OpenMed/multicare-articles huggingface dataset:
Successful Management of Complicated Uterine Displacement Caused by Unilateral Incarceration of the Bicornuate Uterus
Authors: Nozomi Ouchi, Yoshimitsu Kuwabara, Mirei Yonezawa, Ryuhei Kurashina, Tomoko Ichikawa, Rintaro Sawa, Toshiyuki Takeshita
Journal: Case Rep Obstet Gynecol (2019)
MeSH terms: Case Reports

Uterine incarceration is a serious complication of pregnancy, in which the gravid uterus becomes trapped in the posterior pelvis. When labor occurs, delivery does not progress, and the uterus may rupture. Therefore, preoperative diagnosis of uterine incarceration is important, and a caesarian section is indispensable except when the polarity of the uterus can be successfully restored. We report the case of a 35-year-old primipara with a complication of a bicornuate uterus who became pregnant after in vitro fertilization and embryo transfer. No abnormality was observed on regular checkups until the second trimester. At 28 weeks' gestation, the uterine cervix revealed marked dislocation, and, at 31 weeks, magnetic resonance imaging (MRI) revealed uterine cervix elongation and left horn incarceration. At 37 weeks' gestation, an elective cesarean section was performed. On laparotomy, the uterus was found to be markedly dislocated, and distended blood vessels were observed on the surface. Ultrasound examination was performed directly on the uterine wall to decide the incision site. After delivery of the baby, manual repositioning of the uterus revealed the unique concurrent clockwise rotation and retro-vertical deflection. Thus, we concluded that incarceration accompanied by a bicornuate uterus can cause complicated uterine displacement, and preoperative MRI and intraoperative ultrasound examination are useful for managing this condition.
Efficacy of anti-VEGF in the treatment of choroidal neovascular membrane secondary to pattern dystrophy simulating fundus flavimaculatus
Authors: Purna Nangia, Dhaivat Shah, Kumar Saurabh, Rupak Roy
Journal: GMS Ophthalmol Cases (2019)
MeSH terms: Case Reports

Pattern dystrophies are a group of inherited disorders of the retinal pigment epithelium. A 44-year-old female came with loss of vision in her right eye. The fundus of both eyes showed flecks in the posterior pole with a CNVM in the right eye. FFA and SD OCT confirmed the presence of CNVM. The patient underwent treatment with anti-VEGF injection. Post treatment, the vision improved with a reduction in subretinal fluid along with a scarring CNVM. To conclude, we report an extremely rare case of PDSFF associated CNVM and its favourable response to anti-VEGF injection.
Case report: Effect of Hb E heterozygosity on HbA1c value by the Tosoh HLC-723G11
Authors: Wei Gao, Wenyu Li, Qian Zheng, Nenggang Jiang, Huairong Tang
Journal: Front Public Health (2023)
Keywords: hb e, hba1c, tosoh hlc-723g11, heterozygosity, high-pressure liquid chromatography
MeSH terms: Blood Glucose, Prediabetic State, Case Reports, Research Support, Non-U.S. Gov't, Asian People, Female, Glycated Hemoglobin / genetics, Humans, Middle Aged, Reference Values, Blood Glucose, Glycated Hemoglobin

Objective:
We report the effect of Hb E heterozygosity on HbA1c value by the Tosoh HLC-723G11.
Case report:
A 45 years-old Chinese woman presented with an abnormally low HbA1c level of 3.7% (3.9%-6.1%) in a health examination. Fasting blood glucose was normal. Blood routine examination and serum bilirubin were in the normal range. HbA1c was determined by Tosoh HLC-723G11. There was an abnormal peak between A1c and A0 on the chromatogram. Hemoglobin electrophoresis indicated that the Hb E zone accounted for 25.1%. The β-thalassemia-related genes (mutant type) were βE M/N, and the related gene CD26 (A > G) was mutated. OGTT indicated prediabetes.
Conclusion:
Hb E heterozygosity may reduce HbA1c value with abnormal chromatograms, as determined by a Tosoh HLC G11 analyzer. The Tosoh HLC G11 analyzer can well identify Hb E variation. In this case, further blood glucose-related tests should be performed to avoid missed diagnoses. However, a large sample size is needed to confirm this conclusion.
Nutrition problems in a severe burn patient with schizophrenia: a case report
Authors: Rizka Khairiza, Lucretya Yeniwati Tanuwijaya, Najatullah
Journal: Pan Afr Med J (2020)
Keywords: burn, nutrition, schizophrenia
MeSH terms: Burns / complications, Nutrition Disorders / etiology, Schizophrenia / complications, Suicide, Attempted, Case Reports, Adult, Burns / psychology, Burns / therapy, Humans, Male, Nutrition Assessment, Nutrition Disorders / psychology, Nutrition Disorders / therapy, Nutritional Support, Wound Healing / physiology

Hypermetabolic conditions with nutrition deficiencies are common in patients with extensive burns. Balanced nutrition status is required to achieve adequate wound healing. Mental disorder, which tended to make a patient uncooperative, complicates the management. We report the case of a 35-year-old man with schizophrenia who suffered full- and partial-thickness burns in approximately 38% of total body surface area due to attempted suicide. The patient was hospitalized for 66 days and underwent multiple surgeries. His body mass index (BMI) was continuously low. Tissue injuries provoked inflammatory responses that contributed to metabolic disarrangement, meanwhile the presence of psychiatric disorder complicated the means of nutrition assessment and therapy needed to compensate for the high nutrition demand during the treatment period. Nutrition support should be assessed and adjusted continuously.
Molecular Diagnosis and Prenatal Phenotype Analysis of Eight Fetuses With Ciliopathies
Authors: Yuefang Liu, Hui Wang, Xin Jin, Qixiang Shao, Qiong Pan
Journal: Front Genet (2021)
Keywords: ciliopathies, occipital encephalocele, polycystic kidneys, polydactyly, prenatal clinical phenotype, whole-exome sequencing
MeSH terms: Case Reports

Human ciliopathies are hereditary conditions caused by variants in ciliary-associated genes. Ciliopathies are often characterized by multiple system defects. However, it is not easy to make a definite diagnosis in the prenatal period only based on the imageology. In this report, eight new prenatal cases from five unrelated families diagnosed with ciliopathies were systematically examined. The clinical manifestations of these fetuses showed such prenatal diagnostic features as occipital encephalocele, and polydactyly and polycystic kidneys. Situs inversus caused by CPLANE1 variant was first reported. In Family 1 and Family 3, homozygous variants of CPLANE1 and NPHP4 caused by consanguineous marriage and uniparental disomy were detected by whole-exome sequencing, respectively. In Family 2, Family 4 and Family 5, compound heterozygotes of TMEM67 and DYNC2H1 including two novel missense variants and one novel nonsense variant were identified. The distribution of pathogenic missense variants along TMEM67 gene mainly clustered in the extracellular cysteine rich region, extracellular area with unknown structure, and the transmembrane regions. Genotype-phenotype relationship between CPLANE1 and TMEM67 genes was concluded. This report describes new clinical manifestations and novel variants in CPLANE1, TMEM67, NPHP4, and DYNC2H1.
Simultaneous Bilateral Rupture of the Patellar Tendon and Medial Collateral Ligament: A Case Report and Literature Review
Authors: Jean G Louka, Damien Pourre
Journal: Case Rep Orthop (2020)
MeSH terms: Case Reports

Bilateral rupture of the patellar tendon is considered an uncommon and rare musculoskeletal injury. The association of this lesion with medial collateral ligament tear appears to be exceedingly rare. We present the case of a combined rupture of the medial collateral ligament (MCL) and the patellar tendon of both knees in a 48-year-old man, after falling 2 meters down an embankment. While there are numerous publications concerning associated MCL tears and other knee ligaments, a combination of MCL tear with a patellar tendon rupture is very rare. In addition, our case presents the first case recorded in the literature, involving both knees of a patient. The clinical case is described and discussed following a review of the literature. The symmetrical knee injury was treated with a primary direct repair of the MCL tears and using a suture anchor fixation of the patellar tendon ruptures, which was reinforced by a stainless steel wire and an autograft of the ipsilateral quadriceps tendon.
Calcified amorphous tumor of the heart with purple digit
Authors: Feridoun Sabzi, Hosein Karim, Babak Eizadi, Reza Faraji, Nasrin Javid
Journal: J Cardiovasc Thorac Res (2014)
Keywords: heart neoplasms, right atrium, tumor
MeSH terms: Case Reports

A calcified amorphous tumor (CAT) of the right atrium (RA) is an exceedingly rare non-neoplastic cardiac mass. It was initially described in 1997 and only a handful of cases has been published so far. We present a case of tumor in 77-year-old male, in the RA that attached to the rim of the fossa ovalis, with classic pathological and clinical findings. Under cardiopulmonary bypass (CPB) and bicaval and aortic cannulation and cardioplegic arrest, right atrial mass, was resected and septal defect was repaired with a fresh pericardial patch. Pathological exam of the mass revealed CAT. The patient had an uneventful hospitalization and his blue discoloration of finger recovered normally.
Case report: Lamin A/C gene mutation in patient with drug-induced type 1 Brugada syndrome at high arrhythmic risk
Authors: Vincenzo Russo, Giovanni Papaccioli, Valeria Maddaloni, Adriano Caputo, Nicola Pepe, Anna Rago, Michele Maiorino, Paolo Golino, Gerardo Nigro
Journal: Front Cardiovasc Med (2023)
Keywords: brugada syndrome, lamin a/c mutation, arrhythmias, electroanatomical mapping, flecainide challenge test, induced type 1 brugada pattern, programmed ventricular stimulation
MeSH terms: Case Reports

We report the case of drug-induced type 1 Brugada syndrome at high arrhythmic risk associated with Lamin A/C gene mutation.
Genomic analysis of a Mycobacterium bovis bacillus [corrected] Calmette-Guérin strain isolated from an adult patient with pulmonary tuberculosis
Authors: Xuming Li, Liping Chen, Yongqiang Zhu, Xia Yu, Jun Cao, Rui Wang, Xinyan Lv, Jin He, Aizhen Guo, Hairong Huang, Huajun Zheng, Siguo Liu
Journal: PLoS One (2015)
MeSH terms: Genes, Bacterial, Mycobacterium bovis / genetics, Tuberculosis, Pulmonary / microbiology, Case Reports, Research Support, Non-U.S. Gov't, Adult, Epitopes / chemistry, Genomics, High-Throughput Nucleotide Sequencing, Humans, Male, Molecular Sequence Data, Mycobacterium bovis / isolation & purification, Mycobacterium tuberculosis / genetics, Phylogeny, Sequence Analysis, DNA, Tuberculosis, Pulmonary / prevention & control, Virulence / genetics, Epitopes

For years, bacillus Calmette-Guérin (BCG) has served as the unique vaccine against tuberculosis and has generally been regarded as safe. However, a clinical strain labeled 3281 that was isolated from a TB patient was identified to be BCG. Via the combination of next-generation sequencing (NGS) and comparative genomic analysis, unique 3281 genetic characteristics were revealed. A region containing the dnaA and dnaN genes that is closely related to the initial chromosome replication was found to repeat three times on the BCG Pasteur-specific tandem duplication region DU1. Due to the minimum number of epitopes in BCG strains, 3281 was inferred to have a high possibility for immune evasion. Additionally, variations in the virulence genes and predictions for potential virulence factors were analyzed. Overall, we report a pathogen that has never previously been thought to be pathogenic and initial insights that are focused on the genetic characteristics of virulent BCG.
Spontaneous exudative retinal detachment in a patient with sturge-weber syndrome after taking arginine, a supplement for erectile dysfunction
Authors: Austin Bach, Aaron S Gold, Victor M Villegas, Andrea C Wildner, Fiona J Ehlies, Timothy G Murray
Journal: Eye Vis (Lond) (2014)
Keywords: choroidal hemangioma, exudative retinal detachment, nitric oxide, sturge-weber syndrome, arginine
MeSH terms: Case Reports

Background:
Patients with Sturge-Weber syndrome can have ipsilateral diffuse or circumscribed choroidal hemangiomas. These hemangiomas have been seen to undergo spontaneous exudative or hemorrhagic retinal detachments. There is no definitive treatment for these types of retinal detachments, but radiotherapy, photodynamic therapy, oral propranolol, pegaptinib and bevacizumab have been used.
Case presentation:
A 26-year-old male with Sturge-Weber Syndrome developed an exudative retinal detachment that occurred immediately after taking a supplement containing arginine. The patient was treated with intravitreal bevacizumab 1.25 mg in 0.05 ml solution. Resolution of the retinal detachment was seen after 4 treatments over a six-month period.
Conclusions:
Arginine and other medications that cause a release of nitric oxide may lead to intravascular leakage and exudative retinal detachments in patients who have a choroidal hemangioma.
The Incidental Resolution of Severe Alcohol Use Disorder during Esketamine Treatment of Major Depressive Disorder: A Case Report
Authors: Zeeshan Faruqui, Christopher Kim
Journal: Case Rep Psychiatry (2022)
MeSH terms: Case Reports

Alcohol use disorder (AUD) is especially prevalent among individuals with major depressive disorder (MDD) and is associated with higher morbidity, mortality, disability, and risk for suicide. Intranasal esketamine has been documented to be a safe and effective option for treatment resistant MDD and received US FDA approval in 2019. However, the availability of esketamine is limited due to requirements for a Risk Evaluation and Mitigation Strategy program for its administration as well as concerns over substance use disorders (SUD) as a potential contraindication or adverse effect. This case presents a 61-year-old female with a history of severe recurrent treatment resistant MDD and severe AUD who has expressed interest in esketamine. To date, she has completed 20 sessions of 56 mg intranasal esketamine twice a week before increasing to 5 weekly sessions and then 14 weekly sessions of 84 mg. Although there was immediate subjective improvement in mood as well as reductions in PHQ-9 and HAM-D scores, the dosage was increased to extend the therapeutic benefit throughout the entire intertreatment interval. She was able to complete these sessions without complication. Incidentally, she also reported decreased desire to use alcohol, decreased impulsivity, and the complete cessation of alcohol use by the second week. While on 56 mg, she had a single relapse of binging which was addressed with motivational therapy and has remained alcohol-free since. This case presents the first documented example of the safe and effective use of intranasal esketamine in patient with treatment resistant MDD in which there was incidental resolution of their comorbid severe AUD. This suggests that esketamine can be used without risk of SUD onset or exacerbation. Thus, esketamine should not be discounted in patients with SUD and continued research is needed to further elucidate its role in treating SUD.
Leptomeningeal Carcinomatosis: A Rare Complication of Metastatic Gastric Cancer
Authors: Steven Y Lai, Sharonlin Bhardwaj, Phillis Wu
Journal: Cureus (2023)
Keywords: central nervous system diseases, intrathecal methotrexate, leptomeningeal disease, leptomeningeal metastasis, metastatic gastric cancer
MeSH terms: Case Reports

Leptomeningeal disease, also known as leptomeningeal carcinomatosis, occurs when cancer metastasizes to the meninges. This rare complication is associated with a poor prognosis. It is most commonly seen in patients with metastatic breast cancer, lung cancer, and melanoma. However, it is extremely rare in patients with metastatic gastric cancer. A 64-year-old female with poorly differentiated gastric adenocarcinoma metastatic to the peritoneum developed new neurological symptoms twelve months after initiating palliative chemotherapy. Her uptrending tumor markers, brain magnetic resonance imaging (MRI) findings, and lumbar puncture results were consistent with leptomeningeal disease. The patient was started on treatment with intrathecal methotrexate (IT MTX), which resulted in significant improvement in her neurological symptoms. Leptomeningeal disease in gastric cancer has limited treatment options due to poor blood-brain barrier penetration. IT MTX is a potentially effective treatment for patients with leptomeningeal disease from gastric cancer.
Evaluating the Presence of a Stage IV Low-Grade Well-Differentiated Neuroendocrine Tumor of the Ileocecum: A Case Report with Evaluation of Staging Protocol of Neuroendocrine Tumors and Treatment Options Based on Current Available Evidence
Authors: Vineet Madishetty, Alicia J Starr, Quyen D Chu, P A-C Brianna Starr
Journal: Case Rep Surg (2023)
MeSH terms: Case Reports

Neuroendocrine tumors (NET) are rare neoplasms that can originate throughout the human body. An initial treatment option includes upfront surgical resection of the primary tumor (pT) if the tumor can be localized. Current systemic therapy options following resection of the pT or with evidence of metastatic disease include somatostatin analogs, evorlimus, peptide receptor radionuclide therapy, cytotoxic chemotherapy, and interferon alpha among other less common therapy options. We present a case of a patient with a NET that originated in the ileocecal region. The patient underwent upfront surgical resection with a right hemicolectomy due to the location of the tumor. The pT was notable for extensive invasion into the visceral peritoneum and metastasis to nearby lymph nodes. However, despite being diagnosed as a stage IV NET, the Ki67 index was less than 1%, categorizing it as a low-grade well-differentiated tumor. Following resection of the tumor, there was no evidence of metastasis to the liver on the follow-up magnetic resonance imaging and recurrent somatostatin receptor overexpressing neoplasm on the Gallium-68 DOTATE PET/CT scan. Due to the juxtaposition of the low grade of the tumor and the high staging, several different treatment options were discussed with the main distinction being whether to base these options off of the stage or the grade of the tumor in the case. Low-grade well-differentiated NET have a good prognosis. On the other hand, stage IV NET and tumors that have metastasized to nearby lymph nodes and organs have an increased likelihood to reoccur and worse outcomes. Recommendations for NET based on current evidence have a lack of clarity in terms of when to undergo observation versus systemic therapy.
Intraoperative and Postoperative Intraocular Lens Opacifications: Analysis of 42545 Cases
Authors: Xiaochen Wang, Xiaoming Wu, Yunhai Dai, Yusen Huang
Journal: J Ophthalmol (2021)
MeSH terms: Review

Purpose:
To assess the types and causes of intraocular lens (IOL) turbidity in a tertiary eye center. Setting. Qingdao Eye Hospital of Shandong First Medical University, Qingdao, China.
Design:
Retrospective case series.
Methods:
Patients who underwent uncomplicated phacoemulsification and IOL implantation for cataract between January 2015 and December 2019 were included. Medical records were reviewed of participants with intraoperative or postoperative IOL opacification for clinical data, artificial crystal materials, and causes of the opacification.
Results:
A total of 42545 IOLs were implanted in the five years, comprising 25471 (66.0%) hydrophilic IOLs, 11881 (27.9%) hydrophobic IOLs, and 2601 (6.1%) hydrophilic-hydrophobic acrylic IOLs. Among the operated eyes, 14 eyes (13 patients) experienced IOL opacification, which was permanent for 10 IOLs, including 7 (0.6%) hydrophilic IOLs (860UV) and 3 (0.2%) hydrophilic-hydrophobic acrylic IOLs (L-312). The mean interval between surgery and diagnosis of permanent opacification was 34.4 ± 18.4 (SD) months (range, 12 to 59 months). Permanent IOL clouding led to a statistically significant reduction in best corrected visual acuity (mean, 0.64 ± 0.4 logMAR; P < 0.004). Acute IOL clouding occurred in four eyes during the implantation of a hydrophilic-hydrophobic acrylic IOL of L-312, 809M, or 839M and returned to transparency several hours later. All four procedures were performed in winter, with the mean outside temperature being -5.75°C.
Conclusions:
The rate of IOL opacification was 0.03%. Both delayed postoperative and acute intraoperative opacifications occurred with various characteristics in IOLs made of different materials and designs. Clinicians should be aware of this risk for cataract surgery.
Primary pulmonary leiomyosarcoma with coexistent pulmonary aspergillosis: a case report
Authors: Ahmed Badheeb, Nasser Al Gharem, Shehab Al Hammadi, Said Elsagheer, Mohamed Badheeb, Faisal Ahmed
Journal: Pan Afr Med J (2022)
Keywords: primary pulmonary leiomyosarcoma, aspergillosis, case report, chemotherapy
MeSH terms: Aspergillosis / diagnosis, Leiomyosarcoma / complications, Leiomyosarcoma / diagnosis, Leiomyosarcoma / pathology, Lung Neoplasms / complications, Lung Neoplasms / diagnosis, Lung Neoplasms / pathology, Pulmonary Aspergillosis / complications, Pulmonary Aspergillosis / diagnosis, Pulmonary Aspergillosis / pathology, Case Reports, Female, Humans, Lung / pathology, Middle Aged

Coexisting primary pulmonary leiomyosarcoma (PPL) with pulmonary Aspergillosis in immunocompetent patients is a rare occurrence. Here, we presented a 54-year-old woman presented with a dry cough for two months. Bronchoscopy revealed pulmonary aspergillosis. The patient was treated with antifungal therapy for one month without improvement. To evaluate further, a chest computed tomography (CT) scan showed a large heterogeneous enhancing mass in the lower lobe of the left lung with left atrium thrombosis. Computed tomography-guided biopsy was performed, and histopathology demonstrated the diagnosis of PPL. The metastasis workup staging showed multiple metastases in vertebrae, scapula, rib, and liver. The patient was treated with chemotherapy followed by tumor bed radiotherapy. Unfortunately, her general condition worsened, and she passed away with overall survival of fourteen months. In conclusion, clinicians should be alert to underlying malignant disease if airway Aspergillus infection is suspicious in patients without strong risk factors for invasive fungal infection.
A Forgotten Cause of Allergy at ER That Is Still Difficult to Diagnose and Treat at Poor Resource Setting: Angioedema after Using Angiotensin Converting Enzyme Inhibitors for 4 Years
Authors: A A Nilanga Nishad, K Arulmoly, S A S Priyankara, P K Abeysundara
Journal: Case Reports Immunol (2019)
MeSH terms: Case Reports

Angiotensin converting enzyme inhibitors (ACEi) are the most commonly used antihypertensives. Therefore, ACEI induced angioedema (ACEi-AE) is not uncommon. Physicians tend to miss the diagnosis whenever a patient is taking the drug for years due to misbelief of "a drug that was taken for years may not be the cause for an allergic reaction or an angioedema". But ACEi can induce angioedema after many years of usage as well as sometimes after stopping the drug even. Most of the emergency physicians and centers are not aware of clinical diagnosis and diagnostic criteria including available diagnostic tests and more importantly the treatment options of ACEi-AE. Therefore not only the diagnosis is delayed or missing but also proper treatment options are not practiced at many emergency rooms and at wards.