OpenMed/multicare-articles huggingface dataset:
Single Port 11 mm Laparoscopic Hysterectomy Performed on a 32-Year-Old Female with Adhesive Disease
Authors: Greg J Marchand, Ali Azadi, Sienna Anderson, Stacy Ruther, Sophia Hopewell, Giovanna Brazil, Katelyn Sainz, Hannah Wolf, Alexa King, Janelle Vallejo, Kelly Ware, Kaitlynne Cieminski, Anthony Galitsky, Akarshi Kaue Brar
Journal: Case Rep Obstet Gynecol (2020)
MeSH terms: Case Reports

In the field of minimally invasive surgery, there is constant drive to devise and execute the most minimally invasive surgeries possible. By the very nature of laparoscopy and robotic surgery, what one can accomplish with several ports of a given size will invariably be studied and attempted with fewer ports and with ports of smaller sizes. Although more complex pathology may require a more invasive approach, surgical cases without serious complicating factors may be amenable to extremely minimally invasive procedures. We report one such case where a 32-year-old female suffering from adenomyosis and endometriosis was able to receive a laparoscopic single-port hysterectomy and bilateral salpingo-oophorectomy through a single 11 mm port created with a blunt trochar.
Enterorenal Fistula as an Unusual Complication from Ureteroscopic Lithotripsy: A Case Report
Authors: Sabah Akbani, J Stuart Wolf Jr, E Charles Osterberg
Journal: J Endourol Case Rep (2019)
Keywords: enterorenal fistula, ureteroscopic lithotripsy, urosepsis
MeSH terms: Case Reports

Background: This case highlights an enterorenal fistula as a rare complication from ureteroscopic lithotripsy. Case Presentation: A 56-year-old woman with significant obesity, decompensated cirrhotic and ascitic liver disease, hypertension, type 2 diabetes mellitus, and nephrolithiasis treated with five prior ureteroscopic lithotripsies for a partial left staghorn stone presented to the emergency department (ED) with worsening left flank pain and sepsis. A CT scan of the abdomen and pelvis with contrast showed a large left perinephric hematoma. She underwent drain placement and during fluoroscopic imaging, there was a fistula from the left subcapsular hematoma/abscess to the proximal descending colon. The patient wished to proceed with a surgical course involving nephrectomy with hemicolectomy despite extensive counseling regarding her high mortality risk. However, because of worsening nutritional status as well as several other high-risk comorbidities, a shared decision was made with the patient to postpone the procedure. The patient was discharged to a skilled nursing facility for nutritional optimization and prehabilitation; however, she continued to decline with recurrent sepsis and cirrhosis-related complications and unfortunately passed away. Conclusion: A subscapular hematoma evolving into a perinephric abscess is a rare but known complication of ureteroscopic lithotripsy; however, this patient developed an enterorenal fistula that has yet to be reported after repeated ureteroscopy.
Case Report: Cumulative proton dose reconstruction using CBCT-based synthetic CT for interfraction metallic port variability in breast tissue expanders
Authors: Chin-Cheng Chen, Jiayi Liu, Peter Park, Andy Shim, Sheng Huang, Sarah Wong, Pingfang Tsai, Haibo Lin, J Isabelle Choi
Journal: Front Oncol (2023)
Keywords: cbct-based synthetic ct, breast cancer, dose reconstruction and dosimetric impact, proton, tissue expander
MeSH terms: Case Reports

Introduction:
Dose perturbation of spot-scanning proton beams passing through a dislocated metallic port (MP) of a breast tissue expander may degrade target dose coverage or deliver excess dose to the ipsilateral lung and heart. The feasibility of utilizing daily cone-beam computed tomography (CBCT)-based synthetic CTs (synCTs) for dose reconstruction was evaluated, and the fractional and cumulative dosimetric impact due to daily MP dislocation is reported.
Methods:
The synCT was generated by deforming the simulation CT to daily CBCT. The MP structure template was mapped onto all CTs on the basis of daily MP position. Proton treatment plans were generated with two and three fields on the planned CT (pCT, Plan A) and the first verification CT (vCT, Plan B), respectively, for a fractional dose of 1.8 Gy(RBE). Plan A and Plan B were used alternatively, as determined by the daily MP position. The reconstructed fractional doses were calculated with corresponding plans and synCTs, and the cumulative doses were summed with the rigid or deformed fractional doses on pCT and vCT.
Results:
The planned and reconstructed fractional dose demonstrated a low-dose socket around the planned MP position due to the use of field-specific targets (FSTs). Dose hot spots with >120% of the prescription due to MP dislocation were found behind the planned MP position on most reconstructed fractional doses. The reconstructed cumulative dose shows two low-dose sockets around the two planned MP positions reflecting the two plans used. The doses at the hot spots behind the planned MPs averaged out to 114% of the prescription. The cumulative D95% of the CTV_Chest Wall decreased by up to 2.4% and 4.0%, and the cumulative V20Gy(RBE) of the left lung decreased to 16.1% and 16.8% on pCT and vCT, respectively. The cumulative Dmean of the heart decreased to as low as 0.7 Gy(RBE) on pCT but increased to as high as 1.6 Gy(RBE) on vCT.
Conclusion:
The robustness of proton plans using FSTs around the magnet in the MP of the tissue expander can be improved by applying multiple fields and plans, which provides forgiveness of dose heterogeneity incurred from dislocation of high-Z materials in this single case.
Acute pancreatitis in a young woman with COVID-19 infection: A case-report
Authors: Masood Faghih Dinevari, Mehdi Rasoolimanesh, Mehdi Tarverdizadeh, Ali Riazi, Samaneh Abbasian, Aysan Zeinolabedini, Sina Hassannezhad
Journal: Caspian J Intern Med (2021)
Keywords: acute pancreatitis, covid-19, case report
MeSH terms: Case Reports

Background:
Little is known about the development of acute pancreatitis as a complication of corona virus disease of 2019 (COVID-19) infection. This case report describes the presentation of acute pancreatitis in a young woman who then was diagnosed with COVID-19 infection.
Case presentation:
An 18-year old previously healthy woman referred to Imam Raza hospital, Tabriz, Iran with a 3-day history of intermittent and crampy abdominal pain. She had serum amylase of 1288 IU/L and serum lipase of 1541 IU/L. She was diagnosed with acute pancreatitis. She was instructed nil per os (NPO) and serum therapy and also was given pantoprazole, and pethidine for her pain management. The laboratory tests for assessing the etiology of acute pancreatitis were normal. Abdominal and pelvic spiral computed tomography (CT) scan revealed edematous pancreas and enhancing loculi fluid accumulation around pancreas along with the small amount of ascites fluid that all suggest acute pancreatitis. Due to the presentation of fever and COVID-19 pandemic and her potential society exposure, we tested SARS CoV-2 by polymerase chain reaction which was positive. The blood C-reactive protein (CRP) level was 3+ but the chest x-ray showed no findings compatible with COVID-19. Eventually after receiving conservative therapy for her pancreatitis, she was discharged from hospital in the good general condition and she has not experienced any episodes of abdominal pain again.
Conclusion:
This case highlights acute pancreatitis as a suspected complication associated with COVID-19 and the need for further research.
A case delayed hemorrhage from the stump of the superior rectal artery after abdominoperineal resection of the rectum
Authors: Yuichi Sanada, Kenichi Nonaka, Takao Takahashi, Yoshihiro Tanaka, Shinji Osada, Kazuhiro Yoshida
Journal: Case Rep Med (2010)
MeSH terms: Case Reports

A 66-year-old man underwent abdominoperineal resection for advanced rectal cancer. On day 3 post surgery, a decompression tube was placed for postoperative ileus. Symptoms associated with ileus immediately disappeared. On day 7 post surgery, the patient vomited large amounts of fresh blood and became hemodynamically unstable. An emergency angiography revealed active bleeding from the stump of the superior rectal artery communicating with the third portion of the duodenum. Complete obliteration of the stump by proximal coil embolization was performed to achieve successful hemostasis. The postclinical course was uneventful and the patient was discharged on day 40 post surgery.
Transtibial Pullout Repair of Lateral Meniscus Posterior Root Tear with Tissue Loss: A Case with Anterior Cruciate Ligament Injury and Medial Meniscus Tear
Authors: Masanori Tamura, Takayuki Furumatsu, Takaaki Hiranaka, Keisuke Kintaka, Naohiro Higashihara, Yusuke Kamatsuki, Eiji Nakata, Toshifumi Ozaki
Journal: Case Rep Orthop (2022)
MeSH terms: Case Reports

Lateral meniscus (LM) posterior root tear (LMPRT) is mainly caused by trauma, especially trauma associated with anterior cruciate ligament (ACL) injuries. Although a transtibial pullout repair or a side-to-side repair is commonly performed for LMPRT, to the best of our knowledge, there is no clinical report of LMPRT with tissue loss using the pullout technique. Thus, the purpose of this report was to describe a clinical, radiographic, and arthroscopic outcome after pullout repair for a case of LMPRT with a large defect with a chronic ACL tear and complex medial meniscus (MM) tears. A 31-year-old man complained of knee pain and restricted range of motion after twisting his knee when he stepped on an iron pipe. The patient had a football-related injury to his right knee 14 years before presentation, and since then, the patient's knee has given out more than 10 times but was left unassessed. Magnetic resonance imaging showed LMPRT with tissue loss, ACL tears, and complex MM tears. Transtibial pullout repair of the LMPRT with ACL reconstruction and MM repairs were performed. Following the pullout repair of the LMPRT, an approximately 6 mm gap remained between the LM posterior root and root insertion. However, magnetic resonance imaging and second-look arthroscopy at 1 year postoperatively revealed meniscal healing, gap filling with some regeneration tissue, of the LM posterior root. Furthermore, the lateral meniscus extrusion in the coronal plane improved from 3.1 mm (preoperative) to 1.6 mm (1 year postoperatively). Transtibial pullout repair with the remaining gap could be a viable treatment option for LMPRT with tissue loss, combined with ACL reconstruction.
Implementing Health Policy: Lessons from the Scottish Well Men's Policy Initiative
Authors: Flora Douglas, Edwin van Teijlingen, Cairns Smith, Mandy Moffat
Journal: AIMS Public Health (2015)
Keywords: policy implementation, scotland, health inequalities, men's health, planning frameworks

Background:
Little is known about how health professionals translate national government health policy directives into action. This paper examines that process using the so-called Well Men's Services (WMS) policy initiative as a 'real world' case study. The WMS were launched by the Scottish Government to address men's health inequalities. Our analysis aimed to develop a deeper understanding of policy implementation as it naturally occurred, used an analytical framework that was developed to reflect the 'rational planning' principles health professionals are commonly encouraged to use for implementation purposes.
Methods and materials:
A mixed-methods qualitative enquiry using a data archive generated during the WMS policy evaluation was used to critically analyze (post hoc) the perspectives of national policy makers, and local health and social care professionals about the: (a) 'policy problem', (b) interventions intended to address the problem, and (c) anticipated policy outcomes.
Results and conclusions:
This analysis revealed four key themes: (1) ambiguity regarding the policy problem and means of intervention; (2) behavioral framing of the policy problem and intervention; (3) uncertainty about the policy evidence base and outcomes, and; (4) a focus on intervention as outcome. This study found that mechanistic planning heuristics (as a means of supporting implementation) fails to grapple with the indeterminate nature of population health problems. A new approach to planning and implementing public health interventions is required that recognises the complex and political nature of health problems; the inevitability of imperfect and contested evidence regarding intervention, and, future associated uncertainties.
A simple method for preventing graft detachment during phacoemulsification cataract surgery after Descemet stripping automated endothelial keratoplasty: A case report
Authors: Shiuh-Liang Hsu, Po-Yen Lee, Li-Yi Chiu
Journal: Medicine (Baltimore) (2019)
MeSH terms: Descemet Stripping Endothelial Keratoplasty / adverse effects, Descemet Stripping Endothelial Keratoplasty / methods, Phacoemulsification / methods, Case Reports, Humans, Male, Middle Aged

Rationale:
Graft detachment and endothelial cell damages are 2 major concerns for cataract surgeries in cases after Descemet stripping automated endothelial keratoplasty (DSAEK). We invented a simple but innovative method to anchor the DSAEK graft with sutures during the surgery to avoid possible graft detachment.
Patient concerns:
We present a 59-year-old male who had done DSAEK surgery. Due to progressed blurry vision due to cataract, he underwent sequential cataract surgery 1 year after DSAEK surgery. We applied the method to the patient successfully and the result was satisfying.
Diagnosis:
Cataract post-DSAEK surgery.
Interventions:
At the beginning of surgery, we made 4 radial fixation sutures with Nylon 10-0 though cornea-DSAEK graft at paracentral point and then through limbus. The sutures were located at 45°, 135°, 225°, and 315°. At the end of surgery, 4 fixation sutures were removed.
Outcomes:
The DSAEK graft was kept well attached during and after the surgery. Only low-grade corneal edema was found postoperation.
Lessons:
We provide this special method and applied it to our patient successfully. By using our method, surgeons can reassure graft adhesion during and after surgery, especially for those need cataract surgery after DSAEK surgery.
Neuroimaging and Neuropsychological Outcomes Following Clinician-Delivered Cognitive Training for Six Patients With Mild Brain Injury: A Multiple Case Study
Authors: Amy Lawson Moore, Dick M Carpenter 2nd, Randolph L James, Terissa Michele Miller, Jeffrey J Moore, Elizabeth A Disbrow, Christina R Ledbetter
Journal: Front Hum Neurosci (2020)
Keywords: learningrx, mri, brain injury, brain training, cognitive rehabilitation, cognitive training, concussion, mild tbi

Nearly half of all mild brain injury sufferers experience long-term cognitive impairment, so an important goal in rehabilitation is to address their multiple cognitive deficits to help them return to prior levels of functioning. Cognitive training, or the use of repeated mental exercises to enhance cognition, is one remediation method for brain injury. The primary purpose of this hypothesis-generating pilot study was to explore the statistical and clinical significance of cognitive changes and transfer of training to real-life functioning following 60 h of Brain Booster, a clinician-delivered cognitive training program, for six patients with mild traumatic brain injury (TBI) or non-traumatic acquired brain injury (ABI). The secondary purpose was to explore changes in functional connectivity and neural correlates of cognitive test gains following the training. We used a multiple case study design to document significant changes in cognitive test scores, overall IQ score, and symptom ratings; and we used magnetic resonance imaging (MRI) to explore trends in functional network connectivity and neural correlates of cognitive change. All cognitive test scores showed improvement with statistically significant changes on five of the seven measures (long-term memory, processing speed, reasoning, auditory processing, and overall IQ score). The mean change in IQ score was 20 points, from a mean of 108 to a mean of 128. Five themes emerged from the qualitative data analysis including improvements in cognition, mood, social identity, performance, and Instrumental Activities of Daily Living (IADLs). With MRI, we documented significant region-to-region changes in connectivity following cognitive training including those involving the cerebellum and cerebellar networks. We also found significant correlations between changes in IQ score and change in white matter integrity of bilateral corticospinal tracts (CST) and the left uncinate fasciculus. This study adds to the growing body of literature examining the effects of cognitive training for mild TBI and ABI, and to the collection of research on the benefits of cognitive training in general. Clinical Trial Registration: www.ClinicalTrials.gov, identifier NCT02918994.
Analysis of Genetic Mutations in a Cohort of Hereditary Optic Neuropathy in Shanghai, China
Authors: Dekang Gan, Mengwei Li, Jihong Wu, Xinghuai Sun, Guohong Tian
Journal: J Ophthalmol (2017)

Purpose:
To evaluate the clinical classification and characteristics of hereditary optic neuropathy patients in a single center in China.
Method:
Retrospective case study. Patients diagnosed with hereditary optic neuropathy between January 2014 and December 2015 in the neuro-ophthalmology division in Shanghai Eye and ENT Hospital of Fudan University were recruited. Clinical features as well as visual field, brain/orbital MRI, and spectrum domain optical coherence tomography (SD-OCT) were analyzed.
Results:
Eighty-two patients diagnosed by gene test were evaluated, including 66 males and 16 females. The mean age of the patients was 19.4 years (range, 5-46 years). A total of 158 eyes were analyzed, including 6 unilateral, 61 bilateral, and 15 sequential. The median duration of the disease was 0.5 year (range, 0.1-20 years). Genetic test identified 68 patients with Leber hereditary optic neuropathy, 9 with dominant optic neuropathy, and 2 with a Wolfram gene mutation. There was also one case of hereditary spastic paraplegia, spinocerebellar ataxia, and polymicrogyria with optic nerve atrophy, respectively.
Conclusion:
Leber hereditary optic neuropathy is the most common detected type of hereditary optic neuropathy in Shanghai, China. The detection of other autosomal mutations in hereditary optic neuropathy is limited by the currently available technique.
Acute Upper Airway Obstruction Due to Massive Cervical Subcutaneous Emphysema: A Case Report
Authors: Rani Hammoud, Fatima Emam, Suzan Mohamed, Hassanin Abdulkarim
Journal: Cureus (2023)
Keywords: acute airway obstruction, boerhaave syndrome, difficult airway management, spontaneous esophageal perforation, subcutaneous emphysema
MeSH terms: Case Reports

With upper airway obstruction being an emergency, a high index of suspicion and proper and timely treatment planning are crucial to the patient's life. Spontaneous esophageal perforation, also known as Boerhaave syndrome, has been observed to cause subcutaneous emphysema; however, airway compromise secondary to subcutaneous emphysema is extremely rare when there is no associated broncho-tracheal injury. Here, we present a case of esophageal perforation complicated with cervical emphysema that led to acute airway obstruction requiring invasive ventilation.
Expectant Management Leading to Successful Vaginal Delivery following Intrauterine Fetal Death in a Woman with an Incarcerated Uterus
Authors: Masafumi Yamamoto, Mio Takami, Ryosuke Shindo, Michi Kasai, Shigeru Aoki
Journal: Case Rep Obstet Gynecol (2017)
MeSH terms: Case Reports

Expectant management leads to successful vaginal delivery following intrauterine fetal death in a woman with an incarcerated uterus. Management of intrauterine fetal death in the second or third trimester of pregnancy in women with an incarcerated uterus is challenging. We report a case of successful vaginal delivery following intrauterine fetal death by expectant management in a woman with an incarcerated uterus. In cases of intrauterine fetal death in women with an incarcerated uterus, vaginal delivery may be possible if the incarceration is successfully reduced. If the reduction is impossible, expectant management can reduce uterine retroversion, thereby leading to spontaneous reduction of the incarcerated uterus. Thereafter, vaginal delivery may be possible.
Nonoperative Korean Medicine Combination Therapy for Lumbar Spinal Stenosis: A Retrospective Case-Series Study
Authors: Kiok Kim, Yongjae Jeong, Yousuk Youn, Jeongcheol Choi, Jaehong Kim, Wonseok Chung, Tae-Hun Kim
Journal: Evid Based Complement Alternat Med (2015)

This is a retrospective case series exploring the therapeutic benefits and harm of nonoperative Korean medicine combination therapy for lumbar spinal stenosis (LSS). The medical records of a total of 33 LSS patients, who were treated as inpatients at Mokhuri Neck and Back Hospital, Republic of Korea, from November 2010 to January 2012, were reviewed first and telephone survey on these patients was conducted after one year. Body acupuncture, pharmacoacupuncture, Chuna, and oral administration of herbal medicines were offered to all patients. A Visual analogue scale (VAS) of pain and the walking duration without pain were used to assess the patients during the approximately 1-month treatment period. The average VAS score of pain and the walking duration improved significantly; the VAS score decreased from 9 (SD, 1.15) to 2.75 (2.22) (p < 0.01), and the walking duration increased from 5.5 (6.66) to 16.75 (13.00) minutes (p < 0.01). No adverse event was reported during the treatment. In addition, the decreased pain level and improved function continued for over one year. Although we did not find definitive evidence, the study results suggest that KM combination therapy may be beneficial for decreasing pain and improving function in LSS patients and may produce comparatively few adverse events.
Recurrent Herpes Zoster Ophthalmicus Preceded by Anabolic Steroids and High-Dose L-Arginine
Authors: Stephen A LoBue, Adam Goldman, Richard A Giovane, Stacy M Carlson, Michael Bivona, Sinan Albear, Thomas D LoBue
Journal: Case Rep Ophthalmol Med (2020)
MeSH terms: Case Reports

Purpose:
To report a case of a 34-year-old male with recurrent herpes zoster ophthalmicus (HZO) preceded by a 6-week cycle of anabolic steroids and high-dose amino acid supplementation. Case Presentation. A 34-year-old man presented to our institution for left eye pain for one week associated with a vesicular rash in the V1 dermatome, respecting the midline. The patient had no significant past medical or past ocular history, including systemic immunosuppressive agents or HIV. However, prior to the onset of his symptoms the patient had completed a 6-week course of anabolic steroids including trenbolone, deca-durabolin, and testosterone as well as high-dose arginine supplementation averaging more than 40 grams a day. The best-corrected vision was 20/25 OS with slit-lamp examination remarkable for punctate staining and pseudodendrites at 6 o'clock, outside the visual axis. The patient was treated with oral acyclovir 800 mg five times a day for seven days along with prednisolone QID and moxifloxacin QID which was tapered over a month. Four months after resolution, the patient developed a recurrent HZO keratitis preceded by another cycle of anabolic steroids and amino acid supplementation.
Conclusion:
In vitro L-arginine supplementation has been associated with the proliferation and virulence of a variety of herpes viruses. Anabolic steroids have also been demonstrated by various studies to negatively affect cell-mediated immunity necessary to prevent viral infection. Thus, it is possible that anabolic steroids in conjunction with increased L-arginine intake may have precipitated a recurrent HZO in a previously healthy, immunocompetent individual.