OpenMed/multicare-articles huggingface dataset:
A Catastrophic Complication of Thoracic Endovascular Aortic Repair: Aortoesophageal Fistula
Authors: Julio C Sauza-Sosa, Jorge Fernández-Tapia, Karen Arratia-Carlin, Raúl Zenteno-Langle, Jorge Mendoza-Ramírez, Felix Damas-de Los Santos, Gildardo Cortes-Julian
Journal: Methodist Debakey Cardiovasc J (2022)
Keywords: chiari’s triad, tevar, aortoesophageal fistula, graft replacement, sentinel hematemesis, thoracic endovascular aortic repair
MeSH terms: Aortic Aneurysm, Thoracic / complications, Aortic Aneurysm, Thoracic / diagnostic imaging, Aortic Aneurysm, Thoracic / surgery, Aortic Diseases / diagnostic imaging, Aortic Diseases / etiology, Aortic Diseases / surgery, Blood Vessel Prosthesis Implantation / adverse effects, Esophageal Fistula / diagnostic imaging, Esophageal Fistula / etiology, Esophageal Fistula / surgery, Vascular Fistula / diagnostic imaging, Vascular Fistula / etiology, Vascular Fistula / surgery, Case Reports, Humans, Male, Middle Aged

A 62-year-old man was admitted to the hospital due to sepsis secondary to a hemodialysis catheter-related infection that, upon diagnostic evaluation, demonstrated to be caused by P. aeruginosa and was treated with meropenem. Eradication of the infectious episode was confirmed by blood workup, including cultures. One month after the initial episode, the patient was readmitted due to a symptomatic penetrating aortic ulcer, which was classified as a cardiovascular emergency. The patient underwent an aortic stent-graft placement. Four weeks later, he presented to the emergency department with a 2-hour onset of thoracic pain and massive hematemesis. The esophagus and aortic segment with aortic stent graft were resected en bloc after an aortoesophageal fistula was diagnosed.
Can Total Wrist Arthroplasty Be an Option for Treatment of Highly Comminuted Distal Radius Fracture in Selected Patients? Preliminary Experience with Two Cases
Authors: Ingo Schmidt
Journal: Case Rep Orthop (2015)

We present two case reports of successful primary shortening of the forearm and total wrist arthroplasty (TWA) using the new angle-stable Maestro Wrist Reconstructive System (WRS) for treatment of highly comminuted distal radius fracture in selected autonomous patients. In a 56-year-old male patient with adequate bone stock, insertion of the noncemented Maestro WRS was combined with ulnar shortening osteotomy. In an 84-year-old female patient with poor osteoporotic bone stock, insertion of the radial cemented Maestro WRS was combined with ulnar head resection. Both patients could resume their work without additional surgery after TWA. At the 1-year follow-up, there were no changes in position of either implant without signs of loosening, no impingement, and no instability of the distal radioulnar joint or the distal ulna stump. All clinical parameters (DASH score, pain through VAS, and grip strength) were satisfactory. Both patients reported that they would have the same procedure again. Further experience is needed to validate this concept.
Surrogacy as a good option for treatment of repeated implantation failure: a case series
Authors: Nastaran Aflatoonian, Maryam Eftekhar, Behrooz Aflatoonian, Elham Rahmani, Abass Aflatoonian
Journal: Iran J Reprod Med (2013)
Keywords: in vitro fertilization, pregnancy rate, repeated implantation failure, surrogacy
MeSH terms: Case Reports

Background:
Repeated implantation failure (RIF) is defined as pregnancy failure after two to six times with at least ten high grade embryo transfer to uterus. A variety of causes have been anticipated for RIF, including anatomical, autoimmune, genetics, endocrine and thrombotic anomalies. Factors responsible for RIF have important implication regarding treatment however in many couples a perfect cause cannot be found.
Cases:
In these case series, we reported nine couples with RIF that after investigation no definitive etiology was found for RIF and empirical therapy by heparin, aspirin and or immunotherapy was not effective. In these cases we recommended transfer of embryos to surrogate uterus. Nine patients were studied and six of them developed a normal pregnancy (pregnancy rate=66.66%).
Conclusion:
This study showed that surrogacy is a good option for treatment of RIF.
An atypical cutaneous reaction to rivastigmine transdermal patch
Authors: T Grieco, M Rossi, V Faina, I De Marco, P Pigatto, S Calvieri
Journal: J Allergy (Cairo) (2011)
MeSH terms: Case Reports

Rivastigmine is a cholinesterase inhibitor which improves cognitive function and is currently being used in patients with mild to moderate Parkinson's and Alzheimer's dementia. This drug can be given orally or topically, as transdermal patch. The latter form is currently used for most excellent compliance and few side effects. The most common cutaneous side effects are irritative dermatitis. We report the second case of active sensitization by the rivastigmine-patch in a patient suffering from Alzheimer's dementia.
Next-Generation Sequencing in Early Diagnosis of Dent Disease 1: Two Case Reports
Authors: Min Wen, Tian Shen, Ying Wang, Yongzhen Li, Xiaoliu Shi, Xiqiang Dang
Journal: Front Med (Lausanne) (2018)
Keywords: clcn5 gene mutation, dent disease 1, early diagnosis, low molecular weight proteinuria, next-generation sequencing
MeSH terms: Case Reports

Dent disease 1 is a rare X-linked recessive inherited disease, caused by pathogenic variants in the chloride voltage-gated channel 5 (CLCN5) gene. Dent disease 1 is characterized by low molecular weight (LMW) proteinuria, hypercalciuria, nephrocalcinosis, and chronic kidney disease. Infants may manifest only asymptomatic LMW proteinuria, which increases the difficulty of early diagnosis. We describe two male infants presenting only with nephrotic-range LMW proteinuria observed on examination using urine protein electrophoresis. Hereditary renal tubular diseases were highly suspected based on early onset age and LMW proteinuria. Thus, next-generation sequencing (NGS) was performed and pathogenic mutations in CLCN5 were identified in both patients. A diagnosis of Dent disease 1 was established based on the above informations. The two patients developed hypercalciuria during late follow-up, which verified the diagnosis. These two cases highlight the importance of next-generation sequencing in the early diagnosis of Dent disease 1 with only LMW proteinuria.
Cytomegalovirus Retinitis Associated with Lenalidomide Use for Multiple Myeloma in an Immunocompetent Patient
Authors: Matthew K Adams, Christina Y Weng
Journal: Case Rep Ophthalmol Med (2019)
MeSH terms: Case Reports

Purpose:
The aim of this report is to present a case of cytomegalovirus (CMV) retinitis in an immunocompetent patient using lenalidomide.
Methods:
Case report with fundus photography, spectral-domain optical coherence tomography, and fluorescein angiography imaging.
Results:
A 55-year-old male with history of multiple myeloma treated with lenalidomide presented with blurriness and floaters in his right eye and was found to have vitreous biopsy-confirmed CMV retinitis. The patient was treated with pars plana vitrectomy, oral valganciclovir, and intravitreal foscarnet. More than one year later, the patient was doing well with visual acuity of 20/25 and no recurrence of retinitis.
Conclusion:
This represents the second report of CMV retinitis associated with lenalidomide therapy. It suggests that even immunocompetent patients can be affected by CMV retinitis in the context of lenalidomide treatment. It is critical that patients being treated with lenalidomide receive prompt evaluation if they develop ophthalmic symptoms.
Artificial Intelligence and Machine Learning Applied at the Point of Care
Authors: Zuzanna Angehrn, Liina Haldna, Anthe S Zandvliet, Eva Gil Berglund, Joost Zeeuw, Billy Amzal, S Y Amy Cheung, Thomas M Polasek, Marc Pfister, Thomas Kerbusch, Niedre M Heckman
Journal: Front Pharmacol (2020)
Keywords: artificial intelligence and machine learning in medical practice, chronic disease management, clinical decision support tools, model-informed precision dosing, precision dosing, real-world evidence, software as a medical device
MeSH terms: Review

Introduction:
The increasing availability of healthcare data and rapid development of big data analytic methods has opened new avenues for use of Artificial Intelligence (AI)- and Machine Learning (ML)-based technology in medical practice. However, applications at the point of care are still scarce.
Objective:
Review and discuss case studies to understand current capabilities for applying AI/ML in the healthcare setting, and regulatory requirements in the US, Europe and China.
Methods:
A targeted narrative literature review of AI/ML based digital tools was performed. Scientific publications (identified in PubMed) and grey literature (identified on the websites of regulatory agencies) were reviewed and analyzed.
Results:
From the regulatory perspective, AI/ML-based solutions can be considered medical devices (i.e., Software as Medical Device, SaMD). A case series of SaMD is presented. First, tools for monitoring and remote management of chronic diseases are presented. Second, imaging applications for diagnostic support are discussed. Finally, clinical decision support tools to facilitate the choice of treatment and precision dosing are reviewed. While tested and validated algorithms for precision dosing exist, their implementation at the point of care is limited, and their regulatory and commercialization pathway is not clear. Regulatory requirements depend on the level of risk associated with the use of the device in medical practice, and can be classified into administrative (manufacturing and quality control), software-related (design, specification, hazard analysis, architecture, traceability, software risk analysis, cybersecurity, etc.), clinical evidence (including patient perspectives in some cases), non-clinical evidence (dosing validation and biocompatibility/toxicology) and other, such as e.g. benefit-to-risk determination, risk assessment and mitigation. There generally is an alignment between the US and Europe. China additionally requires that the clinical evidence is applicable to the Chinese population and recommends that a third-party central laboratory evaluates the clinical trial results.
Conclusions:
The number of promising AI/ML-based technologies is increasing, but few have been implemented widely at the point of care. The need for external validation, implementation logistics, and data exchange and privacy remain the main obstacles.
Case report: Bilateral spinal neurofibromatosis
Authors: Ali Baradaran Bagheri, Sepehr Aghajanian, Aliasghar Taghi Doulabi, Mehdi Chavoshi-Nejad, Somayeh Sorouredin Abadi
Journal: Front Neurol (2022)
Keywords: von recklinghausen's disease, case report, nerve sheath tumor, neurosurgical oncology, spinal neurofibromatosis, spinal tumor
MeSH terms: Case Reports

Spinal neurofibromatosis (SNF) is a rare form of Neurofibromatosis in which neurofibromas exist bilaterally throughout all spinal roots. Despite previous attempts made to characterize and classify the disease as a separate clinical form of the disease, the low incidence rate of the disease and scarcity of previous reports calls for further studies and reports to elaborate this clinical entity. The patient in this report was a 36-year-old man presenting with lower limb weakness, unsteady gait, and paresthesia. The patient also presented with multiple cutaneous café-au-lait spots, cutaneous neurofibromas, and a large neurocutaneous neurofibroma of right facial nerve. Magnetic resonance imaging (MRI) of spine revealed bilateral spinal neurofibromas across all spinal cord roots. MRI study of head revealed no abnormalities in the brain and optic tract. The patient fulfilled both NIH criteria as well as revised criteria for NF1. Despite total spinal cord involvement, surgical intervention was withheld from the patient due to high propensity of recurrence as seen with previous attempts in removing peripheral neurofibromas, slow progression of symptoms, and lack of significant pain and impairment. SNF is often described as a form of disease with infrequent presentation of classical NF1 symptoms other than spinal tumors. The case presented here however, presented with several cutaneous neurofibromas and café-au-lait spots. Considering the positive outcome of surgical intervention in a few other reports, the decision to surgically intervene should be left to the clinical judgement of the participating surgeon, patient preference and socioeconomic background in a case-by-case manner.
Hemorrhagic fever with renal syndrome presenting with hemophagocytic lymphohistiocytosis
Authors: Je-Jung Lee, Ik-Joo Chung, Dong-Hyeon Shin, Sang-Hee Cho, Duck Cho, Dong-Wook Ryang, Ali S Khan, Hyeoung-Joon Kim
Journal: Emerg Infect Dis (2002)
MeSH terms: Hantaan virus / isolation & purification, Hemorrhagic Fever with Renal Syndrome / complications, Hemorrhagic Fever with Renal Syndrome / diagnosis, Histiocytosis, Non-Langerhans-Cell / virology, Case Reports, Diagnosis, Differential, Female, Hemorrhagic Fever with Renal Syndrome / blood, Histiocytosis, Non-Langerhans-Cell / blood, Humans, Middle Aged

Hemophagocytic lymphohistiocytosis--which is associated with a variety of infections, malignant neoplasms, autoimmune diseases, and immunodeficiencies--is an uncommon syndrome with a rapidly fatal outcome. We describe the first case of hemorrhagic fever with renal syndrome due to Hantaan virus presenting with reactive hemophagocytosis.
Closure Device-Related Thrombosis After Anticoagulation With Dabigatran in Patients Undergoing Percutaneous Left Atrial Appendage Closure: Case Reports and Literature Review
Authors: Xiaoye Li, Qinchun Jin, Xiaochun Zhang
Journal: Front Pharmacol (2020)
Keywords: atrial fibrillation, dabigatran, device-related thrombosis, left atrial appendage closure, novel oral anticoagulation
MeSH terms: Case Reports

Percutaneous left atrial appendage closure (LAAC) is an effective and safe operation strategy for stroke prevention in patients who are diagnosed with atrial fibrillation (AF) but cannot tolerate long term anticoagulation medication. We presented four rare cases of thrombosis formation on the occluder device. After the LAAC operation was successfully performed on patients, they followed a course of anticoagulation with dabigatran (110 mg b.i.d.), and device-related thrombosis (DRT) occurred as indicated by a transesophageal echocardiogram (TEE) during the follow-up period. Regressions were achieved after replacing dabigatran with rivaroxaban or warfarin for more than 1 month. No thrombosis or bleeding-related complications occurred in subsequent follow-ups.
Eosinophilic Granulomatosis with Polyangiitis in an 8-year-old Girl Manifesting as Hypereosinophilic Syndrome with Myocarditis, Stroke, and Subsequent Orbital Involvement
Authors: Aleksandra Panina, Elīna Ligere, Elīna Aleksejeva, Zane Davidsone, Elizabete Cebure, Irina Erdmane
Journal: Acta Med Litu (2023)
Keywords: churg–strauss syndrome, eosinophilic myocarditis, orbital involvement, paediatric hypereosinophilic syndrome, stroke
MeSH terms: Case Reports

Hypereosinophilic syndrome (HES) is a heterogeneous group of disorders characterized by peripheral blood eosinophilia of 1.5 × 109/L (1,500/μL) or greater, with evidence of end-organ damage attributable to eosinophilia (e.g., heart, liver or lung) with no other cause for the end-organ damage [1]. Eosinophilic granulomatosis with polyangiitis (EGPA) is a rare disorder that may affect multiple organ systems (lungs, heart, kidneys, or the nervous system). The disorder is characterized by hypereosinophilia in the blood and tissues, inflammation of blood vessels (vasculitis), and the development of inflammatory nodular lesions called granulomatosis [2]. We report a case with a 9-year-old girl presenting with severe hypereosinophilia, ischemic stroke, right-sided hemiparesis and myocarditis treated with methylprednisolone, enoxaparin, rivaroxaban and carvedilol. The patient recovered successfully from myocarditis and stroke but manifested with right-sided orbital involvement as pre- and post-septal orbital cellulitis 10 months later with necrotizing granulomatous perivascular chronic infiltration with eosinophilic infiltration treated with methylprednisolone and subsequent mepolizumab with successful remission of orbital involvement, but severe exogenous Cushing's syndrome and myocardial fibrosis.
An enterogenous cyst with atypical pathological findings and chemical meningitis
Authors: Lu Wang, Xiaona Chang, Chao Fu, Weidong Yu, Xiaoxuan Fang
Journal: Springerplus (2016)
Keywords: enterogenous cyst, immunohistochemistry, meningitis, neurenteric cyst

Introduction:
Intracranial enterogenous cysts are rare and mainly occur in the posterior fossa. These cysts are usually extra-axial, midline, anterior to the brainstem, or at the cerebellopontine angle. We report a case of an enterogenous cyst in which diagnosis was difficult because the lesion showed atypical pathologic findings.
Case presentation:
A healthy 41-year-old man complained of paroxysmal occipital headaches lasting over a week, with increased severity for 3 days accompanied by slight dizziness and mild nausea. Magnetic resonance imaging showed a cystic lesion between clivus and brainstem. The patient underwent surgery for removal of the lesion via the right-sided far-later approach, and the lesion was resected totally. Although pathologic examinations showed a cyst had a mono-to-multilayered squamous epithelium, which are not accord with typical enterogenous cyst, the diagnosis was finally made based on the presence of basement membrane and immunohistochemical results.
Discussion and evaluation:
To confirm the diagnosis of enterogenous cyst, further pathologic examinations were performed and immunohistochemical characters were summarized. Chemical meningitis, a rare complication of enterogenous cyst, happened in current case. Use a syringe and aspirate the contents before incision might be a procedure to prevent chemical meningitis.
Conclusions:
To our knowledge, this is the first report of an enterogenous cyst associated with mono-to-multilayered squamous epithelium. Although during the follow-up time, no recurrence happened, long-term follow-up is needed.
Case Report: Congenital Arthrogryposis and Unilateral Absences of Distal Arm in Congenital Zika Syndrome
Authors: Silvina Noemí Contreras-Capetillo, José Rafael Palma-Baquedano, Nina Valadéz-González, Pablo Manrique-Saide, Hirian Alonso Moshe Barrera-Pérez, Doris Pinto-Escalante, Norma Pavía-Ruz
Journal: Front Med (Lausanne) (2021)
Keywords: zika virus, arthrogryposis, birth defects, congenital infection, disruption, microcephaly, sequence
MeSH terms: Case Reports

Zika virus was recognized as a teratogen in 2015, when prenatal Zika infection was associated with neonatal microcephaly. The transmission, virulence, tropism, and consequences of Zika virus infection during pregnancy are currently studied. Decreased neural progenitor cells, arrest in neuronal migration and/or disruption of the maturation process of the fetus central nervous system have been associated. Congenital Zika Syndrome produces a fetal brain disruption sequence resulting in structural brain abnormalities, microcephaly, intracranial calcifications, fetal akinesia and arthrogryposis. Vascular abnormalities like unique umbilical artery and decreased cerebral vascular flow have been described in some patients. This article reports a Zika positive patient with sequence of fetal brain disruption, arthrogryposis and absence of distal third of the right forearm. This report expands the clinical observations of congenital Zika syndrome that may be related to disruptive vascular events.
Retrospective analysis of quantitative electroencephalography changes in a dissimulating patient after dying by suicide: A single case report
Authors: Tomáš Rakús, Katarína Hubčíková, Lucia Bruncvik, Zuzana Petrášová, Martin Brunovsky
Journal: Front Psychiatry (2023)
Keywords: depressive disorder, dissimulation, quantitative electroencephalography, suicidality, theta cordance
MeSH terms: Case Reports

We present the case of a 49-year-old man who was diagnosed with depressive disorder, with the first episode having a strong reactive factor. He was involuntarily admitted to a psychiatric hospital after a failed attempt at taking his own life, where he responded to psychotherapy and antidepressant therapy, as evidenced by a >60% reduction in his MADRS total score. He was discharged after 10 days of treatment, denied having suicidal ideations, and was motivated to follow the recommended outpatient care. The risk for suicide during hospitalization was also assessed using suicide risk assessment tools and psychological assessments, including projective tests. The patient underwent a follow-up examination with an outpatient psychiatrist on the 7th day after discharge, during which the suicide risk assessment tool was administered. The results indicated no acute suicide risk or worsening of depressive symptoms. On the 10th day after discharge, the patient took his own life by jumping out of the window of his flat. We believe that the patient had dissimulated his symptoms and possessed suicidal ideations, which were not detected despite repeated examinations specifically designed to assess suicidality and depression symptoms. We retrospectively analyzed his quantitative electroencephalography (QEEG) records to evaluate the change in prefrontal theta cordance as a potentially promising biomarker of suicidality, given the inconclusive results of studies published to date. An increase in prefrontal theta cordance value was found after the first week of antidepressant therapy and psychotherapy in contrast to the expected decrease due to the fading of depressive symptoms. As demonstrated by the provided case study, we hypothesized that prefrontal theta cordance may be an EEG indicator of a higher risk of non-responsive depression and suicidality despite therapeutic improvement.
Screening Children with a Family History of Central Congenital Hypoventilation Syndrome
Authors: Hina Emanuel, Kimberly Rennie, Kelly Macdonald, Aravind Yadav, Ricardo A Mosquera
Journal: Case Rep Pediatr (2020)
MeSH terms: Case Reports

Congenital central hypoventilation syndrome (CCHS) is a rare genetic disorder of an autonomic nervous disorder that affects breathing. It is characterized by respiratory insufficiency secondary to insensitivity to hypoxemia and hypercarbia, particularly during sleep leading to persistent apnea. We report four individuals across two generations harboring heterozygous 25 polyalanine repeats mutations (PARMs) in PHOX2B with a varying degree of phenotypic clinical manifestations. Two family members who reported to be "asymptomatic" were subsequently diagnosed with CCHS, based on genetic testing, obtained because of their family history. Genetic studies in the family including a mother and three offsprings revealed in-frame five amino acid PARMs of PHOX2B consistent with CCHS in addition to full clinical assessment. All affected individuals had evidence of hypercapnia on blood gas analysis with PCO2 in the range of 32-70 (mean; 61). Nocturnal polysomnogram revealed evidence of hypoventilation in two individuals (1 offspring and mother) with the end-tidal CO2 median of 54. Magnetic resonance imaging of brain revealed no abnormalities in the brain stem. There was no evidence of cor pulmonale on echocardiograms in all individuals. Neuropsychological testing was conducted on all four patients; two patients (mother and 1 offspring) had normal results, while the other two offspring exhibited some impairments on neuropsychological testing. This case series emphasizes the importance of screening first-degree relatives of individuals with confirmed CCHS to minimize complications associated with long-term ventilatory impairment. It also suggests that some patients with CCHS should undergo neuropsychological evaluations to assess for cognitive weaknesses secondary to their CCHS.