OpenMed/multicare-articles huggingface dataset:
The language faculty that wasn't: a usage-based account of natural language recursion
Authors: Morten H Christiansen, Nick Chater
Journal: Front Psychol (2015)
Keywords: cultural evolution, domain-general processes, language evolution, language faculty, recursion, sequence learning, usage-based processing
MeSH terms: Review

In the generative tradition, the language faculty has been shrinking-perhaps to include only the mechanism of recursion. This paper argues that even this view of the language faculty is too expansive. We first argue that a language faculty is difficult to reconcile with evolutionary considerations. We then focus on recursion as a detailed case study, arguing that our ability to process recursive structure does not rely on recursion as a property of the grammar, but instead emerges gradually by piggybacking on domain-general sequence learning abilities. Evidence from genetics, comparative work on non-human primates, and cognitive neuroscience suggests that humans have evolved complex sequence learning skills, which were subsequently pressed into service to accommodate language. Constraints on sequence learning therefore have played an important role in shaping the cultural evolution of linguistic structure, including our limited abilities for processing recursive structure. Finally, we re-evaluate some of the key considerations that have often been taken to require the postulation of a language faculty.
Clostridium subterminale Septicemia in a Patient with Metastatic Gastrointestinal Adenocarcinoma
Authors: Kevin M Trapani, Leigh J Boghossian, Elizabeth Caskey
Journal: Case Rep Infect Dis (2018)
MeSH terms: Case Reports

Clostridium subterminale is a rare member of the Clostridiaceae family that is rarely cultured. This report examines a case of Clostridium subterminale cultured from the blood of a 72-year-old man who was ultimately diagnosed with metastatic gastrointestinal (GI) adenocarcinoma. The patient was receiving treatment for nosocomial pneumonia prior to culture of the C. subterminale, which led to suspicion for malignancy. Extensive GI and oncologic workup demonstrated multiple comorbidities and a primary GI cancer, which likely caused a breach in the GI mucosa and C. subterminale entrance into the bloodstream. After a prolonged intensive care unit (ICU) stay, the patient died on hospital day 23. Though rarely reported, C. subterminale septicemia has been demonstrated in patients with malignancy, specifically of the GI tract. Therefore, this case represents a typical C. subterminale septicemia patient. Given the prevalence of Clostridia and the contemporary emergence of multidrug resistant (MDR) microorganisms, both typical and atypical cases regarding rare members of the species have a significant role in the clinical management and public health planning.
Aspergillus Pericarditis with Tamponade in a Renal Transplant Patient
Authors: Sylvia Biso, Rapeepat Lekkham, Antoinette Climaco
Journal: Case Rep Cardiol (2017)
MeSH terms: Case Reports

Aspergillus pericarditis is a rare and life-threatening infection in immunosuppressed patients. It has nonspecific clinical manifestations that often mimic other disease entities especially in patients who have extensive comorbidities. Diagnosis is oftentimes delayed and rarely done antemortem. A high degree of suspicion in immunocompromised patients is necessary for evaluation and timely diagnosis. This is a case of Aspergillus pericarditis with cardiac tamponade in a renal transplant patient with liver cirrhosis. Two months after transplant, he developed decompensation of his cirrhosis from hepatitis C, acute cellular rejection, and Kluyvera bacteremia, followed by vancomycin-resistant Enterococcus faecium (VRE) bacteremia. Four months after transplant, the patient presented with lethargy and fluid overload. He subsequently developed shock and ventilator-dependent respiratory failure. An echocardiogram showed pericardial effusion with cardiac tamponade. He had emergent pericardiocentesis that showed purulent drainage. He was started on broad-spectrum antibiotics. Amphotericin B was initiated when the pericardial fluid grew mold that was later identified as Aspergillus fumigatus. The patient quickly decompensated and expired.
Successful Treatment of Invasive Mucormycosis in Orthotopic Liver Transplant Population
Authors: Taryn A Eubank, Constance M Mobley, Mozhgon Moaddab, Mark J Hobeika, Melissa O'Neal, William L Musick, Joshua M Knight, Joseph S Galati, Sudha Kodali, Akshay Shetty, David W Victor 3rd, Ashish Saharia, R Mark Ghobrial, Kevin A Grimes
Journal: Case Rep Transplant (2021)
MeSH terms: Case Reports

Mucormycosis is caused by ubiquitous fungi and encompasses a variety of different opportunistic syndromes in humans that disproportionately affect immunocompromised patients. Mortality has been documented to range between 50 and 100%; however, location of infection greatly dictates likelihood of survival. Treatment of mucormycosis involves aggressive surgical intervention and combination therapy of antifungal agents. In solid organ transplant recipients, immunosuppressive agents used to prevent rejection of the transplanted organ pose additional obstacles in the treatment of invasive fungal infections. We report on 3 high models for end-stage liver disease (MELD-Na) score orthotopic liver transplant (OLT) recipients who all were diagnosed with Rhizopus spp. infections with positive, 1-year outcomes after aggressive, individualized treatment.
Atypical Presentation of Atraumatic Spinal Subdural Hematoma Associated with Warfarin: A Case Report and Review of the Literature
Authors: Abdul Rehman Arain, Muhammad Moral, Saadia Shams, Khusboo Desai, Khunwar Kalsa
Journal: Case Rep Orthop (2019)
MeSH terms: Case Reports

Nontraumatic spinal subdural hematomas secondary to anticoagulants are remarkably rare. A case of spontaneous, atraumatic subdural hematoma involving the thoracic region in an 80-year-old woman on warfarin is reported. The patient presented with gross motor and sensory loss, delayed onset of incontinence, and no other symptoms. An MRI suggested an epidural hematoma concentrated around the T4-T9 levels. She was taken emergently to the OR approximately 30 hours after the initial onset of symptoms for a T3-T11 laminectomy. No epidural hematoma was noted. However, discoloration and bulging of the thecal sac were noted, and the dura was incised longitudinally from T2 to T10 revealing an expansive jelly-like blood clot which was evacuated. Postoperatively, the patient had regained 1/2 sensory function in the bilateral lower extremities. At the 2-week mark, the patient was still incontinent and showed 2/2 sensory and 2/5 motor functions in select muscle groups in her bilateral lower extremities. Completely nontraumatic, spontaneous subdural hematomas of the spine are very rare, and early surgical decompression within 24 hours from symptom onset may allow neurological recovery. Large extensive laminectomies up to 10 thoracic levels have been shown to be safe and effective in a few cases, including our case.
Wernicke's Encephalopathy: An Unusual Consequence of the Acquired Immune Deficiency Syndrome-Case Report and Literature Review
Authors: Timothy R Larsen, Dritan Dragu, Michael Williams
Journal: Case Rep Med (2013)

Introduction. Wernicke's encephalopathy is a well-described syndrome characterized by the classic triad of confusion, ataxia, and ophthalmoplegia. Wernicke's encephalopathy results from thiamine (vitamin B1) deficiency. Common causes include alcoholism and gastric disorders. Wernicke's has been described in patients with acquired immune deficiency syndrome (AIDS); however, given these patients' immunosuppressed state, the diagnosis of Wernicke's encephalopathy is not apparent. Case Presentation. A 31-year-old previously healthy male presented to the ER complaining of progressive dyspnea. Workup revealed HIV/AIDS and PCP pneumonia. He was treated and improved. On day 14 he became confused and developed nystagmus and ataxia. Considering his immunocompromised state, infectious and neoplastic etiologies topped the differential diagnosis. CT head was negative. Lumbar puncture was unremarkable. Brain MRI revealed increased T2 signal in the medial thalamus bilaterally. Intravenous thiamine was administered resulting in resolution of symptoms. Discussion. The classic triad of Wernicke's encephalopathy occurs in 10% of cases. When immunosuppressed patients develop acute neurologic symptoms infectious or neoplastic etiologies must be excluded. However, given the relative safety of thiamine supplementation, there should be a low threshold for initiating therapy in order to reverse the symptoms and prevent progression to Korsakoff dementia, which is permanent.
Quality-of-life benefits and evidence of antitumour activity for patients with brain metastases treated with gefitinib
Authors: A Katz, P Zalewski
Journal: Br J Cancer (2003)
MeSH terms: Antineoplastic Agents / therapeutic use, Brain Neoplasms / drug therapy, Carcinoma, Non-Small-Cell Lung / drug therapy, Lung Neoplasms / drug therapy, Neoplasm Recurrence, Local / drug therapy, Quinazolines / therapeutic use, Review, Brain Neoplasms / secondary, Carcinoma, Non-Small-Cell Lung / secondary, Gefitinib, Humans, Lung Neoplasms / pathology, Quality of Life, Antineoplastic Agents, Quinazolines, Gefitinib

Brain metastases are a common complication of non-small-cell lung cancer (NSCLC). The role of chemotherapy in the treatment of brain metastases has not been clearly defined. Emerging case reports of patients with recurrent NSCLC treated as part of the Expanded Access Programme reveal that gefitinib ("Iressa", ZD1839) has clinical activity in some patients with brain metastases. Here, we describe a number of case studies documenting the response of patients with brain metastases to treatment with gefitinib. Many of these patients had quality-of-life benefits with improvement of neurological and systemic symptoms; some had a partial response of their brain metastases and even complete responses have been seen in a few patients. One case report also describes a durable long-term response with concurrent treatment with gefitinib and radiotherapy. Such results call for larger trials designed to evaluate and define the role of gefitinib in the treatment of brain metastases in NSCLC patients, either as a single agent or in combination with radiation therapy.
A Case of Adult T-Cell Leukemia/Lymphoma Complicated with Bilateral Chylothorax
Authors: Satoko Kako, Satoru Joshita, Akemi Matsuo, Kenji Kawaguchi, Takeji Umemura, Eiji Tanaka
Journal: Case Rep Oncol Med (2019)
MeSH terms: Case Reports

We present the case of a 74-year-old Japanese woman who presented with dyspnea, a palpable right breast mass, and swollen right axillary lymph node. Imaging studies revealed bilateral pleural effusion and systemic lymph adenopathy and pleural fluid study showed high levels of triglycerides. A right inguinal lymph node biopsy disclosed malignant lymphoma cells that were human T-cell leukemia virus type 1 (HTLV-1) provirus DNA-positive, a condition endemic to patient's birthplace, by the Southern blot hybridization method. She was diagnosed as having adult T-cell leukemia/lymphoma (ATL) with chylothorax. After commencing chemotherapy for ATL, her chylothorax disappeared and swollen lymph nodes reduced remarkably, indicating an association between the chylothorax and ATL. Bilateral chylothorax is a relatively rare condition associated with such nontraumatic causes as ATL. Clinicians should therefore bear chylothorax in mind when encountering patients with pleural effusion. A detailed medical history can also enable prompt diagnosis and appropriate treatment.
Renal cell carcinoma with gallbladder metastasis: a case report
Authors: Hamza Dergamoun, Abdelaziz El Gdaouni, Imad Ziouziou
Journal: Pan Afr Med J (2022)
Keywords: renal cell carcinoma, case report, gallbladder, metastasis
MeSH terms: Carcinoma, Renal Cell / diagnosis, Carcinoma, Renal Cell / pathology, Carcinoma, Renal Cell / surgery, Gallbladder Neoplasms / diagnosis, Gallbladder Neoplasms / surgery, Kidney Neoplasms / diagnosis, Kidney Neoplasms / pathology, Kidney Neoplasms / surgery, Case Reports, Aged, 80 and over, Cholecystectomy, Female, Humans

Renal cell carcinoma (RCC) is the most frequent renal neoplasm, with a high rate of metastasis, especially in the lungs and bones. The gallbladder is one of the rare metastatic sites. We report an 80-year-old woman who presented with chronic right flank pain for the last six months. A computer tomography scan revealed a heterogeneous right renal mass measuring 86 ×76× 68 mm and multi lithiasis in the gallbladder. A right radical nephrectomy, lymphadenectomy, and cholecystectomy were performed. The postoperative clinical course was uneventful, without any complications. The histological results showed a clear RCC with metastasis to the gallbladder. After 12-months follow-up, the patient is free from disease. In conclusion, even though the coexistence of metastatic gallbladder from clear RCC is rare, the possibility of concurrence should be considered if suspected findings in the gallbladder are identified intraoperatively.
Suspected Neratinib Macular Toxicity Presenting As Macular Telangiectasia Type II
Authors: Moises Enghelberg, Syeda Kaifee
Journal: Cureus (2023)
Keywords: chemotherapy-related toxicity, maculopathy, retinal toxicity, tyrosine kinase receptor inhibitors, retina
MeSH terms: Case Reports

The purpose of this case report is to present the first case of neratinib maculopathy. We describe the initial presentation, baseline characteristics, imaging findings, and outcomes. The case report is accompanied by a thorough literature review including possible mechanisms of tyrosine kinase inhibitor (TKI) maculopathy. Neratinib is a novel TKI that is commonly used in the treatment of breast-associated malignancies. Neratinib toxicity presents similarly to macular telangiectasia type II but differs with the fine granular hypofluorescent areas spanning the limit of the posterior pole and vascular arcades as well as the nasal aspect of the optic nerve. We report a case of suspected macular toxicity secondary to neratinib. Concomitant use of neratinib in conjunction with docetaxel and other chemotherapeutics with known retinal side effects should alert clinicians of an increase in the risk of macular toxicity. Albeit commonly reported ocular side effects of TKIs, maculopathy is a rare and potentially overlooked side effect. Patients that have planned chemotherapy should undergo a baseline retinal examination.
Scleral Fixation of Akreos AO60 Intraocular Lens Using Gore-Tex Suture: An Eye on Visual Outcomes and Postoperative Complications
Authors: Mariana Leuzinger-Dias, Mário Lima-Fontes, Rita Rodrigues, Cláudia Oliveira-Ferreira, Carolina Madeira, Fernando Falcão-Reis, Vítor Fernandes, Amândio Rocha-Sousa, Manuel Falcão
Journal: J Ophthalmol (2021)

Purpose:
"In-the-bag" placement of an IOL is the Holy Grail for any cataract surgeon. However, in the absence of capsular integrity, alternative surgical options to place the IOL must be sought. We aim to report the clinical outcomes and safety profile of scleral-fixated Akreos AO60 intraocular lens implantation using Gore-Tex suture, combined with pars plana vitrectomy.
Methods:
This is a single-center, retrospective case series descriptive study. Electronic clinical records of all patients subjected to scleral fixation of a Bausch and Lomb Akreos AO60 IOL combined with pars plana vitrectomy, between April 1, 2017, and August 1, 2021, were reviewed. Data concerning age, sex, laterality, past ophthalmological history, pre- and postoperative best-available visual acuity, surgical indication, and intra- and postoperative complications were collected. Measured outcomes were the differences in best-available visual acuity and frequency of postoperative complications.
Results:
A total of 37 eyes (20 right eyes and 17 left eyes) from 36 patients (16 females and 20 males) were included in the statistical analysis. The mean age at time of surgery was 72.0 ± 12.4 years. The mean follow-up period was 548.9 days (range 39-1564 days). Globally, the mean best-available logMAR visual acuity improved from 1.61 preoperatively (0.025 decimal equivalent) to 0.57 postoperatively (0.3 decimal equivalent), this difference being statistically significant (P < 0.001). Indications for surgery included aphakia due to complicated cataract surgery (24.3%; n = 9); subluxated IOL due to closed trauma (21.6%; n = 8); PEX-related subluxated IOL (16.2%; n = 6); non-traumatic, non-PEX-related subluxated IOL (18.9%; n = 7); subluxated crystalline lens due to closed trauma (8.1%; n = 3); aphakia due to open-globe injury (5.4%; n = 2); silicone-induced IOL opacification (2.7%; n = 1); and aphakia post-endophthalmitis (2.7%; n = 1). Postoperative complications included transient ocular hypertension (27.0%; n = 10), transient corneal edema (18.9%; n = 7), cystoid macular edema (18.9%, n = 7), self-limited hypotension (5.4%, n = 2), self-limited vitreous hemorrhage (2.7%, n = 1), central retinal vein occlusion (2.7%, n = 1), late retinal detachment (2.7%, n = 1), and Akreos IOL opacification (2.7%, n = 1). No suture-related complications were observed.
Conclusion:
There was a statistically significant improvement in visual acuity after scleral fixation of Akreos AO60 intraocular lens using Gore-Tex suture, with no suture-related problems recorded. This procedure seems to be a valuable alternative for posterior chamber IOL placement when secondary IOL implantation is required.
Methotrexate and actinomycin D chemotherapy in a patient with porphyria: a case report
Authors: Yukiko Mikami, Tomonori Nagai, Yousuke Gomi, Yasushi Takai, Masahiro Saito, Kazunori Baba, Hiroyuki Seki
Journal: J Med Case Rep (2016)
MeSH terms: Antibiotics, Antineoplastic / therapeutic use, Antineoplastic Agents / adverse effects, Chorionic Gonadotropin / blood, Dactinomycin / therapeutic use, Hydatidiform Mole, Invasive / drug therapy, Hysterectomy, Lung Neoplasms / drug therapy, Methotrexate / adverse effects, Porphyria, Acute Intermittent / complications, Uterine Neoplasms / drug therapy, Case Reports, Antineoplastic Agents / administration & dosage, Drug Eruptions / drug therapy, Drug Eruptions / etiology, Female, Humans, Hydatidiform Mole, Invasive / secondary, Hydatidiform Mole, Invasive / surgery, Lung Neoplasms / secondary, Methotrexate / administration & dosage, Middle Aged, Pregnancy, Treatment Outcome, Uterine Neoplasms / pathology, Uterine Neoplasms / surgery, Antibiotics, Antineoplastic, Antineoplastic Agents, Chorionic Gonadotropin, Dactinomycin, Methotrexate

Background:
Despite their broadly recommended use as chemotherapeutic agents, the porphyrogenicity of methotrexate and actinomycin D have not been confirmed. Accordingly, it is not known whether these agents are safe for use in patients with porphyria.
Case presentation:
In this report, we present a case of an invasive mole with lung metastasis in a 49-year-old Japanese woman who had previously been diagnosed with acute intermittent porphyria at 27 years of age but had no recent history of acute intermittent porphyria attacks. Her serum human chorionic gonadotropin level was elevated 1 month after hysterectomy, and she was referred to our center for chemotherapy. After she received 100 mg of methotrexate, drug eruptions were observed starting on day 3 and grew progressively worse. Erythema and mucosal erosion spread throughout her body, whereupon she was administered prednisolone. In addition, our patient experienced febrile neutropenia and required granulocyte colony- stimulating factor treatment. No changes in our patient's urinary coproporphyrin or uroporphyrin levels were detected during this entire episode. Methotrexate was replaced by actinomycin D (0.5 mg/body intravenously on days 1-5 every 2 weeks). After five uneventful cycles of actinomycin D, our patient achieved and maintained a normal serum human chorionic gonadotropin level for 3 years.
Conclusions:
Methotrexate and actinomycin D did not induce acute porphyric attacks in this patient with acute intermittent porphyria; however, severe adverse effects were noted with methotrexate. Although further investigation is required, our data suggest that these agents are nonporphyrinogenic and can therefore be used to treat patients with comorbid porphyria.
Melorheostosis: a rare entity: a case report
Authors: Abdelhakim Kherfani, Hachem Mahjoub
Journal: Pan Afr Med J (2014)
Keywords: ct, mri, melorheostosis, sclerotic bone dysplasias
MeSH terms: Melorheostosis / diagnosis, Rare Diseases / diagnosis, Case Reports, Adult, Anti-Inflammatory Agents, Non-Steroidal / therapeutic use, Bone and Bones / abnormalities, Bone and Bones / pathology, Dentin Dysplasia / pathology, Female, Humans, Magnetic Resonance Imaging, Melorheostosis / drug therapy, Multimodal Imaging, Rare Diseases / drug therapy, Tomography, X-Ray Computed, Anti-Inflammatory Agents, Non-Steroidal, Dentin dysplasia sclerotic bones

Melorheostosis is a rare entity belonging to the group of sclerotic bone dysplasias. Described for the first time in 1922 by Leri, it remains imperfectly known as clinical presentations are highly variable, and the etiological diagnosis is not fully elucidated. We report a case of polyostoticmelorheostosis for which radiological investigations were complete, in order to study this disease.
Mediastinal abscess, an unusual way of presentation of eosinophilic esophagitis
Authors: Paul Gisasola, Ainara Iriarte, Martha Rosa Larez, Laura Casanova, Luis Bujanda
Journal: Allergy Asthma Clin Immunol (2019)
Keywords: eosinophilic, eosinophilic esophagitis, esophagitis, mediastinal abscess
MeSH terms: Case Reports

Eosinophilic esophagitis (EoE) is one of the most prevalent esophageal diseases and the leading cause of dysphagia and food impaction in children and young adults. EoE represents a chronic, local immune-mediated esophageal disease, characterized clinically by symptoms related to esophageal dysfunction and histologically by eosinophil-predominant inflammation. Mediastinal abscess is an uncommon condition that typically appears after esophageal perforations or thoracic surgeries, usually requiring treatment for surgical intervention due to its high morbidity-mortality. Mediastinal abscess, outside these two contexts, is extremely rare. We present the case of a mediastinal abscess secondary to EoE. It is important to think about this entity when there is a mediastinal abscess without trauma or previous surgery.