OpenMed/multicare-articles huggingface dataset:
Lower airway obstruction due to a massive clot resulting from late bleeding following mini-tracheostomy tube insertion and subsequent clot removal and re-intubation
Authors: Hiroshi Inoue, Jun Ito, Hiroaki Uchida, Mariko Morita, Takahiko Masuda, Kazuhiro Yamaya, Masaki Hata, Shigeaki Kato
Journal: JA Clin Rep (2017)
Keywords: clot, endotracheal tube obstruction, extubation, fiberoptic bronchoscopy, lower airway obstruction, mini-tracheostomy

Background:
Easier to perform than the conventional procedure, mini-tracheostomy (MT) is widely used in the operating room or intensive care unit to remove sputum or other obstructions of the upper airway. This option, however, does carry the risk of various complications, including malposition, disposition, bleeding, and subcutaneous emphysema. Here, we report a case of endotracheal tube obstruction due to a massive clot resulting from late bleeding around the insertion site of an MT tube. This necessitated removal of the endotracheal tube together with the clot followed tube re-introduction.
Case presentation:
The patient was an 85-year-old man in whom an MT tube had been inserted 6 days earlier following aortic replacement surgery. On re-admittance to our intensive care unit, large amounts of hemosputum and clotting were observed around the insertion site of the tube. The MT tube was subsequently removed and tracheal intubation performed. Ventilation via the endotracheal tube proved impossible, however, and cardiac arrest ensued. Fiberoptic bronchoscopy revealed that the endotracheal tube was completely obstructed by a massive clot. Therefore, we immediately pushed the clot toward the right main bronchus to secure ventilation via the left lung. After many attempts to remove the massive clot, including suction and grasping with basket forceps, it was successfully dislodged by replacing the endotracheal tube with a new one while maintaining oxygenation by one-lung ventilation. Any small fragments of the clot that still remained were then removed by suction under fiberoptic bronchoscopy.
Conclusions:
Here, we report a case of endotracheal tube obstruction due to a clot derived from very late (6 days) bleeding after insertion of an MT tube. The patient was successfully rescued by replacing the clot-bearing endotracheal tube with a new one. This experience suggests that the intensive care physician should be aware of the potential risk of clot retention in endotracheal tubes after the elapse of several days.
The impact on life cycle carbon footprint of converting from disposable to reusable sharps containers in a large US hospital geographically distant from manufacturing and processing facilities
Authors: Brett McPherson, Mihray Sharip, Terry Grimmond
Journal: PeerJ (2019)
Keywords: co2 equivalent, carbon footprint, disposable, environmental impact, ghg, healthcare, medical waste, reusable, sharps containers, sustainable purchasing

Background:
Sustainable purchasing can reduce greenhouse gas (GHG) emissions at healthcare facilities (HCF). A previous study found that converting from disposable to reusable sharps containers (DSC, RSC) reduced sharps waste stream GHG by 84% but found transport distances impacted significantly on GHG outcomes and recommended further studies where transport distances are large. This case-study examines the impact on GHG of nation-wide transport distances when a large US health system converted from DSC to RSC.
Methods:
The study's scope was to examine life cycle GHG emissions during 12 months of facility-wide use of DSC and RSC at Loma Linda University Health (LLUH). The facility is an 1100-bed US, 5-hospital system where: the source of polymer was distant from the RSC manufacturing plant; both manufacturing plants were over 3,000 km from the HCF; and the RSC processing plant was considerably further from the HCF than was the DSC disposal plant. Using a "cradle to grave" life cycle GHG tool we calculated the annual GHG emissions of CO2, CH4 and N2O expressed in metric tonnes of carbon dioxide equivalents (MTCO2eq) for each container system. Primary energy input data was used wherever possible and region-specific energy-impact conversions were used to calculate GHG of each unit process over a 12-month period. The scope included Manufacture, Transport, Washing, and Treatment & disposal. GHG emissions from all unit process within these four life cycle stages were summed to estimate each container-system's carbon footprint. Emission totals were workload-normalized and analysed using CHI2test with P ≤ 0.05 and rate ratios at 95% CL.
Results:
Converting to RSC, LLUH reduced its annual GHG by 162.4 MTCO2eq (-65.3%; p < 0.001; RR 2.27-3.71), and annually eliminated 50.2 tonnes of plastic DSC and 8.1 tonnes of cardboard from the sharps waste stream. Of the plastic eliminated, 31.8 tonnes were diverted from landfill and 18.4 from incineration.
Discussion:
Unlike GHG reduction strategies dependent on changes in staff behavior (waste segregation, recycling, turning off lights, car-pooling, etc), purchasing strategies can enable immediate, sustainable and institution-wide GHG reductions to be achieved. This study confirmed that large transport distances between polymer manufacturer, container manufacturer, user and processing facilities, can significantly impact the carbon footprint of sharps containment systems. However, even with large transport distances, we found that a large university health system significantly reduced the carbon footprint of their sharps waste stream by converting from DSC to RSC.
Vulvar Darier-Ferrand dermatofibrosarcoma: unusual localization of a rare tumor
Authors: Ines Zemni, Imène Sassi, Nedia Boujelbene, Sabrine Haddad, Raoudha Doghri, Riadh Chargui, Khaled Rahal
Journal: Pan Afr Med J (2019)
Keywords: dermatofibrosarcoma, histopathology, surgery, vulva
MeSH terms: Dermatofibrosarcoma / diagnosis, Skin Neoplasms / diagnosis, Vulvar Neoplasms / diagnosis, Case Reports, Dermatofibrosarcoma / pathology, Dermatofibrosarcoma / surgery, Female, Humans, Margins of Excision, Middle Aged, Skin Neoplasms / pathology, Skin Neoplasms / surgery, Vulvar Neoplasms / pathology, Vulvar Neoplasms / surgery

Dermatofibrosarcoma protuberans (DFSP) is a low-to-intermediate grade sarcoma of dermal origin that rarely presents in the vulva, typically occurring on the trunk of young to middle-aged adults. Even though it has a low potential for distant metastases, it often recurs locally. Therefore, surgical excision is the treatment of choice. We report a case of DFSP with fibrosarcoma transformation involving the vulva treated by large excision with tumor free margins followed by plastic reconstruction. Our aim is to highlight this rare disease and through literature evaluate the safety and efficacy of surgical treatment. Early recognition of this rare entity whose localization and the aggressive nature of the fibrosarcomatous component will be an issue in the surgical management.
A synchronous papillary and follicular thyroid carcinoma presenting as a large toxic nodule in a female adolescent
Authors: Joke Van Vlaenderen, Karl Logghe, Eva Schiettecatte, Hubert Vermeersch, Wouter Huvenne, Kathleen De Waele, Hanne Van Beveren, Jo Van Dorpe, David Creytens, Jean De Schepper
Journal: Int J Pediatr Endocrinol (2020)
Keywords: children, follicular thyroid carcinoma, hyperthyroidism, papillary thyroid carcinoma, pediatric, toxic nodule
MeSH terms: Case Reports

Case presentation:
We report for the first time a synchronous papillary and follicular thyroid carcinoma in a 12-year-old girl presenting with a large (5 cm diameter) left thyroid nodule, an increased left and right upper pole technetium tracer uptake at scintigraphy and hyperthyroidism. The uptake at the right lobe was explained by the crossing of the left nodule to the right site of the neck at Computed Tomography (CT) scanning.
Background:
Although thyroid nodules are less common in children than in adults, there is more vigilance required in children because of the higher risk of malignancy. According to literature, about 5% of the thyroid nodules in adults are malignant versus 20-26% in children. The characteristics of 9 other pediatric cases with a differentiated thyroid carcinoma presenting with a toxic nodule, which have been reported during the last 20 years, are summarized. A nodular size of more than 3.5 cm and female predominance was a common finding.
Conclusions:
The presence of hyperthyroidism in association with a hyperfunctioning thyroid nodule does not rule out thyroid cancer and warrants careful evaluation, even in the absence of cervical lymph node invasion.
A Rare Case of Human Coronavirus 229E Associated with Acute Respiratory Distress Syndrome in a Healthy Adult
Authors: Foula Vassilara, Aikaterini Spyridaki, George Pothitos, Athanassia Deliveliotou, Antonios Papadopoulos
Journal: Case Rep Infect Dis (2018)
MeSH terms: Case Reports

Human coronavirus 229E (HCoV-229E) is one of the first coronavirus strains being described. It is linked to common cold symptoms in healthy adults. Younger children and the elderly are considered vulnerable to developing lower respiratory tract infections (LRTIs). In particular, immunocompromised patients have been reported with severe and life-threatening LRTIs attributed to HCoV-229E. We report for the first time a case of LRTI and acute respiratory distress syndrome developed in a healthy adult with no comorbidities and HCoV-229E strain identified as the only causative agent. A 45-year-old female with a clear medical history presented with fever, cough, and headache. Respiratory tract infection was diagnosed, and empirical antibiotics were started. Within two days, she developed bilateral pleural effusions, diffuse consolidations, and ground glass opacities involving all lung fields. She needed immediate oxygen supply, while ABGs deteriorated and chest imaging and PaO2/FiO2 indicated ARDS. Early administration of systemic corticosteroids led to gradual clinical improvement. Multiplex PCR from nasal secretions was positive only for HCoV-229E and negative for multiple other pathogens. It remains to be elucidated how an immunocompetent adult developed a life-threatening LRTI caused by a "benign considered" coronavirus strain, the HCoV-229E.
Neurotropic Cutaneous Malignancies: Case Report on Keratinocyte Derived Malignancies of the Head and Neck With Perineural Invasion
Authors: Grace Sora Ahn, Brian Hinds, Frederic Kolb, Amy K Reisenauer, Seaver L Soon, Ali R Sepahdari, Kathryn B Bollin, Soo J Park
Journal: Front Oncol (2022)
Keywords: basal cell carcinoma, cutaneous oncology, cutaneous squamous cell carcinoma, immune checkpoint inhibitors, immunotherapy, neurotropic cutaneous malignancies, non-melanoma skin cancer, perineural invasion
MeSH terms: Case Reports

Background:
The recent addition of immunotherapy as a treatment modality to surgery and radiation has vastly improved disease control for patients with keratinocyte-derived carcinomas (KCs) that are incurable with local therapies alone. With the advent of immune checkpoint inhibitors (ICPis) in non-melanoma skin cancers comes diagnostic and therapeutic challenges when considering treatment strategies for patients presenting with clinical perineural invasion (cPNI) of locally advanced KC of the head and neck.
Objectives:
We report four cases that convey the diagnostic and therapeutic complexity of managing patients with neuropathic symptoms from cutaneous neurotropic carcinomas of the head and neck. We also discuss an updated review regarding immunotherapies and perineural invasion within KC management.
Conclusion:
Patients presenting with symptoms suspicious for cPNI warrant an expanded diagnostic evaluation to correlate neurological findings with neurotropic spread of disease. While nerve biopsies can be precarious in sensitive areas, a history of skin cancer and clinical presentation suggestive of neurotropism may be enough to pursue timely management in the form of surgery, radiation, and/or systemic therapy given each patient's individual priorities, comorbidities, and prognosis. When adding ICPi as a treatment modality for patients with disease not amenable to local therapies, the potential for immune-related adverse events must be considered. A multi-disciplinary review and approach to the management of patients with KC and cPNI is essential for obtaining optimal patient outcomes.
Fatal retroperitoneal bleeding caused by metastasis of a sigmoid carcinoma
Authors: Cornelis G Vos, Arjan W J Hoksbergen
Journal: Case Rep Med (2011)
MeSH terms: Case Reports

Retroperitoneal bleeding is relatively rare and a potentially life-threatening condition with significant mortality. Early recognition requires a high index of suspicion. Increased life expectancy, the widespread use of anticoagulants, and the rise of endovascular interventions have caused an increase in the incidence of retroperitoneal bleeding. We present a case of a 74-year-old woman who died because of retroperitoneal bleeding caused by retroperitoneal metastasis of a sigmoid carcinoma with angioinvasive growth into a lumbar artery. In addition we discuss etiology, diagnostic management, and treatment strategy.
Successful recovery of associated interstitial nephritis and focal segmental glomerulosclerosis in patients with HCV and HIV treated with sofosbuvir and daclatasvir and revision of literature
Authors: Michele Mirabella, Lucia Taramasso, Laura Ambra Nicolini, Rodolfo Russo, Claudio Viscoli, Antonio Di Biagio
Journal: Clin Nephrol Case Stud (2018)
Keywords: hiv/hcv coinfection, focal segmental glomerulosclerosis, kidney disease, mycophenolate mofetil, sustained viral response
MeSH terms: Case Reports

In this report, we describe the coexistence of two rare and debated complications of hepatitis C virus (HCV) infection: interstitial nephritis, with associated focal glomerulosclerosis, and autoimmune hepatitis, in a 55-year-old HIV/HCV-coinfected woman. The patient was treated for the immune-mediated manifestations with mycophenolate mofetil, which she continued for 9 years, as symptoms relapsed at every attempt to discontinue immunosuppression. The patient finally cleared HCV infection thanks to new direct-acting agents and could discontinue immunosuppressive therapy maintaining stable conditions and laboratory parameters after 24-weeks follow-up.
Genetically confirmed chronic granulomatous disease in a Kenyan child: case report
Authors: Diana Marangu-Boore, Fred Kambuni, Mary Onyinkwa, Stalin Ramprakash, Raghuram C P, Brian Eley, Sagar Bhattad
Journal: Front Immunol (2023)
Keywords: africa, inborn errors of immunity, mycobacteria, primary immunodeficiency, tuberculosis
MeSH terms: Granulomatous Disease, Chronic / diagnosis, Granulomatous Disease, Chronic / genetics, Lymphadenopathy, Case Reports, Aftercare, Child, Humans, Infant, Kenya, Male, Patient Discharge, Trimethoprim, Sulfamethoxazole Drug Combination / therapeutic use, Trimethoprim, Sulfamethoxazole Drug Combination

Introduction:
We report the first case of genetically confirmed chronic granulomatous disease (CGD) in a Kenyan child.
Clinical findings:
A 7-month-old male infant, the only child of non-consanguineous parents, presented with cough, fever, fast breathing, oral thrush, and axillary lymphadenopathy ipsilateral to the Calmette-Guérin bacillus scar. He had been hospitalized 5 weeks prior for severe pneumonia. Plain chest radiography showed bilateral patchy airspace opacification; chest computed tomography revealed multiple large lung nodules and left axillary lymphadenopathy. HIV ELISA was negative; tuberculin skin test was positive; lymph node biopsy macroscopically revealed caseous granulomas seen on histology; isoniazid- and rifampicin-susceptible Mycobacterium tuberculosis complex isolate was detected on the Hain test. First-line anti-tuberculous drugs were added to his empiric treatment comprising piperacillin-tazobactam, amikacin, cotrimoxazole, and fluconazole. He was discharged after 10 days based on clinical resolution.
Diagnoses interventions and outcome:
An inborn error of immunity (IEI) was considered given the recurrent fevers and atypical lung nodules. Genetic analysis revealed a hemizygous pathogenic variant on CYBB in keeping with X-linked CGD. The child's fevers recurred 2 weeks post-discharge but completely resolved on prophylactic itraconazole and cotrimoxazole. He underwent a successful haplo-identical hematopoietic stem cell transplantation at an experienced center in India with his father as the donor and is currently doing well on post-transplant follow-up.
Conclusion:
Genetic testing is relatively accessible and cost-effective for the diagnosis of IEI in low-and-middle-income countries. Expert multi-disciplinary collaboration is key for successful outcomes.
Prenatal Diagnosis of Fetus With Transaldolase Deficiency Identifies Compound Heterozygous Variants: A Case Report
Authors: Jiaxin Xue, Jin Han, Xiaopeng Zhao, Li Zhen, Shanshan Mei, Zhiyang Hu, Xiuzhen Li
Journal: Front Genet (2022)
Keywords: taldo1, transaldolase deficiency, pentose phosphate pathway, prenatal diagnosis, whole-exome sequencing (wes)
MeSH terms: Case Reports

Transaldolase (TALDO) deficiency is a rare autosomal recessive disorder caused by variants in the TALDO1 gene that commonly results in multisystem dysfunction. Herein, we reported compound heterozygous variants in a Chinese prenatal case with TALDO deficiency using whole-exome sequencing (WES) for trios and Sanger sequencing. The heterozygous variants were located on the TALDO1 gene: NM_006755.2:c.574C > T(Chr11:g.763456C > T), a missense variant in exon 5 paternally inherited; NM_006755.2:c.462-2A > G(Chr11:g.763342A > G), a splicing aberration in intron 4 maternally inherited. The qualitative analysis of urinary polyols in neonatal urine indicated that xylitol + arabitol and ribitol in the proband's urine were significantly increased. These findings expand the variation spectrum of the TALDO1 gene, provide solid evidence for the counseling of the family in regard to future pregnancies, strongly support the application of WES in prenatal diagnosis, and further prove that effective postpartum treatments could improve prognosis.
Early hyaluronidase use in preventing skin necrosis after treatment with dermal fillers: Report of two cases
Authors: Francesco Ciancio, Maria Stella Tarico, Giuseppe Giudice, Rosario Emanuele Perrotta
Journal: F1000Res (2018)
Keywords: dermal filler, filler complications, skin necrosis, vascular complications
MeSH terms: Cosmetic Techniques, Dermal Fillers, Case Reports, Adult, Female, Humans, Hyaluronic Acid, Hyaluronoglucosaminidase, Injections, Subcutaneous, Middle Aged, Dermal Fillers, Hyaluronic Acid, Hyaluronoglucosaminidase

Injection of dermal fillers, like hyaluronic acid (HA), is a safe procedure, with few and transient side effects such as erythema, bruising and swelling etc. The aim of this report is to provide our protocol for the early treatment of necrotic complications after facial treatment with dermal fillers. We present two cases of skin suffering of the face after dermal infiltration of HA, treated successfully with our early protocol. Our protocol includes the early infiltration of hyaluronidase in the treated areas. We start with infiltration of hyaluronidase distributed over the area to be treated through micro-injections with dosage 40 IU per cm 2. Our protocol includes the use of systemic corticosteroids for 4 days, anti-aggregation therapy, oral antibiotic, topical cream with nitric oxide and compresses with gauze and warm water. In the skin complications after dermal filler treatment, marked pain and characteristic reticulated erythema in the skin distribution of the affected vessels is often developed. Due to the implementation of our protocol in these patients, we managed to avoid an irreversible necrotic complication of the face in both cases. In this report, our protocol was compared with results published in the literature and allowed us to avoid complications such as skin necrosis with permanent damage.
Malacoplakia of the bladder combined with infected renal calculi: A case report
Authors: Qunjun He, Yi Wang, Xian Chen, Baopiao Xia, Xuqiang Zeng, Binhui Wang, Yong Fang, Shulin Liu, Wujun Xu
Journal: Front Surg (2023)
Keywords: case report, malacoplakia of the bladder, renal calculi, transurethral resection, urinary tract infection

Introduction:
The malacoplakia of the bladder is a rare chronic acquired infection- associated granulomatous disease and even less common in combination with urinary stones.
Case presentation:
We report the case of a 58-year-old female patient with malacoplakia of the bladder combined with renal calculi. The patient was admitted to the hospital with bilateral low back pain for one month and space-occupying lesions of the bladder for three days. Preoperative imaging suggested space-occupying lesions of the bladder: high probability of bladder cancer. Following the anti-infection treatment, the transurethral electrodesiccation was performed on the space-occupying lesions of the bladder. Pathological examination confirmed the diagnosis of malacoplakia of the bladder. Left-sided percutaneous nephrolithotomy was performed electively to remove the predisposing factors of infection. After the operation, the patient continued to receive anti-infection treatment for two months. The patient had a good prognosis in the six-month follow-up.
Conclusions:
Malacoplakia of the bladder is easily misdiagnosed as bladder cancer before operation, and the diagnosis depends on pathological diagnosis. Complete removal of urinary calculi, infection and other inducing factors, is beneficial to the treatment of malacoplakia of the bladder.
Case report: Urgent surgical management of pediatric clear cell sarcoma of the kidney with atrial obstruction
Authors: Alexandra Varga, Gábor Bogáts, Katalin Rácz, Tamás Kovács
Journal: Front Pediatr (2022)
Keywords: atrial obstruction, cavoatrial tumor thrombus, clear cell sarcoma of the kidney, pediatric oncology, urgent surgery
MeSH terms: Case Reports

Clear cell sarcoma of the kidney (CCSK) is an uncommon renal neoplasm of childhood. Progression of intracaval or cavoatrial thrombosis is extremely rare and mostly asymptomatic, treated with neoadjuvant therapy followed by surgery. However, in an unstable patient, acute radical surgical intervention is the treatment of choice. We present a 2-year-old girl diagnosed as having a large left kidney tumor and acute cardiac decompensation via cavoatrial thrombotic progression. Urgent radical nephrectomy and removal of tumor thrombus were performed using atriotomy and inferior vena cava (IVC) endarterectomy under cardiopulmonary bypass. Histopathology revealed CCSK. The patient is tumor-free at 9-year follow-up.