OpenMed/multicare-articles huggingface dataset:
Kidney transplant in a 26-year-old nigerian patient with sickle cell nephropathy
Authors: U H Okafor, C Wachukwu, P Emem-Chioma, F S Wokoma
Journal: Case Rep Nephrol (2012)

Sickle cell nephropathy (SCN) is a common complication of sickle cell disease (SCD). It has variable presentation, ranging from hyposthenuria to end-stage renal disease (ESRD). Management of ESRD in SCD patients is froth with multiple challenges which has potential to impact negatively the outcome of the patient. Kidney transplant is the preferred renal replacement therapy in these patients. The objective of this case study is to report kidney transplant in a Nigerian young man with sickle cell nephropathy and to highlight the outcome and the challenges to kidney transplant in this patient. The index case is a 26-years-old sickle cell disease patient with ESRD complicated with cardiovascular, pulmonary, immunological, and infective challenges. These conditions were controlled, and the patient had a successful live-related kidney transplant. Kidney transplant is a viable option for sickle cell disease patients with ESRD.
The Diagnosis Is in the Smear: A Case and Review of Spur Cell Anemia in Cirrhosis
Authors: Gabriella A Raffa, Diana M Byrnes, John J Byrnes
Journal: Case Rep Hematol (2021)
MeSH terms: Case Reports

The etiology of anemia in liver cirrhosis is multifactorial; one less recognized cause is hemolytic anemia due to spur cells, known as spur cell anemia. We present the case of a 57-year-old woman with alcoholic cirrhosis who presented with symptomatic macrocytic anemia with a hemoglobin level of 7.4 g/dL and signs of decompensated liver disease. Notably, she had no signs of overt bleeding. Further workup was consistent with hemolysis, with peripheral smear demonstrating spur cells. The patient was treated with both steroids and IVIG, although she eventually expired. The characteristic morphology of spur cells is due to alteration of the lipid composition of the erythrocyte membrane, changing its shape and leading to splenic sequestration and destruction. Characteristic of this disorder is an increased ratio of cholesterol to phospholipid on the membrane, as well as low levels of apolipoproteins and low- and high-density lipoproteins. The presence of spur cells is an indicator of poor prognosis and high risk of mortality. Currently, the only definitive cure is liver transplantation. There is a paucity of literature on the prevalence of this phenomenon and even less about treatment. This case highlights the importance of recognition of spur cell anemia as a cause of anemia in cirrhosis as well as the importance of the peripheral smear in the diagnostic workup. Early recognition can lead to avoidance of unnecessary procedures. Further research is needed to elucidate the true prevalence of spur cell anemia and examine further treatment options.
Role of Alendronate in Managing Osteoporosis in Celiac Disease - Illustrative Case Report
Authors: David Widjaja, Kalyan C Kanneganti, Madanmohan Patel, Sridhar S Chilimuri
Journal: Gastroenterology Res (2011)
Keywords: alendronate, celiac disease, osteoporosis
MeSH terms: Case Reports

Management of bone density loss, as the result of calcium malabsorption in celiac disease, is critical in preventing premature bone fracture. As many of these patients need follow-up with primary care providers, internists are expected to be aware of screening and prompt management of osteopenia or osteoporosis in celiac disease. We present a case of a 32-year-old man with celiac disease who was diagnosed with osteoporosis. He was treated with calcium, vitamin D and alendronate which improved bone mineral density. This case illustrates the importance of using bisphosphonate in treating osteoporosis in celiac disease.
Revisiting the forgotten remnant: Imaging spectrum of Meckel's diverticulum
Authors: Manish Kumar, Priya Singh, Priti Kumari, Rohit Kaushik
Journal: SA J Radiol (2022)
Keywords: meckel’s acute abdomen, meckel’s diverticulum, complications, computed tomography, imaging
MeSH terms: Case Reports

Meckel's diverticulum is a true diverticulum of the alimentary tract occurring resulting from the persistence of remnants of the vitello-intestinal duct. They are often asymptomatic and incidentally diagnosed during surgery. Complications such as intestinal obstruction, diverticulitis, intestinal haemorrhage and perforation may occur with Meckel's diverticulum, which renders them symptomatic. The clinical and imaging diagnosis of Meckel's diverticulum is very challenging. As a result of the rare occurrence of complicated Meckel's diverticulum and the difficult preoperative diagnosis, knowledge of its imaging features is limited. The presented case series describes a spectrum of complications caused by Meckel's diverticulum and its CT imaging features. It highlights the importance of a high clinical suspicion by carefully searching for a Meckel's diverticulum on CT in its characteristic location to avoid missing it preoperatively.
Head Tilting Elicited by Head Turning in Three Dogs with Hypoplastic Cerebellar Nodulus and Ventral Uvula
Authors: Shinji Tamura, Yuya Nakamoto, Takashi Uemura, Yumiko Tamura
Journal: Front Vet Sci (2016)
Keywords: cerebellar, dog, nodulus, positioning head tilt, ventral uvula
MeSH terms: Case Reports

The nodulus and ventral uvula (NU) of the cerebellum play a major role in vestibular function in humans and experimental animals; however, there is almost no information about NU function in the veterinary clinical literature. In this report, we describe three canine cases diagnosed with presumptive NU hypoplasia. Of them, one adult dog presented with cervical intervertebral disk disease, and two juvenile dogs presented with signs of central vestibular disease. Interestingly, an unusual and possibly overlooked neurological sign that we called "positioning head tilt" was observed in these dogs. The dogs were able to turn freely in any direction at will. The head was in a level position when static or when the dog walked in a straight line. However, the head was tilted to the opposite side when the dog turned. Veterinary clinicians should be aware of this neurological sign that has not been reported previously, and its application in lesion localization in dogs.
Exercise-induced bronchospasm: a case study in a nonasthmatic patient
Authors: Mary Lou Hayden, Stuart W Stoloff, Gene L Colice, Nancy K Ostrom, Nemr S Eid, Jonathan P Parsons
Journal: J Am Acad Nurse Pract (2012)
MeSH terms: Bronchial Spasm, Exercise, Humans

Purpose:
To provide an overview of the clinical presentation, diagnosis, and management of exercise-induced bronchospasm (EIB) without underlying asthma.
Data sources:
Case presentation and review of the EIB Landmark Survey.
Conclusions:
EIB is a common and well-described occurrence in patients with asthma, as well as in patients with no overt respiratory condition. Treatment with a short-acting beta-agonist before starting exercise is effective, yet this treatment approach is underutilized in the majority of patients with asthma.
Implications for practice:
This case highlights the implications of undermanaged EIB and the disconnect between healthcare provider recommendations and the beliefs and behaviors in patients with EIB. Inhaled short-acting beta-agonists can attenuate EIB in 80%-95% of patients and are effective during 2-3 h of exercise. Patients with a compromised level of physical activity because of EIB who do not respond to conventional treatment strategies should be referred to a respiratory specialist for diagnostic evaluation and confirmation of underlying asthma. Nurse practitioners should remain vigilant to identify untreated EIB and ensure that affected patients understand the condition and appropriate treatment options.
Effect of myopia on the progression of normal tension glaucoma
Authors: Chun-Mei Hsueh, Jong-Shiuan Yeh, Jau-Der Ho
Journal: PLoS One (2023)
MeSH terms: Low Tension Glaucoma / diagnosis, Myopia / complications, Myopia / diagnosis, Optic Disk, Observational Study, Disease Progression, Humans, Intraocular Pressure, Retrospective Studies, Visual Field Tests

Purpose:
Identify risk factors of progression in treated normal-tension glaucoma (NTG) in highly myopic and non-highly myopic eyes.
Methods:
This retrospective, observational case series study included 42 highly myopic glaucoma (HMG, <-6D) eyes and 39 non-highly myopic glaucoma (NHG,≧-6D) eyes. Glaucoma progression was determined by serial visual field data. Univariate and multivariate logistic regression method were used to detect associations between potential risk factors and glaucoma progression.
Results:
Among 81 eyes from 81 normal-tension glaucoma patients (mean follow-up, 3.10 years), 20 of 42 eye (45.24%) in the HMG and 14 of 39 eyes (35.90%) in the NHG showed progression. The HMG group had larger optic disc tilt ratio (p = 0.007) and thinner inferior macular thickness (P = 0.03) than the NHG group. Changes in the linear regression values for MD for each group were as follows: -0.652 dB/year for the HMG and -0.717 dB/year for the NHG (P = 0.298). Basal pattern standard deviation (PSD) (OR: 1.55, p = 0.016) and post treatment IOP (OR = 1.54, p = 0.043) were risk factors for visual field progression in normal tension glaucoma patients. In subgroup analysis of HMG patients, PSD (OR: 2.77, p = 0.017) was a risk factor for visual field progression.
Conclusion:
Reduction IOP was postulated to be contributing in the prevention of visual field progression, especially in highly myopic NTG patients with large basal pattern standard deviation.
Leiomyoma of the female urethra-a rare tumor: case report and review of the literature
Authors: Mrinal Pahwa, Yusuf Saifee, Archna R Pahwa, Manu Gupta
Journal: Case Rep Urol (2012)

Leiomyoma is a benign smooth muscle tumor which is rarely found in urethra. Only a handful of cases have been reported in the literature. We hereby report a case of urethral leiomyoma in a twenty-seven-year-old female who presented with intermittent hematuria. Mass was completely excised with a rim of normal tissue. Patient remained asymptomatic with no evidence of recurrence in followup.
Case Report: 18F-PSMA PET/CT May Improve the Clinical Management of Penile Metastases From Prostate Cancer
Authors: Junjie Fan, Hua Liang, Xing Zhang, Xingfa Chen, Xiaoyi Duan, Lei Li, Dalin He, Kaijie Wu
Journal: Front Oncol (2021)
Keywords: psma pet/ct, early diagnosis, penile metastases, prostate cancer, survival advantage
MeSH terms: Case Reports

Metastases from prostate cancer (PCa) to the penis are extremely rare, and few case reports exist in the literature. Because most patients usually present with multiple distant metastases at diagnosis, the prognosis is very poor. With the wide application of prostate-specific membrane antigen (PSMA) PET/CT, penile metastases may be detected at an early stage. Thus, questions regarding whether early diagnosis and precise treatment will equate to a survival advantage have recently been raised. In the present study, we reported 3 cases of penile metastasis from castration-resistant PCa. Moreover, a patient with asymptomatic penile metastases was diagnosed by 18F-PSMA PET/CT followed by lesion biopsy, and the prognosis was very well, despite with an aggressive pathological feature and low treatment intensity. In addition, we performed a literature review and found 62.5% of asymptomatic penile metastases were diagnosed by PSMA PET/CT in past seven years. Thus, we believe that PSMA PET/CT may detect more asymptomatic penile metastases in future, which led to early diagnosis, treatment and survival advantage.
The importance of the lifelike esthetic appearance of all-ceramic restorations on anterior teeth
Authors: Daniela Micheline Dos Santos, Amália Moreno, Aljomar José Vechiato-Filho, Liliane da Rocha Bonatto, Aldiéris Alves Pesqueira, Murilo César Bento Laurindo Júnior, Rodrigo Antonio de Medeiros, Emily Vivianne Freitas da Silva, Marcelo Coelho Goiato
Journal: Case Rep Dent (2015)

The success of rehabilitation will not depend on just clinical procedures. A proper dental technique (ceramist) is required as well as the respect for some biomimetic principles to obtain the desired final result. This study has the purpose of describing a prosthetic rehabilitation with laminate veneers and all-ceramic crowns of a patient unsatisfied with a previous esthetic treatment because of the negligence of some biomimetic principles. A 45-year-old female patient was admitted to the dental clinic complaining about the lifelike appearance of her all-ceramic restorations. Before the fabrication of new restorations, a mock-up was conducted to verify the patient's satisfaction. A ceramist conducted all the fabrication process so that surface characterizations could be visually verified and the lifelike appearance of natural tooth could be reproduced. After the cementation procedure, the patient reported being satisfied with the lifelike appearance of the new restorations. Based on the clinical findings of the present case report, it can be concluded that the reproduction of the lifelike esthetic appearance of natural teeth and the visualization of the final results before definitive procedures are essential to obtain the clinical success.
Case Report: Considerations of nocturnal ventilator support in ROHHAD syndrome in chronic care of childhood central hypoventilation with hypothalamus dysfunction
Authors: Rui Zhao, Xiaosong Dong, Zhancheng Gao, Fang Han
Journal: Front Pediatr (2022)
Keywords: rohhad syndrome, hypothalamic dysfunction, hypoventilation, noninvasive positive pressure ventilation, obesity
MeSH terms: Case Reports

Rapid-onset obesity with hypothalamic dysfunction, hypoventilation, and autonomic dysregulation (ROHHAD) is a rare life-threatening disorder that can occur during childhood. All children with ROHHAD develop alveolar hypoventilation during wakefulness and sleep. The key treatment for these patients is the optimization of oxygenation and ventilation. Here, we report the case of a 5-year-old girl with suspected ROHHAD, with rapid weight gain, breathing cessation, decreased height, hypoventilation, central hypothyroidism, hyperprolactinemia, and absolute deficiency of growth hormone, and negative PHOX2B sequencing results. The presentation met the diagnostic criteria for ROHHAD syndrome. During the 5-year follow-up, she presented with progressive deterioration of the function of the hypothalamus and respiratory center, hypoxemia (PO2 < 60 mmHg), and hypercapnia [transcutaneous carbon dioxide (TcPCO2) > 70 mmHg] during the first two cycles of N3 sleep with a poor response to ventilatory support. Early diagnosis and application of non-invasive positive pressure ventilation during sleep can improve the quality of life and outcomes of patients with ROHHAD, and polysomnography and TcPCO2 should be repeated every 3-6 months to follow the progress and regulate ventilator support. Multidisciplinary care is crucial for the successful management of these patients.
MELAS Missed for Years: Stroke-Like Lesions Are No Indication for Brain Biopsy
Authors: J Finsterer
Journal: Case Rep Neurol Med (2019)
MeSH terms: Case Reports

A 56-year-old female with a history of chronic alcoholism until age 38 y with a relapse between ages 45 and 46 y developed seizures, psychosis, and hemianopia to the left at age 46 y. Imaging revealed a right parieto-occipital lesion with intralesional bleeding. Five months after the first lesion she developed a second left parieto-occipital lesion, resulting in cortical blindness. Extensive workup, including brain biopsy, was noninformative. Retrospectively, the occipital abnormalities were identified as stroke-like lesions (SLLs). Further manifestations of the mitochondrial disorder (MID) were tremor, cerebral atrophy, bilateral basal ganglia, calcification, glaucoma, hypoacusis, short stature, hyperostosis frontalis, hyperthyroidism, sick-sinus syndrome and AV-block-1, and myopathy. According to the Walker criteria, a possible MID was diagnosed. In conclusion, adult-onset MID may be missed for years, SLLs may be easily misinterpreted entailing brain biopsy, and psychosis may contribute to a reduced impact for proper workup of a MID.
Haematochezia from a Splenic Artery Pseudoaneurysm Communicating with Transverse Colon: A Case Report and Literature Review
Authors: James O'Brien, Francesca Muscara, Aser Farghal, Irshad Shaikh
Journal: Case Rep Vasc Med (2016)

Splenic artery aneurysms (SAA) are the third most common intra-abdominal aneurysm. Complications include invasion into surrounding structures often in association with preexisting pancreatic disease. We describe an 88-year-old female, with no history of pancreatic disease, referred with lower gastrointestinal bleeding. CT angiography showed a splenic artery pseudoaneurysm with associated collection and fistula to the transverse colon at the level of the splenic flexure. The pseudoaneurysm was embolised endovascularly with metallic microcoils. Rectal bleeding ceased. The patient recovered well and follow-up angiography revealed no persistence of the splenic artery pseudoaneurysm. SAA rupture results in 29%-50% mortality. Experienced centres report success with the endovascular approach in haemodynamically unstable patients, as a bridge to surgery, and even on a background of pancreatic disease. This case highlights the importance of prompt CT angiography, if endoscopy fails to identify a cause of gastrointestinal bleeding. Endovascular embolisation provides a safe and effective alternative to surgery, where anatomical considerations and local expertise permit.
Differential diagnosis problems in a patient with dysphonia and chronic lymphocytic leukemia
Authors: Gabriela-Ariadna Gavrila, Romeo-Gabriel Mihaila, Ioan Manitiu
Journal: Pak J Med Sci (2015)
Keywords: chronic lymphocytic leukemia, dysphonia, genomic instability, lung cancer, mediastinal compression
MeSH terms: Case Reports

Dysphonia is frequently an expression of laryngitis, especially when it comes in the evolution of an immunosuppressed patient, as happens in chronic lymphoproliferation. But other causes of dysphonia should also not be forgotten, including the possibility of new malignancies, especially due to the fact that these patients have genomic instability that predisposes to appearance of a second or even a third cancer. We present the case of a patient who developed dysphonia during chronic lymphocytic leukemia evolution. Its etiology was a mediastinal compression through lymph nodes, not linked to leukemia, but produced by metastases of a bronchopulmonary cancer, appeared recently. Dysphonia condition due to vocal cord dysfunction must include diseases of the mediastinum, the neck and the brain stem. The rapid and correct diagnosis and the prompt start of an appropriate treatment are of paramount importance for clinician who manage their care and for patient survival.
Case Report: Caecal volvulus management from diagnosis to treatment in a young patient
Authors: Imed Abbassi, Wissem Triki, Racem Trigui, Ramy Ben Salah, Ahmed Itaimi, Karim Ayed, Hajer Sebri, Oussema Baraket, Sami Bouchoucha
Journal: F1000Res (2022)
Keywords: caecal volvulus, caecectomy, caecopexy, whirl sign
MeSH terms: Cecal Diseases / complications, Cecal Diseases / diagnosis, Cecal Diseases / surgery, Intestinal Obstruction / diagnosis, Intestinal Obstruction / etiology, Intestinal Obstruction / surgery, Intestinal Volvulus / diagnostic imaging, Intestinal Volvulus / surgery, Case Reports, Adult, Biopsy, Female, Humans, Tomography, X-Ray Computed / adverse effects, Young Adult

Caecal volvulus (CV) is a rare cause of intestinal obstruction, defined by an axial torsion of the caecum, ascending colon, and terminal ileum around the mesenteric vascular pedicles, leading to ischemia and bowel necrosis. A 20-year-old woman, with no significant medical history, was admitted for generalized abdominal pain evolving for three days, along with constipation and abdominal distension, but with no vomiting. Physical examination showed a generalized abdominal tenderness with no rigidity or rebound tenderness, associated with abdominal distension and tympanic upon percussion. Laboratory findings were within normal limits. An abdominal computed tomography scan revealed distension of a loop of the large bowel with its long axis extending from the right lower quadrant to the epigastrium or left upper quadrant. Colonic haustral pattern was absent. An abdominal computed tomography scan showed a rounded focal collection of air-distended bowel with haustral creases in the upper left quadrant. In addition, spiraled loops of the collapsed cecum (giving a whirl sign) were noted, along with low-attenuating fatty mesentery from the twisted bowel. The patient underwent an emergency laparotomy and caecectomy using GEA 80 charges. The patient had no complaints post-operation. CV is a rare cause of bowel obstruction, mainly caused by an exceedingly mobile caecum. Despite its rareness, CV represents the second most common cause of large bowel volvulus, behind sigmoid volvulus. For acute obstruction by CV, it is hard to differentiate it clinically from obstruction of the small bowel; therefore, radiological exams are needed. Surgery is the gold standard treatment for CV. We report a rare case of CV to highlight the rarity of this pathology, specify its diagnostic and therapeutic means, and its clinical and biological evolution.
Case report: Flow changes in routes of collateral circulation in patients with LVO and low NIHSS: a point favor to treat
Authors: Elizeu Pereira Dos Santos Neto, Ícaro Araújo de Sousa, Arthur de Oliveira Veras, Marx Lima de Barros-Araújo, Irapuá Ferreira Ricarte, Octávio Marques Pontes-Neto
Journal: Front Neurol (2023)
Keywords: acute ischemic stroke (ais), collateral circulation, endovascular thrombectomy, large vessel occlusion (lvo), low nihss score, transcranial doppler ultrasound
MeSH terms: Case Reports

The effectiveness of endovascular thrombectomy in patients presenting low National Institutes of Health Stroke Scale (NIHSS) scores remains controversial, and the acquisition of additional evidence is required to refine the selection of candidates who may benefit the most from this therapeutic modality. In this study, we present the case of a 62-year-old individual, with left internal carotid occlusion stroke and low NIHSS, who had compensatory collateral flow from Willis polygon via the anterior communicating artery. The patient subsequently exhibited neurological deterioration and collateral flow failure from Willis polygon, indicating the need for urgent intervention. The study of collaterals in patients with large vessel occlusion stroke has garnered considerable attention, with research suggesting that individuals with low NIHSS scores and poor collateral profiles may be at a heightened risk of early neurological deterioration. We postulate that such patients may derive significant benefits from endovascular thrombectomy, and may posit that an intensive transcranial Doppler monitoring protocol could facilitate the identification of suitable candidates for such intervention.