OpenMed/multicare-articles huggingface dataset:
Spontaneous diaphragmatic hernia with bowel perforation complicated by tension hydropneumothorax
Authors: Andrea Mardighian, Giulia Roberta Ercolino, Diego Palladino, Giuseppe Guglielmi
Journal: BJR Case Rep (2016)
MeSH terms: Case Reports

In this case report, we describe a rare case of spontaneous diaphragmatic hernia with perforation of the incarcerated ascending colon and subsequent formation of tension pneumothorax. A 73-year-old male with a past medical history of chronic right pleural effusion, restrictive ventilatory impairment and hypertension presented to us for evaluation of severe right chest pain of few days' duration and severe dyspnoea. The chest radiograph revealed the presence of a loop of bowel in the basal right hemithorax with associated air/fluid levels. A CT scan of the chest confirmed the hydropneumothorax and revealed a right lower lobe ipo-expansion and a flogistic lung consolidation. After surgery, the patient underwent a contrast-enhanced CT scan of the chest, which showed no abnormal findings.
Ultrasound-guided popliteal nerve block in a patient with malignant degeneration of neurofibromatosis 1
Authors: Arjun Desai, Brendan Carvalho, Jenna Hansen, Jonay Hill
Journal: Case Rep Anesthesiol (2012)
MeSH terms: Case Reports

A 41-year-old female patient with neurofibromatosis 1 presented with new neurologic deficits secondary to malignant degeneration of a tibial lesion. Ultrasound mapping of the popliteal nerve revealed changes consistent with an intraneural neurofibroma. Successful popliteal nerve blockade was achieved under ultrasound guidance.
Case report: acute unintentional carbachol intoxication
Authors: Martin Schulz, Thomas Graefe, Klaus Stuby, Hilke Andresen, Nikolai Kupfermann, Achim Schmoldt
Journal: Crit Care (2006)
MeSH terms: Carbachol / adverse effects, Carbachol / analysis, Case Reports, Aged, 80 and over, Atropine / therapeutic use, Bradycardia / chemically induced, Bradycardia / diagnosis, Bradycardia / drug therapy, Fatal Outcome, Heart Arrest / chemically induced, Heart Arrest / diagnosis, Heart Arrest / drug therapy, Humans, Male, Muscarinic Agonists / adverse effects, Muscarinic Agonists / analysis, Nausea / chemically induced, Nausea / diagnosis, Nausea / drug therapy, Muscarinic Agonists, Atropine, Carbachol

Introduction:
Intoxications with carbachol, a muscarinic cholinergic receptor agonist are rare. We report an interesting case investigating a (near) fatal poisoning.
Methods:
The son of an 84-year-old male discovered a newspaper report stating clinical success with plant extracts in Alzheimer's disease. The mode of action was said to be comparable to that of the synthetic compound 'carbamylcholin'; that is, carbachol. He bought 25 g of carbachol as pure substance in a pharmacy, and the father was administered 400 to 500 mg. Carbachol concentrations in serum and urine on day 1 and 2 of hospital admission were analysed by HPLC-mass spectrometry.
Results:
Minutes after oral administration, the patient developed nausea, sweating and hypotension, and finally collapsed. Bradycardia, cholinergic symptoms and asystole occurred. Initial cardiopulmonary resuscitation and immediate treatment with adrenaline (epinephrine), atropine and furosemide was successful. On hospital admission, blood pressure of the intubated, bradyarrhythmic patient was 100/65 mmHg. Further signs were hyperhidrosis, hypersalivation, bronchorrhoea, and severe miosis; the electrocardiographic finding was atrio-ventricular dissociation. High doses of atropine (up to 50 mg per 24 hours), adrenaline and dopamine were necessary. The patient was extubated 1 week later. However, increased dyspnoea and bronchospasm necessitated reintubation. Respiratory insufficiency was further worsened by Proteus mirabilis infection and severe bronchoconstriction. One week later, the patient was again extubated and 3 days later was transferred to a peripheral ward. On the next day he died, probably as a result of heart failure. Serum samples from the first and second days contained 3.6 and 1.9 mg/l carbachol, respectively. The corresponding urine concentrations amounted to 374 and 554 mg/l.
Conclusion:
This case started with a media report in a popular newspaper, initiated by published, peer-reviewed research on herbals, and involved human failure in a case history, medical examination and clinical treatment. For the first time, an analytical method for the determination of carbachol in plasma and urine has been developed. The analysed carbachol concentration exceeded the supposed serum level resulting from a therapeutic dose by a factor of 130 to 260. Especially in old patients, intensivists should consider intoxications (with cholinergics) as a cause of acute cardiovascular failure.
Psoriatic juvenile idiopathic arthritis associated with uveitis: a case report
Authors: Davide Moretti, Ilaria Cianchi, Gaia Vannucci, Rolando Cimaz, Gabriele Simonini
Journal: Case Rep Rheumatol (2013)

According to the definition proposed by the International League of Associations for Rheumatology (ILAR), juvenile idiopathic arthritis (JIA) is defined as an arthritis of unknown etiology, starting under 16 years of age and lasting for at least 6 weeks, once other known conditions have been excluded. JIA represents the most common chronic rheumatic disease of childhood and is considered an important cause of short- and long-term acquired disability in children. It is currently estimated that psoriatic JIA represents up to 10% of all JIA subtypes, and chronic uveitis may occur in 10 to 15% of children with psoriatic JIA. In this report we describe a case of psoriatic JIA complicated by uveitis, in a child failing previous treatments with nonsteroidal anti-inflammatory drugs, methotrexate, and etanercept. Finally, adalimumab was prescribed, which led to sustained clinical remission in both arthritis and uveitis.
A Case of Inverted Papilloma Originating from the Middle Ear and Review of the Literature
Authors: Eray Bayindir, Fatih Mehmet Hanege, Mahmut Tayyar Kalcioglu, Tulay Zenginkinet, Serdal Celik
Journal: Case Rep Otolaryngol (2019)
MeSH terms: Case Reports

Inverted papilloma (IP) with malignant transformation is rarely seen in the middle ear. Up to now, there have been 16 primary middle ear IPs reported in the English literature. Even though it is very rare in the middle ear, this pathology should be kept in mind for the differential diagnosis of middle ear masses. In this case, we report a 77-year-old female who had recurrent IP with malignant transformation and complication.
Familial hypercholesterolemia with bilateral cholesterol granuloma: A case series
Authors: Nouf Albakheet, Yazeed Al-Shawi, Mohammed Bafaqeeh, Hanadi Fatani, Yasser Orz, Ibrahim Shami
Journal: Int J Surg Case Rep (2019)
Keywords: cholesterol granuloma, familial hypercholesterolemia, mastoid cavity

Introduction:
Cholesterol granuloma is a benign mass that commonly involves the petrous apex but rarely affects other structures, such as the mastoid cavity. It is diagnosed histologically by the presence of giant cells, and Its management is individualized based on some factors such as the size and location of the lesion.
Presentation of case:
The first case was a 33-year-old man who presented to the outpatient clinic with a two-year history of right-sided pulsatile tinnitus, hearing loss, and vertigo. Upon investigations, a large, destructive mass in the tympanomastoid region was found and managed surgically. The other case was for a 41-year-old man who presented to the emergency department with loss of consciousness. Urgent CT was done and revealed an aggressive hypodense posterior fossa mass destroying the right temporal bone that was managed surgically.
Discussion:
In this report, we describe two patients with familial hypercholesterolemia who developed bilateral cholesterol granuloma that were managed surgically.
Conclusion:
These cases are reported because of their rare location and presentation since few cases of bilateral cholesterol granuloma have been reported in the literature.
Acute Cytotoxic Cerebellar Edema Subsequent to Fentanyl Patch Intoxication in an Infant
Authors: Lindsey N Haut, Rupa Radhakrishnan, Riad Lutfi, Louise W Kao, Laurie L Ackerman
Journal: Case Rep Crit Care (2021)
MeSH terms: Case Reports

The opioid epidemic continues to have devastating consequences for children and families across the United States with rising prevalence of opioid use and abuse. Given the ease of access to these medications, accidental ingestion and overdose by children are becoming increasingly more common. The recognition of opioid-induced neurotoxicity and the associated life-threatening complication of acute cerebellar cytotoxic edema are crucial, as are the high morbidity and mortality without timely intervention. We discuss an infant with acute cytotoxic cerebellar edema following mucosal exposure to a transdermal fentanyl patch.
Laparoscopic Resection of an Appendix Mucocele in a Breast Cancer Patient
Authors: Scarlett Hao, Roberta Lilly, Hugo J R Bonatti
Journal: Case Rep Surg (2018)
MeSH terms: Case Reports

Background:
Acute appendicitis may be treated with antibiotics, but most surgeons offer laparoscopic appendectomy (LA). Appendiceal mucocele (AMC) is a rare disorder. Surgical removal is recommended due to the risk of pseudomyxoma peritonei. LA has been suggested for this condition. Although rare, breast cancer (BC) may metastasize to the appendix. An appendiceal mass in a breast cancer patient should be approached as a possible metastatic focus until proven otherwise.
Case presentation:
A 45-year-old Caucasian woman with invasive lobular BC underwent bilateral mastectomy. An AMC was found on CT scan. LA was done with a strict minimal touch technique. The appendix was resected with a 1 cm margin of the cecal pole, and the specimen was removed from the abdomen in a retrieval bag. Pathology showed benign cystadenoma. The patient had an uneventful postoperative course.
Conclusion:
This case highlights the diagnostic challenge of an appendiceal mass in a BC patient. BC patients with AMC should undergo appendectomy to rule out metastatic disease and to prevent pseudomyxoma peritonei. LA can be performed safely in patients with AMC.
Complications following Iliac Wing Fibrosarcoma
Authors: G Stan, H Orban, R Deculescu
Journal: Case Rep Orthop (2019)
MeSH terms: Case Reports

The aim of this case report is to underline surgical strategies for complications in a case of a young man with fibrosarcoma of the bone treated with pelvic resection followed by reconstruction with massive bone allograft. A type I pelvic resection was performed as a radical resection of tumor followed by a biological reconstruction of iliac wing using frozen allograft. The iliac allograft was fixed in place using 4 screws. The immediate postoperative period was complicated with local sepsis of reconstructed site treated with pediculate omentoplasty. After 1 year from surgery, the X-ray exam showed an integrated allograft. After 20 years from the first surgery, the patient presented with the left hip pain of 3-month duration with mechanical pattern. The X-ray and CT exam showed the left hip arthritis and no signs of recurrence. A total hip arthroplasty with dual mobility cup and uncemented stem was performed. Despite the immediate postoperative local infection, the allograft was left in place and integrated after all. Omentoplasty could be a very useful technique in eradicating local infection, due to the immunogenic properties of the omentum. The allograft is still strong enough to give support for a hip arthroplasty at 20 years after implantation.
A novel use for the rigid cystoscope: the removal of sacral tacks after a coloanal anastamosis dehiscence
Authors: W Mahmalji, H Mackenzie, A Chopada, A Raza
Journal: Adv Urol (2009)
MeSH terms: Case Reports

A 69-year-old female presented as an emergency with atrial fibrillation, which was treated with warfarin. She subsequently developed fresh rectal bleeding and after further investigations a Dukes B adenocarcinoma of the rectum was found. She subsequently underwent a low anterior resection, coloanal anastamosis and a defunctioning ileostomy. Three sterile surgical metallic tacks (pins) were inserted into the sacrum to stop brisk bleeding from the presacral venous plexus. Following discharge, she was readmitted with septic shock and a CT scan revealed a presacral fluid collection in the area surrounding the sacral tacks (pins) and an anastamotic dehiscence. The patient was not fit for further pelvic surgery to remove the tacks, so an alternative minimally invasive cystoscopic procedure was performed. The sacral tacks (pins) were removed by the urologist using a rigid cystoscope and cold cup biopsy forceps. To our knowledge, this is the first reported case in the literature.
Recurrent plunging ranula
Authors: Pavai Arunachalam, Nithya Priyadharshini
Journal: J Indian Assoc Pediatr Surg (2010)
Keywords: plunging ranula, recurrence, salivary gland
MeSH terms: Case Reports

We report two cases of plunging ranula, which had recurred after marsupialization. Both were successfully treated by removal of the ipsilateral sublingual gland. A brief review of the literature regarding the treatment options is presented.
A case of absent right and persistent left superior vena cava
Authors: Attila Pálinkás, Edit Nagy, Tamás Forster, Zita Morvai, Endre Nagy, Albert Varga
Journal: Cardiovasc Ultrasound (2006)
MeSH terms: Vena Cava, Superior / abnormalities, Vena Cava, Superior / diagnostic imaging, Case Reports, Angiography, Digital Subtraction, Diagnosis, Differential, Echocardiography, Humans, Male, Middle Aged

Background and purpose:
Our case report deals with the importance of detailed echocardiographic examination for differential diagnosis of coronary sinus dilation and development of abnormalities of great thoracic veins.
Case presentation:
A 49-year-old man underwent transthoracic echocardiography for atypical chest pain. A dilated coronary sinus was found and venous contrast echocardiography raised the suspicion of absent right and persistent left superior vena cava. Transesophageal echocardiography showed absence of right superior vena cava. The echocardiographic findings were confirmed by upper venous digital subtraction cavography.
Conclusion:
combination of agenesia of right SVC and isolated persistent left SVC in adult patients is a very rare abnormality. Both clinicians and sonographers should be alerted to the possible presence of this combined venous anomaly. Transthoracic echocardiograpy - including agitated saline infusion to the antecubital vein - is an important diagnostic tool for accurate diagnosis of this congenital thoracic venous malformation.
An 8-Year-Old Child with Delayed Diagnosis of Netherton Syndrome
Authors: Alexander K C Leung, Benjamin Barankin, Kin Fon Leong
Journal: Case Rep Pediatr (2018)
MeSH terms: Case Reports

We report an 8-year-old boy with Netherton syndrome who was misdiagnosed and treated as severe atopic dermatitis. The diagnosis of Netherton syndrome was not made until the child was 8 years of age. We discuss the pitfalls in the diagnosis and alert physicians to the proper and early diagnosis of this syndrome. The child was treated with a low dose (0.25 mg/kg) of oral acitretin and a topical moisturizer with marked improvement of his skin and pruritus in 2 months. At 6-month follow-up, the skin was almost clear of erythema and scaling, and the hair was longer and stronger. The dose of acitretin was reduced to 0.12 mg/kg for another 6 months and then discontinued.
Ureteropelvic Junction Obstruction and Parathyroid Adenoma: Coincidence or Link?
Authors: Salah Termos, Majd AlKabbani, Tim Ulinski, Sami Sanjad, Henri Kotobi, Francois Chalard, Bilal Aoun
Journal: Case Rep Nephrol (2017)
MeSH terms: Case Reports

Congenital ureteropelvic junction obstruction (UPJO) is the most common cause of upper urinary tract obstruction in children. It is generally diagnosed in the routine work-up during antenatal period and is characterized by spontaneous recovery. It can be associated with urolithiasis; hence further investigation should be carried out. We report the case of a 15-year-old boy, who is known to have right UPJO, presented with right renal colic and discovered to have bilateral kidney stones. Further studies showed primary hyperparathyroidism and genetic analysis revealed a CDC73 mutation (initially HRPT2). We believe that association of UPJO and PHPT is a rare coincidence that can be linked. Careful work-up of children with UPJO and urolithiasis is recommended to exclude an underlying metabolic disease. Surgical correction can be evitable as treatment of the primary cause can lead to complete dissolution of kidney stones and improvement of the medical condition.
Autogenous Chin Block Grafts in the Aesthetic Zone: A 20-Year Follow-Up Case Report
Authors: Carlo Maiorana, Susanna Ferrario, Pier Paolo Poli, Mattia Manfredini
Journal: Case Rep Dent (2020)
MeSH terms: Case Reports

The successful use of osseointegrated implants in the treatment of partial or complete edentulism requires a sufficient bone support. Whenever rehabilitation in atrophic edentulous areas is needed, bone augmentation procedures are recommended. The aim is to provide adequate amount of supporting bone to achieve a prosthetically guided implant placement. This in turn leads to functional and aesthetic improvements that can be maintained on the long term. Bone grafting of the atrophic site can be performed either prior to implant placement or at the time of implantation. Irrespective of the timing, bone augmentation by means of autogenous bone grafts is a reliable technique, as confirmed by several studies. On the other hand, long-term evidence on the use of autogenous chin block grafts in preprosthetic implant surgery is still scarce. Thus, the purpose of the present case is to report the 20-year clinical and radiological outcome of autogenous chin block grafts used to augment a bilateral defect due to agenesis of the upper lateral incisors for implant placement purposes.
Primary Squamous Cell Carcinoma of Thyroid: A Rare Entity
Authors: Rahulkumar N Chavan, Bhargav Chikkala, Cinjini Biswas, Somak Biswas, Diptendra Kumar Sarkar
Journal: Case Rep Pathol (2015)

Primary squamous cell carcinoma (PSCC) of thyroid is an extremely rare malignancy of thyroid. Herewith, we describe a case report of female patient who presented with neck swelling; FNAC misdiagnosed it as papillary carcinoma of thyroid but, after resection, biopsy revealed it to be a case of squamous cell carcinoma of thyroid. After extensive investigations no possible primary focus of squamous cell carcinoma was found elsewhere, so diagnosis of primary squamous cell carcinoma of thyroid was made. Patient underwent chemoradiation but still patient succumbed to death within a year.
X-linked lymphoproliferative disease presenting as pancytopenia in a 10-month-old boy
Authors: S Nicole Chadha, David Amrol
Journal: Case Rep Med (2010)
MeSH terms: Case Reports

X-linked lymphoproliferative disease, also known as Duncan's syndrome, is a rare genetic disorder that causes exaggerated immune responses to Epstein-Barr virus (EBV) infection and often leads to death. Patient presentation varies but can include signs and symptoms typical of EBV, pancytopenia, and fulminant hepatitis.
Acute radiation dermatitis in breast cancer: topical therapy with vitamin E acetate in lipophilic gel base
Authors: S Martella, M Rietjens, V Lohsiriwat, R Lazzari, A Vavassori, Ba Jereczek, V Lazzati, Mc Leonardi, Jy Petit
Journal: Ecancermedicalscience (2010)
Keywords: radiation dermatitis, breast cancer, vitamin e
MeSH terms: Case Reports

Background:
Radiotherapy can cause adverse skin reactions over the course of their treatment. Currently, management is based on several tropical products although there is no gold-standard approach to prevention and management of radiation toxicity.
Method:
We report our experience of vitamin E acetate in the treatment of radiation dermatitis in breast cancer patients who experienced grade 4 side effects (according to Radiation Therapy Oncology Group criteria).
Results:
Clinical management consisted of oral antibiotics and local application of vitamin E acetate and local escarectomy. All of the patients achieved complete re-epithelialization within 40 days.
Conclusion:
Skin ulceration and necrosis post-radiation may interrupt oncological treatment in breast cancer patients. In acute radiodermatitis with skin necrosis, we propose the use of oral antibiotics together with escarectomy and the application of vitamin E acetate to facilitate the healing process in order to minimize the interruption to the oncological treatment.
Anomalous muscles and nerves in the hand of a 94-year-old cadaver-A case report
Authors: H L Nation, S Y Jeong, S W Jeong, A P Occhialini
Journal: Int J Surg Case Rep (2019)
Keywords: anomalous, berrettini anastomosis, case report, flexor digiti minimi longus, kaplan’s anastomosis, lumbrial

Introduction:
During an anatomical dissection of the distal upper extremities, numerous muscular and nervous anomalies were found in the forearm and hand of a 94-year-old cadaver. These anomalies are clinically relevant with regard to medical or surgical interventions.
Presentation of case:
The presence of a "flexor digiti minimi longus" muscle was observed passing through Guyon's canal; to our knowledge this passageway has never been previously reported. An aberrant first lumbrical with three origins was noted. Additionally, numerous atypical nerves were found innervating the hand; the dorsal branch of the ulnar nerve contributed to cutaneous innervation of the palm of the hand (Kaplan's anastomosis), the superficial ulnar nerve provided muscular innervation to the flexor digiti minimi brevis muscle, and two connections between the common palmar digital branches of the median and superficial ulnar nerves were observed (Berrettini anastomosis).
Discussion:
Here, we describe an extranumerary muscle associated with the hypothenar group of muscles. We also describe unusual origins of the first lumbrical muscle, and atypical cutaneous and muscular innervation to the palm of the hand.
Conclusion:
Clinically, understanding the existence of these anatomical variations may influence medical care or surgical procedures.
Stroke in a Patient with Tuberculous Meningitis and HIV Infection
Authors: Maria Bruna Pasticci, Maurizio Paciaroni, Piero Floridi, Enisia Cecchini, Franco Baldelli
Journal: Mediterr J Hematol Infect Dis (2013)
MeSH terms: Case Reports

Tuberculous meningitis (TBM) is a devastating disease. TBM occurs more commonly in HIV infected patients. The influence of HIV co-infection on clinical manifestations and outcome of TBM is not well defined. Yet, some differences have been observed and stroke has been recorded to occur more frequently. This study reports on an HIV infected Caucasian female with lung, meningeal tuberculosis and stroke due to a cortical sub-cortical ischemic lesion. TBM was documented in the absence of neurologic symptoms. At the same time, miliary lung TB caused by multi-susceptible Mycobacterium tuberculosis was diagnosed. Anti-TB therapy consisting of a combination of four drugs was administered. The patient improved and was discharged five weeks later. In conclusion, TBM and multiple underling pathologies including HIV infection, as well as other risk factors can lead to a greater risk of stroke. Moreover, drug interactions and their side effects add levels of complexity. TBM must be included in the differential diagnosis of HIV infected patients with stroke and TBM treatment needs be started as soon as possible before the onset of vasculopathy.