OpenMed/multicare-articles huggingface dataset:
The Scientific and Clinical Case for Reviewing Diagnostic Radiopharmaceutical Extravasation Long-Standing Assumptions
Authors: Dustin Osborne, Ronald Lattanze, Josh Knowland, Tonia E Bryant, Iryna Barvi, Yitong Fu, Jackson W Kiser
Journal: Front Med (Lausanne) (2021)
Keywords: adverse events, dosimetry, extravasation, infiltration, patient harm, quality

Background: The patient benefit from a diagnostic nuclear medicine procedure far outweighs the associated radiation risk. This benefit/risk ratio assumes a properly administered radiopharmaceutical. However, a significant diagnostic radiopharmaceutical extravasation can confound the procedure in many ways. We identified three current extravasation hypotheses espoused by medical societies, advisory committees, and hundreds of individual members of the nuclear medicine community: diagnostic extravasations do not cause harm, do not result in high absorbed dose to tissue, and require complex dosimetry methods that are not readily available in nuclear medicine centers. We tested these hypotheses against a framework of current knowledge, recent developments, and original research. We conducted a literature review, searched regulatory databases, examined five clinical cases of extravasated patients, and performed dosimetry on those extravasations to test these globally accepted hypotheses. Results: A literature review found 58 peer-reviewed documents suggesting patient harm. Adverse event/vigilance report database reviews for extravasations were conducted and revealed 38 adverse events which listed diagnostic radiopharmaceutical extravasation as a factor, despite a regulatory exemption for required reporting. In our own case material, assessment of care was evaluated for five extravasated patients who underwent repeat imaging. Findings reflected results of literature review and included mis- or non-identification of lesions, underestimation of Standardized Uptake Values (SUVs) by 19-73%, classification of scans as non-diagnostic, and the need to repeat imaging with the associated additional radiation exposure, inconvenience, or delays in care. Dosimetry was performed for the same five cases of diagnostic radiopharmaceutical extravasation. Absorbed doses to 5 cm3 of tissue were between 1.1 and 8.7 Gy, and shallow dose equivalent for 10 cm2 of skin was as high as 4.2 Sv. Conclusions: Our findings suggest that significant extravasations can or have caused patient harm and can irradiate patients' tissue with doses that exceed medical event reporting limits and deterministic effect thresholds. Therefore, diagnostic radiopharmaceutical injections should be monitored, and dosimetry of extravasated tissue should be performed in certain cases where thresholds are thought to have been exceeded. Process improvement efforts should be implemented to reduce the frequency of extravasation in nuclear medicine.
Radiological-Pathological Correlation in Plasmablastic Lymphoma in an Immunocompromised Patient
Authors: A Moramarco, M Marenco, M La Cava, A Lambiase
Journal: Case Rep Ophthalmol Med (2018)
MeSH terms: Case Reports

Plasmablastic lymphoma (PBL) is a malignant, rare, and aggressive form of non-Hodgkin's lymphoma with poor response to treatment that most commonly involves the oral mucosa of immunodeficient patients. The orbit might be primarily or secondarily involved; on the other hand other pathological conditions, i.e., fungal infections, may localize in the orbit in both immunocompromised patients and drug user, which might have similar radiological features. We describe the clinical, radiological, and pathological features of an orbital plasmablastic lymphoma (PBL) in an immunocompromised HIV positive drug user patient.
Myotonia congenita and periodic hypokalemia paralysis in a consanguineous marriage pedigree: Coexistence of a novel CLCN1 mutation and an SCN4A mutation
Authors: Chenyu Zhao, DongFang Tang, Hui Huang, Haiyan Tang, Yuan Yang, Min Yang, Yingying Luo, Huai Tao, Jianguang Tang, Xi Zhou, Xiaoliu Shi
Journal: PLoS One (2020)
MeSH terms: Chloride Channels / genetics, Hypokalemic Periodic Paralysis / complications, Hypokalemic Periodic Paralysis / genetics, Myotonia Congenita / complications, Myotonia Congenita / genetics, NAV1.4 Voltage-Gated Sodium Channel / genetics, Case Reports, Research Support, Non-U.S. Gov't, Adolescent, Adult, Aged, Amino Acid Sequence, China, Chloride Channels / chemistry, Chloride Channels / metabolism, Consanguinity, Conserved Sequence, Diagnosis, Differential, Exome Sequencing, Female, HEK293 Cells, Humans, Hypokalemic Periodic Paralysis / metabolism, Male, Middle Aged, Models, Molecular, Mutant Proteins / genetics, Mutant Proteins / metabolism, Mutation, Myotonia Congenita / metabolism, NAV1.4 Voltage-Gated Sodium Channel / metabolism, Pedigree, Recombinant Proteins / genetics, Recombinant Proteins / metabolism, Young Adult, CLC-1 channel, Chloride Channels, Mutant Proteins, NAV1.4 Voltage-Gated Sodium Channel, Recombinant Proteins, SCN4A protein, human, Hypokalemic Periodic Paralysis, Type 2

Myotonia congenita and hypokalemic periodic paralysis type 2 are both rare genetic channelopathies caused by mutations in the CLCN1 gene encoding voltage-gated chloride channel CLC-1 and the SCN4A gene encoding voltage-gated sodium channel Nav1.4. The patients with concomitant mutations in both genes manifested different unique symptoms from mutations in these genes separately. Here, we describe a patient with myotonia and periodic paralysis in a consanguineous marriage pedigree. By using whole-exome sequencing, a novel F306S variant in the CLCN1 gene and a known R222W mutation in the SCN4A gene were identified in the pedigree. Patch clamp analysis revealed that the F306S mutant reduced the opening probability of CLC-1 and chloride conductance. Our study expanded the CLCN1 mutation database. We emphasized the value of whole-exome sequencing for differential diagnosis in atypical myotonic patients.
Cross-cultural comparison of nudging effects for environmental protection: A case-study of risk-averse attitudes toward disposable plastics
Authors: Hidenori Komatsu, Hiromi Kubota, Nobuyuki Tanaka, Mariah Griffin, Jennifer Link, Glenn Geher, Maryanne L Fisher
Journal: PLoS One (2022)
MeSH terms: COVID-19 / prevention & control, Plastics, Randomized Controlled Trial, Attitude, Conservation of Natural Resources, Cross-Cultural Comparison, Female, Humans, Plastics

Disposable plastics are drawing considerable attention as a source of environmental risk despite their benefits in daily life. Banning the use of disposable plastics could increase other types of risks, which may damage the public good in the long run. Considering the trade-off of the risks and benefits, one way to improve social welfare is to conduct proper recycling and to continue using plastics but limit them to essential use, avoiding an unnecessary ban. A potential barrier to such a policy might be risk-averse attitudes toward actions that are perceived to threaten future generations, which is a well-known phenomenon. We previously designed a framework for information provision using messages that remind individuals about familial support, which had significant effects in multiple countries on increasing positive attitudes toward air pollution caused by industrialization. We hypothesized that this information provision could also be effective for disposable plastic use. Thus, we conducted a randomized controlled trial via online surveys in Japan, Canada, and the US to identify the effects of our designed messages about recycling on increasing positive attitudes toward disposable plastics. The intervention effects were measured by the difference-in-difference method and panel analysis based on linear regression models using the respondents' attributes and personality traits. The effects were consistently correlated with a sense of familial support, with the effect sizes varying according to country (US > Japan > Canada). Attributes that positively contributed to the message being more effective were higher agreeableness, lower Machiavellianism, lower psychopathy, and being a woman. Although personal fear about COVID-19 moderated the message effects, concern about the threats to relatives and family boosted the effects. Although the effect sizes were influenced by external factors, the results suggested that our proposed framework for information provision has the potential to be applied to a wider variety of risk-related topics.
Recurrent borderline phyllodes tumor of the breast submitted to mastectomy and immediate reconstruction: Case report
Authors: Bruno Bisognin Garlet, Luciano Zogbi, Juliana Piveta de Lima, Paulo Pereira de Souza Favalli, Frederico Diefenthaeler Krahe
Journal: Int J Surg Case Rep (2019)
Keywords: breast, case report, mammaplasty, mastectomy, phyllodes tumor, plastic surgery

Introduction:
Phyllodes tumors are biphasic fibroepithelial tumors that account for fewer than 1% of mammary tumors. They usually appear in middle-aged women, with an average size of 4-7 cm and rapid growth.
Presentation of case:
A 25-year-old woman sought care after excision of recurrent nodules in the right breast, with a diagnosis of borderline phyllodes tumor. She had no new lesions on physical examination. Imaging studies revealed an anechoic collection and nodular areas in a previous surgical site, correlated with pathology. Immuno-histochemical examination was positive for vimentin, calponin, Ki-67 and estrogen receptor. Systemic staging did not show metastases. Skin-reducing mastectomy was performed on the right side, followed by reconstruction and left reduction mammaplasty for symmetry. At 8-month follow-up, there was no relapse of the lesions on clinical and ultrasonographic examinations.
Discussion:
Phyllodes tumors are rare neoplasms characterized by rapid growth, occurring in women between 35-55 years of age. They are classified as benign, borderline and malignant, according to histological parameters. There are reports of genetic mutations in TP53 associated with malignant phyllodes tumor. On immunohistochemistry, there is a greater tendency to malignancy in tumors with Ki-67 and estrogen receptor expression. Imaging methods may aid in diagnosis, which is only definitive after excision and histopathological analysis of the tumor. These tumors have high local recurrence rates and possibility of metastases, closely related to histology.
Conclusion:
Phyllodes tumors are a great challenge to the surgeon. Treatment is surgical, with wide excision; radiotherapy and chemotherapy are controversial.
The Challenges of Managing Ovarian Cancer in the Developing World
Authors: Olivier Mulisya, Franck K Sikakulya, Mbusa Mastaki, Tambavira Gertrude, Mathe Jeff
Journal: Case Rep Oncol Med (2020)
MeSH terms: Case Reports

Ovarian cancer has high morbidity and mortality rates among cancers of the reproductive system. The disease typically presents at late stage when the 5-year relative survival rate is only 29%. Similarly, access to prevention, early diagnosis, treatment, and palliative care for cancer-related disease is insufficient. The availability of cancer treatments in Africa is especially poor. Case. A 17-year-old lady, nulliparous, was admitted with complaint of abdominal swelling and loss of weight and a huge left ovarian cyst revealed by ultrasound scan. Laparotomy was done, and a mass which resembled a hemorrhagic solid tumor was found. Grossly, the left ovarian mass measured 15.0 × 20.0 × 8.0 cm and a left salpingectomy was performed. Two months later, she came back with lower limb swelling progressively increased in a week with vulvar edema, with a palpable mass. She was discharged on request by her relatives for traditional medicine. One year later, she passed on in an unrevealed picture. The management of ovarian cancer is too challenging in low-resource countries, from hospital settings to the communities with poor cancer awareness. It is therefore imperative that healthcare resources, policies, and planning focus to be coordinated in a rational way.
Locally advanced breast implant-associated anaplastic large-cell lymphoma: a case report of successful treatment with radiation and chemotherapy
Authors: Christopher F Estes, Da Zhang, Ruben Reyes, Richard Korentager, Marilee McGinness, Christopher Lominska
Journal: Front Oncol (2015)
Keywords: breast, breast implant, breast implant-associated anaplastic large-cell lymphoma, chemotherapy, non-hodgkin lymphoma, radiation therapy

The development of breast implant-associated anaplastic large-cell lymphoma (ALCL) is a rare phenomenon. A typical presentation is an effusion associated with a breast implant. Less commonly, disease can be more advanced locoregionally or distantly. The optimal treatment schema is a topic of debate: localized ALCL can potentially be cured with implant removal alone, while other cases in the literature, including those that are more advanced, have been treated with varying combinations of surgery, chemotherapy, and external beam radiotherapy. This is a case report of breast implant ALCL with pathologically proven lymph node involvement, the fifth such patient reported. Our patient experienced a favorable outcome with radiation therapy and chemotherapy.
Prolonged neuromuscular blockade following succinylcholine administration to a patient with a reduced butyrylcholinesterase activity
Authors: Ivo F Panhuizen, Marc M J Snoeck, Soledad Levano, Thierry Girard
Journal: Case Rep Med (2010)
MeSH terms: Case Reports

This case is about a 48-year-old woman known with a reduced butyrylcholinesterase activity, who developed prolonged neuromuscular blockade following the unintentional administration of succinylcholine. We took the opportunity to monitor the development of neuromuscular function during this period and blood samples were taken for molecular genetic analysis and for quantitative and qualitative analysis since not all causative mutations are functionally characterized. Reduced butyrylcholinesterase activity is discussed in many aspects. Clinical considerations are suggested concerning genetic counselling.
Gingival Cyst of the Adult: Report of an Inconspicuous Lesion Associated with Multiple Agenesis
Authors: Juliana Mançano Melhado Brod, Fabrício Passador-Santos, Andresa Borges Soares, Marcelo Sperandio
Journal: Case Rep Dent (2017)
MeSH terms: Case Reports

Gingival cyst of the adult is a rare slow growing and asymptomatic lesion that arises from the rests of the dental lamina. The present report describes the case of a miniscule adult gingival cyst in the lower anterior gingiva in a 51-year-old male with agenesis of lower premolars and lateral incisors. This paper contrasts the literature concerning the differentiation between the gingival cyst of the adult and the lateral periodontal cysts as well as the possible misguided concept that the former may be such rare an occurrence.
Pitfalls in Interventional Pain Medicine: Hyponatremia after DDAVP for a Patient with Von Willebrand Disease Undergoing an Epidural Steroid Injection
Authors: Talal W Khan, Abdulraheem Yacoub
Journal: Case Rep Anesthesiol (2017)
MeSH terms: Case Reports

Desmopressin (DDAVP), a synthetic analog of vasopressin, has been used in patients with von Willebrand disease (VWD), mild hemophilia A, and platelet dysfunction to reduce the risk of bleeding associated with surgical and interventional procedures. We report the case of a patient with VWD presenting with a bulging disc and radicular pain that underwent transforaminal epidural steroid injections. Her course was complicated with the interval development of headaches and dizziness symptomatic of moderate hyponatremia, likely due to excessive fluid intake. This report highlights a relatively rare side effect of DDAVP when used for prophylaxis in patients with VWD and reinforces the need for vigilance in these patients.
First Isolation of West Nile virus from a patient with encephalitis in the United States
Authors: Cinnia Huang, Brett Slater, Robert Rudd, Nandakishore Parchuri, Rene Hull, Michelle Dupuis, Alexander Hindenburg
Journal: Emerg Infect Dis (2002)
MeSH terms: West Nile Fever / physiopathology, West Nile virus / isolation & purification, Case Reports, Research Support, U.S. Gov't, P.H.S., Aged, Antineoplastic Combined Chemotherapy Protocols / therapeutic use, Cyclophosphamide / therapeutic use, Doxorubicin / therapeutic use, Fatal Outcome, Female, Humans, Lymphoma, B-Cell / drug therapy, New York, Prednisone / therapeutic use, Reverse Transcriptase Polymerase Chain Reaction, Vincristine / therapeutic use, West Nile Fever / diagnosis, West Nile Fever / drug therapy, Vincristine, Doxorubicin, Cyclophosphamide, Prednisone, CHOP protocol

West Nile virus (WNV) was isolated from a patient who developed encephalitis while undergoing treatment with CHOP (cyclophosphamide, hydroxydoxorubicin, vincristine [Oncovin], predisone) and rituximab for a non-Hodgkin B-cell lymphoma. Both standard reverse transcription-polymerase chain reaction (RT-PCR) and Taqman RT-PCR established the diagnosis of WNV infection from cerebrospinal fluid (CSF). Several whole blood samples and one serum sample underwent further testing. CSF and serum samples were negative for WNV antibody; however, all samples were positive by both RT-PCR assays. Infectious virus was recovered from a blood sample, and its identity was confirmed by using a WNV-specific immunofluorescence assay. The complete WNV genomes determined from CSF and from the virus isolate adapted from cell culture were the same. The results represent the first complete WNV genome sequence obtained directly from human CSF and the first time that infectious WNV has been recovered from a patient with encephalitis in North America.
IgD Multiple Myeloma Paraproteinemia as a Cause of Myositis
Authors: I Colombo, M E Fruguglietti, L Napoli, M Sciacco, E Tagliaferri, A Della Volpe, V Crugnola, N Bresolin, M Moggio, A Prelle
Journal: Neurol Res Int (2010)
MeSH terms: Case Reports

A 48-years old man was diagnosed an IgD-k multiple myeloma (MM) at age 38 years for which he successfully underwent chemotherapy and bone marrow transplant. He then developed a graft-versus-host disease (GVHD) whose manifestations included, three years later, a polymyositis, diagnosed at muscle biopsy and successfully treated with steroids. Few months after polymyositis remission, myeloma relapsed and the patient was treated with thalidomide for six years with good remission. Soon after thalidomide suspension, MM relapsed again and the patient came to our observation for a new onset of neuromuscular symptoms. He underwent both muscle and peripheral nerve biopsy to discriminate between myositis (paraproteinemia versus GVHD), amyloidosis, and thalidomide toxicity. The first muscle biopsy showed an inflammatory pattern with necrotic fibres, macrophagical invasion (CD68 positive), rare interstitial cellular infiltrates (CD8 positive and CD4 negative), widespread anti-HLA positivity and negative antiMAC. The second muscle biopsy showed the same inflammatory pattern plus an involvement of blood vessels. Direct immunofluorescence for IgD showed diffuse positivity along the sarcolemmal in both muscle biopsies. Sural nerve biopsy demonstrated both demyelinating and axonal aspects with no inflammatory infiltrates, but positivity for HLA and MAC. Congo Red was negative in both skeletal muscle and peripheral nerve.
Advanced Lung Adenocarcinoma Patient with ERBB2 Amplification Identified by Comprehensive Genomic Profiling Benefits from Trastuzumab
Authors: Chi-Wei Tao, Mei-Yin Chen, Ching-Min Tseng, Nina Lapke, Shu-Jen Chen, Kien Thiam Tan
Journal: Case Rep Oncol Med (2020)
MeSH terms: Case Reports

For non-small-cell lung cancer (NSCLC) patients without established actionable alterations in genes such as EGFR or ALK, options for targeted therapy remain limited in clinical practice. About 5% of lung adenocarcinoma patients have tumors with ERBB2 genetic alterations, with even fewer patients harboring ERBB2 amplification. Currently, clinical trials mainly use IHC, FISH, or mutation testing to identify potential responders to ERBB2-targeting agents. The use of next-generation sequencing (NGS) to detect ERBB2 alterations, including copy number variants, is rare. In this study, we present an EGFR- and ALK-negative advanced NSCLC case for which we conducted comprehensive tumor genomic profiling to identify potentially actionable alterations. The tumor harbored an ERBB2 amplification, and trastuzumab-based therapy resulted in an excellent response, with a necrotic regression of the patient's lung lesion. Although he developed brain metastasis four months after trastuzumab initiation, he survived for an additional period of eight months without local recurrence or other systemic metastasis. This case report shows that the use of comprehensive genetic testing enables the identification of rare actionable alterations in NSCLC patients without other options for targeted treatment.
Use of Lumen-Apposing Stents for the Treatment of Postsurgical Fluid Collections: A Case Series and a Review of Literature
Authors: Priyanka Priyanka, William Hsueh, John Nasr
Journal: Case Rep Gastrointest Med (2019)
MeSH terms: Case Reports

Lumen-apposing metal stents (LAMS) use in gastrointestinal endoscopy has been on the rise for various indications for the last few years. Currently, LAMS is a well-established treatment for post-pancreatitis peri-pancreatic fluid collections and walled-off necrosis (WON), but it is still not a standard of care in the treatment of post-surgical fluid collections (PSFC). Most of the earlier studies for treatment of PSFC utilized double pigtail plastic stents (DPS). We present a series of 3 cases where LAMS was successfully used for PSFC drainage. The cases include a patient with perigastric abscess after Whipple's procedure, a case of peri-pancreatic collection after distal pancreatectomy, and a patient with peri-pancreatic fluid collection after right partial hepatectomy and splenectomy due to lacerations from a motor vehicle accident.
Double seropositive neuromyelitis optica associated with COVID-19: A case report
Authors: Dana Antonescu Ghelmez, Adriana Moraru, Florian Antonescu, Altay Sercan Chelmambet, Amanda Ioana Bucur, Sorin Tuţǎ
Journal: Front Neurol (2022)
Keywords: covid-19, nmosd, anti-aqp4 antibodies, anti-mog antibodies, neuromyelitis optica
MeSH terms: Case Reports

Neuromyelitis optica spectrum disorders are characterized by severe demyelination and axonal damage with autoimmune mechanisms, predominantly targeting the optic nerves and the spinal cord. Patients often test positive for anti-AQP4 antibodies, while some have anti-MOG antibodies. Double seropositivity has been described, with a variable prevalence (0 to 26%) dependent on the testing method. The clinical significance of double seropositivity remains unclear. We present the case of a 65-year-old patient, admitted to our clinic with optical neuritis, followed up approximately 10 days later by cervical myelitis, who tested positive for both anti-AQP4 and anti-MOG antibodies. The clinical onset coincided with a mild form of SARS-CoV-2 infection. The neurological symptoms were initially relatively subdued, which delayed the diagnosis. The patient was not vaccinated against SARS-CoV-2. The clinical picture was compatible with an anti-AQP4 phenotype. The patient was started on corticosteroid therapy, under which the clinical response was good. Our case reinforces the idea that SARS-CoV-2 can precipitate autoimmune demyelinating diseases since SARS-CoV-2 infection has already been demonstrated as a risk factor for NMOSD relapses. To the best of our knowledge, this is the first reported case of double seropositive neuromyelitis optica associated with COVID-19. We expect that in the near future, as the true burden of COVID becomes clearer, we shall encounter other cases which can trace their apparent clinical onset to a SARS-CoV-2 infection. Careful attention should be paid to the apparent minor neurological symptoms of COVID-19.