OpenMed/multicare-articles huggingface dataset:
Reconstruction of a surgical defect in the popliteal fossa: A case report
Authors: Dan C Filitis, Juliya Fisher, Faramarz H Samie
Journal: Int J Surg Case Rep (2018)
Keywords: bilobed flap, case report, mohs micrographic surgery, popliteal fossa reconstruction, porcine xenograft

Introduction:
Surgical defects of the popliteal fossa pose a reconstructive challenge to the surgeon, given the intimate relationship of this area with the knee joint and underlying vital neuro-vasculature.
Case presentation:
An 88-year-old woman was treated for a biopsy proven invasive squamous cell carcinoma of the right popliteal fossa with Mohs micrographic surgery. The resultant defect (4.5 × 4.3 cm) was repaired using a random patterned bilobed flap with an undersized secondary lobe and porcine xenograft with excellent functional and cosmetic outcome.
Discussion:
Numerous approaches to reconstruction of the popliteal fossa have been proposed, including primary closure, secondary intent healing, skin grafting, random flaps, muscle flaps, fasciocutaneous flaps, freeflaps, and tissue expansion. Sub-optimal repair of the popliteal fossa can reduce mobility of the knee joint, carry a high risk of wound dehiscence and may result in significant scarring. Here, we present the use of a bilobed flap with an undersized secondary lobe, in a patient with limited tissue laxity, for the repair of the popliteal fossa.
Conclusion:
Utilizing a random pattern bilobed flap with an undersized secondary lobe is an excellent alternative for the repair of moderate sized popliteal fossa defects.
Toward sensor-based context aware systems
Authors: Yoshitaka Sakurai, Kouhei Takada, Marco Anisetti, Valerio Bellandi, Paolo Ceravolo, Ernesto Damiani, Setsuo Tsuruta
Journal: Sensors (Basel) (2012)
Keywords: context-based systems, interpretation uncertainty, sensor data interpretation
MeSH terms: Decision Making, Monitoring, Physiologic / instrumentation, Research Support, Non-U.S. Gov't, Fuzzy Logic, Heart Rate, Humans, Models, Theoretical, Uncertainty

This paper proposes a methodology for sensor data interpretation that can combine sensor outputs with contexts represented as sets of annotated business rules. Sensor readings are interpreted to generate events labeled with the appropriate type and level of uncertainty. Then, the appropriate context is selected. Reconciliation of different uncertainty types is achieved by a simple technique that moves uncertainty from events to business rules by generating combs of standard Boolean predicates. Finally, context rules are evaluated together with the events to take a decision. The feasibility of our idea is demonstrated via a case study where a context-reasoning engine has been connected to simulated heartbeat sensors using prerecorded experimental data. We use sensor outputs to identify the proper context of operation of a system and trigger decision-making based on context information.
Morphological Characteristics of Biliary Strictures after Liver Transplantation Visualized Using SpyGlass™ Cholangioscopy
Authors: Yathip M Chokpapone, Anne R Murray, Ashwini P Mehta, Vichin C Puri, Alejandro Mejia, Parvez Mantry
Journal: Case Reports Hepatol (2020)
MeSH terms: Case Reports

Biliary complications following liver transplant are common. Endoscopic retrograde cholangiopancreatography (ERCP) and magnetic resonance cholangiopancreatography (MRCP) are the main techniques used to diagnose and treat biliary complications; however, these techniques have limits to the depth of visualization. In this report, we present five cases of orthotopic liver transplant patients with biliary complications that underwent ERCP- or MRCP-guided cholangioscopy with the SpyGlass™ DS Direct Visualization System (SDDVS). The SDDVS allowed for the visualization of the morphological characteristics of biliary strictures, and images collected using the SDDVS allowed for four of the cases to be treated endoscopically. Our findings suggest that cholangioscopy with the SDDVS is a promising method to guide the endoscopic treatment of biliary complications after liver transplantation.
The Takotsubo Syndrome: Clinical Diagnosis Using POCUS
Authors: Josu López Libano, Lorenzo Alomar Lladó, Leire Zarraga López
Journal: POCUS J (2022)
Keywords: point of care ultrasound (pocus), takotsubo, systolic anterior movement of the mitral valve (sam)
MeSH terms: Case Reports

Takotsubo syndrome is a cardiomyopathy that can mimic an acute heart attack, in terms of clinical presentation, electrocardiographic changes, and findings on echocardiogram. Point-of-care-ultrasound (POCUS) can be used to detect this condition, even though the definitive diagnosis is made angiographically. We present the case of an 84-year-old woman with a subacute coronary syndrome and high levels of myocardial ischemia markers. The POCUS performed on admission showed characteristic left ventricular dysfunction involving the apex but sparing the base. The coronary angiography ruled out significant arteriosclerotic in the coronary arteries. The wall motion abnormalities were partially corrected in the 48 hours after admission. POCUS might be a useful tool to establish an early diagnosis of Takotsubo syndrome at time of admission.
Xanthogranuloma of the external auditory canal mimicking a benign tumor: a case report
Authors: Keisuke Yoshihama, Yasumasa Kato, Yuh Baba
Journal: Case Rep Otolaryngol (2012)

Exostosis, osteoma, and adenoma are the most commonly encountered benign lesions in the external auditory canal. Herein, we report a case of the mass arising from the external auditory canal in a 24-year-old Japanese man. CT revealed the soft tissue mass without bony erosion, and MRI revealed that the mass showed a homogenous, iso signal intensity on a both T1- and T2-weighted image, suggesting that the mass is a benign tumor such as adenoma. Pathological examination showed that the specimen demonstrated xanthogranuloma in the external auditory canal. Although xanthogranuloma of the external auditory canal is extremely rare, otolaryngologists should recognize this condition during the inspection of the external auditory canal.
Challenges in Treating Secondary Syphilis Osteitis in an Immunocompromised Patient with a Penicillin Allergy: Case Report and Review of the Literature
Authors: Robert Ali, Julio Perez-Downes, Firas Baidoun, Bashar Al Turk, Carmen Isache, Girish Mohan, Charles Perniciaro
Journal: Case Rep Infect Dis (2016)

Syphilis is a sexually transmitted infection that remains fairly commonplace. The introduction of penicillin aided in curbing the incidence of disease; however, with the advent of the human immunodeficiency virus (HIV), syphilis is now on a resurgence with sometimes curious presentations. We present a case of a 36-year-old Caucasian gentleman with untreated HIV who complained of a skin eruption and joint pains for 6 weeks, prompting the diagnosis of secondary syphilis osteitis. Skin lesions were reminiscent of "malignant" syphilis. CD4 count was 57 cells/μL. RPR was elevated with 1 : 64 titer and positive confirmatory TP-PA. Radiography of the limbs revealed polyostotic cortical irregularities corroborated on bone scintigraphy. The patient had an unknown penicillin allergy and was unwilling to conduct a trial of penicillin-based therapy. He was subsequently treated with doxycycline 100 mg twice daily for 6 weeks and commenced antiretroviral therapy, noting dramatic improvement in both the skin lesions and joint pains. Unfortunately, he defaulted on follow-up, precluding serial RPR and bone imaging. Penicillin allergies have proven to be quite a conundrum in such patients, without much recourse for alternative therapy. Doxycycline with/without azithromycin is other options worth considering.
Case Report: Clinically amyopathic dermatomyositis presenting acutely with isolated facial edema
Authors: Efthymia Pappa, Marina Gkeka, Asimina Protogerou, Leonidas Marinos, Chariclia Loupa, Constantinos Christopoulos
Journal: F1000Res (2018)
Keywords: amyopathic dermatomyositis, dermatomyositis, edema, inflammatory myopathy

A 45-year-old Asian man presented with acute-onset periorbital and facial edema associated with pyrexia. Muscle weakness was absent. Initial laboratory investigations showed an inflammatory reaction, while screening for infections was negative. Serum muscle enzyme levels were normal. He was hospitalized and treated empirically with antibiotics and corticosteroids, pending the result of facial skin and muscle biopsy. He showed a good clinical and laboratory response but an attempt to discontinue corticosteroids led to a prompt relapse of facial edema and pyrexia, associated with rising laboratory indices of inflammation. Biopsy findings were typical of dermatomyositis. Reintroduction of corticosteroid treatment resulted in complete clinical and laboratory remission. Facial edema as the sole clinical manifestation of dermatomyositis is extremely rare. There have been no previous reports of isolated facial edema in the setting of acute, clinically amyopathic dermatomyositis in adults. A high level of suspicion is required to make the diagnosis in the absence of myopathy and the hallmark cutaneous manifestations of the disease (heliotrope rash, Gottron papules).
A case of protruding eyeballs and diminishing vision
Authors: Rakesh Biswas, Saroj Gupta, Sumit Dahiya, Shashi Kiran, B V Girish, A S Kasthuri
Journal: Clin Med Case Rep (2010)
Keywords: hypothyroidism, thyroid ophthalmopathy, vision loss
MeSH terms: Case Reports

This case report discusses issues related to a 56-year-old man from Bangalore who presented with complaints of a gradual protrusion of his eyeballs along with diminishing vision for the previous month. The approach to diagnosis and management issues around this unusual presentation is dicussed.
Complete remission in a patient with metastatic gastric cancer receiving tislelizumab combined with chemotherapy: a case report
Authors: Zhe Zhu, Pei-Lin Dai, Shuai Han, Enming Qiu, Yu Wang, Zhou Li
Journal: Front Oncol (2023)
Keywords: advanced gastric cancer, case report, complete remission, immune checkpoint inhibitor, tislelizumab
MeSH terms: Case Reports

The prognosis for patients with advanced gastric cancer (AGC) is poor, with limited treatment options available due to the difficulty of resection. In recent years, chemotherapy and immunotherapy for AGC have shown promising efficacy. However, there is a controversy regarding the surgery of primary tumors and/or metastases in patients with stage IV gastric cancer after systematic therapy. Here, we present a 63-year-old retired female of AGC with supraclavicular metastasis with positive PD-L1 and tumor mutational burden-high (TMB-H). After receiving 8 cycles of capecitabine and oxaliplatin (XELOX) in combination with tislelizumab, the patient achieved complete remission (CR). No evidence of recurrence was identified during follow-up. To the best of our knowledge, this is the first case of AGC with supraclavicular metastasis who achieved CR after treatment with tislelizumab. The mechanism of CR was discussed by genomic and recent clinical studies. The results indicated that programmed death ligand-1 (PD-L1) combined positive score (CPS) ≥5 may serve as a clinical indication and standard for chemo-immune combination therapy. In combination with other similar reports, patients with microsatellite instability-high/defective mismatch repair (MSI-H/dMMR), (TMB-H), and positive PD-L1 had better sensitivity to tislelizumab. The patient recovered successfully except for symptoms of gastrointestinal hemorrhage during treatment, which may be associated with the treatment cycle and age. Immunotherapy with tislelizumab has been well-established in the treatment of malignant melanoma, lung cancer, and clear-cell kidney cancer, but its efficacy and safety for esophageal and gastric cancers remain to be validated. The CR of our patient suggested the prospects of tislelizumab in the immunotherapy of gastric cancer. Additionally, a watch-and-wait (WW) method maybe offered for patients with AGC who achieved complete clinical remission (CCR) after immune combination therapy if the patient was older or in poor physical condition.
Right congenital diaphragmatic hernia associated with abnormality of the liver in adult
Authors: Gezahen Negusse Ayane, Mikel Walsh, Jemal Shifa, Kadimo Khutsafalo
Journal: Pan Afr Med J (2017)
Keywords: bochdalek hernia (bh), appendectomy, colon, congenital, hernia repair
MeSH terms: Hernias, Diaphragmatic, Congenital / diagnosis, Intestinal Obstruction / etiology, Liver / abnormalities, Case Reports, Adult, Appendectomy / methods, Botswana, Colon, Transverse / abnormalities, Female, Follow-Up Studies, Hernias, Diaphragmatic, Congenital / complications, Humans, Intestinal Obstruction / surgery, Laparotomy / methods

A Bochdalek hernia (BH) occurs when abdominal contents herniate through the postero-lateral segment of the diaphragm. The right side is affected considerably less commonly than the left. Most BHs present are diagnosed early in life, with some element of cardio-respiratory distress. Rarely, hernias that remain clinically silent until adulthood when they present as life-threatening surgical emergencies. We report a case 35 year old female who emergency exploratory laparotomy for a complete mechanical bowel obstruction. At surgery the redundant transverse colon was twisted and incarcerated within the right hemithorax, creating a closed loop obstruction. The right colon, appendix, terminal ilium, and three accessories right liver lobes were also dragged into the right thoracic cavity. After reducing the hernia, the diaphragmatic defect was primarily repaired with non-absorbable suture. The redundant transvers colon which had been compromised was resected and primary end-to- end anastomosis was carried out. Incidental appendectomy was done. The patient was sent into ICU for post-operative monitoring. She made an uneventful recovery and remains asymptomatic at nine month follow-up. I discuss what i believe to be the first case report of complicated right diaphragmatic hernia in Botswana, associated with another congenital mal-formation (accessories hepatic lobes, partial mal-rotation, and redundant transvers colon) in adult.
A rare case of neonatal meningoencephalitis from Paenibacillus thiaminolyticus
Authors: Laura S Smallcomb, Terry C Dixon, Kamran N Azad, Whitney E Marvin
Journal: Access Microbiol (2022)
Keywords: paenibacillus thiaminolyticus, encephalitis, meningitis, meropenem, neonate
MeSH terms: Case Reports

Paenibacillus infections can be life threatening and are being reported with increasing incidence. There are only a few case reports of infections and are mainly described in patients who are immunocompromised, injection drug users, or those with prosthetic devices. Due to improved testing and identification, it appears that these infections may not be as rare as once perceived. We present a case of a 16-day-old term neonate who presented with status epilepticus and was found to have Paenibacillus thiaminolyticus meningoencephalitis. The patient was successfully treated with a combination of ampicillin and ceftazidime then meropenem. To our knowledge, this is the first reported case of an infant in the United States who survived this serious invasive infection. We also present an option for therapy given the difficulty treating invasive intracranial infections.
A Prosthodontic Approach as a Complementary Solution for a Complicated Orthodontic Treatment of a Patient with Cleidocranial Dysplasia
Authors: Joanna Jasnoch, Maria Zielke, Izabela Maciejewska
Journal: Case Rep Dent (2021)
MeSH terms: Case Reports

This clinical report describes a prosthodontic rehabilitation of a 29-year-old patient with cleidocranial dysplasia (CCD), who, after completing an orthodontic treatment, was not satisfied with the aesthetic outcome. Besides aesthetics, the patient complained about mastication muscles pain, and clicking while eating but was not aware about her unilateral open bite on the right side. The aim of this treatment was to improve smile appearance and patient's well-being, as well as to restore the proper occlusal vertical dimension (OVD) along with complete intercuspation and to establish masticatory function. The first phase of the treatment concentrated on eliminating the muscle pain and temporomandibular joint (TMJ) clicking with a repositioning splint. During the second phase, the functional and aesthetic rehabilitation was obtained using adhesive prosthesis overlays and veneers.
Case report of simultaneous presentation of pulmonary embolism and pericardial effusion following an oncological esophagectomy
Authors: Daniela Jou-Valencia, Frederieke A Dijkstra
Journal: Int J Surg Case Rep (2020)
Keywords: case report, direct oral anticoagulant (doac), esophageal cancer, esophageal resection, pericardial effusion, pulmonary embolism
MeSH terms: Case Reports

Introduction:
This is the first reported case of simultaneous presentation of pulmonary embolism and pericardial effusion following esophagectomy. This case illustrates a diagnostic and therapeutic challenge exemplifying the difficulties arising from complex anticoagulant considerations in esophageal cancer.
Patient case:
A 72 year old male undergoes an oncological esophageal resection. Postoperatively the patient develops pulmonary embolism for which he is treated with Rivaroxaban. After starting Rivaroxaban the patient develops a large pericardial effusion.
Discussion:
We suspect that the treatment of pulmonary embolism with Rivaroxaban had a causative role in the development of pericardial effusion. Based on literature we suspect that chemoradiotherapy increased susceptibility.
Conclusion:
Diagnosis and treatment of simultaneous pulmonary embolism and pericardial effusion remains a challenge. Special consideration should be taken when using Rivaroxaban in esophageal cancer patients; this should always be conducted in consultation with a coagulation specialist.
Case Report: Identification of Two Variants of ALG13 in Families With or Without Seizure and Binocular Strabismus: Phenotypic Spectrum Analysis
Authors: Tao Cai, Jieting Huang, Xiuwei Ma, Siqi Hu, Lina Zhu, Jinwen Zhu, Zhichun Feng
Journal: Front Genet (2022)
Keywords: alg13, x-linked, development delay, mutation, whole-exome sequencing
MeSH terms: Case Reports

Background: Genetic causes in most affected children with intellectual disability and/or development delay remain unknown. Methods: To identify potential variants responsible for these disorders, we recruited 161 affected families and performed whole-exome sequencing and associated bioinformatics analysis. Results: In the present study, we report the identification of variants in the ALG13 gene in two of the families. In family 1, a known pathogenic missense variant (c.23T > C; p.V8A) of ALG13 was identified in a boy and his mother. In family 2, a novel missense variant (c.862C > G; p.L288V) of the same gene was identified in the affected boy and his phenotypically normal mother. Genotype-phenotype correlation analysis by comparing reported 28 different variants (HGMD) showed that three major phenotypes, including various seizures/epilepsy, intellectual disability, and development delay (such as growth, speech, motor, etc.), are present in most affected individuals. However, other phenotypes, such as strabismus and absence of seizure in our second patient, are not reported if any, which may represent a unique case of X-linked recessive nonsyndromic disorder caused by a mutation in ALG13. Conclusion: We identified two missense variants in ALG13 in a cohort of 161 families with affected individuals diagnosed as intellectual disability and/or development delay. A novel c.862C > G mutation may represent a case of X-linked recessive.
Renal artery stenosis precipitates hyponatremic hypertensive syndrome and posterior reversible leukoencephalopathy
Authors: Pranav Parikh, Danielle Duhame, Laura Monahan, Robert Woroniecki
Journal: Front Pediatr (2015)
Keywords: hypertension, hyponatremia, posterior reversible leukoencephalopathy, renal artery stenosis, revascularization, seizure

Background:
Hyponatremic hypertensive syndrome (HHS) is an uncommon disorder usually encountered in the adult population with unilateral renal artery stenosis and is under-recognized in the pediatric population.
Case diagnosis/treatment:
A 19-month-old male presented with new-onset status epilepticus associated with neurological sequelae, and hypertension to a high of 248/150 mmHg. Lab work revealed significant hyponatremia, elevated peripheral renin activity, and increase in aldosterone and ADH levels. A diagnosis of HHS was made. Initial analysis revealed a high-grade proximal renal artery stenosis by magnetic resonance imaging (MRI) and angiogram. Electroencephalogram and an MRI of the brain demonstrated characteristic abnormalities of the left temporal-parietal regions consistent with posterior reversible leukoencephalopathy syndrome (PRES). The patient responded to right renal artery balloon dilation and stent placement. Since intervention and close blood pressure control with Amlodipine, the patient has been free of seizures and is neurologically intact.
Conclusion:
We report a case of malignant hypertension in a 19-month-old male secondary to renal artery stenosis with associated HHS and PRES. Prognosis of PRES in children with renal disease is excellent. Prompt intervention may offer near complete resolution of physiologic and symptomatic effects of HHS and PRES due to high-grade renal artery stenosis. This report was written with parental consent for de-identified case presentation and radiographs for the educational benefit of other medical professionals.
Revisiting Paraphrenia: A Case Report
Authors: Filipa Andrade, Cláudia Reis, Márcia Mota, Henrique Salgado
Journal: Cureus (2023)
Keywords: atypical psychosis, delusional disorder, paranoid schizophrenia, paraphrenia, psychotic disorder not otherwise specified
MeSH terms: Case Reports

Paraphrenia is a chronic psychotic disorder characterized by a strong delusional component with preservation of thought and personality. It was first introduced as a disorder associated with paranoid dementia and paranoia, but with less personality deterioration than schizophrenia and without fulfilling the clinical features of a delusional disorder. This classic diagnostic entity is not currently listed in main diagnostic systems, rendering delusional disorders difficult to classify in cases that resemble the concept of paraphrenia. We revisit the concept of paraphrenia through a critical review based on a clinical vignette of a patient followed at the psychiatry department of the University Hospital Center of São João.
Heart rate response during cardiopulmonary exercise in the denervated heart
Authors: Ryohei Ono, Togo Iwahana, Hirotoshi Kato, Yoshio Kobayashi
Journal: Clin Case Rep (2023)
Keywords: cardiopulmonary exercise test, denervation, heart rate, heart transplantation, tachycardia
MeSH terms: Case Reports

The patients after heart transplantation usually present resting tachycardia, a slower increase in heart rate (HR) at the onset of exercise, a blunted chronotropic response to exercise in general, maximal HR being attained in the recovery period rather than at peak exercise, and a slower decline in HR after exercise.