OpenMed/multicare-articles huggingface dataset:
Massive Acetaminophen Overdose Treated Successfully with N-Acetylcysteine, Fomepizole, and Hemodialysis
Authors: Michael H Chiu, Natalia Jaworska, Nicholas L Li, Mark Yarema
Journal: Case Rep Crit Care (2021)
MeSH terms: Case Reports

Acetaminophen overdose is one of the most common causes of acute hepatic failure in the developed world. There is strong evidence for N-acetylcysteine (NAC) as a safe and effective antidote for acetaminophen toxicity. However, there is less clarity in the management of massive overdoses (acute, single ingestions > 500 mg/kg with 4-hour equivalent concentrations ~6000 μmol/L) which are often associated with metabolic acidosis and multiorgan dysfunction. In such ingestions, the role of adjuvant treatments such as fomepizole and extracorporeal removal is unclear. We present a case of a 20-year-old female presenting with an acute ingestion of over 120 grams (1764.7 mg/kg) and an acetaminophen concentration of 5880 μmol/L who developed refractory shock, decreased level of consciousness, and metabolic acidosis requiring mechanical ventilation and vasopressor support. She was treated with gastric decontamination with activated charcoal, IV NAC, fomepizole, and hemodialysis. The patient had complete clearance of acetaminophen by 32 hours after presentation and normalization of her acid base and hemodynamic status without any organ failure. This case highlights the potential benefit of a triple strategy of NAC, fomepizole, and early hemodialysis in massive acetaminophen overdose, potentially sparing complications of prolonged intubation and ICU hospitalization.
Endoscopic Totally Extraperitoneal Repair of Parastomal Hernia: A Case Report
Authors: Huiyong Jiang, Dil Momin Thapa, Chun Ma, Xiangjun Cai, Mofei Wang
Journal: Front Surg (2021)
Keywords: endoscopy, parastomal hernia, rectal cancer, surgical repair, totally extraperitoneal repair
MeSH terms: Case Reports

A parastomal hernia is a type of incisional hernia that occurs in abdominal integuments in the proximity of a stoma. It is a frequent late complication following colostomy. Surgical repair is currently the only treatment option for parastomal hernia. Here we present the case of a 74-year-old patient with parastomal hernia and a history of open surgery treated with a totally extraperitoneal (TEP) endoscopic approach. There was no recurrence of the hernia at the 3-month follow-up. We discuss the feasibility and possible operative approaches for endoscopic repair of parastomal hernia with the TEP technique.
Renal Colic: A Red Herring for Mucocele of the Appendiceal Stump
Authors: Sameera Ganti, Pothiawala Sohil
Journal: Case Rep Emerg Med (2018)
MeSH terms: Case Reports

Flank pain with hematuria is a common presentation in the emergency department. The commonest differential diagnosis of these patients is renal/ureteric calculus or pyelonephritis. These patients are usually treated with analgesia, antibiotics in case of pyelonephritis, and are discharged with an outpatient referral to a urologist. This case report describes a 51 year old male who presented to the ED for recurrent flank pain and hematuria. Bedside ultrasonography in the ED demonstrated a cystic lesion in the renal area. CT urography revealed an appendiceal stump mucocele and patient was transferred under surgical care. This case highlights the importance of the utility of bedside ultrasound in patients presenting to the ED with flank pain or abdominal pain which can lead to expedited assessment and appropriate management.
Primary pericardial mesothelioma presenting as multiple pericardial masses on CT
Authors: Mitchell C Raeside, Kirsten Gormly, Susan J Neuhaus, Dusan Kotasek, Craig James
Journal: BJR Case Rep (2016)
MeSH terms: Case Reports

We present the case of a 67-year-old male who was found to have multiple enhancing pericardial masses on CT imaging for investigation of weight loss and was subsequently diagnosed with primary pericardial mesothelioma. Although rare, pericardial mesothelioma is the most common primary malignancy of the pericardium and should be considered in the differential diagnosis of pericardial effusion, pericardial thickening or discreet pericardial mass. It is important for radiologists to be aware of pericardial mesothelioma as its clinical presentation is non-specific and it may be incidentally noted on radiological studies for investigation of apparently non-related symptoms. The prognosis of primary pericardial mesothelioma is universally poor.
Endodontic Retreatment of Maxillary Second Molar with Four Roots
Authors: Gabriel Magnucki
Journal: Case Rep Dent (2019)
MeSH terms: Case Reports

The present communication describes the endodontic retreatment of a rare four-rooted maxillary second molar. A 25-year-old patient was referred to our dental practice requesting an apicoectomy because of continuous and permanent pain reaction six months after the first endodontic treatment. The sent radiograph demonstrated three filled root canals (one mesial, two distal) and four radiographically superimposing roots (two mesial, two distal). Due to the diagnosed chronic apical periodontitis and based on the visible untreated root canal, we decided to endodontically re-treat the quadrangular tooth against the referred apicoectomy. In the first session, only the previously untreated mesiopalatal root canal was mechanically prepared and filled with a corticosteroid- and tetracycline-containing paste. After two symptom-free weeks, the gutta-percha was removed from the other canals and calcium hydroxide was applied. Another two weeks later, the four root canals, whose orifices were "irregular quadrilateral" shaped on the pulp chamber floor representing Versiani Type A, were obturated. After the verification of this rare anatomy by cone beam computed tomography, the tooth was classified as Christie's radicular type II. One characteristic of this type is parallel running buccal and palatal roots, which caused a radiographic superimposition and probably led to the endodontic mistreatment in the first case.
Aggressive Metastatic GATA3-Positive Sarcomatoid Carcinoma with Rapid Progression and Invasion of the Liver
Authors: Irfan Shaukat, Charles Padgett, Maimoona Inayat, Naseruddin Höti, Sadaf Mustafa
Journal: Case Rep Oncol Med (2018)
MeSH terms: Case Reports

Objective. GATA3-positive sarcomatoid carcinoma has never been documented in the past. It is a case of aggressive tumor, positive for GATA3, which should be further studied for its prognostic and therapeutic significance.
Free Floating Thrombus in Carotid Artery in a Patient with Recurrent Strokes
Authors: Moni Roy, Ashish Kumar Roy, Jeffrey R DeSanto, Murad Abdelsalam
Journal: Case Rep Med (2017)
MeSH terms: Case Reports

We present a case of 72-year-old male with reported past medical history of recurrent transient ischemic attacks (TIAs) presenting with myriad of neurological symptoms. Patient was transferred from outlying hospital with complaints of right sided facial droop and dysarthria. Computed tomography angiography (CTA) showed high grade proximal left internal carotid artery (ICA) stenosis along with interesting finding of a free floating thrombus (FFT) in the left ICA. After discussion with the neurosurgical team, our case was treated conservatively with combination of antiplatelet therapy with Aspirin and anticoagulation with Warfarin without recurrence of TIAs or strokes on six-month follow-up.
Case report presenting the diagnostic challenges in a patient with recurrent acquired angioedema, antiphospholipid antibodies and undetectable C2 levels
Authors: Arturo J Bonnin, Charles DeBrosse, Terri Moncrief, G Wendell Richmond
Journal: Allergy Asthma Clin Immunol (2018)
Keywords: acquired angioedema, antiphospholipid antibody syndrome, c1 inhibitor deficiency, c2 deficiency, heterozygous c4 deficiency, lymphoma, rituximab
MeSH terms: Case Reports

Background:
Angioedema secondary to acquired C1 inhibitor deficiency (AAE) is a rare disease. It usually is associated with lymphoproliferative disorders. We present a case of AAE in a patient with antiphospholipid syndrome (APS), a non-Hodgkin lymphoproliferative disorder (NHL) with undetectable levels of C2, C4, and an undetectable CH50. The co-existence of AAE, APS, and NHL, with an undetectable C2 level, to the best of our knowledge, has never before reported together in the same patient.
Case presentation:
A patient with a recent history of thrombosis presented with recurrent episodes of angioedema. The workup revealed undetectable levels of C2, C4 and undetectable CH50. Quantitative levels of C1 inhibitor and C1q were low. C1 inhibitor function was less than 40%. Anti-cardiolipin antibodies were found. The patient was initially treated on demand with intravenous plasma-derived human C1-INH concentrates, (Cinryze® Shire). Later the patient received prophylactic therapy with danazol. She was diagnosed with lymphoma 3 years after her first episode of angioedema. Single agent therapy with rituximab was not only effective in treating her lymphoma but also preventing further episodes of angioedema. Anti-cardiolipin antibody titers also declined. Additionally, marked early primary pathway complement component abnormalities and CH50 also corrected, although incomplete normalization of C4 proved to be due to a heterozygous C4 deficiency.
Conclusion:
This case shows the unique association of AAE, APS and NHL in a patient with undetectable levels of early complement components. Additionally, this case also shows for the first time the effectiveness of rituximab therapy in all three disease states while co-existing simultaneously in the same patient.
Postpartum pneumomediastinum and subcutaneous emphysema: two case reports
Authors: Shivanthi Kandiah, Harish Iswariah, Stephen Elgey
Journal: Case Rep Obstet Gynecol (2013)

Spontaneous pneumomediastinum associated with subcutaneous emphysema is a rare condition also known as Hamman's syndrome. It can also be seen postpartum. We present two cases of subcutaneous emphysema associated with childbirth in nulliparous women, both of which resolved spontaneously.
Interstitial 14q24.3 to q31.3 deletion in a 6-year-old boy with a non-specific dysmorphic phenotype
Authors: Mariluce Riegel, Lilia Ma Moreira, Layla D Espirito Santo, Maria Betânia P Toralles, Albert Schinzel
Journal: Mol Cytogenet (2014)
Keywords: 14q interstitial deletion, array-cgh, genotype-phenotype correlation
MeSH terms: Case Reports

Background:
Few patients with interstitial deletions in the distal long arm of chromosome 14 have been reported, and these patients showed rather indistinct features, including growth and mental retardation and phenotypic alterations.
Results:
We describe a de novo 14q interstitial deletion in a 6-year-old boy with dysmorphic facial traits such as hypertelorism, short and narrow palpebral fissures, broad nose with anteverted nostrils, long philtrum, thin upper lip with cupid's bow, prominent and everted lower lip, mildly low-set ears, as well as moderate developmental delay and mild mental retardation. Array-CGH mapped the deletion to the region 14q24.3 to 14q31.3, including 13.11 Mb, proximal to the imprinted genomic region of 14q32.
Conclusion:
This mild phenotypic presentation suggests that the deleted segment does not contain essential genes for early organ development. Twenty-two genes with known functions, including Neurexin III (NRXN3, OMIM 600567), map to the region deleted in the propositus.
Case report: Continuous spinal cord physiologic monitoring following traumatic spinal cord injury-A report from the Winnipeg Intraspinal Pressure Study (WISP)
Authors: Perry Dhaliwal, Alwyn Gomez, Frederick Adam Zeiler
Journal: Front Neurol (2023)
Keywords: autoregulation, intraspinal pressure, spinal cord, spinal cord injury, spinal cord perfusion pressure
MeSH terms: Case Reports

Introduction:
Acute traumatic spinal cord injury is routinely managed by surgical decompression and instrumentation of the spine. Guidelines also suggest elevating mean arterial pressure to 85 mmHg to mitigate secondary injury. However, the evidence for these recommendations remains very limited. There is now considerable interest in measuring spinal cord perfusion pressure by monitoring mean arterial pressure and intraspinal pressure. Here, we present our first institutional experience of using a strain gauge pressure transducer monitor to measure intraspinal pressure and subsequent derivation of spinal cord perfusion pressure.
Case presentation:
The patient presented to medical attention after a fall off of scaffolding. A trauma assessment was completed at a local emergency room. He did not have any motor strength or sensation to the lower extremities. A computed tomography (CT) scan of the thoracolumbar spine confirmed a T12 burst fracture with retropulsion of bone fragments into the spinal canal. He was taken to surgery for urgent decompression of the spinal cord and instrumentation of the spine. A subdural strain gauge pressure monitor was placed at the site of injury through a small dural incision. Mean arterial pressure and intraspinal pressure were then monitored for 5 days after surgery. Spinal cord perfusion pressure was derived. The procedure was performed without complication and the patient underwent rehabilitation for 3 months where he regained some motor and sensory function in his lower extremities.
Conclusion:
The first North American attempt at insertion of a strain gauge pressure monitor into the subdural space at the site of injury following acute traumatic spinal cord injury was performed successfully and without complication. Spinal cord perfusion pressure was derived successfully using this physiological monitoring. Further research efforts to validate this technique are required.
Case Report: Concomitant Alzheimer's and Lewy-Related Pathology Extending the Spectrum of Underlying Pathologies of Corticobasal Syndrome
Authors: Michaela Kaiserová, Katerina Menšíková, Lucie Tučková, Petr Hluštík, Petr Kaňovský
Journal: Front Neurosci (2021)
Keywords: alzheimer's related pathology, lewy-related pathology, concomitant pathologies, corticobasal degeneration, corticobasal syndrome
MeSH terms: Case Reports

Corticobasal syndrome (CBS) is clinically characterized by progressive asymmetric rigidity and apraxia together with symptoms suggestive of cortical involvement and basal ganglia dysfunction. The spectrum of neurodegenerative diseases that can manifest with CBS is wide. The associations of CBS with corticobasal degeneration, progressive supranuclear palsy, Alzheimer's disease, frontotemporal lobar degenerations, Creutzfeldt-Jakob disease, or diffuse Lewy body pathology have been reported. We describe the case of a 71-year-old woman with CBS. The histopathological examination of brain tissue revealed concomitant pathology corresponding to the limbic stage of Lewy-related pathology and the intermediate stage of Alzheimer's-type pathology. To date, there have been only a few cases with a similar combination of pathology manifesting with the CBS phenotype that have been described in the literature. The extent and distribution of pathological changes in these cases were somewhat different from ours, and significance for clinical manifestation was attributed to only one of these pathologies. In our case, we assume that both types of pathology contributed to the development of the disease, considering the presumed specific spread of both types of pathological processes according to Braak's staging. Our case expands the spectrum of neurodegenerative pathological processes that may manifest with the typical CBS phenotype. Also, it points out the importance of identifying specific biomarkers that would enable more accurate in vivo differential diagnosis and more accurate determination of the underlying pathological processes of these diseases.
Rhabdomyolysis-Induced Acute Kidney Injury in Diabetic Emergency: Underdiagnosed and an Important Association to Be Aware of
Authors: Ami Amin, Bhavika Gandhi, Steven Torre, Alireza Amirpour, Jennifer Cheng, Mayurkumar Patel, Mohammad A Hossain
Journal: Case Rep Med (2018)
MeSH terms: Case Reports

Rhabdomyolysis is a potentially life-threatening clinical syndrome associated with muscle injury which can cause a leakage of intracellular contents, manifested from the range of being asymptomatic to a life-threatening condition causing acute kidney injury and severe electrolyte abnormalities. Rhabdomyolysis has been associated with both diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic nonketotic syndrome, though there is an increased association with rhabdomyolysis and acute kidney injury with hyperosmolar nonketonic state compared with patients with diabetic ketoacidosis. Common clinical manifestations are muscle pain, dark urine, and generalized weakness. The causes of rhabdomyolysis are broadly categorized into three groups: traumatic, nontraumatic exertional, and nontraumatic nonexertional. Here, we present a case of rhabdomyolysis-induced acute kidney injury in a patient with hyperosmolar hyperglycemic state. The patient was discharged on insulin and needed intermittent dialysis for two months. Our case highlights the importance of the rare association of rhabdomyolysis causing acute kidney injury in a diabetic emergency.
A Case of Carbamazepine-Induced Aggravation of Self-Limited Epilepsy with Centrotemporal Spikes Epilepsy and Valproate-Induced Hyperammonemic Encephalopathy in a Child with Heterozygous Gene Variant of Carbomoyl Phosphatase Synthetase Deficiency
Authors: Imalke Kankananarachchi, Eresha Jasinge, Gemunu Hewawitharana
Journal: Case Rep Neurol Med (2021)
MeSH terms: Case Reports

Antiepileptics drugs are the mainstay of the management of epilepsy in children. Sodium valproate (VPA) and carbamazepine (CBZ) are widely used medications in childhood epilepsy. Hyperammonemia has been described as a known side effect of valproate therapy. It is known that VPA-associated HA is common among patients who hold genetic mutations of the carbomoyl phosphatase synthase 1 gene (CPS1). Aggravation of self-limited epilepsy with centrotemporal spikes (SLECTS) is a rare side effect of CBZ. Here, we present a child who had CBZ-induced aggravation of rolandic epilepsy and VPA-induced HA encephalopathy in the background of an unrecognised heterozygous gene variant of CPS1. An 8-year-old boy with SLECTS presented with a history of abnormal behaviours and drowsiness. He was apparently well until six years when he developed seizures in favour of rolandic epilepsy. His electroencephalogram (EEG) showed bilateral predominantly on the right-sided central-temporal spikes and waves. The diagnosis of SLECTS was made, and he was commenced on CBZ. Though he showed some improvement at the beginning, his seizure frequency increased when the dose of CBZ was increased. His repeat EEG showed electrical status in slow-wave sleep, and CBZ was stopped. Subsequently, he was started on VPA, and with that, he developed features of encephalopathy. He had elevated serum ammonia with normal liver functions. VPA was stopped with the suspicion of VPA-induced hyperammonemia. Tandem mass spectrometry did not show significant abnormality in the amino acid profile. Specific genetic analysis revealed a c.2756 C > T.p (Ser919Leu) heterozygote genetic mutation of the CSP 1 gene. This is a classic example where side effects of treatment determine the choice of antiepileptics drugs (AEDs) in childhood epilepsy. It is essential to keep in mind that SLECTS can be aggravated with certain AEDs, and VPA-induced HA in the absence of live failure could be due to underlying inherited metabolic disorders.
Aesthetic Rehabilitation in Teeth with Wear from Bruxism and Acid Erosion
Authors: Pamella Tomazi Godoy de Oliveira, Deise Caren Somacal, Luiz Henrique Burnett Júnior, Ana Maria Spohr
Journal: Open Dent J (2018)
Keywords: bruxism, ceramic laminates, dental erosion, fracture of restorations, gingivoplasty, oral rehabilitation
MeSH terms: Case Reports

Background:
Bruxism is defined as a repetitive activity of grinding the teeth through lateral or protrusive movements of the mandible, and it is considered the most complex and destructive functional disorder. In addition, erosion caused by diet or reflux can damage the remaining teeth.
Objective:
In this report, a patient with bruxism and dental erosion was treated with a multidisciplinary approach to restore the function and aesthetic.
Methods:
This clinical report describes the management of an adult woman, 33 years old, who was dissatisfied with the aesthetics of her smile and complained of joint pain and headaches. As result of her condition, the patient's dentition exhibited generalized wear on the vestibular and incisal surface of the upper incisors incompatible with her age, moderate darkening of the teeth and excess gingival tissue in the upper incisors. After a detailed anamnesis and clinical examination, a diagnosis of bruxism and acid erosion caused by a diet rich in citrus foods and beverages was obtained. Forthwith, a treatment plan was established, and the patient underwent home bleaching, gingivoplasty and ceramic laminates of lithium disilicate on the anterior teeth. After the rehabilitation was completed, a night guard was made to reduce the symptoms of bruxism and avoid fracture of the ceramic restorations. The patient was followed at different time intervals.
Conclusion:
The improvement in the aesthetics of the teeth was significant and remained stable after periodic controls in which no adverse effects were observed.
Permanent biventricular ICD-implantation in a heart failure second re-do-CABG patient: a case report
Authors: Omer Dzemali, Nadejda Monsefi, Anton Moritz, Peter Kleine
Journal: Cases J (2009)

Biventricular pacing has been suggested in end-stage heart failure. We present a 59-year-old patient undergoing second re-do CABG (coronary artery bypass graft) and carotid artery endarterectomy. Ejection fraction was 15%, QRS-width 175 ms. Following the carotid and CABG procedure, an implanted single-chamber ICD (implantable cardioverter defibrillator) was upgraded to permanent biventricular DDD pacing by implantation of one epicardial left ventricular and one epicardial atrial electrode. At follow-up two months postoperatively ejection fraction had significantly improved to 45%, the patient underwent stress test with adequate load and reported a good quality of life.
Vaginal septoplasty in septate uterus with double cervix
Authors: Samuel Barbanti, Nara Chiamulera, Beatriz Botelho
Journal: Case Rep Obstet Gynecol (2014)

Fusion defects of the Müllerian ducts occur frequently and they have been described by the American Fertility Society. However, septate uterus with cervical duplication and longitudinal vaginal septum is not described by this classification and has suggested a change in the classical theory of fusion of the Müllerian ducts. This paper describes a rare case report of a patient with complete septate uterus with double cervix and longitudinal vaginal septum, submitted to the vaginal septoplasty for dyspareunia, progressing to clinical improvement. The description of this case is to contribute with all uncommon cases of Müllerian anomalies reports and clinical treatment protocols, which is not yet established.