OpenMed/multicare-articles huggingface dataset:
One Lung Soldier: A Ventilation Conundrum in a Postpneumonectomy Syndrome Complicated by Acute Respiratory Syndrome
Authors: Jaskaran K Purewal, N F N Sakul, Nikhita R Balabbigari, Alberto Nenninger, Nisha Kotecha
Journal: Case Rep Pulmonol (2020)
MeSH terms: Case Reports

Postpneumonectomy syndrome involves mediastinal shift causing dynamic airway obstruction via compression of the main bronchus and distal trachea. A few case reports describe the development of ARDS in patients with postpneumonectomy syndrome. Reeb et al. (2017) describe the mortality of postpneumonectomy ARDS anywhere from 33% to 88%. One may encounter difficulty in intubation and ventilation as parameters based on ideal body weight may not apply. Prone positioning ventilation and ECMO have been successfully used in isolated cases. We present such a case and highlight challenges in management. A 70-year-old male Vietnam veteran with remote history of right pneumonectomy thirty years prior presented with fever, cough, and dyspnea. Physical exam was significant for T 36.3°C, BP 162/73, heart rate 145 BPM, RR 22 breaths/minute, ht. 1.72 m, and wt. 78 kg, with transmitted right lung sounds and rhonchi on the left. Labs showed WBC 23.92/nL and procalcitonin 0.84 ng/mL. CXR showed left infiltrate and opacification of right hemithorax with right mediastinal shift. EKG showed atrial fibrillation. He was started on broad spectrum antibiotics for pneumonia, but deteriorated, and was intubated for respiratory distress from ARDS. Vasopressors were initiated for shock. Given the history of pneumonectomy, he was initially ventilated with lower tidal volumes (320 mL). However, incremental changes were made to tidal volumes, and ETT was repositioned several times for hypoxia. Epoprostenol and cisatracurium were also initiated. Positional changes would lead to sudden desaturation; hence, prone positioning ventilation was not done. He was not considered for ECMO due to his pneumonectomy status. Unfortunately, his condition worsened progressively and he expired. The guidelines for ARDS are well established. However, postpneumonectomy patients are unique as seen in our patient. It is unclear whether an endobronchial tube advanced into the left bronchus could have helped difficult airway management resulting from suspected postpneumonectomy syndrome as suggested by CXR. Higher tidal volumes were also unsuccessful in alleviating hypoxia and led to persistently elevated plateau pressures and driving pressures as high as 23, which was inconsistent with our goal of lung protective ventilation. Few case reports describe the successful use of prone positioning ventilation or ECMO in postpneumonectomy patients with ARDS. Although not well studied, low tidal volumes supported with ECMO may have been a favorable strategy for our patient.
Non-24-Hour Sleep-Wake Disorder Revisited - A Case Study
Authors: Corrado Garbazza, Vivien Bromundt, Anne Eckert, Daniel P Brunner, Fides Meier, Sandra Hackethal, Christian Cajochen
Journal: Front Neurol (2016)
Keywords: hodgkin’s lymphoma, bright light therapy, circadian rhythm sleep disorders, melatonin, non-24-hour sleep-wake disorder
MeSH terms: Case Reports

The human sleep-wake cycle is governed by two major factors: a homeostatic hourglass process (process S), which rises linearly during the day, and a circadian process C, which determines the timing of sleep in a ~24-h rhythm in accordance to the external light-dark (LD) cycle. While both individual processes are fairly well characterized, the exact nature of their interaction remains unclear. The circadian rhythm is generated by the suprachiasmatic nucleus ("master clock") of the anterior hypothalamus, through cell-autonomous feedback loops of DNA transcription and translation. While the phase length (tau) of the cycle is relatively stable and genetically determined, the phase of the clock is reset by external stimuli ("zeitgebers"), the most important being the LD cycle. Misalignments of the internal rhythm with the LD cycle can lead to various somatic complaints and to the development of circadian rhythm sleep disorders (CRSD). Non-24-hour sleep-wake disorders (N24HSWD) is a CRSD affecting up to 50% of totally blind patients and characterized by the inability to maintain a stable entrainment of the typically long circadian rhythm (tau > 24.5 h) to the LD cycle. The disease is rare in sighted individuals and the pathophysiology less well understood. Here, we present the case of a 40-year-old sighted male, who developed a misalignment of the internal clock with the external LD cycle following the treatment for Hodgkin's lymphoma (ABVD regimen, four cycles and AVD regimen, four cycles). A thorough clinical assessment, including actigraphy, melatonin profiles and polysomnography led to the diagnosis of non-24-hour sleep-wake disorders (N24HSWD) with a free-running rhythm of tau = 25.27 h. A therapeutic intervention with bright light therapy (30 min, 10,000 lux) in the morning and melatonin administration (0.5-0.75 mg) in the evening failed to entrain the free-running rhythm, although a longer treatment duration and more intense therapy might have been successful. The sudden onset and close timely connection led us to hypothesize that the chemotherapy might have caused a mutation of the molecular clock components leading to the observed elongation of the circadian period.
Bone marrow involvement in a patient with alpha heavychain disease: response to tetracycline treatment
Authors: Zahit Bolaman, Irfan Yavasoglu, Gokhan Sargin, Gurhan Kadikoylu, Firuzan Kaçar Doğer
Journal: Mediterr J Hematol Infect Dis (2012)
MeSH terms: Case Reports

A 28-year-old man from East Mediterranean area admitted with abdominal pain, weight loss and diarrhea. Barium x-ray studies showed segmentation, dilatation of bowel loops, mucosal folds thickening and delayed intestinal transit. Histological examination of biopsy specimens revealed villous atrophy and plasmacytic infiltration limited to mucosa and submucosa. Computed tomography showed multiple lymphadenopathy in the abdomen. Serum protein electropheresis and immunoelectropheresis indicated elevated IgA concentration. Bone marrow aspiration and biopsy revealed presence of lymphoplasmacytic infiltration. Immunohistochemical analysis of the intestine, lymph nodes showed positivity for CD45, CD-79, CD-20. After tetracycline treatment the patient's symptoms, abdominal lymphadenopathy and bone marrow infiltration disappeared and IgA concentration decreased to normal levels.
Isolated Persistent Left Superior Vena Cava, Sick Sinus Syndrome, and Challenging Pacemaker Implantation
Authors: Hatice S Kemal, Aziz Gunsel, Levent Cerit, Murat Kocaoglu, Hamza Duygu
Journal: Case Rep Cardiol (2017)
MeSH terms: Case Reports

Persistent left superior vena cava with absent right superior vena cava is a very rare venous anomaly and is known as isolated PLSVC. It is usually an asymptomatic anomaly and is mostly detected during difficult central venous access or pacemaker implantation, though it could also be associated with an increased incidence of congenital heart disease, arrhythmias, and conduction disturbances. Herein, we describe a dual-chamber pacemaker implantation in a patient with isolated PLSVC and sick sinus syndrome.
Novel Use of Double-Layer Amniotic Membrane Technique in Tube Erosion in a Pediatric Patient
Authors: Altan Atakana Ozcan, Burak Ulas
Journal: Beyoglu Eye J (2021)
Keywords: ahmed glaucoma valve, amniotic membrane, tube erosion
MeSH terms: Case Reports

This case report illustrates the successful use of the double-layer amniotic membrane technique in a child with glaucoma and aniridia. A 3.5-year-old girl with bilateral congenital glaucoma as well as aniridia, lens coloboma, nystagmus, and strabismus had been followed up since birth. Medical treatment did not result in the desired intraocular pressure improvement. An Ahmed glaucoma valve was implanted bilaterally. In a follow-up visit at 2 years of age, there were complaints of redness with watery discharge in the right eye. A biomicroscopic evaluation revealed tube erosion of the conjunctiva. The eroded area was dissected from the surrounding tissue and the area was closed using the new double-layer amnion membrane technique. After the surgery, the intraocular pressure was normal. Subsequent follow-up indicated that the erosion defect was closed and stabilized. The double-layer amniotic membrane technique can be used successfully in cases of conjunctival tube erosion. To the authors' knowledge, this is the first published pediatric case report of using the novel technique of amniotic membrane transplantation for tube erosion.
Radiofrequency Thermal Ablation for a Small Papillary Thyroid Carcinoma in a Patient Unfit for Surgery: A Case Report
Authors: Francesca Maletta, Sara Garberoglio, Alessandro Bisceglia, Alberto Ragni, Francesca Retta, Marco Gallo, Roberto Garberoglio, Mauro Papotti
Journal: Front Endocrinol (Lausanne) (2021)
Keywords: ablation, case report, fine needle aspiration, minimally invasive procedure, papillary carcinoma, radiofrequency, thyroid
MeSH terms: Carcinoma, Papillary / surgery, Frail Elderly, Radiofrequency Ablation, Thyroid Neoplasms / surgery, Case Reports, Research Support, Non-U.S. Gov't, Aged, Biopsy, Fine-Needle, Carcinoma, Papillary / pathology, Humans, Male, Minimally Invasive Surgical Procedures / methods, Patient Selection, Physical Fitness, Thyroid Neoplasms / pathology, Papillary Thyroid Microcarcinoma

Ultrasound-guided radiofrequency thermal ablation has been proposed as an effective and safe procedure for treating patients who have low-risk papillary thyroid microcarcinomas and/or are unfit for surgery. We present the case of a 72-year old male patient with a small thyroid nodule diagnosed as papillary carcinoma after fine needle aspiration. Since the patient had other serious comorbidities, priority was given to other therapies and the malignant thyroid nodule was submitted to active surveillance. After detecting at a follow-up examination a slight dimensional increase of the nodule, the possibility of a radiofrequency thermal ablation was proposed to our patient, who accepted. The procedure was safely and effectively carried out. Follow-up examinations with ultrasonography (or contrast enhanced ultrasound), conducted after 1, 3, 6, and 12 months, demonstrated a progressive reduction of size and loss of vascularization in the treated area. The fine needle aspiration was repeated after 6 months: the sample revealed a very poor cellularity composed of inflammatory cells and thick colloid; no residual neoplastic cells were observed. Our experience confirmed what already demonstrated by previous reports: radiofrequency ablation can effectively eliminate small papillary carcinomas, with a very low complication rate. It may be an alternative strategy for the treatment of low-risk, indolent papillary thyroid microcarcinomas, thus avoiding the potential side-effects of surgery in patients at risk for relevant comorbidities.
The First Case of E-Cigarette-Induced Polycythemia
Authors: Marika Okuni-Watanabe, Keiji Kurata, Kimikazu Yakushijin
Journal: Case Rep Hematol (2019)
MeSH terms: Case Reports

A 71-year-old male smoker was referred to our hospital because of increased hemoglobin and hematocrit. At initial consultation, his hemoglobin and hematocrit levels were 21.8 g/dl and 64.8%, respectively. Other laboratory data and his cardiopulmonary functions were almost normal, and JAK2 V617F mutation was negative. He had smoked about 25 cigarettes per day for 50 years until the age of 70, when he switched from conventional smoking to electronic cigarettes (e-cigarettes). We requested that he quit e-cigarette use. Thereafter, his hemoglobin and hematocrit gradually decreased and normalized. Here, we report the first case of e-cigarette-induced polycythemia.
Endoscopic Management of a Proximally Migrated Fully Covered SEMS Using the Stent-in-Stent Technique
Authors: Arunchai Chang, Varayu Prachayakul
Journal: Case Rep Med (2020)
MeSH terms: Case Reports

Endoscopic biliary decompression via stent placement is an important approach for the palliative management of distal malignant biliary obstruction. However, migration of the inserted stent can occur, either distally or proximally; proximal migration is less common, but it also presents a greater challenge for endoscopic resolution. We present a case of a 67-year-old woman who had locally advanced pancreatic cancer and developed a common bile duct obstruction. Upon clinical presentation of chronic, painless, progressive jaundice, the obstruction was managed by placing of a 10 mm × 60 mm covered self-expandable metal stent (CSEMS), which successfully facilitated palliative biliary drainage. Six months later, however, the patient developed recurrent jaundice, which was determined to be due to proximal migration of the CSEMS. Repeat endoscopic retrograde cholangiography was performed, and initial attempts to retrieve the migrated stent failed. Finally, another 10 mm × 60 mm CSEMS was placed across the stricture site, inside the previous stent, which remained in place. The treatment resolved the obstruction and jaundice, and the patient experienced no adverse events.
Successful treatment of recurrent epididymo-orchitis: Laparoscopic excision of the prostatic utricle
Authors: Ashish Jiwane, S V S Soundappan, John Pitkin, Daniel T Cass
Journal: J Indian Assoc Pediatr Surg (2009)
Keywords: epididymo-orchitis, hypospadias, laparoscopy, prostatic utricle
MeSH terms: Case Reports

Prostatic utricle presenting with recurrent epididymo-orchitis is not uncommon. Excision of prostatic utricle is the treatment of choice. The various techniques described in literature suffer from the disadvantages of incomplete excision due to poor view. We report the successful laparoscopic excision of prostatic utricle in childhood.
Penetrating Sacral Injury with a Wooden Foreign Body
Authors: Arash Fattahi, Amin Jahanbakhshi, Ardeshir Shahivand, Alireza Dastmalchi
Journal: Case Rep Med (2018)
MeSH terms: Case Reports

Spinal penetrating trauma has a complex neurosurgical management. This study presents a 55-year-old male admitted in our center with a 1 × 1 centimeter laceration on the sacral area skin due to a wooden penetrating object. The computed tomography (CT) of the spine revealed a hypodense penetrating object that was introduced from the posterior aspect of the sacrum into dural space and then stopped in the S1 vertebral body. We performed a laminectomy of intact superior portion of the S1 lamina and released the wood from the surrounding bone, and finally, we pulled it out.
Posterior Cloacal Variant with Clitorolabial Transposition and a Rectoperineal Fistula
Authors: Niveshni Maistry, Giulia Brisighelli, Chris Westgarth-Taylor
Journal: European J Pediatr Surg Rep (2021)
Keywords: anorectal malformation, cloaca, posterior cloacal variant
MeSH terms: Case Reports

We present a case and discuss the management of a posterior cloacal variant not as yet described in the literature. A 5-week-old infant presented to our institution with a posterior cloacal variant and transposition of the clitoris and labia. After initial radiological investigations, staged operative intervention was performed over a 1-year period. This included an initial laparotomy (with drainage of hydrocolpos and formation of a colostomy), a left ureteric reimplantation and a posterior sagittal anorectoplasty due to a rectoperineal fistula. The child is under continued long-term follow-up by our specialist pediatric surgical team.
Case Report: Paradoxical acrodermatitis of Hallopeau-like eruption following anti-IL-17 therapy
Authors: Giulia Tadiotto Cicogna, Francesco Messina, Linda Nalotto, Serena Szekely, Mauro Alaibac
Journal: F1000Res (2019)
Keywords: acrodermatitis continua of hallopeau, il-17, paradoxical reaction, psoriasis
MeSH terms: Acrodermatitis / chemically induced, Arthritis, Psoriatic, Interleukin-17 / antagonists & inhibitors, Psoriasis, Case Reports, Female, Humans, Middle Aged, Skin, Interleukin-17

Psoriasis is a chronic immune-mediated inflammatory disease. Up to 40% of patients with psoriasis may develop psoriatic arthritis. Currently, interleukin (IL)-17/IL-23 pathways are identified as key factors in the immunopathogenesis of both conditions. Here we describe the case of a patient who developed psoriasiform skin lesions 10 months after the initiation of anti-IL17 therapy for psoriatic arthritis. The underlying disease had responded well to the therapy, but the patient developed a striking pustular eruption at the fingers with nail involvement, onycholysis, yellow discoloration, and subungual keratosis. Clinical and histological findings were consistent with an acrodermatitis continua of Hallopeau-like eruption. Skin lesions subsided after discontinuation of the responsible anti-IL17 agent. The interpretation of this paradoxical side effect of biological therapies remains unclear but may relate to an unbalanced inflammatory cytokine response induced by the inhibition of TNF activity. It is likely that patients, who are genetically prone, may respond exaggeratedly to a cytokine imbalance. The identification of this kind of patient, in the future, could be useful in order to choose the correct therapy.
Interleukin-6 Producing Pheochromocytoma: A Rare Cause of Systemic Inflammatory Response Syndrome
Authors: Nelson Carvalho Cunha, Leonor Gomes, Joana Saraiva, Isabel Paiva
Journal: Case Rep Endocrinol (2019)
MeSH terms: Case Reports

Systemic inflammatory response syndrome (SIRS) can be a rare manifestation of pheochromocytoma, since this adrenal tumor may produce cytokines and other hormones or neuropeptides besides catecholamines. We report the case of a 53-year-old female patient with a pheochromocytoma that presented with fever and weight loss of 5% in one month along with normocytic anemia, thrombocytosis, leukocytosis, and elevated C-reactive protein. In this setting, interleukin-6 (IL-6) was requested and was elevated [26.7ng/L (<7.0)]. She also presented biochemical evidence of ACTH-independent cortisol production without overt Cushing syndrome. After adrenalectomy, the inflammatory syndrome resolved and all biochemical parameters normalized, including IL-6 and ACTH. To our knowledge, this is the first case report of IL6-producing pheochromocytoma along with autonomous cortisol production.
Myxopapillary Ependymoma of the Sacrum
Authors: Arnaud R Goossens, Annelies Van Beeck, Filip M Vanhoenacker
Journal: J Belg Soc Radiol (2023)
Keywords: ct, mri, myxopapillary ependymoma, sacrum, spine
MeSH terms: Case Reports

Teaching Point: Myxopapillary ependymoma presenting as a highly destructive lesion in the sacrum is rare but should be included in the differential diagnosis.
Cavernous Sinus Involvement and Near Miss Mediastinitis following Mandibular Tooth Infection Treated during the COVID-19 Pandemic: Clinical Diagnosis and Treatment
Authors: Alessio Danilo Inchingolo, Sabino Ceci, Luisa Limongelli, Alberto Corriero, Luigi Curatoli, Daniela Azzollini, Pietro Paolo Mezzapesa, Grazia Marinelli, Giuseppina Malcangi, Giovanni Coloccia, Mario Ribezzi, Maria Massaro, Ioana Roxana Bordea, Antonio Scarano, Felice Lorusso, Nicola Brienza, Gianfranco Favia, Nicola Quaranta, Francesco Inchingolo
Journal: Case Rep Dent (2022)
MeSH terms: Case Reports

Odontogenic infections represent a frequent condition that in some cases, if not treated promptly, can spread quickly to the rest of the body and turn into life-threatening infections. In this work, the case is reported of a 59-year-old woman, diabetic and overweight, who presented to the Odontostomatology and Otolaryngology Section of the Policlinic of Bari with mandibular tooth infection that had developed into a deep neck space infection leading to the involvement of cavernous sinuses and near mediastinum. The diagnosis, the surgical drainage of the phlegmon and removal of infection foci, appropriate control of the airways, and a correct antibiotic therapy made it possible to avoid a potentially fatal condition. Prompt management and early diagnosis of deep space neck infections, such as phlegmon and/or necrotizing fasciitis, with the auxilium of CT scans and tools such as LRINEC (Laboratory Risk Indicator for Necrotizing Fasciitis), NLR (Neutrophil-to-Lymphocyte Ratio), and LRINECxNLR scores (Laboratory Risk Indicator for Necrotizing Fasciitis and Neutrophil to Lymphocyte Ratio), are advised to evade delays and complications that could potentially worsen the patient's outcome.
A case of mistaken identity: classic Kaposi sarcoma misdiagnosed as a diabetic foot ulcer in an atypical patient
Authors: Garneisha M Torrence, James S Wrobel
Journal: Clin Diabetes Endocrinol (2019)
Keywords: biopsy, diabetes mellitus, foot tumor, kaposi sarcoma, malignancy
MeSH terms: Case Reports

Background:
The presentation of Kaposi sarcoma is divided into four known clinical subtypes. In this case report we describe classic Kaposi sarcoma in an African-American heterosexual, diabetic, seronegative human immunodeficiency virus male. Classic Kaposi sarcoma is rare in this patient demographic and can be easily misdiagnosed.
Case presentation:
The patient presented with a lesion between the fourth and fifth digits of his right foot which was initially diagnosed as a diabetic foot ulcer. Despite local wound care, the lesion did not resolve. A shave biopsy was performed and histopathology findings were consistent with classic Kaposi sarcoma.
Conclusions:
The patient tolerated local radiotherapy well and had complete resolution of his pedal lesion. There have been emerging associations between diabetes and Kaposi sarcoma. As such, clinicians should have a low threshold when considering the biopsy of suspicious pedal lesions in patients with diabetes. The utilization of appropriate biopsy technique may lead to the diagnosis of classic KS tumors in populations outside of the current four widely accepted clinical subtypes.
Remission of cognitive deficits in Parkinson's disease: recovery from a nonamnestic mild cognitive impairment or psychiatric symptoms remission?
Authors: Jonas Jardim de Paula, Marco Túlio Gualberto Cintra, Débora Marques Miranda, Maria Aparecida Camargos Bicalho, Edgar Nunes Moares, Leandro Fernandes Malloy-Diniz
Journal: Case Rep Psychiatry (2012)

Mild cognitive impairment is a clinical condition more frequent in patients with Parkinson's disease than in general population. The nonamnestic presentations, usually characterized by executive dysfunction, are most prevalent. We present a case report of a Parkinson's disease patient diagnosed with nonamnestic mild cognitive impairment that showed complete remission of cognitive symptoms after one year. We discuss the possible causes for the remission, focusing on the treatment of medical conditions such as a major depressive episode and vitamin B12 deficiency, in addition to the change of pharmacological treatment. In a third assessment, cognitive performance remained normal. The case report highlights the importance of controlling clinical comorbidities on the assessment and followup of mild cognitive impairment, especially on Parkinson's disease.