OpenMed/multicare-articles huggingface dataset:
Extraosseous intra-articular osteochondroma
Authors: Pragash Mohanen, Kumaresan Palania Pillai, Kanagasabai Rangasamy
Journal: Case Rep Orthop (2013)

Background. Conventional osteochondromas are common bone lesions developing in the metaphyseal region of growing skeleton. Marginal excision is the treatment of choice for such tumours. Extraosseous cartilaginous tumours are rare and their biological potential is poorly characterized. Case Presentation. A-52-year old woman presented with 3-year history of fullness and dull pain and inability to flex her left knee, sit cross-legged, or squat. Clinical and imaging studies revealed a nodular mineralised mass in the anterior portion of the knee displacing the patellar tendon laterally. Excision biopsy confirmed the diagnosis of extraosseous osteochondroma-like soft tissue mass. There is no recurrence at two-year followup. Conclusion. An integrated clinicopathological diagnosis helps to clarify the nature of extraosseous cartilaginous tumour that can arise at an unusual anatomic site. Complete surgical excision is the treatment of choice.
Successful abdominal wall closure following collagen-based artificial dermis induced epithelialization for giant omphalocele: A case report
Authors: Masaki Horiike, Tomohiro Kitada, Kenji Santo, Takuro Hashimoto, Onishi Satoshi
Journal: Int J Surg Case Rep (2020)
Keywords: case report, collagen-based artificial dermis, giant omphalocele, jejunal perforation, negative pressure wound therapy, silo infection
MeSH terms: Case Reports

Introduction:
A giant omphalocele (GO) with marked viscero-abdominal disproportion is associated with surgical difficulty and higher morbidity and mortality rates. Despite various treatment strategies, no consensus exists on optimal GO management. We report the clinical course of a neonate with a GO who was successfully treated with abdominal-wall closure through the novel application of collagen-based artificial dermis (CAD) for epithelization.
Presentation of case:
A female neonate (estimated gestational age, 38 weeks; birthweight, 3.047 kg) with a GO where most viscera, including the liver, were completely herniated. G-band analysis showed no chromosomal abnormality and normal karyotype. Conventional silo formation was attempted, but incomplete silo was formed due to adhesion between the portal vein and fascia, and repatriation of the herniated viscera had not progressed. A new silo was formed using biomaterial, but it was infected and removed. Abdominal wall epithelialization using NPWT was attempted again but was interrupted by the occurrence of jejunal perforation. After incising the epithelialized part of the abdominal wall and repairing the perforated jejunum, the GO was covered and fixed using CAD. Epithelialization progressed well, and she was discharged on day 328.
Discussion:
In this case, the major therapeutic challenges (including formation of an incomplete silo, silo infection, and jejunal perforation) were overcome with conventional treatment except for epithelialization of the abdominal wall, which was achieved by using CAD.
Conclusion:
The treatment with CAD for epithelialization can be considered in cases where it is extremely difficult to return the viscera in conventional management.
Management of malignancy-associated bowel obstruction by cervical esophagostomy and total parenteral nutrition, case series of 2 patients
Authors: Paul H Sugarbaker, Puja G Khaitan, Chukwuemeka Ihemelandu
Journal: Int J Surg Case Rep (2018)
Keywords: appendiceal cancer, case series, colorectal cancer, cytoreductive surgery, intestinal obstruction, malignant ascites, peritoneal metastases

Background:
Patients with gastrointestinal or gynecologic malignancy may show disease progression within the abdomen and pelvis causing bowel obstruction in the absence of clinical evidence of disease outside of the peritoneal space. Bowel obstruction eventually results and has a profound effect on quality of life eventually leading to the demise of these patients.
Methods:
In order to improve the quality of life and combat the requirement for a nasogastric tube, a combination of total parenteral nutrition (TPN) to allow adequate caloric intake plus cervical esophagostomy to drain intestinal secretions was utilized as a palliative treatment long-term for patients with malignancy-associated bowel obstruction.
Results:
In 2 patients with appendiceal malignancy no cancer spread outside of the peritoneal space occurred. Unfortunately, total obstruction of the bowel caused unremitting nausea, vomiting, and pain accompanied by an inability to take adequate nutrition by mouth. In these 2 patients TPN long-term was initiated and a cervical esophagostomy tube placed percutaneously. Relief of malnutrition and the symptoms of nausea and vomiting were well treated using this combined approach. Pain management continued as an ongoing problem.
Conclusions:
Long-term management of malignancy-associated bowel obstruction is possible with improvement in quality of life using a combination of TPN and a cervical esophagostomy tube. In these two cases the cervical esophagostomy tube was placed with limited adverse events, and adequate drainage of intestinal secretions long-term.
Case report: Immune profiling links neutrophil and plasmablast dysregulation to microvascular damage in post-COVID-19 Multisystem Inflammatory Syndrome in Adults (MIS-A)
Authors: Mark R Gillrie, Nicole Rosin, Sarthak Sinha, Hellen Kang, Raquel Farias, Angela Nguyen, Kelsie Volek, Jordan Mah, Etienne Mahe, Marvin J Fritzler, Bryan G Yipp, Jeff Biernaskie
Journal: Front Immunol (2023)
Keywords: covid-19, mis-a, case report, immune dysfunction, immunophenotyping, microvascular damage, neutrophil, plasmablast
MeSH terms: COVID-19, Connective Tissue Diseases, Case Reports, Research Support, Non-U.S. Gov't, Adult, Child, Humans, Neutrophils, SARS-CoV-2, adult multisystem inflammatory disease, COVID-19 related, pediatric multisystem inflammatory disease, COVID-19 related

Despite surviving a SARS-CoV-2 infection, some individuals experience an intense post-infectious Multisystem Inflammatory Syndrome (MIS) of uncertain etiology. Children with this syndrome (MIS-C) can experience a Kawasaki-like disease, but mechanisms in adults (MIS-A) are not clearly defined. Here we utilize a deep phenotyping approach to examine immunologic responses in an individual with MIS-A. Results are contextualized to healthy, convalescent, and acute COVID-19 patients. The findings reveal systemic inflammatory changes involving novel neutrophil and B-cell subsets, autoantibodies, complement, and hypercoagulability that are linked to systemic vascular dysfunction. This deep patient profiling generates new mechanistic insight into this rare clinical entity and provides potential insight into other post-infectious syndromes.
Recurrent amaurosis fugax in a patient after stanford type a dissection depending on blood pressure and haemoglobin level
Authors: L Tomaschütz, M Dos Santos, J Schill, F Palm, A Grau
Journal: Case Rep Vasc Med (2012)

Purpose. A transient painless monocular visual loss due to a decrease in retinal circulation-also known as "amaurosis fugax"-often precedes acute territorial cerebral ischaemia. The case we present underlines the importance of a comprehensive diagnostic workup in patients with amaurosis fugax. Case Report. A 44-year-old man who had suffered from a dissection of the ascending aorta (Stanford Type A) five months ago presented with recurrent monocular vision problems. Episodes with sectional vision loss mainly occurred in combination with low blood pressure levels. Furthermore, the haemoglobin level was chronically low (Hb 9.7 mg/dL), and the patient was by mistake on a simultaneous therapy with phenprocoumon and unfractionated heparin. Carotid artery duplex scanning revealed a high-grade stenosis of the proximal right common carotid artery. MR imaging corroborated hypoperfusion in brain area corresponding to the right MCA. Conclusion. Our patient is an example in whom transient retinal ischaemic attacks may originate from haemodynamic reasons.
Cushing's Syndrome With Nocardiosis: A Case Report and a Systematic Review of the Literature
Authors: Da Zhang, Yan Jiang, Lin Lu, Zhaolin Lu, Weibo Xia, Xiaoping Xing, Hongwei Fan
Journal: Front Endocrinol (Lausanne) (2021)
Keywords: cushing’s disease, cushing’s syndrome, ectopic acth syndrome, infection, nocardiosis
MeSH terms: Cushing Syndrome / complications, Nocardia Infections / complications, Case Reports, Research Support, Non-U.S. Gov't, Systematic Review, ACTH Syndrome, Ectopic / complications, ACTH Syndrome, Ectopic / drug therapy, Adrenocorticotropic Hormone / metabolism, Adult, Anti-Bacterial Agents / pharmacology, Cushing Syndrome / diagnosis, Cushing Syndrome / drug therapy, Female, Humans, Male, Middle Aged, Nocardia Infections / diagnosis, Nocardia Infections / drug therapy, Prognosis, Radiography, Thoracic, Risk, Risk Factors, Anti-Bacterial Agents, Adrenocorticotropic Hormone

Objective:
To analyze and summarize the clinical characteristics, treatments, and prognosis of Cushing's syndrome (CS) with nocardiosis.
Methods:
A patient in our hospital and additional 17 patients of CS with nocardiosis in the English literature were included in this study. Clinical characteristics, laboratory data, imaging studies, treatments, and prognosis were evaluated.
Results:
A 41-year-old man with CS was diagnosed and treated in our hospital. He had co-infections of nocardiosis and aspergillosis. Together with 17 patients of CS with nocardiosis in the English literature, 2 patients (11.1%) were diagnosed as Cushing's disease (CD) while 16 (88.9%) were diagnosed or suspected as ectopic ACTH syndrome (EAS). The average 24hrUFC was 7,587.1 ± 2,772.0 μg/d. The average serum total cortisol and ACTH (8 AM) was 80.2 ± 18.7 μg/dl and 441.8 ± 131.8 pg/ml, respectively. The most common pulmonary radiologic findings in CT scan were cavitary lesions (10/18) and nodules (8/18). Co-infections were found in 33.3% (6/18) patients. The CS patients with co-infections had higher levels of ACTH (671.5 ± 398.2 vs 245.5 ± 217.1 pg/ml, P = 0.047), and 38.9% (7/18) patients survived through the antibiotic therapy and the treatment of CS. Patients with lower level of ACTH (survival vs mortality: 213.1 ± 159.0 vs 554.7 ± 401.0 pg/ml, P = 0.04), no co-infection, underwent CS surgery, and received antibiotic therapy for more than 6 months, had more possibilities to survive.
Conclusions:
Nocardia infection should be cautioned when a patient of CS presented with abnormal chest radiographs. The mortality risk factors for CS with nocardiosis are high level of ACTH and co-infections. We should endeavor to make early etiological diagnosis, apply long-term sensitive antibiotics and aggressive treatments of CS.
Formative feedback from the first-person perspective using Google Glass in a family medicine objective structured clinical examination station in the United States
Authors: Julie Youm, Warren Wiechmann
Journal: J Educ Eval Health Prof (2018)
Keywords: communication, formative feedback, google glass, medical education, united states
MeSH terms: Clinical Competence, Computers, Handheld, Educational Measurement / standards, Educational Technology, Family Practice, Formative Feedback, Students, Medical / psychology, Communication, Education, Medical, Undergraduate, Educational Measurement / methods, Empathy, Humans, Patient Simulation, United States

Purpose:
This case study explored the use of Google Glass in a clinical examination scenario to capture the first-person perspective of a standardized patient as a way to provide formative feedback on students' communication and empathy skills 'through the patient's eyes.'
Methods:
During a 3-year period between 2014 and 2017, third-year students enrolled in a family medicine clerkship participated in a Google Glass station during a summative clinical examination. At this station, standardized patients wore Google Glass to record an encounter focused on communication and empathy skills 'through the patient's eyes.' Students completed an online survey using a 4-point Likert scale about their perspectives on Google Glass as a feedback tool (N= 255).
Results:
We found that the students' experiences with Google Glass 'through the patient's eyes' were largely positive and that students felt the feedback provided by the Google Glass recording to be helpful. Although a third of the students felt that Google Glass was a distraction, the majority believed that the first-person perspective recordings provided an opportunity for feedback that did not exist before.
Conclusion:
Continuing exploration of first-person perspective recordings using Google Glass to improve education on communication and empathy skills is warranted.
Conservative approach in the management of radicular cyst in a child: case report
Authors: Narendra Varma Penumatsa, Srinivas Nallanchakrava, Radhika Muppa, Arthi Dandempally, Priyanaka Panthula
Journal: Case Rep Dent (2013)

Radicular cyst is the most common odontogenic cystic lesion of inflammatory origin. It is also known as periapical cyst, apical periodontal cyst, root end cyst, or dental cyst. It arises from epithelial residues in the periodontal ligament as a result of inflammation. The inflammation usually follows the death of dental pulp. This paper presents a case report of a patient with radicular cyst associated with a primary molar.
Optic neuritis in an immunocompetent 40-year-old female due to fungal sphenoidal sinusitis
Authors: Virna M Shah, Kartik Panikkar
Journal: GMS Ophthalmol Cases (2019)
Keywords: 6th nerve palsy, fungal sphenoidal sinusitis, immunocompetent, optic neuritis, osteomyelitis
MeSH terms: Case Reports

Fungal shpenoidal sinusitis with osteomyelitis is rare in young immunocompetent patients. We present a case of a presumed fungal sphenoidal sinusitis presenting with second and sixth cranial nerve involvement which resolved well with systemic anti-fungal treatment.
Fetus in the Bladder: Rare Complication of Vesicouterine Fistula
Authors: Vladimir Lesovoy, Yuryi Parashchuk, Dmytro Shchukin, Roman Safonov, Karyna Didenkova, Maria Lisova, Inessa Safonova
Journal: Case Rep Med (2016)
MeSH terms: Case Reports

The work presents a rare case of spontaneous migration of an 11-week fetus from the uterine cavity into the urinary bladder cavity through the long-standing vesicouterine fistula.
Case report: Therapeutic potential of Flourishing-Life-Of-Wish Virtual Reality Therapy on Relaxation (FLOW-VRT-Relaxation)-a novel personalized relaxation in palliative care
Authors: Olive K L Woo, Antoinette M Lee
Journal: Front Digit Health (2023)
Keywords: flow-vrt, flow-vrt-relaxation, palliative care, personalized, relaxation, virtual reality
MeSH terms: Case Reports

In view of the global aging population and growing need of palliative care, innovative intervention for effective symptom management is of urgent need. Flourishing-Life-Of-Wish Virtual Reality Therapy (FLOW-VRT) is a brief, structured, manualized, and personalized psychological intervention with theoretical foundations based on stress coping theory, self-determination theory, flow theory, and attention restoration theory. With a specific focus on relaxation, FLOW-VRT-Relaxation intends to facilitate adaptive end-of-life coping through delivering personalized relaxation. This paper reports a case study of the application of FLOW-VRT-Relaxation, and discusses its therapeutic potential as a cost-effective method for reducing palliative symptoms by addressing patient's unmet needs. The case study is a 51-year-old Chinese female, diagnosed with advanced cervix cancer, and presented with unmet psychological (i.e., unfulfilled wishes) and physical needs (i.e., pain and fatigue) before FLOW-VRT-Relaxation. To address her unmet needs, FLOW-VRT-Relaxation was delivered by a registered clinical psychologist specialized in palliative care. Need assessment was first conducted, followed by a 10-min VR travel of Japan as her own choice. Relaxation was verbally coached during VR. Right after VR, consolidation with psychological components including psychoeducation, cognitive and emotional processing, and reminiscence intervention were delivered. The patient showed improvement in physical and psychological symptoms, lower sense of loneliness and engulfment, as well as enhanced peace after FLOW-VRT-Relaxation. The current findings provide encouraging initial support for the feasibility, acceptability, and therapeutic potential of using FLOW-VRT-Relaxation as a cost-effective, scalable and personalized VR relaxation for patients under palliative care. It is hoped that with its optimal use, FLOW-VRT-Relaxation can serve as an alternative therapeutic tool that effectively improves the end-on-life care.
Case Report: Aarskog-scott syndrome caused by FGD1 gene variation: A family study
Authors: Yijia Liang, Honglin Wu, Xiumei He, Xiyu He
Journal: Front Genet (2022)
Keywords: fgd1 gene, aarskog-scott syndrome, brother contact, family study, rare syndromes
MeSH terms: Case Reports

Aarskog-Scott syndrome is a rare genetic disorder characterized by short stature, abnormal facial features, and digital and genital deformities. FGD1 gene variation is the known cause of this disorder. This paper described a Chinese family study of Aarskog-Scott syndrome in which the main patients were two brothers. Then, the relationship between genotype and phenotype in Aarskog-Scott syndrome was investigated preliminarily. A new FGD1 gene variant was revealed in this study, providing insights into the link between phenotype and genotype variations in Aarskog-Scott syndrome as well as a foundation for its diagnosis and treatment.
Optical coherence tomography findings in methanol toxicity
Authors: Kendra A Klein, Alexis K Warren, Caroline R Baumal, Thomas R Hedges 3rd
Journal: Int J Retina Vitreous (2017)
Keywords: inner nuclear layer microcysts, methanol, optical coherence tomography (oct), retinal toxicity, toxic optic neuropathy
MeSH terms: Case Reports

Background:
Methanol toxicity poses a significant public health problem in developing countries, and in Southeast Asia, where the most common source of poisoning is via adulterated liquor in local drinks. Methanol toxicity can have devastating visual consequences and retinal specialists should be aware of the features of this toxic optic neuropathy. The authors report a case of severe systemic methanol toxicity and relatively mild optic neuropathy demonstrating unique retinal changes on optical coherence tomography (OCT).
Case presentation:
A previously healthy student developed ataxia, difficulty breathing and loss of consciousness hours after drinking homemade alcohol while traveling in Indonesia. She was found to have a serum pH of 6.79 and elevated methanol levels. She was treated with intravenous ethanol, methylprednisolone and sodium bicarbonate. When she awoke she had bilateral central scotomas. At presentation, she had central depression on visual field testing. OCT of the retinal nerve fiber layer (RNFL) was normal but ganglion cell layer analysis (GCL) showed highly selective loss of the nasal fibers in both eyes. Further, OCT of the macula demonstrated inner nuclear layer (INL) microcysts in the corresponding area of selective GCL loss in both eyes.
Conclusions:
The selective involvement of the papillomacular bundle fibers is common in toxic optic neuropathies and represents damage to the small caliber axons rich in mitochondria. Despite severe systemic toxicity, the relative sparing of the optic nerve in this case enabled characterization of the evolution of methanol toxicity with segmental GCL involvement and preservation of the RNFL, corresponding to the papillomacular bundle. This is the first reported case of INL microcysts in methanol optic neuropathy and supports that they are a non-specific finding, and may represent preferential damage to the papillomacular bundle.
Pectoralis Major Tear with Retracted Tendon: How to Fill the Gap? Reconstruction with Hamstring Autograft and Fixation with an Interference Screw
Authors: L Baverel, K Messedi, G Piétu, V Crenn, F Gouin
Journal: Case Rep Orthop (2017)
MeSH terms: Case Reports

Rupture of the pectoralis major tendon is considered an uncommon injury and a significant number of ruptures are missed or diagnosed late, leading to a chronic tear. We report an open reconstruction technique and its outcomes in a case of chronic and retracted PM tear. At the last follow-up (12 months), the patient was pain-free, with a visual analogic scale at 0 all the time. He was very satisfied concerning the cosmetic and clinical results. The constant score was 93%, the SST value 95%, and the Quick DASH score 4.5. MRI performed one year postoperatively confirmed the continuity between PM tendon and graft, even if the aspect of the distal tendon seemed to be thinner than normal PM tendon. The excellent clinical outcomes at one-year follow-up suggest that PM tear with major tendon retraction can be reliably reconstructed with hamstring autograft, using a bioabsorbable screw to optimize the fixation device. This technique has proven its simplicity and efficiency to fill the gap.
A Novel Homozygous Mutation of the AIRE Gene in an APECED Patient From Pakistan: Case Report and Review of the Literature
Authors: Marsha Pellegrino, Emanuele Bellacchio, Rudina Dhamo, Federica Frasca, Corrado Betterle, Alessandra Fierabracci
Journal: Front Immunol (2018)
Keywords: aire gene, apeced, epidemiology, genotype/phenotype correlation, mutation functional analysis
MeSH terms: Genotype, Mutation / genetics, Polyendocrinopathies, Autoimmune / genetics, Transcription Factors / genetics, Case Reports, Research Support, Non-U.S. Gov't, Review, Adolescent, Autoantibodies / blood, Consanguinity, Female, Homozygote, Humans, Hyponatremia, Iodide Peroxidase / immunology, Pakistan, Pedigree, Polyendocrinopathies, Autoimmune / diagnosis, Polymorphism, Single Nucleotide, APECED protein, Autoantibodies, Transcription Factors, Iodide Peroxidase

Autoimmune-poly-endocrinopathy-candidiasis-ectodermal-dystrophy syndrome (APECED) is a rare monogenic recessive disorder caused by mutations in the autoimmune regulator (AIRE) gene. Criteria for the diagnosis of APECED are the presence of two of the following disorders: chronic mucocutaneous candidiasis (CMC), chronic hypoparathyroidism (CHP), and Addison's disease. APECED develops at high incidence in Finns, Sardinians, and Iranian Jews and presents with a wide range of clinical phenotypes and genotypes. In this manuscript, we report the clinical, endocrinological, and molecular features of a 16-year-old female patient from Pakistan living in Italy and presenting the major APECED clinical manifestations CMC, CHP, and primary adrenal insufficiency. Premature ovarian failure, chronic bronchopneumopathy, vitiligo, Hashimoto's thyroiditis emerged as associated diseases. In our patient, AIRE gene screening revealed the novel c.396G>C (p.Arg132Ser; p.R132S) mutation in homozygosity thus confirming APECED diagnosis. This is the first reported mutation within the nuclear localization signal (NLS) that is associated with APECED. The NLS mutation affects the nuclear import of classical transcription factors through nuclear pore by recognition of nuclear import receptors, the importin α molecules. By displaying crystal structures of the peptide containing the KRK basic residue cluster bound to α importins, we show that p.R132S replacement in 131-KRK-133 does not reproduce these interactions. Thus, we propose that the novel mutation exerts its pathogenetic effect by impairing the nuclear import of the Aire protein. The present case report is added to a limited series of Pakistani APECED patients who we reviewed from the scientific literature, mostly diagnosed on clinical findings.