OpenMed/multicare-articles huggingface dataset:
Graves' Disease Presenting with Periodic Paralysis to the Emergency Department
Authors: Nick Si Rui Lan, P Gerry Fegan
Journal: Case Rep Endocrinol (2018)
MeSH terms: Case Reports

Thyrotoxic periodic paralysis is an infrequent manifestation of hyperthyroidism and an uncommon cause of muscle weakness in western countries. The diagnosis should be considered in the differential when a patient presents with transient and recurrent weakness associated with hypokalaemia. We present a case of a 26-year-old Asian male presenting with sudden onset muscle weakness affecting predominantly his lower limbs on a background of weight loss. Physical examination demonstrated symmetrical proximal muscle weakness with normal sensation and reflexes. Initial biochemical investigations revealed hypokalaemia, hypomagnesaemia, and hyperthyroidism. Intravenous electrolyte replacement was administered in the emergency department. The patient's symptoms resolved during inpatient admission. Subsequent TSH receptor antibody testing and radionuclide thyroid scan confirmed a diagnosis of Graves' disease. The patient was discharged on antithyroid medication with no further episodes of weakness on follow-up. Therefore, thyrotoxic periodic paralysis can be the presenting feature of previously undiagnosed Graves' disease and should be considered in the differential diagnosis in patients presenting with weakness.
Ultrasonography-triggered diagnosis of putrid, ulcero-phlegmonous, hemorrhagic appendicitis and periappendicitis with an atypical symptom pattern: a case report
Authors: Hagen Frickmann, Sven A Jungblut
Journal: Mil Med Res (2016)
Keywords: acute appendicitis, oligosymptomatic, surgery, ultrasound

Background:
Asymptomatic and oligosymptomatic appendicitis are rare and challenging diagnoses that should not be missed.
Case presentation:
A young female patient presented with mild to moderate pain in the middle and lower abdomen, and the results of physical examination, including digital rectal examination, were otherwise non-contributory. Ultrasonography demonstrated a marked increase of the outer appendiceal diameter up to 12 mm and a trace of free liquid around the terminal ileum. Subsequent surgical exploration and histological examination allowed for a final diagnosis of putrid, ulcero-phlegmonous, hemorrhagic appendicitis and periappendicitis.
Conclusions:
Ultrasonography is increasingly used for the diagnosis of appendiceal inflammation, particularly in military medical settings. Increases in the outer appendiceal diameter up to >6 mm under compression have recently been demonstrated to be indicative of acute appendicitis. At a minimum, in cases with doubtful physical examination results, ultrasonography should be considered as an element in the diagnosis of acute appendicitis.
Clinical Neuropathology image 1-2017: incidental schwannoma of the posterior root
Authors: Ellen Gelpi, Mikel Vicente-Pascual
Journal: Clin Neuropathol (2017)
MeSH terms: Incidental Findings, Neurilemmoma / pathology, Peripheral Nervous System Neoplasms / pathology, Spinal Nerve Roots / pathology, Case Reports, Aged, 80 and over, Autopsy, Female, Humans, Thoracic Vertebrae

No Abstract available.
Mechanical Complication with Broviac Repair Kit in a 4-Year-Old Boy with MEN 2a
Authors: Sergio B Sesia, Frank-Martin Haecker, Johannes Mayr
Journal: Int J Pediatr (2009)
MeSH terms: Case Reports

Background. Mechanical complications in the use of indwelling central venous catheters (CVCs) such as the Broviac catheter (BC) include kinking, occlusion, dislocation or leaking. We report on a mechanical complication after using a repair kit for the BC. Method. A 4-year old boy, suffering from multiple endocrine neoplasia type 2a (MEN 2a), intestinal aganglionosis (Hirschsprung's disease), and short bowel syndrome, required a BC for home parenteral nutrition. Result. Due to recurrent leakage of the BC, 5 subsequent repairs were necessary within seven months. During one repair a metallic tube belonging to the repair kit was found to have migrated proximally to the skin entrance level within the BC and requiring surgical removal. Conclusion. To our knowledge, this is the first report focusing on such a serious complication using a BC and its repair kit. The proximal migration of this metallic tube constitutes a distinct theoretical risk of endothoracic foreign body embolization.
Orthotopic Kidney Transplant as a Fifth Intra-Abdominal Organ after Two Previous Kidney and Two Previous Pancreas Transplants
Authors: Yazan Al-Adwan, Navdeep Singh, Amer Rajab, Musab Alebrahim, Jayanthan Subramanian, W Kenneth Washburn, Farjad Siddiqui, Ashley Limkenmann, Pranit N Chotai, Austin Schenk
Journal: Case Rep Transplant (2022)
MeSH terms: Case Reports

Background:
Patients with more than two prior kidney transplant procedures pose unique surgical challenges. Once both the right and left retroperitoneal spaces have been dissected, intra-abdominal implantation is usually necessary. If the external iliac arteries have been used previously, it is sometimes necessary to use the aorta and vena cava for implantation. Gaining safe exposure in these cases can be complicated by history of prior laparotomy, adhesive disease, and other surgical histories. Case Presentation. A 58-year-old female with type 1 diabetes and end-stage renal disease presented for surgical evaluation for kidney transplant. Surgical history was notable for prior simultaneous kidney-pancreas transplant followed by both a living donor kidney transplant and a pancreas after kidney transplant. She had undergone both an allograft nephrectomy and an allograft pancreatectomy and currently had a nonfunctioning kidney in the left retroperitoneal position and a nonfunctioning pancreatic allograft on the right common iliac artery. The entire distal aortoiliac system was surgically inaccessible. She was listed for transplantation, and a cadaveric graft was allocated. Intraoperatively, severe lower abdominal and pelvic adhesions prevented any use of the iliac system. A left native nephrectomy was performed, and the allograft was implanted in the left orthotopic position. The native left renal vein was used for outflow, the donor renal artery was joined end-to-side to the infrarenal aorta, and a uretero-ureterostomy was created. The operation was uneventful. The allograft functioned without delay, and almost one year later, the GFR is approximately 50 mg/dL.
Conclusion:
The left orthotopic position can be a good choice for kidney transplant candidates with histories of prior complex lower abdominal surgery.
Maffucci's syndrome in association with giant tubular adenoma of the breast: Case report and literature review
Authors: Dennis Mazingi, Chenesa Mbanje, George Jakanani, Godfrey I Muguti, Valentine Mandizvidza, Shingi Bopoto
Journal: Int J Surg Case Rep (2019)
Keywords: breast, case report, enchondromatosis, maffucci syndrome, tubular adenoma

Introduction:
Maffucci's syndrome is a rare congenital, non-hereditary mesodermal dysplasia characterised by multiple enchondromas and vascular lesions. To our knowledge this is the first report of tubular adenoma of the breast in association with Maffucci's syndrome.
Presentation of case:
We report a 31-year-old female who presented with a large, ulcerated slow-growing painless breast mass. She had also sustained two pathological fractures during childhood as well as progressive deformity and limb shortening on the right side of the body. Skeletal survey revealed enchondromas exclusively on the right side in association with phleboliths. Excision of the breast mass was performed. Histological examination of the breast lesion revealed a diagnosis of tubular adenoma, core biopsy of the bony lesions confirmed enchondromas and a cutaneous haemangioma was excised from the abdominal wall.
Discussion:
Tubular adenoma of the breast is a rare benign tumour. When large they may cause ulceration leading to diagnostic and management dilemmas. Patients with Maffucci's Syndrome require lifelong surveillance for the development of malignancy.
Conclusion:
Tubular adenomas of the breast carry no risk of malignancy. However, malignancy remains high on the differential list when the skin is ulcerated. Ulceration can also be caused by pressure necrosis in benign tumours. This diagnostic dilemma can lead to unnecessarily radical surgery.
A Rare Case of an Advanced Gastric Adenocarcinoma in a Teenage Syrian Boy
Authors: Baraa Daboul, Ahmad Ghazal, Ayham Al Halak, Sabah Hayed, Yasmin Najjar
Journal: Case Rep Oncol Med (2018)
MeSH terms: Case Reports

In this report, we describe a case of a gastric cancer in young age group with delayed diagnosis and poor prognosis. We report a rare case of a 16-year-old teenager with an advanced moderately differentiated gastric adenocarcinoma without any relevant history. He presented mainly with dysphagia, postprandial vomiting, and eventually hematemesis. On exploratory laparotomy, the tumor was in advanced stage, the excision was not performed, multiple biopsies and a feeding jejunostomy were done, and the patient was referred to receive a palliative therapy. Reporting such cases introduces a better understanding of the relation between gastric cancer and young ages.
Cardiac Arrest due to Butane Gas Inhalation in an 18 Years Old Boy
Authors: Abdulaziz A AlRabiah, Abdulmalik M AlShamrani, Afnan A AlMass
Journal: Case Rep Emerg Med (2019)
MeSH terms: Case Reports

An 18-year-old male smoker inhaled butane gas out of a pocket lighter with his friend for the purpose of changing his voice. He suddenly collapsed and lost his consciousness. Upon arrival to the Emergency Department, he was found pulseless with a rhythm of ventricular fibrillation. Cardiopulmonary resuscitation (CPR) was initiated according to the advanced cardiac life support (ACLS) protocol for three cycles until return of spontaneous circulation archived. After extubation, the patient was ataxic and had significant memory loss and severe confusion. Days later he improved and was discharged with walking aid for his ataxia and a plan to followup with the neurology team for magnetic resonance imaging (MRI) of the brain and electroencephalogram (EEG) as an outpatient.
Assessing the Quality of Teleconsultations in a Store-And-Forward Telemedicine Network - Long-Term Monitoring Taking into Account Differences between Cases
Authors: Richard Wootton, Joanne Liu, Laurent Bonnardot
Journal: Front Public Health (2014)
Keywords: lmics, quality assurance, quality control, telehealth, telemedicine

We have previously proposed a method for assessing the quality of individual teleconsultation cases; this paper proposes an additional step to allow the long-term monitoring of quality. The basic scenario is a teleconsultation system (aka an e-referral system or a tele-expertise system) where the referrer posts a question about a clinical case, the question is relayed to an appropriate expert, and the chosen expert provides an answer. The people running this system want assurances that it is stable, i.e., they want routine quality assurance information about the "output" from the "process." This requires two things. It needs a method of assessing the quality of individual patient consultations. And it needs a method for taking into account differences between patients, so that these quality assessments can be compared longitudinally. Building on the previously proposed methodology, the present paper proposes two techniques for measuring the difficulty posed by a particular teleconsultation. The first is an indirect method, similar to a willingness to pay economic estimation. The second is a direct method. Using these two methods with real data from a telemedicine network showed that the first method was feasible, but did not produce useful results in a pilot trial. The second method, while more laborious, was also feasible and did produce useful results. Thus, when output quality is measured, an allowance can be made for the characteristics of the case submitted. This means that fluctuations in output quality can be attributed to variations in the process (network) or to variations in the raw materials (queries submitted to the network). Long-term quality assurance should assist those providing telemedicine services in low-resource settings to ensure that the services are operated effectively and efficiently, despite the constraints and complexities of the environment.
Pneumatosis intestinalis a trap for the unwary: Case series and literature review
Authors: Sunny Dhadlie, Daniel Mehanna, James McCourtney
Journal: Int J Surg Case Rep (2018)
Keywords: pneumatosis cystoids intestinalis, pneumatosis intestinalis

Introduction:
Pneumatosis Intestinalis (PI) can present with a broad range of presentations from chronic and non-specific to acute and life threatening. It is paradoxically one of the few conditions where a pneumoperitoneum found in the diagnostic workup is not necessarily an indication for laparotomy.
Presentation of cases:
The first case is of a 75 year old gentlemen who attended the emergency department after several weeks of worsening abdominal pain and weight loss. At laparotomy, two segments of nodular, abnormal-looking small bowel were identified with bubbles of air seen in the small bowel mesentery. The second case is of an 86 year old man with of a 5-month history of abdominal pain, weight loss, nausea and diarrhoea. A subsequent endoscopy revealed diffuse gastritis with a small antral gastric ulcer with a small amount of blood. The CT scan demonstrated free air within the bowel wall, with a follow up scan performed 3 weeks later revealing an increase in the amount of free air.
Discussion:
PI is a rare condition characterised by the presence of subserosal and submucosal gas filled cysts occurring anywhere in the gastrointestinal tract from the oesophagus to the anus. Numerous conditions have been associated with PI including bowel obstruction, infections, ischemia and there have been reported cases suggesting as association with Crohn's disease.
Conclusion:
PI is a condition that may manifest with a wide range of symptoms from mild abdominal pain to acute peritonitis. Its treatment is generally medical and even with radiological evidence of perforation laparotomy may not be indicated if the patient is clinically well.
An Unusual Case of Ototoxicity with Use of Oral Vancomycin
Authors: Umut Gomceli, Srija Vangala, Cosmina Zeana, Paul J Kelly, Manisha Singh
Journal: Case Rep Infect Dis (2018)
MeSH terms: Case Reports

Introduction:
Systemic absorption of oral vancomycin is poor due to the size of the molecule and its pharmacokinetics. It has an elimination half life of 5-11 hours in patients with normal renal function. We present a rare case of ototoxicity after oral vancomycin administration and detectable serum vancomycin levels 24 hours after cessation of vancomycin.
Case presentation:
A 42-year-old woman with a history of hypertension, diabetes mellitus, and previously treated Clostridium difficile colitis presented with abdominal pain and diarrhea for two weeks. Clostridium difficile infection was confirmed by PCR, and at the time of diagnosis and initiation of therapy, the patient had normal renal function. Vancomycin was initiated at a dose of 125 mg po q6h. After the third dose of oral vancomycin, the patient reported new symptoms of lightheadedness, sensations of "buzzing" and whistling of bilateral ears, and decreased perception of hearing described as "clogged ears." The patient reported to the emergency department the next day due to worsening of these symptoms, and vancomycin dosing was reduced to every 8 hours; however, the patient reported the auditory symptoms persisted. On day three, vancomycin was discontinued with gradual resolution of symptoms over the next 12 hours. On day four, a serum random vancomycin level obtained 24 hours after the last dose was detectable at 2 mcg/dl. Temporal association of the patient's symptoms and improvement with cessation of therapy along with a detectable vancomycin level indicates systemic absorption of oral vancomycin with subsequent ototoxicity.
Discussion:
The potential for absorption of oral vancomycin is not well described and is attributed to compromised intestinal epithelium allowing for increased drug absorption. Few studies suggested that oral vancomycin may result in therapeutic or even potentially toxic levels of serum vancomycin in patients with impaired renal function. Ototoxicity may be a transient or permanent side effect of vancomycin therapy and is related to high serum levels. Symptoms usually resolve after decreasing the dose or cessation of vancomycin. No detectable serum vancomycin levels were found in 98% of the patients treated with oral vancomycin in a prospective study. The described case is unusual because despite normal renal function, the patient still developed ototoxicity, and systemic absorption of the drug was confirmed with a measurable vancomycin level approximately 24 hours after the drug was stopped. Additionally, the only other medication prescribed to the patient at the time of vancomycin administration was metformin at a dose of 500 mg po bid which has no known idiosyncratic interactions potentiating adverse side effects to vancomycin. This case reflects that some patients may be more susceptible to increased systemic absorption via the oral route, and the possibility for ototoxicity should be considered and discussed with patients while prescribing oral vancomycin.
Spontaneous Hepatic Rupture in a Pregnant Woman with Preeclampsia and HELLP Syndrome
Authors: Nguyen Phuoc Lam, Anh Tuan Mai, Thanh Chi Pham, Hieu Trung Kieu, Hien Quang Nguyen
Journal: Case Rep Crit Care (2023)
MeSH terms: Case Reports

Spontaneous hepatic rupture is a rare complication associated with preeclampsia and is characterized by hemolysis, elevated liver enzymes, and a low platelet count (HELLP syndrome), with a nonspecific clinical presentation and high mortality rate. We present the case of a 34-year-old primigravida woman in whom spontaneous hepatic rupture associated with HELLP syndrome was accidentally detected during cesarean delivery. The patient was successfully managed with liver packing and transcatheter arterial embolization, followed by plasmapheresis. Spontaneous hepatic rupture should be considered in any HELLP syndrome patient presenting with epigastric or right upper quadrant pain and early signs of hemodynamic instability. A multimodal approach can help achieve good clinical outcomes in patients with this rare presentation.
Conquering mount fuji: resolution of tension pneumocephalus with a foley urinary catheter
Authors: Shahid M Nimjee, Ali R Zomorodi, D Cory Adamson
Journal: Case Rep Radiol (2011)
MeSH terms: Case Reports

Tension pneumocephalus is the presence of air or gas in the cranium that is under pressure. It occurs due to disruption of the skull, including trauma to the head or face, after neurosurgical procedures and occasionally, spontaneously (Schirmer et al., 2010). Patients typically present with headache but can also have neurological deficits such as decreased mental status, numbness, and weakness (Schirmer et al., 2010). It is diagnosed by computerized tomography (CT) scan (Michel, 2010). The characteristic finding is that the two frontal poles of the brain are separated by air. After diagnosis, treatment is imperative for both symptomatic relief and preventing further compression. We present a case of a patient who presented with tension pneumocephalus and unconventional treatment that resulted in clinical improvement of his symptoms and radiographic resolution of his condition.
Laparoscopic management of interstitial pregnancy and fertility outcomes after ipsilateral salpingectomy - three case reports
Authors: Cristina Manea, Evangelia Pavlidou, Aline Andrey Urias, Jean Bouquet de la Jolinière, Jean Bernard Dubuisson, Anis Feki
Journal: Front Surg (2014)
Keywords: ectopic pregnancy, interstitial pregnancy, ipsilateral salpingectomy, laparoscopic treatment, methotrexate, minimally invasive laparoscopy

Background:
Interstitial pregnancy after ipsilateral salpingectomy is a rare event with potentially serious consequences. Optimal management strategy remains uncertain and debated. In addition, fertility sparing is determinant of the treatment choice.
Cases:
Here, we report three cases of interstitial pregnancy occurring after homolateral salpingectomy. We expose the therapeutic option held in all three situations, which associated laparoscopic procedure followed by intramuscular methotrexate injection with successful outcome for all patients. We also report the fertility outcome for the first patient, discussing the timing and mode of delivery. Cesarean section at term was performed for this patient.
Conclusion:
In these three situations, we obtained a successful result using a minimally invasive surgical approach combined with systemic methotrexate injection. Cesarean section at term for subsequent intrauterine pregnancy seems to be the safest delivery strategy, although no clear data exist in literature.
Case report: Complete resection of invasive thymoma invading the superior vena cava and right atrium under cardiopulmonary bypass support
Authors: Xiangxin Zhang, Liang Chen, Wenyong Zhou, Zhexin Wang, Chong Wang, Jianxin Shi, Feng Yao
Journal: Front Oncol (2022)
Keywords: cardiopulmonary bypass, case report, invading the right atrium, surgery, thymoma
MeSH terms: Case Reports

Here we describe an uncommon case of a 48-year-old male patient with an invasive thymoma invading the superior vena cava, bilateral innominate veins, right internal jugular vein, right subclavian vein, right atrium, azygos vein, and part of the lung tissues. The tumor was resected entirely under cardiopulmonary bypass support, and the venous bypass using a vascular graft was successfully established between the left innominate vein and the right atrium. The postoperative course was uneventful, and the patient was discharged 15 days after surgery without complications.
A Case of CCDC6-RET Fusion Mutation in Adult Acute Lymphoblastic Leukemia (ALL), a Known Activating Mutation Reported in ALL
Authors: Mateo Mejia Saldarriaga, Amir Steinberg, Eric A Severson, Adam Binder
Journal: Front Oncol (2019)
Keywords: ccdc6-ret, foundationoneheme, ret, acute lymphoblastic leukemia, novel mutation
MeSH terms: Case Reports

We report the case of a patient with B-Cell Acute Lymphoblastic Leukemia (ALL) who was found to harbor a gene fusion involving the CCDC6 and RET genes. Although the RET mutations have been identified before in other malignancies, and it is thought to represent a driver mutation in these neoplasms, it has yet to be described in ALL. The identification of known fusion genes conferring activating tyrosine kinase activity in neoplasms can suggest potential therapeutic role of tyrosine kinase inhibitors (TKI), an approach that has been exploited in several other fusion genes.
Intestinal Duplication and Hirschsprung's Disease: An Extremely Rare and Misleading Combination
Authors: Fabrizio Vatta, Alessandro Raffaele, Noemi Pasqua, Marco Brunero, Gloria Pelizzo, Luigi Avolio
Journal: European J Pediatr Surg Rep (2018)
Keywords: hirschsprung's disease, intestinal duplication, intestinal occlusion
MeSH terms: Case Reports

Hirschsprung's disease and, more rarely, intestinal duplication can both cause intestinal obstruction in neonates. The simultaneous occurrence of these two diseases is reported in only two studies, and in both cases, intestinal duplication was an incidental finding, as it had not determined clinical intestinal occlusion. This paper reports a unique case of coexistence of the two conditions, with both causing intestinal obstruction, delayed appropriate, and definitive surgical treatment.