OpenMed/multicare-articles huggingface dataset:
Acute Parotitis after Lower Limb Amputation: A Case Report of a Rare Complication
Authors: Konstantinos Ioannis Avgerinos, Nikolaos Degermetzoglou, Sofia Theofanidou, Georgia Kritikou, Ioannis Bountouris
Journal: Case Rep Otolaryngol (2018)
MeSH terms: Case Reports

Background:
Postoperative parotitis is a rare complication that occurs usually after abdominal surgery. Parotitis has never been described as a complication of vascular operations, in literature. In the present article, we describe a case of a postamputation parotitis along with its management and its possible pathogenesis.
Case report:
An 83-year-old diabetic man was emergently admitted to hospital because of gangrene below the right ankle and sepsis. The patient underwent a lower limb amputation above the knee. On the 5th postoperative day, he was diagnosed with right parotitis probably because of dehydration, general anesthesia, and immunocompromisation. A CT scan confirmed the diagnosis. He received treatment with antibiotics and fluids. His condition gradually improved, and he was finally discharged on 15th postoperative day.
Conclusions:
Postoperative parotitis can possibly occur after any type of surgery including vascular. Clinicians should be aware of this complication although it is rare. Several risk factors such as dehydration, general anesthesia, drugs, immunocompromisation, head tilt during surgery, and stones in Stensen's duct may predispose to postoperative parotitis. Treatment consists of antibiotics and hydration.
Diagnosis and management of a heterotopic pregnancy and ruptured rudimentary uterine horn
Authors: Paula C Brady, Rose L Molina, Michael G Muto, Brenna Stapp, Serene S Srouji
Journal: Fertil Res Pract (2018)
Keywords: heterotopic pregnancy, mullerian anomaly, three-dimensional ultrasound, unicornuate uterus, uterine rupture
MeSH terms: Case Reports

Background:
Heterotopic pregnancies implanted in a rudimentary uterine horn account for 1 in 2-3 million gestations, and confer significant risk of morbidity due to uterine rupture and hemorrhage.
Case presentation:
A 34-year-old nullipara presented with acute pelvic pain at 17 weeks of gestation with dichorionic-diamniotic twins, one in each horn of an anomalous uterus first diagnosed in pregnancy as bicornuate. Three-dimensional ultrasound and MRI revealed myometrial disruption in the left rudimentary uterine horn, and the patient underwent an uncomplicated abdominal hemi-hysterectomy. Fourteen days later, an uncomplicated dilation and curettage was performed for a fetal anomaly in the remaining twin in the right unicornuate uterus.
Conclusion:
This case demonstrates the utility of magnetic resonance imaging and three-dimensional ultrasound in the assessment of myometrial integrity in a gravid patient with a heterotopic pregnancy and ruptured rudimentary uterine horn. This case demonstrates the importance of pre-pregnancy diagnosis and management of mullerian anomalies.
Universities as Partners in Primary Health Care Innovation
Authors: Henryk Majewski
Journal: Front Public Health (2021)
Keywords: community, innovation, partnership, primary care, university
MeSH terms: Ecosystem, Universities, Research Support, Non-U.S. Gov't, Australia, Health Services Accessibility, Humans, Primary Health Care

Universities have a unique role in the health ecosystem as providers of trained staff and discoverers of health innovations. However, often they sit in silos waiting for their rare blockbuster discoveries to change clinical care or seeing health services simply as future employers of their graduates or clinical trial sites. It is a transactional and targetted relationship. This present case study is of a primary health service Access Health and Community (AccessHC) in Australia and its university partner Swinburne University of Technology. Together they established a Kickstart Program which was to provide seed funding for small joint innovation projects generated by both organisations. One project exemplifies the approach. Swinburne who has a Design School was encouraged through the Kickstart Program to design a clinical waiting room of the future. This project started with a needs analysis. The written report was to inform the design. University staff linked with their internal University animations expertise to better communicate the needs analysis. The "Access me Not" animation was created, unknown to the staff at AccessHC. At initial presentation, the way the animation communicated was not imaginable by AccessHC. "Access me not" was submitted for the 2018 International Design Awards and received an honourable mention. However, the AccessHC staff saw other uses for the approach and contacted Swinburne to design a client journey animation for the newly introduced National Disability Scheme (NDIS). The co design produced an animation of immense help to parents in navigating the scheme for complex and chronic disability care and for AccessHC the scripting served as a framework to develop it new internal NDIS care systems and processes. The Swinburne team is now producing health navigation animations for the State Department of Health and Human Services. The Kickstart Program was an engagement strategy that has produced a set of health communication tools that the health service could not have envisaged and which the University could not have imagined an application. Small low risk seed funding can indeed introduce innovations and create beneficial relationships between health services and universities.
Asthma-like symptoms: is it always a pulmonary issue?
Authors: Davide Piloni, Claudio Tirelli, Rita Di Domenica, Valentina Conio, Amelia Grosso, Vanessa Ronzoni, Filippo Antonacci, Pasquale Totaro, Angelo G Corsico
Journal: Multidiscip Respir Med (2018)
Keywords: central airway, double aortic arch, persistent cough, spirometry
MeSH terms: Case Reports

Background:
Double aortic arch is a rare congenital and complete vascular ring around trachea and esophagus. It is usually diagnosed during infancy. The symptoms are generally related to respiratory and gastroesophageal tracts.
Case presentation:
A 20-year-old female patient was referred to our outpatient clinic for persistent dry cough. She had a history of an episode of inhalation of food bolus as an infant and recurrent bronchitis, anorexia and allergic bronchial asthma since the childhood. Since the beginning, an intrathoracic obstruction was suspected at pulmonary function tests. After 1 month of complete asthma treatment, the cough was unchanged and the spirometry confirmed the presence of an intrathoracic obstruction. Then, she underwent a chest CT with contrast medium, a contrast transthoracic echocardiography, a fiberbronchoscopy and an esophageal radiography with contrast medium. The final diagnosis was made and a double aortic arch was found.
Conclusion:
A careful observation of the flow/volume curve should always be guaranteed and the presence of congenital vascular anomalies should be suspected in case of difficult-to-treat asthma.
Autologous bone marrow mononuclear cells in ischemic cerebrovascular accident paves way for neurorestoration: a case report
Authors: Alok Sharma, Hemangi Sane, Anjana Nagrajan, Nandini Gokulchandran, Prerna Badhe, Amruta Paranjape, Hema Biju
Journal: Case Rep Med (2014)

In response to acute ischemic stroke, large numbers of bone marrow stem cells mobilize spontaneously in peripheral blood that home onto the site of ischemia activating the penumbra. But with chronicity, the numbers of mobilized cells decrease, reducing the degree and rate of recovery. Cellular therapy has been explored as a new avenue to restore the repair process in the chronic stage. A 67-year-old Indian male with a chronic right middle cerebral artery ischemic stroke had residual left hemiparesis despite standard management. Recovery was slow and partial resulting in dependence to carry out activities of daily living. Our aim was to enhance the speed of recovery process by providing an increased number of stem cells to the site of injury. We administered autologous bone marrow mononuclear cells intrathecally alongwith rehabilitation and regular follow up. The striking fact was that the hand functions, which are the most challenging deficits, showed significant recovery. Functional Independence Measure scores and quality of life improved. This could be attributed to the neural tissue restoration. We hypothesize that cell therapy may be safe, novel and appealing treatment for chronic ischemic stroke. Further controlled trials are indicated to advance the concept of Neurorestoration.
Rare association of progressive congenital extrahepatic portosystemic shunt with development of multifocal hepatocellular carcinoma
Authors: Elliot Landau, Dan Shilo, Blair Rolnick, Jeremy Neuman
Journal: BJR Case Rep (2016)
MeSH terms: Case Reports

The association between the Abernethy malformation, a rare vascular anomaly in which the portal blood is diverted into the systemic circulation, and development of hepatic tumours is well established. We present a case of multifocal hepatocellular carcinoma (HCC) in the presence of extrahepatic portosystemic shunt with a diminutive portal vein (Type 2 Abernethy malformation). Abdominal ultrasound performed on a 72-year-old female presenting with elevated liver function tests found a 5.6 cm right hepatic lobe mass. Subsequent CT and MRI examinations demonstrated multifocal lesions. A diminutive portal vein was present (transverse diameter of 7 mm) with a large tortuous complex shunt (maximum transverse diameter 2.0 cm) arising at the portal vein bifurcation with branches connecting to the left renal vein and inferior vena cava. Review of a CT examination performed 10 years ago demonstrated a normal-sized portal vein (transverse diameter of 1.5 cm) with a smaller calibre portosystemic shunt (maximum transverse diameter 9 mm). To our knowledge, this is one of the first reports to demonstrate the evolution of progressive portosystemic shunting and the development of HCC.
Transient abnormal myelopoiesis with extramedullary involvement in a down syndrome preemie leading to an unresponsive course despite chemotherapy
Authors: Saroja Devi Geetha, Ram Singh, Meira Shaham, Ninette Cohen, Kristin Sticco
Journal: Leuk Res Rep (2023)
Keywords: down syndrome, gata1 mutation, leukemia in down syndrome, megakaryoblastic leukemia, transient abnormal myelopoiesis, transient leukemia, transient myeloproliferative disorder
MeSH terms: Case Reports

Introduction:
Transient abnormal myelopoiesis (TAM) is a transient, clonal myeloproliferative disorder unique to Down Syndrome (DS) babies. It is characterized by increased peripheral blasts and presence of GATA1 mutation. The clinical spectrum ranges from jaundice and hepatosplenomegaly to multi-organ failure and death. Here we present a case of a premature baby with DS diagnosed to have TAM with extramedullary involvement at birth who had a fatal outcome.
Case report:
A 30.3-week-old female fetus with DS had leukocytosis (WBC: 187.82 K/uL) with neutrophilia (ANC 27.65 K/uL), macrocytic anemia (RBC: 2.41 m/uL, Hb 8.8 g/dL, MCV 108.3, MCH 36.5, MCHC 33.7) and thrombocytosis (platelet count 361 K/uL) at birth. Liver panels demonstrated normal bilirubin levels with elevated liver enzymes (AST = 239 U/L, ALT = 216 U/L).
Results:
Peripheral smear showed marked leukocytosis with increased blasts (70%), nucleated RBCs, giant platelets, and megakaryocytic elements. Flow cytometry demonstrated two populations of cells: 20% myeloblasts and 26% dim CD45 CD34- cells. GATA1 mutation was present. Based on these findings a diagnosis of TAM with extramedullary hematopoiesis was made. She received two cycles of cytarabine chemotherapy. Though her WBC levels reached a low of 18.93 K/uL, she developed multi-organ failure, eventually leading to death on day 45.
Discussion:
TAM is a transient condition resulting in disease resolution in around 80% of cases. Death is reported in 10% of cases. Risk factors associated with early death include prematurity, hyperleukocytosis, elevated bilirubin levels. Management of high-risk babies with chemotherapy is recommended to improve survival.
Case Report: Rheumatoid meningitis with positive NMDAR antibody: A case treated with intravenous immunoglobulin
Authors: Honglian Zhang, Yuehong Wan, Zhujun Mei, Chen Xie, Shiying Liu, Hongbing Nie, Fan Hu, Renshi Xu
Journal: Front Immunol (2022)
Keywords: ivig, nmdar antibody, case report, diagnosis and treatment, rheumatoid meningitis
MeSH terms: Arthritis, Rheumatoid / complications, Arthritis, Rheumatoid / diagnosis, Arthritis, Rheumatoid / drug therapy, Meningitis / diagnosis, Meningitis / drug therapy, Meningitis / etiology, Case Reports, Research Support, Non-U.S. Gov't, Aged, Autoantibodies / cerebrospinal fluid, Biomarkers, Humans, Immunoglobulins, Intravenous / therapeutic use, Interleukin-6, Male, Rheumatoid Factor, Rheumatoid Factor, Immunoglobulins, Intravenous, Interleukin-6, Autoantibodies, Biomarkers

As a rare complication of rheumatoid arthritis (RA) in the central nervous system (CNS), rheumatoid meningitis (RM) mainly affects the meninges and has various clinical symptoms. The diagnostic and treatment approaches currently used are not practical. RM cases with positive NMDAR antibodies (Abs) have never been reported. In the present study, a 66-year-old man with a 1-year history of RA presented recurrent left lower limb weakness during activities for 1 month. The results showed that rheumatoid factor (RF) and anti-cyclic citrullinated peptide antibody (ACPA) were positive in the serum, and NMDAR Abs were present in cerebrospinal fluid (CSF). Hyperintensity was observed in the leptomeninges of the right frontal and parietal lobes, and subtle hyperintensity was observed in the left frontal and parietal lobes, as indicated by brain MRI. A meningeal biopsy revealed non-specific inflammation with the absence of rheumatoid nodules. The patient was given IVIg on day 7 after admission. The clinical symptoms were relieved, the lesions were alleviated, and abnormal biochemical indicators were gradually recovered 1 week after initiation of the treatment, while NMDAR Abs were present in CSF even after treatment. After 5 months of follow-up, the patient's serum and CSF ACPA and IL-6 levels were still high. The findings showed that brain MRI was adequate for the diagnosis of RM. ACPA and IL-6 might be the specific biomarkers for disease activity in RM. IVIg was effective as induction therapy for RM. Further studies should explore whether the presence of NMDAR Abs is associated with RM.
Stent angioplasty of narrowed portocaval shunt in Budd Chiari syndrome: a case report
Authors: Nilesh Doctor, Vidhyachandra Gandhi, Sharad Shah, Maharra Hussain, Shaji Marar, Sujith Philip
Journal: Cases J (2009)

Background:
Hepatic vein thrombosis (Budd-Chiari Syndrome) is a rare disorder resulting from an obstruction to the outflow of blood from the liver. Early decompression is needed to prevent liver dysfunction and death. Radiological intervention includes angioplasty of stenosis and webs and the placement of transjugular intrahepatic portosystemic shunts (TIPPS). Side-to-side portacaval shunt (SSPCS) remains the gold standard for achieving good long-term results.
Case presentation:
A 37-year old lady underwent side-to-side portacaval shunt for Budd Chiari syndrome. She had early shunt blockage and this was successfully treated with the placement of a metallic stent across the shunt.
Conclusion:
At five years, she remains asymptomatic, with normal liver functions, no ascites, and normal flow through the stent on Colour Doppler examination.
Epistaxis as a Common Presenting Symptom of Glanzmann's Thrombasthenia, a Rare Qualitative Platelet Disorder: Illustrative Case Examples
Authors: Michael Recht, Meera Chitlur, Derek Lam, Syana Sarnaik, Madhvi Rajpurkar, David L Cooper, Sriya Gunawardena
Journal: Case Rep Emerg Med (2017)
MeSH terms: Case Reports

Children often present to emergency departments (EDs) with uncontrollable nose bleeding. Although usually due to benign etiologies, epistaxis may be the presenting symptom of an inherited bleeding disorder. Whereas most bleeding disorders are detected through standard hematologic assessments, diagnosing rare platelet function disorders may be challenging. Here we present two case reports and review diagnostic and management challenges of platelet function disorders with a focus on Glanzmann's thrombasthenia (GT). Patient 1 was a 4-year-old boy with uncontrolled epistaxis. His medical history included frequent and easy bruising. Previous laboratory evaluation revealed only mild microcytic anemia. An otolaryngologist stopped the bleeding, and referral to a pediatric hematologist led to the definitive diagnosis of GT. Patient 2 was a 2.5-year-old girl with severe epistaxis and a history of milder recurrent epistaxis. She had a bruise on her abdomen with a palpable hematoma and many scattered petechiae. Previous assessments revealed no demonstrable hemostatic anomalies. Platelet aggregation studies were performed following referral to a pediatric hematologist, leading to the diagnosis of GT. As evidenced by these cases, the ED physician may often be the first to evaluate severe or recurrent epistaxis and should recognize indications for coagulation testing and hematology consultation/referral for advanced hematologic assessments.
Mycobacterium fortuitum and Mycobacterium abscessus infections in the foot and ankle in two immunocompetent patients
Authors: Khai Phang Wong, Zhi Hao Tang, Gek Meng Tan
Journal: Biomedicine (Taipei) (2020)
Keywords: conventional chemotherapy, musculoskeletal infections, nontuberculous mycobacteria, osteomyelitis, septic arthritis
MeSH terms: Case Reports

Nontuberculous mycobacteria (NTM) infections of the musculoskeletal system are commonly missed due to its rarity and the absence of systemic symptoms. A high clinical index of suspicion is required to recognize such infections as they may occur in immunocompetent hosts. We present two cases of foot and ankle NTM infections involving Mycobacterium fortuitum and Mycobacterium abscessus in two such patients. The first case involves an 83-year old lady who presented with a two-month history of multiple foot abscesses initially treated at a rural hospital. She underwent drainage and debridement of her foot, with eventual cultures growing Pseudomonas aeruginosa and Mycobacterium abscessus. She was initially treated with clarithromycin and doxycycline. At one year follow-up review, her wound healed completely. The second case involves a 55-year old man who presented with infection following midfoot fusion and anterolateral thigh flap for an open complex fracture dislocation of his right foot. Cultures eventually grew Mycobacterium fortuitum and he was treated with cefoxitin, clarithromycin and doxycycline. 10 months after his initial injury, the infection has cleared and his flap was clean. Through these 2 cases, we hope to highlight the unusual presentations of such infections and illustrate that with a high initial index of suspicion and appropriate treatment, these infections can be treated successfully.
Case Report: Phenotype-Driven Diagnosis of Atypical Dravet-Like Syndrome Caused by a Novel Splicing Variant in the SCN2A Gene
Authors: Artem Sharkov, Peter Sparber, Anna Stepanova, Denis Pyankov, Sergei Korostelev, Mikhail Skoblov
Journal: Front Genet (2022)
Keywords: dravet syndrome, kabuki syndrome, scn2a, deep phenotyping, functional analysis
MeSH terms: Case Reports

Febrile-associated epileptic encephalopathy is a large genetically heterogeneous group that is associated with pathogenic variants in SCN1A, PCDH19, SCN2A, SCN8A, and other genes. The disease onset ranges from neonatal or early-onset epileptic encephalopathy to late-onset epilepsy after 18 months. Some etiology-specific epileptic encephalopathies have target therapy which can serve as a clue for the correct genetic diagnosis. We present genetic, clinical, electroencephalographic, and behavioral features of a 4-year-old girl with epileptic encephalopathy related to a de novo intronic variant in the SCN2A gene. Initial NGS analysis revealed a frameshift variant in the KDM6A gene and a previously reported missense variant in SCN1A. Due to lack of typical clinical signs of Kabuki syndrome, we performed X-chromosome inactivation that revealed nearly complete skewed inactivation. Segregation analysis showed that the SCN1A variant was inherited from a healthy father. The proband had resistance to multiple antiseizure medications but responded well to sodium channel inhibitor Carbamazepine. Reanalysis of NGS data by a neurogeneticist revealed a previously uncharacterized heterozygous variant c.1035-7A>G in the SCN2A gene. Minigene assay showed that the c.1035-7A>G variant activates a cryptic intronic acceptor site which leads to 6-nucleotide extension of exon 9 (NP_066287.2:p.(Gly345_Gln346insTyrSer). SCN2A encephalopathy is a recognizable severe phenotype. Its electro-clinical and treatment response features can serve as a hallmark. In such a patient, reanalysis of genetic data is strongly recommended in case of negative or conflicting results of DNA analysis.
Coracoclavicular Double-Button Fixation of Displaced Lateral Clavicular Fracture in a Patient without Coracoid Process
Authors: Rodrigo Nicolás Brandariz, Maria Guillermina Bruchmann, Franco Luis De Cicco, Luciano Andres Rossi, Ignacio Tanoira, Maximiliano Ranalletta
Journal: Case Rep Orthop (2019)
MeSH terms: Case Reports

Background:
Displaced distal clavicular fractures are generally operated on because of the high nonunion rate after nonoperative treatment. Several surgical techniques have been developed to reduce the nonunion rate and improve functional outcomes. One of them is closed reduction and minimally invasive coracoclavicular double-button fixation, which requires the integrity of the coracoid process to be performed.
Case summary:
We present a 35-year-old male patient who had been successfully subjected to a modified Latarjet procedure for glenohumeral instability with bony defect treatment, and 7 months later suffered a distal clavicle fracture in his ipsilateral shoulder. With a CT scan, we analyzed the coracoid remnant size (7 mm), and we consider it enough to perform a minimally invasive double-button technique, using this remnant as a distal fixation.
Postoperative and follow-up:
Radiographic and clinical fracture union occurred 10 weeks after the procedure. The patient returned to sports at the same level he had before surgery and achieved full strength and range of motion.
Conclusion:
Closed reduction and minimally invasive double-button fixation of displaced distal clavicular fractures is a safe, reproducible, and versatile technique, which can even be performed without an intact coracoid process.