OpenMed/multicare-articles huggingface dataset:
Tocilizumab: Another medication related to osteonecrosis of the jaws? A case report and literature review
Authors: Andreas Sakkas, Sebastian Heil, Steffen Kargus, Martin Rebel, Robert A Mischkowski, Oliver C Thiele
Journal: GMS Interdiscip Plast Reconstr Surg DGPW (2021)
Keywords: interleukin-6 receptor inhibitors, medication-related osteonecrosis of the jaw, osteomyelitis, rheumatoid arthritis, tocilizumab
MeSH terms: Case Reports

Introduction: Medication-related osteonecrosis of the jaw (MRONJ) is a serious complication in patients receiving antiresorptive medication, such as bisphosphonates and denosumab, for different oncologic and non-oncologic diseases. Here, we report a case of MRONJ in a patient treated with tocilizumab, a humanized anti-interleukin-6 receptor antibody that effectively treats moderate to severe rheumatoid arthritis in adults. Case description: A 45-year-old female patient diagnosed with severe rheumatoid arthritis, who had been undergoing intravenous tocilizumab therapy for three years without history of bisphosphonate use, was referred to our department. Four weeks previously, several teeth in the maxilla and mandible were removed under local anesthesia by her dentist. Two weeks after the extractions, she felt pain in both jaws. We diagnosed wound dehiscence and delayed healing of the alveolar bone after the tooth extractions. Digital volume tomography showed persistent dry alveolar sockets. The patient underwent surgical debridement of necrotic bone, and intravenous antibiotics were administered in hospital. Five months later, wound dehiscence reoccurred in the same regions. Histopathological analysis of bone biopsies revealed a diagnosis of MRONJ. Four months later, wound dehiscence occurred in the left maxillary alveolar ridge, and local bone resection was performed under antibiotic treatment. Twenty-four months after the last surgery, wound dehiscence had healed completely without signs of recurrence. Discussion: Osteomyelitis of the jaw in patients treated with tocilizumab has not been reported often. This case confirms the potential role of this interleukin-6 receptor inhibitor in the pathogenesis of MRONJ and shows that patients who receive tocilizumab with MRONJ-like symptoms should be closely monitored. The pathomechanism of MRONJ under tocilizumab therapy remains unclear, so dental practitioners, maxillofacial surgeons, and rheumatologists should look for signs of MRONJ in patients receiving tocilizumab to prevent MRONJ onset.
Using General Anesthesia plus Muscle Relaxant in a Patient with Spinal Muscular Atrophy Type IV: A Case Report
Authors: Xiu-Fen Liu, Dong-Xin Wang, Daqing Ma
Journal: Case Rep Anesthesiol (2011)
MeSH terms: Case Reports

Spinal muscular atrophy (SMA) is a rare genetic disease characterized by degeneration of spinal cord motor neurons, which results in hypotonia and muscle weakness. Patients with type IV SMA often have onset of weakness from adulthood. Anesthetic management is often difficult in these patients as a result of muscle weakness and hypersensitivity to neuromuscular blocking agents as shown by (Lunn and Wang; 2008, Simic; 2008, and Cifuentes-Diaz et al.; 2002). Herein we report a case of anesthetic management of a patient with SMA type IV for mammectomy and review some other cases of SMA patients receiving different kinds of anesthesia.
Cytomegalovirus-Immune Recovery Retinitis After Initiation of Highly Active Antiretroviral Therapy: A Case Series
Authors: Yiwen Qian, Luoziyi Wang, Jing Jiang, Jinshan Suo, Huan Weng, Xin Che, Hongzhou Lu, Zhiliang Wang
Journal: Front Med (Lausanne) (2022)
Keywords: case series, cytomegalovirus retinitis, cytomegalovirus-immune recovery retinitis, highly active antiretroviral therapy, human immunodeficiency virus

Purpose:
To delineate the characteristics and treatment of cytomegalovirus-immune recovery retinitis (CMV-IRR) in human immunodeficiency virus (HIV) patients with immune recovery under effective highly active antiretroviral therapy (HAART) regimen.
Methods:
We reported four patients with HIV who were diagnosed with CMV-IRR soon after effective HAART. Plasma levels of CD4 T cells, HAART regimen, and other clinical and laboratory characteristics of the four patients were described. Patients were monitored for ocular manifestations and clinical signs under effective ocular and systemic anti-cytomegalovirus (CMV) and corticosteroid treatment for 12 months.
Results:
With HAART, plasma levels of CD4 T cell counts rose remarkably. The mean baseline CD4 count of the four patients was 14.5 (range from 7 to 33) cells/μl before HAART and 183.25 (range from 153 to 220) cells/μl when diagnosed with CMV-IRR. Ophthalmic examination demonstrated severe vitreous opacities and necrotizing retinitis, intraretinal hemorrhages, and vasculitis. A large number of CMV sequencing was detected by DNA sequencing of vitreous samples. All four patients were recovered from CMV-IRR with anti-CMV and corticosteroid treatment.
Conclusions:
Cytomegalovirus-immune recovery retinitis is a new diagnosis of HIV-associated ocular complication under HAART. These findings suggest that the immunological effects of HAART may accelerate the CMV retinitis in patients with very low initial CD4 T cell counts. HIV patients are recommended to have a thorough fundus examination before HAART initiation and a close follow-up especially in those with low CD4 counts to avoid the progression of CMV retinitis.
Clostridium cadaveris Osteomyelitis: an Unusual Pathogen which Highlights the Importance of Deep Tissue Sampling in Chronic Osteomyelitis
Authors: Ruth Alexandra Corrigan, Jose Lomas-Cabeza, David Stubbs, Martin McNally
Journal: J Bone Jt Infect (2020)
Keywords: chronic osteomyelitis, clostridium cadaveris, intra-operative sampling
MeSH terms: Case Reports

Clostridium cadaveris, named following its identification in human corpses, is an unusual pathogen. We report the first case of C. cadaveris osteomyelitis. This case highlights the importance of deep tissue sampling and appropriate culture to correctly identify causative pathogens and guide targeted antimicrobial therapy in difficult-to-treat infections like chronic osteomyelitis.
Total Pancreatectomy for Ampullary Adenocarcinoma in a 74-Year-Old Patient: Case Report and Literature Review
Authors: Gabriela A Arroyo Murillo, Eleonore Choppin De Janvry, Manuela Garofalo, Fatima Della Pietra
Journal: Case Rep Surg (2020)
MeSH terms: Case Reports

Primary ampullary neoplasms have origin in the ampulla of Vater, an anatomical structure where the common bile duct and the pancreatic duct join together as a common channel. It represents <0.5% of all gastrointestinal cancers and approximately 7% of all periampullary cancers. The adenocarcinomas arising in this region originate from different epithelial cellular constituents present at the site, the histopathological classification encompass: intestinal type, pancreaticobiliary type, and mixed type. Pancreaticoduodenectomy is the treatment of choice when there is an overt or highly suspicious malignant behaviour. We present here the case of a 74-year-old male patient who presented to our department for further investigation of obstructive jaundice and a pancreatic mass associated with a six-month history of significant weight loss and mild epigastric pain. Eventually, a total splenopancreatectomy was performed given the extension of structural anomalies of the organ secondary to an ampullary adenocarcinoma.
Pathological complete response of advanced rectal cancer treated by preoperative chemoradiotherapy with oral tegafur-uracil and leucovorin: a case report
Authors: Masaki Wakasugi, Toru Masuzawa, Mitsuyoshi Tei, Takeshi Omori, Shigeyuki Ueshima, Masayuki Tori, Masahiko Tsujimoto, Hiroki Akamatsu
Journal: Case Rep Oncol Med (2013)

A rare case of pathological complete response of advanced rectal cancer treated by preoperative chemoradiotherapy (CRT) with oral tegafur-uracil and leucovorin is reported. A 73-year-old man with bloody stool was diagnosed with type 2 rectal cancer located 6 cm from the anal verge. Examination of biopsy specimens revealed moderately differentiated adenocarcinoma. Computed tomography scans showed no distant or lymph node metastases. With a diagnosis of advanced lower rectal cancer of T3N0M0 stage III according to the TNM classification, he underwent preoperative CRT with oral tegafur-uracil and leucovorin. He did not experience any adverse events due to CRT. An abdominal CT scan and colonoscopy after CRT demonstrated significant tumor reduction. Then, 63 days after CRT, he underwent laparoscopic-assisted low anterior resection and diverting ileostomy. Pathological examination revealed no residual cancer cells. During 15 months of follow-up after his ileostomy was taken down, the patient continued to do well without any signs of recurrence or metastasis. Preoperative CRT with tegafur-uracil and leucovorin may thus represent a safe, well-tolerated, and effective therapeutic strategy for patients with advanced rectal cancer.
Bilateral mandibular paramolars
Authors: Kanika Singh Dhull, Rachita Singh Dhull, Swagatika Panda, Sonu Acharya, Shweta Yadav, Gatha Mohanty
Journal: Int J Clin Pediatr Dent (2014)
Keywords: hyperdontia, paramolars, supernumerary tooth
MeSH terms: Case Reports

Supernumerary tooth is a developmental anomaly and has been argued to arise from multiple etiologies. These teeth may remain embedded in the alveolar bone or can erupt into the oral cavity. They can cause a variety of complications in the develo-ping dentition. Supernumerary teeth can present in various forms and in any region of the mandible or maxilla, but have a predisposition for the anterior maxilla. Here is the presentation of a case of unusual location of supernumerary teeth located in between mandibular first and second molar region bilaterally. How to cite this article: Dhull KS, Dhull RS, Panda S, Acharya S, Yadav S, Mohanty G. Bilateral Mandibular Paramolars. Int J Clin Pediatr Dent 2014;7(1):40-42.
Inverted takotsubo-like left ventricular dysfunction with pulmonary oedema developed after caesarean delivery complicated by massive haemorrhage in a severe preeclamptic parturient with a prolonged painful labour
Authors: Hyejin Jeong, Seongheon Lee, Cheolwon Jeong, Jongun Lee, Seongtae Jeong, Sungsu Chung, Kyungyeon Yoo
Journal: Case Rep Anesthesiol (2011)
MeSH terms: Case Reports

Inverted takotsubo cardiomyopathy (TTC), a variant of stress-induced cardiomyopathy, features transient myocardial dysfunction characterized by a hyperdynamic left ventricular apex and akinesia of the base. Herein, we describe a 38-year-old primigravida with severe preeclampsia who had active labour for 4 h followed by an emergency caesarean delivery. She developed postpartum haemorrhage due to uterine atony complicated by pulmonary oedema, which was managed with large-volume infusion and hysterectomy. Her haemodynamic instability was associated with cardiac biomarkers indicative of diffuse myocardial injury and echocardiographic findings of an "inverted" TTC. The patient was almost fully recovered one month later. Our case shows that a reversible inverted TTC may result from a prolonged painful labour. TTC should be listed in the differential diagnosis of the patient presenting with pulmonary oedema of unknown origin, especially in patients with severe preeclampsia.
Extragastrointestinal stromal tumor presenting as a scrotal mass: First report from India
Authors: Qutubuddin Ali, Krishnanand Anand, Vishal Bansal
Journal: Int J Surg Case Rep (2020)
Keywords: cd117, cd34, egist, gastrointestinal stromal tumor
MeSH terms: Case Reports

Introduction:
Gastrointestinal Stromal Tumours (GIST) are the most common mesenchymal tumours that arises from the wall of the gastrointestinal tract. Similar tumours elsewhere in the abdomen are called extra gastrointestinal stromal tumor (EGIST).
Presentation of case:
A 68 years male presented with a gradually enlarging scrotal mass over a period of 6month duration. On examination a mass was felt (5 cm × 4 cm) occupying left side of scrotum and abutting the lower pole of left testis. Left inguinal orchidectomy along with excision of mass was done. HPE revealed a spindle cell pattern with low cellularity and Immunohistochemical analysis revealed the tumor reactive for CD 117 and CD 34 which is suggestive of GIST.
Discussion:
EGIST have been reported in unusual locations, including the pancreas, prostate, and abdominal wall. The occurrence of EGIST is extremely rare and little is known about their actual origin. The diagnosis is by the demonstration of a specific marker CD 117 and CD34. We describe an unusual case of extra gastrointestinal stromal tumor (EGIST) presenting as a primary scrotal mass.
Conclusion:
To the best of our knowledge, this is the first Indian case of an EGIST involving the scrotum as primary site and second such case worldwide.
Overview of management of acute renal failure and its evaluation; a case analysis
Authors: Chaudhary Muhammad Junaid Nazar, Faisal Bashir, Saba Izhar, John Anderson
Journal: J Nephropharmacol (2015)
Keywords: acute tubular necrosis, glomerular filtration rate, hemodialysis
MeSH terms: Case Reports

The annual incidence is about 150 per million in the UK, but this figure is six times greater in the >80 years old group. Prerenal azotemia is considered as the most serious reason in community or hospital acquired acute renal failure (ARF). A 67-year-old middle age male was admitted to the hospital with a chief complaint of generalized weakness, volume depletion and dysuria. He has treated with metronidazole for diarrhoea caused by Clostridium difficile considered as the precipitating factor for the ARF. The patient has severe osteoarthritis and takes high dose non-steroidal anti-inflammatory drugs from the last two years. He also complains for obstructive sleep apnea (OSA) and obesity. He has controlled hypertension was on lisinopril to control blood pressure. ARF is quite common, occurring in 80 million populations. Urinary obstruction should be excluded (a cause in around 5-10 of cases) because this is readily reversible if it is diagnosed early. A renal US will be sufficient to identify obstruction in 95 of cases. Most cases of ARF are expected to pre renal failure/acute tubular necrosis (ATN) 70-80%. Risk factor for development for at ATN are old age, drugs (non-steroidal anti-inflammatory drugs, gentamicin), sepsis, and chronic kidney disease and must be considered.
Calibration of patient-specific boundary conditions for coupled CFD models of the aorta derived from 4D Flow-MRI
Authors: Scott MacDonald Black, Craig Maclean, Pauline Hall Barrientos, Konstantinos Ritos, Alistair McQueen, Asimina Kazakidi
Journal: Front Bioeng Biotechnol (2023)
Keywords: 4d flow-mri, cfd, windkessel, aortic dissection, boundary conditions, calibration, patient-specific

Introduction: Patient-specific computational fluid dynamics (CFD) models permit analysis of complex intra-aortic hemodynamics in patients with aortic dissection (AD), where vessel morphology and disease severity are highly individualized. The simulated blood flow regime within these models is sensitive to the prescribed boundary conditions (BCs), so accurate BC selection is fundamental to achieve clinically relevant results. Methods: This study presents a novel reduced-order computational framework for the iterative flow-based calibration of 3-Element Windkessel Model (3EWM) parameters to generate patient-specific BCs. These parameters were calibrated using time-resolved flow information derived from retrospective four-dimensional flow magnetic resonance imaging (4D Flow-MRI). For a healthy and dissected case, blood flow was then investigated numerically in a fully coupled zero dimensional-three dimensional (0D-3D) numerical framework, where the vessel geometries were reconstructed from medical images. Calibration of the 3EWM parameters was automated and required ~3.5 min per branch. Results: With prescription of the calibrated BCs, the computed near-wall hemodynamics (time-averaged wall shear stress, oscillatory shear index) and perfusion distribution were consistent with clinical measurements and previous literature, yielding physiologically relevant results. BC calibration was particularly important in the AD case, where the complex flow regime was captured only after BC calibration. Discussion: This calibration methodology can therefore be applied in clinical cases where branch flow rates are known, for example, via 4D Flow-MRI or ultrasound, to generate patient-specific BCs for CFD models. It is then possible to elucidate, on a case-by-case basis, the highly individualized hemodynamics which occur due to geometric variations in aortic pathology high spatiotemporal resolution through CFD.
Congenital hepatoblastoma presenting with hepatic arteriovenous fistulas: a case report
Authors: Jiao Lin, Jialing Guo, Chun Chen, Liqiong Jiang, Can Lai, Chunlin Wang
Journal: Front Pediatr (2023)
Keywords: congenital hepatoblastoma, diagnosis, hepatic arteriovenous fistulas, metastasis, therapy
MeSH terms: Case Reports

Aim:
Congenital hepatoblastoma, a rare malignant liver tumor in infancy, typically presents with abdominal distension or mass. Tumors detected antenatally or during the first three months of age are considered congenital hepatoblastoma. Hepatic arteriovenous fistulas (HAVF) are associated with high mortality in the neonatal period and can be caused by many secondary factors. This case report focuses on a patient with congenital hepatoblastoma accompanied by HAVF, highlighting the clinical and imaging characteristics and management strategies.
Case presentation:
A term infant presented with sudden tachypnea and heart failure on his first day of life. A cystic-solid mixed lesion in the fetus's liver was detected by an antenatal ultrasound scan. Postnatal digital subtraction angiography confirmed the presence of arteriovenous fistulas, which were treated with trans-arterial embolization. However, despite the intervention, the patient's heart failure did not improve. The patient underwent a left hepatectomy, and hepatoblastoma was discovered by histology of the resected hepatic lobe. Unfortunately, metastases were later discovered in the intracranial and ocular regions. Ultimately, the family decided to discontinue further treatment.
Conclusion:
Congenital hepatoblastoma presenting with hepatic arteriovenous fistulas has not been previously described. Hepatoblastoma should be considered when alpha-fetoprotein levels show a significant elevation in newborns. Prenatal diagnosis may improve pre- and postnatal management.
Management of Impella device fracture during direct aortic explantation
Authors: W Landon Jackson, Matthew J Kepford, Shane S Yamane, John F Carabello, Kryston R Boyer
Journal: J Surg Case Rep (2023)
Keywords: impella, aorta, bypass, cardiothoracic
MeSH terms: Case Reports

The utilisation of mechanical circulatory support devices in patients undergoing high-risk coronary artery bypass continues to increase. The Impella is a ventricular assist device commonly used in the setting of post-cardiotomy cardiogenic shock. This device can be implanted directly into the ascending aorta during open cardiac surgery. Device fracture is a documented complication of the Impella; however, the management of device fracture during direct explantation from an aortic graft has not yet been described. We report a case of Impella device fracture during its removal from a prosthetic aortic graft and discuss the management of this complication.
Unusual explosive growth of a squamous cell carcinoma of the scalp after electrical burn injury and subsequent coverage by sequential free flap vascular connection--a case report
Authors: Raymund E Horch, G Bjoern Stark, Justus P Beier
Journal: BMC Cancer (2005)
MeSH terms: Burns, Electric / physiopathology, Carcinoma, Squamous Cell / physiopathology, Skin Neoplasms / physiopathology, Case Reports, Burns, Electric / complications, Carcinoma, Squamous Cell / complications, Cicatrix / pathology, Fatal Outcome, Humans, Microcirculation, Middle Aged, Recurrence, Skin Neoplasms / complications, Skin Ulcer / physiopathology, Surgical Flaps / pathology, Time Factors, Wound Healing

Background:
Squamous cell carcinomos may arise from chronic ulcerating wounds in scars, most commonly postburn scars. Tumour growth usually takes place over months to years. Localization on the scalp is a relatively rare condition.
Case presentation:
This report presents the case of a 63-year-old man with chronic ulceration of a postburn scar of the scalp due to an electrical burn 58 years ago. Sudden tumour growth started within weeks and on presentation already had extended through the skull into frontal cortex. After radical tumour resection, defect was covered with a free radial forearm flap. Local recurrence occurred 6 weeks later. Subsequent wide excision including discard of the flap and preservation of the radial vessels was followed by transfer of a free latissimus dorsi muscle flap, using the radial vessels of the first flap as recipient vessels. The patient received radiotherapy post-operatively. There were no problems with flap survivals or wound healing. Due to rapidly growing recurrence the patient died 2 months later.
Conclusion:
Explosive SCC tumour growth might occur in post-burn scars after more than 50 years. As a treatment option the use of sequential free flap connections might serve in repeated extensive tumour resections, especially in the scalp region, where suitable donor vessels are often located in distance to the defect.
Cutis Laxa syndrome: a case report
Authors: Mohamed Hbibi, Sana Abourazzak, Mounia Idrissi, Sana Chaouki, Samir Atmani, Moustapha Hida
Journal: Pan Afr Med J (2015)
Keywords: cutis laxa, connective tissue, emphysema
MeSH terms: Cutis Laxa / congenital, Case Reports, Cutis Laxa / pathology, Humans, Infant, Male, Respiratory Tract Diseases / congenital, Respiratory Tract Diseases / pathology, Syndrome

Cutis laxa (CL) is a heterogeneous group of inherited and acquired connective tissue disorders characterized by a loose skin and variable systemic involvement (inguinal hernia, cardiopulmonary disease, and emphysema). Autosomal dominant, autosomal recessive and x-linked recessive patterns have been described in the inherited forms. Acquired forms of this disease have been associated with a previous inflammatory skin disorder (urticaria…). The characteristic symptomatological pattern is resulting from paucity of elastic fibers. We report an 18 months old baby boy with a congenital cutis laxa. He was admitted in pediatric unit for respiratory disorders. The diagnosis of CL syndrome is based on clinical assessment of typical skin features and the associated extracutaneous finding.
Ophthalmic Surgery in Patients with Left Ventricular Assist Devices
Authors: George A Dumas, Ayesha S Bryant, Gwendolyn L Boyd
Journal: Case Rep Ophthalmol Med (2019)
MeSH terms: Case Reports

The newer generation of left ventricular assist devices (LVADs) are commonly used as destination therapy; these devices have demonstrated improved outcomes and increased survival. Given the longer lifespan, it is not surprising that patients with LVADS are increasingly presenting with noncardiac, chronic diseases and interventions for their treatment. This includes ophthalmic procedures in patients with LVAD. There is a paucity of literature about the experiences and outcomes in this cohort of patients presenting for ophthalmologic surgery. Here we present a case series consisting of 7 patients with LVAD that underwent 10 ophthalmic surgeries. No adverse events including intraoperative hemodynamic instability or respiratory compromise occurred. All patients had an on-time discharge with no 30-day recidivism. Most patients underwent a phacoemulsification with intraocular lens implantation and received a topical with intracameral anesthetic. We attribute these successful outcomes to a standardized clinical workflow consisting of careful preoperative screening, communication and presence of VAD coordinator, continuation of antithrombotics, monitoring based on presence of pulsatile flow, and a plan for rapid transfer if needed.