OpenMed/multicare-articles huggingface dataset:
Management of a Previously Failed Root Perforation Repair with Geristore and Deepithelialized Gingival Graft: A 5-Year Follow-Up Case Report
Authors: Talal M Zahid
Journal: Case Rep Dent (2023)
MeSH terms: Case Reports

Iatrogenic root perforation presents a significant management challenge for clinicians as it may seriously harm the periodontium. More specifically, perforations occurring relative to the crestal bone have a poor prognosis even after repair due to their proximity to the gingival tissues. The current literature reports the use of various materials for root perforation repair including calcium hydroxide, glass ionomer cement, amalgam, and mineral trioxide aggregate (MTA), to name a few. This case report describes the clinical management of a cervical perforation that occurred on the maxillary central incisor. The perforated area was initially repaired with MTA but failed after one year, which resulted in an active lesion at the midlabial aspect of the tooth. The case was subsequently treated using a resin-modified glass ionomer cement (Geristore®) and deepithelialized free gingival graft (DGG). There were favorable clinical and radiographic outcomes at 1-, 3-, and 5-year follow-up. The use of DGG, however, led to some late complications such as gingival cul-de-sac and color discrepancy, which were later resolved with gingivoplasty and frenectomy. We thus conclude that Geristore® has the potential to be a better repair material than the existing ones for crestal and subcrestal root perforations.
Case Report: Asymptomatic SARS-COV2 infection triggering recurrent Takotsubo syndrome
Authors: Gianni Dall'Ara, Miriam Compagnone, Roberto Carletti, Sara Piciucchi, Elisa Gardini, Marcello Galvani
Journal: Front Cardiovasc Med (2024)
Keywords: covid, sars-cov-2, takotsubo, apical ballooning syndrome, recurrence, stress cardiomyopathy
MeSH terms: Case Reports

Takotsubo syndrome (TTS) is a rare disease mimicking acute coronary syndrome, often triggered by physical or emotional stress, and characterized by transient left ventricular dysfunction. Recurrences are described in about 5% of cases and may have different clinical and imaging patterns. In the present report, SARS-COV-2 infection, even in the absence of symptoms and overt emotional stress, seems correlated with recurrence of TTS, due to the absence of other recognized triggers. The hypothesis is that in predisposed patients, events like catecholamine-induced myocyte injury, direct viral damage, cytokine storm, immune-mediated damage, and procoagulant state, all possibly induced by the infection, may elicit endothelial dysfunction as substrate for TTS onset.
Combined replantation of the posterior arch of the atlas and bilateral axial lamina in the treatment of intradural schwannoma: a case report
Authors: Ao Leng, Jiacheng Li, Lingzhi Meng, Qi Wang
Journal: Front Surg (2024)
Keywords: case report, cervical atlas, cervical vertebrae, spinal cord neoplasms, surgery
MeSH terms: Case Reports

Background:
Laminotomy and laminar replantation have emerged as novel treatment modalities for intraspinal tumors, aiming to minimize postoperative complications and retain spinal mobility. However, existing research predominantly emphasizes their application in the thoracolumbar spine. The unique anatomy of the atlantoaxial segments necessitates surgical techniques that differ from those used in other spinal regions, and the clinical effect of such procedure remains unknown.
Case presentation:
A 61-year-old male patient with intradural schwannoma at the atlantoaxial level was operated on. The patient underwent posterior laminectomy, as well as a combined replantation of the posterior arch of the atlas and bilateral axial laminae. Postoperatively, the patient experienced significant neurological improvement, with no deformities or instability on the radiological assessments during the follow-up.
Conclusion:
Laminotomy with combined replantation of the posterior arch of the atlas and bilateral axial lamina emerges as an effective approach for managing intraspinal tumors at the atlantoaxial level. This technique not only offers ample operating space but also restores the stability of the spinal canal. Moreover, it preserves the mobility of the atlantoaxial segment, minimizes impact on adjacent segments, and mitigates the formation of postoperative fibrosis.
Neuropathological features of levodopa-responsive parkinsonism in multiple system atrophy: an autopsy case report and comparative neuropathological study
Authors: Mitsuyoshi Tamura, Takahiro Takeda, Yoshihisa Kitayama, Tomoki Suichi, Kazumoto Shibuya, Sakurako Harada-Kagitani, Takashi Kishimoto, Satoshi Kuwabara, Shigeki Hirano
Journal: Front Neurol (2023)
Keywords: levodopa, multiple system atrophy, pathology, presynaptic dopaminergic fibers, putamen
MeSH terms: Case Reports

Background:
In typical patients with multiple system atrophy with predominant parkinsonism (MSA-P) levodopa is ineffective. However, there are some of these patients who respond well to levodopa treatment. Levodopa efficacy in MSA-P patients is thought to be related to the degree of putaminal damage, but the pathological causation between the putaminal involvement and levodopa efficacy has not been established in detail.
Objective:
This study aimed to evaluate the neuropathological features of the nigrostriatal dopaminergic system in a "levodopa-responsive" MSA-P patient in comparison with "levodopa-unresponsive" conventional MSA-P patients.
Materials and methods:
Clinicopathological findings were assessed in a 53-year-old Japanese man with MSA who presented with asymmetric parkinsonism, levodopa response, and later wearing-off phenomenon. During autopsy, the nigrostriatal pathology of presynaptic and postsynaptic dopaminergic receptor density and α-synuclein status were investigated. The other two patients with MSA-P were examined using the same pathological protocol.
Results:
Four years after the onset, the patient died of sudden cardiopulmonary arrest. On autopsy, numerous α-synuclein-positive glial cytoplasmic inclusions in the basal ganglia, pons, and cerebellum were identified. The number of neurons in the putamen and immunoreactivity for dopamine receptors were well-preserved. In contrast, significant neuronal loss and decreased dopamine receptor immunoreactivity in the putamen were observed in the "levodopa-unresponsive" MSA-P control patients. These putaminal pathology results were consistent with the findings of premortem magnetic resonance imaging (MRI). All three patients similarly exhibited severe neuronal loss in the substantia nigra and decreased immunoreactivity for dopamine transporter.
Conclusion:
Levodopa responsiveness in patients with MSA-P may be corroborated by the normal putamen on MRI and the preserved postsynaptic nigrostriatal dopaminergic system on pathological examination. The results presented in this study may provide a rationale for continuation of levodopa treatment in patients diagnosed with MSA-P.
Bilateral Adrenal Hemorrhage Heralds Bronchogenic Carcinoma
Authors: Faysal Azani, Abdur Rehman Alozai, Jimmy William, Jayant Sharma
Journal: Cureus (2024)
Keywords: addison's disease, adrenal metastasis, hemorrhage, lung cancer, nsclc
MeSH terms: Case Reports

This case study delves into the unusual presentation of non-small cell lung carcinoma (NSCLC), where bilateral hemorrhagic adrenal metastasis served as the primary indication of an underlying malignancy. Our patient, a 58-year-old male, sought medical attention due to acute abdominal pain and lower back discomfort, leading to an in-depth diagnostic exploration. Radiological examinations revealed bilateral adrenal masses exhibiting hemorrhagic characteristics, a distinctive feature not commonly associated with NSCLC. The subsequent biopsy and histopathological analysis definitively identified metastatic NSCLC as the culprit. The uniqueness of this case lies in the bilateral nature of the metastasis and the presence of hemorrhagic elements, challenging traditional diagnostic expectations. This report emphasizes the necessity for a nuanced approach to diagnostic investigations when confronted with atypical presentations, especially considering the rarity of bilateral involvement and hemorrhagic features in adrenal metastases from NSCLC. It highlights the importance of interdisciplinary collaboration between radiologists, pathologists, and oncologists to ensure accurate and timely diagnosis. The overarching significance of this case extends beyond its rarity; it underscores the imperative for healthcare practitioners to broaden their diagnostic considerations in the absence of conventional symptoms. By presenting this distinctive case, we contribute to the evolving understanding of the diverse clinical manifestations of NSCLC, advocating for heightened vigilance and comprehensive diagnostic approaches in the pursuit of early intervention and optimal patient care.
Hematohidrosis in Pediatric Practice - a Case Report and Review of the Literature
Authors: Oksana Matsyura, Lesya Besh, Svitlana Jefimova, Slivinska-Kurchak Khrystyna, Sergiy Gerasymov
Journal: Acta Med Litu (2024)
Keywords: case, child, diagnosis, hematohidrosis, treatment
MeSH terms: Case Reports

Hematohidrosis (bloody sweat) is a symptom of trophic damage to the vascular wall, in which sweat mixes with blood and seeps onto undamaged areas of the skin in the form of red or pink liquid (depending on the ratio of sweat to blood). In our study we have analyzed 25 case reports of hematohidrosis in children, reported throughout the world using PubMed, ResearchGate with detailed description and opened access. We took into consideration: age of the patient, sex, location of bloody excretion, cause or trigger, treatment and its effectiveness. Our clinical case present a 9-year-old girl complained of a periodic bleeding from the intact skin of the face, neck, thighs (without visible damage to the skin) manifested by red or pink liquid, nosebleeds, and bloody discharge from the mucous membrane of the eyes. The secretions were of varying intensity and lasted up to several hours. Most of all episodes are associated with a strong emotional exertion. One of the theories of hematohidrosis pathogenesis is evident vasoconstriction of the blood vessels surrounding the sweat glands, provoked by hyperactivation of the sympathetic nervous system, which is followed by their excessive vasodilation up to rupture and blood entering the sweat gland ducts. Capillary endothelial cells are known to contain β2-adrenoceptors, which, through the modulation of nitric oxide release, cause endothelium-dependent vasodilation. Blocking β-adrenoceptors (for example, propranolol) prevents excessive vasodilation of blood vessels and, accordingly, their rupture and blood flow to the sweat gland. We managed to find out that the patient's bloody sweat was a manifestation of a separate pathological phenomenon, and not one of the symptoms of another disease. A properly formed treatment complex and the great trust of the parents enabled to stabilize the child's condition, and later to cure her. Currently, hematohidrosis is recognized as an independent disease that requires in-depth study of the triggering mechanisms of development, pathogenetic and clinical features.
Perforated ulcer at the gastrojejunal anastomosis: a rare complication of pancreaticoduodenectomy (case report)
Authors: Mohamed El Hammouti, Amine Majdoubi, Anass El Achchi, Tariq Bouhout, Badr Serji
Journal: Pan Afr Med J (2024)
Keywords: gastrojejunal anastomosis ulceration, case report, cephalic duodenopancreatectomy, spleen-preserving surgery
MeSH terms: Anastomosis, Surgical / adverse effects, Pancreaticoduodenectomy / adverse effects, Tomography, X-Ray Computed, Case Reports, Abdominal Pain / etiology, Humans, Jejunum / surgery, Male, Middle Aged, Peptic Ulcer Perforation / etiology, Peptic Ulcer Perforation / surgery, Peritonitis / diagnosis, Peritonitis / etiology, Peritonitis / surgery, Postoperative Complications / diagnosis, Postoperative Complications / etiology, Stomach / surgery

Pancreaticoduodenectomy (PD) is recognized as one of the most intricate abdominal surgical procedures, often accompanied by high morbidity rates. The occurrence of an anastomotic ulcer at the gastrojejunal anastomosis post-pancreaticoduodenectomy surgery is a relatively uncommon complication, albeit potentially leading to severe, life-threatening consequences. The predominant symptomatology manifests as acute abdominal pain accompanied by peritonitis. Conventionally, diagnosis is achieved through computed tomography (CT) scans, facilitating subsequent management, and surgical management is recommended in the majority of instances. Herein, we present a rare case of a patient who experienced ulcer perforation at the gastrojejunal anastomosis site after undergoing pancreaticoduodenectomy with stomach preservation, and we reviewed the available literature to gain more comprehension of this rare complication of this type of surgical intervention.
Bilateral Renal Hilar Nutcracker Phenomenon in a Male Cadaver
Authors: Dibakar Borthakur, Rajesh Kumar, Vidhu Dhawan, Rima Dada
Journal: Acta Med Litu (2024)
Keywords: renal hilar nutcracker phenomenon, renal artery, renal hilum, renal vein
MeSH terms: Case Reports

Nutcracker phenomenon (NCP) typically refers to the entrapment of the left renal vein (LRV) between the aorta and the superior mesenteric artery. Similar to the classic NCP, the renal vein can also get entrapped between the segmental branches of the renal artery at the renal hilum, which has been referred to as 'renal hilar nutcracker phenomenon (RHNP).' During routine dissection of a male cadaver of 67 years, the renal veins of both sides at the renal hilum were seen between the segmental branches of renal arteries, which we identified as the 'renal hilar nutcracker phenomenon.' The disposition of the rest of the perihilar structures was normal. 'Renal hilar nutcracker phenomenon' can have similar clinical presentation like that of the nutcracker phenomenon. Hence, knowledge of such anatomical variation at the renal hilum is desirable.
Case report: Difficult diagnosis of Mycobacterium tuberculosis infection in patients after allogeneic hematopoietic stem cell transplantation: two case reports and a literature review
Authors: Zhenghua Liu, Dali Cai, Nan Su
Journal: Front Oncol (2024)
Keywords: allo-hsct, mtb (mycobacterium tuberculosis), case report, diagnosis, mngs (metagenomic next-generation sequencing)
MeSH terms: Case Reports

Background:

Mycobacterium tuberculosis (MTB) is a relatively infrequent infection encountered during hematopoietic stem-cell transplantation (HSCT). The identification of MTB following HSCT remains a complex task, with delayed detection and misdiagnosis potentially resulting in unfavorable outcomes. Metagenomic next-generation sequencing (mNGS) represents a novel, highly sensitive, and rapid diagnostic tool in clinical settings for discerning intricate infections and detecting exceedingly rare pathogens.
Methods:
With the aid of mNGS, we diagnosed MTB in the lymph nodes and lungs of two patients with hematological diseases following allogeneic peripheral blood hematopoietic stem cell transplantation. Both patients presented with a fever, localized symptoms, and clinical signs. Following inconclusive results from routine tests, impractical biopsy procedures, and unsuccessful responses to empirical treatments, mNGS was employed as a final recourse, revealing DNA fragments of MTB in blood samples.
Results:
The diagnoses were ultimately confirmed in conjunction with additional clinical evidence. The application of mNGS in MTB cases after allogeneic HSCT has rarely been reported. The mNGS technique can provide a prompt and highly sensitive indication leading to the definitive diagnosis of MTB in complex post-transplant scenarios.
Vaginal Calculus Formation on Exposed Midurethral Sling Mesh
Authors: Adam J Langer, Zenab Saeed, Elizabeth Barrett, Rose A Maxwell, David N Dhanraj, Geoffrey D Towers, Eyra A Agudu
Journal: Case Rep Obstet Gynecol (2024)
MeSH terms: Case Reports

The presence of a vaginal calculus is a rare clinical entity which may develop in the setting of vaginal urinary stagnation. Numerous factors contribute to stone formation, and management can be complicated by variations in size, location of the stone, and location of adjacent structures. Generally, once diagnosed, vaginal calculi should be removed and surrounding anatomy should be evaluated thoroughly for secondary fistula, erosion, or presence of an instituting foreign body. This report presents a case of vaginal calculus formation on exposed midurethral sling mesh in an elderly patient with hemorrhagic cystitis. This report emphasizes contributing pathophysiology, diagnostic factors, and treatment.
Gonadoblastoma in a patient with 45,X/46XY mosaicism
Authors: Mercedes Bravo-Taxa, Luis Taxa-Rojas
Journal: Ecancermedicalscience (2023)
Keywords: turner syndrome, gonadoblastoma, mosaicism, virilisation
MeSH terms: Case Reports

45,X/46,XY mosaicism is a sex development disorder with an estimated incidence of less than 1 in 15,000 live births. Various studies have shown there is an increased risk of germ cell tumours forming in Mosaic Turner syndrome. This includes gonadoblastoma, a clinically benign mixed germ-stromal cell tumour. However, this can later develop into one or several malignant germ cell neoplasms, for which early prophylactic gonadectomy is often recommended in patients with 45,X/46,XY mosaicism. The study presents the case of an 11-year-old patient diagnosed with a Mosaic Turner syndrome karyotype, who underwent prophylactic bilateral gonadectomy.
Non-toxigenic Corynebacterium diphtheriae endocarditis: A cluster of five cases
Authors: Tamsin Lovelock, Mignon du Plessis, Clinton van der Westhuizen, Jacques T Janson, Charlene Lawrence, Arifa Parker, Alfonso Pecoraro, Hans Prozesky, Anne von Gottberg, Jantjie Taljaard
Journal: S Afr J Infect Dis (2024)
Keywords: infective endocarditis, non-toxigenic corynebacterium diphtheriae, outbreak

Background:
Classical toxin-mediated respiratory diphtheria has become less common because of widespread effective vaccination globally but invasive disease as a result of non-toxigenic strains of Corynebacterium diphtheriae is not prevented by vaccination and may result in severe disease, including infective endocarditis (IE).
Objectives:
To describe the outbreak and subsequent investigation of a cluster of five cases of non-toxigenic C. diphtheriae endocarditis.
Method:
A retrospective observational case series of five cases of non-toxigenic C. diphtheriae endocarditis identified in the rural West Coast district of the Western Cape province of South Africa between May 2021 and June 2021.
Results:
Non-toxigenic C. diphtheriae IE had an aggressive clinical course with high mortality in this cohort. Only one of five patients survived to hospital discharge. The surviving patient received a prompt diagnosis with early surgical intervention but still had a complicated clinical course. Notably, only one case had a pre-existing risk factor for IE, namely a prosthetic valve. Whole genome sequencing of clinical isolates confirmed that all isolates were of the same novel sequence type of non-toxigenic C. diphtheriae but despite a thorough investigation no epidemiological link was ever found between the cases.
Conclusion:
Non-toxigenic strains of C. diphtheriae are less well known but may be highly virulent and cause severe invasive disease.
Contribution:
This is the largest cluster of non-toxigenic C. diphtheriae IE ever described in South Africa and expands the body of literature on this unusual but possibly emerging infection.
Successful pharmaco-invasive approach using a lower alteplase dose and VA-ECMO support in high-risk pulmonary embolism: case report
Authors: Paola Gutierrez-Gallegos, Vicente Jimenez-Franco, Carlos Jerjes-Sanchez, Renata Quevedo-Salazar, Jahir Rodriguez-Rivera, Enrique Paredes-Gutierrez, Daniel Lira-Lozano, Juan Quintanilla-Gutierrez, Rene Gomez-Gutierrez, Erasmo de la Peña-Almaguer, Guillermo Torre-Amione
Journal: Front Cardiovasc Med (2024)
Keywords: ecmo, cardiac arrest, extracorporeal life-support, high-risk pulmonary embolism, thrombolysis
MeSH terms: Case Reports

Despite the elevated mortality rates associated with high-risk pulmonary embolism (PE), this condition remains understudied. Data regarding the effectiveness and safety of invasive therapies such as venoarterial extracorporeal membrane oxygenation (VA-ECMO) in this patient population remains controversial. Here, we present the case of a 61-year-old male with high-risk PE associated with refractory cardiac arrest and cardiogenic shock who underwent a combination of extracorporeal cardiopulmonary resuscitation with VA-ECMO and pharmaco-invasive therapy (mechanical thrombi fragmentation plus lower alteplase dose), resulting in successful pulmonary reperfusion. After a prolonged in-hospital stay, the patient was discharged in stable condition.
Cardiac Oscillations Complicating Brain Death Diagnosis
Authors: Brittany Bolt, Farid Muakkassa, Lindsay Bruening, Cameron Marcus, Brittany Cunningham, Erin Pawlak, Richard Gandee, Christopher Newey
Journal: Case Rep Crit Care (2023)
MeSH terms: Case Reports

Death by neurologic criteria (DNC) or brain death is a clinical diagnosis. It is often complicated by variations in policies as well as confounders on examination. We discuss here the case of a 27-year-old male who had a cardiac arrest following toxic gaseous exposure. He ultimately progressed to brain death but was identified as having cardiac oscillations during clinical assessments that complicated the diagnosis. We discuss the case as well as the maneuvers used to clarify that the "triggered breaths" on the ventilator were indeed cardiac oscillations.
Case report: Extrapontine myelinolysis combined with flupentixol- and melitracen-induced dysphagia
Authors: Zhihong Zhao, Lu Han, Zilong Zhu
Journal: Front Pharmacol (2023)
Keywords: dysphagia, extrapontine myelinolysis, flupentixol and melitracen, hyponatremia, sodium
MeSH terms: Case Reports

Extrapontine myelinolysis (EPM) is a rare symmetrical demyelinating disease of the central nervous system, which is often accompanied with central pontine myelinolysis (CPM) or can appear alone. A combination of flupentixol and melitracen is used as an antianxiety-antidepressant drug which may induce hyponatremia. Herein, we report a 46-year-old woman with depression who was treated with flupentixol and melitracen 0.5/10 mg once daily for 6 months. Later, the dosage increased to 0.5/10 mg twice daily. At the same time, she had complains of intermittent dizziness and fatigue. The laboratory test revealed hyponatremia (121 mmol/L). Dizziness was improved after sodium supplementation, with an increase in blood sodium to 133 mmol/L. Twenty days later, she had difficulty opening the mouth and swallowing, needing a gastric tube due to severe dysphagia. Head magnetic resonance imaging (MRI) showed a symmetric abnormal signal of caudate nucleus and lenticular nuclei. The symptoms were not relieved after active treatment, such as rehydration. However, her symptoms improved significantly after discontinuation of flupentixol and melitracen and switching to promethazine. Follow-up head MRI after 4 months revealed no abnormal signals. The patient who developed EPM had dysphagia, despite appropriate correction of hyponatremia. Flupentixol and melitracen can cause hyponatremia and dysphagia. This case highlights an unexpected association between EPM and flupentixol- and melitracen-induced dysphagia.