OpenMed/multicare-articles huggingface dataset:
Sleep-Induced Glottis Closure in Multiple System Atrophy Evaluated by Four-Dimensional Computed Tomography
Authors: Rumi Ueha, Eriko Maeda, Kenji Ino, Takahiro Shimizu, Taku Sato, Takao Goto, Tatsuya Yamasoba
Journal: Front Med (Lausanne) (2020)
Keywords: four-dimensional computed tomography, multiple system atrophy, sleep apnea, sleep-induced glottis closure, upper airway
MeSH terms: Case Reports

Multiple system atrophy (MSA) is a progressive neurodegenerative disorder. Since patients with MSA often have sleep-related respiratory disorders including upper-airway obstruction and/or central sleep disturbance, appropriate evaluation of the upper airway especially during sleep may be indispensable. Fiberoptic laryngoscopy during diazepam-induced sleep has been reported for upper-airway obstruction verification. However, some patients cannot endure the uncomfortable sensation of the fiberscope. To address these issues, we devised a protocol of four four-dimensional computed tomography (4D-CT) for upper-airway evaluation during sleep. Here, we report the case of patient with MSA who was evaluated for upper-airway obstruction during sleep using 4D-CT. A 46-year-old man (height 1.60 m, weight 79 kg) was admitted to our neurological department for tracheal intubation because of a sudden onset of respiratory failure occurring at night. At the age of 45 years, he was diagnosed as MSA with predominant parkinsonism. As pulmonary disease had been excluded and his swallowing was normal, our differential diagnoses were central sleep apnea or obstructive sleep apnea related to his MSA or obstructive sleep apnea (SA) related to his obesity. A tracheostomy was done to maintain the airway after extubation. Polysomnography showed obstructive SA and not central SA. Awake fiberoptic laryngoscopy showed no upper airway obstruction but bilateral vocal abduction impairment (BVAI) during inspiration. To assess the spatial and temporal conditions of the upper respiratory tract-the patient could not tolerate sleep laryngoscopy-we carried out a 4D-CT. Reconstructed 4D-CT images of respiration during sleep showed clear abnormalities: glottis closure at the terminal stage of inspiration and subsequent velopharyngeal closure. As glottis closure does not occur normally in obesity patients, the cause of the respiratory failure in this patient was considered MSA-related sleep-induced airway obstruction. We decided to keep the tracheostoma, because BVAI in patients with MSA may be getting worse, although central apnea after tracheostomy may cause sudden central origin-related death; 4 months postoperatively, the patient had experienced no further airway-related complications. This report indicates that 4D-CT sequential upper-airway assessment during sleep is useful for determining the abnormalities causing obstructive SA in patients with MSA.
A Case Report: Effect of Robotic Exoskeleton Based Therapy on Neurological and Functional Recovery of a Patient With Chronic Stroke
Authors: Neha Singh, Megha Saini, Nand Kumar, M V Padma Srivastava, S Senthil Kumaran, Amit Mehndiratta
Journal: Front Neurol (2021)
Keywords: case report, cortical excitability, electromyogram, fmri, rehabilitation, robotic exoskeleton, stroke
MeSH terms: Case Reports

Background: In this study, a novel electromechanical robotic exoskeleton was developed for the rehabilitation of distal joints. The objective was to explore the functional MRI and the neurophysiological changes in cortical-excitability in response to exoskeleton training for a 9-year chronic stroke patient. Case-Report: The study involved a 52-year old female patient with a 9-year chronic stroke of the right hemisphere, who underwent 20 therapy sessions of 45 min each. Cortical-excitability and clinical-scales: Fugl-Mayer (FM), Modified Ashworth Scale (MAS), Brunnstrom-Stage (BS), Barthel-Index (BI), Range of Motion (ROM), were assessed pre-and post-therapy to quantitatively assess the motor recovery. Clinical Rehabilitation Impact: Increase in FM wrist/hand by 6, BI by 10, and decrease in MAS by 1 were reported. Ipsilesional Motor Evoked Potential (MEP) (obtained using Transcranial Magnetic Stimulation) was increased by 98 μV with a decrease in RMT by 6% and contralesional MEP was increased by 43 μV with a decrease in RMT by 4%. Laterality Index of Sensorimotor Cortex (SMC) reduced in precentral- gyrus (from 0.152 to -0.707) and in postcentral-gyrus (from 0.203 to -0.632). Conclusion: The novel exoskeleton-based training showed improved motor outcomes, cortical excitability, and neuronal activation. The research encourages the further investigation of the potential of exoskeleton training.
CT: the imaging of choice in the diagnosis of coronary artery fistulae
Authors: Anam Ali, Jonathan Colledge, Iyengar Sri, Constantinos Missouris
Journal: BJR Case Rep (2016)
MeSH terms: Case Reports

Coronary artery fistulae are rare abnormal communications between coronary arteries and cardiac chambers or great vessels. We report a patient with a complex congenital fistula between the pulmonary artery and both the left anterior descending and the right coronary artery, originally diagnosed on routine coronary angiography and subsequently followed up and further elucidated with CT coronary angiography.
Planned pregnancy in a chronic myeloid leukemia patient in molecular remission
Authors: Carolina Pavlovsky, Isabel Giere, Germán Van Thillo
Journal: Case Rep Hematol (2012)
MeSH terms: Case Reports

Excellent response rates and a good quality of life have been observed since the introduction of tyrosine kinase inhibitors (TKIs) in chronic myeloid leukemia (CML) treatment. Consequently, some challenges began to appear in CML women in child-bearing age wishing to become pregnant. Currently, many women around the world are in stable major/complete molecular response MMR/CMR (MMR: <0.1% BCR-ABL/ABL and CMR: undetectable BCR-ABL mRNA by RQ-PCR transcript levels on the international scale). The condition of stable MMR/CMR is linked to a long-term virtual absence of progression to the accelerated and blastic phase and to the possibility of stopping the TKI treatment with the maintenance of a condition of CMR in a proportion of cases. Imatinib teratogenic and prescribing information prohibits the use of it during pregnancy. We describe the case of a 36-year-old female patient with CML in chronic phase who stopped imatinib after 2 years in major molecular response (MMR) to plan a pregnancy. Molecular monitoring by RQ-PCR was performed quarterly. She achieved a safe pregnancy and delivery maintaining an optimal molecular response throughout the pregnancy. Isolated literature reports have been described, but no formal advice has been described at present time.
An Unusual Presentation of Idiopathic Lymphatic Cyst of the Thigh
Authors: Chairat Burusapat, Sophilak Sringkarawat, Sineenard Thanapurirat, Rapeepat Sapruangthong, Chatchai Pruksapong, Kantang Satayasoontorn
Journal: Case Rep Surg (2018)
MeSH terms: Case Reports

Lymphatic cyst is a collection of lymphatic fluid with an epithelial lining which can either represent lymphatic malformations or may occur after trauma or operation. Idiopathic lymphatic cyst of the thigh in adulthood is extremely rare. We report a case of a 27-year-old Thai female presented with a rapidly growing mass over her right thigh. The magnetic resonance imaging scan demonstrated a well-defined, thin rim, enhancing simple cyst. The cyst disappeared for a few days after aspiration. Completed surgical resection was performed for definitive diagnosis and treatment. Immunohistochemical studies revealed the cell lining was positive for CD34, CD31, and D2-40 and negative for calretinin. To our best knowledge, idiopathic lymphatic cyst of the thigh in young adult has never been reported and should be kept in mind in the patient who presents with abnormal thigh mass.
CASE REPORT Removal of Exposed Titanium Reconstruction Plate After Mandibular Reconstruction With a Free Fibula Osteocutaneous Flap With Large Surgical Pin Cutters: A Case Report and Literature Review
Authors: Travis G Boyd, Katherine M Huber, Daniel E Verbist, Jeffery M Bumpous, Bradon J Wilhelmi
Journal: Eplasty (2012)

Locking reconstruction plates have led to significant improvement in osteosynthesis and graft anchorage in mandibular reconstruction following the free fibula osteocutaneous flap. Plate extrusion is the most common complication associated with mandibular reconstruction, occurring in approximately 20% to 48% of cases; often necessitating plate removal once the bone flap has united to the mandible. Radiation therapy is a known risk factor to the development of such a complication and it presents further challenges to the successful removal of the reconstruction plate. Several reports have been published regarding plate removal in the setting of orthopedics that describe the management of jammed or stripped locking screws, but few in the setting of mandibular reconstruction. In this case, we report the successful removal of an exposed titanium mandibular reconstruction plate from a 41-year-old woman 12 months after her initial reconstruction with a free fibula osteocutaneous flap and radiation therapy. The approach was selected because the chin and neck skin could not be expected to be raised for full plate exposure secondary to radiation-induced skin changes (thinning and friability). We also discuss the use of previously employed methods of plate removal in various settings as well as their inherent strengths and weaknesses.
Extremity manifestations and surgical treatment for nasu hakola disease
Authors: Murat Arıkan, Ahmet Yıldırım, Güray Togral, Alp Burak Ekmekçi
Journal: Case Rep Orthop (2014)

Nasu-Hakola disease, which is also known as polycystic lipomembranous osteodysplasia with sclerosing leukoencephalopathy (PLOSL), is a rare and mortal human genetic disorder (Verloes et al., (1997) and Bianchin et al., (2004)). Nasu-Hakola is a progressive disease characterized by early onset cognitive dementia and bone cysts (both evident by the third decade). The disease has a worldwide distribution, but most patients have been reported in Finland and in Japan (Montalbetti et al., (2004)). In the literature less than 200 cases are reported and only a few of them are about the surgical treatment for the extremity (Madry et al., (2007)). Most patients die by their fourth or fifth decade because of neurologic problems. Surgeons generally prefer conservative treatment modalities in the treatment of cystic lesions of the bone in this syndrome. In this case report, we presented a 42-year-old male with Nasu-Hakola disease having bilateral painful talar lipomembranous cystic lesions treated with curettage and iliac bone grafting. He is in the 3rd year of his followup after surgery and he has not any extremity complaints, but his neurological problems sustain. Our aim in this study is to show the beneficial aspect of surgical intervention in the cystic lesions of Nasu Hakola disease in the skeleton to obtain the patient a painless joint although surgery is rarely performed in this systemic and progressive disease.
Fatal Case of Probable Invasive Aspergillosis after Five Years of Heart Transplant: A Case Report and Review of the Literature
Authors: Toufik Mahfood Haddad, Mahesh Anantha Narayanan, Krista E Shaw, Renuga Vivekanandan
Journal: Case Rep Infect Dis (2015)

Invasive fungal infections are very common in solid organ transplants and occur most frequently in the first three months after transplant. A 49-year-old female with a history of two remote heart transplants with the most recent one occurring 5 years ago was admitted for increasing shortness of breath, cough, and fever. Computerized tomography (CT) scan of the chest showed left lower lung ground-glass and tree-in-bud opacities. She was started on broad spectrum antibiotics along with ganciclovir and micafungin. Ganciclovir was added due to the patient's past history of CMV infection and empiric fungal coverage with micafungin. Bronchoalveolar lavage (BAL) was performed as her respiratory status worsened and voriconazole was added for possible aspergillosis in combination therapy with micafungin. BAL galactomannan returned positive which was suggestive of aspergillosis. Patient worsened clinically and subsequently succumbed to cardiorespiratory arrest despite our best efforts. It is important to have a high degree of clinical suspicion for invasive aspergillosis in transplant patients even many years after transplant and initiate aggressive therapy due to poor outcomes.
A patient with chronic lymphocytic leukemia and acquired angioedema: correlation of clinical and biochemical response to CLL therapy
Authors: Gr Mohyuddin, I Rabinowitz
Journal: Ecancermedicalscience (2013)
MeSH terms: Case Reports

Acquired angioedema (AAE) is a result of an acquired deficiency or inactivity of the C1 esterase inhibitor (C1-INH). There is a well-known link between AAE and lymphoplasmacytic disorders.A 65-year-old woman who was diagnosed with chronic lymphocytic leukemia (CLL), presented with recurrent episodes of angioedema. Although no association between the CLL and angioedema was initially recognized, further workup showed her to have low C1-INH levels. Chemotherapy helped prevent subsequent episodes, but three years later she redeveloped angioedema. She was then placed on ofatumumab maintenance and has since remained free of angioedema.Knowledge of this rare disease and anticipation of the link between CLL and AAE can prevent further attacks and associated morbidity.
Clostridium septicum: A usual suspect? Aortic rupture following right hemicolectomy: A case report
Authors: Sam Cresser, Lachlan Maddock, Philip Smart
Journal: Int J Surg Case Rep (2019)
Keywords: aneurysm, case report, colonic neoplasm, infected

Introduction:
There is a known association between Clostridium Septicum, mycotic aneurysm and colon neoplasm.
Case presentation:
We report the case of a 90 year old female admitted with abdominal pain to the general surgery unit. Admission CT scan demonstrated a thick walled caecum and pericaecal inflammation suspicious for a perforated carcinoma. This was subsequently confirmed at colonoscopy with biopsy demonstrating a poorly differentiated adenocarcinoma. A laparoscopic right hemicolectomy was completed the following week after perioperative workup and intravenous antibiotic therapy. On the 9th postoperative day, fever and rising inflammatory markers prompted repeat abdominal CT scan which demonstrated a mycotic aneurysm of the upper abdominal aorta. After discussion with the vascular surgery and infectious diseases team, along the patient and family, the decision was made to palliate. The patient died at home from presumed spontaneous rupture two weeks after discharge.
Discussion:
Mycotic aneurysm in colonic malignancy is a rare and often lethal complication. C. Septicum is causative in over 70% of cases with concomitant colonic malignancy.
Conclusion:
Mycotic aneurysm should be considered in any deteriorating patient with concomitant colonic malignancy.
Dalbavancin to Treat Infected Massive Endoprostheses: A Case Report and Cost Comparison Analysis
Authors: Tariq Azamgarhi, James Donaldson, Ashik Shah, Simon Warren
Journal: J Bone Jt Infect (2019)
Keywords: coagulase negative staphylococcus epidermidis, lipoglycopeptide, osteomyelitis, periprosthetic joint infection
MeSH terms: Case Reports

We report a case of an infected massive endoprosthetic replacement treated successfully with 2 stage surgery and off-label dalbavancin. Dalbavancin was used due to a limited number of antimicrobial options that could be administered safely in an outpatient setting and to avoid the need for daily dosing.
Largest case series of giant gallstones ever reported, and review of the literature
Authors: Mohammad Al Zoubi, Walid El Ansari, Ahmed A Al Moudaris, Abdelrahman Abdelaal
Journal: Int J Surg Case Rep (2020)
Keywords: giant gallstone, laparoscopic cholecystectomy, large gallstone, open cholecystectomy

Introduction:
Giant/large gallstones have high risk of complications, and technical difficulties during surgery. This case series is the largest ever reported.
Presentation of cases:
Case 1: Female (44 years), with one year intermittent right upper quadrant colicky pain. Ultrasound: large gallstone (normal gallbladder). Elective laparoscopic cholecystectomy (LC): 6 × 4 × 3.3 cm gallstone. Case 2: Female (41 years), presented to emergency room with 3 days right upper quadrant pain/tenderness, vomiting, and positive murphy's sign. Ultrasound: large gallstone, calculus cholecystitis. Emergency LC: 4.5 × 3.1 × 3.5 cm gallstone. Case 3: Male (38 years), with history of gallstones and acute cholecystitis presented with intermittent right upper quadrant pain (2 months) and vomiting. Normal abdominal examination. Ultrasound: large gallstone. Elective LC: 4.1 × 4 × 3.6 cm gallstone.
Conclusions:
Gallstones >5 cm are very rare, with higher risk of complications. Gallbladder should be removed even if asymptomatic. Gallstones >3 cm have increased risk for gallbladder cancer, biliary enteric fistula and ileus. LC has challenges that include grasping the gallbladder wall, exposure of Calot's triangle, and retrieval of gallbladder out of the abdomen. LC appears to be procedure of choice and should be performed by an experienced surgeon, considering the possibility of conversion to open cholecystectomy in case of inability to expose the anatomy or intraoperative difficulties.
Case Report of Congenital Hepatoblastoma With the Onset at 30-Weeks' Gestation
Authors: Zheng Yan, Wei Bai, Li Li, Shuo Li, Ying Hua, Xiao-Xiao Zhang, Xin-Lin Hou
Journal: Front Pediatr (2022)
Keywords: alpha-fetoprotein (afp), chemotherapy, congenital hepatoblastoma, recurrence, surgery
MeSH terms: Case Reports

This study reports a case of hepatoblastoma with onset at 30-weeks' gestation and rapid growth rate. The postnatal enhanced CT confirmed an intrahepatic mass with a size of 8.5 cm × 6.6 cm and a clear boundary accompanied by uneven enhancement, displacement, and narrow lumen of the hepatic vein due to compression. The alpha-fetoprotein (AFP) at birth was 1,002,632 ng/ml (normal level 48,406 [±34,718] ng/ml). A diagnosis of congenital hepatoblastoma was established based on the imaging and laboratory outcomes. The infant received chemotherapy of Cisplatin-5 fluorouracil-Vincristine (C5V) on the fourth day after birth. After four courses of C5V, a complete tumor resection was performed, and the postoperative pathology was consistent with mixed epithelial and mesenchymal hepatoblastoma. Four more courses of C5V and one course of C5VD (C5V plus doxorubicin) followed the surgery. Infectious diarrhea and acute kidney injury (stage I) occurred during chemotherapy, which recovered after anti-infection and symptomatic treatment. The patient is currently 2 years old and still in complete remission. In this case, the onset of hepatoblastoma was early, and the tumor grew rapidly, resulting in an obvious compression effect. Chemotherapy was started early after birth, and the curative effect was satisfactory, suggesting that the hepatoblastoma based on clinical diagnosis with rapid tumor progression and severe dysfunction of surrounding organs caused by compression should undergo chemotherapy as soon as possible if a pathological diagnosis cannot be obtained temporarily, which also plays an important role in improving the complete resection rate of intraoperative tumor and reducing the recurrence rate of postoperative tumor.
Cisplatin-Induced Renal Salt Wasting Requiring over 12 Liters of 3% Saline Replacement
Authors: Phuong-Chi Pham, Pavani Reddy, Shaker Qaqish, Ashvin Kamath, Johana Rodriguez, David Bolos, Martina Zalom, Phuong-Thu Pham
Journal: Case Rep Nephrol (2017)
MeSH terms: Case Reports

Cisplatin is known to induce Fanconi syndrome and renal salt wasting (RSW). RSW typically only requires transient normal saline (NS) support. We report a severe RSW case that required 12 liters of 3% saline. A 57-year-old woman with limited stage small cell cancer was admitted for cisplatin (80 mg/m2) and etoposide (100 mg/m2) therapy. Patient's serum sodium (SNa) decreased from 138 to 133 and 125 mEq/L within 24 and 48 hours of cisplatin therapy, respectively. A diagnosis of syndrome of inappropriate antidiuretic hormone secretion (SIADH) was initially made. Despite free water restriction, patient's SNa continued to decrease in association with acute onset of headaches, nausea, and dizziness. Three percent saline (3%S) infusion with rates up to 1400 mL/day was required to correct and maintain SNa at 135 mEq/L. Studies to evaluate Fanconi syndrome revealed hypophosphatemia and glucosuria in the absence of serum hyperglycemia. The natriuresis slowed down by 2.5 weeks, but 3%S support was continued for a total volume of 12 liters over 3.5 weeks. Attempts of questionable benefits to slow down glomerular filtration included the administration of ibuprofen and benazepril. To our knowledge, this is the most severe case of RSW ever reported with cisplatin.
A Case of Acute Hepatitis E Infection in a Patient with Non-Hodgkin Lymphoma Treated Successfully with Ribavirin
Authors: Hasan N Y Haboubi, Rizwan Diyar, Ann Benton, Chin Lye Ch'ng
Journal: Case Rep Gastrointest Med (2017)
MeSH terms: Case Reports

We present the case of a man who, following immunosuppressive treatment for non-Hodgkin lymphoma, became infected with viral hepatitis E. Acute hepatitis E virus infection should be considered in patients with deranged liver function on a background of haematological malignancies or immunosuppression, even without travel to endemic regions. Whilst clearance is usually spontaneous in immune-competent individuals, these at-risk groups may develop a more complicated and protracted disease course. Thus awareness is important as additional treatment with ribavirin or pegylated interferon may be required, as in this case, in order to help achieve eradication.
Diagnosis and Management of Acquired Hemophilia A: Case Reports and a Literature Review
Authors: Ikhwan Rinaldi, Findy Prasetyawaty, Siti Fazlines, Kevin Winston, Yusuf Aji Samudera Nurrobi, Jessica Leoni, Ilham Hidayat Restu Tulus Maha, Satrio Wicaksono, Abdillah Yasir Wicaksono, Averina Octaxena Aslani, Rizkania Ikhsani
Journal: Case Rep Med (2021)
MeSH terms: Case Reports

Background:
Acquired hemophilia A (AHA) is a potentially life-threatening autoimmune hemostatic disorder where autoantibodies that disrupt the functions of factor VIII (FVIII) are present in the circulation. The early diagnosis of AHA is difficult since the symptoms of AHA differ from those of congenital hemophilia A. Furthermore, the management of AHA is also more complex due to the presence of autoantibodies against FVIII (FVIII inhibitors). Here, we present three case reports and conduct a literature review of AHA with the aim to increase awareness and knowledge regarding the diagnosis and treatment of AHA. Case Presentations. We present three patients diagnosed with AHA in these case reports. The first patient was a young female, while the second and third patients were middle-aged and elderly males, respectively. All patients presented with a chief complaint of bruises without hemarthrosis and a history of bleeding. Laboratory examinations of the patients revealed isolated prolonged aPTT, normal PT, and the presence of autoantibodies against factor VIII, which are characteristics of AHA. Patients were then treated with corticosteroids to reduce the titer level of autoantibodies and received factor VIII transfusion to stop bleeding.
Conclusion:
AHA can be suspected in patients presenting with symptoms of bruises without hemarthrosis and without the history of bleeding. Isolated aPTT elevation with normal PT should raise high suspicion of AHA. The presence of FVIII inhibitors can help to confirm the diagnosis of AHA. Treatment consists of factor VIII transfusion and corticosteroid therapy. Bypassing agents are recommended as an alternative to FVIII transfusion.