OpenMed/multicare-articles huggingface dataset:
Difficult Management of a Double-Lumen Endotracheal Tube and Difficult Ventilation during Robotic Thymectomy with Carbon Dioxide Insufflation
Authors: Yuki Sugiyama, Kunihiro Mitsuzawa, Yuki Yoshiyama, Fumiko Shimizu, Satoshi Fuseya, Takashi Ichino, Hiroyuki Agatsuma, Takayuki Shiina, Ken-Ichi Ito, Mikito Kawamata
Journal: Case Rep Surg (2017)
MeSH terms: Case Reports

Robotic surgery with carbon dioxide (CO2) insufflation to the thorax is frequently performed to gain a better operative field of view, although its intraoperative complications have not yet been discussed in detail. We treated two patients with difficult ventilation caused by distal migration of a double-lumen endotracheal tube (DLT) during robotic thymectomy. In the first case, migration of the DLT during one-lung ventilation (OLV) occurred after CO2 insufflation to the bilateral thoraxes was started. Oxygenation rapidly deteriorated because dependent lung expansion was restricted by CO2 insufflation. In the second case, migration of the DLT during OLV occurred while CO2 insufflation to a unilateral thorax and mediastinum was performed. In both cases, once migration of the DLT during OLV occurred with CO2 insufflation, readjusting the DLT became very difficult because our manipulation of bronchofiberscopy was prevented by the robot arms located above the patient's head and because deformation of the trachea/bronchus induced by CO2 insufflation caused a poor image of the bronchofiberscopic view. Thus, during robotic-assisted thoracoscopic surgery with CO2 insufflation, since there is a potential risk of difficult ventilation with a DLT and since readjustment of the DLT is very difficult, discontinuing CO2 insufflation and switching to double-lung ventilation are needed in such a situation.
Small Bowel Obstruction due to Mesodiverticular Band of Meckel's Diverticulum: A Case Report
Authors: Aziz Sumer, Ozgur Kemik, Aydemir Olmez, A Cumhur Dulger, Ismail Hasirci, Umit Iliklerden, Erol Kisli, Cetin Kotan
Journal: Case Rep Med (2010)
MeSH terms: Case Reports

Meckel's diverticulum is the most common congenital anomaly of the small intestine. Common complications related to a Meckel's diverticulum include haemorrhage, intestinal obstruction, and inflammation. Small bowel obstruction due to mesodiverticular band of Meckel's diverticulum is a rare complication. Herein, we report the diagnosis and management of a small bowel obstruction occurring due to mesodiverticular band of a Meckel's diverticulum.
Medulloblastoma in a 6 Year Old Mixed Breed Dog: Surgical Debulking and Chemotherapy
Authors: Rachel Lampe, Miranda D Vieson, Devon Hague, Dana Connell, Kari Foss, Kim A Selting
Journal: Front Vet Sci (2019)
Keywords: brain tumor, chemotherapy, cytoreductive, medulloblastoma, neuroendocrine
MeSH terms: Case Reports

A medulloblastoma was surgically debulked from a 6 year old American Staffordshire Terrier, who then received a modified lomustine (CCNU), vincristine, procarbazine, and prednisolone (LOPP) protocol. The dog improved significantly and continued to do well until deterioration and euthanasia 5 months following surgery. This is the first known published case report of surgical cytoreductive surgery of a medulloblastoma in a dog with documented response to surgery and chemotherapy. Medulloblastoma is a primitive neuroectodermal tumor that is the most common malignant central nervous system (CNS) tumor in children, though it is less common in adults. This case illustrates the value of considering human literature when creating treatment plans for uncommon brain tumors in veterinary patients. Medulloblastoma should be a differential for cerebellar tumors in young to middle aged dogs, and surgery and chemotherapy should be considered.
Toxocariasis presenting as encephalomyelitis
Authors: Gregory Helsen, Stefaan J Vandecasteele, Ludo J Vanopdenbosch
Journal: Case Rep Med (2011)
MeSH terms: Case Reports

We describe a farmer who presented with a clinical picture of a transverse thoracic myelitis. MRI showed inflammatory lesions in brain and thoracic spinal cord. Toxocariasis was suspected because of eosinophilia in blood and cerebrospinal fluid, and this diagnosis was confirmed immunologically. He was successfully treated with antihelminthics in combination with corticosteroids. Neurotoxocariasis is rare and diagnosis can be difficult because of the different and atypical clinical manifestations. It should be considered in every case of central neurological syndrome associated with eosinophilia.
Traumatic Cochlear Implant Electrode Extrusion: Considerations, Management, and Outcome
Authors: Ching Yee Chan, Feifan Wang, Haryani Omar, Henry Kun Kiaang Tan
Journal: Case Rep Otolaryngol (2021)
MeSH terms: Case Reports

Cochlear implantation is the mainstay for patients with severe to profound hearing loss that do not benefit from hearing aids. Falls and head trauma can cause direct damage to the implant, of which hard failure is the most common complication. Traumatic electrode migration is an uncommon occurrence. Our patient underwent successful electrode advancement of a partially migrated, normal functioning electrode two months after head injury. We discuss the factors influencing the decision-making process, progress, and outcomes.
Vanishing Lung Syndrome in a Patient with HIV Infection and Heavy Marijuana Use
Authors: Basheer Tashtoush, Fernando Gonzalez-Ibarra, Roya Memarpour, Anas Hadeh, Laurence Smolley
Journal: Case Rep Pulmonol (2014)

Vanishing lung syndrome (VLS) is a rare and distinct clinical syndrome that usually affects young men. VLS leads to severe progressive dyspnea and is characterized by extensive, asymmetric, peripheral, and predominantly upper lobe giant lung bullae. Case reports have suggested an additive role of marijuana use in the development of this disease in young male tobacco smokers. We herein report a case of a 65-year-old Hispanic male previously diagnosed with severe emphysema and acquired immune deficiency syndrome (AIDS), with a history of intravenous heroin use and active marijuana smoking who presents to the emergency department with severe progressive shortness of breath he was found to have multiple large subpleural bullae occupying more than one-third of the hemithorax on chest computerized tomography (CT), characteristic of vanishing lung syndrome. The patient was mechanically ventilated and later developed a pneumothorax requiring chest tube placement and referral for surgical bullectomy. Surgical bullectomy has shown high success rates in alleviating the debilitating symptoms and preventing the life threatening complications of this rare syndrome. This case further emphasizes the importance of recognizing VLS in patients with severe emphysema and heavy marijuana smoking.
Spontaneous Bacterial Pericarditis and Coronary Sinus Endocarditis Caused by Oxacillin-Susceptible Staphylococcus aureus
Authors: Maurício N Machado, Marcelo A Nakazone, Isabela T Takakura, Carolina M P D C Silva, Lilia N Maia
Journal: Case Rep Med (2010)
MeSH terms: Case Reports

This paper describes a case of a 44-year-old male patient previously healthy admitted with an unusual spontaneous acute bacterial pericarditis associated with coronary sinus mass. Two-dimensional echocardiography showed large loculated pericardial effusion with signs of diastolic restriction and an image suggesting vegetation in topography of the right atrium coronary sinus. Pericardial drainage, coronary sinus vegetation resection, and antibiotic therapy with Oxacillin were performed due to Oxacillin-susceptible Staphylococcus aureus identified on the pericardial effusion and blood culture. This is a rare condition and a unique combination of a spontaneous acute bacterial pericarditis with coronary sinus endocarditis without cardiac valve compromise.
Selective intra-operative parathyroid hormone in re-do neck exploration in parathyroidectomy: A case report
Authors: Henry To, Gregory Otto
Journal: Int J Surg Case Rep (2019)
Keywords: case report, intra-operative assay, non-localised parathyroid, parathyroid adenoma, parathyroidectomy

Introduction:
Intra-operative parathyroid hormone (I-OPTH) levels are an adjunct used in parathyroid surgery which provides assurance that parathyroidectomy surgery is complete and has removed the hypersecreting gland.
Presentation of case:
A 78 year old female with no localisation on pre-operative imaging and had previous hemithyroidectomy. I-OPTH was used to guide the side and timing for completion of exploration, factors which reduced operative time, operative cost and avoided potential complications.
Discussion:
Routine and selective I-OPTH may be used to guide parathyroidectomy, and this case highlights the methodology of use in a selective challenging case. Appropriate application and interpretation of results must be achieved to ensure adequate completion of surgery and cure for the patient.
Conclusion:
Selective use of I-OPTH guides parathyroidectomy in challenging cases, and can be time and cost-effective when used appropriately.
Surgical treatment of a penoscrotal massive localized lymphedema: Case report
Authors: Rodolfo Costa Lobato, Rafael Ferreira Zatz, Wilson Cintra Junior, Miguel Luiz Antonio Modolin, Alex Chi, Yanessa Katiana Van Dunem Filipe de Almeida, Rolf Gemperli
Journal: Int J Surg Case Rep (2019)
Keywords: lymphedema, penis, urological surgical procedures, urology

Introduction:
Massive localized lymphedema is an aggressive type of lymphedema that causes great functional impairment for the patient, depriving from one's basic life activities. The treatment of this type of lesion is eminently surgical, requiring ablative surgery (complete surgical resection of the lesion), but the possible techniques not always provide a good functional result.
Presentation of case:
We reported a case of a penoscrotal massive lymphedema treated by our Body Contour Group/Plastic surgery department of our institute. We performed the resection of the giant penoscrotal lesion, used a posterior scrotal flap for defect's reconstruction and a split-thickness skin graft for penis' body reconstruction, closed with Z-plasty.
Discussion:
Contrary to what the literature says, we prefer to use the split-thickness skin graft to reconstruct the penis' body in these cases, against local flaps. According to our experience with some similar cases, this technique provides a better functional result once it allows the penis to a better expansion during erection. The key maneuver to avoid contracture of the graft and retraction of the penis is to perform a broken line suture (Z-plasty) in the topography of the median raphe.
Conclusion:
In cases of penoscrotal massive lymphedema, the treatment's option with better results is the surgical one. The use of a scrotal flap associated with split-thickness skin graft for penis provides good aesthetic and functional outcomes.
Case Report: PRES-Like Syndrome With Reversible Cortical Blindness Associated With Essential Thrombocythemia
Authors: Ying Li, Yuanfeng Miao, Meng Yu, Ying Zhu, Zeyin Liang, Zhaoxia Wang, Qing Peng
Journal: Front Neurol (2021)
Keywords: essential thrombocythemia, palinopsia, periodic triphasic waves, posterior reversible encephalopathy syndrome, reversible cortical blindness
MeSH terms: Case Reports

Background: There are few reported cases of posterior reversible encephalopathy syndrome (PRES) combined with essential thrombocythemia (ET). We report a case of PRES-like syndrome in ET. Case Report: A 60-year-old man with a history of hypertension and thrombocythemia presented with progressive visual loss after waking up; and neurological examination showed pupils were 3 mm and equally reactive to light, which suggested cortical blindness. Brain magnetic resonance imaging (MRI) revealed restricted diffusion in diffusion-weighted imaging (DWI) in the bilateral parietal and occipital lobes. Routine blood tests revealed a platelet count of 1,044 × 109/L. ET was diagnosed after exclusion of other causes. Electroencephalography (EEG) showed periodic triphasic waves in the occipital region. The lesions of the parietal and occipital lobes on MRI and periodic triphasic waves of EEG disappeared quickly, and patient's vision returned to normal after the treatment with hydroxyurea and sodium bicarbonate. The patient experienced hallucinatory palinopsia during the recovery of vision. Conclusion: ET may be a risk factor for PRES.
Case Report: Right Heart Failure Mistaken for Obesity-A Fault of Telemedicine
Authors: Anna Sabiniewicz, Paulina Lubocka, Robert Sabiniewicz
Journal: Front Pediatr (2022)
Keywords: ascending aorta, cardiac catheterization, cardiac edema, congenital heart defects, pediatric obesity, ruptured aneurysm
MeSH terms: Case Reports

As a result of the COVID-19 pandemic, telemedicine has become an important branch of healthcare worldwide. Apart from their undeniable advantages, the virtual visits lack physical examination, which can lead to important diagnostic mistakes. We hereby present a case of a pediatric patient whose weight gain, initially attributed to a sedentary lifestyle was, in fact, due to sub-acute right heart failure in the context of a ruptured sinus of Valsalva aneurysm. The condition was not diagnosed until the patient presented at the emergency. The boy was successfully treated with two percutaneous interventions and returned to his previous stature.
Hypogammaglobulinemia Observed One Year after Rituximab Treatment for Idiopathic Thrombocytopenic Purpura
Authors: Bilal Ahmad Shoukat, Osama Ali, Dileep Kumar, Muhammad Bilal Gilani, Adeela Zahid, Shaheer Aslam Joiya, Maqsood Anwar Malik
Journal: Case Rep Med (2018)
MeSH terms: Case Reports

We present the case of a 19-year-old female with severe hypogammaglobulinemia after having had treatment with rituximab for idiopathic thrombocytopenic purpura requiring intravenous immunoglobulins. She was admitted with the diagnosis of left-sided pneumonia with parapneumonic effusion. The patient was treated with piperacillin/tazobactam after having a poor response to co-amoxiclav. The patient had been tested for immunoglobulin levels, and the levels were very low. She has a history of ITP for which she received steroids. She also received rituximab for the same on four separate occasions, and the last one was about 1 year ago.
Case report: A 9-year systematic treatment failure of a pulmonary tuberculosis patient
Authors: Hui Jiang, Chendi Zhu, Liyi Qin, Xiaoguang Wu, Jinfeng Yin, Yijia Guo, Huan Ma, Junnan Jia, Fengmin Huo, Yi Xue, Mengqiu Gao, Weimin Li
Journal: Front Public Health (2022)
Keywords: computed tomography-three dimensional, multidrug resistance, treatment failure, tuberculosis, whole genome sequencing
MeSH terms: Mycobacterium tuberculosis / genetics, Tuberculosis, Pulmonary / drug therapy, Case Reports, Research Support, Non-U.S. Gov't, Amikacin / pharmacology, Amikacin / therapeutic use, Antitubercular Agents / pharmacology, Antitubercular Agents / therapeutic use, Capreomycin / pharmacology, Capreomycin / therapeutic use, Drug Resistance, Multiple, Bacterial / genetics, Humans, Microbial Sensitivity Tests, Moxifloxacin / pharmacology, Moxifloxacin / therapeutic use, Treatment Failure, Antitubercular Agents, Capreomycin, Amikacin, Moxifloxacin

Objective:
To explore the reasons of failure in a case of pulmonary tuberculosis (PTB) after 9 years systematic treatment.
Methods:
We extracted the patients' treatment history, drug susceptibility testing (DST), Computed tomography (CT) images, and sequenced the isolated strains by whole gene sequencing (WGS).
Results:
Although most results of the phenotypical DSTs were consistent with the genotype DST, the occurrence of gene resistance to amikacin (AMK), capreomycin (CAP), moxifloxacin (MFX) was earlier than the phenotypical DST. Based on the continuously reversed results of phenotypical DSTs, CT images in different stages and WGS, it can be confirmed that the patient was infected with two different strains of Mycobacterium tuberculosis (M.TB). Moreover, severe cavities may be another factor leading to treatment failure.
Conclusion:
Given the suggestive effect of genotype DST is earlier than the phenotypical DST, so genotype DST can play a better guiding role in patients with MDR-TB. Additionally, for patients who have not been cured for a long time, medication should be more cautious and the role of WGS in drug resistance surveillance should be fully utilized.
Pulmonary Embolism as a Rare Complication of Clomiphene Therapy: A Case Report and Literature Review
Authors: Vinod Solipuram, Kishor Pokharel, Temple Ihedinmah
Journal: Case Rep Endocrinol (2021)
MeSH terms: Case Reports

Background:
Pulmonary embolism (PE) is a medical emergency. Certain medications like oral contraceptives and hormone replacement therapies have been associated with PE. Clomiphene citrate is a selective estrogen receptor modulator, approved for treating infertility in females, but is being used as an off-label therapy in treating male hypogonadism. Very rarely, clomiphene can cause pulmonary embolism. Case Report. A 56-year-old gentleman presented with acute onset shortness of breath and chest discomfort. Upon further workup, he was found to have large volume pulmonary embolism. He was prescribed clomiphene citrate (CC) 2 years ago for hypogonadism. He was started on anticoagulation with improvement in his symptoms, and clomiphene was discontinued.
Conclusion:
Pulmonary embolism is a rare but potential complication of clomiphene therapy. In male patients with suspected hypogonadism, the risk of serious thromboembolic complications should be discussed before prescribing CC. Patients on CC have to be carefully monitored for serious side effects.
Partial abdominal evisceration and intestinal autotransplantation to resect a mesenteric carcinoid tumor
Authors: William H Kitchens, Nahel Elias, Lawrence S Blaszkowsky, A Benedict Cosimi, Martin Hertl
Journal: World J Surg Oncol (2011)
MeSH terms: Carcinoid Tumor / surgery, Intestines / transplantation, Mesentery / surgery, Peritoneal Neoplasms / surgery, Case Reports, Research Support, Non-U.S. Gov't, Carcinoid Tumor / pathology, Endoscopy, Digestive System, Gastrointestinal Hemorrhage / etiology, Humans, Intestinal Obstruction / diagnostic imaging, Intestinal Obstruction / prevention & control, Male, Mesentery / pathology, Middle Aged, Peritoneal Neoplasms / pathology, Prognosis, Tomography, X-Ray Computed, Transplantation, Autologous

Background:
Midgut carcinoids are neuroendocrine tumors that commonly metastasize to the intestinal mesentery, where they predispose to intestinal obstruction, ischemia and/or congestion. Because of their location, many mesenteric carcinoid tumors are deemed unresectable due to the risk of uncontrollable bleeding and prolonged intestinal ischemia.
Case presentation:
We report the case of a 60-year-old male with a mesenteric carcinoid tumor obstructing his superior mesenteric vein, resulting in intestinal varices and severe recurrent GI bleeds. While his tumor was thought to be unresectable by conventional techniques, it was successfully resected using intestinal autotransplantation to safely gain access to the tumor. This case is the first described application of this technique to carcinoid tumors.
Conclusions:
Intestinal autotransplantation can be utilized to safely resect mesenteric carcinoid tumors from patients who were not previously thought to be surgical candidates. We review the literature concerning both carcinoid metastases to the intestinal mesentery and the use of intestinal autotransplantation to treat lesions involving the mesenteric root.
Successful Postoperative Nephrocutaneous Fistula Treatment With Omental Flap Grafting: A Case Report
Authors: Haonan Guan, Di Zhang, Xian Ma, Yechen Lu, Yiwen Niu, Yingkai Liu, Jiaoyun Dong, Yi Gao, Weiping Yang, Qimin Chen, Jiajun Tang, Shuliang Lu
Journal: Front Surg (2021)
Keywords: foreign body reaction, nephrectomy, nephrocutaneous fistula, omentum, sinus tract
MeSH terms: Case Reports

Nephrocutaneous fistula (NCF) is a rare and severe complication of renal disease and surgical procedures. Treatments for NCF are based on the renal function, and can include nephrectomy, heminephrectomy, nephroureterectomy, endourological maneuvers or antibiotic therapy alone. Here we report a case of a chronic NCF which occurred 5 years after partial nephrectomy. In this report, we describe a new surgical approach for the management of a patient with postoperative NCF. In the present case, in addition to removing the fistulous tract, we also performed an omental flap grafting to tightly cover the kidney. In addition to limiting and controlling the local inflammation, the omental flap prevents contact between the kidney and the flank muscle on its posterior rim. No recurrence or complications occurred throughout 10 months of follow-up. The NCF was successfully treated with completely removal of the sinus tract and omental flap grafting, without nephrectomy. This case adds new aspects to the treatment of NCF.
Primary Pulmonary Malignant Melanoma Found While Evaluating New Onset Cough: A Case Presentation and Literature Review
Authors: Fernando Figueroa Rodriguez, Ahsan Uddin, Justine Nasr
Journal: Case Rep Pulmonol (2019)
MeSH terms: Case Reports

Malignant melanoma is a nonepithelial neoplasm of melanocytes. It is tremendously rare for this condition to primarily involve the respiratory tract, accounting only for 0.01% of the lung malignancies. It often presents as a solitary nodule provoking mass effect and/or obstructive symptom. It most commonly affects patients 50 years old and older, with no gender predilection. Complete surgical excision is the treatment of choice; nevertheless, chemotherapy or radiation might be necessary depending on tumor location and/or metastasis status. Recently, biochemotherapy and immunotherapy have emerged as promising treatment modalities. We present a case of Primary Pulmonary Malignant Melanoma (PPMM) in a 76-year-old male with no previous personal or family history of cancer who presented with new onset nonproductive cough. We also present an analysis with high yield points summarizing clinical features, diagnostic workup, and management of PPMM. Finally, we post a table summarizing all the cases ever reported in English literature.
Complex small supernumerary marker chromosome with a 15q/16p duplication: clinical implications
Authors: Denise M Christofolini, Flavia B Piazzon, Carolina Evo, Fernanda A Mafra, Stella R Cosenza, Alexandre T Dias, Caio P Barbosa, Bianca Bianco, Leslie D Kulikowski
Journal: Mol Cytogenet (2014)
Keywords: 15q duplication, 16p duplication, complex ssmc, familial inheritance
MeSH terms: Case Reports

Background:
Complex small supernumerary marker chromosomes (sSMCs) consist of chromosomal material derived from more than one chromosome and have been implicated in reproductive problems such as recurrent pregnancy loss. They may also be associated with congenital abnormalities in the offspring of carriers. Due to its genomic architecture, chromosome 15 is frequently associated with rearrangements and the formation of sSMCs. Recently, several different CNVs have been described at 16p11.2, suggesting that this region is prone to rearrangements.
Results:
We detected the concomitant occurrence of partial trisomy 15q and 16p, due to a complex sSMC, in a 6-year-old girl with clinical phenotypic. The karyotype was analyzed by G and C banding, NOR staining, FISH and SNP array and defined as 47,XX,+der(15)t(15;16)(q13;p13.2)mat. The array assay revealed an unexpected complex sSMC containing material from chromosomes 15 and 16, due to an inherited maternal translocation (passed along over several generations). The patient's phenotype included microsomia, intellectual disability, speech delay, hearing impairment, dysphagia and other minor alterations.
Discussion:
This is the first report on the concomitant occurrence of partial trisomy 15q and 16p. The wide range of phenotypes associated with complex sSMCs represents a challenge for genotype-phenotype correlation studies, accurate clinical assessment of patients and genetic counseling.