OpenMed/multicare-articles huggingface dataset:
Critical Care Admissions following Total Laryngectomy: Is It Time to Change Our Practice?
Authors: Hussein Walijee, Alexandria Morgan, Bethan Gibson, Sandeep Berry, Ali Jaffery
Journal: Int J Otolaryngol (2016)

Critical Care Unit (CCU) beds are a limited resource and in increasing demand. Studies have shown that complex head and neck patients can be safely managed on a ward setting given the appropriate staffing and support. This retrospective case series aims to quantify the CCU care received by patients following total laryngectomy (TL) at a District General Hospital (DGH) and compare patient outcomes in an attempt to inform current practice. Data relating to TL were collected over a 5-year period from 1st January 2010 to 31st December 2015. A total of 22 patients were included. All patients were admitted to CCU postoperatively for an average length of stay of 25.5 hours. 95% of these patients were admitted to CCU for the purpose of close monitoring only, not requiring any active treatment prior to discharge to the ward. 73% of total complications were encountered after the first 24 hours postoperatively at which point patients had been stepped down to ward care. Avoiding the use of CCU beds and instead providing the appropriate level of care on the ward would result in a potential cost saving of approximately £8,000 with no influence on patient morbidity and mortality.
Hypersensitivity reaction to a mosquito bite in a patient with chronic myeloid leukemia
Authors: Uri P Dior, Shaden Salameh, Yonatan Gershinsky, Ruth Stalnikowicz
Journal: Case Rep Emerg Med (2011)
MeSH terms: Case Reports

A twenty-one-year-old male patient with an exaggerated hypersensitivity reaction to a mosquito bite presented to the department of emergency medicine for further evaluation. He was noted on physical examination to have splenomegaly. The hematological blood tests that were performed were compatible with chronic myeloid leukemia (CML). In this case, the mosquito bite heralded the diagnosis of CML.
Influence of the Period of Abstinence on Semen Quality in a Patient with Systemic Lupus Erythematosus: A Case Report and Review of the Literature
Authors: Tarah H B Waters, Carol Pui Shan Chan, Tin Chiu Li, David Yiu Leung Chan
Journal: Case Rep Rheumatol (2020)
MeSH terms: Case Reports

Systemic lupus erythematosus (SLE) is a chronic inflammatory disease that can affect fertility. There is currently little information regarding the semen profile of males with SLE. Moreover, there is no consensus on an appropriate period of sexual abstinence for semen analysis and on the use of DNA fragmentation assay, together with multiple semen analyses to document the semen profile in this clinical population. In this case report, multiple semen analyses, with DNA fragmentation assays, were performed for a male with SLE undergoing fertility treatment at our andrology unit. A 4-day period of abstinence improved the semen concentration, total sperm count, total progressive motile sperm, and sperm morphology, with minimal DNA fragmentation. In conclusion, multiple semen analyses obtained after different periods of sexual abstinence, together with DNA fragmentation assays, may be useful to develop a semen profile for patients with SLE, providing information on the optimal abstinence period to yield the best semen quality for subsequent fertility treatment. For patients with fluctuating semen results, concomitant semen cryopreservation should be considered to preserve the better quality semen before starting assisted reproductive technologies if pregnancy is planned in the future.
A Case of De Novo Antiglomerular Basement Membrane Disease Presenting during Pregnancy
Authors: F A K Lodhi, T Akcan, J N Mojarrab, S Sajjad, R Blonsky
Journal: Case Rep Nephrol (2021)
MeSH terms: Case Reports

Background. Acute kidney injury (AKI) requiring dialysis during pregnancy is uncommon. We present a case of a young female diagnosed with antiglomerular basement membrane (anti-GBM) disease during pregnancy. Case Presentation. A 23-year-old woman approximately 15 weeks pregnant experienced weakness, nausea, vomiting, and anorexia for one week and anuria for 48 hours. No known drug allergies and no significant social or family history for kidney or genitourinary disease were reported. Laboratory analysis revealed anemia, life-threatening hyperkalemia, AKI, and elevated antiglomerular basement membrane (GBM) antibodies. Renal biopsy revealed 100% cellular crescents, confirming the diagnosis. The patient was treated using plasmapheresis and methylprednisolone followed by oral steroids, azathioprine, and tacrolimus. At 24 weeks and 4 days of gestation, the patient had hypoxic respiratory failure as well as preterm premature rupture of membranes. Due to the development of infection and lack of renal recovery, immunosuppression was discontinued. At 28 weeks and 0 days of gestation, the patient developed uncontrollable hypertension requiring emergent delivery. Postpartum, her hypertension improved without signs of preeclampsia though still requires dialysis. Discussion. Pregnancy presents a unique challenge for providers treating patients with anti-GBM disease. Fetal safety should be considered and risks thoroughly discussed with the patient when choosing an immunosuppressive regimen for this condition.
Renal failure associated with APECED and terminal 4q deletion: evidence of autoimmune nephropathy
Authors: Mohammed Al-Owain, Namik Kaya, Hamad Al-Zaidan, Ibrahim Bin Hussain, Hadeel Al-Manea, Hindi Al-Hindi, Shelley Kennedy, M Anwar Iqbal, Hamad Al-Mojalli, Albandary Al-Bakheet, Anne Puel, Jean-Laurent Casanova, Saleh Al-Muhsen
Journal: Clin Dev Immunol (2010)
MeSH terms: Renal Insufficiency, Chronic / genetics, Transcription Factors / genetics, Case Reports, Abnormalities, Multiple, Addison Disease / genetics, Candidiasis, Chronic Mucocutaneous / genetics, Child, Chromosome Deletion, Chromosome Disorders / genetics, Chromosomes, Human, Pair 4 / genetics, Comparative Genomic Hybridization, Consanguinity, Humans, Hypoparathyroidism / genetics, In Situ Hybridization, Fluorescence, Male, Mutation, Polyendocrinopathies, Autoimmune / complications, Polyendocrinopathies, Autoimmune / genetics, Polyendocrinopathies, Autoimmune / pathology, Saudi Arabia, APECED protein, Transcription Factors, Autoimmune polyendocrinopathy syndrome, type 1, Chromosome 4q- Syndrome

Autoimmune polyendocrinopathy-candidiasis-ectodermal dystrophy (APECED) is a rare autosomal recessive disorder caused by mutations in the autoimmune regulator gene (AIRE). Terminal 4q deletion is also a rare cytogenetic abnormality that causes a variable syndrome of dysmorphic features, mental retardation, growth retardation, and heart and limb defects. We report a 12-year-old Saudi boy with mucocutaneous candidiasis, hypoparathyroidism, and adrenocortical failure consistent with APECED. In addition, he has dysmorphic facial features, growth retardation, and severe global developmental delay. Patient had late development of chronic renal failure. The blastogenesis revealed depressed lymphocytes' response to Candida albicans at 38% when compared to control. Chromosome analysis of the patient revealed 46,XY,del(4)(q33). FISH using a 4p/4q subtelomere DNA probe assay confirmed the deletion of qter subtelomere on chromosome 4. Parental chromosomes were normal. The deleted array was further defined using array CGH. AIRE full gene sequencing revealed a homozygous mutation namely 845_846insC. Renal biopsy revealed chronic interstitial nephritis with advanced fibrosis. In addition, there was mesangial deposition of C3, C1q, and IgM. This is, to the best of our knowledge, the first paper showing evidence of autoimmune nephropathy by renal immunofluorescence in a patient with APECED and terminal 4q deletion.
Breast Mass and Lytic Bone Lesions: A Rare Presentation of Non-Hodgkin's Lymphoma Arising in the Breast
Authors: Hira Ali, Oladapo Yeku, Daniel Giesler, Ryan Campbell-Massa, Faye Gao, Ali Imran Amjad
Journal: Case Rep Oncol Med (2013)

Background. Primary breast lymphoma is a rare malignancy representing less than 1% of all tumors presenting in the breast. Case Presentation. A 55-year-old woman presented with altered mental status due to severe hypercalcemia and was found to have a large breast mass with lytic bone lesions in the calvarium of the skull. Biopsy of the mass revealed diffuse large B-cell lymphoma. Staging workup did not reveal any visceral organ or distant lymph node involvement. The patient's bone marrow biopsy was positive for involvement with lymphoma. Interestingly, the patient also had a non quantifiable IgA kappa monoclonal protein in the serum. Conclusion. Here, we describe a common presentation in medical oncology, that is, a patient presenting as a clinically advanced breast tumor with hypercalcemia from lytic bone lesions. However, diagnostic workup led to the diagnosis of another common malignancy in an uncommon location, namely, diffuse large B-cell lymphoma arising in the breast.
The diagnosis of immune-related pancreatitis disguised as multifocal lesions on MRI by endoscopic ultrasound-guided fine-needle biopsy: A case report
Authors: Wen Shi, Bei Tan, Yuan Li, Liang Zhu, Yunlu Feng, Qingwei Jiang, Jiaming Qian
Journal: Front Immunol (2022)
Keywords: endoscopic ultrasound-guided fine needle biopsy, immune checkpoint inhibitor, immune-related adverse events, pancreatitis, programmed death-1 antibody
MeSH terms: Pancreatitis / diagnostic imaging, Pancreatitis / etiology, Case Reports, Research Support, Non-U.S. Gov't, Acute Disease, Aged, Amylases, Endoscopic Ultrasound-Guided Fine Needle Aspiration / methods, Glucocorticoids, Humans, Immune Checkpoint Inhibitors, Lipase, Magnetic Resonance Imaging, Male, Glucocorticoids, Immune Checkpoint Inhibitors, Lipase, Amylases

Immune checkpoint inhibitor (ICI)-related acute pancreatitis (irAP) is a rare, potentially life-threatening immune-related adverse event. Whereas CT and MRI remain first-line diagnostic imaging modalities, more patients are presenting with atypical irAP as ICI use increases. To appropriately manage these events, it is important to catalog these presentations and provide comprehensive clinical, radiological, and pathological descriptions to guide evidence-based practice. Here, we present the case of a 66-year-old man with advanced lung adenocarcinoma who, after the fifth course of toripalimab, developed epigastric discomfort and elevated serum amylase and lipase. irAP was suspected, but MRI revealed atypical, multifocal pancreatic lesions. To exclude metastases, an endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB) was performed. EUS revealed a slightly swollen pancreas with heterogeneous echoic signals and scattered hyperechoic areas in the parenchyma without an obvious mass. Histopathological examination of the FNB revealed retention of the normal lobular pancreatic architecture with focal acinar atrophy associated with a CD8+ T lymphocyte-predominant infiltrate, further confirming the diagnosis of irAP. After starting glucocorticoids, his symptoms resolved, serum amylase and lipase rapidly decreased to normal, and the abnormal MRI features diminished. irAP can, therefore, present as multifocal lesions on MRI, and, when metastatic disease requires exclusion, EUS-FNB is an effective way to establish a definitive diagnosis. Refining the histopathological and immunopathological criteria for the diagnosis of irAP is now warranted.
Atypical Presentation of Acquired Hypoganglionosis in a Patient Taking Clozapine
Authors: Catherine Gisi, Anamaria Munteanu, Lawrence Ku, Samuel French, Michael Fleischman, Viktor Eysselein
Journal: Case Rep Gastrointest Med (2020)
MeSH terms: Case Reports

Acquired hypoganglionosis (HG) is a rare enteric gastrointestinal neuromuscular disorder previously associated with chronic inflammation that can lead to constipation, ileus, and even death. There is little known about the pathophysiology of acquired hypoganglionosis, and it is unclear if medications are related to the development of the disease. Clozapine is an atypical antipsychotic used to treat refractory schizophrenia that is well known for its side effects including agranulocytosis and gastrointestinal dysmotility. This is an unusual case of acquired hypoganglionosis in a patient with anticholinergic toxicity on clozapine therapy.
Public Medical Preparedness at the "Swiss Wrestling and Alpine Games 2013": Descriptive Analysis of 1,533 Patients Treated at the Largest 3-Day Sporting Event in Switzerland
Authors: Simone Hostettler-Blunier, Nora Müller, Tobias Haltmeier, Andreas Hosner, Heinz Bähler, Frank Neff, Daniel Baumberger, Aristomenis Exadaktylos, Beat Schnüriger
Journal: Emerg Med Int (2017)

Introduction. Medical preparedness at mass gatherings is challenging, as little is known about the optimal planning. Most studies and case reports are based on mass casualty incidents, so the results cannot be extrapolated to mass gatherings. Aim of this study was to evaluate the preclinical medical structure and the frequency of specific injuries and medical emergencies during the event. Methods. Retrospective analysis of a prospectively collected database. Three on-site medical assistance points were set up, completed by mobile teams, and coordinated by an on-site operational management team. Medical staff requirements were calculated using Maurer's formula. Results. A total of 1,533 patients were treated during the three-day event. Overall, the medical usage rate (MUR; patients per 10,000 visitors) was 51.1. A total of 58 patients (3.8%) required a hospital transfer. In 1,063 cases (69.3%) a diagnosis was documented. Of these, 503 patients (47.3%) suffered from hymenoptera stings; the two most common non-trauma-related diagnoses were alcohol/drug intoxication (4.1%) and gastrointestinal diseases (4.0%). Conclusion. Overall, the on-site medical care worked well. However, a high frequency of hymenoptera stings occurred, resulting in a shortage of antihistamine medication. Moreover, more than half of the patients were managed at the second largest medical assistance point. Prospective and critical evaluation of medical care at mass gatherings is crucial in order to optimize on-site medical preparedness at future events.
Hyalinizing granuloma: an unusual case of a pulmonary mass
Authors: Viviane Brandão, Edson Marchiori, Gláucia Zanetti, Guilherme Abdalla, Nina Ventura, Carolina Lamas Constantino, Mariana Leite Pereira, Pedro Martins, Rodrigo Canellas, Antonio Muccillo, Romulo Varella de Oliveira
Journal: Case Rep Med (2010)
MeSH terms: Case Reports

We describe the case of pulmonary hyalinizing granuloma in a 34-year-old asymptomatic man who presented with a pulmonary nodule apparent by chest radiography and computed tomography (CT). He had a history of previous treatment for tuberculosis. His laboratory data were normal. Bronchoscopy and CT-guided percutaneous transthoracic fine needle aspiration cytology were inconclusive. The diagnosis was revealed after the histopathological examination of an open lung biopsy.
Treatment in the home setting with intermittent pneumatic compression for a woman with chronic leg ulcers: a case report
Authors: Katrina Young, Harrison Ng Chok, Lesley Wilkes
Journal: BMC Nurs (2017)
Keywords: case report, chronic leg ulcer (clu), chronic venous insufficiency (cvi), home setting, intermittent pneumatic compression (ipc), lymphoedema, venous leg ulcer (vlu)
MeSH terms: Case Reports

Background:
Intermittent Pneumatic Compression (IPC) is shown to improve the healing rate of Venous Leg Ulcers (VLU) in the hospital setting. The current Australian "Gold Standard" treatment according to the Australian and New Zealand Wound Management Associations' (AWMA) Prevention & Management of Venous Leg Ulcer guidelines is compression, generally in the form of bandaging then progressing to hosiery once wounds are healed to prevent recurrence. This is recommended in conjunction with other standards of wound management including; nutrition, exercise, client education and addressing underlying pathophysiology and psychosocial factors. Compression bandaging is predominantly attended by community nurses in the clients' home. Barriers to delivery of this treatment include; client concordance and or suitability for bandaging including client habitus, (shape of legs), client lifestyle, clinician knowledge and clinicians physical ability to attend bandaging, in particular for obese clients with limited mobility who pose a manual handling risk to the clinician themselves. The use of IPC may assist in mitigating some of these concerns, therefore it would seem wise to explore the use of IPC within the home setting.
Case presentation:
This paper will present an original case report on the successful treatment of a woman living with chronic bilateral lower leg ulcers using IPC as an adjunct treatment in her home. This paper supports recommendations to explore the use of IPC therapy in the home setting, for treatment of chronic leg ulcers requiring compression.
Conclusion:
Use of IPC in the home is anticipated to improve client involvement, concordance, client outcomes and reduce risk to staff applying conventional compression bandaging systems, particularly for obese clients with limited mobility.
Dengue Fever-Associated Maculopathy and Panuveitis in Australia
Authors: K G-J Ooi, H Inglis, N Paramanathan, J A Downie, M P Hennessy
Journal: Case Rep Ophthalmol Med (2016)
MeSH terms: Case Reports

Purpose. To describe a case of dengue fever-associated maculopathy and panuveitis to raise awareness of these ophthalmic complications of dengue in Australia in the light of recent increasing numbers of outbreaks from equatorial through to tropical Australia. Case Report. A 37-year-old Caucasian Australian male returning from Cambodia presented with a bilateral dengue fever-associated maculopathy with left panuveitis diagnosed clinically and haematologically. Automated perimetry revealed bilateral paracentral scotomas while optical coherence tomography demonstrated the maculopathies to be of the diffuse retinal thickening type in the right eye and acute macular neuroretinopathy (AMN) type in the left eye. He was treated conservatively with only topical steroids and cycloplegia and made a full clinical visual recovery. Conclusion. Our case study underscores the importance of the awareness of the ophthalmic complications of dengue fever as despite their rarity they can be potentially sight threatening. The incidence of these complications is likely to rise in Australia with increased global warming and the distribution of Aedes aegypti into subtropical Australia.
Snowed In: A Case Report on the Utilization of Ultrasound in the Diagnosis of Fractures
Authors: Keith Hansen, Trevine Albert, Jonathan Quinonez, Samir Ruxmohan
Journal: Cureus (2023)
Keywords: both-bone forearm fracture, general radiology, omm research, plain radiography, ultrasound anatomy
MeSH terms: Case Reports

The standard convention for diagnosing bone fractures is through radiography. However, radiography can miss fractures depending on the type of injury or if human error is present. This may be due to improper patient positioning leading to superimposing bones being captured in the image, obscuring pathology. As of late, ultrasound has been gaining traction in terms of its utilization for diagnosing fractures, which radiography can miss at times. Here we present a case of a 59-year-old female who was diagnosed using ultrasound with an acute fracture that was initially missed on X-ray. We present a case of a 59-year-old female with a past medical history significant for osteoporosis who presented to an outpatient clinic for evaluation of acute left forearm pain. She reported sustaining a mechanical fall forward to the ground three weeks before bracing herself with her forearms, immediately developing left upper extremity pain lateralized to the forearm. Upon initial evaluation, forearm radiographs were obtained and showed no evidence of acute fractures. She then underwent a diagnostic ultrasound that showed an obvious fracture of the proximal radius, distal to the radial head. Upon reviewing initial radiograph films, it was evident that the proximal ulna was superimposed over the radius fracture as a proper neutral anteroposterior view of the forearm was not taken. The patient then underwent a computed tomography (CT) scan of her left upper extremity, which confirmed the presence of a healing fracture. We present a case in which ultrasound is an excellent adjunct when a fracture cannot be identified on plain film radiography. Its utilization should be well-known and considered more often in the outpatient setting.
Neonatal diabetes mellitus accompanied by diabetic ketoacidosis and mimicking neonatal sepsis: a case report
Authors: Ayhan Abacı, Cem Hasan Razi, Osman Ozdemir, Samil Hızlı, Fatih Kıslal, Pınar Işık Argas, Nimet Kabakuş
Journal: J Clin Res Pediatr Endocrinol (2010)
Keywords: neonate, diabetes mellitus, ketoacidosis
MeSH terms: Diabetes Mellitus / congenital, Diabetic Ketoacidosis / congenital, Sepsis / diagnosis, Case Reports, Blood Glucose / metabolism, Diabetes Mellitus / drug therapy, Diabetic Ketoacidosis / complications, Diagnosis, Differential, Glycated Hemoglobin / analysis, Humans, Hypoglycemic Agents / therapeutic use, Infant, Newborn, Insulin / therapeutic use, Male, Pancreas / enzymology, Blood Glucose, Glycated Hemoglobin A, Hypoglycemic Agents, Insulin

Neonatal diabetes mellitus (DM) develops within the first six weeks of life with basic findings including dehydration, hyperglycaemia, and mild or no ketonemia/ketonuria. It can be either transient or permanent. Here, we report a case of a one-month-old infant with permanent neonatal diabetes, due to pancreatic hypoplasia, accompanied by diabetic ketoacidosis (DKA). The hyperglycaemia and ketoacidosis resolved by the 14(th) hour of treatment, consisting of IV insulin and rehydration. Subsequently, insulin treatment was continued with neutral protamine hagedorn (NPH) insulin. Breastfeeding was started and was continued at intervals of three hours. Following initiation of breastfeeding, the stools became watery, loose, yellow-green in color, and frequent (8-10 times a day). They contained no blood or mucus. Replacement of pancreatic enzymes resulted in decreased stool frequency. Neonatal DM due to pancreatic hypoplasia and associated with DKA may mimic sepsis and should be kept in mind in all newborns who present with fever, dehydration, and weight loss.
Harlequin syndrome in a case of toxic goitre: a rare association
Authors: P V Pradeep, Ajith K Benede, Skandha S Harshita, B Jayashree
Journal: Case Rep Med (2011)
MeSH terms: Case Reports

Harlequin syndrome (HS) is known to be associated with conditions like brain stem infarcts and superior mediastinal neurinoma. However, it has not been reported in association with autoimmune hyperthyroidism. We report a case of exacerbation of unilateral sweating in a patient with HS following the onset of toxic goitre. Previous reports have suggested that a tortuous inferior thyroid artery can produce neurovascular compression of the sympathetic chain which was not observed in our patient. Autoimmune aetiology for HS needs to be explored. Increased sweating in hyperthyroid patients needs to be assessed properly so as to prognosticate appropriately.