OpenMed/multicare-articles huggingface dataset:
Endometrial adenocarcinoma presenting as a suprasellar mass: lessons to be learned
Authors: Evgenia Granina, Julia Fehniger, Douglas Kondziolka, Joshua Silverman, Andrea Downey, Dimitris Placantonakis, Franco Muggia
Journal: Ecancermedicalscience (2020)
Keywords: her2/neu, adenocarcinoma, metastases, panhypopituitarism, radiosurgery, stage ia cancer
MeSH terms: Case Reports

A 66-year-old woman with a history of stage IA mixed endometrioid and serous endometrial cancer presented to our centre with 2 weeks of worsening headaches nearly 4 years after her initial surgery. At admission, she manifested bitemporal hemianopsia, difficulty walking and clinical and laboratory findings of panhypopituitarism, including diabetes insipidus. Magnetic resonance imaging of the brain revealed a 2.7 cm sellar/suprasellar mass compressing the optic chiasm and infiltrating the pituitary stalk. Computerised tomography documented mediastinal, lung, adrenal and liver involvement, including a 2.5 cm palpable left supraclavicular node that on excisional biopsy demonstrated metastatic endometrial adenocarcinoma. Due to the advanced stage of her cancer as well as the presence of multiple metastases, including lung and hepatic metastases causing post-obstructive pneumonia and coagulopathy, the sellar/suprasellar mass was treated with fractionated radiosurgery rather than surgical excision.
Clinical metagenomics-challenges and future prospects
Authors: Maliha Batool, Jessica Galloway-Peña
Journal: Front Microbiol (2023)
Keywords: diagnostics, meningitis, metagenomics, next-generation sequencing, sepsis
MeSH terms: Review

Infections lacking precise diagnosis are often caused by a rare or uncharacterized pathogen, a combination of pathogens, or a known pathogen carrying undocumented or newly acquired genes. Despite medical advances in infectious disease diagnostics, many patients still experience mortality or long-term consequences due to undiagnosed or misdiagnosed infections. Thus, there is a need for an exhaustive and universal diagnostic strategy to reduce the fraction of undocumented infections. Compared to conventional diagnostics, metagenomic next-generation sequencing (mNGS) is a promising, culture-independent sequencing technology that is sensitive to detecting rare, novel, and unexpected pathogens with no preconception. Despite the fact that several studies and case reports have identified the effectiveness of mNGS in improving clinical diagnosis, there are obvious shortcomings in terms of sensitivity, specificity, costs, standardization of bioinformatic pipelines, and interpretation of findings that limit the integration of mNGS into clinical practice. Therefore, physicians must understand the potential benefits and drawbacks of mNGS when applying it to clinical practice. In this review, we will examine the current accomplishments, efficacy, and restrictions of mNGS in relation to conventional diagnostic methods. Furthermore, we will suggest potential approaches to enhance mNGS to its maximum capacity as a clinical diagnostic tool for identifying severe infections.
Multifocal severe coronary artery vasospasm mistaken for diffuse atherosclerosis: a case report
Authors: Sarfraz Ahmed Nazir, Sheraz Nazir, Sanjay Kumar, Charles Ilsley
Journal: Case Rep Med (2010)
MeSH terms: Case Reports

Spontaneous severe multivessel coronary artery vasospasm is a rare but important cause of morbidity. One-third of patients have normal coronary vasculature, and these pose a significant therapeutic dilemma as lack of clinical suspicion might potentially lead to unnecessary revascularization therapies. A patient with resting chest pain and ischaemic electrocardiography demonstrated severe coronary obstruction at catheter angiography. Preangioplasty further information highlighted spasm as the likely cause and the angiographic abnormalities resolved post intracoronary nitrate. This paper emphasises thorough history-taking and judicious use of nitrates during diagnostic coronary angiography in such patients. This may negate the need for more complex cardiac interventions.
Successful utilization of angioembolization and delayed laparoscopy in the management of grade 5 hepatic laceration: Case report and literature review
Authors: Adel Elkbuli, John D Ehrhardt Jr, Mark McKenney, Dessy Boneva
Journal: Int J Surg Case Rep (2019)
Keywords: angioembolization, biliary peritonitis, delayed laparoscopy, hemoperitoneum, high-grade hepatic laceration, solid organ injury grading

Introduction:
The liver is the most commonly injured solid organ in blunt abdominal trauma. Although the incidence of hepatic lacerations continues to rise, non-operative management with angioembolization is currently the standard of care. While active arterial hemorrhage is commonly embolized in grade 3 or 4 injuries, patients with grade 5 injuries frequently require operative intervention.
Presentation of case:
A 30-year-old man presented to our level I trauma center following a motor scooter accident. CT abdominal imaging revealed a grade 5 right lobar hepatic laceration. He underwent successful angioembolization without further hemorrhage. The patient later developed abdominal discomfort that worsened to peritonitis and he was taken for laparoscopic drainage of massive hemoperitoneum with bile peritonitis. Postoperatively, the patient's abdominal pain abated and he tolerated oral dietary advancement.
Discussion:
Surgical management of blunt hepatic trauma continues to evolve in tandem with minimally invasive interventional techniques. Patients with high-grade lacerations are at higher risk for developing biliary peritonitis, hemobilia, persistent hemoperitoneum, and venous hemorrhage after angioembolization. Accordingly, the primary role of surgery has shifted in select patients from laparotomy to delayed laparoscopy to address the aforementioned complications.
Conclusion:
While laparotomy remains crucial for hemodynamically unstable patients, angioembolization is the primary treatment option for stable patients with hemorrhage from liver trauma. The combination of angioembolization and delayed laparoscopy may be considered in stable patients with even the highest liver injury grades.
Ollier Disease: A Case Series and Literature Review
Authors: Vėtra Markevičiūtė, Medeinė Šilenė Markevičiūtė, Mindaugas Stravinskas
Journal: Acta Med Litu (2021)
Keywords: ollier disease, chondrosarcoma, echondromatosis, enchondroma
MeSH terms: Case Reports

Summary background:
Ollier disease is the most common nonhereditary type of enchondromatosis. Enchondromas are common, usually benign intraosseous cartilaginous tumors that form near the growth plate cartilage predominantly unilaterally in the metaphyses and diaphyses of tubular bones. They usually affect the long bones of the hand, the humerus, and the tibia, followed by flat bones, such as the pelvis. The estimated prevalence of Ollier disease is 1 in 100,000 and while it is linked with somatic heterozygous mutations in IDH1 or IDH2 genes, exact etiology is unknown. The risk of malignant transformation towards chondrosarcoma is up to 30-35% and it is clinically suspected when pain and a rapid increase in the size of the lesions is seen.
Case presentations:
We report two clinical cases of patients diagnosed with Ollier disease. In both cases transformation to chondrosarcoma was observed.
Conclusions:
Ollier disease is a rare disorder, defined by the presence of multiple enchondromas and an asymmetric distribution of the cartilage lesions that can be extremely variable in terms of size, location, age, gender. Constant monitoring of patients is important due to the high risk of malignancy. Because the disease is very rare and the manifestations vary widely, each patient's case must be evaluated, and the treatment strategy adopted individually.
Transforaminal epidural blood patch for intractable spontaneous cerebrospinal fluid leak: a case report
Authors: Aki Fujiwara, Keisuke Watanabe, Keiji Hashizume, Kozue Shinohara, Michiko Fukumoto, Katsuhiro Kimoto, Masahiko Kawaguchi
Journal: JA Clin Rep (2017)
Keywords: dynamic myelography, spontaneous cerebrospinal fluid leak, transforaminal epidural blood patch

Background:
Epidural blood patch (EBP) is a recognized treatment for spontaneous cerebrospinal fluid leak (SCFL) and is typically administered by the interlaminar approach. Here, we report a case of a patient in whom SCFL failed to resolve after three applications of interlaminar EBPs before finally being successfully treated with transforaminal EBP.
Case presentation:
We report a case of a 41-year-old female with a definitive diagnosis of SCFL according to computed tomography (CT) myelography. A fluoroscopy-guided interlaminar EBP was applied three times without resolution of her orthostatic headache. A second myelography was therefore performed demonstrating a leak point on the ventral side of the dura mater. To close the ruptured ventral dura mater, it was necessary to fill the ventral epidural space with blood. Therefore, transforaminal EBP was performed. On spinal CT performed immediately after treatment, the ventral epidural space was observed to be filled with injected blood. Her headache improved the following day, and her symptoms completely subsided after 5 days.
Conclusion:
Transforaminal epidural blood patch is appropriate for patients with intractable cerebrospinal fluid leak. Patients with cerebrospinal fluid leakage due to rupture of the ventral side of the dura mater may be particularly good candidates for this procedure.
Clinical Presentation of Acute Pulmonary Embolism in Patients with Coronavirus Disease 2019 (COVID-19)
Authors: Nonso Osakwe, Douglas Hart
Journal: Case Rep Hematol (2020)
MeSH terms: Case Reports

The clinical management of severely ill patients with COVID-19-related acute respiratory distress syndrome (ARDS) presents significant challenges. Many COVID-19 patients with ARDS also present with laboratory findings significant for derangement in coagulation function. In this report, we describe acute pulmonary embolism in three patients with COVID-19. We assessed the role of D-dimer assay and anticoagulation treatment in these patients. The aim of this case report is to increase awareness about the use of D-dimer in addition to patient's clinical status for making treatment decision in COVID-19 patients.
IgA Vasculitis Nephritis: A Case Series and Comparison of Treatment Guidelines
Authors: Abdalhamid Al Harash, Stephanie Saeli, Michael Lucke, Swati Arora
Journal: Case Rep Rheumatol (2020)
MeSH terms: Case Reports

Immunoglobulin A (IgA) vasculitis nephritis (IgAVN) and IgA nephropathy (IgAN) share many pathological parallels and are viewed as related diseases by many groups. Current treatment guidelines remain vague, controversial, and without consensus, especially regarding the role of immunosuppressive medications. We present five cases of IgAVN encountered at our tertiary care center between 2016 and 2020, which were treated with different immunosuppression regimens. Infection was the leading cause of death in this series. These cases provide evidence that IgAVN should be distinguished from IgAN on a spectrum of IgA-associated glomerulonephritis. The outcomes presented herein suggest that the morbidity and systematic involvement IgAVN is greater than previously believed and that these substantial risks should be reflected in contemporary treatment guidelines.
A case report of polymicrobial bacteremia with Weissella confusa and comparison of previous treatment for successful recovery with a review of the literature
Authors: Malene Roed Spiegelhauer, Melodi Yusibova, Ida Kirstine Bull Rasmussen, Kristian Asp Fuglsang, Kim Thomsen, Leif Percival Andersen
Journal: Access Microbiol (2020)
Keywords: weissella confusa, bacteremia, case report, infection, polymicrobial, review
MeSH terms: Case Reports

Weissella confusa is a Gram-positive coccus and a commensal bacterium of the human gastrointestinal tract with a potential to cause invasive infections. We report the presence of W. confusa in the blood of a 25-year-old male patient with Crohn's disease, short bowel syndrome treated with home parenteral nutrition, and a history of recurrent bloodstream infections, admitted to our hospital with fever and malaise. A polymicrobial culture of W. confusa and Aeromonas hydrophila was identified from blood, for which treatment with meropenem and metronidazole was initiated. The literature was searched for previous cases of infection with W. confusa . In total, 14 reports describing infection of 28 patients were found, most cases presenting with bacteremia. The previous reports have described variable susceptibility to antibiotics; however, all were reported to be vancomycin resistant. Because of its similarities to other vancomycin-resistant cocci, isolates of W. confusa might be difficult to identify with traditional methods. Infection may be facilitated by its natural vancomycin resistance, leading to severe infection in hosts with underlying diseases. We describe the treatment of previous cases of infection and suggest treatment methods shown effective in other cases. Vancomycin is often used as treatment of infection with Gram-positive organisms, but this may need to be reevaluated, as several pathogenic bacteria are intrinsically vancomycin resistant. A review on reported treatments of bacteremia by W. confusa suggests the use of daptomycin, amoxicillin-clavulanate or piperacillin/tazobactam as recommendable antibiotic regimens.
Case report: Image guidance retrieval of a foreign body in retropharyngeal space
Authors: Xingmei Wu, Yongquan Wang, Wei Sun, Xiaolin Zhu
Journal: Front Surg (2022)
Keywords: case report, foreign body, head and neck, image guidance navigation, retropharyngeal space
MeSH terms: Case Reports

Background:
Ingested foreign bodies fully embedded in retropharyngeal space present a unique challenge, as they can be difficult to locate and visualize via classic transoral laryngoscopy or the transcervical approach.
Methods:
We retrieved a complete extraluminal chicken bone located in the patient's retropharyngeal space at the level of the C4-C5 spine through a well-designed transcervical approach with a combination of image-guided neck navigation.
Conclusion:
A combined use of image-guided neck navigation and a dedicated transcervical approach for location of a foreign body in the retropharyngeal space is practical and available for clinical application.
Re-irradiation of recurrent vertebral metastasis after two previous spinal cord irradiation: A case report
Authors: Rita Bentahila, Rémy Kinj, Constance Huck, Yasmine El Houat, Ange Mampuya, Constantin Tuleasca, Mahmut Ozsahin, Jean Bourhis, Luis Schiappacasse
Journal: Front Oncol (2023)
Keywords: radiosurgery, retreatment, spine, stereotactic radiation, vertebral metastases
MeSH terms: Case Reports

Background:
Management of a recurrent vertebral metastasis in a situation of previously irradiated spinal cord is a challenging clinical dilemma.
Case presentation:
We report a first case of second retreatment of a spinal metastasis initially irradiated with standard radiotherapy and stereotactic body radiation therapy (SBRT), who subsequently progressed with imaging-confirmed local tumor progression at the same level. After a third course of irradiation with SBRT, a complete response was achieved. After 8 months of follow-up, the patients remain free of local recurrence.
Conclusion:
A third course of vertebral irradiation for a recurrent vertebral metastasis failing to two previous irradiations, in this particular case, have shown the feasibility and efficacy of the technique as a salvage treatment option. This approach could be used in a selected group of patient if an adequate dose is delivered to the target while observing critical tissue tolerance limits.
A Case of Undifferentiated Carcinoma in a 2-Month Postpartum Reproductive Tract with a Rapid and Fulminant Course
Authors: Yasuhiro Yokoyama, Mariko Suzuki, Yasumasa Sato, Shegenori Iwagaki, Yuichiro Takahashi, Hitoshi Iwata
Journal: Case Rep Obstet Gynecol (2021)
MeSH terms: Case Reports

Advanced carcinoma of the lower female reproductive tract is rare during pregnancy and the postpartum period. We here present a case of a 32-year-old Japanese woman, whose entire lower reproductive tract had been invaded by carcinomas as of 2 months after childbirth. She had been infertile, and pregnancy had been established by repeated embryo transfer. The gynecological cancer screening, which included Pap smear tests, was negative during the periods she underwent infertility treatment or during the first trimester. At 26 gestational weeks, the patient noticed uterine contractions concomitant with genital bleeding. Labor progressed slowly and steadily; thus, the pregnancy was ended by cesarean section at 29 weeks. At 2 months after childbirth, the patient experienced increased left abdominal pain and underwent a pelvic examination, revealing multiple pelvic masses and diffuse vaginal tumors causing stenosis. Vaginal tumors were biopsied, and histochemical analysis showed undifferentiated carcinoma with possible adenocarcinoma. Imaging modalities including CT, MRI, and PET-CT suggest that the carcinoma had invaded the entire reproductive tract, especially the uterine body, metastasized into the lungs and the ischial bones, and disseminated onto the peritoneum. She received multiple rounds of chemotherapy but died 6 months after childbirth. Taking into consideration the clinical feature and immunohistochemical profiles of the cancer cells, the endometrium is the most likely origin.
Basal cell ameloblastoma of mandible: a rare case report with review
Authors: Hemant Shakya, Vikram Khare, Nilesh Pardhe, Ena Mathur, Mansi Chouhan
Journal: Case Rep Dent (2013)

Ameloblastoma is a slow-growing benign neoplasm that has a strong tendency to local invasion and that can grow to be quite large without metastasizing. Rare examples of distant metastasis of an ameloblastoma in lungs or regional lymph nodes do exist. It has an aggressive and recurrent course and is rarely metastatic. Radiographically it shares common features with other lesions such as the giant cell tumor, aneurysmal bone cyst, and renal cell carcinoma metastasis; a definitive diagnosis can only be made with histopathology. Basal cell ameloblastoma is believed to be the rarest histologic subtype in which the tumor is composed of more primitive cells and has even fewer features of peripheral palisading. Till date, only few cases of basal cell ameloblastoma have been reported in the literature. Considering the rarity of the lesion, we report here an interesting and unique case of basal cell ameloblastoma of the mandible occurring in a very old patient.
Acute myocardial infarction secondary to catecholamine release owing to cocaine abuse and pheochromocytoma crisis
Authors: Efren Martinez-Quintana, Ricardo Jaimes-Vivas, Javiel Cuba-Herrera, Beatriz Saiz-Udaeta, Fayna Rodríguez-Gonzalez, Maria Soledad Martinez-Martin
Journal: Int J Endocrinol Metab (2013)
Keywords: cocaine, myocardial infarction, pheochromocytoma
MeSH terms: Case Reports

Most pheochromocytomas are not suspected clinically while a high percentage of them are curable with surgery. We present the case of an adult cocaine-addicted male patient with an underlying pheochromocytoma and repeated myocardial infarctions. Computed tomography showed a left round adrenal mass, also high 24-hour urine levels of catecholamines and metanephrines were detected from urinalysis. The patient was given alpha and beta blockers, moreover a laparoscopic left adrenalectomy was performed. Cocaine can block the reuptake of noradrenaline, leading to increasing its concentration and consequently its effects as well, and induce local or diffuse coronary vasoconstriction in normal coronary artery segments per se, cocaine can also trigger pheochromocytoma crisis, and therefore, cardiac complications such as myocardial infarction due to these additive effects are intended to occur. For this reason, in the presence of typical clinical manifestations of pheochromocytoma, such as sustained or paroxysmal hypertension, headache, sweating, tachycardia and abdominal pain, probable association of this tumor in patients with cocaine abuse and associated cardiac complications must be ruled out.
Simultaneous Incidental Parathyroid Carcinoma and Intrathyroid Parathyroid Gland in Suspected Renal Failure Induced Hyperparathyroidism
Authors: Andrew Pappa, Trevor Hackman
Journal: Surg J (N Y) (2017)
Keywords: intraoperative pth, intrathryoidal parathyroid, parathyroid cancer, parathyroidectomy, tertiary hyperparathyroidism
MeSH terms: Case Reports

Hyperparathyroidism is a common disorder affecting more than hundreds of thousands of people annually. While most commonly secondary to an adenoma, it may also arise from four-gland hyperplasia or malignancy. In the case of primary hyperparathyroidism, the number of glands involved may be unknown prior to surgery. In contrast, the metabolic disorder associated with renal failure induced hyperparathyroidism ensures a hyperplasia picture. Despite the uniform hyperplasia seen in tertiary disease and the preoperative expectation for four-gland exploration, our case demonstrates the continued need for a surgeon's vigilance during dissection to identify all glands and appropriately use intraoperative parathyroid hormone (PTH) testing. In addition, while intraoperative PTH assessment is an effective method for confirming adequacy of treatment for hyperparathyroidism, only surgical pathology can confirm malignancy, which should be considered with PTH levels > 1,000. The case also underscores the importance of comprehensive surgery management and mindful interpretation of intraoperative PTH levels in the management of hyperparathyroidism. Standard surgical technique includes complete exploration of the central compartment, and thyroid lobectomy when the aforementioned exploration fails to reveal the necessary parathyroid tissue, especially with a persistently elevated PTH. Without a standardized progressive compartment exploration and judicious use of intraoperative hormone testing, intrathyroidal parathyroid glands can be missed.
Cutaneous dirt-adherent disease complicated with Darier's disease, schizophrenia, and cutis verticis gyrata: A case report
Authors: Qing Zhu, Shu-Jing Guo, Bin Wang, Lu-Lu Xu, Guo-Qiang Zhang
Journal: Front Med (Lausanne) (2022)
Keywords: atp2a2 gene, cutaneous dirt-adherent, gyrate cranial skin, keratosis follicularis, schizophrenia
MeSH terms: Case Reports

The patient was a 25-year-old man presented with cutaneous dirt-adherent disease with a past medical history of schizophrenia. Both the patient and his mother had Darier's disease, genetic screening revealed that the patient carried a heterozygous frameshift mutation in ATP2A2 gene, which was inherited from his mother. Cutis verticis gyrata was also found in the patient.
Bacteremia Associated With a Toothpick Lodged in the Duodenal Wall
Authors: Shahbaz Khan, Shakir Ullah, Masroor Anwar, Ravi Athwani, Khalid Nawab
Journal: Cureus (2023)
Keywords: abdominal pain, bacteremia, duodenitis, foreign body ingestion, toothpick
MeSH terms: Case Reports

Toothpick ingestion and perforation of the gastrointestinal tract, although a very rare phenomenon, carries a very high mortality risk. Most cases of toothpick ingestion remain unnoticed until very late. The symptoms are often vague, with the most common being abdominal pain. Any obscure case of abdominal pain with bacteremia must be investigated for foreign body ingestion and perforation. A CT scan is the best initial diagnostic modality for toothpick perforation but has low sensitivity with laparoscopy, and endoscopy is the preferred diagnostic tool. No single bacterium is involved in bacteremia due to toothpick ingestion. Surgical or endoscopic removal of the impacted toothpick along with prompt antibiotic therapy leads to excellent outcomes. If left untreated or in case of a late diagnosis, it may lead to life-threatening consequences. Here, we present a case of a 44-year-old man who had ingested a toothpick that pierced through and was lodged in the duodenal wall, leading to bacteremia. The patient was successfully treated and discharged.