OpenMed/multicare-articles huggingface dataset:
Rare Case of a Well-Differentiated Paratesticular Sarcoma of the Spermatic Cord in a 60-Year-Old Patient
Authors: Marwen Benna, Semia Zarraâ, Asma Belaïd, Aziz Cherif, Lotfi Kochbati, Mohammed Chebil, Farouk Benna
Journal: Case Rep Urol (2017)
MeSH terms: Case Reports

Introduction. Liposarcomas are tumors that occur mostly in the retroperitoneum. Of all liposarcomas only 3 to 7% are found in the paratesticular region. The spermatic cord is the main site of origin in these cases. The patients ages range from 50 to 60 years. This malignant disease can result in a loss of fertility aside from life-threatening sequelae. Case. We present a case of a liposarcoma of the paratesticular region. A 60-year-old man was referred with a painless mass in the scrotum and the right inguinal region. The patient underwent surgery and the mass was removed along with the right testis, the spermatic cord, and the soft tissues to the internal inguinal ring. Histopathological examination found a well-differentiated liposarcoma of 80⁎80 mm. The surgical margins were negative. The adjuvant treatment consisted in radiation therapy of the right inguinoscrotal area to the dose of 54 Gray, 2 Gy per session, 5 times a week. Conclusion. Paratesticular liposarcomas are rare tumors. Surgery with large margin resections was the main treatment in all reported cases. The adjuvant treatment is still unclear especially when the surgical margins are negative. The main factor that indicated this adjuvant treatment was the size of the tumor and the histologic subtype.
Primary peritoneal ectopic pregnancy: A case report
Authors: Hassan M Elbiss, Abeer Al Tahrawi, Fikri M Abu-Zidan
Journal: Int J Surg Case Rep (2023)
Keywords: ectopic pregnancy, laparoscopy, primary peritoneal pregnancy
MeSH terms: Case Reports

Introduction:
Primary peritoneal ectopic pregnancy is a rare condition that can be life-threatening. Herein, we report such a case which was managed by laparoscopy.
Presentation of the case:
A 31-year-old G1P0 woman, who had a history of pelvic infection and primary infertility, presented with lower abdominal pain and mild vaginal spotting. Abdominal and bimanual pelvic examination revealed mild left pelvic tenderness. Her serum β-human chorionic gonadotropin (β-HCG) was 7247 IU. Transvaginal ultrasound demonstrated a mass measuring around 1.5 cm in diameter with a well-defined yolk sac adherent to the left ovary. A left fallopian tube ectopic pregnancy was suspected. Laparoscopy revealed that both fallopian tubes were normal and freely moving. Peritoneal ectopic pregnancy was seen behind the uterus which was removed laparoscopically. Histopathology confirmed the diagnosis. The patient had a smooth postoperative recovery.
Discussion:
Primary peritoneal pregnancy can be life-threatening. A thorough laparoscopic examination of the entire pelvis and abdomen should be done by an experienced surgeon when the location of the suspected ectopic pregnancy could not be identified.
Conclusion:
Diagnostic laparoscopy for ectopic pregnancy should include the whole pelvis and the accessible part of the abdomen when the tubes and ovaries are normal.
Dual prosthetic heart valve presented with chest pain: a case report of coronary thromboembolism
Authors: Supakanya Wongrakpanich, Natanong Thamcharoen, Pakawat Chongsathidkiet, Sarawut Siwamogsatham
Journal: Case Rep Cardiol (2015)

Coronary embolism from a prosthetic heart valve is a rare but remarkable cause of acute coronary syndrome. There is no definite management of an entity like this. Here we report a case of 54-year-old male with a history of rheumatic heart disease with dual prosthetic heart valve and atrial fibrillation who developed chest pain from acute myocardial infarction. The laboratory values showed inadequate anticoagulation. Cardiac catheterization and thrombectomy with the aspiration catheter were chosen to be the treatment for this patient, and it showed satisfactory outcome.
Implementation of lean Six-Sigma project in enhancing health care service quality during COVID-19 pandemic
Authors: Muhammad Mutasim Billah Tufail, Muhammad Shakeel, Faheem Sheikh, Nuzhat Anjum
Journal: AIMS Public Health (2021)
Keywords: covid-19, dmaic, kano model, lss project, lean six sigma, hospital management

The recent outbreak of coronavirus (COVID-19) pandemic has exposed the weakness of the existing healthcare facilities in developing countries, and Pakistan has no exception. The increasing amount of patients has made this condition more vulnerable to failure. It became difficult for health care management to handle the surge of patients. This case study is based on the XYZ hospital system of Pakistan. The hospital initiates passive immunization as a savior in the absence of a vaccine. The process initiates numerous challenges as the same facility was using for passive immunization and routine operations of the hospital. DMAIC lean sig-sigma problem-solving methodology has been adopted to Define, Measure, Analyze, Implement and Control the improvement process for smooth special and routine activities. The staff and patients were interviewed, their issues were listed, and a comprehensive solution was suggested to deal with operational uncertainties. The results identified various factors through VOC and SIPOC processes, prioritized using fishbone diagram, analyzed through Kano model, and finally proposed process improvement by incorporating Kaizen process improvement methodology. Other industries could use this set of tools to evaluate and optimize routine problems, which ultimately enhances the quality and reduces cost.
Minimally invasive treatment of patients with bronchobiliary fistula: a case series
Authors: Unal Aydin, Pinar Yazici, Fatih Tekin, Omer Ozutemiz, Ahmet Coker
Journal: J Med Case Rep (2009)

Introduction:
Bronchobiliary fistula is an uncommon complication secondary to hepatobiliary surgery. Bilioptysis is a pathognomic finding for bronchobiliary fistulas. Diagnosis may be easily established in the light of clinical history, which can be aided by imaging studies to pinpoint the exact location. Some diagnostic procedures such as endoscopic retrograde cholangiopancreatectomy are also useful for treatment.
Case presentation:
We present three Turkish patients with bronchobiliary fistula secondary to previous hepatic surgery due to hydatid cyst in two, a 19-year-old and a 47-year-old man, and iatrogenic trauma of the common bile duct by endoscopy in a 35-year-old man. All of the patients were successfully treated by minimally invasive methods including percutaneous drainage and endoscopic retrograde cholangiopancreatography.
Conclusion:
We suggest that bronchobiliary fistula could be managed through conservative treatment methods which do not require in-hospital follow-up, particularly in uncomplicated cases. Otherwise, surgical management can be unavoidable.
Postrenal Failure due to Urinary Stones Associated with Acute Viral Gastroenteritis: Three Case Reports
Authors: Satoru Kira, Takahiko Mitsui, Hidenori Zakoji, Tadashi Aoki, Norifumi Sawada, Tatsuya Miyamoto, Masayuki Takeda
Journal: Case Rep Urol (2016)

Acute gastroenteritis with viral infection in infants causes severe diarrhea and often results in acute renal failure due to severe dehydration. However, a viral infection, particularly rotavirus, rarely induces postrenal failure due to bilateral stones in infants. Herein, we report three cases of postrenal failure in infants due to bilateral ureteral stones induced by acute gastroenteritis with rotavirus. Following immediately nephrostomy, chemical dissolution therapy succeeded to treat postrenal failure. Immediate nephrostomy for the release of upper urinary tract obstruction combined with urinary alkalization as a chemical dissolution therapy should be considered in such cases.
A case report: Dual-lead deep brain stimulation of the posterior subthalamic area and the thalamus was effective for Holmes tremor after unsuccessful focused ultrasound thalamotomy
Authors: Satoshi Maesawa, Jun Torii, Daisuke Nakatsubo, Hiroshi Noda, Manabu Mutoh, Yoshiki Ito, Tomotaka Ishizaki, Takashi Tsuboi, Masashi Suzuki, Takafumi Tanei, Masahisa Katsuno, Ryuta Saito
Journal: Front Hum Neurosci (2022)
Keywords: holmes tremor, deep brain stimulation, dual-lead, posterior subthalamic area, thalamus
MeSH terms: Case Reports

Holmes tremor is a symptomatic tremor that develops secondary to central nervous system disorders. Stereotactic neuromodulation is considered when the tremors are intractable. Targeting the ventral intermediate nucleus (Vim) is common; however, the outcome is often unsatisfactory, and the posterior subthalamic area (PSA) is expected as alternative target. In this study, we report the case of a patient with intractable Holmes tremor who underwent dual-lead deep brain stimulation (DBS) to stimulate multiple locations in the PSA and thalamus. The patient was a 77-year-old female who complained of severe tremor in her left upper extremity that developed one year after her right thalamic infarction. Vim-thalamotomy using focused ultrasound therapy (FUS) was initially performed but failed to control tremor. Subsequently, we performed DBS using two leads to stimulate four different structures. Accordingly, one lead was implanted with the aim of targeting the ventral oralis nucleus (Vo)/zona incerta (Zi), and the other with the aim of targeting the Vim/prelemniscal radiation (Raprl). Electrode stimulation revealed that Raprl and Zi had obvious effects. Postoperatively, the patient achieved good tremor control without any side effects, which was maintained for two years. Considering that she demonstrated resting, postural, and intention/action tremor, and Vim-thalamotomy by FUS was insufficient for tremor control, complicated pathogenesis was presumed in her symptoms including both the cerebellothalamic and the pallidothalamic pathways. Using the dual-lead DBS technique, we have more choices to adjust the stimulation at multiple sites, where different functional networks are connected. Intractable tremors, such as Holmes tremor, may have complicated pathology, therefore, modulating multiple pathological networks is necessary. We suggest that the dual-lead DBS (Vo/Raprl and Vim/Zi) presented here is safe, technically feasible, and possibly effective for the control of Holmes tremor.
Primary Nasopharyngeal Tuberculosis: A Diagnostic Challenge
Authors: Ahmad-Hazim-Hazlami Ahmad Nizar, Ramiza-Ramza Ramli, Mohd-Najeb Soleh, Ikmal-Hisyam Bakrin
Journal: Iran J Otorhinolaryngol (2023)
Keywords: lymphadenopathy, nasopharyngeal mass, neck mass, tuberculosis
MeSH terms: Case Reports

Introduction:
Primary nasopharyngeal tuberculosis (NPTB) is a rare disease but should not be missed as one of the differential diagnoses for cervical lymphadenopathy or nasopharyngeal mass.
Case report:
We describe a case of a 38 year old lady, who presented with bilateral cervical lymphadenopathy associated with intermittent fever. Nasoendoscopy examination and computed tomography scan of the neck revealed a centrally located mass predominantly at the left posterior nasopharyngeal wall without obliteration of both fossae of Rosenmuller. Typical histopathological features of necrotizing granulomatous lymphadenitis together with the common clinical presentation of cervical lymphadenopathy and nasoendoscopy findings of nasopharyngeal mass conclude the diagnosis of nasopharyngeal tuberculosis. With anti-tuberculous therapy, the cervical lymphadenopathy and nasopharyngeal mass were completely resolved.
Conclusion:
Nasopharyngeal tuberculosis is an uncommon disease with great diagnostic challenges and with early diagnosis and adequate treatment, NPTB carries a good prognosis with complete disease resolution.
Early detected femoral neck insufficiency fracture in a patient treated with long-term bisphosphonate therapy for osteoporosis: A need for MRI
Authors: Yoon Jae Seong, Jong Ki Shin, Won Ro Park
Journal: Int J Surg Case Rep (2020)
Keywords: bisphosphonate, femoral neck, insufficiency fracture, magnetic resonance imaging
MeSH terms: Case Reports

Introduction:
Atypical femoral fracture is an uncommon complication of prolonged use of bisphosphonates, mainly occurring in the femoral shaft. We report a case of an atraumatic insufficiency fracture of femoral neck after four years of treatment with a bisphosphonate.
Presentation of case:
A 71-year-old female presented with history of pain on Lt. hip and difficulty in walking. Although there was no fracture on the radiographs, diagnosis could be made early using magnetic resonance imaging (MRI) scans. She was treated by internal fixation using cannulated screws.
Discussion:
Because bisphosphonate prevents bone healing and remodeling, it is difficult to accomplish the bony union despite of proper treatment in patients who have fractured after long-term use of bisphosphonate.
Conclusion:
A high suspicion index and early diagnosis through the use of MRI are essential for the successful treatment of these fractures.
Jejunal GIST: Hunting down an unusual cause of gastrointestinal bleed using double balloon enteroscopy. A case report
Authors: Diana Mellisa Dualim, Guo Hou Loo, Reynu Rajan, Nik Ritza Kosai Nik Mahmood
Journal: Int J Surg Case Rep (2019)
Keywords: capsule endoscopy, double-balloon enteroscopy, gastrointestinal stromal tumour, laparoscopic, obscure gi bleeding, small bowel bleeding

Introduction:
Gastrointestinal stromal tumours (GISTs) are the most common mesenchymal neoplasms of the alimentary tract but accounts for only 0.1-3% of all gastrointestinal neoplasms. The most common presentation of GISTs is acute or chronic gastrointestinal bleeding, in which the patient presents with symptomatic anaemia.
Presentation of case:
With that in mind, we describe a 66-year-old man who presented with recurrent episodes of obscure gastrointestinal bleeding for two years. Video capsule endoscopy (VCE) showed several small telangiectasias in the proximal small bowel. Oral route double-balloon enteroscopy (DBE) revealed abnormal mucosa 165 cm from incisor with central ulceration and vascular component. He subsequently underwent surgical excision. The histopathological report confirmed the diagnosis of GIST arising from the jejunum. During his clinic follow up, he remains symptom-free with no evidence of recurrence.
Discussion:
The diagnosis of bleeding small intestine GISTs can be challenging as these are inaccessible by conventional endoscopy. Imaging modalities such as double-balloon enteroscopy, capsule endoscopy, CT angiography, intravenous contrast-enhanced multidetector row CT (MDCT) and magnetic resonance enterography (MRE) have been used to assist in the diagnosis of bleeding small intestine GISTs. The mainstay of management for small intestine GIST is complete surgical excision.
Conclusion:
Bleeding jejunal GIST is very rare and only a handful of case reports have been published. The mainstay of management for small intestine GIST is complete surgical excision. It is essential to obtain a complete excision of localised disease and avoiding tumour spillage in order to reduce the risk of local recurrence and metastatic spread of GISTs.
Transradial approach for the endovascular treatment of type I endoleak after aortic aneurysm repair: a case report
Authors: Gabriele Giacomo Schiattarella, Fabio Magliulo, Flora Ilaria Laurino, Roberta Bottino, Antonio Giulio Bruno, Michele De Paulis, Antonio Sorropago, Cinzia Perrino, Bruno Amato, Dario Leosco, Bruno Trimarco, Giovanni Esposito
Journal: BMC Surg (2013)
MeSH terms: Aortic Aneurysm, Abdominal / surgery, Endoleak / surgery, Endovascular Procedures / methods, Case Reports, Aged, 80 and over, Endoleak / classification, Humans, Male, Radial Artery

Background:
Endovascular repair of aortic aneurysms (EVAR) is obtained through the positioning of an aortic stent-graft, which excludes the aneurysmatic dilation. Type I endoleak is the most common complication, and it is caused by an incompetent proximal or distal attachment site, causing the separation between the stent-graft and the native arterial wall, and in turn creating direct communication between the aneurysm sac and the systemic arterial circulation. Endoleak occurrence is associated with high intrasac pressures, and requires a quick repair to prevent abdominal aortic aneurysm rupture.
Case presentation:
We report the first case of a 80-year-old man undergoing percutaneous closure of a peri-graft endoleak (type I) by transcatheter embolization through radial arterial access.
Conclusion:
The transradial approach has been shown to be a safe and effective alternative to the traditional transfemoral approach. A decrease in vascular complications and improved patient comfort are the primary benefits of this technique in patients with previous EVAR.
A pain in the buttock
Authors: Zachary C Landman, Shannon Beres, Michael D Cabana
Journal: Case Rep Pediatr (2011)
MeSH terms: Case Reports

Spondylolysis, a fracture of the pars interarticularis, is a common source back pain in children and adolescents. While the incidence is significantly higher in Asian and Inuit populations, it is never seen in nonambulatory children and is most commonly associated with athletic activities that involve extension or rotational deformity about the spine suggesting a functional component. Given that the associated pain is typically insidious in onset, lacks preceding trauma, and is accompanied by muscular spasm, prompt diagnosis requires a high index of suspicion, familiarity with provocative testing, and knowledge of the appropriate radiographic evaluation. Treatment requires cessation of athletic activity, bracing, and rest for a minimum of four to six weeks, or until symptomatic and radiographic resolution.
Pigmented (melanotic) diffuse neurofibroma of the back in neurofibromatosis type 1
Authors: Reinhard E Friedrich, Christian Hagel
Journal: GMS Interdiscip Plast Reconstr Surg DGPW (2018)
Keywords: diffuse neurofibroma, melanotic neurofibroma, neurofibromatosis type 1, pigmented neurofibroma
MeSH terms: Case Reports

Neurofibromatosis type 1 (NF1) is a tumor predisposition disease. Multiple neurofibromas are among the characteristic tumors of NF1. The report describes the diagnosis and treatment of a large spinal neurofibroma in a NF1 patient. The tumor showed a striking pigmentation and was diagnosed as pigmented (melanotic) neurofibroma. The distinction between this rare tumor variant and other pigmented tumors, especially malignant melanoma, is of primary importance.
Nine year follow-up of a rare case of angioedema due to acquired C1-inhibitor deficiency with late onset and good response to attenuated androgen
Authors: Polliana Mihaela Leru, Vlad Florin Anton, Horia Bumbea
Journal: Allergy Asthma Clin Immunol (2018)
Keywords: acquired angioedema, attenuated androgens, c1 inhibitor deficiency
MeSH terms: Case Reports

Background:
Angioedema due to acquired deficiency of C1-inhibitor (C1-INH-AAE) is a rare disease sharing some clinical and laboratory similarities with hereditary angioedema, but with late onset and no positive family history. The underlining cause may be malignant or due to autoimmune diseases, but some cases remain idiopathic.
Case presentation:
We report a case of a 75 year old woman suffering from recurrent episodes of angioedema since the age of 66, considered first induced by treatment with angiotensin-converting-enzyme inhibitors (ACEI). She continued to have angioedema attacks during 6 years after discontinuation of ACEI, until evaluation in our clinic in 2014, when C1 inhibitor esterase (C1-INH) deficiency was confirmed. The extended medical evaluation for inflammatory, allergic, autoimmune and neoplasic diseases was negative. C1-INH and complement fraction C4 plasma levels were significantly decreased at all measurements, but no diagnostic criteria for diseases known to induce C1-INH deficiency could be found. We first initiated daily prophylactic treatment with tranexamic acid, with no amelioration after 3 months. During the last and most severe attack, with the first facial and laryngeal edema, we have switched to attenuated androgen danazol. The evolution was very good, with prompt remission of angioedema and significant increase of C1-INH and C4 plasma levels after 2 weeks of daily danazol use. She completed 3 years of continuous treatment with low daily maintenance dose of danazol (ongoing), with no angioedema attack. We closely monitored C1-INH and C4 plasma levels, possible danazol side effects and any signs suggesting late onset of C1-INH deficiency causal disease.
Conclusion:
We reported a particular case of rare angioedema due to acquired deficiency of C1-inhibitor, which has no clear cause after long follow-up, but good response to attenuated androgen. We concluded that the awareness of angioedema due to C1-INH deficiency should be increased within medical community and therapeutic options should be more clearly indicated and available for all diagnosed cases.
Traumatic pseudoaneurysm following ankle trauma
Authors: M C A M Melenhorst, K van der Mooren, R C van Nieuwenhuizen, A F J Wüst
Journal: BJR Case Rep (2015)
MeSH terms: Case Reports

False aneurysms following inversion trauma of the ankle are very uncommon. We present a case of a 40-year-old male referred to our radiology department with persisting and painful swelling of the ankle following an inversion trauma. An MRI scan was performed that showed a false aneurysm originating from a distal anterior tibial artery side branch; the lateral malleolar artery. The false aneurysm was confirmed with ultrasound and successfully treated with ultrasoundguided thrombin injection. The patient made an uneventful recovery.
Case Report: Metreleptin Treatment in a Patient With a Novel Mutation for Familial Partial Lipodystrophy Type 3, Presenting With Uncontrolled Diabetes and Insulin Resistance
Authors: Vaia Lambadiari, Aikaterini Kountouri, Eirini Maratou, Stavros Liatis, George D Dimitriadis, Fredrik Karpe
Journal: Front Endocrinol (Lausanne) (2021)
Keywords: pparg, case report, diabetes mellitus, familial partial lipodystrophy, hypertriglyceridemia, insulin resistance, metreleptin
MeSH terms: Leptin / analogs & derivatives, Lipodystrophy, Familial Partial / drug therapy, Case Reports, Diabetes Mellitus, Type 1, Diagnostic Errors, Female, Glycated Hemoglobin / analysis, Humans, Insulin Resistance, Leptin / blood, Leptin / therapeutic use, Lipodystrophy, Familial Partial / blood, Lipodystrophy, Familial Partial / genetics, Lipodystrophy, Familial Partial / pathology, Liver / drug effects, Liver / pathology, Middle Aged, Mutation, Triglycerides / blood, Glycated Hemoglobin A, Leptin, Triglycerides, hemoglobin A1c protein, human, metreleptin

Background:
Familial partial lipodystrophy type 3 (FPLD3) is a very rare autosomal dominant genetic disorder which is caused by mutations in the peroxisome proliferator activated receptor gamma (PPARG) gene. It is characterized by a partial loss of adipose tissue leading to subnormal leptin secretion and metabolic complications. Metreleptin, a synthetic analogue of human leptin, is an effective treatment for generalized lipodystrophies, but the evidence for efficacy in patients with FPLD3 is scarce.
Case presentation:
We present a 61-year-old woman, initially misdiagnosed as type 1 diabetes since the age of 29, with severe insulin resistance, who gradually displayed a more generalized form of lipoatrophy and extreme hypertriglyceridemia, hypertension and multiple manifestations of cardiovascular disease. She was found to carry a novel mutation leading to PPARGGlu157Gly variant. After six months of metreleptin treatment, HbA1c decreased from 10 to 7.9% and fasting plasma triglycerides were dramatically reduced from 2.919 mg/dl to 198 mg/dl.
Conclusions:
This case highlights the importance of early recognition of FPLD syndromes otherwise frequently observed as difficult-to-classify and manages diabetes cases, in order to prevent cardiovascular complications. Metreleptin may be an effective treatment for FPLD3.