OpenMed/multicare-articles huggingface dataset:
An unusual site of gallstones five years after laparoscopic cholecystectomy
Authors: Sean Heywood, Ben Wagstaff, Noel Tait
Journal: Int J Surg Case Rep (2019)
Keywords: complication, gallstones, laparoscopic cholecystectomy, spillage

Introduction:
Gallstone spillage during laparoscopic cholecystectomy is a common occurrence. Complications due to spilled gallstones occur in up to 5% of laparoscopic cholecystectomy cases, with complications having been reported up to 20 years after laparoscopic cholecystectomy.
Case report:
We report the case of a 70 year old male who presented for elective right inguinal hernia repair. At the time of repair he was found to have multiple foreign bodies embedded within an indirect hernia sac. Subsequent pathology confirmed these to be gallstones, having been spilled during emergency laparoscopic cholecystectomy 5 years prior.
Discussion:
Gallbladder perforation and gallstone spillage during laparoscopic cholecystectomy occurs frequently, complications due to spilled gallstones are estimated to occur in less than 5% of cases. The most common complications is abscess formation and infection. Though spilled gallstones have been implicated in the formation of colocutaneous, colovesical, and biliocutaneous fistulae. Following gallbladder perforation during cholecystectomy, closure of the hole should be attempted with laparoscopic graspers, surgical clips, or a laparoscopic ligature. Meticulous collection of all visible spilled gallstones should then take place, followed by intraperitoneal lavage ensuring care is taken not to disperse gallstones throughout the peritoneal cavity.
Conclusion:
Gallbladder perforation during in laparoscopic cholecystectomy is common. Prevention of gallstone spillage, and retrieval of spilled gallstones is essential in minimising the risk of complications due to spillage.
A giant euthyroid endemic multinodular goiter with no obstructive or compressive symptoms
Authors: Ahmed Nada, Ashraf Mohamed Ahmed, Ramon Vilallonga, Manuel Armengol, Ibrahim Moustafa
Journal: Case Rep Med (2011)
MeSH terms: Case Reports

Diffusely enlarged thyroid glands (goitres) are becoming increasingly infrequent. However, in some geographical areas they are still relatively common and can cause compressive symptoms involving the trachea, oesophagus, and recurrent laryngeal nerve. Surgical treatment of diffusely enlarged thyroid glands requires a high level of expertise and may lead to severe complications. Here we present a case report of surgical treatment of an extremely enlarged thyroid gland, found in a 61-year-old female patient. The patient underwent surgery, and a thyroidectomy was performed. The resulting specimen weighed 4.7 kg (10.4 lbs). Histopathological examination revealed a multinodular goitre with multiple cysts and areas of haemorrhage and necrosis. Surgical excision can immediately resolve local symptoms and is often recommended when substernal extension is evident. To the best of our knowledge, this is the largest thyroid gland ever reported in the literature. Only experienced surgeons should treat large thyroid goitres. Ideally, large thyroid goitres should be treated before they reach a substernal component, otherwise any sudden growth in gland size could seriously compromise respiration.
Choroidal and cutaneous metastasis from urothelial carcinoma of the bladder after radical cystectomy: a case report and literature review
Authors: Yozo Mitsui, Naoko Arichi, Keita Inoue, Miho Hiraki, Shigenobu Nakamura, Takeo Hiraoka, Noriyoshi Ishikawa, Riruke Maruyama, Hiroaki Yasumoto, Hiroaki Shiina
Journal: Case Rep Urol (2014)

Bladder cancer is the second most common genitourinary malignancy and has variable metastatic potential; however, choroidal and cutaneous metastases are extremely rare. Generally, a patient with these uncommon metastases has a very poor prognosis. We present a bladder cancer patient with a visual disorder in the right eye and multiple nodules on head and lower abdomen that developed 17 months after a radical cystectomy. These symptoms were determined to be caused by choroidal and cutaneous metastasis of bladder cancer. Although two cycles of combination chemotherapy were performed, the patient died 5 months after diagnosis of multiple metastases.
Clinical experience and safety of Janus kinase inhibitors in giant cell arteritis: a retrospective case series from Sweden
Authors: Per Eriksson, Oliver Skoglund, Cecilia Hemgren, Christopher Sjöwall
Journal: Front Immunol (2023)
Keywords: janus kinase inhibitor (jaki), baricitinib, corticosteroids, giant cell (temporal) arteritis, inflammation, interleukin - 6, large vessel vasculitis, therapy -
MeSH terms: Arthritis, Giant Cell Arteritis / drug therapy, Janus Kinase Inhibitors / adverse effects, Randomized Controlled Trial, Clinical Trial, Phase III, Research Support, Non-U.S. Gov't, Humans, Prednisolone, Sweden, Janus Kinase Inhibitors, Prednisolone

The Janus kinase (JAK)-STAT signaling pathway is relevant in both Takayasu and giant cell arteritis (GCA), and the use of JAK inhibitors (JAKi) in arthritis, psoriasis, and inflammatory bowel disease is nowadays common. Some evidence of the clinical efficacy of JAKi in GCA exists and a phase III randomized controlled trial (RCT) of upadacitinib is currently recruiting. In 2017, we started using barcitinib in a GCA patient with inadequate response to corticosteroids, and later on, we treated other 14 GCA patients with baricitinib/tofacitinib during intense follow-up. The retrospective data of these 15 individuals are here summarized. GCA was diagnosed based on the ACR criteria and/or imaging techniques combined with increased C-reactive protein (CRP) and/or erythrocyte sedimentation rate (ESR) followed by a good initial response to corticosteroids. JAKi was initiated based on inflammatory activity, with increased CRP, presumably dependent on GCA with clinical symptoms, despite unsatisfying high doses of prednisolone. The mean age at JAKi initiation was 70.1 years and the mean exposure to JAKi was 19 months. From initiation, significant reductions in CRP were seen already at 3 (p = 0.02) and 6 (p = 0.02) months. A slower decrease was observed regarding ESR at 3 (p = 0.12) and 6 (p = 0.02) months. Furthermore, the daily prednisolone doses were reduced at 3 (p = 0.02) and 6 (p = 0.004) months. No GCA relapses were observed. Two patients were affected by serious infections, but JAKi therapy was retained or reintroduced after recovery. We present encouraging observational data on JAKi in GCA in one of the hitherto largest case series with long-term follow-up. Our clinical experiences will complement the results from the awaited RCT.
Repetitive transcranial magnetic stimulation induced hypomanic symptoms in a woman with a history of electroconvulsive therapy induced mania: a case report
Authors: Noah S Philip, S Louisa Carpenter
Journal: F1000Res (2013)

Repetitive transcranial magnetic stimulation (rTMS) is a comparatively novel option for the treatment of major depressive disorder (MDD) and other psychiatric illnesses. Previous research has shown rTMS to be safe and without significant side effects compared to pharmacologic options. However, rare cases of rTMS-induced mania have been reported. This case report describes such an affective switch in a 52 year old female veteran with treatment-resistant MDD and a history of electroconvulsive therapy (ECT)-induced mania. Six treatments of rTMS were administered at 5 Hz for a total of 3000 pulses per day, when the patient began to display multiple hypomanic symptoms. These symptoms decreased after the termination of treatment and abated within a couple of days. In conclusion, caution should be used when administering rTMS to patients with a history of ECT-induced mania.
Anti-IL6 Autoantibodies in an Infant With CRP-Less Septic Shock
Authors: Marketa Bloomfield, Zuzana Parackova, Tamara Cabelova, Iva Pospisilova, Pavel Kabicek, Hana Houstkova, Anna Sediva
Journal: Front Immunol (2019)
Keywords: c-reactive protein, anti-il6 autoantibodies, interleukin 6, sarilumab, siltuximab, tocilizumab
MeSH terms: Autoantibodies / blood, Interleukin-6 / immunology, Shock, Septic / immunology, Case Reports, Research Support, Non-U.S. Gov't, C-Reactive Protein, Female, Humans, Infant, Shock, Septic / blood, Autoantibodies, Interleukin-6, C-Reactive Protein

Background: Interleukin-6 (IL-6) is a pleiotropic cytokine with a multitude of pro-inflammatory effects. Serum C-reactive protein (CRP) is an acute phase protein induced mainly by IL-6 in response to inflammatory conditions, particularly infection. The biological functions of CRP include opsonisation, induction of phagocytosis, complement activation, or chemotaxis enhancement. Factors interfering with IL-6-mediated recruitment of innate immune responses, such as the presence of anti-IL6 antibodies, may therefore compromise the host resistance to microbial pathogens. This has major implications for the use of IL-6-targeting biologics, such as tocilizumab or sarilumab in rheumatologic, immune dysregulation diseases, and cancer. Case presentation: 20-month-old Czech female developed severe septic shock with clinical and laboratory signs of systemic inflammation but no increase of CRP or IL-6. The offending pathogen was most likely Staphylococcus aureus, detected in a throat swab; the response to antibiotic treatment was prompt. A defect in the integrity of IL-6/CRP axis was suspected and verified by the detection of neutralizing IL-6 antibodies in the serum of the child. Conclusion: We report a first case of systemic bacterial infection in a patient with anti-IL6 autoantibodies. Disturbed IL-6 signaling, whether iatrogenic by targeted IL-6 blockade or endogenous due to the presence of autoantibodies against IL-6, represents a risk factor for increased infectious susceptibility. Patients with severe bacterial infection without elevation of CRP should be examined for the presence of anti-IL6 autoantibodies.
Lumbar Spondylodiscitis Caused by Burkholderia cepacia in a Previously Healthy Patient
Authors: Danielle Jaafar, Maroun Rizkallah, Firas Atallah, Falah Bachour, Angelique Barakat, Ghassan Maalouf, Matta Matta
Journal: Case Rep Orthop (2017)
MeSH terms: Case Reports

Burkholderia cepacia spondylodiscitis is a rare entity that has been reported in only four cases. We hereby report the case of a 43-year-old, previously healthy, woman who was found to have a B. cepacia spondylodiscitis after a cholecystectomy. She was treated with a three-month regimen of ceftazidime and ciprofloxacin with complete clinical, biological, and radiological remission.
The Digital Abutment Check: An Improvement of the Fully Digital Workflow
Authors: Sebastian Hinz, Daniel Ellmann, Christian Wegner, Wolfgang Bömicke, Tobias Bensel
Journal: Case Rep Dent (2020)
MeSH terms: Case Reports

By using modern digitalization techniques, an existing denture can be digitized and aid the provision of a new implant-supported denture according to a fully digital workflow. This includes fully navigated implant surgery and results in an immediately provided prosthetic restoration. However, even with the current digital workflow, it is challenging to achieve a definitive prosthetic restoration in a single treatment session. In order to achieve a definitive denture in as few treatment sessions as possible, we have implemented the digital abutment test. This test modified the existing data set and determined the final restoration. In the present case, the preexisting maxillary removable complete denture was converted into a fixed immediate restoration using the fully digital workflow. The workflow is divided into two treatment phases, each with three treatment sessions, where part of the second phase involves an innovative digital abutment check. The illustrated case shows an effective use of current digital possibilities. Special attention was also paid to a minimally invasive course of therapy.
Dorsal Onlay Oral Mucosa Graft Urethroplasty: A Case Report and Review of Literature
Authors: Kwaku Addai Arhin Appiah, Christian Kofi Gyasi-Sarpong, Edwin M T Yenli, Patrick Opoku Manu Maison, Charles Kwame Adofo, George Amoah, Roland Azorliade, Dominic Annor Mintah, Augustina Badu-Peprah
Journal: Case Rep Urol (2020)
MeSH terms: Case Reports

The use of buccal mucosa grafts in urethral reconstruction for complex anterior urethral strictures has gained popularity over the years with very good outcomes reported in literature. We report on the successful repair of a complex anterior urethral stricture in a 14-year-old boy following catheterization using this method at the Komfo Anokye Teaching Hospital. The aim is to describe the method of dorsal onlay oral mucosa graft urethroplasty and to review the literature.
Classifying multiple types of hand motions using electrocorticography during intraoperative awake craniotomy and seizure monitoring processes-case studies
Authors: Tao Xie, Dingguo Zhang, Zehan Wu, Liang Chen, Xiangyang Zhu
Journal: Front Neurosci (2015)
Keywords: brain-computer interface (bci), classification, electrocorticography (ecog), feature extraction, hand movements

In this work, some case studies were conducted to classify several kinds of hand motions from electrocorticography (ECoG) signals during intraoperative awake craniotomy & extraoperative seizure monitoring processes. Four subjects (P1, P2 with intractable epilepsy during seizure monitoring and P3, P4 with brain tumor during awake craniotomy) participated in the experiments. Subjects performed three types of hand motions (Grasp, Thumb-finger motion and Index-finger motion) contralateral to the motor cortex covered with ECoG electrodes. Two methods were used for signal processing. Method I: autoregressive (AR) model with burg method was applied to extract features, and additional waveform length (WL) feature has been considered, finally the linear discriminative analysis (LDA) was used as the classifier. Method II: stationary subspace analysis (SSA) was applied for data preprocessing, and the common spatial pattern (CSP) was used for feature extraction before LDA decoding process. Applying method I, the three-class accuracy of P1~P4 were 90.17, 96.00, 91.77, and 92.95% respectively. For method II, the three-class accuracy of P1~P4 were 72.00, 93.17, 95.22, and 90.36% respectively. This study verified the possibility of decoding multiple hand motion types during an awake craniotomy, which is the first step toward dexterous neuroprosthetic control during surgical implantation, in order to verify the optimal placement of electrodes. The accuracy during awake craniotomy was comparable to results during seizure monitoring. This study also indicated that ECoG was a promising approach for precise identification of eloquent cortex during awake craniotomy, and might form a promising BCI system that could benefit both patients and neurosurgeons.
Membranous Nephropathy Secondary to Graves' Disease: A Case Report
Authors: Precil Diego Miranda de Menezes Neves, Monique Pereira Rêgo Muniz, Giuliano Ferreira Morgantetti, Érico Murilo Monteiro Cutrim, Carlos de Andrade Macieira, Natalino Salgado-Filho, Joyce Santos Lages, Dyego José de Araújo Brito, Kaile de Araújo Cunha, Giuseppe Cesare Gatto, Gyl Eanes Barros Silva
Journal: Front Immunol (2022)
Keywords: graves’ disease, auto-immune thyroiditis, kidney biopsy, membranous nephropathy, renal pathology
MeSH terms: Glomerulonephritis, Membranous / diagnosis, Glomerulonephritis, Membranous / drug therapy, Glomerulonephritis, Membranous / etiology, Graves Disease / complications, Graves Disease / diagnosis, Graves Disease / drug therapy, Thyroid Neoplasms, Case Reports, Humans, Iodine Radioisotopes / therapeutic use, Male, Middle Aged, Proteinuria, Iodine Radioisotopes

Membranous nephropathy (MN) is a form of kidney disease that is idiopathic in 70%-80% of cases. Glomerular involvement in autoimmune thyroiditis can occur in 10%-30% of patients, and MN manifests in association with Hashimoto thyroiditis in up to 20% of the cases with glomerular involvement. Reports of MN associated with Graves' disease (GD) are extremely rare in the current literature. Herein, we report the case of a 46-year-old man admitted to the hospital with nephrotic syndrome and symptomatic hyperthyroidism due to GD. Kidney biopsy revealed a secondary MN pattern. Immunohistochemical staining for PLA2R was negative, and thyroglobulin showed weak and segmental staining along the glomerular capillary. Anti-thyroid peroxidase (TPO) antibody test was not performed. The patient was treated for GD with methimazole and prednisone, and despite reaching clinical improvement after 8 months, proteinuria remained close to nephrotic levels. In this scenario, the patient was submitted to radioactive iodine, and there was a dramatic reduction in proteinuria levels after treatment. In conclusion, GD association with MN is rare, and when present, diagnosis using PLA2R and immunohistochemistry can be useful in determining association. In addition, radioactive iodine therapy can be an effective treatment modality when preceded with immunosuppressive corticosteroid therapy.
Paradoxical and Retrograde Air Embolism from Pressurized Peripheral Bolus
Authors: Joshua Santucci, Naresh Mullaguri, Anusha Battineni, Raviteja R Guddeti, Christopher R Newey
Journal: Case Rep Neurol Med (2021)
MeSH terms: Case Reports

Introduction:
Cerebral air embolism is a rare, yet serious neurological occurrence with unclear incidence and prevalence. Here, we present a case of fatal cerebral arterial and venous cerebral gas embolism in a patient with infective endocarditis and known large right-to-left shunt and severe tricuspid regurgitation following pressurized fluid bolus administration. Case Presentation. A 32-year-old female was admitted to the medical intensive care unit from a long-term acute care facility with acute on chronic respiratory failure. Her medical history was significant for intravenous heroin and cocaine abuse, methicillin-sensitive Staphylococcus aureus tricuspid valve infective endocarditis on vancomycin, patent foramen ovale, septic pulmonary embolism with cavitation, tracheostomy with chronic ventilator dependence, multifocal cerebral infarction, hepatitis C, nephrolithiasis, anxiety, and depression. After intravenous fluid administration, she became unresponsive with roving gaze, sluggish pupils, and hypotensive requiring vasopressors. CT of the brain showed diffuse arterial and venous cerebral air embolism secondary to accidental air administration from fluid bolus. Magnetic resonance imaging of the brain showed diffuse global anoxic injury and flattening of the globe at the optic nerve insertion. Given poor prognosis, her family chose comfort measures and she died.
Conclusions:
Fatal cerebral air embolism can occur through peripheral intravenous routes when the lines are inadequately primed and fluids administered with pressure. Caution must be exercised in patients with right-to-left shunting as air may gain access to systemic circulation.
Bilateral Vocal Cord Paralysis and Cervicolumbar Radiculopathy as the Presenting Paraneoplastic Manifestations of Small Cell Lung Cancer: A Case Report and Literature Review
Authors: Jeffrey C Yeung, C Elizabeth Pringle, Harmanjatinder S Sekhon, Shaun J Kilty, Kristian Macdonald
Journal: Case Rep Otolaryngol (2016)

Introduction. Bilateral vocal cord paralysis (BVCP) is a potential medical emergency. The Otolaryngologist plays a crucial role in the diagnosis and management of BVCP and must consider a broad differential diagnosis. We present a rare case of BVCP secondary to anti-Hu paraneoplastic syndrome. Case Presentation. A 58-year-old female presented to an Otolaryngology clinic with a history of progressive hoarseness and dysphagia. Flexible nasolaryngoscopy demonstrated BVCP. Cross-sectional imaging of the brain and vagus nerves was negative. An antiparaneoplastic antibody panel was positive for anti-Hu antibodies. This led to an endobronchial biopsy of a paratracheal lymph node, which confirmed the diagnosis of small cell lung cancer. Conclusion. Paraneoplastic neuropathy is a rare cause of BVCP and should be considered when more common pathologies are ruled out. This is the second reported case of BVCP as a presenting symptom of paraneoplastic syndrome secondary to small cell lung cancer.
School-Based Participatory Response for Reopening During the COVID-19 Pandemic: A Case Study of a Metropolitan High School Implementing the Health Promoting School
Authors: Insook Kwon, Sunjoo Kang, Jin Sun Kim
Journal: Front Public Health (2021)
Keywords: health promoting school, safe environment, safety belt, school disinfection strategy, school reopening
MeSH terms: COVID-19 / prevention & control, Disinfection / methods, Pandemics, Schools, Humans, Seoul

Purpose: This study aimed to analyze how a private high school in Seoul developed and executed a "school disinfection strategy" to ensure the students' right to study in a safe environment, and also to analyze the lessons learned from this process. Methods: This was a case study of school health in a community-based school reopening during the COVID-19 pandemic. The study target was a 64-year-old private high school with 12 classes for each grade with a total of 1,100 students. Results: A "school disinfection strategy" was set up at individual and class environment levels to protect students from the risk of infection. In addition, school health activities were carried out with a "personal protection safety belt" and "community protection safety belt" for effective implementation. To ensure a safe educational environment for high school students and to ensure smooth execution of face-to-face classes (in-person teaching), the "prevention safety belt strategy" was introduced in accordance with governmental guidelines to sequentially implement various preventive measures necessary to guarantee environmental safety of schools. Activating personal prevention safety belts by checking the symptoms of students when entering the school and during each class, and providing self-made disinfectants by spraying alcohol on wet-wipes were cost-effective and sustainable methods used in this school to prevent the spread of infection. Conclusions: The experience of developing a prevention safety belt strategy to adapt the guidelines of the local education office to the school situation was presented. Focusing on the school community, as well as individual students and teachers, the concept of prevention safety belts helped to unite and stimulate voluntary participation of students in health promotion activities.
Isolated paralysis of the adductor pollicis: a case report
Authors: F De Maio, S Bisicchia, P Farsetti, E Ippolito
Journal: Adv Orthop (2011)
MeSH terms: Case Reports

We report a case of isolated paralysis of the right adductor pollicis in a 30-year-old woman. Electromyographic study showed involvement of the deep motor branch of the ulnar nerve. A ganglion and an anomalous muscle were both ruled out clinically and by MRI as a possible cause of the paralysis. At surgical exploration, we found a fibrous band joining the pisiform and the hook of the hamate bone that compressed the deep motor branch of the ulnar nerve. The fibrous band was excised, and a neurolysis of the motor branch of the ulnar nerve was performed. At followup, eight months later, the patient had fully recovered strength of the adductor muscle.