OpenMed/multicare-articles huggingface dataset:
A Conservative Approach by Unilateral Maximal Single-Muscle Recession Surgery for the Treatment of Cyclic Esotropia
Authors: Cem Evereklioglu, Fatih Horozoğlu, Hidayet Sener, Osman Ahmet Polat
Journal: Case Rep Ophthalmol Med (2023)
MeSH terms: Case Reports

Purpose:
Cyclic esotropia (alternate-day squint) is a poorly understood form of strabismus that mostly occurs at younger pediatric ages. It demonstrates classically a 48-hour cycle with 24 hours of manifest esotropia and 24 hours of orthotropia, which is conventionally managed by bilateral or unilateral 2-muscle surgery. We aimed to report a child with cyclic esotropia who was surgically treated by a conservative unilateral 1-muscle approach.
Methods:
Case report.
Results:
A 3.5-year-old girl presented to the strabismus department with an intermittent esodeviation for 2 years that became cyclic in the last 3 months. The diagnosis of primary classical cyclic esotropia was made after seeing her multiple times on different days. The girl was emmetropic bilaterally, had normal visual acuities in both eyes, and high-angle right esodeviation (45-50 Δ ) with normal laboratory and MRI results. Unilateral maximal single-muscle recession of the right medial rectus was performed, and the child was followed up for 9 months. The girl developed excellent alignment after the surgery both at distance and near without cyclic pattern, and near-normal stereopsis (by animals: 100 sec. of arc) with binocularity was reached. The girl did not experience under- or overcorrection nor have a recurrence postoperatively.
Conclusion:
This is the first report of "one eye single-muscle" surgery for high-angle cyclic esotropia. Conservative unilateral medial rectus recession seems to be sufficient to permanently block the circadian rhythm and restore binocular fusion and stereopsis.
Case report: A persistently expanded T cell response in an exceptional responder to radiation and atezolizumab for metastatic non-small cell lung cancer
Authors: David G Coffey, Yuexin Xu, Andrea M H Towlerton, Marcin Kowanetz, Priti Hegde, Martine Darwish, Mahesh Yadav, Craig Blanchette, Shannon M Ruppert, Sarah Bertino, Qikai Xu, Andrew Ferretti, Adam Weinheimer, Matthew Hellmann, Angel Qin, Dafydd Thomas, Edus H Warren, Nithya Ramnath
Journal: Front Immunol (2022)
Keywords: case report, immunotherapy, lung neoplasms, programmed death-ligand 1, t lymphocytes
MeSH terms: Carcinoma, Non-Small-Cell Lung / drug therapy, Carcinoma, Non-Small-Cell Lung / genetics, Lung Neoplasms / drug therapy, Lung Neoplasms / genetics, Case Reports, Research Support, Non-U.S. Gov't, Research Support, N.I.H., Extramural, Antibodies, Monoclonal, Humanized / pharmacology, Antibodies, Monoclonal, Humanized / therapeutic use, HLA-A2 Antigen, Humans, Immune Checkpoint Inhibitors, T-Lymphocytes, Antibodies, Monoclonal, Humanized, HLA-A2 Antigen, Immune Checkpoint Inhibitors, atezolizumab

Most patients with advanced non-small cell lung cancer (NSCLC) do not achieve a durable remission after treatment with immune checkpoint inhibitors. Here we report the clinical history of an exceptional responder to radiation and anti-program death-ligand 1 (PD-L1) monoclonal antibody, atezolizumab, for metastatic NSCLC who remains in a complete remission more than 8 years after treatment. Sequencing of the patient's T cell repertoire from a metastatic lesion and the blood before and after anti-PD-L1 treatment revealed oligoclonal T cell expansion. Characterization of the dominant T cell clone, which comprised 10% of all clones and increased 10-fold in the blood post-treatment, revealed an activated CD8+ phenotype and reactivity against 4 HLA-A2 restricted neopeptides but not viral or wild-type human peptides, suggesting tumor reactivity. We hypothesize that the patient's exceptional response to anti-PD-L1 therapy may have been achieved by increased tumor immunogenicity promoted by pre-treatment radiation therapy as well as long-term persistence of oligoclonal expanded circulating T cells.
Nuclear Imaging to Detect Diaphragmatic Perforation as a Rare Complication of Microwave Ablation
Authors: Stephanie Cull, Gebran Khneizer, Abhishek Krishna, Razi Muzaffar, Sameer Gadani, Zafar Jamkhana
Journal: Case Rep Crit Care (2017)
MeSH terms: Case Reports

Acquired diaphragmatic perforation leading to massive hepatic hydrothorax and respiratory failure is a rare complication of microwave ablation (MWA) of hepatocellular carcinoma (HCC). Imaging modalities to detect pleuroperitoneal communication remain poorly described. We report a nuclear imaging technique used to efficiently diagnose and locate diaphragmatic defects. A 57-year-old male with cirrhosis and HCC presented with respiratory distress after undergoing MWA of a HCC lesion. He was admitted to the intensive care unit for noninvasive positive pressure ventilator support. Chest radiography revealed a new large right pleural effusion. Large-volume thoracentesis was consistent with hepatic hydrothorax. The fluid reaccumulated within 24 hours; therefore an acquired diaphragmatic perforation induced by the ablation procedure was suspected. To investigate, 99mTechnetium-labeled albumin was injected into the peritoneal cavity. The tracer accumulated in the right hemi thorax almost immediately. The patient then underwent transjugular intrahepatic portosystemic shunting in efforts to relieve portal hypertension and decrease ascites volume. Unfortunately, the patient deteriorated and expired after few days. Although diaphragmatic defects develop in cirrhotic patients, such small fenestrations do not normally lead to rapid development of life-threatening pleural effusion. MWA procedures can cause large diaphragmatic defects. Immediate detection of this complication is essential for initiating early intervention.
Microscopic polyangiitis presenting with persistent cough and hemoptysis in pediatrics: A case report and review of the literature
Authors: Yantong Zhu, Xiangrong Zheng
Journal: Front Oncol (2022)
Keywords: children, cough, hemoptysis, microscopic polyangiitis, renal
MeSH terms: Case Reports

Background:
Microscopic polyangiitis (MPA) is a necrotizing vasculitis that involves small- and medium-sized vessels and is associated with the presence of antineutrophil cytoplasmic antibodies with a perinuclear staining pattern (p-ANCA). The kidney and lungs are the organs primarily affected. MPA is rare in children and is easily misdiagnosed. Below is a complete case history of the course of the disease.
Case presentation:
An 11-year-old girl with a 1-month history of cough and hemoptysis showed no improvement after imipenem-cilastatin treatment. p-ANCA and microscopic hematuria and proteinuria were positive, and a chest CT revealed an area of shadow in the bilateral lower lobe of the lungs. Renal biopsies showed crescentic glomerulonephritis, and MPA was diagnosed based on these criteria. The patient exhibited dramatic clinical and imaging improvements after immunosuppressive treatment.
Conclusion:
The organs most commonly involved in MPA in children are the lungs, kidneys, skin, nervous system organs, and organs of the gastrointestinal tract. Careful examination should be carried out in these patients while biopsies of the kidney or any other organs remain the gold standard for diagnostic purposes. Pulmonary involvement may be the initial symptom of the disease and should not be confused with pneumonia. A urinalysis should be performed in patients with hemoptysis. Antibiotics should be used with caution.
Hypertensive crisis associated with high dose soy isoflavone supplementation in a post-menopausal woman: a case report [ISRCTN98074661]
Authors: Andrea M Hutchins, Imogene E McIver, Carol S Johnston
Journal: BMC Womens Health (2005)

Background:
Isoflavones are gaining popularity as alternatives to hormone replacement therapy. However, few guidelines exist to inform the public as to an appropriate dose. This case involves a postmenopausal woman who experienced a hypertensive crisis while consuming a high-dose isoflavone supplement as part of a research protocol.
Case presentation:
The participant was part of a placebo-controlled crossover trial to investigate the potential synergism of the antioxidant activity of soy isoflavones and vitamin C. Upon entry into the study, this healthy, well-nourished, normotensive postmenopausal woman (51 years old), consumed the first of four randomly assigned treatments (500 mg vitamin C plus 5 mg/kg body weight soy isoflavones). During this treatment, the participant's systolic blood pressure spiked to a recorded 226/117 mmHg, necessitating medical intervention and discontinuation of study participation. Two plausible mechanisms for this hypertensive crisis are discussed.
Conclusion:
Due to the availability and increasing popularity of soy supplements, practitioners should be aware of the potential side effects associated with their use. Practitioners counseling clients who are consuming soy isoflavone supplements should advise them that elevated blood pressure may be a potential side-effect to consider and monitor.
"Primary Hyperparathyroidism (PHPT) in Children: Two Case Reports and Review of the Literature"
Authors: Gerdi Tuli, Jessica Munarin, Daniele Tessaris, Raffaele Buganza, Patrizia Matarazzo, Luisa De Sanctis
Journal: Case Rep Endocrinol (2021)
MeSH terms: Case Reports

Primary hyperparathyroidism (PHPT) is a rare disorder in children and adolescents. Typical biochemical features are hypercalcemia and hypophosphatemia, but the clinical features can be heterogeneous, and in some cases, symptoms are vague and nonspecific, leading to misdiagnosis or late diagnosis. Herein, we report two cases of PHPT in pediatric age with different presenting symptoms, pain in the foot, and progressive alteration of the gait in the first case and recurrent abdominal pain with emotional lability in the second. Biochemical and radiological assessment confirmed PHPT. Both cases were treated surgically as definitive treatment, but in the second case, previous medical treatment with cinacalcet, a calcimimetic agent, was required to reduce serum PTH and calcium levels. After surgery, despite conventional treatment with calcium and calcitriol, case 1 developed a hungry bone syndrome. The analysis of the MEN-1 (Multiple Endocrine Neoplasia) gene was negative in both cases. A diagnosis of PHPT should be considered when children or adolescents present bone pain with radiological imaging of osteolytic lesion and biochemical feature of hypercalcemia associated with hypophosphatemia. In PHPT, the gold standard treatment is represented by surgery followed by strict postoperative endocrine monitoring to maintain adequate homeostasis of calcium and bone metabolism.
Laryngeal Neuroendocrine Carcinomas: A Retrospective Study of 14 Cases
Authors: Yingying Zhu, Liming Gao, Yunxiao Meng, Wenwen Diao, Xiaoli Zhu, Guojun Li, Zhiqiang Gao, Xingming Chen
Journal: Biomed Res Int (2015)
MeSH terms: Carcinoma, Neuroendocrine / mortality, Carcinoma, Neuroendocrine / pathology, Carcinoma, Neuroendocrine / therapy, Laryngeal Neoplasms / mortality, Laryngeal Neoplasms / pathology, Laryngeal Neoplasms / therapy, Case Reports, Adolescent, Adult, Disease-Free Survival, Female, Follow-Up Studies, Humans, Male, Middle Aged, Retrospective Studies, Survival Rate

Laryngeal neuroendocrine carcinomas (LNECs) are rare and highly heterogeneous which present a wide spectrum of pathological and clinical manifestations. Fourteen patients with histologically demonstrated LNEC were collected and analyzed retrospectively. The 14 cases were classified into 3 subtypes: typical carcinoid in 2, atypical carcinoid in 5, and small cell neuroendocrine carcinoma in 7. The mean survival time of the 14 patients in this study was 112.5 months (95% CI, 81.5-143.6). Surgeries were performed for 2 patients of typical carcinoid, and they were alive with no evidence of recurrence after 24 and 47 months of follow-ups. Patients in the atypical carcinoid group were treated with surgeries and postoperative radiotherapy. After 58.4 months of follow-ups (range: 9-144), 2 patients showed no evidence of disease and 1 was lost to follow-up after 72 months. The other 2 patients died of other unrelated diseases. In the small cell neuroendocrine carcinoma group, a combination of chemotherapy and radiotherapy was applied. The mean survival time was 79.7 months (95% CI, 37.9-121.4), and the 5-year survival rate was 53.6%. In conclusion, the clinical behaviors, treatment protocols, and prognosis are different for each subtype of LNECs.
Familial Translocation t(2;4) (q37.3;p16.3), Resulting in a Partial Trisomy of 2q (or 4p) and a Partial Monosomy of 4p (or 2q), Causes Dysplasia
Authors: Jian Wang, Shiyuan Zhou, Fei He, Xuelian Zhang, Jianqi Lu, Jian Zhang, Feng Zhang, Xiangmin Xu, Fang Yang, Fu Xiong
Journal: Front Genet (2021)
Keywords: 4p163, 4p163 microduplication syndrome, id/dd, balanced translocation of chromosomes, wolf-hirschhorn syndrome

Background: Wolf-Hirschhorn syndrome, a well-known contiguous microdeletion syndrome, is caused by deletions on chromosome 4p. While the clinical symptoms and the critical region for this disorder have been identified based on genotype-phenotype correlations, duplications in this region have been infrequently reported. Conclusion: Our case report shows that both deletions and duplications of the Wolf-Hirshhorn critical region cause intellectual disability/developmental delay and multiple congenital anomalies.
The Role of Dynamic Contrast-Enhanced MRI in a Child with Sport-Induced Avascular Necrosis of the Scaphoid: A Case Report and Literature Review
Authors: Baris Beytullah Koc, Martijn Schotanus, Bob Jong, Pieter Tilman
Journal: Case Rep Orthop (2016)

Avascular necrosis (AVN) of the scaphoid in children is very rare and there is currently no consensus when conservative or operative treatment is indicated. A 10-year-old boy, practicing karate, presented with acute pain in his left wrist after falling on the outstretched hand. Imaging showed a scaphoid waist fracture with signs of an ongoing AVN. The diagnosis of AVN was confirmed with signal loss of the scaphoid on MRI T1. A dynamic contrast-enhanced MRI was performed for further assessment of the proximal pole vascularity and treatment planning. As dynamic contrast-enhanced MRI showed fair perfusion of the proximal pole, an adequate healing potential with conservative treatment was estimated. We achieved union and good function with cast immobilization for fourteen weeks. This case study showed dynamic contrast-enhanced MRI to be a valuable tool in assessing whether conservative or operative treatment is indicated to achieve union and good functional outcome.
Management of Crown-Root Fracture in Primary Canine by Surgical Extrusion: A Case Report with 1-Year Follow-Up
Authors: I Kanimozhi, Mahesh Ramakrishnan, Dhanalakshmi Ravikumar, Ningthoujam Sharna
Journal: Case Rep Dent (2018)
MeSH terms: Case Reports

Complicated crown-root fractures of primary teeth often present with a greater challenge to the pediatric dentist. Extraction of the involved tooth is the routine treatment indicated. But, early loss of this primary tooth may lead to esthetic and psychological problems and also causes a detrimental effect on the development of occlusion and the alveolar bone. The present case report described the management of crown-root fracture in a primary canine by surgical extrusion and showed a satisfactory prognosis at one-year follow-up.
The first patient recovered from avian influenza A H7N9 viral infection: A case report and review of the literature
Authors: Yanchao He, Qihui Huang, Jindong Shi, Zhoufang Mei, Zhijun Jie
Journal: Respir Med Case Rep (2013)
Keywords: avian influenza a, h7n9, oseltamivir, pneumonia

In March 2013, a novel avian-origin influenza A (H7N9) virus was isolated from throat swabs of 2 patients at the Fifth People's Hospital of Shanghai, China. Subsequently, 4 more patients infected by H7N9 were identified. Of the 6 patients, 4 died of acute respiratory distress syndrome. Here, we report the first case of a patient who recovered from pneumonia induced by H7N9 infection. The patient presented with fever, cough, and blood in sputum. Laboratory tests showed a low level of leukocytes, hypoxaemia, and increased levels of creatine kinase and lactate dehydrogenase. Imaging showed multiple areas of segmental ground-glass opacity in the right lung. Oseltamivir and antibiotics were administered. Supplemental oxygen helped relieve symptoms. Approximately 2 weeks after treatment, the patient finally recovered. A follow-up chest computed tomography scan taken 8 weeks later revealed that the ground-glass opacity was clearly absorbed. Therefore, timely intervention with oseltamivir and supplemental oxygen may be very important in the treatment of H7N9 infection.
Intraoperative Transesophageal Echocardiography to Monitor for Pulmonary Emboli in a Pediatric Patient Undergoing Undifferentiated Embryonal Sarcoma of the Liver Resection
Authors: Irim Salik, Nicolas Lamper, Bhupen Mehta, Kar-Mei Chan
Journal: Case Rep Anesthesiol (2021)
MeSH terms: Case Reports

A minimally invasive monitoring technique, intraoperative transesophageal echocardiography (TEE), has been utilized to provide real-time data on volume status and ventricular function in patients undergoing liver transplantation. In this case, TEE was utilized in an 8-year-old female undergoing undifferentiated embryonal sarcoma of the liver resection to monitor for pulmonary emboli, particularly a saddle embolus. In addition to visualization of cardiac structures, TEE can also be utilized to monitor the liver, lungs, spleen, and kidneys. Monitoring for echocardiographic findings of pulmonary embolism in this high-risk patient was an integral part of effective intraoperative management.
Phrenic artery hemorrhage after percutaneous portal vein stenting to treat cavernous transformation following living donor liver transplantation: a case report
Authors: Qiang Huang, Ningning Lu, Renyou Zhai
Journal: Case Rep Transplant (2011)
MeSH terms: Case Reports

Cavernous transformation is a condition which has an acutely developing harmful effect over intestinal circulation compromising the patients' life before development of portal hypertension and its results. We present the case of phrenic artery hemorrhage after successful percutaneous portal vein stenting to treat cavernous transformation following LDLT. The patient survived the hazard complication with prompt surgery. Three factors may be related to the rare complication in the case were analyzed, including affluent new vessels around the diaphragm related to LDLT procedure, high puncture site allowing the diaphragm been injured, and anticoagulation given before the puncture and soon after the procedure. Cautions should be taken for the interventional procedures in this extreme condition. Cavernous transformation is a condition which has an acutely developing harmful effect over intestinal circulation compromising the patients' life before development of portal hypertension and its results (see the work of Harmanci and Bayraktar (2007)). It is even worse when this happens in a patient after LDLT (living donor liver transplantation). Herein we have presented a case of phrenic artery hemorrhage after successful percutaneous portal vein stenting to treat cavernous transformation following LDLT. The patient survived the hazard complication with prompt surgery.
Variant Creutzfeldt-Jakob disease death, United States
Authors: Ermias D Belay, James J Sejvar, Wun-Ju Shieh, Steven T Wiersma, Wen-Quan Zou, Pierluigi Gambetti, Stephen Hunter, Ryan A Maddox, Landis Crockett, Sherif R Zaki, Lawrence B Schonberger
Journal: Emerg Infect Dis (2005)
MeSH terms: Creutzfeldt-Jakob Syndrome / physiopathology, Case Reports, Adult, Creutzfeldt-Jakob Syndrome / diagnosis, Creutzfeldt-Jakob Syndrome / epidemiology, Fatal Outcome, Female, Humans, United States

The only variant Creutzfeldt-Jakob disease (vCJD) patient identified in the United States died in 2004, and the diagnosis was confirmed by analysis of autopsy tissue. The patient likely acquired the disease while growing up in Great Britain before immigrating to the United States in 1992. Additional vCJD patients continue to be identified outside the United Kingdom, including 2 more patients in Ireland, and 1 patient each in Japan, Portugal, Saudi Arabia, Spain, and the Netherlands. The reports of bloodborne transmission of vCJD in 2 patients, 1 of whom was heterozygous for methionine and valine at polymorphic codon 129, add to the uncertainty about the future of the vCJD outbreak.
Advanced ovarian dysgerminoma infiltrating both ovaries and uterus in a 7-year-old girl
Authors: Nexhmi Hyseni, Sadik Llullaku, Hysni Jashari, Kaltrina Zahiti, Fjolla Hyseni, Fisnik Kurshumliu, Lumturije Luci, Fehim Muqolli, Antigona Hasani
Journal: Case Rep Oncol Med (2014)

Introduction. Ovarian dysgerminoma is a rare malignant ovarian germ cell tumor with its peak incidence in young women. Abdominal pain, abdominal distention, and the presence of a palpable mass are common symptoms at presentation. Depending on the FIGO stage at presentation the prognosis of dysgerminomas after surgical treatment, adjuvant chemotherapy, and radiotherapy is promising. Case Presentation. A 7-year-old girl was presented at our clinic with abdominal pain in all abdominal quadrants. Later the pain localized in the region of her right ovary. CT scan revealed a massive formation which was connected to her right ovary. Conclusion. Although malignant ovarian germ cell tumours are rare in children, physicians must always consider the possibility of MOGT-occurrences. The clinical symptoms might not be specific: abdominal pain, abdominal distention, nausea, and vomiting. In order to make a correct diagnosis the patients should undergo a complete clinical examination including radiological scans. Initial management is frequently surgery, followed by adjuvant chemotherapy and radiotherapy. Although disgerminoma is malignant tumor, the prognosis is promising.
Effect of arginine vasopressin on systemic and pulmonary arterial pressure in a patient with pulmonary hypertension secondary to pulmonary emphysema: a case report
Authors: Toshiyuki Mizota, Kohei Fujiwara, Miho Hamada, Shino Matsukawa, Hajime Segawa
Journal: JA Clin Rep (2017)
Keywords: arginine vasopressin, hypotension, noradrenaline, pulmonary hypertension, vasopressor

Although data from several studies support the use of arginine vasopressin (AVP) for the treatment of hypotension concomitant with pulmonary hypertension (PH) in the cardiac surgery setting, to our knowledge, no previous studies have reported the effect of AVP on the systemic and pulmonary circulation of patients with PH secondary to lung diseases. In this report, we present the hemodynamic responses to bolus administrations of AVP and noradrenaline in a patient with PH secondary to pulmonary emphysema. The patient showed low systemic vascular resistance hypotension during off-pump single-lung transplantation. The bolus administration of AVP (0.5 U) increased systemic arterial pressure by 35.2%, with a minimal change in pulmonary arterial pressure, resulting in a significant decrease in the pulmonary arterial pressure/systemic arterial pressure ratio. In contrast, the bolus administration of noradrenaline (10 or 20 μg) increased both systemic and pulmonary arterial pressures by 14.8 and 6.7%, respectively. In summary, the bolus administration of AVP effectively increased systemic arterial pressure with a minimal effect on pulmonary arterial pressure in a patient with PH secondary to pulmonary emphysema. This case highlights the potential utility of AVP to treat low systemic vascular resistance hypotension in patients with PH secondary to lung diseases.