OpenMed/multicare-articles huggingface dataset:
Emergence Agitation and Anesthetic Considerations in the Management of Patients With Post-Traumatic Stress Disorder: A Report of Two Cases and a Review of the Literature
Authors: Jordan Huang, Nitin Chopra, Natesh Yepuri, Sudhakar Kinthala
Journal: Cureus (2023)
Keywords: anesthetic management, dexmedetomidine, emergence agitation, emergence delirium, post-traumatic stress disorder
MeSH terms: Case Reports

Post-traumatic stress disorder (PTSD) is a psychological disturbance resulting from exposure to a traumatic experience that lasts more than one month. PTSD in the United States has a lifetime prevalence of 3.4% to 26.9% in civilians and 7.7% to 17.0% in military veterans. Emergence agitation (EA) and emergence delirium (ED) are known phenomena in the postanesthetic period. PTSD is closely associated with EA following anesthesia. In addition, EA in patients with PTSD can be severe and challenging to manage. EA is a risk to both patients and healthcare workers. Furthermore, EA has been shown to increase the overall risk of postoperative delirium and complications. Currently, studies on the anesthetic management of patients with PTSD are scarce and limited to case reports. Here, we present a summary of several important published case reports and a brief review of the literature regarding the anesthetic management of PTSD and EA to aid in managing patients with PTSD. In addition, we present two cases of successful EA prevention in patients with severe PTSD. From our review of the literature and the successful prevention of EA in our patients with severe PTSD, we conclude that there is an increased need for overall awareness among anesthesia and perioperative care providers of the effect of PTSD on EA. Anesthesia providers should aim to include as many management recommendations as possible and avoid possible triggers of EA via a multidisciplinary approach. Multiple pharmacological agents have been used for the anesthetic management of PTSD with varying results. Of the agents studied, dexmedetomidine has been found to be the most consistently beneficial.
Management of Groin Pain Using an Iliohypogastric Nerve Block in a Patient with Inguinal Hernia due to Persistent Müllerian Duct Syndrome
Authors: Takanori Sekito, Takuya Sadahira, Masahiro Sugihara, Kohei Edamura, Motoo Araki, Yasutomo Nasu
Journal: Case Rep Urol (2021)
MeSH terms: Case Reports

Persistent Müllerian duct syndrome can cause an inguinal hernia, although this is a rare occurrence; recurrent inguinal hernias can, in turn, cause ongoing groin pain. Management of groin pain plays an important role in patients' quality of life. We present our experience with a 43-year-old man who had a 2-week history of left-sided groin pain. The patient underwent laparoscopic surgery for a left inguinal hernia via the transabdominal preperitoneal approach. Right-sided cryptorchidism was noted during surgery, with a solid structure-thought to be a uterus-extending into the left inguinal canal. The diagnosis was persistent Müllerian duct syndrome, and the groin pain was relieved after a laparoscopic right orchiectomy with a bilateral preperitoneal hernia repair using a mesh. Four years later, magnetic resonance imaging performed for new-onset left groin pain showed a left inguinal hernia caused by the uterine structure. We diagnosed the recurrent hernia as the cause of his pain. Prior to performing any invasive surgical procedures, an iliohypogastric nerve block was performed using 1% lidocaine. Short-term analgesia was provided by the block, improving his quality of life. He has been followed since then and has declined surgical neurectomy. An iliohypogastric nerve block can be an effective method of controlling groin pain caused by an inguinal hernia resulting from persistent Müllerian duct syndrome; the effectiveness of the nerve block will help determine whether surgical neurectomy is indicated for permanent pain control.
Staphylococcus argenteus as an etiological agent of prosthetic hip joint infection: a case presentation
Authors: Bo Söderquist, Peter Wildeman, Bianca Stenmark, Marc Stegger
Journal: J Bone Jt Infect (2020)
Keywords: staphylococcus argenteus, antimicrobial agents, genome analysis, prosthetic joint infections

This report presents a case of prosthetic hip infection caused by Staphylococcus argenteus, a potentially overlooked etiology of prosthetic joint infections (PJIs). Whole-genome sequencing showed that the S. argenteus isolate was an ST2250 and clustered within other CC2250 isolates, the largest clonal group of S. argenteus. This sequence type is prevalent and may be associated with invasive infections. The present isolate was phenotypically fully susceptible to all tested antimicrobial agents and genome analysis did not detect any resistance genes, nor were any staphylococcal cassette chromosome residues detected. Despite initial appropriate management with debridement and biofilm-active antibiotics, the outcome was unfavorable with recurrence and a persistent infection treated with suppressive antibiotics. Regarding the repertoire of genomic traits for virulence in S. argenteus, PJIs caused by this bacterium should be treated accordingly as Staphylococcus aureus PJIs.
A Rare Case of Cryptococcal Meningitis in a Child with a Congenital Heart Disease
Authors: Bhim Gopal Dhoubhadel, Ujjwal Laghu, Raju Poudel, Konosuke Morimoto, Koya Ariyoshi
Journal: Case Rep Infect Dis (2021)
MeSH terms: Case Reports

Cryptococcal meningitis, which has a high mortality rate, is rare in immunocompetent children. Although many immunocompromised conditions are identified as predisposing factors, congenital heart disease in children is not well recognized as a predisposing factor for the disease. A 12-year-old female child presented with a progressively increasing headache for one month. There was history of vomiting and fever off and on. On examination, she had a pansystolic murmur and meningeal signs. Lumbar puncture was done; opening pressure was high (27 cm H2O) and white blood cell (WBC) count in cerebrospinal fluid (CSF) was slightly high. Gram staining, India ink preparation, and culture of CSF were negative. Cryptococcal antigen (CrAg) test was not available. Echocardiography showed a 12 mm ventricular septal defect (VSD). The patient was diagnosed as meningitis with VSD and treated with intravenous ceftriaxone and vancomycin; however, she did not improve after 7 days of antimicrobial treatment. She was then transferred to another hospital where India ink and culture of CSF showed cryptococcus; CrAg test was done, and it was positive. Despite the treatment with lyposomal amphotericin B and flucytosine, she died on 9th day of admission in pediatric intensive care unit. It is necessary for global advocacy for need of availability of CrAg test in resource-limited regions. Treating doctors should consider VSD, a congenital heart disease, as a predisposing factor for cryptococcal meningitis in children. As CrAg is more sensitive than India ink and culture, it should be the first line of investigation in suspected cases.
Adult Ectopic Cervical Thymic Tissue in relation to a Parathyroid Adenoma and a Papillary Thyroid Carcinoma: A Report of Two Cases
Authors: Vijay Shrawan Nijhawan, Roopali Sehrawat, Neeti Goyal, Manish Gupta
Journal: Case Rep Otolaryngol (2020)
MeSH terms: Case Reports

Ectopic cervical thymus is a rare congenital anomaly, which results because of the failure of complete descent of the thymus. They are incidental findings in the young and may disappear during the early years of life; however, they have rarely been described in adults. Some of them may undergo hyperplasia or neoplastic transformation and become visible or cause symptoms. We report two rare cases of incidentally detected cervical thymic tissue in adults. In one case, the thymic tissue was seen adjacent to a parathyroid adenoma of the left inferior parathyroid gland. In the other, it was seen adjacent to the left inferior parathyroid gland in a case of papillary thyroid carcinoma. In both these cases, the ectopic thymic tissue was diagnosed as a result of pathological examination, not clinically by macroscopic appearance during operation or radiological evaluation. The finding needs to be noted as these ectopic foci can occasionally give rise to hyperplasia and neoplasms of the thymus.
A Case of Nivolumab-Induced Severe Mononeuropathy Multiplex and Rhabdomyolysis
Authors: Katsuya Sakai, Hitoshi Mochizuki, Kosuke Mochida, Kazutaka Shiomi, Masahiro Amano, Masamitsu Nakazato
Journal: Case Rep Med (2017)
MeSH terms: Case Reports

We report an 81-year-old man with multiple liver metastases after tumorectomy for primary mediastinal malignant melanoma, who experienced limb weakness and sensory disturbance after nivolumab monotherapy. He was diagnosed with nivolumab-induced mononeuropathy multiplex and rhabdomyolysis based on serologic examination, muscle biopsy, magnetic resonance imaging of the limbs, and a nerve conduction study. A course of intravenous methylprednisolone (mPSL) was initiated at 1 g/day for 3 days. After that, oral prednisolone (PSL) was started at 1 mg/kg/day and gradually tapered. Limb muscle strength improved, but when PSL was reduced to 0.3 mg/kg/day, the weakness recurred, and a nerve conduction study showed exacerbation of mononeuropathy multiplex. The patient was again administered intravenous mPSL (0.5 g/day for 3 days) followed by oral PSL at 0.5 mg/kg/day, and his neurological symptoms improved. Nivolumab, an immune checkpoint inhibitor, is used for the treatment of advanced melanoma and other cancers and causes various immune-related adverse events (irAEs). However, neurological irAEs related to nivolumab are rare. Furthermore, there are no reports of simultaneous nerve and muscle impairment. Unexpected irAEs affecting various organs should be recognized and treated appropriately.
Hypercalcemia due to Primary Hepatic Lymphoma
Authors: Andrew Hsu, Michael Gagnier, Elizabeth Ryer, Mohammed Salhab, Alan G Rosmarin
Journal: Case Rep Hematol (2016)
MeSH terms: Case Reports

A 65-year-old female with a history of mixed connective tissue disease and pulmonary fibrosis on azathioprine, hydroxychloroquine, and prednisone (osteoporosis on teriparatide) presented with a 1-month history of hypercalcemia. After discontinuation of teriparatide, the patient's hypercalcemia persisted. Further evaluation revealed primary hepatic lymphoma as the source of her hypercalcemia.
Papillary thyroid carcinoma with lung metastasis arising from dyshormonogenetic goiter: a case report
Authors: Ersin Sukru Erden, Cenk Babayigit, Ramazan Davran, Mustafa Akin, Sinem Karazincir, Nebihe Isaogullari, Mesut Demirkose, Sebahat Genc
Journal: Case Rep Med (2013)

Prior radiation exposure is the best known risk factor for thyroid cancers, and papillary thyroid carcinoma (PTC) may arise from dyshormonogenetic goiter. A 17-year-old female patient was admitted to the department of chest diseases with respiratory symptoms. The patient had undergone a thyroid surgery for goiter at the age of 9. A bilateral nodular opacity was detected by radiological examination. The histopathologic examination of the specimen obtained from computed tomography guided trucut biopsy was diagnosed as PTC. We present a very rare case of PTC with lung metastasis that had undergone subtotal thyroidectomy due to dyshormonogenetic goiter eight years ago.
Malignant peritoneal mesothelioma presenting as a mass in a Spigelian hernia. Report of a case
Authors: Paul H Sugarbaker
Journal: Int J Surg Case Rep (2020)
Keywords: cytoreductive surgery, hipec, intraperitoneal chemotherapy, peritoneal metastases, peritonectomy, tumor cell entrapment
MeSH terms: Case Reports

Background:
Gastrointestinal cancer, gynecologic cancer and malignant peritoneal mesothelioma may disseminate widely to the surfaces of the abdomen and pelvis. In some patients this spread of the disease may find its way into a hernia sac.
Methods:
The Spigelian hernia is caused by a protrusion of the peritoneum of the anterior abdominal wall into the abdominal wall muscle. This peritoneal defect occurs through the semilunar line of Spiegel in or closely associated with the semicircular line of Douglas.
Results:
A patient presented with a large (11 cm greatest diameter) mass in the left lower quadrant. The mass was composed of malignant peritoneal mesothelioma and was anatomically located within the Spigelian hernia belt. At the time of cytoreductive surgery numerous other sites of malignant peritoneal mesothelioma were present within the abdomen and pelvis.
Conclusions:
The left lower quadrant mass was a malignant peritoneal mesothelioma presenting within a Spigelian hernia defect. This phenomenon has not been previously reported.
Myeloid Sarcomas Causing Unilateral Cranial Nerve Palsies in a Patient with Relapsed Acute Myeloblastic Leukemia
Authors: A Mendez-Hernandez, X A Andrade, S Upadhyay, L M Parra-Rodriguez, E Caldeira, L H Paz, H Mann, M Zia, L Sumoza
Journal: Case Rep Hematol (2020)
MeSH terms: Case Reports

Myeloid sarcomas (MS) are a rare manifestation of myeloid malignancies and can often be misdiagnosed, leading to a delay in treatment. The objective of this clinical case is to highlight the challenges of the clinical presentation and to emphasize the importance of this manifestation ensuring timely diagnosis and therapy. Here, we present a 43-year-old man who was diagnosed with acute myeloblastic leukemia (AML) after being evaluated for unintentional weight loss, subcutaneous nodules, thrombocytopenia, and anemia. The patient underwent chemotherapy with complete remission and presented 4 months later with dysphagia and cranial nerve palsies. Appropriate imaging and biopsy led to a diagnosis of myeloid sarcoma, and a decision was made to begin reinduction chemotherapy for AML achieving a second complete remission although his neurological deficits did not improve. Our case illustrates the protean presentation of myeloid sarcomas; clinicians should have a high suspicion for MS and remain vigilant when unexplained signs and symptoms arise in the background of a myeloid malignancy although challenges still remain when presentation is de novo. Advancements in understanding the pathophysiology of MS have been performed but remain not completely understood. High clinical suspicion, appropriate imaging, biopsy techniques, and expertise are paramount for timely diagnosis and treatment.
Variables to Be Monitored via Biomedical Sensors for Complete Type 1 Diabetes Mellitus Management: An Extension of the "On-Board" Concept
Authors: Ignacio Rodríguez-Rodríguez, José-Víctor Rodríguez, Miguel-Ángel Zamora-Izquierdo
Journal: J Diabetes Res (2018)
MeSH terms: Blood Glucose / analysis, Blood Glucose Self-Monitoring, Diabetes Mellitus, Type 1 / blood, Review, Diabetes Mellitus, Type 1 / drug therapy, Humans, Hypoglycemic Agents / administration & dosage, Hypoglycemic Agents / therapeutic use, Insulin / administration & dosage, Insulin / therapeutic use, Insulin Infusion Systems, Blood Glucose, Hypoglycemic Agents, Insulin

Type 1 diabetes mellitus (DM1) is a growing disease, and a deep understanding of the patient is required to prescribe the most appropriate treatment, adjusted to the patient's habits and characteristics. Before now, knowledge regarding each patient has been incomplete, discontinuous, and partial. However, the recent development of continuous glucose monitoring (CGM) and new biomedical sensors/gadgets, based on automatic continuous monitoring, offers a new perspective on DM1 management, since these innovative devices allow the collection of 24-hour biomedical data in addition to blood glucose levels. With this, it is possible to deeply characterize a diabetic person, offering a better understanding of his or her illness evolution, and, going further, develop new strategies to manage DM1. This new and global monitoring makes it possible to extend the "on-board" concept to other features. This well-known approach to the processing of variable "insulin" describes some inertias and aggregated/remaining effects. In this work, such analysis is carried out along with a thorough study of the significant variables to be taken into account/monitored-and how to arrange them-for a deep characterization of diabetic patients. Lastly, we present a case study evaluating the experience of the continuous and comprehensive monitoring of a diabetic patient, concluding that the huge potential of this new perspective could provide an acute insight into the patient's status and extract the maximum amount of knowledge, thus improving the DM1 management system in order to be fully functional.
Case Report: Danon Disease: Six Family Members and Literature Review
Authors: Yuanyuan Wang, Meixue Jia, Yingjie Guo, Ting Zhang, Bin Ning
Journal: Front Cardiovasc Med (2022)
Keywords: danon disease, case report, liver injury, lysosome-associated membrane 2, pre-excitation, ventricular hypertrophy
MeSH terms: Case Reports

Danon disease is a rare X-linked dominant genetic disorder that manifests with a clinical triad of cardiomyopathy, skeletal myopathy, and intellectual disability. It is caused by mutations in the lysosome-associated membrane 2 (LAMP2) gene. We report one case of Danon disease and his family members, characterized by ventricular pre-excitation, ventricular hypertrophy, abnormal muscle enzymes, and aberrant liver function. All the patients were confirmed to have Danon disease through genetic screening. Relevant literature was reviewed as a reference for the diagnosis and treatment of the disease.
Hodgkin lymphoma transformation of chronic lymphocytic leukemia: cases report and discussion
Authors: Maciej Kaźmierczak, Renata Kroll-Balcerzak, Andrzej Balcerzak, Elżbieta Czechowska, Lidia Gil, Krzysztof Sawiński, Andrzej Szczepaniak, Mieczysław Komarnicki
Journal: Med Oncol (2014)
MeSH terms: Cell Transformation, Neoplastic, Hodgkin Disease / pathology, Leukemia, Lymphocytic, Chronic, B-Cell / complications, Leukemia, Lymphocytic, Chronic, B-Cell / pathology, Case Reports, Adult, Antineoplastic Agents / therapeutic use, Biopsy, Disease Progression, Fatal Outcome, Female, Hodgkin Disease / drug therapy, Humans, Leukemia, Lymphocytic, Chronic, B-Cell / drug therapy, Male, Middle Aged, Antineoplastic Agents

B-cell chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) is the most common form of leukemia affecting adults in Europe and North America. Large B-cell lymphoma known as Richter's syndrome (RS) may develop approximately in 3-15 % patients. Furthermore, other hematological malignancies may also occur as RS variants, among them-Hodgkin lymphoma (HL). CLL/SLL transformation into HL is observed in about 0.5 % of patients, and till now, fewer than 100 cases have been reported in the medical literature. We present two cases of HL transformation of CLL/SLL and review the previously published literature.
Bilateral psoas haematomata complicating renal transplantation
Authors: Jacob A Akoh, Tahawar A Rana, Daniel Higgs
Journal: Surg Res Pract (2014)

Background. The challenge in managing patients undergoing renal transplantation is how to achieve optimum levels of anticoagulation to avoid both clotting and postoperative bleeding. We report a rare case of severe postoperative retroperitoneal bleeding including psoas haematomata complicating renal transplantation. Case Report. SM, a 55-year-old female, had a past history of aortic valve replacement, cerebrovascular event, and thoracic aortic aneurysm and was on long-term warfarin that was switched to enoxaparin 60 mg daily a week prior to her living donor transplantation. Postoperatively, she was started on a heparin infusion, but this was complicated by a large retroperitoneal bleed requiring surgical evacuation on the first postoperative day. Four weeks later, she developed features compatible with acute femoral neuropathy and a CT scan revealed bilateral psoas haematomata. Following conservative management, she made steady progress and was discharged home via a community hospital 94 days after transplantation. At her last visit 18 months after transplantation, she had returned to full fitness with excellent transplant function. Conclusion. Patients in established renal failure who require significant anticoagulation are at increased risk of bleeding that may involve prolonged hospitalisation and more protracted recovery and patients should be carefully counselled about this.
AnaConDa™ and Mirus™ for intensive care sedation, 24 h desflurane versus isoflurane in one patient
Authors: Hagen Bomberg, Heinrich V Groesdonk, Martin Bellgardt, Thomas Volk, Andreas Meiser
Journal: Springerplus (2016)
Keywords: anaconda™, desflurane, intensive care unit (icu), mirus™, sedation

Introduction:
With the AnaConDa™ system, inhalational sedation in the intensive care unit has become popular. The device can be used with common intensive care unit ventilators and is inserted between the Y-piece and the patient. Liquid isoflurane or sevoflurane are delivered by a syringe pump. 90 % of anesthetic exhaled by the patient is absorbed by a reflector and resupplied during the next inspiration. The new Mirus™ system also uses a reflector. Its control unit identifies end-tidal concentrations from the flow, injects anesthetics during early inspiration, controls anesthetic concentrations automatically, and can also apply desflurane. The AnaConDa™ and Mirus™ system are certified 'conformité établi', however, little is known about the Mirus™ and case reports are still lacking.
Case description:
We used the Mirus™ with desflurane for 24 h in a patient suffering from acute respiratory distress syndrome. The patient was treated with kinetic lateral rotational therapy. While deeply sedated, our patient breathed 9.0-12.0 l min(-1) spontaneously. Thereafter, awakening and wash-out were considerably shorter than after isoflurane in the same patient with AnaConDa™. There were no major problems during the sedation. However, consumption of desflurane was high.
Conclusion:
Desflurane sedation with the Mirus™ seems promising, but the reflector should be improved to absorb and resupply more of the anesthetic agent.
A cancer-mimicking diagnosis of peritoneal carcinosis: report of a case of abdominal non-tuberculous mycobacterial infection
Authors: Francesca De Piano, Filippo Savoldi, Francesca Ruju, Mariacristina Ghioni, Vanna Zanagnolo, Stefania Rizzo
Journal: Ecancermedicalscience (2018)
Keywords: abdomen, computed tomography, nontuberculous mycobacteria, peritoneal carcinosis
MeSH terms: Case Reports

Abdominal non-tuberculous mycobacterial infection is a rare condition in healthy patients. When it occurs, it leads to the appearance of typical findings of peritoneal involvement, such as thickening of the peritoneal leaflets and the omentum, ascites and enlargement of lymph nodes and of mesenteric nodules. These findings may be misdiagnosed as tumour peritoneal implants. In case of spontaneous regression of the peritoneal involvement and ascites, as well as in the absence of malignancy, the suspicion of infectious disease, including abdominal nontuberculous mycobacterial infection, should be considered.