OpenMed/multicare-articles huggingface dataset:
Case Report: Resolution of chronic urticaria following treatment of odontogenic infection
Authors: Susan Tadros, Sameer Bahal, Vasantha Nagendran
Journal: F1000Res (2018)
Keywords: chronic spontaneous urticaria, dental infection
MeSH terms: Angioedema, Urticaria, Case Reports, Chronic Disease, Histamine Antagonists, Humans, Jaw Diseases, Male, Omalizumab, Young Adult, Histamine Antagonists, Omalizumab

Background: Chronic spontaneous urticaria (CSU) is a condition characterised by the presence of hives with/without angioedema, that affects individuals on more days than not for 6 weeks or more. The role of infection as a potential trigger for CSU is well described, but the current clinical guidelines do not recommend routine screening for underlying infections. Main observations: We report a case of severe prolonged chronic spontaneous urticaria in a 19-year-old, that went into rapid remission following the treatment of dental infection. Conclusions: Clinicians should recognise the potential role that infection can have in causing chronic urticaria. There should be a low threshold to treat infection in such circumstances.
Bradycardia in Recent Heart Transplant: Will the Microscope Illuminate the True Answer?CME
Authors: Amit Alam, Philip F Halloran, Christo Mathew, Samreen Fathima, Alexia Ghazi, Parag Kale, Shelley A Hall
Journal: Methodist Debakey Cardiovasc J (2021)
Keywords: allograft rejection, endomyocardial biopsy, molecular microscope
MeSH terms: Bradycardia / diagnosis, Bradycardia / etiology, Bradycardia / therapy, Heart Transplantation / adverse effects, Case Reports, Artificial Intelligence, Biopsy, Graft Rejection, Humans, Myocardium

Transplant recipients are at risk of developing rejection that may cause significant morbidity and mortality following transplantation The clinical presentation of rejection may be atypical, leading to difficulties in diagnosis and management especially in cases with a nondiagnostic biopsy specimen. The emergence of artificial intelligence may aid in clinical decision making when traditional techniques are inconclusive.
A case of a large solitary fibrous tumour of the uterine cervix
Authors: Andrzej Nowakowski, Wojciech Kozłowski, Dariusz Włodarczyk, Marta Szajnik-Szczepański, Włodzimierz Baranowski
Journal: BMC Womens Health (2014)
MeSH terms: Solitary Fibrous Tumors / diagnosis, Uterine Cervical Neoplasms / diagnosis, Case Reports, Female, Humans, Hysterectomy, Immunohistochemistry, Middle Aged, Solitary Fibrous Tumors / surgery, Tomography, X-Ray Computed, Uterine Cervical Neoplasms / surgery

Background:
Solitary fibrous tumour of the uterine cervix is an extremely rare phenomenon. We present a case of the largest cervical tumour of this type in this anatomical location reported so far.
Case presentation:
A 45-year old white female presented with abdominal pain, abnormal uterine bleedings and a 15 cm mass of the uterine cervix/left parametrium. Histological examination with immunohistochemistry of the tumour biopsy revealed diagnosis of solitary fibrous tumour. The patient underwent radical abdominal hysterectomy with bilateral salpingo-oophorectomy and pelvic lymphadenectomy. No recurrence has been observed for 8 months of follow-up.
Conclusions:
Solitary fibrous tumour can be occasionally found in patients with large cervical/parametrial masses. Immunohistochemistry was helpful in diagnosis and surgery was feasible and effective in treatment of our case of a large solitary fibrous tumour of the cervix.
"I tried so many diets, now I want to do it differently" - A single case study on coaching for weight loss
Authors: Reinhard Stelter
Journal: Int J Qual Stud Health Well-being (2015)
Keywords: health coaching, case study, diet, life style change, meaning making, obesity, overweight, physical activity, weight loss
MeSH terms: Counseling / methods, Diet / psychology, Feeding Behavior / psychology, Health Behavior, Life Style, Weight Loss, Case Reports, Adult, Denmark, Female, Humans, Surveys and Questionnaires

In this single case study, the author presented an in-depth description and analysis of a coaching intervention with focus on weight loss, conducted over 10 sessions in the course of 17 months. The client was a well-educated woman in her late 30s, who had tried many different forms of dieting over the years-with little and no lasting effect. In his coaching approach, the author went beyond a pure behavioural change model, that is, based on the Health Belief Model, and tried to take a whole-life perspective, where the client learned to link specific events and habits in her work life and everyday life with specific eating habits. In their collaborative practice, coach and coachee initiated changes both in regard to diet, physical activity, and healthy life style, in general. In a theoretical section, the change in understanding with regard to overeating was presented. Finally, an intra-active model-viewing the client as a self-reflective individual-was used as theoretical basis. A narrative analysis of the first session and a cross-session examination was presented to show, analyse, and understand the procedure of the coaching approach. Finally, the voice of the coachee was heard in regard to her personal experiences during the process. The data material was based on audio recordings of selected sessions, notes written by the coach from every session, and final written reflections by the coachee.
Efficacy Analysis of the Reinforcing and Circulation-Promoting Protocol of Acupuncture and Moxibustion in Treatment of Twenty-Four Patients with Refractory Chronic Low Back Pain
Authors: Jincao Zhou, Jingjing Wang, Zhongjie Chen, Mozheng Wu, Yue Jiao, Liyun He
Journal: Evid Based Complement Alternat Med (2022)

Objectives:
The purpose of this study was to observe the clinical efficacy of the reinforcing and circulation-promoting protocol of acupuncture and moxibustion in treatment of refractory chronic low back pain, analyze therapeutic principles to obtain treatment efficacy, and develop new therapeutic principles to treat chronic low back pain.
Methods:
Twenty-four patients from the registry of patients suffering from refractory chronic low back pain were invited to our self-controlled case series, which was conducted in "real-world" settings. We implemented the reinforcing and circulation-promoting protocol of acupuncture and moxibustion to treat these patients and used the Visual Analogue Scale (VAS) and the Oswestry Disability Index (ODI) as the observation indices.
Results:
All 24 patients completed the treatment of acupuncture and moxibustion. The VAS of low back pain was 6.83 ± 2.18 before treatment and 2.13 ± 1.45 after treatment. The difference before and after treatment was significant (P < 0.001). The ODI was 28.21 ± 13.06 before treatment and 16.63 ± 7.20 after treatment. Their difference before and after treatment was significant (P < 0.001).
Conclusion:
The reinforcing and circulation-promoting protocol of acupuncture and moxibustion is effective in treating refractory chronic low back pain mainly because low back pain can be significantly relieved and motor function can be promoted. This trial was registered with AMCTR-OOO-17000045 (3 December 2016).
Overlap Syndrome Involving Systemic Lupus Erythematosus and Autoimmune Hepatitis in Children: A Case Report and Literature Review
Authors: Wan-Tz Lai, Wan-Hua Cho, Hock-Liew Eng, Ming-Hui Kuo, Fu-Chen Huang
Journal: Front Pediatr (2019)
Keywords: autoimmune hepatitis, childhood, jaundice, overlap syndrome, systemic lupus erythematosus
MeSH terms: Case Reports

Background: The diagnosis of overlap syndrome involving systemic lupus erythematosus (SLE) and autoimmune hepatitis (AIH) is not easily established because of its similar clinical presentations and biochemical features to those of lupus hepatitis. The term overlap syndrome is usually used in the context of overlap of autoimmune hepatitis with PSC (primary sclerosing cholangitis) or PBC (primary biliary cholangitis). Few cases of AIH complicated by SLE have been reported in the literature, and the condition is even rarer in childhood. Case presentation: Here we report the case of a 16-year-old girl with SLE who initially presented with autoimmune (cholestatic) hepatitis. According to American Association for the Study of Liver Diseases practice guidelines, the diagnosis was made based on aggregated scores including female (+2); ALP:AST (or ALT) ratio <1.5(+2); elevated serum IgG level(+3); ANA > 1:80 (+3); negative hepatitis viral markers and drug history (+3, +1); average alcohol intake <25 g/day (+2); and histological interface hepatitis features (+3). She then developed a malar rash, ANA positivity, anti-double-stranded DNA (anti-dsDNA) antibodies, and a low complement level. She met 4 of 17 Systemic Lupus International Collaborating Clinics classification criteria (1) for SLE. Our patient responded very well to corticosteroid at an initial dose of methylprednisolone 40 mg Q12H for 4 days tapering to 1 mg/kg/day according to liver function test results and bilirubin level. No relapse occurred during the 3-year follow-up course. Conclusions: Overlapping of SLE and AIH should be suspected when children with SLE have impaired liver function or AIH patients present with a malar or other skin rash. Liver biopsy plays an important role in establishing the differential diagnosis of SLE with liver impairment or overlap with AIH. The prompt diagnosis and adequate further treatment plans can improve disease outcomes.
Case report: Changes in defense mechanisms, personality functioning, and body mass index during psychotherapy with patients with anorexia nervosa
Authors: Ciro Conversano, Mariagrazia Di Giuseppe, Vittorio Lingiardi
Journal: Front Psychol (2023)
Keywords: body mass index, defense mechanisms, eating disorders, personality, psychotherapy
MeSH terms: Case Reports

Eating disorders (EDs) are difficult to treat in psychotherapy due to their pervasive symptomatology and frequent and rapid relapses. Restrictive anorexia nervosa (AN) is the most challenging ED, often associated with severe physical and mental conditions. Perceived as an ego-syntonic syndrome that somehow protects the patient from a number of developmental tasks, treating AN requires extensive multidisciplinary long-term intervention. As with other emotion regulation strategies, defense mechanisms mediate an individual's reaction to internal or external stressors, including those related to ED conditions. Improving defensive functioning adaptiveness predicts psychotherapy outcomes and is an essential component of the therapeutic process. In this study, we qualitatively described changes in the use of defense mechanisms, personality functioning (PF), and body mass index (BMI) in two patients with severe AN in treatment with intense dynamic psychotherapy. Changes in personality functioning and defense mechanisms were periodically assessed every 6 months using clinician report measures such as the Shedler-Westen Assessment Procedure-200 (SWAP-200) and the Defense Mechanisms Rating Scales Q-sort (DMRS-Q), respectively. BMI was also monitored throughout the treatment. A qualitative description of the patient's defensive profile and the quantitative score on all ranges of defense mechanisms were used for studying changes in patients' use of defenses during the treatment and relationships between defenses and outcome indexes. Personality and defensive functioning improved after 1 year of intense dynamic psychotherapy, independently from BMI improvement. All outcome indexes dramatically decreased before a scheduled interruption of the treatment, underling that an integrated therapeutic approach is essential for improving and eventually orienting toward complete ED symptoms remission. Long-term dynamic psychotherapy fosters self-awareness of psychological distress and enhances more mature ways of coping. Monitoring changes in personality and defense mechanisms helps in understanding patients' reactions to stressful life events and in developing specific therapeutic interventions.
High Urinary Sodium Concentrations in Severe SIADH: Case Reports of 2 Patients and Literature Review
Authors: Lynette Mei Yi Lee, Sarah Ying Tse Tan, Wann Jia Loh
Journal: Front Med (Lausanne) (2022)
Keywords: siadh literature review, case report, cerebral salt wasting (csw), hyponatremia, syndrome of inappropriate antidiuretic hormone (siadh), traumatic brain injury, urinary sodium
MeSH terms: Case Reports

We present two cases of severe hyponatremia secondary to syndrome of inappropriate secretion of antidiuretic hormone (SIADH) with very high urine sodium concentrations (>130 mmol/L). The first patient had hyponatremia from traumatic brain injury (TBI) while the second case had a history of recurrent SIADH triggered by various causes including gastritis. In both cases, fluid administration and/or consumption worsened the hyponatremia. Although a low urine sodium of <30 mmol/L is highly suggestive of hypovolemic hyponatremia and good response to saline infusion, there is lack of clarity of the threshold of which high urine sodium concentration can differentiate various causes of natriuresis such as SIADH, renal or cerebral salt wasting. Apart from high urine osmolality (>500 mOsm/kg), persistence of high urine sodium concentrations may be useful to predict poor response to fluid restriction in SIADH. More studies are needed to delineate treatment pathways of patients with very high urine osmolality and urine sodium concentrations in SIADH.
Case Report: Pre- and postnatal management of an allantoic cyst with patent urachus and single umbilical artery
Authors: Than Trong Thach, Vo Duy Quan, Tran Diem Nghi, Nguyen Hoang Anh, Le Phi Hung, Nguyen Thien Luan, Nguyen Phuoc Long
Journal: F1000Res (2015)
Keywords: allantoic cyst, patent urachus, single umbilical artery

Patent urachus is a rare congenital abnormality. Since its first description by Cabriolus in 1550, few cases have been reported. A 26-year-old Vietnamese primigravida presented at 20 weeks of gestation for evaluation of a cystic mass in the umbilical cord, which was first discovered at week 13 of pregnancy by ultrasound scan. The cystic mass originated from the root of the umbilical cord, connected to the urinary bladder, and no intestinal contents were enclosed within. Doppler ultrasound assessment showed that the single umbilical artery existed within the normal range. The progression of the umbilical cyst continued to be screened, but the mass disappeared on ultrasound images at 27 weeks of gestation. This led to the consideration of the cyst's rupture. After 38 gestational weeks, the pregnant woman delivered a 3350g male infant via cesarean section because of an obstructed vaginal labor. The following days, a stream of urine was recorded leaking out from the umbilical mass whenever he cried. Seven weeks after delivery, an open surgical approach was successfully performed. The baby is now 43 months of age, growing and developing normally. Since an allantoic cyst with patent urachus is a rare clinical entity, early discovery, close monitoring and accurate diagnosis through ultrasound in the prenatal period may consequently allow clinicians to have suitable attitudes towards management when the infant is born.
Subacute Disseminated Intravascular Coagulation in a Patient with Liver Metastases of a Renal Cell Carcinoma
Authors: L C van der Wekken, R J L F Loffeld
Journal: Case Rep Oncol Med (2017)
MeSH terms: Case Reports

Disseminated intravascular coagulation (DIC) is a syndrome characterised by simultaneous bleeding and thromboembolic formation. Its acute form is associated with severe bacterial infections and hematological malignancies. It has a fulminant presentation with prolonged bleeding times and diffuse thrombosis. On the other hand, chronic DIC can be asymptomatic for long periods of time and can be seen in patients with disseminated malignancies. This case report describes a patient who developed DIC within one week and bled profusely from venipuncture wounds. An underlying hepatogenic metastasised renal cell carcinoma appeared to be the cause. This is an uncommon and diagnostically challenging presentation.
Hemangioma of the tympanic membrane: a case and a review of the literature
Authors: Emilio Mevio, Marco Cazzaniga, Mauro Mullace, Donatella Paolotti
Journal: Case Rep Otolaryngol (2012)

Hemangiomas of the external auditory canal, involving the posterior bony canal and the adjacent tympanic membrane, although rare, are considered a specific disease entity of the human external auditory canal. Hemangiomas of the tympanic membrane and/or external auditory canal are rare entities; there are 16 previous case reports in the literature. It is a benign vascular tumor. It generally occurs in males in the sixth decade of life. Total surgical excision with or without tympanic membrane grafting appears to be effective in the removal of this benign neoplasm. The authors present a case and a review of the literature discussing diagnostic and surgical approaches.
A Rare Case of Complex Pelvic Injury and Associated Intrathecal Fat Embolism due to Spinopelvic Dislocation with Sacral Burst Fracture
Authors: Jan-Dierk Clausen, Karsten Fink, Michaela Wilhelmi, Christian Macke, Marcel Winkelmann, Christian Krettek, Philipp Mommsen
Journal: Case Rep Orthop (2020)
MeSH terms: Case Reports

Introduction:
Pelvic and lumbar spine injuries are very common especially in multiple trauma patients. The usual mechanism in young patients leading to pelvic fractures is a high-energy trauma such as traffic accidents. In elderly patients, low energy traumas are causal for such injuries. Compared to the high number of patients with pelvic or lumbar spine injuries, cerebral fat embolism is a quite rare finding but it needs to be considered to not misinterpret the radiological findings.
Case:
We present the case of a 41-year-old patient, who got hit and trapped in the lumbar region by a hydraulic arm in a car repair shop. The patient was primarily admitted to a level II trauma center. The radiological and clinical examinations revealed an open pelvic type C injury in terms of a spinopelvic dissociation, dislocation of the left hip joint, rupture of the mesentery of the rectum and colon sigmoideum, and a complex injury to the left ureter. Additionally, CT scan showed fluid with higher density than cerebro spinal fluid (CSF) in the lateral ventricles indicating an intracranial bleeding. After an immediate surgery to stabilize the patient, he was admitted to a level I trauma center. The reanalysis of the existing CT datasets combined with a new head CT leads to the conclusion that the high density fluid in the lateral ventricles is not a intracranial bleeding but rather fat deriving from the complex pelvic and lumbar spine fracture into the CSF system. Therefore, an immediate operation was performed to stabilize the spinopelvic dissociation and to close the injured dural sheath. Additionally, a ventricle drainage has been placed, which confirmed the diagnosis of intrathecal fat embolism. Afterwards, complex plastic surgery was necessary to restore the soft tissue damage.
Conclusions:
Intrathecal fat embolism in muliple trauma patients is a rare condition, which should be considered in patients with complex spine or pelvic injuries. It is important to distinguish this rare condition from intracranial bleedings, which are much more common because the consequent therapeutic strategy is quite different. In case of intrathecal fat embolism, a ventricle drainage system should be placed immediately, and the underlying spine or pelvic injuries need to be stabilized combined with closure of the dural sheath to prevent continuous fat embolism and meningeal infection.
ECMO in major burn patients: feasibility and considerations when multiple modes of mechanical ventilation fail
Authors: Jason D Kennedy, Wesley Thayer, Reuben Beuno, Kelly Kohorst, Avinash B Kumar
Journal: Burns Trauma (2017)
Keywords: ards, burns, conventional ventilation failure, extra corporeal membrane oxygenation, rescue ventilation, veno-venous ecmo
MeSH terms: Case Reports

Background:
We report two cases of acute respiratory distress syndrome in burn patients who were successfully managed with good outcomes with extra corporeal membrane oxygenation (ECMO) after failing multiple conventional modes of ventilation, and review the relevant literature.
Case presentation:
The two patients were a 39-year-old male and 53-year-old male with modified Baux Scores of 79 and 78, respectively, with no known inhalation injury. After the initial modified Parkland-based fluid resuscitation and partial escharotomy, both patients developed worsening hypoxemia and acute respiratory distress syndrome. The hypoxemia continued to worsen on multiple modes of ventilation including volume control, pressure regulated volume control, pressure control, airway pressure release ventilation and volumetric diffusive ventilation. In both cases, the PaO2 ≤ 50 mm Hg on a FiO2 100% during the trial of mechanical ventilation. The deterioration was rapid (<12 h since onset of worsening oxygenation) in both cases. A decision was made to trial the patients on ECMO. Veno-Venous ECMO (V-V ECMO) was successfully initiated following cannulation-under transesophgeal echo guidance-with the dual lumen Avalon® (Maquet, NJ, USA) cannula. ECMO support was maintained for 4 and 24 days, respectively. Both patients were successfully weaned off ECMO and were discharged to rehabilitation following their complex hospital course.
Conclusion:
Early ECMO for isolated respiratory failure in the setting on maintained hemodynamics resulted in a positive outcome in our two burn patients suffered from acute respiratory distress syndrome.
Persistence of the sciatic artery: a case report of a combined (complete and incomplete) type causing leg ischemia
Authors: Beatrice Cavallo Marincola, Alessandro Napoli, Michele Anzidei, Eugenio Marotta, Fabrizio Boni, Gaia Cartocci, Luca Bertaccini, Vincenzo Noce, Maria Antonietta Pacilé, Carlo Catalano
Journal: Case Rep Vasc Med (2012)

Persistent sciatic artery is a very uncommon embryologic vascular variant, with a prevalence of 0.05% based on angiographic studies. Two different types of this anomaly can occur, complete or incomplete, on the basis of the relationship between sciatic artery and femoral artery. Although many of these patients are asymptomatic, it may represent a threat to the viability of the lower extremity because of atherosclerotic degeneration resulting in aneurysmal dilatation, occlusive thrombosis, or embolic phenomena with distal complication. We present a case of a 64-year-old man with combined, complete and incomplete, type of persistent sciatic artery causing ischemic ulcer of the first toe.
Rescue from liver transplantation: TIPSS and thrombectomy successfully treat a case of acute Budd-Chiari syndrome complicated by portal vein thrombosis
Authors: Sarah A Townsend, Salil Karkhanis, Dhiraj Tripathi, Paolo Mueisan, Zergham Zia, Ahmed M Elsharkawy
Journal: BJR Case Rep (2016)
MeSH terms: Case Reports

We report the rare case of a female who presented with fulminant liver failure secondary to acute Budd-Chiari syndrome and complete portal vein thrombosis. She met the criterion for liver transplant and was transferred to our care for assessment and further management. Transplant was deemed a too-high risk and so rescue therapy was undertaken using mechanical thrombectomy and transjugular intrahepatic portosystemic shunt insertion to decompress the portal system. The patient made a full recovery. This is a rare case report of a patient meeting liver transplant criteria secondary to acute Budd-Chiari syndrome and complete portal vein thrombosis, which was managed successfully entirely by radiological means; this technique could be used to avoid or act as a bridge to liver transplantation in the future.