OpenMed/multicare-articles huggingface dataset:
Cerebral Amyloid Angiopathy-Related Inflammation in the Immunosuppressed: A Case Report
Authors: Thomas Nelson, Bo Leung, Serguei Bannykh, Kevin S Shah, Jignesh Patel, Oana M Dumitrascu
Journal: Front Neurol (2019)
Keywords: cerebral amyloid angiopathy-related inflammation, immunosuppression, mycobacteria, sarcoidosis, transplantation
MeSH terms: Case Reports

Cerebral amyloid angiopathy-related inflammation (CAA-ri) is an immune-mediated disorder of the central nervous system characterized by an inflammatory response to amyloid-beta (Aβ) deposition within cerebral blood vessel walls. Immunosuppressive therapy is the mainstay of treatment. We present a case of CAA-ri in a subject already on immunosuppressive therapy after orthotopic heart transplantation (OHT). A 57-year-old man 8 months post-OHT for sarcoid cardiomyopathy developed headaches and staring spells while hospitalized for disseminated mycobacterial infection. His brain MRI revealed bi-hemispheric T2-weighted fluid-attenuated inversion recovery white matter hyperintensities and widespread microhemorrhages. Two weeks later, he developed gait ataxia and alterations in mental status, and repeat brain MRI showed more extensive confluent white matter hyperintensities. Leptomeningeal and cortex biopsy revealed changes consistent with amyloid angiitis, with perivascular and intramural histiocyte and lymphocyte collections. Mass spectroscopy confirmed Aβ deposition. Notably, the patient was on immunosuppression with daily 5 mg oral prednisone and tacrolimus before biopsy. After high-dose intravenous followed by oral corticosteroids, he demonstrated significant clinical and radiographic improvement. No relapse was noted despite the relatively rapid tapering of the prednisone therapy over 3 months, as mandated by his systemic infection. Despite the lack of a standard treatment protocol for CAA-ri, case series have reinforced the benefit of prolonged courses of glucocorticoids as single agent or in combination with other immunomodulatory agents. Hence, management of CAA-ri in patients with disseminated mycobacterial infections or OHT is challenging. Our case is unique, as review of existing literature has not revealed any similar cases of patients on chronic immunosuppression at the time of CAA-ri diagnosis, which one would expect to protect against this disorder. In addition, CAA-ri in association with cardiopulmonary sarcoidosis was not previously reported; however, a common immunopathogenic mechanism may exist.
Middle Ear Neuroendocrine Adenoma: A Case Report and Literature Review
Authors: Luca Bruschini, Rachele Canelli, Christina Cambi, Giacomo Fiacchini, Stefano Berrettini, Francesca Forli
Journal: Case Rep Otolaryngol (2020)
MeSH terms: Case Reports

Neuroendocrine adenomas of the middle ear are rare tumors that represent less than 2% of primary tumors of the ear. In this paper, we describe a case of a 40-year-old woman who developed neuroendocrine adenoma of the middle ear. The specific management strategy for this rare tumor is unclear; information in the available literature on the management of this tumor is varied. However, an extensive demolition seems to be the gold standard treatment for this tumor to avoid recurrence and regional metastases in the lymph node or distant metastases. For the present case, we performed an incisional biopsy to confirm the diagnosis, and thereafter, we performed a canal-wall-down tympanoplasty. For cases like the present one, careful long-term clinical and instrumental follow-up is required to monitor progress and facilitate patient recovery.
Risk factors for Plasmodium falciparum gametocyte positivity in a longitudinal cohort
Authors: Laura Grange, Cheikh Loucoubar, Olivier Telle, Adama Tall, Joseph Faye, Cheikh Sokhna, Jean-François Trape, Anavaj Sakuntabhai, Jean-François Bureau, Richard Paul
Journal: PLoS One (2015)
MeSH terms: Life Cycle Stages, Malaria, Falciparum / parasitology, Plasmodium falciparum / growth & development, Adolescent, Child, Child, Preschool, Cluster Analysis, Humans, Longitudinal Studies, Malaria, Falciparum / epidemiology, Malaria, Falciparum / transmission, Multivariate Analysis, Prevalence, Risk Factors, Senegal / epidemiology

Malaria transmission intensity is highly heterogeneous even at a very small scale. Implementing targeted intervention in malaria transmission hotspots offers the potential to reduce the burden of disease both locally and in adjacent areas. Transmission of malaria parasites from man to mosquito requires the production of gametocyte stage parasites. Cluster analysis of a 19-year long cohort study for gametocyte carriage revealed spatially defined gametocyte hotspots that occurred during the time when chloroquine was the drug used for clinical case treatment. In addition to known risk factors for gametocyte carriage, notably young age (<15 years old) and associated with a clinical episode, blood groups B and O increased risk compared to groups A and AB. A hotspot of clinical P. falciparum clinical episodes that overlapped the gametocyte hotspots was also identified. Gametocyte positivity was found to be increased in individuals who had been treated with chloroquine, as opposed to other drug treatment regimens, for a clinical P. falciparum episode up to 30 days previously. It seems likely the hotspots were generated by a vicious circle of ineffective treatment of clinical cases and concomitant gametocyte production in a sub-population characterized by an increased prevalence of all the identified risk factors. While rapid access to treatment with an effective anti-malarial can reduce the duration of gametocyte carriage and onward parasite transmission, localised hotspots represent a challenge to malaria control and eventual eradication.
Vitreous humour extrusion after suxamethonium induction of anaesthesia in a polytraumatized patient: a case report
Authors: Frederick Ebegue Amadasun, Theodore Ojeide Isesele
Journal: Case Rep Med (2010)
MeSH terms: Case Reports

Introduction. Suxamethonium, a deepolarizing muscle relaxant, increases intraocular pressure. It is therefore advised to be avoided in open globe surgery, for fear of extruding ocular contents. Several anecdotal reports support this fear. Some workers however, dispute this claim. There is as yet no formal case report in the literature on the subject. Case Presentation. A 34-year old Nigerian male, was involved in a road traffic accident. He presented at the Accident & Emergency Unit of our hospital about 2 hours after the accident. Clinical examination revealed right corneal laceration (with intact ocular contents) and intra-abdominal visceral injury. Emergency laparotomy was scheduled, to be followed with corneal repair. Anaesthesia was induced with 10 mg midazolam, 100 mg ketamine, and 100 mg suxamethonium given intravenously in sequence. After laparotomy, the ophthalmologists reported for the corneal repair, only to find that the vitreous humour has been extruded. Conclusion. The fear about the use of suxamethonium in open globe situations is real. It will be good clinical judgment to use alternative drugs and techniques to effect rapid muscle relaxation, in the anaesthetic management of the open globe patient. This would be of interest to anaesthetists, ophthalmologists and clinical pharmacologists among others.
Imatinib, a New Adjuvant Medical Treatment for Multifocal Villonodular Synovitis Associated to Noonan Syndrome: A Case Report and Literature Review
Authors: Romain Dalla-Torre, Vincent Crenn, Pierre Menu, Bertrand Isidor, Pascale Guillot, Benoit Le Goff, Loic Geffroy, Marc Dauty, Alban Fouasson-Chailloux
Journal: Front Med (Lausanne) (2022)
Keywords: imatinib, noonan syndrome, case report, joints, multifocal villonodular synovitis
MeSH terms: Case Reports

Noonan syndrome (NS) is an autosomal dominant multisystem disorder caused by the dysregulation of the Rat Sarcoma/Mitogen-activated protein kinase (RAS/MAPK) pathway and characterized by short stature, heart defects, pectus excavatum, webbed neck, learning disabilities, cryptorchidism, and facial dysmorphia. Villonodular synovitis is a joint disorder most common in young adults characterized by an abnormal proliferation of the synovial membrane. Multifocal Villonodular synovitis is a rare disease whose recurrent nature can make its management particularly difficult. Currently, there is no systemic therapy recommended in diffuse and recurrent forms, especially because of the fear of long-term side effects in patients, who are usually young. Yet, tyrosine kinase inhibitors seem promising to reduce the effects of an aberrant colony stimulating factor-1 (CSF-1) production at the origin of the synovial nodule proliferation. We present here the case of a 21-year-old woman with NS associated to diffuse multifocal villonodular synovitis (DMVS). Our clinical case provides therapeutic experience in this very rare association. Indeed, in association with surgery, the patient improved considerably: she had complete daily life autonomy, knee joint amplitudes of 100° in flexion and 0° in extension and was able to walk for 10 min without any technical assistance. To our knowledge, this is the first case of a patient suffering from DMVS associated with a Noonan syndrome treated with Glivec® (oral administration at a dosage of 340 mg/m2 in children, until disease regression) on a long-term basis.
Tracheobronchial Foreign Body Aspiration Diagnosed with Electrical Impedance Tomography
Authors: Robert D Guglielmo, Robinder G Khemani
Journal: Case Rep Pediatr (2021)
MeSH terms: Case Reports

Background:
Foreign body aspiration (FBA) in children has a high morbidity, and early diagnosis is the key for preventing acute and chronic respiratory complications. To diagnose FBA, commonly used imaging modalities have limited negative predictive value, and rigid bronchoscopy remains as the gold standard. We present a case where the diagnosis of FBA was made in a novel way with electrical impedance tomography (EIT). Case Presentation. A 19-month-old previously healthy boy was admitted with a clinical diagnosis of respiratory failure secondary to bronchiolitis. Chest X-ray showed bilateral lung hyperinflation. He enrolled in a research study which used EIT to measure the effects of high flow nasal cannula (HFNC) on minute ventilation in children with bronchiolitis. On initiation, the patient had near-normal right lung ventilation (98%) and near-absent left lung ventilation (2%). We discontinued the study and alerted the medical team that we suspected FBA. Further imaging (lateral decubitus films and lung ultrasounds) was also obtained, but was not diagnostic. Rigid bronchoscopy was performed and showed a peanut occluding the left mainstem bronchus (LMB). The peanut was removed followed by complete resolution of the patient's symptoms.
Conclusions:
We believe this is the first reported case of FBA diagnosed via EIT. EIT has been shown to be a useful but underutilized technology for diagnosing respiratory disease. While FBA remains a relatively common cause of morbidity and mortality in children less than age four, early diagnosis remains difficult and requires vigilance. This case illustrates the challenges of relying on chest films and ultrasound to assist with diagnosis and suggests that EIT in combination with a thorough history and physical exam can be used to confirm the presence of FBA.
Multiply recurrent episodes of gastric emphysema
Authors: Eric M Pauli, Jonathan M Tomasko, Vishal Jain, Charles E Dye, Randy S Haluck
Journal: Case Rep Surg (2011)
MeSH terms: Case Reports

Introduction. Gastric emphysema can present both a diagnostic challenge and a life-threatening condition for patients and has only once been reported as being recurrent. Background. A 64-year-old male presented with chronic abdominal pain and was found to have gastric pneumatosis on CT scan. The patient was successfully managed conservatively. The cause was attributed to aberrant arterial anatomy and atherosclerosis along with hypotension. The patient has since had 3 episodes of recurrent gastric emphysema, all managed nonoperatively. Discussion. To our knowledge, this is the first case of both serial episodes of gastric pneumatosis and gastric mucosal ischemia as a precipitating factor for the development of gastric emphysema.
The shark flap: a modified internal mammary artery perforator flap for composite defects in head and neck reconstruction
Authors: Anna Scarabosio, Alessandro Tel, Filippo Contessi Negrini, Roberta Albanese, Massimo Robiony, Piercamillo Parodi
Journal: Case Reports Plast Surg Hand Surg (2023)
Keywords: composite flap, head and neck reconstruction, imap flap, pedicled flap, shark flap
MeSH terms: Case Reports

This report describes a multi-vector variant of IMAP flap which allows to reconstruct composite head and neck defects. It was named the 'shark flap' because of its shape: a main body (the regular IMAP) and a superior 'fin' based on a randomic vascular pathway.
Case report: Gastric adenosquamous carcinoma with EBV-positive component of squamous cell carcinoma mixed with gastric carcinoma with lymphoid stroma: A novel case report and literature review
Authors: Chang Lu, Jizhen Feng, Zhigang Yao, Lei Shi, Jiamei Li
Journal: Pathol Oncol Res (2023)
Keywords: epstein-barr virus, adenosquamous carcinoma, case report, gastric cancer, gastric carcinoma with lymphoid stroma
MeSH terms: Adenocarcinoma / pathology, Carcinoma, Adenosquamous, Carcinoma, Squamous Cell, Stomach Neoplasms / pathology, Review, Case Reports, Herpesvirus 4, Human, Humans, Male, Middle Aged

Background: Gastric adenosquamous carcinoma with EBV-positive component of squamous cell carcinoma mixed with gastric carcinoma with lymphoid stroma are extremely unusual variants of gastric carcinoma. We herein reported such a case and summarized five related cases that have been reported previously. Case presentation: A 59-year-old man was admitted to our hospital with upper abdominal discomfort and acid reflux. Gastric endoscopic examination revealed an irregular ulcer in the gastric angle. Biopsy of the lesion revealed adenocarcinoma. The patient underwent laparoscopic distal gastrectomy with lymph node dissection subsequently. Histologically, the tumor showed coexistence of GASC and GCLS. SCC and GCLS were positive for EBER in situ hybridization, while adenocarcinoma component was negative. Accordingly, the present case was diagnosed as GASC with EBV-positive component of SCC mixed with GCLS. Conclusion: GASC with EBV-positive component of SCC mixed with GCLS is extremely rare. Although the pathogenesis of GASC and the role of EBV in the development of an ASC component have not been fully elucidated, this case will help clinicians and pathologists better understand this special subtype of gastric tumor.
Wernekink Commissure Syndrome Secondary to Bilateral Caudal Paramedian Midbrain Infarction Presenting with a Unique "Heart or V" Appearance Sign: Case Report and Review of the Literature
Authors: Chenguang Zhou, Yuanhong He, Zhiwen Chao, Yinghui Zhu, Peng Wang, Xingping Wang, Shanshan Liu, Wei Han, Jianping Wang
Journal: Front Neurol (2017)
Keywords: palatal myoclonus, wernekink commissure syndrome, bilateral internuclear ophthalmolegia, caudal paramedian midbrain infarction, hypertrophic olivary degeneration, “heart-shaped” sign
MeSH terms: Case Reports

Wernekink commissure syndrome secondary to caudal paramedian midbrain infarction (CPMI) is a rare midbrain syndrome involving the decussation of the superior cerebellar peduncle in the caudal paramedian midbrain tegmentum. The central characteristics are constant bilateral cerebellar dysfunction, variable eye movement disorders, and rare delayed palatal myoclonus. Following is a description of the case of a 60-year-old man who presented with dizziness, slurred speech, and difficulty walking. Neurological examination revealed bilateral cerebellar dysfunction and bilateral internuclear ophthalmoplegia (bilateral INO). Serial magnetic resonance imaging (MRI) revealed a lesion in the caudal paramedian midbrain with a "heart-shaped" sign on fluid-attenuation inversion recovery images and a "V-shaped" appearance on diffusion-weighted imaging (DWI). An acute CPMI with a "heart or V" appearance sign was diagnosed. Upon follow-up evaluation 3 months later, a palatal tremor accompanied by involuntary head tremor was discovered. Hypertrophy and increased signal of the bilateral inferior olivary nucleus, compatible with hypertropic olivary degeneration (HOD) were revealed during a subsequent MRI study.
Massive hemothorax caused by Gelpi retractor during posterior correction surgery for adolescent idiopathic scoliosis: a case report
Authors: Long Pang, Kota Watanabe, Yoshiaki Toyama, Morio Matsumoto
Journal: Scoliosis (2014)
MeSH terms: Case Reports

Background context:
Gelpi retractors are used in surgery because they can reduce paravertebral muscle damage during retraction. No pleural injuries associated with their use in posterior spine surgery have been reported.
Purpose:
To describe a patient who suffered a massive postoperative hemothorax caused by a Gelpi retractor used during posterior correction surgery for adolescent idiopathic scoliosis (AIS).
Study design:
Case report.
Methods:
A case report of a rare hemothorax complication due to a Gelpi retractor is reported. The relevant literature was reviewed.
Results:
A 12-year-old girl with Lenke type 2 AIS, with curves of 60° at T2-7 and 75° at T7-L1, underwent posterior correction and fusion surgery using a segmental pedicle screw construct placed between T2 and L2. Although the patient's vital signs were stable during and soon after the surgery, a chest x-ray taken one day later revealed a massive left hemothorax. Her hemoglobin concentration was decreased to 5.5g/dl, and SpO2 remained as low as 92% even with oxygen administration. Thoracoscopy revealed subpleural hemorrhaging at several points in the left upper intercostal area (T3-6), and a penetration of the pleura between the left 4th and 5th ribs. Active bleeding had already stopped. The tip of the Gelpi retractor appeared to have penetrated the pleura. A chest tube was placed in the patient to treat the hemothorax.
Conclusions:
A pleural injury by the Gelpi retractor was determined to be the cause of the hemothorax in this case. The patient's prominent thoracic hump may have increased the risk of such an injury because the tip of a Gelpi retractor might easily have become stuck in the intercostal space rather than the paravertebral muscles.
Choriocarcinoma Syndrome as an Initial Presentation of Testicular Cancer
Authors: Carlos Eduardo Salazar-Mejía, María Elena García-Gutiérrez, María Inés Contreras-Salcido, Carlos Javier Rodríguez-Álvarez, Blanca Otilia Wimer-Castillo, Jackeline Grace Lara-Campos, Edio Llerena-Hernández, José Luis González-Vela, David Hernández-Barajas
Journal: Case Rep Oncol Med (2018)
MeSH terms: Case Reports

Choriocarcinoma syndrome (CS) is a rare clinical entity within the spectrum of nonseminomatous germ-cell tumors (NSGCT). It is characterized by the abrupt establishment of rapidly progressive and hemorrhagic tumors associated with very high levels of the beta fraction of human chorionic gonadotropin (β-hCG) and with a very poor prognosis, particularly in patients with β-hCG values above 50,000 IU/L. We present the case of a 17-year-old man with a sudden onset nonmassive hemoptysis. Physical examination revealed a right testicular mass. Imaging studies showed metastatic lung, bone, and retroperitoneal disease. β-hCG serum levels were 222,493.21 IU/L, AFP 1.56 ng/mL, and DHL 457 IU/L. Histopathological study after right radical orchiectomy showed a mixed germ-cell tumor. Based on poor-risk characteristics, chemotherapy was started with an adequate clinical response. Physicians should be aware of the potential complications of CS in the treatment of testicular cancer with high β-hCG levels since they could be associated with a rapidly progressive and high-volume disease. Patients in this category should be referred to the centers experienced in the treatment of advanced germ-cell tumors. Due to the severity of the presentation, hemodynamic monitoring, ideally in an intensive care unit, is essential as well as timely administration of cytotoxic treatment.
Gel-Based Autologous Chondrocyte Implantation in a Patient with Noncontained Osteochondral Knee Defect at 9-Year Follow-Up
Authors: Ujjval Deliwala, Sumit Jain Sethia
Journal: Case Rep Orthop (2022)
MeSH terms: Case Reports

Osteochondritis dissecans (OCD) is a disorder of the subchondral bone affecting the adjacent articular cartilage that may lead to cartilage and bone fragment detachment. It commonly occurs in the knee joint, elbow, wrist, and ankle. Although several surgical concepts have been described to treat OCD (fragment fixation, microfracture, autologous chondrocyte implantation (ACI), and mosaicplasty), no gold standard treatment has been accepted for managing OCD. Multiple factors like age, stability of defect, and defect size should be considered while selecting a specific treatment for OCD. Here, we discuss the case of an 18-year-old patient with horizontal and noncontained OCD. The MRI and CT scan evaluations of condylar notch view showed a defect (23 mm × 19 mm × 8 mm) with ICRS grade IV lateral femoral condyle OCD that was successfully managed by gel-based ACI. After 9 years of ACI, the patient was asymptomatic with full range of motions at the knees. Improvement in visual analog scale score, International Knee Documentation Committee score, and Magnetic Resonance Observation of Cartilage Repair Tissue score was also seen at 9 years post-ACI. No further surgical interventions were needed post-ACI.
Primary squamous cell carcinoma of the urinary bladder presenting as peritoneal carcinomatosis
Authors: Himisha Beltran, Brian D Robinson, Scott T Tagawa
Journal: Adv Urol (2010)
MeSH terms: Case Reports

We report an unusual case of a 78-year-old Caucasian female, who presented with peritoneal carcinomatosis and hypercalcemia, and was found to have a rapidly progressive primary squamous cell carcinoma of the urinary bladder. Squamous cell bladder carcinoma is a rare malignancy in the United States, accounting for just 1-3% of bladder tumors. Interestingly our patient lacked the established risk factors, including exposure to the parasite Schistosoma haematobium, recurrent urinary tract infections, bladder calculi, radiation exposure, chronic indwelling catheter, neurogenic bladder, or tobacco abuse. Although hypercalcemia has been rarely described, an initial presentation of peritioneal carcinomatosis has not been previously reported.
Left-Sided Inferior Vena Cava Encountered During Organ Retrieval Surgery: Report of Two Cases
Authors: Y Rajabnejad, M Aliakbarian, A Rajabnejad, M R Motie
Journal: Int J Organ Transplant Med (2016)
Keywords: anatomic variation, liver, tissue and organ harvesting, transplantation, vena cava, inferior
MeSH terms: Case Reports

Left-sided inferior vena cava (IVC) is the second most common anatomical anomaly of the IVC after duplication. Herein, we present two cases of left-sided IVC, diagnosed during organ retrieval procedure. In a young brain-dead man, a single left-sided IVC was observed; it originated from iliac confluence in the left side of the aorta and extended throughout the abdomen. There was no retrohepatic IVC in the patient; hepatic veins drained directly into the right atrium. The second case was a brain-dead young woman with a left-sided IVC originated from iliac confluence to the kidney level; then, the IVC crossed anterior to the abdominal aorta to join a normally positioned retrohepatic IVC. In cases of retroperitoneal surgeries, IVC anomalies should be considered during preoperative imaging studies, because they may be misdiagnosed as para-aortic lymphadenopathy, tumor or dilated gonadal vein that may result in iatrogenic damage during surgery.