OpenMed/multicare-articles huggingface dataset:
Upward spontaneous migration of ventriculoperitoneal shunt into the heart: A case report summary
Authors: Shamsi Ghaffari, Khosro Hashemzadeh, Mahmood Samadi, Akbar Molaei, Sahar Sadeghi, Ahmad Jamei Khosroshahi
Journal: J Cardiovasc Thorac Res (2022)
Keywords: hydrocephalus, mediastinum, shunt migration, ventriculoperitoneal
MeSH terms: Case Reports

A male infant with a history of ventriculoperitoneal (VP) implantation due to congenital hydrocephalus presented with fever and lethargy at the age of 8 month-old. Pericardial effusion was detected in transthoracic echocardiography, and he underwent pericardial window operation and was discharged in a stable condition. At 11 months of age, he presented again with fever, lethargy, recurrent vomiting, and respiratory distress. In both plain chest radiography and transthoracic echocardiography, VP shunt migration to the heart cavity was observed. The VP shunt had entered into the right ventricle after perforating the diaphragm and pericardium. The patient underwent open-heart surgery due to vegetation at the tip of the VP shunt inside the right heart. Vegetation was removed and the tip of the shunt was returned to the peritoneal cavity. Two weeks after discharge, the patient presented again with symptoms of tachypnea and lethargy. The imaging revealed the entry of the VP shunt about two centimeters into the anterior mediastinum. The patient was transferred to the operation room and the VP shunt was shortened and re-inserted into the peritoneal cavity. Antibiotic treatment was continued for six weeks and the patient was discharged in stable condition. In follow-up visits after two years, the VP shunt functioned well and no particular complication was observed. This case demonstrates that in patients with VP shunt implantation presenting with pulmonary and cardiac symptoms such as respiratory distress, pericardial effusion, and cardiac tamponade after VP shunt implantation, the possibility of VP shunt catheter migration to the mediastinal cavity should be considered.
Applying results from clinical trials: tranexamic acid in trauma patients
Authors: Ian Roberts, David Prieto-Merino
Journal: J Intensive Care (2014)
Keywords: clinical trials, evidence-based medicine, generalizability, tranexamic acid, trauma
MeSH terms: Review

This paper considers how results from clinical trials should be applied in the care of patients, using the results of the Clinical Randomisation of an Antifibrinolytic in Significant Haemorrhage (CRASH-2) trial of tranexamic acid in bleeding trauma patients as a case study. We explain why an understanding of the mechanisms of action of the trial treatment, and insight into the factors that might be relevant to this mechanism, is critical in order to properly apply (generalise) trial results and why it is not necessary that the trial population is representative of the population in which the medicine will be used. We explain why cause (mechanism)-specific mortality is more generalizable than all-cause mortality and why the risk ratio is the generalizable measure of the effect of the treatment. Overall, we argue that a biological insight into how the treatment works is more relevant when applying research results to patient care than the application of statistical reasoning.
Focal Segmental Glomerulosclerosis and Scheduled Pretransplant Plasmapheresis: A Timely Diagnosis of Nail-Patella Syndrome Avoided More Futile Immunosuppression
Authors: H Trimarchi
Journal: Case Rep Nephrol (2020)
MeSH terms: Case Reports

Focal and segmental glomerulosclerosis (FSGS) is a histopathological pattern of injury. As such, it encompasses a wide variety of dissimilar entities with different pathophysiologic mechanisms. Although ultrastructural morphological characteristics can specifically diagnose certain diseases and genetic mutations can also be unravelled, this ideal situation is generally not available worldwide. In this respect, when proteinuria with or without nephrotic syndrome is encountered and FSGS is the histological lesion, patients start to be prescribed different regimes of immunosuppression, which should only be indicated in cases of primary FSGS, a rare entity that is elusive to response and can hardly be precisely diagnosed. We present a 35-year-old female patient with a life-long diagnosis of FSGS and a heavy burden of immunosuppressants, which had been unable to manage the persistent proteinuria that eventually led to end-stage kidney disease. She was referred to us to organize the kidney transplant. Plasmapheresis had been previously suggested to her to prevent the relapse of primary FSGS. A genetic test disclosed that the patient was heterozygous for LMX1B, and the diagnosis of nail-patella syndrome was made. In this entity, immunosuppression is not indicated, and there is no recurrence of the disease in the transplanted allograft.
Arthroscopic subtalar arthrodesis after a calcaneus fracture covered with a forearm flap
Authors: Frederick Michels, Filip Stockmans, Stéphane Guillo, Jan Van Der Bauwhede, Dirk Oosterlinck
Journal: Minim Invasive Surg (2011)
MeSH terms: Case Reports

Surgical treatment of intraarticular calcaneal fractures is often associated with postoperative wound problems. Soft tissue necrosis, bone loss and uncontrollable infection are a challenge for the surgeon and amputation may in some cases be the ultimate solution. A free flap can be very helpful to cover a significant soft tissue defect and help in fighting the infection. However, the free flap complicates the surgical approach if subtalar arthrodesis and bone reconstruction are needed. This study demonstrates the value of an arthroscopic technique to resect the remaining articular cartilage in preparation for subtalar arthrodesis and bone grafting. This approach avoids compromising the soft tissues and minimizes damage to the free flap.
Clinically Amyopathic Dermatomyositis Caused by a Tattoo
Authors: Bing Han, Qiang Guo
Journal: Case Rep Rheumatol (2018)
MeSH terms: Case Reports

Introduction:
Clinically amyopathic dermatomyositis (CADM) is a rare disease with unknown origin. It is characterized by the specific skin lesions of dermatomyositis (DM) without clinical or laboratory evidence of myopathy. Previous studies indicated that tattoo may induce immune response.
Case report:
A 22-year-old male who tattooed butterfly on the left chest with blue and red ink. Then, he gradually had typical Gottron rash and interstitial lung disease (ILD) without weakness of the muscle. The clinical presentation and laboratory test represent the diagnosis of CADM. According to the history, CADM was induced by the tattoo five months before admission.
Discussion:
We first reported the CADM induced by a tattoo. However, further studies are still needed to approach the specific substances within the tattoo that trigger immune response.
Rapid cognitive improvement in Alzheimer's disease following perispinal etanercept administration
Authors: Edward L Tobinick, Hyman Gross
Journal: J Neuroinflammation (2008)
MeSH terms: Alzheimer Disease / drug therapy, Alzheimer Disease / psychology, Cognition / drug effects, Immunoglobulin G / administration & dosage, Receptors, Tumor Necrosis Factor / administration & dosage, Tumor Necrosis Factor-alpha / antagonists & inhibitors, Case Reports, Aged, 80 and over, Etanercept, Humans, Immunoglobulin G / therapeutic use, Injections, Spinal, Male, Receptors, Tumor Necrosis Factor / therapeutic use, Time Factors, Treatment Outcome, Immunoglobulin G, Receptors, Tumor Necrosis Factor, Tumor Necrosis Factor-alpha, Etanercept

Substantial basic science and clinical evidence suggests that excess tumor necrosis factor-alpha (TNF-alpha) is centrally involved in the pathogenesis of Alzheimer's disease. In addition to its pro-inflammatory functions, TNF-alpha has recently been recognized to be a gliotransmitter that regulates synaptic function in neural networks. TNF-alpha has also recently been shown to mediate the disruption in synaptic memory mechanisms, which is caused by beta-amyloid and beta-amyloid oligomers. The efficacy of etanercept, a biologic antagonist of TNF-alpha, delivered by perispinal administration, for treatment of Alzheimer's disease over a period of six months has been previously reported in a pilot study. This report details rapid cognitive improvement, beginning within minutes, using this same anti-TNF treatment modality, in a patient with late-onset Alzheimer's disease. Rapid cognitive improvement following perispinal etanercept may be related to amelioration of the effects of excess TNF-alpha on synaptic mechanisms in Alzheimer's disease and provides a promising area for additional investigation and therapeutic intervention.
Treatment of anterior corneal scarring, following DSAEK graft failure, with combined graft exchange and phototherapeutic keratectomy
Authors: George Kymionis, Konstantinos Oikonomakis, Myrsini Petrelli, Konstantinos Andreanos, Andreas Mouchtouris, Ilias Georgalas
Journal: Eye Vis (Lond) (2017)
Keywords: anterior corneal scar, dsaek failure, graft exchange, phototherapeutic keratectomy
MeSH terms: Case Reports

Background:
To present a method, alternative to penetrating keratoplasty, for the restoration of impaired corneal clarity with anterior stromal scarring following long-standing corneal graft failure.
Case presentation:
A 48-year old female who had previously underwent Descemet stripping automated endothelial keratoplasty (DSAEK) for the treatment of pseudophakic bullous keratopathy, presented with long-standing corneal oedema and anterior corneal scarring. A significant improvement in corrected distance visual acuity was demonstrated, as corneal clarity was restored following graft exchange and phototherapeutic keratectomy (PTK).
Conclusions:
The combination of corneal graft exchange and phototherapeutic keratectomy may represent an effective therapeutic option for long-standing corneal oedema with concomitant anterior corneal scarring after failure of a DSAEK graft.
Serpentine Supravenous Hyperpigmentation in an HIV Patient Receiving R-CHOP for DLBCL
Authors: Guido Lancman, Amir Steinberg, Janice Gabrilove
Journal: Int J Hematol Oncol Stem Cell Res (2018)
Keywords: chemotherapy, dlbcl, r- chop, ssh, serpentine supravenous hyperpigmentation
MeSH terms: Case Reports

Serpentine supravenous hyperpigmentation (SSH) is a rare vasculo-cutaneous entity that has been associated with peripheral infusion of chemotherapy agents, in particular 5-FU1-3, but also seen with docetaxel4,5, fotemustine6, and vinorelbine7. It consists of a marked hyperpigmentation along the superficial network of veins proximal to the chemotherapy infusion site and was originally described in a 1976 case report in association with 5-FU1. Here, for the first time, we report SSH in association with R-CHOP chemotherapy.
Benign Metastasizing Leiomyoma of the Uterus: Rare Manifestation of a Frequent Pathology
Authors: Maria Inês Raposo, Catarina Meireles, Mariana Cardoso, Mariana Ormonde, Cristina Ramalho, Mónica Pires, Mariana Afonso, Almerinda Petiz
Journal: Case Rep Obstet Gynecol (2018)
MeSH terms: Case Reports

Benign Metastasizing Leiomyoma (BML) is a rare condition with few cases reported in the literature. It is usually incidentally diagnosed several years after a primary gynecological surgery for uterine leiomyoma. Differential diagnosis of BML is complex requiring an extensive work-up and exclusion of malignancy. Here, we report two cases of BML based on similarity of histopathological, immunohistochemical, and genetic patterns between lung nodules and uterine leiomyoma previously resected, evidencing the variability of clinical and radiological features of BML. We highlight the importance of 19q and 22q deletions as highly suggestive of BML. These findings are particularly relevant when there is no uterine sample for review.
Case Report: Endothelial Glycocalyx Damage in Critically ill Patients With SARS-CoV-2-Related Multisystem Inflammatory Syndrome (MIS-C)
Authors: Jaime Fernández-Sarmiento, Steffanie Flórez, Laura C Alarcón-Forero, Lina María Salazar-Peláez, Julio Garcia-Casallas, Hernando Mulett, Lorena Acevedo, Carolina Salamanca
Journal: Front Pediatr (2021)
Keywords: covid-19, pims-ts, children, coronary aneurysm, inflammatory
MeSH terms: Case Reports

Endothelial insult and damage is one of the reported consequences of SARS-CoV-2 infection. It has been associated with severe inflammation, thrombotic phenomena and profound hypoxemia in critically ill patients. Endothelial activation leads to a loss of the endothelium's antithrombotic properties which, under normal conditions, are maintained by the endothelial glycocalyx, a carbohydrate-rich layer that covers the luminal surface of endothelial cells. In children, one of the serious forms of SARS-CoV-2 virus disease (COVID-19) is multisystem inflammatory syndrome (MIS-C). This new disease is characterized by a large inflammatory response and frequent cardiovascular, cutaneous and gastrointestinal disorders. We describe the first two cases of critically ill children with MIS-C who evidenced a large inflammatory response associated with elevated plasma and imaging biomarkers of endothelial activation and endothelial glycocalyx degradation. This microcirculation involvement in MIS-C could, at least partially, explain some of the clinical manifestations and laboratory and imaging alterations found in these patients. These findings contribute to a better understanding of this disease and suggest that medications to modulate the inflammatory response and protect or restore the endothelial glycocalyx should be considered in future studies.
Non-fluent/Agrammatic Variant of Primary Progressive Aphasia With Generalized Auditory Agnosia
Authors: Hiroyuki Watanabe, Manabu Ikeda, Etsuro Mori
Journal: Front Neurol (2020)
Keywords: agrammatism, amusia, apraxia of speech, environmental sound agnosia, word deafness
MeSH terms: Case Reports

Cortical neurodegeneration-induced non-fluent/agrammatic variant of primary progressive aphasia (nfvPPA) is a clinical syndrome characterized by non-fluent speech, such as apraxia of speech or agrammatism. We describe the case of an 80-year-old right-handed woman who exhibited nfvPPA. Atypically, our patient also presented with generalized auditory agnosia. Brain magnetic resonance imaging revealed left-sided predominant atrophy of the bilateral perisylvian area, including the inferior frontal and superior temporal lobes. In a series of auditory tasks assessing generalized auditory agnosia, our patient was unable to accurately identify verbal sounds, environmental sounds, or familiar Japanese songs that she could sing. In the context of recent studies, our study indicates the existence of a clinical syndrome characterized by progressive speech disorder with auditory agnosia. This case report thus provides novel insights into the spectrum of language impairment induced by neurodegenerative disease.
Rapid progression of subcutaneous glioblastoma: A case report and literature review
Authors: Fang Wang, Jiawei Dong, Jiheng Zhang, Hongtao Zhao, Nan Wang, Jiaqi Jin, Xiuwei Yan, Xin Gao, Han Liu, Shaoshan Hu
Journal: Front Oncol (2023)
Keywords: case report, extracranial metastasis, glioblastoma, invade, scalp
MeSH terms: Case Reports

Extra-neural spread of glioblastoma (GBM) is extremely rare. We report a case of postoperative intracranial GBM spreading to the subcutaneous tissue via the channel of craniotomy defect in a 73-year-old woman. Radiological images and histopathology indicate that the tumor microenvironment of the subcutaneous tumor is clearly different from the intracranial tumor. We also model the invasion of GBM cells through the dura-skull defect in mouse. The retrospective analysis of GBM with scalp metastases suggests that craniectomy is a direct cause of subcutaneous metastasis in patients with GBM. Imaging examinations of other sites for systemic screening is also recommended to look for metastases outside the brain when GBM invades the scalp or metastasizes to it.
Primitive Neuroectodermal Tumor and Wegener's Granulomatosis of the Kidney: A Curious Combination of Two Rare Entities
Authors: Rugvedita Parakh, Satyajeet Parakh, Maria Tretiakova
Journal: Case Rep Urol (2017)
MeSH terms: Case Reports

Wegener's granulomatosis (WG) is characterized by necrotizing polyangiitis involving the respiratory tract and kidneys. It causes segmental necrotizing glomerulonephritis in the kidneys. In rare cases, a renal pseudotumor may be seen because of the granulomatous process. Association of WG with renal malignancy, however, is very uncommon. We report a case of a patient who presented several years after being treated for WG with malignant hypertension and an infiltrating mass in the right kidney. The histopathology of radical nephrectomy specimen showed presence of primitive neuroectodermal tumor (PNET). Association of renal cell carcinoma (RCC) with WG has been documented in a few cases, but PNET in such circumstances has not been reported. Long-term immunosuppressive treatment is a known risk factor in the development of malignancies, so it is proposed that the occurrence of RCC in WG may have been a side effect of cyclophosphamide treatment. It is not clear whether the same mechanism for PNET holds true in the present case. It is important to make a differential diagnosis between true malignancy and pseudotumors in WG as these entities cannot be distinguished based solely on imaging. We suggest a need to routinely screen the WG patients for increased risk of urologic malignancies.
Clinicopathological features of combined hepatocellular-cholangiocarcinoma with sarcomatous change: Case report and literature review
Authors: Qianru Gu, Xia Yu, Hanbin Chen, Guorong Chen
Journal: Medicine (Baltimore) (2018)
MeSH terms: Bile Duct Neoplasms / pathology, Carcinoma, Hepatocellular / pathology, Cholangiocarcinoma / pathology, Liver Neoplasms / pathology, Neoplasms, Multiple Primary / pathology, Case Reports, Review, Adult, Humans, Male, Middle Aged

Rationale:
Combined hepatocellular-cholangiocarcinoma (cHCC-CC) is a rare subtype of primary liver malignancy comprising <1.5% of all primary liver tumors. Sarcomatoid changes in cHCC-CC are even rarer. Due to the rarity of this subtype, its clinicopathological feature is poorly understood. Therefore, here we report 2 tumors.
Patient concerns:
The first patient was a 44-year-old man with 5-year history of hepatitis B-induced cirrhosis. The resection of right liver revealed a 2.5 × 2.5 × 2 cm tumor mass. Histologically, the tumor showed areas of the typical moderately differentiated HCC. An intermingled adenocarcinoma with pleomorphic and spindle-shaped cells was also identified. The second case involved a 54-year-old man with a history of hepatitis B-induced cirrhosis. A 3.5 × 3 × 3 cm mass was found in the middle left of falciform ligament. Microscopically, the tumor consisted of spindle-shaped sarcomatoid carcinoma cells mixed with typical well-differentiated HCC and well-differentiated CC.
Diagnoses:
According to the clinicopathological features, diagnosis of cHCC-CC with sarcomatous change was made.
Interventions:
In the first case, right lobectomy of the liver was performed. The second patient underwent laparoscopic, hepatic left lateral lobectomy.
Outcomes:
The first patient was alive and well 10 years after the surgical resection without additional treatment. In second case, at 8 months after surgical resection, there was no evidence of recurrence or metastasis.
Lessons:
In this report, we describe 2 rare cases of cHCC-CC with sarcomatous change, and findings are helpful for the pathologists would like to further identify the clinicopathological features of this rare tumor.
Isolated ectopic cilia in an 11-year-old girl
Authors: Hosny Ahmed Zein, M Tarek A Moustafa
Journal: GMS Ophthalmol Cases (2016)
Keywords: cilia, eyelids, pathology
MeSH terms: Case Reports

Ectopic cilia (EC) are a very rare condition with only few cases reported in literature. Many associations were seen with ectopic cilia which include distichiasis, choristoma and aberrant lacrimal gland, hypochromic nevus, atopic eczema and others. We are reporting a case of an 11-year-old girl with isolated left upper lid ectopic cilia, which was confirmed by surgical removal and histopathological study.
A pediatric case report of Epiploic appendagitis presented with abdominal pain
Authors: Ohoud Baajlan, Hotoun Bokhari, Khalid AlGhamdi, Mazen Zidan
Journal: Int J Surg Case Rep (2020)
Keywords: appendicitis, case report, computed tomography, epiploic appendagitis
MeSH terms: Case Reports

Introduction:
Epilopic appendagitis (EA) is an uncommon condition of abdominal pain caused by the local inflammation of the fat-filled peritoneal outpouchings due to torsion or thrombosis of its vessels leads to ischemia and gangrenous necrosis of the aappendages, as it can cause peritoneal irritation, acute ischemia, and fat necrosis.
Case report:
We present a case of epilopic appendagitis mimicking appendicitis of a 10 years old male, presented to the emergency department with severe right quadrant pain pointedly at the right lumbar area. Associated with constipation and nausea for once. Computed tomography (CT) scan with contrast was performed showing an ovoid fat structure with thin enhancing rim and surrounding inflammatory stranding as well as prominent lymph nodes at hepatic flexure, free fluid and no evidence of appendicitis. The patient was discharged with pain control medications.
Discussion:
Epiploic Appendages are mobile, pedunculated peritoneal out pouches. Considering its mobility and narrow pedicle appendages are disposed to torsion leading to appendagitis causing local inflammation, peritoneal irritation, acute ischemia, and fat necrosis. The patient's main complaint would be a subacute lower abdominal pain, left-sided in 60-80% of cases.
Conclusion:
Early recognition of this condition is crucial to avoid an operation when unnecessary leading to prolonged hospital stays. The management is conservative with analgesic.
Clear cell sarcoma of tendons and aponeuroses of the parapharyngeal space: an unusual localization of a rare tumor (a case report and review of the literature)
Authors: Aissa Abdellah, Berhili Soufiane, Bazine Amine, El Majjaoui Sanaa, Elkacemi Hanan, Kharbaoui Ijlal, Latib Rachida, El Khannoussi Basma, Kebdani Tayeb, Benjaafar Noureddine
Journal: Pan Afr Med J (2014)
Keywords: clear cell, parapharyngeal space, rare, sarcoma
MeSH terms: Pharyngeal Neoplasms / pathology, Sarcoma, Clear Cell / pathology, Soft Tissue Neoplasms / pathology, Case Reports, Review, Humans, Male, Middle Aged, Tendons / pathology

The clear cell sarcoma of tendons and aponeuroses (CCSTA) is a rare soft tissue sarcoma in the head and neck region and parapharyngeal space. Over 95% of CCSTAs present in the extremities, with the head and neck region (1.9%) being an unusual site. This study presents an additional case of CCSTA of the head and neck region involving the parapharyngeal space in a 48-year-old men and review of the literature on CCSTA.