OpenMed/multicare-articles huggingface dataset:
Novel CT Features of an Abdominal Gossypiboma in a Female Dog
Authors: Mylene Auger, Shelly Olin, Federica Morandi
Journal: Case Rep Vet Med (2019)
MeSH terms: Case Reports

Case description:
An eight-year-old Golden Retriever was presented with hypercalcemia and a complex abdominal mass.
Clinical findings:
A well-defined, heterogeneously contrast-enhancing, cavitary, soft tissue attenuating, non-organ associated abdominal mass was identified caudal to the right kidney. This mass was confluent with the distal tip of the right limb of the pancreas. A connected large, rim enhancing, cystic subcutaneous mass was also present in the right lumbar subcutaneous tissues, and there were multiple fistulous tracts through the hypaxial musculature.
Treatment and outcome:
The dog underwent a surgical exploratory laparotomy and a gossypiboma was removed from the intra-abdominal mass; the cystic extra-abdominal mass was drained percutaneously. Surgical recovery was uneventful and a follow-up CT after 3 months was consistent with resolving granulomatous inflammation and fibrosis.
Clinical relevance:
The presence of multiple peripherally enhancing tracts extending from the abdominal mass through the hypaxial musculature is a CT feature which has not yet been described in the veterinary literature. Additionally, incorporation of the pancreas into the abdominal mass has also not yet been described in the veterinary literature.
Multiple Autoimmune Syndromes Including Acute Disseminated Encephalomyelitis, Myasthenia Gravis, and Thyroiditis Following Messenger Ribonucleic Acid-Based COVID-19 Vaccination: A Case Report
Authors: Khouloud Poli, Sven Poli, Ulf Ziemann
Journal: Front Neurol (2022)
Keywords: adem, mrna-based covid-19 vaccines, multiple autoimmune syndrome, myasthenia gravis, thyroiditis
MeSH terms: Case Reports

The global pandemic has resulted from the emergence of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), causing coronavirus disease 2019 (COVID-19). To control the spread of the pandemic, SARS-CoV-2 vaccines have been developed. Messenger ribonucleic acid (mRNA)-based COVID-19 vaccines have been the most widely used. We present the case of a 65-year-old patient, who was diagnosed with acute disseminated encephalomyelitis, ocular myasthenia gravis, and autoimmune thyroiditis, following his third mRNA COVID-19 vaccination. On admission, the patient showed mild left-sided hemiparesis, contralateral dissociated sensory loss, dizziness, and right-sided deafness. Brain MRI revealed multiple acute inflammatory contrast-enhancing periventricular and brainstem lesions with involvement of vestibulo-cerebellar tract and cochlear nuclei. Despite steroid pulse and intravenous immunoglobulin therapy, clinical symptoms and MRI lesions worsened, and additional signs of ocular myasthenia gravis and elevated but asymptomatic thyroid antibodies developed. After repeated plasma exchange, all clinical symptoms resolved. This is, to the best of our knowledge, the first case report of multiple autoimmune syndromes triggered by COVID-19 vaccination. The rare occurrence of such treatable autoimmune complications should not question the importance of vaccination programs during the COVID-19 pandemic.
Case Report: Prenatal Diagnosis of Postaxial Polydactyly With Bi-Allelic Variants in Smoothened (SMO)
Authors: Lihong Fan, Pengzhen Jin, Yeqing Qian, Guosong Shen, Xueping Shen, Minyue Dong
Journal: Front Genet (2022)
Keywords: bi-allelic variants, genetic counseling, postaxial polydactyly, smoothened, whole-exome sequencing
MeSH terms: Case Reports

Postaxial polydactyly is a common congenital malformation which involves complex genetic factors. This retrospective study analyzed the cytogenetic and molecular results of a Chinese fetus diagnosed with postaxial polydactyly of all four limbs. Fetal karyotyping and chromosomal microarray analysis (CMA) did not find any abnormality while trio whole-exome sequencing (trio-WES) identified bi-allelic variants in smoothened (SMO) and (NM_005631.5: c.1219C > G, NP_005622.1: p. Pro407Ala, and NM_005631.5: c.1619C > T, NP_005622.1: p. Ala540Val). Sanger sequencing validated these variants. The mutations are highly conserved across multiple species. In-depth bioinformatics analysis and familial co-segregation implied the compound heterozygous variants as the likely cause of postaxial polydactyly in this fetus. Our findings provided the basis for genetic counseling and will contribute to a better understanding of the complex genetic mechanism that underlies postaxial polydactyly.
Isolated Radial Nerve Palsy as a Complication After Anterior Dislocation of the Glenohumeral Joint: A Case Report and Clinical Review
Authors: Grigorios Kastanis, Petros Kapsetakis, George Velivasakis, Manolis Spyrantis, Anna Pantouvaki
Journal: J Investig Med High Impact Case Rep (2019)
Keywords: anterior shoulder dislocation, radial palsy, terrible triad of the shoulder
MeSH terms: Accidental Falls, Radial Neuropathy / etiology, Rotator Cuff Injuries / complications, Shoulder Dislocation / complications, Case Reports, Review, Humans, Magnetic Resonance Imaging, Male, Middle Aged, Physical Therapy Modalities, Rotator Cuff Injuries / diagnostic imaging, Rotator Cuff Injuries / rehabilitation, Shoulder Dislocation / diagnostic imaging, Shoulder Dislocation / rehabilitation

Shoulder dislocation is the most common feature in emergencies, while the anterior dislocation of the glenohumeral joint is the most frequent and requires reduction. Accompanied nerve injury is common with an incidence of 21%, while radial nerve palsy is very rare. We describe the case of a 56-year-old man who presented with an anterior dislocation of the left shoulder due to a fall on an outstretched hand with wrist drop 8 hours after injury. Neurological examination revealed loss of sensation along the radial border of the forearm. Closed reduction with Kocher procedure was performed. Magnetic resonance image demonstrated a rotator cuff tear, and 3 weeks after the injury electromyography showed complete radial nerve palsy. A physiotherapy program was applied to the wrist and fingers with the goal of maintaining a full passive range of motion in all joints affected while shoulder rehabilitation started 6 weeks after his fall. Isolated radial nerve palsy associated with an anterior dislocation of the shoulder is very rare but not impossible to occur. Correct diagnosis of the nerve injury associated with the anterior dislocation is very important because it has serious implications on the management and activity morbidity.
Incidental Metastatic Meningioma Presenting as a Large Liver Mass
Authors: Ifeyinwa E Obiorah, Metin Ozdemirli
Journal: Case Reports Hepatol (2018)
MeSH terms: Case Reports

Meningiomas are slow growing neoplasms of the central nervous system (CNS). Most of the tumors are benign and distant metastasis from a benign meningioma is rare. Metastasis to the liver, although rare, usually presents with hypoglycemia or occurs in conjunction with a clinical history of an intracranial meningioma or following the resection of a prior CNS meningioma, thus making clinical diagnosis relatively easy. Here we present an unusual case of metastatic meningioma to the liver in a 54-year-old female who presented with an incidental liver mass by ultrasound. Her clinical history and physical examination were unremarkable. A partial hepatectomy revealed a meningioma on histology. Further investigation by imaging studies showed a frontal parasagittal dural mass which was confirmed to be a World Health Organization (WHO) grade 1 meningioma. To our knowledge, this is the first report of a clinically silent metastatic meningioma to the liver without either a concurrent or a previous history of meningioma. Precise diagnosis of this challenging case requires high clinical suspicion, histopathology, and immunohistochemistry.
Surgical replacement of iatrogenically prolapsed penis in a dromedary camel
Authors: M I Siddiqui, M N Telfah, S A T Al-Qubati
Journal: Open Vet J (2012)
Keywords: paraphimosis, penile prolapse, preputial cavity, preputial orifice
MeSH terms: Case Reports

Prolapse of the penis through an iatrogenic incision on the right side of the preputial base in a five year old dromedary camel was handled surgically and the organ was successfully replaced into the preputial cavity. The condition occurred as a result of draining an abscess at the base of the prepuce by a quack about eight months earlier. The reason to report this case lies in its peculiarity that although the penis remained outside the preputial cavity for about eight months exposed to the external environment, yet no complications pertaining to its fragile tissue and urination occurred during this long period as seen in cases of paraphimosis.
Treatment of Misophonia with Risperidone in a Patient with Autism Spectrum Disorder
Authors: Eric J Pan, Jeremy Weleff, Akhil Anand, Brian S Barnett
Journal: Case Rep Psychiatry (2022)
MeSH terms: Case Reports

We report the case of a 32-year-old male with autism spectrum disorder (ASD) suffering from severe misophonia. After titrating risperidone to 2 mg twice a day, the patient reported a significant reduction in his symptoms and his Amsterdam misophonia scale-revised (AMISOS-R) score dropped by from 31 to 5. Upon discharge, the patient was noted to have decreased irritability and overall improved behavior and effect. This significant symptomatic improvement was likely not explained by inpatient admission alone or other simultaneous pharmacologic treatments, as the effect was seen during an isolated titration of risperidone with other treatments remaining constant. Although, unfortunately, follow-up findings indicated that the treatment was not curative for the patient, risperidone's potential for treating misophonia may warrant systematic investigation.
The Valuable Role of Imaging Modalities in the Diagnosis of the Uncommon Presentations of COVID-19: An Educative Case Series
Authors: Mohammadreza Khaleghi, Alireza Aziz-Ahari, Nahid Rezaeian, Sanaz Asadian, Amirsajjad Mounesi Sohi, Omid Motamedi, Shilan Azhdeh
Journal: Case Rep Med (2021)
MeSH terms: Case Reports

The outbreak of coronavirus disease 2019 (COVID-19) in late 2019 rapidly turned into a global pandemic. Although the symptoms of COVID-19 are mainly respiratory ones, the infection is associated with a wide range of clinical signs and symptoms. The main imaging modality in COVID-19 is lung computed tomography (CT) scanning, but the diagnosis of the vast spectrum of complications needs the application of various imaging modalities. Owing to the novelty of the disease and its presentations, its complications-particularly uncommon ones-can be easily missed. In this study, we describe some uncommon presentations of COVID-19 diagnosed by various imaging modalities. The first case presented herein was a man with respiratory distress, who transpired to suffer from pneumothorax and pneumomediastinum in addition to the usual pneumonia of COVID-19. The second patient was a hospitalized COVID-19 case, whose clinical condition suddenly deteriorated with the development of abdominal symptoms diagnosed as mesenteric ischemia by abdominal CT angiography. The third patient was a case of cardiac involvement in the COVID-19 course, detected as myocarditis by cardiac magnetic resonance imaging (MRI). The fourth and fifth cases were COVID-19-associated encephalitis whose diagnoses were established by brain MRI. COVID-19 is a multisystem disorder with a wide range of complications such as pneumothorax, pneumomediastinum, mesenteric ischemia, myocarditis, and encephalitis. Prompt diagnosis with appropriate imaging modalities can lead to adequate treatment and better survival.
Honokiol in glioblastoma recurrence: a case report
Authors: Ce Wang, Zehao Cai, Yue Huang, Xinrui Liu, Xing Liu, Feng Chen, Wenbin Li
Journal: Front Neurol (2023)
Keywords: blood–brain barrier permeability, clinical trial, glioblastoma, liposomal honokiol, tumor progression
MeSH terms: Case Reports

Glioblastoma is the most common and aggressive primary tumor in the central nervous system. There is no standard of care for patients with recurrent GBM. Honokiol is a pleiotropic lignan and has the potential to be a potent and safe anticancer agent in human GBM when it is encapsulated by liposomes. We report an efficient and safe response to three phases of treatment with liposomal honokiol in a patient with recurrent glioblastoma.
Cortical and thalamic electrode implant followed by temporary continuous subthreshold stimulation yields long-term seizure freedom: A case report
Authors: Juan Luis Alcala-Zermeno, Nicholas M Gregg, Jamie J Van Gompel, Matt Stead, Gregory A Worrell, Brian Nils Lundstrom
Journal: Epilepsy Behav Rep (2020)
Keywords: anterior thalamic nucleus, chronic subthreshold cortical stimulation, chronic subthreshold stimulation, drug-resistant epilepsy, neuromodulation, seizure freedom
MeSH terms: Case Reports

Neuromodulation strategies that target the epileptogenic network are options for treating focal drug-resistant epilepsy. These brain stimulation approaches include responsive neurostimulation and more recently, chronic subthreshold stimulation. Long-term seizure freedom with neuromodulation is uncommon. Seizure control typically requires ongoing froms of electrical stimulation. Here, we present the case of a patient implanted with three cortical electrodes targeting the inferior frontal lobe, insula, and one subcortical electrode targeting the ipsilateral anterior thalamic nucleus. This patient received continuous subthreshold electrical stimulation to the frontal electrodes for 7 months, at which time stimulation was inadvertently stopped. He has now been free of seizures for 42 months. This case suggests the possibility that neuromodulation can alter epileptogenic networks and lead to seizure freedom without ongoing electrical stimulation.
Multivisceral Resection with Performing a Double Roux-en-Y Reconstruction for Advanced Gastric Cancer
Authors: Zijah Rifatbegovic, Zlatan Mehmedovic, Majda Mehmedovic, Jasmin Hasanovic, Amra Mestric
Journal: Case Rep Surg (2015)

Background. The role of multivisceral resection, in the setting of locally advanced gastric cancer, is still debated. Previous studies have reported a higher risk for perioperative morbidity and mortality, with limited objective benefit in terms of survival. Patient. A male patient, 55 years old, was admitted to the clinic of surgery for surgical treatment of bleeding gastric ulceration. Preoperative diagnostic evaluation was performed, and patient had undergone a surgical treatment which revealed a large mass in head of the pancreas, infiltrating the hepatoduodenal ligament and transverse mesocolon. Total gastrectomy, duodenopancreatectomy, and right hemicolectomy were performed. The digestive tube continuity was reestablished by deriving the double Roux limbs. Conclusion. The aim of this case presentation is to demonstrate a method of digestive tube reconstruction by performing the double Roux-en-Y reconstruction in advanced gastric cancer when the multivisceral resection is performed.
Short-lasting unilateral neuralgiform headache attacks with ispilateral facial flushing is a new variant of paroxysmal extreme pain disorder
Authors: Noboru Imai, Noriko Miyake, Yoshiaki Saito, Emiko Kobayashi, Masako Ikawa, Shinya Manaka, Masaaki Shiina, Kazuhiro Ogata, Naomichi Matsumoto
Journal: J Headache Pain (2015)
MeSH terms: Cluster Headache / diagnosis, Flushing / diagnosis, Pain / diagnosis, Rectum / abnormalities, Case Reports, Research Support, Non-U.S. Gov't, Child, Preschool, Cluster Headache / genetics, Cluster Headache / physiopathology, DNA Mutational Analysis, Female, Flushing / genetics, Flushing / physiopathology, Headache, Humans, Mutation, NAV1.7 Voltage-Gated Sodium Channel / genetics, Pain / genetics, Pain / physiopathology, Rectum / physiopathology, NAV1.7 Voltage-Gated Sodium Channel, SCN9A protein, human, Paroxysmal Extreme Pain Disorder

Background:
We encountered a 5-year-old girl who had short-lasting, severe, unilateral temporal headaches with ipsilateral lacrimation, nasal congestion and rhinorrhoea, and facial flushing after severe attacks. Family history revealed similar short-lasting, severe headaches in an older brother, younger sister, mother, maternal aunt, and maternal grandfather's brother.
Methods:
We performed routine laboratory examinations and electrophysiological and radiological studies for three children, and whole-exome sequencing to determine the genetic causality in this family.
Results:
Focal hyperperfusion of the right trigeminal root entry zone was seen during a right-sided attack in one child, while left-sided temporal headache attacks were provoked by bilateral electrical stimulation of the upper extremities in another. We identified a novel SCN9A mutation (NM_002977: c.5218G>C, p.Val1740Leu) in all affected family members, but not in any of the unaffected members. SCN9A encodes the voltage-gated sodium-channel type IX alpha subunit known as Na(v)1.7.
Conclusions:
Gain-of-function mutations in Na(v)1.7 are well known to cause paroxysmal extreme pain disorder (PEPD), a painful Na-channelopathy characterized by attacks of excruciating deep burning pain in the rectal, ocular, or jaw areas. The SCN9A mutation suggests that our patients had a phenotype of PEPD with a predominant symptom of short-lasting, severe, unilateral headache.
Castleman disease: Case series of two surgical patients from different ends of the disease spectrum with literature review
Authors: Radhika Raj C G, Suresh B
Journal: Int J Surg Case Rep (2018)
Keywords: castleman disease, cytokine storm, hhv8, interleukin-6, lymphoproliferative disorder

Castleman Disease (CD) is a rare, heterogeneous group of hyperimmune lymphoproliferative disorders, not very familiar to surgeons. Unicentric Castleman Disease (UCCD) at one end of the spectrum is a localized disease, with little or no systemic symptoms. It may be an incidental radiological finding or detected while investigating for a symptomatic lymph node mass. Surgery is the primary treatment and has good long term prognosis. Multicentric Castleman Disease (MCCD) is a more serious systemic condition, often associated with constitutional symptoms. Exaggerated systemic inflammatory response secondary to "Cytokine storm" involving Interleukin-6 (IL-6) may cause multi-organ dysfunction. In addition, immunosuppression or malignant transformation can prove lethal. Human Herpes Simplex Virus 8 (HHV8) associated MCCD is a major subgroup occurring in immunocompromised individuals due to the viral trigger. Antiviral therapy is important in its treatment. Idiopathic MCCD (IMCCD) has no known biomarker and is diagnosed after excluding infective, autoimmune and malignant conditions of lymphoid tissue. IMCCD requires systemic therapy. We report a patient of UCCD who presented as a retroperitoneal mass in right iliac fossa causing pressure on femoral nerve. Following successful surgical excision she had good recovery. We report another patient who had large inguinal lymph node mass with constitutional symptoms. IMCCD was diagnosed after excision biopsy and comprehensive work up. Patient was started on corticosteroids followed by CD-20 targeted therapy. These two cases showcase the two ends of the clinical spectrum of CD requiring different management protocols. Awareness among surgeons and diligent work-up is imperative for early diagnosis and best outcome.
Finding the infectious dose for COVID-19 by applying an airborne-transmission model to superspreader events
Authors: Mara Prentiss, Arthur Chu, Karl K Berggren
Journal: PLoS One (2022)
MeSH terms: COVID-19 / epidemiology, Influenza, Human, Exhalation, Humans, Serologic Tests, Viral Load

We probed the transmission of COVID-19 by applying an airborne transmission model to five well-documented case studies-a Washington state church choir, a Korean call center, a Korean exercise class, and two different Chinese bus trips. For all events the likely index patients were pre-symptomatic or mildly symptomatic, which is when infective patients are most likely to interact with large groups of people. Applying the model to those events yields results that suggest the following: (1) transmission was airborne; (2) superspreading events do not require an index patient with an unusually high viral load; (3) the viral loads for all of the index patients were of the same order of magnitude and consistent with experimentally measured values for patients at the onset of symptoms, even though viral loads across the population vary by a factor of >108. In particular we used a Wells-Riley exposure model to calculate q, the total average number of infectious quanta inhaled by a person at the event. Given the q value for each event, the simple airborne transmission model was used to determined Sq, the rate at which the index patient exhaled infectious quanta and N0, the characteristic number of COVID-19 virions needed to induce infection. Despite the uncertainties in the values of some parameters of the superspreading events, all five events yielded (N0∼300-2,000 virions), which is similar to published values for influenza. Finally, this work describes the conditions under which similar methods can provide actionable information on the transmission of other viruses.
Pregnancy Management in a Patient With Congenital Heart Disease and Severe Right Ventricle to Pulmonary Artery Conduit Stenosis
Authors: Sajan S Gill, Kelly K Shum, Sangeeta B Shah
Journal: Ochsner J (2020)
Keywords: heart defects–congenital, pregnancy, pulmonic insufficiency, pulmonic stenosis
MeSH terms: Case Reports

Background: Pregnancy causes multiple hemodynamic changes that place significant stress on the cardiovascular system. With advancements in medical care, individuals with complex congenital heart disease are living into their childbearing years. Much remains to be understood about the effects and management of pregnancy in individuals with complex congenital heart disease. Case Report: We describe the management and delivery of a 29-year-old pregnant female with repaired tetralogy of Fallot or ventricular septal defect with pulmonary atresia. The patient presented at 21 weeks' gestation with New York Heart Association class II symptoms and pulmonary conduit stenosis, with a mean gradient of 52 mmHg. At 36.5 weeks' gestation, she developed severe pulmonary conduit stenosis with a mean gradient of >75 mmHg. The patient was admitted at 37 weeks' gestation for planned delivery. After a successful cesarean section and bilateral tubal ligation, the patient had an uncomplicated postoperative course. She was scheduled for follow-up for severe conduit stenosis at 6 weeks postpartum to discuss management options. Conclusion: Management of a pregnant patient with adult congenital heart disease should involve risk stratification for complications (commonly congestive heart failure exacerbation and arrhythmias) using tools such as the modified World Health Organization pregnancy risk classification. Based on the risk category, decisions must be made about frequency of follow-up, anesthesia, and mode of delivery. Patients in moderate to high-risk stratification should be managed by a multidisciplinary team at a specialty center, and all patients should undergo an anesthesia consultation prior to delivery. The decision for vaginal or cesarean delivery should be made on a case-by-case basis with consideration given to patient preference. Patients with asymptomatic moderate to severe pulmonic stenosis can be managed conservatively with appropriate follow-up and cardiac imaging, allowing intervention to be completed after delivery.