OpenMed/multicare-articles huggingface dataset:
Hypnosis and superficial cervical anesthesia for total thyroidectomy in a high-risk patient - A case report
Authors: P Makovac, A Potié, A Roukain, L Pucci, T Rutz, P A Kopp, M Matter
Journal: Int J Surg Case Rep (2020)
Keywords: hypnosis, superficial anesthesia, thyroidectomy
MeSH terms: Case Reports

Introduction:
Total thyroidectomy can be challenging in high-risk patients. Local cervical anesthesia with sedation is an alternative to general anesthesia.
Case presentation:
A 33-year old male patient with cyanotic congenital heart disease due to unrepaired tricuspid atresia type Ic and associated pulmonary arterial hypertension presented with tachycardic atrial fibrillation and amiodarone-induced thyrotoxicosis resulting in recurrent hemodynamic instability. Because of difficulties controlling the thyrotoxic state, the indication for total thyroidectomy was established. Total thyroidectomy was subsequently performed using local anesthesia combined using a hypnosis-analgesia technique instead of intravenous sedation. The intervention and the post-operative course were uneventful.
Discussion:
A well-established therapist-patient relationship is crucial for a successful induction of hypnosis. Patient motivation and expectations are equally important for a successful implementation of this approach.
Conclusion:
We conclude that hypnosis combined with local anesthesia provides an effective alternative in selected patients with very high anesthesiological risk.
Case series: Portomesenteric venous thrombosis complicating laparoscopic bariatric procedures
Authors: Marwan Mohamed Bucheeri, Abdulmenem Yahya Abulsel
Journal: Int J Surg Case Rep (2019)
Keywords: bariatric surgery, bypass, complications, gastric, mesenteric, minigastric, obesity, portal, portomesenteric, roux en y, sleeve gastrectomy, splenic, thrombosis, vein

Introduction:
Portomesenteric vein thrombosis is a rare but documented complication of laparoscopic surgery. This rare complication is currently being encountered more frequently with the increase in the rates of laparoscopic bariatric surgery procedures being performed worldwide.
Methods:
A retrospective analysis was performed on all bariatric procedures performed in our center between July 2012 & December 2017 to identify cases complicated by portomesenteric venous thrombosis. The cases were compared in terms of operative details, patient presentation, diagnosis, patient risk factors for developing thrombosis, demographics and thrombophilia analysis & subsequent treatment and prognosis.
Results:
A total of 1030 bariatric procedures were performed between July 2012 & December 2017. Portomesenteric venous thrombosis complicated 3 of these cases (0.29%). Two of these cases had underwent a laparoscopic sleeve gastrectomy while the third had underwent a gastric band removal and a conversion to a single anastomosis gastric bypass. Amongst these patients, 2 were female while 1 was male with an average BMI 38.9 kg/m2. Only one of these patients was a smoker while none of them tested positive for thrombophilias. The diagnosis of portomesenteric venous thrombosis was confirmed with a contrast CT of the abdomen as all patients were re-admitted between 4-20 days post operatively after being discharged on postoperative day 2. All three cases were managed with systemic anticoagulants and none underwent invasive procedures or were re-explored surgically. All were subsequently discharged in good condition.
Conclusion:
Portomesenteric venous thrombosis is an uncommon yet potentially fatal complication of bariatric surgery. A high index of suspicion, early diagnosis and subsequent adequate management is required. Based on this case series and the potential risk of portomesenteric venous thrombosis, we altered our clinical practice to include a 1 week course of low molecular weight heparin to be administered to all patients after discharge.
Pneumothorax as adverse event in patients with lung metastases of soft tissue sarcoma treated with pazopanib: a single reference centre case series
Authors: Arie J Verschoor, Hans Gelderblom
Journal: Clin Sarcoma Res (2014)
Keywords: adverse event, pazopanib, pleural metastases, pneumothorax, pulmonary metastases, soft tissue sarcoma
MeSH terms: Case Reports

Background:
Recently, the phase III PALETTE study introduced pazopanib (Votrient®) as treatment for adult patients with locally advanced or metastatic non-liposarcoma soft tissue sarcoma after prior treatment with doxorubicin and/or ifosfamide. Pneumothorax was reported as adverse event in 8 of 246 treated patients (3.3%) in that study. This case series presents the incidence and clinic of this complication in the Leiden University Medical Centre.
Cases:
Forty-three patients were treated with pazopanib of which six patients (14.0%) developed a pneumothorax. These six patients were treated for malignant peripheral nerve sheath tumour, angiosarcoma, synovial sarcoma, fibromyxomatoid sarcoma, pleomorphic sarcoma and endometrial stromal sarcoma. All six patients had subpleural pulmonary or pleural metastases at the start of pazopanib and the pneumothorax developed during or shortly after treatment with pazopanib and was difficult to treat.
Discussion:
The incidence reported by us is higher than the incidence in the PALETTE study. Trials with pazopanib in renal cell carcinoma, urothelial carcinoma and cervix carcinoma did not report pneumothorax as an adverse event, suggesting pneumothorax as a specific adverse event in soft tissue sarcoma patients treated with pazopanib. This may be related to the fact that there is often pleural metastatic involvement and cystic degeneration due to pazopanib treatment may add to the risk.
Conclusion:
The risk of an, often difficult to treat, pneumothorax during pazopanib therapy should be discussed with the patient before initiation of treatment for a pulmonary metastasized sarcoma and physicians should be alert to the occurrence of such an event.
Pushing the Envelope in Obstetric Care: A Case Report of Cesarean Delivery in a Parturient with a BMI >100 kg m-2
Authors: Sangeeta Kumaraswami, Itamar Futterman, Suryanarayana Pothula, Geetha P Rajendran, Ashutosh Kaul
Journal: Case Rep Anesthesiol (2020)
MeSH terms: Case Reports

An increasing number of women with a body mass index (BMI) ≥ 60 kg m-2, referred to as super-super obesity, are requiring anesthetic care for labor and delivery. Management of these patients presents obstetric, anesthetic, and logistical challenges. We report our experience in the management of cesarean delivery in a parturient with a BMI of 112 kg m-2. Use of epidural anesthesia and performance of a supraumbilical transverse surgical incision with caudal placement of the panniculus resulted in optimal hemodynamic and ventilatory parameters. Effective multidisciplinary planning and communication is key. We present this case to highlight decision-making strategies and elucidate our approach in the management of this complex obstetric case.
Combined Pre- and Postnatal Minimally Invasive Approach to Complicated Pulmonary Sequestrations
Authors: Martina Ichino, Francesco Macchini, Anna Morandi, Nicola Persico, Isabella Fabietti, Andrea Zanini, Ernesto Leva
Journal: European J Pediatr Surg Rep (2020)
Keywords: congenital lung malformation, fetal therapy, laser coagulation, pulmonary sequestration, thoracoscopy
MeSH terms: Case Reports

Pulmonary sequestration (PS) is mostly asymptomatic but there is a proportion of fetuses that develop hydrops, leading to fetal or neonatal death. Fetal treatments are available, but postnatal management of the residual lesions is not uniformly defined. We present two cases of combined pre- and postnatal minimally invasive approach to complicated extra-lobar PS. Patient 1 presented with complicated PS at 31 weeks of gestation. Ultrasound-guided laser coagulation of the anomalous artery was successful. The patient was born asymptomatic at 38 weeks. Neonatal magnetic resonance imaging (MRI) showed a residual mass, confirmed by computed tomography (CT) at 6 months. No systemic artery was described, but perfusion was present. We decided for thoracoscopic resection. A residual artery was identified and sealed. Patient 2 presented with complicated PS at 25 weeks of gestation, underwent laser coagulation of the anomalous artery and was born asymptomatic at 38 weeks. Neonatal MRI showed persistence of the lesion, confirmed by CT scan at 4 months. We proceeded with thoracoscopic resection. A residual vessel was ligated. The patients 1 and 2 are now 24 and 21 months old, respectively, and healthy. Prenatal treatment of complicated PS is a life-saving procedure. Postnatal thoracoscopic resection of the residual lesion is feasible and safe; we believe it is the best course of treatment to grant the complete excision of the malformation.
Aphasic Dystextia as Presenting Feature of Ischemic Stroke in a Pediatric Patient
Authors: Arpita Lakhotia, Alok Sachdeva, Supriya Mahajan, Nancy Bass
Journal: Case Rep Neurol Med (2016)

Aphasia is an important presenting symptom of acute stroke. With increasing reliance on electronic communication, incoherent texting or "dystextia," which is a subset of aphasia that is reflected in text messages, can be a useful tool for symptom recognition and analysis. It can be a red flag for the family and therefore can help in early identification of an acute neurological deficit. It is also useful for providers to reliably analyze the deficit as well as establish a timeline of evolution of symptoms. There have been case reports where dystextia has been the presenting feature of stroke or complicated migraine and in one case of meningioma. We present the case of a teenage patient that in our knowledge is the youngest reported case of dystextia, whose aphasia recorded in a text message assisted with stroke localization. This also adds to the literature of dystextia which so far has only seven other cases reported.
Graph Representation Forecasting of Patient's Medical Conditions: Toward a Digital Twin
Authors: Pietro Barbiero, Ramon Viñas Torné, Pietro Lió
Journal: Front Genet (2021)
Keywords: digital twin, generative adversarial networks, graph representation learning, monitoring, precision medicine

Objective: Modern medicine needs to shift from a wait and react, curative discipline to a preventative, interdisciplinary science aiming at providing personalized, systemic, and precise treatment plans to patients. To this purpose, we propose a "digital twin" of patients modeling the human body as a whole and providing a panoramic view over individuals' conditions. Methods: We propose a general framework that composes advanced artificial intelligence (AI) approaches and integrates mathematical modeling in order to provide a panoramic view over current and future pathophysiological conditions. Our modular architecture is based on a graph neural network (GNN) forecasting clinically relevant endpoints (such as blood pressure) and a generative adversarial network (GAN) providing a proof of concept of transcriptomic integrability. Results: We tested our digital twin model on two simulated clinical case studies combining information at organ, tissue, and cellular level. We provided a panoramic overview over current and future patient's conditions by monitoring and forecasting clinically relevant endpoints representing the evolution of patient's vital parameters using the GNN model. We showed how to use the GAN to generate multi-tissue expression data for blood and lung to find associations between cytokines conditioned on the expression of genes in the renin-angiotensin pathway. Our approach was to detect inflammatory cytokines, which are known to have effects on blood pressure and have previously been associated with SARS-CoV-2 infection (e.g., CXCR6, XCL1, and others). Significance: The graph representation of a computational patient has potential to solve important technological challenges in integrating multiscale computational modeling with AI. We believe that this work represents a step forward toward next-generation devices for precision and predictive medicine.
Restorative Management and Treatment of Pseudo-Class III Malocclusion
Authors: Ali H Alfaifi
Journal: Case Rep Dent (2021)
MeSH terms: Case Reports

Introduction:
One of the challenges that clinicians encounter in the dental office is treating occlusal discrepancies. Malocclusion has been classified into three main classes that were further classified by researchers into more detailed subclasses later on. Pseudo-class III malocclusion has been called apparent or positional class III malocclusion, and its treatment usually consists of different modalities depending on how early the case is treated. When early orthodontic intervention was not possible, the restorative treatment becomes an excellent alternative especially when the teeth require restorative rehabilitation. Treatment. In this case report, the patient was suffering from dental wear, multiple failed old restorations, and edge-to-edge occlusal relationship which could be classified as pseudo-class III malocclusion. The patient's esthetic complaint was addressed with full-coverage lithium disilicate and monolithic zirconia restorations that were successful in reestablishing the patient's occlusal relationship and were able to eliminate the biological manifestations of dental caries.
Conclusion:
We were able to provide an alternative to orthodontic treatment where esthetic and functional needs of the patient were met after careful diagnosis and proper management. This clinical approach will give chance to treat patients suffering from minor occlusal discrepancies that require restorative intervention without the need to go through orthodontic therapy.
A rare case of myeloid sarcoma presenting as an anorectal ulcer
Authors: Laxmi Parsa, Priti Bijpuria, Daniel Ringold, David Stein
Journal: Case Rep Med (2012)
MeSH terms: Case Reports

Myeloid Sarcoma is a rare tumor composed of myeloblasts occurring at an extramedullary site like bones, or various soft tissues. Myeloid sarcoma may involve the gastrointestinal tract very rarely either solitarily, or occurring simultaneously with acute myeloid leukemia. Its diagnosis is challenging and needs biopsy and immunohistochemical staining. We are describing a case of myeloid sarcoma which presented as a painful anal ulcer mimicking an atypical fissure. Its appearance resembled crohn's disease on sigmoidoscopy. A biopsy of the ulcer along with histochemical staining led to the diagnosis of myeloid sarcoma. Our case demonstrates the need for aggressive evaluation of any common gastrointestinal complaint with an atypical presentation.
Benign Lymphoid Hyperplasia Presenting as Bilateral Scleral Nodules
Authors: Ricardo J Cumba, Rene Vazquez-Botet
Journal: Case Rep Ophthalmol Med (2015)

Purpose. To report a case of transient lymphoid hyperplasia presenting as bilateral nodular scleral mass in a young male patient. Design. Observational case report. Methods. Chart review. Causes of scleritis were considered and excluded based on detailed history, physical examination, and laboratory investigations. Results. Excisional biopsy of scleral lesions indicated lymphoid tissue. Immunohistochemical studies revealed a polyclonal population of T and B cells consistent with a benign reactive process. Conclusions. Chronic exposure of the ocular adnexa to many allergens and irritants may lead to activation of the inflammatory cascade. In severely allergic patients activation may be exponential and elicit an immune-mediated response resulting in a transient lymphoid reactive process.
Rituximab-Associated Inflammatory Progressive Multifocal Leukoencephalopathy
Authors: Chandra Punch, Christina Schofield, Penelope Harris
Journal: Case Rep Infect Dis (2016)

Progressive multifocal leukoencephalopathy (PML) is a rare disease of the immunosuppression that results from neurotropic invasion of the JC virus which leads to demyelination of oligodendrocytes. Immune reconstitution inflammatory syndrome (IRIS), on the other hand, is a condition of inflammation that develops as the immune system reconstitutes. This case report describes a case of a 35-year-old HIV-negative male who presented with three weeks of right lower extremity paresthesias as well as right upper extremity apraxia. He was diagnosed with PML complicated by IRIS secondary to Rituximab, which he had completed four months prior to presentation. Despite the condition's poor prognosis, the patient recovered with only minor deficits.
Recognition of a disulfiram ethanol reaction in the emergency department is not always straightforward
Authors: Kristof Segher, Liesbeth Huys, Tania Desmet, Evi Steen, Stefanie Chys, Walter Buylaert, Peter De Paepe
Journal: PLoS One (2020)
MeSH terms: Disulfiram / therapeutic use, Drug Interactions / physiology, Ethanol / adverse effects, Case Reports, Acetaldehyde / analysis, Acetaldehyde / blood, Adult, Alcohol Deterrents / therapeutic use, Alcohol Drinking / adverse effects, Alcoholism / drug therapy, Disulfiram / metabolism, Emergency Service, Hospital, Female, Humans, Male, Middle Aged, Retrospective Studies, Alcohol Deterrents, Ethanol, Acetaldehyde, Disulfiram

Objectives:
Disulfiram is an adjunct in the treatment of alcohol use disorders, but case reports indicate that disulfiram ethanol reactions are not always recognized in the emergency department. Our first aim is to remind of this risk with two case reports of life-threatening reactions not immediately considered by the emergency physician. The second aim is to estimate the probability that a disulfiram reaction goes unrecognized with the use of a retrospective study of patients admitted to the emergency department.
Methods:
Clinical files of patients admitted between October 1, 2010 and September 30, 2014 to the emergency department were retrospectively screened for the key words "ethanol use" and "disulfiram". Their diagnoses were then scored by a panel regarding the probability of an interaction.
Results:
Seventy-nine patients were included, and a disulfiram-ethanol reaction was scored as either 'highly likely', 'likely' or 'possible' in 54.4% and as 'doubtful' or 'certainly not present' in 45.6% of the patients. The interrater agreement was 0.71 (95% CI: 0.64-0.79). The diagnosis was not considered or only after a delay in 44.2% of the patients with a 'possible' to 'highly likely' disulfiram interaction. One patient with a disulfiram overdose died and was considered as a 'possible' interaction.
Discussion and conclusions:
A disulfiram ethanol interaction can be life threatening and failure to consider the diagnosis in the emergency department seems frequent. Prospective studies with documentation of the intake of disulfiram and evaluation of the value of acetaldehyde as a biomarker are needed to determine the precise incidence. Improving knowledge of disulfiram interactions and adequate history taking of disulfiram intake may improve the care for patients.
Case-report: EBV driven lymphoproliferative disorder associated with Ruxolitinib
Authors: Róbert Pálmason, Ola Lindén, Johan Richter
Journal: BMC Hematol (2015)
Keywords: ebv, lymphoma, lymphoproliferative disorder, ruxolitinib, side-effects
MeSH terms: Case Reports

Background:
Ruxolitinib, a novel inhibitor of Janus kinases 1 and 2, was recently approved for the treatment of myelofibrosis but, recently, attention has been drawn to potential side effects and especially opportunistic infections and virus reactivations. EBV reactivation has not previously been reported to occur in association with Ruxolitinib.
Case presentation:
We report a case of a 57 year old female with post-polycythemic myelofibrosis who was treated with Ruxolitinib. Approximately 9 weeks later she presented with a rapidly fatal, suspected EBV driven lymphoproliferative disorder in the CNS.
Conclusions:
Our report further underlines that patients treated with Ruxolitinib should be monitored closely for reactivations of opportunistic pathogens and viral infections.
Pulmonary Edema Occurring after Nitric Acid Exposure
Authors: Christopher W Meaden, John S Kashani, Stephen Vetrano
Journal: Case Rep Emerg Med (2019)
MeSH terms: Case Reports

Nitric acid (HNO3) is a strong acid and oxidizing agent used for various applications including production of ammonium nitrate in the fertilizer industry. Nitrogen oxides formed when nitric acid interacts with the environment have been implicated in inhalation injuries. This describes a case of a 49-year-old male who presented to the emergency department complaining of an acute onset of shortness of breath approximately 12 hours after being exposed to nitric acid fumes. He presented with a room air oxygen saturation of 80 percent with moderate to severe respiratory distress. His plain film chest radiograph showed bilateral pulmonary infiltrates and pulmonary edema. Over a seven-day hospital course, he had an improvement in his clinical status and chest X-ray with normal pulmonary function tests one month after discharge. Although exposure to the fumes of nitric acid is known to cause delayed pulmonary edema, it is rarely reported in the medical literature. This case serves as a reminder to consider exposure to fumes of nitric acid in a patient presenting with pulmonary edema and highlights the importance of obtaining a work history.
A Chinese Patient with Spastic Paraplegia Type 4 with a De Novo Mutation in the SPAST Gene
Authors: Li Xu, Zijuan Peng, Chunhui Zhou, Jiqing Wang, Hunjin Luo, Qin Lu, Zhengjun Bao
Journal: Case Rep Genet (2021)
MeSH terms: Case Reports

Background:
Spastic paraplegia type 4 (SPG4) is the most common type of hereditary spastic paraplegia (HSP) caused by mutations in the SPAST gene. Case Presentation. We report the case of a 27-year-old pregnant Chinese woman with HSP in whom we identified a missense mutation in the SPAST gene (c.1496G>A, p.Arg499His) and a nonsense mutation in the NEFH gene (c.289G>T, p.Glu97 ∗ ) via whole-exome sequencing; this finding corroborated that of Sanger sequencing. The patient exhibited the pure SPG4 phenotype with onset during childhood. The SPAST mutation was absent in the parents and paternal relatives. However, the NEFH mutation was identified in five people with no clinical phenotype. Based on theoretical conjecture and the family gene segregation information, we concluded that the SPAST mutation, but not the NEFH mutation, accounted for the proband's phenotype. Eventually, the woman gave birth to a healthy baby girl with the NEFH mutation.
Conclusion:
In this report, we identified a missense mutation in the SPAST gene (p.Arg499His) in a 27-year-old pregnant Chinese woman with HSP. We believe that this study expands the knowledge about the clinical parameters and mutation spectrum of SPG4.
The subject, its biology, and the chronic recurrent cystitis
Authors: Michael Noll-Hussong, Michael Autenrieth, Dan Pokorny, Simone Herberger, Dorothea Huber
Journal: Case Rep Psychiatry (2012)
MeSH terms: Case Reports

Functional disorders in urology are troubling for both patients and physicians. Moreover, advances in recent research promise to provide biological insights into psycho-neuro-endocrino-immunological pathways that are one important facet of chronic urogenital inflammations. We present a case of a middle-aged woman with long-lasting recurrent cystitis for which especially a psychosomatic approach helped to understand and cure the disorder. Altogether, as practitioners treat subjects, not illnesses, a biopsychosocial understanding of human disease should be taken into account in cases of chronic recurrent cystitis.