OpenMed/multicare-articles huggingface dataset:
Endovascular Embolization of a Dissected External Carotid Artery Pseudoaneurysm in a Young Female with Neurofibromatosis Complicated by Preeclampsia
Authors: Sasha Lalla, Rajeev Seecheran, Valmiki Seecheran, Sangeeta Persad, Ronald Henry, Naveen Anand Seecheran
Journal: Case Rep Vasc Med (2019)
MeSH terms: Case Reports

Carotid artery pseudoaneurysms are infrequently encountered in clinical practice. Major contributory etiologies include blunt trauma, infections, cystic medial necrosis, fibromuscular dysplasia, arteriosclerosis, and congenital abnormalities. The authors report an exceedingly rare case of a dissected external carotid artery pseudoaneurysm in a 26-year-old female patient with neurofibromatosis complicated by preeclampsia at 28-week period of gestation, safely and successfully treated by coil embolization.
Gastric IgG4-Related Autoimmune Fibrosclerosing Pseudotumour: A Novel Location
Authors: Katie E Rollins, Samir P Mehta, Maria O'Donovan, Peter M Safranek
Journal: ISRN Gastroenterol (2011)
MeSH terms: Case Reports

We describe the first reported case of an IgG4-related autoimmune fibrosclerosing pseudotumour located in the stomach of a 75-year old woman presenting with weight loss and vomiting. A lesion was detected in the gastric body at endoscopy. Subsequent characterisation by CT was suggestive of a gastrointestinal stromal tumour. Following laparoscopic resection, the patient recovered uneventfully. Histological examination of the resected specimen revealed an IgG4-related fibrosclerosing pseudotumour, a novel location for this histopathological entity.
Spontaneous Remission of an Untreated, MYC and BCL2 Coexpressing, High-Grade B-Cell Lymphoma: A Case Report and Literature Review
Authors: D Alan Potts, Jonathan R Fromm, Ajay K Gopal, Ryan D Cassaday
Journal: Case Rep Hematol (2017)
MeSH terms: Case Reports

Non-Hodgkin lymphomas (NHL) are a heterogeneous group of hematologic malignancies typically treated with multiagent chemotherapy. Rarely, spontaneous remissions can be observed, particularly in more indolent subtypes. The prognosis of aggressive NHL can be predicted using clinical and histopathologic factors. In aggressive B-cell NHL, the importance of MYC and BCL2 proto-oncogene coexpression (as assessed by immunohistochemistry) and high-grade histologic features are particularly noteworthy. We report a unique case of spontaneous remission in a patient with an aggressive B-cell NHL which harbored high-risk histopathologic features, including MYC protein expression at 70-80%, BCL2 protein expression, and morphologic features suggestive of high-grade B-cell lymphoma, NOS (formerly B-cell lymphoma unclassifiable with features intermediate between diffuse large B-cell lymphoma and Burkitt lymphoma [BCLU]). After undergoing a biopsy to confirm this diagnosis, he opted to forego curative-intent chemotherapy. The single, yet relatively large area of involvement noted on 18F-fluorodeoxyglucose positron emission tomography-computed tomography steadily resolved on subsequent follow-up studies. He remained without evidence of recurrence one year later, having never received treatment. This case emphasizes the potential for spontaneous remission in NHL and demonstrates that this phenomenon can be observed despite contemporary high-risk histopathologic features.
Application of multimodal analgesia combined with opioid-free anesthetics in a non-intubated video-assisted thoracoscopic surgery bullectomy: A case report
Authors: Longbin Zheng, Xiaojing Zhang, Qing Ma, Weimin Qin, Wenbo Liang, Zhiqiang Ren, Guoxiang Fan, Ning Yin
Journal: Front Surg (2023)
Keywords: asthma, case report, enhanced recovery after surgery (eras), non-intubated video-assisted thoracoscopic surgery (nivats), opioid-free, thoracic paravertebral nerve block (tpvb)
MeSH terms: Case Reports

Background:
Non-intubated video-assisted thoracoscopic surgery (NIVATS) has been increasingly applied worldwide owing to its benefits of enhanced recovery after surgery (ERAS). Anesthetic management for patients with asthma should focus on minimizing airway stimulation.
Case description:
A 23-year-old male patient with a history of asthma was diagnosed with left-sided spontaneous pneumothorax. The patient then underwent left-sided NIVATS bullectomy under general anesthesia with preserved spontaneous breathing. Left thoracic paravertebral nerve block (TPVB) with an injection of 0.375% ropivacaine (30 ml) was performed in the 6th paravertebral space under ultrasound guidance. Anesthesia induction commenced until the cold sensation in the surgical area had disappeared. General anesthesia was induced by midazolam, penehyclidine hydrochloride, esketamine, and propofol and then maintained using propofol and esketamine. Surgery commenced after the patient was positioned in the right lateral recumbency. The collapse of the left lung was satisfactory, and the operative field was ensured after artificial pneumothorax. The surgical procedure was uneventful, intraoperative arterial blood gases were within normal ranges, and vital signs were stable. The patient awakened rapidly without any adverse reactions at the end of the surgery and was then transferred to the ward. During the postoperative follow-up, the patient experienced mild pain 48 h after surgery. The patient was discharged from the hospital 2 days postoperatively and developed no nausea, vomiting, or any other complications.
Conclusion:
The present case suggests the feasibility of TPVB in combination with non-opioid anesthetics to provide high-quality anesthesia in patients undergoing NIVATS bullectomy.
Prognostic value of automated SPECT scoring system for coronary artery disease in stress myocardial perfusion and fatty acid metabolism imaging
Authors: Tomoaki Nakata, Akiyoshi Hashimoto, Takayuki Matsuki, Keiichiro Yoshinaga, Kazumasa Tsukamoto, Nagara Tamaki
Journal: Int J Cardiovasc Imaging (2013)
MeSH terms: Coronary Artery Disease / diagnostic imaging, Coronary Circulation, Fatty Acids / metabolism, Myocardial Perfusion Imaging / methods, Myocardium / metabolism, Tomography, Emission-Computed, Single-Photon, Case Reports, Comparative Study, Evaluation Study, Aged, Algorithms, Area Under Curve, Automation, Chi-Square Distribution, Coronary Artery Disease / metabolism, Coronary Artery Disease / physiopathology, Disease-Free Survival, Exercise Test, Female, Humans, Image Interpretation, Computer-Assisted, Iodobenzenes, Kaplan-Meier Estimate, Male, Middle Aged, Multivariate Analysis, Predictive Value of Tests, Proportional Hazards Models, ROC Curve, Radiopharmaceuticals, Reproducibility of Results, Retrospective Studies, Risk Assessment, Risk Factors, Time Factors, Fatty Acids, Iodobenzenes, Radiopharmaceuticals, iodofiltic acid

Quantitative SPECT analysis contributes to the diagnostic and prognostic assessment of coronary artery disease. A novel automated scoring system (heart score view) can provide identical quantitative information to that determined by expert visual analysis. The aim of the present study is to evaluate the prognostic value of the automated SPECT scoring system when applied to stress thallium and resting beta-methyl-iodophenyl pentadecanoic acid (BMIPP) SPECT images. After a preliminary validation of the automated system by comparison with expert visual analyses, outcome data from 151 consecutive patients with suspected or known coronary artery disease without prior myocardial infarction were analyzed using automated SPECT scores on stress thallium and resting BMIPP images. The software quantified abnormalities as summed stress (SSS), summed rest and summed difference scores for stress thallium and as summed BMIPP scores (SBS). Cardiac events occurred over a period of 48 months in 29 (19.2%) patients with diabetes mellitus, a lower left ventricular ejection fraction (LVEF) and more abnormal scores for thallium and BMIPP. Multivariate predictors of all cardiac events included diabetes mellitus and thallium SSS. The global Chi-square value was significantly increased when SSS was added to the clinical information (diabetes mellitus and LVEF). Negative predictive values of thallium SSS and SBS were almost identical at 84% for all cardiac events and 98% for hard cardiac events. Automatically quantified perfusion and BMIPP scores are related to cardiac events and these values can improve the risk stratification of coronary patients particularly when stress thallium imaging is combined with clinical information.
The Traumatic Tube: Bleeding Rectal Ulcer Caused by Flexi-Seal Device
Authors: Abhinav Tiwari, Himani Sharma, Khola Qamar, Yaseen Alastal, Thomas Sodeman, Ali Nawras
Journal: Case Rep Gastrointest Med (2017)
MeSH terms: Case Reports

Diarrhea and fecal incontinence are common in critically ill patients and present a challenging problem in patient management. The Flexi-Seal® Fecal Management System is a device to divert the stools away from the patient, thus improving the care to patients with fecal incontinence. There have been only few case reports describing the complications with the use of this device. Here, we present a case of a 77-year-old woman who was admitted due to massive hematochezia while on anticoagulation. She was found to have a large rectal ulcer caused by the Flexi-Seal device, used during the last hospital stay for fecal incontinence. Flexi-Seal device can be effective for the management of incontinence; however, caution should be exercised during handling and pressure from the retention balloon should be relieved periodically.
A Rare Case of Aortoatrial Fistula from Streptococcal Endocarditis
Authors: Hammad Arshad, Meilin Young, Parth Rali
Journal: Case Rep Pulmonol (2017)
MeSH terms: Case Reports

We represent an unfortunate case of postinfluenza streptococcal endocarditis in a 34-year-old healthy male. He presented with hypoxic respiratory failure and was found to have mitral and aortic valve vegetation. Hospital course was complicated by the presence of an aortoatrial fistula from an aortic root abscess, persistent septic shock, and multiorgan failure.
Hypofertility in a persistence of mullerian duct syndrome: Case report
Authors: Issam Jandou, Tarik Mhanna, Mehdi Chennoufi, Mohamed Aynaou, Amine El Houmaidi, Ali Barki
Journal: Int J Surg Case Rep (2020)
Keywords: anti-mullerian hormone, disorders of sexual development, hypofertility, mullerian duct syndrome, transverse ectopic testis
MeSH terms: Case Reports

Introduction:
Persistent Mullerian duct syndrome is a rare form of pseudohermaphroditism, possibly resulting from the absence of Mullerian duct inhibiting factor.
Presentation of case:
We report the case of a 36 year-old patient with a syndrome of persistent Müllerian ducts (PMDS) of the female type. The Clinical examination revealed avacant scrotum, a normal penis. The spermogram analysis found azoospermia. Imaging using ultrasound and tomotensidometry found the presence of amass in the back of bladder. A Laparoscopic exploration revealed two slightly enlarged testicles, in a pelvic situation intimately confined to a rudimentary uterus with two tubes. The histological examination was in favor of a uterine endometrium and two fallopian tubes. The karyotype requested later was male 46 XY.
Discussion:
Since the first case, between 200 and 262 cases have been reported in literature around the world, this might reveal that the incidence and prevalence of this type of diseases are not well-estimated. The diagnosis is often a fortuitous discovery during a cryptorchidism surgery or inguinal hernia, more rarely during the management of a state of infertility or the degenerescence of the testis or Mullerian derivative. It is caused by either the anti-Mullerian hormone deficiency (AMH) or a dysfunction of its receptor.
Conclusion:
A multidisciplinary approach is necessary for surgical management. long-term prognosis is favorable, though fertility seem to be decreased and also it might lead to a riskiness of malignancy owing to cryptorchidism and preserved Mullerian remants.
Endoscopic Removal of a Supernumerary Premolar in the Mandible during a Dental Implant Placement
Authors: Víctor Beltrán, Mario Cantín, Eduardo Borie, Ramón Fuentes, Wilfried Engelke
Journal: Case Rep Dent (2014)

The surgical removal of supernumerary teeth is necessary in some cases, especially before the commencement of any orthodontic or implant treatment procedure. In the mandibular supernumerary premolar, a more conservative approach is required because of the presence of complications associated with conventional surgery due to the close proximity of the said premolar to the alveolar inferior and mental nerves, and the need for bone conservation for implant placement. The endoscopic surgical approach has been used for the removal of the maxillary supernumerary tooth, impacted third molar, and implants. In this case report, we present an endoscopically assisted surgical technique for the removal of an unerupted supernumerary premolar in the mandible associated with a dental implant placement procedure.
Case report: Peripheral nerve stimulation relieves post-traumatic trigeminal neuropathic pain and secondary hemifacial dystonia
Authors: Junchi Li, Yongjie Li, Wei Shu
Journal: Front Neurol (2023)
Keywords: neuromodulation, peripheral induced movement disorders, peripheral nerve stimulation (pns), post-traumatic neuropathic pain, trigeminal nerve
MeSH terms: Case Reports

Post-traumatic trigeminal neuropathic pain (PTNP) combined with secondary dystonia are rare sequelae of orofacial injury and often do not respond to conservative treatment. The consensus on treatment for both symptoms is yet to be standardized. This study reports the case of a 57-year-old male patient with left orbital trauma who developed PTNP immediately after the injury and secondary hemifacial dystonia 7 months thereafter. To treat his neuropathic pain, we performed peripheral nerve stimulation (PNS) using a percutaneously implanted electrode to the ipsilateral supraorbital notch along the brow arch, which instantly resolved the patient's pain and dystonia. PTNP was relieved in a satisfactory manner until 18 months after the surgery, despite a gradual recurrence of the dystonia since 6 months after the surgery. To the best of our knowledge, this is the first reported case of PNS used for the treatment of PTNP combined with dystonia. This case report highlights the potential benefits of PNS in relieving neuropathic pain and dystonia and discusses the underlying therapeutic mechanism. Moreover, this study suggests that secondary dystonia occurs due to the uncoordinated integration of afferent sensory and efferent motor information. The findings of the present study indicate that PNS should be considered for patients with PTNP following the failure of conservative treatment. Secondary hemifacial dystonia may benefit from PNS upon further research and long-term assessment.
From the Old, the Best: Parathyroidectomy in the Management of Soft-Tissue and Vascular Calcification in Patients with Chronic Renal Disease
Authors: P Mariel Hernandez, B Daniel Enos, T Gonzalo Labarca, A Guillermo Vanderstelt
Journal: Case Rep Nephrol (2021)
MeSH terms: Case Reports

Introduction. Bone mineral disease in patients with chronic kidney disease (CKD-MBD) is a clinical syndrome involving bone, biochemical changes, and extraosseous calcification. These complications increase morbidity and mortality. Prevalence reports are rare. Case Report. This case shows a young woman on peritoneal dialysis (PD) for 10 years with severe secondary hyperparathyroidism and soft-tissue calcifications in the hands, pelvis, and right knee, as well as severe vascular calcification, managed with calcimimetics without success. We decided to perform subtotal parathyroidectomy (STPTX). Three months after surgery, she had satisfactory evolution, despite notable hungry bone disease, without bone pain or functional limitation and almost no calcifications. Discussion. The benefit of hemodialysis has been shown with better volume management and improvement of calcium/phosphate products. STPTX allowed biochemical control and calcification improvement, with an evident better quality of life for our patient. Therapeutic alternatives need to be tailored to the patient's characteristics in the calcimimetics era.
Late diagnosis of multidrug-resistant tuberculosis in a child at Dr George Mukhari Academic Hospital, Ga-Rankuwa, South Africa: A case report
Authors: Bakani A Siwele, Ndivhuho A Makhado, Matodzi T Mariba
Journal: Afr J Lab Med (2019)
Keywords: extrapulmonary tuberculosis, laboratory diagnosis, multidrug-resistant tuberculosis, radiological improvement, spinal tuberculosis

Introduction:
South Africa has one of the top ten tuberculosis burdens in the world, only lagging behind countries with significantly larger populations. Increased awareness of extrapulmonary tuberculosis, specifically spinal tuberculosis, is necessary, because of the HIV epidemic.
Case presentation:
This report describes the case of a 9-year-old male patient who was suspected of having multidrug-resistant (MDR) tuberculosis, based on failure to recover clinically and radiologically after 6 months on first-line anti-tuberculosis treatment. Pus samples were sent to an accredited academic laboratory for histopathology, microscopy, culture, line-probe assay (MTBDRplus assay) and phenotypic MGIT 960 drug susceptibility tests. Second-line MDR tuberculosis treatment was introduced. Clinical, radiological, physical processes and more laboratory tests were conducted to document whether or not there was improvement in the patient.
Management and outcome:
After laboratory diagnosis of MDR tuberculosis, the patient was started on MDR tuberculosis treatment. The patient started improving remarkably after the introduction of anti-tuberculosis treatment and rehabilitation, although he also required surgery to stabilise the spine. Neurological improvement was observed in the patient and he fully recovered.
Discussion:
Although the diagnosis of spinal MDR tuberculosis may not be achieved easily by culture, the well-known gold standard method of tuberculosis diagnosis, it is of great importance to rapidly initiate an effective anti-tuberculosis treatment of drug-resistant strains to reduce the deformity of the spine.
Tubular Carcinoma of the Breast: Advantages and Limitations of Breast Tomosynthesis
Authors: Filipa Vilaverde, Ana Rocha, Alcinda Reis
Journal: Case Rep Radiol (2016)
MeSH terms: Case Reports

Tubular carcinoma of the breast is a rare variant of invasive ductal carcinoma. We report a case of 42-year-old asymptomatic female with a histopathological proven multifocal tubular carcinoma, studied by mammography, Tomosynthesis, Ultrasound, and Magnetic Resonance. Herein, we discuss the advantages and limitations of Tomosynthesis, an emerging imaging technique, in this particular case.
Combined accelerated corneal collagen crosslinking and intrastromal Kerarings implantation for treatment of advanced superior keratoconus
Authors: Amr Mounir, Engy Mohamed Mostafa
Journal: GMS Ophthalmol Cases (2020)
Keywords: kerarings, corneal collagen crosslinking, superior keratoconus
MeSH terms: Case Reports

Purpose: To report early results of combined accelerated corneal collagen crosslinking (CXL) and intrastromal Kerarings implantation by femtosecond laser in a case of advanced superior keratoconus. Methods: The patient was a 27-year-old male with left eye grade 3 keratoconus with superior cone. He was diagnosed by Sirius Scheimpflug corneal topography (CSO, Florence, Italy). The right eye had previously been subjected to penetrating keratoplasty. The uncorrected visual acuity (UCVA) in the right eye (RE) was 1.2 LogMAR, best corrected visual acuity (BCVA) was 0.8 by a refraction of -7.50Ds -3.00Dc @12. The UCVA in the left eye (LE) was 1.2 LogMAR, BCVA was 0.9 by a refraction of -8.50 Ds -5.50Dc @169. Intrastromal Kerarings implantation by femtosecond laser was carried out by IntraLase (iFS, Abbott) along with accelerated transepithelial corneal collagen crosslinking by KXL system (Avedro, USA) in the same session. Follow-up was done for a period of 12 months after surgery. Results: The patient was followed up for 12 months with improvement of visual acuity as regards UCVA and BCVA and improvement of corneal topographic parameters including keratometry and front and back elevations. Conclusion: Combined accelerated corneal collagen crosslinking and intrastromal Kerarings implantation by femtosecond laser is an effective method in the treatment of this uncommon type of keratoconus.
Continuous Spinal Anaesthesia for Intertrochanteric Femur Fracture in a Patient with Skeletal Dysplasia
Authors: Sharad Khakurel, Rupesh Kumar Yadav
Journal: Case Rep Anesthesiol (2021)
MeSH terms: Case Reports

The practice of continuous spinal anaesthesia is not common. Though underutilised, it offers significant advantage when compared to the single-shot technique nonetheless. Time and again, it has proven its worth in patients with advanced cardiac illness, spinal deformities, and obesity. We here successfully employed this neuraxial anaesthetic technique in a sixty-two-year-old male patient with skeletal dysplasia, who presented for surgical fixation of intertrochanteric fracture of the femur. With short stature, anticipated difficult airway, and poor pulmonary status complicating the anaesthetic plan, we opted for continuous spinal anaesthesia. The procedure was carried out uneventfully with 8 mg of hyperbaric bupivacaine used in titration to anaesthetic needs. Patients with skeletal dysplasia present with wide array of clinical conditions that pose a formidable challenge to anaesthesiologists. Continuous spinal anaesthesia can be safely practiced in such patients as it provides a titratable form of neuraxial blockade with reduced dose of local anaesthesia. This, in turn, ensures a predictable block and, thus, hemodynamic stability.
Ecthyma gangrenosum on the face of a malnourished child with Pseudomonas sepsis: Simulating Cancrum oris
Authors: Khadijat O Isezuo, Usman M Sani, Usman M Waziri, Bilkisu I Garba, Yahaya Mohammed, Joy F Legbo, Nazish P Aquil, Fatima I Abubakar, Memuna Omar
Journal: Afr J Lab Med (2018)

Introduction:
Ecthyma gangrenosum (EG) is a cutaneous lesion commonly caused by Pseudomonas aeruginosa that involves mainly the lower limbs and gluteal region, seen more in immunosuppressed patients with neutropenia. Cancrum oris (Noma) is a gangrenous necrosis of the face that begins as a gingival ulcer and progresses rapidly to destroy contiguous tissues in malnourished children.
Case presentation:
This article reports a case of facial EG which was similar to Noma in a malnourished child: a 16-month old girl with fever, cough, weight loss, watery stool and swelling on right cheek. She was febrile, pale, wasted with bilateral pitting pedal oedema. She had a solitary circumscribed round necrotic lesion, with surrounding hyperaemia on the right malar area which extended to destroy the right ala nasi. No intra-oral rashes but she had left ear discharge. She received blood transfusion, antibiotics, antiseptic wound care and nutritional rehabilitation.
Management and outcome:
Swabs of the lesion and ear discharge both revealed Gram-negative bacilli and culture yielded P. aeruginosa. Retroviral, Mantoux and Gene Xpert tests were negative. She had moderate anaemia, normal white blood cell count, and neutropaenia. Parenteral ceftriazone was changed to ciprofloxacin based on sensitivity results and lack of clinical response. The wound healed with residual scarring and partial destruction of right ala nasi.
Discussion:
Although this patient had facial necrosis to suggest Noma, she did not have initial oral involvement, and clinical features such as Pseudomonas sepsis and neutropaenia suggested EG. Facial necrosis in malnourished children may be due to EG.