OpenMed/multicare-articles huggingface dataset:
Characterization of retinal microvasculature in acute non-arteritic anterior ischemic optic neuropathy using the retinal functional imager: a prospective case series
Authors: Amanda D Henderson, Hong Jiang, Jianhua Wang
Journal: Eye Vis (Lond) (2019)
Keywords: blood flow velocity, non-arteritic anterior ischemic optic neuropathy, retinal functional imager

Background:
Non-arteritic anterior ischemic optic neuropathy (NAION) is the most common cause of acute optic neuropathy in patients over 50 years of age, and many affected individuals are left with permanent visual deficits. Despite the frequency of NAION and its often devastating effects on vision, no effective treatment has been established. Further understanding of the acute vascular effects in NAION, using advanced ophthalmic imaging techniques like the retinal function imager, may shed light on potential treatment targets.
Methods:
Five patients with acute NAION underwent retinal functional imaging within 2 weeks of the onset of their visual symptoms, and at 1 month and 3 months after onset. Average arteriolar and venular blood flow velocities were calculated for each eye at each time point. The Wilcoxon rank sum test was used to compare blood flow velocity results with a normative database.
Results:
The average arteriolar blood flow velocity in the normative group was 3.8 mm/s, and the average venular blood flow velocity was 3.0 mm/s, versus 4.1 mm/s and 2.7 mm/s, respectively, in the NAION-affected group at presentation. Average arteriolar blood flow increased slightly to 4.2 mm/s one month after the acute NAION event, then decreased to 3.8 mm/s three months after the event. Average venular blood flow velocity was 2.8 mm/s 1 month after the NAION event and 2.7 mm/s 3 months after the event. Differences in blood flow velocity between the NAION-affected and control groups were not statistically significant at any time point; however, there was a trend toward increasing blood flow velocity initially after an NAION, with a decrease over time.
Conclusions:
This study demonstrates the feasibility of retinal function imaging to quantify macular blood flow velocity in patients with acute NAION. There were no statistically significant differences in blood flow velocity detected between NAION-affected eyes and healthy controls at any of the time points examined; however, there was a trend toward an increase in both arteriolar and venular BFV subacutely, then a decrease in the chronic phase after NAION, which could be suggestive of a mechanism of attempted compensation in the setting of acute ischemia.
Determining the cause of intrauterine fetal death in monochorionic twins: A case report
Authors: Anxia Xie, Yan Cui, Gang Luo, Xianxia Chen, Xuecheng Zhang, Jie Han, Li Tong, Yanming Ren, Xiaoxing Wei
Journal: Front Med (Lausanne) (2023)
Keywords: case report, double-embryo transfer, fetal death, monochorionic dizygotic (mcdz) twins, partial trisomy 9, vascular anastomoses
MeSH terms: Case Reports

Background:
Determining the cause of intrauterine fetal death is essential for patients to manage their next pregnancy. However, in the majority of cases of fetal death, the cause remains unexplained despite comprehensive evaluation, especially in the cases of twins. Among twin pregnancies, conditions of monochorionic twinning, commonly regarded as monozygotic, are more complicated than dichorionic ones.
Case summary:
We systematically evaluated the cause of fetal death for a Han Chinese woman with monochorionic twinning following in vitro fertilization/embryo transfer. Discrepant karyotypes were unexpectedly discovered between the twins. One fetus had an aneuploid male karyotype (46, XY), dup (9) (p24.3-q13), and the other had a normal female karyotype (46, XX). We considered that the male died of aberration of chromosome 9 and the female died of subsequent acute exsanguination through vascular anastomosis.
Conclusion:
This study demonstrated the importance of recognizing the presence of monochorionic dizygotic twinning and the challenges of clinical management for twins following in vitro fertilization/double embryo transfer.
The dangers of hemilithotomy positioning on traction tables: case report of a well-leg drop foot after contralateral femoral nailing
Authors: Kai-Lan Hsu, Chih-Wei Chang, Chii-Jeng Lin, Chih-Han Chang, Wei-Ren Su, Shu-Min Chen
Journal: Patient Saf Surg (2015)
Keywords: contralateral leg, drop foot, hemilithotomy position, morbidity, peroneal palsy
MeSH terms: Case Reports

Background:
Postoperative contralateral morbidities after fracture fixation surgery by hemilithotomy positioning on traction table is uncommon. We'd report a case of unexpected common peroneal nerve palsy developed on the contralateral side manifesting with drop foot after a common orthopedic femoral nailing.
Case report:
A 28-year-old female sustained an unusual common peroneal nerve palsy manifesting contralateral drop foot after prolonged femoral nailing. Although the initial presentations were similar to the notorious well-leg compartment syndrome, a benign course with complete recovery in functions was observed 3 months later. After neurophysiologic exam and review of pertinent literature, this iatrogenic and transient dysfunction was delineated to be position-related neuropraxia.
Conclusion:
Position adjustment at intervals or complete avoidance of prolonged knee hyperflexion is recommended to prevent contralateral common peroneal nerve morbidity.
Concurrent Tumors Revealed by an Autopsy-A Case Report and Literature Review
Authors: Miruna Cristian, Mădălina Boșoteanu, Mariana Așchie, Angelica Potamian, Cătălin Adrian Boșoteanu, Gabriela Izabela Bălțătescu
Journal: Case Rep Gastrointest Med (2022)
MeSH terms: Case Reports

Introduction:
Multiple primary malignant neoplasms are an uncommon phenomenon, given the very low incidence of two or more different tumors, while neoplasm may be limited to a single organ or may involve multiple separate anatomical organs. The main purpose of this study is to highlight the importance of morphological and immunohistochemical tests to distinguish the origin of the primary tumor. Case Presentation. We report the case of a 65-year-old deceased male, presenting multiple tumors in the lung, stomach, kidneys, and adrenal organs. The main symptoms presented by the patient were dyspnea with a range of 77% with oxygen saturation, fatigability, and productive cough. Histopathological examination revealed a solid and papillary lung adenocarcinoma, concurrent with tubular gastric adenocarcinoma. Immunohistochemical testing was mandatory by using a panel of seven monoclonal mouse antibodies (TTF-1, Napsin A, CK7, CK20, p40, synaptophysin, and chromogranin A). The pulmonary tumoral immunophenotype (positive for TTF-1, Napsin A, CK7; negative for CK20, p40, synaptophysin, and chromogranin A) confirms the diagnosis of primary lung ADC and invalidates the hypothesis of a metastasis arisen from a gastric adenocarcinoma or other forms of lung cancer.
Conclusion:
The importance of the ancillary test is to distinguish a primary tumor from a metastatic one.
The Sedative Effect of Propranolol on Critically Ill Patients: A Case Series
Authors: Junji Shiotsuka, Andrew Steel, James Downar
Journal: Front Med (Lausanne) (2017)
Keywords: adrenergic beta-antagonists, delirium, hypnotics and sedatives, intensive care unit, propranolol, psychomotor agitation

Introduction:
Recent studies have examined the effectiveness of alpha-2 adrenergic agonists for controlling delirium and agitation. Propranolol, a non-selective beta-adrenergic antagonist with good penetration of the blood-brain barrier, has not been investigated for this purpose.
Materials and methods:
We retrospectively reviewed the medical records of all patients who were prescribed propranolol in our Medical Surgical ICU from January 1, 2010, to December 31, 2013. We recorded the sedation level and daily dose of sedatives, analgesics, and antipsychotics administered each day for 6 days after starting propranolol, and compared them to the day before starting propranolol.
Results:
Sixty-four patients met inclusion criteria. Thirty-eight episodes met exclusion criteria, leaving 27 patients (31 episodes). The administration of propranolol was associated with significant reductions in fentanyl equivalents (65%, p = 0.009), midazolam equivalents (57%, p = 0.048), propofol (16%, p = 0.009), and haloperidol (44%, p = 0.024) on day 2 after starting propranolol compared with baseline. A stratified analysis showed that these decreases were seen regardless of clinical improvement or deterioration.
Conclusion:
The use of propranolol was associated with a significant reduction in doses of sedatives and analgesia. Further studies are needed to determine whether propranolol may be a useful adjuvant for managing delirium and agitation in the ICU.
Uncharacteristic metastasis of a renal clear-cell carcinoma to the muscles of the forearm-case report
Authors: Oliwia Kozak, Paweł Turzyński, Karolina Markiet, Joanna Pieńkowska, Katarzyna Skrobisz-Balandowska, Michał Studniarek
Journal: BJR Case Rep (2017)
MeSH terms: Case Reports

Clear-cell renal carcinoma constitutes over 90% of all cases of renal cancers. One of the least common locations of metastases of this type of cancer are skeletal muscles. We believe that this is the first case ever presented of renal clear-cell cancer metastasis to the extensor digitorum muscle. Our case should sensitize clinicians and radiologists dealing with this type of carcinoma to the abundance of metastases, their uncommon locations and frequently asymptomatic nature, which all makes them easy to overlook on physical and imaging examinations.
Congenital Diaphragmatic Hernia with Gastric Volvulus and Splenic Herniation: An Unusual Delayed Presentation in a Six-Month Child
Authors: Mathayo Shadrack, Jamil Suleiman, David Msuya, Rune Philemon, Adnan Sadiq, Murad Tarmohamed, Jay Lodhia
Journal: East Afr Health Res J (2022)
MeSH terms: Case Reports

Background:
Acute gastric volvulus associated with congenital diaphragmatic hernia is an uncommon disorder in infancy and a surgical emergency.
Methods:
We present a six-month female baby who presented with clinical features of intestinal obstruction. Ultrasonography of the abdomen revealed gastric volvulus. The baby underwent emergency laparotomy. Gastric volvulus with splenic herniation was encountered through a diaphragmatic hernia.
Results:
The defect was corrected, the stomach and spleen were mobilized into the normal anatomical position. The baby recovered well.
Conclusion:
A high index of clinical suspicion and thorough radiological assessments are necessary for this life-threatening condition along with surgical correction of the abnormalities.
Case Report: Kasai Operation in Biliary Atresia After Extensive Bowel Resection
Authors: Szu-Han Chen, Kai-Chi Chang, Jia-Feng Wu, Huey-Ling Chen, Wen-Hsi Lin
Journal: Front Surg (2022)
Keywords: kasai operation, biliary atresia, malrotation, midgut volvulus, short bowel
MeSH terms: Case Reports

Biliary atresia (BA) is a major and devastating cholestatic liver disease in infancy. The Kasai procedure is an operation to re-establish bile flow from the liver into the intestine that can prevent the young infant from progressing rapidly to cirrhosis. The standard Kasai procedure includes the removal of extrahepatic bile duct remnants and reconstruction. We report a case of BA with short bowel due to previous small intestinal volvulus. This full-term female infant received extensive small bowel resection after birth due to intestinal volvulus. The length of the residual small bowel was 55 cm with an intact ileocecal valve. Because of progressive cholestasis and clay stool, another laparotomy was performed under the diagnosis of BA on the 52 days old. After dissection of the hepatic portal area, a segment of the colon instead of intestine was used as a biliary conduit to avoid further shortening her small bowel. The patient recovered from the procedure uneventfully and the parenteral nutrition was discontinued 2 weeks later. Two episodes of cholangitis happened after discharge. She gradually resumed body weight gain and the bilirubin level returned to normal range 6 months after the operation. This unique case demonstrated successful use of this specific procedure in the patient with BA and short bowel that have never been reported in the literature.
Multi-System Langerhans Cell Histiocytosis as a Mimic of IgG4-Related Disease: A Case Report and Literature Review
Authors: Xiaohui Feng, Lu Zhang, Fuqiong Chen, Gang Yuan
Journal: Front Endocrinol (Lausanne) (2022)
Keywords: igg4-related disease, langerhans cell histiocytosis, case report, central diabetes insipidus, diagnosis
MeSH terms: Histiocytosis, Langerhans-Cell / complications, Histiocytosis, Langerhans-Cell / diagnosis, Histiocytosis, Langerhans-Cell / pathology, Immunoglobulin G4-Related Disease / complications, Immunoglobulin G4-Related Disease / pathology, Pituitary Diseases / complications, Case Reports, Review, Research Support, Non-U.S. Gov't, Adult, Female, Humans, Immunoglobulin G, Thyroid Gland / metabolism, Immunoglobulin G

Langerhans cell histiocytosis (LCH) is a rare disease characterized by the clonal accumulation and/or proliferation of specific dendritic cells resembling normal epidermal Langerhans cells (LCs). Clinical manifestations are variable, depending on the affected tissues or organs, however, LCH with elevated serum IgG4 has not been reported. Herein, we reported a 26-year-old Chinese female multi-system LCH (MS-LCH) who first presented with central diabetes insipidus (CDI), accompanied by panhypopituitarism and hepatic dysfunction. Diagnostic investigations were strongly suspicious of IgG4-RD because of elevated serum IgG4 levels during the process. Furtherly, thyroid and lymph node involvement and biopsy led to the diagnosis of MS-LCH; the strongly positive staining of CD1a, S100, CD207 (langerin), and Ki67 was found. Moreover, after systemic treatment with five cycles of chemotherapy, many lesions were greatly improved. Since both LCH and IgG4-RD are orphan diseases that can affect any organ, the differential diagnosis is challenging, especially when LCH is associated with unexplained serum IgG4 elevation. In this article, the case of a young woman suffering from MS-LCH that affected organs including the pituitary, thyroid, lymph node, and liver was summarized, and relevant literature was reviewed to better equip the diagnosis and treatment in its early stages.
Capsule endoscopy: a cause of late small bowel obstruction and perforation
Authors: Anders Peter Skovsen, Jakob Burcharth, Stefan Kobbelgaard Burgdorf
Journal: Case Rep Surg (2013)

Case Report. A 71-year-old man was admitted to the department of gastroenterology with diffuse abdominal pain. Through the previous 12 months, the patient had experienced episodes of vomiting and watery diarrhea of increasing intensity as well as weight loss. The patient was evaluated with ultrasound, MRI, and subsequently a capsule endoscopy. Six months later, the patient presented, and an abdominal CT-scan showed mechanical small bowel obstruction with suspicion of metallic foreign body and perforation. Laparotomy showed perforation, stenosis, and foreign body, approximately 5 cm from the ileocecal valve. A right hemicolectomy and distal ileectomy (60 cm) with an ileostomy were performed. On further inspection of resection, a capsule endoscope was found impacted in a stenosis. The ileostomy was later reversed without complications. Conclusion. It is important to be aware of the possibility of capsule retention, especially in patients with known or suspected Crohn's disease, due to the propensity of Crohn's disease to form stenosis of the bowel. In cases where a stenosis is suspected, it is warranted to perform a patency capsule swallow before subjecting the patient to a capsule endoscopy.
Bacillus cereus Typhlitis in a Patient with Acute Myelogenous Leukemia: A Case Report and Review of the Literature
Authors: James D Denham, Sowmya Nanjappa, John N Greene
Journal: Case Rep Infect Dis (2018)
MeSH terms: Case Reports

Bacillus cereus is a Gram-positive rod that is now recognized as a rare cause of frank disease in the neutropenic hematologic malignancy patient. Because this pathogen is rarely isolated in clinical specimens, no large studies exist to guide the management of these acutely ill patients. Individual case reports and case series exist in the literature describing various clinical manifestations of B. cereus in the neutropenic patient including bacteremia/septicemia, pneumonia, meningitis/encephalitis, hepatic abscesses, and gastritis. In this report, we describe a case of typhlitis caused by B. cereus in a 74-year-old female with recently diagnosed acute myelogenous leukemia (AML), and we summarize the available English language literature to draw tentative conclusions regarding the clinical manifestations of this organism.
Identification of KIT and BRAF mutations in thyroid tissue using next-generation sequencing in an Ecuadorian patient: A case report
Authors: Santiago Cadena-Ullauri, Elius Paz-Cruz, Rafael Tamayo-Trujillo, Patricia Guevara-Ramírez, Viviana Ruiz-Pozo, Paola Solis-Pazmino, Cristhian Garcia, Richard Godoy, Eddy Lincango-Naranjo, Ana Karina Zambrano
Journal: Front Oncol (2023)
Keywords: cancer, case report, genomics, mestizo, thyroid
MeSH terms: Case Reports

Background:
The incidence of thyroid cancer has increased worldwide. Ecuador presents the highest incidence among Latin American countries and the second around the world. Genetic alteration is the driving force for thyroid tumorigenesis and progression. The change from valine (V) to glutamic acid (E) at codon 600 of the BRAF gene (BRAFVal600Glu) is the most commonly reported mutation in thyroid cancer. Moreover, the BRAF mutation is not the only mutation that has been correlated with TC. For instance, mutations and overexpression of the KIT gene has been associated with different types of cancer, including lung and colon cancer, and neuroblastoma.
Case presentation:
A woman in her early fifties, self-identified as mestizo, from Otavalo, Imbabura-Ecuador had no systemic diseases and denied allergies, but she had a family history of a benign thyroid nodule. Physical examination revealed a thyroid gland enlargement. The fine-needle aspiration biopsy indicated papillary thyroid cancer. The patient underwent a successful total thyroidectomy with an excellent recovery and no additional treatments after surgery. Using Next-Generation sequencing a heterozygous mutation in the BRAF gene, causing an amino acid change Val600Glu was identified. Similarly, in the KIT gene, a heterozygous mutation resulting in an amino acid change Leu678Phe was detected. Moreover, an ancestry analysis was performed, and the results showed 3.1% African, 20.9% European, and 76% Native American ancestry.
Conclusions:
This report represents the genetic characteristics of papillary thyroid cancer in an Ecuadorian woman with a mainly Native American ethnic component. Further studies of pathological variants are needed to determine if the combined demographic and molecular profiles are useful to develop targeted treatments focused on the Ecuadorian population.
Successful birth of an IVF baby in a patient with Parkinson's disease
Authors: Baxi Asha, Neema Hansali, Pauranik Apoorva
Journal: J Hum Reprod Sci (2010)
Keywords: anti-parkinsonian drugs, ivf, parkinson's disease, infertility, levodopa, pregnancy
MeSH terms: Case Reports

Parkinson's disease, although rare in young patients, may be encountered in the reproductive age group. We report a rare combination of this disease with infertility, which has not been previously reported. The case record of a 29-year-old woman with infertility and Parkinson's disease are retrospectively reviewed. An IVF indicated for tubal factor infertility resulted in a successful singleton pregnancy. She delivered a healthy male baby without experiencing any worsening of her Parkinsonism. The course of pregnancy remained unaffected by the Parkinson's disease and anti-Parkinsonian drugs. The details of the infertility management, antenatal and postnatal course, and medications are described. With careful evaluation, counseling, and monitoring, IVF may be safely used in women with Parkinson's disease.
Severe Aplastic Anemia following Acute Hepatitis from Toxic Liver Injury: Literature Review and Case Report of a Successful Outcome
Authors: Kamran Qureshi, Usman Sarwar, Hicham Khallafi
Journal: Case Reports Hepatol (2014)

Hepatitis associated aplastic anemia (HAAA) is a rare syndrome in which severe aplastic anemia (SAA) complicates the recovery of acute hepatitis (AH). HAAA is described to occur with AH caused by viral infections and also with idiopathic cases of AH and no clear etiology of liver injury. Clinically, AH can be mild to fulminant and transient to persistent and precedes the onset SAA. It is assumed that immunologic dysregulation following AH leads to the development of SAA. Several observations have been made to elucidate the immune mediated injury mechanisms, ensuing from liver injury and progressing to trigger bone marrow failure with the involvement of activated lymphocytes and severe T-cell imbalance. HAAA has a very poor outcome and often requires bone marrow transplant (BMT). The findings of immune related myeloid injury implied the use of immunosuppressive therapy (IST) and led to improved survival from HAAA. We report a case of young male who presented with AH resulting from the intake of muscle building protein supplements and anabolic steroids. The liver injury slowly resolved with supportive care and after 4 months of attack of AH, he developed SAA. He was treated with IST with successful outcome without the need for a BMT.
Upper Ureteral Reconstruction with a Tapered Descending Colon after Failed Pyeloplasties in a 13-Year-Old Boy
Authors: Hideaki Nakajima, Hiroyuki Koga, Seitaro Kosaka, Mao Ikari, Geoffrey J Lane, Atsuyuki Yamataka
Journal: European J Pediatr Surg Rep (2023)
Keywords: long ureteral stenosis, tapered segment of the descending colon, ureteral reconstruction, ureteropelvic junction obstruction
MeSH terms: Case Reports

An 11-year-old boy was referred for further management of a 6-cm-long grossly stenosed ureter following two failed left ureteropelvic junction (UPJ) obstruction repairs elsewhere. A tapered segment of the descending colon (TDC) was used successfully for ureteral reconstruction. The UPJ was exposed through a left flank incision. The stenosed segment was excised; both ends appeared severely inflamed and thickened. Tissue interposition was required and ureteroplasty with a TDC was performed by incising the peritoneum adjacent to the excised ureter to mobilize the descending colon to the retroperitoneal space. To prepare the TDC, an 8-cm segment of the colon with intact blood vessels was isolated, tapered, and sutured into a funnel shape using a 14-Fr catheter as a temporary stent. After colocolostomy, the colon was returned to the abdominal cavity, the peritoneum was closed carefully to prevent vascular compromise, and the TDC was anastomosed to the ureter and renal calyx with interrupted absorbable sutures. A double J stent (DJS) and percutaneous nephrostomy tube were placed. Postoperative recovery was uneventful. The DJS was removed on day 50 after confirming smooth urine flow through both the ureter-TDC and calyx-TDC anastomoses. Diuretic renography performed 68 days postoperatively was unobstructed. The patient is currently well after 12 months follow-up. This would appear to be the first report of a TDC being used to create a funnel-shaped segment to reconstruct a long, grossly stenosed ureter. The TDC is simpler than the re-tubularizing colon but requires monitoring for postoperative mucus-related complications and malignant transformation.