OpenMed/multicare-articles huggingface dataset:
Benign Recurrent Intrahepatic Cholestasis (BRIC): An African Case Report
Authors: Adil Salyani, Linda Barasa, Allan Rajula, Sayed K Ali
Journal: Case Rep Gastrointest Med (2020)
MeSH terms: Case Reports

Benign recurrent intrahepatic cholestasis (BRIC) is a rare disorder characterised by recurrent episodes of cholestatic jaundice. First described in 1959, BRIC has been reported in patients all over the world including of African descent. Here, we describe a case of a 21-year-old male with recurring episodes of cholestatic jaundice where we diagnosed BRIC and terminated an episode with rifampicin. To our knowledge, this is the first case report of BRIC diagnosed in Africa.
Granulomatous reaction to migrating silicone oil clinically mimicking a xanthelasma: A case report
Authors: Saleh Hamad Alrashed, Hind Manaa Alkatan, Adel H Alsuhaibani
Journal: Int J Surg Case Rep (2020)
Keywords: case report, granuloma, pseudo-xanthelasma, silicone oil migration, xanthelasma
MeSH terms: Case Reports

Introduction:
Silicone oil has been used for many years in retinal surgeries for retinal detachment. One of its reported complications is oil migration to the periorbital area, resulting in granulomatous reaction.
Presentation of case:
A 56-year-old lady, with history of retinal detachment that was repaired by vitrectomy, silicone oil removal and epi-retinal membrane peeling, presented to us with unilateral ptosis and a skin lesion that resembled xanthelasma.
Discussion:
Histopathology of this lesion showed silicone oil infiltrating the surrounding connective tissue and fat with absence of foamy histiocytes.
Conclusion:
We are reporting a case of silicone oil migration with pseudo-xanthelasma lesion. This has been reported only twice to the best of our knowledge in the English-written literature.
A Chromosomal Inversion of 46XX, inv (6) (p21.3p23) Connects to Congenital Heart Defects
Authors: Liangping Cheng, Yanlai Tang, Yuese Lin, Hongjun Ba, Yiqian Ding, Dubo Chen, Min Liu, Peizhen Pan, Youzhen Qin, Zhan-Peng Huang
Journal: Front Cardiovasc Med (2020)
Keywords: chromosomal rearrangement, congenital heart disease, human chromosome 6, proband, ventricular septal defect
MeSH terms: Case Reports

Congenital heart defects (CHDs) represent the most common human birth defects. Ventricular septal defect (VSD) is the most common subtype of CHDs. It has been shown that about 20-40% of VSDs are closely related to chromosomal aneuploidies or Mendelian diseases. In this study, we report a pedigree with VSD associated with a balanced paracentric inversion of chromosome 6, inv (6)(p21.3p23), a rarely reported CHD-associated chromosomal abnormality related to the fragile site at 6p23. We have found that the major clinical features of the proband include CHDs (ventricular septal defect, severe pulmonary hypertension, tricuspid regurgitation, and patent foramen ovale), severe pneumonia, and growth retardation. Our study reports a rare chromosomal abnormality connected to CHDs, which may represent a new genetic etiology for VSD.
A Case of Idiopathic Recurrent Spontaneous Bladder Rupture
Authors: Reid Bartholomew, Mentor Ahmeti
Journal: Case Rep Surg (2021)
MeSH terms: Case Reports

Background:
A female patient presented four years following spontaneous bladder rupture with a recurrent spontaneous bladder rupture. Summary. Urinary bladder rupture is a condition usually caused by trauma or surgical instrumentation. Spontaneous bladder rupture is a much more uncommon condition and is associated with intoxication, radiation, stricture, or neurogenic bladder. We describe a case of a 40-year-old woman with a history of three caesarian sections with an idiopathic recurrent spontaneous bladder rupture. Originally, she presented with one day of worsening severe abdominal pain. CT showed possible ischemic bowel. She was taken to the operating room (OR) and found to have a bladder rupture. This was repaired, and she did well postoperatively. Four years later, she presented to the emergency department (ED) with one week of worsening abdominal pain that became severe acutely. Given that she had a similar issue four years prior the patient was suspicious, her bladder was again ruptured. CT cystogram showed contrast extravasation into the peritoneum. The patient was taken urgently to the operating room for an open repair of the bladder rupture. She did well following the procedure.
Conclusion:
Spontaneous bladder rupture is a surgical emergency and should be in the differential diagnosis of any patient with peritonitis with elevated creatinine and free intraperitoneal fluid. This diagnosis should especially be considered if the patient has a history pelvic radiation, neurogenic bladder, or intoxication. We submit that a history of multiple pelvic surgeries should be included in this list. CT cystogram is the diagnostic test of choice. Operative repair is generally the treatment for this condition.
Simple trachelectomy during pregnancy for cervical cancer
Authors: Estefania Moreno-Luna, Patricia Alonso, Javier De Santiago, Ignacio Zapardiel
Journal: Ecancermedicalscience (2016)
Keywords: cancer of the cervix, early stage, management, pregnancy
MeSH terms: Case Reports

Invasive cervical cancer is rare during a pregnancy, even though it is one of the most frequently diagnosed neoplasias during that time. It is noted that around 30% of women diagnosed with cervical cancer are of reproductive age. This means that up to 3% of cases of cervical cancer are found in pregnant women or those who are in the post-birth period. A cervicovaginal Pap smear is performed as part of the regular checkup for a pregnant woman during the first visit so that cervical cancer can easily be diagnosed early in these women, detecting it early in up to 70-80% of cases. We present here the case of a patient with initial diagnosis of cervical cancer made around 20th week of pregnancy. It was then treated by a simple trachelectomy and cerclage during week 24. The pregnant woman gave birth to a healthy baby at the end of her pregnancy. Definitive treatment was completed three months after giving birth with a total hysterectomy and laparoscopic bilateral salpingectomy while preserving both ovaries. After 17 months of monitoring the patient showed no signs of reoccurrence. In conclusion, during the early stage of cervical cancer conservative management may be a reasonable option to preserve the current pregnancy.
Cardiac Arrest as the First Presentation of Gitelman Syndrome
Authors: Abeselom Geletu, Jayna Gardner-Gray, Meaghan Roche, Marina Ngassa
Journal: Cureus (2023)
Keywords: bartter syndrome, cardiac arrythmia, familial hypokalemia-hypomagnesemia, gitelman syndrome, implantable cardioverter-defibrillator (icd), metabolic alkalosis
MeSH terms: Case Reports

Gitelman syndrome is a salt-wasting tubulopathy characterized by profound hypokalemia, hypomagnesemia, metabolic alkalosis, and hypocalciuria. Cardiac arrest is a relatively rare manifestation of Gitelman syndrome. Here we present a case of Gitelman syndrome in a patient with recurrent cardiac arrest. A 43-year-old female was admitted for out-of-hospital cardiac arrest secondary to ventricular fibrillation. Initial workup revealed severe hypokalemia, hypomagnesemia, metabolic alkalosis, and prolonged QTc. The workup revealed a picture of salt-wasting tubulopathy with hypokalemia, hypomagnesemia, and hypocalciuria. Potassium was repleted aggressively, and the patient received potassium-sparing agents resulting in the stabilization of potassium levels. Before discharge, an implantable cardioverter defibrillator (ICD) was placed for secondary prevention of cardiac arrest. The patient remained symptom-free, and electrolytes remained stable. This case highlights the diagnostic challenges of Gitelman syndrome and the importance of accurate diagnosis in improving patient outcomes.
Minimally Invasive Approach for Improving Anterior Dental Aesthetics: Case Report with 1-Year Follow-Up
Authors: H Sevilay Bahadır, Gökhan Karadağ, Yusuf Bayraktar
Journal: Case Rep Dent (2018)
MeSH terms: Case Reports

Dental aesthetics have become highly important in recent years. Treating aesthetic demands with noninvasive or minimally invasive techniques can preserve the natural tissues. A 20-year-old female patient presented to the clinic with aesthetic concerns. After the clinical and radiographic examinations, hypomineralization was identified in the maxillary anterior teeth except the maxillary right canine. An external discoloration was also identified in the maxillary left canine tooth. Moreover, the right canine tooth was identified as a Turner's tooth according to the patient's anamnesis. The resin infiltration technique was applied to the maxillary anterior teeth except the maxillary right canine. The bleaching treatment was applied to the maxillary left canine tooth. Then, a laminate veneer restoration was applied to the upper right canine tooth with Turner's hypoplasia. Following the treatment, a satisfactory aesthetic restoration was achieved. After 1-year examination, no clinical failures were observed.
Rapidly growing chondroid syringoma of the external auditory canal: report of a rare case
Authors: Ioannis Vasileiadis, Stylianos Kapetanakis, Aristotelis Petousis, Euthimios Karakostas, Christos Simantirakis
Journal: Case Rep Med (2011)
MeSH terms: Case Reports

Introduction. Chondroid syrinoma of the external auditory canal is an extremely rare benign neoplasm representing the cutaneous counterpart of pleomorphic adenoma of salivary glands. Less than 35 cases have been reported in the international literature. Case Presentation. We report a case of a 34-year-old male in whom a rapidly growing, well-circumscribed tumor arising from the external auditory canal was presented. Otoscopy revealed a smooth, nontender lesion covered by normal skin that almost obstructs the external auditory meatus. MRI was performed to define the extension of the lesion. It confirmed the presence of a 1.5 × 0.8 cm T2 high-signal intensity lesion in the superior and posterior wall of EAC without signs of bone erosion. The patient underwent complete resection of the tumor. The diagnosis was confirmed by histopathologic examination. Conclusion. Although chondroid syringoma is extremely rare, it should always be considered in the differential diagnosis of an aural polyp. Chondroid syringomas are usually asymptomatic, slow-growing, single benign tumors in subcutaneous or intradermal location. In our case, the new information is that this benign tumor could present also as a rapidly growing lesion, arising the suspicion for malignancy.
Case report: Later onset of NRAS-mutant metastatic melanoma in a patient with a partially-excised giant congenital melanocytic nevus
Authors: Bruno Almeida Costa, Victor Zibara, Vasundhara Singh, Omid Hamid, Sonal Gandhi, Andrea P Moy, Allison S Betof Warner
Journal: Front Med (Lausanne) (2022)
Keywords: mdm2 amplification, nras mutation, congenital melanocytic nevi, giant nevus, metastatic melanoma
MeSH terms: Case Reports

Despite recent advances in treatment and surveillance, metastatic melanoma still carries a poor prognosis. Large/giant congenital melanocytic nevi (CMNs) constitute a known risk factor for the condition, with the greatest risk for malignant transformation thought to be during childhood (median age at diagnosis of 3 years in a previous cohort). Herein, we present the case of a 30-year-old male who, after undergoing multiple excision/grafting procedures for a giant CMN as a child, was diagnosed with an NRAS-mutant, MDM2-amplified metastatic melanoma more than 20 years later. Response to ipilimumab/nivolumab immunotherapy, cisplatin/vinblastine/temozolomide chemotherapy, and nivolumab/relatlimab immunotherapy was poor. This case highlights the importance of lifetime monitoring with once-yearly dermatological examination (including lymph node palpation) in large/giant CMN patients, as well as the need for further clinical trials evaluating novel therapies for NRAS-mutant melanoma.
Coronary bypass surgery in a 105-year-old patient with cardiopulmonary bypass
Authors: Temucin Noyan Ogus, Filiz Erdim, Ozer Selimoglu, Fatih Tekiner, Murat Ugurlucan
Journal: Case Rep Med (2010)
MeSH terms: Case Reports

Coronary artery bypass grafting is one of the routine daily surgical procedures in the current era. Parallel to the increasing life expectancy, cardiac surgery is commonly performed in octogenarians. However, literature consists of only seldom reports of coronary artery bypass grafting in patients above 90 years of age. In this report, we present our management strategy in a 105-year-old patient who underwent coronary artery bypass grafting at our institution.
The free bilamellar autograft (FBA) procedure: A comprehensive case series of an alternative surgical approach to reconstruction of large eyelid defects
Authors: Heather M McDonald, Katherine A McDonald, Hector McDonald
Journal: Front Surg (2023)
Keywords: eyelid graft, eyelid reconstruction, eyelid surgery, free bilamellar autograft, full thickness eyelid defect, large eyelid defect

Purpose:
The free bilamellar autograft (FBA) procedure involves harvesting a free, full-thickness section of eyelid tissue from one of the patient's healthy eyelids to reconstruct a large defect of the involved eyelid. No vascular augmentation is employed. The purpose of this study was to determine the structural and cosmetic results of this procedure.
Methods:
A case series was performed, looking at patients who underwent the FBA procedure for large, full-thickness eyelid defects (>50% eyelid length) between 2009 and 2020 at a single oculoplastic surgical centre. Basal cell carcinomas most frequently met criteria for the procedure. OHSN-REB waived ethics approval. All surgeries were performed by one surgeon. A single operation, with surgical steps reported in detail, was completed with follow-up documentation at ideally 1 day, 1 week, 1 month, 3 months, 6 months, and 1 year. The mean follow-up period was 28 months.
Results:
Thirty-one patients (17 males, 14 females, mean age 78-years-old) were included in the case series. Comorbidities included diabetes and smoking. Most patients had known basal cell carcinomas removed from the upper or lower eyelid. The mean widths of the recipient and donor sites were 18.8 and 11.5 mm, respectively. All 31 FBA surgeries resulted in structurally functional, cosmetically pleasing, and viable eyelids. Six patients developed minor graft dehiscence, 3 developed an ectropion, and 1 developed mild superficial graft necrosis secondary to frostbite, which fully recovered. Three healing phases were identified.
Conclusion:
This case series adds to the currently sparse data on the free bilamellar autograft procedure. The surgical technique is clearly articulated and illustrated. The FBA procedure is a simple and efficient alternative to current surgical techniques in the reconstruction of full-thickness upper and lower eyelid defects. The FBA provides functional and cosmetic success, despite the absence of an intact blood supply, with decreased operative time and faster recovery.
Myelofibrosis associated with romiplostim treatment in a patient with immune thrombocytopenia
Authors: Maria Fernanda Gonzalez, Jonathan King Freeman
Journal: Case Rep Hematol (2012)
MeSH terms: Case Reports

Immune thrombocytopenia is characterized by antibody-mediated platelet destruction and insufficient platelet production resulting in isolated thrombocytopenia in the absence of underlying cause. Despite many treatment options, low-to-intermediate rates of remission and high rates of resistance to treatment are seen. Approximately 20% of patients do not attain a hemostatic platelet count after splenectomy or after first- and second-line medical approaches. A new option in these cases is treatment with romiplostim. Bone marrow (BM) fibrosis has been reported in clinical trials with romiplostim. We report a case with marked reticulin fibrosis of the BM, worsening of cytopenias and dyserythropoiesis, and atypical megakaryocytes, which did not reverse following cessation of the drug. Although this could represent idiopathic myelofibrosis, unrelated to therapy, the pretreatment biopsy demonstrating no fibrosis combined with the concordant timing of the drug and fibrosis suggests the treatment with romiplostim may be causative.
Atypical presentation of hepatocellular carcinoma: a mass on the left thoracic wall
Authors: Sahin Coban, Osman Yüksel, Seyfettin Köklü, Koray Ceyhan, Meltem Baykara, Abdulkadir Dökmeci
Journal: BMC Cancer (2004)
MeSH terms: Carcinoma, Hepatocellular / secondary, Liver Neoplasms / pathology, Thoracic Neoplasms / secondary, Thoracic Wall / pathology, Case Reports, Aged, Humans, Male

Background:
Hepatocellular carcinoma is a common malignancy for which chronic hepatitis B infection has been defined as the most common etiologic factor. The most frequent metastatic sites are the lung, bone, lymphatics, and brain, respectively. Metastases to the chest wall have been reported only rarely.
Case presentation:
We report a patient with hepatocellular carcinoma who presented with an isolated metastatic mass on the left anterolateral chest wall in the axillary region.
Conclusions:
Metastasis of HCC should be included in the differential diagnosis of rapidly growing lesions in unusual localizations, particularly in patients with chronic liver disease even if a primary tumor can not be radiologically identified.
A Case Report of the Reconstruction of a Bone Defect Following Resection of a Comminuted Fracture of the Lateral Clavicle Using a Titanium Prosthesis
Authors: Sahar Ahmed Abdalbary, Sherif M Amr, Khaled Abdelghany, Amr A Nssef, Ehab A A El-Shaarawy
Journal: Front Surg (2021)
Keywords: clavicle, clavicle prosthesis, comminuted fracture, finite element analysis, fracture
MeSH terms: Case Reports

Introduction: This case report describes the reconstruction of a severe comminuted fracture and bone defect in the lateral half of the clavicle using a novel titanium prosthesis. This unique prosthesis has been specifically designed and three dimensionally printed for the clavicle, as opposed to the Oklahoma cemented composite prosthesis used in common practice. The aims of this study were to: (1) describe the prosthesis, its stress analysis, and its surgical fixation and (2) to demonstrate the results of the 2-year follow-up of the patient with the lateral clavicle prosthesis. Patient's Main Concerns: A 20-year-old, right-handed woman complaining of severe pain in the right shoulder was admitted to our hospital following a traffic accident. Physical examination revealed pain, swelling, tenderness, limb weakness, asymmetric posturing, and loss of function in the right shoulder. Diagnosis, Intervention, and Outcomes: Radiographic evaluation in the emergency room showed complete destruction with a comminuted fracture of the lateral half of the right clavicle and a comminuted fracture of the coracoid. We designed a new prosthesis for the lateral half of the clavicle, which was then tested by finite element analysis and implanted. Use of the new prosthesis was effective in the reconstruction of the comminuted fracture in the lateral half of the clavicle. After 2 years of follow-up, the patient had an aesthetically acceptable curve and was able to perform her activities of daily living. Her pain was relieved, and the disabilities of the arm, shoulder, and hand score improved. Active range of motion of the shoulder joint and muscle strength were also improved. Conclusion: This novel prosthesis is recommended for reconstruction of the lateral half of the clavicle following development of bony defects due to fracture. Our patient achieved functional and aesthetic satisfaction with this prosthesis.
Anaesthetic management in a patient with multiple sclerosis
Authors: Lata M Kulkarni, Cs Sanikop, Hl Shilpa, Anupama Vinayan
Journal: Indian J Anaesth (2011)
Keywords: anaesthetic, demyelination, multiple sclerosis

Multiple sclerosis (MS) is a rare autoimmune demyelinating disorder of the central nervous system clinically manifesting as periodic attacks of varied neurologic symptoms, eventually progressing to fixed neurologic deficits and disability. The treatment is symptomatic and directed towards prevention of future progression of the disease involving multiple agents. We present here a case report of a patient with MS who underwent an orthopaedic procedure under general anaesthesia (G.A.) uneventfully. Anaesthetic implications include assessment of neurological deficits with documentation pre- and postoperatively, awareness towards side-effects, potential drug interactions of medications, selection of suitable techniques/anaesthetic agents, neuromuscular monitoring-guided titration of non-depolarizing blocking agents with lowest necessary dose and avoidance of hyperthermia along with temperature, haemodynamic and respiratory monitoring. Lower concentrations of local anaesthetic (LA) should be used for regional blocks keeping in mind the susceptibility of demyelinated neurons, towards LA neurotoxicity. To the best of our knowledge, this is the first report of anaesthetic management of MS in India.
Bilateral optic neuritis associated with the use of infliximab
Authors: Jan O Aasly
Journal: Case Rep Ophthalmol Med (2011)
MeSH terms: Case Reports

A 40 year old man was admitted with a 2 weeks history of headache, blurred vision and bilateral optic neuritis. During the 6 months period prior to admission he had treated with infliximab infusions for prsoriasis arthritis. He had 0.2 vision in right eye and 0.5 in left Fundoscopy showed moderate disc swelling more on the right than on the left side and right-sided splinter heamorrhages at the disc margin. The intracranial pressure was normal. He was treated with oral methylprednisolone, 100 mg daily for 1 week. His vision improved gradually and when seen 10 weeks later his visual acuity was 1.0 in both eyes and he had normal visual fields. Optic neuritis is a rare but well recognized serious adverse effect of treatments with tumor necrosis factor (TNF) antagonists. This case report illustrates a rare but typical side effect of a TNF alpha inhibitors used for treating a number of inflammatory diseases. These reactions usually appear during first year of treatments and never after the first one or two infusions. Both genders and all ages are affected. In some patients the visual defects are irreversible.
Ocular trauma or Oedipism: completing the evisceration
Authors: Ujjwala Narang, Laura Maubon, Vishal Shah, Vijay Wagh
Journal: GMS Ophthalmol Cases (2021)
Keywords: eye haemorrhage, eye injury, self-mutilation
MeSH terms: Case Reports

Self-enucleation, also known as Oedipism, is a rare form of ocular trauma. The objective of this clinical case report is to highlight the importance of diagnosing this unusual injury and thus ensuring its appropriate management. We herein describe a case of a 58-year-old man who presented to hospital with a bleeding left eye. Initially, limited history was provided, however, on further enquiry it was revealed that he had paranoid schizophrenia. The patient eventually had to be sectioned with assistance from the Police and Psychiatry team, upon discovery of self-inflicted mechanism of injury. Subsequently, the patient had evisceration of the left eye and afterwards, demonstrated insight into the pre-operative problems. Literature review emphasizes the importance of close cooperation required between medical specialities to ensure that the underlying cause, usually schizophrenia, is managed in conjunction to the eye injury in order to provide optimum care for the patient.