OpenMed/multicare-articles huggingface dataset:
The use of intravenous immunoglobulin in the treatment of Hashimoto's encephalopathy: case based review
Authors: Victoriţa Şorodoc, Mihai Constantin, Andreea Asaftei, Cătălina Lionte, Alexandr Ceasovschih, Oana Sîrbu, Raluca Ecaterina Haliga, Laurenţiu Şorodoc
Journal: Front Neurol (2023)
Keywords: hashimoto’s encephalopathy, alpha-enolase, anti-thyroglobulin, anti-thyroid peroxidase, autoimmune encephalopathy, intravenous immunoglobulin
MeSH terms: Review

Background:
Hashimoto's encephalopathy (HE) is a controversial immunological neuropsychiatric disease, with a poorly understood pathogenesis. It is characterized by symptoms of acute or subacute encephalopathy which usually occur in the presence of elevated levels of antithyroid antibodies. Even though it is also known as steroid responsive encephalopathy associated with autoimmune thyroiditis (SREAT), some cases appear to be steroid-resistant. This review examined whether treatment of Hashimoto's encephalopathy with intravenous immunoglobulin (IVIG) is associated with better clinical outcomes than the standard therapy. Additionally, we presented a case of a 59-year-old man who presented with severe neurological manifestations and was successfully treated with intravenous immunoglobulin.
Methods:
The online databases PubMed and EMBASE were searched.
Results:
A total of 1,365 articles were identified. After the deletion of 112 duplicates, 1,253 studies were screened by evaluating the title and abstract, focusing on Hashimoto's encephalopathy cases where IVIG were used. 846 studies were excluded because they were not relevant to the topic or included pediatric population. Therefore, 407 full-text articles were assessed for eligibility. The final analysis included 14 eligible articles after 393 were excluded (irrelevant texts, not written in English, full-text not available). In the majority of the selected case-reports, IVIG was associated with a good outcome, sometimes even with dramatic improvements in patient's status.
Conclusion:
In last years, intravenous immunoglobulin therapy proved its utility in Hashimoto's encephalopathy's treatment, being a well tolerated therapy associated with remarkable improvement in patient's status. Further research is still needed in order to define the optimal treatment protocol for Hashimoto's encephalopathy and to establish if intravenous immunoglobulin can also be used as a first-line therapy, alone or in combination with steroids.
Case Report: Unique management strategy for rare case of esophageal foreign body
Authors: Dastan Rustemov, Ruslan Bilal, Ruslan Tukinov, Adilzhan Nekessov, Damir Dzhenalaev, Erbulat Ermeshev, Zarip Mukhamedov, Dulat Mustafinov, Ruslan Utebaliev, Zhenis Sakuov, Baurzhan Kaliev
Journal: Front Surg (2024)
Keywords: case report, endoscopy, esophageal perforation, foreign body, post-traumatic aneurysm of aorta
MeSH terms: Case Reports

Background:
Foreign bodies that enter the esophagus can cause serious complications that may require extensive surgical intervention, including open surgery. The treatment method depends on the location, size, configuration, and number of foreign bodies in the esophagus, but to date, the best method to remove foreign bodies from the esophagus remains uncertain. Foreign bodies which can damage the walls of esophagus varies from bones and bone fragments, to metallic objects and batteries. In this article, we present a rare case of a "fish bone" penetrating through the esophagus walls and directly punctured the aorta, forming a post-traumatic saccular pseudoaneurysm of the descending thoracic aorta, which was successfully treated with endovascular stent placement to the aorta and with endoscopic foreign body removal.
Case summary:
We reported a case of a 16-year-old male with a 6-day history of chest pain after consuming fish. As result of immediate test in regional hospital using oral flexible esophagogastroduodenoscopy abnormalities were not reported. Due to persistence of beforementioned symptoms, a fiberoptic esophagogastroduodenoscopy was performed 3 days later, revealing a 1.5-2.0 cm long altered area with contact bleeding 33.0 cm from the incisors, but no visualization of any foreign body. Computed tomography revealed a fish bone that had completely passed through walls of the esophagus and punctured the aortic wall, forming an aneurysm. Patient was urgently hospitalized by air ambulance to our hospital for high-specialized medical intervention after 6 days. After the endovascular placement of a stent graft, the fish bone was successfully removed by endoscopic intervention. 12 months follow up showed no abnormalities.
Conclusion:
Endoscopic removal of foreign bodies in the esophagus and extracting a foreign body after thoracic endovascular aortic stent may be a feasible option for some cases.
Anesthetic Management of a Broken Tracheostomy Tube Stem as a Foreign Body in the Trachea: A Case Report
Authors: Nisha Jain, Yudhyavir Singh, Abhishek Singh
Journal: Cureus (2024)
Keywords: difficult airway management, foreign bodies, pediatric airway emergency, supraglottic airway device, tracheostomy complications
MeSH terms: Case Reports

Tracheostomy is commonly performed in patients to secure the airway. There are known early and late complications related to tracheostomy. Few case reports have described the rupture of the stem of the tracheostomy tube and its migration into the tracheobronchial tree. Here we describe a pediatric case with a broken stem of the tracheostomy tube in the trachea, acting as a foreign body and causing mild respiratory distress. The patient was successfully managed with neck exploration under general anesthesia using a supraglottic airway device in low-resource settings. In addition, we have described the potential problems that may be faced while managing the airway of such patients and how to deal with these complications.
Primary segmental omental torsion, mimicking acute appendicitis
Authors: Paschalis Gavriilidis, Salomone Di Saverio, Mauro Podda, Nicola de'Angelis
Journal: J Med Life (2024)
Keywords: hemoperitoneum, primary omental torsion, torsion
MeSH terms: Appendicitis / diagnosis, Appendicitis / surgery, Omentum / pathology, Torsion Abnormality / diagnosis, Torsion Abnormality / diagnostic imaging, Torsion Abnormality / surgery, Case Reports, Abdominal Pain / etiology, Acute Disease, Diagnosis, Differential, Humans, Male, Middle Aged

Primary segmental omental torsion (PSOT) is a very rare cause of acute abdominal pain, and it may often imitate the clinical picture of acute appendicitis. In instances of acute abdominal pain without anorexia, nausea, and vomiting, omental torsion should be included in the differential diagnosis. Any misdiagnosis may lead to major complications such as intraabdominal abscesses and adhesions. A 63-year-old overweight man with a body mass index (BMI) of 41 Kg/m2 presented to the emergency department on a remote island with acute abdominal pain. His medical history included type 2 diabetes mellitus managed with insulin, essential hypertension, osteoarthritis, and no previous abdominal operations. He reported a sharp pain originating in the epigastrium and the right hypochondrium that started five days prior. Physical examination revealed rebound tenderness and guarding across the abdomen with a positive McBurney sign. However, the patient did not report vomiting and was not nauseous. Vital signs were as follows: blood pressure 116/56 mmHg, heart rate 98 beats/min, respiratory rate 19 breaths/min, and a temperature of 38.2 0C. Laboratory results showed a white blood cell count of 10.6, neutrophils of 8.11, C-reactive protein (CRP) 74 mg/l, haemoglobin11.6 g/dl, and hematocrit 36.9%. Due to the absence of a radiographer at the hospital during that period, no imaging investigations were conducted. Diagnostic laparoscopy demonstrated diffused hemoperitoneum and necrotic mass at the site of the hepatic flexure. Initially suspected to be an advanced colon cancer, the decision was made to proceed with open surgery. The necrotic segment of the omentum was found at the right superior point of attachment of the omentum to the hepatic flexure. Consequently, the necrotic segment of the omentum was resected. A thorough investigation of the abdominal cavity did not detect any other abnormalities or pathologies. The patient recovered uneventfully and was transferred to the surgical ward. Torsion of the omentum is a very rare cause of acute abdominal pain. This case highlights the necessity of considering PSOT in the differential diagnosis of acute abdominal pain, especially in cases where symptoms are suggestive of appendicitis but diagnostic findings are negative.
Acute Myocardial Infarction in the Setting of Pulmonary Hypertension due to a Patent Foramen Ovale and Paradoxical Embolism
Authors: Madeline Franke, Zeenat Safdar
Journal: Case Rep Pulmonol (2024)
Keywords: myocardial infarction, paradoxical embolism, patent foramen ovale, pulmonary hypertension, shunt, thrombus, troponin
MeSH terms: Case Reports

A 67-year-old woman with pulmonary hypertension (PH) presented with a 1-day history of worsening shortness of breath and pleuritic chest pain and was found to have a troponin T level of 3755 ng/L (ref. range 0-19 ng/L). An initial diagnostic workup in the emergency department (ED) led to an urgent left heart catheterization which revealed a 90% occlusive right coronary artery blood clot, even though a recent heart catheterization less than a month prior was completely unremarkable. Further workup led to the discovery of a patent foramen ovale (PFO) and an aneurysmal interatrial septum, suggesting the presence of a paradoxical embolism. While typically asymptomatic, a PFO is an important clinical entity that can lead to irreversible cardiac damage. Suspicion should be high for this finding in the case of an acute myocardial infarction (MI) with no clear cause, especially in a patient with elevated right heart pressures.
Case report: Magnetocardiography as a potential method of therapy monitoring in amyloidosis
Authors: Ainoosh Golpour, Phillip Suwalski, Ulf Landmesser, Bettina Heidecker
Journal: Front Cardiovasc Med (2023)
Keywords: amyloidosis, diagnosis, magnetocardiography, monitoring, screening, tafamidis, therapy response, treatment
MeSH terms: Case Reports

Amyloidosis is characterized by a disorder of protein conformation and metabolism, resulting in deposits of insoluble fibrils in various organs causing functional disturbances. Amyloidosis can also affect the heart. Cardiac amyloidosis tends to have a poor prognostic outcome if diagnosed at a late stage. Therefore, early diagnosis and initiation of therapy as well as monitoring of treatment response are crucial to improve outcomes and to learn more about its pathophysiology and clinical course. We present an 83-year-old woman with cardiac transthyretin amyloidosis (ATTR) who was treated with tafamidis. The patient significantly improved 18 months after initiation of therapy with regards to exercise capacity and quality of life. In addition to standard diagnostic methods, we used magnetocardiography (MCG) to monitor potential treatment response by detecting changes in the magnetic field of the heart. MCG is a non-invasive method that detects the cardiac magnetic field generated by electrical currents in the heart with high sensitivity. We have recently shown that this magnetic field changes in various types of cardiomyopathies may be used as a non-invasive screening tool. We determined previously that an MCG vector ≥0.052 was the optimal threshold to detect cardiac amyloidosis. The patient's MCG was measured at various time points during therapy. At the time of diagnosis, the patient's MCG vector was 0.052. After starting therapy, the MCG vector increased to 0.090, but improved to 0.037 after 4 months of therapy. The MCG vector reached a value of 0.017 after 5 months of therapy with tafamidis, and then increased slightly after 27 months to a value of 0.027 (<0.052). Data from this case support our previous findings that MCG may be used to monitor treatment response non-invasively. Further research is needed to understand the unexpected changes in the MCG vector that were observed at the beginning of therapy and later in the course. Larger studies will be necessary to determine how these changes in the electromagnetic field of the heart are related to structural changes and how they affect clinical outcomes.
Shielding the Pier Abutment Using a Nonrigid Connector
Authors: Ekta M Kanojia, Anjali Bhoyar, Surekha R Dubey, Seema Sathe, Sheetal R Khubchandani, Rakhi Shinde
Journal: Cureus (2024)
Keywords: key and keyway, nonrigid connector, pier abutment, semi-precision attachment, stress breakers
MeSH terms: Case Reports

The attachment of a fixed partial denture (FPD) on a pier abutment may be necessary in some partially edentulous instances because of the pattern of lost teeth. Nonetheless, it has been noted that using a stiff FPD to restore two lost teeth and an intermediate pier abutment is not the best course of action. In this case, using a stiff connector concentrates the stresses on the pier abutment. In this situation, the pier abutment serves as a pivot, increasing the debonding of the fixed dental prosthesis and ultimately compromising the success of the FPD. Connectors that are not stiff can solve these issues. A nonrigid connector allows abutments to move independently and distributes shear forces to the supporting bone. Instead of the typical rigid connector, the nonrigid connector serves as a stress breaker between the retainer and the pontic.
Case Report: Abdominal Wall Reconstruction in a High-Risk Patient With Incisional Hernia and Complications From Oncological Treatment
Authors: Thiago Souza Silva, Mario Rino Martins, Thales Lima Batista, Euclides Dias Martins, Marcelo Henrique Fernandes, Eduarda Araujo Hinrichsen
Journal: J Abdom Wall Surg (2023)
Keywords: abdominal wall reconstruction, case report, hernia sac transposition, incisional hernia, mesh-free technique
MeSH terms: Case Reports

Introduction: A high risk patient with evisceration underwent to abdominal wall reconstruction without mesh or drains. We present a case of a 62 years-old female patient with a significant medical history of Wilson's disease-related hepatopathy Child-Pugh class B classification, sequelae of a stroke, and relevant surgical background including total hysterectomy, oophorectomy, and Hartmann's procedure for ovarian neoplasm stage 3. The patient developed a large incisional hernia in the midline incision while undergoing Bevacizumab (Avastin) treatment for clinical oncology. During an attempt at skin closure due to erosion and necrosis, there was progressive deterioration leading to evisceration. We opted for abdominal wall reconstruction by transposing the hernia sac without using mesh and employing hemostatic powder (Arista) to mitigate the risk of bleeding in a high-risk patient due to recent bevacizumab use and hepatopathy. The patient had a favorable postoperative course without any other intervention in abdominal wall. Patient developed worsening hepatic function with the presence of ascites, constipation, and disorientation. On the 6th day postoperative, a tomography was performed, which showed colonic distension without obstructive factors and a slight amount of supra-aponeurotic fluid. The patient was discharged on the 10th day postoperative after improvement of the condition with clinical treatment. The patient has been progressing under outpatient follow-up for 5 months, with a resumption of chemotherapy cycles and no evidence of hernia recurrence. Conclusion: Further studies and long-term follow-up are necessary to evaluate the efficacy and safety of hernia sac transposition as a mesh-free technique and the use of hemostatic powder without drains in high-risk patients. However, our case highlights the potential feasibility of these approaches in carefully selected cases.
Case Report: Identification of novel CDH2 mutation (p. P183A het)-induced arrhythmogenic cardiomyopathy in China
Authors: Kun Li, Yifei Wang, Jing Yang, Fang Liu, Fulan Liu, Ping Zhang
Journal: Front Cardiovasc Med (2023)
Keywords: acm, cdh2, adolescence, cadherin-2, mutation
MeSH terms: Case Reports

Background:
Arrhythmogenic cardiomyopathy/dysplasia (ACM) is an inheritable heart disease closely related to gene variations induced heart fibrofatty replacement, which increases the risk of arrhythmia events and even sudden cardiac death. In this study, we reported a 10-year-old patient with a novel mutation diagnosed with ACM.
Case presentation:
We present the case of a 10-year-old patient admitted with recurrent palpitation, whose electrocardiogram suggested the existence of right ventricle origin premature ventricular contractions and ε wave. Furthermore, echocardiography showed an enlarged right ventricle corrected to a body surface area of 29.57 mm/m2. The diagnosis of ACM was clear. Further gene sequencing revealed a novel heterozygous missense mutation of CDH2 (cadherin-2) c.547C > G (p. P183A) that potentially increases ACM risk by affecting adherens junctions of the intercalated discs.
Conclusions:
This is the first case of CDH2 mutation (c.547C > G, p. P183A) related ACM in the Chinese population. Compared to previously reported mutations inducing ACM by affecting desmosome function, the newly reported CDH2 variation revealed a novel potential mechanism that induces ACM by disturbing cell-cell adhesion.
Augmented Reality-Assisted Placement of Ommaya Reservoir for Cyst Aspiration: A Case Report
Authors: Joshua Olexa, Annie Trang, Kevin Kim, Maureen Rakovec, Jordan Saadon, Whitney Parker
Journal: Cureus (2024)
Keywords: augmented reality, cyst, image guidance, mixed reality, ommaya reservoir
MeSH terms: Case Reports

Image guidance technologies can significantly improve the accuracy and safety of intracranial catheter insertions. Augmented reality (AR) allows surgeons to visualize 3D information overlaid onto a patient's head. As such, AR has emerged as a novel image guidance technology that offers unique advantages when navigating intracranial targets. A 71-year-old woman with a history of brain metastasis from breast cancer and prior resection surgery and chemotherapy presented with altered mental status and generalized weakness worse on her left side. Magnetic resonance imaging (MRI) demonstrated right frontotemporoparietal edema with a contrast-enhancing mass. MR perfusion confirmed an active tumor with an enlarging right temporal pole cyst. A cyst aspiration was performed via Ommaya reservoir placement. Neuro-navigation (BrainLab, Munich, Germany) and AR navigation were used to plan the trajectory from the temporal gyrus to the cyst. Post-operative computed tomography (CT) demonstrated good placement of the reservoir, reconstitution of the temporal horn of the lateral ventricle with decreased external mass effect, and no areas of hemorrhage. AR has tremendous potential in the field of neurosurgery for improving the accuracy and safety of procedures. This case demonstrates an encouraging application of AR and can serve as an example to drive expanded clinical use of this technology.
Hematologists/Physicians Need to Be Aware of Pseudohypercalcemia in Monoclonal Gammopathy: Lessons from a Case Report
Authors: Svenja F B J Mennens, Ellen Van der Spek, Janneke Ruinemans-Koerts, Marcel M G J Van Borren
Journal: Case Rep Hematol (2024)
MeSH terms: Case Reports

We present a patient at risk of misdiagnosis with multiple myeloma due to pseudohypercalcemia. Examinations showed monoclonal protein, 50% monoclonal plasma cells in bone marrow, and hypercalcemia but no osteolytic bone lesions. Follow-up tests revealed pseudohypercalcemia, with elevated total calcium, but normal ionized calcium: a discrepancy due to calcium binding to monoclonal paraprotein (confirmed by laboratory experiments). Accordingly, the patient was diagnosed with smouldering myeloma. After 900 days, the presence of bone lesions prompted the start of treatment for myeloma. Consequently, monoclonal paraprotein levels declined and pseudohypercalcemia dissolved. Hence, ionized calcium should be measured in monoclonal gammopathies to avoid misdiagnosis.
Guanfacine Treatment in a Patient with Intravenous Buprenorphine/Naloxone Misuse
Authors: Sercan Karabulut
Journal: Case Rep Psychiatry (2024)
MeSH terms: Case Reports

In this case report, we described a patient admitted with buprenorphine/naloxone (BN) misuse, accompanied by intermittent pregabalin misuse, to self-treat the opioid withdrawal symptoms. We treated the withdrawal symptoms after cessation of BN with guanfacine extended-release (XR). To our knowledge, it has been the first case report describing guanfacine-XR in the treatment of BN misuse. Notably, our patient responded to the treatment with a decrease in withdrawal symptoms without any significant side-effect. Although it is not possible to generalize our findings with a single case report, it might be useful to mark guanfacin-XR as a potential treatment agent for opioid use disorders, including patients with synthetic opioid misuse.
A Rare Cause and Management of Ventricular Fibrillation: 5-Fluorouracil Toxicity
Authors: Kutluhan Eren Hazir, Cenk Sari
Journal: Arq Bras Cardiol (2024)
MeSH terms: Arrhythmias, Cardiac, Ventricular Fibrillation / chemically induced, Ventricular Fibrillation / therapy, Case Reports, Fluorouracil / adverse effects, Humans, Fluorouracil

Um homem de 65 anos com histórico de carcinoma de língua procurou o pronto-socorro com contrações insensíveis estando em casa. Ele estava em terapia com 5-fluorouracil (5-FU) na época. O paciente foi desfibrilado e intubado porque a fibrilação ventricular (FV) se desenvolveu durante o monitoramento no pronto-socorro. A ecocardiografia mostrou que a fração de ejeção do ventrículo esquerdo (FEVE) era de 70% e a espessura do septo interventricular era de 15 mm. A angiografia coronária não revelou qualquer estenose crítica. A ressonância magnética cardíaca (RMC) não mostrou anormalidade de perfusão, fibrose ou cicatriz sugestiva de envolvimento cardíaco. Foi sugerido que a arritmia do paciente estava relacionada principalmente à cardiotoxicidade induzida pelo 5-FU.


O fato de as causas secundárias terem sido proeminentes em nosso caso, de nenhuma patologia cardíaca óbvia que pudesse causar arritmia ter sido encontrada no exame detalhado e de a arritmia não ter recorrido durante a internação hospitalar, que durou até 15 dias, nos levou a acreditar que esse paciente poderia receber alta sem um cardioversor-desfibrilador implantável. Nosso caso foi apresentado para contribuir com a literatura.