OpenMed/multicare-articles huggingface dataset:
Idiopathic omental infarction, diagnosed and managed laparoscopically: a case report
Authors: Ahmed Abdulaziz, Tamer El Zalabany, Abdul Rahim Al Sayed, Ahmed Al Ansari
Journal: Case Rep Surg (2013)

Idiopathic omental infarction is a rare cause of acute abdomen in adults, and the clinical finding can mimic acute appendicitis. Although idiopathic omental infarction is uncommon, the incidence of its detection has become more frequent as a result of advances in radiological technologies. We reported on a 21-year-old man who presented with sudden onset of intermittent right lower quadrant abdominal pain for seven days. The pain became more localized at the right iliac fossa (RIF) at day 2 before admission. A physical examination revealed a fever (38.2°C), severe RIF tenderness, mass-like fullness, and positive rebound tenderness. A CT of the abdomen showed inflammatory changes and increased fat density mass in the right upper quadrant measuring 5 × 4 cm representing focal panniculitis. However, the appendix was visualized normally and the findings were not in favor of acute appendicitis. Diagnosis was carried on laparoscopically. Serosanguinous free fluid was found in all abdominal quadrants. A 6 × 4 cm gangrenous omental mass was noted. The omental mass was excised and an appendectomy was performed. In summary, omental infarction should be considered as a deferential diagnosis for acute right-sided abdominal pain, especially if the clinical finding does not correspond to appendicitis.
PTLD Burkitt Lymphoma in a Patient with Remote Lymphomatoid Granulomatosis
Authors: A Stravodimou, A Cairoli, T Rausch, R Du Pasquier, P Michel
Journal: Case Rep Med (2012)
MeSH terms: Case Reports

Posttransplant lymphoproliferative disorder (PTLD) is a potentially fatal complication of solid organ transplantation. The majority of PTLD is of B-cell origin, and 90% are associated with the Epstein-Barr virus (EBV). Lymphomatoid granulomatosis (LG) is a rare, EBV-associated systemic angiodestructive lymphoproliferative disorder, which has rarely been described in patients with renal transplantation. We report the case of a patient with renal transplantation for SLE, who presented, 9 months after renal transplantation, an EBV-associated LG limited to the intracranial structures that recovered completely after adjustment of her immunosuppressive treatment. Nine years later, she developed a second PTLD disorder with central nervous system initial manifestation. Workup revealed an EBV-positive PTLD Burkitt lymphoma, widely disseminated in most organs. In summary, the reported patient presented two lymphoproliferative disorders (LG and Burkitt's lymphoma), both with initial neurological manifestation, at 9 years interval. With careful reduction of the immunosuppression after the first manifestation and with the use of chemotherapy combined with radiotherapy after the second manifestation, our patient showed complete disappearance of neurologic symptoms and she is clinically well with good kidney function. No recurrence has been observed by radiological imaging until now.
Relapsing Kikuchi-Fujimoto Disease Requiring Prolonged Steroid Therapy
Authors: Ulrich Gerwig, Rolf Guenter Weidmann, Gregor Lindner
Journal: Case Rep Emerg Med (2019)
MeSH terms: Case Reports

We report the case of a 26-year-old woman with an eight-week history of painfully enlarged cervical lymph nodes, recurrent headache, and malaise. Her medical history was unremarkable. The physical examination showed multiple enlarged cervical lymph nodes. Laboratory examination was unremarkable, and magnetic resonance tomographic imaging showed multiple enlarged cervical lymph nodes with aspect of a lymphoma. Lymph node biopsy revealed Kikuchi-Fujimoto disease, histologically characterized by histiocytic necrotizing lymphadenitis. A therapeutic trial with nonsteroidal anti-inflammatory drugs (NSAID) showed no effect, so steroid therapy was started. Due to relapse of symptoms after steroid withdrawal the tapering regimen was prolonged for a total of seven months.
A groundwork for allostatic neuro-education
Authors: Lee Gerdes, Charles H Tegeler, Sung W Lee
Journal: Front Psychol (2015)
Keywords: rdoc, allostasis, executive function, neuro-education, neurodevelopment, neurotechnology, polyvagal theory, toxic stress

We propose to enliven educational practice by marrying a conception of education as guided human development, to an advanced scientific understanding of the brain known as allostasis (stability through change). The result is a groundwork for allostatic neuro-education (GANE). Education as development encompasses practices including the organic (homeschooling and related traditions), cognitive acquisition (emphasis on standards and testing), and the constructivist (aimed to support adaptive creativity for both learner and society). Allostasis views change to be the norm in biology, defines success in contexts of complex natural environments rather than controlled settings, and identifies the brain as the organ of central command. Allostatic neuro-education contrasts with education focused dominantly on testing, or neuroscience based on homeostasis (stability through constancy). The GANE perspective is to view learners in terms of their neurodevelopmental trajectories; its objective is to support authentic freedom, mediated by competent, integrated, and expansive executive functionality (concordant with the philosophy of freedom of Rudolf Steiner); and its strategy is to be attuned to rhythms in various forms (including those of autonomic arousal described in polyvagal theory) so as to enable experiential excitement for learning. The GANE presents a variety of testable hypotheses, and studies that explore prevention or mitigation of the effects of early life adversity or toxic stress on learning and development may be of particular importance. Case studies are presented illustrating use of allostatic neurotechnology by an adolescent male carrying diagnoses of Asperger's syndrome and attention-deficit hyperactivity disorder, and a grade school girl with reading difficulties. The GANE is intended as a re-visioning of education that may serve both learners and society to be better prepared for the accelerating changes of the 21st century.
Myopathy in the York Platelet Syndrome: An Underrecognized Complication
Authors: Joy Roman, Michael I Palmer, Cheryl A Palmer, Nicholas E Johnson, Russell J Butterfield
Journal: Case Rep Pathol (2018)
MeSH terms: Case Reports

York Platelet Syndrome (YPS) is a calcium channelopathy caused by gain of function in STIM1, a gene which acts as a calcium sensor. It is characterized by platelet abnormalities and muscle weakness. Medical literature emphasizes the hematologic aspects of the cases with few data of the neuromuscular and neuropathologic evaluation. We present a patient with YPS whose myopathy was the most prominent aspect. She presented around 2 years of age with proximal weakness and easy bruisability. YPS was diagnosed in the infant at 16 months of age at the National Institutes of Health. Muscle biopsy demonstrated a severe chronic myopathy. Rimmed vacuoles and tubular aggregates were noted. Although YPS is rare, the combination of a congenital myopathy with thrombocytopenia may facilitate the diagnosis and enable further insights into the disease.
Pylephlebitis: A Case of Inferior Mesenteric Vein Thrombophlebitis in a Patient with Acute Sigmoid Diverticulitis-A Case Report and Clinical Management Review
Authors: Aleena Zia, Sumit Sohal, Chris Costas
Journal: Case Rep Infect Dis (2019)
MeSH terms: Case Reports

Pylephlebitis is a rare complication of intra-abdominal infections and describes thrombosis and infection as two different pathophysiological phenomena in the cause of this disease. The nonspecific presentation of disease makes its diagnosis difficult and thus leads to high mortality. The treatment comprises antibiotics and also includes controversial use of anticoagulation in these patients. Here, we present a patient with past medical history of human immunodeficiency virus and past diverticulitis who presented with fever, chills, diarrhea, neck pain, and photophobia. He was diagnosed with acute sigmoid diverticulitis with associated inferior mesenteric vein thrombophlebitis. He improved after intravenous antibiotics and anticoagulation and was discharged. He underwent sigmoid colectomy 3 months after his initial presentation and was advised to take anticoagulation for a total of 6 months.
Upper Gastrointestinal Bleeding From Aberrant Right Subclavian Artery-Esophageal Fistula
Authors: Shira Peress, Wa'el Tuqan, Austin Thomas
Journal: Ochsner J (2021)
Keywords: aberrant right subclavian artery, aneurysm, esophageal fistula, gastrointestinal hemorrhage
MeSH terms: Case Reports

Background: The most common aortic arch abnormality is an aberrant right subclavian artery (ARSA). ARSA-esophageal fistula is a rare sequela that can present with a life-threatening upper gastrointestinal (GI) bleed. Case Report: We report the case of an 88-year-old male who presented with signs of upper GI bleeding. Esophagogastroduodenoscopy demonstrated extrinsic compression of the upper third of the esophagus with ulceration. Imaging studies revealed ARSA posterior to the esophagus with pseudoaneurysm formation. These findings confirmed an upper GI bleed secondary to ARSA-esophageal fistula. The patient underwent prompt embolization of the ARSA pseudoaneurysm, followed a few days later by coil embolization of the ARSA pseudoaneurysm. Despite these interventions, the patient continued to have bleeding with anemia. He and his family opted to avoid any further interventions and instead pursued comfort care. The patient was discharged to hospice and died 3 months later. Conclusion: ARSA-esophageal fistula is a rare but potentially lethal cause of upper GI bleeding. Initial signs and symptoms can be subtle, but the presence of a GI bleed requires immediate stabilization. Surgical interventions have been shown to have longer-lasting success, but endovascular repair may be an option for patients who are deemed unfit for surgery but still require prompt stabilization. Regardless of the intervention, mortality rates for ARSA-esophageal fistula are high.
Macrofollicular variant of papillary thyroid carcinoma with metastasis to femur
Authors: Fernando Candanedo-Gonzalez, Diana Rodriguez-Orihuela, Julian Arista-Nasr
Journal: Thyroid Res (2020)
Keywords: bone metastases, femur, macrofollicular variant of papillary thyroid carcinoma, thyroid carcinoma
MeSH terms: Case Reports

Background:
Macrofollicular variant of papillary thyroid carcinoma (MFV-PTC) is a rare subtype with histological features and an indolent clinical course that can be confused with nodular goiter or follicular adenoma. However, on rare occasions it may show more aggressive biological behavior. Only two cases of MFV-PTC with bone metastases have been reported previously. We describe the clinical-pathological characteristics of a man with MFV-PTC that developed femur metastasis. This the first case of MFV-PTC with femur metastases diagnosed histologically by means of an image-guided core needle biopsy in English literature.
Case presentation:
A 33-year-old man presented two years earlier with swelling in the right neck associated with weight loss and pain in the left knee. Neck ultrasonography showed hyperechogenic and hypogenic nodular images in the thyroid's right lobe. A fine needle aspiration biopsy specimen was initially interpreted as nodular hyperplasia. A CT showed a large tumor involving right thyroid lobe with trachea and vascular structures displaced to the right, and a total thyroidectomy was performed. Subsequently, a MRI of the knee confirmed the presence of a destructive tumor in the femur. A guided core-needle biopsy of the knee tumor showed the presence of metastatic MFV-PTC. Re-assessment of the histology from thyroidectomy was also consistent with MFV-PTC. A whole-body 18F-FDG PET/CT showed presence of lesions in the left anterior costal arch, metaphysis of the left femur and in the sternum handle. Therefore, he received 200 mCi radioactive iodine, and 40 Gy of radiotherapy to left costal arches and knee, which decreased his symptoms. Currently, after 10 months of follow-up, the patient is alive with bone tumor activity.
Conclusions:
Our case supports the view that, on rare ocassions, MFV-PTC may show a more aggressive biological behavior than expected. The synchronous or asynchronous presence of one or more bone lesions, should raise the suspicion of metastasis. Given the suspicion, it is necessary to take a biopsy to confirm histologically. Only a careful analysis of the architectural and cytological characteristics of goiter or hyperplastic nodules will allow to recognize this rare variety of carcinoma.
Case Report: Tracheal stenosis due to fibrotic bridges in a post-tracheostomy COVID-19 patient
Authors: Lina Zuccatosta, Borja Recalde Zamacona, Francesco Porcarelli, Federico Mei, Francesca Gonnelli, Stefano Gasparini, Alessandro Di Marco Berardino
Journal: Front Med (Lausanne) (2022)
Keywords: covid-19, case report, laser therapy, tracheal stenosis, tracheostomy
MeSH terms: Case Reports

Tracheal stenosis is a common complication of prolonged endotracheal intubation or tracheostomy, that can be classified as simple (without cartilage involvement) or complex (with cartilaginous support involvement). We report a case of a post-COVID-19 tracheal stenosis with fibrotic bridges between the tracheal walls, creating a net within the lumen and causing significant respiratory distress. The absence of cartilaginous support involvement allowed a definitive bronchoscopic treatment with complete and permanent resolution of stenosis.
Initial-Stage Primary Intraosseous Squamous Cell Carcinoma Derived from Odontogenic Keratocyst with Unusual Keratoameloblastomatous Change of the Maxilla: A Case Report and Literature Discussion
Authors: Kentaro Kikuchi, Fumio Ide, Shota Takizawa, Seiji Suzuki, Hideaki Sakashita, Tie-Jun Li, Kaoru Kusama
Journal: Case Rep Otolaryngol (2018)
MeSH terms: Case Reports

Primary intraosseous squamous cell carcinoma (PIOSCC) is a rare malignant neoplasm derived from odontogenic epithelial remnants in the central jaw bone. Most PIOSCCs originate from odontogenic cysts with a nonkeratinized epithelial lining, especially from radicular/residual and dentigerous cysts. There have been few reports of PIOSCCs derived from the odontogenic keratocyst (OKC), particularly those describing pathological features at the initial stage. The diagnosis of PIOSCC is difficult and based on exclusion of other carcinomas, including metastatic tumors from other primary sites. Here, we report an extremely rare case of initial-stage PIOSCC derived from the OKC with unusual keratoameloblastomatous change of the maxilla.
Therapy with Ulipristal Acetate in a Hypertensive Patient
Authors: A Alcalde Dominguez, J Rabasa Antonijuan, M Cusidó Gimferrer, M Jiménez Ortuño
Journal: Case Rep Med (2018)
MeSH terms: Case Reports

Ulipristal acetate (UPA) is a medical therapy for patients with symptomatic uterine fibroids. The drug has shown efficacy in the control of heavy menstrual bleeding and, as a consequence, in anaemia improvement. We report the case of a hypertensive patient treated with two courses of UPA. In addition to its observed benefits on hypermenorrhea caused by uterine fibroids, no exacerbation of the underlying disease was observed. No adverse effects were observed, and blood pressure levels were well controlled throughout.
Palpitations and Asthenia Associated with Venlafaxine in a CYP2D6 Poor Metabolizer and CYP2C19 Intermediate Metabolizer
Authors: Sofia Garcia, Michael Schuh, Anvir Cheema, Herjot Atwal, Paldeep S Atwal
Journal: Case Rep Genet (2017)
MeSH terms: Case Reports

Cardiotoxicity has been extensively reported in venlafaxine (VEN) overdoses. Asthenia is also among the common side effects described for this antidepressant. VEN is metabolized mainly by CYP2D6 and to a minor extent by CYP2C19 to the major active metabolite O-desmethylvenlafaxine (ODV). Altered pharmacokinetic parameters in patients with polymorphisms in the CYP2D6 and CYP2C19 genes that result in decreased enzymatic activity have been documented. Here we describe a patient case of VEN associated palpitations and asthenia. The patient takes VEN extended release 150 mg twice daily. Genotyping confirmed the patient is a poor metabolizer for CYP2D6 and an intermediate metabolizer for CYP2C19. We propose that the palpitations and asthenia are related to sustained VEN exposure due to reduced metabolism.
Anesthesia for patients with PTRF mutations: a case report
Authors: Atsuko Hirano, Tomohiko Takada, Mariko Senda, Hidemasa Takahashi, Takeo Suzuki
Journal: JA Clin Rep (2018)
Keywords: general anesthesia, lipodystrophy, long qt syndrome, malignant hyperthermia, neuromuscular disease, ptrf mutation

Background:
Polymeraze I and transcript release factor (PTRF) mutations are a newly recognized disease, which cause congenital generalized lipodystrophy associated with myopathy.
Case presentation:
A 29-year-old man (height 126 cm; weight 22 kg) with a PTRF mutation was scheduled for mandibular dentigerous cystectomy. His primary symptoms were lipodystrophy, myopathy, long QT syndrome, refractory nephrosis, and abnormal lipid metabolism. Defibrillator pads were applied soon after the patient entered the operating room. Anesthesia was induced using continuous administration of dexmedetomidine (4 μg/kg/h) for 15 min; midazolam (7 mg) was added while monitoring the bispectral index and his vital signs. Remifentanil and rocuronium were administered before endotracheal intubation. The surgeon used local anesthesia, and dexmedetomidine and remifentanil were titrated throughout the surgery. The surgery was performed uneventfully, and the patient was extubated following the administration of sugammadex and flumazenil.
Conclusion:
Patients with PTRF mutations require careful anesthetic planning. We planned to administer lipid-free, non-inhalational agents for the induction and maintenance of anesthesia. The anesthetic method used for this minor surgery was safe and effective.
Cesarean Scar Pregnancy Management: Minimally Invasive Suction of the Gestational Sac Content Combined With Local and Intramuscular Methotrexate Injection
Authors: Feras Sendy, Samer J Ahmeed, Sulaiman Al Obaid, Bahaaldden Sallout, Sameer Sendy
Journal: Ochsner J (2020)
Keywords: hemorrhage, methotrexate, pregnancy–ectopic, suction, ultrasonography–prenatal
MeSH terms: Case Reports

Background: Cesarean scar pregnancy is a rare, potentially life-threatening complication in patients with prior cesarean delivery. Vaginal bleeding is a common presenting symptom. Case Report: A 23-year-old female who presented with mild vaginal bleeding was diagnosed by transvaginal ultrasound with a viable cesarean scar pregnancy of 7 weeks' gestation. After the sac content was suctioned through a transvaginal approach under ultrasound guidance, the patient was injected with 50 mg local and 25 mg systemic methotrexate. One week later, a repeat systemic methotrexate dose of 50 mg was administered. The patient's beta human chorionic gonadotropin (hCG) levels were followed weekly until a negative beta hCG level was established. Conclusion: No management approach has been universally approved for cesarean scar pregnancy; the best option depends on case presentation, surgeon experience, and available facilities. We suggest that our minimally invasive treatment is an acceptable approach, especially if embryonic cardiac activity is present. We recommend the referral of such cases to tertiary centers to avoid complications.
Large Brunner's gland adenoma of the duodenum for almost 10 years
Authors: Bo Yang, Ke Li, Runlan Luo, Zuming Xiong, Lianwei Wang, Jinming Xu, Dengyang Fang
Journal: Open Life Sci (2020)
Keywords: brunner’s glands, adenoma, benign tumor, duodenum
MeSH terms: Case Reports

Background:
Brunner's gland adenoma is a rare benign tumor arising from Brunner's glands. It is mostly small in size, and patients with this tumor are asymptomatic.
Case presentation:
We report the case of a 63-year-old woman with upper gastrointestinal obstruction for almost 10 years, who was pathologically diagnosed with large Brunner's gland adenoma of the duodenum. Postoperatively, no sign of recurrence has been noted until now.
Conclusion:
This study may help clinicians to understand and provide a more accurate diagnosis of Brunner's gland adenoma.
Utility of Botulinum Injections in Stiff-Person Syndrome
Authors: L M Conners, A Betcher, A Shahinian, P Janda
Journal: Case Rep Neurol Med (2019)
MeSH terms: Case Reports

Stiff-person syndrome (SPS) is an uncommon neurological disorder characterized by significant rigidity and muscle spasms primarily affecting the truncal and proximal musculature. Furthermore, a wide-based gait with functional impairment is generally seen. High-dose benzodiazepines or baclofen are widely considered the optimal initial therapy; however, major adverse effects often preclude adequate dosing. Refractory cases may be treated with intravenous immunoglobulins (IVIG), plasma exchange, or B-cell depletion with rituximab, although these are also associated with major, sometimes fatal, adverse reactions. Several reports have validated the safety and utility of botulinum injections in this setting, yet botulinum remains markedly underutilized in this cohort. Below, a case report and review of the literature show botulinum can decrease pain and stiffness, improve gait and balance, and decrease dependence on powerful systemic treatments in this group.
Outpatient and home chemotherapy with novel local control strategies in desmoplastic small round cell tumor
Authors: Dolly Aguilera, Andrea Hayes-Jordan, Peter Anderson, Shiao Woo, Margaret Pearson, Holly Green
Journal: Sarcoma (2008)
MeSH terms: Case Reports

Desmoplastic Small Round Cell Tumor (DSRCT) has a very poor prognosis. This report illustrates novel chemotherapy and local control interventions in a 5-year old patient. The patient was treated in the outpatient setting, achieved remission, with excellent quality of life. The patient presented with massive ascites and >1000 abdominal tumors. Neoadjuvant chemotherapy included vincristine (1.5 mg/m(2)), ifosfamide (3 g/m(2)/day x 3), dexrazoxane/doxorubicin (750/75 mg/m(2)), and etoposide (150 mg/m(2)). Continuous hyperthermic peritoneal perfusion (CHPP) with cisplatin (100 mg/m(2)) was given after extensive cytoreductive surgery. This was followed by irinotecan (10 mg/m(2)/day x 5 x 2 weeks) + temozolomide monthly x 2, then abdominal radiation 30 Gy with simultaneous temozolomide (100 mg/m(2)/day x 5). A total of 12 cycles of irinotecan and temozolamide were given. Except for initial chemotherapy, subsequent courses were in the outpatient setting. Focal retroperitoneal relapse at 18 months was treated with IMRT with bevacizumab (5 mg/kg) and 2 perihepatic metastases with radio frequency ablation/cryoablation followed by chronic outpatient maintenance chemotherapy (valproic acid, cyclophosphamide, and rapamycin). Almost 2 years from diagnosis, the patient maintained an excellent quality of life. This is a novel approach to the treatment of children with massive abdomino-pelvic DSRCT.