OpenMed/multicare-articles huggingface dataset:
Nitrogen Oxide-Added Extracorporeal Membrane Oxygenation for Treating Critical Acute Heart Failure after Cardiac Surgery
Authors: V V Pichugin, S E Domnin, E V Sandalkin, S A Fedorov, V V Bober, S A Zhurko
Journal: Sovrem Tekhnologii Med (2021)
Keywords: critical acute heart failure, extracorporeal membrane oxygenation, nitric oxide
MeSH terms: Cardiac Surgical Procedures / adverse effects, Extracorporeal Membrane Oxygenation / methods, Heart Failure / etiology, Thoracic Surgery, Case Reports, Humans, Male, Middle Aged, Nitric Oxide, Nitric Oxide

The aim of the study was to test the use of gaseous nitric oxide added to the extracorporeal membrane oxygenation (ECMO) system for treating critical acute heart failure after cardiac surgery.
Materials and methods:
Venoarterial ECMO with addition of nitric oxide into the extracorporeal circuit was used for treating a 52-year-old patient after two-step cardiac surgery for acute dissection of the thoracic aorta and aortic valve insufficiency. After the Bentall-de Bono procedure, a technical error was revealed: that was a non-functioning anastomosis to the right coronary artery, which caused massive ischemic myocardial injury. An emergency myocardial revascularization was performed with the help of the cardiopulmonary bypass converted into ECMO; the patient's condition improved and he was transferred to the ICU.
Results:
Considering the sharp decrease in heart contractility and the extremely high level of myocardial damage markers, it was decided to supply nitric oxide (40 ppm) to the ECMO circuit. A positive effect was noted within 8 h from the start of the procedure: the concentration of creatine phosphokinase-MB decreased almost 4 times and the concentration of troponin I decreased twofold. The most pronounced changes were observed by the end of day 1: a significant decrease in the concentration of myocardial damage markers, a decrease in the VIS indicator by 7.5 times; an improvement in the contractile function. Further on, the patient's condition gradually stabilized: the manifestations of acute heart failure and multiple organ failure stopped, and then ECMO was discontinued after 82 h of work. The patient was decannulated and he continued to show stable hemodynamic parameters. He was discharged from the clinic on day 18 after surgery.
Conclusion:
For the first time, venoarterial ECMO with supply of gaseous nitric oxide into the extracorporeal circuit was used to support blood circulation after cardiac surgery. This made it possible to ensure the survival of the patient with critical ischemia-reperfusion injury developed after the surgery.
Successful Sirolimus Treatment for Recurrent Pericardial Effusion in a Large Cervicomediastinal Provisionally Unclassified Vascular Anomaly: A Case Report
Authors: Julio César Moreno-Alfonso, María San Basilio Berenguer, María Del Carmen Sarmiento Caldas, Jesús González Cayón, Santiago de la Puente, Paloma Triana, Juan Carlos López-Gutiérrez
Journal: European J Pediatr Surg Rep (2023)
Keywords: case report, pericardial effusion, provisionally unclassified vascular anomaly, sirolimus, vascular malformations
MeSH terms: Case Reports

Provisionally unclassified vascular anomalies (PUVA) are a group of diseases with unique characteristics that make them unclassifiable within vascular tumors or malformations. We describe a PUVA as the cause of recurrent pericardial effusion and its response to sirolimus. A 6-year-old girl was referred with a cervicothoracic vascular anomaly, a violaceous, and irregular lesion in the neck and upper chest, diagnosed as "hemangioma". She had pericardial effusion at the neonatal age that required pericardiocentesis, propranolol, and corticosteroids. She remained stable for 5 years, when she presented with a severe pericardial effusion. A magnetic resonance visualized a diffuse vascular image in the cervical and thoracic region with mediastinal extension. The pathological study showed a vascular proliferation in the dermis and hypodermis with positive staining for Wilms' Tumor 1 Protein (WT1) and negative for Glut-1. Genetic testing found a variant in GNA14 , for which the diagnosis of PUVA was established. When a pericardial drain was placed without response, treatment with sirolimus was started with resolution of the effusion. Sixteen months later, the malformation is stable and there has been no recurrence of pericardial effusion. In a significant group of patients, definitive diagnosis is not possible despite pathological and genetic analysis. Mammalian target of rapamycin inhibitors may become a therapeutic option if symptoms are severe enough, with a low rate of reported side effects.
Metformin-associated lactic acidosis treated successfully by peritoneal dialysis in a resource limited setting: case report
Authors: Khaled Elmezughi, Chukwuma Ekpebegh
Journal: Pan Afr Med J (2019)
Keywords: lactic acidosis, south africa, metformin overdose, metformin toxicity, peritoneal dialysis
MeSH terms: Acidosis, Lactic / chemically induced, Hypoglycemic Agents / poisoning, Metformin / poisoning, Peritoneal Dialysis / methods, Case Reports, Acidosis, Lactic / therapy, Adolescent, Female, Humans, Treatment Outcome, Hypoglycemic Agents, Metformin

Metformin is a commonly used treatment modality in type 2 diabetes mellitus with lactic acidosis as a rare but life-threatening side effect. In this case report we highlight the importance of recognizing this uncommon side effect and the treatment options in a resource limited situation. We present a 14-year-old African girl who ingested an unknown amount of metformin intentionally after an argument with her mother. She was referred late to our institution in severe lactic acidosis. Lactic acidosis resolved with appropriate treatment including peritoneal dialysis. We conclude that in resource constrained settings, peritoneal dialysis may be used for metformin associated lactic acidosis with favourable outcome.
Ureteroarterial Fistula: A Diagnosis Which Is Not Always Black and White
Authors: A Haffar, T Trump, A A Elbakry, K McCluskey, M W Salkini, A Luchey
Journal: Case Rep Urol (2021)
MeSH terms: Case Reports

Ureteroiliac artery fistulas are a rare, life-threatening condition that requires a high index of suspicion for prompt diagnosis. Presurgical diagnosis is challenging as this condition can lie hidden despite advanced imaging modalities. We present two cases of patients presenting with gross hematuria and exsanguination in the setting of a ureteroiliac artery fistula. These cases highlight the difficulties in timely diagnosis and treatment in a multidisciplinary team.
Solitary Laryngeal Metastasis from Transitional Cell Carcinoma of the Kidney: Clinical Case and Review of the Literature
Authors: Tarek Assi, Elie El Rassy, Amine Haddad, Joseph Kattan
Journal: Case Rep Otolaryngol (2015)

The urogenital tract is a rare origin of laryngeal metastasis; transitional cell carcinoma with laryngeal metastases had never been reported previously. In this paper, we describe the clinical and pathological characteristics, evolution, and treatment of the first reported case of a laryngeal metastasis of a TCC followed by a brief review of the literature.
Case report: Combined cervical incision with an intercostal uniportal video-assisted thoracoscopic surgery approach for mediastinal brachial plexus schwannoma
Authors: Linlin Wang, Lihui Ge, Yi Ren
Journal: Front Oncol (2023)
Keywords: brachial plexus, faster rehabilitation, minimally invasive, schwannomas, uniportal video-assisted thoracoscopic surgery
MeSH terms: Case Reports

Mediastinal neurogenic tumors primarily originate from the intercostal and sympathetic nerves, whereas schwannomas originating from the brachial plexus are rare. Surgical intervention for such tumors is complex and associated with the risk of postoperative upper limb dysfunction due to their unique anatomical location. In this report, we present the case of a 21-year-old female diagnosed with a mediastinal schwannoma, who underwent a novel surgical approach combining cervical incision and intercostal uniportal video-assisted thoracoscopic surgery (VATS). Our study reviewed the patient's clinical presentation, treatment approach, pathology, and prognosis. The findings of this study demonstrate that the cervical approach, combined with intercostal uniportal VATS, is a feasible surgical method for the removal of mediastinal schwannomas originating from the brachial plexus.
Case series of post-thrombolysis patients undergoing hemicraniectomy for malignant anterior circulation ischaemic stroke
Authors: A Williams, M Sittampalam, N Barua, A Mohd Nor
Journal: Cardiovasc Psychiatry Neurol (2011)
MeSH terms: Case Reports

While ischaemic stroke remains a leading cause of death and disability, there have been recent advancements in treatment modalities including thrombolysis and decompressive hemicraniectomy. A retrospective review of patients treated in our NHS teaching hospital, in Plymouth (UK), over a 2 year period identified 17 thrombolysed patients, of whom two had undergone subsequent decompressive hemicraniectomy. These were non-dominant hemisphere strokes in young patients, aged 51 and 57. Initial NIHSS scores were 16 and 17, and they received thrombolysis at 2 hrs 42 min and 5 hrs 10 min post onset of symptoms respectively. CT imaging demonstrated cerebral swelling with significant midline shift in both cases, and decompressive hemicraniectomy was undertaken at 29 hrs 8 min and 27 hrs 30 min post-thrombolysis. We found no significant intra-operative complications attributable to prior use of thrombolytics. Both patients have had acceptable psychological and physical outcomes, with Barthel Index scores of 40 and 25, and MMSE scores of 29/30 and 27/30. We conclude that the use of thrombolytic therapy does not contra-indicate subsequent decompressive hemicraniectomy in well selected patients with non-dominant hemisphere strokes. More research in this field is required to elucidate factors which would facilitate recognition of stroke patients who will benefit most from aggressive medical and neurosurgical intervention.
Intramuscular Epinephrine-Induced Transient ST-Elevation Myocardial Infarction
Authors: Binav Shrestha, Paritosh Kafle, Shivani Thapa, Suyash Dahal, Vijay Gayam, Alix Dufresne
Journal: J Investig Med High Impact Case Rep (2018)
Keywords: kounis syndrome, stemi, anaphylaxis, epinephrine, transient

Introduction. Myocardial infarction in the setting of anaphylaxis may result from the anaphylaxis itself or from the epinephrine used to treat the anaphylaxis. While cases of myocardial infarction due to large doses of intravenous epinephrine have previously been reported, myocardial infarction after therapeutic doses of intramuscular epinephrine is rarely reported. Case Report. A 23-year-old male presented with sudden onset of difficulty in swallowing and speech after eating takeout food. He was treated with intramuscular epinephrine for presumed angioedema following which he immediately developed chest tightness associated with ST elevation on electrocardiogram and elevated serum troponin. His symptoms and electrocardiogram findings were transient and resolved within the next 10 minutes. Conclusion. Epinephrine is lifesaving during anaphylaxis and should be promptly used. Health care providers, however, need to be aware and vigilant of this rare complication of epinephrine.
Resynchronization Therapy During Sustained Ventricular Tachycardia
Authors: Sergio F Cossú
Journal: J Innov Card Rhythm Manag (2017)
Keywords: biventricular implantable cardioverter-defibrillator, resynchronization therapy, ventricular sense response, ventricular tachycardia
MeSH terms: Case Reports

A 62-year-old gentleman with a history of an ischemic cardiomyopathy and previous implantation of a biventricular cardioverter-defibrillator presented with complaints of palpitations and a wide complex ventricular paced rhythm at 120 bpm. This was originally thought to be ventricular tracking of an atrial tachycardia at the upper tracking rate, as the patient remained hemodynamically stable for three consecutive days in this rhythm. On the third day, the patient's implantable cardioverter-defibrillator (ICD) was interrogated and it was found that he was indeed in a sustained ventricular tachycardia with biventricular pacing being delivered as a function of the ventricular sense response feature. When this feature was turned off, the patient immediately deteriorated hemodynamically and required a commanded shock through the ICD to terminate the tachycardia. This is an extremely rare presentation of this pacing feature found in biventricular ICDs, which in this case provided significant hemodynamic benefit during a malignant arrhythmia.
Diagnosis of heterotopic pregnancy using ultrasound and magnetic resonance imaging in the first trimester of pregnancy: a case report
Authors: Sue Yazaki Sun, Edward Araujo Júnior, Julio Elito Júnior, Liliam Cristine Rolo, Felipe Favorette Campanharo, Stéphanno Gomes Pereira Sarmento, Luciano Marcondes Machado Nardozza, Antonio Fernandes Moron
Journal: Case Rep Radiol (2012)

Heterotopic pregnancy is a condition characterized by implantation of one or more viable embryos into the uterine cavity while another one is implanted ectopically, particularly into the uterine tube. Its occurrence has increased drastically over the last few years due to assisted reproduction procedures. In general, the diagnosis is made during the first trimester by using endovaginal two-dimensional ultrasound (2DUS), through observing a complex para- or retrouterine mass in association with a viable uterine pregnancy. However, under some conditions such as atypical ultrasonographic presentations, 2DUS does not clarify the situation whereas magnetic resonance imaging (MRI) of the pelvis is able to do so. We present the case of a pregnant woman in her fifth pregnancy, with a clinical condition of lower abdominal pain and pallor. Endovaginal 2DUS showed a complex voluminous mass in the left pelvic region in association with a viable intrauterine pregnancy. 2DUS in power Doppler mode showed "ring" vascularization, compatible with an ectopic gestational sac. MRI was of great importance in that it suggested that the mass had hematic content, which together with the clinical features, indicated that laparotomy should be performed. This surgical choice was essential for the woman to achieve a clinical improvement and for good continuation of the intrauterine pregnancy.
Angiojet System Used in the Treatment of Submassive Pulmonary Embolism: A Case Report of Two Patients
Authors: Jinbo Liu, Tianrun Li, Wei Huang, Na Zhao, Hongwei Zhao, Hongyu Wang
Journal: Case Rep Vasc Med (2022)
MeSH terms: Case Reports

Background:
Massive or submassive pulmonary embolism (PE) carries a high mortality. Percutaneous mechanical thrombectomy using the Angiojet system is accepted for the treatment of PE. Here, we reported two submassive PE cases who were treated with the Angiojet system successfully, to provide some advice for the therapy of submassive PE.
Method:
Two patients with suffocation were admitted to our hospital. One patient was accompanied by lower blood pressure (20% lower than basal blood pressure) and higher pulmonary artery pressure (89 mmHg); the other patient had larger right ventricular transverse diameter (46 mm), decreased left ventricular end diastolic anteroposterior diameter (34 mm), and higher heartbeats (107 heartbeats per minute). Pulmonary artery computed tomography angiography showed bilateral pulmonary embolism.
Result:
The Angiojet system with a high-pressure jet spray pattern (urokinase 25 wiu + sodium chloride injection 50 ml) was used. Intravascular thrombolysis by urokinase (100 wiu/day for 1 day) was done after being back in the ward. And low molecular weight heparin was used in hospitalization, and rivaroxaban was used after discharge. Both patients were treated successfully. However, the level of platelet was significantly lower in one patient after Angiojet system usage and recovered to the preoperative level the next day. Another patient suffered from bradyarrhythmias during the usage of Angiojet, and bradyarrhythmias disappeared when the Angiojet system stopped. Pulmonary embolism was cured after 3 months in both patients.
Conclusion:
Angiojet could be a simple, safe, and well-tolerated treatment for massive or submassive PE. And hematocrit, platelet, kidney function, and heart rhythm should be monitored during perioperation.
Genome sequence of a commensal bacterium, Enterococcus faecalis CBA7120, isolated from a Korean fecal sample
Authors: Joon Yong Kim, Hye Seon Song, Yeon Bee Kim, Joseph Kwon, Jong-Soon Choi, Yong-Joon Cho, Byung-Yong Kim, Jin-Kyu Rhee, Jinjong Myoung, Young-Do Nam, Seong Woon Roh
Journal: Gut Pathog (2016)
Keywords: comparative genomics, enterococcus faecalis, genome sequence, virulence factors
MeSH terms: Case Reports

Background:

Enterococcus faecalis, the type strain of the genus Enterococcus, is not only a commensal bacterium in the gastrointestinal tract in vertebrates and invertebrates, but also causes serious disease as an opportunistic pathogen. To date, genome sequences have been published for over four hundred E. faecalis strains; however, pathogenicity of these microbes remains complicated. To increase our knowledge of E. faecalis virulence factors, we isolated strain CBA7120 from the feces of an 81-year-old female from the Republic of Korea and performed a comparative genomic analysis.
Results:
The genome sequence of E. faecalis CBA7120 is 3,134,087 bp in length, with a G + C content of 37.35 mol%, and is comprised of four contigs with an N50 value of 2,922,046 bp. The genome showed high similarity with other strains of E. faecalis, including OG1RF, T13, 12107 and T20, based on OrthoANI values. Strain CBA7120 contains 374 pan-genome orthologous groups (POGs) as singletons, including "Phages, Prophages, Transposable elements, Plasmids," "Carbohydrates," "DNA metabolism," and "Virulence, Disease and Defense" subsystems. Genes related to multidrug resistance efflux pumps were annotated in the genome.
Conclusions:
The comparative genomic analysis of E. faecalis strains presented in this study was performed using a variety of analysis methods and will facilitate future identification of hypothetical proteins.
Management of COVID-19 in Kidney Transplant Recipients: A Single-Center Case Series
Authors: Maruhum Bonar H Marbun, Riahdo J Saragih, Tantika Andina
Journal: Int J Nephrol (2022)

Background:
Kidney transplant recipients (KTRs) were reported to be at higher risk of developing severe coronavirus disease-2019 (COVID-19). Despite being one of the most impacted countries, little is known about KTRs with COVID-19 in Indonesia. This report aims to explore the management strategies and short-term clinical outcomes of KTRs with COVID-19 in an Indonesian transplant center.
Methods:
We observed KTRs who were admitted following COVID-19 diagnosis. Anamnesis, physical, laboratory, and radiologic examinations were performed. Demographic and transplant histories were recorded, along with symptoms, vaccination status, and management related to COVID-19.
Results:
Nineteen KTRs were observed and 14 (73.6%) were male. The most common presenting symptoms were fever, cough, and shortness of breath. Nine (47.3%) KTRs had severe-critical COVID-19. The mortality rate was 42.1%. Acute kidney injury (AKI) was present in six (31.6%) of KTRs, five (83.3%) of whom were nonsurvivors. The median D-dimer level was higher in nonsurvivors (5,800 versus 670 μL), while other laboratory parameters were comparable. Seven (36.8%) KTRs were vaccinated. The mortality rates of vaccinated and unvaccinated KTRs were 14.2% and 70%, respectively. Antiviral therapy, anticoagulant, intravenous immunoglobulin, and tocilizumab were prescribed to 89.5%, 89.5%, 15.8%, and 10.5%, respectively. Immunosuppressive therapy (IST) was halted in 68% of KTRs, among which 61.5% passed away.
Conclusion:
The clinical presentation of COVID-19 in KTRs was similar to that in the general population, whereas the mortality rate was higher. Management strategies for KTRs with COVID-19 should include prevention of AKI and hypercoagulation. Vaccination seems to be beneficial for KTRs, while temporary withdrawal of IST does not.
Fracture of distal humerus: MIPO technique with visualization of the radial nerve
Authors: Daniel Romano Zogbi, Alberto Maranon Terrivel, Guilherme Grisi Mouraria, Maurício Leal Dias Mongon, Fernando Kenji Kikuta, Américo Zoppi Filho
Journal: Acta Ortop Bras (2014)
Keywords: diaphyses, humeral fractures, peripheral nerve injuries, radial nerve

Objectives:
To evaluate the outcomes in patients treated for humerus distal third fractures with MIPO technique and visualization of the radial nerve by an accessory approach, in those without radial palsy before surgery.
Methods:
The patients were treated with MIPO technique. The visualization and isolation of the radial nerve was done by an approach between the brachialis and the brachiorradialis, with an oblique incision, in the lateral side of the arm. MEPS was used to evaluate the elbow function.
Results:
Seven patients were evaluated with a mean age of 29.8 years old. The average follow up was 29.85 months. The radial neuropraxis after surgery occurred in three patients. The sensorial recovery occurred after 3.16 months on average and also of the motor function, after 5.33 months on average, in all patients. We achieved fracture consolidation in all patients (M=4.22 months). The averages for flexion-extension and prono-supination were 112.85° and 145°, respectively. The MEPS average score was 86.42. There was no case of infection.
Conclusion:
This approach allowed excluding a radial nerve interposition on site of the fracture and/or under the plate, showing a high level of consolidation of the fracture and a good evolution of the range of movement of the elbow. Level of Evidence IV, Case Series.
A Seropositive Nodular Rheumatoid Polyarthritis without Arthritis: Does It Exist?
Authors: Fatma Ben Fredj Ismail, Amel Rezgui, Monia Karmani, Olfa Ben Abdallah, Samira Azzebi, Chedia Laouani Kechrid
Journal: Case Rep Med (2012)
MeSH terms: Case Reports

The rheumatoid polyarthritis is the most frequent chronic polyarthritis. It affects essentially the woman between 40 and 60 years. Rheumatic subcutaneous nodules and tenosynovitis are usually associated with seropositive symptomatic rheumatoid polyarthritis. It is, however, rare that they constitute the essential clinical expression of the disease. In this case, it makes dispute another exceptional form of rheumatoid arthritis such as rheumatoid nodulosis. A 60-year-old woman was hospitalized for tumefaction of the dorsal face of the right hand evolving two months before. The clinical examination found subcutaneous nodules from which the exploration ended in rheumatoid nodules with tenosynovitis. The evolution after four years was favourable under corticosteroid therapy, methotrexate, and colchicine.
Sporadic Insulinoma as a Rare Cause of Recurrent Hypoglycemia in Children
Authors: Hedyeh Saneifard, Ahmad Khaleghnejad Tabari, Maryam Kazemi Aghdam, Mohadese Musavi Khorshidi, Ali Sheikhy
Journal: Case Rep Pediatr (2017)
MeSH terms: Case Reports

Insulinoma is a rare pancreatic tumor in children and adolescents. As a result of insulin hypersecretion, signs and symptoms are more commonly consequences of the pathophysiologic responses to hypoglycemia. According to rarity of this tumor in children and nonspecificity of clinical presentations, diagnosis of insulinoma in this group of patients is usually delayed. Early diagnosis is very important for preventing neurologic damage. In this case report, we present the case of a 10-year-old boy with signs and symptoms of hypoglycemia and final diagnosis of insulinoma.