OpenMed/multicare-articles huggingface dataset:
Complete Cubonavicular Coalition Associated with Midfoot Osteoarthritis
Authors: Anne Kummer, Eric Dugert, Mouas Jammal
Journal: Case Rep Orthop (2020)
MeSH terms: Case Reports

Introduction. Cubonavicular coalitions represent a relatively rare condition with less than forty cases described in the literature, the majority of which are fibrocartilaginous. To our knowledge, cubonavicular osseous coalition associated with osteoarthritis of the midfoot has never been described. Case Presentation. We present the case of a 26-year-old man with bilateral Achilles tendinosis, in whom radiological studies show an incidental finding of a complete osseous cubonavicular coalition, as well as a partial osseous cubo-third cuneiform coalition and a fibrous band between the first and second cuneiforms of the right foot, associated with arthritic changes of the tarsometatarsal joint. A nonosseous calcaneocubonavicular coalition was found on the left foot. These multiples coalitions were asymptomatic in this case. Discussion. Cubonavicular coalition, even asymptomatic, can cause midfoot osteoarthritis in young patients. We may therefore suspect that the immobility of the cubonavicular joint causes additional stress on the midfoot.
Dislocation after Posterior Stabilized Primary Total Knee Replacement: A Rare Complication in Four Cases
Authors: W Spierenburg, E L A R Mutsaerts, J J A M van Raay
Journal: Case Rep Orthop (2021)
MeSH terms: Case Reports

Introduction:
Dislocation of a total knee arthroplasty is a rare complication that has rarely been described, while the total knee arthroplasty is frequently performed. From literature, we know patient-related factors, like obesity, neuropsychiatric disease, and severe valgus or varus deformity, are associated with higher risk of dislocation. We show our cases for awareness of the risk factors for surgeons. Case Presentations. We present four patients with a dislocation after a total knee arthroplasty. We compare these case reports with previous literature and show the most important risk factors for these dislocations. In our cases, three of them suffered from obesity, which possibly has contributed to the dislocation. Three patients did have instability which emphasizes the importance of ligament balancing while performing a total knee replacement. In all cases, an exchange of the polyethylene liner was performed.
Conclusion:
Implant-related factors and surgical technique as well as patient-related factors can contribute to this uncommon complication. Obesity, neuropsychiatric disorders, and a severe valgus or varus deformity are important patient-related risk factors. Our cases show these risk factors too. Some of these risk factors were encountered as well as other comorbidity factors. Such risk factors must be taken into consideration when deciding whether to perform a total knee arthroplasty. This stresses the importance of patient education and shared decision-making before performing a total knee replacement.
Case report: Rapid symptom resolution of a mixed affective state with high-frequency repetitive transcranial magnetic stimulation
Authors: Emily M Beydler, Lauren Katzell, Lauren Schmidt, Brent R Carr, Richard C Holbert
Journal: Front Psychiatry (2023)
Keywords: bipolar (affective/mood) disorders, bipolar disorder, hypomania, major depression (mdd), mixed features specifier, transcranial magnetic stimulation (tms), treatment-refractory depression
MeSH terms: Case Reports

Introduction:
Bipolar major depressive episodes with mixed features are diagnosed in patients who meet the full criteria for a major depressive episode exhibiting three additional concurrent symptoms of hypomania or mania. Up to half of patients with bipolar disorder experience mixed episodes, which are more likely to be treatment-refractory than pure depression or mania/hypomania alone.
Case:
We present a 68-year-old female with Bipolar Type II Disorder with a four-month medication-refractory major depressive episode with mixed features referred for neuromodulation consultation. Previous failed medication trials over several years included lithium, valproate, lamotrigine, topiramate, and quetiapine. She had no history of treatment with neuromodulation. At the initial consultation, her baseline Montgomery-Asberg Depression Rating Scale (MADRS) was moderate in severity at 32. Her Young Mania Rating Scale (YMRS) was 22, with dysphoric hypomanic symptoms consisting of heightened irritability, verbosity and increased rate of speech, and decreased sleep. She declined electroconvulsive therapy but elected to receive repetitive transcranial magnetic stimulation (rTMS).
Interventions:
The patient underwent repetitive transcranial magnetic stimulation (rTMS) with a Neuronetics NeuroStar system, receiving nine daily sessions over the left dorsolateral prefrontal cortex (DLPFC). Standard settings of 120% MT, 10 Hz (4 sec on, 26 sec off), and 3,000 pulses/session were used. Her acute symptoms showed a brisk response, and at the final treatment, her repeat MADRS was 2, and YMRS was 0. The patient reported feeling "great," which she defined as feeling stable with minimal depression and hypomania for the first time in years.
Conclusion:
Mixed episodes present a treatment challenge given their limited treatment options and diminished responses. Previous research has shown decreased efficacy of lithium and antipsychotics in mixed episodes with dysphoric mood such as the episode our patient experienced. One open-label study of low-frequency right-sided rTMS showed promising results in patients with treatment-refractory depression with mixed features, but the role of rTMS in the management of these episodes is largely unexplored. Given the concern for potential manic mood switches, further investigation into the laterality, frequency, anatomical target, and efficacy of rTMS for bipolar major depressive episodes with mixed features is warranted.
Delays in Diagnosis of Pulmonary Lymphangitic Carcinomatosis due to Benign Presentation
Authors: Swati Pandey, Shishir Ojha
Journal: Case Rep Oncol Med (2020)
MeSH terms: Case Reports

The diagnosis of lymphangitic carcinomatosis is challenging due to the manifestation of nonspecific symptoms and radiographic abnormalities that bear similarity to those of interstitial lung disease. Herein, we report the case of a 53-year-old woman diagnosed with lymphangitic carcinomatosis from metastatic gastric adenocarcinoma, 3 months after her initial presentation.
Right Ventricular Clot in Transit in a Patient with Coronavirus Disease 2019 (COVID-19) Pneumonia Successfully Treated with Thrombolytics
Authors: Yaman Alali, Ian Jackson, Abedel Rahman Anani, Marisa Varghese, Muhammad Ebrahim Khan, Suchitra Pilli
Journal: Case Rep Crit Care (2022)
MeSH terms: Case Reports

Background:
Right heart thrombus or clot in transit is a rare venous thromboembolism (VTE) with high mortality. COVID-19 infection has been associated with increased risk of such events. We present the case of a 63-year-old man with no traditional VTE risk factors who was diagnosed with a clot in transit three weeks after diagnosis of COVID-19. Clinical Case. A 63-year-old male with no significant past medical history who presented to the emergency department with shortness of breath. He tested positive for COVID-19 three weeks prior. His oxygen saturation was 60% on room air and was put on nonrebreather mask. He was still showing signs of respiratory distress including tachypnea, tachycardia, diaphoresis, and accessory muscle use. The patient was subsequently intubated and mechanically ventilated. Chest computed tomography with contrast showed acute bilateral pulmonary emboli with flattening of the interventricular septum suggestive of right heart strain. Bedside echocardiogram showed severely enlarged right ventricle with reduced systolic function and evidence of right ventricular strain and a mobile echodensity in the right ventricle attached to the tricuspid valve consistent with a clot in transit. The patient was treated with full dose systemic thrombolysis with rapid improvement in his symptoms. He was extubated the following day and a repeat echocardiogram showed resolution of the clot in transit.
Conclusion:
Clot in transit is rare but can occur in COVID-19 patients even in the absence of traditional thromboembolism risk factors. Management includes systemic anticoagulation, systemic thrombolysis, and surgical embolectomy. Our patient was successfully treated with systemic thrombolysis.
Treatment and cost of pressure injury stage III or IV in four patients with spinal cord injury: the Basel Decubitus Concept
Authors: Christine Meier, Stefan Boes, Armin Gemperli, Hans Peter Gmünder, Kamran Koligi, Stefan Metzger, Dirk J Schaefer, Klaus Schmitt, Wolfram Schwegmann, Reto Wettstein, Anke Scheel-Sailer
Journal: Spinal Cord Ser Cases (2019)
Keywords: outcomes research, rehabilitation
MeSH terms: Health Care Costs, Health Services Research, Outcome Assessment, Health Care, Pressure Ulcer / economics, Pressure Ulcer / etiology, Pressure Ulcer / therapy, Spinal Cord Injuries / complications, Spinal Cord Injuries / rehabilitation, Case Reports, Research Support, Non-U.S. Gov't, Adult, Female, Humans, Male, Middle Aged, Quality Improvement, Retrospective Studies, Severity of Illness Index

Study design:
Retrospective chart analyses as part of a quality improvement project.
Objectives:
To demonstrate treatment of pressure injury (PI) in patients with spinal cord injuries (SCI) and analyse costs using the "modified Basel Decubitus Concept".
Setting:
Inpatient setting of a specialised acute care and rehabilitation clinic for SCI.
Methods:
Complex treatment courses of four patients with chronic SCI and PI stage III or IV were described and costs were recorded. The total healthcare services' costs per patient and different profession's involvement were analysed in relation to patient characteristics, treatment phases and milestones demonstrated.
Results:
The treatment of PI stage III and IV in patients with SCI included input from plastic surgery, rehabilitation medicine, nursing and other involved professions. Recommended interventions were chosen according to the "modified Basel Decubitus Concept". The cost course of PI treatment in patients with SCI depicted the multimodal treatment concept, including three clinically and financially relevant milestones (debridement, flap surgery and mobilisation to wheelchair) as well as the highest costs in the functionally highly dependent patient. Acute care and rehabilitation overlapped with different intensities during the whole treatment process.
Conclusion:
Multimodal treatment concepts connecting acute and rehabilitation care were applied in these complex health conditions. Cost-explication models including treatment phases and milestones helped to understand resources more easily and integrate aspects of process-based management and quality of care. Scientific evidence is needed to create a recommended quality standard in line with adequate financing of this health condition.
Analysis of Haematological Parameters as Predictors of Malaria Infection Using a Logistic Regression Model: A Case Study of a Hospital in the Ashanti Region of Ghana
Authors: Ellis Kobina Paintsil, Akoto Yaw Omari-Sasu, Matthew Glover Addo, Maxwell Akwasi Boateng
Journal: Malar Res Treat (2019)

Malaria is the leading cause of morbidity in Ghana representing 40-60% of outpatient hospital attendance with about 10% ending up on admission. Microscopic examination of peripheral blood film remains the most preferred and reliable method for malaria diagnosis worldwide. But the level of skills required for microscopic examination of peripheral blood film is often lacking in Ghana. This study looked at determining the extent to which haematological parameters and demographic characteristics of patients could be used to predict malaria infection using logistic regression. The overall prevalence of malaria in the study area was determined to be 25.96%; nonetheless, 45.30% of children between the ages of 5 and 14 tested positive. The binary logistic model developed for this study identified age, haemoglobin, platelet, and lymphocyte as the most significant predictors. The sensitivity and specificity of the model were 77.4% and 75.7%, respectively, with a PPV and NPV of 52.72% and 90.51%, respectively. Similar to RDT this logistic model when used will reduce the waiting time and improve the diagnosis of malaria.
Successfully ablated atrioventricular nodal reentrant tachycardia in unconventional presentation
Authors: Wang Jun-Hua, Huang Cong-Chun, Tan Wei-Jie, Liu Chao-Zhong, Sun Jin-Jin, Luo Hui-Lan
Journal: J Cardiovasc Dis Res (2010)
Keywords: atrioventricular nodal reentrant tachycardia (avnrt), atrioventricular reentrant tachycardia (avrt), radiofrequency catheter ablation (rfca)
MeSH terms: Case Reports

Background:
#ENTITYSTARTX02014; Sometime, it's difficult to distinguish the electrophysiological mechanism of some tachycardia, and so, influencing the efficacy and safety of ablation operation. Therefore, it's helpful to analysis some tachycardia in particular mechanism, as in this case.
Methods and results:
#ENTITYSTARTX02014; A 49 years old Chinese male patient had a history of paroxysmal palpitation for 25 years, and recurred more frequently in the month before admission. Electrocardiogram (ECG) showed no abnormity under sinus rhythm, and showed no specific sign to distinguish its reentrant mechanism when tachycardia running. Electrophysiological examination and the result of successful ablation showed that the retrograde pathway of its reentry was in slow conduction, and from which the reentry started; moreover, after partially ablating, the reentry started from antegrade slow conduction.
Conclusion:
#ENTITYSTARTX02014; Careful cardiac electrophysiological examination and paying more attention to inducing conditions of tachycardia are critical to accurately determining the tachycardia mechanism.
Case Report: Capillary Leak Syndrome With Kidney Transplant Failure Following Autologous Mesenchymal Stem Cell Therapy
Authors: Željka Večerić-Haler, Nika Kojc, Matjaž Sever, Samo Zver, Urban Švajger, Primož Poženel, Katrina Hartman, Tereza Urdih, Gregor Mlinšek, Manca Oblak, Andreja Aleš Rigler, Alojz Ihan, Jadranka Buturović Ponikvar, Philip P Halloran, Miha Arnol
Journal: Front Med (Lausanne) (2021)
Keywords: autologous stem cell, capillary leak syndrome, kidney graft, kidney graft failure, kidney graft rejection, kidney transplant, mesenchymal stem cell, stem cell transplant
MeSH terms: Case Reports

Mesenchymal stem cells (MSCs) have attracted great interest in the field of kidney transplantation due to their immunomodulatory and reparative properties. In registered clinical trials, MSCs have been used before, at the time of, or early after transplantation and have been reported to be well-tolerated with no serious safety concerns. No results are available on the use of MSCs in the late post-transplant period. Here, we present a case report of a severe systemic complication mimicking capillary leak syndrome with ultimate kidney transplant failure after autologous transplantation of MSCs used as rescue treatment of late antibody-mediated kidney allograft rejection.
Sunitinib Induced Thrombotic Thrombocytopenic Purpura in addition to Severe Hypothyroidism: A Case Report and Review of the Literature
Authors: Imane El Dika, Deborah Mukherji, Sally Temraz, Rita Assi, Ali Shamseddine
Journal: Case Rep Med (2014)

Introduction. Sunitinib malate is an oral multitargeting tyrosine kinase inhibitor approved for the first line treatment of metastatic renal cell carcinoma. Sunitinib administration is associated with several adverse events including fatigue, diarrhea, skin toxicity, hypothyroidism, and cytopenia. Herein, we present a case of thrombotic thrombocytopenic purpura and clinical hypothyroidism presenting within 4 weeks of starting sunitinib therapy. Case Presentation. A 72-year-old woman with metastatic renal cell carcinoma presented with generalized fatigue 28 days after starting sunitinib 50 mg daily. She was found to have severe hypothyroidism, in addition to significant thrombocytopenia and anemia. The latter were explained by a clinical and laboratory diagnosis of thrombotic thrombocytopenic purpura. Sunitinib was stopped and she recovered completely after plasmapheresis. Conclusion. To our knowledge, this is the fourth case report of thrombotic thrombocytopenic purpura secondary to sunitinib. Oncologists should be aware of this rare but potentially fatal adverse event. We highly suggest to routinely test for platelet count and thyroid stimulating hormone level as early as two weeks after initiating sunitinib.
Porphyria Cutanea Tarda in a Patient with End-Stage Renal Disease: A Case of Successful Treatment with Deferoxamine and Ferric Carboxymaltose
Authors: Natacha Rodrigues, Fernando Caeiro, Alice Santana, Teresa Mendes, Leonor Lopes
Journal: Case Rep Nephrol (2017)
MeSH terms: Case Reports

Porphyria cutanea tarda (PCT) is a rare disease, with a strong association with hepatitis C virus. PCT is particularly problematic in end-stage renal disease patients as they have no renal excretion of porphyrins and these are poorly dialyzed. Also, conventional treatment of PCT is compromised in these patients as hydroxychloroquine is contraindicated, phlebotomies with the stipulated frequency are poorly tolerated in already anaemia-prone patients, and iron-chelating agents are less efficient in removing iron and contribute to worsening anaemia. The authors report a patient on haemodialysis, with hepatitis C infection, that is diagnosed with PCT. Despite the good clinical results with deferoxamine, she became dependent on blood transfusions because of her ferropenic state. Every time oxide iron was started, the patient developed clinical features of the disease, resolving after the suspension of the drug. A decision was made to start the patient on ferric carboxymaltose, which was well tolerated without disease symptoms and need of further blood transfusions. This case suggests that deferoxamine is efficient in treatment of porphyria cutanea tarda. Also, ferric carboxymaltose may be a valuable option for refractory anaemia in patients with this disease and end-stage renal disease, as it seems to provide iron without clinical relapse of the disease.
Transgluteal CT-Guided Percutaneous Renal Access for Percutaneous Nephrolithotomy in a Pelvic Horseshoe Kidney
Authors: Ryan J Mullins, Casey A Dauw, Michael S Borofsky, Nadya York, Aashish A Patel, James E Lingeman
Journal: J Endourol Case Rep (2015)
MeSH terms: Case Reports

CT-guided percutaneous renal access has been described as a safe and effective access technique in patients with complex anatomy, including ectopic kidney, retrorenal colon, spinal dysraphism, hepatomegaly, and splenomegaly. In comparison to conventional intraoperative fluoroscopic-guided access, CT imaging allows for delineation of surrounding structures that are at risk for injury during percutaneous access. However, previous reports indicate that pelvic kidneys might be inaccessible percutaneously without laparoscopic assistance. Herein, we present a novel transgluteal route to renal access for percutaneous nephrolithotomy (PCNL) in a patient with a pelvic horseshoe kidney and severe spinal deformity.
Acute Truncal Lymphedema Secondary to Axillary Metastatic Melanoma Presenting Like Cellulitis
Authors: Shelley J E Hwang, Benjamin Y Kong, Shaun Chou, Deepal Wakade, Matteo S Carlino, Pablo Fernandez-Penas
Journal: Case Rep Med (2017)
MeSH terms: Case Reports

There are reported cases of diphencyprone used in treating cutaneous metastases of melanoma. Here, we report a patient with previous primary melanoma on his left back treated with surgical excision and lymphadenectomy, followed by radiotherapy for the recurrent tumor on the primary site. Despite radiotherapy and treatment with dabrafenib and trametinib, in-transit metastases have developed and topical diphencyprone was applied to these metastases. Six weeks later, the patient developed fever and a spreading erythematous tender indurated plaque covering the left side of the body including axillae, back, and flank, clinically suggestive of cellulitis. Systemic antibiotic therapy did not improve the condition and a biopsy showed sparse lymphocytic infiltrate. With the diagnosis of possible acute lymphedema, a CT scan was requested that showed significant axillary lymph node metastasis. The fever was considered secondary to dabrafenib and trametinib therapy. This case highlights that, in patients with lymphadenectomy, atypical forms of lymphedema on the body may appear. Truncal lymphedema is an infrequent event.
Case report: Germline RECQL mutation potentially involved in hereditary predisposition to acute leukemia
Authors: Wei Yuan, Zhen Shang, Kefeng Shen, Qiuxia Yu, Qiuxia Lv, Yang Cao, Jue Wang, Yi Yang
Journal: Front Oncol (2023)
Keywords: acute leukemia, case report, fusion gene, germline mutation, hereditary predisposition
MeSH terms: Case Reports

The pathogenesis of acute leukemia is still complex and vague. Most types of acute leukemia are related to somatic gene mutations, and familial incidence is rare. Here we report a case of familial leukemia. The proband presented to our hospital with vaginal bleeding and disseminated intravascular coagulation at the age of 42 and was diagnosed with acute promyelocytic leukemia with typical PML-RARα fusion gene caused by t(15;17)(q24;q21) translocation. By taking the history, we found that the patient's second daughter had been diagnosed with B-cell acute leukemia with ETV6-RUNX1 fusion gene at age 6. Then we performed whole exome sequencing in peripheral blood mononuclear cells from these two patients at remission status and identified 8 shared germline gene mutations. Using functional annotation and Sanger sequencing validation, we finally focused on a single nucleotide variant in RecQ like helicase (RECQL), rs146924988, which was negative in the proband's healthy eldest daughter. This gene variant potentially led to a relative lack of RECQL protein, disordered DNA repair and chromatin rearrangement, which may mediate the occurrence of fusion genes, as driving factors for leukemia. This study identified a novel possible leukemia-related germline gene variant and provided a new understanding for the screening and pathogenesis of hereditary predisposition syndromes.
A Case Study of Malrotated Kidneys with Asymmetric Multiple Renal Arteries, Variant Venous Drainage, and Unilateral Ureteral Duplication
Authors: Martine Dunnwald, Marc A Pizzimenti
Journal: Case Rep Vasc Med (2019)
MeSH terms: Case Reports

Variations in the arterial, venous, and ureteral patterning of the right (r) and left (l) kidneys are common; however, concomitant involvement with all three systems is rare. Specimens that demonstrate anatomic variation across multiple systems provide an opportunity to illustrate links between anatomic concepts, embryologic development, clinical practice, and education. During anatomic study of the abdominal cavity, a total of five major arteries (3l and 2r) emerged from the aortic and common iliac axes in a cadaveric donor. Through continued study, multiple contributing veins, of different caliber, coalesced into four major renal veins (2l and 2r) that returned blood from the kidneys to the inferior vena cava (IVC) at different locations. In addition, unilateral duplication of the kidney with concomitant ureters was evident on the right side. Both ureters continued inferiorly and independently entered the bladder, each with an observable orifice adjacent to the bladder trigone. Most evident in the specimen was the anteriorly directed hilum for both kidneys. Reported measures for each of the observed anatomic variations suggest that the current specimen has an estimated incidence of less than 0.3%. This comparatively rare specimen provides an example of important anatomic concepts that are relevant to educational and clinical practices.