OpenMed/multicare-articles huggingface dataset:
The Interplay of Infidelity, Sexuality, and Religiosity in the Discourse of Mixed-Orientation Marriages: A Discursive Psychological Analysis
Authors: Mohd Asyraf Zulkffli, Radzuwan Ab Rashid, Mohammad Affiq Kamarul Azlan, Hanita Hanim Ismail
Journal: Front Psychol (2022)
Keywords: islam, malaysia, muslims, discursive psychology, gay, infidelity, marriage

This research examines the complex interplay of religiosity, sexuality, and infidelity. We adopted a case study approach in this research, and discourse was made central to the analysis. There were two participants; both identified as homosexuals. One participant, Fahrin, is married while the other, Muzz, is divorced at the time of the interview. The participants were subjected to an in-depth, semi-structured interview to gauge their experiences, perceptions, opinions, beliefs, and thoughts on their sexuality, Islamic faith as well as relationship with their spouses. The data were then transcribed and analyzed using the Discursive Action Model (DAM) and Discursive Psychology (DP) frameworks. From the analysis, two overarching themes were identified. They are (1) the allocation of blame and accountability and (2) the participants' attachment to their Islamic identity. The discussion then revolves around the societal role that pressures gay men to marry women and contextualizes the position of Islam on Homosexuality.
Surgical treatment of gastric outlet obstruction from a large trichobezoar: A case report
Authors: E Chahine, R Baghdady, N El Kary, M Dirani, M Hayek, E Saikaly, E Chouillard
Journal: Int J Surg Case Rep (2019)
Keywords: bezoars, case report, gastric outlet obstruction, pica disorder

Introduction:
Bezoars are concretions of foreign indigestible material accumulating in the gastrointestinal tract leading to intraluminal mass formation that impairs the gastrointestinal motility and can lead to gastric obstruction of the small or the large bowel. There are different types of bezoars, named according to the material they are made of. These include phytobezoar, lactobezoar, pharmacobezoar, trichobezoar, and polybezoar. Trichobezoars (hair ball) are usually located in the stomach but may extend through the pylorus into the duodenum and small bowel (Rapunzel syndrome).
Case presentation:
Herein, we report a case of a young adult female known to have a long-standing trichophagia who presented with gastric outlet obstruction due to a large trichobezoar. Endoscopy revealed a large and hard gastric trichobezoar not amenable to endoscopic retrieval leading to surgical extraction as a last resort.
Discussion:
They are almost always associated with trichotillomania and trichophagia or other psychiatric disorders. Trichobezoar can be treated either surgically by laparotomy/laparoscopy or by endoscopic intervention.
Conclusion:
Treatment should be coupled to psychiatric evaluation and therapy to prevent recurrence.
Case Report: Two Newly Diagnosed Patients With KBG Syndrome-Two Different Molecular Changes
Authors: Katarzyna Wojciechowska, Joanna Nurzyńska-Flak, Borys Styka, Magdalena Kacprzak, Monika Lejman
Journal: Front Pediatr (2021)
Keywords: 16q242 microdeletion, kbg syndrome, ankyrin repeat domain 11, intellectual disability, neural development
MeSH terms: Case Reports

Mutations or deletions of ANKRD11 gene are responsible for the symptoms of KBG syndrome. The KBG syndrome is a rare genetic disorder which is inherited in an autosomal dominant manner. Affected patients usually have characteristic facial features, macrodontia of the upper central incisors, hand abnormalities, developmental delay and short stature. In the present article we would like to report a clinical and molecular case study of two patients affected by KBG syndrome. The diagnosis of the first patient was confirmed by the identification of the novel pathogenic variant in ANKRD11 gene by next-generation sequencing. The second patient was diagnosed after the detection of a 16q24.2q24.3 deletion encompassing the ANKRD11 gene microarray.
Lipoma of the uterine corpus: exceptional eventuality combined with an ovarian thecoma
Authors: R Vilallonga, A García, J Castellví, J M Fort, M Armengol, S Ramón y Cajal
Journal: Case Rep Med (2009)
MeSH terms: Case Reports

Uterine lipomas are very uncommon with symptoms that are similar to leiomyomas. Their diagnosis is always histological although some radiological methods may suggest their existence prior to surgery. They are sometimes associated with endometrial pathology, but there are no previous reported cases related to ovarian thecoma. Their prognosis is excellent. Clinical, radiological, morphologic, and immunohistochemical findings are shown which correspond to uterine lipoma associated with endometrial polyps and ovarian thecoma.
Viekira Pak Induced Fatal Lactic Acidosis: A Case Report of an Unusual Side Effect
Authors: Molham Abdulsamad, Ariyo Ihimoyan
Journal: Case Reports Hepatol (2016)

Viekira Pak is a new direct-acting antiviral agent that has an excellent efficacy in treating patients with chronic HCV. FDA released a safety warning that Viekira Pak can cause serious liver injury mostly in patients with underlying advanced liver disease. We report the first case of fatal lactic acidosis presenting 3 days after initiating therapy with Viekira Pak. Although it is very hard to precisely determine the cause of lactic acidosis, our case highlights an unusual side effect that ensued after starting the medication. Given the complexity of drug-drug interactions that can happen with the new direct-acting antiviral agents and the paucity of data regarding coadministration and methods of monitoring, a thorough review should be pursued prior to initiating these medications.
Difficulties of Management of Multiple Synchronous Bone Tumors in Li-Fraumeni Syndrome
Authors: Marine Huby, Laurence Brugières, Eric Mascard, Nathalie Gaspar, Stéphanie Pannier, Jean-Charles Aurégan
Journal: Case Rep Orthop (2019)
MeSH terms: Case Reports

Li-Fraumeni syndrome is a rare inherited disease characterized by the early onset of multiple primary malignant tumors. Sarcomas account for more than 30% of all malignant tumors occurring at pediatric age. Furthermore, it was shown that the rates of second cancer were higher in childhood cancer survivors. We report the case of a patient with Li-Fraumeni syndrome who was referred to us with three synchronous skeletal tumors. This unique situation led to difficulties for the medical team regarding the diagnosis of malignancy and the surgical treatment to propose. The discovery of multiple lesions in the extension assessment underlines the usefulness of whole-body imaging for the follow-up of patients with germline TP53 mutations. Most recent guidelines now recommend annual whole-body MRI for screening for cancer patients carrying germline TP53. With this report, we aim to share our experience with this rare situation in order to improve care about these specific cases.
Profound loss of general knowledge in retrograde amnesia: evidence from an amnesic artist
Authors: Emma Gregory, Michael McCloskey, Barbara Landau
Journal: Front Hum Neurosci (2014)
Keywords: brain damage, general world knowledge, memory, retrograde amnesia, single case study

Studies of retrograde amnesia have focused on autobiographical memory, with fewer studies examining how non-autobiographical memory is affected. Those that have done so have focused primarily on memory for famous people and public events-relatively limited aspects of memory that are tied to learning during specific times of life and do not deeply tap into the rich and extensive knowledge structures that are developed over a lifetime. To assess whether retrograde amnesia can also cause impairments to other forms of general world knowledge, we explored losses across a broad range of knowledge domains in a newly-identified amnesic. LSJ is a professional artist, amateur musician and history buff with extensive bilateral medial temporal and left anterior temporal damage. We examined LSJ's knowledge across a range of everyday domains (e.g., sports) and domains for which she had premorbid expertise (e.g., famous paintings). Across all domains tested, LSJ showed losses of knowledge at a level of breadth and depth never before documented in retrograde amnesia. These results show that retrograde amnesia can involve broad and deep deficits across a range of general world knowledge domains. Thus, losses that have already been well-documented (famous people and public events) may severely underestimate the nature of human knowledge impairment that can occur in retrograde amnesia.
Spontaneous Massive Adrenal Hemorrhage: A Management Dilemma
Authors: Praveen Pushkar, Anshuman Agarwal
Journal: J Endourol Case Rep (2015)
MeSH terms: Case Reports

Adrenal hemorrhage (AH) is a rare but life-threatening condition. Small focal hemorrhage may present subclinically, but massive hemorrhage may lead to rapid cardiovascular collapse and ultimately death if not diagnosed appropriately and treated quickly. Most cases reported in the literature have been treated conservatively. In an event of increasing hemorrhage during conservative management, it may be tricky to intervene surgically because of the hematoma around the gland. Here we describe a case where we managed a large spontaneous AH by a combination of angioembolization and laparoscopic adrenalectomy.
Hemianopia and Features of Bálint Syndrome following Occipital Lobe Hemorrhage: Identification and Patient Understanding Have Aided Functional Improvement Years after Onset
Authors: Nicola McDowell, Gordon N Dutton
Journal: Case Rep Ophthalmol Med (2019)
MeSH terms: Case Reports

Introduction. Cerebral visual impairment (CVI) can present around birth or any time thereafter. Homonymous hemianopia is a common feature. The concept that functional improvement is unattainable augurs against active management. Dorsal stream dysfunction (or Bálint syndrome when severe) results from bilateral posterior parietal dysfunction but may go undetected, especially in children. Case Presentation. At 16 the patient suffered spontaneous left occipital lobe brain hemorrhage from a ruptured arteriovenous malformation. This was surgically excised. Short lived right upper limb intermittent jerking, with additional left sided weakness, ensued. Anomalous EEG recordings, with right-sided bias, arose from the posterior temporoparietal area. A right homonymous hemianopia was evident. During the ensuing 17 years she experienced multiple complex difficulties, until, at a lecture describing how to identify and support children with CVI, she realized she herself had many of the difficulties described. Visual assessment identified hemianopia and dorsal stream dysfunction. Discussion. Following identification, characterization, and explanation of the impact of her visual difficulties, she both gained greater awareness of her visual difficulties and their impact and developed a range of strategies leading to functional improvement of her visual field loss and amelioration of her dorsal stream dysfunction, with great improvement in quality of life.
Bullous hemorrhagic dermatosis is an under-recognized side effect of full dose low-molecular weight heparin: a case report and review of the literature
Authors: Armand Russo, Susanna Curtis, Raisa Balbuena-Merle, Roxanne Wadia, Ellice Wong, Herta H Chao
Journal: Exp Hematol Oncol (2018)
Keywords: bullous hemorrhagic dermatosis, enoxaparin, low molecular weight heparin
MeSH terms: Review

Bullous hemorrhagic dermatosis (BHD) is a systemic side-effect of low molecular weight heparin, characterized by multiple intra-epidermal hemorrhages distant from the site of injection. There have been several small case series and literature reviews on BHD, but none have captured a complete set of reported patients. We sought to describe a case of BHD with late diagnosis and completely summarize the existing English and Spanish literature with searches of Pubmed, Scopus, Ovid Embase and Ovid Medline. After narrowing to 33 relevant reports, we describe 90 reported cases worldwide from 2004 to 2017, in addition to a new case from our institution as a means of comparison. We found that BHD was common in elderly men (mean age 72 ± 12; male:female, 1.9:1) and typically occurred within 7 days of administration of anticoagulation (median 7 days ± 6.4) usually with enoxaparin use (66% of cases). Lesions occurred primarily on the extremities only (67.9% of cases). Coagulation testing was most often normal before administration, and the majority of patients had coagulation testing in therapeutic range during treatment. Most practitioners stopped anticoagulation if continued therapeutic intervention was no longer required (57% of cases), or changed therapy to another anticoagulation if continued treatment was required (14.3% of cases). Therapy was continued outright in 23% of patients. The lesions usually resolved within 2 weeks (mean days, 13.0 ± 7.4). There was no difference in time to resolution between patients who continued the culprit anticoagulant or changed to a different anticoagulant, and those who discontinued anticoagulation altogether (13.9 days vs. 12.1, p = 0.49). Four deaths have been reported in this clinical context, two specified as intracranial hemorrhage. These deaths were unrelated to the occurrence of BHD. Continuation of low-molecular weight heparins appeared to be safe in patients with BHD.
Supporting a student with visual impairment in the intensive care unit
Authors: Michael Rowe, Tania Steyl, Joliana Phillips, Anthea Rhoda
Journal: S Afr J Physiother (2019)
Keywords: disability, intensive care, intensive care unit, physiotherapy education, visual impairment

Background:
The Department of Physiotherapy at the University of the Western Cape began accepting students with visual impairments (VIs) into the undergraduate physiotherapy programme in 1996. However, until recently, none had received a clinical rotation in any high care setting.
Objectives:
The aim of this study was to explore the experiences of all stakeholders involved in the process of placing a student with VI into the intensive care unit (ICU).
Method:
This case study used interviews with relevant stakeholders to explore their experiences of integrating the ICU placement into the student's clinical programme. Interviews were recorded and transcribed, and then analysed thematically.
Results:
There was a certain amount of anxiety present, especially among clinical staff, before the placement began. Discussions among stakeholders at each stage of the process served to identify potential problems before they arose, and allowed staff to plan solutions in advance. Challenges were found in both the attitudes of staff, and in the clinical environment, some of which were relatively easy to address, while others will require significant investments of resources to resolve.
Conclusion:
Our findings suggest that it may be possible to successfully place students with VI into intensive care settings, and they can enjoy positive learning experiences, given an appropriate context and adequate support. However, care needs to be taken at every stage of the process to ensure that supporting structures are in place prior to, and during, the placement.
Clinical implications:
All stakeholders, including the students and the relevant clinical and academic staff, need to be actively involved in the process of planning for the clinical placement.
Complete resection of rectal cancer with a synchronous solitary adrenal metastasis: A case report
Authors: Hirokatsu Hayashi, Yusuke Murase, Hitoya Sano, Kimitosi Nishio, Iwao Kumazawa
Journal: Int J Surg Case Rep (2020)
Keywords: adrenal metastasis, colorectal cancer, complete resection
MeSH terms: Case Reports

Introduction:
Solitary adrenal metastasis derived from colorectal cancer is rare. Adrenal metastasis is usually associated with systemic spread of the disease and is considered to be unsuitable for surgical resection. However, it has been reported that an aggressive surgical resection of adrenal metastasis results in improved overall survival in selected patients. We herein report an extremely rare case of complete resection of rectal cancer with a synchronous solitary adrenal metastasis.
Presentation of case:
A 70-year-old woman who presented with bloody stool was diagnosed with rectal cancer with a synchronous solitary adrenal metastasis and was suspected of having liver invasion. After a total of 2 cycles of chemotherapy with capecitabine and oxaliplatin, an abdominoperineal resection with D2 (proxD3) lymph node dissection and right adrenalectomy was performed and complete resection was possible. According to the TNM classification, the diagnosis was stage IVA (fT3N1bM1a[ADR]). At 18 months after surgery, the patient is alive with no evidence of recurrence and distant metastasis.
Discussion:
Complete resection of adrenal metastasis may have a possibility of leading to a good prognosis in patients with a synchronous solitary adrenal metastasis.
Conclusion:
Adrenalectomy should be considered in patients who can undergo complete resection, as it may offer a good long-term prognosis.
Trans-visceral migration of retained surgical gauze as a cause of intestinal obstruction: a case report
Authors: Nello Grassi, Calogero Cipolla, Adriana Torcivia, Alessandro Bottino, Eugenio Fiorentino, Leonardo Ficano, Gianni Pantuso
Journal: J Med Case Rep (2008)

Introduction:
A retained surgical sponge in the abdomen is uncommon although it is likely that this finding is underreported in the medical literature. The intravisceral migration of retained surgical gauze is even rarer, as demonstrated by the very few cases reported.
Case presentation:
Three years after undergoing anterior resection of the rectum, a 75-year-old man presented with symptoms of small bowel obstruction. Plain abdominal radiography and CT showed a radio-opaque marker; a foreign body was suspected, probably a piece of retained surgical gauze. An ileotomy of about 5 cm. was performed to confirm this diagnosis and remove the gauze.
Conclusion:
Although rare, retained gauze in the abdomen is a complication of surgery. The authors consider that this event may be more frequent than it appears from reports in the literature, probably because of its medico-legal implications. If all such cases were reported, it would be possible to estimate their exact number, classify the occurrence as a possible surgical complication and thus modify its medico-forensic consequences.
Denture Impaction Causing an Upper Esophageal Diverticulum
Authors: Shireen Samargandy, Hani Marzouki, Talal Al-Khatib, Mazin Merdad
Journal: Case Rep Gastrointest Med (2019)
MeSH terms: Case Reports

Background:
Dentures are a common cause of inadvertent foreign body ingestion particularly in the elderly. Due to their radiolucent nature, they often present a diagnostic challenge to care providing physicians.
Case presentation:
A 66-year-old female presented to our otolaryngology clinic with a 2-year history of dysphagia. Her physical examination was unremarkable. Computed tomography scan of the neck and barium swallow suggested Zenker diverticulum. She was planned for endoscopic diverticulotomy; however, during surgery, a foreign body was incidentally found and retrieved, which was a partial lower denture. The diverticulum resolved thereafter, and the patient's symptoms abated.
Conclusion:
The authors recommend evaluating the esophagus endoscopically first in cases of upper esophageal diverticular formation, even when planning an open repair approach, to rule out any concealed foreign bodies.
Unusual Presentation of Leukemic-Phase Mantle Cell Lymphoma: A Case Report
Authors: Alshaimaa M Alsaati, Meshal M Alasiri, Bayan A Alansari, Wed Y Mulla, Adel F Al-Marzouki, Yara M Daous, Osman Radhwi
Journal: Cureus (2023)
Keywords: atypical presentation, b-cell lymphoma, ccnd1, differential diagnosis, mantle cell lymphoma, non-hodgkin’s lymphoma
MeSH terms: Case Reports

Mantle cell lymphoma (MCL) is a rare subtype of B-cell lymphoma that can present in a variety of ways, including the leukemic phase, where it can occasionally be mistaken for acute leukemia due to the unusually high or rapidly growing number of leukocytes and the presence of circulating cancer cells that are morphologically similar to leukemic blasts in myeloid or acute lymphoblastic leukemia. We present the case of an 83-year-old Yemeni woman with multiple comorbidities who presented with abdominal pain and constitutional symptoms. She was found to have diffuse lymphadenopathy on clinical and radiological assessments. Her white blood cell count at presentation was 221 × 109/L with marked monocytosis (72.8%). Lymph node biopsy and bone marrow studies, including CCND1/IGH molecular studies, confirmed MCL, the pleomorphic subtype. The patient was deemed unfit for standard-of-care chemotherapy and was started on single-agent rituximab with a slow introduction to ibrutinib but succumbed to death after two weeks of ibrutinib 280 mg daily. This case serves as a reminder to keep an open mind and take into account atypical disease presentations when formulating differential diagnoses to prevent late diagnosis and any unnecessary intervention that can postpone appropriate therapy.
Durable Response of Spinal Chordoma to Combined Inhibition of IGF-1R and EGFR
Authors: Tamara Aleksic, Lisa Browning, Martha Woodward, Rachel Phillips, Suzanne Page, Shirley Henderson, Nicholas Athanasou, Olaf Ansorge, Duncan Whitwell, Sarah Pratap, A Bassim Hassan, Mark R Middleton, Valentine M Macaulay
Journal: Front Oncol (2016)
Keywords: egfr, igf-1r, chordoma, nuclear igf-1r, tyrosine kinase inhibitor
MeSH terms: Case Reports

Chordomas are rare primary malignant bone tumors arising from embryonal notochord remnants of the axial skeleton. Chordomas commonly recur following surgery and radiotherapy, and there is no effective systemic therapy. Previous studies implicated receptor tyrosine kinases, including epidermal growth factor receptor (EGFR) and type 1 insulin-like growth factor receptor (IGF-1R), in chordoma biology. We report an adult female patient who presented in 2003 with spinal chordoma, treated with surgery and radiotherapy. She underwent further surgery for recurrent chordoma in 2008, with subsequent progression in pelvic deposits. In June 2009, she was recruited onto the Phase I OSI-906-103 trial of EGFR inhibitor erlotinib with linsitinib, a novel inhibitor of IGF-1R/insulin receptor (INSR). Treatment with 100 mg QD erlotinib and 50 mg QD linsitinib was well-tolerated, and after 18 months a partial response was achieved by RECIST criteria. From 43 months, a protocol modification allowed intra-patient linsitinib dose escalation to 50 mg BID. The patient remained stable on trial treatment for a total of 5 years, discontinuing treatment in August 2014. She subsequently experienced further disease progression for which she underwent pelvic surgery in April 2015. Analysis of DNA extracted from 2008 (pre-trial) tissue showed that the tumor harbored wild-type EGFR, and a PIK3CA mutation was detected in plasma, but not tumor DNA. The 2015 (post-trial) tumor harbored a mutation of uncertain significance in ATM, with no detectable mutations in other components of a 50 gene panel, including EGFR, PIK3CA, and TP53. By immunohistochemistry, the tumor was positive for brachyury, the molecular hallmark of chordoma, and showed weak-moderate membrane and cytoplasmic EGFR. IGF-1R was detected in the plasma membrane and cytoplasm and was expressed more strongly in recurrent tumor than the primary. We also noted heterogeneous nuclear IGF-1R, which has been linked with sensitivity to IGF-1R inhibition. Similar variation in IGF-1R expression and subcellular localization was noted in 15 further cases of chordoma. In summary, this exceptionally durable response suggests that there may be merit in evaluating combined IGF-1R/INSR and EGFR inhibition in patients with chordomas that recur following failure of local treatment.