leads to a delay in adjuvant treatment. Recently, advances in regenerative medicine, specifically xenogeneic extracellular matrix compounds, have been shown to promote tissue growth while limiting scar tissue formation (Badylak 2004). To our knowledge, this paper is the first case series using the porcine extracellular matrix bioscaffold (MatriStem ACell, Columbia, MD, USA) to salvage flaps with extensive wound breakdown on the face and neck.
Patellar Tendon Excision and Repair for Residual Patella Alta after Prior Failed Patellar Tendon Repair: Surgical Decision Making and Outcome
Authors: Richard N Puzzitiello, Avinesh Agarwalla, Austin Stone, Brian Forsythe
Journal: Case Rep Orthop (2018)
MeSH terms: Case Reports

Presented in this report is a complex revision case of a patellar tendon repair preceded by excess tendon excision to correct for recurrent patella alta deformity, in a workers' compensation patient. The goal of this procedure was to alleviate this patient's pain, to preserve his ability to function in his activities of daily living, and to allow him to return to work at some capacity. On postoperative radiographs, the revision procedure appeared to have successfully corrected this patient's patella alta deformity. After an extended rehabilitation process, this patient had reached maximal medical improvement at 1-year follow-up. He displayed modest improvements in all PROs, including a clinically significant improvement in his short-form mental component score. Despite his functional capacity being still somewhat limited, this patient reported subjective satisfaction after this complicated salvage procedure.
Total laparoscopic surgery for treatment of leiomyoma of the transverse colon in a patient with an abdominal mesh: A case report
Authors: Goshi Fujimoto, Shunichi Osada
Journal: Int J Surg Case Rep (2019)
Keywords: abdominal mesh, case report, intraabdominal anastomosis, leiomyoma, tram flap, total laparoscopic surgery

Introduction:
Gastrointestinal stromal tumors are the most common mesenchymal tumors of the gastrointestinal tract; however, gastrointestinal leiomyomas are relatively rare. Surgical resection is recommended for leiomyomas and gastrointestinal stromal tumors of the colon. We present a case in which we performed laparoscopic right hemicolectomy with intraabdominal anastomosis for treating leiomyoma of the transverse colon in a patient with an abdominal mesh.
Presentation of case:
A 64-year-old woman with a history of right subtotal adrenalectomy and right mastectomy was incidentally found to have an abdominal mass on a follow-up computed tomography (CT) scan, which was confirmed as a gastrointestinal stromal tumor of the mesentery following abdominal contrast-enhanced CT. We planned surgical resection for preoperative diagnosis because the tumor was >5 cm in diameter. However, she had undergone transverse rectus abdominis myocutaneous (TRAM) flap reconstruction after right mastectomy, in which the TRAM flap was replaced with an abdominal mesh; hence, total laparoscopic surgery was performed to avoid damaging the mesh owing to the risk of mesh infection. Laparotomy revealed that the tumor originated from the transverse colon; thus, transverse colectomy with intraabdominal anastomosis was performed. The total operative time and blood loss were 3 h 32 min and 5 mL, respectively. No postoperative leakage or mesh infection was observed. The resected specimen revealed a leiomyoma without malignancy.
Discussion:
We successfully performed colectomy that minimized the resection range and intraabdominal anastomosis.
Conclusion:
Total laparoscopic surgery was effective for colonic leiomyoma with an abdominal mesh to avoid mesh-related complications.