OpenMed/multicare-articles huggingface dataset:
Pistol Shooting Dystonia Treated with Thalamotomy
Authors: Masahiko Nishitani, Shiro Horisawa, Taku Nonaka, Kotaro Kohara, Tatsuki Mochizuki, Takakzu Kawamata, Takaomi Taira
Journal: Tremor Other Hyperkinet Mov (N Y) (2023)
Keywords: dystonia, pistol shooting, thalamotomy
MeSH terms: Dystonia, Dystonic Disorders / surgery, Case Reports, Research Support, Non-U.S. Gov't, Adult, Female, Humans, Neurosurgical Procedures

Background:
Neurosurgical treatment for pistol shooting dystonia has not been studied.
Case report:
The patient was a 41-year-old woman who participated in the Olympic Games four times as a shooting player. Five months after the final Tokyo Olympic trials, she developed dystonia of the right index finger when shooting. Stereotactic thalamotomy was performed, and a complete resolution of dystonia was achieved. She garnered her personal best score and placed fifth in the Tokyo Olympics.
Discussion:
Thalamotomy along with deep brain stimulation can be a surgical modality for patients with task-specific dystonia who fail oral medications or botulinum toxin therapy.
Pulmonary aspergillosis in a horse: a case report
Authors: Ubiratan Pereira Melo, Cíntia Ferreira, Suziane Wilma Mota Barreto
Journal: Braz J Vet Med (2024)
Keywords: aspergillus spp, equine, itraconazole, pneumonia
MeSH terms: Case Reports

Respiratory diseases considerably affect equine athletes, being the second most common cause of poor performance. Among these diseases, fungal pneumonia in horses, caused specifically by Aspergillus spp., is relatively rare but potentially fatal. Fungal pneumonia typically affects horses exposed to fungal elements due to environmental factors, immunosuppression, or previous debilitating illnesses. Treatment is complex, with minimal success due to late diagnosis and serious concomitant underlying diseases. The choice of medication depends on the site of infection, the fungal species involved, and financial considerations. This report describes a case of pulmonary aspergillosis diagnosed in a 10-year-old castrated Quarter Horse. Transtracheal lavage revealed fungal elements characteristic of Aspergillus fumigatus. Treatment with dexamethasone, bromhexine hydrochloride, and itraconazole led to a successful recovery. The diagnosis of equine aspergillosis is challenging because its clinical signs overlap with other respiratory diseases. Fungal infections like aspergillosis are gaining attention in the equine health scene. Early and accurate diagnosis is crucial to avoid unnecessary use of antibiotics and prevent antimicrobial resistance. Furthermore, veterinarians and horse handlers must be aware of the risks of spreading aspergillosis to humans, emphasizing preventative measures and respiratory protection.
A Case of a Patient With Spinal Muscular Atrophy With Dysphagia Who Acquired Vacuum Swallowing
Authors: Keishi Okamoto, Kenjiro Kunieda, Tomohisa Ohno, Mika Ogawa, Ichiro Fujishima
Journal: Cureus (2024)
Keywords: dysphagia, high-resolution manometry, lower esophageal sphincter, negative pressure in esophagus, neuromuscular disorders, pharyngeal pressure, swallowing disorders, vacuum swallowing
MeSH terms: Case Reports

We present a case of acquired vacuum swallowing in a patient with spinal muscular atrophy associated with dysphagia. A 67-year-old male presented with spinal muscular atrophy. Even though he was able to eat orally, he required a long time to eat and faced difficulty while swallowing saliva, resulting in frequent spitting. Instructions regarding vacuum swallowing to eliminate pharyngeal residue were provided, and a reduction in meal duration and improved saliva swallowing were observed. High-resolution manometry revealed a significant increase in pharyngeal contractile integral and a significant decrease in esophageal pressure with vacuum swallowing, which enabled the passage of a bolus through the pharynx compared with non-vacuum swallowing. Furthermore, an increase in the lower esophageal sphincter pressure, reflecting diaphragmatic contraction, was also observed. Therefore, this case report elucidates that a patient with neuromuscular disorders could acquire vacuum swallowing with proper instructions.
A Single-System Ectopic Ureter in a Child: A Challenge for Early Diagnosis
Authors: Barbara A Reinig, Bianca M Silva, Marilyse Fernandes, Ana Luiza Onofre, Erika Veruska Paiva Ortolan
Journal: Cureus (2024)
Keywords: congenital anomaly of kidney and urinary tract, congenital anomaly of urinary tract, ectopic ureter, pediatric surgery, pediatric urology, ureter ectopic insertion, urinary incontinence (ui)
MeSH terms: Case Reports

An ectopic ureter is an uncommon anomaly, usually associated with a duplicated urinary system. Up to 20% of ectopic ureters occur in a single system. In females, only 25% of ectopic ureters insert into the vagina and usually cause urinary incontinence, which can be confused with vaginal discharge. The diagnostic investigation includes urinary tract ultrasound, DMSA, and urethrocystography, which evaluate renal morphology and function, determining factors for surgical treatment decision that aims to preserve renal function, prevent the recurrence of infections, and reestablish urinary continence. The rarity of this anomaly and the delay in recognizing symptoms are factors related to late diagnosis.
Organ donation after euthanasia in a patient living with dementia: a landmark case report
Authors: Nathalie van Dijk, Fabiënne Vliegen, Angelique Ham, Wim de Jongh, Freek Jan Berkhout, Jeroen Blankevoort, Rankie Ten Hoopen, Jan Bollen, Walther van Mook
Journal: Front Dement (2023)
Keywords: advance care, advance directive, case, dementia, euthanasia, legislation, organ donation
MeSH terms: Case Reports

Background:
Organ donation after euthanasia (ODE) has been performed over 100 times in the Netherlands, primarily involving patients suffering from a neurodegenerative or psychiatric disease. In recent years, the number of euthanasia cases related to dementia has increased in the Netherlands, with some patients living with dementia expressing a wish for organ donation after euthanasia.
Methods:
We describe a unique case of a 67-year-old female diagnosed with primary progressive aphasia as part of frontotemporal dementia who requested and underwent organ donation after euthanasia.
Results:
The patient had expressed her explicit wishes for both euthanasia and organ donation, which were discussed with her family physician, the Euthanasia Expertise Center (EE), and an organ donation coordinator. The patient was informed that to proceed with ODE, she should still be capable of voicing a voluntary and well-considered request for organ donation. The legally required euthanasia assessment procedure was carefully completed before ODE. Multiple healthcare professionals assessed the patient's competence, voluntariness, and unbearable suffering. Thereafter the patient's ODE request was granted, and both lungs and kidneys were successfully donated and transplanted. Post hoc analysis confirmed that all due diligence criteria for euthanasia were met, and the patient's relatives received an anonymous letter of gratitude from one of the organ recipients.
Conclusions:
This unique case demonstrates that ODE is feasible from medical, ethical, and legal perspectives in patients living with dementia. This case highlights several aspects essential to enable an ODE request by a patient living with dementia to be granted, such as the role of the physician performing euthanasia, the relevance of the decision-making capacity of the patient, the presence of an advance directive, and the involvement of and support by relatives and caregivers. However, several unresolved ethical issues surrounding ODE in patients with dementia, especially in patients with advanced stages of dementia, warrant further exploration, including the timing of discussing organ donation after the initial euthanasia request.
Case report: Fatal Legionella infection diagnosed via by metagenomic next-generation sequencing in a patient with chronic myeloid leukemia
Authors: Chunhong Bu, Shuai Lei, Linguang Chen, Yanqiu Xie, Guoli Zheng, Liwei Hua
Journal: Front Med (Lausanne) (2023)
Keywords: legionella pneumonia, bloodstream infection, case report, metagenomic next-generation sequencing, myeloid leukemia
MeSH terms: Case Reports

Legionella is an aerobic, gram-negative, intracellular pathogen and is an important cause of community-acquired pneumonia. Legionella pneumophila is the most common causative agent of Legionella pneumonia. Clinical diagnosis of Legionella pneumonia is challenging due to the lack of specific clinical manifestations and the low positive rates of conventional pathogen detection methods. In this study, we report a case of a patient with chronic myeloid leukemia who developed rigors and high fever after chemotherapy and immunotherapy. Chest computed tomography revealed consolidation in the left lower lobe of the lung and ground-glass opacities in both lower lobes. Multiple blood cultures showed Escherichia coli, Staphylococcus aureus, Bacillus licheniformis, and positive results in the β-D-glucan test (G test). The patient was treated with various sensitive antimicrobial agents, including meropenem plus fluconazole, meropenem plus carpofungin, and vancomycin. Unfortunately, the patient's condition gradually worsened and eventually resulted in death. On the following day of death, metagenomic next-generation sequencing (mNGS) of 1whole blood revealed L. pneumophila pneumonia with concurrent bloodstream infection (blood mNGS reads 114,302). These findings suggest that when conventional empirical antimicrobial therapy proves ineffective for critically ill patients with pneumonia, the possibility of combined Legionella infection must be considered, and mNGS can provide a diagnostic tool in such cases.
Nerve Root Compression Due to Contralateral Compensatory Hypertrophy: A Rare Case of Vertebral Artery Thrombosis
Authors: Ertugrul Cakir, Merve Nur Tasdemir, Alptekin Tosun
Journal: J Belg Soc Radiol (2023)
Keywords: compensatory, compression, computed tomography angiography, nerve root, thrombosis, vertebral artery
MeSH terms: Case Reports

In the patient who complained of dizziness, thrombus was observed in the right vertebral artery. Compression was detected in the nerve root due to compensatory hypertrophy in the left vertebral artery. In conclusion, in cases of unilateral vertebral artery thrombosis, should be aware of the pathologies that may develop in adjacent structures due to compensatory hypertrophy.
Teaching point:
An occluded vertebral artery (VA) can cause contralateral VA hypertrophy, which can cause various pathologies including nerve root compression.
Delivery of average assured pressure support (AVAPS) through tracheostomy in paediatric patients
Authors: Vishal Saddi, Antonia O'Connor, Ganesh Thambipillay, Arthur Teng
Journal: Respirol Case Rep (2023)
Keywords: average volume‐assured pressure support, paediatrics, tracheostomy
MeSH terms: Case Reports

Average volume-assured pressure support (AVAPS) mode has been available since 2009 and allows the ventilator to deliver a constant pre-set tidal volume by automatically adjusting the inspiratory pressures within a set range. Data in AVAPS mode use is limited in both paediatric populations, and in patients who are ventilated through a tracheostomy. This case series reports on the successful use of AVAPS mode in four paediatric patients with tracheostomy ventilation.
Clear Aligners and Miniscrews in a Scissor Bite Adult Treatment
Authors: Teresa Pinho, Duarte Rocha, Sara Gonçalves, Maria Luís Martins
Journal: Case Rep Dent (2024)
MeSH terms: Case Reports

Scissor bite does not correct spontaneously. It gradually worsens by overeruption, negatively affecting masticatory function. It is intended with this manuscript to evaluate the different treatment strategies to correct this malocclusion in adult patients, exploring treatment with clear aligners, bite ramps, and MS (miniscrews), especially in this case of a patient with unilateral right scissor bite, with high dental compensation in the three planes of space, asymmetrical sagittal dental position, overeruption on the scissor bite condition, and a high mandibular arch constriction and maxillary expansion. A comprehensive literature research was performed from 2002 until March 2023. PubMed and BVS databases were used, with the following keywords: "scissor bite OR brodie bite" AND "malocclusion" AND "treatment OR correction OR therapeutics". Since correcting skeletal asymmetries after the growth completion is challenging, adult patient cases often involve a combined orthodontic-surgical approach. In the present clinical case, the severe limitations to decompensating tooth positions for a surgical treatment, with the necessity to perform lower asymmetric extraction and a must longer orthodontic treatment, were the major reasons to avoid the surgical approach, after the scissor bite correction. In spite of this, the efficiency of the clear aligners and auxiliaries like bite ramps, MS, and elastics in successfully correcting a complex scissor bite in an adult patient was demonstrated, with significant esthetic and functional commitment, demonstrated by the case reliability PAR (peer assessment rating) index.
Case report: Successful treatment with contezolid in a patient with tuberculous meningitis who was intolerant to linezolid
Authors: Zhe Xu, Jing Zhang, Tingting Guan, Guichuan Wan, Chao Jiang, Linchuan Lang, Lianzhi Wang
Journal: Front Med (Lausanne) (2023)
Keywords: antituberculosis drugs, case report, contezolid, linezolid, tuberculous meningitis
MeSH terms: Case Reports

Tuberculous meningitis (TBM) is the most common form of central nervous system tuberculosis (TB) and the most severe form of extrapulmonary TB. It often presents with non-specific symptoms initially and has a high mortality and disability rate. With good central nervous system penetration, linezolid is recommended for treating drug-resistant, severe, or refractory tuberculous meningitis in China. Despite the benefits of linezolid on TBM treatment, the adverse effects of long-term therapy, such as myelosuppression, peripheral neuritis, and optic neuritis, are notable and can be severe and even life-threatening, leading to discontinuation and compromising treatment expectations. Contezolid is a novel oxazolidinone antibacterial agent approved by the National Medical Products Administration of China in 2021, which has a more favorable safety profile than linezolid in terms of myelosuppression and monoamine oxidase inhibition. Here we first report a case of TBM in a patient who was intolerant to antituberculosis treatment with linezolid and achieved good efficacy and safety results after the compassionate use of contezolid. Given the widespread use of linezolid in TB treatment and the potential risks for long-term use, multi-center prospective controlled clinical trials in TB and TBM patients are needed to investigate the appropriate use of contezolid further.
Management of Lipedema Beyond Liposuction: A Case Study
Authors: Victoria N Bouillon, Chandler S Hinson, MengJie Hu, Ronald M Brooks
Journal: Aesthet Surg J Open Forum (2023)
MeSH terms: Case Reports

Lipedema is a pathologic accumulation of adipose tissue in the subcutaneous layer of the extremities. This connective tissue disorder, which predominately affects females, is often misdiagnosed despite an incidence of ∼11%. Misdiagnosis often leads to delays in appropriate treatment, further increasing the morbidity of the condition. The authors report their facilities' experience in treating a patient with lipedema, requiring multiple surgical interventions involving liposuction and skin debulking to achieve desired aesthetic outcomes. The patient presented to the plastic surgery clinic with severe lipedema of the bilateral lower extremities. She previously underwent a panniculectomy and bilateral lower extremity liposuction without achieving the desired aesthetic results. Prior conservative management and liposuction alone were both unsuccessful treatment options and she required debulking procedures, along with further liposuction, as definitive management. The patient underwent 2 procedures at the clinic, both consisting of liposuction and panniculectomy of the lower extremities and buttocks. The procedures were conducted 1 year apart but were able to achieve the patient's desired aesthetics goals. Management of lipedema can be challenging, but not impossible. This case report shows that local excision is a viable option for treatment if minimally invasive options yield limited results.
Case Report: p40 phox deficiency underlying pediatric-onset systemic lupus erythematosus
Authors: Alejandro Nieto-Patlán, Natalia S Fernández Dávila, Yuqing Wang, Michelle Zelnick, Eyal Muscal, Martha Curry, James R Lupski, Steven M Holland, Bo Yuan, Douglas B Kuhns, Tiphanie P Vogel, Ivan K Chinn
Journal: Front Pediatr (2024)
Keywords: nadph oxidase complex, ncf4, inborn error of immunity, p40phox deficiency, pediatric sle, reactive oxygen species, systemic lupus erythematosus
MeSH terms: Case Reports

Introduction:
Systemic lupus erythematosus is a multi-faceted autoimmune disorder of complex etiology. Pre-pubertal onset of pediatric systemic lupus erythematosus (pSLE) is uncommon and should raise suspicion for a genetic driver of disease. Autosomal recessive p40 phox deficiency is a rare immunologic disorder characterized by defective but not abolished NADPH oxidase activity with residual production of reactive oxygen species (ROS) by phagocytic cells.
Case presentation:
We report the case of a now 18-year-old female with pSLE onset at 7 years of age. She presented with recurrent fever and malar rash. Aspects of her immune dysregulation over time have included typical pSLE features including production of autoantibodies, hematologic manifestations, and hypocomplementemia, as well as chronic suppurative skin lesions and recurrent infections. Genetic analysis revealed biallelic pathogenic variants in NCF4 resulting in p40 phox deficiency. Comprehensive NADPH oxidase activity studies confirmed significantly decreased production of reactive oxygen species, confirming the cellular phenotype seen in p40 phox deficient patients.
Conclusions:
Here, we present a patient with pSLE harboring biallelic variants in NCF4. Our patient represents a unique clinical presentation of severe onset autoimmunity in the setting of a rare inborn error of immunity affecting NADPH oxidase activity. This case underscores the need to consider genetic causes of pSLE in cases of pre-pubertal onset and atypical disease.
A Case Report of Yamaguchi Syndrome in a Saudi Male
Authors: Arwa Almehrij, AlReem Z AlSaleem, Ihab Suliman
Journal: Cureus (2024)
Keywords: apical cardiomyopathy, apical hypertrophic cardiomyopathy, apical hypertrophy, apical hypertrophy cardiomyopathy, saudi, saudi arabia, spade like cavity, yamaguchi cardiomyopathy, yamaguchi syndrome
MeSH terms: Case Reports

Apical hypertrophic cardiomyopathy, also called Yamaguchi syndrome, is a rare variant of hypertrophic cardiomyopathy. Yamaguchi syndrome is characterized by hypertrophy almost confined to the apical region of the left ventricle rather than the left ventricular septum. A case of 65-year-old Saudi man presented to the ER with angina, and the ECG, echocardiogram, and nuclear study confirmed the diagnosis with Yamaguchi. Reporting this case serves to help physicians broaden their vision in approaching patients with symptoms mimicking acute coronary syndrome.
Case Report: Leiomyosarcoma of the right external iliac artery: a diagnostic-based study on a rare case
Authors: Mpano Olivier, Ahmed Abu Ryash, Weiwei Yin, YuHui Bao, Qiangyong Zhou, Xi Wang, Guorong Chen, Xiaojian Yan
Journal: Front Oncol (2023)
Keywords: computed tomography, diagnosis, immunohistochemistry, leiomyosarcoma, smooth muscles
MeSH terms: Case Reports

Leiomyosarcoma (LMS) is an uncommon and aggressive form of cancer that originates in the smooth muscles. It possesses the capacity for rapid growth and often manifests with general, nonspecific symptoms arising from the displacement of nearby structures rather than direct invasion. In this particular instance, an 81-year-old woman presented with right lower abdominal pain, leading to the discovery of a mass adjacent to the right external iliac artery. In this case, the patient was misdiagnosed initially because of her nonspecific and poorly distinguished clinical symptoms. The laboratory results were within normal ranges. A well-defined tumor was detected through laparoscopic operation and subsequently surgically excised. The histopathological analysis of the tumor revealed the presence of malignant spindle cells, nuclear pleomorphism, and tumor giant cells. Immunohistochemistry tests indicated positive results for CD34 and Desmin, while CD117 and DOG1 showed adverse effects. It is worth noting that LMS of the right external iliac artery is an infrequent occurrence, potentially resulting in delayed diagnosis and misidentification. To enhance our comprehension of this uncommon cancer, more cases with detailed information are essential.
Examining Atherosclerosis Patterns in the Circle of Willis: A Case Study of Duplicated Anterior Communicating Artery
Authors: Tara Tritsch, Mohammadali M Shoja, Andrew Schleffer, R Shane Tubbs
Journal: Cureus (2024)
Keywords: anatomy, artery, atherosclerosis, cerebral, variations
MeSH terms: Case Reports

The anterior communicating artery (ACoA) plays a pivotal role in maintaining cerebral hemodynamics, as its diameter is a major determinant of blood collateralization through the circle of Willis following internal carotid artery occlusion. While variations of this artery are not uncommon, data on their clinicopathologic relevance are limited. In this report, we present our observation from a fresh cadaver of a male individual who had succumbed to cardiac causes. The circle of Willis displayed a duplicated ACoA with atherosclerosis that predominantly affected the posterior horn while sparing the anterior horn. The anterior horn was characterized by its shorter length and larger diameter compared to the posterior horn. The paper focuses on elucidating the microsurgical anatomy of this particular ACoA variant and exploring potential mechanisms that may underlie the pattern of atherosclerotic distribution within the circle of Willis. Based on this report, while further evidence is needed for confirmation, it is plausible that the existence of a duplicated ACoA may offer a protective mechanism, ensuring uninterrupted collateral circulation in the event of a blockage in one of the horns. Further analysis of the ACoA and its pattern of involvement in intracranial atherosclerosis is warranted, as the atherosclerotic patterns in this region hold clinical and pathological significance.
Epicardial Implantation of a Micra™ Pacemaker in a Premature Neonate with Congenital Complete Heart Block
Authors: Farida Karim, Daniel Peck, Shanti Narasimhan, Nicholas H Von Bergen
Journal: J Innov Card Rhythm Manag (2024)
Keywords: congenital complete heart block, micra™, pacemaker therapy, transvenous pacemaker
MeSH terms: Case Reports

Pacemaker implantation in neonates can be challenging due to their small size. Even pulse generators adapted for pediatric patients, such as the Microny device (Abbott, Chicago, IL, USA), are proportionately large in comparison to the size of the smallest newborns. Due to anatomic considerations, such as small vascular and ventricular sizes, leadless pacemakers and transvenous implantation in the youngest neonatal population remain unsuitable. Even so, the desire for leadless devices has prompted the industry to create the smallest pacemakers available. Adapting the smaller Micra™ transcatheter leadless pacing system (Medtronic, Minneapolis, MN, USA) for an epicardial pacing application may be advantageous to the smallest patients. This case illustrates the use of a Micra™ device modified with a header block to serve as the pulse generator in a ventricular epicardial pacing system for a 1-day-old, 2.68-kg patient with complete heart block.