OpenMed/multicare-articles huggingface dataset:
Gastric tuberculosis with outlet obstruction: a case report presenting with a mass lesion
Authors: Ruth Shifa Ecka, Zeeshn Ahamad Wani, Malay Sharma
Journal: Case Rep Med (2013)

Tuberculosis is a major health problem worldwide. In India, it is highly endemic. The most common manifestation is a pulmonary disease, but involvement of the gastrointestinal tract is not uncommon with the ileocecal region being the commonest site. Gastric tuberculosis is rare and usually associated with pulmonary tuberculosis or an immunodeficient state. Here, we report a case of gastric tuberculosis presenting as gastric outlet obstruction in an immunocompetent patient without evidence of pulmonary tuberculosis. Biopsy and PCR confirmed the diagnosis, and the patient responded well to standard antitubercular treatment. Though, gastric tuberculosis is rare, it should be considered as a possibility when patients present with gastric outlet obstruction, particularly in endemic areas with tuberculosis.
Autoimmune Gastritis in the Pediatric Age: An Underestimated Condition Report of Two Cases and Review
Authors: Chiara Saglietti, Amedeo Sciarra, Karim Abdelrahman, Vanessa Schneider, Arti Karpate, Andreas Nydegger, Christine Sempoux
Journal: Front Pediatr (2018)
Keywords: ecl cell hyperplasia, autoimmune gastritis, children, gastric atrophy, intestinal metaplasia, iron-deficiency anemia
MeSH terms: Case Reports

Background: Diagnosis of pediatric autoimmune gastritis (AIG) in children is important due to poor outcome and risk of malignancy. This condition is often underestimated in the clinico-pathologic diagnostic work-up, leading to delayed time-to-diagnosis. To increase the awareness of this condition in the pediatric population, we present two cases encountered at our institution, discuss their clinical, biological, and histological presentations in relation with evidence from the literature, and propose an algorithm for diagnosis and follow-up of AIG in children. Case presentation: Two patients (12 and 17 years old) presented with iron deficiency anemia and negative family history for autoimmune disorders. In both cases, the final diagnosis of autoimmune gastritis was delayed until pathological examination of endoscopic gastric biopsies showed atrophy of oxyntic glands. Helicobacter pylori search was negative. Follow up biopsies revealed persistent disease. Literature review on this condition shows unclear etiology and poor long term outcome in some patients because of increased risk of malignancy. Conclusions: AIG should be considered in the differential diagnosis of iron deficiency anemia in the pediatric population.Standardized clinico-pathologic work-up is mandatory. Endoscopic follow-up should be performed due to the risk of malignancy.
" It is very difficult in this business if you want to have a good conscience": pharmaceutical governance and on-the-ground ethical labour in Ghana
Authors: Kate Hampshire, Simon Mariwah, Daniel Amoako-Sakyi, Heather Hamill
Journal: Glob Bioeth (2022)
Keywords: access to medicines, africa, essential medicines, ethical labour, pharmaceutical governance, substandard and falsified (sf) medical products

The governance of pharmaceutical medicines entails complex ethical decisions that should, in theory, be the responsibility of democratically accountable government agencies. However, in many Low- and Middle-Income Countries (LMICs), regulatory and health systems constraints mean that many people still lack access to safe, appropriate and affordable medication, posing significant ethical challenges for those working on the "front line". Drawing on 18 months of fieldwork in Ghana, we present three detailed case studies of individuals in this position: an urban retail pharmacist, a rural over-the-counter medicine retailer, and a local inspector. Through these case studies, we consider the significant burden of "ethical labour" borne by those operating "on the ground", who navigate complex moral, legal and business imperatives in real time and with very real consequences for those they serve. The paper ends with a reflection on the tensions between abstract, generalised ethical frameworks based on high-level principles, and a pragmatic, contingent ethics-in-practice that foregrounds immediate individual needs - a tension rooted in the gap between the theory and the reality of pharmaceutical governance that shifts the burden of ethical labour downwards and perpetuates long-term public health risks.
Intracoronary artery retrograde thrombolysis for ST-segment elevation myocardial infarction with a tortuous coronary artery: A case report and review of the literature
Authors: Mingzhi Shen, Haihui Lu, Yichao Liao, Jian Wang, Yi Guo, Xinger Zhou, Yingqiao Nong, Zhenhong Fu, Jihang Wang, Yuting Guo, Shihao Zhao, Li Fan, Jinwen Tian
Journal: Front Cardiovasc Med (2022)
Keywords: intracoronary retrograde thrombolysis, myocardial infarction, reperfusion preconditioning, thrombosis, tortuous coronary artery
MeSH terms: Case Reports

Background:
How to deal with large thrombus burdens of culprit's blood vessel remains a great challenge in the treatment of acute myocardial infarction.
Case presentation:
A 32-year-old Chinese man was diagnosed with ST-segment elevation myocardial infarction (STEMI). Coronary angiography revealed that the distal end of a tortuous left circumflex was completely occluded by a large amount of thrombus. Cutted balloon-directed intracoronary artery retrograde thrombolysis (ICART) with urokinase led to the restoration of coronary blood flow. Because there was no obvious plaque rupture or artery stenosis in the coronary artery, it was only dilated, and no stent was implanted.
Conclusion:
Cutted balloon-directed ICART can be performed effectively and safely in some STEMI patients with tortuous coronary vessels and large thrombus. (REST or named ICART ClinicalTrials.gov number, ChiCTR1900023849).
Peripheral T-cell lymphoma with hypercalcemic crisis as a primary symptom accompanied by polymyositis: A case report and review of the literature
Authors: Luyin Ding, Xibin Xiao, Liansheng Huang
Journal: Oncol Lett (2015)
Keywords: cancer-associated myositis, hypercalcemia, non-hodgkin’s lymphoma, peripheral t-cell lymphoma, polymyositis

The present study reports the case of a 61-year-old male with polymyositis who presented with exacerbated weakness in the lower limbs and a recurrent fever that had persisted for one month. Positron emission tomography/computed tomography scans revealed multiple regions of elevated fluorodeoxyglucose metabolism in the lymph nodes, lungs, liver, spleen and bones. While symptoms of nonchalance and confusion were identified on admission, the patient's serum calcium level was high at 3.87 mmol/l, so a hypercalcemic crisis was confirmed. A biopsy of the right lingual lymph node revealed peripheral T-cell lymphoma, not otherwise specified. The serum calcium level was restored to within the normal range following emergency measures, such as saline rehydration, diuretics, calcitonin and glucocorticoids, and partial remission was achieved following two courses of chemotherapy. The study may improve our present understanding of the diagnosis and treatment of cancer-associated myositis (CAM) and malignancy-associated hypercalcemia.
A Case of Unresectable Papillary Thyroid Carcinoma Treated with Lenvatinib as Neoadjuvant Chemotherapy
Authors: Hiroyuki Iwasaki, Soji Toda, Hiroyuki Ito, Daiji Nemoto, Daisuke Murayama, Yoichiro Okubo, Hiroyuki Hayashi, Tomoyuki Yokose
Journal: Case Rep Endocrinol (2020)
MeSH terms: Case Reports

A 75-year-old woman visited a nearby clinic with complaints of right clavicle discomfort, and she underwent diagnostic thoracoscopic lung biopsy, being diagnosed with lung metastasis and a right-upper mediastinal mass. The superior mediastinum mass was extrapulmonary and covered by the pleura, and it was not biopsied. Papillary thyroid carcinoma was diagnosed following biopsy of the lung metastasis. Only a small tumor, with a maximum diameter of 70 mm from the right neck to the superior mediastinum, in the thyroid gland invades the internal jugular vein and subclavian vein, forming a tumor embolus in the right brachiocephalic vein and reaching the vicinity of the superior vena cava. For life-saving purposes, we obtained approval from the Cancer Board of Kanagawa Cancer Center and used lenvatinib according to unresectable undifferentiated cancer IRB approval number 28-41. The tumor had shrunk after 4 months, and surgery was performed. The postoperative course has been good, and the patient is being followed up. The patient is alive three months after surgery, and lung metastases have disappeared on CT images. This case is reported as a successful case of neoadjuvant chemotherapy and interval debulking surgery.
Case report: Electrocardiographic changes in pembrolizumab-induced fatal myocarditis
Authors: Kazuhiro Nishiyama, Kei Morikawa, Yusuke Shinozaki, Junko Ueno, Satoshi Tanaka, Hajime Tsuruoka, Shinya Azagami, Atsuko Ishida, Nobuyuki Yanagisawa, Yoshihiro J Akashi, Masamichi Mineshita
Journal: Front Immunol (2023)
Keywords: covid-19, irae, lung cancer, myocarditis, pembrolizumab
MeSH terms: COVID-19, Lung Neoplasms, Myocarditis, Case Reports, Female, Humans, Immune Checkpoint Inhibitors, Methylprednisolone, Middle Aged, SARS-CoV-2, pembrolizumab, Immune Checkpoint Inhibitors, Methylprednisolone

Immune checkpoint inhibitor (ICI)-induced myocarditis is rare but fatal. Because of the rapid course of ICI-induced myocarditis, understanding of clinical course is only possible through information from case reports. We report a case of pembrolizumab-induced myocarditis in which we were able to document the course of electrocardiographic changes from onset to death. A 58-year-old woman with stage IV lung adenocarcinoma, who had completed her first cycle of pembrolizumab, carboplatin, and pemetrexed, was admitted with pericardial effusion. She underwent pericardiocentesis after admission. A second cycle of chemotherapy was administered 3 weeks after the first cycle. Twenty-two days after admission, she developed a mild sore throat and tested positive for SARS-CoV-2 antigen. She was diagnosed with mild coronavirus disease 2019 (COVID-19), isolated, and treated with sotrovimab. Thirty-two days after admission, an electrocardiogram showed monomorphic ventricular tachycardia (VT). Suspecting myocarditis caused by pembrolizumab, the patient was started on daily methylprednisolone after coronary angiography and endocardial biopsy. Eight days after the start of methylprednisolone administration, she was considered to have passed the acute stage. However, four days later, R-on-T phenomenon triggered polymorphic VT and she died. The impact of viral infections such as COVID-19 on patients be treated with immune checkpoint inhibitors is still unknown and we need to be careful with systemic management after viral infections.
Mucinous Tubular and Spindle Cell Renal Cell Carcinoma (MTSC-RCC) with an Unusual Presentation in a Child
Authors: Kanika Sharma, Anjan Dhua, Sandeep Agarwala, Seema Kaushal
Journal: J Kidney Cancer VHL (2022)
Keywords: children, mucinous tubular and spindle cell carcinoma, renal cell carcinoma
MeSH terms: Case Reports

Mucinous tubular and spindle cell renal cell carcinoma (MTSC-RCC) is a rare but favorable variant of renal cell carcinoma, predominantly found in adults. Complete surgical excision is the treatment of choice. We are reporting an intriguing case of bilateral MTSC-RCC in a 13-year-old-boy with rapid disease progression, leading to metastatic disease and subsequent demise of the child.
Isolated T Wave Inversion in Lead aVL: An ECG Survey and a Case Report
Authors: Getaw Worku Hassen, Ana Costea, Claire Carrazco, Tsion Frew, Anand Swaminathan, Jason Feliberti, Roger Chirurgi, Tennyson Smith, Alice Chen, Sarah Thompson, Neola Gushway-Henry, Bonnie Simmons, George Fernaine, Hossein Kalantari, Soheila Talebi
Journal: Emerg Med Int (2015)

Background. Computerized electrocardiogram (ECG) analysis has been of tremendous help for noncardiologists, but can we rely on it? The importance of ST depression and T wave inversions in lead aVL has not been emphasized and not well recognized across all specialties. Objective. This study's goal was to analyze if there is a discrepancy of interpretation by physicians from different specialties and a computer-generated ECG reading in regard to a TWI in lead aVL. Methods. In this multidisciplinary prospective study, a single ECG with isolated TWI in lead aVL that was interpreted by the computer as normal was given to all participants to interpret in writing. The readings by all physicians were compared by level of education and by specialty to one another and to the computer interpretation. Results. A total of 191 physicians participated in the study. Of the 191 physicians 48 (25.1%) identified and 143 (74.9%) did not identify the isolated TWI in lead aVL. Conclusion. Our study demonstrated that 74.9% did not recognize the abnormality. New and subtle ECG findings should be emphasized in their training so as not to miss significant findings that could cause morbidity and mortality.
Mild hypothermia after near drowning in twin toddlers
Authors: Ortrud Vargas Hein, Andreas Triltsch, Christoph von Buch, Wolfgang J Kox, Claudia Spies
Journal: Crit Care (2004)
MeSH terms: Critical Care / methods, Diseases in Twins / therapy, Near Drowning / therapy, Treatment Outcome, Case Reports, Bradycardia / etiology, Diseases in Twins / physiopathology, Female, Heart Arrest / etiology, Heart Arrest / therapy, Hospitals, Community, Hospitals, University, Humans, Hypothermia / etiology, Hypothermia / therapy, Infant, Intensive Care Units, Pediatric, Male, Near Drowning / physiopathology, Time Factors

Introduction:
We report a case of twin toddlers who both suffered near drowning but with different post-trauma treatment and course, and different neurological outcomes.
Methods and results:
Two twin toddlers (a boy and girl, aged 2 years and 3 months) suffered hypothermic near drowning with protracted cardiac arrest and aspiration. The girl was treated with mild hypothermia for 72 hours and developed acute respiratory dysfunction syndrome and sepsis. She recovered without neurological deficit. The boy's treatment was conducted under normothermia without further complications. He developed an apallic syndrome.
Conclusion:
Although the twin toddlers experienced the same near drowning accident together, the outcomes with respect to neurological status and postinjury complications were completely different. One of the factors that possibly influenced the different postinjury course might have been prolonged mild hypothermia.
Low laser therapy as an effective treatment of recurrent aphtous ulcers: a clinical case reporting two locations
Authors: Narjiss Akerzoul, Saliha Chbicheb
Journal: Pan Afr Med J (2018)
Keywords: aphtous ulcers, diode laser, low level laser therapy, oral ulcers, pain relief
MeSH terms: Lasers, Semiconductor / therapeutic use, Low-Level Light Therapy / methods, Stomatitis, Aphthous / radiotherapy, Case Reports, Adult, Female, Humans, Recurrence, Stomatitis, Aphthous / pathology, Treatment Outcome

Apthous ulcers, commonly referred to as canker sores, are the most common ulcerative lesions of the oral mucosa. These are usually painful and are associated with redness and occasional bleeding from the affected area(s). Low Level Laser Therapy (LLLT) has shown excellent results in relieving the pain and complete remission of the oral ulcers. Through a clinical case, we report two locations of oral ulcers treated successfully with diode laser.
Cryptogenic Organizing Pneumonia Complicated With Cutaneous Disseminated Nocardia Infection: A Case Report and Literature Review
Authors: Zhijing Wei, Pengchen Bao, Tianle Wang, Wei Wang, Wen-Yang Li
Journal: Front Med (Lausanne) (2022)
Keywords: nocardia infection, brain abscess, cranial abscess puncture and drainage, cryptogenic organizing pneumonia, cutaneous disseminated nocardia infection
MeSH terms: Case Reports

Nocardia disease is a rare opportunistic infection that usually occurs in individuals with solid organ transplantation, malignant tumors, human immunodeficiency virus (HIV) infection, or chronic lung disease history. Here, we reported a rare case of cryptogenic organizing pneumonia (COP) combined with disseminated Nocardia infection. A 75-year-old man was admitted to the respiratory department due to weakness and poor appetite for 3 months. The chest CT scan showed dense patchy shadows in the dorsal lower lobe of both lungs. After the transbronchial lung biopsy, the histopathological findings supported the diagnosis of COP. During the period of glucocorticoid reduction (oral methylprednisolone tablets 24 mg one time a day), the patient presented with masses on the back and bilateral upper limbs and intermittent fever for 3 days. After admission, the patient underwent a series of examinations and an ultrasound puncture of the mass. The puncture fluid was caseous necrosis, which was confirmed to be Nocardia infection after bacterial culture, so the diagnosis was disseminated Nocardia infection. After 13 days of admission, the patient developed a headache, accompanied by decreased visual acuity and blurred vision. An imaging (enhanced brain CT) examination revealed intracranial space-occupying lesions. The neurosurgeon was consulted and performed transcranial abscess puncture and drainage, intravenous antibiotics (meropenem, etc.) for 2 months, and trimethoprim/sulfamethoxazole (TMP-SMX) for 6 months. The patient was followed up for 3 years and has remained relapse-free. The mortality rate of disseminated Nocardia infection is as high as 85%, especially when combined with brain abscesses. Therefore, timely diagnosis and correct treatment are crucial for the prevention of fatal consequences. The report of this case can enable more patients to receive early diagnosis and effective treatment, so as to obtain a satisfied prognosis.
Life changing response to successive surgical interventions on cranial venous outflow: A case report on chronic fatigue syndrome
Authors: J Nicholas P Higgins, Patrick R Axon, Andrew M L Lever
Journal: Front Neurol (2023)
Keywords: chronic fatigue syndrome, cranial venous outflow obstruction, fibromyalgia, idiopathic intracranial hypertension, spontaneous intracranial hypotension
MeSH terms: Case Reports

Recognition of similarities between chronic fatigue syndrome and idiopathic intracranial hypertension (IIH) has raised suggestions that they might be connected, with chronic fatigue syndrome representing a mild version of IIH, sharing many of its symptoms, but without the signature features of elevated intracranial pressure that characterize the complete syndrome. A further development of this idea factors in the effects of a cerebrospinal fluid leak, a known complication of IIH, to explain cases where symptoms seem out of proportion to the apparent physiological disturbance. Cranial venous outflow obstruction has been proposed as the pathological substrate. We describe a patient with multiple symptoms, including headache and disabling fatigue, in which this model guided investigation and treatment. Specifically, CT and catheter venography identified focal narrowings of both jugular and the left brachiocephalic veins. Treatment of brachiocephalic obstruction was not feasible. However, in separate surgical procedures, relief of jugular venous obstruction produced incremental and significant clinical improvements which have proven durable over the length of follow-up. We suggest that investigating chronic fatigue syndrome under this model might not only bring benefit to individual patients but also will provide new insights into IIH and its relationship with spontaneous intracranial hypotension.
Extracorporeal membrane oxygenation for acute respiratory distress syndrome in burn patients: a case series and literature update
Authors: Mehran Dadras, Johannes M Wagner, Christoph Wallner, Julika Huber, Dirk Buchwald, Justus Strauch, Kamran Harati, Nicolai Kapalschinski, Björn Behr, Marcus Lehnhardt
Journal: Burns Trauma (2019)
Keywords: ards, acute respiratory distress syndrome, burns, ecmo, extracorporeal membrane oxygenation, inhalation injury

Background:
Acute respiratory distress syndrome (ARDS) has a reported incidence of 34-43% in ventilated burn patients and is associated with a mortality of 59% in the severe form. The use and experience with extracorporeal membrane oxygenation (ECMO) in burn patients developing ARDS are still limited. We present our results and discuss the significance of ECMO in treating burn patients.
Methods:
A retrospective analysis of burn patients treated with ECMO for ARDS between January 2017 and January 2019 was performed. Demographic, clinical, and outcome data were collected and analyzed.
Results:
Eight burn patients were treated at our institution with ECMO in the designated time period. Of these, all but one patient had inhalation injury, burn percentage of TBSA was 37 ± 23%, ABSI score was 8.4 ± 2, and R-Baux-score was 98 ± 21. Seven patients developed severe ARDS and one patient moderate ARDS according to the Berlin classification with a PaO2/FiO2 ratio upon initiation of ECMO therapy of 62 ± 22 mmHg. ECMO duration was 388 ± 283 h. Three patients died from severe sepsis while five patients survived to hospital discharge.
Conclusions:
ECMO is a viable therapy option in burn patients developing severe ARDS and can contribute to survival rates similar to ECMO therapy in non-burn-associated severe ARDS. Consequently, patients with severe respiratory insufficiency with unsuccessful conventional treatment and suspected worsening should be transferred to burn units with the possibility of ECMO treatment to improve outcome.
Multiple Geminated Supernumerary Premolars: A Rare Case Report
Authors: Atul Soin, Gaurav Sharma, Gayatri Soin, Anudeep Raina, Puneet Mutneja, Archna Nagpal
Journal: Case Rep Dent (2015)

Supernumerary teeth may be defined as any teeth or tooth substance in excess of the usual configuration of 20 deciduous and 32 permanent teeth. Gemination is defined as an attempt by a single tooth bud to divide, with a resultant formation of either a large tooth with a bifid crown or two completely divided teeth throughout the crown and root. Geminated supernumerary premolar is a rarity and the possibility of multiple occurrences is even rarer. An exhaustive review of English literature and a PubMed search conducted using the terms "gemination" and "multiple geminated supernumerary" revealed no case of multiple geminated supernumerary premolars. We report a case of multiple geminated supernumerary premolars in a 23-year-old male.
Calcifying ghost cell odontogenic cyst: report of a case and review of literature
Authors: Archana Sonone, V S Sabane, Rajeev Desai
Journal: Case Rep Dent (2011)
MeSH terms: Case Reports

The calcifying ghost cell odontogenic cyst (CGCOC) was first described by Gorlin et al. in 1962. Calcifying ghost cell odontogenic cyst is comparatively rare in occurrence, constituting about 0.37% to 2.1% of all odontogenic tumors. The most notable features of this pathologic entity are histopathological features which include a cystic lining demonstrating characteristic "Ghost" epithelial cells with a propensity to calcify. In addition, the CGCOC may be associated with other recognized odontogenic tumors, most commonly odontomas. There are variants of CGCOC according to clinical, histopathological, and radiological characteristics. Therefore a proper categorization of the cases is needed for better understanding of the pathogenesis of each variant. Here, we report a classical case of calcifying odontogenic cyst along with a brief review of literature.