OpenMed/multicare-articles huggingface dataset:
Intravascular large B-cell lymphoma presenting with fever and refractory acidosis
Authors: Michael Harrison Storandt, Mark Alan Koponen
Journal: Autops Case Rep (2021)
Keywords: lymphoma, non-hodgkin, lactic acidosis
MeSH terms: Case Reports

Intravascular large B-cell lymphoma (IVLBCL) is a rare form of diffuse large B-cell lymphoma, characterized by malignant B-cells primarily localized to the lumina of small- and medium-sized blood vessels without lymphadenopathy. Two patients initially presented with fever of unknown origin and persistent lactic acidosis without evidence of tissue hypoxia. Neither patient had an identifiable source of infection and both underwent peripheral blood smear demonstrating leukocytosis with a neutrophilic predominance and thrombocytopenia without evidence of hematologic malignancy. One had previously had a bone marrow biopsy which was unremarkable. Both patients' condition deteriorated rapidly, progressing to multiorgan failure requiring pressors and mechanical ventilation, which ultimately resulted in cardiopulmonary arrest. At autopsy, each patient demonstrated malignant lymphocytoid cells, staining positive for CD20, localized to the lumina of small- and medium-sized vessels in multiple organs, including the lungs, liver, spleen, and kidneys, among others, allowing for the diagnosis of IVLBCL. IVLBCL is exceedingly rare, which in combination with significant variability in presentation, can make identification and diagnosis challenging. Diagnosis requires biopsy, therefore a high index of suspicion is needed to obtain an adequate tissue sample, whether pre- or postmortem. In the presented cases, both patients exhibited type B lactic acidosis with an unknown etiology that was ultimately determined at autopsy.
Delayed Calcium Normalization after Successful Parathyroidectomy in Primary Hyperparathyroidism
Authors: Iván Emilio de la Cruz Rodríguez, Elsy Sarahí García Montesinos, María Fernanda Rodríguez-Delgado, Guadalupe Vargas Ortega, Lourdes Balcázar Hernández, Victoria Mendoza Zubieta, Victor Hernández Avendaño, Baldomero González Virla
Journal: Case Rep Endocrinol (2021)
MeSH terms: Case Reports

Introduction:
Parathyroidectomy is the curative treatment option in primary hyperparathyroidism (PHPT). The decrease of parathormone (PTH) by 50% or more from levels prior to surgery after excision predicts successful parathyroidectomy. Serum calcium is expected to return to normal within 24-72 hours after the surgery; however, nearly 10% have transient, persistent postoperative hypercalcemia. We present a case report of delayed calcium normalization after successful parathyroidectomy in a 38-year-old patient with PHPT.
Methods:
Parathyroidectomy was performed, with evidence of a decrease in PTH levels of more than 50% in the first 24 hours postoperatively compared to presurgical PTH; however, despite curative parathyroidectomy, a delayed calcium normalization was evidenced, with hypercalcemia persistence up to 120 hours postoperatively.
Results:
After the first month postoperatively, serum calcium remained normal. In conclusion, approximately 10% of patients with curative parathyroidectomy have transient, persistent postoperative hypercalcemia, which is more likely to occur in patients with higher preoperative serum calcium and PTH levels.
Conclusion:
Persistent hypercalcemia after the first month postoperatively is related with persistent PHPT, highlighting the importance of calcium monitoring after parathyroidectomy to predict short-term, medium-term, and long-term outcomes and prognosis.
Phantom Limb Pain in Pediatric Oncology
Authors: Patrick DeMoss, Logan H Ramsey, Cynthia Windham Karlson
Journal: Front Neurol (2018)
Keywords: adolescent, amputation, cancer, children, pediatrics, phantom limb pain, therapy, treatment
MeSH terms: Review

Phantom limb pain (PLP) is a prevalent problem for children and adolescents undergoing amputation due to cancer treatment. The symptoms are wide ranging from sharp to tingling. PLP in children typically lasts for a few minutes but can be almost constant and can be highly distressing. This focused review describes the characteristics, epidemiology, mechanisms, and evidence-based treatment of PLP in pediatric populations, focusing on pediatric cancer. In pediatric oncology, the administration of chemotherapy is a risk factor that potentially sensitizes the nervous system and predisposes pediatric cancer patients to develop PLP after amputation. Gabapentin, tricyclic antidepressants, opiates, nerve blocks, and epidural catheters have shown mixed success in adults and case reports document potential utility in pediatric patients. Non-pharmacologic treatments, such as mirror therapy, psychotherapy, and acupuncture have also been used in pediatric PLP with success. Prospective controlled trials are necessary to advance care for pediatric patients with PLP.
Rickettsia mongolotimonae infection in South Africa
Authors: Anne-Marié Pretorius, Richard J Birtles
Journal: Emerg Infect Dis (2004)
MeSH terms: Rickettsia Infections / physiopathology, Case Reports, Adult, Anti-Bacterial Agents / therapeutic use, Doxycycline / therapeutic use, Humans, Male, Rickettsia Infections / diagnosis, Rickettsia Infections / drug therapy, South Africa, Anti-Bacterial Agents, Doxycycline

We report the first laboratory-confirmed case of Rickettsia mongolotimonae infection in Africa. The patient sought treatment for an eschar on his toe; lymphangitis, severe headaches, and fever subsequently developed. After a regimen of doxycycline, symptoms rapidly resolved. R. mongolotimonae infection was diagnosed retrospectively by serologic tests and molecular-based detection of the organism in biopsy specimens of eschar material.
Presentation of a Case of Short Root Anomaly in an 11-Year-Old Child
Authors: Angeliki Sofia Trimeridou, Aristidis Arhakis, Konstantinos Arapostathis
Journal: Case Rep Dent (2023)
MeSH terms: Case Reports

Short root anomaly (SRA) is a developmental anomaly in which the affected teeth present morphologically normal crowns and short, round roots. The exact cause of SRA is unknown. A case of an 11-year-old female patient with SRA is described. The patient presented short, round roots of all permanent teeth but first molars. Maxillary lateral incisors presented severe root resorption and mobility. Treatment plan included preservation of the maxillary lateral incisors by splinting them to their adjacent teeth using a stainless steel coaxial wire. A custom mouthguard for dental trauma protection was also constructed using a computer-aided design - computer-aided manufacturing (CAD-CAM) system in order to fabricate 3D-printed dental casts. At 2-year follow-up, the mobility of maxillary lateral incisors decreased, and the patient's dentition remained stable. Considerations regarding differential diagnosis, orthodontic management, and treatment options after an eventual loss of teeth are thoroughly discussed.
Diagnostic Management and Surgical Treatment of Isolated Tricuspid Regurgitation
Authors: Arthur Cicupira Rodrigues de Assis, Gustavo Andre Boeing Boros, Lea Maria Macruz Ferreira Demarchi, Thiago Luis Scudeler, Paulo Cury Rezende
Journal: Case Rep Cardiol (2021)
MeSH terms: Case Reports

Severe tricuspid regurgitation is especially caused by pulmonary hypertension. Primary tricuspid regurgitation in the absence of pulmonary hypertension and of unknown etiology is a very rare condition with scarce data about its diagnosis, treatment, and follow-up. The particularities of surgery indication and outcomes are still not clearly known. A 72-year-old woman with a medical history of coronary artery bypass grafting three years ago presented with shortness of breath and low limb edema. Physical examination revealed a prominent bilateral jugular turgescence, hepatomegaly, peripheral edema, and a left midsternal border holosystolic murmur, suggestive of tricuspid regurgitation. The echocardiogram confirmed the diagnosis and showed preserved right and left ventricular dimensions and function. Coronary angiography showed no new obstructive lesions and patent surgical grafts. Right cardiac catheterization revealed mild pulmonary hypertension and increased right atrium pressure. Cardiac magnetic resonance showed mild right ventricular dilation with normal systolic function and normal left chambers. No late gadolinium enhancement was detected. Because of persistent symptoms, even after optimization of medical therapy, the patient was submitted to tricuspid valve replacement surgery. Immediately after the surgery, the patient developed significant right ventricular dysfunction, with the need of continuous hemodynamic support. She had progressive clinical recovery that was confirmed by serial echocardiograms that showed improvement in right ventricular volume and function. The patient was discharged with no signs or symptoms of right heart failure. The histopathological examination showed significant and diffuse myxomatous degeneration of the leaflets. No signs of infection or vegetation nor disruption of strands were observed. This report illustrates a very rare case of symptomatic primary isolated severe tricuspid regurgitation caused by myxomatous degeneration of the leaflets. The thoroughly diagnostic workup is presented, and only the histopathological analysis of the leaflets revealed the etiologic process. Surgical treatment indicated before the onset of right ventricular failure was essential to patient's full recovery.
Silicosis-related pleural effusion diagnosed using elemental analysis of the pleural fluid cell block: A case report
Authors: Shouichi Okamoto, Isao Kobayashi, Hiroshi Moriyama, Mayuka Tanimura, Kotaro Kadoya, Hiroki Ienaga, Toshiaki Kikuchi, Kazuhisa Takahashi
Journal: Respir Med Case Rep (2022)
Keywords: ct, computed tomography, cell block, elemental analysis, pleural effusion, silica, silicosis
MeSH terms: Case Reports

Pleural disease in silicosis remains an underrecognized entity. Herein, we describe the case of an 85-year-old man with a 20-year history of silica exposure between the ages of 9-28 years. He presented with bilateral exudative pleural effusions, and chest computed tomography revealed typical silicosis findings. Thoracentesis was performed thrice, but did not reveal the cause of effusion. However, pleural fluid cell-block elemental analysis revealed a silicon compound, suggesting that silicosis-related pleural effusion had developed after a long latency period. Therefore, elemental analysis of the pleural fluid cell block may help diagnose occupational lung diseases with pleural effusion.
Treatment of a rapidly expanding thoracoabdominal aortic aneurysm after endovascular repair of descending thoracic aortic aneurysm in an old patient
Authors: Vito Mannacio, Michele Mottola, Danilo Ruggiero, Andrea D'Alessio, Giuseppina Gabriella Surace, Ettorino Di Tommaso, Bruno Amato, Gabriele Iannelli
Journal: BMC Surg (2012)
MeSH terms: Aortic Aneurysm, Thoracic / surgery, Aortic Rupture / surgery, Blood Vessel Prosthesis Implantation / methods, Endovascular Procedures / methods, Case Reports, Aged, 80 and over, Disease Progression, Humans, Male, Reoperation

Background:
Aortic pathology progression and/or procedure related complications following endovascular repair should always be considered mostly in older patients. We herein describe a hybrid procedure for treatment of rapidly expanding thoracoabdominal aneurysm following endovascular treatment of a descending thoracic aortic aneurysm in an older patient.
Case presentation:
A 82-year-old man at 18 months after endovascular surgery for a contained rupture of descending thoracic aortic aneurysm revealed a type IV thoracoabdominal aneurysm with significant increase of the aortic diameters at superior mesenteric and renal artery levels. A hybrid approach consisting of preventive visceral vessel revascularization and endovascular repair of entire abdominal aorta was performed. Under general anaesthesia and by xyphopubic laparotomy, the infrarenal aneurysmatic aorta and common iliac arteries were replaced by a bifurcated woven prosthetic graf. From each of the prosthetic branches two reverse 14 x 7 mm bifurcated PTFE prosthetic grafts were anastomized to both renal arteries and to the celiac axis and superior mesenteric artery, respectively. Vessel ischemia was restricted to the time required for anastomosis. Three 10 cm Gore endovascular stent-grafts for a total length of 15 cm, were used. The overlapping of the stent-grafts was carried out from the bottom upwards, starting from the aorto-iliac prosthetic body up to the healthy segment of thoracic aorta, 40 mm from the previous stent-grafts.The patient was discharged on the 9th postoperative day.
Conclusion:
This technique offers the advantage of a less invasive treatment, reducing the risk of paraplegia, visceral ischaemia and pulmonary complications, mostly in older patients.
Neuroendocrine tumour masquerading as intussusception: A case report
Authors: Lingwei Wong, Senthil Vasan Kanthasamy, Gunaseelan Durairaj, Ramesh R Thangaratnam
Journal: Int J Surg Case Rep (2020)
Keywords: adult intussusception, case report, neuroendocrine tumour
MeSH terms: Case Reports

Introduction:
Intussusception usually occurs in the paediatric population. When it occurs in the adult population, it is normally caused by a malignant intraluminal pathology.
Presentation of case:
A 72-year-old female presented to us with right-sided abdominal pain for 3 weeks, associated with vomiting and diarrhoea. She had an appendectomy done 30 years ago and a recent myocardial infarction. Abdominal examination revealed a previous appendectomy scar and tenderness over the right lumbar region. Computed tomography showed ileocaecal intussusception. Right hemicolectomy with a double barrel stoma was performed as she was unstable intraoperatively. Histopathological examination of the tumour showed a well-differentiated neuroendocrine tumour. Subsequent PET scan showed no systemic disease and a reversal of the stoma was done. She remained disease free for a year.
Discussion:
Our patient had undergone a right hemicolectomy despite the high risk of mortality, as there is a high chance of malignancy. Double barrel stoma was done, as she was unstable intraoperatively. Fortunately, she recovered well and had her stoma reversed without any further recurrence of her disease.
Conclusion:
Adult patients who present with intussusception should be managed with resection, as there is a high possibility of a malignancy. Early resection should be planned to prevent further spread of the tumour.
IV Infiltration and Latex Allergy in an Infant: Early Recognition is Key to Prevent Lasting Disability
Authors: Brandon Lucke-Wold, Roopa Avula, Neal Shah, Gregory Borah, Carl Shrader
Journal: Clin Pediatr Dermatol (2017)
Keywords: compartment syndrome, early recognition, favorable outcome, iv infiltration, latex allergy

Latex allergy confounded by IV infiltration presents a serious problem for pediatric patients. If unrecognized, it can lead to serious neurologic deficits, loss of limb mobility, compartment syndrome, and ultimately lasting disability. Appropriate early recognition can prevent progression to these devastating outcomes. In this case report, we present an infant with IV infiltration and latex allergy. The case is used to highlight important clinical diagnostic criteria, treatment approaches, and how to prevent detrimental outcomes. We provide a detailed review of the literature and highlight the key teaching points in a reader-friendly reference table.
Surgical management of calciphylaxis associated with primary hyperparathyroidism: a case report and review of the literature
Authors: Jennifer Bishop, Eric Brown, Augusto Podesta, Cathrine Troy, Xiang Eric Dong
Journal: Int J Endocrinol (2010)
MeSH terms: Case Reports

Calciphylaxis, or calcific uremic arteriolopathy, commonly affects people with end-stage renal disease and carries with it a high rate of morbidity and mortality. Here, we present the unusual case of a 56-year-old woman, with extensive medical problems, who developed calciphylaxis in the presence of primary hyperparathyroidism. Our patient initially presented with bilateral, exquisitely tender thigh lesions. The diagnosis of calciphylaxis was rendered histologically by extensive calcification of the subcutaneous blood vessels. Subsequent parathyroidectomy identified the presence of a hyperactive mediastinal parathyroid adenoma, weighing 0.62 grams. Postoperatively, the patient had normalization of hypercalcemia and parathyroid hormone levels, with subsequent healing of her thigh wounds. Currently, there have been sixteen cases described in the English literature, with only nine being offered a potentially therapeutic parathyroidectomy. It is contingent upon the vigilant physician to diagnose and properly manage this difficult yet treatable condition.
Intramuscular cavernous haemangioma of the triceps
Authors: Nabil Dammak, Hassen Cheikh Rouhou, Issam Khalifa, Ines Haddad, Yadh Zitoun, Faouzi Abid
Journal: Pan Afr Med J (2020)
Keywords: cavernous haemangioma, mri, x-ray, intramuscular haemangioma, triceps
MeSH terms: Hemangioma, Cavernous / diagnosis, Muscle Neoplasms / diagnosis, Case Reports, Adolescent, Arm / pathology, Arm / surgery, Elbow / pathology, Elbow / surgery, Hemangioma, Cavernous / surgery, Humans, Magnetic Resonance Imaging, Male, Muscle Neoplasms / surgery, Muscle, Skeletal / pathology, Muscle, Skeletal / surgery, Tomography, X-Ray Computed, Tunisia

A 16-year-old teenager presented himself with a swollen left elbow, with no associated vascular-nerve complications. The standard radiography was without abnormalities. The echography showed the presence of an oblong vascularized formation occupying the posterior part of the elbow. The magnetic resonance imaging (MRI) showed a hyper vascularized lesion developing at the expense of the brachial triceps muscle with an intermediate signal intensity on the sequences weighted in T1 and a hyper signal in T2. The anatomopathological study of the initial biopsy and of the tumor part concluded with a cavernous hemangioma. Although their origin is vascular, hemangiomas never metastasize and do not undergo malignant transformation. The treatment of symptomatic hemangioma consists of surgical excision.
Successful therapeutic strategy for a patient with obese end-stage kidney disease by simultaneous laparoscopic sleeve gastrectomy and implantation of a buried peritoneal dialysis catheter: A case report
Authors: Tomohisa Yamashita, Tatsuya Sato, Kazuyuki Yamamoto, Atsuko Abiko, Keitaro Nishizawa, Masahiro Matsuda, Yuma Ebihara, Takeshi Maehana, Toshiaki Tanaka, Toshiyuki Yano, Hironori Kobayashi
Journal: Front Med (Lausanne) (2022)
Keywords: a buried catheter for peritoneal dialysis, end-stage kidney disease, kidney transplantation, laparoscopic sleeve gastrectomy, obesity, personalized therapeutic approach
MeSH terms: Case Reports

For morbidly obese patients with end-stage kidney disease (ESKD), there are often difficulties in accessing, implementing, and maintaining kidney replacement therapy (KRT). Although recent weight-loss surgery has the potential to solve these problems, its therapeutic strategy and appropriate perioperative management for morbidly obese patients with ESKD have not been established. Here, we describe the case history of a 47-year-old man diagnosed with ESKD due to obesity-related glomerulopathy with an uncorrected estimated glomerular filtration rate (eGFR) of 16.1 ml/min. He hoped for kidney transplantation but was not eligible due to his high body mass index (BMI) (36.9 kg/m2). Therefore, a combination strategy for both attaining weight loss and preparing for KRT was needed. We performed modified laparoscopic sleeve gastrectomy (LSG) combined with a buried catheter for peritoneal dialysis (PD), which resulted in reduction of multiple surgical invasions while simultaneously preparing for PD. After these operations, his body mass dropped to below 30.0 kg/m2, making him a candidate for kidney transplantation, while maintaining PD. Finally, he was able to have kidney transplantation with success. Collectively, in this case, our novel therapeutic approach was able to avoid multiple surgeries, to assist catheter insertion by laparoscopy, and to provide optimal KRT for an obese patient with ESKD. Simultaneous LSG and implantation of a buried PD catheter may be a promising strategy for morbidly obese patients with ESKD.
Examination of Molecular Effects of MYLK Deletion in a Patient with Extensive Aortic, Carotid, and Abdominal Dissections That Underlie the Genetic Dysfunction
Authors: Sarah K Macklin, Katelyn A Bruno, Charitha Vadlamudi, Haytham Helmi, Ayesha Samreen, Ahmed N Mohammad, Stepahnie Hines, Paldeep S Atwal, Thomas R Caulfield
Journal: Case Rep Med (2020)
MeSH terms: Case Reports

We describe the phenotype of a patient with extensive aortic, carotid, and abdominal dissections. The proband was found to have a heterozygous deletion of exons 21-34 in MYLK, which is a rare finding, as deletions in this gene have been infrequently reported. We describe this finding following detection in a proband with an extensive history of aortic, carotid, and abdominal dissections. Neoteric molecular modeling techniques to help determine the impact of this deletion on protein function indicated loss of function due to lack of any kinase domain. We also provide the electrostatics calculations from the wild type and mutant variant. Through a combined multiomic approach of clinical, functional, and protein informatics, we arrive at a data fusion for determination of pathogenicity embedded within the genetic code for this particular genetic variant, which, as a platform, continues to broaden its scope across the field of variants of uncertain significance classification.
Coexistence of type 1 and type 2 diabetes mellitus: a case report of "double" diabetes in a 17-year-old Nigerian girl
Authors: Michael Adeyemi Olamoyegun, Oluwabukola Ayodele Ala, Ejiofor Ugwu
Journal: Pan Afr Med J (2020)
Keywords: nigeria, type 1 diabetes, adolescent, double diabetes, hybrid diabetes, type 2 diabetes
MeSH terms: Diabetes Mellitus, Type 1 / diagnosis, Diabetes Mellitus, Type 2 / diagnosis, Insulin Resistance, Case Reports, Adolescent, Autoantibodies / analysis, Diabetes Mellitus, Type 1 / epidemiology, Diabetes Mellitus, Type 2 / epidemiology, Female, Humans, Nigeria, Pediatric Obesity / epidemiology, Autoantibodies

Double diabetes otherwise known as hybrid diabetes, a new variant, is a combination of both type 1 and type 2 diabetes in children and adolescents. It is a diabetes variant increasing in prevalence in developed countries because of epidemic obesity among children and adolescents but extremely rare in developing countries. Double diabetes is characterized by features of both type 1 (diabetes auto-antibodies) and type 2 (obesity and insulin resistance). This occurrence can either develop on a background of type 1 diabetes due to an abnormal increase in weight from physiological growth spurt in adolescents or from high insulin dosage developing on a background of type 2 diabetes. The variant has been linked to possible increased cardiovascular risks and worsened morbidity including poor glycaemic control. Here, we report a case of a 17-year-old girl who developed features of type 2 diabetes on a background of type 1 diagnosed 6 years after T1D diagnosis.