OpenMed/multicare-articles huggingface dataset:
Translating antibiotic prescribing into antibiotic resistance in the environment: A hazard characterisation case study
Authors: Andrew C Singer, Qiuying Xu, Virginie D J Keller
Journal: PLoS One (2019)
MeSH terms: Drug Prescriptions / statistics & numerical data, Drug Resistance, Microbial, Rivers / microbiology, Research Support, Non-U.S. Gov't, Anti-Bacterial Agents / analysis, Databases, Factual, England, Fluoroquinolones / analysis, Macrolides / analysis, Seasons, Sewage / chemistry, Anti-Bacterial Agents, Fluoroquinolones, Macrolides, Sewage

The environment receives antibiotics through a combination of direct application (e.g., aquaculture and fruit production), as well as indirect release through pharmaceutical manufacturing, sewage and animal manure. Antibiotic concentrations in many sewage-impacted rivers are thought to be sufficient to select for antibiotic resistance genes. Yet, because antibiotics are nearly always found associated with antibiotic-resistant faecal bacteria in wastewater, it is difficult to distinguish the selective role of effluent antibiotics within a 'sea' of gut-derived resistance genes. Here we examine the potential for macrolide and fluoroquinolone prescribing in England to select for resistance in the River Thames catchment, England. We show that 64% and 74% of the length of the modelled catchment is chronically exposed to putative resistance-selecting concentrations (PNEC) of macrolides and fluoroquinolones, respectively. Under current macrolide usage, 115 km of the modelled River Thames catchment (8% of total length) exceeds the PNEC by 5-fold. Similarly, under current fluoroquinolone usage, 223 km of the modelled River Thames catchment (16% of total length) exceeds the PNEC by 5-fold. Our results reveal that if reduced prescribing was the sole mitigating measure, that macrolide and fluoroquinolone prescribing would need to decline by 77% and 85%, respectively, to limit resistance selection in the catchment. Significant reductions in antibiotic prescribing are feasible, but innovation in sewage-treatment will be necessary for achieving substantially-reduced antibiotic loads and inactivation of DNA-pollution from resistant bacteria. Greater confidence is needed in current risk-based targets for antibiotics, particularly in mixtures, to better inform environmental risk assessments and mitigation.
Reversible craniocervical dystonia associated with levofloxacin
Authors: Karlo J Lizarraga, Maria R Lopez, Carlos Singer
Journal: J Clin Mov Disord (2015)
Keywords: craniocervical dystonia, levofloxacin, quinolones, renal disease
MeSH terms: Case Reports

Background:
Dystonia is a hyperkinetic movement disorder related to dysfunction of inhibitory basal ganglia and cortical circuits. GABA is the major inhibitory neurotransmitter in the central nervous system. Quinolones can rarely produce serious neurologic effects, which have been attributed to impaired inhibition through GABA antagonism. We report a case of reversible craniocervical dystonia associated with oral levofloxacin.
Case presentation:
A 62-year-old man on hemodialysis presented with craniocervical dystonia 3 days after initiation of levofloxacin 500 mg. twice daily. Levofloxacin was discontinued. Seven days later the abnormal movements completely disappeared and did not recur in the following 3 months.
Conclusion:
Levofloxacin should be considered as a rare but potentially reversible trigger of craniocervical dystonia. Older age, renal impairment and high doses of the drug might be risk factors.
Idiopathic superior mesenteric vein thrombosis resulting in small bowel ischemia in a pregnant woman
Authors: Hao Lin, Chih-Che Lin, Wan-Ting Huang
Journal: Case Rep Obstet Gynecol (2011)
MeSH terms: Case Reports

Background. Small bowel ischemia due to superior mesenteric vein thrombosis (MVT) is rare during pregnancy. However, additional precipitating factors should usually be identified. Case. A 31-year-old woman, pregnant at 34 weeks, was sent to the emergency department because of acute peritonitis. An emergency exploration revealed a segmental gangrene of the small intestine without any mechanical obstruction. Together with the termination of pregnancy, resection of the damaged small bowel was performed, and an end-to-end enterostomy was followed. Based on the operative and pathological findings, small bowel ischemia might be attributed to superior mesenteric vein thrombosis. Conclusion. Hypercoagulation state normally found in pregnant women is believed to lead to this catastrophic condition without other precipitating factors.
Tuberculous Enteritis Presenting as Acute Appendicitis and Perirectal Abscess
Authors: Kelechukwu U Okoro, Maria Gomez De La Espriella, Douglas J Grider, Anthony W Baffoe-Bonnie
Journal: Case Rep Med (2018)
MeSH terms: Case Reports

Mycobacterium tuberculosis has a wide variety of presentations. A rare occurrence is gastrointestinal tuberculosis. It may occur anywhere along the alimentary canal but usually occurs in the ileocecum with rare involvement of the appendix.
Accidental Removal of a Carotid Endovascular Stent during Oropharyngeal Mass Biopsy
Authors: Charbel Rameh, Arnaud Deveze, Jean-Pierre Lavieille, Jacques Magnan, Melanie Sanjuan
Journal: Int J Otolaryngol (2009)
MeSH terms: Case Reports

A 54-year-old male patient, with a history of a right mandibular adenocarcinoma, previously excised, and treated with post operative chemo- and radio-therapy, presented with a right oropharyngeal necrotic mass of several months duration. His history is pertinent for a right internal carotid endovascular stenting 2 years prior to presentation. During biopsy of his oropharyngeal lesion, a specimen of tissue was retrieved, with the carotid stent within. There was no bleeding. To the best of our knowledge, there is no such case reported in the literature. We present this case as a reminder on the importance and risks of radiation-induced necrosis and its distortion of the surrounding anatomy, especially in the presence of foreign bodies or protheses.
Trichilemmal cyst of the eyelid: masquerading as recurrent chalazion
Authors: Manju Meena, Ruchi Mittal, Debarati Saha
Journal: Case Rep Ophthalmol Med (2012)
MeSH terms: Case Reports

A 52-years-old female presented with a history of a painless, progressive swelling in the left lower eyelid of one-year duration. The lesion was excised twice as a chalazion and recurred. Excisional biopsy of the mass was performed and histopathological findings were consistent with those of trichilemmal cyst. We report a rare case of trichilemmal cyst of the eyelid which was masquerading as chalazion for which the patient had undergone multiple surgeries. Wide excision was done and diagnosis was confirmed on histopathology. There was no recurrence seen till 2 months of postoperative period. Trichilemmal cyst, although rare, should be considered as differential diagnosis of recurrent chalazion.
Leiomyosarcoma arising in the pancreatic duct: a case report and review of the current literature
Authors: Nicole D Riddle, Brian C Quigley, Irwin Browarsky, Marilyn M Bui
Journal: Case Rep Med (2010)
MeSH terms: Case Reports

Context. Leiomyosarcomas are rare malignant smooth muscle tumors that may arise in any organ or tissue that contains smooth muscle, commonly within the gastrointestinal tract. They are most often found in the stomach, large and small intestines, and retroperitoneum. Primary pancreatic leiomyosarcoma is extremely rare, and to the best of our knowledge only 30 cases have been reported in the world literature since 1951. Our case represents the first to have a clear origin from the main pancreatic duct. Case Report. This case was diagnosed in a large, tertiary care center in Tampa, Florida. Pertinent information was obtained from chart review and interdepartmental collaboration. A mass in the tail of the pancreas was identified with large pleomorphic and spindle-shaped cells. Immunohistochemistry for vimentin, smooth muscle actin, and desmin was positive. All remaining immunohistochemical markers performed were negative. The tumor clearly originated from the pancreatic duct wall, filled and expanded the duct lumen, and was covered with a layer of benign biliary epithelium. Conclusion. Leiomyosarcoma of the pancreas is an extremely rare malignancy with few reported cases in the literature. The prognosis is poor, and treatment consists of alleviating symptoms and pain management. To our knowledge, this represents the first reported case demonstrating clear origin of a leiomyosarcoma from the pancreatic duct.
Accidental guidewire migration following emergency femoral central venous catheterization
Authors: Isaac Okyere, Christiana Adu-Takyi, John Appiah Adabie, Perditer Okyere, Nana Addo Boateng
Journal: Pan Afr Med J (2019)
Keywords: guidewire migration, central venous catheterization, complication, femoral vein, groin incision, retrieval
MeSH terms: Catheterization, Central Venous / adverse effects, Foreign-Body Migration / diagnosis, Jugular Veins, Case Reports, Child, Female, Femoral Vein, Humans, Intensive Care Units, Pediatric

Central venous catheter placement especially the femoral venous catheter is a common practice in critically ill patients. Awareness of potential complications of the guidewire such as guidewire migration is of utmost importance. Though potentially retrievable by a vascular surgeon or interventional radiologist if it occurs, close supervision by a senior person during passage by a junior or inexperienced person, the use of ultrasound before and after placement of catheter, and use of a checklist may help to identify and prevent its occurrence. We present a very rare complication of central venous cannulation of a guidewire migration in our institution. A 12-year-old girl presented to the Paediatric Emergency Unit (PEU) with status epilepticus and aspiration pneumonia and subsequently transferred to the Paediatric Intensive Care Unit (PICU) for ventilatory support. She had accidental guidewire migration to the left internal jugular vein following a right transfemoral central venous catheterization. She underwent successful guidewire retrieval via a right groin incision.
Intrahepatic Sarcomatous Cholangiocarcinoma: Case Report and Review of the Literature
Authors: Thana Boonsinsukh, Vichit Viriyaroj, Thammanij Rookkachart, Therdkiat Trongwongsa
Journal: Case Rep Surg (2018)
MeSH terms: Case Reports

The authors report a case of a patient with intrahepatic sarcomatous cholangiocarcinoma. A 45-year-old Thai man presented with a 3-month history of right upper abdominal pain. CT scan revealed hepatomegaly with a 6.5 cm hypovascular soft tissue density mass in the right lobe and showed mild delayed enhancement. On exploratory laparotomy, the tumor adherent to right diaphragm was found. We performed right hepatectomy, partial resection of right diaphragm, and cholecystectomy. The immunohistological results suggested "sarcomatous intrahepatic cholangiocarcinoma." The tumor was recurrent in 5 months after operation and unresectable. Therefore, the treatment in this patient was supportive care. He died 11 months after his initial presentation. The literature reviews showed that intrahepatic sarcomatous cholangiocarcinoma is aggressive malignant with poor prognosis. Early detection, radical resection, and careful follow-up would be the treatment for the favorable prognosis.
Late Onset Combined Immunodeficiency Presenting with Recurrent Pneumocystis jiroveci Pneumonia
Authors: Ilias Papakonstantinou, Ioannis G Baraboutis, Lazaros Karnesis
Journal: Case Rep Med (2014)

Late onset combined immunodeficiency (LOCID) is a recently described variant of common variable immunodeficiency (CVID), involving adult patients presenting with opportunistic infections and/or low CD4+ lymphocyte counts. A 36-year-old male with unremarkable past medical history presented with fever, respiratory failure, and lymphocytopenia. He was found to have Pneumocystis jiroveci pneumonia (PJP), subsequently complicated by recurrent hospital-acquired Pseudomonas aeruginosa pneumonia and immune reconstitution phenomena, attributed to restoration of immunoglobulin levels. Clinicians should be aware of LOCID, which could be confused with HIV infection/AIDS or idiopathic CD4 lymphocytopenia. In the English bibliography there is only one case report, where PJP was the initial presentation of CVID (that case would probably be classified as LOCID). Phenomena of immune reconstitution are described in various settings, including primary immunodeficiency, manifesting as temporary clinical and radiologic deterioration and leading to misperceptions of therapeutic failure and/or presence of alternative/additional diagnoses.
Histological Characteristics of Myxoid (Metaplastic) Meningioma in a 44-Year-Old Woman
Authors: Akiko Marutani, Ryou Nakano, Noriyuki Nishi, Tomonori Yamada
Journal: Case Rep Oncol Med (2019)
MeSH terms: Case Reports

Myxoid (metaplastic) meningioma is the rarest WHO grade 1 meningioma, and its histological characteristics are useful in diagnostics. We present the case report of a myxoid (metaplastic) meningioma in a 44-year-old woman to highlight the important histological features and observations that are critical for making an accurate diagnosis. We report a rare myxoid meningioma using magnetic resonance imaging (MRI) images and its histopathological features.
Transient basilar artery occlusion monitored by transcranial color Doppler presenting with a spectacular shrinking deficit: a case report
Authors: Giuseppe Nicoletti, Gerardina Albano, Sandro Sanguigni, Salvatore Tardi, Giovanni Malferrari, Massimo Del Sette, Filomena Bruno, Aldo Nicolai
Journal: J Med Case Rep (2010)

Introduction:
We describe the case of a 79-year-old Caucasian Italian woman with a transient basilar occlusion monitored by transcranial Doppler, with subsequent recanalization and clinical shrinking deficit. This is the first case of transient basilar occlusive disease diagnosed and monitored by transcranial Doppler. This case is important and needs to be reported because transient basilar occlusion may be easily diagnosed if transcranial Doppler is performed.
Case presentation:
A 79-year-old woman affected by chronic atrial fibrillation and not treated with oral anticoagulants, cardioverted to sinus rhythm during a gastric endoscopy. She then showed a sudden-onset loss of consciousness, horizontal and vertical gaze palsy, tetraparesis and bilateral miosis and coma. Two hours later, the symptoms resolved quickly, leaving no residual neurologic deficits. Transcranial Doppler examination showed a dampened flow in the basilar artery in the emergency examination and a restored flow when the symptoms resolved.
Conclusion:
This is the first case of transient basilar occlusive disease diagnosed and monitored by transcranial Doppler. We believe that transcranial Doppler should be performed in all cases of unexplained acute loss of consciousness, in particular, if associated with signs of brainstem dysfunctions.
Spontaneous intraperitoneal rupture of a hepatic hydatid cyst with subsequent anaphylaxis: a case report
Authors: Benjamin Tinsley, Aula Abbara, Raghunandan Kadaba, Hemant Sheth, Gurjinder Sandhu
Journal: Case Reports Hepatol (2013)

Hydatid cyst rupture into the abdomen is a serious complication of cystic hydatid disease of the liver (Cystic Echinococcosis) with an incidence of up to 16% in some series and can result in anaphylaxis or anaphylactoid reactions in up to 12.5% of cases. At presentation, 36-40% of hydatid cysts have ruptured or become secondarily infected. Rupture can be microscopic or macroscopic and can be fatal without surgery. Hydatid disease of the liver is primarily caused by the tapeworm Echinococcus granulosus and occurs worldwide, with incidence of up to 200 per 100,000 in endemic areas. Our case describes a 24-year-old Bulgarian woman presenting with epigastric pain and evidence of anaphylaxis. Abdominal CT demonstrated a ruptured hydatid cyst in the left lobe of the liver. A partial left lobe hepatectomy, cholecystectomy, and peritoneal washout was performed with good effect. She was treated for anaphylaxis and received antihelminthic treatment with Albendazole and Praziquantel. She made a good recovery following surgery and medical treatment and was well on follow-up. Intraperitoneal rupture with anaphylaxis is a rare occurrence, and there do not seem to be any reported cases from UK centres prior to this.
An unusual condition during internal jugular vein catheterisation: vertebral artery catheterisation
Authors: Ozge Korkmaz, Sabahattin Göksel, Burçak Söylemez, Kasim Durmuş, Ahmet Cemil Işbir, Öcal Berkan
Journal: Cardiovasc J Afr (2016)
MeSH terms: Catheterization, Central Venous / adverse effects, Coronary Artery Bypass, Jugular Veins / diagnostic imaging, Subclavian Artery / injuries, Vascular System Injuries / etiology, Vertebral Artery / injuries, Case Reports, Aged, Catheterization, Central Venous / instrumentation, Central Venous Catheters, Computed Tomography Angiography, Device Removal, Humans, Male, Punctures, Subclavian Artery / diagnostic imaging, Subclavian Artery / surgery, Treatment Outcome, Vascular System Injuries / diagnostic imaging, Vascular System Injuries / surgery, Vertebral Artery / diagnostic imaging, Vertebral Artery / surgery

Vertebral artery cannulation is an unusual complication during internal jugular vein cannulation. We report a case of vertebral artery cannulation, which occurred during an attempt to cannulate the right internal jugular vein, and we discuss the management of such a rare complication.
Polymorphous Adenocarcinoma: A Rare Case Report with Unique Radiographic Appearance on CBCT
Authors: Jagadish Chandra, Junaid Ahmed, K M Veena, M Vijayakumar, Nandita Shenoy, Nanditha Sujir
Journal: Case Rep Dent (2021)
MeSH terms: Case Reports

Background:
Polymorphous low-grade adenocarcinoma (PLGA) is a slow growing malignant tumor of minor salivary glands and is generally of indolent nature. However, according to the most recent WHO Classification of Salivary Gland Tumors (2017), the cancer is classified as Polymorphous AdenoCarcinoma (PAC). PAC presents as a less aggressive tumor, though it could on rare occasions demonstrate distant metastasis. Case Presentation. A 47-year-old man who was referred by a private practitioner for a CBCT scan in reference to a proliferative soft-tissue growth in the hard palate. The growth was mild and tender and there was Grade III mobility in relation to all the maxillary teeth. Panoramic radiograph taken previously had revealed evidence of alveolar bone loss in relation to the maxillary teeth and was inconclusive of any other findings. The CBCT scan revealed evidence of moth-eaten appearance of maxilla with destruction of medial and lateral walls and floor of maxillary sinus. There was also evidence of involvement of right eustachian tube, ethmoidal wall, and nasopalatine canal. An intraosseous malignancy of the palate was suspected, and a total maxillectomy was performed. The tissue sample was sent for histopathological assessment wherein changes diagnostic for polymorphous low-grade adenocarcinoma of the palate were observed.
Conclusion:
PAC is a distinct, yet commonly occurring, minor salivary gland tumor with varied clinical and histologic appearance. This case report highlights the importance of CBCT in diagnosing the intraosseous involvement of such tumors which can help shed some light in enhancing our knowledge about the minor salivary gland malignancies like PAC.
The therapeutic benefit of allopurinol in the treatment of foreign body granulomas caused by polymethylmethacrylate microspheres
Authors: Luisa Kelmer Côrtes de Barros Silveira, Felipe Ladeira de Oliveira, Thais de Barros Castro Alves, Maria Lourdes Candela Rambaldi, Felipe Cupertino de Andrade, Santuzza de Carvalho Kelmer, Fabio Cuiabano Barbosa
Journal: Case Rep Dermatol Med (2012)

Injectable polymethylmethacrylate (PMMA) microspheres are nonbiodegradable and too large for macrophage phagocytosis. There are several complications possible to happen, like chronic nonspecific inflammatory reactions, lip stiffness, infection, and granulomas. The occurrence of granulomas can lead to a not aesthetic result, making some extreme changes in the patient's life. The objective of this case report is to describe the successful treatment of foreign body granulomas caused by polymethylmethacrylate microspheres using allopurinol, an innovative therapy for this condition.
Colon Adenoma Implicating Myasthenia Gravis: A Case Report of a Patient with Postcolectomy Complications
Authors: Y Papachatzakis, E Tseliou, I Tatouli, I Dialoupi, F Michas, E Papadopoulou, D Kousouris, S Kontogiannis, M A Dimopoulos
Journal: Case Rep Neurol Med (2016)

We report the case of a 63-year-old patient with myasthenia gravis (MG) due to acetylcholine receptor antibodies (AChR) who underwent colectomy due to colon adenoma and developed myasthenic crisis and anastomosis leakage after surgery. The patient underwent two plasma exchanges, 4 and 6 days preoperatively, and received intravenous prednisolone and immunoglobulin infusion due to the crisis, which included primarily bulbar symptoms. The patient developed on the 10th postoperative day bowel obstruction symptoms and anastomosis leakage which required surgical repair and ileostomy. Bowel obstruction occurred in a patient with AChR related myasthenia after plasma exchange and during immunosuppression although it is more commonly reported in patients with thymoma related myasthenia.
Rupture of renal transplant
Authors: Shona Baker, Maria Popescu, Jacob A Akoh
Journal: Case Rep Transplant (2015)

Background. Rupture of renal allograft is a rare and serious complication of transplantation that is usually attributed to acute rejection, acute tubular necrosis, or renal vein thrombosis. Case Presentation. LD, a 26-year-old male with established renal failure, underwent deceased donor transplantation using kidney from a 50-year-old donor with acute kidney injury (Cr 430 mmol/L). LD had a stormy posttransplant recovery and required exploration immediately for significant bleeding. On day three after transplant, he developed pain/graft swelling and another significant haemorrhage with cardiovascular compromise which did not respond to aggressive resuscitation. At reexploration, the renal allograft was found to have a longitudinal rupture and was removed. Histology showed features of type IIa Banff 97 acute vascular rejection, moderate arteriosclerosis, and acute tubular necrosis. Conclusion. Possible ways of avoiding allograft rupture include use of well-matched, good quality kidneys; reducing or managing risk factors that would predispose to delayed graft function; ensuring a technically satisfactory transplant procedure with short cold and warm ischemia times; and avoiding large donor-recipient age gradients.