OpenMed/multicare-articles huggingface dataset:
Case Report: Ultrasound Sciatic and Saphenous Nerve Blocks for Tibial Malunion Surgical Correction in a Pediatric African Leopard ( Panthera pardus)
Authors: Giuliano Ravasio, Federica Alessandra Brioschi, Vanessa Rabbogliatti, Daniela Gioeni, Federica Di Cesare, Federico Corletto, Maurizio Oltolina, Liliana Carnevale
Journal: Front Vet Sci (2020)
Keywords: locoregional anesthesia, patient state index, pediatric, saphenous nerve, sciatic nerve, ultrasound, zoo animals
MeSH terms: Case Reports

Little information is available regarding ultrasound-guided locoregional anesthesia in non-domestic species. Locoregional techniques have been shown to reduce intraoperative anesthetic requirements and provide postoperative pain relief. Decreasing dosage of general anesthetics allows more stable cardiopulmonary function during anesthesia and reduces the probability of side effects. An 11-week-old African leopard (Panthera pardus) was referred for treatment of a malunion angular limb deformity secondary to a tibial and fibular fracture. The animal was scheduled to undergo angular correction of the tibia via closing wedge osteotomy and fixation with a locking plate system. Following preanesthetic medication and induction of general anesthesia, a saphenous nerve block (ropivacaine 0.5%; 0.15 ml/kg) was performed under ultrasound guidance and a sciatic nerve block (ropivacaine 0.5%; 0.15 ml/kg) was performed using ultrasound and a peripheral nerve stimulator. Intraoperative anesthetic plane was considered light, yet no abrupt cardiocirculatory changes were seen, nor was rescue analgesia required. This case report suggests that sciatic and saphenous blockade could therefore be recommended as part of a multimodal plan of analgesia for orthopedic surgeries in pediatric exotic felids.
A Chinese family with cat eye syndrome and abnormality of eye movement: First case report
Authors: Yang Lu, Liping Shen, Yue Zheng, Haichen Zhang, Yanbo Liu, Ming Qi, Shangzhi Huang, Bo Shen
Journal: Front Pediatr (2023)
Keywords: 135 mb tetrasomy, abnormality of eye movement, cat eye syndrome (ces), early diagnosis, first report
MeSH terms: Case Reports

Background:
Cat eye syndrome (CES) is a rare disease with a wide spectrum of phenotypic variability that is observed in 1:150,000 newborns. CES is characterized clinically by the combination of iris coloboma, anal atresia, and preauricular tags and/or pits. Many eye malformations have been reported to be associated with CES, such as iris and chorioretinal coloboma. However, an abnormality of eye movement has not been previously reported.
Case presentation:
We report on a Chinese family carrying a 22q11.1-q11.21 duplication of 1.7Mb tetrasomy (chr22:16,500,000-18,200,000, hg38) in two generations. Based on the proband and her father's clinical manifestations, including ophthalmological examination, cytogenetic analysis, FISH, CNV-seq, and WES, the diagnosis of CES with an abnormality of eye movement was made.
Conclusion:
Our findings broadened the symptom spectrum of CES syndrome and laid the foundation for pathogenesis, diagnostic targets, and drug research on the abnormality of eye movement, and were helpful for early diagnosis and intervention of CES.
Misinterpretation of an inflammatory FDG uptake in a patient treated for Hodgkin lymphoma: a case report
Authors: Alberto Nieri, Luca Urso, Matteo Caracciolo, Maria Ciccone, Licia Uccelli, Corrado Cittanti, Antonio Cuneo, Mirco Bartolomei
Journal: Asia Ocean J Nucl Med Biol (2023)
Keywords: 18f-fdg pet/ct, biopsy, hodgkin lymphoma, pitfall, therapy response
MeSH terms: Case Reports

Hodgkin Lymphoma (HL) is a malignancy involving lymph nodes and lymphatic system. [18F]F-FDG PET/CT (FDG-PET) imaging is routinely used for staging, to assess early chemotherapy response (interim FDG-PET), at the end of treatment (EoT FDG-PET) and for the identification of disease recurrence. We present a case of a 39-year-old man treated for HL. FDG-PET scans performed after first line therapy (both Interim PET and at the end of therapy) demonstrated a persistent and significant mediastinal FDG uptake. The patient was treated with a second line therapy but the FDG-PET uptake did not change. After board discussion a new surgical, thoracoscopy-guided biopsy was performed. Histopathology demonstrated a dense fibrous tissue with occasional chronic inflammatory infiltrates. Persistent FDG-PET positivity may suggest refractory or relapsed disease. However, occasionally, non-malignant conditions are responsible for a persistent FDG uptake, not related to primary disease. An accurate evaluation of clinical history and previous imaging exams is mandatory for clinicians and others experts to avoid misinterpretations of FDG-PET results. Nevertheless, in some cases, only a more invasive procedure, such as a biopsy, may finally lead to a definitive diagnosis.
Hemorrhage from Umbilical Cord Ulceration Identified on Real-Time Ultrasound in a Fetus with Duodenal Atresia
Authors: William M Curtin, Jaimie L Maines, Christina T DeAngelis, Niamh A Condon, Serdar H Ural, Karmaine A Millington
Journal: Case Rep Obstet Gynecol (2019)
MeSH terms: Case Reports

Umbilical cord ulceration has been associated with congenital upper intestinal (duodenal or jejunal) atresia and can lead to fatal fetal intrauterine hemorrhage. We report a case of spontaneous hemorrhage from the umbilical cord, incidentally noted at the time of ultrasound in a 33-week fetus with suspected duodenal atresia, in which immediate delivery resulted in a good outcome. Despite many reports in the literature of congenital upper intestinal atresia and its association with umbilical cord ulceration, the propensity for this lesion for fetal hemorrhage, and the resulting perinatal morbidity and mortality, there appears to be a gap in the dissemination of this knowledge. In fetuses with suspected congenital upper intestinal atresia, recognition of the entity of umbilical cord ulceration may be improved by ultrasound with special attention to the amount of Wharton's jelly within the cord. Routine antepartum fetal surveillance may reduce perinatal morbidity and mortality from this condition. A high index of suspicion is needed to make the diagnosis of umbilical cord ulceration in association with congenital upper intestinal atresia. The role of amniotic fluid bile acids in the genesis of this disorder needs further study.
Case Report: [18F]PI2620 as a Tau Imaging Agent in Posterior Cortical Atrophy
Authors: Yu Kong, Kexin Xie, Hongwen Qiao, Yue Cui, Donglai Jing, Yuting Wang, Xuying Li, Liyong Wu
Journal: Front Neurol (2020)
Keywords: mapt mutation, tau pet, [18f]pi2620, dementia, posterior cortical atrophy (pca)
MeSH terms: Case Reports

Posterior cortical atrophy (PCA) is widely considered as an atypical variant of Alzheimer disease and is characterized by a progressive decline in visual function. PCA has been investigated from the standpoints of brain structure and metabolism, but tau deposition and its relationship to disease severity still remain unclear. Here, we used a novel tau ligand, [18F]PI2620, to visualize tau deposition in a PCA patient. The results showed that high [18F]PI2620 uptake in posterior cortical regions was associated with clinical manifestations, morphologic changes in the brain observed by magnetic resonance imaging (MRI), and hypometabolism detected by [18F] fluorodeoxyglucose (FDG) positron emission tomography (PET). This is the first report demonstrating a clinical anatomical correspondence between [18F]PI2620 PET results, clinical manifestations, MRI, and [18F]FDG PET findings in a Chinese patient with PCA. The results also support the utility of [18F]PI2620 for visualizing tau aggregation in PCA.
Acute internal carotid artery occlusion due to dissection of the paraclinoid segment: Diagnostic usefulness of angiographic findings during stent retriever deployment
Authors: Isao Sasaki, Taichiro Imahori, Tatsuya Yano, Kana Onobuchi, Masanori Gomi, Junko Kuroda, Norikata Kobayashi, Kimitoshi Sato, Yoji Niwa, Koichi Iwasaki, Hiroshi Hasegawa
Journal: Radiol Case Rep (2022)
Keywords: acute ischemic stroke, dissection, endovascular treatment, large vessel occlusion, mechanical thrombectomy, stent retriever
MeSH terms: Case Reports

Intracranial artery dissection is an uncommon but possible cause of ischemic stroke, and is usually diagnosed based on imaging findings such as mural hematoma and dissection flap. However, it is challenging to recognize the underlying dissection in cases of acute large vessel occlusion. In this report, we present a case of acute internal carotid artery occlusion, in which the underlying dissection of the paraclinoid segment was found during the thrombectomy procedure. Two thrombectomy procedures failed to recanalize the acute internal carotid artery occlusion without removing any clot. Angiography performed during a Trevo stent retriever deployment in the first pass showed obscure contrast defects in the stent strut with temporary flow restoration. In the next pass, the appearance of the contrast defects changed and a parallel linear contrast appeared on the outside of the vessel wall. These angiographic findings were identified as mural hematoma and dissection flap, indicating dissection of the paraclinoid as the cause of the occlusion. During antiplatelet loading and preparation of a dedicated intracranial stent, the Trevo stent retriever was left deployed again at the occlusion site to maintain the blood flow. After permanent stenting with an Enterprise stent, angiography revealed complete recanalization. The patient recovered fully after the procedure. In the present case, stent retriever deployment revealed the hallmarks of dissection on angiography, such as mural hematoma, dissection flap, and temporal morphological changes, by restoring the blood flow temporarily. Such angiographic findings can provide useful information on the occlusion characteristics and real-time feedback for optimal treatment strategy.
The Usefulness of Dual-Layer Spectral Computed Tomography for Myelography: A Case Report and Review of the Literature
Authors: Yuji Iyama, Takeshi Nakaura, Ayumi Iyama, Kazuhiro Katahira, Yasuyuki Yamashita
Journal: Case Rep Orthop (2018)
MeSH terms: Case Reports

We describe a case of lumbar stenosis in which retrospective spectral analysis using dual-layer spectral detector computed tomography (CT) had the ability to expand the evaluable region in the spinal canal. Spinal canal stenosis is a common condition whose symptoms (such as lower back and leg pain with walking) deteriorate the quality of life. Generally, magnetic resonance imaging (MRI) and CT myelography are performed to diagnose canal stenosis. Dual-layer spectral detector CT can yield virtual monochromatic imaging and retrospective on-demand spectral analysis without a prescan setting. Spectral analysis could expand the evaluable region in the spinal canal for increasing the contrast enhancement in the canal.
Bilateral Pheochromocytomas in a Patient with Y175C Von Hippel-Lindau Mutation
Authors: Olga Astapova, Anindita Biswas, Alessandra DiMauro, Jacob Moalem, Stephen R Hammes
Journal: Case Rep Endocrinol (2018)
MeSH terms: Case Reports

Von Hippel-Lindau (VHL) disease, caused by germline mutations in the VHL gene, is characterized by metachronously occurring tumors including pheochromocytoma, renal cell carcinoma (RCC), and hemangioblastoma. Although VHL disease leads to reduced life expectancy, its diagnosis is often missed and tumor screening guidelines are sparse. VHL protein acts as a tumor suppressor by targeting hypoxia-inducible factors (HIFs) for degradation through an oxygen-dependent mechanism. VHL mutants with more severely reduced HIF degrading function carry a high risk of RCC, while mutants with preserved HIF degrading capacity do not cause RCC but still lead to other tumors. VHL disease is classified into clinical types (1 and 2A-2C) based on this genotype-phenotype relationship. We report a case of bilateral pheochromocytomas and no other VHL-related tumors in a patient with Y175C VHL and show that this mutant preserves the ability to degrade HIF in normal oxygen conditions but, similar to the wild-type VHL protein, loses its ability to degrade HIF under hypoxic conditions. This study adds to the current understanding of the structure-function relationship of VHL mutations, which is important for risk stratification of future tumor development in the patients.
Imiquimod-induced bullous pemphigoid: A case report
Authors: Heidi Oi-Yee Li, Michael Aw, Steven J Glassman
Journal: SAGE Open Med Case Rep (2023)
Keywords: bullous pemphigoid, actinic keratoses, imiquimod
MeSH terms: Case Reports

A 72-year-old man treated with 3.5% imiquimod cream for scalp actinic keratoses developed the usual crusted and erosive reaction but developed bullae on the scalp, as well as the limbs and torso after several weeks into treatment. Biopsy confirmed bullous pemphigoid. He was treated with clobetasol ointment, prednisone and methotrexate, with eventual disease control. He had a severe disease course. Bullous pemphigoid is usually idiopathic, but can be induced by skin trauma, as well as by several medications; this is the first report of imiquimod as a trigger. Imiquimod is a toll-like receptor 7 agonist that induces cellular apoptosis and recruits pro-inflammatory cytokines including tumour necrosis factor-alpha and interferon-alpha, which have been implicated in autoimmunity. This case highlights an unusual but severe adverse effect from topical imiquimod.
Case report: Epigastric heteropagus twins and literature review
Authors: Wenbin Zhu, Xiongjian Cui, Zhaohan Wu, Zhaolin Li, Gang Chen, Suixin Liang, Jianxiong Mao
Journal: Front Pediatr (2023)
Keywords: birth defect, heteropagus, omphalocele, parasites, parasitic twin, prenatal screening
MeSH terms: Case Reports

Epigastric heteropagus twins are an extremely rare congenital anomaly of conjoined twins. We present a case of epigastric heteropagus twins who were diagnosed via prenatal ultrasound imaging: the fetus (or host) was connected to the abdominal wall of the parasite (the dependent portion), and an omphalocele was present. The male infant was delivered by cesarean section at 35 + 5 weeks gestation. The parasite lacked a head and heart and presented long bones of the limbs. After abdominal computed tomography, omphalocele repair, and parasite removal were surgically performed under general anesthesia. After discharge (follow-up, 3 months), the infant is currently growing well and is healing satisfactorily. Forty-one cases of epigastric heteropagus twins were retrieved from database searches: 38 good postoperative outcomes, 2 perioperative deaths, and 1 termination. The case highlights that even when parasites are massive in size, births can present good outcomes with suitable surgical treatment.
Spontaneous perforation of a primary duodenal diverticulum stepped treatment model: A 10-patient case report
Authors: Bin Zhong, Zhonghu Li, Zhenyu Lin, Yanbing Shen, Jianxin Zhang, Weidong Jin
Journal: Front Surg (2022)
Keywords: duodenum, duodenum diverticulum, perforation, stepped treatment, surgery
MeSH terms: Case Reports

After colonic diverticula, a duodenal diverticulum (DD) is the second most common type of gastrointestinal diverticulum. DD is mainly caused by poor congenital development, resulting in a limited outward protrusion of the duodenal wall in a sac (primary diverticula). Perforation is one of the infrequent but most severe complications of DD, most commonly in the second segment of the duodenum (D2, 58%), followed by the third segment (D3, 30%). In the current case reports on the treatment of DD perforation, preoperative diagnosis is rare, with most patients being diagnosed and treated by laparotomy; the surgical approach is complex and varied, with artificial choices; and there is a high rate of complications and mortality (6%-34%) after surgical treatment. This study aimed to review our experience treating spontaneous perforation of the primary duodenal diverticulum, focusing on the surgical treatment model. A retrospective review of all spontaneous perforations of primary DD was conducted at one center between January 2010 and January 2022. We identified 10 patients with spontaneous perforation of primary DD (6 women and 4 men; median age: 51.5 years; range: 24-87 years). The patients had a median American Society of Anesthesiologists (ASA) score of 2. All patients underwent surgical treatment, of which six had percutaneous retroperitoneal drainage, two had diverticulectomy, one had distal gastrectomy + gastrojejunostomy + diverticuloplasty, and one had diverticulum repair. No patients died. The median length of stay was 12 days (range: 3-21 days). There were no long-term complications during the follow-up period (median follow-up of 12 months). A stepwise treatment model for spontaneous perforation of primary DD appears to have more advantages, and transabdominal exploratory surgery should probably not be the preferred treatment modality.
Retrospective Identification of Herpes Simplex 2 Virus-Associated Acute Liver Failure in an Immunocompetent Patient Detected Using Whole Transcriptome Shotgun Sequencing
Authors: Atsushi Ono, C Nelson Hayes, Sakura Akamatsu, Michio Imamura, Hiroshi Aikata, Kazuaki Chayama
Journal: Case Reports Hepatol (2017)
MeSH terms: Case Reports

Acute liver failure (ALF) is a severe condition in which liver function rapidly deteriorates in individuals without prior history of liver disease. While most cases result from acetaminophen overdose or viral hepatitis, in up to a third of patients, no clear cause can be identified. Liver transplantation has greatly reduced mortality among these patients, but 40% of patients recover without liver transplantation. Therefore, there is an urgent need for rapid determination of the etiology of acute liver failure. In this case report, we present a case of herpes simplex 2 virus- (HSV-) associated ALF in an immunocompetent patient. The patient recovered without LT, but the presence of HSV was not suspected at the time, precluding more effective treatment with acyclovir. To determine the etiology, stored blood samples were analyzed using whole transcriptome shotgun sequencing followed by mapping to a panel of viral reference sequences. The presence of HSV-DNA in blood samples at the time of admission was confirmed using real-time polymerase chain reaction, and, at the time of discharge, HSV-DNA levels had decreased by a factor of 106. Conclusions. In ALF cases of undetermined etiology, uncommon causes should be considered, especially those for which an effective treatment is available.
Successful treatment for disseminated intravascular coagulation (DIC) corresponding to phenotype changes in a heat stroke patient
Authors: Hironori Matsumoto, Jun Takeba, Kensuke Umakoshi, Yuki Nakabayashi, Naoki Moriyama, Suguru Annen, Muneaki Ohshita, Satoshi Kikuchi, Norio Sato, Mayuki Aibiki
Journal: J Intensive Care (2019)
Keywords: anticoagulant, antithrombin, disseminated intravascular coagulation, heat stroke, soluble fibrin, thrombin-antithrombin complex, thrombomodulin
MeSH terms: Case Reports

Background:
Heat stroke induces coagulofibrinolytic activation, which leads to life-threatening disseminated intravascular coagulation (DIC). However, treatment strategies for DIC in heat stroke have not yet been established, and also, the time course changes in coagulofibrinolytic markers have not been thoroughly evaluated. We report a severe heat stroke case with DIC who was eventually saved by anti-DIC treatments in accordance with changes in coagulofibrinolytic markers.
Case presentation:
A 45-year-old man was found unconscious outside, and his body temperature was elevated to 41.9 °C. For heat stroke, we performed an immediate tracheal intubation under the general anesthesia along with cooling by iced gastric lavage, cold fluid administration, and an intravascular cooling using Thermogard™. About 4 h after admission, his core temperature fell to 37 °C. We assessed coagulofibrinolytic biomarkers and treated in accordance with changes in these parameters. This case exhibited a biphasic change varying from an enhanced to a suppressed fibrinolytic type of DIC depending on the relative balance between fibrinolytic activation and the level of plasminogen activator inhibitor-1 (PAI-1). In the early phase with consumption coagulopathy and enhanced fibrinolysis, we transfused a large amount of fresh frozen plasma (FFP) and platelets with tranexamic acid, an antifibrinolytic agent, possibly providing relief for the bleeding tendency. Anticoagulant therapy using recombinant human thrombomodulin-α (rh-TM-α) and antithrombin III (ATIII) concentrate was especially effective for DIC with a suppressed fibrinolytic phenotype in the later phase, after which organ failure that included severe hepatic failure was remarkably improved.
Conclusion:
The present case may indicate the clinical significance of monitoring coagulifibrinolytic changes and the potential benefits of anticoagulants for heat stroke-induced DIC.
Secondary Bilateral Angle Closure Glaucoma due to Topiramate
Authors: Miguel Paciuc-Beja, Myriam Retchkiman-Bret, Cecilio Francisco Velasco-Barona, Victor Hugo Galicia-Alfaro
Journal: Case Rep Ophthalmol Med (2011)
MeSH terms: Case Reports

We examined a 39-year-old female with severe headache and blurred vision. She was on topiramate, 50 mg once a day for one week because of migraine. Periorbital edema, chemosis, myopia, high intraocular pressures, and shallow anterior chambers were present at the initial examination. Iridocorneal angles were closed, ultrasound showed choroidal effusions. We stopped topiramate and started antiglaucoma treatment. After one week the intraocular pressure was 10 mm Hg in both eyes without treatment. A new ultrasound showed no choroidal effusions. Topiramate has been associated with acute secondary angle closure glaucoma as an idiosyncratic reaction to the drug. Physicians prescribing topiramate need to alert patients of this potential sight-threatening idiosyncratic reaction.
Gastrocolic Fistula: A Rare Presentation of Colon Cancer
Authors: Chukwunonso Chime, Madhavi Ravi, Myrta Daniel, Harish Patel, Bhavna Balar
Journal: Case Rep Gastrointest Med (2018)
MeSH terms: Case Reports

Gastrocolic fistulae have been described for benign conditions including penetrating peptic ulcer and complicated pancreatitis. Malignant etiology can arise from gastric or colon cancer and is a rare and late complication with an incidence of 0.3-0.4%. Usual presentation is the classic triad of weight loss, diarrhea, and feculent vomiting. Barium enema has been shown to have the highest diagnostic accuracy but endoscopy offers additional advantage of biopsy to aid in diagnosis of malignant etiology; the role of computed tomography (CT) scan is controversial. Treatment by one-stage en bloc surgical approach is the current acceptable standard of care with variable recurrence and survival rates. Adjuvant chemotherapy would be based on lymph node involvement and patient discussion.