OpenMed/multicare-articles huggingface dataset:
Medical Qigong for Mobility and Balance Self-Confidence in Older Adults
Authors: James E Stahl, Shoshana S Belisle, Wenyan Zhao
Journal: Front Med (Lausanne) (2020)
Keywords: balance, falls, health confidence, mind-body medicine, qigong, stability
MeSH terms: Case Reports

Background/Objectives: Physical inactivity, sedentary lifestyle, and impaired neuromuscular function increases fall risk and fractures in our aging population. Mind-body modalities, improve strength, balance and coordination, mitigating these risks. This study examined whether a manualized Medical Qigong protocol measurably improves balance, gait, and health self-confidence among older adults. Design: Randomized prospective cohort pre-post study with wait time control. Setting: Two martial arts centers in Massachusetts and Arizona. Participants: Ninety-five adults age ≥ 50 (mean age 68.6 y.o., range 51-96) were randomly assigned to an immediate start group (N = 53) or 4-week delayed start group (N = 43). Intervention: A 10 form qigong protocol taught over 12 weekly classes. Measurments: Primary outcome measures were the Community Balance and Mobility Scale (CBMS) and Activities-Specific Balance Confidence (ABC) Scale. Data was collected at baseline, 1-month and 4-months. Results: Both groups at both sites demonstrated improved balance and gait (CBMS + 11.9 points, p < 0.001). This effect was strongest in patients in their 60 s (CBMS +12.9 p < 0.01) and 70 s (CBMS + 14.3, p < 0.001), was equal across genders and socioeconomic status. Balance self-confidence did not significantly change (ABC + 0.9, p = 0.48), though several elements within ABC trended toward improvement [e.g., walk up/down ramp (p = 0.07), bend over/pick up (p = 0.09)]. Falls in the past year was inversely correlated with balance self-confidence (p = 0.01). Conclusion: A 12-week manualized Medical Qigong protocol significantly improved balance and gait and modestly improved balance self-confidence among older adults. Medical Qigong may be a useful clinical intervention for older adults at heightened risk for falls and related injuries. Clinical Trial Registration: www.ClinicalTrials.gov, identifier: NCT04430751.
Arthroscopic Excision of Intra-Articular Osteoid Osteoma at the Elbow
Authors: Taku Hatta, Masami Hosaka, Munenori Watanuki, Toshihisa Yano, Shinichirou Yoshida, Mika Watanabe, Shin Hitachi, Eiji Itoi
Journal: Case Rep Orthop (2019)
MeSH terms: Case Reports

Osteoid osteoma (OO) apparent in the intra-articular region of the elbow is very rare. Although computed tomography-guided excision and radiofrequency ablation have been recognized as useful treatment options, arthroscopic excision has recently received focus as an alternative strategy for lesions close to neurovascular structures or intra- and juxta-articular lesions. We herein report a 17-year-old female who underwent arthroscopic treatment for intra-articular OO located at the olecranon/coronoid fossa. Her symptoms included elbow pain that was exacerbated at night and contracture of elbow flexion-extension, and she was diagnosed with intra-articular OO after 12 months of symptomatic history. Arthroscopically, thorough synovectomy for both the anterior and posterior aspects of the joint enabled definition of the tumor margin with hyperemic alteration and excision of the lesion as an en bloc specimen. At the 12-month follow-up, the patient had no recurrence of elbow limitation or pain. This case report describes the advantages of arthroscopic treatment, including a low-invasive approach and easy accessibility to the whole intra-articular space, which can provide clear visualization of the tumorous lesion.
A Novel Germline Mutation of KEAP1 (R483H) Associated with a Non-Toxic Multinodular Goiter
Authors: Eijun Nishihara, Akira Hishinuma, Takahiko Kogai, Nami Takada, Mitsuyoshi Hirokawa, Shuji Fukata, Mitsuru Ito, Tomonori Yabuta, Mitsushige Nishikawa, Hirotoshi Nakamura, Nobuyuki Amino, Akira Miyauchi
Journal: Front Endocrinol (Lausanne) (2016)
Keywords: graves’ disease, keap1 germline mutation, nrf2 expression, familial goiter, multinodular goiter
MeSH terms: Case Reports

Background:
A germline mutation of KEAP1 gene was reported as a novel genetic abnormality associated with familial multinodular goiter. That report was limited, and the pathogenic features were not well established.
Patient findings:
We report a 47-year-old Japanese woman who presented with hyperthyroidism and a large multinodular goiter. The family history was notable for a paternal history of goiter. Graves' disease was diagnosed based on positive TRAb, but scintiscan imaging showed that the patient's radioiodine uptake was restricted in the non-nodular areas, indicating largely cold nodules. A total thyroidectomy was performed. The resected thyroid tissue weighed 209 g, and subsequent pathological findings were benign. The patient had a germline heterozygous KEAP1 mutation, c. 1448 G > A, resulting in an amino acid substitution (p.R483H). A next-generation sequencing analysis covering all known genes associated with multinodular goiter showed no additional germline mutation. The nuclear accumulation of NRF2, a protein associated with KEAP1, was shown at much higher rates in the patient's nodules compared with nodules obtained from four unrelated patients with multinodular goiters.
Conclusion:
A novel germline mutation (R483H) of KEAP1 gene was associated with the development of a non-toxic multinodular goiter.
Rapid improvement of angiostenosis due to isolated middle cerebral artery dissection: A case report
Authors: Li Zhang, Guangxian Nan, Ying Mao, Lumei Chi
Journal: Medicine (Baltimore) (2018)
MeSH terms: Aortic Dissection / complications, Aortic Dissection / diagnostic imaging, Aortic Dissection / drug therapy, Aphasia / etiology, Cerebral Infarction / etiology, Intracranial Aneurysm / complications, Intracranial Aneurysm / diagnostic imaging, Intracranial Aneurysm / drug therapy, Middle Cerebral Artery / diagnostic imaging, Case Reports, Cerebral Revascularization / methods, Constriction, Pathologic, Humans, Male, Middle Aged, Platelet Aggregation Inhibitors / therapeutic use, Platelet Aggregation Inhibitors

Rationale:
Intracranial arterial dissection is a rare cause of ischemic stroke, and isolated middle cerebral artery dissection (MCAD) is extremely rare, having been described only in sparse case reports. The etiology, clinicoradiological features, and treatment strategies are not yet well understood.
Patient concerns:
A 49-year-old man presented with rapidly progressive aphasia and motor disturbance of the right limbs.
Diagnoses:
Neuroimaging evaluation confirmed a diagnosis of MCAD and cerebral infarction.
Interventions:
The patient underwent oral anti-platelet therapy (100 mg aspirin daily).
Outcomes:
The patient recovered to normal status within 2 weeks following antiplatelet treatment. During a follow-up period of 2 years, he remained neurologically asymptomatic and led a virtually normal life.
Lessons:
It is crucial for clinicians to be aware of this entity, as the diagnosis of MCAD is quite challenging. Antiplatelet therapy is effective for treating this condition, and the prognosis can be favorable.
Case Report: Pediatric Hepatic Rhabdomyosarcoma With Maximum Lifetime
Authors: Xu Li, Xiang Li, Dian-Fei Yang, Miao Li, Hong-Qin Xu, Shuang Zheng, Pu-Jun Gao
Journal: Front Med (Lausanne) (2022)
Keywords: diagnosis, embryonal, hepatic, liver, rhabdomyosarcoma
MeSH terms: Case Reports

Primary intrahepatic rhabdomyosarcoma is an extremely rare malignant tumor. Here, we describe a case of embryonal rhabdomyosarcoma of the liver in a 7-year-old boy without any symptoms. Serologically, the patient showed abnormal levels of serum tumor markers and liver function. Imaging revealed a large mass in the left lobe of the liver and no lesions elsewhere. At first, the patient was misdiagnosed by percutaneous liver biopsy as having clear cell sarcoma. However, the final diagnosis was established to be hepatic embryonal rhabdomyosarcoma based on postoperative histopathology and typical immunohistochemical staining, which was positive for desmin and myogenin. For treatment, the patient received two cycles of preoperative chemotherapy, prophylactic radiotherapy, and 13 cycles of combined postoperative chemotherapy. Routine follow-ups after all treatment conducted by imaging examinations showed no sign of recurrence or metastasis over 13 months, and the patient survives more than 38 months since initial diagnosis. To our knowledge, this patient is the first with hepatic rhabdomyosarcoma to receive neoadjuvant chemotherapy (preoperative chemotherapy) combined with relative comprehensive treatment and achieve a favorable result.
Miliary Histoplasmosis in a Patient with Rheumatoid Arthritis
Authors: Jessica Lum, Maheen Z Abidi, Bruce McCollister, Andrés F Henao-Martínez
Journal: Case Rep Med (2018)
MeSH terms: Case Reports

Miliary histoplasmosis is a rare presentation that may mimic miliary tuberculosis. We report a case of miliary histoplasmosis in a 52-year-old male who was being treated with hydroxychloroquine, methotrexate, and sulfasalazine for his rheumatoid arthritis and presented to the emergency department with shortness of breath and fevers. Computed tomography (CT) chest revealed miliary pulmonary nodules. Urine Histoplasma antigen and serum Histoplasma antigen were negative; however, Coccidioides immitis complement immunofixation assay and Coccidioides IgM were positive. The patient was initiated on treatment for pulmonary coccidioidomycosis and immunosuppression was held. However, a few days later, Histoplasma capsulatum was isolated from cultures from bronchoscopy. This case highlights the difficulty in diagnosing histoplasmosis in immunocompromised patients and the importance of having a broad differential diagnosis for miliary pulmonary nodules. Tissue culture and histopathology remain the gold standard for the diagnosis of histoplasmosis. Further research needs to be conducted to determine the optimal duration of histoplasmosis treatment in immunocompromised patients.
Inadvertent Traumatic Fracture of Central Venous Catheter during Procurement, Transmitted Through Solid Organ Transplant
Authors: Thaer Obaid, Corinne Cricco, Ani Simka, Richard Fine, Saravanan Ramamoorthy, Radi Zaki
Journal: Case Rep Transplant (2018)
MeSH terms: Case Reports

Central venous catheters play a pivotal role in the perioperative support of critically ill patients. They are used for administration of fluids, vasopressors, blood products, and various medications; however, their use may be associated with serious complications, such as catheter fracture and embolization. While most data on catheter fracture embolization consist of isolated case reports, only a few studies have examined patients with central venous catheter embolism. We report a traumatic inadvertent transection of central venous catheter that migrated through a donor transplanted liver and was found to be lodged in the recipient's right ventricle. The catheter was retrieved under fluoroscopy using a trilobed snare device.
Use of Nonvascularized Autologous Fibular Strut Graft in the Treatment of Major Bone Defect after Periprosthetic Knee Fracture
Authors: Vincenzo Giordano, Bruno Parilha Coutinho, Mateus Kenji Miyahira, Felipe Serrão Mendes de Souza, Ney Pecegueiro do Amaral
Journal: Case Rep Orthop (2017)
MeSH terms: Case Reports

We present the case of a patient who suffered a comminuted supracondylar periprosthetic femur fracture. The patient was an 86-year-old lady who suffered a minor fall at home and presented at our hospital with a right comminuted distal femur fracture around a total knee arthroplasty. The patient was submitted to a cruciate-sacrificing total knee replacement 6 years before at the same institution. Despite severe metaphyseal fragmentation and short distal fragment, the prosthesis was stable; thus, open fracture reduction and stabilization with internal fixation were performed. The surgical technique included the use of a nonvascularized autologous fibular strut graft as an augmentation technique in conjunction with double plating fixation. Clinically, patient presented a painless aligned knee 12 months after femur fixation, although she was not able to return to an independent level of activity. No pain involving the donor graft site was reported at the time of the most recent follow-up examination. This case study demonstrates the use of free nonvascularized autogenous fibular strut bone graft as an option to bridge major bone defects. This proved to be a relatively simple, not expensive procedure that can be done percutaneously and does not need high-quality training.
Deep Brain Stimulation of the Ventral Intermediate Nucleus of the Thalamus in Writer's Cramp: A Case Report
Authors: Lisa Hirt, Fabio Grassia, Jeanne Feuerstein, John A Thompson, Steven Ojemann, Drew S Kern
Journal: Tremor Other Hyperkinet Mov (N Y) (2021)
Keywords: vim, deep brain stimulation, directional, dystonia, thalamus, writer’s cramp
MeSH terms: Deep Brain Stimulation, Dystonic Disorders / therapy, Case Reports, Globus Pallidus, Humans, Male, Middle Aged, Thalamus / diagnostic imaging, Thalamus / surgery, Treatment Outcome

Background:
Globus pallidus internus (GPi) deep brain stimulation (DBS) and thalamotomy are interventions for writer's cramp (WC). Ventralis intermedius nucleus (VIM) DBS is targeted for tremor, however, many aspects of VIM DBS remained underexplored in WC.
Case report:
A 62-year-old man with WC underwent DBS. Dystonic tremor improved intraoperatively with ventralis oralis anterior (VoA)/ventral oralis posterior (VoP) and with subthalamic nucleus stimulation; although greatest benefit was obtained with VIM stimulation. Sustained benefit with VIM DBS at ten months post-operative was obtained.
Discussion:
This case demonstrates an intraoperative approach in target selection and supports benefits of VIM DBS for WC.
Highlights:
This case highlights the intraoperative approach and clinical effects of VIM DBS in the treatment of medically refractory writer's cramp (WC). We contextualize our results from this case with previous reports of VoA/VoP stimulation for WC.
Isolated Large Glenoid Fracture in Acute Glenohumeral Dislocation in the Elderly: A Novel Indication for Reverse Shoulder Arthroplasty
Authors: Tyler Smith, Joseph D'Alonzo, Alfonso Arevalo, Jack Kazanjian
Journal: Case Rep Orthop (2020)
MeSH terms: Case Reports

Case:
Two elderly males presented with traumatic shoulder dislocation and bony Bankart fracture consisting of greater than 25% of the glenoid width. Due to several concomitant factors such as polytrauma, activity level, rotator cuff pathology, optimization of comorbidities, risk of complications, and potential for revision surgery, the patients were treated with reverse shoulder arthroplasty (RSA).
Conclusion:
RSA may be a satisfactory treatment option for isolated, large glenoid fractures associated with anterior glenohumeral instability in the elderly. These patients are susceptible to rapid deconditioning with prolonged immobilization and may not be medically suited to undergo the prolonged recovery period associated with open reduction internal fixation or potentially undergo revision operations.
A Misdiagnosed Complication of a Metal-on-Metal Total Hip Arthroplasty
Authors: Az-Eddine Djebara, Cédric Joseph, Florence Rousseau, Benoit Brunschweiler, Patrice Mertl
Journal: Case Rep Orthop (2018)
MeSH terms: Case Reports

Introduction:
The enterobacterial genus Yersinia includes a number of human pathogens. Large-diameter, metal-on-metal prostheses are no longer used because of their high failure rate. Here, we describe the first case of Yersinia enterocolitica infection of a metal-on-metal total hip arthroplasty.
Clinical examination:
A metal-on-metal prosthesis failed ten years after implantation. After surgical revision, bacteriological testing revealed the presence of a pathogenic strain of Yersinia enterocolitica. Combination antibiotic therapy resulted in a favorable clinical outcome.
Discussion:
Three cases of hip arthroplasty infected with Yersinia enterocolitica have been described in the literature. The present case is the first infection of a metal-on-metal total hip arthroplasty. We suggest that the risk of infection is increased by the release of metal wear particles and their influence on the surrounding tissue.
Conclusion:
When a large-diameter, metal-on-metal total hip arthroplasty fails, the known complications associated with this type of prosthesis should not deter the physician from screening for an infectious process that requires specific treatment.
Update in Autoimmune Movement Disorders: Newly Described Antigen Targets in Autoimmune and Paraneoplastic Cerebellar Ataxia
Authors: Madeline Garza, Amanda L Piquet
Journal: Front Neurol (2021)
Keywords: ap3b2 antibody, itpr1 antibody, trim46 antibody, trim67 antibody, trim9 antibody, autoimmune cerebellar ataxia, mglur2 antibody, paraneoplastic cerebellar ataxia
MeSH terms: Review

Movement disorders are a common feature of many antibody-associated neurological disorders. In fact, cerebellar ataxia is one of the most common manifestations of autoimmune neurological diseases. Some of the first autoantibodies identified against antigen targets include anti-neuronal nuclear antibody type 1 (ANNA-1 or anti-Hu) and Purkinje cell cytoplasmic antibody (PCA-1) also known as anti-Yo have been identified in paraneoplastic cerebellar degeneration. Historically these antibodies have been associated with an underlying malignancy; however, recently discovered antibodies can occur in the absence of cancer as well, resulting in the clinical syndrome of autoimmune cerebellar ataxia. The pace of discovery of new antibodies associated with autoimmune or paraneoplastic cerebellar ataxia has increased rapidly over the last few years, and pathogenesis and potential treatment options remains to be explored. Here we will review the literature on recently discovered antibodies associated with autoimmune and paraneoplastic cerebellar ataxia including adaptor protein-3B2 (AP3B2); inositol 1,4,5-trisphophate receptor type 1 (ITPR1); tripartite motif-containing (TRIM) proteins 9, 67, and 46; neurochondrin; neuronal intermediate filament light chain (NIF); septin 5; metabotropic glutamate receptor 2 (mGluR2); seizure-related 6 homolog like 2 (SEZ6L2) and homer-3 antibodies. We will review their clinical characteristics, imaging and CSF findings and treatment response. In addition, we will discuss two clinical case examples of autoimmune cerebellar ataxia.
Case report of EUS-guided endoscopic transduodenal necrosectomy in a patient with sleeve gastrectomy
Authors: Avik Sarkar, Ragui Sadek, Matthew Lissauer, Swati Pawa
Journal: BMC Obes (2016)
Keywords: altered gastric anatomy endoscopic necrosectomy, sleeve gastrectomy endoscopic necrosectomy
MeSH terms: Case Reports

Background:
After an acute attack of pancreatitis, walled-off pancreatic fluid collections (PFC) occur in approximately 10 % of cases. Drainage of the cavity is recommended when specific indications are met. Endoscopic drainage has been adopted as the main intervention for symptomatic walled-off PFC. Altered gastric anatomy in these patients poses an interesting challenge. We present the first case of a patient with sleeve gastrectomy who underwent successful endoscopic transduodenal necrosectomy (TDN).
Case presentation:
Forty year old woman with history of morbid obesity status post sleeve gastrectomy in 2009 was found to have symptomatic gallstone disease complicated by severe necrotizing gallstone pancreatitis and further complicated by symptomatic walled off pancreatic necrosis (WOPN). Imaging significant for 10.8 × 7.6 cm fluid collection with necrotic debris in the body and tail of the pancreas and endoscopic necrosectomy was attempted. EGD showed tubular gastric body and antrum, with extrinsic compression in the antrum and duodenal bulb from the pancreatic cyst. Duodenal bulb was selected as the preferred fistula site due to sleeve gastrectomy. Patient underwent successful TDN in two sessions. Patient had symptomatic improvement at follow-up with resolution of WOPN.
Conclusion:
To our knowledge, this is the first reported case of EUS-guided endoscopic necrosectomy in a patient with sleeve gastrectomy. The duodenal approach was used in our patient due to history of sleeve gastrectomy.
Congenital glucose-galactose malabsorption: A case report with a novel SLC5A1 mutation
Authors: Manar Al-Lawama, Jumana Albaramki, Mutaz Altamimi, Hatem El-Shanti
Journal: Clin Case Rep (2018)
Keywords: slcsa1 gene, congenital diarrhea, glucose‐galactose malabsorption, neonate
MeSH terms: Case Reports

A three-day-old newborn girl presented with decreased feeding and dehydration. She was sick and in shock. She had renal impairment and hypernatremia. With the resumption of breast feeding, she developed watery stools and hypernatremia. Glucose-Galactose Malabsorption was suspected and confirmed by the presence of a likely pathogenic homozygous variant in SLC5A1.
Mandibular Ossifying Fibroma and Multiple Oral Papillomas in a Roe Deer ( Capreolus capreolus)
Authors: Samoa Zürcher-Giovannini, Thomas-Daniel Ruder, Roy Pool, Karoly Erdelyi, Francesco C Origgi
Journal: Front Vet Sci (2020)
Keywords: computed tomography, ossifying fibroma, papilloma, roe deer, wildlife
MeSH terms: Case Reports

An emaciated, adult, free-ranging roe deer (Capreolus capreolus) presenting a large mandibular mass, was shot by a game warden in Sissach, Switzerland. The head of the roe deer was submitted to the Center for Fish and Wildlife Health for examination. Grossly, the mass consisted of a 6 × 7 × 4 cm mandibular exophytic growth, associated with loss of incisors teeth. On cut section, a hard, light-tan core was rimmed by a thick layer of soft tissue. Computed tomography examination confirmed the mandibular origin of the mass. Histologically, the mass consisted of an unencapsulated fibro-osseous neoplasm. The bony portion was composed of multiple haphazardly arranged spicules rimmed by osteoblasts with no associated periosteal layer. Embedding the bony spicules were short anastomosing and branching streams and bundles of spindled cells. The overlaying partially ulcerated mucosa, showed prominent rete ridges deepening into the submucosa. In addition to the mandibular mass, multiple soft cauliflower-like proliferations were expanding from the gingival surface. Histologically, these masses were arranged in papillary elements composed of pluristratified squamous epithelium with long rete ridges extending into a rich underlying fibrovascular supportive stroma. Neither papillomaviral DNA nor antigen could be identified in association with the oral masses. The gross, histological and radiological features of the mandibular mass are consistent with an ossifying fibroma, while the cauliflower oral masses were diagnosed as papillomas.