OpenMed/multicare-articles huggingface dataset:
Case Report: Are We Witnessing an Increase of Chronic Ascending Aortic Dissection as a Collateral Effect to the COVID-19 Pandemic?
Authors: Arnaud Lyon, Ziyad Gunga, Lars Niclauss, Valentina Rancati, Piergiorgio Tozzi
Journal: Front Cardiovasc Med (2021)
Keywords: covid−19, aortic surgery, ascending aorta, chronic aortic dissection, delayed management
MeSH terms: Case Reports

Background: The COVID-19 (coronavirus disease 2019) pandemic is reducing health care accessibility to non-life-threatening diseases, thus hiding their real incidence. Moreover, the incidence of potentially fatal conditions such as acute type A aortic dissection seems to have decreased since the pandemic began, whereas the number of cases of chronic ascending aortic dissections dramatically increased. We present two patients whose management has been affected by the exceptional sanitary situation we are dealing with. Case report: A 70-year-old man with chest pain and an aortic regurgitation murmur had his cardiac workup delayed (4 months) because of sanitary restrictions. He was then diagnosed with chronic type A aortic dissection and underwent urgent replacement of ascending aorta and aortic root. The delay in surgical treatment made the intervention technically challenging because the ascending aorta grew up to 80 mm inducing strong adhesions and chronic inflammation. The second case report concerns a 68-year-old woman with right lower-limb pain who was diagnosed with deep vein thrombosis. However, a CT scan to exclude a pulmonary embolism could not be realized until 5 months later because of sanitary restrictions. When she eventually got the CT scan, it fortuitously showed a chronic dissection of the ascending aorta. She underwent urgent surgery, and the intervention was challenging because of adhesions and severe inflammation. Conclusion: Delayed treatment due to sanitary restrictions related to COVID-19 pandemic is having a significant impact on the management of potentially life-threatening conditions including type A aortic dissection. We should remain careful to avoid COVID-19 also hitting patients who are not infected with the virus.
Clinical outcomes and safety of Diphoterine® irrigation for chemical eye injury: A single-centre experience in the United Kingdom
Authors: Muzammil Ahmad Nahaboo Solim, Teresa Maria Lupion-Duran, Romeela Rana-Rahman, Trushar Patel, Desiree Ah-Kine, Darren S J Ting
Journal: Ther Adv Ophthalmol (2021)
Keywords: diphoterine, chemical eye burn, chemical eye injury, irrigation, ocular surface

Purpose:
Diphoterine® is an amphoteric irrigating solution armed with rapid pH-neutralising action. It serves as an effective first-aid treatment for managing chemical burns, including chemical eye injury (CEI). However, its use is not widely adopted in current clinical practice, primarily attributed to limited clinical evidence. This study aims to highlight the experience in using Diphoterine for managing CEI in a UK tertiary referral centre.
Methods:
This retrospective case series included all patients who presented with CEI and treated with Diphoterine at the James Cook University Hospital, UK, between April 2018 and February 2020.
Results:
Seven patients (10 eyes) were included; the mean age was 28.2 ± 17.0 years (ranged, 3-70 years) and 85.7% were male. All patients presented with an alkaline injury with a mean presenting pH of 8.7 ± 0.7 and a median (±interquartile range [IQR]) corrected-distance visual acuity (CDVA) of 0.10 ± 0.28 logMAR. Based on Roper-Hall classification, 90% and 10% of the eyes were of grade-I and -IV CEI, respectively. All eyes received normal saline/water as the first irrigation fluid and Diphoterine as second irrigation fluid. The mean pH improved slightly after first irrigation (8.4 ± 0.7; p = 0.13) and significantly after second irrigation (7.6 ± 0.4; p = 0.001). The volume of irrigation used was significantly less for Diphoterine (520 ± 193 mL) than for normal saline/water (2700 ± 2451 mL; p = 0.016). At final follow-up (median = 5 days), the median CDVA remained stable at 0.10 ± 0.28 logMAR (p = 0.60). One patient developed near-total limbal stem cell deficiency as a complication of grade-IV injury and was awaiting limbal stem cell transplantation at last follow-up.
Conclusion:
This study represents the first case series in the United Kingdom, reporting the use of Diphoterine in managing CEI. The rapid pH-neutralising action of Diphoterine, with less volume required, makes it an ideal initial treatment for efficiently managing adult and paediatric patients with CEI in clinics.
Acute Profound Thrombocytopenia Induced by Eptifibatide Causing Diffuse Alveolar Hemorrhage
Authors: Gregory Byrd, Sabina Custovic, David Byrd, Deanna Ingrassia Miano, Jasdeep Bathla, Antonious Attallah
Journal: Case Rep Crit Care (2021)
MeSH terms: Case Reports

Background:
Eptifibatide is a glycoprotein IIb/IIIa (GP IIb/IIIa) receptor inhibitor which prevents platelet activation. The mechanism in which eptifibatide causes profound thrombocytopenia is poorly understood. One hypothesis suggests antibody-dependent pathways which cause thrombocytopenia upon subsequent reexposure to eptifibatide. This case reports acute profound thrombocytopenia (platelets < 20 × 103/mm3) within 24 hours of administration. Alveolar hemorrhage occurred during a second eptifibatide infusion 5 days after initial asymptomatic eptifibatide treatment. Case Presentation. A 50-year-old male presenting with a STEMI was treated with eptifibatide during cardiac catheterization. Twelve hours posttreatment, the patient encountered profound thrombocytopenia and hemoptysis. The patient was briefly intubated for airway protection. The patient was stabilized after receiving platelet transfusion and fully recovered.
Conclusion:
This is one of several cases reported on eptifibatide causing acute profound thrombocytopenia and subsequent alveolar hemorrhage. This case supports the theory in which antibodies contribute to eptifibatide-induced thrombocytopenia.
rTMS in the treatment of drug addiction: an update about human studies
Authors: Elisa Bellamoli, Paolo Manganotti, Robert P Schwartz, Claudia Rimondo, Maurizio Gomma, Giovanni Serpelloni
Journal: Behav Neurol (2014)
MeSH terms: Behavior, Addictive / therapy, Brain / physiopathology, Substance-Related Disorders / therapy, Transcranial Magnetic Stimulation / methods, Research Support, Non-U.S. Gov't, Review, Behavior, Addictive / physiopathology, Humans, Substance-Related Disorders / physiopathology, Treatment Outcome

Drug addiction can be a devastating and chronic relapsing disorder with social, psychological, and physical consequences, and more effective treatment options are needed. Repetitive transcranial magnetic stimulation (rTMS) is a noninvasive brain stimulation technique that has been assessed in a growing number of studies for its therapeutic potential in treating addiction. This review paper offers an overview on the current state of clinical research in treating drug addiction with rTMS. Because of the limited research in this area, all studies (including case reports) that evaluated the therapeutic use of rTMS in nicotine, alcohol, or illicit drug addiction were included in this review. Papers published prior to December 2012 were found through an NCBI PubMed search. A total of eleven studies were identified that met review criteria. There is nascent evidence that rTMS could be effective in reducing cocaine craving and nicotine and alcohol craving and consumption and might represent a potential therapeutic tool for treating addiction. Further studies are needed to identify the optimal parameters of stimulation for the most effective treatment of drug addiction, to improve our comprehension of the treatment neurophysiological effects, and to conduct rigorous, controlled efficacy studies with adequate power.
Case report: Cholesterol granuloma of femur
Authors: Shenshen Hao, Shengli Dong, Hongke Li, Shuai Liu, Honglei Chen, Zhifang Zhang
Journal: Front Surg (2022)
Keywords: benign lesion, case report, cholesterol granuloma, femur, surgical treatment
MeSH terms: Case Reports

Background:
Cholesterol granuloma (CG) is a particular type of granulation tissue reaction. It is a very rare benign lesion characterized by swelling growth due to a large number of cholesterol crystals and foreign body giant cells. There has been no report of a CG of the femur.
Case presentation:
A 74-year-old woman suffered from pain and discomfort in the upper right knee for 10 years, which became aggravated for 10 days. She was diagnosed with CG of the right femur at our hospital and was treated with surgery. During the operation, a large amount of yellow-brown, oily, crystal structures was found. Postoperative pathology investigations confirmed the lesion as a CG. Postoperative follow-up was carried out for 15 months that confirmed the effect of treatment was satisfactory.
Conclusions:
CG of the femur is an extremely rare benign lesion. Surgical treatment can provide effective treatment results.
How to Be 80 Year Old and Have a VO2max of a 35 Year Old
Authors: Trine Karlsen, Ingeborg Megård Leinan, Fredrik Hjulstad Bækkerud, Kari Margrethe Lundgren, Atefe Tari, Sigurd Loe Steinshamn, Asbjørn Støylen, Øivind Rognmo
Journal: Case Rep Med (2015)

Background. To discuss the cardiovascular and pulmonary physiology and common risk factors of an 80-year-old man with a world record maximal oxygen uptake of 50 mL·kg(-1)·min(-1). Methods.
Case report:
Results. His maximal oxygen uptake of 3.31 L·min(-1), maximal heart rate of 175 beats·min(-1), and maximal oxygen pulse of 19 mL·beats(-1) are high. He is lean (66.6 kg) and muscular (49% skeletal muscle mass). His echo parameters of mitral flow (left ventricular filling, E = 82 cm·s(-1) and E/A = 1.2) were normal for 40- to 60-year-old men. Systolic and diastolic function increased adequately during exercise, with no increase in left ventricular filling pressure. He has excellent pulmonary function (FVC = 4.31 L, FEV1 = 3.41, FEV1/FVC = 0.79, and DLCO = 12.0 Si(1)) and normal FMD and blood volumes (5.8 L). He has a high level of daily activity (10,900 steps·day(-1) and 2:51 hours·day(-1) of physical activity) and a lifelong history of physical activity. Conclusion. The man is in excellent cardiopulmonary fitness and is highly physically active. His cardiac and pulmonary functions are above expectations for his age, and his VO2max is comparable to that of an inactive 25-year-old and of a normal, active 35-year-old Norwegian man.
Kostmann Syndrome With Neurological Abnormalities: A Case Report and Literature Review
Authors: Baiyu Lyu, Wei Lyu, Xiaoying Zhang
Journal: Front Pediatr (2020)
Keywords: hax1 gene, kostmann syndrome, epilepsy, neurologic manifestations, severe congenital neutropenia
MeSH terms: Case Reports

Background: Severe congenital neutropenia (SCN), also known as Kostmann syndrome, is a rare heterogeneous group of diseases characterized by arrested neutrophil maturation in the bone marrow. Case Presentation: We report a case of Kostmann syndrome and review previously reported SCN cases with neurological abnormalities. A 10-year-old boy had a history of recurrent, once a month, infection starting at 6 months of age. He had neutropenia for more than 9 years, as well as intellectual disability. He was homozygous for the exon 3 c.430dupG mutation of the HAX1 gene NM-006118. After treatment of antibiotics and G-CSF, his symtoms were relieved and was 3 months free of infection. The search revealed 29 articles related to Kostmann syndrome caused by HAX1 gene mutation; they were screened, and the main clinical features of 13 cases of Kostmann syndrome with neurological abnormalities were summarized and analyzed. Conclusions: Kostmann syndrome has three main characteristics: severe neutropenia (<0.2 × 109/L), maturation arrest of granulopoiesis at the promyelocyte stage, and death due to infections. HAX1 gene mutations affecting both isoforms A and B are associated with additional neurological symptoms. G-CSF can improve and maintain neutrophil counts, and improve prognosis and quality of life. At present, hematopoietic stem cell transplantation is the only cure.
Mesenteric cyst in infancy: presentation and management
Authors: Samia Belhassen, Braiki Meriem, Laamiri Rachida, Kechiche Nahla, Hidouri Saida, Krichen Imed, Mosbahi Sana, Ksiaa Amine, Sahnoun Lassad, Mekki Mongi, Belguith Mohsen, Nouri Abdellatif
Journal: Pan Afr Med J (2017)
Keywords: mesenteric, child, cyst, surgery
MeSH terms: Intestinal Obstruction / etiology, Mesenteric Cyst / diagnostic imaging, Tomography, X-Ray Computed / methods, Case Reports, Child, Preschool, Female, Follow-Up Studies, Humans, Infant, Newborn, Male, Mesenteric Cyst / pathology, Mesenteric Cyst / surgery, Tunisia

Mesenteric cysts are documented as a rare entity in pediatric population. They are considered as benign intra-abdominal tumors with an unknown etiology. Symptoms are not specific and knowledge of such condition is essential in order to establish a proper management. We report three pediatrics cases of mesenteric cysts managed between 2000 and 2009 in the pediatric surgery Department of Monastir College Hospital. We described the clinical, radiological and operative findings. Two males and a female were managed (age range: 10 days-5years, mean age: 6,3years). Two patients were presented with an intestinal obstruction. A preoperative diagnosis was made basing on imaging. Thus, abdominal ultrasonography was performed in all of our reported cases and showed a cystic mass in all cases. The cystic nature of the mass, its margins and its extension were better described on tomographic images. The mesenteric cyst was completely and successfully removed in all cases. The histopathological report confirmed the diagnosis and showed a multiloculated cyst with columnar mesothelial lining, without any defined muscular layer or cellular atypia and without any evidence of malignancy. The children were evaluated post-operatively with a mean follow-up of 2 years and a half. No recurrence was noted in our patients during the follow-up period. It is known that clinical features are not specific of such anomaly but once the diagnosis is made, the complete surgical removal of the cyst remains the treatment of choice with excellent outcomes.
Functional Reconstruction of Severely Burned Hand With Osseous Blood Flow Deficiency With Immediate Surgery Using an Abdominal Bipediceled Flap: A Case Report
Authors: Masakatsu Hihara, Takashi Matsushima, Yoshihito Tanaka, Yutaka Ogawa, Natsuko Kakudo, Kenji Kusumoto
Journal: Eplasty (2018)
Keywords: finger reconstruction, hand burn, immediate operation, osseous blood flow deficiency, third-degree burn
MeSH terms: Case Reports

Objective: When hands suffer burns, the tendons and digital bones are rarely injured because of the quick withdrawal reflex away from the heat source. Hence, a consensus of opinion regarding the treatment of severe hand burns with osseous blood flow deficiency has not been reached among clinicians. Methods: The patient was a 28-year-old woman whose fingers were accidentally soaked in heated cooking oil (160°C-170°C) for approximately 1 minute. The result was fourth-degree (extending to the tendon) digital burns of the distal end of the proximal interphalangeal joint with blood flow deficiency to the skin, tendon, and bone. Results: We performed immediate reconstructive surgery using an abdominal bipediceled flap. Two weeks later, after the flap was separated, all fingers showed complete range of motion, restoration of the metacarpophalangeal joint, and a high range (0°-75°) of proximal interphalangeal joint mobility with an acceptable digital length. Conclusions: Our experience shows that immediate surgery is highly preferable for deep burns of the hand to avoid delayed intractable complications and to achieve better and faster results.
Central retinal vein occlusion complicating spontaneous dural carotid-cavernous fistula after phacoemulsification
Authors: Mahmoud Mohamed Farouk, Engy Mohamed Mostafa, Amr Mounir
Journal: GMS Ophthalmol Cases (2019)
Keywords: central retinal vein occlusion, dural carotid-cavernous fistula, phacoemulsification
MeSH terms: Case Reports

In this report, we are presenting a case of a 49-year-old female complaining of defective vision in the left eye. The main complaints were: pain, redness, mild proptosis, and high intraocular pressure. She had a history of uneventful phacoemulsification surgery 3 months prior to presenting to us. Investigations revealed a macular edema caused by central retinal vein occlusion and computed tomography angiography showed an early opacified left cavernous sinus with a dilated superior ophthalmic vein along with a fistula between the meningeal branches of the carotid arteries and the cavernous sinus. Improvement of ocular symptoms was achieved after endovascular treatment by transarterial and transvenous embolization.
Upper gastrointestinal bleeding due to hepatic artery aneurysm: Case report and literature review
Authors: Laura Alonso-Lamberti Rizo, Carlos Bustamante Recuenco, Julián Cuesta Pérez, José Luis Ramos Rodríguez, Andrea Salazar Carrasco, Ainhoa Valle Rubio, Virginia Jiménez Carneros, Francisco Javier Jiménez Miramón, José María Jover Navalón
Journal: Int J Surg Case Rep (2020)
Keywords: embolization, hepatic aneurysm, hepatic artery, upper gastrointestinal bleeding
MeSH terms: Case Reports

Introduction:
Aneurysm of the hepatic artery is most of the time a rare and asymptomatic pathology, but in case of complication it shows high morbidity and mortality requiring in many cases an urgent treatment.
Presentation of case:
A 92-year-old male presented at the emergency department with high gastrointestinal bleeding and abdominal pain. Gastroscopy showed a submucosal lesion with active bleeding that was controlled through this approach. The study was expanded with a CT angiogram and a complicated hepatic aneurysm with duodenal fistulization was observed.
Discussion:
After reviewing the case, surgical treatment is proposed as the first option but it is rejected by the patient. Thus, aneurysm embolization with coils and thrombin is performed, without further complications.
Conclusion:
Selective embolization of the hepatic artery aneurysm is a therapeutic alternative in cases that implies large comorbidities, being an increasingly used technique.
Nightmares that mislead to diagnosis of reactivation of PTSD
Authors: Stefan Roepke, Marie-Luise Hansen, Anita Peter, Angela Merkl, Carla Palafox, Heidi Danker-Hopfe
Journal: Eur J Psychotraumatol (2013)
Keywords: rem sleep behaviour disorder, nightmares, periodic limb movements, posttraumatic stress disorder, sleep disturbance
MeSH terms: Case Reports

Background:
Sleep disturbance is a common characteristic of patients with post-traumatic stress disorder (PTSD). Besides the clinical descriptions of nightmares and insomnia, periodic limb movements (PLMs) are reported to co-occur in PTSD. Although the causal relationship between sleep disturbance and PTSD is not fully understood, sleep disturbance is an independent risk factor for the development and reactivation of PTSD. In contrast, the link between PTSD and REM sleep behaviour disorder (RBD) is less clear.
Method:
A case report is presented to illustrate differential diagnosis and time course of sleep disturbance in the context of PTSD.
Result:
A 63-year-old man who had been successfully treated for PTSD but who suffered the re-occurrence of disturbed sleep due to RBD and PLM, which was misdiagnosed as reactivation of PTSD.
Conclusions:
RBD can mimic PTSD-related nightmares. Accurate diagnosis of sleep disturbance in PTSD is relevant for treatment and prognostic evaluation.
Outcome of infections due to pandrug-resistant (PDR) Gram-negative bacteria
Authors: Matthew E Falagas, Ioannis A Bliziotis, Sofia K Kasiakou, George Samonis, Panayiota Athanassopoulou, Argyris Michalopoulos
Journal: BMC Infect Dis (2005)
MeSH terms: Anti-Bacterial Agents / pharmacology, Anti-Bacterial Agents / therapeutic use, Drug Resistance, Multiple, Bacterial, Gram-Negative Bacterial Infections / drug therapy, Gram-Negative Bacterial Infections / microbiology, Case Reports, Adolescent, Adult, Aged, Aged, 80 and over, Anti-Bacterial Agents / administration & dosage, Female, Humans, Male, Middle Aged, Treatment Outcome, Anti-Bacterial Agents

Background:
The increasing problem of infections due to multidrug-resistant Gram-negative bacteria has led to re-use of polymyxins in several countries. However, there are already clinical isolates of Gram-negative bacteria that are resistant to all available antibiotics, including polymyxins.
Methods:
We present a case series of patients with infections due to pathogens resistant to all antimicrobial agents tested, including polymyxins. An isolate was defined as pandrug-resistant (PDR) if it exhibited resistance to all 7 anti-pseudomonal antimicrobial agents, i.e. antipseudomonal penicillins, cephalosporins, carbapenems, monobactams, quinolones, aminoglycosides, and polymyxins.
Results:
Clinical cure of the infection due to pandrug-resistant (PDR) Gram-negative bacteria, namely Pseudomonas aeruginosa or Klebsiella pneumoniae was observed in 4 out of 6 patients with combination of colistin and beta lactam antibiotics.
Conclusion:
Colistin, in combination with beta lactam antibiotics, may be a useful agent for the management of pandrug-resistant Gram-negative bacterial infections. The re-use of polymyxins, an old class of antibiotics, should be done with caution in an attempt to delay the rate of development of pandrug-resistant Gram-negative bacterial infections.
Functional Localization of Adult-Onset Idiopathic Nesidioblastosis
Authors: Jess C Hercus, Pouneh Pasha, Sadiq Al Lawati, Peter Kim, Andre Mattman, Douglas Webber, David M Thompson
Journal: Case Rep Endocrinol (2022)
MeSH terms: Case Reports

Nesidioblastosis is a rare pancreatic disorder involving enlarged beta cells throughout the pancreas, causing elevated insulin production. We present the case of a 53-year-old woman with the initial symptom of fasting hypoglycemia. No pancreatic lesions were indicated on computed tomography and magnetic resonance imaging scans, and an octreotide scan was negative for insulinoma. Selective arterial calcium stimulation (SACST) showed increased insulin production from the stimulation of 3 out of 5 arteries. The SACST results suggested a diagnosis of nesidioblastosis, which was confirmed by histopathology after a subtotal distal pancreatectomy. The patient has normal glucose tolerance after surgery with no further problems of hypoglycemia, indicating that this is a rare case of nesidioblastosis extending only partially through the pancreas.