OpenMed/multicare-articles huggingface dataset:
Essure Microinsert Abdominal Migration after Hysteroscopic Tubal Sterilization of an Appropriately Placed Essure Device: Dual Case Reports and Review of the Literature
Authors: Shadi Rezai, Meghan LaBine, Hunter Azdel Gomez Roberts, Isamarie Lora Alcantara, Cassandra E Henderson, Malvina Elmadjian, Dilfuza Nuritdinova
Journal: Case Rep Obstet Gynecol (2015)

Background. The Essure device is a method of permanent sterilization widely used in the US that has proven to be safe and effective in most cases. However, there have been reports of device migration that have led to failed tubal occlusion as well as several other serious complications resulting from the presence of the device in the abdominal cavity. Case. This paper represents two cases of failed tubal occlusion by an appropriately placed Essure device without signs or symptoms of further complications related to device migration. Conclusion. Although there have only been 13 reported cases of abdominal device migration since November 2014, this case indicates that the actual number may be higher than reported since it is possible for migration to occur without additional complications. In the majority of reported cases of abdominal migration a major complication requiring surgical correction occurred, such as adhesions, small bowel obstruction, bowel perforation, or persistent pelvic pain. To avoid these complications it is recommended that migrating implants be removed; however, this case also represents an example of when a migrating device may remain in situ in an asymptomatic patient.
Replaced gastroduodenal artery with continuation as accessory left hepatic artery: a rare anatomical variant
Authors: Jesse Chen, Amit Ramjit, Noor Ahmad
Journal: CVIR Endovasc (2018)
Keywords: accessory left hepatic artery, hepatic artery, replaced gda

Background:
Presented here is a rare case of a gastroduodenal artery (GDA) replaced to the superior mesenteric artery with continuation into an accessory left hepatic artery. To the authors' knowledge, this rare anomaly is not described previously. Replaced GDA is reported, however without continuation into an accessory LHA.
Case presentation:
A 74-year-old male with recurrent peptic ulcer disease presented with acute onset melena. This anomaly was discovered during abdominal angiography performed for treatment of a hemorrhagic duodenal ulcer. Initial celiac and common hepatic artery (CHA) subselection and angiography demonstrated no branch vessels. Angiography via the superior mesenteric artery demonstrated free extravasation into the duodenum and distal perfusion of the left hepatic lobe.
Conclusions:
This is a rare variant of hepatic arterial anatomy. Importantly, this variant challenges a previously described anatomical model that attempts to explain observed CHA variation.
Successful Multimodality Endoscopic Treatment of Gastric Outlet Obstruction Caused by an Impacted Gallstone (Bouveret's Syndrome)
Authors: Jason N Rogart, Melissa Perkal, Anil Nagar
Journal: Diagn Ther Endosc (2008)
MeSH terms: Case Reports

Bouveret's syndrome is a rare condition of gastric outlet obstruction resulting from the migration of a gallstone through a choledochoduodenal fistula. Due to the large size of these stones and the difficult location in which they become impacted, endoscopic treatment is unsuccessful and most patients require surgery. We report the case of an elderly male who presented with nausea and hematemesis, and was found on CT scan and endoscopy to have an obstructing gallstone in his duodenal bulb. After several endoscopic sessions and the use of multiple instruments including a Holmium: YAG laser and electrohydraulic lithotripter, fragmentation and endoscopic removal of the stone were successful. We believe this to be the first case of Bouveret's syndrome successfully treated by endoscopy alone in the United States. We describe the difficulties encountered which necessitated varied and innovative therapeutic techniques.
Optical Coherence Tomography Angiography of Purtscher Retinopathy after Severe Traffic Accident in 16-Year-Old Boy
Authors: Hassan Hamoudi, Marie Krogh Nielsen, Torben Lykke Sørensen
Journal: Case Rep Ophthalmol Med (2018)
MeSH terms: Case Reports

Purpose:
To describe optical coherence tomography (OCT) angiography (OCTA) in a case of Purtscher retinopathy.
Methods:
A 16-year-old male underwent ophthalmological examination including color fundus photography, spectral domain OCT, OCTA, and microperimetry. Examination was performed 10 days, 1 month, and 6 months after the trauma. Diagnosis was based on the characteristic clinical presentation.
Patients:
A single patient case.
Results:
Only the right eye was affected, and all examinations of the left eye were normal. The visual acuity of the right eye was 0.03 (Snellen equivalent) at 10 days and at one month, improving to 0.16 at 6 months. The imaging confirmed the findings of Purtscher retinopathy with ischemic whitening of the retina and retinal hemorrhages and thickened inner retina on OCT. Microperimetry showed reduced sensitivity in the central macula of the right eye. OCTA revealed nonperfusion in both the superficial and the deep retinal capillary plexus of the right eye.
Conclusion:
The OCTA in traumatic Purtscher retinopathy following traffic accident showed nonperfusion in both the superficial and the deep capillary plexus of the retina. OCTA is a valuable noninvasive diagnostic examination in Purtscher retinopathy, and fluorescein angiography became redundant in this case.
Rifampicin-Associated Secondary Minimal Change Disease Presenting with Nephrotic Syndrome in a Pulmonary Tuberculosis Patient
Authors: Satyanand Sathi, Anil Kumar Garg, Manoj Kumar Singh, Virendra Singh Saini, Devinder Vohra
Journal: Case Rep Nephrol (2021)
MeSH terms: Case Reports

Various extraglomerular disease processes have been associated with drug-induced secondary minimal change disease (MCD). In a majority of cases, preferably, a hypersensitivity reaction appears to be involved, and in some cases, there is direct toxic effect over glomerular capillaries. There are several reports to demonstrate that rifampicin has been associated with various nephrotoxic adverse effects, but rifampicin-induced secondary minimal change disease (MCD) is very rare. Here, we report the case of a young adult male who presented with nephrotic proteinuria with bland urine sediment after one month of initiation of rifampicin treatment for pulmonary tuberculosis. The patient had no proteinuria before the start of antituberculosis treatment. Renal biopsy showed nonproliferative glomerulopathy and immunofluorescence did not show significant glomerular immune deposits. Electron microscopy showed diffuse effacement of visceral epithelial cell foot processes and did not show any presence of glomerular immune complexes and thickening of glomerular basement membrane, promoting the diagnosis of minimal change nephrotic syndrome. The patient got complete remission after discontinuation of rifampicin.
Robotic-assisted aberrant thoracic duct ligation for persistent chyle-leak post cervical rib resection
Authors: Amalan Thuraisingam
Journal: J Surg Case Rep (2023)
MeSH terms: Case Reports

Chyle leak following cervical rib resection is a serious uncommon complication. Aberrant anatomy can further confound treatment and require the involvement of multiple specialties to delineate the ducts course and allow successful management.
Spontaneous Heterotopic Pregnancy: Dual Case Report and Review of Literature
Authors: Annika Chadee, Shadi Rezai, Catherine Kirby, Ekaterina Chadwick, Sri Gottimukkala, Abraham Hamaoui, Vasiliy Stankovich, Theodore Hale, Hamid Gilak, Mohammad Momtaz, Harvey Sasken, Cassandra E Henderson
Journal: Case Rep Obstet Gynecol (2016)

Introduction. Heterotopic pregnancy is a rare complication usually seen in populations at risk for ectopic pregnancy or those undergoing fertility treatments. It is a potentially dangerous condition occurring in only 1 in 30,000 spontaneous pregnancies. With the advent of Assisted Reproduction Techniques (ART) and ovulation induction, the overall incidence of heterotopic pregnancy has risen to approximately 1 in 3,900 pregnancies. Other risk factors include a history of pelvic inflammatory disease (PID), tubal damage, pelvic surgery, uterine Mullerian abnormalities, and prior tubal surgery. Heterotopic pregnancy is a potentially fatal condition, rarely occurring in natural conception cycles. Most commonly, heterotopic pregnancy is diagnosed at the time of rupture when surgical management is required. Case. This paper represents two cases of heterotopic pregnancies as well as a literature review. Conclusion. Heterotopic pregnancy should be suspected in patients with an adnexal mass, even in the absence of risk factors. Clinicians must be alert to the fact that confirming an intrauterine pregnancy clinically or by ultrasound does not exclude the coexistence of an ectopic pregnancy. A high index of suspicion in women is needed for early and timely diagnosis, and management with laparotomy or laparoscopy can result in a favorable and successful obstetrical outcome.
Mitochondrial Neurogastrointestinal Encephalomyopathy: Novel Pathogenic Mutation in Thymidine Phosphorylase Gene in a Patient from Cape Verde Islands
Authors: Catarina Falcão de Campos, Miguel Oliveira Santos, Rafael Roque, Isabel Conceição, Mamede de Carvalho
Journal: Case Rep Neurol Med (2019)
MeSH terms: Case Reports

Mitochondrial Neurogastrointestinal Encephalomyopathy (MNGIE) is a rare autosomal recessive disorder caused by mutations in the gene encoding the Thymidine Phosphorylase (TP). It is clinically characterized by severe gastrointestinal dysmotility, cachexia, palpebral ptosis, ophthalmoparesis, sensorimotor polyneuropathy and leukoencephalopathy. The diagnosis is established by the presence of typical clinical and neuroimaging features, positive family history, and abnormal genetic test. A 19-year-old Cape Verdean patient with a history since childhood of recurrent episodes of nausea, vomiting, diarrhoea and painful abdominal distension associated with progressive motor disability with difficulty in climbing stairs and running and clumsiness with her hands. The diagnostic workup was suggestive of MNGIE. Genetic screening of the TYMP gene identified a novel mutation (c. 1283 G>A). Patients with MNGIE have significant comorbidity and mortality, and they are frequently misdiagnosed. A better acknowledgment of this disorder is essential to permit an earlier diagnosis and to improve disease management.
Differences in Rhodococcus equi Infections Based on Immune Status and Antibiotic Susceptibility of Clinical Isolates in a Case Series of 12 Patients and Cases in the Literature
Authors: Praveen Gundelly, Yasuhiro Suzuki, Julie A Ribes, Alice Thornton
Journal: Biomed Res Int (2016)
MeSH terms: Actinomycetales Infections / immunology, Actinomycetales Infections / microbiology, Anti-Bacterial Agents / pharmacology, Rhodococcus equi / drug effects, Rhodococcus equi / isolation & purification, Case Reports, Actinomycetales Infections / drug therapy, Actinomycetales Infections / mortality, Adult, Aged, Anti-Bacterial Agents / therapeutic use, Demography, Female, Humans, Immunocompetence / drug effects, Immunocompromised Host, Male, Microbial Sensitivity Tests, Middle Aged, Organ Specificity, Anti-Bacterial Agents

Rhodococcus equi is an unusual zoonotic pathogen that can cause life-threatening diseases in susceptible hosts. Twelve patients with R. equi infection in Kentucky were compared to 137 cases reported in the literature. Although lungs were the primary sites of infection in immunocompromised patients, extrapulmonary involvement only was more common in immunocompetent patients (P < 0.0001). Mortality in R. equi-infected HIV patients was lower in the HAART era (8%) than in pre-HAART era (56%) (P < 0.0001), suggesting that HAART improves prognosis in these patients. Most (85-100%) of clinical isolates were susceptible to vancomycin, clarithromycin, rifampin, aminoglycosides, ciprofloxacin, and imipenem. Interestingly, there was a marked difference in susceptibility of the isolates to cotrimoxazole between Europe (35/76) and the US (15/15) (P < 0.0001). Empiric treatment of R. equi infection should include a combination of two antibiotics, preferably selected from vancomycin, imipenem, clarithromycin/azithromycin, ciprofloxacin, rifampin, or cotrimoxazole. Local antibiograms should be checked prior to using cotrimoxazole due to developing resistance.
Intracoronary imaging-guided rotational atherectomy combined with intravascular lithotripsy in the treatment of severe coronary artery calcification-A case report
Authors: Fengwen Cui, Yaliang Tong, Guohui Liu, Wenqi Zhang, Kun Liu, Daoyuan Si, Yuquan He
Journal: Front Cardiovasc Med (2023)
Keywords: intracoronary imaging, intravascular lithotripsy, percutaneous coronary intervention, rotational atherectomy, severe coronary artery calcification
MeSH terms: Case Reports

Background:
Severe coronary artery calcification increases the difficulty of percutaneous coronary intervention procedures and impairs stent expansion. Herein, we report a case of a patient who was successfully treated with rotational atherectomy using a stepped burr strategy combined with intravascular lithotripsy for plaque modification under intracoronary imaging.
Case summary:
A 65 year-old woman presented to our hospital with recurrent chest pain evolving for 1 year. Coronary angiography showed approximately 80% stenosis of the proximal mid-left anterior descending artery. Intravascular ultrasound (IVUS) and optical coherence tomography (OCT) revealed a 360° annular calcification. The calcification was rotablated with 1.5 and 1.75 burrs, and the lesion was undilatable with a 3.0 mm non-compliant balloon at 14 atm. Subsequently, the intravascular lithotripsy was reset for the modification of the calcified lesion. A shockwave balloon measuring 3.0 mm × 12 mm was delivered, and 40 pulses were performed at 6 atm. Intravascular imaging modalities (IVUS and OCT) revealed a circumferential calcified plaque with deep fractures. After post-balloon expansion followed by drug-eluting stent placement with a final stent expansion of 84%, there were no intraoperative complications and no major adverse cardiovascular events within 90 days postoperatively.
Conclusion:
A combination of rotational atherectomy and intravascular lithotripsy may be an effective and complementary strategy for the treatment of severely calcified lesions that cannot be resolved using a single procedure. However, more clinical studies are required to clarify this finding.
Acute Liver Failure in a Patient Treated With Metamizole
Authors: Philipp Krisai, Deborah Rudin, David Grünig, Kathrin Scherer, Werner Pichler, Luigi Terracciano, Stephan Krähenbühl
Journal: Front Pharmacol (2019)
Keywords: 4-aminoantipyrine (aa), n-methyl-4-aminoantipyrine (maa), liver failure, lymphocyte transformation test (ltt), metamizole
MeSH terms: Case Reports

We report on a patient who developed acute liver failure while being treated with metamizole. After liver transplantation, the patient recovered rapidly. Liver biopsy showed massive necrosis and lobular infiltration of lymphocytes. A lymphocyte transformation test performed 20 months after transplantation was positive for metamizole. In vitro investigations with N-methyl-4-aminoantipyrine (MAA) and 4-aminoantipyrine (AA), the two active metabolites of metamizole, did not reveal relevant toxicity in HepG2 and HepaRG cells. The demonstration of activated lymphocytes by the lymphocyte transformation test and the absence of relevant cytotoxicity by MAA and AA in hepatocyte cell lines suggest an immunological mechanism of metamizole-associated hepatotoxicity.
Veillonella Bacteremia in Alcoholic Hepatitis
Authors: Patrick Lee, Brandon K K Fields, Tom Liang, Michael P Dubé, Seth Politano
Journal: Case Reports Hepatol (2021)
MeSH terms: Case Reports

Veillonella species are commensal bacteria of the human oral, gut, and vaginal microbiota that are rarely identified as clinically relevant pathogens. Here, we describe a novel case of Veillonella atypica bacteremia in a patient with biopsy-proven alcoholic hepatitis. Veillonella species have been correlated with disease severity and hepatic encephalopathy in liver diseases such as autoimmune hepatitis and cirrhosis. Their abundance has also been recently observed to be increased in alcoholic hepatitis, where postinflammatory infections are known to impact mortality. This case report highlights the possible clinical manifestations that result from significant gut dysbiosis in patients with severe alcoholic hepatitis. Early identification and treatment of Veillonella bacteremia in susceptible populations could be crucial to survival given this organism's predilection for causing life-threatening infections, including meningitis, endocarditis, and osteomyelitis.
Nasal oral fistula revealing Langerhans´ cell histiocytosis in adult patient: case report
Authors: Anis Mzabi, Maissa Thabet, Taghrid Tlili, Hend Zorgati, Jihed Anoun, Imen Ben Hassine, Monia Karmeni, Fatma Ben Fredj, Moncef Mokni, Chadia Laouani
Journal: Pan Afr Med J (2021)
Keywords: langerhans cell histiocytosis, adult, case report, chemotherapy, histiocytofibroma
MeSH terms: Histiocytosis, Langerhans-Cell / diagnosis, Nasal Cavity / abnormalities, Oral Fistula / diagnosis, Case Reports, Adrenal Cortex Hormones / administration & dosage, Adult, Histiocytosis, Langerhans-Cell / complications, Histiocytosis, Langerhans-Cell / drug therapy, Humans, Male, Nasal Cavity / surgery, Oral Fistula / etiology, Oral Fistula / surgery, Vinblastine / administration & dosage, Adrenal Cortex Hormones, Vinblastine

Langerhans cell histiocytosis (LCH) is a rare systemic disease caused by proliferation of mature histiocytes; its association to histiocyto fibroma is rarely reported. It rarely affects adults. We report a case of systemic LCH, in an adult patient with osteolytic lesion causing a fistula between the left nasal cavity and hard palate, involving the bone, lung, lymph node and associated to multiple histiocyto fibroma. The patient was operating for a fistula, and he was treated by chemotherapy and corticosteroids. Langerhans´ cell histiocytosis is a rare case, especially in adult patient. The diagnosis was based on histological and immunohistochemical analyses. This patient was treated by steroids and chemotherapy.
Rabson Mendenhall Syndrome caused by a novel missense mutation
Authors: Krishnapradeep Sinnarajah, M B K C Dayasiri, N D W Dissanayake, S T Kudagammana, A H H M Jayaweera
Journal: Int J Pediatr Endocrinol (2016)
Keywords: acanthosis nigricans, insr gene, insulin resistance, rabson-mendenhall syndrome
MeSH terms: Case Reports

Background:
Rabson Mendenhall syndrome is a rare endocrine condition characterized by severe insulin resistance and hyperglycemia. It occurs due to mutations in the insulin receptor gene. Few mutations which are associated with Rabson Mendenhall syndrome have been identified and reported in the past. The management of this condition is extremely challenging and will need multi-disciplinary approach.
Case presentation:
An 11 year old boy presented with polyuria and polydipsia. He was noted to have coarse facies, severe acanthosis nigricans, hypertrichosis, retarded growth and developmental delay. Investigations revealed severe hyperglycemia which was poorly responsive to high doses of insulin. A diagnosis of Rabson Mendenhall syndrome was suspected based on his physical characteristics in the presence of insulin resistance. Genetic studies revealed a homozygous missense mutation in the Insulin receptor gene confirming the diagnosis of Rabson Mendenhall syndrome. This is a novel mutation which has not been reported previously.
Conclusion:
Rabson Mendenhall syndrome should be suspected in a patient with characteristic physical features, severe hyperglycemia and insulin resistance. The genetic studies will not only confirm the diagnosis but also will help in counselling. Wider collaboration is needed to identify definitive treatment options for managing this rare condition.
Case Report: Ovulation Induction in Greater One-Horned Rhinoceros ( Rhinoceros unicornis)
Authors: Robert Hermes, Folko Balfanz, Simone Haderthauer, Eveline Dungl, Thomas B Hildebrandt, Franz Schwarzenberger
Journal: Front Vet Sci (2021)
Keywords: gnrh analog, indian rhinoceros, endocrinology, estrus, hcg, ultrasound
MeSH terms: Case Reports

Despite a profound knowledge on reproduction biology in greater one-horned (GOH) rhinoceros, many individuals cope with sub or infertility or an-ovulatory estrous. At the same time, early and regular captive breeding is of high importance in female GOH rhinoceros due to their high prevalence to develop genital tract tumors with consequent cessation of reproduction. Thus, mature, an-ovulatory GOH rhinoceros represent a challenge for captive breeding programs and warrant for means of reliable ovulation induction. Here, we used hCG and GnRH analog histrelin to induce ovulation in an-ovulatory GOH rhinoceros. Upon ultrasound diagnosis of a preovulatory follicle hCG or GnRH were injected to induce ovulation (n = 11). As a result, 75% of the hCG (n = 6/8) and 33% of GnRH (n = 1/3) inductions resulted in ovulation. Ovulation occurred when fecal estrogen concentration increased before and pregnane concentration after induction. Thirty-six percent of all treatments (n = 4/11) failed to induce ovulation. When ovulation induction by hCG/GnRH injection failed, estrogen and pregnane concentrations were significantly lower compared to ovulatory estrous (P < 0.001). Our results suggest that hCG and GnRH analog facilitate an easily applicable treatment to induce ovulation in females with behavioral but at times an-ovulatory estrous. Frequent use of hCG as an ovulation inducer might help to achieve pregnancies in genetically important but an-ovulatory GOH rhinoceroses.
Case Report: Subtherapeutic Vancomycin and Meropenem Concentrations due to Augmented Renal Clearance in a Patient With Intracranial Infection Caused by Streptococcus intermedius
Authors: Marcus Fransson, Anders Helldén, Åse Östholm Balkhed, Dženeta Nezirević Dernroth, Maria Ha, Mats Haglund, Peter Milos, Håkan Hanberger, Bertil Kågedal
Journal: Front Pharmacol (2021)
Keywords: augmented renal clearance, creatinine clearance, glomerular filtration rate, iohexol clearance, suboptimal antibiotic treatment, tubular cell membrane transporters, urea clearance, vancomycin clearance

Streptococcus intermedius occasionally causes brain abscesses that can be life-threatening, requiring prompt antibiotic and neurosurgical treatment. The source is often dental, and it may spread to the eye or the brain parenchyma. We report the case of a 34-year-old man with signs of apical periodontitis, endophthalmitis, and multiple brain abscesses caused by Streptococcus intermedius. Initial treatment with meropenem and vancomycin was unsuccessful due to subtherapeutic concentrations, despite recommended dosages. Adequate concentrations could be reached only after increasing the dose of meropenem to 16 g/day and vancomycin to 1.5 g × 4. The patient exhibited high creatinine clearance consistent with augmented renal clearance, although iohexol and cystatin C clearances were normal. Plasma free vancomycin clearance followed that of creatinine. A one-day dose of trimethoprim-sulfamethoxazole led to an increase in serum creatinine and a decrease in both creatinine and urea clearances. These results indicate that increased tubular secretion of the drugs was the cause of suboptimal antibiotic treatment. The patient eventually recovered, but his left eye needed enucleation. Our case illustrates that augmented renal clearance can jeopardize the treatment of serious bacterial infections and that high doses of antibiotics are needed to achieve therapeutic concentrations in such cases. The mechanisms for regulation of kidney tubular transporters of creatinine, urea, vancomycin, and meropenem in critically ill patients are discussed.