OpenMed/multicare-articles huggingface dataset:
Resolution of dialyzer membrane-associated thrombocytopenia with use of cellulose triacetate membrane: a case report
Authors: Feyisayo Olafiranye, Win Kyaw, Oladipupo Olafiranye
Journal: Case Rep Med (2011)
MeSH terms: Case Reports

Blood and dialyzer membrane interaction can cause significant thrombocytopenia through the activation of complement system. The extent of this interaction determines the biocompatibility of the membrane. Although the newer synthetic membranes have been shown to have better biocompatibility profile than the cellulose-based membranes, little is known about the difference in biocompatibility between synthetic membrane and modified cellulose membrane. Herein, we report a case of a patient on hemodialysis who developed dialyzer-membrane-related thrombocytopenia with use of synthetic membrane (F200NR polysulfone). The diagnosis of dialyzer membrane-associated thrombocytopenia was suspected by the trend of platelet count before and after dialysis, and the absence of other possible causes of thrombocytopenia. We observed significant improvement in platelet count when the membrane was changed to modified cellulose membrane (cellulose triacetate). In patients at high risk for thrombocytopenia, the modified cellulose membrane could be a better alternative to the standard synthetic membranes during hemodialysis.
Diagnostic Laparoscopy as Decision Tool for Re-recurrent Inguinal Hernia Treatment Following Open Anterior and Laparo-Endoscopic Posterior Repair
Authors: Ferdinand Köckerling, Christine Schug-Pass
Journal: Front Surg (2017)
Keywords: tapp, explorative laparoscopy, guidelines, inguinal hernia, re-recurrence

Introduction:
The guidelines of the international hernia societies recommend posterior repair in laparo-endoscopic technique for recurrent inguinal hernia after open anterior mesh repair and, conversely, open anterior repair for recurrence after laparo-endoscopic primary repair. Even when these guidelines are followed, already 1 year after repair a re-recurrence rate of 1-2% must be expected, with that rate rising further in the subsequent years. Accordingly, increasingly more patients with re-recurrence after anterior and posterior mesh implantation must be treated, which constitutes a problem that to date has been investigated in only very few studies. Hence, there are no well-founded recommendations. This paper now presents a number of case reports aimed at identifying the role of explorative laparoscopy as decision tool for re-recurrent inguinal hernia treatment.
Patients and methods:
Based on three case reports the role of explorative laparoscopy as decision tool for re-recurrent inguinal hernia treatment is presented below.
Results:
In all the three cases described explorative laparoscopy played a key role as decision tool when deciding how best to treat re-recurrence after anterior and posterior inguinal hernia repair. In one case severe adhesions after robotic prostatectomy and in another case correct placement of the mesh in the posterior plane, adhesions from the cecum to the groin region and no definitive finding of a re-recurrence resulted in an open repair. In the third case, an insufficient laparoscopic posterior mesh placement made the re-recurrent TAPP procedure relatively easy.
Conclusion:
Explorative laparoscopy is an important decision tool for re-recurrent inguinal hernia treatment to minimize the risks of the procedure for the patients.
Erythritol-Enriched Air-Polishing Powder for the Surgical Treatment of Peri-Implantitis
Authors: Silvio Taschieri, Roberto Weinstein, Massimo Del Fabbro, Stefano Corbella
Journal: ScientificWorldJournal (2015)
MeSH terms: Dental Implants, Erythritol / therapeutic use, Peri-Implantitis / surgery, Case Reports, Meta-Analysis, Review, Systematic Review, Female, Humans, Middle Aged, Peri-Implantitis / diagnostic imaging, Radiography, Treatment Outcome, Dental Implants, Erythritol

Peri-implantitis represents a major complication that can compromise the success and survival of implant-supported rehabilitations. Both surgical and nonsurgical treatment protocols were proposed to improve clinical parameters and to treat implants affected by peri-implantitis. A systematic review of the literature was performed on electronic databases. The use of air-polishing powder in surgical treatment of peri-implantitis was investigated. A total of five articles, of different study designs, were included in the review. A meta-analysis could not be performed. The data from included studies reported a substantial benefit of the use of air-polishing powders for the decontamination of implant surface in surgical protocols. A case report of guided bone regeneration in sites with implants affected by peri-implantitis was presented. Surgical treatment of peri-implantitis, though demanding and not supported by a wide scientific literature, could be considered a viable treatment option if an adequate decontamination of infected surfaces could be obtained.
High risk-myelodysplastic syndrome following CAR T-cell therapy in a patient with relapsed diffuse large B cell lymphoma: A case report and literature review
Authors: Eugenia Accorsi Buttini, Mirko Farina, Luisa Lorenzi, Nicola Polverelli, Vera Radici, Enrico Morello, Federica Colnaghi, Camillo Almici, Emilio Ferrari, Andrea Bianchetti, Alessandro Leoni, Federica Re, Katia Bosio, Simona Bernardi, Michele Malagola, Alessandro Re, Domenico Russo
Journal: Front Oncol (2023)
Keywords: car t-cell therapy, clonal hematopoiesis, diffuse large b cell lymphoma, myelodysplastic syndrome, next generation sequencing
MeSH terms: Case Reports

Background:
Chimeric antigen receptor (CAR) T-cell therapy represents the most advanced immunotherapy against relapsed/refractory B cell malignancies. While cytokine release syndrome and immune effector cell-associated neurotoxicity syndrome are distinctive, known CAR T-cell acute adverse events, hematological toxicity has been increasingly reported. Cytopenia following CAR T-cell treatment is attributed in most cases to lymphodepletion regimens, bridging chemotherapy, or radiotherapy. However, when cytopenia becomes prolonged, the development of myelodysplastic syndrome (MDS) should be considered.
Case presentation:
We report a case of high risk (HR)-MDS following CAR T-cell therapy in a patient with relapsed diffuse large B cell lymphoma. Eight months after CAR T-cell infusion, the blood count showed progressive, worsening cytopenia and the bone marrow biopsy revealed multilineage dysplasia without excess of blasts associated with chromosome 7 deletion and RUNX1 mutation. Next generation sequencing analysis, retrospectively performed on stored samples, showed a germ line CSF3R mutation, CEBPA clonal hematopoiesis, but no RUNX1 lesion.
Conclusion:
We describe a case of HR-MDS, with deletion of chromosome 7 and acquisition of RUNX1 mutation, developing after CAR T-cell therapy in a patient with clonal hematopoiesis (CH). Previous chemotherapy favored MDS onset; however, we could not exclude the fact that the impairment of immunosurveillance related to either lymphodepletion or CAR T-cell infusion may play a role in MDS development. Thus, we designed a multicenter prospective study (ClonHema-CAR-T-Study) to investigate if cytopenia after CAR T-cell treatment may be due to underling CH as well as the presence of secondary myeloid malignancies.
Low dose corticosteroid in association with methotrexate for therapy of ocular sarcoidosis: report of a case
Authors: Grasiane Nunes Mayer, Morgana Longo, Bárbara Brandi Gomes, Mário Junqueira Nóbrega
Journal: Int J Retina Vitreous (2015)
Keywords: diagnosis of sarcoidosis, ocular sarcoidosis, sarcoidosis in ophthalmology
MeSH terms: Case Reports

Sarcoidosis is a multisystem granulomatous disease of unknown etiology. Ocular involvement can be the initial manifestation, occurring by itself, or it can be associated with other systemic signs of sarcoidosis. A 31 years-old caucasian female presented a 10-day history of decreased vision and pain in OS. Biomicroscopy revealed fine keratic precipitates, a mild reaction in the anterior chamber and in the vitreous cavity in both eyes and a small posterior synechiae in OS. Intraocular pressure was 12 mmHg in the OD and 9 mmHg in OS. Fundoscopy disclosed mild swollen and hyperemic optic discs and some subretinal yellowish nodules of 1/3 to 1 disc diameter, partially delimited, located in the posterior pole and midperiphery in both eyes. The Chest X-ray disclosed the suspicion of hilar lymphadenopathy, especially on the left-side. The positron emission tomography (PET-scan) showed increased 18 F-fluorodeoxyglucose uptake in the paratracheal and bilateral hilar lymph nodes, indicating high local cellular metabolism. A mediastinal lymph node biopsy was performed afterwards, which depicted non-caseating granulomas with multinucleated giant cells and absence of acid-alcohol resistant bacilli. The patient was initially treated with oral prednisone 60 mg/day with slow tapering over the next months. A decreased papillitis and an increased size of the choroidal granulomas was observed after a 6-month therapy (Figs. 1B and 2B). Then, a combination of methotrexate 20 mg/week and prednisone 10 mg/day was given over the following months, which led to a gradual reduction in size and thickness of the choroidal granulomas. A weak response to steroid monotherapy was initially observed in this patient. The introduction of a non-steroid immunosuppressant drug (methotrexate) was associated with significant anatomic improvement in the following months. This report raises the suggestion that an early introduction of a nonsteroidal immunosuppressive drug to systemic steroids may be beneficial for a rapid remission of the uveitis.
The worst is yet to come: probable sporadic Creutzfeldt-Jakob disease in a well-controlled HIV patient
Authors: Euripedes Gomes De Carvalho Neto, Matheus Ferreira Gomes, Marina De Oliveira, Maryuris Isabel Niño Guete, Iuri Pereira Santos, Mateus Damiani Monteiro, Fernando Gustavo Stelzer, Fernando Kowacs, Liselotte Menke Barea
Journal: Prion (2019)
Keywords: eeg, hiv, mri, prion, prion disease
MeSH terms: Brain / pathology, Creutzfeldt-Jakob Syndrome / complications, HIV Infections / complications, Case Reports, Creutzfeldt-Jakob Syndrome / pathology, HIV Infections / pathology, HIV-1 / isolation & purification, Humans, Male, Middle Aged, Sepsis / complications, Sepsis / pathology, Creutzfeldt-Jakob Disease, Sporadic

We describe a case of probable sporadic Creutzfeldt-Jakob disease in the setting of well-controlled HIV and discuss whether exist, in fact, HIV-related factors that may predispose to the development of prion disease. To the best of our knowledge, this is the third report of this association.
Percutaneous endoscopic drainage for acute long segment epidural abscess following endoscopic lumbar discectomy: A case report
Authors: Tao Li, Hui Wu, Jinghong Yuan, Jingyu Jia, Tianlong Wu, Xigao Cheng
Journal: Front Surg (2022)
Keywords: peld = percutaneous endoscopic lumbar discectomy, case report, epidural abscess, minimal invasive, percutaneous endoscopic drainage
MeSH terms: Case Reports

Introduction:
Acute epidural abscess after percutaneous endoscopic lumbar discectomy is a rare but grievous complication. When faced with a long-segment epidural abscess, open surgery has traditionally been performed which can lead to huge surgical trauma and unpredictable complications. For this reason, surgeons around the world are constantly looking for more minimally invasive and effective surgical methods.
Patient concerns:
Our patient was a 32-year-old woman who had been receiving percutaneous endoscopic interlaminar discectomy for L5/S1 lumbar disc herniation one week ago. She returned to our institution with a fever and lower back pain.
Diagnoses:
Magnetic resonance imaging revealed a long segment epidural abscess accompanied by a paravertebral abscess, and staphylococcus aureus was detected in a bacterial culture of pyogenic fluids extracted from the paravertebral abscess.
Treatments:
We performed percutaneous endoscopic drainage (PED) for the epidural abscess. Long-term sensitive antibiotic treatment after surgery.
Outcomes:
Immediate pain relief was achieved and the inflammatory reaction subsided after 4 weeks of antibiotic therapy. Re-examination of the lumbar spine MRI after 1 month showed that the epidural abscess disappeared completely.
Conclusion:
Percutaneous endoscopy allowed us to approach the epidural abscess directly, enabling the immediate drainage of the abscess with minimal trauma to the patient. The good results obtained show that percutaneous endoscopic drainage is a reliable way to treat a long-segment epidural abscess.
Lymph Drainage of Posttraumatic Edema of Lower Limbs
Authors: Ana Carolina Pereira de Godoy, Rodrigo Ocampos Troitino, Maria de Fátima Guerreiro Godoy, José Maria Pereira de Godoy
Journal: Case Rep Orthop (2018)
MeSH terms: Case Reports

Objective:
The present study was aimed at evaluating the use of mechanical and manual lymphatic therapy as a treatment for lymphedema resulting from orthopedic surgery that became painful after an episode of erysipelas.
Case report:
A 70-year-old male patient suffered direct trauma resulting in a compound fracture of the tibia and fibula of the left leg. He was treated with an external fixator for four months followed by plaster cast immobilization for three weeks. He presented with fever and paresthesia in the lower left limb that resulted in an episode of erysipelas, and the patient evolved with painful lymphedema. Treatment using the Godoy and Godoy technique was proposed, including manual and mechanical lymphatic therapy. Water displacement volumetry was used to quantify the leg size reduction.
Results:
After 10 sessions of therapy, the patient presented a significant reduction in the limb volume and remission of symptoms.
Conclusions:
The method used may be a promising option for the treatment of posttraumatic edemas with pain.
ECMO for Metabolic Crisis in a Patient with Mitochondrial Disease
Authors: Sonal Sharma, Clifford Deerman, Michael H Andreae, Conrad Myler
Journal: Case Rep Anesthesiol (2021)
MeSH terms: Case Reports

Patients with mitochondrial disease exhibit disrupted pyruvate oxidation, resulting in intraoperative and perioperative physiologic derangements. Increased enzymatic conversion of pyruvate via lactate dehydrogenase during periods of fasting or stress can lead to metabolic decompensation, with rapid development of fatal lactic acidosis. We describe the intraoperative management and postoperative critical care of a patient with mitochondrial disease who presented for repair of esophageal perforation following repair of a paraesophageal hernia. His surgery was complicated by the development of metabolic crisis and severe lactic acidosis which became resistant to conventional therapy before ultimately resolving with the initiation of venoarterial extracorporeal membrane oxygenation (VA-ECMO).
Antisynthetase Syndrome in a Patient with Pulmonary Embolism and Nonbacterial Thrombotic Endocarditis
Authors: Anusha Vege, Jesse Beery, Areeba Kara
Journal: Case Rep Rheumatol (2023)
MeSH terms: Case Reports

Antisynthetase syndrome is a rare autoimmune disease within the subset of idiopathic inflammatory myopathies. The diagnostic criteria include the presence of an aminoacyl-tRNA synthetase antibody, and typical clinical findings, including myositis, mechanic's hands, Raynaud phenomenon, unexplained fever, and interstitial lung disease. We describe a case of a 59-year-old male who presented with a 1-month history of progressive purplish discoloration and pain of the fingertips, dyspnea, cough, weight loss, fatigue, and who developed progressive proximal muscle weakness and dysphagia. Investigations revealed pulmonic valve and mitral valve marantic endocarditis, pulmonary embolism, myositis, organizing pneumonia, and elevation of anti-OJ antibodies. He was diagnosed with antisynthetase syndrome and treated with high dose corticosteroids and mycophenolate mofetil with a fair response.
Recurrence, Reactivation, or Inflammatory Rebound of SARS-CoV-2 Infection With Acute Vestibular Symptoms: A Case Report and Revision of Literature
Authors: Salvatore Zaffina, Paola Lanteri, Francesco Gilardi, Sergio Garbarino, Annapaola Santoro, Maria Rosaria Vinci, Rita Carsetti, Alessandro Scorpecci, Massimiliano Raponi, Nicola Magnavita, Vincenzo Camisa
Journal: Front Hum Neurosci (2021)
Keywords: case report, healthcare workers, neurocovid, neurologic symptoms, occupational medicine, recurrence, vestibular syndrome
MeSH terms: Case Reports

A case of recurrent coronavirus disease 2019 (COVID-19) with neurovestibular symptoms was reported. In March 2020, a physician working in an Italian pediatric hospital had flu-like symptoms with anosmia and dysgeusia, and following a reverse transcription PCR (RT/PCR) test with a nasopharyngeal swab tested positive for SARS-CoV-2. After home quarantine, 21 days from the beginning of the symptoms, the patient tested negative in two subsequent swabs and was declared healed and readmitted to work. Serological testing showed a low level of immunoglobulin G (IgG) antibody title and absence of immunoglobulin M (IgM). However, 2 weeks later, before resuming work, the patient complained of acute vestibular syndrome, and the RT/PCR test with mucosal swab turned positive. On the basis of the literature examined and reviewed for recurrence cases and vestibular symptoms during COVID-19, to our knowledge this case is the first case of recurrence with vestibular impairment as a neurological symptom, and we defined it as probably a viral reactivation. The PCR retest positivity cannot differentiate re-infectivity, relapse, and dead-viral RNA detection. Serological antibody testing and viral genome sequencing could be always performed in recurrence cases.
Pathological complete response in MMR-deficient/MSI-high and KRAS-mutant patient with locally advanced rectal cancer after neoadjuvant chemoradiation with immunotherapy: A case report
Authors: Mai Zhang, Hua Yang, Ling Chen, Kunli Du, Lina Zhao, Lichun Wei
Journal: Front Oncol (2022)
Keywords: abscopal effect, immunotherapy, locally advanced rectal cancer, neoadjuvant chemoradiation, pathological complete response
MeSH terms: Case Reports

To date, preoperative chemoradiation (CRT) is the standard of care for patients with locally advanced rectal cancer (LARC) regardless of status of mismatch repair. Immunotherapy showed promising results in the neoadjuvant treatment trials in patients with mismatch repair-deficient (dMMR) or high microsatellite instability (MSI-H) LARC. The efficacy of CRT plus programmed death 1 (PD-1) inhibitor in these patients with complex gene mutation remains unclear. Additionally, very few studies reported on whether such combination could induce abscopal effect. We report a case of dMMR and MSI-H LARC with KRAS mutation that achieved pathological complete response of primary lesion and liver metastases after neoadjuvant short-course radiotherapy followed by four cycles chemotherapy of XELOX plus PD-1 inhibitor tislelizumab and a subsequent total mesorectal excision. This case indicates that this combined treatment strategy has remarkable clinical response both in locoregional and distant diseases, which potentially leads to reduction in the risk of distant metastases and better locoregional control for this subgroup of population.
Successful Simultaneous Subtotal Splenectomy During Left Lobe Auxiliary Liver Transplantation for Portal Inflow Modulation and Severe Hypersplenism Correction: A Case Report
Authors: Guang-Peng Zhou, Wei Qu, Zhi-Gui Zeng, Li-Ying Sun, Ying Liu, Lin Wei, Zhi-Jun Zhu
Journal: Front Med (Lausanne) (2022)
Keywords: auxiliary liver transplantation, hypersplenism, portal inflow modulation, subtotal splenectomy, thrombocytopenia
MeSH terms: Case Reports

Adult-to-adult living donor liver transplantation with small partial liver grafts often requires intraoperative portal inflow modulation to prevent portal hyperperfusion and subsequent small-for-size syndrome (SFSS). However, there are concerns about the specific morbidity of these modulation techniques. This study aims to lower post-perfusion portal venous pressure and correct severe hypersplenism in a patient with end-stage liver cirrhosis by simultaneous subtotal splenectomy during auxiliary partial orthotopic liver transplantation (APOLT). A 29-year-old man was diagnosed with cryptogenic cirrhosis and severe portal hypertension suffered recurrent acute variceal bleeding, severe thrombocytopenia, and massive ascites before admission to our hospital. After the recipient's left liver was resected, we performed APOLT using his 51-year-old father's left lobe graft with a graft-to-recipient weight ratio of 0.55%. Intraoperatively, simultaneous subtotal splenectomy was performed to lower graft post-perfusion portal vein pressure below 15 mmHg and correct severe hypersplenism-related pancytopenia. The recipient's postoperative hospital course was uneventful with no occurrence of SFSS and procedure-related complications. Platelet and leukocyte counts remained in the normal ranges postoperatively. The living donor was discharged 6 days after the operation and recovered well-with no complications. After a follow-up period of 35.3 months, both the recipient and donor live with good liver function and overall condition. This is the first case report of simultaneous subtotal splenectomy during APOLT using small-for-size living-donated left liver lobes, which is demonstrated to be a viable procedure for modulating portal inflow and correcting severe hypersplenism in selected adult patients with end-stage liver cirrhosis. APOLT using a small-for-size liver graft may be a safe and feasible treatment option for selected adult patients with end-stage liver cirrhosis.
The Role of Corticosteroids in Treating Acute Ocular Toxoplasmosis in an Immunocompetent Patient: A Case Report
Authors: Hung-Yi Lin, Wan-Ju Annabelle Lee
Journal: Front Med (Lausanne) (2022)
Keywords: choroidoretinitis, corticosteroid, ocular toxoplasmosis, retinal detachment, retinal necrosis
MeSH terms: Case Reports

Background:
This study aimed to report a case who was treated with corticosteroids and anti- parasitic agents for ocular toxoplasmosis, but who progressed to acute retinal necrosis, and finally retinal detachment.
Case presentation:
A 42-year-old man presented to the ophthalmology clinic with a 1-month history of progressive blurred vision and floaters in his right eye. His best visual acuity (VA) was 20/20 in both eyes. The anterior segment was unremarkable. Funduscopic examination of the right eye revealed active lesions of whitish foci of chorioretinitis with surrounding edema along the superonasal vessels, and retinal vasculitis with perivascular sheathing. Serologic testing was positive for Toxoplasma gondii IgM and IgG, but negative for other virus- and syphilis infections. Ocular toxoplasmosis was diagnosed. Corticosteroids and anti-parasitic agents were given simultaneously, but his right eye VA became 20/100. Funduscopic examination revealed retinal necrosis with localized retinal breaks. We immediately performed focal photocoagulation, however, his right eye progressed to retinal detachment and required vitrectomy.
Conclusion:
Early administration of systemic corticosteroids in patients with acquired acute ocular toxoplasmosis may lead to complications that impair vision. Intensive observation should be arranged after corticosteroid use.