OpenMed/multicare-articles huggingface dataset:
A Longitudinally Extensive Spinal Cord Lesion Restricted to Gray Matter in an Adolescent Male
Authors: Danielle Golub, Faith Williams, Taylor Wong, Nishanth Iyengar, Hannah Jolley, Sakinah Sabadiah, David Rhee, Gabrielle Gold-von Simson
Journal: Front Neurol (2019)
Keywords: adem, acute flaccid myelitis, anterior horn, gray matter, myelitis
MeSH terms: Case Reports

Longitudinally extensive spinal cord lesions (LECL) restricted to gray matter are poorly understood as are their neurodevelopmental repercussions in children. We herein report the critical case of a 13-year-old male presenting with progressive quadriparesis found to have cervical LECL restricted to the anterior horns. Challenged with a rare diagnostic dilemma, the clinical team systematically worked through potential vascular, genetic, infectious, rheumatologic, and paraneoplastic diagnoses before assigning a working diagnosis of acute inflammatory myelopathy. Nuanced consideration of and workup for both potential ischemic causes (arterial dissection, fibrocartilaginous embolism, vascular malformation) and specific inflammatory conditions including Transverse Myelitis, Neuromyelitis Optica Spectrum Disorders (NMOSD), Multiple Sclerosis (MS), Acute Disseminated Encephalomyelitis (ADEM), and Acute Flaccid Myelitis (AFM) is explained in the context of a comprehensive systematic review of the literature on previous reports of gray matter-restricted longitudinally extensive cord lesions in children. Treatment strategy was ultimately based on additional literature review of treatment-refractory acute inflammatory neurological syndromes in children. A combination of high-dose steroids and plasmapheresis was employed with significant improvement in functional outcome, suggesting a potential benefit of combination immune-modulatory treatment in these patients. This case furthermore highlights quality clinical reasoning with respect to the elusive nature of diagnosis, nuances in neuroimaging, and multifocal treatment strategies in pediatric LECL.
Central retinal artery occlusion as a result of symptomatic patent foramen ovale
Authors: Haroon Tayyab, Faiqa Binte Aamir, Salman Kirmani
Journal: Rom J Ophthalmol (2023)
Keywords: central retinal artery occlusion, patent foramen ovale, transesophageal echocardiography
MeSH terms: Foramen Ovale, Patent / complications, Foramen Ovale, Patent / diagnosis, Retinal Artery Occlusion / complications, Retinal Artery Occlusion / etiology, Case Reports, Adolescent, Echocardiography, Transesophageal, Female, Humans

Objective: The objective of this case report is to highlight the importance of patent foramen ovale (PFO) as a potential cause of central retinal artery occlusion (CRAO). Methods: A teenage girl presented with a sudden painless onset of vision loss in the right eye, which was accompanied by frontal headaches and vertigo. The patient was referred to the Ophthalmology Department, where subsequent examination revealed a best corrected visual acuity of 20/ 400 and a positive relative afferent pupillary defect (RAPD) in the right eye. Fundoscopy and optical coherence tomography confirmed the diagnosis of central retinal artery occlusion following which investigations to rule out hematologic, vascular, and cardiac causes were performed. Results: Transoesophageal echocardiography revealed PFO as the cause of this cryptogenic stroke. All the necessary blood testing work was performed (complete blood counts, erythrocyte sedimentation rate, C-reactive protein, lipid profile, homocysteine levels, prothrombin time, activated partial thromboplastin time, international normalized ratio, liver, renal and thyroid function tests, antinuclear antibodies, anti-smooth muscle antibodies, anti-mitochondrial antibodies, p-ANCA, c-ANCA, anti-cardiolipin antibodies, protein C, Protein S, activated protein C resistance, anti-thrombin III, VDRL, antibodies for viral retinitis, angiotensin converting enzyme, Mantoux test, detailed urine and electrolyte reports). Transoesophageal echocardiography revealed right to left shunt. Conclusions: This case along with other reported evidence in literature support the strong connection between PFO and CRAO. Closure of symptomatic PFO may result in prevention of severe visual loss. Abbreviations: CRAO = central retinal artery occlusion, PFO = patent foramen ovale, RAPD = relative afferent pupillary defect, BCVA = best corrected visual acuity, OCT = Optical coherence tomography, IOP = Intraocular pressures, TTE = transthoracic echocardiography, HM = hand motion, TEE = transesophageal echocardiogram.
Utility of hybrid SPECT-CT in the detection of unsuspected single lytic vertebral metastases in renal cell carcinoma
Authors: Cnb Harisankar, Bhagwant Rai Mittal, Anish Bhattacharya, Baljinder Singh
Journal: Indian J Nucl Med (2010)
Keywords: bone scan, spect-ct, metastasis, renal cell carcinoma
MeSH terms: Case Reports

Authors describe the incremental value of hybrid SPECT-CT in upstaging disease and changing the management strategy of a case of renal cell carcinoma.
Down syndrome associated childhood myeloid leukemia with yet unreported acquired chromosomal abnormalities and a new potential adverse marker: dup(1)(q25q44)
Authors: Faten Moassass, Abdulsamad Wafa, Thomas Liehr, Ayman Al-Ablog, Walid Al Achkar
Journal: Mol Cytogenet (2018)
Keywords: aml, acquired chromosomal abnormalities (acas), clone evolution, cytogenetics, down syndrome, fluorescence in situ hybridization (fish), prognostic factors, trisomy 21
MeSH terms: Case Reports

Background:
Children with constitutional trisomy 21, i.e. Down syndrome (DS, OMIM #190685) have a 10 to 20-fold increased risk for a hematopoietic malignancy. They may suffer from acute lymphoblastic leukemia or acute myeloid leukemia (AML). AML referred to as myeloid leukemia of Down syndrome (ML-DS) is observed especially after birth at an early gestational age and characterized by enhanced white blood cell count, failure of spontaneous remission, liver fibrosis or liver dysfunction, and is significantly associated with early death. There are only few studies yet focusing on the clonal cytogenetic changes during evolution of ML-DS.
Case presentation:
In a 1.4-year-old boy with DS an immunophenotype consistent with AML-M1 according to French-American-British (FAB) classification was diagnoses. Cytogenetic and molecular cytogenetic analyses revealed, besides constitutional free trisomy 21, an unbalanced translocation as der(16)t(1;16)(q25.3;q24), plus a balanced translocation t(3;20)(q25;q13.1). A poor clinical outcome was observed here.
Conclusions:
To the best of our knowledge, an ML-DS case associated with identical acquired chromosomal abnormalities was not previously reported. Our findings suggest that especially partial trisomy 1q25 to 1q44 may be indicative for a poor prognosis in ML-DS.
Recurrent 8-Year Ongoing Unilateral Breast Seroma Formation after PIP Implant Removal-A Case Report and Review of the Literature
Authors: Sonja Kästner, Felix Julian Paprottka, Phillipp Gonser, Manuel De Villegas López, Kai Oliver Kaye
Journal: Surg J (N Y) (2018)
Keywords: alcl, pip, autologous fat transfer, breast augmentation, breast reconstruction, capsular contracture, implant rupture, implants, late seroma
MeSH terms: Case Reports

Late seroma formation is a rare complication after implant-based breast enlargement surgery and even less frequent after implant removal. This case report presents a case of painful recurrent seroma formation after the removal of a ruptured Poly Implants Prothèse implant. A 52-year-old patient presented herself in our clinic with a clinical history of recurrent unilateral seroma of the right breast over a period of 8 years after the initial unilateral implant removal. Removal of the remaining implant and complete bilateral capsulectomy was performed. Intraoperative findings revealed a macroscopically thickened capsule with signs of chronic inflammation on the affected side. The clinical history and the macroscopic appearance of the capsule demanded histopathological exclusion of a possible anaplastic large cell lymphoma. Histopathological and microbiological analysis of the capsule and encapsulated material revealed no signs of malignancy or infection. Immediate soft tissue reconstruction of the breast was successfully performed using autologous fat transfer. An aesthetically satisfying result regarding symmetry and volume was achieved, and no further seroma formation was observed within a 6-month follow-up period. Level of evidence: V, Case Report.
Ovarian tuberculosis masquerading as ovarian cancer in HIV infected patient: a plea to avoid unnecessary surgery
Authors: Ballah Akawu Denue, Salisu Aliyu Kwayabura, Haruna Asura Ngadda
Journal: Pan Afr Med J (2014)
Keywords: hiv-tb co infection, ovarian tb, ovarian cancer
MeSH terms: HIV Infections / complications, Ovarian Diseases / diagnosis, Ovarian Neoplasms / diagnosis, Tuberculosis, Female Genital / diagnosis, Case Reports, Adult, Antitubercular Agents / therapeutic use, CD4 Lymphocyte Count, Female, Humans, Ovarian Diseases / drug therapy, Ovarian Diseases / microbiology, Tuberculosis, Female Genital / drug therapy, Antitubercular Agents

Female patients who present with adnexial mass and weight loss should not be presumed to have ovarian carcinoma until after extensive investigation. This is to avoid the mistake of radical surgery with its attendant morbidity and mortality. An important disease to consider in our environment is ovarian TB that respond well to medication. A 35 year old HIV-1 positive house wife presented with fever, persistent vomiting, progressive weight loss, vague abdominal pain and swelling. Patient occasionally ingest unpasteurized milk since childhood but had no sustained contact with adult with chronic cough. She had no menstrual abnormality. Imaging studies revealed right ovarian mass measuring 11.8 cm x 10 cm. Right ovarian malignancy was highly suspected, for which she underwent exploratory laporotomy. Histopathology result was consistent with tuberculous granuloma. Chest radiograph was normal. Her CD4 count was 541 cells/ul. Patient was commenced on anti tuberculotic therapy based on the Nigerian National TB control and she responded well. Tuberculosis of the ovary can masquerade as ovarian cancer, especially among HIV patients in regions where TB-HIV co infections is endemic, it should be ruled out before performing extended surgery.
Isolated tuberculosis of metacarpal bone in a 3 year-old child
Authors: El Mouhtadi Aghoutane, Tarik Salama, Redouane El Fezazi
Journal: Pan Afr Med J (2017)
Keywords: tubercular osteomyelitis, children, metacarpal bone
MeSH terms: Antitubercular Agents / administration & dosage, Metacarpal Bones / microbiology, Tuberculosis, Osteoarticular / diagnosis, Case Reports, Child, Preschool, Female, Humans, Metacarpal Bones / pathology, Tuberculosis, Osteoarticular / drug therapy, Tuberculosis, Osteoarticular / pathology, Antitubercular Agents

Primary tuberculosis osteomyelitis of metacarpal bone is rare. The majority of cases occur in children and young adults and there is difficulty in diagnosis mainly in young children. We report a new case in children aged of 3 years, presenting a swelling on the dorsal side of her right hand since 8 months. X-ray showed an expansile, cystic and lytic lesion involving the little finger metacarpal. Tuberculosis was confirmed on histological examination. No lesions in lung parenchyma or lymphadenopathy were associated. Patient was successfully managed by anti-tubercular drugs.
Home-based transcranial direct current stimulation in dual active treatments for symptoms of depression and anxiety: A case series
Authors: Mónica Sobral, Raquel Guiomar, Vera Martins, Ana Ganho-Ávila
Journal: Front Psychiatry (2022)
Keywords: flow, anxiety, case series, depression, home-based, tdcs
MeSH terms: Case Reports

Transcranial direct current stimulation (tDCS) is a potential treatment strategy across some psychiatric conditions. However, there is high heterogeneity in tDCS efficacy as a stand-alone treatment. To increase its therapeutic potential, researchers have begun to explore the efficacy of combining tDCS with psychological and pharmacological interventions. The current case series details the effect of 6-10 weeks of self-administered tDCS paired with a behavioral therapy smartphone app (Flow™), on depressive and anxiety symptoms, in seven patients (26-51 years old; four female) presenting distinctive psychiatric disorders (major depression, dysthymia, illness anxiety disorder, obsessive-compulsive disorder, and anxiety disorders). tDCS protocol consisted of an acute phase of daily 30 min sessions, across 10 workdays (2 weeks Monday-to-Friday; Protocol 1) or 15 workdays (3 weeks Monday-to-Friday; Protocol 2). A maintenance phase followed, with twice-weekly sessions for 4 or 3 weeks, corresponding to 18 or 21 sessions in total (Protocol 1 or 2, respectively). The Flow tDCS device uses a 2 mA current intensity, targeting the bilateral dorsolateral prefrontal cortex. The Flow app offers virtually guided behavioral therapy courses to be completed during stimulation. We assessed depressive symptoms using MADRS-S and BDI-II, anxious symptoms using STAI-Trait, acceptability using ACCEPT-tDCS, and side effects using the Adverse Effects Questionnaire, at baseline and week 6 of treatment. Six patients underwent simultaneous cognitive-behavioral psychotherapy and two were on antidepressants and benzodiazepines. According to the Reliable Change Index (RCI), for depressive symptoms, we found clinically reliable improvement in five patients using MADRS-S (out of seven; RCI: -1.45, 80% CI; RCI: -2.17 to -4.82, 95% CI; percentage change: 37.9-66.7%) and in four patients using BDI-II (out of five; RCI: -3.61 to -6.70, 95% CI; percentage change: 57.1-100%). For anxiety symptoms, clinically reliable improvement was observed in five patients (out of six; RCI: -1.79, 90% CI; RCI: -2.55 to -8.64, 95% CI; percentage change: 12.3-46.4%). Stimulation was well-tolerated and accepted, with mild tingling sensation and scalp discomfort being the most common side effects. This case series highlights the applicability, acceptability, and promising results when combining home-based tDCS with psychotherapy and pharmacotherapy to manage depression and anxiety symptoms in clinical practice.
Case Report: Pathological Complete Response to Neoadjuvant Alectinib in a Patient With Resectable ALK-Positive Non-Small Cell Lung Cancer
Authors: Yan Hu, Siying Ren, Ruoyao Wang, Wei Han, Peng Xiao, Li Wang, Fenglei Yu, Wenliang Liu
Journal: Front Pharmacol (2022)
Keywords: alk, alectinib, neoadjuvant therapy, non-small cell lung cancer, pathological complete response
MeSH terms: Case Reports

Background: Alectinib, a highly selective inhibitor of ALK, is currently used in the first-line setting of untreated advanced ALK-positive NSCLC and in the second-line setting of crizotinib-resistant ALK-positive NSCLC. Despite promising efficacy and tolerability in the treatment of advanced ALK-positive NSCLC, the activity of alectinib as neoadjuvant therapy in resectable ALK-positive NSCLC remains to be investigated. Case presentation: Herein, we report a case of a 58-year-old female patient presented to our hospital with hemoptysis for 1 month. Contrast-enhanced computerized tomography (CT) of the chest showed an approximately 4.2 × 3.4 cm mass in the right hilum with localized obstructive pneumonia in the right lower lobe and multiple enlarged lymph nodes in the right hilum and mediastinum. Serum oncological markers results showed elevated levels of CA19-9, CEA, CA125, and CA242. Bronchoscopic biopsy of the mass showed poorly differentiated pulmonary adenocarcinoma and immunohistochemical testing results confirmed ALK positivity. Neoadjuvant alectinib was given at a dosage of 600 mg twice per day for two cycles (56 days), achieving a partial response of the disease with 90% shrinkage of the mass at the subsequent whole-body positron emission tomography. Repeat serum oncological markers results showed that only CA125 was elevated, but lower than before therapy. A bilobectomy of the right middle and lower lobes and systemic lymphadectomy under video-assisted thoracoscopic approach was successfully performed 7 days after the last dose of alectinib. Postoperative pathology showed pathological complete response (pCR). The patient experienced an uneventful postoperative course and continued to receive alectinib and did not report any specific discomfort at her 8-month follow-up. Thoracoabdominal CT at 8 months postoperatively showed no recurrence and repeated examination of serum oncological markers were negative. Conclusion: We report a case of resectable ALK-positive NSCLC treated with neoadjuvant aletinib achieving pCR. Our case highlights the feasibility of alectinib as neoadjuvant therapy for the treatment of resectable ALK-positive NSCLC. Undoubtedly, the safety and efficacy of this novel treatment modality needs to be explored in future large clinical trials.
Application of anterior segment optical coherence tomography in pediatric ophthalmology
Authors: Ricardo Salles Cauduro, Caroline do Amaral Ferraz, Maira Saad Ávila Morales, Patricia Novita Garcia, Yara Cristina Lopes, Paulo Henrique Souza, Norma Allemann
Journal: J Ophthalmol (2012)

Purpose. Application of anterior segment optical coherence (AS-OCT) in pediatric ophthalmology. Methods. Retrospective clinical study case series of 26 eyes of 19 pediatric patients throughout a 21-month period, presenting anterior segment pathologies, were submitted to AS-OCT examination (OCT Visante, 1310 nm, Zeiss), noncontact technique, no sedation requirement. Results. AS-OCT images were obtained from 19 patients (range: 2 months to 12 years). Clinical diagnosis of anterior segment abnormalities included cornea disease (n = 7), congenital anterior segment conditions (n = 10), ocular trauma (n = 1), anterior segment surgeries (n = 2), iridocorneal angle abnormalities (n = 4), intermediate uveitis (n = 2). The most common OCT findings were corneal hyperreflectivity and thickening (n = 15), shallow anterior chamber with iris-lens diaphragm anterior displacement (n = 4), atypical corneal curvature (n = 4), corneal thinning (n = 4), peripheral synechiae with angle closure (n = 3), increased anterior chamber depth (n = 2), and proximal portion of glaucoma drainage tube (n = 2). Conclusion. In the present study, noncontact AS-OCT demonstrated to be a feasible technique to evaluate the anterior segment providing anatomic details and useful to clarify diagnosis in the pediatric population.
Idiopathic Giant Hepatic Artery Pseudoaneurysm
Authors: Ahmed Abdelbaki, Neeraj Bhatt, Nishant Gupta, Shuo Li, Shady Abdelbaki, Yogesh Kumar
Journal: Case Rep Vasc Med (2017)
MeSH terms: Case Reports

Hepatic artery pseudoaneurysm (HAP) incidence is rising due to more common use of endoscopic and percutaneous hepatic interventions. HAP is potentially fatal, as it could lead to sudden life-threatening hemorrhage. HAP can be intrahepatic or extrahepatic. On computed tomography angiogram (CTA) and magnetic resonance angiogram (MRA), HAP follows blood pool on multiphasic examination, with brisk arterial enhancement that washes out, similar to the abdominal aorta on later phases. We present a case of idiopathic giant HAP in an 82-year-old male. Currently, angioembolization is replacing surgery as the initial modality of choice for management of this condition.
Selectable Implant Removal Methods due to Mechanical and Biological Failures
Authors: Jong-Bin Lee
Journal: Case Rep Dent (2017)
MeSH terms: Case Reports

Dental implant has been restoring the function and esthetics lost from missing tooth. However, biomechanical implant complications are the major cause of failing implants. Therefore, implant removal is one of the indispensable dental treatments. The 70-year-old male and 66-year-old female who had discomfort on posterior implants region came to Department of Periodontology. Conventional method using trephine bur and the new, nontraumatic method using a fixture removal kit were used for implant removal, respectively. Two different methods are commonly used for implant removal. Each has advantages and disadvantages; thus, the applied surgical method must consider a patient's intraoral condition, posttreatment plan, and the level of surgeon's skill and experience. In conclusion, strategically executing the most optimal implant removal method plays a pivotal role in maximizing the success rate of implant reinstallation that follows afterwards.
Vascularized medial femoral condyle graft for nonunion after failed radiolunate arthrodesis
Authors: Akito Nakanishi, Shohei Omokawa, Kenji Kawamura, Takamasa Shimizu, Yasuhito Tanaka
Journal: Case Reports Plast Surg Hand Surg (2019)
Keywords: vascularized bone graft, medial femoral condyle flap, nonunion, osteoarthritis, radiolunate arthrodesis
MeSH terms: Case Reports

Since the medial femoral condyle flap was originally described in 1989, the indications for use of this versatile flap as a graft have broadened. We used this procedure in a patient with nonunion after failed arthrodesis of the radiolunate joint. Early bone union was achieved, with marked postoperative improvement in VAS and DASH scores.
First case report of pulmonary and cutaneous nocardiosis caused by Nocardia mexicana in Iran
Authors: Darioush Shokri, Tahereh Motalebirad, Morteza Jafarinia, Davood Azadi, Kazem Ghaffari
Journal: Access Microbiol (2019)
Keywords: linezolid, nocardia mexicana, pulmonary infection, cutaneous wound
MeSH terms: Case Reports

Background:

Nocardia are aerobic partially acid-fast bacteria that are environmentally ubiquitous. This group of bacteria causes a rare bacterial infection of either the lungs (pulmonary) or body (systemic) that usually affects immunocompromised individuals. Nocardia mexicana was first isolated in 2004 from a patient with chronic bronchitis. However, there have been few reports on the clinical significance of this organism up to now. We herein report the first cases of N. mexicana in patients with pulmonary and cutaneous infection from Iran.
Case presentation:
A 57-year-old man was admitted to hospital due to a cutaneous wound on his left foot, fever, weakness, persistent cough and chest pain. At first, due to clinical examination and laboratory test, the patient was diagnosed as having tuberculosis. However, PCR of Mycobacterium tuberculosis was negative from broncho-alveolar lavage (BAL) samples. Direct PCR of BAL was performed for this patient and according to the clinical examinations and microbiological evaluations; the micro-organism was identified as N. mexicana and was isolated from both BAL and the wound. Finally, the patient was treated with linezolid and amikacin.
Conclusion:
The infections, with actinomycetes such as Nocardia , are easily neglected or misdiagnosed due to the fastidious nature of the organism and the inadequate microbiological experience of laboratories in the hospitals of developing countries. This case shows that hospitals should consider a better laboratory protocol to deal with the clinical cases in which fastidious organisms, and in particular Nocardia , are involved.
Retrobulbar chondrosarcoma in a dog
Authors: M Ralić, J Vasić, M Jovanović, B Cameron
Journal: Open Vet J (2014)
Keywords: chondrosarcoma, computed tomography, exophthalmos
MeSH terms: Case Reports

This paper presents a review of a dog, with a retrobulbar chondrosarcoma, which was admitted for surgery for visible changes in his eye during inspection. Orbital neoplasia in dogs may be primary and secondary. Sixty percent of orbital neoplasia in dogs are primary, ninety percent of which are malignant. Retrobulbar neoplasms are rare and in their early stage represent a diagnostic challenge. Chondrosarcoma of the skull is a slow-progressing malignant disease which occurs locally, aggressive with invasion into the surrounding tissues. Dogs with chondrosarcoma of the skull have life expectancy between 210 and 580 days - in our case it was 180 days - after the first alterations on the eye of the dog occurred.