OpenMed/multicare-articles huggingface dataset:
The Use of Portal Vein Pulsatility to Differentiate Hypervolemic and Hypovolemic Hyponatremia
Authors: Gurkeerat Singh, Jean-Sebastien Rachoin, Christina Chien, Sharad Patel
Journal: Case Rep Crit Care (2019)
MeSH terms: Case Reports

Hypotonic hyponatremia is a common electrolyte disorder defined by a blood serum sodium value of less than 136 meq/L. A challenge in managing hyponatremia is accurately determining the etiology for the free water excess as management can markedly differ. Accurate diagnosis of the etiology of hypotonic hyponatremia requires precision in the determination of extracellular volume status. Determination of volume status has traditionally relied on physical examination, imaging modalities, and clinical gestalt, all of which are inaccurate. Portal vein pulsatility is an easy to perform bedside ultrasound imaging study which can be used as a marker for hypervolemia and venous congestion. We present 2 cases of hypervolemic hyponatremia in which portal vein pulsatility was used in the diagnosis and management and as a marker for efficacy of treatment.
Current access and recruitment practices in nursing education institutions in KwaZulu-Natal: A case study of student nurses with disabilities
Authors: Selvarani Moodley, Gugu Mchunu
Journal: Afr J Disabil (2019)

Background:
While institutions of higher education may have increased access and accommodation for students with disabilities, institutions primarily providing nurse training in South Africa do not mirror the same practice.
Objectives:
Notwithstanding the integration of disability policies enacted in South Africa in 2010, a majority of people with disabilities are still excluded from the activities of society equally applicable to nursing education. This article describes the current access and recruitment practices for student nurses with disabilities (SNWDs) in nursing education institutions in KwaZulu-Natal to provide baseline data, which is largely absent in nursing institutions.
Method:
A concurrent mixed-method design using a multiple embedded case study approach was employed. This article presented phase 1 of the study, a quantitative survey of all private nursing education institutions (n = 27), complemented by individual, in-depth interviews with SNWDs (n = 10). Quantitative data were analysed using SPSS version 24, with a response rate of 78% (n = 21), whereas qualitative data were analysed using content analysis.
Results:
The findings revealed that the majority of private NEIs lack policy guidelines for recruiting SNWDs; however, other means of guidance is sought, for example, using the technical assistance. While NEIs were willing to recruit SNWDs, access to clinical sites, lectures, support systems and reasonable accommodation was challenging.
Conclusion:
Private NEIs are providing an inclusive education to all students including those with disabilities; however, they still have a long way to go in meeting the needs of SNWDs with regards to support and accommodation.
A Case of Fetal Tachycardia after Electroconvulsive Therapy: A Possible Effect of Maternal Hypoxia and Uterine Contractions
Authors: Anri Watanabe, Nobutaka Ayani, Miyoko Waratani, Tatsuji Hasegawa, Maki Ishii, Teruyuki Matsuoka, Jin Narumoto
Journal: Case Rep Psychiatry (2019)
MeSH terms: Case Reports

Electroconvulsive therapy (ECT) is considered to be an effective and safe treatment for depression in pregnant women in that it avoids the risk of psychotropic pharmacotherapy. However, clinicians should be cautious about the adverse effects in the fetus, such as fetal cardiac arrhythmia. Most of the previous studies have demonstrated a reduction in fetal heart rate associated with ECT. However, we encountered a case of fetal tachycardia after maternal ECT-induced convulsions. The patient was a woman who was 30 weeks' pregnant and had severe depression; fetal tachycardia (180-200 bpm) occurred immediately after the electrical stimulation and lasted for more than 30 minutes. The fetal tachycardia might have been caused by maternal hypoxia and uterine contractions. To our knowledge, this is the first report of fetal tachycardia as an adverse effect of ECT. Prolonged fetal tachycardia may cause fetal heart failure. Therefore, oxygenation during convulsions and careful fetal cardiac monitoring are essential when administering ECT in pregnancy.
Severe acute pancreatitis 5 years after pancreaticoduodenectomy: A case report
Authors: Yuya Ashitomi, Shuichiro Sugawara, Ryosuke Takahashi, Koki Ashino, Toshihiro Watanabe, Osamu Hachiya, Wataru Kimura
Journal: Int J Surg Case Rep (2019)
Keywords: acute pancreatitis, case report, necrosectomy, pancreaticoduodenectomy

Introduction:
Acute pancreatitis is a known complication of pancreaticoduodenectomy (PD). However, no reports in the literature describe a late delayed severe acute pancreatitis. We report a case of acute pancreatitis 5 years after PD in a patient who needed intensive care for his complication.
Presentation of case:
A 64-years-old man presented with upper abdominal pain and reported a history of PD 5 years prior to presentation. Contrast-enhanced computed tomography revealed an edematous pancreatic remnant with inflammation of the surrounding tissue, and he was diagnosed with acute pancreatitis. His condition worsened, and he was transferred to our hospital the following day. He was admitted to the intensive care unit to manage respiratory and circulatory insufficiency. Although his condition improved, an abdominal abscess was identified, and necrosectomy was performed on day 43 of hospitalizaiton. We carefully removed as much necrotic tissue as was possible without injury to the pancreaticojejunal anastomosis and the ascending colon. Inflammation gradually subsided, and he was discharged on day 111 of hospitalization. The last drain was removed in day 133 of admission to our hospital. Pancreatitis and abdominal abscess have not recurred until the time of writing this paper.
Discussion:
Delayed severe acute pancreatitis is rare. Necrosectomy can treat an abdominal abscess; however it is important to avoid injury to other organs.
Conclusion:
Clinicians should be aware that severe acute pancreatitis can occur after PD.
Evidence-based health care policy in reimbursement decisions: lessons from a series of six equivocal case-studies
Authors: Pieter Van Herck, Lieven Annemans, Walter Sermeus, Dirk Ramaekers
Journal: PLoS One (2013)
MeSH terms: Decision Making, Evidence-Based Practice / economics, Health Policy / economics, Insurance, Health, Reimbursement / economics, Antibodies, Monoclonal, Humanized / economics, Antibodies, Monoclonal, Humanized / therapeutic use, Aorta / surgery, Breast Neoplasms / diagnosis, Endovascular Procedures / economics, Habits, Humans, Lobbying, Mass Media, Neutrons / therapeutic use, Oseltamivir / economics, Oseltamivir / therapeutic use, Proton Therapy / economics, Trastuzumab, Antibodies, Monoclonal, Humanized, Oseltamivir, Trastuzumab

Context:
Health care technological evolution through new drugs, implants and other interventions is a key driver of healthcare spending. Policy makers are currently challenged to strengthen the evidence for and cost-effectiveness of reimbursement decisions, while not reducing the capacity for real innovations. This article examines six cases of reimbursement decision making at the national health insurance authority in Belgium, with outcomes that were contested from an evidence-based perspective in scientific or public media.
Methods:
In depth interviews with key stakeholders based on the adapted framework of Davies allowed us to identify the relative impact of clinical and health economic evidence; experience, expertise & judgment; financial impact & resources; values, ideology & political beliefs; habit & tradition; lobbyists & pressure groups; pragmatics & contingencies; media attention; and adoption from other payers & countries.
Findings:
Evidence was not the sole criterion on which reimbursement decisions were based. Across six equivocal cases numerous other criteria were perceived to influence reimbursement policy. These included other considerations that stakeholders deemed crucial in this area, such as taking into account the cost to the patient, and managing crisis scenarios. However, negative impacts were also reported, in the form of bypassing regular procedures unnecessarily, dominance of an opinion leader, using information selectively, and influential conflicts of interest.
Conclusions:
'Evidence' and 'negotiation' are both essential inputs of reimbursement policy. Yet, purposely selected equivocal cases in Belgium provide a rich source to learn from and to improve the interaction between both. We formulated policy recommendations to reconcile the impact of all factors identified. A more systematic approach to reimburse new care may be one of many instruments to resolve the budgetary crisis in health care in other countries as well, by separating what is truly innovative and value for money from additional 'waste'.
Treatment of moyamoya syndrome associated with systemic lupus erythematosus and hypothyroidism in an adult by encephaloduroarteriosynangiosis: a case report
Authors: Arata Tomiyama, Hitoshi Kimura, Haruo Nakayama, Hideaki Izukura, Jun-Ichi Harashina, Keisuke Ito, Ken-Ichiro Sato, Morito Hayashi, Norihiko Saito, Takatoshi Sakurai, Yoko Hirata, Kazuya Aoki, Satoshi Iwabuchi
Journal: Case Rep Med (2012)

A 54-year-old woman presented to our hospital with progressive motor weakness of the right arm. She had a medical history of systemic lupus erythematosus (SLE) and hypothyroidism. Magnetic resonance imaging indicated a watershed infarction of the left hemisphere. Cervical echogram indicated severe stenosis of the internal carotid artery (ICA) without wall thickening. Cerebral angiography indicated left ICA occlusion, development of unilateral moyamoya vessels, and leptomeningeal anastomosis. Encephaloduroarteriosynangiosis (EDAS) was performed after cerebral (99) (m)Technetium-ethyl-cysteinate-dimer single-photon emission computed tomography indicated a decreased cerebral blood flow, diminished cerebrovascular perfusion reserve. Motor weakness finally disappeared 6 months after surgery. Moyamoya syndrome is a rare complication of both SLE and hypothyroidism, and the surgical indication remains controversial. By evaluating the decreased cerebral perfusion reserve capacity and the existence of leptomeningeal anastomosis, EDAS could be an efficient method for the treatment of moyamoya syndrome associated with SLE and hypothyroidism.
Bilateral Sensorineural Deafness in a Young Pregnant Female Presenting with a Fever: A Rare Complication of a Reemerging Disease-Spotted Fever Group Rickettsioses
Authors: A G T A Kariyawasam, D R Palangasinghe, C L Fonseka, P U T De Silva, T E Kanakkahewa, N J Dahanayaka
Journal: Case Rep Infect Dis (2019)
MeSH terms: Case Reports

Background:
Rickettsial illnesses are a group of arthropod-borne remerging diseases. They are subdivided into three groups as typhus, spotted fever, and scrub typhus group. Complications such as reversible bilateral deafness due to spotted fever rickettsioses are infrequently reported in the literature.
Case presentation:
We present a young pregnant female who developed bilateral sensorineural deafness on the fifth day of an acute febrile illness with a maculopapular rash. Rickettsia conorii IgG (>1/450) became highly positive, and she received oral azithromycin for ten days with complete resolution of fever and rash. The sensorineural deafness slowly improved over several months.
Conclusion:
Sensorineural deafness is a rare complication of spotted fever group rickettsioses. Since usage of doxycycline is controversial in pregnancy, azithromycin gave a favourable recovery of fever. Sensorineural deafness took several months to resolve after completion of antibiotics.
Surgical Treatment of Jacob's Disease: A Case Report Involving an Osteochondroma of the Coronoid Process
Authors: Dale E Stringer, Kourt B Chatelain, Rahul Tandon
Journal: Case Rep Surg (2013)

Although it is one of the most common benign tumors of bone in the axial skeleton, the osteochondroma is relatively rare in the maxillofacial region. Its discovery on the coronoid process is even more rare. First described by Jacob in 1899, it remains a rare entity as only a few reported cases have been described in the literature. Nevertheless, the symptomatic features remain relatively nonspecific: limited opening, tightness, and slight expansion of the affected area with or without pain. The demographic features are more established, as it affects younger males. Definitive diagnosis is made after histological analysis, post-resection of the growth. We report a 27 year-old male with a history of limited opening and tightness of the mouth. Computed Tomography (CT) imaging revealed a well corticated exophytic protuberance from the left coronoid process. Left coronoidectomy and excision of the exophytic growth was performed, and was confirmed by histologic analysis to be an osteochondroma, demonstrating Jacob's disease.
Case Report: Severe Peripartum Cardiac Disease in Myotonic Dystrophy Type 1
Authors: Georgia Besant, Pierre R Bourque, Ian C Smith, Sharon Chih, Mariana M Lamacie, Ari Breiner, Jocelyn Zwicker, Hanns Lochmüller, Jodi Warman-Chardon
Journal: Front Cardiovasc Med (2022)
Keywords: cardiomyopathy, cardiovascular, neuromuscular disease, pregnancy, spontaneous coronary artery dissection
MeSH terms: Case Reports

Background:
Myotonic dystrophy type 1 (DM1) is a hereditary muscular dystrophy affecting ∼2.1-14.3/100,000 adults. Cardiac manifestations of DM1 include conduction disorders and rarely cardiomyopathies. DM1 increases the risk of obstetric complications, however, little is known about the relationship between pregnancy and cardiomyopathy in DM1 due to disease rarity.
Case:
A 23-year-old with DM1 developed cardiomyopathy during pregnancy. Despite initial medical stabilization, she subsequently developed multiple spontaneous coronary artery dissections postpartum, worsening cardiomyopathy and multiorgan failure. She died 5 months postpartum.
Conclusion:
Though cardiomyopathy and arterial dissection are both known complications of pregnancy, this case suggests individuals with myotonic dystrophy type 1 may be at heightened risk for cardiac disease during the peripartum period. Physicians caring for women with suspected or proven DM1 should offer counseling and be alerted to the risk of cardiac complications with pregnancy and in the peripartum period. Pregnant and peripartum women with DM1 are likely to benefit from more frequent assessments of cardiac function including echocardiograms and early institution of heart failure management protocols when symptoms of cardiomyopathy present.
Transcranial magnetic stimulation and intravenous ketamine combination therapy for treatment-resistant bipolar depression: A case report
Authors: Laurent Elkrief, Olivier Payette, Jean-Nicolas Foucault, Christophe Longpré-Poirier, Maxime Richard, Véronique Desbeaumes Jodoin, Paul Lespérance, Jean-Philippe Miron
Journal: Front Psychiatry (2022)
Keywords: iv ketamine, tms, trd, case report, rtms
MeSH terms: Case Reports

About a third of patients suffering from major depression develop treatment-resistant depression (TRD). Although repetitive transcranial magnetic stimulation (rTMS) and intravenous ketamine have proven effective for the management of TRD, many patients remain refractory to treatment. We present the case of a patient suffering from bipolar TRD. The patient was referred to us after failure to respond to first-and second-line pharmacotherapy and psychotherapy. After minimal response to both rTMS and ketamine alone, we attempted a combination rTMS and ketamine protocol, which led to complete and sustained remission. Various comparable and complimentary mechanisms of antidepressant action of ketamine and rTMS are discussed, which support further study of this combination therapy. Future research should focus on the feasibility, tolerability, and efficacy of this novel approach.
Joubert syndrome presenting with motor delay and oculomotor apraxia
Authors: Harjinder Gill, Brinda Muthusamy, Denize Atan, Cathy Williams, Matthew Ellis
Journal: Case Rep Pediatr (2011)
MeSH terms: Case Reports

We describe two sisters who presented in early childhood with motor delay and unusual eye movements. Both demonstrated hypotonia and poor visual attention. The older girl at 14 weeks of age showed fine pendular horizontal nystagmus more pronounced on lateral gaze, but despite investigation with cranial MRI no diagnosis was reached. The birth of her younger sister four years later with a similar presentation triggered review of the sisters' visual behaviour. Each had developed an unusual but similar form of oculomotor apraxia (OMA) with head thrusts to maintain fixation rather than to change fixation. MRI of the older sibling demonstrated the characteristic "molar tooth sign" (MTS) of Joubert syndrome which was subsequently confirmed on MRI in the younger sibling. We discuss the genetically heterogeneous ciliopathies now grouped as Joubert syndrome and Related Disorders. Clinicians need to consider this group of disorders when faced with unusual eye movements in the developmentally delayed child.
Laparoscopic treatment of a large cystic adenomyosis of the uterus: A case report
Authors: Congqing Li, Youjiang Xu, Lin Cong
Journal: Int J Surg Case Rep (2020)
Keywords: adenomyosis, cystic adenomyosis, endometriosis, laparoscopy
MeSH terms: Case Reports

Introduction:
We describe a patient with a large cystic adenomyosis of the uterus who was treated by a laparoscopic approach.
Case presentation:
A 38-year-old woman presented with dysmenorrhoea for 4 months. A 104 mm × 55 mm × 60 mm cystic mass was detected on the right side of the posterior wall of the uterus by ultrasound. Laparoscopy was performed, during which a bumpy mass was discovered protruding from the surface of the uterine myometrium. Both ovaries were normal. When the wall of the cystic mass was opened, chocolate-colored fluid was visible. The cyst was completely removed, and postoperative histopathology confirmed a cystic adenomyosis. One month later, the uterus was found to be normal on ultrasound.
Discussion:
Endometriosis is a common disease in women and is divided into ovarian endometrioid cysts, superficial endometriosis, deep infiltrating endometriosis and other special types according to pathological characteristics. As a special type of endometriosis, the incidence of cystic adenomyosis is low, and its specific incidence is unknown. Cystic adenomyosis is clinically characterized by the appearance of one or more cystic cavities between the walls of the uterine muscles.
Conclusion:
Laparoscopic surgery is an effective method for the diagnosis and treatment of large cystic masses in the uterine myometrium.
Catecholaminergic Crisis After a Bleeding Complication of COVID-19 Infection: A Case Report
Authors: Angel Rebollo-Román, Maria R Alhambra-Expósito, Yiraldine Herrera-Martínez, F Leiva-Cepas, Carlos Alzas, Concepcion Muñoz-Jiménez, R Ortega-Salas, María J Molina-Puertas, Maria A Gálvez-Moreno, Aura D Herrera-Martínez
Journal: Front Endocrinol (Lausanne) (2021)
Keywords: covid19, bleeding, catecholamines, complication, pheochromocytoma
MeSH terms: Adrenal Gland Neoplasms / complications, COVID-19 / complications, Hemorrhage / complications, Pheochromocytoma / complications, Case Reports, Research Support, Non-U.S. Gov't, Humans, Male, Middle Aged, Pneumonia / complications

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) presents in some cases with hemostatic and thrombotic complications. Pheochromocytomas are unusual, though potentially lethal tumors. Herein we describe the first case of hemorrhage in a pheochromocytoma related to SARS-CoV-2 infection. A 62-year-old man consulted for syncope, fever, and palpitations. He was diagnosed with SARS-CoV-2 pneumonia and presented with a hemorrhage in a previously unknown adrenal mass, which resulted in a catecholaminergic crisis. Medical treatment and surgery were required for symptom control and stabilization. We hereby alert clinicians to watch for additional/unreported clinical manifestations in COVID-19 infection.
Depression Relapse during Long-Term Remission due to Media-Amplified Fear during the COVID-19 Pandemic
Authors: Nobutaka Ayani, Teruyuki Matsuoka, Sumihiro Yamano, Jin Narumoto
Journal: Case Rep Psychiatry (2021)
MeSH terms: Case Reports

The coronavirus disease 2019 (COVID-19) pandemic has reoriented societies across the world and placed a significant burden on caring for mental health among its population. In this study, we reported two cases where patients experiencing severe depression with delusions of having COVID-19 required inpatient treatment after long-term remission owing to the negative impact of media reports related to the pandemic. Despite the aggravation of their anxiety, the patients were unable to distance themselves from negative information in attempts to remain informed through media to prevent their families and themselves from being infected. Self-protection through improved media literacy is imperative for people to protect themselves from the fearmongering of the media and infodemic in the present-day scenario.
Prosthodontic rehabilitation of hereditary ectodermal dysplasia in an 11-year-old patient with flexible denture: a case report
Authors: Neha Jain, Dinesh Naitam, Arti Wadkar, Anuradha Nemane, Shiva Katoch, Ashish Dewangan
Journal: Case Rep Dent (2012)

Hereditary ectodermal dysplasia is a rare group of inherited disorders characterized by aplasia or dysplasia of two or more tissues of ectodermal origin such as hair, nails, teeth, and skin. The dental characteristics of this syndrome include anodontia or hypodontia of the primary and/or permanent teeth, hypoplastic conical teeth, and underdevelopment of the alveolar ridges. The options for a definitive treatment plan include fixed, removable or implant-supported prostheses, singly or in combination. This clinical report describes the prosthetic rehabilitation of an 11-year-old boy with hereditary ectodermal dysplasia. Maxillary flexible removable partial denture and mandibular conventional complete denture were fabricated to establish an acceptable masticatory function, speech, and esthetics for the patient.
Pelvic Discontinuity Caused by Acetabular Overreaming during Primary Total Hip Arthroplasty
Authors: Iori Takigami, Yoshiki Ito, Takashi Mizoguchi, Katsuji Shimizu
Journal: Case Rep Orthop (2011)
MeSH terms: Case Reports

Intraoperative acetabular fracture is a rare complication of primary total hip arthroplasty (THA), typically occurring during impaction of the cementless acetabular component. Here we report an unusual case of pelvic discontinuity caused by overreaming of the acetabulum during primary THA. Restoration of posterior columnar continuity was achieved with an autologous fibular graft and a reconstruction plate. Wall defects and cavitary defects were reconstructed with metal mesh and femoral head allograft, followed by placement and fixation of a Kerboull-type acetabular reinforcement device. Previous reports of acetabular fracture during THA have indicated that it has a relatively good prognosis without extensive treatment. However, to our knowledge, there has been no report of pelvic discontinuity necessitating acetabular reconstruction surgery as an intraoperative complication of primary THA.
Solitary subungual neurofibroma with glomus tumor-like appearance: a case report
Authors: Rui Suzuki, Hiroyuki Hashimoto, Osamu Okamoto
Journal: Case Reports Plast Surg Hand Surg (2020)
Keywords: solitary neurofibroma, glomus tumor-like appearance, subungual
MeSH terms: Case Reports

We present a case of subungual neurofibroma which clinically presented a glomus tumor-like appearance. Six months after surgical resection, no clinical recurrence or pain was reported. We herein report the difficulty of its preoperative diagnosis, including literature review.