OpenMed/multicare-articles huggingface dataset:
The Difficult Task of Assessing and Interpreting Treatment Deterioration: An Evidence-Based Case Study
Authors: Sarah Bloch-Elkouby, Catherine F Eubanks, Lauren Knopf, Bernard S Gorman, J Christopher Muran
Journal: Front Psychol (2019)
Keywords: case study, deterioration, outcome, patient satisfaction, process, treatment failure
MeSH terms: Case Reports

Objectives: Literature on outcome assessment suggests that 35-40% of patients in randomized control trials terminate treatment with unchanged or higher levels of symptomatology. The goal of the present study was to shed light on this phenomenon and the factors accounting for it using a single case study design that investigates the process and outcome of a treatment conducted within a non-randomized clinical trial comparing a cognitive behavioral and a brief relational treatment. Method: The condition of L., a Caucasian man undergoing cognitive-behavioral therapy in a large metropolitan research program, was classified as deteriorating using the Reliable Change Index for the Inventory of Interpersonal Problems (IIP) and the Symptom Checklist-90 (SCL-90). Therapeutic process and outcome were examined using quantitative and qualitative methods rated by several sources. Results: Analysis showed that the treatment was delivered skillfully, and that despite initial difficulties, a strong alliance eventually developed between the patient and the therapist whose perspectives on the outcome of therapy nevertheless diverged. The patient's satisfaction with treatment was high, and he believed his deterioration was caused by its termination. Discussion: Results suggest that the deterioration was not caused by a negative process or a faulty delivery of the therapy. Several explanations were discussed in the context of the literature.
Bilateral Diffuse Leukoencephalopathy in an Electrocuted Patient Where the Brain Was Not in the Pathway of Conduction
Authors: Jamie Jacobs, Kyla Price, Minette Lagman, Jain Shreya, Antonio K Liu
Journal: Cureus (2023)
Keywords: cerebral leukodystrophy, diffuse leukoencephalopathy, electrocution, leukoencephalopathy, mri, neuron
MeSH terms: Case Reports

Electrocution, damage caused by electric current passing through the body, is usually a serious event causing significant morbidity or even mortality. Graded damage is seldom encountered. According to Ohm's law, the current is directly proportional to the applied voltage and inversely proportional to the resistance of a circuit. Electric current is expected to travel through cells that have the least resistance. Therefore, cells that allow action potential to travel down their cell membrane are presumably the ones with the least resistance. Among these are neurons and cells within the cardiac conduction system. Within a neuron, the axon will conduct electricity better than the cell body. While there have been a few cerebral white matter lesions caused by electrocution described in the literature, the mechanism is not fully understood. We report a patient with bilateral symmetrical subcortical abnormality where the electric current entered one hand and exited through her legs without affecting the head directly. We reviewed the literature and we hope it will further our understanding of how electrocution affects the central nervous system and which groups and parts of neurons are more susceptible than others.
A rare hepatic artery variant reporting and a new classification
Authors: Xiaojing Wu, Jianxiong Kang, Yuwei Liu, Guodong Sun, Ying Shi, Junqi Niu
Journal: Front Surg (2022)
Keywords: accessory hepatic artery, case report, classification, phrenic artery, vascular variants

Variations of the hepatic artery are very common, but they greatly increase the difficulty of surgery and the risk of complications in perihepatic surgeries such as liver transplantation, liver segmentectomy, and gastroduodenal surgery. Thus, it is important to precisely define the type of hepatic artery variant before surgery. However, there are often rare variants that cannot be defined with existing classifications. For example, the type of hepatic artery variant in the current case could not be classified with conventional classifications, and no such variation has been reported to date, involving two accessory left hepatic arteries from the common hepatic and left inferior phrenic arteries, respectively. Based on the existing 3DCT technology and the CRL classification method, which is applicable to the most common hepatic artery variants, we reviewed many rare variant types and proposed a new classification method (ex-CRL classification) for hepatic artery variations that do not fit the classic scope. The ex-CRL classification can accurately classify the vast majority of rare cases in the literature, greatly compensates for the limitations of current hepatic artery classifications, improves the generalization and understanding of rare cases, and reduces surgical complications.
Treating Diabetes Utilizing a Low Carbohydrate Ketogenic Diet and Intermittent Fasting Without Significant Weight Loss: A Case Report
Authors: Kristen Gavidia, Tro Kalayjian
Journal: Front Nutr (2021)
Keywords: a1c, diabetes, fasting, insulin resistance, ketogenic, low carbohydrate, nutrition
MeSH terms: Case Reports

Prediabetes and diabetes are leading causes of morbidity and mortality in the United States and are growing in prevalence up to 45% of the population over the past 50 years. Current guidelines from the ADA recommend focusing on energy balance, portion sizes, and weight loss while cautioning that no ideal macronutrient composition has been determined. The guidelines also do not recommend intermittent fasting. In contrast, we report three cases of a substantial reduction in A1C without clinically significant weight loss using a unique, patient-centered program that utilizes low carbohydrate diets with intermittent fasting. These results call into question the role of weight reduction in the management of diabetes while highlighting the unique importance of carbohydrate restriction and intermittent fasting. In this study, we demonstrate a case series of three patients with a substantial reduction in A1C and significantly reducing the need for pharmacotherapy without clinically significant weight loss. Although anecdotal, these results call into question the emphasis of ADA on weight reduction and energy intake reduction for the management of diabetes.
A Case of Coronavirus Disease 2019 With Concomitant Acute Cerebral Infarction and Deep Vein Thrombosis
Authors: Bo Zhou, Jianqing She, Yadan Wang, Xiancang Ma
Journal: Front Neurol (2020)
Keywords: covid-19, ct, acute cerebral infarction, case, thrombosis
MeSH terms: Case Reports

We report a case of a 75-year-old woman diagnosed with severe coronavirus disease 2019 (COVID-19) complicated by acute cerebral infarction. The patient was admitted to our hospital on 5 February 2020 with severe COVID-19. On 20 February 2020, she was diagnosed with concomitant acute cerebral infarction via head computed tomography (CT) and deep vein thrombosis in both lower limbs. After symptomatic and supportive treatments, the patient was discharged on 13 March 2020. She will comply with quarantine for another 2 weeks and receive rehabilitation training from a specialist doctor. Cerebral infarction should be considered and promptly managed in patients with COVID-19.
Case report: A rare case of Rosai-Dorfman-Destombes disease after the COVID-19 infection
Authors: Pooja Gogia, Fahmina Tanni, Juan Coca-Guzman, Neil Chen, Yiwu Huang
Journal: Front Med (Lausanne) (2022)
Keywords: covid-19, covid-19 vaccination, moderna vaccine, rosai–dorfman disease, sinus histiocytosis with massive lymphadenopathy
MeSH terms: Case Reports

Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is known to cause immune dysregulation and, therefore, has varied and often rare presentations. Rosai-Dorfman-Destombes disease (RDD) is an unusual non-Langerhans cell (non-LC) histiocytosis presenting with massive lymphadenopathy and various systemic symptoms. A 55-year-old Asian-American woman with no significant medical history or recent use of new drugs initially presented with cervical lymphadenopathy and urticarial rash 1 week after receiving the COVID-19 messenger RNA (mRNA) vaccine (Moderna, mRNA-1273) against SARS-CoV-2. The biopsy of the skin rash was consistent with a drug reaction. Approximately 2 months later, she developed mild flu-like symptoms and was diagnosed with a COVID-19 infection. Her symptoms were mild and self-resolving. Approximately 3 months later, she developed a generalized patchy erythematous rash on the face and the body that gradually worsened; diffuse lymphadenopathy involving the bilateral cervical, axillary, and inguinal areas; and constitutional symptoms. Laboratory results were consistent with lymphopenia, anemia, and an elevated sedimentation rate. Supraclavicular lymph node biopsy showed Rosai-Dorfman disease with a marked polyclonal plasmacytosis. She was started on a tapering dose of corticosteroids and showed clinical improvements over the next few weeks. Herein, we present a rare case of a histiocytic disorder that developed after contracting the SARS-COV2 infection in the event of receiving a recent mRNA COVID vaccination.
Collet-sicard syndrome from thrombosis of the sigmoid-jugular complex: a case report and review of the literature
Authors: Tom P B Handley, Mohammed S Miah, Samit Majumdar, S S Musheer Hussain
Journal: Int J Otolaryngol (2010)
MeSH terms: Case Reports

Purpose. Collet-Sicard syndrome is a very rare condition characterised by unilateral palsy of the IX-XII cranial nerves. It is distinguished from Villaret syndrome by lack of presence of sympathetic involvement. Current literature contains only two cases of Collet-Sicard syndrome due to idiopathic internal jugular vein thrombosis. Method and Results. We report the case of Collet-Sicard syndrome in a 30-year-old man who presented with delayed development of XIth nerve dysfunction, due to internal jugular vein-sigmoid sinus thrombosis. A multidisciplinary team approach was employed in the management of this patient. At three-month followup, he had significantly improved swallowing, and repeat computed tomography neck scan showed partial recanalisation of the right internal jugular vein. Conclusion. In suspected Collet-Sicard syndrome, a focal primary lesion or metastasis to the temporal bone must be excluded, and sigmoid-jugular complex thrombosis should be considered in the differential diagnosis. Early recognition and treatment may result in significant functional recovery.
Unilateral opaque chest radiograph in paediatrics: A case series
Authors: Tengku A Raja Mamat, Khairil A Sayuti, Chandran Nadarajan, Mohd R Mohd Zain
Journal: SA J Radiol (2021)
Keywords: congenital disease, pulmonary agenesis, pulmonary aplasia, pulmonary hypoplasia, pulmonary underdevelopment
MeSH terms: Case Reports

Pulmonary underdevelopment is a rare congenital disease which manifests as persistent hemithorax opacification at chest radiography. We present three patients with different types of pulmonary underdevelopment, their imaging features and associated anomalies. Case 1 is a premature neonate with persistent respiratory distress. Further imaging confirmed right pulmonary hypoplasia, associated with a patent foramen ovale, patent ductus arteriosus and vertebral anomalies. Case 2 is a 6-year-old child with corrected anorectal malformation, and recurrent pneumonia. Further imaging confirmed left pulmonary aplasia, associated with an aberrant right subclavian artery and vertebral anomaly. Case 3 is a full term neonate who developed excessive drooling of saliva and respiratory distress. Further imaging confirmed right pulmonary agenesis, associated with an atrial septal defect, patent ductus arteriosus and tracheo-oesophageal fistula. Pulmonary underdevelopment is classified into three types: hypoplasia, aplasia and agenesis. The majority of them have associated anomalies. This condition should be considered a differential diagnosis in paediatric patients with an opaque hemithorax on chest radiography.
Case report: Diverticulitis complicating a giant Meckel's divertuculum
Authors: Javier García-Quijada García, Carlos Bustamante Recuenco, Alberto Carabias Hernández, Ainhoa Valle Rubio
Journal: Int J Surg Case Rep (2019)
Keywords: abdomino-pelvic ct, adult, diverticulum, giant, intestinal resection, meckel

Introduction:
In this paper, we discuss a unique case of diverticulitis in which the patient presented a giant Meckel's diverticulum.
Presentation of case:
The patient was a 44 year old male whose medical history included a laparoscopic gastric bypass four years before the finding, and chronical high blood pressure. The patient came to the emergency department with an abdominal pain and elevated acute-phase reactants. An abdominal CT revealed a 17 cm long Meckel's diverticulum with signs of severe inflammation. The patient was then taken to the operating room, and subjected to a 4 cm ileum resection, including the entire diverticulum, with a manual end-to-end anastomosis.
Discussion:
Although Meckel's diverticulum is the most common congenital abnormality of the intestinal tract, it is unusual for it to cause symptoms in adults. However, when a patient arrives at the emergency department with a complicated Meckel's diverticulum, an early diagnosis is essential to prevent serious complications, such as perforation of the diverticulum and subsequent peritonitis. The presence of a giant diverticulum is an extremely rare condition. There are few publications to date, but these diverticula are associated with more complications, presenting a higher risk of torsion, volvulus or intestinal obstruction. This paper include a bibliographic review of existing studies on etiopathogenesis, and the diagnosis and treatment of complicated Meckel's diverticulum, particularly in its giant variant.
Conclusion:
Although Meckel's diverticulitis is a rare entity, it can appear as an acute abdomen. An early diagnosis and treatment to prevent subsequent complications is essential to ensure an optimal recovery.
Production of Pseudomonas aeruginosa Intercellular Small Signaling Molecules in Human Burn Wounds
Authors: Yok-Ai Que, Ronen Hazan, Colleen M Ryan, Sylvain Milot, François Lépine, Martha Lydon, Laurence G Rahme
Journal: J Pathog (2011)
MeSH terms: Case Reports

Pseudomonas aeruginosa has developed a complex cell-to-cell communication system that relies on low-molecular weight excreted molecules to control the production of its virulence factors. We previously characterized the transcriptional regulator MvfR, that controls a major network of acute virulence functions in P. aeruginosa through the control of its ligands, the 4-hydroxy-2-alkylquinolines (HAQs)-4-hydroxy-2-heptylquinoline (HHQ) and 3,4-dihydroxy-2-heptylquinoline (PQS). Though HHQ and PQS are produced in infected animals, their ratios differ from those in bacterial cultures. Because these molecules are critical for the potency of activation of acute virulence functions, here we investigated whether they are also produced during human P. aeruginosa acute wound infection and whether their ratio is similar to that observed in P. aeruginosa-infected mice. We found that a clinically relevant P. aeruginosa isolate produced detectable levels of HAQs with ratios of HHQ and PQS that were similar to those produced in burned and infected animals, and not resembling ratios in bacterial cultures. These molecules could be isolated from wound tissue as well as from drainage liquid. These results demonstrate for the first time that HAQs can be isolated and quantified from acute human wound infection sites and validate the relevance of previous studies conducted in mammalian models of infection.
Management of major bile duct injury after laparoscopic cholecystectomy: a case report
Authors: Andreas Manouras, Nikolaos Pararas, Pantelis Antonakis, Emannuel E Lagoudiannakis, George Papageorgiou, Ioannis G Dalianoudis, Manoussos M Konstadoulakis
Journal: J Med Case Rep (2009)

Introduction:
Bile duct injury is a severe and potentially life-threatening complication of laparoscopic cholecystectomy. Several series have described a 0.5% to 0.6% incidence of bile duct injury during laparoscopic cholecystectomy. The aim of this study was to analyze the presentation, characteristics, related investigation, and treatment results of major bile duct injuries after laparoscopic cholecystectomy.
Case presentation:
A rare case of a 48-year-old Greek woman with a triple bile duct injury (right and left hepatic duct ligation and common bile duct cross-section) is presented. A Roux en Y hepaticojejunostomy was performed after repeated endoscopic retrograde cholangiopancreatographies, percutaneous transhepatic catheterization of the ducts and magnetic resonance cholangiographies to delineate the biliary anatomy and assess the level of injury.
Conclusion:
Early recognition and an adequate multidisciplinary approach are the cornerstones for the optimal final outcome. Suboptimal management of injuries often leads to more extensive damage to the biliary tree and its vasculature. Early referral to a tertiary care center with experienced hepatobiliary surgeons and skilled interventional radiologists would appear to be necessary to assure optimal results.
Ex Vivo Drug Screening Informed Targeted Therapy for Metastatic Parotid Squamous Cell Carcinoma
Authors: Noora Nykänen, Rami Mäkelä, Antti Arjonen, Ville Härmä, Laura Lewandowski, Eileen Snowden, Rainer Blaesius, Ismo Jantunen, Teijo Kuopio, Juha Kononen, Juha K Rantala
Journal: Front Oncol (2021)
Keywords: her2, t-dm1, ex vivo drug screening, molecular profiling, parotid squamous cell carcinoma, precision oncology, trastuzumab

The purpose of ex vivo drug screening in the context of precision oncology is to serve as a functional diagnostic method for therapy efficacy modeling directly on patient-derived tumor cells. Here, we report a case study using integrated multiomics ex vivo drug screening approach to assess therapy efficacy in a rare metastatic squamous cell carcinoma of the parotid gland. Tumor cells isolated from lymph node metastasis and distal subcutaneous metastasis were used for imaging-based single-cell resolution drug screening and reverse-phase protein array-based drug screening assays to inform the treatment strategy after standard therapeutic options had been exhausted. The drug targets discovered on the basis of the ex vivo measured drug efficacy were validated with histopathology, genomic profiling, and in vitro cell biology methods, and targeted treatments with durable clinical responses were achieved. These results demonstrate the use of serial ex vivo drug screening to inform adjuvant therapy options prior to and during treatment and highlight HER2 as a potential therapy target also in metastatic squamous cell carcinoma of the salivary glands.
The first case of isolated facial cutanenous leishmaniasis in a Down syndrome infant: a case report and review of the literature
Authors: Kotb Abass, Hekma Saad, Alaa A Abd-Elsayed
Journal: Cases J (2009)

Background:
Cutaneous leishmaniasis can be caused by several Leishmania species and is transmitted to human beings and animals by sand flies, Down syndrome is known to cause immunodeficiency that might lead to increase the susceptibility to infection with Leishmania.Up to our knowledge this is the first case of isolated facial cutaneous leshmaniasis in association with Down syndrome.
Case presentation:
A 2 month old Saudi Arabian male infant was admitted in the pediatric ward of maternity and children's hospital, Buraidah, Kingdom of Saudi Arabia for the management of multiple ulcers on his face, two ulcers were big and were surrounded by edema, causing severe disfigurement. This disfigurement caused difficulty in recognizing the facial feature of Down syndrome. The presence of hypotonia, microcephaly, low set ears, bilateral simian creases and wide separation between big toe and other toes directed us to request karyotyping. The result of karyotyping confirmed the diagnosis of Down syndrome.
Conclusion:
Children with Down syndrome are immunodeficient, they have been reported to have a complex of immunological alterations which might lead to increased susceptibility to infection.
Massive pericardial effusion causing cardiac tamponade accompanied by elevated CA-125 and thoracic lymphadenopathy in sarcoidosis: a case report
Authors: Taalaibek Kudaiberdiev, Elmira Tukusheva, Zhanybek Gaibyldaev, Gulnaz Tursunbekova, Zhunus Kadyraliev, Irina Akhmedova, Nurjan Tulopbergenov, Emil Muraliev
Journal: Int J Surg Case Rep (2020)
Keywords: ca-125, case report, mediastinal lymphoadenopathy, pericardial effusion, pericardial lymphoadenopathy, sarcoidosis, tamponade
MeSH terms: Case Reports

Introduction:
Pericardial effusion and cardiac tamponade are rare manifestations of cardiac sarcoidosis. This is a first case report that describes a patient with severe pericardial effusion and signs of cardiac tamponade with elevated carbohydrate antigen 125 (CA-125) levels, enlarged pericardial (PLN) and mediastinal lymph nodes (MLN), histologically confirmed as sarcoidosis.
Presentation of case:
A 51-year-old female patient was admitted with complaints of sickness, shortness of breath on minimal exertion, swelling in lower extremities, and heaviness in right upper abdomen. Patient had diminished heart sounds, peripheral edema and hepatomegaly. She had elevated CA-125 level without gynecologic pathology. There were QRS alternation on ECG and water-bottle configuration on chest-X-ray, severe pericardial effusion, and signs of cardiac tamponade on echocardiography. CT demonstrated massive pericardial effusion, pericardial mass and enlargement of anterior MLN. The patient underwent pericardial drainage with removal of 850 mL of pericardial fluid and excision of enlarged PLN. Histological examination of PLN revealed non-caseating epithelioid cell granulomas. The diagnosis of cardiac sarcoidosis was established. Patient was discharged and 6-month follow-up was uneventful.
Discussion:
There are no reports on association of pericardial effusion, with increased CA-125 level in sarcoidosis, as we established in our patient. Our case is notable by incidental finding of enlarged PLN, mimicking pericardial mass and mediastinal lymphoadenopathy on CT, further confirmed by histological examination of PLN specimen as cardiac sarcoidosis.
Conclusion:
It should be kept in mind that sarcoidosis may present as massive pericardial effusion, with signs of tamponade and pericardial lymphoadenopathy mimicking pericardial mass, mediastinal lymphoadenopathy and elevated CA-125, mimicking malignancy.
Laparoscopic Right Hemicolectomy in an Automated Peritoneal Dialysis Patient without Removal of the PD Catheter: A Case Report
Authors: Joseph A Attard, Alexander Attard
Journal: Case Rep Surg (2014)

Introduction. Laparotomy in patients on peritoneal dialysis (PD) is associated with an increased risk of morbidity. Furthermore, standard protocol recommends removal of the PD catheter when surgery on the intestine is required. As far as we are aware, this is the first case report of laparoscopic right hemicolectomy in a patient on automated PD where the PD catheter was left in situ. Case Report. A 61-year-old man man on APD who presented with a caecal carcinoma was stabilised on temporary haemodialysis (HD) prior to undergoing a laparoscopic right hemicolectomy without removal of the PD catheter. He made an uneventful recovery and APD was resumed successfully 2 weeks after surgery. Discussion. PD patients undergoing intra-abdominal surgery are at increased risk of complications. While the benefits of laparoscopic surgery in the standard surgical population are well established, there is limited experience of the technique in PD patients. Possible advantages could theoretically be early resumption of PD as well as less PD failure due to the formation of adhesions. Conclusion. Our experience with this case indicates that laparoscopic right hemicolectomy in a background of PD can be undertaken without removal of the PD catheter and is associated with early resumption of PD.