OpenMed/multicare-articles huggingface dataset:
Case report: Meningitis and intracranial aneurysm caused by mixed infection of oral microflora dominated by anaerobes
Authors: Hongjiang Cheng, Lina Xu, Fengbing Yang, Longbin Jia, Doudou Zhao, Huimin Li, Wei Liu, Yujuan Li, Xiaoli Liu, Xia Geng, Jiaying Guo, Chen Ling, Jing Zhang
Journal: Front Neurol (2022)
Keywords: anaerobes, case report, intracranial aneurysm, meningitis, oral microflora
MeSH terms: Case Reports

Introduction:
Meningitis caused by oral anaerobic bacteria is rare, especially when complicated with an infected intracranial aneurysm. This paper has described an extremely rare case of bacterial meningitis caused by a mixed infection of oral microflora dominated by anaerobes, which developed cerebral infarcts, brain abscess, intracranial aneurysm, and severe hydrocephalus during treatment.
Case report:
We describe a 65-year-old male patient who was presented with fever and headache as the initial symptoms and then developed left ophthalmoplegia, right hemiplegia, and disturbance of consciousness. Brain imaging showed that intracranial lesions were increased progressively, and cerebral infarcts, brain abscesses, intracranial aneurysm, and severe hydrocephalus were appeared gradually. Eventually, we diagnosed it as anaerobic meningitis by making deoxyribonucleic acid sequencing from the brain abscess pus. After using an anti-microbial regimen that can sufficiently cover anaerobes, the patient's condition was effectively controlled.
Conclusion:
Anaerobic meningitis can cause a series of intracranial complications. Among them, the intracranial aneurysm is extremely rare. When evidence shows that the infection originates from oral flora, physicians should consider the possibility of this type of encephalitis. An early diagnosis and timely treatment are crucial to improving the prognosis.
Multistep reconstruction of a post-traumatic defect in the lower limb with AV loop and free myocutaneous latissimus dorsi flap combined with a perforator monitor skin island after loss of ALT flap
Authors: Tobias Summer, Mazen Abou Mrad, Olimpiu Bota, Kevin Bienger, Adrian Dragu
Journal: GMS Interdiscip Plast Reconstr Surg DGPW (2021)
Keywords: latissimus dorsi, lower limb, microsurgery, plastic surgery, reconstruction
MeSH terms: Case Reports

Crush injuries of the lower extremity with extensive osseous and soft tissue damage impose a big challenge even for an interdisciplinary reconstructive approach. Multistep reconstruction with negative wound pressure therapy for soft tissue management and external fixation for osseous stability preceding free flap transfer leads to optimized outcome. We report the successful multistep reconstruction of a third-degree open right tibial fracture with extensive soft tissue defect with an arteriovenous loop preceding latissimus dorsi flap coverage with a perforator skin island after loss of an anterior lateral thigh (ALT) flap due to intima damage of the recipient vessels. The described method is a safe reconstructive concept after primary flap loss with persistent extensive tissue damage.
First dorsal compartment musculotendinous avulsion accompanied by close radial styloid fracture: Case report
Authors: Emre Anıl Özbek, Mehmet Armangil, Sırrı Sinan Bilgin
Journal: Int J Surg Case Rep (2018)
Keywords: apl, epl, first dorsal compartment, musculotendinous avulsion, radial styloid fracture

Introduction:
Radial styloid fracture and concomitant first dorsal compartment proximal musculotendinous avulsion is extremely rare injury. This togetherness is difficult to diagnose fully on routine physical examination.
Presentation of case:
In this study, we present a thirty nine year old male patient who suffered musculotendinous avulsion injury of the extensor pollicis brevis (EPB) tendon and abduc- tor pollicis longus (APL) tendon that is rarely accompanied by a closed, non-displaced radial styloid fracture developed following an in-car traffic accident. Diagnosis of avulsion was made with preop- erative magnetic resonance imaging (MRI) and the fracture was fixed with open reduction. The measurements of isometric APL and EPL muscle strength for two thumb were performed using a digital hand dynamometer, no statistically significant difference was found between the muscle strengths of the affected and non-affected thumbs at the postoperative second year follow- up (p > 0.05).
Discussion:
The literature does not hold enough cases to establish the grounds for hypotheses related to the injury mechanism in the 1 st extensor tendon musculotendinous injuries ac- companying radial styloid fractures. Although the diagnosis of the injury in our case was inadver- tently made with preoperative MRI, the routine application of MRI does not seem to be cost-effec- tive.
Conclusion:
We suggest that checking and assuring the intactness of the 1 st extensor compartment with a gentle traction during surgery should be a routine step in the treatment of radial styloid fractures treated with open reduction.
Infarction of middle third posterior cortex of kidney: a complication of extended pyelolithotomy, intra-operative electrohydraulic lithotripsy and extraction of calyceal stones under vision using stone basket and flexible cystoscope in a spinal cord injury patient - a case report
Authors: Subramanian Vaidyanathan, Peter L Hughes, Gurpreet Singh, Bakul M Soni
Journal: Cases J (2009)

Background:
Spinal cord injury produces multiple systemic and metabolic alterations. A decrease in micro vascular blood flow to liver, spleen and muscle has been described following spinal cord injury.
Case presentation:
We present a 46-year-old male patient with C-4 complete tetraplegia, who developed a large stag horn calculus with branches in upper, middle and lower calyces of left kidney. This patient underwent Gil-Vernet extended pyelolithotomy and required intra-operative electrohydraulic lithotripsy and retrieval of stones from upper, middle and lower calyces using flexible cystoscope and stone basket. Computed tomography, performed eighteen days after surgery, showed multiple areas of non-enhancing cortex posteriorly and in the upper pole, suggestive of focal infarction. Magnetic resonance imaging of left kidney confirmed the presence of an area of infarction in middle third of posterior cortex, but there was no evidence of trauma to posterior division of renal artery. Therefore, we postulate that compression of renal parenchyma by Gil-Vernet retractors during surgery, and firm pressure that was applied over the middle of kidney for prolonged periods while several attempts were being made to retrieve fragments of calculi from renal calyces, led to ischaemia and subsequently, infarction of mid-third posterior cortex of left kidney.
Conclusion:
This case illustrates importance of gentle handling of kidney during extended pyelolithotomy in order to prevent subtle renal trauma, which may be detected only by advanced imaging studies. Further, spinal cord physicians should take a pragmatic approach to management of stones located inside renal calyces. Both spinal cord injury patients and their physicians should remember that in our enthusiasm to achieve complete clearance of stones embedded deeply within renal calyces, we could produce irreversible injury to kidney, as indeed happened in this patient. Therefore, emphasis should be placed on prevention of struvite renal calculi by discarding indwelling urinary catheters and eliminating Proteus bacteriuria.
Cesarean Scar Endometriosis: An Uncommon Surgical Complication on the Rise? Case Report and Literature Review
Authors: Imane Khachani, Abdelhai Filali Adib, Rachid Bezad
Journal: Case Rep Obstet Gynecol (2017)
MeSH terms: Case Reports

Endometriosis is defined by the presence and growth of ectopic functional endometrial tissue outside the uterus. Scar endometriosis has been described following obstetrical and gynecological surgery. It is a rare condition, though probably on the rise, due to the considerable increase of cesarean sections performed worldwide. Its physiopathology is complex; its symptomatology is rich and diverse but thorough clinical examination along with ultrasound imaging and potentially pretherapeutic cytologic evaluation are usually efficient in diagnosing the condition. Treatment is mostly surgical. We report the case of a cesarean section scar endometriosis, managed at a tertiary level center and emphasize the diagnosis and treatment options.
Multifocal Warthin's Tumor: An Uncommon Presentation of Bilateral Cervical Lymphadenopathy
Authors: Ryan A Rimmer, Elizabeth E Cottrill
Journal: Case Rep Otolaryngol (2018)
MeSH terms: Case Reports

Warthin's tumor is the second most common benign lesion of the parotid gland. It is most commonly encountered in male smokers in the fifth to seventh decades of life. Uniquely, among benign lesions of the parotid gland, it can be seen bilaterally in 7-10% of cases. Very rarely, Warthin's tumor can also mimic malignant or metastatic disease by presenting within cervical lymph nodes. We present a rare case of a 71-year old male smoker with bilateral parotid lesions in addition to progressively enlarging cervical and mediastinal lymphadenopathy. Excisional biopsy of a cervical lymph node ultimately revealed Warthin's tumor.
Gastric adenocarcinoma after gastric bypass for morbid obesity: a case report and review of the literature
Authors: Maxwel Capsy Boga Ribeiro, Luiz Roberto Lopes, João de Souza Coelho Neto, Valdir Tercioti Jr, Nelson Adami Andreollo
Journal: Case Rep Med (2013)

Gastric adenocarcinoma after gastric bypass for morbid obesity is rare but has been described. The diet restriction, weight loss, and difficult assessment of the bypassed stomach, after this procedure, hinder and delay its diagnosis. We present a 52-year-old man who underwent Roux-en-Y gastric bypass 2 years ago and whose previous upper digestive endoscopy was considered normal. He presented with weight loss, attributed to the procedure, and progressive dysphagia. Upper digestive endoscopy revealed stenosing tumor in gastric pouch whose biopsy showed diffuse-type gastric adenocarcinoma. He underwent total gastrectomy, left lobectomy, distal pancreatectomy and splenectomy, segmental colectomy, and bowel resection with esophagojejunal anastomosis. The histopathological analysis confirmed the presence of gastric cancer. The pathogenesis of gastric pouch adenocarcinoma is discussed with a literature review.
Two Children With Novel TRPC6 Spontaneous Missense Mutations and Atypical Phenotype: A Case Report and Literature Review
Authors: Meiqiu Wang, Ren Wang, Xu He, Min Yu, Zhengkun Xia, Chunlin Gao
Journal: Front Pediatr (2020)
Keywords: genetic testing, srns, trpc6, immune complex-mediated glomerulonephritis, proteinuria
MeSH terms: Case Reports

Background: The phenotypes of TRPC6 mutations have been reported mainly in familial and sporadic focal segmental glomerulosclerosis (FSGS), which can occur in both adults and children. Herein, we report on two children with novel TRPC6 spontaneous missense mutations associated with immune complex-mediated glomerulonephritis and minor glomerular abnormality (MGA) that showed to be resistant to corticosteroids and other immunosuppressants. Case Presentation: A 9-year-old girl presented with steroid-resistant nephrotic syndrome (SRNS), while another 11-year-old boy developed proteinuria at 7 years old. Treatment with a variety of immunosuppressants had no effect, and the renal biopsy showed immune complex-mediated glomerulonephritis and MGA. No members of their family were clinically affected. Genetic testing was performed in the two patients, revealing two novel spontaneous missense mutations in TRPC6-N110S and P112R. The girl developed end-stage renal disease (ESRD) 5 months after onset while the boy continued to have sub-nephrotic range proteinuria and normal creatinine. Conclusions: Two novel TRPC6 mutations were associated with the atypical phenotype-immune complex-mediated glomerulonephritis and MGA, rather than FSGS as previously reported. Their rates of disease progression are different. Genetic testing is helpful to identify the etiology and avoid the side effects brought on by immunosuppressants.
What is really a nonobstructive hypertrophic cardiomyopathy? The importance of orthostatic factor in exercise echocardiography
Authors: Carlos Cotrim, Ana Rita Almeida, Luís Lopes, Paula Fazendas, Isabel João, Hélder Pereira
Journal: ISRN Cardiol (2011)
MeSH terms: Case Reports

The authors report the case of a 23-year-old girl with nonobstructive hypertrophic cardiomyopathy evaluated by resting echocardiography. The patient complained of syncope after playing basketball. The patient was submitted to treadmill exercise echocardiogram, and she exercised for 9 minutes in standard Bruce protocol. The left ventricular outflow gradient did not occur at peak workload; however she developed intraventricular gradient greater than 100 mmHg after exercise in orthostatic position. There was fall in arterial pressure, and the patient was then put in supine position. The authors suggest the possible role of exercise stress echo in symptomatic patients with no significant gradient at baseline, as well as maintenance in orthostatic position after exercise, as an important stress factor. This can disclose the occurrence of left ventricular outflow tract obstruction that should not be detected in other way and has potential relevance in the patient's symptoms understanding.
MIRAGE Syndrome Caused by a De Novo c.3406G>C (p. Glu1136Gln) Mutation in the SAMD9 Gene Presenting With Neonatal Adrenal Insufficiency and Recurrent Intussusception: A Case Report
Authors: Xinyi Chin, Aravind Venkatesh Sreedharan, Ene Choo Tan, Heming Wei, Jyn Ling Kuan, Christopher Wen Wei Ho, Joyce Ching Mei Lam, Teck Wah Ting, Rashida Farhad Vasanwala
Journal: Front Endocrinol (Lausanne) (2021)
Keywords: mirage, samd9/samd9 mutations, adrenal hypoplasia, intussesception, primary adrenal insufficiency
MeSH terms: Adrenal Hyperplasia, Congenital / genetics, Intracellular Signaling Peptides and Proteins / genetics, Intussusception / genetics, Case Reports, Research Support, Non-U.S. Gov't, Adrenal Gland Diseases / genetics, Female, Humans, Infant, Newborn, Infant, Premature, Intussusception / congenital, Mutation, Parenteral Nutrition, Recurrence, Steroids / therapeutic use, Syndrome, Thrombocytopenia / complications, Intracellular Signaling Peptides and Proteins, SAMD9 protein, human, Steroids

Introduction:
Primary adrenal insufficiency (PAI) presenting in the neonatal period can be life threatening and requires early recognition, diagnosis, and management. PAI due to adrenal hypoplasia (syndromic/non-syndromic) is a rare disorder. MIRAGE is a recently described syndrome with PAI and multisystem involvement.
Case presentation:
A preterm female neonate presenting with PAI and persistent severe thrombocytopenia was diagnosed to have MIRAGE syndrome due to a de novo pathogenic variant c.3406G>C (p. Glu1136Gln) in the SAMD9 gene. In the first year of life, she had recurrent respiratory and gastrointestinal infection causing failure to thrive. At 17 months, she suffered recurrent intussusception requiring treatment with parenteral nutrition and high-dose steroids. Subsequently, she established oral feeds with hydrolysed formula and demonstrated good weight gain.
Conclusion:
In neonates presenting with PAI and associated multisystem involvement, a thoughtful approach and genetic testing is valuable in discerning an etiological diagnosis. This case of MIRAGE adds to the spectrum of reported cases and is the first to report on recurrent intussusception and its management with high-dose steroids.
Hypercalcemia of malignancy caused by parathyroid hormone-related peptide-secreting pancreatic neuroendocrine tumors (PTHrP-PNETs): Case Report
Authors: Stephanie Pitts, Amit Mahipal, David Bajor, Amr Mohamed
Journal: Front Oncol (2023)
Keywords: pthrp, hypercalcemia, management, neuroendocrine tumors, pancreatic
MeSH terms: Case Reports

Parathyroid hormone-related protein (PTHrP) secretion is occasionally detected in various solid tumors such as renal cell carcinoma and lung cancers. It is considered quite rare for neuroendocrine tumors with only few published case reports. We reviewed the current literature and summarized a case report of a patient with metastatic pancreatic neuroendocrine tumor (PNET) presenting with hypercalcemia due to elevation of PTHrP. The patient had histological confirmation of well-differentiated PNET and developed hypercalcemia years after his initial diagnosis. In our case report, evaluation showed intact parathyroid hormone (PTH) in the setting of concomitant elevation of PTHrP. The patient's hypercalcemia and PTHrP levels were improved by using a long-acting somatostatin analogue. In addition, we reviewed the current literature regarding the optimal management of malignant hypercalcemia due to PTHrP-producing PNETs.
Internal and external root resorption management: a report of two cases
Authors: Nanditha Hegde, Mithra N Hegde
Journal: Int J Clin Pediatr Dent (2013)
Keywords: flowable gutta-percha system, inflammatory root resorption, mineral trioxide aggregate, nonsurgical endodontic therapy
MeSH terms: Case Reports

The response of the dentoalveolar apparatus to infection is characterized by inflammation which may result in tooth resorption. Depending upon the type of resorption and etiology, different treatment regimens have been proposed. The following two cases demonstrate internal and external inflammatory root resorption arrest by conventional nonsurgical endodontic therapy combined with calcium hydroxide-iodoform dressing, mineral trioxide aggregate (MTA) and flowable gutta-percha system.The patient has been regularly recalled every 6 months and radiographically the apical lesion showed signs of healing and arrest of root resorption after 1 year and 6 months. How to cite this article: Hegde N, Hegde MN. Internal and External Root Resorption Management: A Report of Two Cases. Int J Clin Pediatr Dent 2013;6(1):44-47.
Octreotide-treated diabetes accompanied by endogenous hyperinsulinemic hypoglycemia and protein-losing gastroenteropathy
Authors: Nobuhiko Takahashi, Miho Nagamine, Mitsuko Fukuda, Wataru Motomura, Atsuko Abiko, Masakazu Haneda, Mikihiro Fujiya, Masahiro Ieko, Yutaka Kohgo
Journal: Case Rep Med (2011)
MeSH terms: Case Reports

Occurrence of hypoglycemia in diabetes patients is very rare. We report here a case of frequent hypoglycemic attacks caused by inappropriate endogenous hyperinsulinemia in a female patient with poorly controlled diabetes and protein-losing gastroenteropathy. The blood glucose profiles of the patient were unstable. Results of the fasting test performed to investigate the cause of hypoglycemia suggested endogenous hyperinsulinism. Repeated selective arterial calcium injection tests suggested that hyperinsulinemia might be extrapancreatic in origin. However, efforts to detect a responsible lesion such as insulinoma were unsuccessful. Octreotide was used for the treatment of hypoglycemia and protein-losing gastroenteropathy. After treatment, although her leg edema caused by hypoalbuminemia persisted, hypoglycemia almost disappeared.
Osteoblastic Osteosarcoma Arising beneath an Osteochondroma in an 11-Year-Old Male with Multiple Hereditary Exostoses
Authors: Emmanuel Bukara, Alex M Buteera, Robert Karakire, Felix Manirakiza, Samuel Muhumuza, Emmanuel Rudakemwa, Lynnette Kyokunda
Journal: Case Rep Orthop (2018)
MeSH terms: Case Reports

Introduction:
Multiple hereditary exostoses (MHE) is a rare autosomal dominant disorder characterized by the presence of multiple skeletal deformities. They are painless slow-growing lesions. Malignant transformation tends to occur later in adulthood and has only been seen in 1-5% of patients.
Objective:
We describe the clinical, radiological, and pathological characteristics of a child with MHE who developed osteoblastic osteosarcoma beneath an osteochondroma.
Case presentation:
An 11-year-old male Rwandan presented to our hospital with a two-week history of a dull persistent pain in his left distal femur and loss of weight and appetite. There was no relief with pain killers. He was a known case of multiple hereditary exostoses diagnosed at age 3. He began experiencing mild symptoms 6 months prior to admission which worsened in the last two weeks prior to his admission. On examination, he had multiple palpable bony swellings bilaterally on the proximal humeri and distal femurs. X-rays showed multiple exostoses and MRI showed a lesion with heterogeneous signal intensities that suggested malignant transformation. At surgery, a necrotic lesion beneath the exostosis was excised and sent for histopathological analysis which confirmed osteochondroma with an osteoblastic osteosarcoma in the marrow cavity. Chemotherapy and limb-salvaging surgery were done and he has recovered well.
Conclusion:
Osteosarcomas arising at sites of MHE have not been previously reported in Africa. These tumors rarely undergo malignant transformation.
The case of pulmonary tuberculosis with COVID-19 in an Indian male-a first of its type case ever reported from South Asia
Authors: Sankalp Yadav, Gautam Rawal
Journal: Pan Afr Med J (2020)
Keywords: covid-19, sars-cov-2, tuberculosis
MeSH terms: COVID-19 / diagnosis, Coinfection / diagnosis, Mycobacterium tuberculosis / isolation & purification, SARS-CoV-2 / isolation & purification, Tuberculosis, Pulmonary / diagnosis, Case Reports, Adult, COVID-19 / complications, Humans, India, Male, Reverse Transcriptase Polymerase Chain Reaction, SARS-CoV-2 / genetics, Tuberculosis, Pulmonary / complications

We report the first case of tuberculosis with COVID-19 from South Asia. The patient was a 43 years old Indian male. He reported to us in the outpatient department with chief complaints of cough with expectoration associated with fever, chest pain, and night sweats. The diagnosis of tuberculosis in the current pandemic of COVID-19 required a high degree of suspicion to rule out the SARS-CoV-2 infection along with the infection of Mycobacterium tuberculosis. The clinical presentations in the two diseases are quite similar and thus the present case will serve as a tool to help the clinicians handling cases of both the viral and bacterial infection across the globe.