OpenMed/multicare-articles huggingface dataset:
Report of an unusual combination of arterial, venous and neural variations in a cadaveric upper limb
Authors: Theodore G Troupis, Adamantios Michalinos, Vasiliki Manou, Dimitrios Vlastos, Elizabeth O Johnson, Theano Demesticha, Panayiotis Skandalakis
Journal: J Brachial Plex Peripher Nerve Inj (2014)
Keywords: brachial artery, brachial plexus, cephalic vein
MeSH terms: Case Reports

In this study an unusual combination of arterial, venous and neural variations discovered during dissection of cervical, axillary and brachial area of a cadaver is described. Variations are thoroughly described and literature is briefly reviewed. Lateral cord of brachial plexus was not formed; Eight Cervical root divided into anterior and posterior division before uniting with First Thoracic root and Upper Trunk was unusually short. Axillary artery gave origin to a superficial brachial artery and then continued as deep brachial artery. Multiple variations in typical axillary artery branches were present including existence of inferior pectoral artery. Cephalic vein was absent. A variety of interventions, from relative simple as central venous catheter placement to most complicated as brachial plexus injury repair demand thorough knowledge of area's regional anatomy. Familiarity with anatomic variations allows more precise and careful interventions. Research on these variations is valuable for anatomists and embryologists but also for clinicians because it may provide useful information for non - typical cases but also helps in raising a high level of suspicion.
Cornelia de lange syndrome
Authors: Naeimeh Tayebi
Journal: Indian J Hum Genet (2008)
Keywords: cornelia de lange syndrome, synophrys, distinctive facial features, long philtrum, malformation of upper limbs
MeSH terms: Case Reports

Background:
Cornelia de Lange syndrome (CDLS) is a rare multiple congenital anomaly syndrome characterized by a distinctive facial appearance, developmental delay, growth retardation, low birth weight, skeletal formation anomaly, and hirsutism.
Case:
Here for the first time a case of CDLS from Iran, a 15-week-old male infant who was refereed as a case of multiple congenital anomalies. Clinical investigation showed that the child was a case of CDLS.
Conclusion:
This is the first case report with CDLS in Iran.
McKittrick-Wheelock Syndrome: A Rare Case of Secretory Diarrhea
Authors: Mohammad Nabil Rayad, Noreen Mirza, Maria Bernardeth Herrera-Gonzalez, Yatinder Bains, Sarahi Herrera-Gonzalez
Journal: Case Rep Gastrointest Med (2022)
MeSH terms: Case Reports

McKittrick-Wheelock syndrome commonly presents with a triad of chronic secretory diarrhea, electrolyte disturbances, and renal failure. Secretory diarrhea is due to active ion secretion secondary to secretagogue secretion (cyclic adenosine monophosphate and prostaglandin E2). The mainstay of treatment for these lesions is surgical since it will arrest the loss of electrolytes that may lead to serious clinical consequences. Nonsteroidal anti-inflammatory drugs (NSAIDs) such as indomethacin may be used to decrease electrolyte secretion in patients that desire a nonsurgical approach. Our patient is unique in that this is the first case of a tubular adenoma with high-grade dysplasia leading to MWS and progressing to circulatory collapse with severe electrolyte disturbances. Aggressive replacement of fluids and electrolytes is essential to the survival of these patients.
Oto-tricho-tussia: An Unexpected Cause of Cough
Authors: Rebecca A Castro, Craig H Zalvan, Craig Berzofsky
Journal: Case Rep Otolaryngol (2020)
MeSH terms: Case Reports

Chronic cough is a frequently encountered condition with multiple etiologies. In patients with neurogenic chronic cough, peripheral laryngopharyngeal hypersensitivity of the vagus nerve stimulates the cough reflex. We present three cases of "Oto-tricho-tussia," describing hair within the ear canal stimulating Arnold's branch of the vagus nerve and triggering the urge-to-cough. All three patients experienced significant improvement or complete resolution of their cough symptoms after removal of the hair resting on their tympanic membrane and external auditory canal. We encourage ear canal examination and promotion of proper ear cleaning habits as this is an easily treatable consideration for the cause of chronic cough.
Congenital Syphilis Coinfection in a Preterm Infant with Early Onset Sepsis due to Enterobacter cloacae
Authors: Sakviseth Bin, Sethikar Im
Journal: Case Rep Infect Dis (2021)
MeSH terms: Case Reports

Introduction:
Syphilis is a tropical disease, caused by a spirochete Treponema pallidum, which can be transmitted transplacentally from untreated mothers to the fetus during any stages of pregnancy. Clinical manifestations of early congenital syphilis are variable and nonspecific. The diagnosis is based on the serology status of the mother, newborn clinical symptoms, and comparative serology titer between mother and newborn. Case Presentation. A late preterm female infant, appropriate for gestational age, was treated for severe early onset sepsis due to Enterobacter cloacae since day 2 of life. The coinfection with Treponema pallidum was suspected and confirmed at day 4 with clinical signs and a fourfold increase of rapid plasma reagin (RPR) compared to mother's serology. Combined with meropenem and amikacin, Benzyl-Penicillin was used for 10 days, thereby resulting in a significant clinical and laboratory improvement. The girl was discharged at day 18 and brought for regular follow-ups for both growth milestone and syphilis serology. RPR decreased fourfold at the age of 1 month.
Conclusion:
Syphilis should not be overlooked. The vertical transmission is preventable by an on-time treatment of the infected mother, triggered by a proper antenatal screening at the right time. Congenital syphilis should be ruled out in any challenging neonatal sepsis. The diagnosis tools and treatments are easily accessible and inexpensive in our economical settings.
Enhancing behavioral change with motivational interviewing: a case study in a Cardiac Rehabilitation Unit
Authors: Giada Pietrabissa, Martina Ceccarini, Maria Borrello, Gian Mauro Manzoni, Annamaria Titon, Ferruccio Nibbio, Mariella Montano, Gianandrea Bertone, Luca Gondoni, Gianluca Castelnuovo
Journal: Front Psychol (2015)
Keywords: brief strategic therapy, adherence, behavioral change, cardiac rehabilitation, cardiovascular disease, heart failure, motivational interviewing, self-care

Background:
Psychological interventions in cardiac rehabilitation programs appear relevant in as much they significantly contribute to achieve the goals of rehabilitation, to reduce the risk of relapses and to improve patients' adherence to therapy. To this aim, motivational interviewing (MI) has shown promising results in improving motivation to change and individuals' confidence in their ability to do so.
Objective:
The purpose of this article is to integrate theory with practice by describing a three-session case scenario. It illustrates how MI's skills and strategies can be used to enhance heart-healthy habits. MI may be synergistic with other treatment approaches and it is used here in conjunction with brief strategic therapy.
Conclusion:
By the use of MI principles and techniques, the patient reported an increase in his motivation and ability to change, developing a post discharge plan that incorporates self-care behaviors.
Clinical implications:
MI may be effective in motivating and facilitating health behavior change among obese patients suffering from heart failure.
Case Report: Intact Survival of a Marginally Viable Male Infant Born Weighing 268 Grams at 24 Weeks Gestation
Authors: Takeshi Arimitsu, Daiki Wakabayashi, Satoshi Tamaoka, Mona Takahashi, Mariko Hida, Takao Takahashi
Journal: Front Pediatr (2021)
Keywords: birth weight of 268 g, extremely low birth weight, family involvement, intact survival, male, marginally viable infant, minimal handling
MeSH terms: Case Reports

We report the case of a preterm small for gestational age male infant born at 24 weeks of gestation with a birth weight of 268 g who was discharged from our hospital without the requirement for home oxygen therapy or tube feeding. He did not experience severe intraventricular hemorrhage, periventricular leukomalacia, hearing disability, or any other serious complications. At that time (February 2019), according to the University of Iowa's Tiniest Babies Registry, he was the tiniest male infant in the world to survive without any serious complications other than severe retinopathy of prematurity that required laser therapy. Although the survival rate of infants with extremely low birth weight is improving worldwide, a high mortality rate and incidence of severe complications remain common for infants weighing <300 g at birth, particularly in male infants. In recent years, there have been frequent discussions regarding the ethical and social issues involved in treating extremely preterm infants weighing <400 g. Despite the challenges, reports of such infants surviving are increasing. Neonatal medicine has already achieved great success in treating infants weighing 400 g or more at birth. However, lack of evidence and experience may make physicians reluctant to treat infants weighing less than this. The present case demonstrates that intact survival of a marginally viable male infant with a birth weight of <300 g is possible with minimal handling and family involvement beginning shortly after birth. Our detailed description of the clinical course of this case should provide invaluable information to physicians around the world who treat such infants. This report will aid in the progress of neonatal medicine and help to address many of the social and ethical issues surrounding their care.
Occupational protein contact dermatitis: two case reports
Authors: Joana Rocha, Teresa Pereira, Artur Sousa-Basto, Celeste Brito
Journal: Case Rep Med (2010)
MeSH terms: Case Reports

Protein contact dermatitis (PCD) is a contact dermatitis caused by high-molecular-weight proteins. This entity has been reported with increasing frequency, most commonly as occupational hand dermatitis in food handlers. Clinically, it is characterized by a chronic and recurrent dermatitis with erythema, scaling, and fissures with acute exacerbations occurring a few minutes after contact with offending allergen. We report two cases in confectioners who presented with chronic hand dermatitis.
Autonomic dysfunction after moderate-to-severe traumatic brain injury: symptom spectrum and clinical testing outcomes
Authors: Lucia M Li, Ekawat Vichayanrat, Martina Del Giovane, Helen Hoi Lun Lai, Valeria Iodice
Journal: BMJ Neurol Open (2022)
Keywords: autonomic function | traumatic brain injury | sympathetic | parasympathetic | health outcome

Background:
Survivors of moderate-to-severe traumatic brain injury (msTBI) frequently experience troublesome unexplained somatic symptoms. Autonomic dysfunction may contribute to these symptoms. However, there is no previous study of clinical subjective and objective autonomic dysfunction in msTBI.
Methods:
We present results from two groups of patients with msTBI. The first, a case-control comparative study, comprises prospectively recruited msTBI outpatients, in whom we measured burden of autonomic symptoms using the Composite Autonomic Symptom Score (COMPASS31) questionnaire. The second, a descriptive case series, comprises retrospectively identified msTBI outpatients who had formal clinical autonomic function testing at a national referral autonomics unit.
Results:
Group 1 comprises 39 patients with msTBI (10F:20M, median age 40 years, range 19-76), median time from injury 19 months (range 6-299) and 44 controls (22F:22M, median age 45, range 25-71). Patients had significantly higher mean weighted total COMPASS-31 score than controls (p<0.001), and higher gastrointestinal, orthostatic and secretomotor subscores (corrected p<0.05). Total COMPASS31 score inversely correlated with subjective rating of general health (p<0.001, rs=-0.84). Group 2 comprises 18 patients with msTBI (7F:11M, median age 44 years, range 21-64), median time from injury 57.5 months (range 2-416). Clinical autonomic function testing revealed a broad spectrum of autonomic dysfunction in 13/18 patients.
Conclusions:
There is clinically relevant autonomic dysfunction after msTBI, even at the chronic stage. We advocate for routine enquiry about potential autonomic symptoms, and demonstrate the utility of formal autonomic testing in providing diagnoses. Larger prospective studies are warranted, which should explore the causes and clinical correlates of post-TBI autonomic dysfunction.
Primary renal primitive neuroectodermal tumour causing Budd-Chiari syndrome: a rare case report
Authors: Biswajit Mishra, S H Chandrashekhara, Smita Manchanda, Sudheer Arava
Journal: BJR Case Rep (2016)
MeSH terms: Case Reports

Primary Ewing's sarcoma/primitive neuroectodermal tumour (ES/PNET) of the kidney is a rare neoplasm characterized by an aggressive clinical course. Most often, ES/PNET arises in the chest wall and paraspinal locations, and less commonly in the limbs or the genitourinary tract. We present a rare case of renal ES/PNET presenting as Budd-Chiari syndrome.
A Successful Medical Treatment of Necrotizing Pneumonia in a Pediatric Patient
Authors: Herlina Uinarni, Felicia Nike, Andi Dwi Bahagia
Journal: Case Rep Pediatr (2020)
MeSH terms: Case Reports

Necrotizing pneumonia is a rare, serious complication of pneumonia in children. We present a case of a 20-month-old girl presenting with respiratory distress which later be diagnosed with necrotizing pneumonia. In this paper, we highlight the role of imaging such as chest X-ray, chest CT, and lung ultrasonography for diagnosis and the importance of intravenous antibiotic therapy for better outcome.
Flucytosine Pharmacokinetics in a Critically Ill Patient Receiving Continuous Renal Replacement Therapy
Authors: Megan E Kunka, Elizabeth A Cady, Heejung C Woo, Melissa L Thompson Bastin
Journal: Case Rep Crit Care (2015)

Purpose. A case report evaluating flucytosine dosing in a critically ill patient receiving continuous renal replacement therapy. Summary. This case report outlines an 81-year-old male who was receiving continuous venovenous hemofiltration (CVVH) for acute renal failure and was being treated with flucytosine for the treatment of disseminated Cryptococcus neoformans infection. Due to patient specific factors, flucytosine was empirically dose adjusted approximately 50% lower than intermittent hemodialysis (iHD) recommendations and approximately 33% lower than CRRT recommendations. Peak and trough levels were obtained, which were supratherapeutic, and pharmacokinetic parameters were calculated. The patient experienced thrombocytopenia, likely due to elevated flucytosine levels, and flucytosine was ultimately discontinued. Conclusion. Despite conservative flucytosine dosing for a patient receiving CVVH, peak and trough serum flucytosine levels were supratherapeutic (120 μg/mL at 2 hours and 81 μg/mL at 11.5 hours), which increased drug-related adverse effects. The results indicate that this conservative dosing regimen utilizing the patient's actual body weight was too aggressive. This case report provides insight into flucytosine dosing in CVVH, a topic that has not been investigated previously. Further pharmacokinetic studies of flucytosine dosing in critically ill patients receiving CVVH are needed in order to optimize pharmacokinetic and pharmacodynamic parameters while avoiding toxic flucytosine exposure.
Thoracic Aorta Aneurysm Repair in a Patient with a Solitary Kidney: Hybrid Surgery as a Bailout Procedure
Authors: Chris Bakoyiannis, Demetrios Moris, George Karaolanis, Nikolaos Patelis, Dimitrios Schizas, Sotirios Georgopoulos, Theodoros Liakakos
Journal: Front Surg (2016)
Keywords: hybrid surgery, stent-graft, thoracic aorta, thoracic endovascular aneurysm repair, vascular access
MeSH terms: Case Reports

Thoracic endovascular aortic repair (TEVAR) is an emerging treatment option for thoracic aorta aneurysms (TAA). Endovascular access is a challenge. We present a novel TEVAR technique in a patient with single kidney and a 6.4 cm TAA. Attempting to place a sheath through iliac arteries was unsuccessful. The decision to proceed to hybrid TEVAR was made. The protection of the solitary kidney was achieved through axillo-femoral bypass, followed by an end-to-side anastomosis between the aorta and a bifurcated graft. Through the graft, a stent was introduced in the thoracic aorta. With the use of contrast material, the right position of the graft was confirmed.
Early intervention combined with targeted treatment promotes cognitive and behavioral improvements in young children with fragile x syndrome
Authors: Tri Indah Winarni, Andrea Schneider, Mariya Borodyanskara, Randi J Hagerman
Journal: Case Rep Genet (2012)
MeSH terms: Case Reports

Fragile X syndrome (FXS) is the most common inherited cause of intellectual disability due to an expansion in the full mutation range (>200 CGG repeats) of the promoter region of the FMR1 gene leading to gene silencing. Lack of FMRP, a critical protein for dendritic spine formation and maturation, will cause FXS. Early environmental enrichment combined with pharmacological intervention has been proven to rescue dendritic spine abnormalities in the animal model of FXS. Here we report on 2 young children with FXS who were treated early with a combination of targeted treatment and intensive educational interventions leading to improvement in their cognition and behavior and a normal IQ.
CASE REPORT Successful Treatment of a Rare Massive Dabska Tumor
Authors: Oliver S Eng, Gregory L Borah, Christopher J Gannon
Journal: Eplasty (2013)
Keywords: dabska, abdominal, reconstruction, resection, tumor

Objective:
The Dabska tumor is a rare low-grade angiosarcoma first described in 1969 by Maria Dabska. Approximately 30 cases of varying presentations have been reported since its initial description.
Methods:
We describe a case of a 23-year-old woman presenting with a massive recurrent left flank hemangioendothelioma, at final resection diagnosed to be an endovascular papillary angioendothelioma (Dabska tumor). The sheer size of the tumor necessitated reconstructive surgery.
Results:
Successful abdominal reconstruction after radical resection of a Dabska tumor was achieved using local fasciocutaneous-type flaps.
Conclusion:
To our knowledge, this is the first case report describing reconstructive surgery following resection of an abdominal Dabska tumor.
Effect of splenectomy on type-1/type-2 cytokine gene expression in a patient with adult idiopathic thrombocytopenic purpura (ITP)
Authors: Fotios P Panitsas, Athanasia Mouzaki
Journal: BMC Blood Disord (2004)

BACKGROUND: In view of clinical observations and laboratory results that support a central role of the spleen in idiopathic thrombocytopenic purpura (ITP) pathophysiology, we studied the effect of splenectomy on type-1 and type-2 cytokine gene expression in an adult ITP case, refractory to conservative treatment. CASE PRESENTATION: The patient was subjected to splenectomy 9 months after the diagnosis with complete response, attaining platelet counts over 150 x 106/L within 10 days after the operation. Two consecutive blood samples were obtained from the patient, 3 and 7 months after the splenectomy for the purposes of this study. A control group consisted of 11 healthy adults. Peripheral blood mononuclear cells were prepared from each blood sample and cultured in vitro for 8 h with the addition of the mitogens phorbol myristate acetate and ionomycin. Total cellular RNA extracted from 106 cells was submitted to semiquantitave reverse transcriptase-polymerase chain reaction (RT-PCR) for the amplification of IL-2, IFN-gamma, IL-4, IL-5, and IL-10 metagraphs. The PCR products were run on ethidium-stained agarose gels, photographed and quantified by densitometry.A steep decrease of type-1 cytokine expression (IL-2, IFN-gamma) and their calculated sum expressing Th1 activity was observed at 7 months post-splenectomy compared to 3 months post-splenectomy, in parallel with a rise of platelet count from 190 x 106/L to 265 x 106/L. The change of type-2 cytokine expression (IL-4, IL-5, IL-10) was slight and the Th2 activity (IL-4+IL-5) remained largely unchanged. The Th1/Th2 ratio, that reflects the pathogenic disease-specific T-cell immune deviation, was accordingly reduced 7 months post-splenectomy (Th1/Th2 = 1.3) compared to 3 months (Th1/Th2 = 3.5). CONCLUSIONS: The reduction of the Th1/Th2 cytokine ratio that was observed over time after splenectomy was accompanied by full clinical remission. Nevertheless, the persistence of a type-1 polarization, even after several months following spleen removal, is suggestive of a more basic abnormality of the immune function in these patients.
Aortic Dissection in a Pregnant Patient without Other Risk Factors
Authors: Priya V Patel, Raanan Alter, Recia Frenn, Thaddeus P Waters
Journal: Case Rep Obstet Gynecol (2019)
MeSH terms: Case Reports

Background. An aortic dissection is a life-threatening condition in which the intima of the artery tears causing separation of the intima and media. Pregnancy places women at a significantly increased risk of common vascular events including venous thromboembolism, myocardial infarction, and stroke, while also increasing the risk of rarer vascular events such as aortic dissection and aortic rupture. Case. A 30-year-old previously healthy multiparous woman presenting at 36 weeks of pregnancy with a Type A aortic dissection. She underwent a combined emergent cesarean delivery followed by repair of her aortic root. Conclusions. Aortic dissection should be high on the differential for pregnant patients presenting with the characteristic complaints and physical exam findings given the high mortality rate associated with this vascular event. Teaching Points. (1) This report reviews the characteristic presentation, risk factors, and physical exam findings in a patient with an aortic dissection. (2) The report includes treatment options for pregnant patients based on the classification of the dissection.
A case of giant sarcomatoid carcinoma ex-pleomorphic adenoma of the parotid gland
Authors: Mehdi Hasnaoui, Mohamed Masmoudi, Nouha Ben Abdeljelil, Takwa Belaid, Khalifa Mighri
Journal: Pan Afr Med J (2020)
Keywords: parotid neoplasms, carcinoma, pleomorphic adenoma
MeSH terms: Adenoma, Pleomorphic / diagnosis, Parotid Neoplasms / diagnosis, Salivary Gland Neoplasms / diagnosis, Case Reports, Adenoma, Pleomorphic / pathology, Adenoma, Pleomorphic / surgery, Biopsy, Fine-Needle, Female, Humans, Magnetic Resonance Imaging, Middle Aged, Parotid Neoplasms / pathology, Parotid Neoplasms / surgery, Salivary Gland Neoplasms / pathology, Salivary Gland Neoplasms / surgery, Sarcoma / diagnosis, Sarcoma / pathology, Sarcoma / surgery, Salivary Gland Adenoma, Pleomorphic

Carcinoma ex pleomorphic adenoma is a rare malignant parotid neoplasm arising from primary or recurrent benign pleomorphic adenoma. Histologically, it can be sub-classified by upwards of eight different variations (e.g., myoepithelial carcinoma, salivary duct carcinoma, adenoid cystic carcinoma sarcomatoid carcinoma). We present the fourth case in the literature of sarcomatoid carcinoma arising from an underlying pleomorphic adenoma of the parotid gland. We present a case of a 47-year-old female who consulted for a left parotid mass of 15cm long axis. There was no facial paralysis. Fine needle aspiration cytology smears showed a pleomorphic adenoma. The parotid MRI showed a left parotid mass, with heterogeneous signal (hyposignal T1 and hypersignal T2 and in diffusion sequences). The patient underwent a total parotidectomy with a pleomorphic adenoma on extemporaneous examination. Histological examination of the part revealed a pleomorphic adenoma on which a sarcomatoid carcinoma developed. Therefore, a second operation occurred. We performed selective lymph node dissection carrying out the sectors I, II and III followed by radiotherapy. The evolution was favorable. In addition to its rarity, our case joins historical cases by its huge size.