OpenMed/multicare-articles huggingface dataset:
Using an anterolateral thigh flap in autologous breast reconstruction as a salvage procedure in a patient with adult-onset Still's disease: A case report
Authors: Tarek Al-Malat, Berivan Taskin, Sebastian Schäller, Daniela Mettal-Minski, Lijo Mannil
Journal: GMS Interdiscip Plast Reconstr Surg DGPW (2023)
Keywords: aosd, anterolateral thigh flap, breast reconstruction, deep inferior epigastric artery perforator flap, interdisciplinary
MeSH terms: Case Reports

The deep inferior epigastric artery perforator (DIEP) flap is an excellent option for microsurgical breast reconstruction. In selected cases, e.g. in case of previous abdominoplasty, other autologous options like transverse upper gracilis (TUG) or superior gluteal artery perforator (sGAP) flaps can be considered. The anterolateral thigh (ALT) flap is reported to be used as a salvage procedure in selected cases of breast reconstruction, where other flaps were not available or failed. We present a case of a 41-year-old woman who was undergoing bilateral breast reconstruction after bilateral mastectomies following implant-based mastopexie and multiple infections. She also suffered from an adult onset Still's disease (AOSD) and was thus immunosuppressed. Microsurgical breast reconstruction was performed in a two-stage procedure. The left breast was reconstructed using a TUG flap. On the right side the TUG reconstruction failed due to vascular anomaly, so an ALT flap was successfully used instead. The whole procedure was accompanied by a multidisciplinary approach including a rheumatological complex treatment and enabled a successful bilateral breast reconstruction in this challenging case.
Pneumomediastinum in blunt chest trauma: a case report and review of the literature
Authors: Gregory Mansella, Roland Bingisser, Christian H Nickel
Journal: Case Rep Emerg Med (2014)

Blunt trauma is the most common mechanism of injury in patients with pneumomediastinum and may occur in up to 10% of patients with severe blunt thoracic and cervical trauma. In this case report we present a 24-year-old man with pneumomediastinum due to blunt chest trauma after jumping from a bridge into a river. He complained of persistent retrosternal pain with exacerbation during deep inspiration. Physical examination showed only a slight tenderness of the sternum and the extended Focused Assessment with Sonography for Trauma (e-FAST) was normal. Pneumomediastinum was suspected by chest X-ray and confirmed by computed tomography, which showed a lung contusion as probable cause of the pneumomediastinum due to the "Mackling effect." Sonographic findings consistent with pneumomediastinum, like the "air gap" sign, are helpful for quick bedside diagnosis, but the diagnostic criteria are not yet as well established as for pneumothorax. This present case shows that despite minimal findings in physical examination and a normal e-FAST a pneumomediastinum is still possible in a patient with chest pain after blunt chest trauma. Therefore, pneumomediastinum should always be considered to prevent missing major aerodigestive injuries, which can be associated with a high mortality rate.
Use of a Novel Portable Non-powered Suction Device in Patients With Oropharyngeal Dysphagia During a Choking Emergency
Authors: Matthew J McKinley, Jennifer Deede, Brian Markowitz
Journal: Front Med (Lausanne) (2022)
Keywords: choking, dysphagia, emergency, life saving, oropharyngeal dysphagia, portable non-invasive non-powered suction device, resuscitation

Choking remains a leading cause of accidental death and morbidity worldwide. Currently, there is no device to assist in the resuscitation of a choking victim when standard maneuvers fail. A novel portable non-powered suction device (LifeVac; LifeVac LLC, Nesconset, NY) has been developed and may have potential use in patients with oropharyngeal dysphagia who are at increased risk of choking. The device is FDA registered and distributed worldwide. This case series provides a summary of self-reported data regarding the use of the suction device in adult patients with oropharyngeal dysphagia during real-world choking emergencies recorded between January 2014 and July 2020. Over a 6-year monitoring period the device has been reported to be successful in the resuscitation of 38 out of 39 patients with oropharyngeal dysphagia during choking emergencies. Although the obstruction was removed with the device from the 39th patient, resuscitation was not successful and he succumbed to his injuries. This portable, non-powered suction device may be useful in resuscitating patients with oropharyngeal dysphagia who are choking. The reported cases describe successful use of the device in real-world settings with minimal risk. Resuscitating patients with oropharyngeal dysphagia using this device may be a viable option when abdominal thrusts or back blows fail to resolve a choking emergency.
A Rare Case of Giant Mesenteric Lipoblastoma in a 6-Year-Old Child and Review of the Literature
Authors: Maria Enrica Miscia, Gabriele Lisi, Giuseppe Lauriti, Angela Riccio, Dacia Di Renzo, Valentina Cascini, Pierluigi Lelli Chiesa
Journal: Case Rep Surg (2020)
MeSH terms: Case Reports

Giant mesenteric lipoblastoma is a rare benign tumor arising from the adipocytes. It can mimic malignant tumors, and its diagnosis is difficult before surgery. Imaging studies could lead the diagnosis but not confirm it. Those tumors arising in the abdomen are usually larger and can cause symptoms of compression. Surgical excision is the treatment of choice, and a long-term follow-up is necessary to detect local recurrences. Only a few cases of lipoblastomas arising from the mesentery are reported in literature. We present a case of a rare giant lipoblastoma arising from the mesentery of a 6-year-old girl, with a history of postprandial abdominal pain.
Reconstruction of Abdominal Wall Defects Using a Pedicled Anterolateral Thigh Flap including the Vastus Lateralis Muscle: A Report of Two Cases
Authors: Kiyoko Fukui, Masaki Fujioka, Satoko Ishiyama
Journal: Case Rep Surg (2016)
MeSH terms: Case Reports

The purpose of abdominal wall reconstruction is to prevent hernias and protect the abdominal viscera. In cases involving full-thickness defects of the rectus abdominis muscle, the muscle layer should be repaired. We present 2 cases in which full-thickness lower rectus abdominis muscle defects were reconstructed using vastus lateralis-anterolateral thigh flaps. The pedicled vastus lateralis-anterolateral thigh flap provides skin, fascia, and muscle tissue. Furthermore, it has a long neurovascular pedicle and can reach up to the periumbilical area and cover large defects. We consider that this muscle flap is a good option for repairing full-thickness lower abdominal defects.
Hypercalcemia of Malignancy in Thymic Carcinoma: Evolving Mechanisms of Hypercalcemia and Targeted Therapies
Authors: Cheng Cheng, Jose Kuzhively, Sanford Baim
Journal: Case Rep Endocrinol (2017)
MeSH terms: Case Reports

Here we describe, to our knowledge, the first case where an evolution of mechanisms responsible for hypercalcemia occurred in undifferentiated thymic carcinoma and discuss specific management strategies for hypercalcemia of malignancy (HCM). Case Description. We report a 26-year-old male with newly diagnosed undifferentiated thymic carcinoma associated with HCM. Osteolytic metastasis-related hypercalcemia was presumed to be the etiology of hypercalcemia that responded to intravenous hydration and bisphosphonate therapy. Subsequently, refractory hypercalcemia persisted despite the administration of bisphosphonates and denosumab indicative of refractory hypercalcemia. Elevated 1,25-dihydroxyvitamin D was noted from the second admission with hypercalcemia responding to glucocorticoid administration. A subsequent PTHrP was also elevated, further supporting multiple mechanistic evolution of HCM. The different mechanisms of HCM are summarized with the role of tailoring therapies based on the particular mechanism underlying hypercalcemia discussed. Conclusion. Our case illustrates the importance of a comprehensive initial evaluation and reevaluation of all identifiable mechanisms of HCM, especially in the setting of recurrent and refractory hypercalcemia. Knowledge of the known and possible evolution of the underlying mechanisms for HCM is important for application of specific therapies that target those mechanisms. Specific targeting therapies to the underlying mechanisms for HCM could positively affect patient outcomes.
Dynamical systems in computational psychiatry: A toy-model to apprehend the dynamics of psychiatric symptoms
Authors: Christophe Gauld, Damien Depannemaecker
Journal: Front Psychol (2023)
Keywords: computational psychiatry, dynamical systems, psychiatric disorders, symptoms dynamics, theoretical psychiatry

Introduction:
These last years, scientific research focuses on the dynamical aspects of psychiatric disorders and their clinical significance. In this article, we proposed a theoretical framework formalized as a generic mathematical model capturing the heterogeneous individual evolutions of psychiatric symptoms. The first goal of this computational model based on differential equations is to illustrate the nonlinear dynamics of psychiatric symptoms. It offers an original approach to nonlinear dynamics to clinical psychiatrists.
Methods:
In this study, we propose a 3+1 dimensions model (x, y, z + f) reproducing the clinical observations encountered in clinical psychiatry with: a variable modeling environmental noise (z) on the patient's internal factors (y) with its temporal specificities (f) and symptomatology (x). This toy-model is able to integrate empirical or simulated data from the influence of perceived environmental over time, their potential importance on the internal and subjective patient-specific elements, and their interaction with the apparent intensity of symptoms.
Results:
Constrained by clinical observation of case formulations, the dynamics of psychiatric symptoms is studied through four main psychiatric conditions were modeled: i) a healthy situation, ii) a kind of psychiatric disorder evolving following an outbreak (i.e., schizophrenia spectrum), iii) a kind of psychiatric disorder evolving by kindling and bursts (e.g., bipolar and related disorders); iv) and a kind of psychiatric disorder evolving due to its high susceptibility to the environment (e.g., spersistent complex bereavement disorder). Moreover, we simulate the action of treatments on different psychiatric conditions.
Discussion:
We show that the challenges of dynamical systems allow to understand the interactions of psychiatric symptoms with environmental, descriptive, subjective or biological variables. Although this non-linear dynamical model has limitations (e.g., explanatory scope or discriminant validity), simulations provide at least five main interests for clinical psychiatry, such as a visualization of the potential different evolution of psychiatric disorders, formulation of clinical cases, information about attracting states and bifurcations, or the possibility of a nosological refinement of psychiatric models (e.g., staging and symptom network models).
Coexistence of pyoderma gangrenosum and sweet's syndrome in a patient with ulcerative colitis
Authors: Faida Ajili, Asmahan Souissi, Fathi Bougrine, Najah Boussetta, Nadia Ben Abdelhafidh, Sameh Sayhi, Bassem Louzir, Nejib Doss, Janet Laabidi, Salah Othmani
Journal: Pan Afr Med J (2015)
Keywords: pyoderma gangrenosum, neutrophilic dermatosis, sweet′s syndrome, ulcerative colitis
MeSH terms: Colitis, Ulcerative / complications, Pyoderma Gangrenosum / etiology, Sweet Syndrome / etiology, Case Reports, Aged, Biopsy, Colitis, Ulcerative / physiopathology, Glucocorticoids / therapeutic use, Humans, Male, Prednisone / therapeutic use, Pyoderma Gangrenosum / diagnosis, Pyoderma Gangrenosum / pathology, Sweet Syndrome / diagnosis, Sweet Syndrome / pathology, Glucocorticoids, Prednisone

Pyoderma gangrenosum (PG) and Sweet's Syndrome (SS) are inflammatory skin diseases caused by the accumulation of neutrophils in the skin and, rarely, in internal organs. These neutrophilic dermatosis (NDs) are distinguished by the existence of forms of transition or overlap. They are frequently associated to systemic diseases especially hematologic and gastrointestinal ones. We report a case of a patient with ulcerative colitis (UC) who successively developed two types of NDs: PG then SS. A 66 years old patient with a history of UC consulted in July 2012 for an erythematous swelling of the back of the right hand treated with antibiotics without improvement. At that time, bacteriological samples were negative. In October 2012, he was hospitalized for polyarthralgia and impaired general condition. In physical examination, he had vesiculobullous plaque of 10 cm long of the right hand and wrist, infiltrated erythematous plaque on the right leg and another topped with a large pustule at the left ankle. Skin biopsy showed at the back of the right hand an aspect of PG and at the infiltrated plaques of the ankle an aspect of SS. Prednisone was started with improvement of the skin lesions and a recovery condition. The combination of PG and SS has already been described in cases of hematologic malignancy and rarely in UC. There is also the notion of passage from a neutrophilic dermatosis to another. Indeed, a typical lesion initially of SS can evolve to a future PG. This case demonstrates that neutrophilic dermatoses form a continous spectrum of entities that may occur in UC.
Xanthomatous hypophysitis mimicking a pituitary adenoma: case report and review of the literature
Authors: Laura Aste, Mattia Bellinzona, Veronica Meleddu, Graziella Farci, Cristina Manieli, Umberto Godano
Journal: J Oncol (2010)
MeSH terms: Case Reports

Background. Hypophysitis is an inflammatory disease of the pituitary gland that may mimic pituitary tumors clinically and radiologically. Case Description. We report a case of a xanthomatous hypophysitis initially diagnosed as pituitary adenoma. A 31-year-old woman presented with headache, diabetes insipidus, and amenorrhea. A head CT scan showed no intrasellar changes, while an MRI scan showed a sellar cystic mass. An endocrinological work up revealed mild hypocortisolism and diabetes insipidus (DI). Transsphenoidal surgery was performed. The intraoperative histological examination suggested a pituitary adenoma. The removed tissue showed central necrosis surrounded by accumulation of foamy cells and xanthomatous epithelioid cells. The patient made an uneventful postoperative recovery, Nevertheless, DI persisted and the adenohypophysis hypofunction did not recover. Conclusion. We describe an unusual inflammatory lesion of the pituitary gland mimicking an adenoma. A high level of clinical suspicion of inflammatory disorders is necessary for correct diagnosis and optimal management.
Case report: First report of haploidentical allogeneic hematopoietic stem cell transplantation from donors with mild alpha-thalassemia for acute leukemia
Authors: Wenshuai Zheng, Yamei Wu, Lixun Guan, Longcan Cheng, Yalei Hu, Min Tan, Yuhui Yang, Hongmei Ning
Journal: Front Oncol (2022)
Keywords: acute leukemia, haploidentical allogeneic hematopoietic stem cell transplantation, haploidentical donors, successful, thalassemia
MeSH terms: Case Reports

For acute leukemia (AL) with adverse prognostic factors, allogeneic hematopoietic stem cell transplantation (allo-HSCT) is the standard care option after the first complete remission. Meanwhile, as the success of haploidentical HSCT (haplo-HSCT), haploidentical donors (HIDs) become a reliable choice. However, there have been no reports on haplo-HSCT from HIDs with mild alpha(α)-thalassemia for AL yet. In the present report, we first describe two cases of successful haplo-HSCT from HIDs with mild α-thalassemia for AL.
Improvised vacuum assisted closure dressing for enterocutenous fistula, a case report
Authors: Masawa K Nyamuryekunge, Biswalo Yango, Ally Mwanga, Athar Ali
Journal: Int J Surg Case Rep (2020)
Keywords: africa, case report, negative pressure wound therapy, postoperative enterocutaneous fistula
MeSH terms: Case Reports

Introduction:
Management of enterocutaneous fistula is challenging with high morbidities and mortalities despite the recent advances in surgical technique. The bad outcomes are a result of associated metabolic complications. Vacuum-assisted closure dressing for the management of enterocutaneous fistula is a relatively new technique with benefit as a bridge to definitive surgery or definitive management in achieving spontaneous closure at a shorter time. In the current report, we share our experience of improvising vacuum-assisted closure dressing for managing postoperative enterocutaneous fistula and achieving spontaneous closure PRESENTATION OF CASE: We describe a case of a 56-year-old male from Tanzanian with a postoperative discharge of intestinal contents from the wound. He was diagnosed to have a proximal enterocutaneous fistula. After sepsis control and achieving hemodynamic stability, the enterocutaneous fistula was managed with parenteral nutrition, proton pump inhibitors, anti-cathartics, and somatostatin analogs. Endoscopic therapies and fibrin sealants are other described nonoperative interventions for enterocutaneous fistula. The unavailability of these modalities limited us. Vacuum-assisted closure dressing was improvised using gauze pieces, feeding tube, and Op-site dressings at a pressure of -30 mmHg. We achieved spontaneous closure of the proximal enterocutaneous fistula in 32 days.
Discussion:
The time to closure was within the range of 12-90 described for conventional vacuum assisted closure dressing, and there were no complications. Close monitoring of improvised VAC dressings is required as the risks are unknown; however, given the known complications of conventional VAC dressing, a risk of hemorrhage and creation of entero-atmospheric fistula exists.
Conclusion:
Improvised VAC dressing for ECF is potentially an acceptable option with promising outcomes in low-resource settings.
Perianal Basal Cell Carcinoma Successfully Managed with Excisional Biopsy
Authors: Paola C Aldana, Harris G Yfantis, Preeti R John
Journal: Case Rep Dermatol Med (2019)
MeSH terms: Case Reports

Basal cell carcinoma (BCC) is the most common cutaneous malignancy in the United States and is often nonaggressive. Its location in the perianal region is very rare and it is estimated that only 0.08% of all BCCs occur in this region. Herein, we present a case of perianal basal cell carcinoma, nodular type. The diagnosis was made using excisional biopsy of a skin lesion. Immunohistochemical staining confirmed the diagnosis: it showed diffuse and strong positivity for smooth muscle actin (SMA) and monoclonal antibody BER-Ep4 and was negative for carcinoembryonic antigen (CEA), pancytokeratin (AE1/AE3), and epithelial membrane antigen (EMA). The treatment of choice has traditionally been local excision to clear margins but the newest guidelines recommend Mohs Micrographic surgery (MMS) or standard 4mm surgical margins for this high-risk BCC. Our patient was successfully treated using excisional biopsy without recurrence. In select patients with lesions smaller than 1cm, excisional biopsy may be sufficient to treat the disease and may be better tolerated than MMS and wider surgical margins. Literature review suggests a predisposition for perianal BCC in individuals susceptible to cutaneous malignancies. Therefore, any history of cutaneous malignancy should further prompt clinicians to examine nonsun exposed areas on full body skin exams.
Hypoparathyroidism: an uncommon adverse effect of treatment with durvalumab
Authors: Alexander Kreze, Matěj Homer, Tereza Barešová, Kristina Klemperová
Journal: Endocr Oncol (2022)
Keywords: durvolumab, hypoparathyroidism, immune checkpoint inhibitors, immune-related adverse effects
MeSH terms: Case Reports

Summary:
Immune checkpoint inhibitors (ICIs) are monoclonal antibodies approved for the treatment of numerous cancer types. Toxicities induced by ICIs may affect any organ system and manifest as endocrinopathy. The main side effects related to treatment are immune-related adverse events (irAEs), especially thyroid dysfunction and hypophysitis. Rare endocrine irAEs are diabetes insipidus, hypoparathyroidism, thyrotoxic crisis and hypogonadism. We report a case of hypoparathyroidism induced by ICI treatment with durvalumab, which has not previously been described.
Learning points:
Treatment with immune checkpoint inhibitors (ICIs) is associated with many endocrine side effects.It is recommended that patients treated with ICIs are observed by an endocrinologist.If side effects are treated accordingly, ICI therapy can continue.
Specific Effects of Anti-Hypertensive Treatment in an Older Patient with Dementia
Authors: Jadwiga Attier Zmudka, Jean Marie Sérot, Salif Dao, Claire Sorel, Anne-Sophie Macaret, Olivier Balédent
Journal: Open Neurol J (2017)
Keywords: asprin, cerebral blood flow, dementia, hypertension, mri, stroke
MeSH terms: Case Reports

Dementia is one of the most common health problems in the world. Alzheimer's disease (AD) is the most common form of dementia. The presence of vascular risk factors such as hypertension (HT) may increase the risk of AD [1,2]. The relation between blood pressure (BP) and dementia has been the subject of numerous epidemiological studies, midlife HT is a risk factor for dementia and AD [3-7] but the association between HT and risk of dementia is lower in the older population [8]. A fair modulation of an antihypertensive treatment, based on the cognitive status of the elderly, can avoid multiple complications. A case of an older for whom cognitive improvement and reduced risk of falls were noticed after mild blood pressure elevation is reported.
Increasing the Interval of Canakinumab Administration Effectively Supports the Remission of Schnitzler's Syndrome
Authors: Vadim R Gorodetskiy, Svetlana O Salugina, Evgeny S Fedorov
Journal: Case Rep Rheumatol (2018)
MeSH terms: Case Reports

Schnitzler's syndrome (SchS) is a rare, disabling, autoinflammatory disorder characterized by recurrent urticarial rash and monoclonal IgM gammopathy. Interleukin-1 beta (IL-1β) plays an important role in the pathophysiology of SchS. Only anecdotal reports demonstrate the efficiency and safety of human monoclonal anti-human IL-1β antibody (canakinumab) use in SchS therapy. However, there are no generally accepted recommendations concerning the scheme (or frequency) of canakinumab use for this disease. Here, we report the effective long-term treatment of SchS in a 44-year-old male with a standard canakinumab dose (150 mg) but with an increased 4-month injection interval.
Anesthetic management of a patient with esophageal penetration of a tracheal stent: a case report
Authors: Yoko Hori, Hiroaki Kishikawa, Atsuhiro Sakamoto
Journal: JA Clin Rep (2016)
Keywords: laryngeal mask, tracheal stent

Background:
Tracheal stent is a good way to maintain a patent airway in case of stenosis. Although anesthesia techniques for the placement of a stent in the trachea of patients with tracheal stenosis have been reported, the management of general anesthesia in patients with a tracheal stent is not well established.
Case presentation:
We report the anesthetic management in the patient with a partly fractured tracheal stent. A 65-year-old man with colon cancer was scheduled for colectomy under general anesthesia. Eight years ago, a tracheal stent was placed because of lung cancer. Preoperative evaluation revealed that a part of the tracheal stent had penetrated the esophagus. We induced general-epidural anesthesia via spontaneous breathing through a laryngeal mask airway to avoid mediastinal emphysema caused by positive pressure ventilation. The patient has been followed up for 2 years without any respiratory complications.
Conclusion:
General anesthesia can be safely induced under spontaneous ventilation through a laryngeal mask airway in a patient with a fractured tracheal stent.