OpenMed/multicare-articles huggingface dataset:
Pes Anserinus Syndrome Caused by Osteochondroma in Paediatrics: A Case Series Study
Authors: Akio Sakamoto, Shuichi Matsuda
Journal: Open Orthop J (2017)
Keywords: children, hereditary multiple exostoses, osteochondromas, paediatrics, pes anserinus syndrome, tibia

Introduction:
Osteochondroma is a common benign bone tumor, protruding from the underlying normal bone. Osteochondromas can cause pain depending on their location and size. The pes anserinus is located at the proximal medial side of the tibia, where the tendinous insertions of the sartorius, gracilis and semitendinosus muscles collectively attach. Pes anserinus syndrome, or anserine bursitis, is a painful condition of the pes anserinus, and is more common in adults typically with overweight females. The occurrence of pes anserinus syndrome is rare in the paediatric population.
Results:
In the current case series, five patients with pes anserinus syndrome due to proximal tibial osteochondroma are reported. Pain was present in all cases, with snapping in one case. The average age of the patients was 13 ± 1.2 years, ranging from 12 to 15 years. Three patients had a single osteochondroma, and two patients had hereditary multiple exostoses. The sizes of the osteochondromas on plain radiographs varied from 0.5 to 2.5 cm, with an average of 1.46 ± 0.83 cm. All lesions characteristically were located at the medial-posterior edge of the proximal tibia. The symptoms resolved in four cases with surgical resection, and persisted in one non-resected patient.
Conclusion:
The characteristic location of the osteochondroma causes pes anserinus syndrome, even though the lesion is small. The diagnosis of osteochondroma or pes anserinus syndrome may be overlooked when it occurs in a paediatric population. The symptoms seem to be consistent, and resection of the osteochondroma is necessary for treatment.
Use of recombinant human deoxyribonuclease in pediatric intensive care unit - a single-center experience
Authors: Daniel Meireles, Sofia Ribeiro Fernandes, Alzira Sarmento, Telma Barbosa, Manuel Ferreira Magalhães, Ana Ramos, Paula Cristina Fernandes
Journal: Rev Paul Pediatr (2021)
MeSH terms: Cystic Fibrosis, Deoxyribonuclease I, Case Reports, Child, Female, Humans, Infant, Intensive Care Units, Pediatric, Lung, Male, Recombinant Proteins, Respiration, Artificial, Respiratory Function Tests, Recombinant Proteins, Deoxyribonuclease I

Objective:
Dornase alfa (rhDNase) reduces the viscosity of purulent sputum in the lungs. The use in patients with cystic fibrosis (CF) is proven. However, the evidence of its applicability to other conditions is limited. This study aims to present the authors' experience with the use of rhDNase in non-CF patients admitted to the Pediatric Intensive Care Unit (PICU). At the study center, rhDNase was used during flexible bronchoscopies in 24 cases, of which 20 (83%) had atelectasis and seven (29%) were admitted to PICU. Four patients (57%) were on invasive mechanical ventilation (MV).
Case description:
Two cases of daily rhDNase administration at PICU are presented: patient A was an 8-year-old boy admitted with septic shock and acute respiratory distress syndrome (ARDS). The patient required mechanical ventilation with aggressive settings and experienced several clinical complications. On D50, he started rhDNase treatment with an improvement in FiO2, PaCO2 and PaO2/FiO2 ratio according to radiologic findings. He was extubated on D23 of treatment.Patient B was a 17-month-old girl admitted with a convulsive status epilepticus who experienced respiratory complications (infectious and barotrauma) with ARDS, requiring aggressive ventilation. She initiated rhDNase treatment on D60. During the treatment an improvement in FiO2, PaO2/FiO2 ratio and a tendency of PaCO2 decrease were found. She had radiological improvement. No complications were described.
Comments:
RhDNase may be a helpful and safe tool to use in PICU prolonged intubated patients with ventilator-induced lung injury. Further studies are needed to assess and propose valid indications.
Winging of Scapula due to a Sinister Etiology
Authors: Shania Niromi Gunasekera, Priyanka Yogananda, Harindra Karunatilaka, Bimsara Senanayake
Journal: Case Rep Neurol Med (2020)
MeSH terms: Case Reports

Background:
Scapular winging is a rare but disabling deformity, which is commonly caused by lesions of the long thoracic and spinal accessory nerves that innervate the serratus anterior and trapezius muscles, respectively. Across the literature, traumatic injury to the nerves account for the majority of cases. Less common, nontraumatic causes include viral illness, neuroinflammatory conditions, toxins, compressive lesions, and C7 radiculopathy. We present a case where an apical lung malignancy causes winging of scapula by infiltrating C5-C7 roots of brachial plexus, which has been reported only once in the literature.
Case:
A 54-year-old male presented with recent onset painful difficulty in raising his right arm. He had no respiratory or constitutional symptoms. On examination, winging of scapula on the right side was noted with wasting and fasciculation involving the ipsilateral shoulder girdle. Proximal muscle power of the right upper limb was of 3/5 with preserved distal muscle power. No sensory loss was noted. A patch of bronchial breathing was found in the upper zone of the right lung with multiple hard cervical lymphadenopathies. Chest X-ray and contrast-enhanced computerized tomography-chest revealed a large tumor in the upper lobe of the right lung, which was confirmed to be a carcinoma of the lung. Electromyogram revealed large motor unit potentials and poor activation of right serratus anterior and internal scapulae muscles, while nerve conduction studies concluded the presence of a compressive lesion involving C5-C7 nerve roots of brachial plexus. Histology of a biopsy of the cervical lymph node confirmed metastasis from a poorly differentiated adenocarcinoma of the lung. The patient denied further investigation with MRI cervical spine. He was transferred to the cancer institute for further treatment.
Conclusion:
This case highlights the value of considering a compressive lung pathology with infiltration in the differential diagnosis, when evaluating winging of scapula.
Recurrent Occipital Seizures with Transient MRI Changes
Authors: Mohankumar Kurukumbi, Allison Jacobs
Journal: Case Rep Neurol Med (2017)
MeSH terms: Case Reports

Peri-ictal magnetic resonance imaging (MRI) findings following seizure activity are a recognized phenomenon that is not well understood (Cole, 2004). Transient changes are not usually expected to be present in postictal MRI studies because of their rarity. Here, we present a unique case of peri-ictal MRI findings located in the occipital lobe, present in a 34-year-old female with recurrent occipital seizures occurring twice in four years. MRI changes completely resolved after both episodes with no residual focal damage. The peri-ictal occipital changes on MRI in this patient are unique because they have been captured on more than one occasion. Peri-ictal MRI findings are a known phenomenon with unknown pathophysiology, although attempts have been made to understand these findings. Though the MRI findings and presentation appear to be stroke-like or PRES-like, seizures should be kept in the differential for better treatment outcomes.
Aortic balloon valvuloplasty prior to orthotopic liver transplantation: a novel approach to aortic stenosis and end-stage liver disease
Authors: Edward Coverstone, Kevin Korenblat, Jeffrey S Crippin, William C Chapman, Andrew M Kates, Alan Zajarias
Journal: Case Rep Cardiol (2014)

The combination of severe aortic stenosis and end-stage liver disease increases the morbidity and mortality of surgical aortic valve replacement or orthotopic liver transplantation resulting in a prohibitive operative risk. We propose a staged approach of balloon aortic valvuloplasty prior to orthotopic liver transplantation as a bridge to definitive aortic valve replacement. Between 2010 and 2012, four patients with severe aortic stenosis and end-stage liver disease underwent staged balloon aortic valvuloplasty followed by orthotopic liver transplantation. All patients had been deemed to be inappropriate candidates for liver transplantation or aortic valve surgery due to their comorbidity. One patient died of complications from a perivalvular abscess. Three patients went on to successful graft implantation and function and surgical recovery. Two of the three patients proceeded to definitive surgical aortic valve replacement with the remainder currently undergoing evaluation. In this case series, we present a novel approach of balloon aortic valvuloplasty prior to liver transplantation as a potential bridge to definitive treatment of severe aortic stenosis in the end-stage liver patient.
Case Report: Leaflet Thrombosis After Transcatheter Aortic Valve Replacement With Worsening Heart Failure-A Successful Resolution Using Non-vitamin K Antagonist Oral Anti-coagulant
Authors: Kae-Woei Liang, Chu-Leng Yu, Wei-Wen Lin, Wen-Lieng Lee
Journal: Front Cardiovasc Med (2021)
Keywords: aortic valve stenosis (as), case report, leaflet thrombosis, non-vitamin k antagonist oral anti-coagulant, transcatheter aortic valve replacement (tavr), transcatheter heart valve
MeSH terms: Case Reports

Background: Transcatheter aortic valve replacement (TAVR) is indicated for treating symptomatic severe aortic valve stenosis (AS) with intermediate-to-high surgical risks. Few reports are available on managing leaflet thrombosis after TAVR with worsening heart failure. Case Summary: A 77-year-old man with severe AS and coronary artery disease (CAD) received a successful TAVR with Edwards Sapien 3 valve. A year later, the patient developed a worsening heart failure with pulmonary edema, new-onset atrial fibrillation (Af), an increase in mean trans-aortic valve pressure gradient to 48 mmHg, worsening mitral regurgitation (MR), and pulmonary hypertension (PH). The response of the patient to intravenous diuretics and inotropic treatments was poor. Multi-slice CT (MDCT) revealed hypo-attenuated thrombus and thickened transcatheter heart valve leaflets. A non-vitamin K antagonist oral anti-coagulant (NOAC) was added to treat the new-onset Af and leaflet thrombosis on top of the con-current single antiplatelet for CAD. A series of follow-up echocardiograms showed a progressive decrease in trans-aortic valve pressure gradient to 17 mmHg and reductions in MR and PH. Three months after the NOAC treatment, MDCT revealed the resolution of hypo-attenuated thrombus and thickened leaflets. Symptoms of heart failure were also improved gradually. Discussion: Worsening heart failure or an increase in trans-aortic valve pressure gradient after TAVR warranted further MDCT studies. Leaflet thrombosis can be resolved after using NOAC as in our present case.
Successful Management in an Infant Patient of PHACE Syndrome with a Complicated Aortic Arch Anomaly
Authors: Shun Suzuki, Mitsuru Seki, Koichi Kataoka, Reina Koga, Tomoyuki Sato, Masaaki Kawada, Takanori Yamagata
Journal: Case Rep Pediatr (2022)
MeSH terms: Case Reports

PHACE syndrome is a congenital disorder often associated with a cervicofacial infantile hemangioma and complicated cardiovascular malformations. Patients with PHACE syndrome often have complex aortic arch anomalies, longer aortic stenosis or agenesis segments, and increased vascular tortuosity; therefore, perioperative management and surgical repair are challenging. We report a case of a female infant with PHACE syndrome and complex cardiovascular anomalies such as a double aortic arch associated with interruption of the left aortic arch, coarctation of the right aortic arch, patent ductus arteriosus, ventricular septal defect, and atrial septal defect. She was born at 36 weeks of gestation (birth weight, 2,150 g) and the diagnosis was confirmed by three-dimensional computed tomography. Because her patent ductus arteriosus did not close at first, her heart failure was managed preoperatively without prostaglandin E 1. We initially attempted to promote weight gain. Surgical planning and simulation were performed using the patient-specific three-dimensional cardiovascular model created from computed tomography data. She underwent a successful aortic arch reconstruction by an end-to-side anastomosis with anterior patch augmentation at the age of 56 days. Detailed planning and simulation before surgery were vital in achieving favorable outcomes. Careful management and surgical planning using a patient-specific three-dimensional model are vital, especially in patients with complex malformations, such as in our case.
Case Report: Uterine Anomalies in Girls With a Congenital Solitary Functioning Kidney
Authors: Mark J C M van Dam, Bas S H J Zegers, Michiel F Schreuder
Journal: Front Pediatr (2021)
Keywords: müllerian anomalies, case series, clinical management, congenital anomalies of the kidney and urinary tract, solitary functioning kidney
MeSH terms: Case Reports

Unilateral renal agenesis and multicystic dysplastic kidney, resulting in a contralateral solitary functioning kidney (SFK), are part of the broad spectrum of congenital anomalies of the kidney and urinary tract (CAKUT). In girls with SFK, screening for asymptomatic Müllerian anomalies of uterus and vagina is not yet routinely performed, and therefore often overlooked until clinical complications in the menstrual cycle or fertility process occur. In this case series, we report on four teenagers with congenital SFK presenting with menstrual problems due to a Müllerian anomaly. Routine peri-menarchal screening for Müllerian anomalies in girls with SFK may provide timely counseling, surgical treatment and prevention of associated complications such as endometriosis, infertility and miscarriages.
The dangers of castor oil tea in neonates in rural Haiti: A case report
Authors: Wilhermine Jean Baptiste, Michelucia Casseus, Alka Dev, Patrice Joseph, Peter F Wright
Journal: Front Pediatr (2023)
Keywords: haiti, castor oil, neonatal, ricin, sepsis, toxin
MeSH terms: Case Reports

During a 2-year period, eight cases of a distinct illness were seen among 1,424 neonates admitted to a newly established neonatal care unit in southern Haiti. The newborns presented with a picture of sepsis with shock, vomiting, hypotonia, lethargy, and abdominal distention. Five cases proved fatal and another case left the hospital against advice in extremis with little chance of survival. In each case, the illness was associated with a history of ingestion of teas that included castor oil, known as lok in Haitian Creole. The presumptive cause of the illness was established by the presence of a dark, oily substance in drainage from the nares and nasogastric tubes and by subsequent admission on direct questioning of the caregivers, who said that the infants had been given large amounts of lok. The castor oil tea had been given to three infants in the immediate neonatal period where its use is attributed to encouraging the passage of meconium. The five remaining infants were between 15 and 30 days of life when they were given lok shortly before admission to the neonatal unit for treatment of an undefined illness. All of them were term infants with no identified risks at birth. As nasogastric tubes are not routinely placed in sick neonates, and the parents did not volunteer information about lok administration, the practice may be more widespread than that recorded here. Although our data are confined to observations in Haiti, the use of traditional medicines is a globally widespread phenomenon. Attention must be drawn to the potential toxicity of such preparations and means found to ban their use in neonates.
A case of newly diagnosed klippel trenaunay weber syndrome presenting with nephrotic syndrome
Authors: Egemen Cebeci, Secil Demir, Meltem Gursu, Abdullah Sumnu, Mehmet Yamak, Barıs Doner, Serhat Karadag, Sami Uzun, Ahmet Behlul, Oktay Ozkan, Savas Ozturk
Journal: Case Rep Nephrol (2015)

Klippel Trenaunay Weber syndrome (KTWS) is a rare disease characterized by hemihypertrophy, variceal enlargement of the veins, and arteriovenous (AV) malformations. Renal involvement in KTWS is not known except in rare case reports. Herein, we present a case of KTWS with nephrotic syndrome. A 52-year-old male was admitted due to dyspnea and swelling of the body for the last three months. The pathological physical findings were diffuse edema, decreased lung sounds at the right basal site, increased diameter and decreased length of the left leg compared with the right one, diffuse variceal enlargements, and a few hemangiomatous lesions on the left leg. The pathological laboratory findings were hypoalbuminemia, hyperlipidemia, increased creatinine level (1.23 mg/dL), and proteinuria (7.6 g/day). Radiographic pathological findings were cystic lesions in the liver, spleen, and kidneys, splenomegaly, AV malformation on the left posterolateral thigh, and hypertrophy of the soft tissues of the proximal left leg. He was diagnosed to have KTWS with these findings. Renal biopsy was performed to determine the cause of nephrotic syndrome. The pathologic examination was consistent with focal segmental sclerosis (FSGS). He was started on oral methylprednisolone at the dosage of 1 mg/kg and began to be followedup in the nephrology outpatient clinic.
Hemangiosarcoma in a Dog: Unusual Presentation and Increased Survival Using a Complementary/Holistic Approach Combined with Metronomic Chemotherapy
Authors: Philip Chaikin, Anja Welihozkiy
Journal: Case Rep Vet Med (2018)
MeSH terms: Case Reports

This case report documents the clinical and pathologic findings in a 12-year-old terrier mix with intraocular and splenic hemangiosarcoma. Pathologic findings in both the spleen and globe were consistent with hemangiosarcoma with a low mitotic count. Initial treatment consisted of enucleation and then splenectomy followed by one cycle of conventional doxorubicin chemotherapy. Due to poor tolerance, a subsequent treatment regimen consisted of metronomic chemotherapy with chlorambucil combined with an alternative/complementary regimen of I'm-Yunity (polysaccharopeptide) and Yunnan Baiyao. Follow-up thoracic radiographs and abdominal ultrasounds over a period of 24 months showed no evidence of pulmonary, hepatic, or right atrial metastases, during which time the patient had an excellent quality of life. However, shortly after achieving two-year survival, the patient developed new onset seizures unresponsive to anticonvulsant therapy. Therefore, a decision was made to euthanize the dog given that the most likely etiology of the seizures was a brain tumor. Overall, this is an exceptional treatment response given the poor survival statistics of hemangiosarcoma even with conventional chemotherapy. However, additional clinical pharmacology and clinical trial data are needed to further support the use of a complementary/holistic approach in combination with metronomic chemotherapy.
Anaphylactic shock due to patent blue: case report and review of literature
Authors: Asma Korbi, Amel Khaskhoussy, Ons Cherif, Ahmed Hajji, Imen Gaddab, Amel Chaabene, Mouna Gara, Fathi Jbeli, Lotfi Grati, Med Salah Rhim, Raja Faleha
Journal: Pan Afr Med J (2018)
Keywords: breast cancer, allergic reaction, anaphylactic shock, patent blue, sentinel lymph node
MeSH terms: Anaphylaxis / etiology, Coloring Agents / adverse effects, Rosaniline Dyes / adverse effects, Case Reports, Review, Anaphylaxis / immunology, Anaphylaxis / therapy, Coloring Agents / administration & dosage, Drug Eruptions / etiology, Drug Eruptions / immunology, Female, Humans, Middle Aged, Rosaniline Dyes / administration & dosage, Rosaniline Dyes / immunology, Coloring Agents, Rosaniline Dyes, sulfan blue

Intraoperative search for the sentinal node using patent blue is considered a non risk procedure. We emphasize the highly exceptional nature of this adverse effect previously observed in other disciplines using this coloring agent. We present a case of allergic reaction to patent blue in a patient who underwent left mastectomy with sentinel lymph node. About 25 min after the dye injection, the patient developed increased heart frequency and allergic skin reaction. The patient was treated successfully with decreased inspired fraction of inhaled anesthetic and fluid replacement. The patient recovered uneventfully and was discharged from the PACU 3h after the end of surgery without skin changes and was discharged from hospital on the morning after surgery. Allergic reactions with the use of patent blue are far superior to the hypersensitivity reactions seen with anesthetic and adjuvant drugs. Therefore, the anesthesiologist must be aware of cardiovascular instability associated with skin changes during the use of patent blue, for early diagnosis and appropriate treatment of this hypersensitivity reaction to this dye. Skin tests done later confirmed allergy to patent blue dye; the tests induced a small syndrome reaction. Surgical personnel who use patent blue dye should be made aware of the risk of allergic reactions, sometimes severe, to this dye.
Acute panmyelosis with myelofibrosis - a rare subtype of acute myeloid leukemia
Authors: Tathagata Chatterjee, Srishti Gupta, Ajay Sharma, Sanjeevan Sharma, Devika Gupta
Journal: Mediterr J Hematol Infect Dis (2013)
MeSH terms: Case Reports

One case of acute panmyelosis with myelofibrosis (APMF) is here reported. A 45 year old male presented with abrupt onset of rapidly progressing low backache, weakness and pancytopenia. On examination there was no organomegaly. Peripheral blood examination revealed normocytic normochromic red blood cells with 10% circulating blasts. Flowcytometric examination of peripheral blood revealed blasts which were positive for CD34, HLA- DR and myeloid associated antigens (i.e. CD13 and CD33). Blasts were negative for anti MPO. Bone marrow aspirate resulted in a dry tap. Bone marrow biopsy revealed panmyeloid proliferation with scattered blasts which were CD34 positive on imunohistochemistry and negative for anti MPO. Reticulin stain showed grade III myelofibrosis (WHO). Differential diagnosis considered included AML-M7, MDS-RAEB II and AML with myelodysplasia. He was started on chemotherapy [idarubicin and cytarabine; 3+7 induction regimen followed by three cycles of HIDAC (High dose cytosine arabinoside)] after which patient was in complete morphological remission with markedly reduced bone marrow fibrosis. He is now being worked up for allogeneic stem cell transplantation. Patient is asymptomatic at eight months of diagnosis. In conclusion these patients should be managed aggressively with AML therapy and this case report reaffirms the fact that APMF is subtype of AML.