OpenMed/multicare-articles huggingface dataset:
Infective endocarditis with anomalous origin of coronary arteries and an abnormal aortic root bulge: A case report
Authors: Guoliang Yang, Xiaoyue Lai, Chunshui Liang, Weijie Fan, Wanlei Fu, Zheng Liu, Hongmei Xia
Journal: Front Cardiovasc Med (2023)
Keywords: anomalous origin of the coronary artery, aortic diverticulum, computed tomography, echocardiography, infective endocarditis
MeSH terms: Case Reports

Background:
The aortic bulge sign possibly indicates an arterial aneurysm, pseudoaneurysm, aortic dissection, or aortic diverticulum. The aortic diverticulum is a congenital abnormality of the aorta, mainly known as an aneurysmal remnant of the dorsal fourth aortic arch or ductus arteriosus. However, the diverticulum of another part of the aorta has rarely been reported.
Case summary:
We report a case of a 24-year-old male with a history of oral ulcer presented with recurrent hyperpyrexia and chest pain. Echocardiography and computed tomography showed the anomalous origin of the coronary arteries, aortic valve vegetations, and a bulge at the aortic root. The patient then received a Bentall procedure. The aorta and aortic valves were replaced by a valved conduit. The bulge with a normal arterial wall at the aortic root was considered to be a diverticulum. The infective endocarditis was verified as a secondary oral-derived streptococcal infection. The patient was discharged 15 days after surgery. Post-operative echocardiography had no positive findings.
Conclusion:
Our case report highlights the role of multimodal cardiovascular imaging for the diagnostic workup of rare disorders, such as the presence of a diverticulum in the aortic root in a patient with endocarditis and anomalous origin of the right coronary artery.
A Rare Case of Spontaneous Hemorrhage in a Giant Accessory Spleen in a Child
Authors: Gianpaolo Grilli, Valentina Pastore, Vincenzo Bertozzi, Annarita Nunzia Cintoli, Francesco Perfetto, Maria Nobili, Francesco Canale, Luca Macarini
Journal: Case Rep Pediatr (2019)
MeSH terms: Case Reports

Accessory spleen (AS) is a condition found in about 20% of patients and is most commonly located in the hilar region of the spleen. It is more often asymptomatic, single, and smaller than 2 cm. In the present study, we report the rare case of a 13-year-old boy with giant accessory spleen underwent spontaneous intrasplenic hemorrhage who presented with recurrent abdominal pain. Contrast-enhanced MRI was mandatory for the diagnosis before surgical procedure.
Evaluation of 1-year follow-up results of macular telangiectasia type 2 cases by optical coherence tomography angiography
Authors: Semra Tiryaki Demir, Dilek Güven, Mehmet Egemen Karatas, Ayse Burcu Dirim, Selam Yekta Sendül, Melih Ustaoglu
Journal: GMS Ophthalmol Cases (2019)
Keywords: deep capillary plexus, superficial capillary plexus, vessel densities
MeSH terms: Case Reports

The results of 1-year follow-up with optical coherence tomography angiography (OCTA) of 3 patients with macular telangiectasia type 2 (MacTel 2) were evaluated. The 3X3 mm OCTA imaging was performed in January 2017 and February 2018. The superficial and deep capillary plexus vascular density changes of the whole area, the parafoveal temporal and parafoveal nasal areas were examined. The mean whole, parafoveal temporal, and parafoveal nasal vessel densities at superficial capillary plexus were 51.31, 50.39, 54.57 at baseline and 49.93, 46.79, 51.83 at 1-year follow-up, respectively. The mean whole, parafoveal temporal and parafoveal nasal vessel densities at deep capillary plexus were 59.06, 59.05, 63.39 at baseline and 52.18, 54.68, 57.9 at 1-year follow-up, respectively. In this case series, it was shown quantitatively that vessel densities of MacTel2 patients markedly decreased over time, more pronounced in the deep capillary plexus.
The Value of Desmethylclozapine and Serum CRP in Clozapine Toxicity: A Case Report
Authors: Khalid Abou Farha, Andre van Vliet, Henderikus Knegtering, Richard Bruggeman
Journal: Case Rep Psychiatry (2012)

Clozapine, an atypical antipsychotic, has proved to be superior to other antipsychotics in treating patients with refractory schizophrenia. An increased plasma clozapine level above the therapeutic window may be associated with serious adverse events including paralytic ileus. Clozapine toxicity may occur in association with infection or after drug overdose. In a medical emergency situation, differentiating between a toxic clozapine ingestion and an infection-induced toxicity might be hindered by associated CNS changes and by the clozapine modulation of the inflammatory process. This may delay prompt initiation of a tailored treatment strategy. Here, we report a case of paralytic ileus developed within the context of clozapine toxicity. Although the underlying cause of toxicity was not clinically obvious, giving antimicrobial therapy resulted in an improvement in the patient's clinical condition. This report indicates the value of serum levels of C-reactive protein and desmethylclozapine, major metabolite of clozapine, in the treatment of aetiologically unclear clozapine toxicity.
Discrete papular lichen myxedematosus: a rare entity or an under- diagnosed disease?
Authors: Iman Hadj, Salim Gallouj, Mariame Meziane, Fatima Zahra Mernissi
Journal: Pan Afr Med J (2014)
Keywords: mucinosis-discrete, myxedematosus, papular lichen
MeSH terms: Scleromyxedema / diagnosis, Skin Diseases / diagnosis, Case Reports, Adult, Humans, Male, Scleromyxedema / epidemiology, Scleromyxedema / pathology, Skin Diseases / epidemiology, Skin Diseases / pathology

Primary cutaneous mucinoses are characterized by abnormal mucin deposits in the skin. Discrete papular lichenmyxedematosus (DPLM) is an unusual subtype which is characterized by the presence of multiples smooth, waxy, or flesh-colored papules, 2 to 5 mm in size affecting the trunk and limbs and most commonly proximal sites. We report a 42-year-old man with both the clinical and histopathological described criteria.
Transient Asystole after Sugammadex Administration for Immediate Reversal of Deep Blockade while on Dexmedetomidine Infusion in a Super Obese Patient
Authors: Michal Gajewski, Sorochi Esochaghi
Journal: Case Rep Anesthesiol (2019)
MeSH terms: Case Reports

Sugammadex is increasingly used to reverse aminosteroid neuromuscular blocking agents. Dosing is calculated based on actual body weight, even for those who are obese. We report a case where a super obese patient (BMI 58.5 kg/m2) developed asystole, following coadministration with dexmedetomidine, for rapid reversal after deep blockade. Although 16mg/kg of actual body weight is recommended for prompt reversal of deep blockade, dosing adjustments may be prudent in the obese population, especially when used in conjunction with other negative chronotropic agents.
Maximum intensity projection aids in diagnosing acute appendicitis and mobile caecum: A case report and literature review
Authors: Kakia A F Namugenyi, Ferdinand M Oompie, Kasandji F Kabambi
Journal: SA J Radiol (2021)
Keywords: acute appendicitis, childhood, maximum intensity projection, mobile caecum, multi detector computed tomography
MeSH terms: Case Reports

Appendicitis is a common childhood condition requiring surgical intervention and delayed diagnosis can have serious consequences. This report describes the case of a child who presented with an acute abdomen and intestinal obstruction. Multidetector (MD) CT demonstrated a left-sided caecum and an inflamed appendix with a faecolith. Maximum intensity projection (MIP) post-processing was key in identifying the appendicular artery and determine the diagnosis. At surgery, however, a mobile caecum and the appendix were positioned on the right side.
First Demonstration of Functional Task Performance Using a Sonomyographic Prosthesis: A Case Study
Authors: Susannah M Engdahl, Samuel A Acuña, Erica L King, Ahmed Bashatah, Siddhartha Sikdar
Journal: Front Bioeng Biotechnol (2022)
Keywords: functional tasks, gesture recognition, prosthesis control, rehabilitation, sonomyography, ultrasound imaging, upper limb

Ultrasound-based sensing of muscle deformation, known as sonomyography, has shown promise for accurately classifying the intended hand grasps of individuals with upper limb loss in offline settings. Building upon this previous work, we present the first demonstration of real-time prosthetic hand control using sonomyography to perform functional tasks. An individual with congenital bilateral limb absence was fitted with sockets containing a low-profile ultrasound transducer placed over forearm muscle tissue in the residual limbs. A classifier was trained using linear discriminant analysis to recognize ultrasound images of muscle contractions for three discrete hand configurations (rest, tripod grasp, index finger point) under a variety of arm positions designed to cover the reachable workspace. A prosthetic hand mounted to the socket was then controlled using this classifier. Using this real-time sonomyographic control, the participant was able to complete three functional tasks that required selecting different hand grasps in order to grasp and move one-inch wooden blocks over a broad range of arm positions. Additionally, these tests were successfully repeated without retraining the classifier across 3 hours of prosthesis use and following simulated donning and doffing of the socket. This study supports the feasibility of using sonomyography to control upper limb prostheses in real-world applications.
Tropical Diabetic Hand Syndrome: report of 2 cases
Authors: Ngim Ewezu Ngim, Paul Amah, Innocent Abang
Journal: Pan Afr Med J (2012)
Keywords: tropical, diabetic, hand, syndrome
MeSH terms: Diabetes Complications / diagnosis, Hand Dermatoses / diagnosis, Hand Dermatoses / etiology, Skin Ulcer / diagnosis, Skin Ulcer / etiology, Case Reports, Female, Humans, Male, Middle Aged, Syndrome

Diabetes mellitus is known to be complicated by foot lesions. However, a few cases of hand complications have been reported in some parts of the world. The case notes of two patients who presented with this condition in our hospital were retrieved and relevant information extracted. The cases of diabetic hand complications seen in our centre are here reported to draw the attention of medical practitioners to the occurrence of this potentially debilitating and occasionally fatal condition. Appropriate counselling of diabetic patients on hand care strategies and good glycemic control are important preventive measures.
Minimally invasive perineal redo surgery for rectovesical and rectovaginal fistulae: A case series
Authors: A A J Grüter, S E Van Oostendorp, L J H Smits, M Kusters, M Özer, J A Nieuwenhuijzen, J B Tuynman
Journal: Int J Surg Case Rep (2020)
Keywords: case series, minimally invasive, perineal redo surgery, rectovaginal fistula, rectovesical fistula, sils

Introduction:
Iatrogenic recto-urogenital fistulae are refractory complications that rarely heal without surgical intervention. The ongoing local infection causes pain, discomfort and substantially impacts quality of life. Surgical repair requires adequate exposure and space to fill with healthy tissue, which is a major challenge in pelvic redo surgery. An abdominal approach to repair the fistula is associated with major morbidity and often fails to expose the deep pelvis. In our experience a novel transperineal minimally invasive approach a utilizing single incision laparoscopic surgery (SILS) technique could offer improved results.
Presentation of cases:
In the present study, three cases of patients with recto-urogenital fistulae after pelvic surgery are described. Two patients were diagnosed with a rectovesical fistula and one patient with a rectovaginal fistula. In all three cases, a minimally invasive perineal approach, using a SILS port, was used to perform surgical repair. The closure of the fistulae involved: a separate repair of the urethra/bladder or vaginal defect and the rectal defect, followed by interposition of vascularized tissue by either a pudendal thigh fasciocutaneous flap or omentoplasty.
Discussion and conclusion:
This study is the first to report on a minimally invasive perineal approach, utilizing a SILS technique for recto-urogenital fistulae repair after previous pelvic surgery. The current approach improves exposure, creates surgical space, optimizes view and allows the interposition of vascularized tissue, without causing substantial blood loss and avoiding major abdominal surgery.
Case Report: Immune and Genomic Characteristics Associated With Hyperprogression in a Patient With Metastatic Deficient Mismatch Repair Gastrointestinal Cancer Treated With Anti-PD-1 Antibody
Authors: Wenyue Zhou, Yuwen Zhou, Cheng Yi, Xinyao Shu, Guixia Wei, Xiaorong Chen, Xudong Shen, Meng Qiu
Journal: Front Immunol (2021)
Keywords: msi-h/dmmr, case report, gastrointestinal cancer, hyperprogression, immune checkpoint inhibitors
MeSH terms: Gastrointestinal Neoplasms / drug therapy, Gastrointestinal Neoplasms / genetics, Gastrointestinal Neoplasms / immunology, Gastrointestinal Neoplasms / pathology, Immune Checkpoint Inhibitors / therapeutic use, Nivolumab / therapeutic use, Programmed Cell Death 1 Receptor / antagonists & inhibitors, Case Reports, B7-H1 Antigen / immunology, DNA Mismatch Repair, Disease Progression, Gene Expression Regulation, Neoplastic, Humans, Male, Middle Aged, Programmed Cell Death 1 Receptor / immunology, Tumor Microenvironment / genetics, Tumor Microenvironment / immunology, B7-H1 Antigen, CD274 protein, human, Immune Checkpoint Inhibitors, PDCD1 protein, human, Programmed Cell Death 1 Receptor, Nivolumab

Microsatellite instability-high/deficient mismatch repair (MSI-H/dMMR) status of tumors is a distinct predictive biomarker of immune checkpoint inhibitors (ICIs) for colorectal and non-colorectal cancer populations. The overall response rate (ORR) varies from approximately 40% to 60%, indicating that nearly half of MSI-H tumors do not respond to ICIs. The mechanism of response heterogeneity in MSI-H/dMMR cancers is unclear. Some patients who have been treated with ICIs have developed a novel pattern of progression called hyperprogression, which is defined as unexpected accelerated tumor growth. No case of MSI-H/dMMR immunotherapy-associated hyperprogression has been reported in the literature. Here, we present the case of a patient with dMMR gastrointestinal cancer who suffered hyperprogressive disease (HPD) after treatment with nivolumab. We explored the potential mechanisms of HPD by clinical, immune, and genomic characteristics. Extremely high levels of serum LDH, low TMB and TILs, and the disruption of TGFβ signaling, may be related to hyperprogression.
Immune system correlates of extensive limb swelling in response to conjugated pneumococcal vaccination
Authors: Mike Recher, Julia R Hirsiger, Marc B Bigler, Martin Iff, Barbara Lemaître, Kathrin Scherer, Peter Häusermann, Claire-Anne Siegrist, Christoph T Berger
Journal: NPJ Vaccines (2018)
MeSH terms: Case Reports

Pneumococcal conjugate vaccine (PCV) is recommended for adults with chronic disease. Extensive limb swelling (ELS) is an acute vigorous local inflammatory reaction following vaccination. Predisposing immune system correlates and the influence of ELS on vaccine responses are not known. Here, we report a case of a 67-year-old woman with a history of multiple pneumonias who had a detailed immunological work-up pre-vaccination because of suspected immunodeficiency. Four days following a first vaccination with PCV13 she developed ELS-mimicking erysipelas. Treatment with 20 mg cortisone completely alleviated symptoms within 2 days. Skin biopsy showed a dense dermal and subdermal infiltration dominated by CD4+ T cells and macrophages. In a multiplexed serotype-specific measurement of the anti-pneumococcal IgG response, the patient showed very broad and strong vaccine responses. Pre-vaccination titers were low for the vaccine serotypes. We did not find in vivo nor in vitro evidence of an excessive T cell response to the diphtheria-derived PCV carrier protein. However, we could demonstrate a high antibody titer to a non-vaccine serotype, indicating in vivo pre-exposure to pneumococcus bacteria. Thus, traces of pneumococcal proteins included in PCV13 may have boosted pre-existing pneumococcus-specific T helper cells, which subsequently orchestrated ELS. Our case raises awareness for the risk of vaccine-induced ELS, especially in patients with a history of recurrent pneumococcal disease and thus partial immunity.
Case Report: Intraoperative Open-Heart Coronary Angiography in Acute Type A Aortic Dissection
Authors: Jue Yang, Xin Li, Zerui Chen, Tucheng Sun, Ruixin Fan, Changjiang Yu
Journal: Front Cardiovasc Med (2021)
Keywords: aortic dissection, case report, coronary angiography, coronary artery disease, open-heart
MeSH terms: Case Reports

For patients with acute type A aortic dissection, strongly suspected of having concomitant severe coronary artery disease (CAD), preoperative or intraoperative coronary angiography has been recommended. However, conventional selective coronary angiography in this setting may extend the dissection or aortic rupture. We present the use of intraoperative open-heart coronary angiography in a patient with acute type A aortic dissection. A 50-year-old man presented with chest pain and dyspnea and was admitted to our department with acute type A aortic dissection. The patient underwent coronary artery stent implantation in the left anterior descending coronary artery (LAD) 3 years previously due to an acute myocardial infarction. This time we failed to evaluate the patency of the LAD using multidetector computed tomography. An aortic rupture occurred due to conventional coronary angiography, and open-heart coronary angiography was performed. The examination revealed no significant stenosis. A Bentall procedure and total aortic arch replacement were performed, with an intraoperative stent inserted into the descending aorta, and the patient had an uneventful postoperative course. From this case, we learn that intraoperative open-heart coronary angiography is safe and effective in patients with acute type A aortic dissection.
Peroneal Nerve Palsy due to Bulky Osteochondroma from the Fibular Head: A Rare Case and Literature Review
Authors: T Cherrad, M Bennani, H Zejjari, J Louaste, L Amhajji
Journal: Case Rep Orthop (2020)
MeSH terms: Case Reports

Common peroneal neuropathy is the most common compressive neuropathy in the lower extremities. The anatomical relationship of the fibular head with the peroneal nerve explains entrapment in this location. We report the case of a 14-year-old boy admitted with a left foot drop. The diagnosis was an osteochondroma of the proximal fibula compressing the common peroneal nerve. The patient underwent surgical decompression of the nerve and resection of the exostosis. Three months postoperatively, there was a complete recovery of the deficits. The association of osteochondroma and peroneal nerve palsy is rare. Early diagnosis is required in order to adjust the management and improve the results. It is worth to underscore that surgical resection is proven to be the appropriate treatment method ensuring high success rates.
Paraduodenal hernia: An exceptional cause of acute bowel obstruction
Authors: Med Mehdi Trabelsi, Annouar Oueslati, Mehdi Kammoun, Hichem Jerraya, Ibtissem Bouasker, Ramzi Nouira
Journal: Clin Case Rep (2023)
Keywords: general surgery
MeSH terms: Case Reports

Internal hernias represent only 0.2%-0.9% of all causes of bowel obstruction. A 59-year-old patient presented urgently with small bowel obstruction. Laparotomy revealed a left paraduodenal hernia with most of the small bowel herniating through a space between the inferior mesenteric vein and duodenojejunal junction.
Tubuloglomerular Disease With Cone-Shaped Epiphyses Associated With Hypomorphic Variant and a Novel p.Cys14Arg in the TTC21B Gene: A Case Report
Authors: Martin Bezdíčka, Dana Zemková, Sylva Skálová, Eva Hovorková, Miroslav Podhola, Jan Burkert, Jakub Zieg
Journal: Front Pediatr (2021)
Keywords: ttc21b, case report, cone-shaped epiphyses, nephrotic syndrome, podocyte, proteinuria
MeSH terms: Case Reports

Monogenic nephrotic syndrome (NS) is associated with a resistance to initial glucocorticoid therapy and causative variants, which may be found in several genes influencing podocyte stability and kidney development. The TTC21B gene, which encodes the retrograde intraflagellar transport protein IFT139, is found mostly in association with ciliopathies in humans. The role of this protein in podocyte cytoskeleton stability was confirmed later and the mutated TTC21B also may be associated with proteinuric diseases, such as nephrotic syndrome. Our patient manifested as an infant with brachydactyly, nephrotic-range proteinuria, and renal tubular acidosis, and a kidney biopsy revealed focal segmental glomerulosclerosis (FSGS). Multiple phalangeal cone-shaped epiphyses of the hand were seen on X-ray. Next-generation sequencing revealed the well-described p.Pro209Leu heterozygous variant and a novel heterozygous p.Cys14Arg variant in the TTC21B gene. Our finding confirmed that the causative variants in the TTC21B gene may contribute to a spectrum of clinical features, such as glomerular proteinuric disease with tubulointerstitial involvement and skeletal abnormalities.
A Case of Euthyroid Graves' Ophthalmopathy in a Patient Sero-Negative for TSH Receptor Autoantibody
Authors: Asami Hotta, Tomohiro Tanaka, Haruka Kato, Shota Kakoi, Yuki Shimizu, Chie Hasegawa, Akiko Hayakawa, Satoshi Yasuda, Kento Ogawa, Shunsuke Ito, Hideomi Ohguchi, Takashi Yagi, Hiroyuki Koyama, Mihoko Kawamura, Kazuhiko Sugitani, Yuichiro Ogura, Takashi Joh, Kenro Imaeda
Journal: Case Rep Endocrinol (2018)
MeSH terms: Case Reports

We report of a case of Graves' ophthalmopathy presented solely with symptoms of the eyes with normal thyroid function tests and negative immunoreactive TSH receptor autoantibody. 40-year-old male was referred to our hospital due to 2-month history of ocular focusing deficit without any signs or symptoms of hyper- or hypothyroidism. Serum thyroid function tests and 99mTc uptake were both within the normal range. Anti-thyroid autoantibodies were all negative except for the cell-based assay for serum TSH receptor stimulating activity. Since orbital CT scan and MRI gave typical results compatible with Graves' ophthalmopathy, we treated the patients with corticosteroid pulse therapy and orbital radiation therapy, leading to a partial improvement of the symptoms. This case gives insights into the potential pathophysiologic mechanism underlying Graves' ophthalmopathy and casts light upon the difficulties of establishing the diagnosis in a euthyroid case with minimal positive results for anti-thyroid autoantibodies.
A unique dedifferentiated tumor of the retroperitoneum
Authors: Shahzeer Karmali, Halligrimur Benediktson, Walley Temple, Oliver F Bathe
Journal: World J Surg Oncol (2004)

Background:
Dedifferentiated liposarcomas represent heterogeneous tumors with lipomatous and nonlipomatous elements starkly juxtaposed. It is thought that the high grade nonlipomatous elements of the tumor portend a worse prognosis.
Case presentation:
A 19.8 kg heterogeneous retroperitoneal tumor was successfully and completely resected. Because of its extent, no additional treatment modalities were practicable. The tumor soon recurred. The recurrent tumor differed from the primary tumor in that it was more homogeneous, consisting mainly of nonlipogenic, calcific tissue.
Conclusions:
Dedifferentiated liposarcomas are known to have a very high recurrence rate. The biological behavior of dedifferentiated liposarcomas is likely dictated by the most aggressive element of these heterogeneous tumors.