OpenMed/multicare-articles huggingface dataset:
Extraction of terminal ileal lipomas to cecum can facilitate endoscopic resection: A case series with video
Authors: Hiroshi Yamazaki, Yohei Minato, Deepak Madhu, Toshifumi Iida, Susumu Banjyoya, Tomoya Kimura, Koichi Furuta, Shinya Nagae, Yohei Itou, Nao Takeuchi, Shunya Takayanagi, Yoshiaki Kimoto, Yuki Kano, Takashi Sakuno, Kohei Ono, Ken Ohata
Journal: DEN Open (2024)
Keywords: endoscopic mucosal resection, endoscopic submucosal dissection, lipoma, submucosal tumor, traction

Large ileal lipomas over 2 cm can cause symptoms, that may require a resection. Due to the narrow lumen and thin walls of the ileum, endoscopic treatments can have a high risk of adverse events and require technical expertise, thus surgical resection is currently the mainstay of treatment. To overcome the technical challenges, we developed a novel method to endoscopically resect terminal ileal lipomas. The technique involves extracting the lesion into the cecum, which creates sufficient space to maneuver, and a better field of view. The lipoma is resected with endoscopic mucosal resection or endoscopic submucosal dissection. The appearance of the lipoma protruding out of the ileocecal valve resembles that of a tongue sticking out of the mouth, thus we named this the "tongue out technique". To assess the technical feasibility of this method, we retrospectively analyzed seven cases of terminal ileal lipoma that were endoscopically resected using the "tongue out technique" at NTT Medical Center Tokyo between January 2017 and October 2023. Technical success was 100% and en bloc resection was achieved in all cases. The median size was 31 (14-55) mm. Three cases were resected with endoscopic mucosal resection while endoscopic submucosal dissection was performed on the other four cases. There was one case of delayed post-endoscopic mucosal resection bleeding, which was caused by clip dislodgement. There were no perforations. No recurrence of the lipoma or associated symptoms have been observed. This new technique can allow more ileal lipomas to be treated with minimally invasive and organ-preserving endoscopic procedures.
Oncocytic Papillary Cystadenoma: A Case of a Misdiagnosed Laryngeal Mass
Authors: Eftychia Kanioura, Dimitra Riga, Spyridon Potamianos, Georgia Kafiri
Journal: Cureus (2024)
Keywords: cyst, cystadenoma, laryngeal disease, laryngeal neoplasms, larynx, otorhinolaryngologic neoplasm, vocal cords
MeSH terms: Case Reports

Cystadenomas are benign neoplasms found in major and minor salivary glands. In cases where both oncocytic cells and papillary architecture, without a lymphoid component, exist, the lesion is called oncocytic papillary cystadenoma (OPC). OPCs are rarely encountered in the laryngeal region and that is why they are usually misdiagnosed as other types of laryngeal tumors. Hereby, we present a case of a misdiagnosed laryngeal OPC in an attempt to raise awareness of this rare entity, both for the surgeon performing the excision of the laryngeal mass and for the pathologists examining the specimen.
Serotonin syndrome caused by a CYP2C19-mediated interaction between low-dose escitalopram and clopidogrel: a case report
Authors: Jianhong Wu, Jiao Yu, Kankan Qu, Jiajun Yin, Chunming Zhu, Xiaowei Liu
Journal: Front Psychiatry (2023)
Keywords: cyp2c19, case report, clopidogrel, escitalopram, serotonin syndrome
MeSH terms: Case Reports

Background:
Serotonin syndrome has been recognized as a serious adverse reaction to antidepressants and is characterized by sudden or severe autonomic nerve dysfunction and neuromuscular symptoms. Without an accurate diagnosis and prompt treatment, serotonin syndrome progresses rapidly and can be life-threatening. It is usually related to the dose of 5-hydroxytryptamine drugs, and the dose is the basis for diagnosis. Therefore, serotonin syndrome induced by low-dose antidepressants rarely occurs, and clinicians are more likely to misdiagnose patients who take low-dose antidepressants with similar symptoms. Here, we present a case study of serotonin syndrome caused by a relatively low dose of escitalopram, which is not common in past references.
Case summary:
The patient was a 74-year-old Asian woman with a 42-year history of schizophrenia. After 6 weeks of antidepressant treatment, our patient presented with characteristic myoclonus in the lower limbs and closed eyes with fluttering. Initially, she was misdiagnosed with neuroleptic malignant syndrome (NMS) due to antipsychotic medication and was treated accordingly, even with discontinuation of clozapine. However, her symptoms persisted, and then therapeutic drug monitoring was initiated with the involvement of a clinical pharmacist. Eventually, she was diagnosed with serotonin syndrome due to escitalopram levels reaching the warning level. Subsequently, the patient's treatment was modified, and her clinical outcome was satisfactory without any other serious adverse reactions. Gene detection was also performed, and a cytochrome P450 enzyme (CYP) 2C19-mediated interaction between low-dose escitalopram and clopidogrel seems to be a possible mechanism.
Conclusion:
Data on this is extremely scarce, and to the best of our knowledge, serotonin syndrome caused by low-dose antidepressants has not yet been discussed to any great extent in the literature. Our case provides more clinical experience in the treatment of serotonin syndrome.
How to Deal With an Unreconstructable Distal Radius Fracture
Authors: Angelos Assiotis, Adam Rumian, Harpal S Uppal, Clarence Yeoh
Journal: Cureus (2024)
Keywords: distal radio-ulnar joints, distal radius fracture management, external ﬁxator as definitive fixation, intra-articular fracture distal radius, unstable distal radius fractures
MeSH terms: Case Reports

The most prevalent long bone fracture is that of the distal radius, and it affects all age groups. These fractures can present after low-energy or high-energy trauma, and their configuration often varies depending on the mechanism of injury. Their management can be operative or non-operative, and the scientific literature is abundant in studies comparing these two treatment modalities. There is also a healthy scientific debate as to the indications that should guide surgery for these injuries. A male patient sustained a high-energy fracture to his distal radius and presented to our unit soon after the injury. His fracture presented significant surgical challenges due to its complexity. It was stabilised surgically, and the patient recovered good function after rehabilitation. This case aims to demonstrate a surgical treatment protocol and the relevant surgical considerations when dealing with significant injuries, such as the one presented in this paper, where traditional fixation techniques may not yield a satisfactory outcome.
A Case Report of Under-Recognized Conditions in Pulmonary Embolism: Patent Foramen Ovale and Right Ventricular Thrombus
Authors: Satoshi Sera, Yuji Okazaki, Kenichiro Kashiwa, Toshihisa Ichiba
Journal: Cureus (2024)
Keywords: acute pulmonary embolism, paradoxical embolism, patent foramen ovale (pfo), renal artery infarction, right ventricular cardiac thrombus
MeSH terms: Case Reports

Pulmonary embolism (PE) is a potentially life-threatening condition that presents with a spectrum of clinical symptoms ranging from asymptomatic to hemodynamic instability. The early diagnosis in the emergency department is often challenging. Although the association between patent foramen ovale (PFO) and thromboembolic events in patients with PE is well-documented, the significance of the presence of PFO in patients with PE may be underrecognized. In addition, the occurrence of right ventricular thrombus (RVT) in PE is a rare but significant complication with implications for disease management. We report a case of acute-on-chronic PE with concurrent bilateral renal infarction due to a paradoxical embolus, alongside RVT. A 35-year-old male presented at our emergency department with complaints of sudden onset abdominal pain. Bilateral renal infarction was identified on a contrast-enhanced computed tomography (CT). Point-of-care ultrasound showed suggestive findings of PE and RVT. Subsequently, a pulmonary CT angiography confirmed bilateral PE, a PFO, and RVT. The patient was effectively managed with thrombolytic therapy, with extracorporeal membrane oxygenation on standby. This case highlights the need to recognize the diverse clinical manifestations of PE and the importance of considering coexisting PFO and RVT in affected patients. The diagnosis of PE can be complex when symptoms overlap with arterial thrombosis, such as renal infarction secondary to a PFO. In addition, RVT, although uncommon, is a serious complication in patients with PE that may require careful evaluation for thrombolytic or anticoagulant therapy. It is critical to consider the possibility of a PFO in all cases of PE, even in the absence of arterial embolism, and to promptly evaluate for RVT prior to initiating treatment.
Celecoxib-induced acute generalized exanthematous pustulosis: uncommon and under-recognized side effect
Authors: Abul Hasan Shadali Abdul Khader, Meenu Singh
Journal: EXCLI J (2024)
Keywords: nsaids, adverse drug reactions, celecoxib, dermatology
MeSH terms: Case Reports

Celecoxib, a selective COX-2 inhibitor, and non-selective anti-inflammatory drug, is commonly prescribed as the first-line analgesic for osteoarthritis, rheumatoid arthritis, and certain acute pain cases. It is mainly preferred for its lower risk of gastrointestinal adverse effects. However, it also carries risks, including renal and liver toxicity, anaphylaxis, and Stevens-Johnson syndrome. A rare but severe cutaneous adverse reaction associated with celecoxib is Acute Generalized Exanthematous Pustulosis (AGEP), characterized by extensive nonfollicular sterile pustules on an erythematous background, fever, and neutrophilic leukocytosis. AGEP is a rare condition with an incidence rate of 1-5 cases per million per year in the general population. It is primarily triggered by drugs, with antibiotics accounting for over 90 % of cases. Here, we present the case of a 44-year-old female who presented with a sudden, rapidly progressive, painful, pruritic rash all over her body with associated leukocytosis. A skin biopsy confirmed the presence of a pustular rash. The patient reported taking Celebrex (celecoxib) for worsening arthritis two weeks prior to symptom onset. The patient was diagnosed with Celecoxib-induced AGEP based on clinical and histopathological features. Treatment involved steroid therapy and discontinuation of NSAIDs (non-steroidal anti-inflammatory drugs). Encouragingly, the patient's rash improved within three days. Our case report aims to raise awareness of AGEP as a side effect of NSAIDs. Although AGEP is not typically serious, it can be fatal in elderly patients. Therefore, prompt identification and immediate cessation of the culprit drug is crucial.
Successful conservative management of a large 12-week-old cervical ectopic pregnancy in a nulliparous woman: a case report
Authors: John Jude Kweku Annan, Stephen Ansah-Asamoah, Benedict Apaw Agyei, Eric Lartey Quarshie, Frank Ankobea, Sylvia Vanderpuye, Collins Oteng, Sebastian Yidana Ninimiya, Nana Esi Abedua Abaidoo
Journal: Pan Afr Med J (2023)
Keywords: cervical ectopic pregnancy (cep), case report, cervical encerclage tamponade, methotrexate, uterine-conserving
MeSH terms: Conservative Treatment, Pregnancy, Ectopic / diagnosis, Pregnancy, Ectopic / therapy, Case Reports, Adult, Female, Health Care Costs, Humans, Neck, Pregnancy, Uterus

Cervical ectopic pregnancy (CEP) accounts for less than 0.1% of all ectopic pregnancies. CEP is associated with high morbidity and mortality potential due to the associated life-threatening hemorrhage. When it is large, detected late, and occurs in a nulliparous woman, management is more challenging as it requires the need to preserve the uterus. We present a case of a 33-year-old nulliparous woman with a large live cervical ectopic pregnancy at 12 weeks + 1 day gestation and a very high serum β-HCG of 126,750 Miu/ml. She was successfully managed with suction curettage and cervical encerclage tamponade in order to preserve the uterus. The treatment was associated with significant hemorrhage and a prolonged period of follow-up. In low-resource settings, uterine-conserving management of CEP can be challenging, and curettage with cervical encerclage tamponade can be a cost-effective treatment modality even though it is associated with significant haemorrhage and prolonged treatment period.
Post-epidemic health system recovery: A comparative case study analysis of routine immunization programs in the Republics of Haiti and Liberia
Authors: Sanjana J Ravi, Christina M Potter, Ligia Paina, Maria W Merritt
Journal: PLoS One (2023)
MeSH terms: Epidemics, Hemorrhagic Fever, Ebola / epidemiology, Hemorrhagic Fever, Ebola / prevention & control, Vaccines, Research Support, Non-U.S. Gov't, Disease Outbreaks / prevention & control, Haiti / epidemiology, Humans, Immunization Programs, Liberia / epidemiology, Vaccines

Large-scale epidemics in resource-constrained settings disrupt delivery of core health services, such as routine immunization. Rebuilding and strengthening routine immunization programs following epidemics is an essential step toward improving vaccine equity and averting future outbreaks. We performed a comparative case study analysis of routine immunization program recovery in Liberia and Haiti following the 2014-16 West Africa Ebola epidemic and 2010s cholera epidemic, respectively. First, we triangulated data between the peer-reviewed and grey literature; in-depth key informant interviews with subject matter experts; and quantitative metrics of population health and health system functioning. We used these data to construct thick descriptive narratives for each case. Finally, we performed a cross-case comparison by applying a thematic matrix based on the Essential Public Health Services framework to each case narrative. In Liberia, post-Ebola routine immunization coverage surpassed pre-epidemic levels, a feat attributable to investments in surveillance, comprehensive risk communication, robust political support for and leadership around immunization, and strong public-sector recovery planning. Recovery efforts in Haiti were fragmented across a broad range of non-governmental agencies. Limitations in funding, workforce development, and community engagement further impeded vaccine uptake. Consequently, Haiti reported significant disparities in subnational immunization coverage following the epidemic. This study suggests that embedding in-country expertise within outbreak response structures, respecting governmental autonomy, aligning post-epidemic recovery plans and policies, and integrating outbreak response assets into robust systems of primary care contribute to higher, more equitable levels of routine immunization coverage in resource-constrained settings recovering from epidemics.
Case report: A clinical report of photodynamic neoadjuvant combined with fluorescent laparoscopic localization robotic surgery for the treatment of patients with advanced colorectal cancer combined with obstruction
Authors: Xiaodong Huang, Xiaowen Han, Weidong Li, Jiayi Zhang, Bin Ma, Yuhan Wang, Zhenyu Yin, Lei Gao, Jianming Shi, Ewetse Paul Maswikiti, Hao Chen
Journal: Front Immunol (2024)
Keywords: case report, colon cancer, fluorescence laparoscopy, neoadjuvant therapy, photodynamic
MeSH terms: Colorectal Neoplasms / complications, Intestinal Obstruction / etiology, Intestinal Obstruction / surgery, Intestinal Obstruction / therapy, Laparoscopy / methods, Neoadjuvant Therapy, Photochemotherapy / methods, Robotic Surgical Procedures / methods, Case Reports, Aged, Female, Humans, Male, Middle Aged, Neoplasm Staging, Treatment Outcome

The incidence of colorectal cancer is relatively high in our country, with the majority of patients being diagnosed at an advanced stage. For individuals with advanced-stage colorectal cancer, conversion or neoadjuvant therapy is frequently necessitated to facilitate surgical intervention and achieve a curative effect. And about 10% to 30% of colon cancer patients are complicated with intestinal obstruction. Surgical intervention remains the primary treatment for managing intestinal obstructions, albeit with a considerable risk of perioperative mortality and an increased likelihood of postoperative complications. PDT, as a neoadjuvant treatment for colon cancer, can shrink the local tumor and relieve obstruction, and is effective in colon cancer combined with obstruction. Robotic surgery has the advantages of high stability and low trauma, and compared with laparoscopic colon cancer surgery, robotic surgery can achieve better results. Fluorescent laparoscopic clarifies the location and size of the tumor lesion, allowing for greater precision when removing colon cancer lesions in robotic surgery. Therefore, in the treatment of colon cancer, PDT can offer an opportunity for surgery after relieving obstruction in patients with obstructive colon cancer. Additionally, when combined with fluorescent laparoscopic robotic colon cancer surgery, it provides a novel treatment approach for patients with obstructive colon cancer. Preoperative photodynamic neoadjuvant therapy combined with robotic colon cancer surgery has not yet been reported. Here, we report a case of colon cancer with obstruction, preoperative TNM stage was T4N1, and the lesion had caused intestinal stenosis. After four sessions of PDT, the patient's intestinal lumen was unobstructed and the lesion had regressed. After evaluation, fluorescent laparoscopic localization and visualization of lymph nodes combined with robotic colon cancer resection were performed. Postoperative pathology showed that the patient's tumor regression grade was grade 1. The patient's tumor was completely resected with good resection effect. No tumor invasion was found on both sides of the resection margin, and the patient did not relapse after surgery.
Internal post-bariatric hernia due to hepatic adhesion: a case report
Authors: Bruno Mirandola Bulisani, Murilo Rocha Rodrigues, Luiz Guilherme Lisboa Gomes, Milena Arruda de Oliveira Leite, Felipe Martin Bianco Rossi, Nathan Rostey, Jaques Waisberg
Journal: Einstein (Sao Paulo) (2023)
MeSH terms: Bariatrics, Laparoscopy, Obesity, Morbid / complications, Obesity, Morbid / surgery, Case Reports, Adult, Female, Humans, Internal Hernia, Liver / diagnostic imaging

Roux-en-Y gastric bypass, a procedure proven effective for treating morbid obesity and metabolic disorders, carries the risk of complications such as the formation of internal hernias. These hernias are often difficult to diagnose and can be potentially fatal because they can cause structural obstruction. Most internal hernias occur in the jejunojejunostomy mesentery space, followed by Petersen's space hernias, although herniation at other locations can also occur. Our case report presents an example of a rare internal hernia after laparoscopic Roux-en-Y gastric bypass. A 36-year-old woman presented with an uncommon internal hernia located between the liver and alimentary loop, resulting in the formation of a new space and consequently incarcerating the entire biliopancreatic loop. This type of internal hernia is rare and has not been reported in the literature, indicating that this is the first report of such a case. In this case, we realized that the diagnosis was challenging and imaging examinations could not help determine the etiology of the pain and obstruction. Therefore, videolaparoscopy revealed an uncommon hernia formed by firm adhesion between the hepatic segment III and the alimentary loop mesentery. Our case is an example of an internal hernia that was not detected with a normal computed tomography scan of the abdomen and pelvis. Only diagnostic laparoscopy revealed herniation, effectively preventing further complications for the patient.
Bardet-Biedl syndrome in a 19-year-old male: the first case report from Palestine
Authors: Hamza B Karmi, Yahya Abu Jwaid, Mohammad Hakam Shehadeh, Dareen Njoom, Aya Awwad, Hasan Eideh
Journal: Front Pediatr (2024)
Keywords: bardet-biedl syndrome, fbn3 gene, palestine, retinitis pigmentosa, type 2 diabetes
MeSH terms: Case Reports

Bardet-Biedl syndrome (BBS) is a rare genetic disorder characterized by retinitis pigmentosa, polydactyly, type 2 diabetes mellitus, and obesity. This case report presents a 19-year-old male from Palestine with BBS, exhibiting delayed diagnosis and variable phenotypic expression. The patient had familial BBS history and presented with obesity, type 2 diabetes mellitus, retinitis pigmentosa, and cryptorchidism. Genetic analysis identified heterozygous missense variants in the FBN3 gene, yet additional genetic factors may contribute to the phenotype. Renal abnormalities included kidney shrinkage and mild hydronephrosis. Management of this patient involves a multidisciplinary approach with lifestyle modifications, surgical interventions, and supportive care. Early diagnosis, genetic counseling, and regular follow-up are crucial for improving outcomes in BBS. This report highlights diagnostic and therapeutic challenges and underscores the need for further research on this complex disorder.
Multidimensional features of sporadic Creutzfeldt-Jakob disease in the elderly: a case report and systematic review
Authors: Jiangfeng Liao, Wenming Hu, Shiheng Chen, Chunyu Huang, Senwei Dong, Wanjin Chen, Xiaochun Chen, Longfei Chen
Journal: Front Aging Neurosci (2024)
Keywords: clinical features, diagnosis biomarkers, elderly, neuropathology hallmarks, sporadic creutzfeldt-jakob disease

Background:
As a rare neurodegenerative disease, sporadic Creutzfeldt-Jakob disease (sCJD) is poorly understood in the elderly populace. This study aims to enunciate the multidimensional features of sCJD in this group.
Methods:
A case of probable sCJD was reported in a 90-year-old Chinese man with initial dizziness. Then, available English literature of the elderly sCJD cases (aged 80 years and over) was reviewed and analyzed. Patients (15 cases) were subdivided and compared geographically.
Results:
In the elderly sCJD cohort, the onset age was 84.9 ± 4.5 years and the median disease duration was 6.8 months, with respiratory infection/failure as the commonest death cause. Various clinical symptoms were identified, with cognitive disorder (86.7%) as the commonest typical symptom and speech impairment (66.7%) as the most atypical one. Restricted hyperintensities were reported in 60.0% cases on DWI, periodic sharp wave complexes in 73.3% cases on electroencephalogram, and cerebral hypoperfusion/hypometabolism in 26.7% cases on molecular imaging. The sensitive cerebrospinal fluid biomarkers were total tau (83.3%), 14-3-3 protein (75.0%), and PrP RT-QuIC (75.0%). Neuropathological profiles in the cerebral cortex revealed vacuolar spongiosis, neuronal loss, gliosis, and aging-related markers, with synaptic deposit as the commonest PrP pattern (60.0%). The polymorphic PRNP analysis at codon 129 was M/M (90.9%), with MM1 and MM2C as the primary molecular phenotypes. Latency to first clinic visit, hyperintense signals on DWI, and disease duration were significantly different between the patient subgroups.
Conclusion:
The characteristics of sCJD are multidimensional in the elderly, deepening our understanding of the disease and facilitating an earlier recognition and better care for this group.