OpenMed/multicare-articles huggingface dataset:
Ultrasound-guided ethyl alcohol injection to the deep branch of the ulnar nerve to relieve hand spasticity in stroke patients: A case series
Authors: Min Cheol Chang, Gyu-Sik Choi, Mathieu Boudier-Revéret
Journal: Transl Neurosci (2021)
Keywords: muscle spasticity, stroke, ulnar nerve

Hand spasticity with a flexor pattern is a common problem affecting stroke patients and can result in pain, contractures, esthetic concerns, skin maceration, and overall loss of function. Poststroke (≥6 months) hemiparetic adult patients having a Modified Ashworth Scale (MAS) score of ≥1 for metacarpophalangeal flexion and thumb adduction spasticity were selected to receive an ultrasound-guided 20% ethyl alcohol block performed perineurally at the level of the deep branch of the ulnar nerve. Their MAS scores were evaluated pretreatment at 1 month and the change in MAS scores was assessed using Wilcoxon's test. The threshold for statistical significance was set at p < 0.05. The mean MAS score for the flexor muscles of the 5 MCP joints and for thumb adduction was reduced from 3.3 ± 0.5 at pretreatment to 0.9 ± 0.5 at 1 month after the injection for the 10 patients. One month after the injection, the MAS scores were significantly reduced compared with those at pretreatment (p < 0.001), without complications. These are encouraging results showing that ultrasound-guided alcohol blocks of the deep branch of the ulnar nerve are safe and can help chronic stroke patients with metacarpophalangeal flexion and thumb adduction spasticity at 1 month.
Rare Strain of Vibrio cholerae Septicemia in a Patient with Multiple Myeloma
Authors: Deepu Daniel, Sunil Kumar
Journal: Case Rep Crit Care (2015)

Introduction. Non-O1/non-O139 is a rare strain of Vibrio cholera that has been documented to cause significant morbidity and mortality in the immunosuppressed population. Case Presentation. A patient with multiple myeloma develops non-O1/non-O139 Vibrio cholera septicemia, leading to multiorgan failure and ultimately death. Discussion. An exceedingly rare strain of Vibrio cholera, non-O1/non-O139, may be an important factor of morbidity and mortality in certain immunosuppressed populations, such as patients with multiple myeloma and malignancies. Conclusion. Bacteremia involving generally noninvasive microbes, such as non-O1/non-O139 Vibrio cholerae, can have significant deleterious effects in the immunosuppressed patients as shown by this case report. Physicians need to be more diligent when treating these patients.
Mimic for Child Physical Abuse: Biochemical and Genetic Evidence of Hypophosphatasia without Classic Radiologic Findings
Authors: Kasra Zarei, John A Bernat, Yutaka Sato, Rachel Segal, Guru Bhoojhawon
Journal: Case Rep Pediatr (2020)
MeSH terms: Case Reports

Infants presenting with multiple fractures without a plausible accident history need to be evaluated for child abuse or underlying predisposing conditions such as osteogenesis imperfecta and hypophosphatasia. We present a case of infantile hypophosphatasia with multiple unexplained fractures but otherwise normal radiographs in the setting of biochemical and genetic evidence of hypophosphatasia. Standard screening tests for hypophosphatasia include serum alkaline phosphatase level and genetic testing. Despite the presented case's positive biochemical and genetic testing, the case did not have any other radiologic finding suggesting infantile hypophosphatasia, such as severe bone mineralization deficits and rickets. While patients with hypophosphatasia can have increased bone fragility, this has been reported in the context of radiologic abnormalities of the skeleton. Thus, this case is potentially the first reported infantile hypophosphatasia case presenting with no findings of rickets on radiographs, raising concern that the fractures and especially the radius head dislocation might be due to physical abuse.
Case Report: Auditory Neuropathy and Central Auditory Processing Deficits in a Neuro-Otological Case-Study of Infratentorial Superficial Siderosis
Authors: Natallia Kharytaniuk, Peter Cowley, David J Werring, Doris-Eva Bamiou
Journal: Front Neurol (2021)
Keywords: mri, auditory neuropathy, case report, central auditory deficits, infratentorial superficial siderosis
MeSH terms: Case Reports

Hearing and balance impairment are the most frequently reported features of infratentorial (classical) superficial siderosis (iSS). There are few comprehensive descriptions of audiovestibular function in iSS and therefore limited understanding of the affected segment(s) of the audiovestibular pathway. In addition, monitoring disease progression and response to treatment is challenging and currently mainly guided by subjective patient reports and magnetic resonance imaging. To the best of our knowledge, there have been no previous reports assessing central auditory function in iSS. We describe such findings in a patient with iSS in an attempt to precisely localize the site of the audiovestibular dysfunction, determine its severity and functional impact. We confirm the presence of (asymmetrical) auditory neuropathy and identify central auditory processing deficits, suggesting involvement of the central auditory pathway beyond the brainstem. We correlate the audiological and vestibular findings with self-report measures and the siderosis appearances on brain magnetic resonance images.
Occipital anaplastic oligodendroglioma with multiple organ metastases after a short clinical course: a case report and literature review
Authors: Gang Li, Zhiguo Zhang, Jianghong Zhang, Tianbo Jin, Hongjuan Liang, Li Gong, Guangbin Cui, Haixia Yang, Shiming He, Yongsheng Zhang, Guodong Gao
Journal: Diagn Pathol (2014)
MeSH terms: Brain Neoplasms / pathology, Occipital Lobe / pathology, Oligodendroglioma / secondary, Case Reports, Research Support, Non-U.S. Gov't, Review, Bone Marrow Neoplasms / genetics, Bone Marrow Neoplasms / secondary, Bone Neoplasms / genetics, Bone Neoplasms / secondary, Brain Neoplasms / genetics, Humans, Lymphatic Metastasis / genetics, Lymphatic Metastasis / pathology, Male, Middle Aged, Oligodendroglioma / genetics

Background:
It is generally believed that malignant gliomas never metastasize outside the central nervous system (CNS). However, the notion that oligodendrogliomas (OGDs) cells cannot spread outside CNS is being challenged.
Methods:
We described in detail the clinical story of one patient with anaplastic OGD, which metastasized to lymph nodes, bone marrowand bones Genetic analyses included detection of 1p and 19q chromosomal arms, methylation status of MGMT promoter, and PTEN exon mutations. A search of worldwide literature was conducted for reports of metastatic OGDs using NCBI-PubMed, with the keywords "extracranial", "extraneural", "oligodendroglioma", "oligodendrogliomas", "metastatic", "metastasis", and "metastases", in different combinations.
Results:
An open biopsy of the infiltrated bones in our patient revealed that malignant cells had replaced the patient's marrow. Moreover, the diagnosis of multiple-organ metastases of anaplastic OGD was confirmed based on immunohistochemical staining. Genetic analyses showed that the tumors originated from previously resected brain lesions. None of the lesions had 1p and 19q deletions, but hypermethylation of MGMT promoter, and the G → A transversion at codon 234 of PTEN exon 2 were detected. Literatures review yielded 60 reports of metastatic OGDs from 1951 to the present, which with our patient makes 61 cases. Concerning these 61 patients, there were 110 infiltrated sites correlated closely with primary OGDs. The most frequent metastatic sites were bone and bone marrow (n = 47; 42.7%), lymph nodes (n = 22; 20.0%), liver (n = 7; 6.4%), scalp (n = 6; 5.5%), lung (n = 6; 5.5%), pleura (n = 4; 3.6%), chest wall (n = 3; 2.7%), iliopsoas muscle (n = 2; 1.8%), soft tissue (n = 2; 1.8%), and parotid gland (n = 2; 1.8%).
Conclusions:
Extracranial metastases in anaplastic OGD are very rare but they do occur; bone and bone marrow may be the most common sites. Detection of certain molecular markers such as deletion of 1p and 19q chromosomal arms, hypermethylation of MGMT promoter, and characteristic PTEN exon mutations may help differentiate subtypes which are more prone to extracranial metastases.
Virtual slides:
The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/8749838611478560.
Successful Outcome of Programmed Death 1 Blockade Plus GemOx for Epstein-Barr Virus-Associated Primary Nodal T/NK Cell Lymphoma: A Case Report
Authors: Liang Xia, Han-Shuo Zhang, Jing Bao, Yu-Chen Zhao, Hai-Long Xia
Journal: Front Oncol (2021)
Keywords: ebv-associated nodal tnkl, gemcitabine and oxaliplatin, pd-1 blockade, case report, tislelizumab
MeSH terms: Case Reports

Epstein-Barr virus (EBV)-associated lymph nodal T/NK cell lymphoma (nodal TNKL) is a rare and aggressive malignancy with an extremely poor prognosis. Although treatments of extranodal NK/T cell lymphoma are frequently reported, the characteristics and pathogenesis of EBV-associated nodal TNKL are different. However, there is no known effective therapy regimen at present. Here, we reported the clinical efficacy and feasibility of the programmed death 1 (PD-1) blockade therapy regimen in an elderly female patient with EBV-associated nodal TNKL. The patient failed to respond to cyclophosphamide, doxorubicin, vindesine, and prednisone regimen but achieved complete response after three cycles of anti-PD-1 antibody (tislelizumab) combined with gemcitabine and oxaliplatin (GemOx) regimen. The finding indicated that tislelizumab combined with the GemOx regimen may be a potent salvage regimen for EBV-associated nodal TNKL.
Hypophosphatemic Rickets in Siblings: A Rare Case Report
Authors: Gummadapu Sarat, Nuthalapati Priyanka, Meka Purna Venkata Prabhat, Chintamaneni Raja Lakshmi, Sujana Mulk Bhavana, Dharmavaram Ayesha Thabusum
Journal: Case Rep Dent (2016)

Hypophosphatemic rickets (HR) is a type of hereditary rickets characterized by persistent hypophosphatemia and hyperphosphaturia. The most predominant type is inherited in an X-linked fashion and caused by mutation in the gene encoding the phosphate-regulating endopeptidase homolog, X-linked (PHEX), identified in 1995. The X-linked hypophosphatemic (XLH) rickets is a rare hereditary metabolic disorder with a prevalence of 1 in 20,000 and causes deficient calcification of mineralized structures such as bones and teeth resulting in dental problems in terms of delayed eruption, spontaneous periapical infections, and exfoliation. We report one such unique case of hypophosphatemic vitamin D-resistant rickets in siblings exhibiting classical features of rickets with emphasis on its treatment and dental considerations.
Abnormal branching of the left lingular pulmonary artery diagnosed by three-dimensional computed tomographic angiography in a patient with lung cancer: a case report
Authors: Dai Sonoda, Masashi Mikubo, Kazu Shiomi, Yukitoshi Satoh
Journal: J Cardiothorac Surg (2016)
MeSH terms: Lung Neoplasms / surgery, Pulmonary Artery / abnormalities, Case Reports, Aged, Humans, Imaging, Three-Dimensional / methods, Male, Preoperative Care / methods, Pulmonary Artery / diagnostic imaging, Pulmonary Artery / surgery, Thoracic Surgery, Video-Assisted / methods, Tomography, X-Ray Computed / methods

Background:
In general, there are several anomalies of the pulmonary artery. The mediastinal lingular pulmonary artery is well-known for its abnormal branching from the pulmonary artery. However, other types of variation are rare.
Case presentation:
We herein report the case of a patient with primary lung cancer who underwent left upper lobectomy in which the lingular pulmonary artery branching from the mediastinal basal artery was demonstrated by preoperative three-dimensional computed tomographic (3D-CT) angiography.
Conclusions:
A preoperative evaluation using 3D-CT angiography was useful for detecting the abnormal pulmonary branching in this patient because it allowed for the precise division of the pulmonary arteries during surgery.
How much might a society spend on life-saving interventions at different ages while remaining cost-effective? A case study in a country with detailed data
Authors: Giorgi Kvizhinadze, Nick Wilson, Nisha Nair, Melissa McLeod, Tony Blakely
Journal: Popul Health Metr (2015)
Keywords: age, cost-effective, cost-effectiveness threshold, health system costs, health-adjusted life expectancy (hale), health-adjusted life-years (halys), morbidity, quality-adjusted life-years (qalys)

Objective:
We aimed to estimate the maximum intervention cost (EMIC) a society could invest in a life-saving intervention at different ages while remaining cost-effective according to a user-specified cost-effectiveness threshold.
Methods:
New Zealand (NZ) was used as a case study, and a health system perspective was taken. Data from NZ life tables and morbidity data from a burden of disease study were used to estimate health-adjusted life-years (HALYs) gained by a life-saving intervention. Health system costs were estimated from a national database of all publicly funded health events (hospitalizations, outpatient events, pharmaceuticals, etc.). For illustrative purposes we followed the WHO-CHOICE approach and used a cost-effectiveness threshold of the gross domestic product (GDP) per capita (NZ$45,000 or US$30,000 per HALY). We then calculated EMICs for an "ideal" life-saving intervention that fully returned survivors to the same average morbidity, mortality, and cost trajectories as the rest of their cohort.
Findings:
The EMIC of the "ideal" life-saving intervention varied markedly by age: NZ$1.3 million (US$880,000) for an intervention to save the life of a child, NZ$0.8 million (US$540,000) for a 50-year-old, and NZ$0.235 million (US$158,000) for an 80-year-old. These results were predictably very sensitive to the choice of discount rate and to the selected cost-effectiveness threshold. Using WHO data, we produced an online calculator to allow the performance of similar calculations for all other countries.
Conclusions:
We present an approach to estimating maximal cost-effective investment in life-saving health interventions, under various assumptions. Our online calculator allows this approach to be applied in other countries. Policymakers could use these estimates as a rapid screening tool to determine if more detailed cost-effectiveness analyses of potential life-saving interventions might be worthwhile or which proposed life-saving interventions are very unlikely to benefit from such additional research.
Intravascular Thrombolysis Followed by Stenting as Management of Retrohepatic Inferior Vena Caval Thrombosis due to a Twist in the Inferior Vena Cava after Deceased Donor Liver Transplant
Authors: Olivia Kituuka, Rakesh Rai, Ashok Thorat, Vianney Kweyamba, Alex Elobu, Prabath Mondel
Journal: Case Rep Surg (2019)
MeSH terms: Case Reports

Inferior vena cava (IVC) occlusion due to acute thrombosis is a rare but important vascular complication after deceased donor liver transplantation (DDLT) that has been reported to occur up to 2% of recipients in a posttransplant period. This may be caused by direct instrumentation of the IVC stenosis at the anastomotic site, haematoma, and rarely by a twist in the retrohepatic IVC. The location of the thrombus, the timing after the surgery, and associated hemodynamic disturbances define the outcome of the patient. Without prompt diagnosis and timely intervention, the outcome after IVC thrombosis is usually dismal. Herein, we report a rare case of near-complete occlusion of the IVC secondary to intracaval thrombosis after DDLT associated with twisting of the IVC at the suprahepatic anastomosis which was successfully managed by intravascular thrombolysis and stenting.
Increased Intracranial Pressure on a Patient with Neuromyelitis Optica Spectrum Disorder
Authors: Seyed Mohammad Forouzannia, Pourya Yarahmadi, Mohammad Alirezaei, Nasim Rezaeimanesh, Abdorreza Naser Moghadasi
Journal: Caspian J Intern Med (2021)
Keywords: anti- aquaporin antibody, high intra cranial pressure, neuromyelitis optica spectrum disorder
MeSH terms: Case Reports

Background:
Neuromyelitis optica spectrum disorder (NMOSD) is an autoimmune astrocytopathic disease affecting central nervous system (CNS). CSF pressure in these patients is usually normal.
Case presentation:
A 30-year-old woman was admitted with complaints of headache and lower limbs paresis. Lumbar puncture (LP) and magnetic resonance imaging were performed for the patient. Opening pressure was 42 cm H2O in the first LP. According to the clinical evidences, imaging, and the patient's positive aquaporin-4 antibody, the diagnosis of NMOSD was established.
Conclusion:
High intracranial pressure headache; however rare, may be the first sign of the onset of the acute exacerbation phase of NMOSD.
Incisal Interference Correction after Severe Extrusive Luxation Trauma during Orthodontic Treatment
Authors: M Aarts, C M Suttorp
Journal: Case Rep Dent (2022)
MeSH terms: Case Reports

This case report presents the treatment of a 12-year-old boy who suffered serious dental trauma, accompanied with buccal alveolar socket wall fractures, during orthodontic treatment. The maxillary right lateral incisor and canine were severely extruded and laterally luxated to the palatal side, resulting in an anterior crossbite and creating an incisal interference that prevented the jaws from closing in normal occlusion. During emergency treatment, the dentist attempted manual repositioning, but both severely extruded teeth were found to be immobile. One day after trauma, orthodontic repositioning was started using full fixed appliances with light 0.012″ nickel-titanium round wires, and this occlusal interference was corrected within 3 weeks. In the various internationally recognized treatment guidelines, the options for orthodontic repositioning for dental luxation trauma are only marginally described. Internationally accepted dental treatment guidelines may include immediate orthodontic repositioning after trauma as a treatment option in the management of dental extrusive and lateral luxation trauma.
Air Leak Syndrome: Pneumoperitoneum in a Ventilated Neonate
Authors: Chandana Ravikumar, Dawn McDaniel, Amy Quinn
Journal: Case Rep Pediatr (2019)
MeSH terms: Case Reports

Air leak syndrome has several manifestations and is common in neonates with meconium aspiration syndrome (MAS) due to air trapping. While pneumoperitoneum is classically a result of intestinal perforation, intra-abdominal free air may be a less common presentation of air leak syndrome. In the ventilated neonate, there is insufficient clinical evidence outlining management of pneumoperitoneum in this situation. We report a case of a term neonate with MAS and air leak syndrome who developed benign pneumoperitoneum (BPPT).
Budd-Chiari syndrome caused by latent hepatic metastasis from a thymoma
Authors: Tomoya Horiguchi, Yoko Toyama, Yosuke Sakakibara, Aki Ikeda, Hisashi Kako, Takuma Ina, Takuya Okamura, Sakurako Uozu, Yasuhiro Goto, Kohei Yokoi, Kazuyoshi Imaizumi
Journal: Respir Med Case Rep (2021)
Keywords: ascites, bcs, budd–chiari syndrome, budd-chiari syndrome, camp, cisplatin, doxorubicin, and methylprednisolone, ivc, inferior vena cava, liver metastasis, saag, serum-ascites albumin gradient, thymoma
MeSH terms: Case Reports

A 34-year-old woman visited our hospital because she had had abdominal bloating for 2 months. She had been diagnosed with invasive thymoma (WHO pathological type B2), for which she had undergone chemotherapy and total thymectomy 10 years previously. Six years previously, pleural dissemination was diagnosed and she had undergone right extra-pleural pneumonectomy. On presentation to our hospital, abdominal computed tomography and ultrasound scans revealed abundant ascites and a huge liver lesion, likely a metastasis from her thymoma, obstructing the inferior vena cava. The serum-ascites albumin gradient was high at 1.4 g/dL, which indicated portal hypertension. We diagnosed Budd-Chiari syndrome caused by liver metastasis from a previous thymoma. Steroid therapy resulted in shrinkage of her liver tumor and a marked decrease in her ascites. Although rare, Budd-Chiari syndrome caused by liver metastasis from a thymoma is a possible serious complication of advanced invasive thymoma.
Respiratory distress in a patient with Klinefelter syndrome: a suspicion of COVID-19 hiding severe pulmonary embolism
Authors: Elyes Lagha, Rami Tlili, Fares Azaiez, Rym Ben Romdhane, Kawther Bachraoui, Nourelhouda Nouira, Meriam Chaabouni, Youssef Ben Ameur
Journal: Pan Afr Med J (2020)
Keywords: covid-19, klinefelter syndrome, pulmonary embolism
MeSH terms: COVID-19 / diagnosis, Klinefelter Syndrome / physiopathology, Pulmonary Embolism / diagnosis, Respiratory Distress Syndrome / diagnosis, Case Reports, Adult, Bundle-Branch Block / diagnosis, Chest Pain / etiology, Dyspnea / etiology, Electrocardiography, Emergency Service, Hospital, Humans, Male, Respiratory Distress Syndrome / etiology, Tomography, X-Ray Computed

Klinefelter syndrome is the most common congenital abnormality causing primary hypogonadism and predisposing to a state of hypercoagulability. We report the case of a 37-year-old man, of Algerian nationality, diagnosed with Klinefelter syndrome admitted to the hospital via the emergency room for acute chest pain and dyspnea. The patient arrived in Tunisia 36 hours ago. On admission, body temperature was 38.2°C, blood pressure, pulse and respiratory rate were 130/70 mmHg, 120/minute and 26/minute, respectively. He had an oxygen saturation of 87% in room air. His electrocardiography revealed a complete right bundle-branch block, chest X-Ray was normal. In front of the clinical presentation and the origin of the patient coming from an endemic country, COVID-19 infection was suspected but ruled out by pharyngeal swabs testing negative by real-time reverse-transcription polymerase chain reaction test and massive pulmonary embolism was diagnosed from his chest computed tomography images. The symptoms improved with anticoagulation treatment.
Repair of a perforated duodenal diverticulum using intraduodenal suture in 94 year old woman: A case report
Authors: Hidenori Maki, Yasuhiro Yuasa, Yuta Matsuo, Osamu Mori, Atsushi Tomibayashi
Journal: Int J Surg Case Rep (2020)
Keywords: case report, diverticulum, duodenal suture, perforation
MeSH terms: Case Reports

Introduction:
In case of gastrointestinal diverticula, the duodenal type is quite frequent; duodenum is the second most common site for diverticula following the colon (Glener et al., 2016). However, duodenal diverticular perforation is rare, so the appropriate surgical treatment for this condition is yet unclear (Simoes et al., 2014). This literature has been written in line with the SCARE criteria (Agha et al., 2018).
Presentation of case:
A 94-year-old woman emergently presented to our department with diffuse abdominal tenderness and guarding, indicating pan-peritonitis. Computed tomography revealed pneumoretroperitoneum; Therefore, gastrointestinal perforation was suspected. Emergency surgery was performed; we detected the perforated diverticulum located at the posterior wall of the duodenum with accompanying inflammation. Considering the location, postoperative leakage, and the patient's advanced age, we placed trans-section on duodenal wall against the lesion and resected the diverticulum, The lumen was then manually sutured from within. The anterior wall was closed using linear staplers. The patient recovered uneventfully and was discharged 24 days after surgery.
Discusssions:
As perforated duodenal diverticulum is rare, the ideal management is unclear. Several studies mention various surgical procedures. However, actual treatment varies based on the patient's situation and surgeon's assessment. Almost all cases that require surgery present emergently; therefore, simpler and more effective treatment methods are required (Simoes et al., 2014; Philip et al., 2019; Fujisaki et al., 2014).
Conclusion:
We used a unique surgical technique; intraduodenal suture for perforated diverticulum. This technique can be a feasible alternative for managing this condition.