OpenMed/multicare-articles huggingface dataset:
An Orthopaedic Robotic-Assisted Rehabilitation Method of the Forearm in Virtual Reality Physiotherapy
Authors: Miguel A Padilla-Castañeda, Edoardo Sotgiu, Michele Barsotti, Antonio Frisoli, Piero Orsini, Alessandro Martiradonna, Cristina Laddaga, Massimo Bergamasco
Journal: J Healthc Eng (2018)
MeSH terms: Elbow Joint / physiology, Orthopedics / methods, Physical Therapy Modalities / instrumentation, Robotics, Virtual Reality, Wrist Joint / physiology, Research Support, Non-U.S. Gov't, Adult, Aged, Aged, 80 and over, Calibration, Computers, Elbow Joint / physiopathology, Equipment Design, Exercise, Feedback, Female, Humans, Male, Middle Aged, Pilot Projects, Principal Component Analysis, Stress, Mechanical, Stroke Rehabilitation, Upper Extremity / physiopathology, User-Computer Interface, Wrist Joint / physiopathology, Young Adult

The use of robotic rehabilitation in orthopaedics has been briefly explored. Despite its possible advantages, the use of computer-assisted physiotherapy of patients with musculoskeletal injuries has received little attention. In this paper, we detailed the development and evaluation of a robotic-assisted rehabilitation system as a new methodology of assisted physiotherapy in orthopaedics. The proposal consists of an enhanced end-effector haptic interface mounted in a passive mechanism for allowing patients to perform upper-limb exercising and integrates virtual reality games conceived explicitly for assisting the treatment of the forearm after injuries at the wrist or elbow joints. The present methodology represents a new approach to assisted physiotherapy for strength and motion recovery of wrist pronation/supination and elbow flexion-extension movements. We design specific game scenarios enriched by proprioceptive and haptic force feedback in three training modes: passive, active, and assisted exercising. The system allows the therapist to tailor the difficulty level on the observed motion capacity of the patients and the kinesiology measurements provided by the system itself. We evaluated the system through the analysis of the muscular activity of two healthy subjects, showing that the system can assign significant working loads during typical physiotherapy treatment profiles. Subsequently, a group of ten patients undergoing manual orthopaedic rehabilitation of the forearm tested the system, under similar conditions at variable intensities. Patients tolerated changes in difficulty through the tests, and they expressed a favourable opinion of the system through the administered questionnaires, which indicates that the system was well accepted and that the proposed methodology was feasible for the case study for subsequently controlled trials. Finally, a predictive model of the performance score in the form of a linear combination of kinesiology observations was implemented in function of difficult training parameters, as a way of systematically individualising the training during the therapy, for subsequent studies.
Chronic Lymphocytic Leukemia and Myelofibrosis
Authors: Fares Darawshy, Arieh Ben-Yehuda, Karine Atlan, Deborah Rund
Journal: Case Rep Hematol (2018)
MeSH terms: Case Reports

Background:
Chronic lymphocytic lymphoma (CLL) can be associated with several malignancies, but rarely with myelofibrosis. Only isolated case reports in the literature described the association between CLL and primary myelofibrosis (PMF) in the same patient.
Objectives:
We describe a case of CLL characterized by the development of PMF and a review of literature.
Methods:
We describe an 86-year-old female diagnosed as having CLL and followed by the development of splenomegaly and progressively rising LDH levels 27 months later. A bone marrow biopsy was consistent with the diagnosis of PMF, with positive JAK-2 V617F mutation. We also review the clinical and molecular characteristics of patients with CLL and PMF.
Results:
Patients with CLL and PMF are usually older. A lead diagnosis of CLL harbored by PMF is the most common clinical course, although concomitant diseases may occur in 31.7% of patients. JAK-2 V617F mutation can be found in 48.7% of patients.
Conclusion:
This case reported here constitutes an unusual situation of CLL characterized by the development of PMF. Etiologic and pathogenic associations-the role of t (1; 6) and JAK-2 V617F mutation-are discussed.
Patients with positive HER-2 amplification advanced gastroesophageal junction cancer achieved complete response with combined chemotherapy of AK104/cadonilimab (PD-1/CTLA-4 bispecific): A case report
Authors: Jieqiong Peng, Qiang Zhu, Ziru Peng, Zhen Chen, Yuantao Liu, Bo Liu
Journal: Front Immunol (2022)
Keywords: ak104/cadonilimab, her-2 positive, pd-1/ctla-4 bispecific, advanced gastroesophageal junction cancer, complete response
MeSH terms: Esophageal Neoplasms / drug therapy, Esophageal Neoplasms / pathology, Hepatitis / pathology, Stomach Neoplasms / drug therapy, Stomach Neoplasms / genetics, Stomach Neoplasms / metabolism, Case Reports, Research Support, Non-U.S. Gov't, Adult, CTLA-4 Antigen, Esophagogastric Junction / pathology, Humans, Male, Positron Emission Tomography Computed Tomography, Programmed Cell Death 1 Receptor, Programmed Cell Death 1 Receptor, CTLA-4 Antigen

Background:
Human epidermal growth factor receptor 2 (HER2) is the most prominent therapeutic target for advanced gastric (G)/GEJ cancer. However, targeted therapy did not significantly improve survival. Currently, there are no regimens for the treatment of HER-2 amplification that exclude targeted agents.
Case presentation:
A 42-year-old man was diagnosed with adenocarcinoma of GEJ (stage IV) with liver metastasis and lung metastasis. The patient was enrolled in a trial that excluded patients with known HER2-positivity: AK104, a PD-1/CTLA-4 bispecific antibody, combined with chemotherapy (mXELOX) as first-line therapy for advanced gastric G/GEJ cancer (NCT03852251). After six cycles of AK104 combined with chemotherapy therapy, immune-related pulmonary toxicity was observed. We rechallenged AK104 after hormone therapy, and no further pulmonary toxicity was observed. Immune-related hepatitis occurred in the patient during immunotherapy combined with single-drug capecitabine therapy. After combining steroid therapy with mycophenolate mofetil, the patient's immune hepatitis improved. Nevertheless, the patient was excluded from the clinical study due to the long-term absence of medication. Antitumor therapy was also discontinued in view of the patient's adverse immune response. The patient did not receive subsequent immune antitumor therapy, and immune-related hepatitis still occurred intermittently, but the disease evaluation was maintained at PR. A complete response was confirmed by PET/CT and the biopsy specimen from gastroscopy on 2020-06-10. Next generation sequencing of biopsy tissue was used to guide subsequent therapy at a recent follow-up visit. The results indicated that ERBB2 mutations occurred at copy number 58.4934 (HER-2), TMB = 3.1, MSS. IHC: EBV (-), PD-L1 CPS = 3, HER-2 (3+).
Conclusion:
Patients with HER-2-positive advanced GEJ cancer received PD-1/CTLA-4 bispecific immunotherapy combined with chemotherapy and achieved complete remission. It offers a novel, highly specific, and highly potent therapeutic option for HER-2-positive patients. Its use should be considered as a new treatment when trastuzumab is not viable. Currently, we are working to overcome this resistance.
Follicular Variant of Acquired Dermal Macular Hyperpigmentation: A Case Report
Authors: Ammar A Bakhsh, Basant A Alzubaidy, Mohammed A Attas, Khalil F Miyajan, Khalid Al Hawsawi
Journal: Cureus (2023)
Keywords: acquired dermal macular hyperpigmentation, admh, follicular lichen planus pigmentosus, lichen planopilaris (lpp), lichen planus pigmentosus
MeSH terms: Case Reports

Acquired dermal macular hyperpigmentation (ADMH) is a term used to describe a group of diseases that are characterized by idiopathic macular dermal hypermelanosis. These skin conditions include erythema dyschromicum perstans, lichen planus pigmentosus, and pigmented contact dermatitis, also known as Riehl's melanosis. This case report involves a 55-year-old woman who was generally healthy but who had been experiencing asymptomatic, slowly progressive skin lesions for the previous four years. A thorough inspection of her skin revealed many non-scaly, pin-point follicular brown macules, which in some spots had coalesced into patches across her neck, chest, upper extremities, and back. Darier disease and Dowling-Degos disease were included in the differential diagnosis. The biopsies of the skin revealed follicular plugging. The dermis had pigment incontinence with melanophages and slight perivascular and perifollicular mononuclear cell infiltrates. The patient was diagnosed with a follicular form of ADMH. Patient's skin condition caused her concern. She was reassured and prescribed topical steroids 0.1% betamethasone valerate ointment application twice a day for two days per week (weekends) and 0.1% tacrolimus ointment application twice a day for five days per week for three months. She showed some improvement and was put under periodic follow-ups.
Primary Eccrine Porocarcinoma of the Breast: A Case Report and Review of Literature
Authors: Yi Xin Li, Mihir Gudi, Zhiyan Yan
Journal: Case Rep Oncol Med (2022)
MeSH terms: Case Reports

Eccrine porocarcinoma (EPC) is a rare cutaneous neoplasm, with less than 500 reported cases worldwide since it was first described in 1963. EPC tends to affect the elderly and most commonly affects the head and neck. The mainstay of EPC treatment is surgery, with lymphadenectomy in the case of nodal involvement or presence of unfavourable characteristics. No evidence exists to guide the use of adjuvant chemotherapy or radiation. EPC is prone to misdiagnosis given its multiple clinical and histopathological mimics, especially in uncommon sites of presentation such as the breast. Herein, we report the case of a 59-year-old woman who presented with a left breast skin lump. The biopsied specimen revealed an infiltrative carcinoma involving the dermis and epidermis with positive IHC staining for P63 and CK5/6 and negative staining for ER, PR, and HER2. The tumour was resected and diagnosed as EPC with atypical features as overlapping characteristics of squamous cell carcinoma (SCC) were detected on histopathological analysis. In our case, a simple mastectomy with broad margins and axillary lymph node dissection with adjuvant radiotherapy to a dose of 60 Gy failed to achieve loco-regional control with nodal recurrence occurring 4 months postsurgery-a testament to the aggressive course of this rare malignancy.
Malignant rhabdoid tumor in a solitary kidney arising in an adult patient with chronic obstructive renal calculi
Authors: Y Ayari, S Ben Rhouma, H Boussaffa, M Krarti, L Charfi, M Jrad, Y Nouira
Journal: Int J Surg Case Rep (2019)
Keywords: adult, hydronephrosis, malignant, renal, renal calculi, rhabdoid tumor

Introduction:
Malignant rhabdoid tumor (MRT) is one of the most aggressive and lethal malignancies in pediatric oncology, MRT of the kidney is an uncommon renal tumor in children and it's extremely rare in adult patients. With only seven previously reported adult cases in the English-literature, to our knowledge this is the first case that is associated with renal calculi.
Presentation of case:
We present the case of a 65-year-old man with an MRT arising in a solitary kidney with multiple enlarged lymph nodes that compressing the inferior vena cava.
Discussion:
Malignant rhabdoid tumor of the kidney was originally described as a "rhabdomyosarcomatoid" variant of Wilm's tumor due to the resemblance of cells to rhabdomyoblasts, now this type of tumor is recognized as distant and unique malignant renal tumor. It affects usually children before the age of 2 years. Tumor tissue sampling is required to make the diagnosis of MRTK, based on either nephrectomy, core biopsy, or autopsy specimens. There is no established standard of care due to the paucity of cases. Surgery is considered to be the first choice of treatment if possible.
Conclusion:
This case report reinforces the importance of recognizing this entity in the adult population, and discuss the possible treatment options of this rare and highly aggressive tumor.
Nail Salon a Potential Source of a Rare Mycobacterium Fortuitum Infection In Proximal Tibia Megaprosthesis? A Case Report
Authors: Thomas A Novack, Tyler Hoskins, Jay N Patel, Christopher Mazzei, David Goyette, Kaitlin Zeedyk, James C Wittig
Journal: J Bone Jt Infect (2020)
Keywords: infection, mycobacterium fortuitum, parosteal osteosarcoma
MeSH terms: Case Reports

Mycobacterium Fortuitum (M. Fortuitum) is a type of opportunistic pathogen commonly found in water/soil and belongs to the nontuberculosis mycobacteria (NTM) family. Prosthetic joint infection due to M. Fortuitum is extremely rare. We present a case of a 21-year-old female with an infection following a radical resection of the proximal tibia due to a parosteal osteosarcoma.
Post-Myocardial Infarction Ventricular Septal Defect Successfully Treated with Impella as Bridge to Cardiac Transplantation
Authors: Lauren Giudicatti, Benjamin Silbert, Xiao-Fang Xu, Anthony Putrino, Felicity Lee, Amit Shah, Robert Larbalestier, Karim Slimani, Andrew Laycock, Kaitlyn Lam
Journal: Case Rep Cardiol (2022)
MeSH terms: Case Reports

A 63-year-old female presented late with anterior ST-elevation myocardial infarction and cardiogenic shock. This was complicated by acute ventricular septal defect with large left-to-right shunt. An Impella CP was inserted on day seven with rapid haemodynamic improvement. This facilitated bridge to cardiac transplant on day twelve post-MI.
Case report: Clinical success targeting BRAF-mutated, hormone receptor positive, HER2- negative advanced breast cancer patient with BRAF-inhibitor plus MEK- inhibitor
Authors: Alfonso López de Sá, Alicia de Luna, Mónica Antoñanzas, Vanesa García-Barberán, Fernando Moreno-Anton, Jose A García-Sáenz
Journal: Front Oncol (2022)
Keywords: braf, escat, hr+, advanced breast cancer, case report, dabrafenib, trametinib
MeSH terms: Case Reports

Hormone receptor-positive, human epidermal growth factor 2-negative advanced breast cancer patients have had a wide range of therapeutical options since the incorporation of targeted therapies alongside classic chemotherapy. However, because of their disease, virtually all patients will eventually experience disease progression that might compromise their lives. Thriving investigation regarding molecular therapies has provided clinicians with new options for the treatment of many cancer patients. Dabrafenib and trametinib combination has proven useful in treating malignant melanoma patients harboring a BRAF V600E mutation, improving progression-free survival and overall survival, and it has been tested in other tumors. Here we report the case of a metastatic breast cancer patient harboring a BRAF V600E mutation that achieved complete response with dabrafenib and trametinib combination.
Intramuscular Myxoma in the Supinator Muscle with Transient Postoperative Posterior Interosseous Nerve Palsy: A Case Report
Authors: Toshihiro Nonaka, Motoki Sonohata, Shuhei Takeshita, Yosuke Oba, Yoshimasa Fujii, Masaaki Mawatari
Journal: Open Orthop J (2018)
Keywords: intramuscular myxoma, posterior interosseous nerve, supinator muscle
MeSH terms: Case Reports

Background:
Intramuscular myxomas are rare, benign mesenchymal tumors in the musculoskeletal system, and usually, the tumors arise in the large muscles of the thigh, buttocks, shoulder, and upper arm. However, a tumor of the forearm is very rare. Herein, we describe the case of an intramuscular myxoma in the supinator muscle of a 56-year-old female patient.
Case presentation:
Magnetic resonance imaging showed a well-defined mass that was hypointense with the peritumoral fat ring sign. The differential diagnoses might have been myxoma, schwannoma, or intramuscular hemangioma. The histopathological image showed abundant myxoid tissue, hypocellularity, and poor vascularization. The cells of the tumor were spindle and stellate-shaped with normochromic nuclei. Based on these findings, the pathological diagnosis was an intramuscular myxoma. After excising the tumor, the patient had transient posterior interosseous nerve palsy.
Conclusion:
This tumor is curative by resection in toto; however, when the tumor exists in the forearm, surgeons should be careful to avoid damaging surrounding tissues because the tumor is very hard and relatively large compared to the forearm.
Case Report: Could Hennebert's Sign Be Evoked Despite Global Vestibular Impairment on Video Head Impulse Test? Considerations Upon Pathomechanisms Underlying Pressure-Induced Nystagmus due to Labyrinthine Fistula
Authors: Andrea Castellucci, Cecilia Botti, Margherita Bettini, Ignacio Javier Fernandez, Pasquale Malara, Salvatore Martellucci, Francesco Maria Crocetta, Martina Fornaciari, Francesca Lusetti, Luigi Renna, Giovanni Bianchin, Enrico Armato, Angelo Ghidini
Journal: Front Neurol (2021)
Keywords: hennebert's sign, case report, fistula sign, labyrinthine fistulae, pressure-induced nystagmus, video head impulse test
MeSH terms: Case Reports

We describe a case series of labyrinthine fistula, characterized by Hennebert's sign (HS) elicited by tragal compression despite global hypofunction of semicircular canals (SCs) on a video-head impulse test (vHIT), and review the relevant literature. All three patients presented with different amounts of cochleo-vestibular loss, consistent with labyrinthitis likely induced by labyrinthine fistula due to different temporal bone pathologies (squamous cell carcinoma involving the external auditory canal in one case and middle ear cholesteatoma in two cases). Despite global hypofunction on vHIT proving impaired function for each SC for high accelerations, all patients developed pressure-induced nystagmus, presumably through spared and/or recovered activity for low-velocity canal afferents. In particular, two patients with isolated horizontal SC fistula developed HS with ipsilesional horizontal nystagmus due to resulting excitatory ampullopetal endolymphatic flows within horizontal canals. Conversely, the last patient with bony erosion involving all SCs developed mainly torsional nystagmus directed contralaterally due to additional inhibitory ampullopetal flows within vertical canals. Moreover, despite impaired measurements on vHIT, we found simultaneous direction-changing positional nystagmus likely due to a buoyancy mechanism within the affected horizontal canal in a case and benign paroxysmal positional vertigo involving the dehiscent posterior canal in another case. Based on our findings, we might suggest a functional dissociation between high (impaired) and low (spared/recovered) accelerations for SCs. Therefore, it could be hypothesized that HS in labyrinthine fistula might be due to the activation of regular ampullary fibers encoding low-velocity inputs, as pressure-induced nystagmus is perfectly aligned with the planes of dehiscent SCs in accordance with Ewald's laws, despite global vestibular impairment on vHIT. Moreover, we showed how pressure-induced nystagmus could present in a rare case of labyrinthine fistulas involving all canals simultaneously. Nevertheless, definite conclusions on the genesis of pressure-induced nystagmus in our patients are prevented due to the lack of objective measurements of both low-acceleration canal responses and otolith function.
Autoimmune Hepatitis with Concomitant Idiopathic Thrombocytopenic Purpura Diagnosed by Transjugular Liver Biopsy
Authors: Hiromi Fukuda, Kazuhide Takata, Takanori Kitaguchi, Ryo Yamauchi, Hideo Kunimoto, Takashi Tanaka, Keiji Yokoyama, Daisuke Morihara, Yasuaki Takeyama, Satoshi Shakado, Ai Mogi, Shinichi Kora, Kaori Koga, Morishige Takeshita, Kengo Yoshimitsu, Shotaro Sakisaka
Journal: Case Reports Hepatol (2018)
MeSH terms: Case Reports

Patients with autoimmune hepatitis (AIH) may sometimes have concomitant idiopathic thrombocytopenic purpura (ITP). Severe thrombocytopenia in ITP interferes with percutaneous liver biopsy for pathological diagnosis of AIH. Here, we report a case of AIH with ITP in a 63-year-old woman. The patient presented to our hospital with liver dysfunction and thrombocytopenia. For histological examination, transjugular liver biopsy (TJLB) was performed, leading to a diagnosis of AIH. Corticosteroids treatment led to an improvement in her liver enzyme levels and platelet count. In conclusion, patients with AIH may sometimes have concomitant ITP. TJLB was effective for making the diagnosis of AIH with severe thrombocytopenia due to ITP.
Successful Mechanical Thrombectomy of a Middle Cerebral Artery Occlusion 14 Hours after Stroke Onset
Authors: Anelia Dietmann, Kety Wha-Vei Hsieh, Andrea M Humm, Claudio L Bassetti, Urs Fischer, Jan Gralla
Journal: Case Rep Neurol Med (2017)
MeSH terms: Case Reports

A 54-year-old patient presented with mild right-sided weakness of hand and face with a National Institutes of Health Stroke Scale (NIHSS) of 2 and occlusion of the left middle cerebral artery (MCA) in the M1 segment with a large perfusion deficit on computed tomography (CT). Due to mild neurological deficits no IVT was performed. Nine hours after symptom onset the patient gradually deteriorated with a NIHSS fluctuating between 9 and 15. MRI showed a persistent occlusion of the MCA with a large diffusion-perfusion mismatch. Immediate endovascular thrombectomy was performed 14 hours after symptom onset with complete recanalization and complete clinical recovery. Although mechanical thrombectomy is generally considered an effective alternative strategy up to 8 hours after stroke onset, selected patients with a large diffusion/perfusion mismatch and small infarct cores may benefit from an expanded therapeutic window.
A case report of successful identification of ectopic parathyroid adenomas with a sequence of selective parathyroid venous sampling and 4D-computed tomography in a patient with recurrent hyperparathyroidism
Authors: Onnicha Suntornlohanakul, Rattana Leelawattana
Journal: Int J Surg Case Rep (2020)
Keywords: 4d-computed tomography, case report, ectopic parathyroid gland, recurrent primary hyperparathyroidism, selective parathyroid venous sampling
MeSH terms: Case Reports

Introduction:
Recurrent hyperparathyroidism is difficult to manage due to the difficulty in finding the missing adenoma. Herein we present a case of recurrent hyperparathyroidism from ectopic adenomas which basic investigations failed to locate but were finally localized by a 4DCT following selective venous sampling (SVS) of parathyroid hormone (PTH).
Presentation of case:
A young female presented with recurrent hyperparathyroidism. She had severe primary hyperparathyroidism and temporary normocalcemia after first parathyroidectomy. Her hypercalcemia recurred and required second operation. However, the second operation was unsuccessful due to the pre-operation ultrasound, computed tomography (CT) neck, and sestamibi failed to identify the culprit parathyroid adenoma. After the second operation, positron emission tomography (PET), CT neck and sestamibi failed to identify the tumor but a sequence of SVS PTH and four-dimensional computed tomography (4DCT) successfully identified several ectopic adenomas.
Discussion:
Ectopic parathyroid tissue is the most common cause of recurrent hyperparathyroidism but precisely locating these ectopic glands is often challenging. Despite modern modalities such as PET scans, the success rate is not impressive. SVS PTH is a good method to regionalize the ectopic source of PTH. With the more specified area, fine-tuning imaging with a 4DCT can identify the specific location of the ectopic parathyroid tissue.
Conclusion:
A sequence of SVS PTH followed by 4DCT could identify the exact location of ectopic parathyroid adenomas in a patient when conventional non-invasive imaging studies failed.