OpenMed/multicare-articles huggingface dataset:
Successful pulmonary embolectomy for massive pulmonary embolism during pregnancy: a case report
Authors: Hiroki Taenaka, Chiyo Ootaki, Chie Matsuda, Yuji Fujino
Journal: JA Clin Rep (2017)
Keywords: embolectomy, fetal monitoring, intracardiac echography, labor epidural, massive pulmonary embolism, preterm cardiac surgery

Background:
Pulmonary embolism (PE) resulting from venous thromboembolism is a leading cause of maternal mortality in pregnancy. In patients with massive PE and hemodynamic instability, the treatment options often considered are thrombolytics, inferior vena caval filters, or embolectomy. We report here the case of a patient with massive PE at 28 weeks' gestation, who underwent emergency pulmonary embolectomy via cardiopulmonary bypass.
Case presentation:
A 35-year old primigravida with a history of massive PE at 25 weeks of gestation was referred to our hospital at 28 weeks of gestation, following treatment failure after insertion of an inferior vena cava filter and heparin administration. Emergency thrombectomy was performed, and intracardiac echography was used for intraoperative fetal heart rate monitoring. However, the patient developed hemodynamic collapse following anesthesia induction; hence, emergency cardiopulmonary bypass (CPB) was performed via median sternotomy. Thrombectomy and tricuspid valve plication were performed under cardiac arrest. After confirming postoperative hemostasis, heparin administration was resumed. At 40 weeks of gestation, labor was induced under epidural analgesia. Both mother and child were discharged with no complications.
Conclusion:
In conclusion, intracardiac echography is useful for fetal heart rate monitoring during emergency cardiac surgery in pregnancy. Careful CPB management is important to maintain uteroplacental blood flow. Although there is no consensus on the delivery methods in such cases, epidural analgesia during labor was useful in reducing cardiac load and wound traction.
Case Report: Clinical and Procedural Implications of Ommaya Reservoir Implantation in Cystic Brain Metastases Followed by Radiosurgery Treatment
Authors: Junhui Lv, Zhuoxuan Wu, Kun Wang, Yirong Wang, ShuXu Yang, Weidong Han
Journal: Front Surg (2022)
Keywords: gamma knife radiosurgery, ommaya reservoir, craniotomy, cystic brain metastases, stereotactic cyst aspiration
MeSH terms: Case Reports

Background:
Therapy for large or deep cystic brain metastases is a troublesome procedure in clinical departments. Stereotactic cyst aspiration, combined with Gamma Knife radiosurgery, can be an effective treatment for cystic brain metastases. However, there is still a possibility that a reaccumulation of cystic fluid may lead to poor efficacy or even reoperation.
Case presentation:
We present a case of a 67-year-old man who was diagnosed with lung cancer brain metastasis. The intracranial lesion seen on imaging appeared to be cystic and located deep inside the brain with associated limb dysfunction. The patient did not respond well to chemotherapy and underwent cyst aspiration with Ommaya reservoir implantation under neuronavigation. Repeated cystic fluid reaccumulation and exacerbation of symptoms occurred during treatment. We performed repeated aspiration via the Ommaya reservoir to control the symptoms and combined it with radiotherapy. During the follow-up period of 14 months, the intracranial tumor was effectively and satisfactorily controlled.
Conclusions:
We highlight that Ommaya reservoir implantation during stereotactic cyst aspiration is necessary to prevent fluid reaccumulation, thereby avoiding the need for a second surgical procedure.
A Case of Intertwin Membrane Hemorrhage with Spontaneous Resolution
Authors: Lily Criscione, Kristen Elmezzi, Saioa Torrealday, Barton C Staat, Kimberly Hickey
Journal: Case Rep Obstet Gynecol (2019)
MeSH terms: Case Reports

Vaginal bleeding during pregnancy places women at increased risk of spontaneous abortion. Etiologies for threatened and spontaneous abortions have been well studied, but there is little information on intertwin membrane hemorrhage. We present a patient with a multiple gestation pregnancy who experienced first trimester vaginal bleeding with visualization and subsequent rapid resolution of an intertwin membrane hemorrhage. The patient had an otherwise normal pregnancy until the third trimester when she developed preeclampsia with severe features and elected for a primary cesarean section at 35 + 5 weeks. The implications of an intertwin membrane hemorrhage are not well understood, although there could be a possible correlation between the hemorrhage and the ultimate progression to preeclampsia with severe features. Despite the final diagnosis, the patient did not have any noticeable complications due to the hemorrhage both when it was discovered and in the weeks following its discovery.
Delayed Acetaminophen Absorption Resulting in Acute Liver Failure
Authors: Huiling Tan, Paul Stathakis, Benoj Varghese, Nicholas A Buckley, Angela L Chiew
Journal: Case Rep Crit Care (2022)
MeSH terms: Case Reports

Introduction. Acetaminophen is a common medication involved in deliberate and accidental self-poisoning. The acetaminophen treatment nomogram is used to guide acetylcysteine treatment. It is rare to develop hepatotoxicity with an initial acetaminophen concentration below the nomogram line. We present a case of acetaminophen ingestion with an initial concentration below the nomogram line that developed hepatic failure, due to a delayed peak acetaminophen concentration secondary to coingesting medications that slow gastric emptying. Case Report. A 43-year-old (55 kg) female presented after ingesting an unknown quantity of acetaminophen, clonidine, and alcohol. Her acetaminophen level was 41 mg/L (256 μmol/L) at 4.5 h post-ingestion, well below the nomogram line, and ALT was 25 U/L. Hence, acetylcysteine was not commenced. She was intubated for decreased level of conscious. A repeat acetaminophen level 4 h later was 39 mg/L (242 μmol/L), still below the nomogram line. She was extubated 24 h later.At 38 h post-ingestion she developed abdominal pain, the repeat acetaminophen level was 85 mg/L (560 μmol/L), ALT was 489 U/L, and acetylcysteine was commenced. The patient developed hepatic failure with a peak ALT of 7009 U/L and INR of 7.5 but made a full recovery. It was discovered that she had ingested a combination acetaminophen product containing dextromethorphan and chlorphenamine. Acetaminophen metabolites were measured, including nontoxic glucuronide and sulfate conjugates and toxic cytochrome P450 (CYP) metabolites. The metabolite data demonstrated increasing CYP metabolites in occurrence with the delayed acetaminophen peak concentration. Discussion. Opioids and antimuscarinic agents are known to delay gastric emptying and clonidine may also have contributed. These coingested medications resulted in delayed acetaminophen absorption. This case highlights the issue of altered pharmacokinetics when patients coingest gut slowing agents.
Acute Effects of Insulin on Cardiac Function in Patients with Diabetes Mellitus: Clinical Applicability and Feasibility
Authors: Deeb Daoud Naccache, Sergey Yalonetsky, Ronen Bar-Yoseph
Journal: Int J Endocrinol (2020)

Background:
Insulin promotes glucose consumption as the main cardiac energy source, while increasing myocardial efficiency. The short-term effects of insulin on cardiac function and its potential curative role in an acute diabetological cardiology setting remain unknown. Our study evaluated the role of acute insulin administration in the diabetic heart, its corresponding effective blood insulin level, and the time-course applicability of insulin treatment in a routine clinical setting.
Methods:
We evaluated a case series of six male (48.1 ± 4.9 y/o) patients with controlled diabetes (HbA1c of 6.6 ± 0.3%) and disease duration of 14.4 ± 6.7 yr. Each subject was evaluated for glucose homeostasis, as well as hemodynamic and echocardiographic (systolic and diastolic) parameters at three points: baseline followed by two successive insulin loads in euglycemic hyperinsulinemic clamp study. Results were analysed using Student's t-test.
Results:
The first insulin load led to a physiologic blood insulin level of 145 ± 36 μU/ml, and both systolic (7 mmHg) blood pressure and diastolic (4 mmHg) blood pressure decreased significantly. Left ventricular fractional shortening (LVFS) increased significantly by 11.8%. Diastolic function parameters of mitral annulus movement of the A' wave increased relative to baseline by 20.0% (27.8% under the second insulin load), A' medial increased relative to baseline by 30%, and A' lateral increased relative to baseline by 17%, displayed by tissue Doppler imaging.
Conclusions:
Insulin acutely affected the diabetic heart at a physiologic level within a 2 h time course. Insulin mainly increased left ventricular systolic function and, to a second degree, improved left ventricular diastolic functions and atrial systole in diabetic subjects. These results may facilitate the development of insulin-based acute treatment in diabetic patients with cardiac morbidity. This trial is registered with NCT02962921.
Penetrating injury of pelvis, abdomen and thorax in a child with a trident (trishula)
Authors: Jile Dar Rawat, Prabudh Goel, Vijaymahantesh S Kunnur, Bb Kushwaha, Renu Kushwaha
Journal: APSP J Case Rep (2013)
Keywords: child, injury, trident, trishula, thoraco-abdomino-pelvic impalement
MeSH terms: Case Reports

Penetrating abdominal injuries are uncommon in the pediatric age group and are associated with a high mortality. A seven year old girl suffered penetrating injury to perineum when she fell onto the trident (trishula - traditional three pronged spear) implanted alongside Lord Shiva's idol. The rod caused perforations of the transverse mesocolon, ileum at 3 places, right lobe of liver, diaphragm, parietal pleura, and exited from 7th intercostal space. Surgical repair of each damaged site was undertaken. Despite delayed presentation, the child survived following surgery.
Progressive multifocal cerebral infarction from intravascular large B cell lymphoma presenting in a man: a case report
Authors: Pornpong Jitpratoom, Patcharawan Yuckpan, Panitta Sitthinamsuwan, Wattanachai Chotinaiwattarakul, Yingyong Chinthammitr
Journal: J Med Case Rep (2011)

Introduction:
Intravascular lymphoma is rare, and may present as ischemic stroke. Diagnosis is difficult due to the non-specific presentation and lack of lymphadenopathy, thus leading to frequent instances of autopsy-proven diagnosis. To the best of our knowledge, this is the first report of progressive stroke from intravascular lymphoma diagnosed antemortem by random skin biopsy.
Case presentation:
A 42-year-old Thai man presented to our hospital with progressive multifocal cerebral infarction. Despite taking aspirin (300 mg/day), his neurological symptoms worsened. During admission, he developed an unexplained fever and hypoxemia. Magnetic resonance angiography clearly showed patency of all cerebral arteries including the internal carotid and vertebrobasilar arteries. Echocardiography, an antiphospholipid antibody test, cerebrospinal fluid cytology and a bone marrow study were normal. Other laboratory test results showed an elevated lactate dehydrogenase level, nephrotic range proteinuria (3.91 g/day), hypoalbuminemia (1.9 g/dL), a very low high-density lipoprotein level (7 mg/dL) and hypertriglyceridemia (353 mg/dL). Because of suspected vasculitis, pulse methylprednisolone was given with transiently minimal improvement. A random skin biopsy from both thighs revealed intravascular large B cell lymphoma. Chemotherapy was not given due to our patient having ventilator associated pneumonia. He died 10 days after the definite diagnosis was established.
Conclusion:
One etiology of stroke is intravascular lymphoma, in which random skin biopsy can be helpful for antemortem diagnosis.
New technique for the management of anteriorly located midline prostatic cysts causing severe lower urinary tract symptoms: Case report and literature review
Authors: Khalid Abdulrahman Al-Nasser, Raed Mohammed Almannie
Journal: Int J Surg Case Rep (2019)
Keywords: anterior prostatic cyst, case report, cyst, lower urinary tract symptoms, obstruction, prostate

Introduction:
Prostatic cysts are uncommon and usually asymptomatic. In most cases, these cysts are found incidentally by imaging. In some cases, these cysts can be symptomatic and missed for years.
Case report:
We report the case of a 36-year-old male patient presented with a 3-year history of weak urine stream, dysuria, frequency and urgency. Ultrasound, computed tomography and magnetic resonance imaging demonstrated a prostatic cyst measuring 1.5*1.2 cm occupying the bladder outlet and causing obstruction. Transverse incision of the cyst provided a satisfactory resolution of the patient's complaint.
Conclusion:
Incision of a symptomatic midline anterior prostatic cyst is a safe and effective management option with no potential risk of retrograde ejaculation.
A rare case of disseminated cutaneous zoster in an immunocompetent patient
Authors: S Gupta, A Jain, C Gardiner, S K Tyring
Journal: BMC Fam Pract (2005)
MeSH terms: Acyclovir / therapeutic use, Antiviral Agents / therapeutic use, Herpes Zoster / diagnosis, Skin Diseases, Vesiculobullous / diagnosis, Case Reports, Aged, Early Diagnosis, Herpes Zoster / drug therapy, Herpes Zoster / physiopathology, Humans, Male, Skin Diseases, Vesiculobullous / drug therapy, Skin Diseases, Vesiculobullous / etiology, Time Factors, Antiviral Agents, Acyclovir

Background:
Disseminated cutaneous herpes zoster in healthy persons is uncommon, though it has been described in immunocompromised patients.
Case presentation:
We describe a case of disseminated cutaneous herpes zoster in an elderly man with no apparent immunosuppressive condition. The patient was treated successfully with intravenous Acyclovir.
Conclusion:
We suggest that disseminated zoster can occur in an immunocompetent host and should be promptly recognized and treated to prevent serious complications.
Seizure and Acute Vision Loss in a Filipino Lupus Patient: A Case of Posterior Reversible Encephalopathy Syndrome with Intraparenchymal Hemorrhage
Authors: Deonne Thaddeus V Gauiran, Therese Eileen B Lladoc-Natividad, Ida Ingrid I Rocha, Bernadette Heizel Manapat-Reyes
Journal: Case Rep Med (2018)
MeSH terms: Case Reports

Posterior reversible encephalopathy syndrome (PRES) is a rare and poorly understood neurologic condition that has been described in some patients with systemic lupus erythematosus (SLE). Intracerebral hemorrhage is a unique and atypical presentation of PRES and has been described only in a small number of patients with SLE. We present the case of a 33-year-old female, diagnosed with SLE and active nephritis, who was admitted for seizures. She had acute-onset headache, confusion, and bilateral vision loss associated with severe hypertension. CT scan revealed right occipital and parietal lobe hemorrhage. MRI showed vasogenic edema and hyperintense foci in bilateral cortical and subcortical regions of the occipital and posterior parietal lobes which are consistent with posterior reversible encephalopathy syndrome (PRES). Strict blood pressure control and medical ICP-lowering treatment were immediately instituted, while maintaining her on anticonvulsants, high-dose steroids, and mycophenolate mofetil. The patient was discharged with improvement in vision and resolution of headache. On follow-up, she had gained her premorbid visual acuity and reported no recurrence of headache or seizures. Despite its name, reversibility remains to be conditional in PRES. A high index of suspicion is important, especially among those who present with seizure, headache, and visual loss. Early diagnosis and timely initiation of therapy is recommended, as clinical symptoms are potentially reversible and delayed therapy may result in life-threatening complications, such as coma or death.
Successful renal re-transplantation in the presence of pre-existing anti-DQ5 antibodies when there was zero mismatch at class I human leukocyte antigen A, B, & C: a case report
Authors: John Hartono, Bhavna Lavingia, Peter Stastny, Martin Senitko, Miguel Vazquez, Juan Arenas, Christopher Lu
Journal: J Med Case Rep (2009)

Introduction:
Hyperacute rejection may be prevented by avoiding the transplantation of kidneys into patients with pre-existing anti-donor Class I human leukocyte antigen antibodies. However, the role of anti-donor-Class II-human leukocyte antigen-DQ antibodies is not established. The question is ever more relevant as more sensitive cross-matching techniques detect many additional antibodies during the final crossmatch. We now report successful renal transplantation of a patient who had pre-existing antibodies against his donor's human leukocyte antigen-DQ5.
Case presentation:
Our patient, a Caucasian man, was 34 years of age when he received his first deceased donor renal transplant. After 8 years, his first transplant failed from chronic allograft dysfunction and an earlier bout of Banff 1A cellular rejection. The second deceased donor kidney transplant was initially allocated to the patient due to a 0 out of 6 mismatch. The B cell crossmatch was mildly positive, while the T Cell crossmatch was negative. Subsequent assays showed that the patient had preformed antibodies for human leukocyte antigen DQ5 against his second donor. Despite having preformed antibodies against the donor, the patient continues to have excellent allograft function two years after his second renal transplant.
Conclusion:
The presence of pre-existing antibodies against human leukocyte antigen DQ5 does not preclude transplantation. The relevance of having other antibodies against class II human leukocyte antigens prior to transplantation remains to be studied.
Drug free remission after steroid-dependent disappearance of lymphoproliferative disorder in rheumatoid arthritis patient treated with TNF-alpha blockade: case study
Authors: Kosaku Oda, Mutsuko Minata
Journal: Springerplus (2015)
Keywords: complete remission, lymphoproliferative disorder, rheumatoid arthritis, tumor necrosis factor alpha inhibitor

Introduction:
TNF-α inhibitors plus MTX appear to have benefit in the longer-term reduction of RA. Boolean long-term remission under drug-free conditions is rare. The therapeutic mechanism and the factor of predicting response have not been clarified yet.
Case description:
A 24-year-old female rheumatoid arthritis (RA) patient, who once attained complete remission (CR) with the combination therapy with tumor necrosis factor alpha (TNF-alpha) inhibitor adalimumab (ADA) and methotrexate (MTX), showed the occurrence of Epstain- Barr virus (EBV)-associated lymphoproliferative disorder (LPD). Pulse treatment with methylprednisolone after the termination of anti TNF-α therapy resulted in the remission of EBV-associated LPD. The administration of prednisolone (PSL) was tapered off after the improvement of clinical symptoms and laboratory data. The patients achieved drug-free 12 months after urgent hospitalization and delivered healthy baby 2 years after hospital discharge. She has been complete drug-free Boolean remission for 5 years.
Discussion and evaluation:
The purpose of this brief case is report that we experienced the remission of LPD after CR with combined therapy with ADA and MTX. We believe this case report will be one of the paths for unveiling the pathogenesis and improving the treatment for RA.
Conclusions:
We believe this case report will be one of the paths for unveiling the pathogenesis and improving the treatment for RA.
Thyroid involvement in two patients with Bannayan-Riley-Ruvalcaba syndrome
Authors: Valentina Peiretti, Alessandro Mussa, Francesca Feyles, Gerdi Tuli, Arianna Santanera, Cristina Molinatto, Giovanni Battista Ferrero, Andrea Corrias
Journal: J Clin Res Pediatr Endocrinol (2013)
MeSH terms: Hamartoma Syndrome, Multiple / pathology, Thyroid Gland / pathology, Case Reports, Child, Child, Preschool, Female, Hamartoma Syndrome, Multiple / diagnosis, Hamartoma Syndrome, Multiple / genetics, Humans, Male, PTEN Phosphohydrolase / genetics, Point Mutation, PTEN Phosphohydrolase

Bannayan-Riley-Ruvalcaba syndrome (BRRs) is an overgrowth disorder characterized by macrocephaly, pigmented maculae of the glans penis, and benign mesodermal hamartomas (primarily subcutaneous and visceral lipomas, multiple hemangiomas, and intestinal polyps). Dysmorphic features as well as delayed neuropsychomotor development can also be present. These patients have also a higher risk of developing tumors, as the gene involved in BRRs is phosphatase and tensin homologue (PTEN), and up to 30% of the patients have thyroid involvement consistent with multinodular goiter, thyroid adenoma, differentiated non-medullary thyroid cancer, or Hashimoto's thyroiditis. Here, we report two cases of BRRs at opposite ends of its phenotypic spectrum: clinical manifestations of the first patient were more severe, while the second one showed only few signs and had no family history of the disease. Both cases developed thyroid disorders detected by thyroid ultrasound screening. We believe that it is important for clinicians, specifically pediatric endocrinologists, to know that this syndrome can appear in very subtle ways and also to be aware that thyroid nodules and intestinal polyps seem to be its most frequently encountered features.
Diverse presentations of carcinoma erysipelatoides from a teaching hospital in australia
Authors: Hui Ting Chow, Kim Tran, Ewan K A Millar, Jodi Lynch, Dedee F Murrell
Journal: Case Rep Dermatol Med (2012)

Inflammatory breast carcinoma is a rare form of advanced breast cancer which carries a poor prognosis, even with treatment. Diagnosis is reached on clinical and pathological grounds; however, due to its propensity to mimic other conditions, it may often be delayed or missed by attending physicians. This case series describes four patients seen at our institution with a diagnosis of inflammatory breast cancer; 3 patients had a history of previously treated breast malignancy. In these cases, the emergence of a new breast lesion evaded initial diagnosis due to incomplete initial physical examination, falsely reassuring imaging results, lack of recognition that a cellulitis picture can resemble metastatic carcinoma, and inconclusive initial biopsy sections. These obstacles to achieve diagnosis serve to further worsen the prognosis by delaying the initiation of multimodality treatment which can improve survival. The purpose of our paper is to increase awareness among breast cancer specialists of the importance of undressing the patient for basic clinical examination of the breasts, recognition of the appearances of this type of local recurrence of breast cancer, and not to rely purely on ultrasound and mammography due to delay in diagnosis in some of our local cases. Sometimes deeper sections and repeat biopsies are needed to make the diagnosis.