OpenMed/multicare-articles huggingface dataset:
Oxidative Stress in Takotsubo Syndrome-Is It Essential for an Acute Attack? Indirect Evidences Support Multisite Impact Including the Calcium Overload-Energy Failure Hypothesis
Authors: Jan Manousek, Petr Kala, Petr Lokaj, Tomas Ondrus, Katerina Helanova, Marie Miklikova, Vojtech Brazdil, Marie Tomandlova, Jiri Parenica, Monika Pavkova Goldbergova, Jiri Hlasensky
Journal: Front Cardiovasc Med (2021)
Keywords: takotsubo syndrome, antioxidants, calcium overload, catecholamines, cytochrome p450, energy failure, oxidative stress, sarco(endo)plasmic reticulum - mitochondria complex

Indirect evidences in reviews and case reports on Takotsubo syndrome (TTS) support the fact that the existence of oxidative stress (OS) might be its common feature in the pre-acute stage. The sources of OS are exogenous (environmental factors including pharmacological and toxic influences) and endogenous, the combination of both may be present, and they are being discussed in detail. OS is associated with several pathological conditions representing TTS comorbidities and triggers. The dominant source of OS electrones are mitochondria. Our analysis of drug therapy related to acute TTS shows many interactions, e.g., cytostatics and glucocorticoids with mitochondrial cytochrome P450 and other enzymes important for OS. One of the most frequently discussed mechanisms in TTS is the effect of catecholamines on myocardium. Yet, their metabolic influence is neglected. OS is associated with the oxidation of catecholamines leading to the synthesis of their oxidized forms - aminochromes. Under pathological conditions, this pathway may dominate. There are evidences of interference between OS, catecholamine/aminochrome effects, their metabolism and antioxidant protection. The OS offensive may cause fast depletion of antioxidant protection including the homocystein-methionine system, whose activity decreases with age. The alteration of effector subcellular structures (mitochondria, sarco/endoplasmic reticulum) and subsequent changes in cellular energetics and calcium turnover may also occur and lead to the disruption of cellular function, including neurons and cardiomyocytes. On the organ level (nervous system and heart), neurocardiogenic stunning may occur. The effects of OS correspond to the effect of high doses of catecholamines in the experiment. Intensive OS might represent "conditio sine qua non" for this acute clinical condition. TTS might be significantly more complex pathology than currently perceived so far.
Superior dislocation hip with anterior column acetabular fracture - open reduction and internal fixation using a twin incision technique
Authors: Nipun Jindal, Sohan S Sankhala
Journal: Pan Afr Med J (2012)
Keywords: anterior column acetabulum, fracture, hip, ilioinguinal, superior dislocation
MeSH terms: Acetabulum / injuries, Fracture Fixation, Internal / methods, Fractures, Bone / complications, Fractures, Bone / surgery, Hip Dislocation / complications, Hip Dislocation / surgery, Multiple Trauma / surgery, Case Reports, Adolescent, Humans, Male

Superior variety of anterior dislocation of the hip is a rare injury. Its occurrence with acetabular fractures has been documented infrequently. We report a case of superior dislocation of the hip with anterior column acetabular fracture. Open reduction of the hip and internal fixation of the fracture was carried out using a twin incision technique. The course to recovery has been uneventful.
An Innovative Approach to Treat Incisors Hypomineralization (MIH): A Combined Use of Casein Phosphopeptide-Amorphous Calcium Phosphate and Hydrogen Peroxide-A Case Report
Authors: Stefano Mastroberardino, Guglielmo Campus, Laura Strohmenger, Alessandro Villa, Maria Grazia Cagetti
Journal: Case Rep Dent (2012)

Molar Incisor Hypomineralization (MIH) is characterized by a developmentally derived deficiency in mineral enamel. Affected teeth present demarcated enamel opacities, ranging from white to brown; also hypoplasia can be associated. Patient frequently claims aesthetic discomfort if anterior teeth are involved. This problem leads patients to request a bleaching treatment to improve aestheticconditions.Nevertheless, hydrogen peroxide can produce serious side-effects, resulting from further mineral loss. Microabrasion and/or a composite restoration are the treatments of choice in teeth with mild/moderate MIH, but they also need enamel loss. Recently, a new remineralizing agent based on Casein Phosphopeptide-Amorphous Calcium Phosphate (CPP-ACP) has been proposed to be effective in hypomineralized enamel, improving also aesthetic conditions. The present paper presents a case report of a young man with white opacities on incisors treated with a combined use of CPP-ACP mousse and hydrogen peroxide gel to correct the aesthetic defect. The patient was instructed to use CPP-ACP for two hours per day for three months in order to obtain enamel remineralization followed by a combined use of CPP-ACP and bleaching agent for further two months. At the end of this five-month treatment, a noticeable aesthetic improvement of the opacities was observed.
Surgical treatment of intestinal perforation in Behçet Syndrome: an unusual presentation
Authors: Carla Sofia Vicente, António Dias Freitas
Journal: Pan Afr Med J (2018)
Keywords: behçet, intestinal perforation, vasculitis
MeSH terms: Behcet Syndrome / diagnosis, Intestinal Perforation / etiology, Oral Ulcer / etiology, Uveitis / etiology, Case Reports, Adult, Behcet Syndrome / complications, Behcet Syndrome / surgery, Humans, Intestinal Perforation / surgery, Male, Tomography, X-Ray Computed / methods

Behçet syndrome is a chronic, recurring, systemic disorder characterized by the histopathologic finding of nonspecific vasculitis in multiple organs. Behçet syndrome involves the gastrointestinal tract in 10-50% of patients; The main sites of involvement are the terminal ileum and cecum. In patients with Behçet syndrome, CT is advocated for early detection of complications as well as for exclusion of other abdominal pathologic conditions but there is no specific exam. The report of histology in conjunction with the clinical history and the presence of oral ulcers, uveitis and suspected cutaneous lesions suggests the diagnosis. The optimal medical treatment of Behçet syndrome has not yet been well established. In rare cases surgery must be required to control the disease. The authors report one case of Behcet Syndrome presenting with intestinal perforation.
A Clinical Case of Patient Carrying Rare Pathological PSEN1 Gene Mutation (L424V) Demonstrates the Phenotypic Heterogenity of Early Onset Familial AD
Authors: Kaloyan R Stoychev, Maya Stoimenova-Popova, Petranka Chumpalova, Lilia Ilieva, Mohamed Swamad, Zornitsa Kamburova-Martinova
Journal: Front Psychiatry (2019)
Keywords: psen1 mutation, early onset alzheimer’s disease (eoad), genetic inheritance, phenotypic heterogeneity, whole exome sequencing
MeSH terms: Case Reports

Dementia comprises several neurodegenerative disorders with similar neuropsychiatric features and Alzheimer's disease (AD) is the most common of them. Genetic factors are strongly implicated into its etiology especially for early-onset cases (EOAD) occuring before the age of 65. About 10% of these are inherited in autosomal dominant fashion via pathogenic polymorphisms in three genes- APP, PSEN-1, and PSEN-2. Despite genotypic clarity, however, phenotypic variability exists with different symptom constellations observed in patients with identical mutations. Below, we present a case of a 39-year-old male with a family history for early onset dementia who was referred to our department with anamnesis for abrupt behavioral change 7 months prior to hospitalization-noticeable slowing of speech and reactivity, impaired occupational functioning and irritability, followed by aphasic symptoms and transient episodes of disorientation. He was followed up for 2 years and manifested rapidly progressing cognitive decline with further deterioration of speech, apraxia, acalculia, ataxia, and subsequently bradykinesia and tremor. Based on the clinical and neuroimaging findings (severe cortical atrophy), familial EOAD was suspected and a whole exome sequence (WES) analysis was performed. It identified a heterozygous missense variant Leu424Val (g.71074C > G) in PSEN-1 gene considered to be pathogenic, and only reported once until now in a Spanish patient in 2009. Despite genotype identity however, distinct phenotypic presentations were observed in the two affected subjects, with different neuroimaging findings, and the presence and absence of seizures in the Spanish and Bulgarian case, respectively. Besides, myoclonus and spastic paraparesis considered "typical" EOAD clinical features were absent. Age of symptom onset was consistent with two of the reported mutations affecting 424 codon of PSEN-1 gene and significantly earlier than the other two implying that factors influencing activity of PSEN-1 pathological forms are yet to be clarified. Furthermore, our patient had co-occurring lupus erythematosus (LE) and we suggest that this condition might be etiologically linked to the PSEN-1 mutation. In addition to illustrating the symptomatic heterogeneity of PSEN-1 caused EOAD, our study confirms that in patients presenting with early cognitive deterioration and family history for dementia, WES can be especially informative and should be considered as a first-line examination.
Conservative Management of Cervical Pregnancy with the Administration of Methotrexate and Potassium Chloride: A Case Report
Authors: Mojgan Javedani Masroor, Anna Zarei, Hossein Sheibani
Journal: Case Rep Obstet Gynecol (2022)
MeSH terms: Case Reports

Background. Cervical pregnancy is a rare form of ectopic pregnancy in which the fetus implants and grows inside the endocervical canal. This report aims at introducing a case of successful conservative management of cervical ectopic pregnancy. Case presentation. The patient was a 35-year-old woman, who had received treatment for primary infertility for 5 years. She complained of painless bleeding on day 37 of gestational age with a start point from 10 days before. The patient had stable vital signs and was referred to Shahid Akbar Abadi Hospital in Tehran affiliated with the Iran University of Medical Sciences. In the ultrasonography, the pregnancy sac and the yolk sac with the embryonic pole with a positive fetal heart rate were presented and located near the internal os, so the cervical pregnancy was diagnosed, and after treatment with intramuscular methotrexate and intra-amniotic administration of potassium chloride, a gradual decrease in β-HCG levels was observed without the need for additional interventional treatment. Conclusion. The primary takeaway of our report is that the conservative treatment, including intramuscular methotrexate and intrauterine potassium chloride administration, may be effective in treating cervical pregnancy that can be detected early without the use of curettage.
Pulmonary Metastases from an Undifferentiated Embryonal Sarcoma of the Liver: A Case Report and Review
Authors: Mingxia Shi, Hongzhi Xu, Guillermo P Sangster, Xin Gu
Journal: Case Rep Oncol Med (2018)
MeSH terms: Case Reports

Undifferentiated embryonal sarcoma of the liver (UESL) is a rare malignant hepatic tumor that occurs primarily in children. Only a limited number of cases have been reported in the literature due to low incidence of one per million, and reports of metastatic lesion of UESL are even rarer. We hereby describe the case of a 13-year-old male who presented with a palpable mass with imaging findings suggestive of a large complex tumor in the right lobe of the liver. He underwent extended right hepatectomy followed by adjuvant chemotherapy. The tumor was confirmed to be UESL by postoperative pathology and immunohistochemical staining analysis. Four years later, surveillance imaging revealed a small lung nodule in the left lower lobe. Complete removal of the lung tumor by wedge resection was performed, and a histological diagnosis of metastatic UESL was made. The patient also received postoperative adjuvant chemotherapy and is currently in a good general condition and tumor-free in the present eight-month period. This case is presented with emphasis on clinicopathological and immunohistochemical findings of the primary UESL and lung metastases with the aim of collecting more data and expanding our understanding of this rare malignancy.
Hypercalcemia-Induced ST-Segment Elevation Mimicking Acute Myocardial Injury: A Case Report and Review of the Literature
Authors: Ashraf Abugroun, Aneesh Tyle, Farah Faizan, Michael Accavitti, Chaudhary Ahmed, Theodore Wang
Journal: Case Rep Emerg Med (2020)
MeSH terms: Case Reports

ST-segment elevation in absence of acute coronary syndrome can be seen in multiple conditions, including acute pericarditis and coronary vasospasm, but it is rarely seen with severe hypercalcemia. The authors present a case of an 81-year-old female with a history of stage 4 squamous cell cancer of the lung, who presented to the emergency room with profound fatigue, weakness, anorexia, and drowsiness two weeks after her first chemotherapy cycle. Additionally, she had complaints of right-sided chest pain associated with worsening shortness of breath, as well as right arm numbness. An EKG obtained on arrival to the hospital showed diffuse ST-segment elevation (leads V3-V6, I, II, III, and aVF). Basic lab work found a calcium level of 20.4 mg/dl with elevated parathyroid hormone-related protein (PTHrP) of 135 pg/ml. Troponin I remained within normal limits. Serial EKS obtained during the patient's hospitalization demonstrated resolution of the ST elevation as calcium level normalized. This case emphasizes the importance of hypercalcemia as a differential diagnosis for ST-segment elevation and QT shortening when acute coronary syndrome is not present. Awareness of these EKG changes is critical for early diagnosis, recognition, and appropriate treatment.
Case study of ecstatic meditation: fMRI and EEG evidence of self-stimulating a reward system
Authors: Michael R Hagerty, Julian Isaacs, Leigh Brasington, Larry Shupe, Eberhard E Fetz, Steven C Cramer
Journal: Neural Plast (2013)
MeSH terms: Brain / physiology, Meditation, Reward, Awareness / physiology, Electroencephalography, Functional Neuroimaging, Humans, Magnetic Resonance Imaging, Male, Middle Aged

We report the first neural recording during ecstatic meditations called jhanas and test whether a brain reward system plays a role in the joy reported. Jhanas are Altered States of Consciousness (ASC) that imply major brain changes based on subjective reports: (1) external awareness dims, (2) internal verbalizations fade, (3) the sense of personal boundaries is altered, (4) attention is highly focused on the object of meditation, and (5) joy increases to high levels. The fMRI and EEG results from an experienced meditator show changes in brain activity in 11 regions shown to be associated with the subjective reports, and these changes occur promptly after jhana is entered. In particular, the extreme joy is associated not only with activation of cortical processes but also with activation of the nucleus accumbens (NAc) in the dopamine/opioid reward system. We test three mechanisms by which the subject might stimulate his own reward system by external means and reject all three. Taken together, these results demonstrate an apparently novel method of self-stimulating a brain reward system using only internal mental processes in a highly trained subject.
An Unusual Case of Zero Percent Coagulopathic Factor in a Patient With Polymyalgia Rheumatica
Authors: Nathalie De Paz, Miguel A Belaunzaran, Ruben Cabrera, Tommy Macias, Sherard Lacaille, Carlos Guida
Journal: Cureus (2023)
Keywords: acquired hemophilia a, case report, factor viii deficiency, factor viii inhibitors, polymyalgia rheumatica
MeSH terms: Case Reports

We present a case of a 74-year-old male with a past medical history of polymyalgia rheumatica that presented as a transfer for evaluation of hematomas of the scrotum, left groin, back, and bilateral thighs. Further questioning revealed hematuria and bleeding gums for the past month. The patient complained of left thigh pain without recent fever, chills, chest pain, or shortness of breath. A physical exam showed hematomas of the left groin, scrotum, bilateral thighs, and back with an ecchymotic appearance. Initial pertinent laboratory workup showed decreased hemoglobin, leukocytosis, and elevated partial thromboplastin time (PTT). Therefore, a decision was made to obtain a CT angiogram of the abdomen and pelvis, which revealed retroperitoneal hematoma. Further diagnostic workup showed a coagulation factor VIII level of zero percent and mixing studies supporting the presence of an acquired factor VIII inhibitor. Therefore, the patient was treated with rituximab and recombinant factor VIIa, with an improvement of factor VIII levels to normal limits within a week.
Case report of aggressive treatments for large-cell neuroendocrine carcinoma of the esophagus
Authors: Yosuke Nakao, Tetsuya Okino, Yo-Ichi Yamashita, Katsunobu Taki, Shigeki Nakagawa, Katsutaka Matsumoto, Mataro Goto, Hideo Baba
Journal: Int J Surg Case Rep (2019)
Keywords: case report, esophagus, large cell, neuroendocrine carcinoma

Introduction:
Neuroendocrine carcinoma of the esophagus is a rare and highly aggressive disease, and the biological features are poorly understood.
Presentation of case:
We report a case of large-cell neuroendocrine carcinoma of the esophagus in a 73-year-old male patient with aggressive surgical treatment. Upper gastrointestinal endoscopy revealed an esophageal large mass. Histological examination of biopsy specimens indicated a neuroendocrine carcinoma. First, we performed subtotal esophagectomy with lymphadenectomy, but he experienced metastasis at the liver and rib 5 months later. Next, we performed partial hepatectomy and radiotherapy for rib metastasis, but he experienced metastasis at the left pulmonary hilar lymph node and sacral bone. Finally, we performed chemotherapy using cisplatin and irinotecan.
Discussion:
The therapeutic strategy for large-cell NEC of the esophagus is unestablished. Thus, accumulating the therapeutic results garnered from various treatment tools is considerably important.
Conclusion:
Aggressive multimodal treatments including surgery have a possibility to gain better survival in patients with large-cell NEC of the esophagus.
A long-term survivor of Bland-White-Garland syndrome with systemic collateral supply: a case report and review of the literature
Authors: N Barbetakis, A Efstathiou, N Efstathiou, P Papagiannopoulou, V Soulountsi, I Fessatidis
Journal: BMC Surg (2005)
MeSH terms: Coronary Vessel Anomalies / complications, Mitral Valve Insufficiency / etiology, Pulmonary Artery / abnormalities, Case Reports, Coronary Vessel Anomalies / diagnostic imaging, Coronary Vessel Anomalies / surgery, Echocardiography, Female, Humans, Middle Aged, Mitral Valve Insufficiency / diagnostic imaging, Mitral Valve Insufficiency / surgery

Background:
Bland-White-Garland syndrome (anomalous origin of the left coronary artery from the pulmonary artery) is a rare disease which may result in myocardial infarction, congestive heart failure and sometimes death during the early infantile period.
Case presentation:
A successfully treated case of a 45-year-old mother of 2 children with Bland-White-Garland syndrome and concomitant severe mitral regurgitation is presented. Subsequent therapy consisted of ligation of the anomalous origin of the left coronary artery, anastomosis of the left internal mammary artery to the left anterior descending branch and mitral valve replacement. Continuous blood flow from the left coronary artery ostium during extracorporeal circulation and aorta clamping suggested systemic collateral supply.
Conclusions:
Recognition and diagnosis of Bland-White-Garland syndrome is important due to its potentially life-threatening complications.
Atypical Features Resembling Poorly Differentiated Thyroid Carcinoma Presenting Entirely within a Follicular Adenoma
Authors: Daniel Ching, Connull Leslie
Journal: Case Rep Pathol (2018)
MeSH terms: Case Reports

Poorly differentiated thyroid carcinoma (PDTC) is rare and is usually widely invasive at presentation. Here we present an unusual case with a component meeting diagnostic criteria for PDTC by Turin consensus proposal arising within a follicular adenoma. A 44-year-old female was found to have an incidental right thyroid nodule that was suggestive of follicular neoplasm on FNA. Histological examination of hemithyroidectomy revealed an 11 mm focus with insular growth pattern, alteration in cell morphology, and high mitotic count meeting criteria for PDTC. In addition there were several regions showing trabecular architecture with increased mitotic activity but not meeting criteria for PDTC. The literature for such cases is sparse but suggests much better prognosis than conventional invasive PDTC, although a biological potential for aggressive behaviour may be possible.
Anesthetic management of cesarean section in a patient with a large anterior mediastinal mass: a case report
Authors: Kunio Kusajima, Satoshi Ishihara, Takeshi Yokoyama, Katsuyuki Katayama
Journal: JA Clin Rep (2017)
Keywords: anesthetic management, cesarean section, combined spinal epidural anesthesia, mediastinal mass, pregnancy, respiratory distress, tracheal stenosis

Background:
Symptomatic anterior mediastinal mass in pregnancy is rare, and cesarean section for such patients poses a risk of cardiopulmonary collapse.
Case presentation:
A 30-year-old woman at 40 weeks' gestation complained of breathlessness and cough, and she was not able to lie supine because of respiratory distress. Computed tomography scan revealed a large anterior-superior mediastinal mass severely compressing the trachea, bilateral main bronchus, and superior vena cava. Because clinical symptoms and computed tomographic findings suggested imminent respiratory catastrophe, urgent cesarean section was planned. The patient was able to lie in the semi-recumbent position with minimal symptoms; therefore, we considered it safe to perform cesarean section with combined spinal epidural anesthesia. In the event of cardiopulmonary collapse, emergent intubation and extracorporeal membrane oxygenation were also planned. The operation was performed successfully with combined spinal epidural anesthesia. The infant was healthy, and the postoperative hospital course was uneventful.
Conclusions:
Combined spinal epidural anesthesia is preferable in the anesthetic management of cesarean section with symptomatic anterior mediastinal mass. A well-designed preoperative strategy can lead to favorable outcomes even in this complicated situation.
Increased density of the liver and amiodarone-associated phospholipidosis
Authors: Sunao Kojima, Shinobu Kojima, Hirofumi Ueno, Motohiro Takeya, Hisao Ogawa
Journal: Cardiol Res Pract (2009)
MeSH terms: Case Reports

This is a case report in which a 60-year-old man who suffered from ventricular tachycardia with dilated cardiomyopathy was prescribed amiodarone. After taking amiodarone, liver enzymes were increased and computed tomographic (CT) scanning of the abdomen showed a significant increase in the density of the liver without contrast medium. He was suspected as hemochromatosis and liver biopsy was performed. An abnormal high density of liver tissue may be observed in an unenhanced CT in patients treated with amiodarone and we suggest that periodic monitoring of liver function and/or liver biopsy is warranted before an irreversible stage is reached.