OpenMed/multicare-articles huggingface dataset:
Congenital Descending Aorta-Right Atrial Tunnel: A Case Report
Authors: Xing Zhang, Zhongjian Su, Yanfei Yang, Liping Ge, Bin Li
Journal: Front Pediatr (2020)
Keywords: computed tomography angiography, congenital descending aorta-right atrial tunnel, congenital heart defects, transcatheter closure, ventricular septal defect occluder
MeSH terms: Case Reports

Introduction: Congenital descending aorta-right atrial tunnel is a rare congenital heart defect. Herein, a new case successfully treated by transcatheter closure using a new type of ventricular septal defect occluder from the aortic side was reported. Case Presentation: An 11-month-old Chinese girl presenting with a cardiac murmur was suspected with partial anomalous pulmonary venous connection as assessed by echocardiography. Descending aorta-right atrial tunnel was confirmed by computed tomography angiography and cardiac catheterization. Subsequently, transcatheter closure was performed successfully using a new type of ventricular septal defect occluder from the aortic side. The cardiac murmur disappeared after the intervention, and echocardiography did not reveal any abnormal flow inside the right atrium. At 6 months, the patient had no murmur, and no residual shunt was found using the echocardiogram. Conclusion: Descending aorta-right atrial tunnel is a rare anomaly. Transcatheter closure was successful in our case. Long-term follow-up is needed to assess any progressive growth of the residual tunnel.
Prostatic Abscess on Xanthogranulomatous Prostatitis: Uncommon Complication of an Uncommon Disease
Authors: Youness Jabbour, Hamza Lamchahab, Sumba Harrison, Hafsa El Ouazzani, Tarik Karmouni, Khalid El Khader, Abdellatif Koutani, Ahmed Iben Attya Andaloussi
Journal: Case Rep Urol (2018)
MeSH terms: Case Reports

Xanthogranulomatous prostatitis is a rare benign inflammatory process of the prostate. Only few cases have been reported in the English literature. Xanthogranulomatous prostatitis is usually an incidental finding after needle biopsy or transurethral resection of the prostate in patients suffering from low urinary tract symptoms. We report the case of a 59-years-old patient diagnosed with prostatic abscess managed by transurethral resection of the prostate. Histopathological examination of resected prostatic tissue revealed abscessed xanthogranulomatous prostatitis with no evidence of malignancy. Xanthogranulomatous prostatitis presenting as a prostatic abscess is a rare finding. To the best of our knowledge our case represents the fourth case of xanthogranulomatous prostatitis presenting as prostatic abscess reported in the English literature so far.
An unusual occurrence: a case of venous thromboembolism in pregnancy associated with heterotaxy syndrome
Authors: Narendranath Epperla, Erika Peterson, Patrick Foy
Journal: BMC Hematol (2015)
Keywords: inferior vena cava, low molecular weight heparin, venous thromboembolism
MeSH terms: Case Reports

Background:
Heterotaxy is a relatively uncommon congenital anomaly that is usually diagnosed incidentally on imaging studies in adults. We present an unusual case of venous thromboembolism in a 26 year old pregnant female with Heterotaxy syndrome.
Case presentation:
A 26 year-old pregnant female at 13 weeks gestation suffered cardiac arrest with successful cardiac resuscitation and return of spontaneous circulation. The cardiac arrest was secondary to massive pulmonary embolism requiring thrombolytic therapy and stabilization of hemodynamics. She had extensive evaluation to determine the etiology for the pulmonary embolism and was noted to have an anatomic variation consistent with heterotaxy syndrome on imaging studies. After thrombolysis the patient was treated with UFH and then switched to enoxaparin without complication until 25 weeks of gestation when she experienced worsening abdominal pain with associated headaches, lightheadedness and elevated blood pressures needing elective induction of labor. The infant died shortly after delivery. The anticoagulation was continued for additional 3 months and she was subsequently placed on low dose aspirin to prevent recurrent venous thromboembolic episodes. She is currently stable on low dose aspirin and is into her third year after the venous thromboembolism without any recurrence.
Conclusion:
To our knowledge, this is the first reported case of venous thromboembolism in pregnancy associated with heterotaxy syndrome. A discussion on pathophysiology of venous thromboembolism in pregnancy and heterotaxy syndrome has been undertaken along with treatment approach in such situations.
Two cases of omental torsion mimicking acute appendicitis
Authors: Feeroz Alam Khan, Naeem Liaqat, Sajid Hameed Dar, Asif Iqbal Sandhu, Sajid Nayyer
Journal: APSP J Case Rep (2014)
Keywords: appendectomy, omental torsion, omentectomy
MeSH terms: Case Reports

Acute appendicitis is often simulated by other entities like mesenteric adenitis, worm infestation, Meckel's diverticulitis, urinary tract infection and rarely omental torsion. We report two cases, a 6 year old boy and an 11 year old girl, who presented with symptoms and signs of acute appendicitis but upon exploration turned out to be omental torsion.
Supraglottic Kaposi's Sarcoma in HIV-Negative Patients: Case Report and Literature Review
Authors: Ela A Server, Yusuf M Durna, Ozgur Yigit, Erol R Bozkurt
Journal: Case Rep Otolaryngol (2016)

This paper presents a case report of an HIV-negative, supraglottic Kaposi's sarcoma patient. The 80-year-old male patient was admitted with complaints of hoarseness, difficulty in swallowing, and a stinging sensation in his throat for approximately six months. The endoscopic larynx examination revealed a lesion which had completely infiltrated the epiglottis, reached right aryepiglottic fold, was vegetating, pink and purple in color, multilobular, fragile, and shaped like a bunch of grapes, and partially blocked the bleeding airway passage. The case was discussed by the hospital's head-neck cancer committee and a surgery decision was made. A tracheotomy was performed under local anesthesia before the operation due to respiratory distress and endotracheal intubation difficulty. Direct laryngoscopy showed that the mass was limited in the supraglottic area, had invaded the entire left aryepiglottic fold and one-third of the front right aryepiglottic fold, and completely covered epiglottis. It should be remembered that although rare, Kaposi's sarcoma may be encountered in larynx malignancy cases. Disease-free survival may be achieved through local excision and postoperative radiotherapy.
Epoetin Alfa: A Cause of Coronary Artery Thrombosis
Authors: Muhammad Umer Siddiqui, Yelena Galumyan, James Klein, Zunaira Naeem, Aron Schwarcz
Journal: Case Rep Cardiol (2017)
MeSH terms: Case Reports

Introduction:
Epoetin alfa is an erythrocyte-stimulating factor. We here present a case of an anemic patient, who was given epogen before a coronary artery bypass (CABG) surgery and developed periprocedural myocardial infarction. To our knowledge, there has been no previous case reported of epogen causing myocardial infarction.
Case presentation:
66-year-old female presented with substernal chest pain. EKG showed ST segment elevations in aVf and L-III. Patient underwent left heart catheterization (LHC) and had triple vessel disease. A bare metal stent was placed in RCA. Patient continued to have symptoms after discharge and presented to the ED again with these complaints. She underwent coronary artery bypass surgery (CABG). Before the procedure, patient's hemoglobin was 11.1 grams/deciliter and was given epogen to raise hemoglobin level. Postoperative day (POD) #1 patient had ST elevations in inferior and anterolateral leads. She was diagnosed with periprocedural myocardial infarction. Patient underwent repeat LHC, which identified obstruction of saphenous vein graft (SVG). Hypercoagulable workup was negative for any disease and the patient was diagnosed with epogen induced early graft occlusion.
Conclusion:
Epogen administration can cause myocardial infarction and coronary artery thrombosis. We suggest that physicians use epogen very cautiously, especially in population who has underlying coronary artery disease.
Role of a clinical pharmacist in managing diabetic nephropathy: an approach of pharmaceutical care plan
Authors: Amer Khan Mohammed, Chaitanya Medarametla, Mohammed Mahboob E Rabbani, Kolamadhi Prashanthi
Journal: J Diabetes Metab Disord (2015)
MeSH terms: Case Reports

Aim:
To evaluate the effect of low-protein diet on renal function in patient with diabetic nephropathy.
Materials and methods:
This is a case of a 57-year-old obese patient who is a known case of type 2 diabetes, hypertension, benign prostate hypertrophy and chronic kidney disease 4(th) stage presented with the complaints of weakness, dyspnea, arthralgia, neuropathic pains and pedal edema which are prominent symptoms of Chronic kidney disease. Our healthcare team had visited patient's home and analyzed the available reports on kidney profile, fasting sugar, post prandial sugar, HbA1c, lipid profile test and prescriptions which was found to be high. The glomerular filtration rate, serum creatinine and blood urea were 24 ml/min, 3.4 mg/dL and 90 mg/dL, fasting blood sugar, post prandial blood sugar and HbA1c were 226, 305 and 7.4 %, and total cholesterol and triglycerides were 145 & 95 respectively. Further discussion on diet, it came to know that the patient was on high carbohydrate diet. By considering the objective and subjective data, our team had done the assessment and come to a conclusion that high amount of carbohydrate diet with poor medication adherence had led to the hyperglycemia which developed diabetic nephropathy. We have recommended low protein, unsaturated fat, multivitamins, antioxidants and moderate carbohydrate diet. Two dietary assessment tools had been used in order to monitor patient's adherence to the diet i.e. dietary record book and food frequency questionnaire.
Results:
We have carefully monitored the serum creatinine, glomerular filtration rate and blood urea for 12 months initially with an interval of 30 days for 3 months and later trimonthly up-to 12 months. Glomerular filtration rate was calculated by using the formula CKD-EPI creatinine equation. The values trend for first three months of serum creatinine and glomerular filtration rate were 2.8 mg/dL, 2.6 mg/dL,1.5 mg/dL and 24 ml/min, 26 ml/min, 51 ml/min respectively. Further, results has shown a significant improvement in the 6th, 9th and 12th month. The values of serum creatinine in the 6th, 9th and 12th month were 1.3 mg/dL, 1.1 mg/dL and 0.9 mg/dL, whereas golmerular filtration rate in the 6th, 9th and 12th month were 61 ml/min, 74 ml/min and 94 ml/min.
Conclusion:
The present study has demonstrated the protein diet restriction in-order to control the progression of renal failure. The dietary intervention on diabetic nephropathy plays a significant role in controlling the kidney failures. This is the first study, to our knowledge, to demonstrate the impact of pharmacist role in managing diabetic nephropathy by providing pharmaceutical care. Pharmaceutical care services should be encouraged in the community and hospital pharmacy which definitely plays a major impact in reaching the definite outcomes and providing higher quality of life.
Case Report: Penile Strangulation Secondary to Hair Tourniquet
Authors: William F Rawls, Jeffrey T White, Ahmad Mohamed, Dennis Peppas, Eran Rosenberg
Journal: Front Pediatr (2020)
Keywords: excessive crying, hair tourniquet, pediatric emergency, penile edema, penile strangulation
MeSH terms: Case Reports

Penile strangulation is a rare condition in children caused by circumferential constriction of the coronal sulcus by constricting material, commonly thin maternal hair. Vague presenting symptoms often makes diagnosis difficult, but delay in diagnosis can lead to a variety of severe complications including urethral injury and penile necrosis. Providers must have a high index of suspicion and carry out a careful examination to identify maternal hair strands that may bury deep within penile edema. We describe two cases of penile strangulation secondary to maternal hair strands that were successfully treated with thorough examination and division of the constricting hair in the emergency department. In both cases, presentation involved penile swelling and erythema which was noticed by caregivers. Once the diagnosis has been made, urgent treatment using depilatory cream or mechanical removal must occur, with urgent referral to specialists if unable to remove to constricting material. Caregivers must also be counseled on appropriate steps to prevent penile hair tourniquet syndrome. Devastating complications can be avoided by early recognition and proper management of the syndrome, but providers must have knowledge of the condition and a high index of suspicion.
Estimating age-dependent per-encounter chlamydia trachomatis acquisition risk via a Markov-based state-transition model
Authors: Yu Teng, Nan Kong, Wanzhu Tu
Journal: J Clin Bioinforma (2014)
Keywords: acquisition risk, chlamydial infection, parameter estimation, state transition model, transmission probability

Background:
Chlamydial infection is a common bacterial sexually transmitted infection worldwide, caused by C. trachomatis. The screening for C. trachomatis has been proven to be successful. However, such success is not fully realized through tailoring the recommended screening strategies for different age groups. This is partly due to the knowledge gap in understanding how the infection is correlated with age. In this paper, we estimate age-dependent risks of acquiring C. trachomatis by adolescent women via unprotected heterosexual acts.
Methods:
We develop a time-varying Markov state-transition model and compute the incidences of chlamydial infection at discrete age points by simulating the state-transition model with candidate per-encounter acquisition risks and sampled numbers of unit-time unprotected coital events at different age points. We solve an optimization problem to identify the age-dependent estimates that offer the closest matches to the observed infection incidences. We also investigate the impact of antimicrobial treatment effectiveness on the parameter estimates and the differences between the acquisition risks for the first-time infections and repeated infections.
Results:
Our case study supports the beliefs that age is an inverse predictor of C. trachomatis transmission and that protective immunity developed after initial infection is only partial.
Conclusions:
Our modeling method offers a flexible and expandable platform for investigating STI transmission.
Case Report: Bronchogenic Cyst in the Right Atrium of a Young Woman
Authors: Yuya Fukudome, Michinari Hieda, Shiho Masui, Taku Yokoyama, Shutaro Futami, Shohei Moriyama, Kei Irie, Mitsuhiro Fukata, Tomoki Ushijima, Akira Shiose, Koichi Akashi
Journal: Front Cardiovasc Med (2022)
Keywords: bronchogenic cyst, cardiac mri, cardiac biopsy, cardiac mass, imaging
MeSH terms: Case Reports

A 31-year-old woman was referred to our hospital for evaluation of a cardiac mass in the right atrium. Cardiac magnetic resonance imaging indicated a cystic mass filled with fluid accumulation in the right atrium. The mass was identified as a cardiac cyst and was surgically removed. Pathological examination revealed an extremely rare bronchogenic cyst. Bronchogenic cysts are benign congenital abnormalities of primitive foregut origins that form in the mediastinum during embryonic development. There is unusual clinical dilemmas surrounding the treatment plan for cardiac surgery or biopsy of cardiac masses, especially in patients with rare cardiac cysts. The anatomical location of the cyst can be related to various clinical symptoms and complications. In cases of indeterminate cardiac cysts, direct cyst removal without prior biopsy is of utmost importance.
A rare combination of closed fracture of right talar body Sneppen 2 with associated medial malleolus: A case report
Authors: Ihsan Oesman, Ahmad Nugroho
Journal: Int J Surg Case Rep (2019)
Keywords: fracture, internal fixation, medial malleolus, sneppen 2, talar body, tension band wiring

Introduction:
Ankle fractures are common, with the incidence of up to 174 cases per 100,000 adults per year. The talus, the second largest tarsal bone, has distinctive imaging characteristics and injury patterns. The combination of talar body fracture in sagittal plane along with medial malleolus fracture is an unusual pattern of injury and rarely reported in the literature.
Presentation of case:
We presented a case of nineteen-year old male with pain on the right ankle as a result from motorcycle accident twelve hours before admitted to Cipto Mangunkusumo Hospital. After the patient underwent close reduction and immobilization using back slab, patient then underwent open reduction surgery of the right ankle then fixated using plate and screw combined by tension band wiring (TBW) at the right medial malleolus.
Discussion:
Talar and Medial malleolus fracture was initially evaluated by physical examination and radiographic imaging and classified by Sneppen classification. After the diagnosis was established the patient underwent ORIF plate, screw and tension band wiring. In post-operative x-ray examination, there was a significant improvement in talocrural angle and medial clear space but same result in tibiofibular overlap and tibiofibular.
Conclusion:
Open reduction and internal fixation (ORIF) plate and screw combined by tension band wiring (TBW) is the right surgical treatment for patient with closed fracture of right talar body Sneppen 2 with associated medial malleolus fracture. The outcome of the treatment is excellent because the patient presented was able to fully recover to normal activity.
Presumed Chemotherapy-Induced Optic Neuropathy and Maculopathy: A Case Report
Authors: David J Mathew, Anupriya Arthur, Sheeja Susan John
Journal: Open Ophthalmol J (2017)
Keywords: aml, cancer chemotherapy, cytarabine, daunorubicin, toxic maculopathy, toxic optic neuropathy

Purpose:
With the advent of more aggressive cytotoxic chemotherapy regimens, the incidence of ocular toxicity due to these drugs is also on the rise. We report a case of Presumed Chemotherapy-Induced optic neuropathy and maculopathy secondary to treatment with cytarabine and daunorubicin for Acute Myeloid Leukaemia (AML).
Case report:
A 50-year-old man with AML developed sudden decrease in vision in his left eye after three cycles of chemotherapy with cytarabine and daunorubicin. He presented to us six weeks later with bilateral optic atrophy and foveal atrophic changes with early bull's eye maculopathy. A diagnosis of presumed chemotherapy-induced optic neuropathy with maculopathy was made, and the patient was put on an alternative chemotherapeutic regimen. There was no further decrease in vision on follow up.
Conclusion:
To the best of our knowledge, this is the first report of clinically demonstrable macular toxicity in the form of macular atrophic changes and bull's eye maculopathy associated with the use of cytarabine and daunorubicin. Early diagnosis and appropriate management of such cases is imperative to prevent further visual deterioration.
Chylous ascites: Case report of a rare presentation of blunt abdominal trauma
Authors: Vânia Fernandes, Jacinta Queirós, Carlos Soares
Journal: Int J Surg Case Rep (2020)
Keywords: blunt abdominal trauma, case report, chylous ascites, low-fat diet, triglycerides
MeSH terms: Case Reports

Introduction:
Chylous ascites is the accumulation of a milk-like peritoneal fluid rich in triglycerides, due to the presence of intestinal lymph in the abdominal cavity. The most common causes of chylous acites in adults are abdominal malignancy and cirrhosis. Very few cases of chylous ascites associated to blunt abdominal trauma have been published in the literature.
Clinical case:
A 27-year-old, female patient was admitted to the emergency department (ED) with abdominal pain due to a deceleration-type traffic accident. During surveillance the patient presented a progressive decrease in hemoglobin levels and an increase in free intra-abdominal fluid detected on computed tomography scan. The patient underwent an exploratory laparoscopy and a milky-looking peritoneal fluid was identified. The diagnosis of chylous ascites was confirmed by the determination of increased triglyceride levels in the peritoneal fluid. A low-fat diet, with a restriction of long-chain triglycerides, was started in the post-operative period and the patient presented a progressive decrease in abdominal drainage. The patient had a favorable clinical and analytical evolution and was discharged on the fifth post-operative day.
Discussion:
Chylous ascites is an uncommon finding in trauma. Although surgery may be indicated in selected patients, conservative treatment can be effective in most patients, with or without abdominal drainage. A high-protein and low-fat diet, with medium-chain triglycerides, is the indicated dietary regimen to decrease the amount of lymphatic fluid produced.
Conclusion:
Chylous ascites, although rare in trauma patients must be considered in the diferential diagnosis of free peritoneal fluid. Conservative treatment should be considered in the majority of cases reserving invasive treatments for specific situations.
Turmeric Induced Liver Injury: A Report of Two Cases
Authors: Raphael P Luber, Clarissa Rentsch, Steve Lontos, Jeffrey D Pope, Ar Kar Aung, Hans G Schneider, William Kemp, Stuart K Roberts, Ammar Majeed
Journal: Case Reports Hepatol (2019)
MeSH terms: Case Reports

Turmeric is a commonly used oral herbal supplement with purported anti-inflammatory and antineoplastic properties. It is promoted as safe, with limited reports of severe adverse effects directly related to oral turmeric thus far in the literature. Herein we report two cases of turmeric supplement induced severe hepatitis. These cases highlight the need for physicians to be aware of patients taking this common supplement and the potential risks that exist.
Ineffective off-label use of recombinant activated factor VII in a case of bone-marrow transplantation-related gastrointestinal bleeding
Authors: P Eller, C Pechlaner, Cj Wiedermann
Journal: Thromb J (2006)

Background:
For patients with a normal coagulation system, who experience serious bleeding, sound evidence for recombinant activated factor VII (rFVIIa) as an effective haemostatic agent is only scarcely available so far from controlled clinical trials. In systematic reviews on the clinical use of rFVIIa, treatment failures were only rarely reported.
Case presentation:
We present a 45-year old, Caucasian male with persistent intestinal bleeding due to enterocolitis associated with cytomegalovirus infection and acute graft-versus-host-disease. He had received allogeneic peripheral blood stem cell transplantation from an unrelated HLA-identical donor because of chronic myelogenous leukaemia diagnosed two years earlier. Bleeding started at day 18 after transplantation with bloody diarrhea, which was treated with multiple transfusions of fresh frozen plasma, platelet, and red blood cell concentrates, and continued relentlessly, despite all efforts, including continued transfusions, high-dose prednisolone, broad antibiotic and antiviral coverage, and tranexamic acid. Recombinant FVIIa was started at boluses of 90-120 mug/kg every 4-8 hours. Despite more than 10 doses, recurrent severe bleeding progressed to refractory shock, multiorgan failure and death.
Conclusions:
Little can be concluded from single case reports of clinical improvement, because publication bias in favour of positive effects is likely. Our case suggests that rFVIIa is not a panacea, in particular for severe bleeding after bone-marrow transplantation. As long as rigorous, controlled studies or comprehensive registries are lacking, conventional interventions remain the standard of care in non-haemophilic patients with severe bleeding.