OpenMed/multicare-articles huggingface dataset:
Case report: Endoluminal removal of a retrievable conical inferior vena cava filter with a ruptured retraction hook attached to the wall
Authors: Xuan Tian, Jianlong Liu, Jinyong Li, Xiao Liu
Journal: Front Surg (2022)
Keywords: case report, complex, complications, filter retrieval, inferior vena cava (ivc)
MeSH terms: Case Reports

We report the case of a patient who underwent endovascular retrieval of a conical inferior vena cava (IVC) filter with a ruptured retraction hook that was attached to the IVC wall. A 21-year-old woman with a Celect (Cook) filter, implanted 1,522 days prior, requested retrieval. Preoperative ultrasound and CT examinations showed that the filter was inclined, the retraction hook was attached to the IVC wall, and one of the filter's pedicles was broken. The inferior vena cava was patent, with no thrombus. Old superficial femoral vein thrombosis could be seen in the right lower extremity. The filter retrieval equipment (Gunther Tulip, Cook) failed to capture the retraction hook. By means of a pigtail catheter (with a partly removed catheter tip) and loach guidewire, we applied a modified loop-snare technique to successfully cut the proliferative tissue near the tip of the retraction hook, by which the hook re-entered the inferior vena cava. Although the snare successfully captured the retraction hook and retrieved the filter, the broken pedicle was retained in the inferior vena cava. We used forceps to capture and pull it to the distal end. In the end, the inferior vena cava became patent, with no contrast agent spillage or residual, and no symptomatic pulmonary embolization. A simultaneous occurrence of oblique adherence and fracture is rarely found in the same filter; however, by using the modified loop-snare technique and biopsy forceps technique, we successfully retrieved the filter and broken pedicle. Our case provides a practical auxiliary technique for regular clinical practice.
MARPE as an adjunct to orthodontic treatment
Authors: Orlando Tanaka, Sergio Luiz Mota-Júnior
Journal: Dental Press J Orthod (2023)
MeSH terms: Malocclusion, Angle Class II / therapy, Palatal Expansion Technique / methods, Case Reports, Esthetics, Dental, Female, Humans, Malocclusion / therapy, Treatment Outcome, Young Adult

Introduction:
Miniscrew or microimplant-assisted rapid palatal expansion (MARPE) devices are used to achieve a skeletal expansion of the palate and to increase the arch perimeter.
Objective:
To describe the treatment of a 23-year-old woman with an Angle Class II, division 1 malocclusion with constricted maxillary and mandibular arches.
Case report:
The patient's main complaint was mandibular anterior crowding. The treatment plan included expansion of the mandibular arch concurrent with maxillary expansion, using a MARPE appliance in combination with a full-fixed appliance to align and level the crowded mandibular teeth, along with miniscrews as anchorage for the maxillary teeth and for distalization of the molars and premolars. A successful non-extraction orthodontic treatment was accomplished after 28 months, and the occlusion and teeth alignment, as well as facial goals, were resolved in a clinically satisfactory manner.
Conclusion:
The treatment objectives were met, and the outcome of the expansion of the maxillary arch with a MARPE appliance as an adjunct to a fixed appliance was considered a success. An esthetic, functional, and stable result after a 1-year follow-up was achieved and was satisfactory to the patient.
Successful treatment of hemorrhagic bullous henoch-schönlein purpura with oral corticosteroid: a case report
Authors: Celebi Kocaoglu, Ramazan Ozturk, Yasar Unlu, Fatma Tuncez Akyurek, Sukru Arslan
Journal: Case Rep Pediatr (2013)

Henoch-Schönlein purpura (HSP) is a vasculitis of small-sized blood vessels, resulting from immunoglobulin-A-mediated inflammation. It is the most common acute systemic vasculitis in childhood and mainly affects skin, gastrointestinal tract, joints, and kidneys. The characteristic rash of HSP consists of palpable purpuric lesions 2 to 10 mm in diameter concentrating in the buttocks and lower extremities. The occurrence of hemorrhagic bullae in children with HSP is rarely encountered. This report describes a 4.5-year-old female patient with HSP associated with hemorrhagic bullous lesions.
Antithrombin Deficiency Is Associated with a Novel Homozygous Detrimental Mutation in SERPINC1 Gene in a Saudi Female
Authors: Sana Alqarni, Baraah Alqarni, Abdulrahman Alsultan
Journal: Case Rep Med (2023)
MeSH terms: Case Reports

Antithrombin (AT) deficiency is a blood disorder associated with an increased tendency to form thrombosis. Hereditary AT deficiency is frequently caused by mutations in SERPINC1 gene. It is usually inherited as an autosomal dominant with variable penetrance. Homozygous pathogenic mutations in this gene are extremely rare. We present a case of a 7-year-old female who presented at age of 4 years with massive cerebral sinus venous thrombosis. Thrombophilia workup showed a low AT level of 30%. Targeted genetic sequencing of SERPINC1 revealed a novel pathogenic homozygous mutation c.1320C>G p. (Phe440Leu). The patient was managed initially with unfractionated heparin with AT replacement using fresh frozen plasma and was later switched to only low-molecular-weight heparin. There was no recurrence or new thrombosis with 3 years of follow-up.
Case Report: Inferior Bilobectomy for Lung Cancer to Allow Weaning From Veno-Venous Extracorporeal Membrane Oxygenation
Authors: Francesca Signore, Debora Brascia, Marcella Schiavone, Giulia De Iaco, Teodora Panza, Angela De Palma, Francesco Murgolo, Antonio Civita, Rosa Di Mussi, Salvatore Grasso, Giuseppe Marulli
Journal: Front Surg (2021)
Keywords: lung cancer, lung resection, multidiscipinary approach, respiratory failure, veno-venous extracorporeal membrane oxygenation
MeSH terms: Case Reports

In recent years, veno-venous extracorporeal membrane oxygenation (V-V ECMO) has allowed complex lung and airways resections in patients with a compromised perioperative respiratory function. In the following report, we present a case of successful weaning from V-V ECMO in a patient who underwent an inferior bilobectomy for lung cancer.
Case report: A case of isolated cardiac sarcoidosis diagnosed by multimodal imaging and endomyocardial biopsy
Authors: Yongling Wa, Xiaowei Niu, Jizhe Xu, Gaxue Jiang, Sixiong Hu, Ming Bai
Journal: Front Cardiovasc Med (2022)
Keywords: cmr (cardiovascular magnetic resonance), fdg (18f-fluorodeoxyglucose)-pet/ct, cardiovascular imaging (card), isolated cardiac sarcoidosis, multimodal imaging, myocardial endocardial biopsy
MeSH terms: Case Reports

Due to its low incidence, isolated cardiac sarcoidosis (ICS) is often missed or misdiagnosed. Herein, we describe a case of ICS in a 52-year-old male patient. Advanced imaging, including cardiac magnetic resonance (CMR) and fluorine-18 fluorodeoxyglucose positron emission tomography (FDG-PET), could not only screen high-risk patients for establishing diagnosis, but also guide endomyocardial biopsy (EMB) for improving cardiac disease detection rate. This case highlights the importance of multimodal imaging for screening and necessity of EMB for diagnosis.
Recurrent venous thrombosis in an adequately anticoagulated patient with pemphigus vulgaris
Authors: Paul R J Ames, Maria Graf, Fabrizio Gentile
Journal: Thromb J (2016)
Keywords: pemphigus vulgaris, thrombosis
MeSH terms: Case Reports

Background:
Several autoimmune skin disorders are characterised by an increased risk of thrombosis, with bollous pemphigoid carrying a higher risk than pemphigus vulgaris (PV). We describe the case of a middle aged gentleman who developed recurrent venous thromboembolism despite adequate oral anticoagulation during very active PV that required escalation of treatment to bring the disease under control.
Case presentation:
In May 2014 a 49 year gentleman was admitted for widespread mucocutaneous blistering diagnosed as PV by histology and immunofluorescence. After 6 weeks of treatment with systemic steroids and azathioprine the patient developed pulmonary emboli and started oral anticoagulation with warfarin. In late September, the patient re-presented with a severe flare of PV and a recurrent deep vein thrombosis despite oral anticoagulation within therapeutic range. Warfarin was changed to subcutaneous low molecular heparin in therapeutic dose while treatment for pemphigus was escalated: first azathioprine was switched to mycophenolate mofetil and the steroids dose increased; then due to poor response, intravenous immunoglobulins were given for three courses and finally he received four infusions of Rituximab that induced sustained remission. In April 2015 the dose of mycophenolate was decreased but anticoagulation was continued until the beginning of July 2015 to ensure that decreasing immune suppression did not allow the emergence of another flare with attendant thrombotic risk.
Conclusion:
The case highlights the risk of thrombosis and re-thrombosis in aggressive PV and demands further clinical research in this area to assess the need for thromboprophylaxis in aggressive bollous skin disease.
Does Early Decompressive Craniectomy Improve Outcome? Experience from an Active UK Recruiter Centre
Authors: E García Vicente, V Garnelo Rey, M Manikon, S Ashworth, M H Wilson
Journal: Case Rep Crit Care (2013)

Introduction. The results of the recent DECRA study suggest that although craniectomy decreases ICP and ICU length of stay, it is also associated with worst outcomes. Our experience, illustrated by these two striking cases, supports that early decompressive craniectomy may significantly improve the outcome in selected patients. Case Reports. The first patient, a 20-year-old man who suffered severe brain contusion and subarachnoid haemorrhage after a fall downstairs, with refractory ICP of 35 mmHg, despite maximal medical therapy, eventually underwent decompressive craniectomy. After 18 days in intensive care, he was discharged for rehabilitation. The second patient, a 23-year-old man was found at the scene of a road accident with a GCS of 3 and fixed, dilated pupils who underwent extensive unilateral decompressive craniectomy for refractory intracranial hypertension. After three weeks of cooling, paralysis, and neuroprotection, he eventually left ICU for rehabilitation. Outcomes. Four months after leaving ICU, the first patient abseiled 40 m down the main building of St. Mary's Hospital to raise money for the Trauma Unit. He has returned to part-time work. The second patient, was decannulated less than a month later and made a full cognitive recovery. A year later, with a titanium skull prosthesis, he is back to part-time work and to playing football. Conclusions. Despite the conclusions of the DECRA study, our experience of the use of early decompressive craniectomy has been associated with outstanding outcomes. We are currently actively recruiting patients into the RESCUEicp trial and have high hopes that it will clarify the role of the decompressive craniectomy in traumatic brain injury and whether it effectively improves outcomes.
Acute Flaccid Paralysis by Enterovirus D68 Infection: First Italian Description in Adult Patient and Role of Electrophysiology
Authors: Marco Ceccanti, Emilia Sbardella, Federica Letteri, Manuela De Michele, Anne Falcou, Federica Romanzi, Emanuela Onesti, Maurizio Inghilleri
Journal: Front Neurol (2017)
Keywords: emg, acute flaccid paralysis, bone marrow transplantation, electrophysiology, enterovirus d68, nerve conduction study, poliomyelitis
MeSH terms: Case Reports

A Peruvian woman was admitted to the Emergency Department, due to an acute flaccid paralysis (AFP) of the upper limbs that progressively involved also lower limbs and respiratory muscles. She previously suffered from non-Hodgkin's lymphoma and had to undergo hematopoietic stem cell transplantation. A magnetic resonance imaging showed a T2 hyperintensity in the anterior and central region of the cervical segment with an elective involvement of gray matter. This finding, combined with other clinical, laboratory, and electrophysiological data, led to a diagnosis of AFP. Enterovirus D68 was isolated in the patient's cerebrospinal fluid, plasma, and throat swab. To our knowledge, this is the first Italian case of AFP by Enterovirus D68 infection in an adult. The diagnostic assessment and management of AFP by Enterovirus D68 are discussed.
Impact of systemic steroid treatment on talc pleurodesis: a report of six cases
Authors: Soichiro Ishii, Hiroshi Sakurashita, Emiko Mashida, Yasuyuki Saeki, Hiroaki Matsuo
Journal: J Pharm Health Care Sci (2020)
Keywords: anti-inflammatory effects, pleurodesis, sterile graded talc, steroids
MeSH terms: Case Reports

Background:
Instillation of sterile graded talc in the pleural space is performed to prevent reaccumulation of malignant pleural effusion after drainage. Talc is thought to encourage pleural adhesions as part of the repair process by provoking inflammation, suggesting that adhesions are less likely to form in patients taking corticosteroids or other drugs with anti-inflammatory effects. However, the relationship between steroid therapy and pleurodesis efficacy remains unclear.
Case presentation:
We report the outcomes of six patients who underwent pleurodesis at Hiroshima University Hospital while being treated with systemic steroid therapy for non-cancer-related illnesses. Talc pleurodesis was successful at the first attempt in five of the six patients. The five successful cases were receiving low-dose oral prednisolone or methyl prednisolone (range, 1-20 mg/day) at the time of pleurodesis and had serum albumin levels ranging from 2.2 to 3.0 g/dL. In contrast, the patient in whom pleurodesis was unsuccessful was receiving a higher dose of prednisolone (40 mg/day) intravenously and had a relatively low serum album level (1.7 g/dL).
Conclusions:
The outcome of pleurodesis may be affected by the dose and/or route of systemic steroid therapy. Further analysis with more patients will be necessary to clarify the relationship between steroid dosage and talc pleurodesis success rate.
Ocular vaccinia infection in laboratory worker, Philadelphia, 2004
Authors: Felicia M T Lewis, Esther Chernak, Erinn Goldman, Yu Li, Kevin Karem, Inger K Damon, Richard Henkel, E Claire Newbern, Patrina Ross, Caroline C Johnson
Journal: Emerg Infect Dis (2006)
MeSH terms: Conjunctivitis, Viral / diagnosis, Conjunctivitis, Viral / virology, Occupational Exposure, Research Personnel, Vaccinia / diagnosis, Vaccinia / virology, Vaccinia virus / physiology, Case Reports, Adult, Conjunctivitis, Viral / drug therapy, Conjunctivitis, Viral / pathology, Female, Humans, Immunoglobulins, Intravenous / therapeutic use, Laboratories, Safety, Vaccinia / drug therapy, Vaccinia / pathology, Vaccinia virus / isolation & purification, Immunoglobulins, Intravenous

We report a case of ocular vaccinia infection in an unvaccinated laboratory worker. The patient was infected by a unique strain used in an experiment performed partly outside a biosafety cabinet. Vaccination should continue to be recommended, but laboratories with unvaccinated workers should also implement more stringent biosafety practices.
Recovery from Spatial Neglect with Intra- and Transhemispheric Functional Connectivity Changes in Vestibular and Visual Cortex Areas-A Case Study
Authors: Julian Conrad, Rainer Boegle, Matthias Ertl, Thomas Brandt, Marianne Dieterich
Journal: Front Neurol (2018)
Keywords: caloric, functional connectivity, neglect, parietal operculum 2, spatial, vestibular, visual
MeSH terms: Case Reports

Objective:
Vestibular signals are involved in higher cortical functions like spatial orientation and its disorders. Vestibular dysfunction contributes, for example, to spatial neglect which can be transiently improved by caloric stimulation. The exact roles and mechanisms of the vestibular and visual systems for the recovery of neglect are not yet known.
Methods:
Resting-state functional connectivity (fc) magnetic resonance imaging was recorded in a patient with hemispatial neglect during the acute phase and after recovery 6 months later following a right middle cerebral artery infarction before and after caloric vestibular stimulation. Seeds in the vestibular [parietal operculum (OP2)], the parietal [posterior parietal cortex (PPC); 7A, hIP3], and the visual cortex (VC) were used for the analysis.
Results:
During the acute stage after caloric stimulation the fc of the right OP2 to the left OP2, the anterior cingulum, and the para/hippocampus was increased bilaterally (i.e., the vestibular network), while the interhemispheric fc was reduced between homologous regions in the VC. After 6 months, similar fc increases in the vestibular network were found without stimulation. In addition, fc increases of the OP2 to the PPC and the VC were seen; interhemispherically this was true for both PPCs and for the right PPC to both VCs.
Conclusion:
Improvement of neglect after caloric stimulation in the acute phase was associated with increased fc of vestibular cortex areas in both hemispheres to the para-hippocampus and the dorsal anterior cingulum, but simultaneously with reduced interhemispheric VC connectivity. This disclosed a, to some extent, similar but also distinct short-term mechanism (vestibular stimulation) of an improvement of spatial orientation compared to the long-term recovery of neglect.
Acquired factor VIII deficiency: two case reports and a review of literature
Authors: Lan Mo, George C Bao
Journal: Exp Hematol Oncol (2017)
Keywords: acquired factor viii deficiency, acquired hemophilia a, glucocorticoids, immunosuppression, intravenous immunoglobulin, myositis, parvovirus b19, rituximab
MeSH terms: Case Reports

Background:
Acquired factor VIII (FVIII) deficiency, or acquired hemophilia A (AHA), is a rare autoimmune disorder involving antibody-mediated depletion of coagulation FVIII, leading to severe, life-threatening bleeding. The condition is often associated with other autoimmune disorders, and its treatment involves replacement of FVIII and various modes of immunosuppression. Recently, a few noteworthy therapeutic advances have been made. We present two cases of severe AHA in Chinese women. One of these women developed this disorder in the setting of possible parvovirus B19 infection, which has not yet been reported in association with AHA. Other notable features of her case included paradoxical venous thrombosis and possible association with Sjogren's syndrome and myositis. The other woman failed to respond to usual first-line therapies despite exhibiting a less severe clinical course, illustrating the varied but potentially stubborn behavior of this disorder.
Case 1:
An 87-year-old woman presented with diffuse ecchymoses, melena, vaginal bleeding. Labs showed hemoglobin (Hgb) nadir of 5.7 mg/dL, elevated partial thromboplastin time (PTT), FVIII level <1%, mixing study consistent with an inhibitor, elevated anti-Sjogren's-Syndrome-related antigen A antibody, elevated creatinine kinase, and elevated parvovirus IgM and IgG. Imaging of her arm showed diffuse myositis and deep venous thrombosis. After intravenous and oral steroids, her FVIII levels normalized, and her symptoms subsided.
Case 2:
A 59-year-old woman presented with recurrent ecchymoses and hematomas in her extremities. Labs showed Hgb of 11.7 mg/dL, elevated PTT, FVIII level of 3%, and mixing study consistent with an inhibitor. Despite receiving a long course of steroids, several courses of IVIG, and a few courses of Rituximab, her FVIII level remained critically low.
Conclusion:
The rarity of AHA limits our understanding of this disease and the ability to perform trials to discover optimal therapies. We hope that these case reports and discussion will shed further light on the varied clinical manifestations and natural histories of this disorder to guide better recognition and treatment of AHA.
Duchenne Muscular Dystrophy With Low Acidic α-Glucosidase Activity: Two Case Reports and Literature Review
Authors: Xiufang He, Xuandi Li, Yuese Lin, Hongjun Ba, Huimin Peng, Lili Zhang, Ling Zhu, Youzhen Qin, Shujuan Li
Journal: Front Pediatr (2022)
Keywords: duchenne muscular dystrophy, acid α-glucosidase, child, creatine kinase, pseudodeficiency alleles
MeSH terms: Case Reports

Background:
Pompe disease is usually considered in children with elevated creatine kinase (CK) levels and decreased acidic α-glucosidase (GAA) enzyme activity. However, there are exceptions, such as GAA pseudo deficiency alleles, which result in lower GAA enzyme activity but do not cause Pompe disease. Here, we report two cases presenting with high CK levels and low GAA activity who were ultimately diagnosed with Duchenne muscular dystrophy (DMD).
Case presentation:
Case 1 patient was a 2-month-old boy who presented with an extremely high serum CK level (5,480∼11,880 U/L) and low GAA activity (2.72 nmol/1 h/mg). The whole-exome sequencing did not find the pathogenic GAA gene mutation, however, there was a DMD gene hemizygous variation (c. 7657C > T, p. Arg2553Ter) inherited from his mother, which was verified by the first-generation sequencing. Further genetic analysis of GAA identified two homozygous pseudo deficiency alleles (c.1726G > A, p. Gly576Ser and c.2065G > A, p. Glu689Lys), which were believed to induce the patient's low GAA activity. Therefore, the boy was diagnosed with DMD, although he had extremely low GAA activity. Case 2 patient was also a 2-month-old boy presenting with a significant increase in CK level (12,408∼24,828 U/L). His blood GAA activity (colorimetric method) was 9.02 nmol/1 h/mg. Similarly, his whole-exome sequencing did not find the pathogenic mutation of the GAA gene, but a DMD gene hemizygous variation (c.5571del, p. Lys1857AsnfsTer8), hence he was diagnosed with DMD as well. Regarding GAA activity, the case 2 patient was not as low as the case 1 patient, mainly because his two GAA pseudo deficiency alleles were heterozygous.
Conclusion:
Pompe disease is usually screened in infants with high CK levels. We should be aware that pseudo deficiency alleles can cause low GAA activities but not Pompe disease. Genetic tests would be helpful to distinguish cases with GAA pseudo deficiency alleles from patients with some muscular disorder diseases such as DMD.
Positioning a proned patient with cauda equina syndrome who presents at 15 weeks gestation: a case report
Authors: Elizabeth Speirs, Matthew Wiles, Andrew Bacon, Stephen Radley
Journal: F1000Res (2014)

Cauda equina syndrome is a neurosurgical emergency that requires prompt intervention to prevent irreversible spinal cord paralysis. This article describes how we managed a case of an obese pregnant patient who was placed in the prone position for surgery. We discuss the evidence behind the management options and choice of operating tables available.