OpenMed/multicare-articles huggingface dataset:
An Unusual Case of Radicular Pain Caused by Bilateral Lumbar Synovial Cyst: A Case Report and Review of the Literature
Authors: David Ruiz-Picazo, José Ramírez-Villaescusa, Ana Verdejo-González
Journal: Case Rep Orthop (2020)
MeSH terms: Case Reports

Introduction:
Spinal synovial cysts (SSCs) constitute an uncommon degenerative lesion of the spine. They are usually asymptomatic but they may also cause symptoms of variable severity. SSCs are benign growths adjoining the facet joints that may induce low back pain, lumbar radiculopathy, and neurological deficit. There are different treatment options that range from conservative management to interventions like image-guided epidural steroid injection or direct cyst puncture and finally to open or endoscopic spinal canal decompression and spinal bone fusion with/without instrumentation. A discussion of current management options for this unusual disease is presented. Material and Methods. A 52-year-old female patient presented with low back pain and left leg pain. Plain radiography demonstrated instability at the L4-L5 level. Magnetic resonance images (MRIs) revealed a bilateral cystic lesion at the L4-L5 level with associated instability and degenerative disc disease at the level L5-S1. Initially, conservative treatment was performed by aspiration of the left cyst and infiltration with corticosteroids with improvement of the pain for 1 year. After this period, the radicular and the low back pain reoccurred.
Results:
Following leg pain recurrence, a hybrid L4-S1 fusion was performed. After surgery, there was clinical improvement and six months later, the patient returned to daily activities. The radiological study after five-year follow-up shows adequate implant position, without signs of loosening, compatible with solid fusion.
Conclusion:
After reviewing the literature, the optimal management for patients with symptomatic lumbar synovial cyst must be very individualized, which is essential to achieve a favorable outcome.
Adhesive bowel obstruction? Not always
Authors: D Mittapalli, B J Sebastian, E Leung, N Barnes, P S P Senapati
Journal: J Emerg Trauma Shock (2011)
Keywords: adhesion, non-hodgkins lymphoma, intestinal lymphoma, small bowel obstruction
MeSH terms: Case Reports

A 58-year-old man presented acutely with features of post-surgical adhesive small bowel obstruction. Following an unsuccessful trial of conservative management, computed tomography (CT) of the abdomen was performed. This revealed a mass in the ileocaecal region, for which he underwent a subsequent right hemicolectomy. Histology revealed diffuse B-cell Non-Hodgkin's lymphoma of the terminal ileum. Confounding obstructive lesion of the intestine in patients with a history of previous laparotomy is extremely uncommon. Early high resolution imaging may predict diagnosis and consolidate clinical management plans.
Case Report: Safe and Effective Sublingual Birch Allergen Immunotherapy in Two HIV-Positive Patients
Authors: Elena Latysheva, Evgeniya Nazarova, Tatiana Latysheva, Natalia Ilina
Journal: Front Immunol (2021)
Keywords: hiv positive, allergen immunotherapy, birch allergen, case report, sublingual
MeSH terms: Desensitization, Immunologic / methods, HIV Infections / therapy, Rhinitis, Allergic, Seasonal / therapy, Case Reports, Research Support, Non-U.S. Gov't, Administration, Sublingual, Adult, Allergens / immunology, Betula / immunology, Drug-Related Side Effects and Adverse Reactions, Female, HIV Infections / immunology, HIV-1 / physiology, Humans, Male, Middle Aged, Pollen / immunology, Rhinitis, Allergic, Seasonal / immunology, Treatment Outcome, Allergens

Allergen-specific immunotherapy (AIT) is a safe, effective treatment for respiratory allergies (such as moderate-to-severe allergic rhinoconjunctivitis) that are not controlled by symptomatic medications. The indications and contraindications for AIT have been defined in international guidelines and consensus statements. However, some of these contraindications are not evidenced- based but have been deduced from the theoretical risk of an interaction between AIT disease-modifying effect and immune or inflammatory comorbidities. In the absence of clinical trial evidence, the accumulation of experience as case reports can narrow the spectrum of absolute contraindications. The majority of international guidelines list HIV infection as a contraindication to AIT. Here, we describe two cases of safe, effective sublingual birch pollen AIT in HIV-positive patients undergoing concomitant antiretroviral therapy. A 32-year-old female and a 63-year-old male sensitized to tree pollen and with clinically confirmed birch pollen allergy underwent pre- and co-seasonal sublingual birch pollen AIT for three and two pollen seasons, respectively. The therapy was associated with a marked reduction in the frequency and intensity of allergic symptoms, and the reduced use of (symptomatic) rescue medication. Mild, local, treatment-emergent adverse events were noted throughout the course of treatment but resolved spontaneously. No serious adverse events were reported. In particular, there were no obvious harmful effects on the patients' immune status or viral load. Hence, sublingual birch pollen AIT proved to be effective and safe in two HIV-positive patients.
Case Report: do heart transplant candidates benefit from mechanically supported revascularization?
Authors: Lukasz Pyka, Janusz Szkodzinski, Jacek Piegza, Malgorzata Swietlińska, Mariusz Gąsior
Journal: Front Cardiovasc Med (2023)
Keywords: congestive heart failure, heart transplant, mechanical circulatory support, myocardial recovery, outcomes, revascularisation
MeSH terms: Case Reports

Introduction:
Recently published studies suggest that percutaneous coronary intervention (PCI) has no significant impact on outcomes in patients with heart failure and stable coronary artery disease. The use of percutaneous mechanical circulatory support is growing, but its value is still uncertain. If large areas of viable myocardium are ischemic, the benefit from revascularization should be evident. In such instances, we should strive for complete revascularization. The use of mechanical circulatory support in such cases is vital because it provides hemodynamic stability throughout the complex procedure.
Case report:
We present a case of a 53-year-old male heart transplant candidate with type 1 diabetes mellitus, initially considered unsuitable for revascularization and qualified for heart transplantation, transferred to our center due to acute decompensated heart failure. At this time, the patient had temporary contraindications for heart transplantation. As the patient was considered no-option, we have decided to reassess the possibility of revascularization. The heart team opted for a high-risk mechanically supported PCI with the aim of complete revascularization. A complex multivessel PCI was performed with optimal effect. The patient was weaned off dobutamine on the second day post-PCI. Four months post-discharge, he remains stable, is in NYHA II class, and has no chest pain. Control echocardiography showed improved ejection fraction. The patient is not a heart transplant candidate anymore.
Conclusions:
This case report shows that we must strive for revascularization in select heart failure cases. The outcome of this patient suggests that heart transplant candidates with potentially viable myocardium should be considered for revascularization, especially as the shortage of donors persists. In the most complex coronary anatomy and severe heart failure, mechanical support in the procedure might be essential.
Frozen Section Diagnostic Pitfalls of Sertoli-Leydig Cell Tumor with Heterologous Elements
Authors: Ashley Burris, Caleb Hixson, Nathaniel Smith
Journal: Case Rep Pathol (2018)
MeSH terms: Case Reports

A woman in her sixth decade presented with several months of abdominal cramping, decreased appetite, bloating, and increased constipation. Radiologic imaging revealed a 28 cm, multilocular, heterogeneous cystic neoplasm involving the right adnexa. An intraoperative frozen section showed mucinous glandular epithelium, with and without foci of goblet cells, embedded in apparent ovarian stroma. The findings were concerning at least borderline mucinous cystadenoma with possible invasion. Subsequent surgical management and staging were performed. Permanent sections showed a moderately to poorly differentiated Sertoli-Leydig cell tumor (SLCT) with retiform foci and heterologous elements. The discrepancy between frozen and permanent sections was attributable to solely sampling a focus of heterologous elements during intraoperative consultation. The rarity of SLCT and even rarer presence of both heterologous and retiform elements make this concerning frozen section diagnostic pitfall.
Fostering Children's Connection to Nature Through Authentic Situations: The Case of Saving Salamanders at School
Authors: Stephan Barthel, Sophie Belton, Christopher M Raymond, Matteo Giusti
Journal: Front Psychol (2018)
Keywords: affective relationships with nature, affordances, longitudinal approach, nature experience, qualitative methods, situated learning, stewardship, urban

The aim of this paper is to explore how children learn to form new relationships with nature. It draws on a longitudinal case study of children participating in a stewardship project involving the conservation of salamanders during the school day in Stockholm, Sweden. The qualitative method includes two waves of data collection: when a group of 10-year-old children participated in the project (2015) and 2 years after they participated (2017). We conducted 49 interviews with children as well as using participant observations and questionnaires. We found indications that children developed sympathy for salamanders and increased concern and care for nature, and that such relationships persisted 2 years after participation. Our rich qualitative data suggest that whole situations of sufficient unpredictability triggering free exploration of the area, direct sensory contact and significant experiences of interacting with a species were important for children's development of affective relationships with the salamander species and with nature in an open-ended sense. Saving the lives of trapped animals enabled direct sensory interaction, feedback, increased understanding, and development of new skills for dynamically exploring further ways of saving species in an interactive process experienced as deeply meaningful, enjoyable and connecting. The behavioral setting instilled a sense of pride and commitment, and the high degree of responsibility given to the children while exploring the habitat during authentic situations enriched children's enjoyment. The study has implications for the design of education programs that aim to connect children with nature and for a child-sensitive urban policy that supports authentic nature situations in close spatial proximity to preschools and schools.
Influenza vaccine and subsequent development of zoster
Authors: Kai-Che Wei, Yu-Chia Chang, Yu-Tung Huang
Journal: Influenza Other Respir Viruses (2023)
Keywords: herpes zoster, influenza vaccine, side effect
MeSH terms: COVID-19, Herpes Zoster Vaccine / adverse effects, Herpes Zoster / epidemiology, Herpes Zoster / prevention & control, Influenza Vaccines / adverse effects, Influenza, Human / epidemiology, Influenza, Human / prevention & control, Research Support, Non-U.S. Gov't, COVID-19 Vaccines, Humans, Male, Middle Aged, Retrospective Studies, Vaccination / adverse effects, Herpes Zoster Vaccine, Influenza Vaccines, COVID-19 Vaccines

Background:
Herpes zoster (HZ), which is caused by reactivation of the latent varicella zoster virus, was not listed as a side effect of any vaccines until the introduction of coronavirus disease 2019 (COVID-19) vaccine. This study used a nationwide population database to examine whether the HZ risk is increased after receiving the influenza vaccination.
Methods:
This population-based retrospective self-controlled case series evaluated the association between influenza vaccine exposure and HZ risk. Data were collected from Taiwan's National Health Insurance Research Database between 2015 and 2017. Patients with HZ diagnosed within 6 months before and after receiving the influenza vaccination were included. After receiving the influenza vaccine, the first 15 and 30 days were defined as risk intervals, while the other periods were defined as control intervals. Poisson regression was used to compare the incidence rate ratio (IRR) for HZ during the risk interval vs. the control interval.
Results:
In total, 13,728 patients were diagnosed with HZ before and after receiving the influenza vaccine. The IRR for days 1-15 was significantly higher (IRR = 1.11; 95% confidence interval [CI], 1.02-1.20), but insignificant for days 1-30 (IRR = 1.04; 95% CI, 0.98-1.10). In a subgroup analysis, the IRRs were significantly higher in participants, including 50-64 years old (1.16; 95% CI, 1.02-1.33), males (1.14; 95% CI, 1.01-1.28), and healthier individuals (i.e., no history of cancer or autoimmune diseases).
Conclusions:
There was a slight increase in risk of HZ in people receiving influenza vaccine in the first 1-15 days after vaccination.
A Novel Mutation of the CYP11B2 in a Saudi Infant with Primary Hypoaldosteronism
Authors: Lama Alfaraidi, Abrar Alfaifi, Rawan Alquaiz, Faten Almijmaj, Horia Mawlawi
Journal: Case Rep Endocrinol (2017)
MeSH terms: Case Reports

Isolated hypoaldosteronism is a rare autosomal recessive disease presenting with severe salt wasting and failure to thrive in infancy. A 6-month-old Saudi girl born to consanguineous parents was referred from primary health care for failure to thrive and developmental delay. Laboratory tests revealed hyponatremia, hyperkalemia, and metabolic acidosis with high renin and low aldosterone. Blood samples were collected for endocrine and genetic studies. Sequence analysis of the CYP11B2 revealed a T to A transition at position 1398 + 2 in exon 8 of the gene in a homozygous state (c.1398+T>A). This result was confirmed by sequencing an independent PCR product. Given the position of the transition at a highly conserved nucleotide and the predictions of different bioinformatic algorithms, it is likely that the mutation is the pathogenic cause of this condition. This result was compared with the reference NM_000498.3. Here, we report a novel homozygous mutation resulting in aldosterone synthase deficiency. To the best of our knowledge, this mutation has not been described in the literature or in any database thus far. The mutation manifested as a rare inherited disease in an infant exhibiting critical salt loss. An adequate replacement treatment will give a good long-term prognosis.
Long-Term Hydromethylthionine Treatment Is Associated with Delayed Clinical Onset and Slowing of Cerebral Atrophy in a Pre-Symptomatic P301S MAPT Mutation Carrier
Authors: Peter Bentham, Roger T Staff, Bjoern O Schelter, Helen Shiells, Charles R Harrington, Claude M Wischik
Journal: J Alzheimers Dis (2021)
Keywords: frontotemporal dementia, p301s, hydromethylthionine, leucomethylthioninium, microtubule-associated protein tau
MeSH terms: Atrophy / pathology, Atrophy / prevention & control, Carrier State, Frontotemporal Dementia / drug therapy, Frontotemporal Dementia / genetics, Methylene Blue / analogs & derivatives, Mutation / genetics, tau Proteins / genetics, Case Reports, Letter, Adult, Brain / pathology, Humans, Magnetic Resonance Imaging, Male, Methylene Blue / administration & dosage, Time Factors, MAPT protein, human, tau Proteins, hydromethylthionine, Methylene Blue

One of the mutations in the microtubule-associated protein tau, P301S, is causative for dominantly inherited frontotemporal dementia characterized by extensive tau pathology for which no licensed treatment is available. Hydromethylthionine is a potent tau aggregation inhibitor. We report treatment of an asymptomatic carrier of the P301S mutation using hydromethylthionine over a 5-year period beginning at the mean age of onset of clinical decline in the family. During the period of treatment, the rates of progression of cerebral atrophy were reduced by 61%-66% in frontal and temporal lobes, and the patient remained clinically asymptomatic.
Case Report: Small intestinal metastatic breast cancer: A case report and literature review
Authors: Yishan Li, Lianru Zhang, Huiping Yu, Xiaoyan Xin, Jian He, Yongzhong Yao, Baorui Liu, Rutian Li, Li Xie
Journal: Front Oncol (2022)
Keywords: breast cancer, clinical diagnosis, driving genes, small intestinal metastasis, small intestinal obstruction
MeSH terms: Case Reports

Breast cancer is considered a malignant tumor with the highest incidence among women and is prone to develop distant metastasis. Small intestinal metastasis of breast cancer, however, is relatively rare. This case report describes a 49-year-old Chinese female patient who presented with small intestinal obstruction and was diagnosed with lobular breast cancer with small intestinal and contralateral breast metastasis. Clinical manifestations, clinicopathological features and potential mechanisms of metastasis, along with diagnosis and treatment, are discussed with a review of the relevant literature. Although small intestinal metastasis is rare in breast cancer, we should keep high alert on the possibility of gastrointestinal metastasis when treating lobular breast cancer patients.
Paratubal Cystectomy in a Pregnant Woman Using the Single-Incision Laparoscopic Surgery (SILS) Technique
Authors: Luke William Nelson, Elliot MacKenzie
Journal: Case Rep Obstet Gynecol (2022)
MeSH terms: Case Reports

Introduction:
The proliferation of prenatal ultrasound has enhanced the detection of adnexal masses during pregnancy. The presentation necessitates a clear approach to investigation and treatment that balances both maternal and fetal risk. Laparoscopy is a safe approach to surgical management in the pregnant patient, and SILS may contribute to minimising perioperative complications. Case Presentation. We present the case of a 21-year-old female in her second trimester of pregnancy presenting with a large 20 cm right adnexal cyst. We proceeded with laparoscopic cystectomy via the SILS technique. There were no intraoperative complications, and she recovered well postoperatively.
Conclusion:
Laparoscopic resection of adnexal lesions is safe during pregnancy and should be favoured over the open approach. SILS minimises incision sites and has potential for reduction in perioperative morbidity.
Acute Deterioration of Pulmonary Arterial Hypertension (PAH) in a Patient with Neurofibromatosis Type 1 (NF1)
Authors: Seiya Tanaka, Fuko Kawahara, Taro Miyamoto, Satoshi Tsurusaki, Yoshihito Sanuki, Kiyoshi Ozumi, Takashi Harada, Hiromi Tasaki
Journal: Case Rep Cardiol (2019)
MeSH terms: Case Reports

A 56-year-old woman was diagnosed as having chronic obstructive pulmonary disease with heavy smoking. Mild pulmonary hypertension (mean pulmonary arterial pressure: 31 mmHg) was detected at the first visit. She was diagnosed with pulmonary hypertension due to pulmonary disease and medicated only with bronchodilators. Simultaneous, multiple freckling in the trunk of her body and café au lait macules in her back with some cutaneous neurofibromas were also detected. A plastic surgeon removed one of the neurofibromas and pathologically diagnosed it as neurofibromatosis type 1 (NF1). We finally rediagnosed her with pulmonary hypertension with unclear and/or multifactorial factors when she deteriorated 1 year after being treated only with bronchodilators. We then administrated upfront combination therapy with macitentan and tadalafil. Mean pulmonary arterial pressure rapidly improved. Learning Objective. Pulmonary arterial hypertension (PAH) in neurofibromatosis type 1 (NF1) can occur due to lung disease or due to certain involvement of pulmonary arteries, or a combination of both. Increased awareness of PAH in NF1 is very important for patients survival. The current therapeutic strategy is almost identical to that of idiopathic PAH; however, there is no clinical evidence. Insights gained from clinical experiences should help identify promising novel therapeutic approaches in NF1-PAH.
Common carotid artery occlusion: a case series
Authors: Zoltán Bajkó, Rodica Bălaşa, Anca Moţăţăianu, Smaranda Maier, Octavia Claudia Chebuţ, Szabolcs Szatmári
Journal: ISRN Neurol (2013)

Subjects and Methods. We analysed 5000 cerebrovascular ultrasound records. A total of 0.4% of the patients had common carotid artery occlusion (CCAO). Results. The mean age was 59.8 ± 14.2 years, and the male/female ratio was 2.33. The most frequent risk factors were hypertension, ischaemic heart disease, dyslipidemia, diabetes mellitus, and smoking. Right-sided and left-sided CCAO occurred in 65% and 30% of the cases, respectively, and bilateral occlusion was detected in one case (5%). Patent bifurcation was observed in 10 cases of CCAO in which the anterograde flow in the ICA was maintained from the external carotid artery with reversed flow. In two of the cases, the occluded CCA was hypoplastic. The aetiology of CCAO in the majority of cases was the atherosclerosis (15 cases). The male/female ratio was higher in the patients with occluded distal vessels, and the short-term outcome was poorer. Only two cases from this series underwent revascularisation surgery. Spontaneous recanalisation was observed in one case. Conclusions. The most frequent cause of CCAO was atherosclerosis. The outcome is improved in the cases with patent distal vessels, and spontaneous recanalisation is possible. Treatment methods have not been standardised. Surgical revascularisation is possible in cases of patent distal vessels, but the indications are debatable.
Emergent completion pneumonectomy for postoperative hemorrhage from rupture of the infected pulmonary artery in lung cancer surgery
Authors: Takanori Ayabe, Tetsuya M Shimizu, Masaki Tomita, Mitsuhiro Yano, Kunihide Nakamura, Toshio Onitsuka
Journal: Case Rep Surg (2011)
MeSH terms: Case Reports

Completion pneumonectomy (CP) is one of the most difficult procedures and known to be associated with a high morbidity and mortality. A 74-year-old male underwent a left upper lobectomy for pulmonary adenocarcinoma (T3N0M0); six days later after the surgery, he had a sudden postoperative intrathoracic excessive hemorrhage with shock. Emergent redo thoracotomy was performed to treat the bleeding from the ablated interlobar pulmonary artery by suturing with prolene. However, 3 days later after the second operation, he had the second intrathoracic bleeding. Emergent CP was performed with cardiopulmonary bypass by anterior transpericarsial approach via a median sternotomy. The hemorrhage was caused by a rupture of the proximal fragile and infected pulmonary artery. We performed omentopexy for the infected intrathoracic cavity and for covering of the divided main bronchial stump. We had a rare experience of two times of postoperative life-threatening hemorrhage from rupture of the infected pulmonary artery after left upper lobectomy. Emergent CP as salvage surgery should have an advantage in control of infected proximal pulmonary arterial hemorrhage. We should take care of tearing off of adventitia of pulmonary artery in lobectomy because of a possibility of postoperative hemorrhage under a fragility of the injured pulmonary artery with infection.