OpenMed/multicare-articles huggingface dataset:
Pleural effusion as an isolated finding in COVID-19 infection
Authors: Mousa Hussein, Irfan Ul Haq, Mansoor Hameed, Merlin Thomas, Anam Elarabi, Mona Allingawi, Issam Al-Bozom
Journal: Respir Med Case Rep (2020)
Keywords: covid-19, lactate dehydrogenase, pleural biopsy, pleural effusion
MeSH terms: Case Reports

Common radiological findings of COVID -19 infection include bilateral ground-glass opacities in lower lobes with a peripheral distribution. Pleural effusion is considered a rare manifestation of COVID -19 infection. We present a 52 years old patient with a three-week history of right-sided pleuritic chest pain, fever, and dyspnea. Laboratory investigations revealed high C-reactive protein and ferritin levels and a positive COVID-polymerase chain reaction (PCR) from a nasopharyngeal swab. Chest X-ray and Computed tomography (CT) identified a moderate right-sided pleural effusion, which was exudative with mixed cellularity and high Lactate dehydrogenase (LDH). Histopathology of thoracoscopic pleural biopsy didn't reveal granulomas, malignancy, or any microbiological growth. We postulate that having ruled out any other cause the effusion was likely related to the Covid-19 infection. Our case highlights that COVID-19 can present with isolated pleural effusions, therefore it should be kept as an etiology of effusions especially if other possible causes have been ruled out.
A Case of Hepatic Portal Venous Gas: Hypothesis of a Transient Direct Communication between a Penetrating Antral Gastric Ulcer and Mesenteric Varices
Authors: Hassan M Ghoz, Shamlan M Sheikh, Kanika Khandelwal, Joseph Fiore, Nicholas James, Joel Weinstock
Journal: Case Rep Gastrointest Med (2017)
MeSH terms: Case Reports

Hepatic portal venous gas (HPVG) is a rare radiological sign that usually signifies an acute intra-abdominal process, most commonly bowel ischemia and sepsis. Few reports described an association with underlying gastric pathologies. We report a 60-year-old patient who presented with melena and chills and was discovered to have a gastric ulcer that appeared to have penetrated into a mesenteric varix. This, in turn, likely caused development of HPVG associated with fungemia. Treatment with a proton pump inhibitor and bowel rest was sufficient to resolve symptoms and the HPVG.
Case Report: Post-gastrectomy reactive hyperinsulinemic hypoglicaemia: glucose trends before and after canagliflozin treatment
Authors: G Bellastella, P Caruso, C Carbone, M di Nuzzo, L Scappaticcio, V Amoresano Paglionico, M I Maiorino, K Esposito
Journal: Front Endocrinol (Lausanne) (2023)
Keywords: fgm (flash glucose monitoring), sglt1, sglt2, canagliflozin, hypoglycaemia, obesity
MeSH terms: Hyperinsulinism, Hypoglycemia / etiology, Sodium-Glucose Transporter 2 Inhibitors, Case Reports, Adult, Blood Glucose, Blood Glucose Self-Monitoring, Canagliflozin, Gastrectomy / adverse effects, Glucose, Humans, Hypoglycemic Agents, Male, Glucose, Canagliflozin, Blood Glucose, Sodium-Glucose Transporter 2 Inhibitors, Hypoglycemic Agents

The pathogenesis of post-gastrectomy reactive hyperinsulinaemic hypoglycaemia is not yet fully clarified. Recent studies suggest an up-regulation of the intestinal glucose transporter SGLT-1 aimed to prevent carbohydrate malabsorption. The overexpression of SGLT-1 could therefore represents one of the mechanisms underlying the wide glycemic excursions found in patients after gastrectomy, but studies investigating the use of SGLT-1/SGLT-2 inhibitors in patients with post-gastrectomy reactive hyperinsulinemic hypoglycaemia are very scant in the literature. We report the case of a 37-year-old non diabetic man who frequently presented symptoms of hypoglycaemia in the postprandial period. In 2012, he underwent Roux en-Y gastric bypass (RYGB) and after two years, he started to experience typical symptoms of reactive hyperinsulinaemic hypoglycaemia. We suggested healthy modifications of dietary habits and periodic follow-up visits with a dietitian. After three months, the patient still presented symptoms of reactive hypoglycaemia; we provided him with Flash Glucose Monitoring (FGM) to assess trend of glucose levels in interstitial fluid during the day and we decided to introduce canagliflozin 300 mg/day before the main meal. Hypoglycaemic events previously referred by the patient and clearly recorded by FGM completely disappeared taking canagliflozin. We found a reduction of time spent in hypoglycaemia, an improvement of glycemic variability and an increase of time in target range. It was also noted a reduction of time spent in hyperglicemia with consequent improvement of average glucose values and of glucose main indicator. This is the first report with FGM supporting a role of canagliflozin in the management of post-gastrectomy reactive hyperinsulinaemic hypoglycaemia. Our preliminary results are very limited but in line with those of the literature and showed for the first time a reduction of hypoglycaemic events and an improvement of glycemic variability through a flash glucose monitoring system. Further studies are mandatory to confirm this therapeutic opportunity.
Bilateral lung transplantation in a patient with humoral immune deficiency: a case report with review of the literature
Authors: Jocelyn R Farmer, Caroline L Sokol, Francisco A Bonilla, Mandakolathur R Murali, Richard L Kradin, Todd L Astor, Jolan E Walter
Journal: Case Reports Immunol (2014)

Humoral immune deficiencies have been associated with noninfectious disease complications including autoimmune cytopenias and pulmonary disease. Herein we present a patient who underwent splenectomy for autoimmune cytopenias and subsequently was diagnosed with humoral immune deficiency in the context of recurrent infections. Immunoglobulin analysis prior to initiation of intravenous immunoglobulin (IVIG) therapy was notable for low age-matched serum levels of IgA (11 mg/dL), IgG2 (14 mg/L), and IgG4 (5 mg/L) with a preserved total level of IgG. Flow cytometry was remarkable for B cell maturation arrest at the IgM+/IgD+ stage. Selective screening for known primary immune deficiency-causing genetic defects was negative. The disease course was uniquely complicated by the development of pulmonary arteriovenous malformations (AVMs), ultimately requiring bilateral lung transplantation in 2012. This is a patient with humoral immune deficiency that became apparent only after splenectomy, which argues for routine immunologic evaluation prior to vaccination and splenectomy. Lung transplantation is a rare therapeutic endpoint and to our knowledge has never before been described in a patient with humoral immune deficiency for the indication of pulmonary AVMs.
Malignant Pleural Effusion Due to Uterine Serous Carcinoma: An Unusual Presentation
Authors: Mustafa Wasifuddin, Nosakhare Ilerhunmwuwa, Ifeanyi Uche, Henry O Aiwuyo, Narek Hakobyan, Ephrem Sedeta, Jamal C Perry, Beatrice E Torere, Hesham Ali Abowali, Larisa Mararenko
Journal: Cureus (2023)
Keywords: endometrial carcinoma, malignant pleural effusion, rare cause of pleural effusion, serous endometrial carcinoma, uterine cancer
MeSH terms: Case Reports

Endometrial cancer is the most common cancer of the female genital tract. It can rarely metastasize to the pleura and present as a malignant pleural effusion. Here we present the case of a 61-year-old female with two primary malignancies, breast and endometrium, who presented to us with shortness of breath. Imaging was suggestive of a malignant pleural effusion. Diagnostic and therapeutic thoracentesis were performed that were initially suggestive of a breast source. However, final pleural fluid studies showed endometrial serous carcinoma as the source of the effusion. The patient received pembrolizumab and lenvatinib treatment and continues to be followed up in our clinic.
Successful Localization of the Source of Hemorrhage in Patient with Post-Whipple Surgery by 99mTc-Labelled Red Blood Cell Scintigraphy
Authors: Ahmed Fathala, Alaa Alduraibi, Moheieldin M Abouzied
Journal: Case Rep Radiol (2018)
MeSH terms: Case Reports

Gastrointestinal Bleeding Scintigraphy (GIBS) of 99mTc-labelled red blood cells is a relatively simple examination to perform, with high diagnostic accuracy and a relatively lower radiation dose. A positive scan can either suggest surgery without further investigation or can indicate angiography, a more targeted procedure. Whipple pancreatoduodenectomy is most often performed for tumors of the head of the pancreas. Pancreatoduodenectomy has 30%-40% morbidity and mortality, and while post-pancreatoduodenectomy hemorrhage is seen in less than 10% of patients, it accounts for 11%-38% mortality. The role of imaging in patients to detect relative hemodynamic stability is essential. Computed tomography angiography (CTA) shows the cause, site, and nature of bleeding, while digital subtraction angiography (DSA) has a diagnostic as well as a therapeutic role. We present a patient who presented with active gastrointestinal bleeding (GI) bleeding after undergoing a Whipple procedure, to highlight the role of GIBS in the successful localization of a bleeding site and the guidance of digital DSA in the embolization and control of the active bleeding.
The risks of self-made diets: the case of an amateur bodybuilder
Authors: Lucio Della Guardia, Maurizio Cavallaro, Hellas Cena
Journal: J Int Soc Sports Nutr (2015)
Keywords: bodybuilding, diy diets, gastrointestinal, high-protein diet, supplementation, vitamin and micronutrients overdose
MeSH terms: Diet, Dietary Supplements, Feeding Behavior, Case Reports, Adult, Athletes, Body Composition, Body Mass Index, Diarrhea / chemically induced, Diarrhea / diet therapy, Diet Records, Dietary Carbohydrates / administration & dosage, Dietary Fats / administration & dosage, Dietary Fiber / administration & dosage, Dietary Fiber / adverse effects, Dietary Proteins / administration & dosage, Energy Metabolism, Follow-Up Studies, Gastrointestinal Diseases / chemically induced, Gastrointestinal Diseases / diet therapy, Humans, Male, Micronutrients / administration & dosage, Micronutrients / adverse effects, Niacin / administration & dosage, Niacin / adverse effects, Nutrition Assessment, Recommended Dietary Allowances, Resistance Training, Risk Factors, Selenium / administration & dosage, Selenium / adverse effects, Vitamin A / administration & dosage, Vitamin A / adverse effects, Zinc / administration & dosage, Zinc / adverse effects, Dietary Carbohydrates, Dietary Fats, Dietary Fiber, Dietary Proteins, Micronutrients, Vitamin A, Niacin, Selenium, Zinc

Background:
Following DIY (do it yourself) diets as well as consuming supplements exceeding by far the recommended daily intake levels, is common among athletes; these dietary habits often lead to an overconsumption of some macro and/or micronutrients, exposing athletes to potential health risks. The aim of this study is to document the development of possible adverse effects in a 33 year-old amateur bodybuilder who consumed for 16 years a DIY high protein diet associated to nutrient supplementation. Body composition, biochemical measures and anamnestic findings were evaluated. We present this case to put on alert about the possible risks of such behavior repeated over time, focusing on the adverse gastrointestinal effects. We discuss the energy and nutrient composition of his DIY diet as well as the use of supplements.
Conclusion:
This study provides preliminary data of the potential risks of a long-term DIY dietary supplementation and a high protein diet. In this case, permanent abdominal discomfort was evidenced in an amateur body builder with an intake exceeding tolerable upper limit for vitamin A, selenium and zinc, according to our national and updated recommendations. As many amateur athletes usually adopt self-made diets and supplementation, it would be advisable for them to be supervised in order to prevent health risks due to a long-term DIY diet and over-supplementation.
Subcutaneous Dorsal Penile Vein Thrombosis or Penile Mondor's Disease: A Case Report and Literature Review
Authors: Adama Ouattara, Abdoul Karim Paré, Aristide F Kaboré, Clotaire Yaméogo, Gnimdou Botcho, Désiré Ky, Abdoul Aziz Ouédraogo, Amidou Bako, Rigobert Kiba, Zakari Nikiéma, Timothée Kambou
Journal: Case Rep Urol (2019)
MeSH terms: Case Reports

A 34-year-old man, trader, and married with four wives, otherwise healthy, without any remarkable medical history, was admitted in urology ward in emergency with superficial venous thrombosis of the penis known also as Penile Mondor's Disease (PMD), a rare nosologic entity of the penis associated with pain and an indurated dorsal cord of the root of the penis. The patient receives nonsteroidal anti-inflammatory drugs and coagulation and platelet aggregation inhibitors drugs. Healing and total recovery occur after eight weeks without any complications.
The gluteus maximus V-Y advancement flap for reconstruction of extensive soft tissue loss following an advanced sacral pressure ulcer. A case report and mini review
Authors: Landry W Tchuenkam, Flobert Titcheu, Aimé Mbonda, Trevor Kamto, Axel M Nwaha, Igor J Kamla, Joel Noutakdie Tochie
Journal: Int J Surg Case Rep (2020)
Keywords: pressure ulcer, v-y advancement flap, sacrum
MeSH terms: Case Reports

Background:
The occurrence of pressure injuries (PIs) in an inpatient is a serious medical condition that requires a rigorous clinical evaluation. Management of these lesions should be comprehensive, including general measures and local care. Wound care occupies a large part of the treatment. For large skin loss, the treatment requires plastic surgery techniques for reconstruction. Myocutaneous advancement flaps are a good therapeutic option due to the provision of vascularized tissue within the skin defect. To ensure the success of the surgery, a good surgical technique preceeded by careful preparation of the patient in conjunction with the anesthesia team is imperative.
Case presentation:
We report the case of a 60-year-old bed ridden man for more than two months following an ischemic stroke with left spastic hemiplegia and loss of sensitivity. He was transferred to our surgical unit for the management of a chronic stage 4 PIs in the sacral area complicated with cellulitis, subcutaneous abscess and severe sepsis. Initial management consisted of resuscitation measures combining fluid therapy, antibiotic therapy, analgesics, blood transfusion, nutritional support, physioteherapy, wound care as well as preventive measures and psychological support. Once the granulation tissues were fully developed, the patient underwent reconstruction surgery with a V-Y myocutaneous advancement flap. The graft was successful with complete wound healing thereafter.
Conclusion:
PIs are a multifactorial, complex and disabling pathology that requires multidisciplinary care. Surgeons, anesthetists, nutritionists, physiotherapists, nurses must act in agreement in order to provide optimal treatment. Prevention is the rule.
Obstetric management of a patient with narcolepsy and cataplexy: a case report
Authors: S Ajayi, R Kinagi, E Haslett
Journal: Case Rep Obstet Gynecol (2012)

We report the management of a patient who suffers from narcolepsy and cataplexy and presented to the clinic at 14 weeks of gestation. Her symptoms were resistant to modafinil but controlled with clomipramine and amphetamine. Discussion concerning mode of delivery for these patients is scarce in the literature. We discuss some issues surrounding the antenatal management and counselling regarding mode of delivery and postpartum care.
Atlantoaxial rotatory fixation as a rare complication from head positioning in otologic surgery: Report of two cases in young children
Authors: Hiroshi Sakaida, Koji Akeda, Akihiro Sudo, Kazuhiko Takeuchi
Journal: Patient Saf Surg (2017)
Keywords: adverse event, atlantoaxial rotatory fixation, otologic surgery, patient safety, torticollis
MeSH terms: Case Reports

Background:
Atlantoaxial rotatory fixation is a condition in which the first and second vertebrae of the cervical spine become interlocked in a rotated position. This condition can result in serious consequences and thus have a significant impact on patients, especially when diagnosis and treatment are delayed. Some cases of atlantoaxial rotatory fixation have been described in association with otologic surgery or plastic surgery involving the ear. We present the cases of two pediatric patients who developed atlantoaxial rotatory fixation following otologic surgery and we review the relevant literature.
Case presentation:
One patient was a 7-year-old boy who underwent tympanoplasty for cholesteatoma. The other patient was a 5-year-old girl with profound sensorineural hearing loss who underwent cochlear implantation. Both patients developed atlantoaxial rotatory fixation on the day after surgery, and they were treated conservatively. Our literature search using relevant terms identified 12 similar published cases. Thus, a total of 14 patients, including our 2 patients, were evaluated. Most of the patients were children and typically they complained of painful torticollis and exhibited a characteristic posture called the "cock-robin" position on the day after surgery. Mostly, the direction of torticollis was opposite to the side of surgery. Most of the patients received conservative treatment alone, but three underwent surgical treatment.
Conclusion:
The correlation between the direction of torticollis and the side of surgery suggests that rotation of the head during surgery has an impact on development of postoperative atlantoaxial rotatory fixation. Thus, children undergoing otologic surgery are thought to be at a risk of postoperative atlantoaxial rotatory fixation. Although rare, the surgical team needs to be aware of this adverse event and pay close attention to this possibility throughout the perioperative period. Perioperative management should include informed consent, preoperative assessment of the range of head and neck motion, proper intraoperative positioning and monitoring of the position, and postoperative follow-up. Postoperative atlantoaxial rotatory fixation is not completely preventable, but good perioperative management can minimize the damage resulting from this condition.
Case Report: Early detection of lung carcinoid in an asymptomatic individual by blood-test initiated PET-CT imaging
Authors: Simon Burg, Ralf Smeets, Martin Gosau, Katja Failing, Audrey Laure Céline Grust
Journal: Front Oncol (2023)
Keywords: apo10/dnasex, fdg-pet/ct, tktl1, blood test, early cancer screening, immunological biopsy
MeSH terms: Case Reports

We present the case of a 53-year-old woman who was diagnosed with early-stage lung cancer by targeted cancer screening consisting of an immunological biopsy-based blood test followed by radiological imaging. The PanTum Detect blood test detects the biomarkers Apo10/DNaseX and Transketolase-like 1 (TKTL1) in circulating macrophage-like cells from peripheral blood samples to identify asymptomatic individuals with a high risk for malignancy. The elevated blood test values initiated an 18F-FDG PET/CT visualization for further clarification. In this case, imaging indicated a lung carcinoma in the right upper lobe. A biopsy confirmed the presence of a lung carcinoma, which was removed surgically. Histologic examination revealed a typical I A2 carcinoid, which was completely removed, making further therapy obsolete.
Surgical management of spontaneous, late-onset Descemet membrane detachment after penetrating keratoplasty for keratoconus: a case report
Authors: Myrsini Petrelli, Konstantinos Oikonomakis, Konstantinos Andreanos, Andreas Mouchtouris, Ilias Georgalas, George Kymionis
Journal: Eye Vis (Lond) (2017)
Keywords: descemet membrane detachment, keratoconus, penetrating keratoplasty, spontaneous
MeSH terms: Case Reports

Background:
To report a surgical method for treating corneal oedema in a case of late-onset Descemet membrane detachment after penetrating keratoplasty.
Case presentation:
A 55-year old patient presented with sudden visual loss in his left eye 28 years after penetrating keratoplasty for keratoconus. Slit-lamp biomicroscopy revealed a distortion of the corneal graft anatomy with protrusion of the graft and peripheral thinning and steepening in the residual host tissue, accompanied by corneal graft oedema. Anterior segment optical coherence tomography revealed detachment of Descemet membrane localized to the area of the graft oedema. We proceeded with a full-thickness, partially circumferential incision in the graft-host junction, followed by repositioning and re-suturing of the graft in place, and intracameral air injection in order to achieve reattachment of Descemet membrane.
Conclusions:
Corneal graft repositioning in combination with re-bubbling may represent an effective therapeutic option in keratoconic patients with peripheral thinning in the residual host corneal tissue and subsequent Descemet membrane detachment.
The lost stone - Laparoscopic exploration of abscess cavity and retrieval of lost gallstone post cholecystectomy: A case series and review of the literature
Authors: Uri Kaplan, Gregory Shpoliansky, Ossama Abu Hatoum, Boaz Kimmel, Doron Kopelman
Journal: Int J Surg Case Rep (2018)
Keywords: abscess cavity, cholecystectomy, gallstone, laparoscopic exploration, video

Background:
Laparoscopic cholecystectomy (LC) is considered the gold standard operation for symptomatic gallstones. Gallbladder perforation occurs in 6-40% of operations. It can lead to spillage of gallstones into the abdominal cavity with possible consequences of long-term complications. We report two cases where a unique use of laparoscopic technique was used to explore abscess cavity and retrieve lost gallstones without penetrating the peritoneal cavity.
Case presentation:
We report two cases of peri-hepatic abscess treated with laparoscopic cavity exploration, using 5 mm and 10 mm ports, to retrieve lost gallstones. It was done without entering the peritoneal cavity.
Discussion:
Today, minimally invasive technique is used in a variety of surgical cases. We report a novel technique, using laparoscopic skills, to drain abscesses caused by lost gallstones post LC without entering the peritoneal cavity. The use of minimally invasive surgery techniques in order to explore abscess cavities not only help us to extract the cause of the abscess but also prevents another surgery in the abdominal cavity.
Conclusion:
Laparoscopic exploration of an abscess cavity is a feasible and safe technique treating long-term complications of gallbladder perforation post LC.
Locus Minoris Resistentiae in Coccidioidomycosis: A Case Series
Authors: Namgyal Sherpa, Rushabh Shah, Brian Nordstrom, Christine Palmares, Arash Heidari, Royce Johnson
Journal: J Investig Med High Impact Case Rep (2019)
Keywords: san joaquin fever, coccidioidomycosis, locus minoris resistentiae, valley fever
MeSH terms: Coccidioides / isolation & purification, Coccidioidomycosis / diagnosis, Dermatomycoses / microbiology, Elbow Injuries, Lung Diseases, Fungal / diagnostic imaging, Tibial Meniscus Injuries / complications, Case Reports, Adolescent, Adult, Humans, Male, Osteomyelitis / diagnostic imaging, Tibial Meniscus Injuries / diagnostic imaging, Tomography, X-Ray Computed, X-Rays

Locus minoris resistentiae refers to decreased resistance in any internal organ or external body region, leaving it more vulnerable to disease processes than other regions. These changes, either congenital or acquired, alter the defense capacity. The concept of locus minoris resistentiae is widely accepted in the medical field and presents itself across specialties. Antecedent trauma is a known risk factor for hematogenous dissemination of infection; this also applies to coccidioidal species. In this article, we describe 2 patients who suffered from pulmonary coccidioidomycosis with subsequent trauma resulting in osseous dissemination to the site of injury.