OpenMed/multicare-articles huggingface dataset:
Adrenal Hemorrhage in a Cortisol-Secreting Adenoma Caused by Antiphospholipid Syndrome Revealed by Clinical and Pathological Investigations: A Case Report
Authors: Kentaro Ochi, Ichiro Abe, Yuto Yamazaki, Mai Nagata, Yuki Senda, Kaori Takeshita, Midori Koga, Yuka Yamao, Toru Shigeoka, Tadachika Kudo, Yuichiro Fukuhara, Shigero Miyajima, Hiroshi Taira, Shoji Haraoka, Tatsu Ishii, Yuichi Takashi, Alfred K Lam, Hironobu Sasano, Kunihisa Kobayashi
Journal: Front Endocrinol (Lausanne) (2022)
Keywords: adrenal hemorrhage, antiphospholipid syndrome, cortisol-secreting adenoma, thrombophilia, thrombosis
MeSH terms: Adenoma / complications, Adenoma / diagnosis, Adenoma / surgery, Antiphospholipid Syndrome / complications, Antiphospholipid Syndrome / diagnosis, Cushing Syndrome / complications, Cushing Syndrome / etiology, Case Reports, Hemorrhage / complications, Hemorrhage / etiology, Humans, Hydrocortisone, Hydrocortisone

Due to its rarity, adrenal hemorrhage is difficult to diagnose, and its precise etiology has remained unknown. One of the pivotal mechanisms of adrenal hemorrhage is the thrombosis of the adrenal vein, which could be due to thrombophilia. However, detailed pathological evaluation of resected adrenal glands is usually required for definitive diagnosis. Here, we report a case of a cortisol-secreting adenoma with concomitant foci of hemorrhage due to antiphospholipid syndrome diagnosed both clinically and pathologically. In addition, the tumor in this case was pathologically diagnosed as cortisol-secreting adenoma, although the patient did not necessarily fulfill the clinical diagnostic criteria of full-blown Cushing or sub-clinical Cushing syndrome during the clinical course, which also did highlight the importance of detailed histopathological investigations of resected adrenocortical lesions.
Case report: Unruptured small middle cerebral artery aneurysm with perianeurysmal edema
Authors: Yoshihiro Goto, Yoichi Morofuji, Eri Shiozaki, Daiki Uchida, Ichiro Kawahara, Tomonori Ono, Wataru Haraguchi, Keisuke Tsutsumi
Journal: Front Surg (2023)
Keywords: aneurysm rupture prediction, clipping, fluid-attenuated inversion recovery, middle cerebral artery (mca), perianeurysmal edema
MeSH terms: Case Reports

Background:
Perianeurysmal edema (PAE) has a tendency to occur in embolized aneurysms but also in partially thrombosed, large, or giant aneurysms. However, there are only a few cases recorded in which PAE was detected in untreated or small aneurysms. We suspected that PAE might be an impending sign of aneurysm rupture in these cases. Herein, we presented a unique case of PAE that was related to an unruptured small middle cerebral artery aneurysm.
Case description:
A 61-year-old woman was referred to our institute due to a newly formed abnormal fluid-attenuated inversion recovery (FLAIR) hyperintense lesion in the right medial temporal cortex. Upon admission, the patient did not present with any symptoms or complaints; however, FLAIR and CT angiography (CTA) suggested an increased risk of aneurysm rupture. Aneurysm clipping was conducted, and no evidence of subarachnoid hemorrhage and hemosiderin deposits around the aneurysm and brain parenchyma was noted. The patient was discharged home without any neurological symptoms. MRI taken at eight months post-clipping revealed complete regression of the FLAIR hyperintense lesion around the aneurysm.
Conclusion:
PAE in unruptured, small aneurysm is thought to be an impending sign of aneurysm rupture. Early surgical intervention is critical even for small aneurysms with PAE.
Case Report: Rectal Perforation Secondary to a Toothbrush in an Elderly Man
Authors: Karthigesu Aimanan, Soon Yee Lim, Ahmad Junaidi Ahmad Hamidi, Tiong How Chieng, Firdaus Hayati
Journal: Front Surg (2022)
Keywords: case report, foreign bodies, pneumoperitoneum, radiography, rectum
MeSH terms: Case Reports

Rectal foreign bodies often constitute an arduous diagnosis and perplexing management. A 72-year-old gentleman who is mentally sound was brought to the emergency department for severe epigastric pain of a 1-week duration. On examination, he was pyrexial and in sepsis. The abdomen was guarded. A digital rectal examination was normal. Erect chest radiography revealed air under the diaphragm and abdominal radiography showed neither dilated bowel nor foreign body. A diagnostic laparoscopy was performed which revealed a yellow hard rod-shaped foreign body at the pelvis. Upon conversion to midline laparotomy, the foreign body was found to be a toothbrush with intraperitoneal rectal perforation of 1 cm in length. The brush was removed and the perforation was repaired primarily. A diverting transverse loop colostomy was created. Rectal foreign bodies may cause life-threatening rectal injuries including lacerations, bleeding, perforation, and obstruction. It is deemed crucial that any patient with rectal foreign body demands an orderly approach with the intention of diagnosis, management, and post-extraction evaluation.
Blurred lines: Performance Enhancement, Common Mental Disorders and Referral in the U.K. Athletic Population
Authors: Claire-Marie Roberts, Andrea L Faull, David Tod
Journal: Front Psychol (2016)
Keywords: case study, clinical psychology, common mental disorders, elite athletes, referral

Through the awareness-raising efforts of several high-profile current and former athletes, the issue of common mental disorders (CMD) in this population is gaining increasing attention from researchers and practitioners alike. Yet the prevalence is unclear and most likely, under-reported. Whilst the characteristics of the sporting environment may generate CMD within the athletic population, it also may exacerbate pre-existing conditions, and hence it is not surprising that sport psychology and sport science practitioners are anecdotally reporting increased incidences of athletes seeking support for CMD. In a population where there are many barriers to reporting and seeking help for CMD, due in part to the culture of the high performance sporting environment, anecdotal reports suggest that those athletes asking for help are approaching personnel who they are most comfortable talking to. In some cases, this may be a sport scientist, the sport psychologist or sport psychology consultant. Among personnel in the sporting domain, there is a perception that the sport psychologist or sport psychology consultant is best placed to assist athletes seeking assistance for CMD. However, sport psychology as a profession is split by two competing philosophical perspectives; one of which suggests that sport psychologists should work exclusively with athletes on performance enhancement, and the other views the athlete more holistically and accepts that their welfare may directly impact on their performance. To add further complication, the development of the profession of sport psychology varies widely between countries, meaning that practice in this field is not always clearly defined. This article examines case studies that illustrate the blurred lines in applied sport psychology practice, highlighting challenges with the process of referral in the U.K. athletic population. The article concludes with suggestions for ensuring the field of applied sport psychology is continually evolving and reconfiguring to ensure that it continues to meet the demands of its clients.
Acute Diffuse Renal Tubulopathy in a Patient With Lung Cancer: A Case Report
Authors: Po-Jung Tseng, Ming-Tso Yan
Journal: Front Med (Lausanne) (2021)
Keywords: acute kidney injury, case report, comorbidity, creatinine, drug therapy, electrolytes, immune checkpoint inhibitors, pembrolizumab
MeSH terms: Case Reports

Immune checkpoints inhibitors (ICPIs), as either a frontline or adjuvant therapy, showed favorable outcomes among diverse malignancies. Immune-related adverse events (IRAEs) are increasingly encountered, but the kidneys are rarely affected. A 67-year-old man with stage IV squamous cell carcinoma of the lung presented with acute kidney injury and hypercalcemia secondary to bone metastasis. After an aggressive saline infusion and subcutaneous denosumab 60mg administration, his renal function and serum calcium level were recovered on day 4. Due to his intolerance to chemotherapy, immunotherapy with a monoclonal antibody targeting programmed cell death protein-1 (PD-1), pembrolizumab 2mg/kg, was used on day 4. On day 11, polyuria, non-albumin dominant proteinuria, and severe deficiencies of electrolytes (potassium 2.5 mmol/L, calcium 5.5 mg/dL, magnesium 1.3 mg/dL, and phosphate 1.5 mg/dL) along with concomitant renal wasting were developed acutely. Except for postponing the next pembrolizumab, prednisolone at 1 mg/kg/day was given on day 13. On day 27, his polyuria subsided and urine protein loss resolved. Serum levels of potassium, phosphate, calcium, and magnesium all returned within the reference range. This case highlighted that renal IRAEs, even though uncommon, could be severe and potentially life-threatening if left unrecognized and untreated. Early recognition of renal IRAEs and prompt withdrawal of ICPIs may result in lower renal morbidity.
Abscopal Effect Following Proton Beam Radiotherapy in a Patient With Inoperable Metastatic Retroperitoneal Sarcoma
Authors: Randall J Brenneman, Nima Sharifai, Benjamin Fischer-Valuck, Comron Hassanzadeh, Jeffrey Guzelian, John S A Chrisinger, Jeff M Michalski, Peter Oppelt, Brian C Baumann
Journal: Front Oncol (2019)
Keywords: smarcb1, abscopal effect, metastasis, proton therapy, retroperitoneal sarcoma
MeSH terms: Case Reports

Background: Retroperitoneal sarcomas (RPS) are rare and primarily managed with surgery, which improves local recurrence-free and overall survival. Radiation can improve local control or provide palliation for inoperable or metastatic RPS by eliciting tumor cell death via irreparable DNA damage. In extraordinary circumstances radiation-induced cell death promotes immune-mediated regression of non-irradiated lesions in a process termed the abscopal effect. Abscopal effects are rare and incompletely understood, involving a balance of radiation's immunogenic and immunosuppressive effects. There are currently no methods to predict abscopal responses following radiotherapy. Case reports documenting post-radiotherapy abscopal effects provide additional information to better characterize these responses and to inform ongoing and future clinical trials attempting to harness radiation-induced immune responses to improve outcomes with systemic therapy, such as SARC-032, a cooperative group trial of pre-operative radiation ± pembrolizumab. We present a case of inoperable metastatic RPS treated with proton radiotherapy with complete responses of un-irradiated metastases. Case Presentation: A 67 year-old female with inoperable metastatic unclassified round cell RPS was treated with palliative proton radiotherapy only to the primary tumor. Following completion of radiotherapy, the patient demonstrated complete regression of all un-irradiated metastases, and near complete response of the primary lesion without additional therapy. Conclusions: Metastatic RPS is typically managed with first-line chemotherapy, with objective response rates <50%. We present a case of inoperable metastatic RPS treated with palliative proton radiotherapy for rapidly progressive disease who had complete regression of non-irradiated metastases consistent with the abscopal effect. To our knowledge this is the first case report describing abscopal effects in inoperable metastatic RPS treated with proton radiation and is among the first case reports of an abscopal effect in a patient treated with proton therapy regardless of disease site. Further investigation is warranted regarding the benefit of proton radiation to primary tumors for inoperable metastatic RPS.
From ACTH-Dependent to ACTH-Independent Cushing's Syndrome from a Malignant Mixed Corticomedullary Adrenal Tumor: Potential Role of Embryonic Stem Cells
Authors: Claudia Ramírez-Rentería, Ana Laura Espinosa-De-Los-Monteros, Espinosa-Cardenas Etual, Daniel Marrero-Rodríguez, Guillermo Castellanos, Rocio Arreola-Rosales, Guillermo Montoya-Martinez, Keiko Taniguchi-Ponciano, Paola Briseño-Díaz, Mayte Lizeth Padilla-Cristerna, María Del Pilar Figueroa-Corona, Mercado Moises
Journal: Case Rep Endocrinol (2020)
MeSH terms: Case Reports

Objective:
To report the immunohistochemical and molecular evaluation of a patient with ectopic ACTH syndrome (EAS) from a MCAT which has single cells with features of both 96 medullary and cortical differentiation. Case Description and Methods. A 16-year-old woman presented with severe EAS and a large right MCAT composed of ACTH-secreting cells resembling pheochromocytoma and another lineage similar to adrenal carcinoma. Immunohistochemistry (IHC) showed positivity for medullary (ACTH, chromogranin A, synaptophysin, and PS-100) and epithelial components (inhibin, melan-A, and calretinin). Embryonic stem cell markers were evaluated using RT/PCR and immunofluorescence. After initial surgery, the tumor recurred shifting to rapidly progressive ACTH-independent liver metastasis.
Results:
Histopathology and IHC revealed two distinct and intermingled cellular patterns, while some cells immunostained for both medullary and cortical markers. Demonstration of all stem cell biomarkers by RT/PCR and immunofluorescence was predominantly localized to the nucleus, whereas SOX2 immunoreactivity was evident in the cytoplasm as well.
Conclusion:
The expression of cancer stem cell biomarkers points towards the involvement of primitive embryonic cells as the origin of this neoplasm and maybe to the clinically aggressive and biochemically changing behavior.
A Rare Cause of Ascites-Disseminated TB with Peritonitis in a Middle-Aged Female
Authors: Sahathevan Vithoosan, Ponnudurai Shanjeeban, Joseph Philip Anpalahan, Paramarajan Piranavan, Harindra Karunatilake, Ananda Jayanaga
Journal: Case Rep Gastrointest Med (2019)
MeSH terms: Case Reports

Background:
Disseminated tuberculosis (TB) has been increasingly recognized in adults in the recent times due to increased prevalence of immune suppression. Here we describe a case of 47-year-old female who presented with disproportionate ascites where the diagnosis of disseminated TB was delayed.
Case report:
A 47-year-old previously healthy female presented with generalised body swelling with disproportionate ascites and loss of appetite and weight for four-month duration. She denied any contact or past history of TB and reported no respiratory symptoms. Physical examination revealed significant ascites. There was no lymphadenopathy or hepatosplenomegaly. Respiratory system examination was normal. Her Erythrocyte Sedimentation Rate (ESR) was above 100. Tuberculin skin test was positive with 17mm. Contrast Enhanced Computed Tomography (CECT) abdomen revealed chronic liver disease with ascites. Diagnostic laparoscopy was in favour of miliary TB and the peritoneal biopsy revealed granulomatous inflammation with caseous necrosis, suggestive of TB. The patient was started on antituberculosis treatment and subsequently improved.
Conclusion:
TB peritonitis due to disseminated TB should be considered in the differential diagnosis of disproportionate ascites. Even though the diagnosis is difficult, diagnostic laparoscopy and biopsy is very helpful. It is important to have an early diagnosis since delay in treatment can be detrimental in most cases.
Disseminated Mycobacterium interjectum Infection with Bacteremia, Hepatic and Pulmonary Involvement Associated with a Long-Term Catheter Infection
Authors: David Sotello, D Jane Hata, Mohammed Reza, Raj Satyanarayana, Vichaya Arunthari, Wendelyn Bosch
Journal: Case Rep Infect Dis (2017)
MeSH terms: Case Reports

We present a 49-year-old female with one year of intermittent fevers, chills, night sweats, and significant weight loss. Liver and lung biopsy showed evidence of a granulomatous process. Blood and liver biopsy cultures yielded growth of presumed Mycobacterium interjectum, thought to be related to a disseminated long-term central venous catheter infection. She successfully received one year of combined antimicrobial therapy after catheter removal without recurrence of disease. M. interjectum has been previously described as a cause of lymphadenitis in healthy children and associated with pulmonary disease in adults, although other localized infections have been reported. This is the first case described of a disseminated M. interjectum infection with bacteremia, hepatic and pulmonary involvement associated with a long-term catheter infection.
Bone Cutting Forceps: A Safe Approach for Saving Strangulated Penis
Authors: Mohamed Ahmed Abd El Salam, Ahmed Gamal, Hossam Elenany
Journal: Case Rep Med (2016)

Penile strangulation is considered a rare andrological emergency that may lead to a wide range of complications. Penile strangulation may be related to mental retardation in children or hypersexuality, abnormal sexual preferences in adults. This case report shows a 23-year-old male who presented to the emergency room with agonizing pain related to a metallic ring placed at the base of the penis for more than 8 hours during an attempt of masturbation. Removing this metallic ring and saving the patient's penis from gangrene without causing injury were very challenging. Patient was successfully managed and had an uneventful recovery.
Phenotypic and Genotypic Characterization of NPRL2-Related Epilepsy: Two Case Reports and Literature Review
Authors: Yulin Sun, Lin Wan, Huimin Yan, Zhichao Li, Guang Yang
Journal: Front Neurol (2021)
Keywords: nprl2, case report, focal epilepsy, genotype, phenotype
MeSH terms: Case Reports

The phenotype of nitrogen permease regulator-like 2 (NPRL2) gene-related epilepsy clinically manifests as a range of epilepsy syndromes, including familial focal epilepsy with variable foci (FFEVF), sleep-related hypermotor epilepsy (SHE), temporal lobe epilepsy (TLE), frontal lobe epilepsy (FLE), and infantile spasms (IS). The association between phenotype and genotype of NPRL2 variants has not been widely explored. This study aimed to explore the phenotype and genotype spectrum of NPRL2-related epilepsy. Here, we presented two clinical cases with NPRL2-related epilepsy, and discussed the characteristics, diagnosis, and treatment processes in the context of existing literature. Two novel NPRL2 likely pathogenic variants were identified by next-generation sequencing, including one splicing mutation (c.933-1G>A), and one frameshift mutation (c.257delG). The results of literature review showed that there were a total of 20 patients with NPRL2-related epilepsy whose mutations were mostly missense and hereditary. These findings indicate that the possibility of NPRL2 gene mutations in focal epilepsy should be considered for patients with family history, and that patients carrying different NPRL2 variants have different clinical manifestations. Our study expanded the genotype spectrum of NPRL2 and suggested that the type of NPRL2 variants might provide important information for the prognosis evaluation.
Cavitary pulmonary tuberculosis with COVID-19 coinfection
Authors: Zohaib Yousaf, Adeel A Khan, Haseeb A Chaudhary, Kamran Mushtaq, Jabeed Parengal, Mohamad Aboukamar, Muhammad Umair Khan, Mouhand F H Mohamed
Journal: IDCases (2020)
Keywords: covid-19, co-infection, mycobacterium tuberculosis, pulmonary tuberculosis, sar-cov-2, tb
MeSH terms: Case Reports

The COVID-19 pandemic has strained the healthcare system worldwide, leading to an approach favoring judicious resource allocation. A focus on resource preservation can result in anchoring bias and missed concurrent diagnosis. Coinfection of Mycobacterium tuberculosis (TB) and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has implications beyond morbidity at the individual level and can lead to unintended TB exposure to others. We present six cases of COVID-19 with newly diagnosed cavitating pulmonary tuberculosis to highlight the significance of this phenomenon and favorable outcomes if recognized early.
Ultrasound-guided para-umbilical block: a pediatric case
Authors: Masayuki Akatsuka, Takeshi Murouchi, Johji Arakawa, Michiaki Yamakage
Journal: JA Clin Rep (2017)
Keywords: para-umbilical block, pediatric anesthesia, perioperative analgesia

Background:
Rectus sheath block is a common peripheral nerve block for patients undergoing umbilical hernia repair surgery. However, rectus sheath block alone can affect only anterior branches of intercostal nerves and, therefore, is incomplete for postoperative analgesia for the anterior abdomen, which is innervated by both anterior and lateral branches. We describe a successful perioperative analgesia with ultrasound-guided para-umbilical block after pediatric umbilical hernia surgery.
Case presentation:
A 4-year-old child underwent hernia repair surgery. Following induction of general anesthesia, the anatomy of the umbilical region was observed under ultrasound with a 5-10-MHz linear probe. An ultrasound-guided injection between the rectus abdominis muscle and the posterior lobe of the rectus sheath and an injection into the subcutaneous space around the umbilicus were performed. The peripheral nerve block was effective during surgery, and the patient required no additional rescue analgesia during the perioperative period. There were no complications.
Conclusion:
We performed ultrasound-guided para-umbilical block with four injections. This peripheral nerve block could be an efficient technique for complete perioperative analgesia.
A multi-modal treatment approach for the shoulder: a 4 patient case series
Authors: Mario Pribicevic, Henry Pollard
Journal: Chiropr Osteopat (2005)

Background:
This paper describes the clinical management of four cases of shoulder impingement syndrome using a conservative multimodal treatment approach.
Clinical features:
Four patients presented to a chiropractic clinic with chronic shoulder pain, tenderness in the shoulder region and a limited range of motion with pain and catching. After physical and orthopaedic examination a clinical diagnosis of shoulder impingement syndrome was reached. The four patients were admitted to a multi-modal treatment protocol including soft tissue therapy (ischaemic pressure and cross-friction massage), 7 minutes of phonophoresis (driving of medication into tissue with ultrasound) with 1% cortisone cream, diversified spinal and peripheral joint manipulation and rotator cuff and shoulder girdle muscle exercises. The outcome measures for the study were subjective/objective visual analogue pain scales (VAS), range of motion (goniometer) and return to normal daily, work and sporting activities. All four subjects at the end of the treatment protocol were symptom free with all outcome measures being normal. At 1 month follow up all patients continued to be symptom free with full range of motion and complete return to normal daily activities.
Conclusion:
This case series demonstrates the potential benefit of a multimodal chiropractic protocol in resolving symptoms associated with a suspected clinical diagnosis of shoulder impingement syndrome.