OpenMed/multicare-articles huggingface dataset:
Should Prophylactic Anticoagulation Be Considered with Large Uterine Leiomyoma? A Case Series and Literature Review
Authors: Mohamed A Satti, Carmen Paredes Saenz, Rubin Raju, Sierra Cuthpert, Abed Kanzy, Sina Abhari, John Hebert Iii, Frederico G Rocha
Journal: Case Rep Obstet Gynecol (2016)

Introduction. Uterine leiomyomas, also called uterine fibroids or myomas, are the most common pelvic tumors in women. They are very rarely the cause of acute complications. However, when complications occur they cause significant morbidity and mortality. Thromboembolic disease has been described as a rare complication of uterine leiomyomas. DVT is a serious illness, sometimes causing death due to acute PE. Cases. We report a case series of 3 patients with thromboembolic disease associated with uterine leiomyoma at Hurley Medical Center, Flint, Michigan, during 2015 and conduct a literature review on the topic. A literature search was conducted using Medline, PubMed, and PMC databases from 1966 to 2015. Conclusion. The uterine leiomyoma is a very rare cause of PE and only few cases have been reported. DVT secondary to uterine leiomyoma should be considered in a female presenting with abdominal mass and pelvic pressure, if there is no clear common cause for her symptoms. Thromboembolic disease secondary to large uterine leiomyoma should be treated with acute stabilization and then hysterectomy. Prophylactic anticoagulation would be beneficial for lowering the risk of VTE in patients with large uterine leiomyoma.
Metacognitive Reflection and Insight Therapy (MERIT) with a Patient with Persistent Negative Symptoms
Authors: R J M van Donkersgoed, S de Jong, G H M Pijnenborg
Journal: J Contemp Psychother (2016)
Keywords: case study, merit, metacognition, negative symptoms

Metacognition comprises a spectrum of mental activities involving thinking about thinking. Metacognitive impairments may sustain and trigger negative symptoms in people with schizophrenia. Without complex ideas of the self and others, there may be less reason to pursue goal-directed activities and less ability to construct meaning in daily activities, leading to the experience of negative symptoms. As these symptoms tend to be nonresponsive to pharmacotherapy and other kinds of treatment metacognition might be a novel treatment target; improvement of metacognition might lead to improvements in negative symptoms. One therapy that seeks to promote metacognition is the Metacognitive Reflection and Insight Therapy (MERIT). In this study, a case is presented in which a first episode patient with severe negative symptoms is treated with MERIT. A case illustration and the eight core principles of MERIT are presented. Independent assessments of metacognition and negative symptoms before and after therapy show a significant increase of metacognition and decrease of negative symptoms over the course of 40 weeks.
Intensive Care Unit-Acquired Weakness in Patients With Extracorporeal Membrane Oxygenation Support: Frequency and Clinical Characteristics
Authors: Xinyi Chen, Xiong Lei, Xin Xu, Yu Zhou, Man Huang
Journal: Front Med (Lausanne) (2022)
Keywords: ecmo, ecmo complications, icu-acquired weakness, mechanical ventilation, sedation

Background:
Intensive care unit-acquired weakness (ICU-AW) is common in critical illness patients and is well described. Extracorporeal membrane oxygenation (ECMO) is used as a life-saving method and patients with ECMO support often suffer more risk factors of ICU-AW. However, information on the frequency and clinical characteristics of ICU-AW in patients with ECMO support is lacking. Our study aims to clarify the frequency and characteristics of ICU-AW in ECMO patients.
Methods:
We conducted a retrospective study, ICU-AW was diagnosed when patients were discharged with a Medical Research Council (MRC) sum score <48. Clinical information was collected from the case report forms. Univariable analysis, LASSO regression analysis, and logistic regression analysis were used to analyze the clinical data of individuals.
Results:
In ECMO population, 40 (80%) patients diagnosed with ICU-AW. On univariable analysis, the ICU-AW group had higher Acute Physiology and Chronic Health Evaluation II (APACHE II) [13.9 (6.5-21.3) versus 21.1 (14.3-27.9), p = 0.005], longer deep sedation time [2 (0-7) versus 6.5 (3-11), p = 0.005], longer mechanical ventilation time [6.8 (2.6-9.3) versus 14.3 (6.6-19.3), p = 0.008], lower lowest albumin [26.7 (23.8-29.5) versus 22.1 (18.5-25.7), p < 0.001]. The LASSO analysis showed mechanical ventilation time, deep sedation time, deep sedation time during ECMO operation, APACHE II, and lowest albumin level were independent predictors of ICU-AW. To investigate whether ICU-AW occurs more frequently in the ECMO population, we performed a 1:1 matching with patients without ECMO and found there was no difference in the incidence of ICU-AW between the two groups. Logistic regression analysis of combined cohorts showed lowest albumin odds ratio (OR: 1.9, p = 0.024), deep sedation time (OR: 1.9, p = 0.022), mechanical ventilation time (OR: 2.0, p = 0.034), and APACHE II (OR: 2.3, p = 0.034) were independent risk factors of ICU-AW, but not ECMO.
Conclusion:
The ICU-AW was common with a prevalence of 80% in the ECMO population. Mechanical ventilation time, deep sedation time, deep sedation time during ECMO operation, APACHE II, and lowest albumin level were risk factors of ICU-AW in ECMO population. The ECMO wasn't an independent risk factor of ICU-AW.
An unusual cause of upper gastrointestinal bleeding due to recurrent hepatocellular carcinoma: A case report
Authors: Yuk Ho Liu, Eugene Yee Juen Lo, Kit Fai Lee, Charing Ching Ning Chong, Paul Bo San Lai
Journal: Int J Surg Case Rep (2020)
Keywords: gastrointestinal bleeding, hepatocellular carcinoma
MeSH terms: Case Reports

Introduction:
Upper gastrointestinal bleeding (UGIB) in patients suffering from hepatocellular carcinoma (HCC) is usually due to oesophageal or gastric varices secondary to portal hypertension. Very rarely, HCC can directly invade into the stomach or duodenum resulting in UGIB.
Presentation of case:
A 62-year-old man presented to the emergency department for haematemesis and tarry stool. He was a hepatitis B carrier and had received open radiofrequency ablation and wedge resection for HCC previously. Urgent endoscopy and contrast computed tomography confirmed recurrent HCC invading into the duodenum. The patient received radical resection and remained disease free for 7 years after the operation.
Discussion:
Direct invasion into gastrointestinal tract by HCC is rare. Different modalities of treatment have been reported in the literature with variable success. En-bloc resection should be considered if surgically feasible in order to achieve good haemostasis and possible long term survival.
Conclusion:
Upper gastrointestinal bleeding is a rare presentation of hepatocellular carcinoma and long term survival can be achieved by curative surgery.
Association of Chronic Myelogenous (Basophilic) Leukemia and the BCR/ABL Mutation in a Yucatan Barrow ( Sus scrofa domestica)
Authors: Catherine Takawira, Carmen B Arsuaga-Zorrilla, Leslie Wilson, Takashi Taguchi, Marilyn A Dietrich, Rhett W Stout, Mandi J Lopez
Journal: Front Vet Sci (2020)
Keywords: philadelphia chromosome, bone marrow, cancer, chronic myelogenous leukemia, flow cytometry, gene, hematologic malignancy, pig
MeSH terms: Case Reports

Background: Chronic myelogenous leukemia (CML) is a clonal proliferative disorder of the myeloid, megakaryocyte, and erythroid lineages. The onset and subsequent progression of CML is well-described in humans. There is comparably little information surrounding CML progression in veterinary species, including Yucatan miniature swine that are common for preclinical pharmaceutical and device testing. In humans, more than 90% of CML cases are associated with a chromosomal translocation that results in the Philadelphia gene (BCR/ABL mutation). In this report, the presence of the Philadelphia gene in a Yucatan burrow was confirmed in white blood cells collected prior to onset of clinical signs with primers designed from the human BCR/ABL sequence. Case Presentation: A 24 month old, 70 kg, Yucatan barrow received a prefabricated bovine cortical bone xenograft following a unilateral zygomatic ostectomy for a preclinical study. Complete blood count and serum chemistries were performed prior to and 28, 53, 106, and 129 days after facial surgery. Fifty three days after surgery, a bone marrow biopsy was performed due to anorexia, severe basophilia, and mild anemia. A finding of a moderate increase in basophilic precursors in bone marrow cytology was followed by lymphocyte immunophenotyping via flow cytometry and RT-PCR amplification of the Philadelphia gene in white blood cell samples from the affected barrow and an unaffected barrow in the same treatment group. Bone marrow, lymph node, liver, spleen, lung, kidney, and adrenal gland lesions of mostly myeloblasts were identified after the affected barrow died 146 days after surgery. Flow cytometry confirmed lymphopenia and suggested basophilia, and RT-PCR established the presence of the BCR/ABL gene. Conclusions: The information in this report confirms the presence of the BCR/ABL mutation and documents progression of chronic myelogenous (basophilic) leukemia from a chronic phase to a terminal blast crisis in an adult Yucatan barrow. The natural occurrence and progression of CML associated with the BCR/ABL mutation in miniature swine establishes potential for future porcine models of human CML. The information also establishes a genetic test to confirm porcine CML to prevent inadvertent attribution of clinical signs to treatment complications during preclinical testing.
Management of calcium channel antagonist overdose with hyperinsulinemia-euglycemia therapy: case series and review of the literature
Authors: Shiwan K Shah, Sanjeev Kumar Goswami, Rajesh V Babu, Gulshan Sharma, Alexander G Duarte
Journal: Case Rep Crit Care (2012)
MeSH terms: Case Reports

Calcium channel antagonists (CCAs) are commonly involved in drug overdoses. Standard approaches to the management of CCA overdoses, including fluid resuscitation, gut decontamination, administration of calcium, glucagon, and atropine, as well as supportive care, are often ineffective. We report on two patients who improved after addition of hyperinsulinemia-euglycemia (HIE) therapy. We conclude with a literature review on hyperinsulinemia-euglycemia therapy with an exploration of the physiology behind its potential use.
Metagenomic Next-Generation Sequencing (mNGS) for the Timely Diagnosis of Carbapenem-Resistant Klebsiella pneumoniae in Leukemia Patients
Authors: Huan Tao, Fang Hua, Yingying Chen, Yongqian Jia
Journal: Case Rep Infect Dis (2022)
MeSH terms: Case Reports

This report shows the contribution of metagenomic next-generation sequencing (mNGS) as an alternative to challenging diagnostic infection in immunosuppressed individuals. Herein, we report two leukemia patients who developed severe infections due to carbapenem-resistant Klebsiella pneumoniae (CrKP). The mNGS can be strongly recommended as an alternative investigation for patients who are at high risk of infection without positivity on body fluid culture. This can provide the opportunity for adequate therapy.
Amyotrophic Lateral Sclerosis and Primary Biliary Cirrhosis Overlap Syndrome: Two Cases Report
Authors: Haibo Zhang, Yaling Liu, Zhenfei Li, Na Liang, Xiaomeng Zhou, Xiangyu Nie, Ting Zhang, Weijing Qi
Journal: Front Neurol (2019)
Keywords: amyotrophic lateral sclerosis, immunological mechanism, mitochondrial mechanism, primary biliary cirrhosis, ursodeoxycholic acid
MeSH terms: Case Reports

Amyotrophic lateral sclerosis (ALS) is a disease of which the underlying etiology and pathogenesis are unknown. Numerous data indicate an important role of the immune system and mitochondrial function in the disease. Primary biliary cirrhosis (PBC) is an autoimmune liver disease resulting from a combination of genetic and environmental risk factors. Patients with PBC develop innate and adaptive immune reactions against mitochondrial antigens. Therefore, common mechanisms could exist in both diseases. We present two cases of ALS with PBC to explore the relationship between the two diseases from the immunological and mitochondrial aspects. Further attention should be given to immune-modulating therapy in ALS patients.
A Simple and Rapid Puncture Method for Draining Hematoma in Pontine Hemorrhage
Authors: Mingzhe Zhang, Raynald Liu, Hongli Xing, Huixuan Luo, Leiting Cui, Zhaosheng Sun
Journal: Front Neurol (2018)
Keywords: method, pontine hemorrhage, puncture, rapid, simple
MeSH terms: Case Reports

We present a patient with pontine hemorrhage. On admission, the patient was in a comatose state (Glasgow coma scale, 3). Due to rapid deterioration of his breathing, we immediately performed a direct puncture to the hematoma site. We present a simple and rapid puncture method for drainage of hematomas. The method is described and discussed in detail in this article. The described technique may be beneficial in emergency situations where the condition of the patient, particularly their respiration is declining rapidly.
Paratubal borderline serous tumor in a postmenopausal woman: a case report
Authors: JongChul Baek
Journal: Pan Afr Med J (2019)
Keywords: paratubal cyst, menopause, paratubal borderline serous tumor
MeSH terms: Fallopian Tube Neoplasms / diagnosis, Ovarian Cysts / pathology, Parovarian Cyst / diagnosis, Postmenopause, Case Reports, Disease Progression, Fallopian Tube Neoplasms / pathology, Female, Follow-Up Studies, Humans, Hysterectomy / methods, Laparoscopy / methods, Middle Aged, Parovarian Cyst / pathology, Salpingo-oophorectomy / methods, Tomography, X-Ray Computed

Unlike borderline ovarian tumors, paratubal borderline tumors are extremely rare gynecologic tumors. They occur in reproductive-aged females at an earlier stage of disease and have a good prognosis. A 61-year-old woman, gravida 3 para 3, presented with progression of ovarian cyst. Computed tomography revealed a 6-cm simple cystic lesion without enhancing papillary projections. The patient underwent total laparoscopic hysterectomy and bilateral salpingo-oophorectomy. Frozen specimens showed that the tumor was benign, thereby confirming a final diagnosis of paratubal borderline serous tumor. The patient refused comprehensive surgical staging and opted for close follow-up. The patient remains asymptomatic with no evidence of recurrence at the 24-month follow-up. To the best of our knowledge, this is the first reported case of paratubal borderline serous tumor in a postmenopausal patient. The findings of this study and those of other case reports can contribute to the understanding, diagnosis, treatment and prognosis of these rare tumors.
Rapidly progressive adult-onset neuronal intranuclear inclusion disease beginning with autonomic symptoms: a case report
Authors: Yi Zhu, Qian Yang, Yun Tian, Weibing Fan, Xinfa Mao
Journal: Front Neurol (2023)
Keywords: autonomic symptom, case report, misdiagnose, neuronal intranuclear inclusion disease, pathological change
MeSH terms: Case Reports

Background:
Neuronal intranuclear inclusion disease (NIID) is a rare neurodegenerative disease that can affect the nervous and other systems of the body. Its clinical manifestations are complex and easily misdiagnosed. Adult-onset NIID beginning with autonomic symptoms such as recurrent hypotension, profuse sweating, and syncope has not been reported.
Case presentation:
An 81-year-old male was admitted to the hospital in June 2018 due to repeated episodes of hypotension, profuse sweating, pale complexion, and syncope for 3 years, and progressive dementia for 2 years. DWI was not possible due to the presence of metal residues in the body. Cutaneous histopathology revealed sweat gland cell nuclear inclusions and immunohistochemistry showed p62 nuclear immunoreactivity. Blood RP-PCR identified an abnormal GGC repeat expansion in the 5'UTR of the NOTCH2NLC gene. Accordingly, this case was diagnosed as adult-onset NIID in August 2018. The patient subsequently received vitamin C nutritional support, rehydration, and other vital signs maintenance treatments during hospitalization, but the above symptoms still recurred after discharge. With the development of the disease, lower extremity weakness, slow movement, dementia, repeated constipation, and vomiting appeared successively. In April 2019, he was hospitalized again for severe pneumonia, and died of multiple organ failure in June 2019.
Conclusion:
The presented case exemplifies great clinical heterogeneity of NIID. Some patients may have neurological symptoms and other systemic symptoms simultaneously. This patient started with autonomic symptoms, including recurrent episodes of hypotension, profuse sweating, pallor, and syncope, which progressed rapidly. This case report provides new information for the diagnosis of NIID.
Fever of Unknown Origin as a Sole Presentation of Subacute Thyroiditis in an Elderly Patient: A Case Report with Literature Review
Authors: Rishi Raj, Srujana Yada, Aasems Jacob, Dileep Unnikrishnan, Wael Ghali
Journal: Case Rep Endocrinol (2018)
MeSH terms: Case Reports

An 80-year-old Caucasian male presented with fever of 3-week duration. Outpatient workup for infectious etiologies was negative and due to persistent fever, he was hospitalized for further evaluation of fever of unknown origin (FUO). Physical examination and laboratory studies remained unremarkable; however a follow-up CT scan of chest, abdomen, and pelvis with contrast done to rule out malignancy as an underlying cause of FUO revealed heterogeneous thyroid gland with surrounding hazy changes suggestive of thyroiditis. Thyroid function tests confirmed the diagnosis of subacute thyroiditis. The patient was started on prednisone with good response in his symptoms and was eventually discharged to home. The importance of our case lies in the fact that diagnosing subacute thyroiditis in the absence of classical symptoms of neck pain can be challenging and a physician should have a very high index of suspicion especially in an elderly patient where FUO can be the sole presentation.
Gallbladder Mucus Plug Mimicking Ascaris Worm: An Ambiguous Cause of Biliary Colic
Authors: Salah Termos, Mohammad Alali, Majd Alkabbani, Abdullah AlDuwaisan, Ahmad Alsaleh, Khalifa Alyatama, Hussein Hayati
Journal: Case Rep Surg (2017)
MeSH terms: Case Reports

Biliary colic is a visceral pain caused by attempts of the gallbladder or bile duct to overcome the obstruction in the cystic duct or ampulla of Vater. Obstruction can be due to different etiologies such as stone, mass, worm, and rarely by mucus plug. We report the case of a 31-year-old gentleman who presented with recurrent biliary colic and weight loss. Work-up showed linear calcifications in the gallbladder extending to the common bile duct suggesting hepatobiliary ascariasis. Further investigations including stool analysis, upper endoscopy, endoscopic ultrasonography (EUS), and endoscopic retrograde cholangiopancreatography (ERCP) did not support our provisional diagnosis. Laparoscopic cholecystectomy was performed. Histopathological finding was grossly ambiguous; a rope-like mucus plug resembling ascaris worm was noted. The patient's condition improved instantly after the procedure. To our knowledge, we are reporting the first case in the English literature describing this unique entity of symptomatic gallbladder disease to increase awareness and improve its management.
Pneumococcal puerperal mastitis in a lactating mother
Authors: T Skalidis, A Stamnidi, V Syriopoulou, G Kontopoulos, N Legakis
Journal: Access Microbiol (2019)
Keywords: breast-feeding, pneumococcal infection, puerperal mastitis
MeSH terms: Case Reports

Introduction:
A case of pneumococcal mastitis in a breast-feeding mother 6 months postpartum is described. Mastitis is usually caused by Staphylococcus aureus . A review of the literature from 1950 to March 2018 revealed only four other cases in which the causative organism was Streptococcus pneumoniae .
Case presentation:
The nursing mother presented with high fever and the four cardinal signs of inflammation of the left breast: calor, dolor, rubor, tumour. In milk culture Streptococcus pneumoniae was isolated in numbers exceeding 105 c.f.u. ml-1 . The strain was of polysaccharide serotype 11 not included in Prevnar-13. Susceptibility testing showed full sensitivity to β-lactam antibiotics as well as to macrolides, lincosamides, vancomycin and tetracycline.
Conclusion:

Streptococcus pneumoniae should be considered as a possible causative agent of puerperal mastitis.
Robot-Assisted Partial Splenectomy for Splenic Epidermoid Cyst
Authors: Mubarak Ali Kirih, Xiao Liang, Yangyan Xie, Jingwei Cai, Junhao Zheng, Feng Xu, Shilin He, Liye Tao, Faisa Ali Abdi
Journal: Case Rep Surg (2020)
MeSH terms: Case Reports

The splenic cyst is a rare disease with unknown etiology. The inner wall of the cyst has lining epithelium. The cyst can be unilocular or multilocular. According to pathology, it can be divided into four types: epidermoid cyst, dermoid cyst, cystic lymphangioma, and cystic hemangioma. Ultrasound examination is often the first choice for splenic cysts because of its nonradiation, low cost, and convenient examination. The images are mostly cystic masses with clear borders and dark areas without echoes, after the detection of splenic space-occupying lesions by ultrasonography, CT, and MRI. Here, we report robot-assisted partial splenectomy for a splenic cyst. Imaging diagnosis of abdominal CT enhancement: the cystic space-occupying of the spleen is considered. We should improve the preoperative examination and exclude operative contraindications. During the operation, there was about 8 cm of the upper pole of the spleen, and the boundary was clear. There was no obvious abnormality in the exploration of the abdominal viscera. The operation was successful. The operative time was 115 minutes, and the blood loss was 20 ml. On the first day after the operation, the patient took a liquid diet. The time of first anal exhaust was on the second day after operation. The patient was discharged at the fourth day. Postoperative pathology revealed epidermoid cyst. The therapy strategy of the splenic cyst is ambiguous. Better understanding of the splenic segmental anatomy and surgical skills has made minimally invasive partial splenectomy a preferred treatment for splenic cysts. In this paper, we report a case of splenic epidermoid cyst managed successfully by robot-assisted partial splenectomy.