OpenMed/multicare-articles huggingface dataset:
Hybrid Strategy for Residual Arch and Thoracic Aortic Dissection following Acute Type A Aortic Dissection Repair
Authors: Sidharth Viswanathan, Vivek Agrawal, Shashidhar Kallappa Parameshwarappa, Ajay Savlania, Santhosh Kumar, Unnikrishnan Madathipat
Journal: Case Rep Vasc Med (2014)

Progressive dilatation of the false lumen in the arch and descending aorta has been encountered in one-third of survivors as a late sequelae following repair of ascending aortic dissection. Conventional treatment for the same requiring cardiopulmonary bypass and deep hypothermic circulatory arrest is associated with high morbidity and mortality especially in the elderly cohort of patients. Herein we report a case of symptomatic progressive aneurysmal dilatation of residual arch and descending thoracic aortic dissection following repair of type A aortic dissection, successfully treated by total arch debranching and ascending aortic prosthesis to bicarotid and left subclavian bypass followed by staged retrograde aortic stent-graft deployment. This case report with relevant review of the literature highlights this clinical entity and the present evidence on its appropriate management strategies. Close surveillance is mandatory following surgical repair of type A aortic dissection and hybrid endovascular procedures seem to be the most dependable modality for salvage of patients detected to have progression of residual arch dissection.
Stability of colon stem cell methylation after neo-adjuvant therapy in a patient with attenuated familial adenomatous polyposis
Authors: Jung Yeon Kim, Robert W Beart, Darryl Shibata
Journal: BMC Gastroenterol (2005)
MeSH terms: Adenomatous Polyposis Coli / genetics, Adenomatous Polyposis Coli / therapy, Colon / metabolism, Colon / pathology, DNA Methylation, Neoadjuvant Therapy, Stem Cells / metabolism, Case Reports, Research Support, N.I.H., Extramural, Research Support, U.S. Gov't, P.H.S., Adenocarcinoma / surgery, Adenocarcinoma / therapy, Adenomatous Polyposis Coli / physiopathology, Adult, Cell Survival, Colectomy, Colon / physiopathology, Genes, APC, Germ-Line Mutation, Humans, Male, Preoperative Care, Rectal Neoplasms / surgery, Rectal Neoplasms / therapy

Background:
Methylation at certain human CpG rich sequences increases with age. The mechanisms underlying such age-related changes are unclear, but methylation may accumulate slowly in a clock-like manner from birth and record lifetime numbers of stem cell divisions. Alternatively, methylation may fluctuate in response to environmental stimuli. The relative stability of methylation patterns may be inferred through serial observations of the same colon.
Case presentation:
A 22 year-old male with attenuated familial adenomatous polyposis received neo-adjuvant chemotherapy and radiation prior to surgery for rectal adenocarcinoma. Colon crypt methylation patterns before and after neo-adjuvant therapy (62 days apart) were essentially identical with respect to percent methylation and diversity. Consistent with previous studies, methylation patterns recorded no evidence for enhanced colon crypt stem cell survival with a germline mutation (codon 215) proximal to the mutation cluster region of APC.
Conclusion:
The inability of neo-adjuvant therapy to significantly alter crypt methylation patterns suggests stem cells are relatively protected from transient environmental changes. Age-related methylation appears to primarily reflect epigenetic errors in stem cells that slowly accumulate in a clock-like manner from birth. Therefore, life-long human stem cell histories are potentially written within and may be read from somatic cell epigenomes.
Giant splenic artery aneurysm: case report
Authors: Sadaf Ali, Vibha Verma, Sastry R, Imtiaz Wani
Journal: ISRN Surg (2011)
MeSH terms: Case Reports

Splenic artery aneurysm is the third most common location of intra-abdominal aneurysms. Giant splenic artery aneurysm is rarely seen and is at a high risk of rupture. Location and size of the splenic artery aneurysm determine the likelihood of rupture. A case of giant splenic artery aneurysm in a 35-year-old woman is reported. She presented with upper gastrointestinal bleeding. She had splenomegaly and extrahepatic hepatic portal hypertension. Angiography confirmed a giant splenic artery aneurysm measuring 8 × 10 centimeters, located in middle and distal two-thirds of the splenic artery. Surgical treatment in the form of in toto excision of aneurysm with splenectomy and devascularization was performed.
Spontaneous splenic rupture: case report and review of literature
Authors: Tariq Ahbala, Khalid Rabbani, Abdelouahed Louzi, Benasser Finech
Journal: Pan Afr Med J (2020)
Keywords: splenic rupture, atraumatic, unknown etiology
MeSH terms: Abdominal Pain / etiology, Splenic Rupture / diagnosis, Case Reports, Review, Diagnosis, Differential, Humans, Male, Middle Aged, Rupture, Spontaneous / diagnosis

Splenic rupture is a potentially life-threatening condition, often associated with chest or abdominal trauma. Spontaneous rupture is very rare and is usually reported as being secondary to underlying pathological conditions. We report a case of atraumatic splenic rupture in a patient with no underlying disease pathology. This case should remind the emergency physician spontaneous splenic rupture should be considered in the differential diagnosis of unexplained acute abdominal pain.
Congenital Ventricular Diverticulum or Aneurysm: A Difficult Diagnosis to Make
Authors: Lloyd Halpern, Carl Garabedian, Neil K Worrall
Journal: Case Rep Cardiol (2018)
MeSH terms: Case Reports

A pouch protruding from the free wall of the left ventricle may be either a congenital ventricular diverticulum (CVD) or aneurysm (CVA). Being aware of these rare congenital anomalies is critical in making the diagnosis. Differentiating the two is important for treatment decisions. We describe a patient with dextrocardia, Tetralogy of Fallot, and a congenital left ventricular apical diverticulum diagnosed following the induction of anesthesia. CVD and CVA may present in the antenatal period through late adulthood with differing morphology, location, and symptoms. Echocardiography is paramount in the diagnosis and characterization of these lesions. If this anomaly is encountered after the induction of anesthesia or during intraoperative echocardiography, the cardiothoracic anesthesiologist should make the surgical team aware so it can be further characterized and a treatment plan made prior to incision.
Laparoscopic Diagnosis and Treatment of Gossypiboma Postconventional Ovariohysterectomy in a Bitch
Authors: Maurício Veloso Brun, Paula Cristina Basso, Marília Teresa de Oliveira, Fabíola Dalmolin, Saulo Tadeu Lemos Pinto-Filho, Helen Fialho Hartmann, Stephanie Lanzarini Abati, Marco Augusto Machado-Silva, Daniel Curvello de Mendonça Müller, Francisco Miguel Sanchez-Margallo
Journal: Case Rep Vet Med (2021)
MeSH terms: Case Reports

Introduction. Gossypiboma is a rare surgical complication in small animals. The authors reported the laparoscopic diagnosis and treatment of an abdominal gossypiboma and chronic draining fistula postopen ovariohysterectomy (OVH) unresponsive to medical treatment in a bitch. Case Presentation. The patient had undergone OVH and exploratory laparotomy in other veterinary practice 3 years previously. The animal, presenting a chronic fistula, was then referred to UFSM Veterinary Hospital. Ultrasonographic examination revealed a structure compatible with a granuloma. For the laparoscopic procedure, a 3-port (two at 11 mm; one at 6 mm) access was used. Adhesiolysis and mass removal were performed by blunt dissection and bipolar electrocoagulation. The fistula was treated by mobilising the omentum through it. There were no intra- or postoperative complications. The chronic wound showed first intention healing. The mass was composed of fibrous tissues surrounding one surgical gauze. Discussion and Conclusion. The removal of a retained surgical gauze in the abdomen by laparoscopy has already been described in medicine. However, a laparoscopic approach for treating a fistulous draining tract due to a gossypiboma has not been previously reported in dogs. Laparoscopic exploration of the fistula allowed the use of a pedicled omental flap through infected sites to control chronic infection. Laparoscopic surgery can be used to identify and treat abdominal gossypiboma in dogs, including those with chronic abdominal sinus.
Case Report: Medical Management of Prolonged Gestation of a Mummified Fetus in a Bitch
Authors: Annemarie Spruijt, Lucinda van Stee, Karin Wolthers, Jeffrey de Gier
Journal: Front Vet Sci (2022)
Keywords: pgf2α, aglépristone, canine, fetal death, mummification, parturition induction
MeSH terms: Case Reports

A 3-year-old female rough coated collie was presented at day 69 (D69) after the first mating. She was mated on 2 consecutive days based on ovulation timing by the referring veterinarian. At day 30 post breeding, a single, live embryo was seen on ultrasound by this veterinarian. On D69, the bitch was presented to us because she lacked signs of impending parturition such as vulvar discharge or nest building behavior. On general examination, the bitch appeared clinically healthy and no prodromi were present. On abdominal palpation a small, firm structure and a slightly enlarged uterus were detected. There was no vulvar discharge. Using vaginoscopy we could not see any signs of cervical dilatation. Additionally, ultrasonography revealed the presence of a collapsed fetus in the uterus with a moderate amount of echogenic fluid surrounding it and the plasma progesterone concentration was 2.6 ng/ml. A parturition induction protocol was initiated: a progesterone receptor antagonist was administered, followed by PGF2α to induce cervical relaxation and uterine contractions. The fetus was expelled 3 days later, without noticeable damage to the reproductive tract of the dam. The bitch subsequently delivered two more litters without complications. To our knowledge this is the first clinical report that demonstrates a successful non-surgical treatment to expel a mummified fetus after prolonged gestation. The pharmacological treatment did not affect the future fertility of the breeding dog, which is an important outcome for breeders.
Coxiella burnetii vascular graft infection
Authors: Takaaki Kobayashi, Fernando Casado Castillo, Jason H Barker, Loreen Herwaldt
Journal: IDCases (2021)
Keywords: coxiella burnetii, vascular graft infection
MeSH terms: Case Reports

Q fever, a zoonotic infection caused by Coxiella burnetii, can present with a wide spectrum of clinical manifestations. The organism is typically transmitted from sheep, goats, or cattle to humans via contaminated aerosols. On average, 1-5% of patients with acute Q fever will develop chronic infection months to decades after their primary infections. We report a case of a chronic vascular graft infection due to Coxiella burnetii in a 61-year-old man without direct exposure to animals who presented with recurrent fever. Indium-111-labeled white blood cell scan with single-emission positron computed tomography demonstrated findings suggesting a graft infection. C. burnetii phase I and phase II IgG antibody titers were > 1:32,768 and polymerase chain reaction performed on the explanted graft was positive for C. burnetii. Q fever should be considered in the differential diagnosis of vascular infections in patients who have a pre-existing lesion such as an aneurysm, or vascular prosthesis even in the absence of a history of direct animal exposure.
Is there a pathogenic association between Fabry's disease and IgA nephropathy?
Authors: Shuichiro Fujinaga, Hitohiko Murakami, Mitsuru Kubota, Hiroshi Mochizuki, Toshiaki Shimizu
Journal: Clin Nephrol Case Stud (2013)
Keywords: fabry’s disease, iga nephropathy
MeSH terms: Case Reports

Several cases of concurrent Fabry's disease and IgA nephropathy have been reported, but the pathogenic association between these two diseases remains unclear. This is a report on the case of a girl with severe IgA nephropathy who was subsequently diagnosed with subclinical Fabry's disease. An 11-year-old girl was admitted to our hospital with massive proteinuria and hematuria detected by urinary screening. An initial renal biopsy revealed severe IgA nephropathy with diffuse mesangial proliferation. She was treated with intravenous methylprednisolone pulses followed by 2 years of oral steroids. The treatment improved both the urinary abnormalities and the second renal biopsy findings. At the age of 15 years, mild proteinuria prompted us to perform a third renal biopsy, and histology revealed minor glomerular abnormalities. In addition, numerous myelin-like bodies were detected in podocytes by electron microscopy. The histological findings combined with the low level of α-galactosidase A activity led to the diagnosis of concomitant Fabry's disease with IgA nephropathy. Our experience suggests that the initial massive proteinuria was not due to Fabry's disease, but was rather a manifestation of coincidental IgA nephropathy. We speculate that the coexistence of IgA nephropathy and Fabry's disease occurred by chance.
Case Report: Diffuse idiopathic skeletal hyperostosis with ossification of the posterior longitudinal ligament in the cervical spine: A rare case with dysphagia and neurological deficit and literature review
Authors: Chaoyuan Li, Wenqi Luo, Hongchao Zhang, Jianhui Zhao, Rui Gu
Journal: Front Surg (2022)
Keywords: opll, cervical spine, diffuse idiopathic skeletal hyperostosis, dysphagia, literature review
MeSH terms: Case Reports

Diffuse idiopathic skeletal hyperostosis (DISH) is characterized by the calcification and ossification of ligaments and tendons. Progressive dysphagia caused by DISH-related anterior cervical osteophytes and deteriorating dysphagia caused by DISH combined with neurological dysfunction resulting from the posterior longitudinal ligament is rare. The initial diagnosis is misleading and patients often consult several specialists before spine surgeons. This study aims to provide a comprehensive review of the literature on this challenging pathological association. We also present a case illustration where a 53-year-old man presented with progressive dysphagia and foreign body sensation in the pharynx, accompanied by a neurological numbness defect in the right upper limb. Radiography and computed tomography confirmed the existence of osteophytes at the anterior edge of the C4-C7 pyramid and ossification of the posterior longitudinal ligament, in which the giant coracoid osteophyte could be seen at the anterior edge of the C4-C5 pyramid. The anterior cervical osteophyte was removed, and decompression and fusion were performed. The symptoms were relieved postoperatively. No recurrence of symptoms was found during the six-month follow-up. Spine surgeons should consider progressive dysphagia caused by DISH-related osteophytes at the anterior edge of the cervical spine as it is easily misdiagnosed and often missed on the first evaluation. When combined with ossification of the posterior longitudinal ligament, following cervical osteophyte resection it is necessary to consider stabilizing the corresponding segments via fusion.
Contraceptive Use among Basic School Pupils in Ghana: A Case Study of a Municipality
Authors: Fred Yao Gbagbo
Journal: Int J Pediatr (2020)

Background:
Ghana over the years strived to improve contraceptive services for young people through various policies and programs. Despite these efforts, contraceptive use among young people remains a challenge. In this study, contraceptive use among basic school pupils in a Ghanaian municipality was explored to inform policy and program decisions.
Methods:
The research design was a cross-sectional and mixed-method survey involving four hundred and twenty-seven (427) respondents randomly selected from four hundred and eleven (411) basic schools (102 from private and 309 from public basic schools) within Effutu Municipality of Ghana.
Results:
Basic school pupils in Ghana are generally sexually active but have high unmet needs for modern contraception due to sociocultural barriers, stigma, and misconceptions. Awareness and use are however more prevalent among junior high school pupils compared to those at the primary levels. Pupils who received contraceptive education from parents/guardians were, however, more likely to use modern contraceptives consistently than their counterparts who do not.
Conclusions:
Because young people in basic schools are becoming sexually active, there is a need for formalized contraceptive education in basic schools for correct information and education.
Rare TACI Mutation in a 3-Year-Old Boy With CVID Phenotype
Authors: Lucia Leonardi, Giulia Lorenzetti, Rita Carsetti, Simona Ferrari, Alessia Di Felice, Bianca Cinicola, Marzia Duse
Journal: Front Pediatr (2019)
Keywords: c193x, cvid phenotype, lig1, rag1, tnfrsf13b
MeSH terms: Case Reports

Common variable immunodeficiency (CVID) is the most common and clinically relevant primary immunodeficiency (PID). Genetic basis of CVID remains largely unknown. However, in a minority of CVID patients, a number of distinct genetic defects affecting the normal processes of B cell maturation and differentiation into memory B cells have now been identified, resulting in markedly reduced serum levels of immunoglobulin G (IgG) and low immunoglobulin A (IgA) or immunoglobulin M (IgM), with impaired antibody responses, despite the presence of normal levels of B cells. Patients with CVID develop recurrent and chronic infections of respiratory and gastrointestinal tracts, autoimmune diseases, lymphoproliferative complications, malignancies, and granulomatous disease. We report the case of a boy admitted to our unit for the first time at the age of three for reduced gamma globulin levels and a clinical history positive for two episodes of pneumonia. Our patient incompletely met ESID diagnostic criteria for CVID, but molecular genetic analysis, a NGS panel including 47 PID-associated genes was performed in the proband and in his parents, revealing the presence of a heterozygous nucleotide substitution in exon 4 (c.579C>A) of TNFRSF13B encoding TACI. This mutation has been described only in two CVID adult patients and in a child with selective IgA deficiency (sIgAD). We highlighted the same mutation in the asymptomatic mother and detected two extra heterozygous mutations of RIG1 and LIG1. We promptly started intravenous immunoglobulin (IVIG) therapy with good tolerance. Despite the diagnosis of CVID remains clinical, in this case report we underline the importance of considering and planning genetic workup in all subjects with unclear diagnosis and of reporting new molecular diagnosis especially in case of rare mutations.
Severe Hepatopulmonary Syndrome in a Child with Caroli Syndrome
Authors: W De Jesus-Rojas, K McBeth, A Yadav, J M Stark, R A Mosquera, C Jon
Journal: Case Rep Pediatr (2017)
MeSH terms: Case Reports

Hepatopulmonary Syndrome (HPS) is a potential complication of chronic liver disease and is more commonly seen in the adult population. Caroli Syndrome is a rare inherited disorder characterized by intrahepatic ductal dilation and liver fibrosis that leads to portal hypertension. In children with liver disease, HPS should be considered in the differential diagnosis of prolonged, otherwise unexplained, hypoxemia. The presence of HPS can improve patient priority on the liver transplantation wait list, despite their Pediatric End-Stage Liver Disease (PELD) score. We present a 6-year-old girl with Caroli Syndrome and End-Stage Renal Disease who presented with persistent hypoxemia. The goal of this report is to increase awareness of HPS in children.
A Case Report on Management of Father Daughter Incest with Schizophrenia
Authors: Tanjir Rashid Soron
Journal: Case Rep Psychiatry (2016)

Incest is a neglected and hidden public health problem. This case is about a patient who was victim of sexual abuse, suffered from schizophrenia and abused his biological daughter. He was physically and sexually abused by seniors and classmates, developed paranoid delusion and auditory hallucination. During the course of the illness, he was hospitalized several times as a case of schizophrenia and sexual dysfunction was his main concern. The patient's illness followed a waxing and waning course. He took medication on on-and-off basis. He abused his biological daughter sexually at the later stage of the illness. Ultimately, the patient attempted suicide after an indecent sexual act with another relative and he was admitted to the hospital. He was treated with risperidone that was titrated to 10 mg per day. After continuing the medication for 2 years he regained a functioning life and remained stable with medication. This case shows the importance of exploring the sexual behavior of the patients and sharing the experience may help in the treatment of schizophrenia patients with incest.
A Case of Bilateral Spontaneous Chylothorax with Respiratory Syncytial Virus Bronchiolitis
Authors: Mario Briceno-Medina, Michael Perez, Jie Zhang, Ronak Naik, Samir Shah, Dai Kimura
Journal: Case Rep Pediatr (2019)
MeSH terms: Case Reports

A case of bilateral spontaneous chylothorax with respiratory syncytial virus (RSV) bronchiolitis has never been reported. We report the case of a 7-month-old boy born at 33 weeks gestation with a history of Down syndrome, atrial septal defect, pulmonary hypertension, and chronic lung disease, hospitalized due to RSV bronchiolitis who developed bilateral spontaneous chylothorax with exacerbation of pulmonary hypertension (PH). The patient died after 9 weeks of mechanical ventilation and treatment for PH. The autopsy showed acute infectious signs, a chronic interstitial lung disease with pulmonary hypertensive changes and subpleural cysts with no evidence of congenital lymphangiectasia. The cause of chylothorax in this child could be multifactorial. However, worsening pulmonary hypertension with RSV infection might have partially contributed to the development of chylothorax through elevated superior venous cava pressure. Thoracentesis should be considered for patients with Down syndrome and PH associated with congenital heart disease who develop persistent pleural effusion during RSV bronchiolitis to rule out chylothorax.
Surgical implantation of a biventricular pacing system via lower half mini sternotomy
Authors: Morteza Tavakkoli Hosseini, Aron Frederik Popov, Antonios Kourliouros, Mazin Sarsam
Journal: J Cardiothorac Surg (2013)
MeSH terms: Cardiac Resynchronization Therapy / methods, Minimally Invasive Surgical Procedures / methods, Sternotomy / methods, Case Reports, Endocardium / microbiology, Humans, Male, Middle Aged, Pacemaker, Artificial, Staphylococcal Infections / etiology, Staphylococcus aureus / isolation & purification

We present a case of surgical implantation of biventricular epicardial pacing leads and a defibrillating patch via lower half mini sternotomy. Although median sternotomy is routinely used for this purpose, lower half mini sternotomy could provide the surgeon with the same surgical field exposure and a faster post operative recovery.
Toxic anterior segment syndrome after foldable artiflex iris-fixated phakic intraocular lens implantation
Authors: Lucien A M van Philips
Journal: J Ophthalmol (2011)
MeSH terms: Case Reports

Toxic anterior segment syndrome (TASS) developed in four cases after uneventful implantation of a foldable iris-fixated phakic intraocular lens (pIOL). Two cases occurred sequentially in one patient. The TASS subsided without complications in all cases after intensive topical steroid treatment. A multitude of possible causes is considered for the occurrence of these TASS cases. From the sterilization and cleaning of surgical instruments to the possibility of endotoxines in ophthalmic viscosurgical devices (OVD). These rare cases should alert the surgeon to the possibility of TASS after pIOL implantation.