OpenMed/multicare-articles huggingface dataset:
Orbital Roof Blowout Fracture With an Intact Orbital Rim: A Case Report
Authors: Kun Hwang, Se Yang Oh
Journal: Eplasty (2020)
Keywords: craniotomy, orbit, orbital fractures, tomography, x-ray computed
MeSH terms: Case Reports

Background: Fractures of the orbital roof not associated with fractures of the orbital rim are unusual. We describe the case of a blowout fracture of the orbital roof with an intact orbital rim, which was found after craniotomy for removal of epidural hematoma. Case: A 64-year-old man was referred to our emergency department from a local hospital. He fell down from a 3-m stepladder while pruning branches of a tree. Brain computed tomographic scan revealed acute epidural hematoma in both frontal convexities, and he underwent craniotomy at the local hospital. On follow-up brain computed tomography, an orbital roof fracture with a displaced bony fragment and hemorrhage was noticed in the left superior extraconal space. Thereafter, he was transferred to our department. Upon examination, movement of the extraocular muscles was normal. He did not complain of diplopia or decreased sensation of the face. He also did not have nasal stuffiness. Exophthalmometry revealed the same findings for both eyes (18 mm/18 mm). Facial computed tomographic scan before the second operation revealed a displaced orbital roof fracture segment. Under general anesthesia, craniotomy was performed and the epidural hematoma was evacuated. The displaced bony fragment was removed from the left anterior cranial fossa, and the anterior skull base was reconstructed with a titanium mesh plate. Conclusion: Through this case of blowout fracture of the orbital roof with an intact orbital rim, found after craniotomy, we should be aware of the possibility that an orbital roof fracture can be missed on conventional brain computed tomography.
Combination of a Novel Genetic Variant in CFB Gene and a Pathogenic Variant in COL4A5 Gene in a Sibling Renal Disease: A Case Report
Authors: Feng-Mei Wang, Yan Yang, Xiao-Liang Zhang, Yan-Li Wang, Yan Tu, Bi-Cheng Liu, Bin Wang
Journal: Front Genet (2021)
Keywords: col4a5, case report, complement alternative pathway, complement factor b, renal disease, variant
MeSH terms: Case Reports

Complement factor B (CFB) variants have been described to play a causative role in auto-immune associated C3 glomerulopathy (C3G) and/or atypical hemolytic uremic syndrome (aHUS) by affecting the dysregulations of alternative pathway activation. However, CFB variant concomitant with COL4A5 variant is scarce. Here, we depict two intriguing cases with concurrent novel heterozygosity for CFB c.2054_2057del (p.Ser687Profs∗16) variant and a previous reported COL4A5 c.2999G > T (p.Gly1000Val) variant in a pair of siblings. The clinical feature of either paternal CFB variant or maternal COL4A5 variant is just mild microscopic hematuria. Interestingly, their two children with paternal CFB c.2054_2057del (p.Ser687Profs∗16) variant and maternal COL4A5 c.2999G > T (p.Gly1000Val) variant presented with massive proteinuria, hematuria, and progressive renal failure with poor treatment response. Moreover, complement pathway activation in renal tissue further supports and strengthens the pathogenic role of CFB variant in the development of renal injury in the presence of COL4A5 variant. In conclusion, the rare sibling cases highlight that the extension of genetic analyses in the proband is helpful for the diagnosis and understanding of some family cluster renal diseases.
The Role of Laparoscopy in the Management of a Diagnostic Dilemma: Jejunal Ectopic Pancreas Developing into Jejunojejunal Intussusception
Authors: Alessio Giordano, Giovanni Alemanno, Carlo Bergamini, Paolo Prosperi, Alessandro Bruscino, Andrea Valeri
Journal: Case Rep Surg (2017)
MeSH terms: Case Reports

Ectopic pancreas (EP) is a rare congenital anomaly defined as the presence of pancreatic tissue in topographic anomaly. It is usually silent but it may become clinically evident when complicated by acute conditions. The development of laparoscopic surgery has changed the way to manage such conditions, especially in the setting of emergency surgery, thanks to its diagnostic and therapeutic role with excellent results. We decided to perform an emergency diagnostic exploratory laparoscopy in a 29-year-old man with an acute abdomen and nonspecific radiological images for intestinal occlusion. A jejunojejunal intussusception was found, caused by a mass. We decided to carry out minilaparotomy to perform a resection of the affected jejunum. Histological examination confirmed the presence of a jejunal ectopic pancreas. Adult intussusception caused by EP represents 5% of all cases of intussusception. As CT scan, especially when performed in emergency setting for small bowel obstruction diagnosis, can usually demonstrate nondiagnostic findings suggestive of intussusception of unknown origin, laparoscopic exploration could help surgeons in order to perform a resolute diagnosis and treat the pathology.
Primary Pyomyositis: Contact Sports as the Rare Risk Factors
Authors: Behzad Amoozgar, Varun Kaushal, Bhaveshkumar Garsondiya
Journal: Case Rep Infect Dis (2019)
MeSH terms: Case Reports

Primary pyomyositis is an infectious disorder that mostly involves children and adults. Direct injury to the muscle or any traumatic process that can cause bacteremia has been described as the common risk factor. Contact sports without direct contusion or injury to the muscle is an uncommon culprit for the manifestation of this disease. In our case, a young male athlete presented to the emergency room with vague signs and symptoms including right leg muscle pain and fever. He denied any direct injury or contusion of the muscle. CT scan was done and showed edematous gluteus minimus muscle. MRI as one of the best tools for investigating soft tissues was done and exhibited myositis. Blood culture became positive for the methicillin-susceptible Staphylococcus aureus. Appropriate antibiotics were started, and the patient condition was improved. Considering prominent risk factors, early diagnosis and treatment of pyomyositis are major key factors for the management of these infectious conditions as it may cause loss of the limb or even result in mortality.
Expanded Dengue Syndrome: A Case of Subarachnoid Haemorrhage, Cranial Diabetes Insipidus, and Haemophagocytic Lymphohistiosis
Authors: H M A U Jayasinghe, V Pinto, T Jayasinghe Arachchi, W M A S B Wasala, S Abeygunawardane, D Dissanayake
Journal: Case Rep Infect Dis (2021)
MeSH terms: Case Reports

Dengue fever is a mosquito-borne viral infection common in tropical countries with increasing incidence. The clinical manifestations can range from asymptomatic or mild infection to multiorgan failure. The latter is also called "Expanded dengue syndrome," and it carries a high rate of mortality and morbidity. Intensive care management of such complicated cases is a challenging task for the treating physician, which requires intense monitoring and a multidisciplinary approach for decision making. We report an atypical case of an expanded dengue syndrome presented with subarachnoid haemorrhage associated with moderate thrombocytopenia, cranial diabetes insipidus, and haemophagocytic lymphohistiosis in a young healthy female patient.
Ultrasound-Guided Regional Anesthesia Under Sedation for Radical Mastectomy in an SAS Patient: A Case Report
Authors: Na Zhang, Tingting Wang, Penghui Wei, Jinfeng Zhou, Jianjun Li
Journal: Front Oncol (2021)
Keywords: anesthesia, breast cancer, regional block, severe aortic stenosis, ultrasound guidance
MeSH terms: Case Reports

Radical mastectomy is commonly performed under general anesthesia, and regional block is often used as assisted or postoperative analgesia. We herein report a case of successful radical mastectomy with severe aortic stenosis (SAS) by using ultrasound-guided regional anesthesia under sedation. A 66-year-old female with an American Society of Anesthesiology physical status IV; limited functional capacity with <4 metabolic equivalents; a lump (10 cm × 8 cm) in the right breast with skin breakage and infection; and a history of hypertension, diabetes, atrial fibrillation, and SAS, underwent lump-resection and rapid pathological examination by biopsy. Considering a high-risk of significant mortality, we used ultrasound-guided regional block to avoid general anesthesia. We performed the right thoracic paravertebral nerve block (TPVB), subclavicular brachial plexus block, and pectoralis plane block (PECS 1). Patient tolerated the procedure well with no significant hemodynamic changes. Nevertheless, when the axillary lymph nodes were wiped, discharge was observed from the patient's upper limbs. We inserted the laryngeal mask airway combined with low-dose sevoflurane inhalation sedation. The operation was successfully completed, and the patient was revived with steady hemodynamics and good prognosis. In the present case, radical mastectomy with SAS was performed successfully using ultrasound-guided regional anesthesia under sevoflurane sedation. Despite some potential limitations, this case report can serve as a reference for other anesthetists.
Electrochemotherapy as a Trigger to Overcome Primary Resistance to Anti-PD-1 Treatment: A Case Report of Melanoma of the Scalp
Authors: Davide Quaresmini, Alessandra Di Lauro, Livia Fucci, Sabino Strippoli, Ivana De Risi, Angela Monica Sciacovelli, Anna Albano, Gaetano Achille, Massimo Montepara, Sabino Russo, Gabriella Tassone, Michele Guida
Journal: Front Oncol (2021)
Keywords: case report, electrochemotherapy, immunotherapy, melanoma, resistance
MeSH terms: Case Reports

Background:
Immunotherapy with immune checkpoint inhibitors is one of the main therapies for advanced melanoma. Nevertheless, albeit remarkable, immunotherapy results are still unsatisfactory as more than half of patients progress, and resistance to treatment still has a dramatic impact on clinical outcomes. Local treatments such as radiotherapy or electrochemotherapy (ECT), in addition to local control with palliative intent, have been shown to release tumoral neoantigens that can stimulate a robust systemic antitumor immune response.
Case presentation:
We report the case of a patient with multiple nodular melanoma lesions of the scalp initially treated with local ECT. Soon after the procedure, multiple new lesions appeared close to the treated ones, therefore the patient started a systemic treatment with the anti-PD-1 nivolumab. The lesions of the scalp did not respond to immunotherapy, presenting a loco-regional spreading. To control the bleeding and painful lesions, we performed a second ECT, while continuing systemic immunotherapy. The treated lesions responded to the second procedure, while the other lesions continued progressing in number and dimension. Unexpectedly, after 2 months from the second ECT, the patient presented a progressive shrinkage of both treated and untreated lesions until complete remission. Concomitantly, he developed immune-related adverse events including grade 4 thyroid toxicity, grade 2 vitiligo-like depigmentation and grade 2 pemphigoid. At present, after 18 months from the first ECT and 14 months from the starting of anti-PD-1 immunotherapy, the patient is in good clinical condition and complete remission of disease still persists.
Conclusion:
This case highlights the potential role of ECT in increasing tumor immunogenicity and consequently in inducing a powerful immune response overcoming primary resistance to checkpoint inhibitor immunotherapy.
Foreign body aspiration through tracheotomy: a case report
Authors: Ricardo R Figueiredoi, Walter S Machado
Journal: Braz J Otorhinolaryngol (2005)
MeSH terms: Bronchi, Bronchoscopy / methods, Foreign Bodies / surgery, Case Reports, Aged, Foreign Bodies / etiology, Humans, Male, Tracheotomy

A 70 year-old man, with a 7-year tracheotomy because of a laryngeal tumor, had an accident during daily canulla cleansing procedure, aspirating a piece of the cleaning brush. Chest radiograph showed metallic foreign body at the right inferior bronchus. Rigid bronchoscopy was performed under general anesthesia, with no resistance in passing the tube through the glottis. The foreign body was easily removed and the patient had no complications. After leaving the hospital, the patient was sent to the ENT service where he used to be followed up.
Increased Intracranial Pressure Due to Transverse Sinus Compression by a Meningioma En Plaque
Authors: Aidan Healy, Upraj Singh, Sahibjot S Bhatia, Neuzil Lai, Forshing Lui
Journal: Cureus (2023)
Keywords: idiopathic intracranial hypertension, lateral sinus thrombosis, meningioma, meningioma en plaque, venous sinus occlusion
MeSH terms: Case Reports

Idiopathic intracranial hypertension (IIH) is defined as raised intracranial pressure of unknown etiology. Looking for underlying causes needs to be undertaken before the diagnosis is confirmed and managed accordingly. We are reporting a rare and unique case of a patient with the clinical diagnosis of idiopathic intracranial hypertension or pseudotumor cerebri. She is not obese and not taking any predisposing medication. Her first magnetic resonance imaging (MRI) and magnetic resonance venogram (MRV) were reported as showing left transverse sinus thrombosis. She was treated with anticoagulation. Her final diagnosis of left transverse sinus compression by a meningioma en plaque (MEP) was finally made with a repeat MRI. A high index of suspicion of unusual causes is important when IIH presents in an atypical patient or with an atypical presentation. The prognosis and management of real IIH and raised intracranial pressure due to other causes are different.
A Standard Lipid Panel Is Insufficient for the Care of a Patient on a High-Fat, Low-Carbohydrate Ketogenic Diet
Authors: Nicholas G Norwitz, Vyvyane Loh
Journal: Front Med (Lausanne) (2020)
Keywords: hdl, ldl, lp(a), cholesterol, ketogenic diet, subfractionation, vitamin c
MeSH terms: Case Reports

High-fat, low-carbohydrate ketogenic diets have recently become popular for weight loss and the treatment of numerous chronic diseases; however, the general medical community still expresses concern regarding the impact of high-fat diets on serum lipids and cardiovascular risk. Herein, we report on a young man who adopted a ketogenic diet to treat his inflammatory bowel disease. Incidentally, changes in his serum lipids that would be considered adverse by current standards were noted. A more critical analysis of his lipid profile suggests that the changes he experienced may not be dangerous and may, at least with regard to several parameters, represent improvements. This case study demonstrates how the manner in which lipid panels are often reported and reviewed can lead to misleading conclusions and highlights that, at least in the care of those on a ketogenic diet, more nuanced analyses of lipid subfractionations should be conducted in order for physicians to provide optimal care and clinical recommendations.
Colonic metastases from pleomorphic carcinoma of the lung presenting as an ileocecal intussusception
Authors: Sadat Rashid, Dhyan Rajan, Robin Jacob, Keith Dahl, Apsara Prasad, Jaspreet Singh, Ghulam Siddiqui, Venkatesh Sasthakonar, Lester Freedman, Wondwoosen Gebre, Umeko Takeshige, Krishnaiyer Subramani, Kaleem Rizvon, Paul Mustacchia
Journal: ISRN Gastroenterol (2011)
MeSH terms: Case Reports

Pleomorphic carcinoma is a rare aggressive type of lung cancer that uncommonly metastasizes to the bowel, leading to bleeding, perforation, obstruction, and rarely intussusception. Serving as a lead point, metastatic lesions in the bowel may precipitate intussusception and require immediate surgical intervention. We present a rare case of colonic metastases from a primary lung malignancy, causing ileocecal intussusception in a 57-year old male.
Lemierre's Syndrome: A Case Report
Authors: Leticia Santos, Filipa Monteiro, Maria Marques, Rita Homem, Vanda Spencer
Journal: Cureus (2023)
Keywords: fusobacterium necrophorum, jugular vein thrombophlebitis, lemièrre’s syndrome, septic embolism, septic thrombophlebitis
MeSH terms: Case Reports

Lemierre's syndrome is a rare condition characterized by septic thrombophlebitis of the internal jugular vein secondary to infection of the head and neck region and septic embolization to other organs. The most frequent etiological agent is Fusobacterium necrophorum, a commensal anaerobic gram-negative bacillus of the oral flora. We report the case of a young male who presented with chest pain after a dental procedure. He developed a masseterian phlegmon, thrombosis of the internal jugular vein, and embolization to the lung complicated by empyema. The diagnosis of Lemierre's syndrome was delayed by the negative blood cultures, but full recovery was achieved after appropriate broad-spectrum antibiotic coverage. Our main objective is to highlight the fact that a high clinical suspicion is required to establish the diagnosis of this rare syndrome.
A Case Report on Endodontic Management of a Rare Vertucci Type III Maxillary Canine
Authors: Hrudi Sundar Sahoo, R Kurinji Amalavathy, D Pavani
Journal: Case Rep Dent (2019)
MeSH terms: Case Reports

Success in root canal treatment demands a thorough knowledge of usual root canal anatomy and its variations pertaining to every tooth. Variations in root canal anatomy are often accompanied by complex orientation of pulp tissues making a thorough mechanical and chemical debridement a challenge. Inability to treat such complexities often leads to endodontic failure. Upon a quick review of the literature, it has been noted that very few root canal complexities in maxillary canines have been reported. To be a successful clinician, one must be aware of such rare anatomical instances in maxillary canines. Based on possible branching of the root canal system, root canal configurations of permanent teeth were divided into eight different types by Vertucci. The classification included single to three separate root canals. This case report presents a permanent right maxillary canine which is single rooted having a single canal orifice and a root canal dividing into two canals (buccal and palatal) at the middle third of the root and then joining at the apical third, before exiting with a single apical foramen (Vertucci type III).
Parapharyngeal neck schwannomas with unusual vascular displacement
Authors: Kiran Sargar
Journal: Case Rep Med (2013)

This case report illustrates two unusual cases of parapharyngeal schwannomas mimicking carotid body tumors in terms of characteristic vascular displacement. Carotid body tumors classically cause splaying of internal and external carotid arteries demonstrating the Lyre sign on imaging. Also interestingly, both of these cases were seen in younger ages and include cervical sympathetic chain schwannoma and vagal schwannoma. However, these schwannomas revealed hypovascularity on imaging studies allowing differentiation from hypervascular carotid body tumors. Preoperative distinction between carotid body tumors and schwannomas is very important.
Lens siderosis resulting from a small intralenticular metallic foreign body
Authors: Mehul A Shah, Shreya M Shah, Pritesh Teori, Anjli Israni
Journal: GMS Ophthalmol Cases (2015)
MeSH terms: Case Reports

We report a rare case of lens siderosis with an undetectable intraocular foreign body by imaging. An 8-year-old boy presented with diminution of vision in the left eye since 3 months. His parents gave a preceding uncertain history of a foreign body injury to his left eye 3 months ago while playing. Presenting visual acuity in the left eye was perception of hand movements. Slit-lamp examination revealed a total white cataract with brownish-pigmented spots on the anterior capsule of the lens, but no intraocular foreign body was found. There was also no evidence of an intraocular foreign body on ultrasonography. Patient underwent cataract extraction with intraocular lens implantation. During the operation, a small (2×1×1 mm in size) intralenticular foreign body of metal material was found and removed carefully with a magnet. The patient regained 20/30 vision after surgery.
Complete remission obtained with azacitidine in a patient with concomitant therapy related myeloid neoplasm and pulmonary mucormycosis
Authors: S Capria, F De Angelis, G Gentile, S M Trisolini, S Brocchieri, M Canichella, P Chiusolo, A Micozzi, R Foà, G Meloni
Journal: Mediterr J Hematol Infect Dis (2013)
MeSH terms: Case Reports

Mucormycosis is the third cause of invasive mycosis after candidiasis and aspergillosis in AML patients, representing a poor prognostic factor associated with a high rate of fatal outcome. We report a case of a patient with AML and a concomitant pulmonary mucormycosis at diagnosis, who obtained a complete remission both of her AML and of the fungal infection. The incidence of the infection at the onset of leukemia is extremely unusual, and, to our knowledge, the sporadic cases reported in the literature are included in heterogeneous series retrospectively examined. In our case, Liposomal Amphotericin B as single agent appeared incapable of controlling the infection, so anti-infective therapy was intensified with posaconazole and simultaneously antileukemic treatment with 5-azacitidine was started, with the understanding that the only antifungal treatment would not have been able to keep the infection under control for a long time if not associated with a reversal of neutropenia related to the disease. We observed a progressive improvement of the general conditions, a healing of pneumonia and a complete remission of the leukemic disease, suggesting that a careful utilization of the new compounds available today, in terms of both antifungal and antileukemic treatment, may offer a curative chance a patient who would have otherwise been considered unfit for a potentially curative therapeutic strategy.
Urothelial Papilloma of the Urinary Bladder in Children: Report of Two Cases
Authors: Kata Davidovics, Sandor Davidovics, Andras Farkas, Noemi Benedek, Tamas Tornoczki, Daniel Kardos, Anna Davidovics, Peter Vajda
Journal: European J Pediatr Surg Rep (2020)
Keywords: children, neoplasm, tumor, urinary bladder
MeSH terms: Case Reports

Urothelial neoplasms of the bladder (UNB) are considerably rare throughout the pediatric population. UNB develops from the urothelial tissue in the form of a benign disease, generally favoring a successful prognosis in the majority of cases. The authors present the diagnosis and treatment regarding two medical case reports in which urothelial papilloma was diagnosed and effectively treated. Case 1 : A 15-year-old male patient was presented to our clinic complaining of a painless yet distinctive, macroscopic form of hematuria. Following a routine examination, which included ultrasound (US) and intravenous pyelography, the urethrocystoscopy revealed an intravesical solitary lesion positioned in the vicinity of the left ureteral orifice. Additionally, histology confirmed urothelial papilloma. During the follow-up, laboratory, urinary control tests, and US results all proved negative. Case 2 : A 13-year-old male patient was admitted to our clinic and examined, in regard to complaints associated with recurrent abdominal pain. The pathology was discovered incidentally on abdominal US. Preoperative US and magnetic resonance imaging (MRI) studies ensued, resulting in a scheduled MRI, followed by urethrocystoscopy, which confirmed an intravesical solitary lesion positioned near the right ureteral orifice. Histology revealed urothelial papilloma. During the follow-up control cystoscopy, one resection was repeated due to the presence of a residual tumor. Today, 10 years since the presence of uroepithelial papilloma, both patients are asymptomatic and tumor-free. If there is likely suspicion of recurrence, cystoscopy is recommended.