OpenMed/multicare-articles huggingface dataset:
Needle EMG induced muscle bleeding complication after guideline approved discontinuation of anticoagulation
Authors: Michael Bartl, Arne Krahn, Joachim Riggert, Walter Paulus
Journal: Clin Neurophysiol Pract (2021)
Keywords: anticoagulation, bleeding, electromyography, non-steroidal anti-inflammatory drugs
MeSH terms: Case Reports

Introduction:
Needle electromyography (EMG) is an essential part of electrodiagnosis (EDX) in neuromuscular disorders. As in all invasive procedures there is a risk of bleeding complications, but which is rare according to the current literature. Controlled, prospective studies that include patients under anticoagulation or antiplatelet therapy are lacking and would be difficult to conduct.
Case reports:
We describe two patients with no history of coagulopathy who developed an intramuscular hematoma after needle EMG. They had been under therapeutic anticoagulation but this had been discontinued, and their standard coagulation parameters had returned to normal prior to the EMG. One patient was found to have a rare genetic defect in thromboxane synthesis with associated markedly impaired platelet aggregation, while no obvious cause of the bleeding was found in the second patient. However, it could have been due to an unexpectedly strong anticoagulatory response to the oral anticoagulant apixaban.
Conclusion:
One must be aware of the increased risk of bleeding events in patients with therapeutic anticoagulation. These can occur even when the recommendations regarding discontinuation of anticoagulant drugs for the procedure have been followed. The patient must be actively questioned for ongoing use of NSAIDs, and if pain therapy is required alternatives with no antiplatelet activity should be given. A larger data pool of adverse EMG events would aid in risk assessment and decision making.
Recurrent Acute Neurogenic Pulmonary Edema after Uncontrolled Seizures
Authors: Daniel C Sacher, Erika J Yoo
Journal: Case Rep Pulmonol (2018)
MeSH terms: Case Reports

Acute pulmonary edema following significant injury to the central nervous system is known as neurogenic pulmonary edema (NPE). Commonly seen after significant neurological trauma, NPE has also been described after seizure. While many pathogenic theories have been proposed, the exact mechanism remains unclear. We present a 31-year-old man who developed recurrent acute NPE on two consecutive admissions after experiencing witnessed generalized tonic-clonic (GTC) seizures. Chest radiographs obtained after seizure during both admissions showed bilateral infiltrates which rapidly resolved within 24 hours. He required intubation on each occasion, was placed on lung protective ventilation, and was successfully extubated within 72 hours. There was no identified source of infection, and no cardiac pathology was thought to be contributory.
Case report: Intrapulmonary tidal volumes in a preterm infant with chest wall rigidity
Authors: Vincent D Gaertner, Tanja Restin, Dirk Bassler, Jean-Claude Fauchère, Christoph M Rüegger
Journal: Front Pediatr (2022)
Keywords: case report, chest wall rigidity, electrical impedance tomography, endotracheal intubation, preterm infant, wooden chest syndrome
MeSH terms: Case Reports

Background:
Chest wall rigidity is a known side effect of fentanyl use, which is why fentanyl is usually combined with a muscle relaxant such as mivacurium. Verifying endotracheal intubation is difficult in case of a rigid chest wall.
Case presentation:
We present the case of a preterm infant (29 completed weeks gestation, birth weight 1,150 g) with a prolonged chest wall rigidity after fentanyl administration for intubation despite adequate doses of mivacurium. This resulted in a pronounced desaturation without any effect on heart rate. Clinically, the infant showed no chest wall movement despite intubation and common tools to verify intubation (including end-tidal carbon dioxide measurement and auscultation) were inconclusive. However, using electrical impedance tomography (EIT), we were able to demonstrate minimal tidal volumes at lung level and thereby, EIT was able to accurately show correct placement of the endotracheal tube.
Conclusions:
This case may increase vigilance for fentanyl-induced chest wall rigidity in the neonatal population even when simultaneously administering mivacurium. Higher airway pressures exceeding 30 mmHg and the use of μ-receptor antagonists such as naloxone should be considered to reverse opioid-induced chest wall rigidity. Most importantly, our data may imply a relevant clinical benefit of using EIT during neonatal intubation as it may accurately show correct endotracheal tube placement.
Multidisciplinary Approach in the Management of a Complex Case: Implant-Prosthetic Rehabilitation of a Periodontal Smoking Patient with Partial Edentulism, Malocclusion, and Aesthetic Diseases
Authors: Alessandro Lanza, Fabrizio Di Francesco, Gennaro De Marco, Fabio Scognamiglio, Valeria Aruta, Angelo Itro
Journal: Case Rep Dent (2017)
MeSH terms: Case Reports

Complex periprosthetic cases are considered as challenges by clinicians. Clinical and radiographic parameters should be considered separately to make the right choice between an endodontically or periodontally compromised treated tooth and implant. Therefore, in order to decide whether the tooth is safe or not, data that have to be collected are specific parameters of both the patient and the clinician. In addition, the presence of periodontal, prosthetic, and orthodontic diseases requires patients to be set in multidisciplinary approach. The aim of this case report is to describe how the multidisciplinary approach could be the best way to manage difficult cases of implant-prosthetic rehabilitation. How to rehabilitate with fixed prosthesis on natural teeth and dental implants a smoker patient who presents with active periodontitis, multiple edentulous areas, dental malocclusion, and severe aesthetic problems was also described.
Multifactorial Etiology Pulmonary Hypertension in a Patient with Sarcoidosis
Authors: Barreto Ana Terra Fonseca, Barreto Lucas Vinícius da Fonseca, Cavalcante Felipe Naze Rodrigues, Oliveira Joselina Luzia Menezes, Almeida-Santos Marcos Antônio, Garcez Juliane Dantas Seabra, Barreto-Filho José Augusto Soares, Sousa Antônio Carlos Sobral
Journal: Case Rep Cardiol (2016)

Differential diagnosis between pre- and postcapillary pulmonary hypertension (PH) in patients with diastolic heart failure (DHF) is a challenge in clinical practice. The presence of PH is implicated in worse prognosis in patients with this disease. This case report approaches the process of investigation of pulmonary hypertension in adult patient with DHF, double mitral lesion, and sarcoidosis with poor clinical outcome.
Catamenial cyclic vomiting syndrome responding to oestrogen therapy: an adolescent case report
Authors: Moulay El Mehdi El Hassani, Benali Saad, Moukit Mounir, Jaouad Kouach, Driss Moussaoui Rahali
Journal: Pan Afr Med J (2019)
Keywords: cyclic vomiting syndrome, catamenial migraine, menstrual period, oestrogen
MeSH terms: Estrogens / administration & dosage, Menstrual Cycle / physiology, Vomiting / drug therapy, Case Reports, Adolescent, Female, Follow-Up Studies, Humans, Treatment Outcome, Estrogens, Familial cyclic vomiting syndrome

Cyclic vomiting syndrome (CVS) is defined by episodes of vomiting lasting from a few hours to several days, alternating with periods of no symptoms. Various symptoms can be associated with vomiting such as nausea, migraine or abdominal pain. Common triggers of CVS include infection, psychological stress and menstruation. CVS's diagnosis requires exclusion of alternative diseases particularly neurological and gastrointestinal. CVS shares many common features with catamenial migraine including treatment. We herein report a case of CVS in a 16 years old girl characterized by stereotypical vomiting attacks occurring in every menstrual period. Recurrent vomiting episodes began 2 years before admission. Given the negativity of paraclinical exams and the absence of response to different therapeutic approaches as well as the similarity with catamenial migraine, we treated our patient with permenstrual percutaneous oestrogen for six months. The evolution was marked by the disappearance of symptoms within the first month and the absence of their recurrence after treatment cessation during a follow-up of 6 years.
An unusual case of Cowden syndrome associated with ganglioneuromatous polyposis
Authors: Steffen Pistorius, Barbara Klink, Jessica Pablik, Andreas Rump, Daniela Aust, Marlene Garzarolli, Evelin Schröck, Hans K Schackert
Journal: Hered Cancer Clin Pract (2016)
Keywords: colon cancer, cowden syndrome, ganglioneuromatous polyposis, pten germline mutation
MeSH terms: Case Reports

Background:
Ganglioneuromatous polyposis (GP) is a very rare disorder which may be associated with other clinical manifestations and syndromes, such as Cowden syndrome, multiple endocrine neoplasia (MEN) type II and neurofibromatosis (NF) 1. The risk for malignant transformation of ganglioneuromas is unknown, and the combination of GP with colon cancer has been only very seldom reported.
Methods and results:
We report the case of a 60-year old male patient with adenocarcinoma, adenomas and lipomas of the colon and multiple gastroduodenal lesions combined with generalised lipomatosis and macrocephaly. Based on the initial endoscopic and histological findings, a (restorative) proctocolectomy was recommended but declined by the patient. Instead, a colectomy was performed. The histological examination revealed an unforeseen GP in addition to the colon cancer. Extensive molecular diagnostics allowed for the differential diagnosis of the causes of the clinical manifestations, and the clinical suspicion of Cowden syndrome could not be confirmed using Sanger Sequencing and MLPA for the analysis of PTEN. Finally, a pathogenic germline mutation in PTEN (heterozygous stop mutation in exon 2: NM_000314 (PTEN):c.138C > A; p.Tyr46*) could be detected by next-generation sequencing (NGS), confirming an unusual presentation of Cowden syndrome with GP.
Conclusions:
Cowden syndrome should be considered in cases of GP with extracolonic manifestation and verified by combined clinical and molecular diagnostics. Because GP may represent a premalignant condition, a surgical-oncological prophylactic procedure should be considered. Based on our experience, we recommend early implementation of Panel NGS rather than classical Sanger sequencing for genetic diagnostics, especially if various diagnoses are considered.
Case Report: Application of Mixed Reality Combined With A Surgical Template for Precise Periapical Surgery
Authors: Tingting Jia, Bo Qiao, Yipeng Ren, Lejun Xing, Baichen Ding, Fang Yuan, Qiang Luo, Hongbo Li
Journal: Front Surg (2022)
Keywords: 3d printed templates, mr, apical microsurge, chronic apical periodontitis, diagnose, prognosis
MeSH terms: Case Reports

Objective:
The etiology of apical diseases is diverse, and most are due to incomplete root canal therapy. The common clinical manifestations include gingival abscess, fistula and bone destruction. The currently existing limitation of procedures is that surgeons cannot visually evaluate the surgical areas. We sought to combine mixed reality (MR) technology with a 3-dimensional (3D) printed surgical template to achieve visualization in apical surgery. Notably, no reports have described this application.
Methods:
We created visual 3D (V3D) files and transferred them into the HoloLens system. We explained the surgical therapy plan to the patient using a mixed reality head-mounted display (MR-HMD). Then, the 3D information was preliminarily matched with the operative area, and the optimal surgical approach was determined by combining this information with 3D surgical guide plate technology.
Results:
We successfully developed a suitable surgical workflow and confirmed the optimal surgical approach from the buccal side. We completely exposed the apical lesion and removed the inflammatory granulation tissue.
Conclusion:
We are the first group to use the MR technique in apical surgery. We integrated the MR technique with a 3D surgical template to successfully accomplish the surgery. Desirable outcomes using minimally invasive therapy could be achieved with the MR technique.
A Case of Impalement Brain Injury That Could Achieve Good Neurological Outcome by Introducing Early Sedation and Immobilization Strategy
Authors: Wataru Takayama, Kaho Yamasaki, Akira Endo, Yasuhiro Otomo
Journal: Case Rep Emerg Med (2018)
MeSH terms: Case Reports

Impalement brain injury is rare, and the initial management of this condition is not well-established. We present a case of a well-managed brain injury caused by impalement with a metal bar. A 29-year-old man whose head had been impaled by a metal bar was transferred to our hospital. Upon arrival, he was agitated, with an unsteady gait and prominent odor of alcohol on his breath. He exhibited normal vital signs and neurological findings, except for his level of consciousness. To address the risk of secondary brain injury caused by movement of the foreign body, we immediately administered a sedative agent and muscle relaxant after the initial neurological evaluation. The imaging evaluation revealed the insertion of a metal bar into the right frontal lobe at a depth of >100 mm through the frontal bone; however, there was no apparent major vessel injury-related complication. Three hours after arrival at the hospital, a craniotomy was performed to remove the foreign body. The patient's postoperative course was uneventful, and he was discharged after rehabilitation without any neurological deficits. The strategy of immediate immobilization to prevent the secondary brain injury is important in the initial management of a patient who has survived an impalement brain injury and presented to an emergency department.
Mycobacterium Bovis Spondylodiscitis: A Rare Complication of Intravesical Bacillus Calmette-Guérin Therapy
Authors: Frédéric Quatannens, Peter Matthys, Charles-Edouard Heylen
Journal: J Belg Soc Radiol (2022)
Keywords: bcg therapy, mycobacterium bovis, spondylodiscitis
MeSH terms: Case Reports

Teaching point: Mycobacterium bovis spondylodiscitis is a rare, often delayed, complication of intravesical Bacillus Calmette-Guérin therapy for bladder cancer.
Unusual presentation of an usual condition-cystic ganglionosis
Authors: Anuradha Rao, Srivalli Nandikoor, Govindarajan Mallarajapatna, Prabhu Meghanathan
Journal: BJR Case Rep (2015)
MeSH terms: Case Reports

Cystic ganglionosis is an unusual benign condition, which presents as multiple ganglion cysts involving multiple joints. The case we report here is probably the first case of an adult reported in the literature. The only other case of multiple ganglion cysts reported in the literature is that of an 11-year-old child with ganglion cysts in multiple joints. A 57-year-old female presented with an approximately 4-year history of pain and swelling below the left knee and in the right hand. An MRI of the left knee showed multiloculated cystic-intensity lesions around the knee joint with intra-/extra-articular and intraosseous components. Similar lesions were noted around the right knee joint, right wrist and ring finger. With all the above findings and in view of multiple joint involvement, the possibility of cystic ganglionosis or multiple giant ganglion cysts was considered and confirmed by biopsy of one of the knee lesions. It is because of this rarity and the unusual presentation involving multiple joints that we have reported this case. The importance of the diagnosis is that unnecessary surgical intervention and hospitalization can be avoided, provided the patient's symptoms are not severe.
A Chromosomal Deletion and New Frameshift Mutation Cause ARSACS in an African-American
Authors: Sean C Dougherty, Amy Harper, Hind Al Saif, Gregory Vorona, Scott R Haines
Journal: Front Neurol (2018)
Keywords: arsacs, charlevoix-saguenay, ataxia, cerebellum, neurogenetics, polyneuropathy, retina, spasticity
MeSH terms: Case Reports

Autosomal Recessive Spastic Ataxia of Charlevoix-Saguenay (ARSACS) is a rare, progressive, neurodegenerative disease characterized by ataxia, spasticity and polyneuropathy. First described in the French-Canadian population of Quebec in 1978, ARSACS has since been identified in multiple patients worldwide. In this clinical case report, we describe the evaluation of an 11-years-old African-American male who presented to neuromuscular clinic for assessment of a gait abnormality. He had a history of gross motor delay since early childhood, frequent falls and a below average IQ. Chromosomal microarray revealed a 1.422 megabase loss in the 13q12.12 region, which includes the SACS gene. Next Generation Sequencing then showed a novel, predicted to be pathogenic missense mutation (c.11824dup) of this gene. His clinical presentation and neurological imaging further confirmed the diagnosis of ARSACS. To our knowledge, this is the first reported case of this disease in the African-American population of the United States. This case report further highlights the growing trend of identifying genetic diseases previously restricted to single, ethnically isolated regions in many different ethnic groups worldwide.
Triplane Fracture of the Proximal Tibia: A Case Report and Literature Review
Authors: Jason Strelzow, Alexander Aarvold, Christopher W Reilly
Journal: Case Rep Orthop (2017)
MeSH terms: Case Reports

Background:
The triplane fracture, a unique transitional physeal injury, is classically described in the distal tibia. A small number of additional anatomic locations are documented in the orthopaedic literature.
Methods:
Available literature surrounding triplane fractures was reviewed. We describe a rare case of a proximal tibial triplane fracture in a thirteen-year-old girl, suffered during a skiing accident.
Results:
Using arthroscopically assisted percutaneous reduction techniques an anatomic reduction was achieved.
Conclusion:
We outline the surgical and postoperative techniques for management of this unique injury.
Two Cases of Primary Testicular Lymphoma Presenting with Direct Spread along the Spermatic Cord and Gonadal Vessels
Authors: Mostafa Ellatif, Raekha Kumar, Alexander Weller, David Katz, Eirini Vrentzou
Journal: Case Rep Radiol (2019)
MeSH terms: Case Reports

Primary testicular lymphoma is a rare testicular neoplasm that mainly affects elderly patients, with Human Immunodeficiency Virus (HIV) being a known risk factor in the younger population. Approximately 20% of patients will have disseminated disease with extra-nodal involvement at clinical presentation. Rarely, direct spread along the spermatic cord and gonadal vessels can occur and has been described in the literature. We present two cases of this phenomenon where the primary testicular tumour has spread along the gonadal vein to its origin at the inferior vena cava.
Multilocular lipoma of the left thumb of the hand: a case report
Authors: Ahmed Wafiq Wafa, Shabir Wani, Tuqa A Alsinan, Sarah Alkhonizy
Journal: Case Reports Plast Surg Hand Surg (2021)
Keywords: benign lipoma, hand surgery, lipoma of the thumb, plastic surgery, soft-tissue lipoma
MeSH terms: Case Reports

Lipoma is a benign soft tissue tumor that is mostly found in the trunk, however, lipomas of the thumb are rarely reported, around 1% of cases. We report a case of a Saudi male aged 32-year-old who presented with a progressive left thumb swelling for a long time. The aim is to add more cases to the literature and to consider it as a differential.
Pulmonary Aspergillosis in a Previously Healthy 13-Year-Old Boy
Authors: Jonathan H Rayment, Indra Narang
Journal: Can Respir J (2016)
MeSH terms: Pulmonary Aspergillosis / diagnostic imaging, Case Reports, Adolescent, Aspergillus fumigatus / isolation & purification, Child, Humans, Male, Pulmonary Aspergillosis / microbiology, Radiography, Thoracic

Chronic granulomatous disease (CGD) is a rare, polygenic primary immunodeficiency. In this case report, we describe a previously healthy 13-year-old boy who presented with multifocal pulmonary aspergillosis and was subsequently diagnosed with an autosomal recessive form of chronic granulomatous disease. CGD has a variable natural history and age of presentation and should be considered when investigating a patient with recurrent or severe infections with catalase-positive organisms.
Hereditary Hemorrhagic Telangiectasia Presenting as High Output Cardiac Failure during Pregnancy
Authors: Tareq Goussous, Alex Haynes, Katherine Najarian, Marcos Daccarett, Shukri David
Journal: Cardiol Res Pract (2009)
MeSH terms: Case Reports

High-output cardiac failure secondary to hepatic involvement is a rare complication of hereditary hemorrhagic telangiectasia (HHT). Here we report a 43-year-old woman who presented at 29 weeks gestation of her second pregnancy with complications of right-sided heart failure and preterm labor. After delivery via cesarean section, the patient was found to have intrahepatic arteriovenous malformations through non-invasive imaging. Subsequently, a family history of vascular malformations and epistaxis was elucidated and a diagnosis of HHT was made. This case is presented, along with a review of the literature and discussion of hepatic involvement in HHT with particular focus on the pregnant patient.
Spontaneous reattachment of a posteriorly dislocated endothelial graft: a case report
Authors: Ka Wai Kam, Alvin L Young
Journal: Case Rep Transplant (2013)

A thirty-year-old Chinese man with a history of severe trauma to his right eye, with secondary sectoral aniridia and multiple operations including intraocular lens insertion more than fifteen years ago, underwent an uneventful Descemet's Stripping Automated Endothelial Keratoplasty (DSAEK) for his pseudophakic bullous keratopathy in a tertiary hospital in Hong Kong. The nature of his previous operations was unknown to the surgeon at the time of transplant. On postoperative day one, the graft was not present in the anterior chamber. Fundal view was limited because of corneal oedema. B-scan ultrasonography could not detect any definite presence of a donor button in the posterior segment as gas was present in the vitreous cavity. The patient was instructed to lie prone full time, and on postoperative day three, the graft was found to be reattached to the stroma with spontaneous resolution of corneal oedema, indicating restoration of pump function of endothelium graft. This is the first case of spontaneous reattachment of a posteriorly dislocated endothelial graft without surgical intervention or abandonment of the grafted endothelial button.
Circular Abscess Formation of the Inner Preputial Leaf as a Complication of a Penile Mondor's Disease: The First Case Report
Authors: Johann Jakob Wendler, Daniel Schindele, Daniel Baumunk, Uwe-Bernd Liehr, Markus Porsch, Martin Schostak
Journal: Case Rep Urol (2014)

Introduction. Mondor's disease of the penis is an uncommon condition characterized by thrombosis or thrombophlebitis involving the superficial dorsal veins. An accompanied lymphangitis is discussed. There is typical self-limiting clinical course. Case Presentation. This paper firstly reports a secondary abscess formation of the preputial leaf two weeks after penile Mondor's disease and subcutaneous lymphangitis as complication of excessive sexual intercourse of a 44-year-old man. Sexual transmitted diseases could be excluded. Lesions healed up completely under abscess drainage, antibiotic, and anti-inflammatory medication. Conclusion. Previous reports in the literature include several entities of the penile Mondor's disease. Our patient is very unusual in that he presented with a secondary preputial abscess formation due to superficial thrombophlebitis, subcutaneous lymphangitis, and local bacterial colonisation. Abscess drainage plus antiphlogistic and antibiotic medication is the treatment of choice.