OpenMed/multicare-articles huggingface dataset:
Total Hip Arthroplasty Concomitant with Patellofemoral Arthroplasty and Medial Patellofemoral Ligament Reconstruction for a Patient with Patellar Dislocation Combined with Hip Dysplasia: A Case Report of a Successful Outcome at 5-Year Follow-Up
Authors: Takuya Iseki, Tomoya Iseki, Shohei Okahisa, Shinichi Yoshiya, Shigeo Fukunishi, Toshiya Tachibana
Journal: Case Rep Orthop (2021)
MeSH terms: Case Reports

Background:
Posttraumatic patellar dislocation is rare, and consistent surgical strategy therefore has not been defined due to multifactorial factor. In this case study, we treated a case of a patellar dislocation with hip osteoarthritis and increased femoral anteversion by performing a two-staged surgery. In the first stage, total hip arthroplasty was performed, and in the second stage, simultaneous patellofemoral arthroplasty and medial patellofemoral ligament reconstruction using semitendinosus tendon autograft were performed. Case Report. A 56-year-old female patient who previously had right hip osteoarthritis complained of right knee pain after a fall. Radiographic examination showed lateral dislocation of the patella with osteoarthritic (OA) change in the patellofemoral joint and an excessive femoral anteversion with OA change on the right hip joint. Total hip arthroplasty was performed firstly to decrease femoral anteversion. Then, simultaneous patellofemoral arthroplasty and medial patellofemoral ligament reconstruction was performed for residual patellar dislocation and patellofemoral OA without tibiofemoral joint OA. At the time of the 5-year follow-up after surgery, the patient was able to walk with a wheelbarrow without any complications.
Conclusion:
To the best of our knowledge, this is the first case of a patellar dislocation with an increased femoral anteversion and patellofemoral OA treated by a combination of total hip arthroplasty, patellofemoral arthroplasty, and medial patellofemoral ligament reconstruction. The clinical outcome improved at 5 years after these surgeries. Therefore, these surgical options can be considered to be useful.
Analysis of recurrence patterns following pterygium surgery with conjunctival autografts
Authors: Soo Hyun Kwon, Hong Kyun Kim
Journal: Medicine (Baltimore) (2015)
MeSH terms: Conjunctiva / transplantation, Pterygium / surgery, Observational Study, Research Support, Non-U.S. Gov't, Adult, Age Factors, Aged, Aged, 80 and over, Autografts, Female, Humans, Male, Middle Aged, Multivariate Analysis, Postoperative Complications, Recurrence, Retrospective Studies, Risk Factors, Young Adult

The aim of this article is to evaluate and classify pathogenetic origins based on morphologic reproliferative patterns in patients who underwent pterygium excision with a conjunctival autograft. In this retrospective, observational case series, a total of 116 eyes of 116 patients with pterygium who underwent pterygium excision with a conjunctival autograft between February 2009 and May 2011 were reviewed. Using consecutively recorded photographs, we evaluated preoperative morphologic severity, postoperative complications, recurrences, and growth patterns. The regrowth of fibrovascular tissue was observed in 14 of our study cases (12.1%). Of these, 5 cases (4.3%) showed clinically significant recurrences. We observed 3 different morphologic patterns of recurrence: regrowth over the epithelial defect; transformation of the conjunctival graft into the pterygial tissue; and regrowth from unexcised pterygial tissue. Each recurrence pattern showed characteristic fibrovascular growth, the origin of this regrowth, and grade of severity. In 25 cases (21.6%), postoperative complications were observed. Of the analyzed variables, age <40 years (P = 0.019; odds ratio [OR], 5.82; 95% confidence interval [CI], 1.34-25.28) and the presence of postoperative complications (P = 0.008; OR, 6.32; 95% CI, 1.62-24.58) were statistically significant in multivariate analyses using logistic regression. The use of conjunctival autografts for pterygium surgery is effective, but recurrences are observed in some cases exhibiting unique pathogenic patterns according to their origin. A complete understanding of the pathogenesis of these lesions based on their morphologic regrowth pattern will help to prevent recurrences in patients who undergo pterygium surgery.
Diagnosing Pulmonary Embolism Using Point-of-Care Ultrasound in a Patient With Malingering and Coccidioidomycosis Infection
Authors: Uday Chauhan, Pal Athwal, Mohammed Elhassan
Journal: Cureus (2023)
Keywords: computed tomography pulmonary angiography, malingering, point-of-care-ultrasound, pulmonary coccidioidomycosis, pulmonary embolism (pe)
MeSH terms: Case Reports

We report a case of a 41-year-old male diagnosed with pulmonary coccidioidomycosis and pulmonary embolism (PE) based on a point-of-care ultrasound (POCUS) finding who was suspected to be malingering for right-sided chest pain considering his psychiatric history. POCUS was performed and showed right ventricular strain with a D-shaped left ventricle and B-lines with subpleural consolidations, and PE was confirmed with computed tomography pulmonary angiography. No other risk factors for PE were found except for coccidioidomycosis. The patient was treated with apixaban and fluconazole and discharged in stable condition. We discuss the usefulness of POCUS in diagnosing PE and the very rare association between coccidioidomycosis and PE.
Mesothelioma presenting as a breast lump: when is a breast lump not a breast lesion?
Authors: S L Savaridas, G D Bristow
Journal: BJR Case Rep (2015)
MeSH terms: Case Reports

A case of mesothelioma presenting as a breast lump. Relevant imaging is reviewed and the differential diagnoses discussed. The absence of the pectoralis muscle on mammogram is a potentially ominous sign which should not be assumed to be due to technical factors.
Management of an Infected Nonunion of an Opening-Wedge High Tibial Osteotomy with 2-Stage Implantation of Rotating Hinge Knee Prosthesis
Authors: Sandrine Mariaux, Olivier Borens
Journal: Case Rep Orthop (2018)
MeSH terms: Case Reports

Introduction:
High tibial osteotomy (HTO) is a frequent and effective treatment for unicompartmental gonarthritis. Only a few articles are focused on the treatment of infected nonunion.
Patient and method:
A 50-year-old obese patient was operated on by medial opening-wedge HTO. She developed a painful nonunion treated by hardware removal, allograft, and plate fixation. However, the nonunion persisted. 2 years later, cellulitis appeared with an abscess adjacent to the HTO plate. Despite surgical debridement and antibiotics, septic knee arthritis occurred. In a situation of infected nonunion and septic arthritis with chondrolysis, she was scheduled for a 2-stage total knee replacement (TKR). The infected tibial articular block was first resected and replaced by a cement spacer. After a short interval, the TKR was implanted. After 2 years, the patient walked pain-free with good knee function.
Discussion:
In the literature, different efficient treatments exist for infected nonunion after HTO, but comprehensive studies are missing for a consensus treatment. Current data are mostly based on case reports, since this pathology is quite rare.
Conclusion:
In a difficult situation of infected nonunion with septic knee arthritis, we performed a 2-stage knee prosthesis implantation. This led to an early mobilization and fast recovery.
The Rare Case of an Adult-Onset Xanthogranuloma of the Paranasal Sinuses: A Histological Dilemma
Authors: J Bastianpillai, N Haloob, S A Panchappa, J Marais
Journal: Case Rep Pathol (2020)
MeSH terms: Case Reports

Xanthogranuloma is a rare benign tumour, part of the non-Langerhans cell histiocytosis group, uncommon in adults and even less common in the paranasal sinuses. Despite its benign nature, it mimics neoplasm due to its local effects which can have serious functional consequences depending on the anatomical location. We present the rare case of a young lady who presented insidiously with a maxillary sinus xanthogranuloma and was treated with endoscopic resection. Tissue diagnosis is of paramount importance to guide correct further investigations and management, and we discuss the potential challenge in identifying such a rarely seen pathology.
Case Report: Adrenal glands degenerated schwannoma: Report of three cases and literature review
Authors: Tao Zhang, Si-Fan Yin, Wen-Bo Feng, Run-Lin Feng, Chang-Xing Ke
Journal: Front Oncol (2023)
Keywords: adrenal glands, clinical features, degenerated schwannoma, diagnosis, treatment
MeSH terms: Case Reports

Background:
Schwannoma is a benign tumor, of which degenerated schwannoma is a subtype. Retroperitoneal schwannomas are extremely rare, as they account for only 3% of retroperitoneal tumors.Degenerated schwannoma is a schwannoma subtype. However,degenerated schwannoma occurring in the adrenal glands is extremely rare.
Case summary:
Case 1: A 42-year-old man was referred to our hospital for further examination of a left adrenal mass that was incidentally discovered during a routine physical check-up.No significant abnormalities were found in laboratory tests results. Robotic-assisted laparoscopic excision of the left adrenal gland was performed under general anesthesia. Case 2: A 47-year-old man was admitted to the hospital because of a left adrenal mass found on a routine physical examination.The patient was previously in good health, and there was no family history of a similar disorder. Left-sided laparoscopic adrenalectomy was performed under general anaesthesia. Case 3: A 62-year-old woman with hypertension and diabetes mellitus was referred to our hospital after an incidentally found left adrenal mass.There was no family history of a similar disorder. Left-sided laparoscopic adrenalectomy was performed under general anaesthesia. None of the patients had a recurrence in our study during the postoperative follow-up.
Conclusion:
Degenerated schwannoma of the adrenal glands is very rare. The clinical presentations of degenerated schwannoma are nonspecific; a small number of patients do not have any symptoms, and the mass is only found incidentally during physical examination for any number of reasons. The preoperative diagnosis of adrenal degenerated schwannoma is difficult because the diagnosis must rely on pathological examination and immunohistochemistry assays. The management is surgical excision and regular follow-up.
Acute central retinal artery occlusion presenting as CREST syndrome: a case report
Authors: Muhammad Sa Raja, Tarnya Marshall, Ben Jl Burton
Journal: Cases J (2009)

Background:
A 75 year old lady presented with acute central retinal artery occlusion and contralateral cotton wool spots.
Case presentation:
General physical examination and investigations led to a diagnosis of CREST syndrome; however, association of central retinal artery occlusion with CREST syndrome is not well known. While diabetes, systemic hypertension, carotid atherosclerosis and cardiac pathology are common causes of CRAO it is always important to rule out giant cell arteritis.
Conclusion:
This case highlights that inflammatory causes of central retinal artery occlusion other than giant cell arteritis should also be considered as a possibility to spare unnecessary use of excessive systemic corticosteroids.
Heterogeneity of resistant mechanisms in an EGFR-TKI relapsed patient with EGFR amplification and response to nimotuzumab: A case report
Authors: Yan Li, Ziyi Xu, Tongji Xie, Puyuan Xing, Jianming Ying, Junling Li
Journal: Front Oncol (2022)
Keywords: egfr amplification, case report, heterogeneity, nimotuzumab, resistance
MeSH terms: Case Reports

EGFR mutations are the most important drivers of gene alterations in lung adenocarcinomas and are sensitive to EGFR-TKIs. However, resistance to EGFR-TKIs is inevitable in the majority of EGFR-mutated lung cancer patients. Numerous resistant mechanisms have been revealed to date, and more are still under investigation. Owing to the selective pressure, intratumoral heterogeneity may exist after resistance, especially in patients after multiple lines of treatment. For those patients, it is important to choose therapies focused on the trunk/major clone of the tumor in order to achieve optimal clinical benefit. Here, we will report an EGFR-mutated lung adenocarcinoma patient with heterogeneity of resistant mechanisms including EGFR amplification, large fragment deletion of RB1, and histological transformations after targeted treatments. In our case, EGFR amplification seemed to be the major clone of the resistant mechanism according to the next-generation sequencing (NGS) results of both liquid biopsy monitoring and tissue biopsies. In consideration of the high EGFR amplification level, the patient was administered by combination treatment with EGFR-TKI plus nimotuzumab, an anti-EGFR monoclonal antibody (mAb), and achieved a certain degree of clinical benefit. Our case sheds light on the treatment of EGFR-mutant patients with EGFR amplification and indicates that a combination of EGFR-TKI with anti-EGFR mAb might be one of the possible treatment options based on genetic tests. Moreover, the decision on therapeutic approaches should focus on the major clone of the tumor and should make timely adjustments according to the dynamic changes of genetic characteristics during treatment.
Clear Cell Papulosis: A Rare Pediatric Dermatosis
Authors: Keng Wein Jeanette Tan, Jin Ho Chong, Jean Aan Mark Koh
Journal: Case Rep Pediatr (2018)
MeSH terms: Case Reports

The diagnosis and management of pediatric hypopigmented lesions can be challenging given their wide range of differentials. In this case report, we present a case of a 3-year-old Chinese boy who was initially treated for tinea versicolor but subsequently diagnosed to have clear cell papulosis. The features, diagnosis, and management of clear cell papulosis are discussed in this article to raise awareness of this condition amongst pediatricians.
Combined iliac crest graft and short-scar pectoralis major flap for clavicular non-union reconstruction
Authors: Daniel Sattler, Hans-Philipp Springorum, Rafael Maria Armbruster, Maria von Kohout, Armin Kraus
Journal: Case Reports Plast Surg Hand Surg (2021)
Keywords: reconstructive surgery, head and neck, scar
MeSH terms: Case Reports

Recently, we reported defect coverage in the clavicular region with a scar-sparing pectoralis major flap. We successfully combine this flap with a clavicular reconstruction by an iliac bone graft for non-union now. We propose this reconstructive combination for cases of clavicular non-union with lack of soft tissue coverage.
Case Report: A Durable Response to Camrelizumab and Apatinib Combination Therapy in a Heavily Treated Small Cell Carcinoma of the Ovary, Hypercalcemic Type
Authors: Guiling Li, Yao Jiang
Journal: Front Oncol (2022)
Keywords: smarca4 mutation, anti-pd-1 antibody, antiangiogenic drug, next-generation sequencing, small cell carcinoma of the ovary hypercalcemic type
MeSH terms: Case Reports

Small cell carcinoma of the ovary, hypercalcemic type (SCCOHT) is a rare and highly aggressive malignancy with a poor prognosis. Most patients experience recurrence even after surgery and chemotherapy, and there are no standard treatment options for recurrent disease. Here, we report the case of a 36-year-old woman with SCCOHT who underwent primary cytoreductive surgery without adjuvant chemotherapy and remained disease-free for 9 months. She then developed retroperitoneal lymph node metastasis and was treated with two cycles of bleomycin/etoposide/cisplatin chemotherapy. However, the disease progressed and the patient received four cycles of liposomal doxorubicin/ifosfamide chemotherapy, followed by local radiation to the enlarged retroperitoneal lymph nodes. She achieved partial remission for 13 months, after which the disease progressed again. Tumor tissues and blood samples were sent for next-generation sequencing. The results indicated a somatic SWI/SNF-related, matrix-associated, actin-dependent regulator of chromatin, subfamily A, member 4 (SMARCA4) mutation, microsatellite stability, and a tumor mutation burden of 1.0 muts/Mb without any germline mutations. An anti-PD-1 antibody, camrelizumab, and an antiangiogenic agent, apatinib, were administered, and the patient achieved partial remission for 28 months. Our study provides the first clinical evidence that the combination therapy of camrelizumab and apatinib could be an effective treatment for recurrent SCCOHT.
Parastomal gallbladder herniation: A case report and review of the literature
Authors: Beat Moeckli, Perparim Limani, Pierre-Alain Clavien, Rene Vonlanthen
Journal: Int J Surg Case Rep (2020)
Keywords: case report, enterostomy, gallbladder herniation, gallbladder incarceration, parastomal hernia
MeSH terms: Case Reports

Introduction:
Parastomal hernia is a common complication of patients living with an enterostomy. However, a parastomal hernia involving the gallbladder is a rare condition with only eight cases documented in the literature.
Presentation of case:
We report the case of a 69-year old female who underwent an open right hemicolectomy with creation of a colostomy and terminal ileostomy. She presented with parastomal swelling and pain 16 months later. A computed tomography scan revealed a parastomal herniation of the gallbladder. We elected to proceed with a cholecystectomy and hernia repair, the patient was asymptomatic at her last follow-up.
Discussion:
A systematic search of the literature found eight previously published cases. This condition primarily affects elderly females. Five patients were treated surgically and three conservatively, all with a favorable outcome. In frail patients without complicating factors, a conservative treatment approach with surveillance may be safe. We chose a surgical approach due to the symptomatic nature of the presentation and the gallstone containing hernia. This is the first case of a parastomal gallbladder herniation containing a large gallstone.
Conclusion:
This report should help broadening the physician's differential diagnosis in dealing with patients with symptomatic parastomal hernias and provide an example for diagnosis and management of this complication.
A Strangulated Congenital Diaphragmatic Bochdalek Hernia Diagnosed in an Adult
Authors: Warsinggih Warsinggih, Julianus Aboyaman Uwuratuw, Arham Arsyad, Muhammad Faruk
Journal: Case Rep Med (2022)
MeSH terms: Case Reports

Although Bochdalek hernias are uncommon in adults and difficult to diagnose, such congenital diaphragmatic hernias (CDHs) are some of the most serious malformations among newborns. In particular, CDHs are accompanied by high mortality and marked disability later in life due to concomitant morbidity (i.e., caused by pulmonary lung hypoplasia and persisting pulmonary hypertension of neonates) and require long-lasting neonatal treatment in an intensive care unit. Late-diagnosed CDHs are extremely rare and always show small defects that justify a better prognosis than CDHs with large defects. In most cases, such CDHs go undiagnosed due to their mild, delayed symptoms. In the case described here, an 18-year-old Asian male presented with abdominal pain and a bowel contour in the epigastric region and left upper quadrant. A chest X-ray and thoracoabdominal computerized tomography scan confirmed the diagnosis of bowel obstruction due to a left diaphragmatic hernia. Moreover, a defect was revealed in the posterolateral left diaphragm, and the transverse colon, spleen, and half of the stomach had herniated through it. A segmentectomy was performed on the transverse colon, followed by an end-to-end anastomosis, a diaphragmatic plasty, and the placement of an intrapleural catheter. In conclusion, diagnosing a diaphragmatic hernia before surgery can be difficult due to its rarity and wide range of symptoms. Although prenatal diagnosis using ultrasonography is possible in up to 80% of fetuses, that method may not be available in all regions in Indonesia or in all countries, where doctors thus continue to face a diagnostic challenge when dealing with CDHs.
Use of methylene blue for treatment of severe sepsis in an immunosuppressed patient after liver transplantation
Authors: Saravanan Ramamoorthy, Shachi Patel, Eric Bradburn, Zakiyah Kadry, Tadahiro Uemura, Piotr K Janicki, Riaz Ali Shah, Dmitri Bezinover
Journal: Case Rep Transplant (2013)

Sepsis in the immunosuppressed patient is associated with very high mortality and morbidity. Treatment of sepsis in immunocompromised patients is especially challenging due to an unbalanced systemic inflammatory reaction with subsequent development of profound vasoplegia. Methylene blue (MB) has been successfully used for the treatment of refractory hypotension, but its use has not previously been reported for treatment of sepsis in immunosuppressed patients. The mechanism of MB's action is thought to be due to its inhibitory effect on cGMP-mediated vasodilatation. This case report describes the successful use of MB for treatment of severe septic shock in an immunosuppressed patient after liver transplantation. Hypotension in this patient was refractory to volume repletion and a combination of vasopressors. After MB administration, hemodynamic stability was rapidly reestablished. In the setting of severe sepsis in an immunosuppressed patient, MB should be considered early as a therapeutic option for treatment of refractory vasoplegia.
A Case of Cat Scratch Disease with Neuroretinitis in a 16-Month-Old Boy
Authors: Daisuke Nakata, Sayaka Kakehi, Hiroshi Okada, Atsuhiro Tanikawa, Yoshiaki Shimada, Masayuki Horiguchi, Yasuki Ito
Journal: Case Rep Ophthalmol Med (2022)
MeSH terms: Case Reports

Purpose:
We report a case of neuroretinitis associated with cat scratch disease (CSD) in young children.
Method:
Case report.
Results:
A 16-month-old boy was admitted for a detailed examination and treatment of a fever of unknown origin. Blood tests revealed no significant findings other than a white blood cell count of 16,100/mm3 and C-reactive protein level of 9.89 mg/dL. Computed tomography revealed no relevant findings to determine the causative disease. Antibiotic therapy with cefotaxime was initiated; however, the fever did not resolve. The patient was referred to our department for further examination to detect the cause of the fever. Fundoscopy revealed neuroretinitis in the right eye. His mother reported a history of breeding cats. Cat scratch disease (CSD) was suspected based on the clinical course and fundus findings. Cefotaxime was discontinued, and azithromycin, rifampicin, and prednisolone were administered, following which the fever disappeared and fundus findings improved. Immunoglobulin G (IgG) and IgM antibodies against Bartonella henselae was positive, leading to a definitive diagnosis of CSD.
Conclusion:
Infants cannot complain of decreased visual acuity; therefore, these findings may be overlooked unless a fundus examination is performed. As in this case, the early detection of neuroretinitis by an ophthalmologist may help in the diagnosis of CSD. It is extremely difficult to capture a photograph of the fundus of an infant, and recording with a smartphone is relatively simple and useful for monitoring continuous changes. Summary. We describe a case of neuroretinitis associated with cat scratch disease (CSD) that was diagnosed on the basis of fundus findings. The findings suggest the importance of an aggressive ophthalmologic examination when CSD is suspected in young children who are unable to describe their symptoms.