OpenMed/multicare-articles huggingface dataset:
Surprising astigmatism hypercorrection after corneal ring segments implantation in keratoconus treatment after 8 years of follow up
Authors: Malta Pio Guilherme, Malta Pio Frederico, Mariano Caldeira Coelho Alessandra, Serpa Braga Carolina, Flávia Ribeiro Pereira Anna, Alves Cotrim Caroline, Bicalho Dias Silva Frederico
Journal: Rom J Ophthalmol (2021)
Keywords: corneal implant, corneal ring, keratoconus, keratometric astigmatism, keratometry
MeSH terms: Astigmatism / therapy, Contact Lenses, Cornea / surgery, Eyeglasses, Keratoconus / surgery, Postoperative Complications / therapy, Refraction, Ocular / physiology, Case Reports, Adult, Astigmatism / etiology, Astigmatism / physiopathology, Cornea / diagnostic imaging, Female, Follow-Up Studies, Humans, Keratoconus / diagnosis, Postoperative Complications / etiology, Postoperative Complications / physiopathology, Time Factors, Visual Acuity

Objective: To report a case of hypercorrection of astigmatism (Cyl) after implantation of 2 segments of short arch ring for keratoconus treatment and to describe its replacement by long arch segment. Methods: This is a case report of a patient with keratoconus and no adaptation to glasses or contact lenses, who was implanted 2 ring segments: upper nasal (155º/ 200μm) and inferior temporal (155º/ 250μm). Results: First postoperative month: CVA = 20/ 50 (-10.50-2.50x135°) and SimK K1 = 48.4x143° and K2 = 51.2x53° (Cyl 2,8D). In the 3rd year: CVA 20/ 30 (-6.00-2.50x135º), with inversion of the axes: K1 = 49,5x60º and K2 = 52,0x150º (Cyl 2,6D). The hypercorrection increased up to the 8th year: CVA = 20/40 (-4,50-6,00x75º) and SimK 47,8x51º/ 60,4x141º (Cyl 12,6D). The 2 segments were replaced for a single segment (320º/ 300μm) and after 1 month: CVA = 20/ 25 (-5,75 spherical) with SimK 46,8x38º/ 48,9x128º (Cyl 2,1D). Conclusion: The ring aims to flatten the most curved meridian, but surpassing the previous value induces astigmatism in the opposite meridian. The hypercorrection of the 2 short segments must occur due to its movement of the extremities, which does not occur with the single long arc segment (≥ 300º). Abbreviations: CVA = Corrected visual acuity, SimK = Simulated keratometry, LE = Left eye, RE = Right eye.
Case Report of a Large Pigmented Epithelioid Melanocytoma With Suspected Lymph Node Metastases
Authors: Rie Akita, Yoshihiro Sowa, Daiki Morita, Toshiaki Numajiri
Journal: Eplasty (2016)
Keywords: epithelioid blue nevus, lymph node metastases, melanocytic tumor, melanoma, pigmented epithelioid melanocytoma
MeSH terms: Case Reports

Objective: Pigmented epithelioid melanocytoma was proposed by Zembowicz et al in 2004 including lesions previously diagnosed as human animal-type melanoma and epithelioid blue nevus. Tumors are composed of epithelioid and spindled melanocytes with heavy pigmentation. Methods: We report a case of pigmented epithelioid melanocytoma in 47-year-old Asian woman. The tumor sized 10 × 6 × 2 cm on the anterior aspect of right lower leg. On resecting surgery, we also found black pigmented lymph nodes in the groin area on harvesting skin graft. Results: Histological examination showed a typical figure for pigmented epithelioid melanocytoma. In groin area, melanocytes were observed only in the lymph node capsule. Thus, we conclude that melanocytes in the capsule of this case could not be associated with metastasis. The patient is doing well 2 years after the surgery, with no evidence of recurrence or distant metastases. Conclusions: Pigmented epithelioid melanocytoma is a rare, heavily pigmented, borderline, melanocytic tumor with infiltrative borders. It has potential for frequent metastases but shows an indolent clinical course.
Glandular odontogenic cyst mimicking central mucoepidermoid carcinoma
Authors: Sudeendra Prabhu, K Rekha, Gs Kumar
Journal: J Oral Maxillofac Pathol (2010)
Keywords: glandular odontogenic cyst, mucoepidermoid cyst, sialoodontogenic cyst
MeSH terms: Case Reports

Glandular odontogenic cyst (GOC) is a rare developmental cyst of the jaws. The most common site of occurrence is the anterior mandible, and it is most commonly seen in middle-aged people. It is a destructive lesion with a high rate of recurrence. A predilection for men is observed. Clinical and radiographic findings are not specific, and it can mimic as any other destructive lesion of the jaw. The histopathological features of GOC and those of low-grade central mucoepidermoid carcinoma (MEC) are similar. Often, they are misdiagnosed as MEC. We present a case of GOC in the posterior maxilla, which is a rare site. The similarities and differences between GOC and central MEC are also discussed.
Early-Onset Parkinson's Disease Caused by PLA2G6 Compound Heterozygous Mutation, a Case Report and Literature Review
Authors: Ting Shen, Jing Hu, Yasi Jiang, Shuai Zhao, Caixiu Lin, Xinzhen Yin, Yaping Yan, Jiali Pu, Hsin-Yi Lai, Baorong Zhang
Journal: Front Neurol (2019)
Keywords: pla2g6, parkinson's disease, early-onset, genetic analysis, neuroimaging
MeSH terms: Case Reports

PLA2G6 has been certified as a causative gene in patients with autosomal recessive early-onset Parkinson's disease (EOPD). We reported an EOPD case caused by PLA2G6 gene mutation, and performed neurological examination, genetic analysis, and multimodal neuroimaging to describe this phenotype. A compound heterozygous mutation c.991G>T/c.1472+1G>A was detected in this patient. Heterozygous for the c.991G>T and c.1472+1G>A were separately detected in his parents. Pathogenicity of these two mutations were predicted according to the American college of medical genetics and genomics (ACMG) guideline. MRI assessment showed absence of bilateral "swallow tail sign" and cerebellar atrophy in this patient, while no obvious difference in brain iron accumulation between PLA2G6 mutant PD patient and healthy controls. Cerebellar abnormalities may be a marker for diagnosis and evaluation of PLA2G6 mutation Parkinsonism. However, the iron accumulation in PD may not be the result of PLA2G6 mutation.
Application of endoscopic submucosal dissection for removal of deep invasive submucosal colon carcinoma
Authors: Sergio A Con, Yutaka Saito, Takahisa Matsuda, Hirokazu Taniguchi, Takeshi Nakajima
Journal: Case Rep Med (2009)
MeSH terms: Case Reports

Endoscopic submucosal (sm) dissection (ESD) is a recently used technique that enables en-bloc resection of large colorectal tumors allowing a more precise histopathological analysis of the resected specimen. However, it has not been widely adopted even in Japan mainly due to its technical difficulty and increased risk of perforation. Herein, we present an ESD-treated lesion with deep sm invasion removed without complications, such as bleeding or perforation, from a patient at high-risk for surgical intervention. A successful ESD was achieved although the sm invasion was greater than 1000 mum from the muscularis mucosae, and the nonlifting sign was positive. It is our belief that this procedure should be performed at least in patients at high-risk for surgical intervention. At present, we have removed 16 lesions with deep sm invasion by ESD without complications, demonstrating that deep sm cancer can be successfully resected by this technique as a local resection. Herein, we report on one of these cases.
Bone marrow fibrosis as a feature of systemic lupus erythematosus: a case report and literature review
Authors: Emilie Chalayer, Martine Ffrench, Pascal Cathébras
Journal: Springerplus (2014)
Keywords: bone marrow, primary myelofibrosis, systemic lupus erythematosus
MeSH terms: Review

Introduction:
Peripheral cytopenias are common in systemic lupus erythematosus (SLE), but bone marrow involvement is rarely reported. Myelofibrosis is a rare disorder characterized by reticulin fibrosis of the bone marrow, which usually occurs in response to clonal proliferation of hematopoietic stem cells in myeloproliferative disorders. However, bone marrow fibrosis has also been described in association with auto-immune diseases, especially SLE.
Method:
We will report here a new case of bone marrow fibrosis associated with SLE. We also reviewed the 27 cases published in the English language literature, and will discuss the clinical presentation, outcome, treatment, and pathophysiology of bone marrow fibrosis occurring in association with SLE.
Results:
Over one half of patients were diagnosed concomitantly with bone marrow fibrosis and SLE. Epidemiological, clinical and biological features of lupus were unremarkable. Except for the presence of reticulin fibrosis, the findings from the bone marrow biopsies proved highly variable. Overall mortality was about 14% but corticosteroid-based therapy lead to clinical improvement and reverted bone marrow fibrosis in most cases. Data on the usefulness of other immunomodulatory therapies are inconclusive.
Conclusions:
SLE may be complicated by bone marrow involvement, of a likely autoimmune origin. Bone marrow fibrosis occurring with SLE is probably similar to "primary autoimmune myelofibrosis" and may respond to steroid and immunomodulatory therapies. Further studies with standardised proofreading of bone marrow aspirations and biopsies are needed to delineate the clinical and biological features of this rare complication of SLE.
Case report: ALK-rearranged spindle and epithelioid cell neoplasms with S100 and CD34 co-expression: Additional evidence of kinase fusion-positive soft tissue tumors
Authors: Shao-Jie Sheng, Ju-Ming Li, Qin-He Fan, Yang Liu, Shao-Yu Chen, Ming Zhao, Qi-Xing Gong
Journal: Front Oncol (2022)
Keywords: alk, eml4, plekhh2, s100 and cd34 co-expression, soft tissue tumor
MeSH terms: Case Reports

ALK rearrangements have rarely been reported in S100- and CD34-co-expressing soft tissue neoplasms with lipofibromatosis-like neural tumor (LPFNT) pattern or stromal and perivascular hyalinization, mimicking NTRK-rearranged spindle cell tumors. Here, we reported ALK fusions involving related partner genes in two adult soft tissue tumors with S100 and CD34 co-expression, and conducted a literature review of mesenchymal tumors harboring ALK or other kinase fusions. Case 1 was a 25-year-old female who underwent excision of a soft tissue mass in the anterior thigh region. Morphologically, the tumor was composed of spindle cells adjacent to epithelioid cells embedded in myxedematous and hyalinized stroma, with infiltrative boundary. Spindle cells mixed with inflammatory infiltration resembling inflammatory myofibroblastic tumor (IMT) were seen sporadically. However, brisk mitosis and focal necrosis was also observed, indicating an intermediate-grade sarcoma. In case 2, the left side of the neck of a 34-year-old man was affected. The tumor was composed of monomorphic spindle cells arranged in fascicular growth or patternless pattern, with stromal and perivascular hyalinization. Sparse inflammatory cell infiltration was also observed. Both tumors showed CD34, S100, and ALK-D5F3 immunoreactivity. Next generation sequencing (NGS) test identified a PLEKHH2::ALK fusion in case 1, which was confirmed by RT-PCR and Sanger sequencing, whereas the RT-PCR (ARMS method) test detected an EML4::ALK fusion in case 2. In conclusion, this study expands the morphological and genetic landscape of tumors with S100 and CD34 co-expression harboring kinase fusions, and suggests that kinase fusion-positive mesenchymal neoplasms are becoming an enlarging entity with a variety of morphological patterns.
Unusual Presentation of an Uncommon Disease: 24-Hour Cyclic Esotropia
Authors: Miguel Paciuc-Beja, Victor Hugo Galicia-Alfaro, Myriam Retchkiman-Bret
Journal: Case Rep Ophthalmol Med (2019)
MeSH terms: Case Reports

Cyclic esotropia is an extremely uncommon form of strabismus. Classically, it follows a 48-hour cycle with 24 hours of orthotropia and 24 hours of manifest esotropia. We are reporting the first case of cyclic esotropia with a 24-hour cycle. A 7-year-old hyperopic female was seen with an esotropia of 6-month duration. Hyperopic glasses were prescribed by another ophthalmologist prior to our evaluation of the patient. While wearing her glasses, esotropia occurred during the morning and early afternoon. After 3.00pm, her eyes were "straight." Many photographs were reviewed, confirming the esotropia pattern. Neurological evaluation was normal, including imaging and blood work to rule out thyroid pathology and myasthenia. After seeing the patient multiple times at different hours on different days, the diagnosis of cyclic esotropia was made. Bimedial recessions were performed with good results. The patient was still "straight" at distance and near 2 years after surgery.
CML Developing Three Years after Therapy Completion in a Child with Ph(-) Pre-B-ALL
Authors: S Hosseini, G H Bahoush, P Vousogh, Sh Ansari, Kh Arjmandi, M Sabzechian
Journal: Case Rep Hematol (2011)
MeSH terms: Case Reports

We report a girl with a history of Ph(-) pre-B-ALL and three years of disease-free survival admitting to our hospital for regular end of treatment checkup with an increased white blood cell count which in follow-up studies and molecular detection of BCR-ABL (p210) fusions gene had been diagnosed as a Ph(+) typical CML. The upcoming question in this case scenario is whether developed CML is a secondary leukemia due to previous ALL chemotherapy or just a relapse case of primary leukemia.
COVID-19 vaccination may cause FDG uptake beyond axillary area
Authors: Vincent Fleury, Bruno Maucherat, Daniela Rusu, Frédéric Dumont, Caroline Rousseau
Journal: Eur J Hybrid Imaging (2021)
Keywords: covid-19, fdg pet/ct, vaccine
MeSH terms: Case Reports

Background:
The vaccination immune response may induce false-positive 18F-FDG PET/CT uptake.
Case presentation:
An extended supraclavicular lymph nodal activation after coronavirus disease 2019 (COVID-19) vaccination revealed on 18F-FDG PET/CT mimics a Virchow nodule in a patient with medical history of well-differentiated appendicular adenocarcinoma.
Conclusion:
This case highlights a nodal activation beyond axillary area and the importance of documenting vaccination history at the time of scanning to avoid false-positive results.
Fungal Endocarditis: A Rare Case of Multiple Arterial Embolization
Authors: Francisca Beires, Raquel Rocha, Diana Mata, Sara Ramos, Nuno Moreno
Journal: Cureus (2023)
Keywords: adult cardiac surgery, antifungal medications, candida parapsilosis, cerebral abscess, infective endocarditis complications, invasive fungal infections, surgical aortic valve replacement (savr)
MeSH terms: Case Reports

Fungal endocarditis is a rare and fatal condition, with a mortality of up to 75%, affecting immunocompromised hosts with a predisposing condition, namely, a history of previous cardiac or noncardiac surgery. Embolization is frequent, accounting for 44% of cases, and as the most common site is the brain, it can cause leptomeningitis, parenchymal granulomas, or abscesses. This case report describes a man with aortic valve replacement one year ago and a recent carotid endarterectomy who was admitted with fever and neurological deficits. The workup permitted a diagnosis of fungal endocarditis, and the patient underwent a combined and aggressive treatment approach with antifungal therapy and surgery, with a successful replacement of the aortic valve. During hospitalization, the patient's neurological status deteriorated, and a cerebral abscess was discovered on the left frontal lobe. Despite the poor prognosis, the patient recovered slowly and was discharged from the hospital three months later. The present case highlights the high index of suspicion needed for the diagnosis and the need for a multidisciplinary team to approach these patients to achieve a positive outcome.
Digoxin for the Management of Unstable Paroxysmal Supraventricular Tachycardia in a Patient Who Refused Electrical Cardioversion in a Rural Hospital
Authors: Belayneh Dessie Kassa, Mekbib Amede, Mollalign Wubante, Mebratu Libanos, Kumlachew Geta
Journal: Case Rep Emerg Med (2023)
MeSH terms: Case Reports

Background:
The most frequent atrioventricular tachycardia in the emergency room is atrioventricular nodal reentrant tachycardia (AVNRT). The first treatment option for ending stable narrow QRS complex SVTs is vagal maneuvers and adenosine. When adenosine or vagal maneuvers fail to change a patient's rhythm to normal sinus rhythm, long-acting AV nodal-blocking medications, including nondihydropyridine calcium channel blockers (verapamil and diltiazem), flecainide, or beta-blockers, are employed. Electricity (synchronized cardioversion) is the preferred form of treatment for unstable patients. Case Presentation. A 40-year-old male patient presented to the Emergency Department of Dubti General Hospital, the Afar regional state in Ethiopia, with a complaint of shortness of breath, palpitation, extreme fatigue, and chest pain of a day's duration. His blood pressure was 80/50 mmHg, he had cold extremities and a weak radial pulse, and his apical heart rate was fast, making it difficult to count. His electrocardiogram (ECG) showed paroxysmal supraventricular tachycardia (PSVT) with a heart rate of 200. He was a candidate for electrical cardioversion due to unstable PSVT, but he and his family members refused to give consent. Even though he is not indicated for pharmacologic therapy, none of the commonly used drugs were available at the hospital. We managed him with digoxin, and the outcome was positive.
Conclusion:
Even though we could not find a clear recommendation regarding the use of digoxin for patients with unstable PSVT (AVNRT), by taking into consideration its negative chronotropic effect and its action to suppress the AV nodal conduction velocity, it may reduce the heart rate, and it can be used as an alternative in such difficult scenarios and a resource-limited setting. But this should be further investigated.
The Diagnosing Challenge of a Positive ANCA Vasculitis in the Paediatric Age
Authors: Clara Preto, Armandina Silva, Sandra Alves, Margarida Guedes, Paula Matos, Conceição Mota, Paula Rocha, Paula C Fernandes
Journal: Case Rep Pediatr (2017)
MeSH terms: Case Reports

ANCA-positive systemic vasculitides, rare in paediatric age, present multiorganic involvement. A female teenager presented with a history of subglottic stenosis diagnosed at the age of 12. From the investigation carried out, we highlight hematoproteinuria and negative ANCAs. At 15 years old, she was admitted for gastrointestinal symptoms and respiratory distress. She presented poor peripheral perfusion, pulmonary haemorrhage, respiratory failure, and severe renal insufficiency. She was started mechanical ventilation and emergency haemodialysis. The immunological study revealed ANCA MPO positive. A presumptive diagnosis of ANCA-positive vasculitis was made, and she was started corticotherapy, cyclophosphamide, and plasmapheresis. A renal biopsy, performed later, showed crescentic glomerulonephritis with chronicity signs. Positive ANCA vasculitis may progress slowly or suddenly. The diagnosis was confirmed by a biopsy; however, we can make a presumptive diagnosis based on clinical findings and in a positive ANCA test in order to start an early treatment and decrease the associated morbimortality.
Buprenorphine/naloxone induction for treatment of acute on chronic pain using a micro-dosing regimen: A case report
Authors: Raman Sandhu, Rebecca Zivanovic, Sukhpreet Klaire, Mohammadali Nikoo, Jennifer Rozylo, Pouya Azar
Journal: Can J Pain (2019)
Keywords: bernese method, buprenorphine/naloxone, chronic pain, micro-dosing, opioid
MeSH terms: Case Reports

Background: Due to its unique pharmacologic properties, efficacy as an analgesic, and role as a first-line medication for the treatment of opioid use disorder, sublingual buprenorphine has emerged as a treatment for patients with concurrent chronic pain and opioid use disorders. One challenge to utilizing buprenorphine is that precipitated opioid withdrawal can result if this medication is initiated in the presence of other opiates with lesser binding affinities. Micro-dosing induction regimens utilize a slower titration to avoid the need for a period of abstinence from other opiates and decrease the risk of precipitated withdrawal. Aims: The aim of this article is to present a case where a standardized micro-dosing induction regimen was used to transition a patient from other opiate analgesia to a sublingual formulation of buprenorphine/naloxone. Methods: This case took place on an inpatient neurosurgical unit of a Canadian tertiary-care city hospital. Written informed consent was collected prior to a detailed chart review. Results: Here we present a case of a postoperative neurosurgical inpatient who was referred to our team for pain management in the context of chronic pain and a past history of opioid use disorder. She was successfully transitioned to buprenorphine/naloxone, replacing all other opioid analgesia, without a period of opioid withdrawal using a micro-dosing induction regimen. Conclusions: Sublingual buprenorphine/naloxone can be safe and effective for treatment of chronic pain, particularly for those with past or current opioid use disorder. Micro-dosing provides a preferable induction strategy for patients who are not able to tolerate the requirement for moderate opioid withdrawal prior to initiation with existing regimens.
Endobronchial Mass: A Rare Manifestation of Multiple Solitary Plasmacytoma
Authors: Thanawat Anukanchanavera, Chayaporn Kaewsathorn, Nantaka Kiranantawat
Journal: J Belg Soc Radiol (2023)
Keywords: endobronchial, endobronchial plasmacytoma, extramedullary, multiple solitary plasmacytoma, plasmacytoma
MeSH terms: Case Reports

Multiple solitary plasmacytoma is the rare presentation of plasma cell neoplasm that can mimic multiple metastases. Primary endobronchial plasmacytoma is an extremely rare condition of extramedullary plasmacytoma. Here, we describe a case of multiple solitary plasmacytoma that initially presented with an endobronchial mass.
Teaching point:
The differential diagnosis of multiple lesions in the airway is mainly metastasis and multiple solitary plasmacytoma.
Congenital complete heart block in a 71-year old
Authors: Kareem Abed, Marc Mugmon, Majd Alfreijat, Robert P Ferguson
Journal: J Community Hosp Intern Med Perspect (2013)
MeSH terms: Case Reports

A case of a 71-year-old male with congenital complete heart block is discussed. Patient remained asymptomatic with stable electrocardiograms.
Visual Outcomes, Quality of Vision, and Quality of Life of Diffractive Multifocal Intraocular Lens Implantation after Myopic Laser In Situ Keratomileusis: A Prospective, Observational Case Series
Authors: John S M Chang, Jack C M Ng, Vincent K C Chan, Antony K P Law
Journal: J Ophthalmol (2017)

Purpose. To report visual performance and quality of life after implantation of a bifocal diffractive multifocal intraocular lens (MIOL) in postmyopic laser in situ keratomileusis (LASIK) patients. Methods. Prospective, observational case series. Patients with prior myopic LASIK who had implantation of Tecnis ZMA00/ZMB00 MIOL (Abbott Medical Optics) at Hong Kong Sanatorium and Hospital were included. Postoperative examinations included monocular and binocular distance, intermediate and near visual acuity (VA), and contrast sensitivity; visual symptoms (0-5); satisfaction (1-5); spectacle independence rate; and quality of life. Results. Twenty-three patients (27 eyes) were included. No intraoperative complications developed. Mean monocular uncorrected VA at distance, intermediate, and near were 0.13 ± 0.15 (standard deviation), 0.22 ± 0.15, and 0.16 ± 0.15, respectively. Corresponding mean values for binocular uncorrected VA were 0.00 ± 0.10, 0.08 ± 0.13, and 0.13 ± 0.10, respectively. No eyes lost >1 line of corrected distance VA. Contrast sensitivity at different spatial frequencies between operated and unoperated eyes did not differ significantly (all P > 0.05). Mean score for halos, night glare, starbursts, and satisfaction were 1.46 ± 1.62, 1.85 ± 1.69, 0.78 ± 1.31, and 3.50 ± 1.02, respectively. Eighteen patients (78%) reported complete spectacle independence. Mean composite score of the quality-of-life questionnaire was 90.31 ± 8.50 out of 100. Conclusions. Implantation of the MIOL after myopic LASIK was safe and achieved good visual performance.