OpenMed/multicare-articles huggingface dataset:
Exercise Therapy Using the Lumbar-Type Hybrid Assistive Limb Ameliorates Locomotive Function after Lumbar Fusion Surgery in an Elderly Patient
Authors: Yoshihiro Yasunaga, Kousei Miura, Masao Koda, Toru Funayama, Hiroshi Takahashi, Hiroshi Noguchi, Kentaro Mataki, Tomoyuki Asada, Keiji Wada, Yoshiyuki Sankai, Masashi Yamazaki
Journal: Case Rep Orthop (2021)
MeSH terms: Case Reports

The number of elderly people who undergo lumbar fusion surgery (LFS) has been increasing. Postoperative rehabilitation for them can be problematic due to lumbar stiffness. This is the first case report describing exercise therapy using the lumbar-type hybrid assistive limb (HAL) after multiple LFS in an elderly patient. An 83-year-old man underwent LFS at L4-S1. Additional fusion surgery at L2-3 for adjacent segment disease was performed 2 years after the primary surgery. Although the patient's leg pain declined, he had severe locomotive dysfunction at 3 months after his final surgery. He started exercise therapy using the lumbar-type HAL including sit-to-stand training and squat training 4 months after his final surgery. He performed 3 sets of 20 sit-to-stand and 20 squat repetitions with adequate rests in between sets. The HAL training was safely conducted every day for 12 weeks without adverse event. Timed up and go test (TUG), 1-minute sit to stand test (1MSTS), one-leg stand test (OLST), and Berg balance scale (BBS) were assessed as locomotive function measurement. Before HAL therapy, TUG, 1MSTS, OLST, and BBS were 18.1 sec, 20 times, less than 1 sec, and 47, respectively. He could not walk without assistance. After the exercise therapy with the lumbar-type HAL, his locomotive function dramatically improved. TUG, 1MSTS, OLST, and BBS were 12.2 sec, 25 times, 3.9 sec, and 52, respectively. Moreover, the patient could walk 60 meters continuously without assistance. The unique characteristics of the lumbar-type HAL to prevent the lumbar overload and assist the voluntary hip joint motion during exercise therapy may be effective for this patient with lumbar stiffness after LFS. Sit-to-stand training and squat training using the lumbar-type HAL are promising options to improve locomotive function in elderly patients after LFS.
First Report of IgG4 Related Disease Primary Presenting as Vertebral Bone Marrow Lesions
Authors: Debby van den Elshout-den Uyl, Clothaire P E Spoto, Mirthe de Boer, Tim Leiner, Helen L Leavis, Roos J Leguit
Journal: Front Immunol (2019)
Keywords: igg4-related disease, mri, bone marrow, histology, immunhistochemistry, plasma cell, spine, vertebra
MeSH terms: Immunoglobulin G4-Related Disease / diagnosis, Spinal Diseases / diagnosis, Case Reports, Aged, Humans, Immunoglobulin G4-Related Disease / pathology, Male, Spinal Diseases / pathology

IgG4-related disease is a fibro-inflammatory disorder characterized by swelling of tissues and affected organs accompanied by the development of scar tissue (fibrosis) and infiltration by IgG4 positive plasma cells. Almost any organ can be affected, including, but rarely, bone marrowinvolvement. Here we present a case of a 76-year-old male with IgG4-related disease presenting primarily with vertebral bone marrow lesions. Histopathology showed the typical features of storiform fibrosis, and increased IgG4 positive plasma cells. Treatment with corticosteroids significantly improved wellbeing and resolved lesion size on MRI.
Containment of a healthcare-associated COVID-19 outbreak in a university hospital in Seoul, Korea: A single-center experience
Authors: Sei Won Kim, Sung Jin Jo, Heayon Lee, Jung Hwan Oh, Jihyang Lim, Sang Haak Lee, Jung Hyun Choi, Jehoon Lee
Journal: PLoS One (2020)
MeSH terms: Betacoronavirus / genetics, Coronavirus Infections / epidemiology, Coronavirus Infections / prevention & control, Cross Infection / epidemiology, Cross Infection / prevention & control, Disease Transmission, Infectious / prevention & control, Hospitals, University, Pandemics / prevention & control, Pneumonia, Viral / epidemiology, Pneumonia, Viral / prevention & control, Case Reports, Adult, Aged, Aged, 80 and over, COVID-19, Coronavirus Infections / diagnosis, Coronavirus Infections / virology, Cross Infection / virology, Female, Health Personnel, Humans, Male, Middle Aged, Patients' Rooms, Pneumonia, Viral / diagnosis, Pneumonia, Viral / virology, Quarantine / methods, Retrospective Studies, Reverse Transcriptase Polymerase Chain Reaction, SARS-CoV-2, Seoul / epidemiology, Young Adult

Background:
Our hospital experienced the first healthcare-associated COVID-19 outbreak in Seoul at the time the first COVID-19 cases were confirmed in Korea. The first confirmed COVID-19 patient was a hospital personnel who was in charge of transferring patients inside our hospital. To contain the virus spread, we shutdown our hospital, and tested all inpatients, medical staff members, and employees.
Methods:
We retrospectively analyzed the results of SARS-CoV-2 RT-PCR testing according to the contact history, occupation, and presence of respiratory symptoms. Closed-circuit television (CCTV) was reviewed in the presence of an epidemiologist to identify individuals who came into contact with confirmed COVID-19 patients.
Results:
A total of 3,091 respiratory samples from 2,924 individuals were obtained. Among 2,924 individuals, two inpatients, and one caregiver tested positive (positivity rate, 0.1%). Although all confirmed cases were linked to a general ward designated for pulmonology patients, no medical staff members, medical support personnel, or employees working at the same ward were infected. Contact with confirmed COVID-19 cases was frequent among inpatients and medical support personnel. The most common contact area was the general ward for pulmonology patients and medical support areas, including clinical and imaging examination rooms. Finally, the total number of hospital-associated infections was 14, consisting of four diagnosed at our hospital and ten diagnosed outside the hospital.
Conclusions:
The robust control of the COVID-19 outbreak further minimized the transmission of SARS-CoV-2 in the hospital and local communities. However, there was also a debate over the appropriate period of hospital shutdown and testing of all hospital staff and patients. Future studies are required to refine and establish the in-hospital quarantine and de-isolation guidelines based on the epidemiological and clinical settings.
The onset of enhanced intestinal permeability and food sensitivity triggered by medication used in dental procedures: a case report
Authors: Aristo Vojdani, Jama Lambert
Journal: Case Rep Gastrointest Med (2012)

Enhanced intestinal permeability and food sensitivity are two of the many proven causes of gastrointestinal disorders. This present report describes a woman with no previous gastrointestinal (GI) complaints, who underwent dental root canal, bone graft, and implant procedures. Postsurgery she experienced an allergic reaction to the combined medications. In the weeks that followed, she presented with multiple food intolerances. Four weeks after the final dental procedure, she was assessed serologically for mucosal immune function, salivary, and blood-gluten reactivity, intestinal permeability, and other food sensitivities. Compared to her test reports from two months prior to her first dental procedure, the patient's results showed high total secretory IgA (SIgA) and elevated salivary antibodies to alpha-gliadin, indicating abnormal mucosal immunity and loss of tolerance to gluten. Her serologic assessments revealed immunoglobulin G (IgG) and IgA antibodies to a range of wheat/gluten proteins and peptides, gut bacterial endotoxins and tight junction proteins. These test results indicate gut dysbiosis, enhanced intestinal permeability, systemic gluten-reactivity, and immune response to other dietary macromolecules. The present case suggests that patients who experience severe allergic or pseudoallergic reactions to medication should be assessed and monitored for gut dysfunction. If left untreated this could lead to autoimmune reactions to self tissues.
Case report: A case of delayed cutaneous metastases from signet-ring cell mixed-type gastric cancer
Authors: Shaohua Yao, Peng Zhou, Yiqing Li, Qin Li
Journal: Front Oncol (2023)
Keywords: case report, cutaneous metastases, late recurrence, post operative metastasis, signet-ring cell gastric carcinoma
MeSH terms: Case Reports

Background:
Signet-ring cell gastric carcinoma is a highly malignant tumor, with the characteristics of strong invasiveness, rapid progression, a high degree of malignancy, and generally poor prognosis. The most common site of metastases is the abdominal organs, especially the liver, while delayed cutaneous metastases are rare.
Case presentation:
We report a case of cutaneous metastases on the head, groin, and thigh, which recurred 7 years after signet-ring cell gastric carcinoma surgery. The patient was diagnosed with a 2.0×1.5×1.0cm tumor at the angle of stomach, and treated with Billroth II distal gastrectomy accompanied with D2 lymph node dissection. According the pathology, the stage was pT1N3M0. Then the patient received two cycles of oxaliplatin and tegafur chemotherapy, which was discontinued due to the inability to tolerate the side effects of chemotherapy. Seven years after the surgery, the patient initially presented with a fleshy mass on the head and beaded nodules in the groin; then, the mass gradually became larger, along with the thighs turning red, swollen, and crusty. Firstly, the patient was diagnosed with "lower extremity lymphangitis" and treated mostly with anti-inflammatory, promote lymphatic return, detumescence and elastic force cannula in vascular surgery department. However, the symptoms relieved insufficient. Finally, the skin biopsy indicates a signet-ring cell gastric carcinoma cutaneous metastasis. The whole-body PET-CT examination showed multiple nodules with increased metabolism. Then the patient was transferred to The Department of Oncology for further chemotherapy.
Conclusion:
Our case highlights that gastric tumor recurrence and metastasis should be highly suspected when skin lesions appear in patients with signet-ring cell gastric carcinoma. At the same time, multidisciplinary consultation and close cooperation between surgeons, oncologists, and dermatologists are of great significance to the diagnosis and treatment of this disease.
A novel germline mutation of PTEN associated with brain tumours of multiple lineages
Authors: F J T Staal, R B van der Luijt, M R M Baert, J van Drunen, H van Bakel, E Peters, I de Valk, H K P van Amstel, M J B Taphoorn, G H Jansen, C W M van Veelen, B Burgering, G E J Staal
Journal: Br J Cancer (2002)
MeSH terms: Amino Acid Substitution, Brain Neoplasms / genetics, Frontal Lobe / pathology, Germ-Line Mutation, Meningeal Neoplasms / genetics, Meningioma / genetics, Mutation, Missense, Neoplasm Proteins / genetics, Neoplasms, Multiple Primary / genetics, Oligodendroglioma / genetics, Phosphoric Monoester Hydrolases / genetics, Point Mutation, Protein Serine-Threonine Kinases, Tumor Suppressor Proteins / genetics, Case Reports, Research Support, Non-U.S. Gov't, Adult, Apoptosis / genetics, Brain Neoplasms / pathology, Cell Division, Cell Lineage, DNA Mutational Analysis, DNA, Neoplasm / genetics, Enzyme Activation / drug effects, Genetic Predisposition to Disease, Humans, Insulin / pharmacology, Loss of Heterozygosity, Male, Meningeal Neoplasms / pathology, Meningioma / pathology, Models, Molecular, Neoplasm Proteins / chemistry, Neoplasm Proteins / physiology, Neoplasms, Multiple Primary / pathology, Oligodendroglioma / pathology, PTEN Phosphohydrolase, Phosphoric Monoester Hydrolases / chemistry, Phosphoric Monoester Hydrolases / physiology, Protein Conformation, Proto-Oncogene Proteins / metabolism, Proto-Oncogene Proteins c-akt, Transfection, Tumor Suppressor Proteins / chemistry, Tumor Suppressor Proteins / physiology, U937 Cells / drug effects, U937 Cells / enzymology, DNA, Neoplasm, Insulin, Neoplasm Proteins, Proto-Oncogene Proteins, Tumor Suppressor Proteins, AKT1 protein, human, Protein Serine-Threonine Kinases, Proto-Oncogene Proteins c-akt, Phosphoric Monoester Hydrolases, PTEN Phosphohydrolase, PTEN protein, human

We have identified a novel germline mutation in the PTEN tumour suppressor gene. The mutation was identified in a patient with a glioma, and turned out to be a heterozygous germline mutation of PTEN (Arg234Gln), without loss of heterozygosity in tumour DNA. The biological consequences of this germline mutation were investigated by means of transfection studies of the mutant PTEN molecule compared to wild-type PTEN. In contrast to the wild-type molecule, the mutant PTEN protein is not capable of inducing apoptosis, induces increased cell proliferation and leads to high constitutive PKB/Akt activation, which cannot be increased anymore by stimulation with insulin. The reported patient, in addition to glioma, had suffered from benign meningioma in the past but did not show any clinical signs of Cowden disease or other hereditary diseases typically associated with PTEN germline mutations. The functional consequences of the mutation in transfection studies are consistent with high proliferative activity. Together, these findings suggest that the Arg234Gln missense mutation in PTEN has oncogenic properties and predisposes to brain tumours of multiple lineages.
Molecular characteristics of multiple primary pulmonary nodules under a three-dimensional reconstruction model and relevant multi-omics analyses: a case report
Authors: Zhilin Luo, Yajie Xiao, Chengwen Luo, Liping Zhang, Runquan Zhou, Zhikun Zhao, Chao Sun, Dongfang Wu, Tianhu Wang
Journal: Front Oncol (2023)
Keywords: genomic profiling, multi-omics analyses, multiple primary lung cancer, three-dimensional (3d) reconstruction, tumor environment
MeSH terms: Case Reports

Background:
In addition to CT images and pathological features, many other molecular characteristics remain unknown about multiple primary lung cancer (MPLC) from intrapulmonary metastatic lung cancer.
Case presentation:
In this study, we reported a patient with an early-stage MPLC with both adenocarcinoma in situ (AIS) subtype and minimally invasive adenocarcinoma (MIA) subtype. The patient was diagnosed with more than 10 nodules and underwent precise surgery assisted by three-dimensional (3D) reconstruction at the left upper lung lobe. Whole-exome sequencing (WES) and multiple immunohistochemistry (mIHC) were performed to reveal the genomic profiling and tumor microenvironments of multiple nodules in this patient with MPLC. Based on 3D reconstruction location information, we found that the genomic and pathological results of adjacent lymph nodes were quite different. On the other hand, PD-L1 expression and the proportion of infiltrating lymphocytes in tumor microenvironments were all at a low status and did not vary in adjacent lymph nodes. Additionally, maximum diameter and tumor mutational burden levels were found to be significantly associated with CD8+ T cell proportion (p<0.05). Besides, CD163+ macrophages and CD4+ T cell proportion were higher in MIA nodules than in AIS nodules (p<0.05). This patient reached a recurrence-free survival of 39 months.
Conclusion:
Generally, in addition to CT imaging and pathological results, genomic profiling and tumor microenvironments may facilitate identifying the potential molecular mechanisms and clinical outcomes in patients with early-stage MPLC.
Acquired Fanconi Syndrome from Tenofovir Treatment in a Patient with Hepatitis B
Authors: Shirley X Jiang, John Duncan, Hin Hin Ko
Journal: Case Reports Hepatol (2023)
MeSH terms: Case Reports

Fanconi syndrome is a rare disease of generalized proximal tubule dysfunction which can be acquired secondary to certain medications, including tenofovir, a commonly used hepatitis B treatment. Signs and symptoms of ensuing renal wasting can be severe but vague, leading to potentially avoidable invasive investigations and delays in diagnosis. We present a case of a 62-year-old female with chronic hepatitis B on tenofovir treatment who was found to have subacute weakness, anorexia, and weight loss. She underwent extensive investigations including computed tomography (CT) imaging, bronchoscopy, upper and lower endoscopy, and psychiatric evaluation. Finally, persistent electrolyte derangements led to urine studies, which demonstrated acquired Fanconi syndrome secondary to tenofovir. After discontinuing tenofovir disoproxil fumarate and starting tenofovir alafenamide, her symptoms resolved and her renal function recovered. This case illustrates the importance of maintaining clinical suspicion for tenofovir-induced Fanconi syndrome, given the common use of tenofovir as first-line hepatitis B treatment and the availability of less nephrotoxic alternatives.
Cone Beam Computed Tomographic Evaluation and Diagnosis of Mandibular First Molar with 6 Canals
Authors: Shiraz Pasha, Bathula Vimala Chaitanya, Kusum Valli Somisetty
Journal: Case Rep Dent (2016)

Root canal treatment of tooth with aberrant root canal morphology is very challenging. So thorough knowledge of both the external and internal anatomy of teeth is an important aspect of root canal treatment. With the advancement in technology it is imperative to use modern diagnostic tools such as magnification devices, CBCT, microscopes, and RVG to confirm the presence of these aberrant configurations. However, in everyday endodontic practice, clinicians have to treat teeth with atypical configurations for root canal treatment to be successful. This case report presents the management of a mandibular first molar with six root canals, four in mesial and two in distal root, and also emphasizes the use and importance of Cone Beam Computed Tomography (CBCT) as a diagnostic tool in endodontics.
Early-Onset Alzheimer's Disease Masquerading as Catatonia
Authors: Aljoharah Alakkas, Aaron Meyer, Eric Debbold, Raisa Yagudayeva, Jonathan Bui
Journal: Case Rep Neurol Med (2020)
MeSH terms: Case Reports

A 35-year-old woman with a history of sexual trauma was brought in by her family for further evaluation of depressive symptoms and progressive decline in activities of daily living. She was admitted to the inpatient psychiatric unit for the treatment of suspected catatonia. After failure to respond to standard medical treatment, she received an extensive workup, which ultimately revealed a PSEN1 mutation consistent with early-onset Alzheimer's disease. Diagnosis was challenging because of her young age, lack of reliable family history, and reports of recent sexual abuse by her biological father. This case is a cautionary reminder for clinicians that end stages of dementia can present similar to catatonia with mutism, lack of spontaneous movement, and refusal to eat. The clues to the diagnosis were profound cortical atrophy and lack of improvement with optimal medical management.
Secondary congenital aphakia
Authors: Catalina Ionescu, Dana Dascalescu, Miruna Cristea, Speranta Schmitzer, Miruna Cioboata, Raluca Iancu, Catalina Corbu
Journal: Rom J Ophthalmol (2016)
MeSH terms: Capsulorhexis, Cataract / congenital, Rubella Syndrome, Congenital / complications, Vitrectomy, Case Reports, Aphakia / congenital, Child, Preschool, Hearing Loss, Sensorineural / congenital, Heart Defects, Congenital / virology, Humans, Intellectual Disability / virology, Male, Microcephaly / virology, Microphthalmos / virology, Treatment Outcome

Abstract
Purpose:
We present the clinical, paraclinical and therapeutic features in a patient with secondary congenital aphakia.
Methods:
A 2-year-old patient, diagnosed with congenital rubella syndrome including sensorineural deafness, congenital heart disease, intellectual disability, microcephaly, microphthalmia, and congenital cataract, presented to our clinic for the surgical treatment of cataract.
Results:
During the surgery, the absence of the lens' cortex was observed, hence, the final diagnose was of secondary congenital aphakia. Surgery was then continued with a posterior capsulorhexis and an anterior vitrectomy, deciding to postpone the implantation of the posterior chamber intraocular lens.
Too Aggressive Drop in Blood Pressure in a Hypertensive Male Leading to "Man-in-the-Barrel Syndrome"
Authors: Chamara Dalugama, Achila Jayasinghe, Udaya Ralapanawa, Shamali Abeygunawardena, Thilak Jayalath
Journal: Case Rep Neurol Med (2020)
MeSH terms: Case Reports

Introduction:
"Man-in-the-barrel syndrome" is a neurological phenotype with brachial diplegia, normal sensation, and preserved motor function of the lower limb. It has been described in various neuropathological conditions affecting the cerebral hemispheres, pons, upper spinal cord, and peripheral neurons. Severe hypotension leading to watershed infarctions leading to this phenotype has been reported. We describe the first case of "man-in-the-barrel syndrome" in a patient with a precipitous drop in blood pressure following oral antihypertensive medications. Case Presentation. A 75-year-old Sri Lankan male presented following a generalized tonic-clonic seizure to a tertiary care hospital. Upon recovery, he was noted to have severe brachia diplegia affecting shoulder movements with preserved hand muscle power and motor functions of the lower limb. The previous day, he was newly diagnosed with markedly elevated blood pressure without acute end organ involvement. Treatment with three antihypertensives had been initiated. Noncontrast CT of the brain revealed watershed infarctions affecting both cerebral hemispheres.
Conclusion:
It is generally unwise to lower blood pressure very rapidly, as ischemic damage can occur in vascular beds that are habituated to high levels of blood pressure in the brain. Ischemic damage caused by rapid lowering of blood pressure may rarely result in "man-in-the-barrel syndrome" leading to severe functional disability.
Severe asymptomatic maternal antepartum hyponatremia leading to neonatal seizures: prevention is better than cure
Authors: Enrico Valerio, Margherita Fantinato, Irene Alba Beatrice Giovannini, Eugenio Baraldi, Lino Chiandetti
Journal: Matern Health Neonatol Perinatol (2015)
Keywords: hyponatremia, intensive care, neonatal seizures, neonatology, newborn, obstetrics
MeSH terms: Case Reports

Background:
Pre-delivery maternal electrolyte derangements may reflect themselves in the newborn, since placental homeostasis determines electrolyte equilibrium between mother and fetus.
Case presentation:
A term newborn, transferred to our Neonatal Intensive Care Unit 1 h after birth for an apnoea episode, presented with initially left-sided, and subsequently generalized tonic-clonic seizures due to severe hyponatremia (119 mmol/L). Seizures rapidly ceased after electrolyte correction plus a phenobarbital bolus. Deep hyponatremia was also detected in the mother (123 mmol/L).
Conclusions:
As placental homeostasis determines electrolytes equilibrium between mother and fetus, obstetrics and neonatologists should be aware that any maternal dyselectrolytemia will reflect itself in the newborn; hence, it is fundamental to detect possible maternal electrolyte imbalances before delivery, in order to be prepared to timely correction of electrolyte derangements in the newborn.