OpenMed/multicare-articles huggingface dataset:
Inferior ST-Segment Elevation Caused by Occlusion of Left Anterior Descending Artery
Authors: Hossein Sheibani, Amirhessam Kheirieh, Elham Azmoodeh
Journal: J Med Life (2020)
Keywords: coronary angiography, electrocardiogram, inferior leads st-segment elevation, lad, myocardial infarction, occlusion
MeSH terms: Arterial Occlusive Diseases / complications, Coronary Vessels / pathology, ST Elevation Myocardial Infarction / etiology, Case Reports, Action Potentials, Aged, Arterial Occlusive Diseases / diagnostic imaging, Arterial Occlusive Diseases / physiopathology, Coronary Angiography, Coronary Vessels / diagnostic imaging, Coronary Vessels / physiopathology, Electrocardiography, Humans, Image Processing, Computer-Assisted, Male, ST Elevation Myocardial Infarction / diagnostic imaging, ST Elevation Myocardial Infarction / physiopathology

Here we present a case of a 70-year-old man with acute myocardial infarction caused by left anterior descending artery occlusion presenting as ST elevation in the inferior leads that suggested an occlusion of the right coronary artery. In contrast, coronary angiography results indicated a complete occlusion of the proximal left anterior descending coronary artery. We reported our observation in electrocardiographic data and coronary angiography and its changes after a percutaneous coronary intervention, and then we discuss its pathophysiologic mechanism.
Uncommon Infections in Children Suggest Underlying Immunodeficiency: A Case of Infective Endocarditis in a 3-Year-Old Male
Authors: Aisha Shakoor, Ahmed El-Isa, Elizabeth Kinsella, Ryan Halas, Andrey Leonov
Journal: Case Rep Infect Dis (2018)
MeSH terms: Case Reports

Infective endocarditis (IE) results from bacterial or fungal infection and is associated with significant morbidity and mortality. Several known risk factors exist for endocarditis, and 90% of pediatric cases have an underlying structural or congenital heart disease or prosthetic heart valve. Literature on IE in previously healthy children is relatively sparse, and the pathogenesis and underlying risk factors remain mostly unknown. Our patient was a 3-year-old male with a unique presentation of IE. His lack of structural and congenital risk factors for endocarditis prompted further workup, and labs were consistent with insufficient immunoglobulin, suggesting a primary immunodeficiency (PAD). PAD presents as heightened susceptibility to infections, commonly seen as recurrent pneumonia, meningitis, septic arthritis, and otitis media. Pediatric patients commonly have infections, yet as many as in 1 in 2000 patients have PAD. Our case emphasizes the potential need for further investigation into PAD in a young patient with no known risk factors who develops an uncommon infection such as IE.
Successful Endovascular Bailout Strategy for Retained Accunet Embolic Protection Device During Vertebral Artery Stenting
Authors: Suraj Sulhan, Kristopher Lyon, Walter S Lesley
Journal: Front Neurol (2019)
Keywords: embolic protection device, endovascular, stent, stroke, vertebral artery
MeSH terms: Case Reports

Introduction: Vertebral artery stenosis can lead to posterior circulation TIAs and stroke. Stenting is often performed to treat symptomatic vertebral artery stenosis. As with carotid stenting, embolic protection devices (EPD) are increasingly used when stenting a vertebral artery stenosis. In general, EPDs may rarely become detached or retained in the circulation during stent revascularization. We discuss a 77-year-old male with a history of cerebral atherosclerosis and prior left occipital lobe and right insular infarcts who presented with increasing left sided weakness and was found to have severe stenosis of the proximal left vertebral artery. We report the only known case and successful endovascular bailout for an irretrievable EPD occurring during vertebral artery stenting. Methods: Systematic reviews of the medical literature were performed using PubMed and multiple combinations of keywords to search for irretrievable EPDs in either the carotid or vertebral arteries. The bibliographies of the results were used to identify additional publications until this process was exhausted. Results: No prior reports were found for retained or detached vertebral artery EPD. A total of six cases were found where an EPD was lost in the carotid circulation. In three of the cases, a carotid arteriotomy was required to retrieve the EPD. In two other cases, diagnostic catheters were used to retrieve the EPD. In our case, an EverFlex Biliary Stent was used to flatten the irretrievable EPD into the vertebral artery wall while preserving robust vertebral artery perfusion. 21-month clinical and 16-month imaging follow-up demonstrated durable vertebral artery patency and no ischemic symptoms. Conclusion: Successful bailout strategy for a retained vertebral artery EPD during stenting may be achieved with a self-expanding stent. The resultant revascularization remained durable and without clinical sequelae.
Rapid diagnosis of fatal Nocardia kroppenstedtii bacteremic pneumonia and empyema thoracis by next-generation sequencing: a case report
Authors: Fanfan Xing, Yao Xia, Qianyun Lu, Simon K F Lo, Susanna K P Lau, Patrick C Y Woo
Journal: Front Med (Lausanne) (2023)
Keywords: minion, nocardia kroppenstedtii, oxford nanopore, immunocompromised patients, next-generation sequencing
MeSH terms: Case Reports

Nocardia species do not replicate as rapidly as other pyogenic bacteria and nocardial infections can be highly fatal, particularly in immunocompromised patients. Here, we present the first report of fatal Nocardia kroppenstedtii bacteremic pneumonia and empyema thoracis diagnosed by next-generation sequencing (NGS) using the Oxford Nanopore Technologies' MinION device. The bacterium was not identified by matrix-assisted laser desorption ionization-time of flight mass spectrometry. Due to its low equipment cost, short turn-around-time, and portable size, the Oxford Nanopore Technologies' MinION device is a useful platform for NGS in routine clinical microbiology laboratories.
Relemed: sentence-level search engine with relevance score for the MEDLINE database of biomedical articles
Authors: Mir S Siadaty, Jianfen Shu, William A Knaus
Journal: BMC Med Inform Decis Mak (2007)
MeSH terms: Information Storage and Retrieval / methods, MEDLINE / standards, Algorithms

Background:
Receiving extraneous articles in response to a query submitted to MEDLINE/PubMed is common. When submitting a multi-word query (which is the majority of queries submitted), the presence of all query words within each article may be a necessary condition for retrieving relevant articles, but not sufficient. Ideally a relationship between the query words in the article is also required. We propose that if two words occur within an article, the probability that a relation between them is explained is higher when the words occur within adjacent sentences versus remote sentences. Therefore, sentence-level concurrence can be used as a surrogate for existence of the relationship between the words. In order to avoid the irrelevant articles, one solution would be to increase the search specificity. Another solution is to estimate a relevance score to sort the retrieved articles. However among the >30 retrieval services available for MEDLINE, only a few estimate a relevance score, and none detects and incorporates the relation between the query words as part of the relevance score.
Results:
We have developed "Relemed", a search engine for MEDLINE. Relemed increases specificity and precision of retrieval by searching for query words within sentences rather than the whole article. It uses sentence-level concurrence as a statistical surrogate for the existence of relationship between the words. It also estimates a relevance score and sorts the results on this basis, thus shifting irrelevant articles lower down the list. In two case studies, we demonstrate that the most relevant articles appear at the top of the Relemed results, while this is not necessarily the case with a PubMed search. We have also shown that a Relemed search includes not only all the articles retrieved by PubMed, but potentially additional relevant articles, due to the extended 'automatic term mapping' and text-word searching features implemented in Relemed.
Conclusion:
By using sentence-level matching, Relemed can deliver higher specificity, thus eliminating more false-positive articles. By introducing an appropriate relevance metric, the most relevant articles on which the user wishes to focus are listed first. Relemed also shrinks the displayed text, and hence the time spent scanning the articles.
Neglected double-J stent with giant bladder stone: a case report
Authors: Khoirul Kholis, Muhammad Asykar Palinrungi, Syakri Syahrir, Syarif, Abdul Azis, Stevent Ricardo, Muhammad Faruk
Journal: Pan Afr Med J (2021)
Keywords: double-j stent, bladder stone, case report, lithotripsy, ureteral stents
MeSH terms: Lithotripsy / methods, Stents / adverse effects, Urinary Bladder Calculi / etiology, Case Reports, Female, Humans, Middle Aged, Ureter / pathology, Ureteral Obstruction / surgery, Urinary Bladder Calculi / therapy

Double-J (DJ) stents have been widely utilized in urological practice. They are commonly used to relieve ureteral obstruction. Serious complications may occur when stents are left in place for long periods of time. In the present paper, we report a patient with a neglected DJ stent that had been inserted for five years after uterus-tumor surgery and led to a bladder stone. We report a case of a female who presented a bladder stone with a right DJ stent in the pelvic cavity. The stone was evident in radiological examination in an incidental finding. The treatment was transurethral cystolithotripsy. This case reminds us of the necessity of providing enough information and appropriate knowledge pertaining to the insertion of a ureteral stent. Transurethral cystolithotripsy is one of the treatment methods and can be suggested as a definitive method in consideration that it is a clinically effective and safe intervention.
Prenatal and Peripartum Management of Patients with Hypofibrinogenemia Resulted in Two Successful Deliveries
Authors: Yuko Teraoka, Hiroshi Miyoshi, Kumi Oshima, Satoshi Urabe, Norifumi Tanaka, Yoshiki Kudo
Journal: Case Rep Obstet Gynecol (2017)
MeSH terms: Case Reports

Fibrinogen is an essential agent involved in maintaining pregnancy and coagulation. Since inherited fibrinogen disorders introduce greater risks for conditions such as placental abruption and postpartum hemorrhage, careful prenatal and perinatal management is essential for this patient population. We report two cases of successful deliveries in patients with hypofibrinogenemia. Case 1 is of a 26-year-old (gravida 1, para 1) woman. The patient's fibrinogen level increased spontaneously to higher than 300 mg/dL during pregnancy, without treatment. She delivered at week 38 of gestation, with no complications. Case 2 is of a 30-year-old (gravida 3, para 1) woman. We performed repeated infusions of fibrinogen to maintain the level higher than 100 mg/dL during pregnancy and at least 200 mg/dL in the perioperative period; the patient delivered a healthy infant. We identified a new mutation, Hiroshima I (γ278Tyr→His). It is important to maintain appropriate fibrinogen levels in cases of inherited fibrinogen disorders for successful prenatal and peripartum management.
Role of Plasmapheresis and Extracorporeal Membrane Oxygenation in the Treatment of Leptospirosis Complicated with Pulmonary Hemorrhages
Authors: C L Fonseka, S Lekamwasam
Journal: J Trop Med (2018)
MeSH terms: Review

Introduction:
Leptospirosis is an emerging infectious disease associated with multiorgan involvement and significant morbidity and mortality. Although pulmonary hemorrhage due to leptospirosis has a high fatality, specific treatment options are limited and their efficacy is not adequately proven. We opted to find out the current evidence on plasmapheresis and extracorporeal membrane oxygenation (ECMO) in pulmonary hemorrhages due to leptospirosis.
Methods:
The first search was conducted in PubMed, OVID, Google Scholar, and Cochrane clinical trial registry using keywords "leptospirosis" OR "Leptospira" OR "Weil's disease" AND "plasmapheresis" OR "plasma exchange" AND "pulmonary hemorrhage" OR "alveolar hemorrhage" OR "lung hemorrhage" and the second search was done using keyword "leptospirosis" OR "Leptospira" OR "Weil's disease" AND "ECMO" OR "Extracorporeal membrane oxygenation." The searches were not limited by study design or the date of publication. Only articles written in English were reviewed. Although we intended to include only clinical trials, it was decided later to include other information such as case reports and case series which addressed these treatment modalities. Two authors selected articles independently in a blinded manner using a set of inclusion and exclusion criteria and discrepancies were solved after discussions.
Results:
The information found was very limited. This included one clinical trial which showed a significant survival benefit with plasmapheresis but the study design had many limitations. Two case reports described the benefit of plasmapheresis in severe leptospirosis with pulmonary hemorrhages. There were eight case reports where ECMO was performed and out of all only one patient has died. One retrospective study on patients with severe leptospirosis mentioned that four out of five patients with pulmonary hemorrhages survived after being treated with ECMO.
Conclusions:
Current evidence is insufficient to recommend the routine use of plasmapheresis or ECMO for patients presenting with pulmonary hemorrhages due to leptospirosis. ECMO may be a promising mode of treatment in acute respiratory failure in leptospirosis related pulmonary hemorrhages. These treatment modalities, however, can be applied based on the availability of resources and expertise at the discretion of the clinician in charge, considering patient related factors such as cardiovascular stability and derangement of coagulation profile. Clinical trials conducted adhering to standard procedures are urgently required to establish the efficacy of these treatment modalities.
Understanding and Managing Immune-Related Adverse Events Associated With Immune Checkpoint Inhibitors in Patients With Advanced Melanoma
Authors: Alyona Weinstein, Ruth-Ann Gordon, Mary Kate Kasler, Matthew Burke, Smita Ranjan, Jackie Hodgetts, Vanessa Reed, Yelena Shames, Nana Prempeh-Keteku, Karla Lingard
Journal: J Adv Pract Oncol (2017)
MeSH terms: Review

The immune checkpoint inhibitors ipilimumab, nivolumab, and pembrolizumab represent a substantial improvement in treating advanced melanoma but are associated with adverse events (AEs) likely related to general immunologic enhancement. To ensure that patients receive optimal benefit from these agents, prompt assessment and treatment of AEs are essential. We review the efficacy and safety profiles of these immune checkpoint inhibitors and describe guidelines for managing immune-related AEs. We also present case studies describing the management of toxicities in patients receiving immune checkpoint inhibitor therapy. These cases illustrate the importance of collecting a detailed medical history when administering immunotherapy, as this information is necessary to establish baseline, inform monitoring, and determine the etiology of symptoms. Advanced practice nurses and physician assistants are uniquely positioned to educate patients on the early recognition of AEs and have an important role in establishing appropriate monitoring and open dialogue among services.
Clinical evaluation of percutaneous vertebroplasty in a patient with paraplegia and immobilization syndrome: a case report
Authors: Salvatore Masala, Eros Calabria, Marco Nezzo, Dominique De Vivo, Luca Neroni, Giovanni Simonetti
Journal: Case Rep Radiol (2013)

We will discuss a potential role of percutaneous vertebroplasty (PVP) in the management of a patient with immobilization syndrome due to paraplegia and vertebral osteoporotic fractures. While PVP is commonly used for the treatment of osteoporotic thoracolumbar vertebral compression fractures, its role in vertebral stabilization in patient with immobilization syndrome has not been reported in the literature. A 73-year-old woman affected by immobilization syndrome due to paraplegia and vertebral osteoporotic fractures was treated with PVP of vertebrae D12, L1, and L4. After PVP, the patient did not need any antalgic therapy, and there was a significant improvement regarding mobilization, performance of physiological functions, daily management of personal care, and treatment of decubitus ulcers, increasing life quality and psychological well-being.
Primary Esophageal Diffuse Large B-Cell Lymphoma: A Comparative Review of 15 Cases
Authors: Faisal Inayat, Ahmed Munir, Ahsan Wahab, Fariha Younus, Fahad Zafar, Waqas Ullah
Journal: J Investig Med High Impact Case Rep (2018)
Keywords: diagnosis, diffuse large b-cell lymphoma, incidence, management, primary esophageal lymphoma
MeSH terms: Esophageal Neoplasms / diagnosis, Lymphoma, Large B-Cell, Diffuse / diagnosis, Case Reports, Review, Antineoplastic Combined Chemotherapy Protocols, Deglutition Disorders / etiology, Esophageal Neoplasms / pathology, Esophageal Neoplasms / therapy, Female, Humans, Immunohistochemistry, Lymphoma, Large B-Cell, Diffuse / pathology, Lymphoma, Large B-Cell, Diffuse / therapy, Middle Aged, Radiotherapy, Treatment Outcome

Primary esophageal diffuse large B-cell lymphoma (DLBCL) is an extremely rare clinicopathologic entity. We report one case from our clinical experience and undertake a review of the previously published cases. A systematic literature search of the medical databases PubMed and Google Scholar was conducted. A total of 15 cases fulfilled the inclusion criteria. The data on patients' characteristics, epidemiology, clinical features, HIV status, gross appearance of the lesion, esophageal location, treatment, and outcome were collected and analyzed. Primary esophageal DLBCL was more common among males, primarily in the fifth and sixth decades of life. Dysphagia was the most common initial clinical presentation. Tissue biopsy with immunohistochemistry was an indispensable diagnostic modality. The mainstay of treatment was chemotherapy with cyclophosphamide, vincristine, doxorubicin, and prednisone regimen, in addition to anti-CD20 antibody rituximab, with or without radiotherapy. This review serves to outline our current understanding of the epidemiology of and risk factors for primary esophageal DLBCL, the pathophysiology of this disorder, and currently available approaches to diagnosis and management.
Cerebrospinal fluid protein levels are elevated 100 times in a Leptomeningeal metastasis patient: a case report and literature review
Authors: Shengnan Wang, Wenzhuo Yang, Mingqin Zhu, Xiaochuang Wang, Lin Pan, Tao Jin, Youqi Chen, Jianxin Xi, Laiyu Yang, Run Cui
Journal: Front Neurosci (2023)
Keywords: cns tumor, csf protein, cytology, leptomeningeal metastasis, tuberculous meningitis
MeSH terms: Case Reports

Leptomeningeal metastasis (LM) has a high degree of malignancy and high mortality. We describe a patient admitted to hospital with acute lower extremity weakness, dysuria, and high intracranial pressure. Enhanced magnetic resonance imaging (MRI) showed extensive enhancement of the leptomeningeal and spinal meninges with multiple nodular changes and extensive fusion. His cerebrospinal fluid (CSF) was yellow and cloudy, the Pandy test was strongly positive (++++), the protein was 46 g/L (normal range 0.15-0.45 g/L), which attracted our attention. Initially, miliary TB with associated tuberculous meningitis (TBM) was diagnosed, and neurosarcoidosis cannot be ruled out. After poor therapeutic effect of standard antituberculosis (anti-TB) therapy, further inspection found that malignant cells were detected by cerebrospinal fluid (CSF) cytology. PET/CT suggested the diagnosis of LM. The purpose of this paper is to describe the characteristics of atypical diffuse LM. In conclusion, when patient with unexplained high levels of CSF protein, it is necessary to be alert to the diagnosis of LM. Multiple examinations of fresh CSF are helpful to increase the positive detection rate of tumor cells. Early diagnosis and active treatment are conducive to improving survival rate.
Acute Myocardial Infarction Caused by an Anomalous Right Coronary Artery Occlusion Presenting with Precordial ST Elevation
Authors: Bruno da Silva Matte, Alexandre Damiani Azmus
Journal: Case Rep Cardiol (2017)
MeSH terms: Case Reports

Acute coronary syndrome with precordial ST segment elevation is usually related to left anterior descending artery occlusion, although isolated right ventricular infarction has been described as a cause of ST elevation in V1-V3 leads. We present a case of a patient with previous inferior wall infarction and new acute ST elevation myocardial infarction (STEMI) due to proximal right coronary thrombotic occlusion resulting in right ventricular infarction with precordial ST elevation and sinus node dysfunction. The patient was treated with successful rescue angioplasty achieving resolution of acute symptoms and electrocardiographic abnormalities.
Leptospira infection complicated by demyelinating disease: A case report
Authors: Shu-Xin Chen, Deng-Ke Han, Yin Liu, Zhi-Hua Ye, Kui Lu, Biao Xu, Hui-Qiang Mai
Journal: Front Neurol (2022)
Keywords: emergency, infection, leptospira burgdorferi, leptospirosis, multiple organ dysfunction
MeSH terms: Case Reports

Leptospirosis is a zoonotic disease, found worldwide, that is caused by bacteria of the genus Leptospira. People can be infected with Leptospira if they come in direct contact with the urine of an infected animal. Leptospirosis may be associated with demyelinating lesions of the central nervous system. This case report describes a 66-year-old female patient who presented with fever and generalized aches and progressed to unconsciousness within a few hours of admission. Laboratory tests showed Leptospira infection, and brain magnetic resonance imaging revealed acute demyelinating lesions. The patient responded well to penicillin and intravenous methylprednisolone therapy. Leptospirosis presenting with acute disseminated encephalomyelitis is rare. In this patient, an interdisciplinary collaboration involving the neurologist, radiologist, and pathologist was crucial for diagnosis and management. Further studies are warranted to investigate whether there is a correlation between demyelinating lesions and leptospiral infection.
Tracheal or bronchial wedge resection: Case report
Authors: Zhenhua Jiao, Zhe Tang, Jun Yu
Journal: Front Surg (2023)
Keywords: case report, parenchymal sparing procedure, tracheal or bronchial tumor, tracheal or bronchial wedge resection, videoassisted thoracoscopic surgery
MeSH terms: Case Reports

Background:
Primary tracheal or bronchial tumors are relatively uncommon, whether benign or malignant. Sleeve resection is an excellent surgical technique for most primary tracheal or bronchial tumors. However, depending on the size and location of the tumor, thoracoscopic wedge resection of trachea or bronchus can be performed with the assistance of a fiberoptic bronchoscope for some malignant and benign tumors.
Case description:
We performed a single incision video-assisted bronchial wedge resection in a patient with a left main bronchial hamartoma with a size of 7 × 5 × 5 mm. The patient was discharged from the hospital six days after the surgery with no postoperative complications. There was no obvious discomfort during the 6-month postoperative follow-up, and the reexamination of fiberoptic bronchoscopy revealed no evident stenosis of the incision.
Conclusions:
Through the detailed case study and literature review, we believe that tracheal or bronchial wedge resection is a significantly superior technique under the appropriate conditions. Video-assisted thoracoscopic wedge resection of trachea or bronchus should be a new and excellent development direction of minimally invasive bronchial surgery.