OpenMed/multicare-articles huggingface dataset:
Bilateral Angle Narrowing and Acute Myopia Induced by Indapamide: A Case Report
Authors: Ana Catarina Pedrosa, Joana Rodrigues Araújo, João Paulo Macedo, Sérgio Estrela Silva, António Melo, Fernando Falcão-Reis
Journal: Case Rep Ophthalmol Med (2018)
MeSH terms: Case Reports

Purpose:
To describe a clinical case of indapamide induced bilateral angle narrowing and acute myopia.
Materials and methods:
Clinical case report.
Results:
A 37-year-old Caucasian emmetropic man presented to the Emergency Department with complaints of acute-onset bilateral blurry vision, nine days after starting treatment for arterial hypertension with a combination of indapamide and amlodipine. Clinical examination revealed the presence of myopia and appositional closure of the anterior chamber angle. Ultrasound biomicroscopy and mode B ultrasonography disclosed bilateral ciliochoroidal effusion with anterior rotation of the ciliary body and iridocorneal angle narrowing. After intraocular pressure control with brimonidine and timolol, and replacement of indapamide/amlodipine by amlodipine only, the patient was discharged. Complete resolution of the clinical manifestations was observed after three weeks, with no sequelae.
Conclusions:
Indapamide may cause acute myopia and angle closure secondary to ciliochoroidal effusion that are fully reversible after drug withdrawal, as long as timely diagnosis is established. Therefore, indapamide, as well as other sulfonamide-derived drugs, must always be considered in the differential diagnosis of acute myopia and angle closure.
Pleomorphic adenoma of the external auditory canal
Authors: Sushma Aradhya, Namratha Ravishankar, Suchitha Satish
Journal: Autops Case Rep (2023)
Keywords: ear canal, immunohistochemistry, pathology, surgical
MeSH terms: Case Reports

Pleomorphic adenoma (PA) of the external auditory canal (EAC) is a rare clinical entity with a few cases reported in the literature. The clinical diagnosis of these lesions can be formidable due to their rarity and unusual location. This tumor occurs at various other anatomical locations apart from the major salivary glands. A 30-year-old female presented with a two-year history of a gradually enlarging and painless mass in the left external auditory canal. The tumor was excised, and histopathological and immunohistochemical evaluation revealed a mixed tumor with both epithelial and stromal components of different proportions, recognized and classified today by the World Health Organization (WHO) as a pleomorphic adenoma. The post-operative course was uneventful, and at the 10-month follow-up, no recurrence of the pleomorphic adenoma was noted. We highlight the histological features and the immunohistochemical profile of the tumor and review the literature on glandular neoplasms of the EAC and their recent classification, emphasizing on the histogenesis, clinical presentations, and microscopic features of the tumor. In addition, we aim to discuss vital features in differentiating these tumors from other tumors of the external auditory canal to enable clinicians and pathologists to recognize this uncommon benign neoplasm.
Velamentous cord insertion in a singleton pregnancy: an obscure cause of emergency cesarean-a case report
Authors: Juliana Rocha, Joana Carvalho, Fernanda Costa, Isabel Meireles, Olímpia do Carmo
Journal: Case Rep Obstet Gynecol (2012)

Approximately 2% of low-risk pregnant women still require an emergency Cesarean section after the onset of labor. Because it is likely that half of these cases are associated with placental and umbilical cord abnormalities, it is thought that prenatal detection of such abnormalities would reduce the number of emergency cesarean sections in low-risk women. Velamentous cord insertion is an abnormal cord insertion in which the umbilical vessels diverge as they traverse between the amnion and chorion before reaching the placenta. With a reported incidence of 1% in singleton pregnancies, it has been associated with several obstetric complications. This condition has been diagnosed by ultrasonography with a sensitivity of 67% and specificity of 100% in the second trimester. The present case highlights the importance of the systematic assessment of the placental cord insertion site at routine obstetric ultrasound and the potential of identifying pregnancies with velamentous insertion and, therefore, those at risk for obstetric complications.
Magnetic Resonance Imaging and Flexible Hysterofiberscopic Findings of a Uterine Adenofibroma: Case Report and Literature Review
Authors: Hideki Watanabe, Naoya Harada, Ichiro Nobuhara, Noriko Haruta, Yumi Higashiura, Shioka Watanabe
Journal: Case Rep Obstet Gynecol (2018)
MeSH terms: Case Reports

To our knowledge, highly detailed findings of flexible hysterofiberscopy in patients with adenofibroma have not been described. A 75-year-old nulliparous asymptomatic woman presented with a uterine polyp, which exhibited punctate heterogeneous hyperintensity or islands of isointense-to-hypointense signals on T2-weighted magnetic resonance imaging (MRI), hypointense signals on T1-weighted images (T1WI), and a little enhancement on contrast-enhanced T1WI. Flexible hysterofiberscopy revealed a red-pink polyp with a white-yellow, cobblestone-like surface easily deformed by perfusion fluid. The tumor was diagnosed histologically as an adenofibroma. Total abdominal hysterectomy and bilateral salpingo-oophorectomy were performed. The tumor in the uterus was necrotic macroscopically and histologically, and a residual adenofibroma could not be confirmed. At present, two years after surgery, the patient remains healthy. MRI and hysterofiberscopy can reveal the histological features of uterine adenofibromas and be useful for their diagnosis.
A Rare Case of Iatrogenic Inverted Stress Cardiomyopathy
Authors: Parviz-Ali Lotfian, Arun Umesh Mahtani, Seyed Zaidi, Richard Grodman
Journal: Methodist Debakey Cardiovasc J (2022)
Keywords: broken heart syndrome, myocardial disease, myocardiopathies, stress cardiomyopathy, takotsubo cardiomyopathy
MeSH terms: Takotsubo Cardiomyopathy / diagnostic imaging, Takotsubo Cardiomyopathy / etiology, Takotsubo Cardiomyopathy / therapy, Case Reports, Adult, Cardiac Catheterization / adverse effects, Female, Humans, Iatrogenic Disease

We discuss a case of a 42-year-old female who was admitted for chronic intractable lower back pain requiring elective spinal surgery. Postoperatively, she experienced chest pressure and abdominal pain with a notable elevation in cardiac markers. A cardiac catheterization and left ventriculogram revealed normal coronary arteries and basal anterolateral hypokinesis, with the normal movement of the distal segment of the anterior wall. A rare variant of stress cardiomyopathy was diagnosed.
An unanticipated diagnosis with bedside ultrasonography in patients with acute abdominal pain: rectus hematoma
Authors: Erden Erol Ünlüer, Eylem Kuday Kaykısız
Journal: Pan Afr Med J (2017)
Keywords: abdominal pain, hematoma, ultrasonography
MeSH terms: Abdominal Pain / etiology, Hematoma / diagnostic imaging, Rectus Abdominis / diagnostic imaging, Case Reports, Female, Hematoma / pathology, Humans, Middle Aged, Point-of-Care Testing, Tomography, X-Ray Computed / methods, Ultrasonography / methods

Although abdominal pain is a common presentation in emergency departments, rectus sheath hematoma (RSH) is among the rarest diagnosis. Here we present 2 cases of RSH likely caused by coughing due to upper respiratory tract infection. The two described cases were diagnosed by bedside ultrasonography and confirmed as RSH by computed tomography. Review of patient history and use of ultrasonography are important to avoid misdiagnosisof RSH.
Photodynamic therapy of extrahepatic cholangiocarcinoma using digital cholangioscopy
Authors: Vítor Ottoboni Brunaldi, José Eduardo Brunaldi, José Dirceu Vollet-Filho, Mariangela Ottoboni Brunaldi, José Celso Ardengh, Vanderlei Salvador Bagnato, José Sebastião Dos-Santos, Rafael Kemp
Journal: Arq Bras Cir Dig (2020)
MeSH terms: Bile Duct Neoplasms / diagnostic imaging, Bile Duct Neoplasms / drug therapy, Cholangiocarcinoma / diagnostic imaging, Cholangiocarcinoma / drug therapy, Endoscopy, Digestive System, Photochemotherapy, Case Reports, Aged, 80 and over, Bile Ducts, Intrahepatic, Fatal Outcome, Humans, Male

Background:
Photodynamic therapy (PDT) of an extrahepatic cholangiocarcinoma using a digital cholangioscopy to deliver the laser.
Background:
Cholangiocarcinoma is an aggressive neoplasm that usually requires palliative biliary drainage. Photodynamic therapy (PDT) has been described as a successful adjunct treatment to malignant biliary obstruction.
Aim:
To describe the use of digital cholangioscope to help provide laser light during biliary PDT session using locally developed light source.
Method:
Patient receives intravenous photosensitizer 24 h before the procedure. It starts with a regular duodenoscopy. After identification of the major papilla and retrograde cannulation, the digital cholangioscope is introduced into the common bile duct. Then, the cholangioscopic examination helps to identify the neoplastic stricture. Under direct visualization lighting catheter is advanced through the cholangioscope. Repositioning is recommended every centimeter to cover all strictured area. At the end of the procedure, a final cholangioscopy assesses the bile duct for the immediate result and adverse events.
Result:
This procedure was applied in one 82-year-old male due to obstructive jaundice in the last two months. EUS and ERCP revealed a severe dilation of the common bile duct associated with choledocholithiasis. Besides, was revealed dilation of hepatic duct up to a well-circumscribed hypoechoic solid mass measuring 1.8x2 cm compressing the common hepatic duct. The mass was deemed unresectable and the patient was referred for palliative treatment with PDT. He remained asymptomatic for three months. He perished due to complications 15 months after the PDT session.
Conclusion:
Digital cholangioscopy-guided biliary PDT is feasible and seems safe and effective as an adjunct modality in the palliation of extrahepatic cholangiocarcinoma.
Posterior leukoencephalopathy following repair of an ileocecal anastomosis breakdown: a case report and review of the literature
Authors: Pascal O Zinn, Rivka R Colen, Ekkehard M Kasper, Clark C Chen
Journal: J Med Case Rep (2011)

Introduction:
Posterior reversible leukoencephalopathy syndrome refers to a constellation of neurologic symptoms related to temporary white matter changes. The disease typically presents in the context of an abrupt and drastic elevation in blood pressure (>180/110 mmHg). We report an unusual case of posterior reversible leukoencephalopathy syndrome in a post-operative setting, with a blood pressure parameter generally tolerated by most patients.
Case presentation:
We report the case of a 22-year-old Caucasian man who suffered acute onset visual acuity loss four days after an ileocecal anastomosis. A head magnetic resonance imaging scan revealed findings typically associated with posterior reversible leukoencephalopathy syndrome. His symptoms developed in the context of blood pressure parameters that are typically well tolerated in a post-operative setting (150-160/80-90 mmHg). He did not have a history of renal failure or immunosuppression. His symptoms resolved with aggressive blood pressure management.
Conclusions:
Posterior reversible leukoencephalopathy syndrome can occur in a post-operative setting with blood pressure parameters typically well-tolerated in most post-surgical patients. Timely diagnosis and treatment will minimize the risk of permanent neurologic injury.
An Underlooked Cause of Periodic Fever (PFAPA) in an Adult Patient with No Response to Tonsillectomy
Authors: Fiaz Alam, Mohammed Hammoudeh
Journal: Case Rep Rheumatol (2018)
MeSH terms: Case Reports

Periodic fever with aphthous stomatitis, pharyngitis, and adenitis (PFAPA) is an autoinflammatory disease manifested as recurrent febrile episodes associated with one of the following cardinal features: aphthous ulceration, pharyngitis, and cervical adenitis. It was initially described in children and thought to be a disease of pediatric age group. Few adult cases were also reported in the literature. We describe the case of a 39-year-old female affected by PFAPA who presented with a history of febrile episodes associated with aphthous ulceration, stomatitis, and tonsillitis for 4 years. The febrile episodes occurred at a regular interval of 4 weeks and resolved within 5 days. The patient underwent tonsillectomy without any significant improvement. The patient responded only to a single high dose of steroid during the attack. Although PFAPA was initially thought to be a disease of pediatric age group, it should be considered in patients with recurrent febrile illness in all age groups.
Reconstruction of Elbow by Free Fibular Graft in a Case of Osteoclastoma of Proximal Ulna: A Rare Case Report
Authors: Kiran Kalaiah, S G Thejaswi, Marula Siddappa
Journal: Case Rep Med (2015)

Giant cell tumour is a benign aggressive bone tumour. Most commonly, it is seen in epiphysiometaphyseal region around knee and distal radius. Proximal ulna is a rare location for giant cell tumour. According to reports, only 4 such cases have been reported in English literature. We report one such case of giant cell tumour of proximal ulna. Patient presented with painless, progressive swelling around right elbow since 4 months. Proximal ulna along with tumour was resected and elbow was reconstructed using nonvascularized free fibular graft. At two years of follow-up, patient is tumour-free and has functional range of movement in elbow. We are reporting the case because of its rare location and for the indigenous treatment modality of using free fibular graft for elbow reconstruction.
The Relationship of Triphasic Waves with Intracranial Pressure as a Possible Prognostic Marker in Traumatic Brain Injury
Authors: Nakul Katyal, Aarti Sarwal, Pravin George, Biswajit Banik, Christopher R Newey
Journal: Case Rep Neurol Med (2017)
MeSH terms: Case Reports

Background:
Continuous electroencephalography (CEEG) monitoring is used for detection of convulsive and nonconvulsive seizures and assessing the degree of encephalopathy in critically ill patients. A commonly seen encephalopathic pattern on CEEG is generalized periodic discharges with triphasic wave (TW) morphology. The underlying role and prognostic significance of TW in relationship to intracranial pressure (ICP) remain unknown. We present a case highlighting the relationship of TW with ICP in a case with severe traumatic brain injury (TBI).
Method:
Case report.
Results:
A patient with severe TBI and no underlying metabolic abnormalities was admitted to the neurocritical care unit. TW were seen on CEEG. The TW diminished during episodes of intracranial hypertension but reappeared with reduction of the intracranial pressure.
Conclusion:
This study highlights a possible favorable prognostic marker of finding TW in a patient with intracranial hypertension. We have proposed a preliminary understanding of the relationship between TW and intracranial hypertension, which may be helpful in formulating future studies involving larger cohorts.
Rare Clinical Entity: Metastatic malignant struma ovarii diagnosed during pregnancy - Lessons for management
Authors: Corey J Lager, Ronald J Koenig, Richard W Lieberman, Anca M Avram
Journal: Clin Diabetes Endocrinol (2018)
Keywords: pregnancy, radioactive iodine, struma ovarii, thyroid cancer, thyroid imaging
MeSH terms: Case Reports

Background:
Malignant struma ovarii is an ovarian teratoma containing at least 50% thyroid tissue which has the potential to metastasize and produce thyroid hormone. Given its rarity, management strategies are not well-established. We report a case of metastatic malignant struma ovarii discovered during pregnancy with lessons for evaluation and management.
Case presentation:
A 30-year-old woman who was two months pregnant was discovered to have struma ovarii with over half of the struma comprised of papillary thyroid cancer. Following tumor resection, delivery, and thyroidectomy, she underwent evaluation with stimulated thyroglobulin testing and diagnostic staging sodium iodide-131 scan (I-131), which revealed the presence of skeletal metastases. Following administration of 320 mCi I-131, post-therapy scan also showed miliary pulmonary metastases with improved ability to localize the bony and pulmonary metastases with concurrent SPECT/CT imaging. A second dosimetry-guided I-131 therapy resulted in complete resolution of pulmonary metastases; however, small foci of residual bone disease persisted. Post-therapy scans demonstrated additional findings not shown on diagnostic I-131 scans obtained prior to both her initial and second I-131 therapy.
Conclusions:
SPECT/CT provides accurate anatomic correlation and localization of metastatic foci and can serve as a baseline study to assess interval response to treatment. Post-therapy scans should always be obtained when I-131 treatment is administered, as additional findings may be revealed versus low dose I-131 activity diagnostic scans. This patient had a high metastatic burden that would not have been discovered in a timely fashion with the conservative approach advocated by others. Thyroidectomy followed by a diagnostic staging radioiodine scan and a stimulated thyroglobulin level should be considered in patients with malignant struma ovarii for guiding therapeutic I-131 administration as metastatic risk is difficult to predict based on histopathologic examination.
Attentive-executive functioning and compensatory strategies in adult ADHD: A retrospective case series study
Authors: Martino Ceroni, Stefania Rossi, Giorgia Zerboni, Elena Biglia, Emiliano Soldini, Alessia Izzo, Lucia Morellini, Leonardo Sacco
Journal: Front Psychol (2022)
Keywords: adult adhd, attention, cognition, executive functions, socio-demographic factors

Background:
Adults with ADHD exhibit a neuropsychological profile that may present deficits in many cognitive domains, particularly attention and executive functions (EFs). However, some authors do not consider executive disfunction as an important part of the clinical profile of the syndrome; this could be related to the use of inappropriate neuropsychological tests, probably not adapted and not sufficiently ecological. Moreover, new data are required on specific correlation of attentive-executive symptoms with socio-demographic factors. Therefore, the aim of this study is to analyze the neuropsychological performance of a group of adults with ADHD, also evaluating the influence of gender, age and education level.
Methods:
We retrospectively collected health-related personal data of 40 adult ADHD patients, clinically diagnosed and evaluated via a battery of 4 neuropsychological tests and 1 self-administered questionnaire. Gender, age and years of education differences were assessed.
Results:
Attention and EFs deficits have been highlighted mainly on the d2-R and 5-point neuropsychological tests, which therefore seem to be more sensitive in measuring the attention-executive dysfunction in an adult ADHD population, than TAP Go/No-go and ROCFT. ADHD patients also manifested subjective behavioral impulsivity disorders on BIS-11. There were no statistically significant gender differences in cognitive performance. On the contrary, younger patients performed worse on subscales TAP Go/No-go errors and 5-points number of drawings, while participants with a higher education level performed better on subscales d2-R speed of execution and d2-R errors. This supports a reduction in the number of errors and the execution time as a function of older age and a higher level of education. Finally, patients with higher education also self-reported greater impulsivity in planning.
Conclusion:
Our preliminary findings suggest that adult ADHD is not a lifelong stable disorder, but it may change over time. Moreover, attention-executive deficits may be influenced and partially counterbalanced by experience (i.e., advancing age) and a higher level of education. This could underlie the development of specific psycho-behavioral and cognitive compensatory strategies. The use of self-administered questionnaires is therefore recommended to highlight attentional and executive difficulties that may not result in neuropsychological tests.
A unique complication associated with concurrent chemoradiation for the treatment of locally advanced head and neck cancer
Authors: Oren Cahlon, Ashok Shaha, Nancy Lee
Journal: Clin Med Oncol (2008)
Keywords: chemoradiation, complications, locally advanced head and neck cancer, radiation, toxicity
MeSH terms: Case Reports

Background:
Concurrent chemoradiation is becoming an increasingly popular treatment for patients with locally advanced head and neck cancer. The full extent of treatment related complications has not been completely documented in the literature.
Methods:
We present the case of a patient treated with definitive intensity modulated radiation therapy and concurrent carboplatin and fluorouracil for a locally advanced oral cavity and base of tongue cancer.
Results:
The patient suffered acute grade 4 dermatitis and mucositis during treatment. One month after completion of treatment, the patient was found to have permanent adherence of the tongue to the buccal mucosa as a result of severe scar tissue formation.
Conclusions:
As more patients undergo chemoradiation for the treatment of locally advanced head and neck cancer, the full extent of treatment related complications are being identified. To our knowledge, this is the first report of chemoradiation for head and neck cancer resulting in adherence of the tongue to the buccal mucosa.
A Giant Duodenal Leiomyoma Showing Increased Uptake on 18F-Fluorodeoxyglucose Positron Emission Tomography
Authors: Keisuke Nonoyama, Hidehiko Kitagami, Akira Yasuda, Shiro Fujihata, Minoru Yamamoto, Yasunobu Shimizu, Moritsugu Tanaka
Journal: Case Rep Surg (2018)
MeSH terms: Case Reports

Background:
Although 18F-fluorodeoxyglucose positron emission tomography (FDG-PET/CT) is now widely used in their differential diagnosis, it is sometimes difficult to distinguish between benign and malignant diseases.
Case presentation:
A 44-year-old woman was found to have abnormalities on health screening. Magnetic resonance imaging for detailed examination showed an intra-abdominal tumor measuring 12 cm in the major axis near the cranial end of the uterus. Upper gastrointestinal tract endoscopy showed a tumor with an ulcer in the third part of the duodenum, involving half the circumference. Heterogeneous uptake was observed within the tumor on FDG-PET/CT. Based on these findings, the patient underwent surgery for suspected primary malignant lymphoma of the duodenum or gastrointestinal stromal tumor. Laparotomy revealed a 12 cm tumor in the third part of the duodenum. Partial duodenectomy and end-to-end duodenojejunostomy were performed. Pathological findings showed a solid tumor growing from the muscle layer of the duodenum to outside the serous membrane; based on immunostaining, it was diagnosed as a leiomyoma.
Conclusions:
Duodenal leiomyomas are originally benign; to date, there have been no reports of uptake in duodenal leiomyomas on FDG-PET/CT; therefore, our case is rare. Leiomyomas should be considered in the differential diagnosis of duodenal neoplastic diseases.