OpenMed/multicare-articles huggingface dataset:
Bupropion Maintenance Treatment in Refractory Bipolar Depression: A Case Report
Authors: Julia Dehning, Heinz Grunze, Armand Hausmann
Journal: Clin Pract Epidemiol Ment Health (2017)
Keywords: bipolar disorder, bupropion, depression, guidelines, maintenance treatment, teas

Background:
The optimal duration of antidepressant treatment in bipolar depression appears to be controversial due to a lack of quality evidence, and guideline recommendations are either vague or contradictive. This is especially true for second line treatments such as bupropion that had not been subject to rigourous long term studies in Bipolar Disorder.
Case presentation:
We report the case of a 75 year old woman who presented with treatment refractory bipolar depression. Because of insufficient response to previous mood stabilizer treatment and refractory depressive symptoms, bupropion was added to venlafaxine and lamotrigine. From there onwards, the patient improved continuously without experiencing deterioration of depression or a switch into hypomania. Our patient being on antidepressants for allmost four years experienced an obvious benefit from longterm antidepressant administration.
Conclusion:
Noradrenergic/dopaminergic mechanisms of action may play a more prominent role in bipolar depression, and may still be underused as a therapeutic strategy in the acute phase as well as in long-term maintenance in at least a subgroup of bipolar patients. There is still a lack of evidence from RCTs, but this case report further supports antidepressant long-term continuation and the usefulness of a noradrenergic/dopaminergic antidepressant in the acute and maintenance treatment of bipolar disorder.
Spontaneous Loculated Pneumomediastinum in a COVID-19-Infected Patient
Authors: Sirous Jafari, Zahra Jahani, Reihane Alikhani, SeyedAhmad SeyedAlinaghi, Malihe Hasannezhad, Faeze Salahshour, Ali Asadollahi-Amin
Journal: Case Rep Infect Dis (2022)
MeSH terms: Case Reports

While we are still learning about COVID-19 affecting people, older persons and persons with underlying diseases such as high blood pressure, heart disease, and diabetes mellitus (DM) appear to develop serious illness and more complications often than others. In this report, we presented a patient with spontaneous pneumomediastinum after COVID-19. The patient was a 61-year-old man with a history of DM, hypertension, and heart failure, who has been infected with COVID-19. The patient was diagnosed with COVID-19 based on RT-PCR analysis of nasopharyngeal samples, and chest X-ray showed patchy infiltration upper and lower lobes bilaterally. By day 4, imaging was repeated, performed due to exacerbation of pleuritic chest pain, decreased O2 saturation (80%), and coughing that revealed multiple ground-glass opacities bilaterally, and interlobular septal thickening with emphysema in most of the left upper lobe and a small part of right upper lobe which led to severe spontaneous left pneumomediastinum and parenchymal consolidation was also observed. The combination of a chest tube, antibiotics (vancomycin 1 gr/bid and meropenem 1 g/bid), and antiviral (hydroxychloroquine 200 mg/bid and atazanavir 300 mg/daily) was prescribed, and continued treatment with antiviral and appropriate care for pneumomediastinum was successful. Spontaneous pneumomediastinum in the context of COVID-19 should be considered as a prognostic factor in favor of worsening diseases.
Case Report: TNF-Alpha Inhibitors to Rescue Pregnancy in Women With Potential Pregnancy Loss: A Report of Ten Cases
Authors: Zixing Zhong, Yuhan Wang, Guiqin Wang, Feifei Zhou
Journal: Front Immunol (2022)
Keywords: tnf – α, tnfi, case series, hcg (human chorionic gonadotrophin), miscarriage, pregnancy-rescue management
MeSH terms: Abortion, Habitual / drug therapy, Tumor Necrosis Factor-alpha, Case Reports, Research Support, Non-U.S. Gov't, Chorionic Gonadotropin / therapeutic use, Female, Humans, Infant, Newborn, Pregnancy, Pregnancy Trimester, First, Tumor Necrosis Factor Inhibitors, Chorionic Gonadotropin, Tumor Necrosis Factor Inhibitors, Tumor Necrosis Factor-alpha

Miscarriage poses a significant threat to pregnant women globally. Recurrent miscarriages or potential poor embryonic development indicated by early drops in serum human chorionic gonadotrophin (hCG) are even more catastrophic for pregnant women. However, these patients receive either individualized medical intervention supported by limited evidence or no treatment at all. In this study, we report ten patients who shared at least one episode of an early decline of hCG in the first trimester and were treated with compassionate use of tumor necrosis factor-alpha inhibitor (TNFi). They were then followed up regularly with caution. Their hCG trajectory all resumed a normal pattern within one week and the obstetric outcomes were promising. No adverse fetal, neonatal, or maternal health issues have been observed. This case series supports current safety evidence of TNFi and provides new insight into its use in pregnancy when the embryo is in danger. Further well-designed clinical trials should be carried out to consolidate the evidence.
Case Report: An Unusual Case of Ectopic ACTH Syndrome Caused by Mediastinal Paraganglioma
Authors: Bo Li, Zhe Yan, Hui Huang
Journal: Front Endocrinol (Lausanne) (2022)
Keywords: cushing’s syndrome, pet/ct, ectopic acth syndrome, mediastinal, paraganglioma
MeSH terms: ACTH Syndrome, Ectopic / diagnosis, Cushing Syndrome / diagnosis, Mediastinal Neoplasms / diagnosis, Paraganglioma, Extra-Adrenal / diagnosis, Case Reports, Research Support, Non-U.S. Gov't, ACTH Syndrome, Ectopic / complications, Adult, Cushing Syndrome / etiology, Diagnostic Techniques, Endocrine, Humans, Magnetic Resonance Imaging, Male, Mediastinal Neoplasms / complications, Mediastinal Neoplasms / pathology, Mediastinal Neoplasms / surgery, Paraganglioma, Extra-Adrenal / complications, Paraganglioma, Extra-Adrenal / pathology, Paraganglioma, Extra-Adrenal / surgery, Positron Emission Tomography Computed Tomography, Tomography, X-Ray Computed

Ectopic adrenocorticotrophic hormone (ACTH) syndrome is not common, which is more unusual when caused by paraganglioma. We herein present a 40-year-old Chinese male who was diagnosed with ACTH-dependent Cushing's syndrome. However, the localization of the ACTH source was troublesome due to the inconsistent results of the high-dose dexamethasone suppression test and the desmopressin stimulation test. Bilateral inferior petrosal sinus sampling was performed, and ectopic ACTH syndrome was diagnosed. After 68Ga-DOTATATE-PET/CT and 18F-FDG-PET/CT were performed, it was localized in the anterior mediastinum. Post-operation histopathology demonstrated an ACTH-secreting mediastinal paraganglioma. The patient obtained complete clinical remission after a mediastinal tumorectomy.
Development of Asymmetric Facial Depigmentation in a Patient Treated with Dasatinib with New-Onset Hypovitaminosis D: Case Report and Review of the Literature
Authors: Kirsten C Webb, Magdalena Harasimowicz, Monica Janeczek, Jodi Speiser, James Swan, Rebecca Tung
Journal: Case Rep Dermatol Med (2017)
MeSH terms: Case Reports

Dasatinib is a second-generation tyrosine kinase inhibitor (TKI) used to treat imatinib-resistant chronic myelogenous leukemia (CML), as well as other Philadelphia chromosome-positive lymphoproliferative disorders. While the most commonly reported cutaneous side effects with this therapy include a morbilliform eruption, skin exfoliation, and skin irritation, pigmentary abnormalities have also been observed, albeit much more rarely. We present the case of a 72-year-old South Asian male with CML who presented with new-onset hypopigmentation of his face and scalp three years after a dose increase of dasatinib therapy, in the setting of newly discovered borderline hypovitaminosis D. Dasatinib and the other TKIs are believed to induce dyschromias via modulation of the c-kit receptor and its associated signaling pathway, which is involved in melanocyte survival, proliferation, and migration.
A New Appliance for Class III Treatment in Growing Patients: Pushing Splints 3
Authors: Stefano Martina, Roberto Martina, Lorenzo Franchi, Vincenzo D'Antò, Rosa Valletta
Journal: Case Rep Dent (2019)
MeSH terms: Case Reports

Several orthopedic procedures have been used in early treatment to reduce the need for orthognathic surgery in skeletal Class III. The most used treatment is Rapid Maxillary Expansion and Facemask. This procedure also determines a clockwise rotation of the mandible, increasing the vertical dimensions of the lower third of the face. Therefore, the control of vertical dimension appears to be a key objective in Class III hyperdivergent patients. This article shows two skeletal Class III patients treated with a new appliance (Pushing Splints 3), that is able to correct sagittal discrepancy with a good control of the vertical growth. In both cases, Class I relationship with a proper Overjet and Overbite was achieved with improvement of profile. The final cephalometric values demonstrated a stable sagittal relationship and a good control of the vertical growth. The specific biomechanic features of the PS3 appliance permit the improvement of the sagittal jaw relationship, delivering at the same time vertical vectors that are able to control the alveolar and skeletal components of the vertical growth. This could be useful in the treatment of Class III hyperdivergent patients.
Ultrasound in Rheumatologic Interstitial Lung Disease: A Case Report of Nonspecific Interstitial Pneumonia in Rheumatoid Arthritis
Authors: A Laria, A Lurati, M Scarpellini
Journal: Case Rep Rheumatol (2015)

According to the American Thoracic Society (ATS)/European Respiratory Society consensus classification, idiopathic interstitial pneumonias (IIPs) include several clinic-radiologic-pathologic entities: idiopathic pulmonary fibrosis (IPF), usual interstitial pneumonia (UIP), nonspecific interstitial pneumonia (NSIP), cryptogenic organizing pneumonia, acute interstitial pneumonia, respiratory bronchiolitis-associated ILD, desquamative interstitial pneumonia, and lymphoid interstitial pneumonia. Ultrasound Lung Comets (ULCs) are an echographic chest-sonography hallmark of pulmonary interstitial fibrosis. We describe the ultrasound (US) findings in the follow-up of a NSIP's case in rheumatoid arthritis (RA).
Minimally Invasive SPML Surgery for Children with Cerebral Palsy: Program Development
Authors: Dana L Wild, Caroline W Stegink-Jansen, Christine P Baker, Kelly D Carmichael, David A Yngve
Journal: Minim Invasive Surg (2020)

Improvements in surgical and rehabilitation care are critical to lessen the burden of cerebral palsy (CP), the most common cause of severe physical disability in childhood. The selective percutaneous myofascial lengthening (SPML) surgical procedure is a minimally invasive method designed to improve ambulation by lengthening contracted musculoskeletal tissues. Information on surgical procedures, efficacy, and safety of SPML for children with CP is lacking. Phase 1 of our research is a "proof-of-principle" study for multisite SPML to improve functional mobility of children with CP, and Phase 2 assesses safety, reoperation rates, and efficacy over time in subsequent patient series. Phase 1 was a repeated measurement case series study of 17 children (mean age 7.6 years). One physical therapist, blinded to the surgeon's measurements, measured bilateral knee and ankle motion before and after SPML procedures, using video recordings of a standardized gait path. Functional Mobility Scale (FMS) 5, 50, and 500 outcomes were taken pre- and postoperatively and via telephone follow-up. In Phase 2, multisite SPLM surgeries were implemented in larger successive cohorts from 2006 to 2017. Complications, reoperation rates, and efficacy were retrospectively analyzed. Phase 1 results showed improvement in the children's knee and ankle motion while ambulating and improved FMS 5, 50, and 500 outcomes postoperatively (mean, 6.3 months). At second follow-up (mean 33.3 months), FMS 500 scores continued improvement, while FMS 5 and FMS 50 scores maintained. During Phase 2, the complication rate was 2.4%, and reoperation rates (including reoperations due to maturation) were between 8% and 13%. Improvements to correct ankle equinus were recorded in 498 cases. In conclusion, in a specialized center, single-event, multilevel SPML surgeries of children with CP safely improved ambulatory knee and ankle angle motion and daily mobility outcomes. Future educational studies of training needs for surgeons new to the approach are needed.
Laparoscopic paraduodenal hernia repair with bioabsorbable mesh: A case of a novel technique for a rare cause of bowel obstruction
Authors: Bianca Kwan, Jane E Theodore, Jason Wong
Journal: Int J Surg Case Rep (2020)
Keywords: bioabsorbable mesh, case report, internal hernia, paraduodenal hernia, paraduodenal hernia repair
MeSH terms: Case Reports

Introduction:
Paraduodenal hernias are the most common type of internal hernia but a rare cause of bowel obstruction. Given the high risk of incarceration, obstruction and associated mortality, surgical repair is recommended.
Presentation of case:
We present a novel technique for laparoscopic repair of paraduodenal hernia using biosynthetic mesh to reinforce suture closure of the hernia defect. An 18-year-old healthy female presented with symptoms of recurrent subacute small bowel obstruction and right paraduodenal hernia was diagnosed on computed tomography (CT). Laparoscopic repair was performed with reinforcement of suture repair with GORE® BIO-A® Hiatal Tissue Reinforcement to decrease the risk of recurrence. The patient had an uneventful recovery and was discharged on the second post-operative day. Subsequent follow-up revealed complete resolution of symptoms.
Discussion:
Biosynthetic tissue reinforcement carries a lower theoretical risk of erosion than permanent mesh. A hiatal-shaped prosthesis represents a suitable shape for paraduodenal hernia repair.
Conclusion:
We present the first reported use of bioabsorbable mesh to repair paraduodenal hernia. This technique may minimise risk of mesh erosion and can be considered a safe and effective approach where suture repair is inadequate due to large defect size.
Cutaneous mastocytosis. Getting beneath the skin of the issue: a case report
Authors: Parag M Tamhankar, Jyoti Suvarna, Chandrahas T Deshmukh
Journal: Cases J (2009)

An eleven month old girl presented with chronic urticaria since three months of age. There was a generalised hyperpigmented maculo-papular rash. Darier sign was positive. The skin biopsy showed plenty of spindle shaped mast cells with eosinophilic cytoplasm infiltrating the dermis and the appendiceal structures. The diagnosis of cutaneous mastocytosis (urticaria pigmentosa) was made. The child received symptomatic relief with chronic oral hydroxyzine and ranitidine therapy. Automated epinephrine self-injectors usually prescribed in this condition for self-management of anaphylactic episodes were not available. Intramuscular administration of (1:1000) diluted adrenaline via a disposable tuberculin syringe was taught to the mother. A medical bracelet containing her diagnosis and instructions in emergency was custom-made for her.
Generalized Anxiety Disorder in Very Young Children: First Case Reports on Stability and Developmental Considerations
Authors: Michael S Scheeringa, Lauren C Burns
Journal: Case Rep Psychiatry (2018)
MeSH terms: Case Reports

Generalized anxiety disorder (GAD) is purported to start in early childhood but concerns about attenuation of anxiety symptoms over time and the development of emerging cognitive and emotional processing capabilities pose multiple challenges for accurate detection. This paper presents the first known case reports of very young children with GAD to examine these developmental challenges at the item level. Three children, five-to-six years of age, were assessed with the Diagnostic Infant and Preschool Assessment twice in a test-retest reliability study. One case appeared to show attenuation of the worries during the test-retest period based on caregiver report but not when followed over two years. The other two cases showed stability of the full complement of diagnostic criteria. The cases were useful for demonstrating that the current diagnostic criteria appear adequate for this developmental period. The challenges of accurate assessment of young children that might cause missed diagnoses are discussed. Future research on the underlying dysregulation of negative emotionality and long-term follow-ups are needed to better understand the etiology, treatment, and course of GAD in this age group.
Severe Thrombocytopenic Purpura in a Child with Brucellosis: Case Presentation and Review of the Literature
Authors: Alexandros Makis, Aikaterini Perogiannaki, Nikolaos Chaliasos
Journal: Case Rep Infect Dis (2017)
MeSH terms: Case Reports

Brucellosis is still endemic and a significant public health problem in many Mediterranean countries, including Greece. It is a multisystemic disease with a broad spectrum of clinical manifestations including hematological disorders, such as anemia, pancytopenia, leucopenia, and thrombocytopenia. Thrombocytopenia is usually moderate and attributed to bone marrow suppression or hypersplenism. Rarely, autoimmune stimulation can cause severe thrombocytopenia with clinically significant hemorrhagic manifestations. We present the case of a girl with severe thrombocytopenic purpura as one of the presenting symptoms of Brucella melitensis infection. Treatment with intravenous immunoglobulin and the appropriate antimicrobial agents promptly resolved the thrombocyte counts. A review of similar published cases is also presented.
Posterior Interosseous Nerve Syndrome Resulting from Parosteal Lipoma of the Proximal Radius: An Elusive Diagnosis Yet Excellent Outcome
Authors: Muhammad Saaiq, Saad Siddiui
Journal: World J Plast Surg (2017)
Keywords: parosteal lipoma, posterior interosseous nerve, posterior interosseous nerve syndrome
MeSH terms: Case Reports

A 53-year old man presented with seven months history of progressive weakness of extension of the digits and the thumb of the left hand. The wrist extension was normal and sensations were also intact. The patient had also been noticing a progressively enlarging lump on the lower anterolateral aspect of the left antecubital fossa for the last three months. Physical examination andelectro diagnostic studies revealed motor deficit along the posterior interosseous nerve (PIN) distribution with preservation of sensations. Also a soft tissue solitary lump (measuring 6×5 cm in its greatest dimensions) was palpable in the left antecubital fossa. The magnetic resonance imaging (MRI) of the forearm revealed a well-defined, non-enhancing, homogenous, fat intensity lesion in the left antecubital fossa, attached to the proximal radius. The patient underwent surgical excision of the lump with decompression of the PIN in the radial tunnel. Histopathology confirmed the diagnosis of parosteal lipoma. Although the diagnosis was elusive at the very outset, yet prudent clinical judgment, appropriate ancillary investigations and timely surgical intervention resulted in optimal functional recovery of the hand drop. There was complete motor recovery at 4-months follow up with no recurrence of the lipomaafter one year.
Ectopic intranasal canine tooth in a child: A rare case report and literature review
Authors: Abdulaziz AlMulhim, Ali AlMomen, Abdulrahman AlKhatib
Journal: Int J Surg Case Rep (2019)
Keywords: ectopic tooth, inferior turbinate, nasal obstruction, nasal tooth

Introduction:
Intranasal teeth are a rare form of ectopic teeth. Their clinical manifestation are truly variable. In children, intranasal teeth are typically associated with cleft lip and alveolus.
Presentation of case:
Here, we report a case of 11 years -old girl presented with right nasal obstruction and occasional headache without any obvious etiology. 0Computed tomography of the paranasal sinuses (coronal and axial view) revealed displaced right upper maxillary tooth with the crown oriented inferiorly and medially toward and within the lower right anterior nasal cavity. She underwent surgery by anterior rhinoscopy and endoscopic guidance. The patient's symptoms were resolved completely post-operatively and remained symptom-free for 18 months postoperatively.
Discussion:
Ectopic intranasal tooth is a rare phenomenon, with a male predominance and around half of all patients are diagnosed before adulthood. Ectopic intranasal tooth arising from inferior turbinate is very rare. No clear etiological factor has been suggested in most of the reported cases. Idiopathic etiology has been described as an etiologic factor for ectopic teeth. The treatment of intranasal teeth is early surgical extraction to alleviate the symptoms and prevent the possible morbidities.
Conclusion:
Intranasal teeth are a rare form of ectopic teeth encountered to otolaryngology clinic and may cause a variety of symptoms and complications. CT is very useful; it confirms the diagnosis and facilitates surgical planning. Early diagnosis and treatment are very important to avoid their possible complications.
Localized subacute thyroiditis presenting as a painful hot nodule
Authors: Lian-Xi Li, Xing Wu, Bing Hu, Hui-Zhen Zhang, Han-Kui Lu
Journal: BMC Endocr Disord (2014)

Background:
A diagnosis of subacute thyroiditis is readily considered when patients present with a particular set of typical clinical characteristics. Subacute thyroiditis sometimes presents as a solitary cold nodule; however, the presence of a hot nodule in patients with subacute thyroiditis is exceedingly rare.
Case presentation:
Here, the case of a 57-year-old woman complaining of pain in the left neck and fatigue for two weeks is presented. Physical examination revealed a painful and tender nodule with a diameter of approximately 1.5 cm in the left neck, although all laboratory tests, including white blood cell count, neutrophil percentage, erythrocyte sedimentation rate (ESR), thyroid function, and thyroglobin levels, were normal. A neck ultrasound revealed a hypoechoic mass (1.5 × 0.8 cm) in the left thyroid, and thyroid scintigraphy of the left thyroid with Technetium-99 m (99 m-Tc) demonstrated a focal accumulation of radiotracer. Furthermore, fine-needle aspiration biopsy from the nodule revealed the presence of multinuclear giant cells. The patient was well; there was no cervical mass detected upon palpation following two months of prednisone treatment, and follow-up ultrasound screening and scintigraphy demonstrated the disappearance of the nodule.
Conclusion:
This case, presenting with a localized painful hot nodule, normal thyroid function, normal ESR, and normal serum thyroglobulin levels, is a rare case of subacute thyroiditis, which should be considered during differential diagnosis.
Creutzfeldt-Jakob Disease Presenting as Nonconvulsive Status Epilepticus
Authors: Aleksei Rakitin, Riina Vibo, Vaiko Veikat, Anne Õunapuu, Aive Liigant, Sulev Haldre
Journal: Case Rep Neurol Med (2018)
MeSH terms: Case Reports

Creutzfeldt-Jakob disease is a rare, rapidly progressive spongiform encephalopathy in humans. EEG plays an important role in diagnosing this disease. In some patients, epileptic activity and encephalopathy from various aetiologies may share morphological features on EEG. This similarity could create difficulties in EEG interpretation, especially if the patient presents with disturbed consciousness. In this case report, a 74-year-old female with Creutzfeldt-Jakob disease presented initially with rapidly progressive impairment of consciousness and focal epileptiform activity on EEG. An EEG performed 25 days later showed periodic sharp-wave complexes with triphasic morphology at a rate of 0.5 Hz, compatible with a diagnosis of Creutzfeldt-Jakob disease. Based on these results, we recommend that a diagnosis of Creutzfeldt-Jakob disease be considered in patients presenting with a rapid deterioration of consciousness and a clinical presentation of nonconvulsive status epilepticus. Monitoring these patients with serial EEGs could be useful to establish an accurate diagnosis.