OpenMed/multicare-articles huggingface dataset:
Case Report: Endoscope-Assisted Bilateral Nasal Leech Retrieval in a Dog
Authors: Manpreet Singh, Amit Kumar, Adarsh Kumar, Som P Tyagi, Rishu Wadhawan
Journal: Front Vet Sci (2022)
Keywords: case report, endoscope, epistaxis, nasal leech, retrieval
MeSH terms: Case Reports

A non-descript male dog was presented with symptoms, such as chronic recurrent epistaxis, sneezing, and episodes of nasal leech infestation from the past 3 months. The dog was subjected to basic clinical examination, hemato-biochemistry test, and radiographic examination before rhinoscopy. Rhinoscopy was performed with Karl Storz's 5-mm video-otoscope under general anesthesia. Leech infestation in the nasal cavity was found to be the cause of the epistaxis under rhinoscopic examination. The endoscopic guided retrieval of the leech from both the nostrils was successfully done with help of grasping forceps without any major complication. The video-otoscope-guided retrieval of nasal leeches was quite convenient and also provide the exact localization of the nasal leech.
Large thoracic defect due to shotgun violation - surgical emergency management
Authors: Holger Rupprecht, Katharina Gaab
Journal: GMS Interdiscip Plast Reconstr Surg DGPW (2017)
Keywords: damage control, deadly triad, emergency thoracotomy, shotgun injury, tension pneumothorax
MeSH terms: Case Reports

Shotgun injuries from a short distance (<3 m) may cause massive bleeding and tissue destruction. Only immediate aggressive (surgical) therapy prevents lethal outcome. We report about a 27-year-old patient, who was wounded on the left chest wall by a straight-cut shotgun from a short distance. In cases of this special traumatic pattern damage control measures are necessary. The measures should take place in preclinical emergency management (by the on-site emergency physician). We report about the emergency management from admission to our hospital and the following surgical treatment until discharge from the hospital.
Multimodal therapy for the treatment of severe ischemic stroke combining endovascular embolectomy and stenting of long intracranial artery occlusion
Authors: Matjaz Bunc, Igor J Kocijancic, Rado Pregelj, Vinko V Dolenc
Journal: Case Rep Med (2010)
MeSH terms: Case Reports

Embolic occlusion of cerebral arteries is a major cause for stroke. Intravenous thrombolysis showed positive results in this condition, however even when strict criteria are used, the risk of hemorrhagic transformation is possible. Microsurgical embolectomy has been described earlier. Purpose. We performed multimodal therapy of cerebral artery occlusion. Case Report. We present a case of a 49-year-old female patient who-according to the National Institute of Health Stroke Scale (NIHSS)-was rated as 19 due to acute occlusion of the horizontal segment of the left middle cerebral artery (MCA). After failed i.v. thrombolysis, only a part of the clot could be evacuated by the endovascular approach-without restoration of blood flow. Normal patency of the left MCA was re-established after stenting. Within 72 hours, the patient had an NIHSS score of 14, with a small haematoma in the left hemisphere. Conclusion. In our case multimodal therapy combining i.v. thrombolysis, mechanical disruption of thrombus, MCA stenting and platelet function antagonists, resulted in successful recanalization of the acutely occluded left MCA.
Mandibular Brown Tumor of Secondary Hyperparathyroidism Requiring Extensive Resection: A Forgotten Entity in the Developed World?
Authors: Mohammed Qaisi, Matthew Loeb, Lindsay Montague, Ron Caloss
Journal: Case Rep Med (2015)

Brown tumor of hyperparathyroidism (BTHPT) is rare in the United States and not frequently seen in clinical practice. This is likely because early diagnosis and prompt treatment of this disease process prevent the progression and development of BTHPT. Conversely, BTHPT is more common in underdeveloped countries where fewer patients have access to health care and hyperparathyroidism (HPT) goes untreated. It has been reported that the incidence of BTHPT in underdeveloped countries can be as high as 58 to 69 percent in patients with primary HPT. We present a case report of a patient in the United States with a large mandibular BTHPT requiring an extensive resection in the setting of secondary HPT. Despite being rare in this country, it is important for nephrologists, primary care physicians, and oral health care providers to be able to recognize this entity, so that intervention may be rendered early.
Appendiceal torsion in Ehlers-Danlos syndrome: A case report of a rare phenomenon in a rare disease
Authors: Soobin Kim, Dustin Baldwin, Bernardo Duarte
Journal: Int J Surg Case Rep (2020)
Keywords: appendiceal torsion, appendicitis, case report, connective tissue disorders, ehlers-danlos syndrome, volvulus
MeSH terms: Case Reports

Introduction:
Appendiceal torsion is a rare phenomenon with only a few reported cases and never in a patient with Ehlers-Danlos syndrome (EDS). We present the first case of appendiceal torsion leading to acute appendicitis in a patient with EDS.
Presentation of case:
A 36-year-old male with history of musculoskeletal EDS presented with one week of abdominal pain localizing to the right lower quadrant. He was evaluated in the emergency department with a complete set of labs and CT abdomen/pelvis. The CT scan showed acute appendicitis, but did not mention any appendiceal torsion. He was taken to the operating room for a standard laparoscopic appendectomy. Intraoperatively, there was inflammation at the tip of the appendix with a 270-degree torsion of the mid-appendix and mesoappendix. After untwisting, the appendix was safely removed from the base of the cecum. Patient recovered well postoperatively and no masses or tumors were identified on final pathology.
Discussion:
Primary appendiceal torsion occurs without an identifiable cause and secondary torsion occurs due to pathology such as carcinoid tumor or other masses. Patients with EDS may be more prone to either torsion as they have hyperelastic skin, joints and ligaments. EDS patients require special workup prior to any operation including cardiopulmonary evaluation and may have unique postoperative complications.
Conclusion:
The ligamentous hypermobility of EDS may have predisposed our patient to appendiceal torsion and acute appendicitis. This is a rare phenomenon and may be underdiagnosed in EDS patients. Practitioners should be aware of this manifestation of EDS.
A surgical partial excision for the treatment of lingual ectopic thyroid: a case report
Authors: Ariefian Erlangga, Muhtarum Yusuf
Journal: Pan Afr Med J (2023)
Keywords: ectopic thyroid, case report, childbirth complications, health outcome, surgery
MeSH terms: Lingual Thyroid / diagnosis, Lingual Thyroid / surgery, Thyroid Dysgenesis / diagnosis, Thyroid Dysgenesis / surgery, Case Reports, Adult, Child, Female, Humans, Thyroidectomy / methods, Tongue / surgery, Young Adult

The lingual ectopic thyroid is a sporadic case. Based on the medical records of Dr. Soetomo General Academic Hospital, Surabaya, they only found one case of ectopic thyroid at least in the last ten years. There is no consensus in the literature about the best therapeutic strategy in managing ectopic thyroid. A 20-year-old female patient with a diagnosis of ectopic lingual thyroid. She has complained of lumps at the base of her tongue since she was ten years old. She performed a partial excision of the tumor with a transoral approach. Partial excision of the lingual ectopic thyroid results in an airway free from obstruction, leaving the rest of the thyroid tissue functioning so that the patient does not require lifelong hormone treatment but has the potential for hypertrophy to recur. The transoral approach provides post-operative results that maintain aesthetic function and reduce morbidity and hospitalization. Partial excision of lingual ectopic thyroid gives good results.
Successful Thrombolysis despite Having an Incidental Unruptured Cerebral Aneurysm
Authors: Diana Briosa E Gala, André Almeida, Nadine Monteiro, Ana Paiva Nunes, Patrícia Ferreira, Nuno Mendonça, Alexandre Amaral-Silva, João Alcântara
Journal: Case Rep Neurol Med (2014)

Purpose. To report a case of successful thrombolysis performed in a patient with an incidental unruptured intracranial aneurysm and review the literature. Case Report. Patient admitted for ischemic stroke due to left posterior cerebral artery occlusion, with an incidental right middle cerebral artery aneurysm, who underwent treatment with tissue plasminogen activator (rtPA) resulting in clinical improvement without complications. Conclusion. The presence of unruptured intracranial aneurysms is considered as a contraindication to thrombolysis, due to a potentially higher hemorrhagic risk of aneurysm rupture. Patients, otherwise, eligible for thrombolysis are usually excluded from receiving this emergent treatment, despite its potential benefits. A reevaluation of the strict exclusion criteria for thrombolysis in acute stroke patients should be considered.
A Double Whammy Pneumonia: The First Reported Case of Concurrent Neisseria meningitidis and SARS-CoV-2 Pneumonia
Authors: Michael Valdez, Rupam Sharma, Jaspreet Joshi, Harleen Sandhu, Shikha Mishra, Rasha Kuran, Arash Heidari
Journal: J Investig Med High Impact Case Rep (2022)
Keywords: neisseria meningitidis, antibiotics, chemoprophylaxis, meningococcal pneumonia, pneumonia
MeSH terms: COVID-19 / complications, Influenza A Virus, H1N1 Subtype, Influenza, Human / complications, Meningococcal Infections / complications, Meningococcal Infections / diagnosis, Meningococcal Infections / microbiology, Neisseria meningitidis, Pneumonia / complications, Case Reports, Aged, Female, Humans, SARS-CoV-2

Meningococcal pneumonia (MP) is a rare manifestation of meningococcal disease. The MP was first described in 1907 when Neisseria meningitidis (NM) isolates were identified in sputum samples obtained from soldiers with pneumonia. Preceding and concurrent viral infections constitute a major risk for MP. During the 1918-1919 influenza pandemic, a significant increase in MP cases were reported in patients with preceding influenza infection. Despite the end of the last H1N1 influenza pandemic in 2010, seasonal influenza infections still pose a risk for simultaneous MP. History appears to be repeating itself with concomitant bacterial and viral coinfection amid the current SARS-CoV-2 pandemic. Herein presented is a unique case of an elderly woman who presented with, to the best of our knowledge, the first reported case of possible concurrent SARS-CoV-2 and MP infections.
Subacute Thyroiditis Presenting as Idiopathic Intracranial Hypertension
Authors: Kanyanatt Boonyatarp, Kanoksri Samintharapanya, Thanawat Vongchaiudomchoke, Nuttaya Wachiraphansakul
Journal: Case Rep Endocrinol (2021)
MeSH terms: Case Reports

Background:
Several case reports have illustrated a rare neurological manifestation, idiopathic intracranial hypertension (IIH), in patients with thyrotoxicosis. However, none were diagnosed with thyroiditis. We report the case of a patient with subacute thyroiditis who presented with severe intractable headache due to IIH. Case Presentation. A 36-year-old woman visited Lampang Hospital in February 2021 complaining of neck pain and progressive severe intractable headache. Her vital signs and neurological examination were normal. Thyroid examination revealed a single 1 cm right thyroid nodule. A computed tomography (CT) scan of her brain illustrated diffuse brain edema. However, CT angiography and venography of the brain did not show abnormalities. The opening pressure of the cerebrospinal fluid was elevated (27 cmH2O). The free triiodothyronine level was 6.19 pg/mL, free thyroxine was 2.32 ng/dL, and thyroid-stimulating hormone was 0.0083 μIU/mL. Anti-Tg was positive at a low titer, but anti-TPO was negative. TRAb was also negative. Methimazole and acetazolamide were prescribed and monitored. The symptoms resolved completely within 2 weeks of onset. Thyroid hormones had returned to normal by 8 weeks.
Conclusion:
This is the first case report of subacute thyroiditis presenting with IIH.
Truth of Floating Carotid Plaques
Authors: Wei Liu, Shuo Lu, Yibo Feng, Zhiyong Zhang, Peng Liu, Zunjing Liu
Journal: Front Neurol (2017)
Keywords: atherosclerosis, carotid endarterectomy, floating carotid plaque, ischemic stroke, pathological features, ultrasonography
MeSH terms: Case Reports

The floating plaque in carotid artery is an uncommon condition that can be detected by a duplex ultrasonography scan and is a high-risk factor for embolic cerebrovascular disease. The histopathological features of floating plaque in carotid artery vary. To the best of our knowledge, there is still considerable controversy about the treatment of floating carotid plaque. In this case, the floating carotid plaque was located in the edge of atherosclerotic plaque in common carotid artery, pathological finding following carotid endarterectomy confirmed that the mobile substances were formed by the contents of the plaque protruding into the carotid lumen after the rupture of the fibrous cap, without mural thrombus. This pathological change was different from those of the mobile substances, which were commonly considered as mural thrombotic substances of ulcer plaque caused by the ruptures of fibrous cap of vulnerable plaque. According to pathological differences, we investigated pathogenesis of ischemic cerebrovascular disease caused by floating carotid plaque and possible treatments.
Can endobronchial or endotracheal metastases appear from rectal adenocarcinoma?
Authors: G L Serbanescu, R M Anghel
Journal: J Med Life (2017)
Keywords: endobronchial/ endotracheal metastasis, radiotherapy, rectal cancer
MeSH terms: Bronchial Neoplasms / secondary, Rectal Neoplasms / pathology, Tracheal Neoplasms / secondary, Case Reports, Adenocarcinoma / diagnostic imaging, Adenocarcinoma / pathology, Adenocarcinoma / radiotherapy, Adenocarcinoma / surgery, Bronchial Neoplasms / surgery, Bronchoscopy, Female, Humans, Middle Aged, Rectal Neoplasms / diagnostic imaging, Rectal Neoplasms / radiotherapy, Rectal Neoplasms / surgery, Tomography, X-Ray Computed, Tracheal Neoplasms / surgery

Background: Endobronchial and endotracheal metastases from extra-pulmonary solid tumors are rare. Patients and methods: We reported the case of a patient diagnosed with endobronchial and endotracheal metastases from rectal adenocarcinoma. Case report: Patient P.G., 62 years old, was diagnosed with a rectal tumor in 2011, for which, a surgical intervention was performed (pT3 pN2a M0, stage IIIB). Afterwards, she underwent adjuvant chemotherapy and concomitant radiochemotherapy. In September 2013, the chest CT showed 2 nodules for which, an incomplete surgical resection was done and which were histopathologically diagnosed as metastases from rectal cancer. The patient continued the treatment with chemotherapy associated with Bevacizumab and after 6 months only Bevacizumab for maintenance. In June 2015, the chest CT pointed out a nodule in the right upper lobe and the bronchoscopy highlighted a 4-5 mm lesion at the level of the right primary bronchus, whose biopsy proved the rectal origin. Afterwards, another surgical intervention was performed. Unfortunately, the postoperative chest CT revealed an intratracheal tissue mass (11/ 7mm) and multiple metastases in the right lung. The bronchoscopy showed 2 endotracheal lesions, out of which one was biopsied (histopathological result of metastasis from rectal cancer). Despite the fact that chemotherapy was continued, other endobronchial lesions appeared. All of them were removed and the patient started radiotherapy on the tracheal area. Afterwards, she refused to continue chemotherapy. The last bronchoscopy highlighted one endobronchial and two endotracheal secondary malignant lesions. Conclusion: Endobronchial and endotracheal metastases must be taken into consideration in all the patients with a history of extra-pulmonary cancer. Abbreviations: CT = computed tomography, MRI = magnetic resonance imaging, IMRT = intensity-modulated radiotherapy, ESMO = European Society for Medical Oncology, NCCN = National Comprehensive Cancer Network, iv = intravenous, PET - CT = Positron Emission Tomography - Computed Tomography.
Dual infections of two carbapenemase-producing Acinetobacter baumannii clinical strains isolated from the same blood culture sample of a patient in Iran
Authors: Linda Hadjadj, Saeed Shoja, Seydina M Diene, Jean-Marc Rolain
Journal: Antimicrob Resist Infect Control (2018)
Keywords: acinetobacter baumannii, carbapenemase, genome, iran
MeSH terms: Acinetobacter Infections / microbiology, Acinetobacter baumannii / isolation & purification, Acinetobacter baumannii / pathogenicity, Bacterial Proteins / biosynthesis, Blood Culture / methods, beta-Lactamases / biosynthesis, Case Reports, Research Support, Non-U.S. Gov't, Acinetobacter baumannii / drug effects, Acinetobacter baumannii / genetics, Anti-Bacterial Agents / pharmacology, Bacterial Proteins / genetics, Base Sequence, Carbapenems / pharmacology, Child, Drug Resistance, Multiple, Bacterial / genetics, Female, Genes, Bacterial / genetics, Genotype, Humans, Iran, Microbial Sensitivity Tests, Phenotype, Whole Genome Sequencing, beta-Lactamases / genetics, Anti-Bacterial Agents, Bacterial Proteins, Carbapenems, beta-Lactamases, carbapenemase

In this study, the draft genome sequences of two different carbapenem-resistant Acinetobacter baumannii clinical strains isolated from the same blood culture sample of an Iranian patient were determined. The strain A. baumannii 554S harbouring blaoxa72 gene belonged to ST 307 whereas A. baumannii 554L carrying blaoxa23 gene belonged to ST 2. We found that this sample contains two different isolates of A. baumannii, each phenotypically and genetically different.
Human aortic allograft: an excellent conduit choice for superior vena cava reconstruction
Authors: Kristyn Spera, Kenneth A Kesler, Amjadullah Syed, Jack H Boyd
Journal: J Cardiothorac Surg (2014)
MeSH terms: Aorta, Thoracic / transplantation, Blood Vessel Prosthesis, Plastic Surgery Procedures / methods, Stents, Superior Vena Cava Syndrome / surgery, Tissue Donors, Vena Cava, Superior / surgery, Case Reports, Allografts, Aorta, Thoracic / physiology, Follow-Up Studies, Humans, Male, Mediastinitis / complications, Middle Aged, Prosthesis Design, Sclerosis / complications, Sternotomy, Superior Vena Cava Syndrome / diagnosis, Superior Vena Cava Syndrome / etiology, Tomography, X-Ray Computed, Vascular Patency, Vena Cava, Superior / diagnostic imaging, Mediastinal Fibrosis

Superior vena cava (SVC) reconstruction is occasionally required in the treatment of benign and malignant conditions. We report a patient with symptomatic SVC obstruction secondary to mediastinal fibrosis successfully reconstructed with an aortic allograft.
Descemet membrane endothelial keratoplasty in cases with existing scleral-sutured and iris-sutured intraocular lenses
Authors: Daniel Röck, Tobias Röck, Karl-Ulrich Bartz-Schmidt, Efdal Yoeruek
Journal: BMC Ophthalmol (2014)
MeSH terms: Corneal Diseases / surgery, Descemet Membrane / surgery, Descemet Stripping Endothelial Keratoplasty, Lens Implantation, Intraocular / methods, Pseudophakia / surgery, Case Reports, Aged, Corneal Edema / surgery, Female, Humans, Iris / surgery, Middle Aged, Sclera / surgery, Treatment Outcome

Background:
To report two cases of Descemet Membrane Endothelial Keratoplasty (DMEK) in patients with existing scleral-fixated and iris-fixated intraocular lenses (sf-IOL and if-IOL, respectively).
Case presentation:
DMEK procedures were performed on a 49-year-old woman with a pre-existing sf-IOL (case 1) and a 69-year-old woman with a pre-existing if-IOL (case 2) in order to treat secondary corneal edema due to pseudophakic bullous keratopathy. Visual acuity, refractive error, intraocular pressure, slit lamp examination, pachymetry measurements and endothelial cell density (ECD) were considered and repeated during follow-ups.Both cases had no intraoperative complications. At postoperative day 1 graft centration and complete attachment were noted. The IOL positions were unchanged in comparison to their preoperative positions. In case 1, visual acuity improved from 1/15 at 1 meter preoperative to 20/200 within one week and to 20/63 within 12 weeks of follow up. In case 2, visual acuity improved from counting fingers at 1 meter preoperative to 20/200 within one week and to 20/100 within 12 weeks of follow-up. In case 2 a partial graft dislocation was observed at postoperative day twenty. Complete graft re-apposition was achieved by rebubbling procedure performed with intracameral air injection.
Conclusions:
DMEK surgery in the treatment of pseudophakic bullous keratopathy in the presence of sf-IOL and if-IOL can successfully be performed. These eyes are at increased risk of IOL dislocation into the vitreous cavity during DMEK surgery.
Development of the R263K Mutation to Dolutegravir in an HIV-1 Subtype D Virus Harboring 3 Class-Drug Resistance
Authors: N Ahmed, S Flavell, B Ferns, D Frampton, S G Edwards, R F Miller, P Grant, E Nastouli, R K Gupta
Journal: Open Forum Infect Dis (2018)
Keywords: arvs, hiv, adolescents, dolutegravir, resistance
MeSH terms: Case Reports

Dolutegravir (DTG), a second-generation integrase strand-transfer inhibitor (INSTI), is equivalent or superior to current non-nucleotide reverse transcriptase inhibitors (NNRTIs), protease inhibitors (PIs), and first-generation INSTI-based antiretroviral regimens (ARVs). It has the potential to make big improvements in HIV control globally and within patients. This is perhaps the most "precious" HIV drug available. The integrase mutation R263K has been observed in tissue culture experiments and in patients treated with dolutegravir monotherapy in clinical trials. Globally, adherence and monitoring may be less than optimal and therefore DTG resistance more common. This is particularly important in low-middle-income countries, where patients may remain on failing regimens for longer periods of time and accumulate drug resistance. Data on this mutation in non-subtype B infections do not exist. We describe the first report of the R263K integrase mutation in a dolutegravir-exposed subtype D-infected individual with vertically acquired HIV. We have used deep sequencing of longitudinal samples to highlight the change in resistance over time while on a failing regimen. The case highlights that poorly adherent patients should not be offered dolutegravir even as part of a combination regimen and that protease inhibitors should be used preferentially.
Increased FDG avidity in lymphoid tissue associated with response to combined immune checkpoint blockade
Authors: Katy K Tsai, Miguel H Pampaloni, Charity Hope, Alain P Algazi, Britt-Marie Ljung, Laura Pincus, Adil I Daud
Journal: J Immunother Cancer (2016)
Keywords: biomarker, ctla-4, immunotherapy, pd-1, pet/ct

Background:
Antibodies against programmed death 1 (PD-1) receptor and cytotoxic T-lymphocyte-associated antigen 4 (CTLA-4) have transformed the systemic treatment of melanoma and many other cancers. Understanding the spectrum of benign findings and atypical response patterns seen in immune checkpoint blockade is important for accurately assessing treatment response as these immunotherapies become more widely used.
Case presentation:
We report a 63-year-old man with metastatic melanoma successfully treated with combination CTLA-4 and PD-1 blockade (ipilimumab and nivolumab), after non-response to pembrolizumab monotherapy. The initial impression of disease progression, based on cutaneous and PET/CT findings of increased fluoro-2-deoxy-D-glucose (FDG) uptake in benign lymphoid tissue, proved to be erroneous after assiduous review of radiographic imaging and correlative pathology.
Conclusions:
These findings indicate that increased FDG uptake in benign lymphoid tissue seen on PET/CT may be a surrogate marker of immune activation and treatment response. Prospective studies will be invaluable in validating immune-related radiographic findings as a prognostic biomarker of response in cancer patients being treated with immune checkpoint blockade.