OpenMed/multicare-articles huggingface dataset:
Cellulite and the Aesthetic Management of the Buttocks and Thighs: 6 Cases Illustrating Targeted Verifiable Subcision as Part of a Multimodal Approach to Lower Body Rejuvenation
Authors: Laurie A Casas, M Bradley Calobrace, Johnny Franco, Jennifer Harrington, Kristi Hustak, Sachin M Shridharani
Journal: Aesthet Surg J Open Forum (2024)
MeSH terms: Case Reports

Background:
In the buttocks and thighs, skin quality, focal adiposity, volume deficiency, skin laxity, and/or textural issues each contribute to overall appearance. For patients undergoing rejuvenation/beautification procedures, global improvement is desired, making multimodal treatment the standard of care to address these mechanistically distinct concerns. Resolution of cellulite depressions is central to patient satisfaction and aesthetic outcomes: without management, the overall aesthetic suffers, and patients are left partially unsatisfied with treatment results. With minimally invasive Targeted Verifiable Subcision (TVS; Avéli [Revelle Aesthetics, Inc., Mountain View, CA]), septa with a confirmed role in dimple formation can be released through mechanically verified subcision, permitting consistent outcomes.
Objectives:
Discuss the application of TVS as part of a multimodal approach to buttock and thigh rejuvenation and share best practices for obtaining optimal improvement.
Methods:
A group of 6 experts in aesthetic plastic surgery and dermatology convened for a 2 h roundtable discussion of select case studies, best practices, and their approaches for obtaining optimal outcomes in clinical practice.
Results:
Clinical cases from 6 patients who presented for buttock and/or thigh rejuvenation/beautification are presented where TVS was applied as part of a multimodal approach. Before and after images, details of patient cases, and a discussion of best practices for patient education and evaluation, treatment planning, technique, safety, postprocedure care, and open research questions are included.
Conclusions:
TVS is emerging as a valuable tool for the treatment of cellulite in the buttocks and thighs that may potentially be used alongside surgical and nonsurgical approaches, often on the same day.
Case Report: Electroanatomic mapping as an early diagnostic tool in arrhythmogenic cardiomyopathy
Authors: Jose F de Melo Jr, Samuel A Shabtaie, Martin van Zyl, Jeremy D Collins, Konstantinos C Siontis
Journal: Front Cardiovasc Med (2024)
Keywords: arrhythmogenic cardiomyopathy, case report, electroanatomic mapping, premature ventricular contraction, task force criteria
MeSH terms: Case Reports

Background:
Abnormal substrate on invasive electroanatomic mapping (EAM) correlates with areas of myocardial thinning and fibrofatty replacement in Arrhythmogenic Cardiomyopathy (ACM). However, EAM parameters are absent from all sets of diagnostic criteria for ACM.
Case summary:
A 41-year-old female with no significant family history was referred for evaluation of frequent premature ventricular complexes (PVCs). Twelve-lead ECG showed diffuse low-voltage QRS complexes. Holter monitor showed 28% burden of PVCs with various morphologies consistent with right ventricular (RV) inflow and outflow tract exits. Transthoracic echocardiogram revealed normal biventricular function and dimension. Cardiac magnetic resonance revealed a mildly increased indexed RV end-diastolic volume with normal RV systolic function and no dyssynchrony, akinesia, dyskinesia, or late gadolinium enhancement. Electrophysiologic study demonstrated 2 predominant PVC morphologies that were targeted with ablation, in addition to extensive abnormality with low-voltage and fractionated electrograms in the peri-tricuspid and right ventricular outflow tract free wall regions with septal sparing, suggestive of RV cardiomyopathy. Subsequent genetic testing revealed two pathogenic variants in the desmoplakin and plakophilin-2 genes, confirming the diagnosis of ACM.
Conclusion:
Advanced RV electropathy can precede RV structural changes in ACM. Invasive evaluation of the electroanatomic substrate should be considered in select cases even when imaging findings are not diagnostic. Future iterations of ACM guidelines may need to consider EAM substrate as one of the diagnostic criteria. A high index of diagnostic suspicion for ACM should be maintained in patients with multifocal RV ectopy.
LAPAROTOMIC RADIOFREQUENCY ABLATION OF PANCREATIC INSULINOMA
Authors: Allan Rubens Zucolotto Cansi, Jhonatan de Souza Vitor, João Felipe da Silva Lopes, Rogério Dardengo Glória
Journal: Arq Bras Cir Dig (2024)
MeSH terms: Insulinoma / diagnostic imaging, Insulinoma / surgery, Laparotomy, Pancreatic Neoplasms / diagnostic imaging, Pancreatic Neoplasms / surgery, Radiofrequency Ablation / methods, Case Reports, Letter, Female, Humans, Middle Aged

Insulinomas are rare neoplasms of the endocrine pancreas. Minimally invasive treatment options for insulinomas have gained prominence, replacing surgical resection due to its associated morbidity and mortality. Radiofrequency ablation (RFA) has emerged as a relevant treatment option. We present a case of a female patient with neuroglycopenic symptoms and severe hypoglycemic crises. The abdominal magnetic resonance imaging (MRI) showed a small nodular lesion in the pancreatic body. Laparotomy was performed, followed by RFA using a 15-mm active-tipped needle. No complications transpired, and no hypoglycemic episodes were observed during 12 months of follow-up.
Application value of 18F-FDG PET/CT in primary spleen angiosarcoma with liver metastasis: a case report and literature review
Authors: Mingyan Shao, Wanling Qi, Rong Xu, Zhehuang Luo, Fengxiang Liao, Sisi Fan
Journal: Front Oncol (2024)
Keywords: 18f-fdg pet/ct, ct, liver metastasis, primary, spleen angiosarcoma
MeSH terms: Case Reports

Background:
Primary splenic angiosarcoma (PSA) is a rare neoplasm. It is a malignant tumor derived from endothelial cells of the splenic sinuses. PSA has an unknown etiology, a high degree of malignancy, easy early metastasis, atypical clinical symptoms and imaging findings, and difficult early diagnosis. This paper reports the 18F-FDG PET/CT findings of a case of PSA with intrahepatic metastasis; summarizes its clinical, imaging, and pathological data; and reviews the literature.
Case description:
A 64-year-old male patient presented with left lower abdominal distending pain without obvious causes on 13 March 2022. The pain was persistent and dull and worsened after sitting and eating. Blood routine examination results were RBC ↓ 3.33 × 1012/L, WBC ↑ 12.32 × 109/L, and PLT ↓ 40 × 109/L. The tumor markers indicated CA125 ↑ 47.0 U/ml, AFP (-), CEA (-), CA199 (-), and CA724 (-). Non-contrast-enhanced CT scan of the abdomen showed that the spleen was significantly enlarged in volume and irregular in shape and had multiple nodules and clumpy low-density shadows, unclear boundaries, uneven density, and multiple necrotic areas. Enhanced CT showed diffuse uneven mild enhancement of the spleen, and the degree of enhancement increased with time. Multiple nodular low-density shadows were seen in the liver, which were slightly enhanced by the enhanced scan.18F-FDG PET/CT showed multiple nodular and massive lesions in the spleen with multiple necrotic areas. There were multiple nodular lesions in the liver, the level of FDG metabolism increased, the SUVmax of the spleen lesions was 9.0, and the SUVmax of the liver lesions was 5.6. The 18F-FDG PET/CT diagnosis was splenic malignancy with liver metastasis. Finally, after a multidisciplinary discussion, it was decided to perform laparoscopic total splenectomy and portal vein infusion chemotherapy. Pathological examination showed that the tumor cells were round, oval, or fusiform, with obvious atypia, arranged into a cable or anastomosed vascular lumen. The final diagnosis was primary splenic angiosarcoma with massive necrosis. After surgery, the patient received antitumor combined therapy and died 5 months later.
Conclusion:
The incidence of PSA is very low, and its clinical and radiological manifestations lack specificity. 18F-FDG PET/CT imaging has a certain diagnostic value for PSA and significant utility in preoperative staging, guiding biopsy procedures, evaluating postoperative treatment response, and monitoring disease recurrence. PSA should be considered in the presence of a space-occupying lesion within the spleen that exhibits necrotic areas, shows progressive enhancement on contrast-enhanced scans, and demonstrates heterogeneous increases in FDG uptake.
Omadacycline for the treatment of patients with Legionella pneumophila pneumonia after experiencing liver dysfunction: case series
Authors: Ani Zhu, Qian Ma, Zhiyan Liu
Journal: Front Microbiol (2024)
Keywords: legionella pneumophila, case series, liver function, omadacycline, pneumonia

Introduction:
Antibiotics frequently induce abnormal liver function. Omadacycline is a novel aminomethylcycline antibiotic, which shows potent activity against Gram-positive and Gram-negative aerobic, anaerobic, and atypical (including Legionella pneumophila) bacteria. Of note, omadacycline is tolerable in most patients with liver impairment. However, evidence regarding the application of omadacycline in patients with Legionella pneumophila pneumonia after experiencing liver dysfunction is scarce.
Methods:
The current study reported 6 cases of patients with Legionella pneumophila pneumonia receiving omadacycline as subsequent antibiotics after experiencing liver dysfunction.
Results:
These 6 cases were admitted to the hospital for pneumonia and received antibiotic therapy, including piperacillin-tazobactam, imipenem, meropenem, and moxifloxacin. After receiving these antibiotics, increased liver enzymes were noted. Although hepatoprotective therapy (such as magnesium isoglycyrrhizinate and glutathione) was given, the liver function was still abnormal. According to metagenomic next-generation sequencing, these patients were diagnosed with Legionella pneumophila pneumonia. Considering the abnormal liver function, the antibiotic therapy was switched to omadacycline-containing antibiotic therapy. After that, liver function was improved, and the infection was ameliorated. Ultimately, all patients discharged from the hospital, including 2 patients who achieved complete clinical symptomatic improvement and 4 patients who achieved partial clinical symptomatic improvement.
Discussion:
This study emphasizes the successful treatment of switching to omadacycline after experiencing abnormal liver function in patients with Legionella pneumophila pneumonia. This study suggests that omadacycline may serve as an optional antibiotic for patients with Legionella pneumophila pneumonia, especially when occurring liver dysfunction. However, more clinical studies are required to validate our findings.
Identification of mixed anaerobic infections after inguinal hernia repair based on metagenomic next-generation sequencing: A case report
Authors: Jun Zhang, Yuming Zhou, Zhenzhou Zhong, Yan Lv, Xuying Yang, Xianghong Liu
Journal: Open Med (Wars) (2024)
Keywords: adjustment of the antibiotic regimen, anaerobes, case report, infection after inguinal hernia repair, metagenomic next-generation sequencing, mixed infection
MeSH terms: Case Reports

Infection following inguinal hernia repair (IHR) is uncommon. Rational use of antibiotics can significantly improve the prognosis of patients. However, accurately identifying the pathogen involved is usually challenging. This case report describes a patient who developed intermittent fever after undergoing open preperitoneal tension-free repair of a bilateral inguinal hernia. The scrotal fluid specimen was cultured and subjected to metagenomic next-generation sequencing (mNGS). Culture revealed the presence of Enterococcus faecalis (a facultative anaerobe). However, mNGS detected E. faecalis along with multiple anaerobic bacteria including Bacteroides thetaiotaomicron, Parabacteroides distasonis, and Levyella massiliensis. The patient was finally diagnosed with a mixed infection of E. faecalis and multiple anaerobes, and his condition was effectively controlled after timely adjustment of the antibiotic regimen. Treating postoperative infections with multiple concurrent conditions can be challenging. mNGS is valuable for the accurate diagnosis and treatment of infections, as it not only can further verify the culture results, but also assist clinicians in ruling out pulmonary infection caused by hematogenous dissemination after IHR in patients.
Complex relationship between growth hormone and sleep in children: insights, discrepancies, and implications
Authors: Marco Zaffanello, Angelo Pietrobelli, Paolo Cavarzere, Alessandra Guzzo, Franco Antoniazzi
Journal: Front Endocrinol (Lausanne) (2024)
Keywords: children, growth hormone, pediatric, recombinant growth hormone, sleep quality
MeSH terms: Dwarfism, Pituitary / drug therapy, Human Growth Hormone / therapeutic use, Hypopituitarism / drug therapy, Systematic Review, Case Reports, Review, Research Support, Non-U.S. Gov't, Child, Growth Hormone, Humans, Sleep, Growth Hormone, Human Growth Hormone

Growth hormone (GH) is crucial to growth and development. GH secretion is regulated by a complex feedback system involving the pituitary gland, hypothalamus, and other organs, and predominantly occurs during deep sleep. Isolated and idiopathic growth hormone deficiency (GHD) is a condition characterized by GHD without any other signs or symptoms associated with a specific syndrome or disease. The aim of this narrative review was to evaluate the relationship between GH and sleep in children using published data. Various databases (Medline/PubMed, Scopus, and Web of Science) were systematically searched for relevant English language articles published up to April 2023. Search strategies included the terms 'children/pediatric', 'growth hormone', 'growth hormone deficiency' and 'sleep'. Data were extracted by two independent reviewers; 185 papers were identified of which 58 were duplicates and 118 were excluded (unrelated n=83, syndromic/genetic GHD n=17, non-English n=13, abstract n=1, case report n=1). Overall, nine studies (six clinical studies, two case series, and one survey) were included. GHD appears to have an adverse effect on sleep in children, and GH therapy has only been shown to have a beneficial effect on sleep parameters in some individuals. Notably, identified data were limited, old/poor quality, and heterogenous/inconsistent. Further research of GHD in pediatric populations is necessary to improve the understanding of GHD impact on sleep and its underlying mechanisms, and to determine the specific impacts of GH therapy on sleep in children.
Retroperitoneal schwannoma mimicking a metastatic lymph node of renal clear cell carcinoma: a case report
Authors: Shaorong Pan, Pengyuan Wang, Zeyang Chen, Yucun Liu, Zhengfei Zhou
Journal: Front Neurol (2024)
Keywords: case report, metastatic lymph node, radiological examination, renal clear cell carcinoma, schwannoma
MeSH terms: Case Reports

Schwannomas are usually benign tumors typically found in the head, neck, and extremities, with approximately 3% originating in the retroperitoneum. In this case, a young male presented with incidental masses in the left kidney and retroperitoneum. Abdominal pelvic enhanced computerized tomography (CT) revealed a tumor apparently originating from the left kidney, along with a retroperitoneal mass suspected to be a metastatic lymph node. Subsequently, a radical nephrectomy of the left kidney and retroperitoneal mass resection was performed. Pathological examination confirmed the left kidney mass as renal clear cell carcinoma and the retroperitoneal mass as schwannoma. The patient recovered uneventfully and was discharged from the hospital. A 6-month postoperative follow-up showed no evidence of recurrence. Preoperative diagnosis of schwannomas concurrent with other concurrent malignancies in rare sites, such as the retroperitoneum, is challenging due to their rare and non-specific radiological features. Although retroperitoneal schwannomas are rare, they should be considered in the differential diagnosis during CT examinations for renal cancer. Additionally, the advantages of a multidisciplinary team approach should be utilized in tumor management.
Case report: Lymph node metastasis of pelvic alveolar rhabdomyosarcoma diagnosed by fine needle aspiration cytology
Authors: Xinyu Hu, Chenxin Huang, Qiyuan Li, Baolin Wu, Chuyun Yue, Xueying Su
Journal: Front Oncol (2024)
Keywords: arms, fna (fine needle aspiration), alveolar rhabdomyosarcoma, fine needle aspiration cytology, lymph node metastasis
MeSH terms: Case Reports

Rhabdomyosarcoma (RMS) is a common soft tissue malignant tumor, especially in young patients. Alveolar rhabdomyosarcoma (ARMS) is a subtype of RMS that is prevalent in adolescents. This malignant tumor usually develops in the extremities and can also involve the trunk, perineum, and pelvis. Now, we report a rare case of pelvic lymph node metastatic alveolar RMS in a young patient, which was determined by fine needle aspiration cytology (FNAC). To the best of our knowledge, this is the first case in which the definite diagnosis of ARMS was initially made by FNAC.
Semidirect Resin Composite Veneers in a Patient with Bruxism
Authors: Franciele Floriani, Natália Fiuza Coelho, Ludimila de Azevedo Linhares, Sheila Cristina Stolf, Guilherme Carpena Lopes
Journal: Case Rep Dent (2024)
MeSH terms: Case Reports

This case report details the esthetic rehabilitation of a 32-year-old male patient suffering from sleep bruxism, primarily manifesting as a fracture and significant loss of tooth structure in the anterior maxillary central incisors. To address these concerns, the patient underwent a restorative treatment involving the application of semidirect resin composite veneers on the maxillary incisors and direct resin composite restoration on the incisal regions of the maxillary canines. This approach not only restored the functional integrity of the teeth but also significantly enhanced the patient's esthetic appearance.
Rituximab and improved nodular regenerative hyperplasia-associated non-cirrhotic liver disease in common variable immunodeficiency: a case report and literature study
Authors: Willem Roosens, Frederik Staels, Sien Van Loo, Stephanie Humblet-Baron, Isabelle Meyts, Hadewijch De Samblanx, Chris Verslype, Hannah van Malenstein, Schalk van der Merwe, Wim Laleman, Rik Schrijvers
Journal: Front Immunol (2023)
Keywords: common variable immune deficiency (cvid), inborn errors of immunity, nodular regenerative hyperplasia, non-cirrhotic portal hypertension, non-infectious complications, primary immunodeficiency, rituximab
MeSH terms: Common Variable Immunodeficiency / complications, Common Variable Immunodeficiency / drug therapy, Hypertension, Portal / drug therapy, Hypertension, Portal / etiology, Review, Case Reports, Research Support, Non-U.S. Gov't, Ascites, Humans, Hyperplasia / drug therapy, Rituximab / therapeutic use, Rituximab

Common variable immunodeficiency (CVID) associated liver disease is an underrecognized and poorly studied non-infectious complication that lacks an established treatment. We describe a CVID patient with severe multiorgan complications, including non-cirrhotic portal hypertension secondary to nodular regenerative hyperplasia leading to diuretic-refractory ascites. Remarkably, treatment with rituximab, administered for concomitant immune thrombocytopenia, resulted in the complete and sustained resolution of portal hypertension and ascites. Our case, complemented with a literature review, suggests a beneficial effect of rituximab that warrants further research.
Evaluating the implementation fidelity of basic emergency obstetrics and neonatal care services in Beyeda District, Northwest Ethiopia: a case study evaluation
Authors: Hawltu Abeyu Ejigu, Lake Yazachew, Getasew Amare, Chalie Tadie Tsehay, Asebe Hagos, Tesfahun Zemene Tafere
Journal: Front Glob Womens Health (2024)
Keywords: bemonc, ethiopia, adherence, participant responsiveness, quality of delivery

Background:
Worldwide, nearly 830 women die from complications of pregnancy and childbirth daily. Ninety-nine per cent of these maternal deaths take place in low and middle-income countries. Basic Emergency Obstetric Care (BEmONC) is one method of reducing maternal mortality related to pregnancy and childbirth complications. However, the status of its implementation fidelity has not been investigated. Therefore, this study sought to evaluate the implementation fidelity of BEmONC services in Beyeda District, Northwest Ethiopia.
Evaluation methods:
A single case study design with mixed method was employed from June 01 to July 30, 2022. 415 client exit interviews, 14 key informants' interviews and 423 retrospective document reviews were conducted. Adherence, participant responsiveness and quality of delivery dimensions from Carroll's conceptual framework, with a total of 21 indicators were used in this evaluation. The overall implementation fidelity status of BEmONC service was judged based on the pre-seated judgmental criteria as; low, medium, and high fidelity.
Results:
The overall degree of implementation fidelity of the BEmONC services was 74.5%. Moreover, the implementation fidelity status of adherence, quality of delivery, and participant responsiveness dimensions were 74.7%, 77.2%, and 71.5% respectively. Uterotonic drugs were not administered as per the recommended protocol. Participants' engagement towards the neonatal resuscitation service delivery was inadequate. Likewise, healthcare providers' respect for the clients was not sufficient. Furthermore, women aged >30 years, being government employed and ANC visits four and above were variables positively associated with the quality of delivery of BEmONC services.
Conclusion:
The overall implementation fidelity of the BEmONC services was judged as implemented in medium fidelity. Moreover, the adherence, participant responsiveness and quality of delivery dimensions were found to be implemented in medium fidelity. Therefore, public health sectors at all levels should strive to enhance the implementation fidelity of BEmONC services. Moreover, healthcare providers should adhere to the BEmONC implementation protocol guideline during service delivery. Healthcare managers should facilitate a continuous awareness creation for mothers regarding the merit of neonatal resuscitation for neonatal complications. Furthermore, healthcare providers should give due respect to mothers while delivering the services.