OpenMed/multicare-articles huggingface dataset:
Propofol Infusion Syndrome in Refractory Status Epilepticus: A Case Report and Topical Review
Authors: Akil Walli, Troels Dirch Poulsen, Mette Dam, Jens Børglum
Journal: Case Rep Emerg Med (2016)

Propofol infusion syndrome (PRIS) is a fatal complication when doses of propofol administration exceed 4 mg/kg/h for more than 48 hours. Propofol overdosage is not uncommon in patients with refractory status epilepticus (RSE). We describe a case of refractory status epilepticus complicated by propofol infusion syndrome and collect from 5 databases all reports of refractory status epilepticus cases that were treated by propofol and developed the syndrome and outline whether refractory status epilepticus treatment with propofol is standardized according to international recommendations, compare it with alternative medications, and discuss how this syndrome can be treated and prevented. A total of 21 patients who developed this syndrome reported arrhythmia in all cases (100%), rhabdomyolysis in 9 cases (42%), lactic acidosis in 13 cases (62%), renal failure in 8 cases (38%), lipemia in 7 cases (33%), and elevated hepatic enzymes in 6 cases (28%). 13 patients died (66%). Propofol is still given in a dosage higher than what is internationally recommended, and new treatment modalities such as renal replacement therapy, blood exchange, and extracorporeal membrane oxygenation seem to be promising. In conclusion, propofol should be carefully titrated, the maximal infusion rate needs to be reassessed, and combination of different sedative agents may be considered.
Extracorporeal Testicular Ectopia through Inguinal Canal: A Case Report
Authors: A M Haidar, B M Gharmool
Journal: J Neonatal Surg (2013)
Keywords: ectopia, neonate, testicle
MeSH terms: Case Reports

A preterm (36 week) neonate, presented with his left testicle hanging outside through the inguinal canal. The testicle was pexed in a sub-dartos pouch.
Metronidazole caused profound drug-induced immune thrombocytopenia
Authors: Jeffrey Lew, Jeffrey Berenberg
Journal: Clin Case Rep (2017)
Keywords: drug‐dependent platelet‐reactive antibodies, drug‐induced immune thrombocytopenia, metronidazole, thrombocytopenia
MeSH terms: Case Reports

Metronidazole is commonly prescribed and has not been known to cause drug-induced immune thrombocytopenia. We have provided clinical and laboratory evidence with DDabs that metronidazole can cause drug-induced immune thrombocytopenia (DITP). Providers must be aware of metronidazole causing DITP because recognition of thrombocytopenia is critical and cessation of the drug should occur promptly.
Multiple Resistance Mechanisms to Tyrosine Kinase Inhibitors in EGFR Mutated Lung Adenocarcinoma: A Case Report Harboring EGFR Mutations, MET Amplification, and Squamous Cell Transformation
Authors: Rossella Bruno, Marzia Del Re, Federico Cucchiara, Iacopo Petrini, Greta Alì, Stefania Crucitta, Agnese Proietti, Simona Valleggi, Antonio Chella, Romano Danesi, Gabriella Fontanini
Journal: Front Oncol (2021)
Keywords: egfr, met amplification, case report, lung adenocarcinoma, multiple resistance mechanisms, squamous cell transformation
MeSH terms: Case Reports

Resistance to EGFR tyrosin kinase inhibitors (TKI) inevitably occurs. Here it is reported the case of a young patient affected by lung adenocarcinoma harboring the L858R EGFR sensitive mutation. The patient developed multiple TKI resistance mechanisms: T790M EGFR resistance mutation, detected only on tumor cell-free DNA, squamous cell transformation and MET amplification, both detected on a tumor re-biopsy. The co-occurrence of squamous cell transformation and de novo MET amplification is an extremely rare event, and this case confirms how dynamic and heterogeneous can be the temporal and spatial tumor evolution under treatment pressure.
Two patients with extremely elevated tumor markers: where is the malignancy?
Authors: Patrick P J van der Veek, Wouter H de Vos Tot Nederveen Cappel, Alexandra M J Langers, Bart van Hoek
Journal: Gastroenterol Res Pract (2011)
MeSH terms: Case Reports

Serum tumor markers are useful to evaluate a cancer's response to treatment, for early detection of cancer relapse, and, in some cases, to diagnose malignancy. In this paper, we present two patients with significantly elevated serum tumor markers without evidence of malignant disease. An 18-year-old patient suffering from autoimmune hepatitis had markedly increased alpha-fetoprotein (aFP) levels (2,002 μg/L; normal <10 ug/L). Extensive imaging showed no signs of hepatocellular carcinoma or other cancer, and treatment with Prednisone led to rapid normalization of both liver enzymes and aFP. The second patient, a 60-year-old female with painless jaundice due to biliary stone disease, had very high serum levels of CA19-9 (18,000 kU/L, normal <27 kU/L). Liver biochemistry and serum CA19-9 concentration decreased to almost normal values (45 kU/L) after biliary stenting. These cases demonstrate that serum tumor markers can be elevated in benign disease and are therefore not appropriate to diagnose cancer.
Quality Versus Quantity of Life: Beyond the Dichotomy
Authors: Ariel Dempsey, John Mulder
Journal: Palliat Med Rep (2023)
Keywords: decision making, end-of-life care, goals of care, palliative care, physician patient communication, quality of life
MeSH terms: Case Reports

A restrictive and dichotomous question has become the primary approach in many goals of care discussions. Is the primary goal of care quantity of life through aggressive therapy or quality of life through comfort care and hospice? Even though many health care providers recognize that quality vs quantity of life (QvQ) is a false dichotomy, in practice QvQ underlies many goals of care discussions and can negatively impact patient care. This article offers strategies for assessing patients at the end of life, presenting a first-line conversation process that can support a range of treatment options as well as a diversity of dynamic patient values. Based on decades of experience in palliative care and a review of relevant literature, we recommend four practical questions to serve as values "vital signs," monitoring dynamic notions of quality of life and harmonizing patient values with treatment options.
Simultaneous Replacement of Maxillary Central Incisors with CEREC Biogeneric Reference Technique: A Case Report
Authors: Gokhan Akgungor, Deniz Sen, Eray Bal, Mutlu Ozcan
Journal: J Dent Res Dent Clin Dent Prospects (2013)
Keywords: cad-cam, cerec, crowns, dental porcelain, resin cements
MeSH terms: Case Reports

Biogeneric Reference Technique (BRT) of the CEREC 3D v.3.8 software is an effective technique for single anterior ceramic crowns because it provides computer-controlled match of the tooth form to the contralateral tooth. BRT also enables the fabrication of two or more anterior all-ceramic crowns simultaneously. This clinical report demonstrates the clinical application of BRT for designing and milling two central incisors in one appointment using a single optical impression. After completing the virtual design of the first central incisor, it was copied and a mirror image was created. The second central incisor was designed using this replicated image and therefore a computer-controlled symmetry was obtained. The crowns were milled from monolithic feldspathic ceramic blocks and adhesively luted with dual-cured resin cement following dentin conditioning. At the two-year follow-up appointment, the restorations were intact, no adverse effects were noted, and the resultant appearance was highly satisfactory for the patient. A step-by-step protocol is described from design to cementation of these restorations.
A Case Series: Adjunctive Treatment of Major Depressive Disorder in the Geriatric Population with the Methylphenidate Patch
Authors: Kamal Patel, Ashley Collins, Suzanne Holroyd, Andre Benja Lamyaithong
Journal: Case Rep Psychiatry (2019)
MeSH terms: Case Reports

Major depressive disorder can affect anyone regardless of age. In geriatric populations depression is often overlooked and untreated, which subsequently may lead to serious consequences. Almost one third of elderly patients with depression fail to respond to initial treatment and require adjunctive treatment. Methylphenidate is one such option, which is seldom used in the geriatric population to treat depression despite reports of improvement in symptoms of mood within a brief period of time. Methylphenidate is also available in a patch formulation that can be used in patient's nonadherent to the medication, which is reported to be an issue in as many as 75% of the geriatric population. Here we present three geriatric patients who were diagnosed with recurrent severe major depressive disorder without psychotic features. The three patients responded well with methylphenidate as adjunctive treatment to conventional antidepressants.
First case report of sepsis caused by Rhizobium pusense in Japan
Authors: Tomokazu Kuchibiro, Katsuhisa Hirayama, Katsuyuki Houdai, Tatsuya Nakamura, Kenichirou Ohnuma, Junko Tomida, Yoshiaki Kawamura
Journal: JMM Case Rep (2018)
Keywords: 16s rrna, rhizobium pusense, sepsis
MeSH terms: Case Reports

Introduction:
Species of the genus Rhizobium are opportunistic, usually saprophytic, glucose-non-fermenting, Gram-negative bacilli found in agricultural soil. Rhizobium pusense infections are the least common Rhizobium infections and have low incidence.
Case presentation:
Herein, we report the first case of sepsis with R. pusense in Japan in a 67-year-old Japanese woman with a history of hyperlipidaemia, hypertension, diabetes, hypothyroidism and osteoporosis. She had undergone cerebrovascular treatment because she was diagnosed with a subarachnoid haemorrhage. The results of postoperative blood culture showed oxidase-positive, urease-positive, non-lactose-fermenting Gram-stain-negative rods. Using the Vitek2 system, the isolate was distinctly identified as Rhizobium radiobacter. However, 16S rRNA gene sequencing showed 99.93 % similarity with the type strain of R. pusense and 99.06 % similarity with the type strain of R. radiobacter. Additional gene sequencing analysis using recA (97.2 %) and atpD (96.2 %) also showed that the isolated strain is most closely related to R. pusense. The patient was cured by treatment using intravenous meropenem (3 g/d) for 4 weeks and was discharged safely.
Conclusion:
The definite source of sepsis was unknown. However, the possibility of having been infected through the catheter during the cerebrovascular operation was speculated.
Synchronous volvulus of the transverse and sigmoid colon: a rare case of large bowel obstruction
Authors: Abderrahim Samlali, Said Boussaidane, Asma Hamri, Youssef Narjis, Ridouan Benelkhaiat Benomar
Journal: Pan Afr Med J (2021)
Keywords: volvulus, bowel obstruction, case report, sigmoid, transverse
MeSH terms: Colon, Sigmoid / pathology, Colon, Transverse / pathology, Intestinal Obstruction / etiology, Intestinal Volvulus / complications, Case Reports, Abdominal Pain / etiology, Anastomosis, Surgical / methods, Colectomy, Colon, Sigmoid / surgery, Colon, Transverse / surgery, Female, Humans, Intestinal Obstruction / diagnosis, Intestinal Obstruction / surgery, Intestinal Volvulus / surgery, Middle Aged

Colonic volvulus usually occurs as a single event that can affect various parts of the colon. The usual sites affected being the sigmoid colon (75%) and the caecum (22%). The phenomenon of multiple sites simultaneously undergoing volvulus is an extremely rare occurrence. We report a rare case of simultaneous sigmoid and transverse colon volvulus in a 52-year-old female. The clinical presentation and the radiological findings were that of large bowel obstruction. A subtotal colectomy and colocolic anastomosis were performed and the postoperative period was uneventful. Though rare the development of transverse and sigmoid volvulus in the same patient must always be considered in the differential diagnosis, when dealing with recurrent intermittent abdominal pain or acute intestinal obstruction.
Long-Term Remission Achieved by Ponatinib and Donor Lymphocytes Infusion in a Ph+ Acute Lymphoblastic Leukemia Patient in Molecular Relapse After Allogenic Stem Cell Transplant and Dasatinib: A Case Report
Authors: Cirino Botta, Nadia Caruso, Sabrina Bossio, Francesca Storino, Giuseppe Console, Massimo Martino, Francesco Mendicino, Eugenio Lucia, Rosellina Morelli, Pierpaolo Correale, Fortunato Morabito, Massimo Gentile, Ernesto Vigna
Journal: Front Oncol (2020)
Keywords: t lymphocytes, acute lymhoblastic leukemia, bone marrow microenviroment, donor lymphocyte infusion (dli), ponatinib
MeSH terms: Case Reports

Currently, the prognosis of Ph+ acute lymphoblastic leukemia (Ph+ ALL) patients relapsing after an allogenic hematopoietic stem cell transplantation (allo-SCT) remains poor, with few therapeutic options available. Here we present the case of a 32 years old patient with dasatinib-resistant post-transplant molecular relapse of ALL, who received, as second-line therapy, the combination of ponatinib and donor lymphocyte infusion (DLI). The therapy was safe and the patient achieved a sustained minimal residual disease negative disease, still ongoing after 22 months, which was accompanied by several changes in the immune populations distribution within the bone marrow (i.e., the increase in the CD8/CD4 lymphocytes ratio). Our report provides evidence of the efficacy of the third generation TKI inhibitor ponatinib in combination with DLI as second line therapy for Ph+ ALL relapsing after an allo-SCT.
Massive Fatal Pulmonary Embolism While on Therapeutic Heparin Drip
Authors: Said Hajouli
Journal: J Investig Med High Impact Case Rep (2020)
Keywords: anticoagulation, fatal pe, heparin drip, massive pe, pulmonary embolism, venous thrombosis
MeSH terms: Heparin / therapeutic use, Pulmonary Embolism / diagnosis, Pulmonary Embolism / drug therapy, Venous Thrombosis / diagnosis, Venous Thrombosis / drug therapy, Case Reports, Anticoagulants / therapeutic use, Fatal Outcome, Hospitalization, Humans, Male, Middle Aged, Risk Factors, Syncope / etiology, Tomography, X-Ray Computed, Anticoagulants, Heparin

Venous thromboembolism (VTE) includes deep venous thrombosis (DVT) and pulmonary embolism (PE). In this article, we present a case of a patient with an acute DVT who was treated with a therapeutic heparin drip, then developed syncope while in the hospital and found to have massive bilateral PEs. This case aims to arouse the medical staff's awareness of the VTE diagnosis even if the patient is fully anticoagulated. We review the indications for DVT hospitalization, heparin infusion monitoring, risk factors for developing PE from DVT, mechanisms of developing PE from DVT while on therapeutic anticoagulation, and signs and treatment of massive PE.
Primary retropharyngeal leiomyosarcoma in a young cat
Authors: Janusz Jaworski, Aaron Harper, Hayley Crosby-Durrani, Jon Hall
Journal: JFMS Open Rep (2023)
Keywords: leiomyosarcoma, computed tomography, retropharyngeal, stridor, surgery
MeSH terms: Case Reports

Case summary:
An Oriental Shorthair cat, aged 1 year and 6 months, developed progressive stridor and a palpable right ventral cervical mass. Fine-needle aspiration of the mass was inconclusive, while thoracic radiography and CT showed no evidence of metastasis. There was initial improvement in stridor with oral doxycycline and prednisolone treatment, but it recurred 4 weeks later and excisional biopsy was performed. Histopathology with immunohistochemistry diagnosed leiomyosarcoma with incomplete surgical margins. Adjunctive radiation therapy was declined. Repeated physical examination and CT 7 months postoperatively documented no evidence of mass recurrence.
Relevance and novel information:
This is the first reported case of retropharyngeal leiomyosarcoma in a young cat with no evidence of local reoccurrence 7 months following an excisional biopsy.
Measures for sustainable forest management in the tropics - A tree-ring based case study on tree growth and forest dynamics in a Central Amazonian lowland moist forest
Authors: Martin Worbes, Jochen Schöngart
Journal: PLoS One (2019)
MeSH terms: Conservation of Natural Resources / methods, Forests, Trees / growth & development, Tropical Climate, Research Support, Non-U.S. Gov't, Models, Statistical, Species Specificity

The conservation of tropical forests is recognized as one of the most important challenges for forestry, ecology and politics. Besides strict protection, the sustainable management of natural forests should be enhanced as a key part of the foundation for the maintenance of tropical rain forest ecosystems. Due to methodological reasons it has been complicated to attain reliable growth data to plan sustainable felling cycles and rotation periods. Tree ring analyses enable the estimation of growth rates over the entire life span of trees and their age as well as giving hints from forest dynamics in previous centuries. For tree ring analysis, stem disk samples were taken from three important commercial tree species (Cariniana micrantha, Caryocar villosum and Manilkara huberi) in the upland (terra firme) forests of the Precious Woods Amazon logging company near Itacoatiara, Brazil. Based on radiocarbon estimates of individual growth zones, the annual nature of tree rings was proven for the three species. Tree rings were measured and the results used together with height estimates to model diameter, height and volume growth. The age of the eldest tree, a C. micrantha, was 585 yrs with 165 cm in diameter. The species' diameter increments range from 0.20±0.12 cm yr-1 to 0.29±0.08 cm yr-1. At first sight, this is considerably lower than increments reported from other Amazonian or African timber species. Considering the respective wood density there is no significant difference in growth performance of dominant timber species across continents. The interpretation of lifetime tree ring curves indicate differences in shadow tolerance among species, the persistence of individuals in the understory for up to 150 years and natural stand dynamics without major disturbances. Management criteria should be adapted for the measured growth rates as they differed considerably from the Brazilian standards fixed by laws (felling cycle of 25-35 years and a common minimum logging diameter of 50 cm). Felling cycles should be increased to 32-51 years and minimum logging diameters to 63-123 cm depending on the species.
Successful Management of Acquired Hemophilia A Associated with Bullous Pemphigoid: A Case Report and Review of the Literature
Authors: Quentin Binet, Catherine Lambert, Laurine Sacré, Stéphane Eeckhoudt, Cedric Hermans
Journal: Case Rep Hematol (2017)
MeSH terms: Case Reports

Background. Acquired hemophilia A (AHA) is a rare condition, due to the spontaneous formation of neutralizing antibodies against endogenous factor VIII. About half the cases are associated with pregnancy, postpartum, autoimmune diseases, malignancies, or adverse drug reactions. Symptoms include severe and unexpected bleeding that may prove life-threatening. Case Study. We report a case of AHA associated with bullous pemphigoid (BP), a chronic, autoimmune, subepidermal, blistering skin disease. To our knowledge, this is the 25th documented case of such an association. Following treatment for less than 3 months consisting of methylprednisolone at decreasing dose levels along with four courses of rituximab (monoclonal antibody directed against the CD20 protein), AHA was completely cured and BP well-controlled. Conclusions. This report illustrates a rare association of AHA and BP, supporting the possibility of eradicating the inhibitor with a well-conducted short-term treatment.
Early Application of High Cut-Off Haemodialysis for de-Novo Myeloma Nephropathy is Associated with Long-Term Dialysis-Independency and Renal Recovery
Authors: Alhossain A Khalafallah, Sie Wuong Loi, Sarah Love, Muhajir Mohamed, Rose Mace, Ramy Khalil, Miriam Girgs, Rajesh Raj, Mathew Mathew
Journal: Mediterr J Hematol Infect Dis (2013)
MeSH terms: Case Reports

Background:
Multiple myeloma (MM) is a haematological malignancy associated with kidney injury resulting from cast nephropathy, which can be caused by monoclonal free light chains (FLC). It has been demonstrated that early reduction of FLC can lead to a higher proportion of patients recovering renal function with a better outcome, especially if high cut-off haemodialysis (HCO-HD) combined with chemotherapy is used.
Patients and methods:
In this study, four cases with MM nephropathy were treated with HCO-HD and chemotherapy at a single institution during the period from August 2009 to August 2011. All of the patients presented with acute renal failure and high serum FLC. All patients underwent a bone marrow biopsy to confirm the diagnosis of MM, according to the WHO criteria. Three patients had de novo MM and one patient had relapsed light chain myeloma disease. All patients underwent HCO-HD concomitantly with specific myeloma therapy once the diagnosis or relapse of MM was established.
Results:
After a medial follow up of 26 months, (range, 13-36) our data showed that all patients had a significant decrease in serum FLC through HCO-HD, proving the effectiveness of HCO-HD in managing MM. De-novo MM patients restored their renal function and achieved low-level FLC early in the treatment and became dialysis-independent. One patient with relapsed myeloma remained dialysis-dependent.
Conclusion:
In summary, our study suggests that in myeloma nephropathy associated with light-chain MM, HCO-HD should be initiated as early as possible. At the same time a specific MM treatment should be initiated to gain control of the disease and salvage the kidneys in order to achieve dialysis-independency. Further randomized trials to confirm our results are warranted.
Actinomadura meyerae osteitis following wound contamination with hay in a woman in France: a case report
Authors: Emilie Bonnet, Xavier Flecher, Sebastien Paratte, Jean-Noël Argenson, Didier Raoult, Pierre-Edouard Fournier
Journal: J Med Case Rep (2011)

Introduction:
Mycetoma is a chronic granulomatous infection caused by environmental fungi or bacteria. It affects dermal and subcutaneous tissues, with putative contiguous extension to muscles or bones. While common in tropical and subtropical areas, mycetoma is rare in Europe.
Case presentation:
We describe a case of Actinomadura meyerae osteitis in a 49-year-old Caucasian woman who suffered a tibia open fracture contaminated with hay; to the best of our knowledge the first case of autochthonous A. meyerae infection reported in France. The bacterium was cultivated from a bone biopsy. Following surgical osteosynthesis and six months of treatment with cotrimoxazole, our patient made a full recovery.
Conclusion:
Our case report suggests that A. meyerae is a potential agent of wound infection in farm workers in contact with hay.