OpenMed/multicare-articles huggingface dataset:
An adapted imaginal exposure approach to traditional methods used within trauma-focused cognitive behavioural therapy, trialled with a veteran population
Authors: Manveer Kaur, Dominic Murphy, Kirsten V Smith
Journal: Cogn Behav Therap (2016)
Keywords: dissociation, ptsd, intrusions, memory fragmentation, traumatic stress

Trauma-focused cognitive behavioural therapy (TF-CBT) is beneficial for individuals with post-traumatic stress disorder (PTSD); however, a subset of clients struggle to engage with traditional methods, due to high levels of avoidance and dissociation. This paper aims to describe an adapted approach to imaginal reliving and prolonged exposure, to facilitate subsequent cognitive updating. The paper demonstrates the technique with veterans, who are a client group that may struggle with some aspects of traditionally implemented TF-CBT. Two case studies are described, both with PTSD symptoms stemming from traumatic military experiences. An adapted exposure technique is utilized to address the barriers of high dissociation, poor access to trauma-related cognitions and fixed intrusive imagery. The approach involved three stages: (1) reliving the trauma outdoors, (2) manipulating the perspectives of the imagery, and (3) restructuring the narrative with new perspectives. Both clients showed decreased dissociation and improved toleration of their traumatic imagery. Improvement of PTSD symptoms and quality-of-life functioning was observed for both clients on objective measures. Adapting TF-CBT to have a stronger emphasis on grounding and allocentric processing may be helpful for a subset of patients with PTSD that present with high levels of dissociation and avoidance. Further research and investigation into alternative populations is needed.
Management of a Splenic Artery Aneurysm in the Third Trimester of Pregnancy
Authors: Oxana Zarudskaya, Madanika Subash, Anita Tamirisa, Nikolina Docheva, Balaji Reddy, Dani Zoorob
Journal: Case Rep Obstet Gynecol (2020)
MeSH terms: Case Reports

Background:
Splenic artery aneurysm (SAA) is a rare but potentially fatal complication associated with high maternal and fetal mortality when occurring during pregnancy.
Case:
A 29-year-old G4P3003 at 34 4/7 weeks of gestation was admitted with left upper quadrant pain and newly diagnosed SAA in the hilum. She was scheduled for embolization of the SAA but the night before went into labor. A multidisciplinary team discussion was held, and the patient underwent successful primary low transverse c-section via Pfannenstiel skin incision followed by laparoscopic splenectomy under general anesthesia. She delivered a male newborn with birth weight of 2855 and Apgar score of 8/5. Summary and Conclusion. Early diagnosis and management of SAA are key for improved maternal and fetal outcomes. Our case demonstrates that through a multidisciplinary approach and anticipation of the possible clinical scenarios, good outcomes can be achieved.
A Palpable Painless Axillary Mass as the Clinical Manifestation of Castleman's Disease in a Patient with Hepatitis C Disease
Authors: Athanasia K Papazafiropoulou, Angeliki M Angelidi, Antonis A Kousoulis, Georgios Christofilidis, Chariklia Sagia, Liountmila Kaftanidou, Kassiani Manoloudaki, Aikaterini Tsavari, Georgios Kranidiotis, Alexandros Kamaratos, Andreas Melidonis
Journal: Case Rep Med (2016)

Introduction. Castleman's disease (CD) is a rare lymphoproliferative disorder. CD is divided into two clinical subtypes: the most common unicentric and the less usual multicentric subtype. The majority of unicentric CD affects the mediastinum, while neck, abdomen, and axilla are less common locations. Case Presentation. Herein, we describe a rare case of unicentric CD in the right axilla in a 36-year-old white male with a medical history of hepatitis C virus infection admitted to our hospital due to palpation of a painless mass in the right axilla. Complete excision of the lesion was performed and, one year after the diagnosis, patient was free of the disease. Conclusions. Although infrequent, it is important to include CD in the differential diagnosis when evaluating axillary lymphadenopathy particularly in young patients with a low-grade inflammation process and chronic disease even in the absence of an abnormal blood picture or organomegaly.
Surgical Management of the Peripheral Osteoma of the Zygomatic Arch: A Case Report and Literature Review
Authors: Umberto Autorino, Claudia Borbon, Maria Chiara Malandrino, Giovanni Gerbino, Fabio Roccia
Journal: Case Rep Surg (2019)
MeSH terms: Case Reports

An osteoma is a benign, slow-growing, osteogenic neoplasm with a low recurrence rate that is typically characterized by the proliferation of a compact or cancellous bone. It can be peripheral, central, or extraskeletal. Usually asymptomatic, peripheral osteomas in the maxillofacial region commonly arise in the paranasal sinuses and mandible and rarely occur in the zygomatic arch, with only six previously documented cases in the literature. Here, we present the management of a solitary peripheral osteoma of the right zygomatic arch in a 72-year-old woman and a review of the literature.
Dominant inheritance and intra-familial variations in the association of Sturge-Weber and Klippel-Trenaunay-Weber syndromes
Authors: José Maria Pereira de Godoy, Agnes Cristina Fett-Conte
Journal: Indian J Hum Genet (2010)
Keywords: genealogical study, klippel–trenaunay–weber syndrome, sturge–weber syndrome
MeSH terms: Case Reports

This case report shows a genealogical study where a woman has limb hypertrophy and her son has an association of Sturge-Weber syndrome with Klippel-Trenaunay-Weber syndrome. The Sturge-Weber and Klippel-Trenaunay-Weber syndromes appear to be different manifestations of the same affliction. Familial aggregation exists and transmission may be almost imperceptible between generations. Identification of minor manifestations may prove to be a valuable contribution to genetic counseling of families and the prevention of new cases.
Surgery of hereditary hemorrhagic telangiectasia with severe refractory gastrointestinal bleeding: A case report of a rare condition
Authors: Dae Ro Lim, Da Bin Kim, Hee Kyung Kim, Eung Jin Shin
Journal: Int J Surg Case Rep (2020)
Keywords: gastrointestinal bleeding, hereditary hemorrhagic telangiectasia, surgery
MeSH terms: Case Reports

Introduction:
Hereditary hemorrhagic telangiectasia (HHT) is an autosomal dominant genetic disease that affects the vasculature of numerous organs. HHT is characterized by the presence of multiple arteriovenous malformations that lack intervening capillaries and result in direct connections between arteries and veins.
Presentation of case:
A 58-year-old South Korean female was admitted presenting with severe anemia, dizziness, and intermittent hematochezia. The patient had experienced chronic severe refractory gastrointestinal bleeding for years. She had an intermittent spontaneous epistaxis, telangiectasias in the oral cavity (tongue), and hepatic arteriovenous malformations and gastrointestinal telangiectasia. She underwent a segmental resection of a segment of the ileum and cecum (about 77 cm). After surgery, the patient experienced no more drops in hemoglobin count or symptoms of anemia and melena. She is living a normal life.
Conclusion:
The present case report is a surgical case of undiagnosed HHT with chronic refractory gastrointestinal bleeding. Surgical treatment is rarely required for gastrointestinal bleeding unless nonsurgical methods such as endoscopy/colonoscopy and angiography have failed.
Membranous or Hypermobile Stapes Footplate: A New Anatomic Site Resulting in Third Window Syndrome
Authors: Arun K Gadre, Ingrid R Edwards, Vicky M Baker, Casey R Roof
Journal: Front Neurol (2020)
Keywords: gray-scale invert function ct scan, head trauma, hypermobile stapes, perilymph fistula, stapes footplate defect, third window syndrome, vertigo

Objectives: To describe a potentially underappreciated pathology for post-traumatic persistent intractable dizziness and third window syndrome as well as the methods to diagnose and surgically manage this disorder. Study Design: Observational analytic case studies review at a tertiary care medical center. Methods: Patients suffering persistent dizziness following head trauma and demonstrating Tullio phenomena or Hennebert signs are included. All had reportedly normal otic capsules on high resolution temporal bone CT scans (CT). The gray-scale invert function was used to visualize the stapes footplate, which helped determine the diagnosis. Gray-scale inversion can be used to improve visualization of temporal bone anatomy and pathologic changes when diagnoses are in doubt. A search to check for the presence of perilymph leakage was performed in all cases. This was accomplished using intraoperative Valsalva maneuvers. Fat grafting of round and oval windows was performed. Results: Over an 11-year period between January 2009 and December 2019, 28 patients (33 ears) were treated. Follow-up with balance testing and audiograms were performed 6-8 weeks following surgery. Follow-up ranged from 6 months to 7 years. Prior to surgery all patients reported dizziness in response to loud sounds and/or barometric pressure changes. Seven out of 33 ears had demonstrable perilymph leakage into the middle ear; the rest (26 ears) appeared to have membranous or hypermobile stapes footplates. Membranous stapes footplates were better visualized using the invert function on CT. Thirteen patients had a fistula sign positive bilaterally while 15 had unilateral pathology. Twenty-four of the 28 patients (85.7%) showed both subjective and objective improvement following surgery. No patients suffered from a deterioration in hearing. Conclusions: A previously underappreciated membranous or hypermobile stapes footplate can occur following head trauma and can cause intractable dizziness typical of third window syndrome (TWS). Durable long term success can be achieved by utilizing fat graft patching of the round and oval windows. High resolution temporal bone CT scans using the gray-scale inversion (invert) function can assist in preoperative diagnosis.
Melanosis of the Bladder: Possible Pathogenetic Mechanisms
Authors: Justin E Dupey, Sarah J Wood, Richard Y Ball
Journal: Case Rep Urol (2022)
MeSH terms: Case Reports

Melanin accumulation within the bladder urothelium and/or macrophages in the lamina propria (melanosis of the bladder) is a very rare phenomenon of unknown pathogenesis. Its rarity argues for a complex, likely multifactorial, causation. We describe bladder melanosis developing after Botox therapy in an elderly woman with a history of overactive bladder, treated grade 2 uterovaginal prolapse, and episodes of urinary tract infection and speculate that one factor (probably of many) in its pathogenesis may be a derangement of local neurourothelial interactions.
Invasive Pleomorphic-Type Lobular Carcinoma of the Breast Presenting as a Mucinous Carcinoma
Authors: A Baig, G Omeroglu-Altinel, A Omeroglu
Journal: Case Rep Pathol (2019)
MeSH terms: Case Reports

Invasive mucinous carcinoma of the breast is mostly associated with invasive carcinoma of no special type (NST) and sometimes with neuroendocrine type tumors such as solid papillary carcinoma. Extracellular mucin production in invasive lobular carcinoma (ILC) is extremely rare. To the best of our knowledge only 18 such cases have been described in the literature. Here we present a unique case of invasive pleomorphic-type lobular carcinoma (IPTLC) presenting as a mucinous carcinoma of the breast on core needle biopsy. Here we discuss the impact and ways to suspect such case.
Intrathymic growing bronchogenic cyst mimicking thymoma: A case report
Authors: Madalina Grigoroiu, Sarah Paisley, Emmanuel Brian, Delphine Natali
Journal: Front Oncol (2023)
Keywords: bronchogenic cyst, case report, robotic surgery, subxiphoid, thymoma
MeSH terms: Case Reports

Intrathymic bronchogenic cysts are extremely rare lesions, and the differential diagnosis with a banal thymic cyst or a solid tumor can be problematic. Thymic carcinomas arising within thymic cysts have also been reported. We report a case of radical thymectomy for a slowly growing small thymic cyst. The pathological finding revealed a bronchogenic cyst rather than a thymic neoplasm.
Case report: A report of the complete pathological response of intrahepatic cholangiocarcinoma after conversion therapy
Authors: Xi Zhang, Hao Tang, Jun Fan, Rui Wang, Yunwei Han, Song Su, Yu Gan, Fangyi Peng, Mingyue Rao, Jianwen Zhang, Bo Li, Xiaoli Yang
Journal: Front Immunol (2022)
Keywords: albumin paclitaxel, carrelizumab, case report, cholangiocarcinoma, cisplatin, conversion therapy, gemcitabine
MeSH terms: Bile Duct Neoplasms / drug therapy, Bile Duct Neoplasms / pathology, Cholangiocarcinoma / drug therapy, Cholangiocarcinoma / pathology, Case Reports, Research Support, Non-U.S. Gov't, Bile Ducts, Intrahepatic / pathology, Deoxycytidine / therapeutic use, Gemcitabine, Humans, Deoxycytidine, Gemcitabine

Cholangiocarcinoma (CCA) is a rare disease with poor prognosis, and surgery remains the only curative treatment option. However, surgery is inappropriate for the majority of patients with CCA. Conversion therapy may provide opportunities for the surgical treatment of these patients. Herein, we describe a patient with intrahepatic CCA who was first treated with albumin-bound paclitaxel, cisplatin, and gemcitabine in combination with camrelizumab. The patient then successfully underwent surgery and achieved pathological complete remission. This report can serve as a reference for clinicians regarding conversion therapy for intrahepatic CCA.
Recurrent Ileal Variceal Bleeding as a Diagnostic and Therapeutic Challenge
Authors: Marek Cingel, Jakub Benko, Matej Samoš, Marián Mokáň
Journal: Case Rep Gastrointest Med (2022)
MeSH terms: Case Reports

Introduction:
Massive ileal variceal bleeding is a rare intricate condition that needs rapid management and treatment. The absence of randomized clinical trials in this field leads to a lack of evidence-based diagnostic and therapeutical approaches. We present a case report describing imaging, endoscopic, and surgical procedures leading to the diagnosis and resolution of severe ileal variceal bleeding. Case Report. We admitted a 63-year-old patient for recurrent anemia and ongoing bleeding from the gastrointestinal tract presenting as enterorrhagia. We were not able to elucidate the source by endoscopic, angiographic, or nuclear imaging methods. As a last resort, we carried out a surgical procedure with peroperative enteroscopy and subsequent resection of the affected part of the intestine.
Conclusion:
We present a patient with a case of ileal variceal bleeding, which required extensive diagnostic and therapeutic effort with a unique peroperative enteroscopic approach.
Plexiform Schwannoma of the Penis: A Rare Subtype of Genital Schwannoma
Authors: Chrysovalantis Gkekas, Vasileios Kalyvas, Evangelos N Symeonidis, Apostolos Malioris, Michail Papathanasiou, Nikolaos Kalinderis, Kyriakos Moisidis, Konstantinos Hatzimouratidis
Journal: Case Rep Urol (2019)
MeSH terms: Case Reports

Schwannomas are benign, encapsulated neurogenic tumors which present in diverse histological subtypes despite the limited variety of their cellular constituents. These include the cellular, ancient, cystic, epithelioid, melanotic, psammomatous, schwannoma with pseudoglandular elements, and plexiform varieties. The plexiform schwannoma (PS) represents 4.3% of all schwannomas. These lesions are commonly encountered in the head and neck region and are extremely rare in the penis. To the best of our knowledge only 34 cases of penile schwannomas have been reported and this is the 3rd case of plexiform penile schwannoma. A 39-year-old patient presented to our andrology outpatient clinic complaining for two painful penile nodules. The lesions were located on the dorsum of the penile shaft. His medical history was insignificant for penile trauma and sexual transmitted diseases. The masses measured 2x1 cm and 0.5x1 cm. After sonographic and magnetic resonance evaluation the patient was admitted to theatre and underwent topical resection of the lesions. Histopathology revealed plexiform schwannoma. Postoperatively, penile tenderness and hyperesthesia ensued which was managed with pregabalin administration and topical corticosteroids. Plexiform schwannomas are rare in the penile region. Surgical excision is inevitably the only way to diagnose and treat the lesions. They must be differentiated by a variety of malignant and benign clinical conditions. Topical excision suffices for oncological control and allows for acceptable functional outcomes.
A case of fibromyalgia involving pain throughout the body treated with site-specific targeted pain control
Authors: Fukami Nakajima, Satoko Aratani, Hidetoshi Fujita, Kou Nakatani, Koshi Makita, Toshishiro Nakajima
Journal: Springerplus (2016)
Keywords: fibromyalgia, musculoskeletal pain, nerve block
MeSH terms: Case Reports

Introduction:
Fibromyalgia is characterized by chronic pain and tenderness throughout the body. Patients with fibromyalgia are treated with pharmacotherapy and many other therapies. However, because the cause of fibromyalgia is unclear, there is currently no clinically effective treatment method.
Case presentation:
We report the case of a patient who developed fibromyalgia after left femoral neck fracture. After several caudal epidural blocks for lumbar pain, the pain throughout the body and abnormal discomfort in the laryngopharyngeal region reduced. Site-specific targeted pain control was effective in treating his pain and discomfort.
Conclusion:
The present case suggests that treatment targeting symptoms in one part of the body might produce a systemic therapeutic effect in patients with fibromyalgia.
An Endoscopic Nasomediastinal Approach to a Mediastinal Abscess Developing after Zenker's Diverticulectomy
Authors: Fatih Altintoprak, Kemal Gundogdu, Ahmet Tarik Eminler, Erkan Parlak, Guner Cakmak, Yener Uzunoglu Mustafa
Journal: Case Rep Gastrointest Med (2017)
MeSH terms: Case Reports

Zenker's diverticulum is the most frequent symptomatic diverticulum of the esophagus, but the prevalence is <0.1%. The optimal treatment is surgery. Here, we present a nasomediastinal drainage approach to treatment of a mediastinal abscess, developing in the late postoperative period and attributable to leakage from the staple line.
Cholangio-Conundrum: A Case Series of Painless Jaundice
Authors: Adam P Johnson, Deviney A Rattigan, Michael J Pucci, Jeffrey P Baliff, Jordan M Winter, Charles J Yeo, Harish Lavu
Journal: Case Rep Pancreat Cancer (2015)
Keywords: mirizzi syndrome, cholangiocarcinoma, painless jaundice, pancreatic cancer
MeSH terms: Case Reports

Background: Correct preoperative diagnosis of hepatobiliary disease can be challenging-even with current advances in radiographical imaging, laboratory testing, and endoscopic evaluation. Case presentation 1: A 65-year-old female with painless jaundice and weight loss was found to have cholelithiasis complicated by the Mirizzi syndrome. Case presentation 2: A 71-year-old female with new-onset painless jaundice and impacted stone in the gallbladder neck was found to have a cholangiocarcinoma. Case presentation 3: A 70-year-old male with progressive painless jaundice and weight loss was found to have a pancreatic adenocarcinoma. Conclusion: Proper diagnosis and management of patients with painless jaundice can be difficult in the preoperative setting and may require surgical exploration to obtain a definitive diagnosis.
Intravesicular Onabotulinumtoxin A Hemorrhage on Rivaroxaban
Authors: Allison Eubanks, Katherine Dengler, Daniel Gruber
Journal: Case Rep Obstet Gynecol (2019)
MeSH terms: Case Reports

Overactive bladder (OAB) is urgency, with or without urgency incontinence. For OAB, an injection of onabotulinumtoxin A (BOTOX®) can be a low-risk outpatient procedure. We present a patient on a novel anticoagulant that experienced excessive bleeding after this procedure. This 80-year-old G2P2002 Caucasian female had a history of urge urinary incontinence. She presented for intravesicular onabotulinumtoxin A injection (150 units) after recent initiation of rivaroxaban (Xarelto®) for her atrial fibrillation. Several hours after an uncomplicated procedure, she presented with anuria and pain after gross hematuria earlier in the day. Her pain was immediately alleviated with bladder irrigation. She was discharged home and remained asymptomatic. With the popularity of the novel anticoagulants, new guidance on management of these medications during procedures is limited. When managing a patient on a novel anticoagulant before any procedure, even a low risk procedure, several factors should be considered to determine if the medication should be held, bridged, or continued. In sum, each patient on anticoagulation undergoing any procedure should be assessed individually for thrombotic risk, bleeding risk, and the procedural risk to best avoid postprocedural hemorrhage.
Case Report: Severe Hypotonia Without Hyperphenylalaninemia Caused by a Homozygous GCH1 Variant: A Case Report and Literature Review
Authors: Yun Chen, Kaiyu Liu, Zailan Yang, Yaozhou Wang, Hao Zhou
Journal: Front Genet (2022)
Keywords: gch1, dopa-responsive dystonia, homozygous, hypotonia, variant
MeSH terms: Case Reports

Dopa-responsive dystonia (DRD) comprises a group of rare but treatable dystonias that exhibit diurnal fluctuation. The GCH1 gene encodes GTP cyclohydrolase-1 (GTPCH-І), a protein that catalyzes the first rate-limiting step of tetrahydrobiopterin biosynthesis. Pathogenic variants in GCH1 are the most common causes of DRD. However, the autosomal recessive form of DRD caused by biallelic GCH1 variants is very rare. Homozygous GCH1 variants have been associated with two clinically distinct human diseases: hyperphenylalaninemia, and DRD with or without hyperphenylalaninemia. Here, we describe one patient who presented during infancy with severe truncal hypotonia and motor developmental regression but without diurnal fluctuation and hyperphenylalaninemia. Treatment with levodopa/carbidopa resulted in the complete and persistent remission of clinical symptoms without any side effects. This was accompanied by age-appropriate neurological development during follow-up. A homozygous GCH1 variant (c.604G>A/p.V202I) was identified in the patient. To our knowledge, this is the first Chinese case of DRD caused by a homozygous GCH1 variant, thus expanding the spectrum of DRD phenotypes. Autosomal recessive DRD that is associated with homozygous GCH1 variants should be considered in patients with severe truncal hypotonia, with or without diurnal fluctuation, even if there is an absence of limb dystonia and hyperphenylalaninemia.