OpenMed/multicare-articles huggingface dataset:
Caesarean Scar Pregnancy: A Case Report
Authors: Vilius Rudaitis, Gailė Maldutytė, Jūratė Brazauskienė, Mykolas Pavlauskas, Dileta Valančienė
Journal: Acta Med Litu (2022)
Keywords: caesarean section, ectopic pregnancy, gynaecologic surgical procedures, ultrasonography
MeSH terms: Case Reports

Caesarean scar pregnancy is a potentially life-threatening gynaecological condition, becoming more common due to steadily increasing rate of caesarean sections worldwide. More than one-third of women presenting with caesarean scar pregnancy are asymptomatic, but over the time if left untreated this condition can lead to the uterine rupture and massive maternal haemorrhage. Therefore it is necessary to diagnose and manage caesarean scar pregnancies properly at the beginning of the first trimester. We present the case of woman with three previous caesarean sections, who was diagnosed with complicated caesarean scar pregnancy and then successfully managed using surgical intervention.
Combined subtotal gastrectomy and splenectomy after partial splenic embolization for a patient with gastric cancer and immune thrombocytopenic purpura: A case report
Authors: Yuki Kaneko, Shin Saito, Daijiro Takahashi, Takashi Ui, Hidenori Haruta, Kentaro Kurashina, Hironori Yamaguchi, Yoshinori Hosoya, Joji Kitayama, Alan Kawarai Lefor, Naohiro Sata
Journal: Int J Surg Case Rep (2019)
Keywords: case report, gastric cancer, immune thrombocytopenic purpura, partial splenic embolization

Introduction:
Immune thrombocytopenic purpura is an acquired thrombocytopenia. Preoperative management of thrombocytopenia is important in patients with gastric cancer. Partial splenic embolization can be effective for patients with thrombocytopenia, but could lead to ischemic necrosis of the remnant stomach when performing subtotal gastrectomy with splenectomy.
Presentation of case:
The patient is an 84-year old woman evaluated for anemia. Endoscopy revealed an advanced gastric cancer with bleeding. The patient also had immune thrombocytopenic purpura with a platelet count <50,000/μL. Administration of platelets did not increase the platelet count. Partial splenic embolization was performed followed by administration of high-dose immunoglobulin. The platelet count was over 50,000/μL preoperatively. The patient underwent combined subtotal gastrectomy and splenectomy, followed by an uneventful course.
Discussion:
Patients with immune thrombocytopenic purpura and advanced gastric cancer can have anemia. Partial splenic embolization has been used to treat patients with refractory immune thrombocytopenic purpura as an alternative to splenectomy. Preoperative partial splenic embolization and high-dose immunoglobulin therapy resulted an increased platelet count in this patient. Elderly patients with gastric cancer have a high risk of postoperative complications. Patients with gastric cancer undergoing total gastrectomy have an impaired postoperative quality of life compared to those who undergo subtotal gastrectomy. We performed a subtotal gastrectomy and splenectomy as a function-preserving operation, completed safely by maintaining blood flow to the remnant stomach.
Conclusion:
Partial splenic embolization is effective for patients with immune thrombocytopenic purpura and gastric cancer. Combined subtotal gastrectomy and splenectomy is achieved by preserving blood flow to the remnant stomach.
An unusual cause of shoulder pain: osteochondroma of ventral scapula (a case report)
Authors: Ameni Ammar, Oussama Abcha, Akram Zaier, Leila Bouhajja, Faten Farah, Mahmoud Smida, Mohamed Samir Daghfous
Journal: Pan Afr Med J (2021)
Keywords: osteochondroma, case report, snapping scapula, winging scapula
MeSH terms: Bone Neoplasms / diagnostic imaging, Osteochondroma / diagnostic imaging, Shoulder Pain / etiology, Case Reports, Adolescent, Bone Neoplasms / surgery, Female, Humans, Magnetic Resonance Imaging, Osteochondroma / surgery, Scapula / diagnostic imaging, Tomography, X-Ray Computed

Osteochondromas mainly affect the metaphysis of long bones such as femur, humerus, and tibia. It is unusual in flat bones such as scapula. Osteochondroma of ventral surface of scapula is one of the rare cause of shoulder pain and difficult to diagnose in first place. We report the case of an 18-year old girl, presenting progressive right shoulder pain for two years. Physical examination showed an imbalance of the shoulders, a winging of the right scapula, and a snapping of the shoulder on mobilization. Radiographic evaluation showed a pedunculated bony structure extruding from the scapula. Computed tomography (CT) scanner and magnetic resonance imaging (MRI) revealed a bony exostosis along the medial border on the ventral surface of the right scapula. The patient had an excision of the exostosis. Histologic examination confirmed that the specimen was an osteochondroma with no signs of malignant transformation. The shoulder was immobilized for two weeks. The patient has regained full function of her shoulder, six weeks postoperatively.
Successful treatment of a granulocytic sarcoma of the uterine cervix in complete remission at six-year follow-up
Authors: Stefano C H Kim, Shanti Natarajan-Ame, Bruno Lioure, Marie-Pierre Chenard, Brigitte Duclos, Raoul Herbrecht, Jean-Pierre Bergerat
Journal: J Oncol (2010)
MeSH terms: Case Reports

Background. Localized granulocytic sarcoma of the uterine cervix in the absence of acute myelogenous leukemia (AML) at presentation is very rare, its diagnosis is often delayed, and its prognosis almost always ominous evolving into refractory AML. Case. We present the case of a 30-year-old woman with vaginal bleeding and a large cervical mass. Further evaluation confirmed the presence of a granulocytic sarcoma but failed to reveal systemic involvement. Results. AML type chemotherapy followed by radiotherapy of the uterus led to a durable complete remission. She remains in complete remission six years after diagnosis. Conclusion. Granulocytic sarcoma of the cervix is a rare entity for which early intensive AML type therapy is effective.
Brain MRI Volumetry Analysis in an Indonesian Family of SCA 3 Patients: A Case-Based Study
Authors: Siti Aminah Sobana, Fathul Huda, Robby Hermawan, Yunia Sribudiani, Tan Siauw Koan, Sofiati Dian, Paulus Anam Ong, Nushrotul Lailiyya Dahlan, Nastiti Utami, Iin Pusparini, Uni Gamayani, Norlinah Mohamed Ibrahim, Tri Hanggono Achmad
Journal: Front Neurol (2022)
Keywords: indonesia, mri, sca3, brain, volumetry
MeSH terms: Case Reports

Introduction:
Spinocerebellar ataxia type-3 (SCA3) is an adult-onset autosomal dominant neurodegenerative disease. It is caused by expanding of CAG repeat in ATXN3 gene that later on would affect brain structures. This brain changes could be evaluated using brain MRI volumetric. However, findings across published brain volumetric studies have been inconsistent. Here, we report MRI brain volumetric analysis in a family of SCA 3 patients, which included pre-symptomatic and symptomatic patients.
Methodology:
The study included affected and unaffected members from a large six-generation family of SCA 3, genetically confirmed using PolyQ/CAG repeat expansion analysis, Sanger sequencing, and PCR. Clinical evaluation was performed using Scale for the Assessment and Rating of Ataxia (SARA). Subjects' brains were scanned using 3.0-T MRI with a 3D T1 BRAVO sequence. Evaluations were performed by 2 independent neuroradiologists. An automated volumetric analysis was performed using FreeSurfer and CERES (for the cerebellum).
Result:
We evaluated 7 subjects from this SCA3 family, including 3 subjects with SCA3 and 4 unaffected subjects. The volumetric evaluation revealed smaller brain volumes (p < 0.05) in the corpus callosum, cerebellar volume of lobules I-II, lobule IV, lobule VIIB and lobule IX; and in cerebellar gray matter volume of lobule IV, and VIIIA; in the pathologic/expanded CAG repeat group (SCA3).
Conclusion:
Brain MRI volumetry of SCA3 subjects showed smaller brain volumes in multiple brain regions including the corpus callosum and gray matter volumes of several cerebellar lobules.
The versatility of a glycerol-preserved skin allograft as an adjunctive treatment to free flap reconstruction
Authors: A Z Mat Saad, T L Khoo, A A Dorai, A S Halim
Journal: Indian J Plast Surg (2009)

Skin allografts have been used in medical practice for over a century owing to their unique composition as a biological dressing. Skin allografts can be obtained in several preparations such as cryopreserved, glycerol-preserved, and fresh allograft. A glycerol-preserved allograft (GPA) was introduced in the early 1980s. It has several advantages compared with other dressings such as ease of processing, storage and transport, lower cost, less antigenicity, antimicrobial properties, and neo-vascularisation promoting properties. Skin allografts are mainly used in the management of severe burn injuries, chronic ulcers, and complex, traumatic wounds. Published reports of the use of skin allografts in association with free flap surgery are few or non existent. We would like to share our experience of several cases of free tissue transfer that utilised GPA as a temporary wound dressing in multiple scenarios. On the basis of this case series, we would like to recommend that a GPA be used as a temporary dressing in conjunction with free flap surgery when required to protect the flap pedicle, allowing time for the edema to subside and the wound can then be closed for a better aesthetic outcome.
Actigraphic recording of manic symptoms induced by methylphenidate
Authors: Tuuli Lahti, Sami Leppämäki, Pekka Tani, Timo Partonen
Journal: Case Rep Med (2009)
MeSH terms: Case Reports

Objective. Attention-deficit hyperactivity disorder (ADHD) is a developmental disorder characterized by a long-standing pattern of impulsive behavior, hyperkinesia, and inattention. Psychostimulants, for example, methylphenidate, are the treatment of choice for ADHD both in children, adolescents, and adults. Method. The effect of methylphenidate on sleep structure is not well known. We studied the effect of long-acting methylphenidate on sleep in adult ADHD patients, in a naturalistic treatment setting, using actigraphic and polysomnographic recordings. Results. One of our patients experienced manic episode after starting methylphenidate. A wrist-worn accelerometer recording demonstrated a decrease in the duration and quality of sleep. After discontinuation of methylphenidate treatment, the patient's symptoms subsided and there was no need for hospital admission. Actigraphic recording showed a decrease in the amount and quality of the patient's sleep as triggering factor for the manic symptoms. Conclusions. Disruptions of the sleep-wake cycle are probably important etiologic factors in mood disorders, especially bipolar disorder. The changes in length and quality of sleep described in this case report bear close resemblance to those of patients with a manic episode, although these symptoms were induced by methylphenidate.
Primary Hyperaldosteronism: A Rare Cause of Malignant Hypertension with Thrombotic Microangiopathy in a Kidney Transplant Recipient
Authors: Carolina Ormonde, Sara Querido, Nuno Rombo, Rita Roque, Belarmino Clemente, André Weigert
Journal: Case Rep Transplant (2021)
MeSH terms: Case Reports

Thrombotic microangiopathy (TMA) is a rare disease that presents with haemolysis and organ damage. The kidney is one of the main affected organs, and TMA is associated with serious complications and increased mortality. In transplanted patients, TMA is even less common and has a variety of possible causes, including thrombotic thrombocytopenic purpura (TTP) and haemolytic-uremic syndrome (HUS), infections, drugs, autoimmune disease, tumours, and malignant hypertension. Transplant-related causes, such as antibody-mediated rejection, calcineurin inhibitors, and viral infections, need to be considered as well. The authors report a rare case of TMA in a kidney transplant recipient, whose investigation revealed malignant hypertension secondary to primary hyperaldosteronism.
Missed gallstones in the abdominal wall: complication of a laparoscopic cholecystectomy
Authors: Sofia Frade, Sofia Carrelha, Nuno Monteiro, Luís Moniz, Helder Viegas
Journal: Pan Afr Med J (2020)
Keywords: laparoscopic cholecystectomy, gallbladder perforation, gallstone
MeSH terms: Cholecystectomy, Laparoscopic / adverse effects, Gallstones / diagnosis, Granuloma, Foreign-Body / diagnosis, Case Reports, Abdominal Pain / etiology, Abdominal Wall / pathology, Abscess / etiology, Adult, Cholecystitis, Acute / surgery, Gallstones / pathology, Gallstones / surgery, Granuloma, Foreign-Body / pathology, Granuloma, Foreign-Body / surgery, Humans, Intraoperative Complications / diagnosis, Male

Laparoscopic cholecystectomy, like any invasive procedure, is associated with complications. One of them often ignored despite its frequency, as the results of the low morbidity rate is stone spillage. We present a case of a 38 years male, with obesity; that underwent laparoscopic cholecystectomy for an acute cholecystitis. During surgery, gallbladder perforation occurred with stone spillage. An attempt was made for recovery of all stones. However, one month after surgery, the patient complained of abdominal pain in the upper right quadrant and an abscess of the deep abdominal wall was found caused by a missed gallstone. Although the definitive treatment was not immediate, an attempt at antibiotic therapy was made, unsuccessfully. Afterwards, this patient underwent gallstone extraction and removal of foreign body granuloma with complete resolution of the clinical condition.
All That Wheezes Is Not Asthma: A Case of Diffuse Large B-Cell Lymphoma of the Larynx
Authors: Bushra Rahman, Jawad Bilal, Qurat Ul Ain Riaz Sipra, Irbaz Bin Riaz
Journal: Case Rep Oncol Med (2017)
MeSH terms: Case Reports

Localized laryngeal lymphoma is a rare entity with an incidence of less than 1% of all laryngeal neoplasms. Diffuse large B-cell lymphoma (DLBCL) is the most common type of laryngeal neoplasms. Here, we describe a case of a young 28-year-old female with large B-cell lymphoma who remained undiagnosed for a long time owing to a myriad of nonspecific presentation including "wheezing." Although primary laryngeal lymphomas constitute a diagnostic challenge since they are rare, one should have a high index of suspicion for lymphoma of the larynx in patients presenting with unresolved wheezing as it can present catastrophically with acute airway obstruction requiring immediate surgical intervention which was observed in this case. Treatment includes radiotherapy, chemotherapy, immunotherapy, or a combination of these. We hope that the discussions ensuing from case reports regarding uncommon presentations of laryngeal lymphoma may spur the formation of regional/international databases for the description of lymphomas with unusual presentations. This effort can lead to in-depth study of cases and prompt awareness of "rare and subtle presentations" of laryngeal lymphoma.
Novel VPS13A Gene Mutations Identified in Patients Diagnosed with Chorea-acanthocytosis (ChAc): Case Presentation and Literature Review
Authors: Yan Shen, Xiaoming Liu, Xi Long, Chao Han, Fang Wan, Wenliang Fan, Xingfang Guo, Kai Ma, Shiyi Guo, Luxi Wang, Yun Xia, Ling Liu, Jinsha Huang, Zhicheng Lin, Nian Xiong, Tao Wang
Journal: Front Aging Neurosci (2017)
Keywords: vps13a, caudate nucleus, chorea-acanthocytosis (chac), gene mutation, neuroimaging

Chorea-acanthocytosis (ChAc) is a rare autosomal recessive inherited syndrome characterized by hyperkinetic movements, seizures, cognitive impairment, neuropsychiatric symptoms, elevated serum biochemical indicators and acanthocytes detection in peripheral blood smear. Vacuolar protein sorting 13A (VPS13A) gene mutations have been proven to be genetically responsible for the pathogenesis of ChAc. Herein, based on the typical clinical symptoms and neuroimaging features, we present two suspected ChAc cases which are further genetically confirmed by four novel VPS13A gene mutations. Nevertheless, the sharp contrast between the population base and published ChAc reports implies that ChAc is considerably underdiagnosed in China. Therefore, we conclude several suggestive features and propose a diagnostic path of ChAc from a clinical, genetic and neuroimaging perspective, aiming to facilitate the diagnosis and management of ChAc in China.
Recurrent Intestinal Obstruction after Radiation Therapy: A Case Report and Review of the Literature
Authors: James Nguyen, Amani Jambhekar, Ziyad Nasrawi, Prasad Gudavalli
Journal: Case Rep Surg (2019)
MeSH terms: Case Reports

Introduction:
In patients who have undergone resection for rectal cancer after neoadjuvant radiotherapy, loop ileostomy is commonly performed with few serious complications. In rare cases, if this irradiated small bowel is strictured, reversal of the affected ileostomy can have dire consequences. We present a case of a 62-year-old male with recurrent intestinal obstruction after closure of his loop ileostomy.
Case report:
RC is a 62-year-old male who initially presented with rectal cancer and underwent neoadjuvant chemoradiation prior to a laparoscopic low anterior resection with diverting loop ileostomy. He underwent elective reversal of his ileostomy and developed persistent postoperative obstruction. He underwent resection of the prior reversal site with normal-appearing dilated proximal bowel loops and collapsed distal bowel loops. He again developed an obstructive picture and underwent resection of the prior anastomosis with creation of an ileocolic anastomosis, after which he recovered well postoperatively.
Conclusion:
In patients who receive radiation adjuvant therapy for colon cancer, radiation-induced stricture should be considered as a cause of small bowel obstruction postoperative. In the setting of a longstanding ileostomy, evaluation of a defunctionalized distal ileum may be necessary to evaluate potential obstruction from radiation changes.
An H- TERT Mutated Skin Metastasis as First Occurrence in a Case of Follicular Thyroid Carcinoma
Authors: Eleonora Monti, Mariella Dono, Edoardo Gonella, Bruno Spina, Francesca Pitto, Floriana Petrogalli, Lucia Conte, Eleonora Ambrosetti, Michele N Minuto, Gian Luca Ansaldo, Silvia Morbelli, Simona Zupo, Massimo Giusti
Journal: Front Endocrinol (Lausanne) (2019)
Keywords: nras, tert promoter, thy 3, follicular thyroid carcinoma, indeterminate lesions, skin metastasis
MeSH terms: Case Reports

Differentiated thyroid cancer arising from thyroid follicular epithelial cells is the most frequent endocrine malignancy, and skin metastases are very rare. We describe a case of a 70-year-old women with a history of an indeterminate thyroid nodule on cytology. A painless, erythematous skin nodule of about 7 mm diameter was removed from the scalp and diagnosed as a metastasis from thyroid cancer. After total thyroidectomy, a histological diagnosis of follicular thyroid cancer was made. Two cycles of radioactive iodine were performed. Both the follicular thyroid carcinoma (FTC) and the metastasis were investigated for the presence of BRAF/RAS and TERT promoter mutations. The results showed that the cutaneous metastasis was BRAF wild-type and TERT promoter-mutated (position g.1,295,228 C>T); in contrast, the primary thyroid lesion was negative for both molecular markers.
A cause of recurrent strokes: carotid webs detected by CT angiogram
Authors: Hannah Smyth, Danielle Byrne, Derek Hayden, Kavanagh Eoin, Sean Murphy
Journal: BJR Case Rep (2017)
MeSH terms: Case Reports

Carotid webs are an uncommon cause of recurrent ischaemic strokes. They are considered a form of fibromuscular dysplasia, possibly developmental in origin, with non-inflammatory and non-atherosclerotic features and a characteristic appearance on CT angiography. They have been described as a thin intraluminal filling defect along the posterior wall of the carotid bulb in oblique sagittal reformats and a septum on axial CT angiography. Here we summarize two cases of ischaemic strokes secondary to carotid webs with characteristic images. Detection and awareness of carotid webs and their imaging features among radiologists and physicians are important as it is associated with a high risk of recurrent cerebrovascular events.
Domiciliary High-Flow Nasal Therapy in Primary Ciliary Dyskinesia
Authors: Rita Gomes, Joana Queirós, Joana Borges, Ana Lúcia Cardoso, Telma Barbosa
Journal: Cureus (2023)
Keywords: high-flow nasal oxygen, noninvasive mechanical ventilation, palliative care, primary ciliary dyskinesia (pcd), respiratory insufficiency
MeSH terms: Case Reports

We report the case of an adolescent with severe primary ciliary dyskinesia (PCD) phenotype associated with a rare genotype. His clinical condition deteriorated, with daily cough and breathlessness, hypoxemia, and lung function decline. Despite being started on home noninvasive ventilation (NIV), the symptoms progressed to dyspnea at rest and thoracic pain. High-flow nasal cannula (HFNC) was started during the daytime as an adjuvant to NIV, and he was started on regular oral opioids for pain and dyspnea control. There was a clear improvement in comfort and dyspnea and breathing work relief. Additionally, better exercise tolerance was also noted. He is currently on the lung transplant waiting list. We aim to emphasize the benefits of HFNC as an add-on therapy for the management of chronic breathlessness since our patient experienced an improvement in breathing and exercise tolerance. However, there is a paucity of studies regarding domiciliary HFNC, particularly in pediatric age. Therefore, further studies are needed to achieve optimal and personalized care. Close monitoring and frequent reassessment in a specialized center are key to adequate management.
A Case Report on Pearson Syndrome With Emphasis on Genetic Screening in Patients Presenting With Sideroblastic Anemia and Lactic Acidosis
Authors: Celeste Shoeleh, Umberto M Donato, Andrew Galligan, Julie Vitko
Journal: Cureus (2023)
Keywords: anemia, genetic screening, mitochondrial disorders, sideroblastic anemia, “pancytopenia”
MeSH terms: Case Reports

Pearson marrow-pancreas syndrome is a rare multisystem mitochondrial disease that is a result of defective oxidative phosphorylation caused by mitochondrial DNA mutations. The average prognosis of infants diagnosed with this disease is death within four years of age. The disease often carries an atypical presentation during the neonatal period causing this rare syndrome to be frequently misdiagnosed. The current report details the diagnosis of Pearson syndrome in a three-month-old male with a history of pancytopenia.
Case Report: Rare Pulmonary Sclerosing Pneumocytoma: Large, Multiple, Metastatic, and Fatal
Authors: Weidong Zhang, Yuanyuan Liu, Yamei Chai, Kefeng Shi, Jialing Chen, Dongfeng Shi, Xiaoming Wu
Journal: Front Med (Lausanne) (2021)
Keywords: fatal, large, metastases, multiple, pulmonary sclerosing pneumocytoma
MeSH terms: Case Reports

Pulmonary sclerosing pneumocytoma (PSP) is a rare benign or low-grade malignant tumor, but it has the potential to present with multiple lesions, lymph node metastasis, extra-pulmonary metastasis, recurrence and even cause death. Herein, a case of PSP that was huge, presented with multiple lesions and had lymph node as well as extrapulmonary metastases (liver, abdominal cavity, bones) is reported for the first time. This patient was also the first one to die of respiratory and circulatory failure caused by the PSP tumor and its metastases which compressed the mediastinal tissue.