OpenMed/multicare-articles huggingface dataset:
Internal hernia in a liver transplant recipien: a case report
Authors: Hironori Hayashi, Hiroyuki Takamura, Yoshinao Ohbatake, Masatoshi Shoji, Shin-Ichi Nakanuma, Hisatoshi Nakagawara, Tomoharu Miyashita, Hidehiro Tajima, Hirohisa Kitagawa, Takashi Tani, Koichi Shimizu, Tetsuo Ohta
Journal: Case Rep Surg (2013)

Biliary complications have great importance for liver transplant recipients because of affecting long-term prognosis. In rare situations, an internal hernia of the Roux-en-Y loop cause graft injury. A 42-year-old woman with a history of living donor liver transplantation 6 years ago presented with prolonged graft injury during the past 6 months. She suddenly developed ileus of the small bowel with internal hernia through the defect of the mesentery around the Roux-en-Y limb of the hepaticojejunostomy. Emergent surgery was performed to reduce the hernia and volvulus; also the mesenteric rent was closed with interrupted suture of silk. Internal hernia of the small bowel after liver transplantation is rare but causes graft injury due to associated biliary complications and rapid deterioration of patient's condition.
Fulminant systemic capillary leak syndrome due to C1 inhibitor deficiency complicating acute dermatomyositis: a case report
Authors: Ilse Gradwohl-Matis, Romana Illig, Hermann Salmhofer, Daniel Neureiter, Andreas Brunauer, Martin W Dünser
Journal: J Med Case Rep (2014)

Introduction:
Dermatomyositis is a chronic inflammatory disorder characterized by muscular and dermatologic symptoms with variable internal organ involvement. This is the first report on a patient with acute dermatomyositis and fulminant systemic capillary leak syndrome.
Case presentation:
A 69-year-old Caucasian woman with chronic dermatomyositis presented with clinical signs of severe hypovolemic shock and pronounced hemoconcentration (hematocrit, 69%). Her colloid osmotic pressure was 4.6mmHg. Following a bolus dose of prednisolone (500mg), fluid resuscitation was initiated. During volume loading, anasarca and acute respiratory distress rapidly developed. Echocardiography revealed an underfilled, hypokinetic, diastolic dysfunctional left ventricle with pericardial effusion but no signs of tamponade. Despite continued fluid resuscitation and high-dosed catecholamine therapy, the patient died from refractory shock 12 hours after intensive care unit admission. A laboratory analysis of her complement system suggested the presence of C1 inhibitor deficiency as the cause for systemic capillary leakage. The post-mortem examination revealed bilateral pleural, pericardial and peritoneal effusions as well as left ventricular hypertrophy with patchy myocardial fibrosis. Different patterns of endomysial/perimysial lymphocytic infiltrations adjacent to degenerated cardiomyocytes in her myocardium and necrotic muscle fibers in her right psoas major muscle were found in the histological examination.
Conclusions:
This case report indicates that acute exacerbation of chronic dermatomyositis can result in a fulminant systemic capillary leak syndrome with intense hemoconcentration, hypovolemic shock and acute heart failure. In the presented patient, the cause for diffuse capillary leakage was most probably acquired angioedema, a condition that has been associated with both lymphoproliferative and autoimmunologic disorders.
Spontaneous Tear of the Tibialis Anterior Tendon Presenting as a Pseudotumor
Authors: Aseel Al-Musaedi, Filip M Vanhoenacker
Journal: J Belg Soc Radiol (2023)
Keywords: mri, anterior tibialis tendon, pseudotumor, tendon rupture, ultrasound
MeSH terms: Case Reports

Teaching Point: Spontaneous rupture of the anterior tibial tendon at the ankle joint may mimic a tumor.
Maximizing Outcomes While Minimizing Morbidity: An Illustrated Case Review of Elbow Soft Tissue Reconstruction
Authors: Adrian Ooi, Jonathan Ng, Christopher Chui, Terence Goh, Bien Keem Tan
Journal: Plast Surg Int (2016)

Background. Injuries to the elbow have led to consequences varying from significant limitation in function to loss of the entire upper limb. Soft tissue reconstruction with durable and pliable coverage balanced with the ability to mobilize the joint early to optimize rehabilitation outcomes is paramount. Methods. Methods of flap reconstruction have evolved from local and pedicled flaps to perforator-based flaps and free tissue transfer. Here we performed a review of 20 patients who have undergone flap reconstruction of the elbow at our institution. Discussion. 20 consecutive patients were identified and included in this study. Flap types include local (n = 5), regional pedicled (n = 7), and free (n = 8) flaps. The average size of defect was 138 cm(2) (range 36-420 cm(2)). There were no flap failures in our series, and, at follow-up, the average range of movement of elbow flexion was 100°. Results. While the pedicled latissimus dorsi flap is the workhorse for elbow soft tissue coverage, advancements in microvascular knowledge and surgery have brought about great benefit, with the use of perforator flaps and free tissue transfer for wound coverage. Conclusion. We present here our case series on elbow reconstruction and an abbreviated algorithm on flap choice, highlighting our decision making process in the selection of safe flap choice for soft tissue elbow reconstruction.
Fertility sparing surgery for ovarian sex cord stromal tumors: a nine case series
Authors: Montassar Ghalleb, Hatem Bouzaiene, Sarah Sghaier, Hanen Bouaziz, Monia Hechiche, Jamel Ben Hassouna, Khaled Rahal
Journal: Pan Afr Med J (2018)
Keywords: sex cord stromal tumors, fertility, ovarian cancer, surgery
MeSH terms: Fertility Preservation / methods, Ovarian Neoplasms / surgery, Sex Cord-Gonadal Stromal Tumors / surgery, Adolescent, Adult, Chemotherapy, Adjuvant / methods, Child, Female, Humans, Lymph Node Excision / methods, Menstruation Disturbances / etiology, Ovarian Neoplasms / pathology, Pelvic Pain / etiology, Retrospective Studies, Salpingo-oophorectomy / methods, Sex Cord-Gonadal Stromal Tumors / pathology, Young Adult

Ovarian Sex Cord Stromal Tumors (SCST) are a rare disease carrying a good prognosis. They generally affect young women; therefore fertility preservation is a critical issue. Fertility Sparing Surgery (FSS) showed promising results in both oncologic safety and fertility preservation. A retrospective case series involving 9 patients diagnosed with SCST and treated with fertility sparing surgery at our institution was conducted between January 2000 and May 2015. The median age was 24 years old (10 to 39). The main clinical manifestation was pelvic pain seen in seven patients. Five patients complained about menstrual cycle disorders. The nine patients went through fertility sparing surgery; seven had conservative staging and the other two had a unilateral salpingo-oophorectomy. Three patients out of nine had a pelvic unilateral lymphadenectomy. Two patients received adjuvant chemotherapy. Only two patients presented locoregional recurrence that occurred respectively after 7 and 192 months. The treatment combined chemotherapy and surgery based on mass resection. One patient achieved a natural pregnancy after the treatment. FSS seems to be a suitable approach for SCST. However, more case series and meta-analysis should be conducted.
Takayasu's arteritis associated with eosinophilic gastroenteritis, possibly via the overactivation of Th17
Authors: Mikihiro Fujiya, Shin Kashima, Yuya Sugiyama, Takuya Iwama, Masami Ijiri, Kazuyuki Tanaka, Keitaro Takahashi, Katuyoshi Ando, Yoshiki Nomura, Nobuhiro Ueno, Takuma Goto, Kentaro Moriichi, Yusuke Mizukami, Toshikatsu Okumura, Junpei Sasajima, Daisuke Fujishiro, Kensaku Okamoto, Yuichi Makino
Journal: Gut Pathog (2018)
Keywords: eosinophilic gastroenteritis, takayasu’s arteritis, the overactivation of th17
MeSH terms: Case Reports

Background:
Takayasu's arteritis (TA) is a large-vessel vasculitis pathologically characterized by granulomatous necrotizing vasculitis with giant cells. Although the cause of TA is still unclear, genetic factors as well as immunological abnormalities, particularly the overactivation of Th1 and Th-17, are considered to play important roles in the pathogenesis of this disease. Eosinophilic gastroenteritis (EGE) is a type of refractory inflammation in which numerous eosinophils infiltrate the inflammatory area. It is known that the overactivation of Th2 is associated with the pathogenesis of EGE, although the cause of EGE is still unclear. The immunological abnormalities in TA are therefore thought to be different from those in EGE. To date, no cases of complication of TA and EGE have been reported.
Case presentations:
An 18 year-old female was diagnosed with EGE and treated with prednisolone. At 6 months after completion of the treatment, the patient experienced chest pain, and was diagnosed with TA. TH1 and TH17 immunity are thought to be involved with TA, while TH2 are considered to be involved with EGE. In this case, the expression of IL-17 mRNA in the colon mucosa greatly decreased after prednisolone treatment for EGE.
Conclusions:
This is the first report of TA complicated with EGE, and the overactivation of TH17 is considered to be associated with the pathogenesis of these two diseases.
An unusual cause of food-induced anaphylaxis in mothers
Authors: J Y Soh, W C Chiang, C H Huang, C K Woo, I Ibrahim, K Heng, A Pramanick, B W Lee
Journal: World Allergy Organ J (2017)
Keywords: anaphylaxis, galacto-oligosaccharide, pregnancy
MeSH terms: Case Reports

Background:
Galacto-oligosaccharides (GOS) are prebiotics added to commercial milk formula of infants and mothers. In recent years, cases of allergy related to GOS in atopic children have been reported in the South East Asian region.
Case presentations:
We describe a series of pregnant (n = 4) and lactating mothers (n = 2) who developed anaphylactic reactions after consumption of maternal milk formula containing GOS. All six subjects had pre-existing atopy and a positive skin prick test to GOS and 5/5 of the subjects who were tested had positive basophil activation tests to GOS. All of the mothers and their babies had normal neonatal outcomes after the reactions.
Conclusions:
The supplementation of GOS into milk and beverages in the Asian region should take into account the rare chance of allergenicity of GOS in the atopic population.
Epidural Fat and Perineural Adipose Tissue Septic Emboli Mimicking Peripheral Nerve Sheath Tumor in a Dog
Authors: Yael Merbl, Kelly M Ramsay, Ashley Hanna, Annie V Chen, Laura Anne White, Claire R Burbick
Journal: Case Rep Vet Med (2022)
MeSH terms: Case Reports

Summary. A 9-year-old 35.6 kg (90 lb) female neutered German Shepherd dog was admitted due to progression of tetraparesis. The dog presented pyrexia, mild leukocytosis, and nonambulatory tetraparesis with decreased general proprioception and withdrawal in all the limbs, with the front limbs more severely affected. Magnetic resonance imaging revealed T2-weighted image (WI) hyperintense, contrast-enhancing lesion at the level of the C6-C8 spinal nerves, and epidural fat, suspected to be an infiltrative neoplasm. Medical treatments during hospitalization included glucocorticoids, antibiotics, and supportive care. Euthanasia was elected 4 days later due to financial constraints, despite clinical improvement. Postmortem findings revealed septic emboli (SE) in the epidural fat exiting the canal and following the tract of the spinal nerve roots and nerves. Staphylococcus pseudintermedius was identified as the causative agent. Although the incidence of SE without severe systemic disease is considered low in dogs, it should be considered in the differential diagnosis of focal intraspinal disease.
Remote postoperative epidural hematoma after subdural hygroma drainage
Authors: Wellingson Silva Paiva, Arthur Maynart Pereira Oliveira, Almir Ferreira de Andrade, Roger Schmidt Brock, Manoel Jacobsen Teixeira
Journal: Case Rep Med (2010)
MeSH terms: Case Reports

Objective. Subdural hygroma is reported to occur in 5%-20% of all patients with closed head trauma, the treatment is controversial and in symptomatic cases surgical drainage is need. We report on a new case with remote acute epidural hematoma (AEH) after subdural hygroma drainage. Case Presentation. A 38-year-old man suffered blunt head trauma and had diffuse axonal injury grade III in CT scan. A CT scan that was late performed showed an increasing subdural fluid collection with mild mass effect and some effacement of the left lateral ventricle. We perform a trepanation with drainage of a hypertensive subdural collection with citrine aspect. Postoperative tomography demonstrated a large left AEH. Craniotomy and evacuation of the hematoma were performed. Conclusion. The mechanism of remote postoperative AEH formation is unclear. Complete reliance on neurologic monitoring, trust in an early CT scan, and a relative complacency after an apparently successful initial surgery for hygroma drainage may delay the diagnosis of this postoperative AEH.
Case report: Open water swimming as a possible treatment for asthma
Authors: Kirsty Greenfield, William Verling, Thomas Larcombe, Gary James Connett
Journal: Front Med (Lausanne) (2023)
Keywords: asthma, cold water shock, diving reflex, exercise induced asthma, involuntary panting, open water swimming, seasonal asthma
MeSH terms: Case Reports

Asthma is a complex medical problem for which currently available treatment can be incompletely effective. This case report describes a 49 year old woman who had suffered from asthma since her teenage years that resolved after she took up regular open water swimming. After sharing this case report with an international open water swimming community on social media, over one hundred people with asthma commented that their symptoms had also improved after taking up this activity. The mechanism whereby open water swimming might alleviate asthma has not been established. Possibilities include benefits to mental health, anti-inflammatory effects, being more fit, improved immune function and suppression of the bronchoconstrictive component of the diving reflex. Further research might usefully confirm or refute these clinical observations.
Leigh syndrome in an infant: autopsy and histopathology findings
Authors: Arushi Gahlot Saini, Debjyoti Chatterjee, Chandana Bhagwat, Sameer Vyas, Savita Verma Attri
Journal: Autops Case Rep (2021)
Keywords: basal ganglia, brain damage, chronic, leigh disease, mitochondrial diseases
MeSH terms: Case Reports

Leigh syndrome is an inherited neurodegenerative disorder of infancy that typically manifests between 3 and 12 months of age. The common neurological manifestations are developmental delay or regression, progressive cognitive decline, dystonia, ataxia, brainstem dysfunction, epileptic seizures, and respiratory dysfunction. Although the disorder is clinically and genetically heterogeneous, the histopathological and radiological features characteristically show focal and bilaterally symmetrical, necrotic lesions in the basal ganglia and brainstem. The syndrome has a characteristic histopathological signature that helps in clinching the diagnosis. We discuss these unique findings on autopsy and radiology in a young infant who succumbed to a subacute, progressive neurological illness suggestive of Leigh syndrome. Our case highlights that Leigh syndrome should be considered in the differential diagnosis of infantile-onset, subacute neuroregression with dystonia and seizures, a high anion gap metabolic acidosis, normal ketones, elevated lactates in blood, brain, and urine, and bilateral basal ganglia involvement.
Case Report: The Coronal Magnetic Resonance Imaging of Three-Dimensional Fast-Field Echo With Water-Selective Excitation Can Identify the Wrapping of Spinal Nerve Fibers Into Subdural Tumors Prior to Operation
Authors: Tao Tang, Jinghong Yuan, Jianhua Yin, Junchao Zhu, Jingyu Jia, Xigao Cheng
Journal: Front Neurol (2022)
Keywords: cmri, cauda equina, sensitivity, specificity, subdural tumors
MeSH terms: Case Reports

Purpose:
In the present study, the authors intend to identify the spatial relationship between subdural tumors and spinal nerve fibers of cauda equina prior to operation using the coronal MRI of three-dimensional fast-field echo with water-selective excitation (CMRI).
Methods:
In total, 30 case series with surgically and pathologically verified subdural tumors were enrolled in the present study. The spatial relationship between subdural tumors and spinal nerve fibers of the cauda equina was assessed via conventional MRI and CMRI by three experts prior to operation. The spatial relationship between subdural tumors and spinal nerve fibers of the cauda equina was classified using CMRI. The accuracy of imaging observation was determined via intraoperative observation.
Results:
Though conventional MRI and gadolinium (Gd)-enhanced MRI (Gd MRI) cannot identify the spatial relationship between subdural tumors and spinal nerve fibers of cauda equina in all cases, CMRI can identify it prior to operation and divide the spatial relationship of spinal nerve fibers of cauda equina with subdural tumors into three types. CMRI shows higher sensitivity (97.44%) and specificity (90.47%) in identifying the spatial relationship of spinal nerve fibers of cauda equina with subdural tumors. Additionally, CMRI also showed a substantial agreement with a kappa value of 0.78.
Conclusion:
Herein, the authors first describe a potential novel application that CMRI can successfully identify the spatial relationship between subdural tumors and spinal nerve fibers of cauda equina prior to operation, which play an essential role in making a prudent surgical plan and preventing postoperative nerve damage.
Summary:
Intraoperative observation confirms spinal nerve fibers of cauda equina are often wrapped into subdural tumors of the thoracolumbar and lumbar region, which can result in a high rate of sensory and motor dysfunction after the operation due to the unconscious about the wrapping of nerves into subdural tumors prior to operation. To date, there is not an effective strategy to identify the wrapping before operation.
First bloodstream infection caused by Prevotella copri in a heart failure elderly patient with Prevotella-dominated gut microbiota: a case report
Authors: Patrizia Posteraro, Flavio De Maio, Giulia Menchinelli, Ivana Palucci, Federica Maria Errico, Mariantonietta Carbone, Maurizio Sanguinetti, Antonio Gasbarrini, Brunella Posteraro
Journal: Gut Pathog (2019)
Keywords: bloodstream infection, heart failure, microbiota, precision medicine, prevotella species
MeSH terms: Case Reports

Background:
Bloodstream infection (BSI) is a constant threat for hospitalized patients, and elderly patients are particularly susceptible to BSI caused by anaerobic bacteria. Changes in the gut microbiota composition may lead to pathogen overgrowth and translocation into the bloodstream. Consequently, domination of specific taxa in the intestinal bacterial community seems to be associated with a higher risk of bacteremia in some patient populations.
Case presentation:
Here, we report the case of a 90-year-old heart failure (HF) patient who was admitted to the hospital for an acute state of cardiac decompensation. Twenty days after admission, he was febrile to 38.2 °C whereas his white blood count and C-reactive protein increased to 6190 cells/μL and 31.2 mg/L, respectively. Of the patient's blood culture (BC) bottle pairs collected under the suspicion of infection, the anaerobic bottle yielded an organism that was later identified as Prevotella copri. Concomitantly, the patient's fecal sample was obtained for the intestinal microbiota characterization by sequencing the V3/V4/V6 regions of the bacterial 16S rRNA gene. The analysis revealed highest relative abundances of Bacteroidales (34.1%), Prevotellaceae (19.0%), Prevotella (15.2%), and P. copri (6.1%) taxa, indicating that the patient's gut microbiota was dominated by Prevotella organisms. The patient was successfully treated with metronidazole, and was discharged to a long-term care facility at 35 days of admission.
Conclusions:
We provide the first evidence for a clinically significant BSI caused by P. copri and its relationship to a Prevotella-rich gut microbiota in the HF patient setting. When strengthening the pathogenicity of P. copri, the present case suggests that the gut may be a source of BSI caused by the rare anaerobic organism. Future studies are necessary to assess the role of the gut microbiota profiling for precise identification and targeted treatment of patients at high risk of BSI.
Case Report: Novel Homozygous Likely Pathogenic SCN1A Variant With Autosomal Recessive Inheritance and Review of the Literature
Authors: Ana Victoria Marco Hernández, Miguel Tomás Vila, Alfonso Caro Llopis, Sandra Monfort, Francisco Martinez
Journal: Front Neurol (2021)
Keywords: dravet syndrome, gefs+, scn1a, autosomal recessive inheritance, homozygous
MeSH terms: Case Reports

Dominant pathogenic variations in the SCN1A gene are associated with several neuro developmental disorders with or without epilepsy, including Dravet syndrome (DS). Conversely, there are few published cases with homozygous or compound heterozygous variations in the SCN1A gene. Here, we describe two siblings from a consanguineous pedigree with epilepsy phenotype compatible with genetic epilepsy with febrile seizures plus (GEFS+) associated with the homozygous likely pathogenic variant (NM_001165963.1): c.4513A > C (p.Lys1505Gln). Clinical and genetic data were compared to those of other 10 previously published patients with epilepsy and variants in compound heterozygosity or homozygosity in the SCN1A gene. Most patients (11/12) had missense variants. Patients in whom the variants were located at the cytoplasmic or the extracellular domains frequently presented a less severe phenotype than those in whom they are located at the pore-forming domains. Five of the patients (41.7%) meet clinical criteria for Dravet syndrome (DS), one of them associated acute encephalopathy. Other five patients (41.7%) had a phenotype of epilepsy with febrile seizures plus familial origin, while the two remaining (17%) presented focal epileptic seizures. SCN1A-related epilepsies present in most cases an autosomal dominant inheritance; however, there is growing evidence that some genetic variants only manifest clinical symptoms when they are present in both alleles, following an autosomal recessive inheritance.
Congenital Diaphragmatic Hernia Presenting in a 7-Day-Old Infant
Authors: Christopher Rouse, Luke Schmidt, Lee Brock, Angela Fagiana
Journal: Case Rep Emerg Med (2017)

A 7-day-old male infant presented to the emergency room after respiratory distress was noted at an outpatient well child check. On exam, he was observed to have tachypnea, increased work of breathing, and decreased breath sounds on the left side of the chest. On chest X-ray, he was found to have a left-sided congenital diaphragmatic hernia. The infant was transported to a tertiary care facility where the defect was repaired without complication. Interestingly, the mother had a history of a normal antenatal ultrasound, completed at 19 + 2 weeks of gestational age. This case report summarizes the challenges of diagnosing late-presenting congenital diaphragmatic hernia, associated malformations, possible etiologies, and prognosis.