OpenMed/multicare-articles huggingface dataset:
Complications and salvage options after laser lithotripsy for a vesical calculus in a tetraplegic patient: a case report
Authors: Subramanian Vaidyanathan, Gurpreet Singh, Fahed Selmi, Peter L Hughes, Bakul M Soni, Tun Oo
Journal: Patient Saf Surg (2015)
Keywords: bladder perforation, complications, laser lithotripsy, neuropathic urinary bladder, spinal cord injury, tetraplegia, vesical calculus

Background:
Laser lithotripsy of vesical calculi in tetraplegic subjects with long-term urinary catheters is fraught with complications because of bladder wall oedema, infection, fragile urothelium, bladder spasms, and autonomic dysreflexia. Severe haematuria should be anticipated; failure to institute measures to minimise bleeding and prevent clot retention can be catastrophic. We present an illustrative case.
Case presentation:
A tetraplegic patient underwent laser lithotripsy of vesical stone under general anaesthesia. During lithotripsy, severe bladder spasms and consequent rise in blood pressure occurred. Bleeding continued post-operatively resulting in clot retention. CT revealed clots within distended but intact bladder. Clots were sucked out and continuous bladder irrigation was commenced. Bleeding persisted; patient developed repeated clot retention. Cystoscopy was performed to remove clots. Patient developed abdominal distension. Bladder rupture was suspected; bed-side ultrasound scan revealed diffuse small bowel dilatation with mild peritoneal effusion; under-filled bladder containing small clot. Patient developed massive abdominal distension and ileus. Two days later, CT with oral positive contrast revealed intra-peritoneal haematoma at the dome of bladder with perforation at the site of haematoma. Free fluid was noted within the peritoneal cavity. This patient was managed by gastric drainage and intravenous fluids. Patient's condition improved gradually with urethral catheter drainage. Follow-up CT revealed resolution of bladder rupture, perivesical haematoma, and intra-peritoneal free fluid.
Conclusion:
If bleeding occurs, bladder irrigation should be commenced immediately after surgery to prevent clot retention. When bladder rupture is suspected, CT of abdomen should be done instead of ultrasound scan, which may not reveal bladder perforation. It is debatable whether laparotomy and repair of bladder rupture is preferable to nonoperative management in tetraplegics. Anti-muscarinic drugs should be prescribed prior to lithotripsy to control bladder spasms; aspirin and ibuprofen should be omitted. If significant bleeding occurs during lithotripsy, procedure should be stopped and rescheduled. Percutaneous cystolithotripsy using a wide channel could be quicker to clear stones, as larger fragments could be retrieved; lesser stimulant for triggering autonomic dysreflexia, as it avoids urethral manipulation. But in patients with small, contracted bladder, and protuberant abdomen, percutaneous access to urinary bladder may be difficult and can result in injury to bowels.
Chronic Cognitive Impairment in AQP4+ NMOSD With Improvement in Cognition on Eculizumab: A Report of Two Cases
Authors: Georges Saab, David G Munoz, Dalia L Rotstein
Journal: Front Neurol (2022)
Keywords: neuromyelitis optica spectrum disorder (nmosd), aquaporin-4 (aqp4), cognitive impairment, corpus callosum, eculizumab
MeSH terms: Case Reports

Cognitive impairment may be associated with aquaporin-4 antibody positive (AQP4+) NMOSD, particularly where there is prominent cerebral, corpus callosum, or thalamic involvement. It is unclear to what extent this phenomenon may be treatable after months to years. We describe two cases of AQP4+ NMOSD with cognitive impairment persisting over more than 6 months, where cognition improved after eculizumab was initiated. In the first case, a 51-year-old woman presented with a 2-month history of cognitive decline and ataxia, and diffuse involvement of the corpus callosum on MRI. AQP4 antibody testing returned positive. Cognitive impairment persisted on therapy with mycophenolate, then rituximab. She was switched to eculizumab from rituximab 18 months after disease onset because of breakthrough optic neuritis; memory and cognitive function improved on eculizumab. In the second case, a 26-year-old woman initially presented with visual, auditory and tactile hallucinations, and impairment in activities of daily living, and was given a diagnosis of schizophrenia. Nine months later she was hospitalized for increasing confusion. MRI showed leukoencephalopathy and diffuse involvement of the corpus callosum with multiple enhancing callosal lesions. AQP4 antibody testing was positive and CSF testing for other antibodies of autoimmune encephalitis was negative. She had some improvement in cognition with high dose corticosteroids but remained significantly impaired. On follow-up, her repeat MRI showed a small new right inferomedial frontal enhancing lesion although she did not complain of any new cognitive issues, her MOCA score was 21/30, and she was started on eculizumab. Two months after eculizumab initiation she and her family reported cognitive improvement and MOCA score was 25/30. Common features of these two cases included extensive callosal involvement and an element of ongoing gadolinium enhancement on MRI. Our experience suggests the possibility that cognitive impairment may be amenable to immunotherapy in certain cases of NMOSD.
Early diagnosis of nonaneurysmal infectious thoracic aortitis using transesophageal echocardiogram in a patient with purulent meningitis
Authors: Ricardo Lopes, Jorge Almeida, Paula Dias, Paulo Pinho, Maria Júlia Maciel
Journal: Cardiol Res Pract (2009)
MeSH terms: Case Reports

Infectious thoracic aortitis is a rare entity in the antibiotic era and usually appears in patients with prior aortic disease and/or associated infective endocarditis. Infected nonaneurysmal aorta will likely progress to mycotic aneurysm if left untreated. In most of the reports, infectious thoracic aortitis presents with a mycotic aneurysm. We report the case of a patient with a nonaneurysmal infectious thoracic aortitis, probably secondary to purulent meningitis, early diagnosed by transesophageal echocardiogram.
A rare dislocation: an open isolated palmar dislocation of the head of the fifth metacarpal bone without fracture
Authors: Tinatin Natroshvili, Rombout Molenaar
Journal: Case Reports Plast Surg Hand Surg (2021)
Keywords: hand joints, anatomy, dislocation, metacarpal bone
MeSH terms: Case Reports

We present an open and isolated palmar dislocation of the head of the fifth metacarpal bone without fracture. The diagnosis, which was initially made based on the X-rays, was confirmed during the operation. The patient was satisfactorily treated with open reduction, Kirschner wires fixation and casting followed with hand physiotherapy.
Pulmonary Lymphangitic Spread of Multiple Myeloma as Early Relapse after Autologous Stem Cell Transplantation
Authors: Bicky Thapa, Gulrayz Ahmed, Meera Mohan, Volodymyr Shponka, Parameswaran Hari
Journal: Case Rep Hematol (2021)
MeSH terms: Case Reports

Clinical relapses early after autologous stem cell transplantation portrays an inferior clinical outcome. Early relapse in this setting with extramedullary disease (EMD) of lung involvement in multiple myeloma is rare. To our knowledge, this is the first reported case of lymphangitic spread of myeloma with pulmonary parenchymal and pleural involvement occurring at first relapse.
Visceral leishmaniasis in a patient with diabetes mellitus type 2 and discrete bicytopenia
Authors: Verena Schwetz, Christian Trummer, Claudia Friedl, Christine Beham-Schmid, Roman Kulnik, Albert Wölfler, Karl Horvath, Stefanie Wunsch, Jürgen Prattes, Ines Zollner-Schwetz, Thomas R Pieber, Julia K Mader, Robert Krause
Journal: Clin Case Rep (2017)
Keywords: leishmania, pancytopenia, splenomegaly, visceral leishmaniasis
MeSH terms: Case Reports

An Austrian patient with diabetes mellitus type 2 developed visceral leishmaniasis after trips to Spain and Crete, presenting with slight bicytopenia, later developing severe pancytopenia. Travel history taking is important due to an extended incubation period. Coexistence of diabetes mellitus can impair T lymphocyte function and cause higher relapse rates.
Adenomatoid odontogenic tumor associated with dentigerous cyst of the maxillary antrum: A rare entity
Authors: Simarpreet V Sandhu, Ramandeep S Narang, Manveen Jawanda, Sachin Rai
Journal: J Oral Maxillofac Pathol (2010)
Keywords: adenomatoid odontogenic tumor, dentigerous cyst, maxillary antrum
MeSH terms: Case Reports

Adenomatoid odontogenic tumor (AOT) is an uncommon tumor of odontogenic origin composed of odontogenic epithelium in a variety of histoarchitectural patterns. Most cases are in females and have a striking tendency to occur in the anterior maxilla. However, AOT of the maxillary antrum is extremely rare. A 25-year-old female presented with a large radiolucent lesion associated with the crown of an unerupted canine located in the maxillary antrum, which was clinically diagnosed as dentigerous cyst. The microscopic examination revealed the presence of AOT in the fibrous capsule of a dentigerous cyst. Very few cases of AOT associated with dentigerous cyst have been reported till date. A case of gigantic AOT that occupied the maxillary sinus and associated with dentigerous cyst is described. Also, an attempt has been made to determine whether the AOT derived from the dentigerous cyst could represent a distinct hybrid variety.
Cerebrovascular accidents indicative of COVID-19 infection: about 4 observations in Guinea
Authors: Hugues Ghislain Atakla, Kaba Condé, Ayub Neishay, Lounceny Fatoumata Barry, Aissatou Kenda Bah, Mamady Konaté, Mamadou Hady Diallo, Farrah Jasmine Mateen, Fodé Abass Cissé
Journal: Pan Afr Med J (2020)
Keywords: covid-19, guinea, rt-pcr, stroke
MeSH terms: Brain Ischemia / diagnostic imaging, COVID-19 / complications, Ischemic Stroke / diagnostic imaging, Case Reports, Aged, Brain Ischemia / virology, COVID-19 / diagnosis, COVID-19 Nucleic Acid Testing, Female, Guinea, Humans, Ischemic Stroke / virology, Male, Middle Aged, Retrospective Studies

Introduction:
Coronavirus is a virus with potential to target the nervous and respiratory systems. The aim of this work is to establish the prevalence of strokes in COVID19 positive patients in Guinea.
Methods:
All patients with stroke confirmed by brain imaging and COVID-positive PCR were included in this study. Retrospective patient data were obtained from medical records. Informed consent was obtained.
Results:
The RT-PCR confirmed the initial diagnosis and the chest CT scan provided a good diagnostic orientation. Brain imaging identified ischemic brain lesions. We report the case of four patients with stroke and a COVID-19 incidental finding in Guinea.
Conclusion:
This work shows that the onset of ischemic stroke associated with COVID-19 is generally delayed, but can occur both early and late in the course of the disease. More attention is needed because the early symptoms of viral attack are not just pulmonary.
Case report: A rare case of synchronous mucinous neoplasms of the renal pelvis and the appendix
Authors: Yuhua Zou, Xiaojuan Xie, Qinlin Wang, Cunzhi Zhong, Quanliang Liu
Journal: Front Oncol (2023)
Keywords: appendiceal mucinous neoplasm, case report, kidney, laparoscopic nephrectomy, mucinous neoplasm, pyonephrosis, renal pelvis
MeSH terms: Case Reports

Background:
Mucinous neoplasms are tumors arising in the epithelial tissue, characterized by excessive mucin secretion. They mainly emerge in the digestive system and rarely in the urinary system. They also seldom develop in the renal pelvis and the appendix asynchronously or simultaneously. The concurrence of this disease in these two regions has not yet been reported. In this case report, we discuss the diagnosis and treatment of synchronous mucinous neoplasms of the right renal pelvis and the appendix. The mucinous neoplasm of the renal pelvis was preoperatively misdiagnosed as pyonephrosis caused by renal stones, and the patient underwent laparoscopic nephrectomy. Herein, we summarize our experience with this rare case in combination with related literature.
Case presentation:
In this case, A 64-year-old female was admitted to our hospital with persistent pain in the right lower back for over a year. Computer tomography urography (CTU) showed that the patient was confirmed as right kidney stone with large hydronephrosis or pyonephrosis, and appendiceal mucinous neoplasm (AMN). Subsequently, the patient was transferred to the gastrointestinal surgery department. Simultaneously, electronic colonoscopy with biopsy suggested AMN. Open appendectomy plus abdominal exploration was performed after obtaining informed consent. Postoperative pathology indicated low-grade AMN (LAMN) and the incisal margin of the appendix was negative. The patient was re-admitted to the urology department, and underwent laparoscopic right nephrectomy because she was misdiagnosed with calculi and pyonephrosis of the right kidney according to the indistinctive clinical symptoms, standard examination of the gelatinous material, and imaging findings. Postoperative pathology suggested a high-grade mucinous neoplasm of the renal pelvis and mucin residing partly in the interstitium of the cyst walls. Good follow-up results were obtained for 14 months.
Conclusion:
Synchronous mucinous neoplasms of the renal pelvis and the appendix are indeed uncommon and have not yet been reported. Primary renal mucinous adenocarcinoma is very rare, metastasis from other organs should be first considered, especially in patients with long-term chronic inflammation, hydronephrosis, pyonephrosis, and renal stones, otherwise, misdiagnosis and treatment delay may occur. Hence, for patients with rare diseases, strict adherence to treatment principles and close follow-up are necessary to achieve favorable outcomes.
Second Trimester Cervical Ectopic Pregnancy and Hemorrhage: A Case Report and Review of the Literature
Authors: Jessian L Munoz, Amanda Kalan, Katherine Singh
Journal: Case Rep Obstet Gynecol (2018)
MeSH terms: Case Reports

Cervical ectopic pregnancies are a rare occurrence in the United States. Here we present the interdisciplinary and conservative management approach to a cervical ectopic at an advanced gestational age. In addition, we review the surgical management of hemorrhage from cervical ectopic pregnancies, which is often catastrophic and life-threatening.
The Safe Administration of Remdesivir in a Patient with Acute Kidney Injury Requiring Hemodialysis
Authors: Vincent Peyko, Helena Ladd, Anthony Cutrona
Journal: Case Rep Infect Dis (2020)
MeSH terms: Case Reports

Remdesivir is a nucleoside analog prodrug with broad-spectrum antiviral activity, including against coronaviruses. This has prioritized the inclusion of remdesivir in coronavirus disease 2019 (COVID-19) clinical trials. The United States Food and Drug Administration has granted emergency use authorization for remdesivir. This emergency use authorization does not recommend the use of remdesivir in patients with estimated glomerular filtration rate (eGFR) less than 30 mL/min unless the benefits outweigh the risks. To date, there are no studies and scant information in the literature evaluating remdesivir utilization in patients with eGFR less than 30 mL/min or receiving hemodialysis. With little utilization data for patients with acute or chronic kidney injury, remdesivir may not be considered, leaving this patient population without the opportunity of a potentially beneficial treatment option. We present a case of one patient with eGFR less than 30 mL/min that required hemodialysis in which remdesivir was safely initiated, with therapy completed without any serious adverse events.
Two-Step Extraction of the Lower First Molar for Class III Treatment in Adult Patient
Authors: Kélei Cristina de Mathias Almeida, Ricardo Fabris Paulin, Taísa Barnabé Raveli, Dirceu Barnabé Raveli, Ary Santos-Pinto
Journal: Case Rep Dent (2016)

The aim of this article is to describe a case report of Class III malocclusion treatment with lower first molar extraction. The 27-year-old Caucasian male patient presented a symmetric face with a straight profile, hyperdivergent growth pattern, molar and cuspid Class III relation, and an anterior crossbite as well as a mild crowding on cuspids area, in both upper and lower arches and a tendency to posterior crossbite. The treatment was performed by the use of Haas expansion appliance followed by an initial alignment and leveling of the upper and lower arches with a fixed edgewise appliance, extraction of lower teeth aiming the correction of the incisors proclination and end the treatment with a Class I molar relationship. It resulted in a significant change in the patient's profile, dentoalveolar Class III correction, upper arch expansion, leveling and alignment of the upper and lower arches, and improvement of tipping of the upper and lowers incisors. In cases of a dentoalveolar compensation in well positioned bone bases the treatment with fixed appliances is an alternative and extraction of lower teeth is considered.
Saphenovenous Graft Aneurysm: A Rare Complication of CABG
Authors: James Thomas Connell
Journal: Case Rep Cardiol (2017)
MeSH terms: Case Reports

Saphenovenous graft aneurysm is a rare complication of coronary artery bypass grafts that is likely underdiagnosed. It is typically asymptomatic, slow growing, and often diagnosed incidentally on angiography or following catastrophic rupture. There is no consensus on best management but PCI and surgery appear to have more favourable mortality outcomes relative to conservative management. We present the case of a 48-year-old male with a cardiovascular risk profile hallmarked by diabetes mellitus, end stage renal failure, recalcitrant hyperlipidaemia, and IHD previously treated with CABG. 11 years following his CABG, he was retrieved from remote Australia to a tertiary cardiology centre with stabbing chest pain. Serial cardiac enzymes were negative. Echocardiogram identified a mass compressing the right ventricular wall. Noncontrast coronary angiogram ultimately identified a large aneurysm at the proximal end of SVG to PDA. He was managed with aggressive risk factor modification prior to planned surgical intervention once medically optimized. His case supports the role of aggressive medical management combined with surgical intervention.
Brugada syndrome and pregnancy: highlights on antenatal and prenatal management
Authors: Laura Giambanco, Domenico Incandela, Antonio Maiorana, Walter Alio, Luigi Alio
Journal: Case Rep Obstet Gynecol (2014)

Introduction. Brugada syndrome is characterized by a disruption of heart's normal rhythm. It is an autosomal dominant disease due to a mutation of SNC5A gene. Its prevalence is low all over the world, but it is a lethal disease. Sudden cardiac death is the result of phenotypic manifestation of Brugada syndrome. Among asymptomatic Brugada patients, arrhythmia could be provoked by physical activity, fever, or pregnancy. About obstetrical management, very few data or reports have been published since this syndrome has been diagnosed in late 1992. Case Presentation. A 20-year-old pregnant woman at 13 weeks of gestation was referred to our department because of her familial history of sudden cardiac deaths. Brothers and sisters of her mother died of Brugada syndrome in childhood or older and live components of this family were carrier of mutation in Brugada gene. The pregnancy was uneventful. The patient gave birth vaginally without any arrhythmia. Strictly cardiological monitoring was performed during labour, delivery, and 12 hours of the postpartum. Conclusion. Even though patient at low risk may never have arrhythmia, some conditions could represent a Brugada trigger. The management could be very easy and uneventful. Otherwise it could be very difficult with need of ECMO or antiarrhythmics drugs or intracardiac device. Obstetrical management of Brugada pregnant women should be very strict and multidisciplinary in cooperation with cardiologist and anaesthesiologist and should provide an informed consent to the couple.
An Innovative Solution to Complex Inguinal Defect: Deepithelialized SIEA Flap With Mini Abdominoplasty
Authors: Augustine Reid Wilson, Justin Daggett, Michael Harrington, Deniz Dayicioglu
Journal: Eplasty (2017)
Keywords: siea, abdominal reconstruction, flap, groin, inguinal reconstruction
MeSH terms: Case Reports

Introduction: We describe a novel technique of contralateral pedicled deepithelialized superficial inferior epigastric artery flaps, followed by abdominal advancement coverage, as an alternative treatment of radiated complicated inguinal or lower abdominal defects, avoiding the donor-site defect typically seen with other methods of coverage. Methods: Two male patients with histories of liposarcoma after excision and radiation to one side of lower abdomen/inguinal area presented with complicated wounds that were reconstructed with this technique. Results: Successful obliteration of dead space and wound closure were achieved with the combination of a superficial inferior epigastric artery flap with an abdominal advancement flap. In each case, patients went on to heal uneventfully without need for any secondary procedures. Discussion: The use of a superficial inferior epigastric artery flap for lower abdomen/groin defect closure is an option as an alternative to rectus abdominis myocutaneous flap and anterolateral thigh flaps and should be considered in patients with vascular anatomy conducive for this muscle-sparing procedure. Conclusions: A second layer-overlay coverage with an abdominal advancement flap creates a more durable repair in the complicated radiated wound and a well-concealed abdominoplasty scar.
Genetic diagnosis of two dopa-responsive dystonia families by exome sequencing
Authors: Zhan-fang Sun, Yu-han Zhang, Ji-feng Guo, Qi-ying Sun, Jun-pu Mei, Han-lin Zhou, Li-ping Guan, Jin-yong Tian, Zheng-mao Hu, Jia-da Li, Kun Xia, Xin-xiang Yan, Bei-sha Tang
Journal: PLoS One (2014)
MeSH terms: Dystonic Disorders / diagnosis, Dystonic Disorders / genetics, Exome / genetics, Genetic Testing, Sequence Analysis, DNA / methods, Case Reports, Research Support, Non-U.S. Gov't, Adolescent, Amino Acid Sequence, Base Sequence, Cell Extracts, Child, Preschool, Female, GTP Cyclohydrolase / chemistry, GTP Cyclohydrolase / genetics, Humans, Male, Middle Aged, Molecular Sequence Data, Mutant Proteins / metabolism, Mutation / genetics, Transfection, Tyrosine 3-Monooxygenase / metabolism, Young Adult, Cell Extracts, Mutant Proteins, Tyrosine 3-Monooxygenase, GTP Cyclohydrolase, Dystonia, Dopa-responsive

Dopa-responsive dystonia, a rare disorder typically presenting in early childhood with lower limb dystonia and gait abnormality, responds well to levodopa. However, it is often misdiagnosed with the wide spectrum of phenotypes. By exome sequencing, we make a rapid genetic diagnosis for two atypical dopa-responsive dystonia pedigrees. One pedigree, presented with prominent parkinsonism, was misdiagnosed as Parkinson's disease until a known mutation in GCH1 (GTP cyclohydrolase 1) gene (NM_000161.2: c.631_632delAT, p.Met211ValfsX38) was found. The other pedigree was detected with a new compound heterozygous mutation in TH (tyrosine hydroxylase) gene [(NM_000360.3: c.911C>T, p.Ala304Val) and (NM_000360.3: c.1358G>A, p.Arg453His)], whose proband, a pregnant woman, required a rapid and less-biased genetic diagnosis. In conclusion, we demonstrated that exome sequencing could provide a precise and rapid genetic testing in the diagnosis of Mendelian diseases, especially for diseases with wide phenotypes.