OpenMed/multicare-articles huggingface dataset:
ADOLESCENT PATIENTS AND THE CLINICAL DECISION ABOUT THEIR HEALTH
Authors: Marlene Pereira Garanito, Vera Lucia Zaher-Rutherford
Journal: Rev Paul Pediatr (2019)
MeSH terms: Adolescent Development, Adolescent Health Services / ethics, Clinical Decision-Making / ethics, Clinical Decision-Making / methods, Informed Consent By Minors / ethics, Informed Consent By Minors / psychology, Patient Participation / methods, Patient Participation / psychology, Professional-Patient Relations / ethics, Review, Adolescent, Humans, Personal Autonomy

Objective:
To carry out a review of the literature on adolescents' participation in decision making for their own health.
Data sources:
Review in the Scientific Electronic Library Online (SciELO), Latin American and Caribbean Health Sciences Literature (LILACS) and PubMed databases. We consider scientific articles and books between 1966 and 2017. Keywords: adolescence, autonomy, bioethics and adolescence, autonomy, ethics, in variants in the English, Portuguese and Spanish languages. Inclusion criteria: scientific articles, books and theses on clinical decision making by the adolescent patient. Exclusion criteria: case reports and articles that did not address the issue. Among 1,590 abstracts, 78 were read in full and 32 were used in this manuscript.
Data synthesis:
The age at which the individual is able to make decisions is a matter of debate in the literature. The development of a cognitive and psychosocial system is a time-consuming process and the integration of psychological, neuropsychological and neurobiological research in adolescence is fundamental. The ability to mature reflection is not determined by chronological age; in theory, a mature child is able to consent or refuse treatment. Decision-making requires careful and reflective analysis of the main associated factors, and the approach of this problem must occur through the recognition of the maturity and autonomy that exists in the adolescents. To do so, it is necessary to "deliberate" with them.
Conclusions:
International guidelines recommend that adolescents participate in discussions about their illness, treatment and decision-making. However, there is no universally accepted consensus on how to assess the decision-making ability of these patients. Despite this, when possible, the adolescent should be included in a serious, honest, respectful and sincere process of deliberation.
Unexpected Favorable Outcome to PD-1 Antibody Plus Lenvatinib in a Patient With Recurrent Intestinal Follicular Dendritic Cell Sarcoma: A Case Report and Literature Review
Authors: Yanna Lei, Sha Zhao, Ming Jiang
Journal: Front Immunol (2021)
Keywords: antiangiogenesis, follicular dendritic cell sarcoma, immune checkpoint inhibitor, lenvatinib, sintilimab
MeSH terms: Antineoplastic Combined Chemotherapy Protocols / therapeutic use, Dendritic Cell Sarcoma, Follicular / drug therapy, Immune Checkpoint Inhibitors / therapeutic use, Intestinal Neoplasms / drug therapy, Phenylurea Compounds / therapeutic use, Quinolines / therapeutic use, Case Reports, Review, Antibodies, Monoclonal, Humanized / therapeutic use, Humans, Male, Middle Aged, Salvage Therapy / methods, Antibodies, Monoclonal, Humanized, Immune Checkpoint Inhibitors, Phenylurea Compounds, Quinolines, sintilimab, lenvatinib

Background:
Follicular dendritic cell sarcoma (FDCS) is an uncommon malignant cancer, and there is no standard treatment to date. Resection followed by adjuvant chemotherapy or radiation is considered the most commonly used strategy for treatment. However, the treatment for patients who have progressed after systemic treatment is more controversial.
Case summary:
In this case report, we describe a 57-year-old man with primary small intestine FDCS where surgery and second-line systemic chemotherapy failed. After disease progression (PD), the patient received sintilimab plus lenvatinib as third-line treatment and achieved a progression-free survival (PFS) with 7 months.
Conclusion:
This is the first report of a FDCS patient treated with immune checkpoint inhibitors (ICIs) and antiangiogenic agents, sintilimab and lenvatinib, as third-line therapy. Our case provides a potential therapeutic option for patients with FDCS who progressed after multiline therapy.
Long-Term Persistence and Relevant Therapeutic Impact of High-Titer Viral-Neutralizing Antibody in a Convalescent COVID-19 Plasma Super-Donor: A Case Report
Authors: Mafalda De Rienzo, Maria Laura Foddai, Laura Conti, Chiara Mandoj, Stefano Iaboni, Ilenia Saladini, Concetta Castilletti, Giulia Matusali, Davide Roberto Donno, Luisa Marchioni, Stefania Ianniello, Angela Corpolongo, Maria Palange, Gennaro Ciliberto, Giulia Piaggio, Federico De Marco
Journal: Front Immunol (2021)
Keywords: covid-19, iga, rbd/ace2-binding inhibition test, case report, hyperimmune plasma, neutralizing antibodies
MeSH terms: Antibodies, Neutralizing / administration & dosage, Antibodies, Viral / administration & dosage, COVID-19 / therapy, SARS-CoV-2 / immunology, Case Reports, Research Support, Non-U.S. Gov't, Aged, Antibodies, Neutralizing / blood, Antibodies, Neutralizing / immunology, Antibodies, Viral / blood, Antibodies, Viral / immunology, Blood Donors, COVID-19 / immunology, COVID-19 / virology, COVID-19 Serotherapy, Humans, Immunization, Passive, Immunoglobulin A / administration & dosage, Immunoglobulin A / blood, Immunoglobulin A / immunology, Male, Middle Aged, Spike Glycoprotein, Coronavirus / immunology, Time Factors, Treatment Outcome, Antibodies, Neutralizing, Antibodies, Viral, Immunoglobulin A, Spike Glycoprotein, Coronavirus, spike protein, SARS-CoV-2

A convalescent, non-severe, patient with COVID-19 was enrolled as a hyper-immune plasma voluntary donor by the Immuno-Hematology and Transfusion Unit of the Regina Elena National Cancer Institute in Rome, under the TSUNAMI national study criteria. During a nearly 6-month period (May-October 2020), the patient was closely monitored and underwent four hyperimmune plasma collections. Serum SARS-CoV-2 (anti-S + anti-N) IgG and IgM, anti-S1 IgA, and neutralizing titers (NTs) were measured. Anti-SARS-CoV-2 antibody levels steadily decreased. No correlation was found between anti-S/anti-N IgG and IgM levels and viral NT, measured by either a microneutralization test or the surrogate RBD/ACE2-binding inhibition test. Conversely, NTs directly correlated with anti-S1 IgA levels. Hyperimmune donor plasma, administered to five SARS-CoV-2 patients with persistent, severe COVID-19 symptoms, induced short-term clinical and pathological improvement. Reported data suggest that high NTs can persist longer than expected, thus widening hyperimmune plasma source, availability, and potential use. In vitro RBD/ACE2-binding inhibition test is confirmed as a convenient surrogate index for neutralizing activity and patients' follow-up, suitable for clinical settings where biosafety level 3 facilities are not available. IgA levels may correlate with serum neutralizing activity and represent a further independent index for patient evaluation.
Post-Esophagectomy Hiatal Hernia: A Case Series
Authors: Vishu Jain, Subhash C Soni, Peeyush Varshney, Vaibhav K Varshney, B Selvakumar
Journal: Cureus (2023)
Keywords: hiatal hernias, mie
MeSH terms: Case Reports

Post-esophagectomy hiatal hernia is a rare complication having varied presentation from asymptomatic cases detected incidentally on follow-up imaging to acute surgical emergency for strangulation or gangrene. Patients presenting as a surgical emergency have a prolonged post-operative course with significant morbidity. We present three cases of post-esophagectomy hiatal hernia. Two of the three cases were operated for esophageal squamous cell carcinoma (SCC) and one patient was operated for esophageal leiomyomatosis. Two of the three cases (SCC and esophageal leiomyomatosis) underwent minimally invasive Mckeown's esophagectomy and one case underwent robotic transthoracic Ivor-Lewis esophagectomy. All cases underwent contrast enhanced CT (CECT) and were biopsy proven prior to their index surgery. Both cases of SCC had prior neoadjuvant chemoradiation followed by surgery while esophageal leiomyomatosis underwent upfront surgery. All three cases have improved symptomatically and are doing well on follow up (case 1 - 12 months, cases 2 and 3 - 3 months). All three of our cases have different clinical presentation in terms of symptoms, severity, and time duration from index surgery. Two of the three cases underwent emergency surgery and one case which was asymptomatic detected incidentally on surveillance imaging and was managed conservatively. Post-esophagectomy hiatal hernia is a rare entity with varying presentation. The management options in such cases vary depending on the severity of symptoms and time after index surgery. In cases presenting as surgical emergency, successful management depends on prompt detection, early surgery, proper post-operative care, and rehabilitation.
Acute health effects of accidental chlorine gas exposure
Authors: Joo-An Kim, Seong-Yong Yoon, Seong-Yong Cho, Jin-Hyun Yu, Hwa-Sung Kim, Gune-Il Lim, Jin-Seok Kim
Journal: Ann Occup Environ Med (2014)
Keywords: chemical hazard release, chlorine, reactive airway dysfunction syndrome
MeSH terms: Case Reports

Objectives:
This study was conducted to report the course of an accidental release of chlorine gas that occurred in a factory in Gumi-si, South Korea, on March 5, 2013. We describe the analysis results of 2 patients hospitalized because of chlorine-induced acute health problems, as well as the clinical features of 209 non-hospitalized patients.
Methods:
We analyzed the medical records of the 2 hospitalized patients admitted to the hospital, as well as the medical records and self-report questionnaires of 209 non-hospitalized patients completed during outpatient treatment.
Results:
Immediately after the exposure, the 2 hospitalized patients developed acute asthma-like symptoms such as cough and dyspnea, and showed restrictive and combined pattern ventilatory defects on the pulmonary function test. The case 1 showed asthma-like symptoms over six months and diurnal variability in peak expiratory flow rate was 56.7%. In case 2, his FEV1 after treatment (93%) increased by 25% compared to initial FEV1 (68%). Both cases were diagnosed as chlorine-induced reactive airways dysfunction syndrome (RADS) on the basis of these clinical features. The most frequent chief complaints of the 209 non-hospitalized patients were headache (22.7%), followed by eye irritation (18.2%), nausea (11.2%), and sore throat (10.8%), with asymptomatic patients accounting for 36.5%. The multiple-response analysis of individual symptom revealed headache (42.4%) to be the most frequent symptom, followed by eye irritation (30.5%), sore throat (30.0%), cough (29.6%), nausea (27.6%), and dizziness (27.3%).
Conclusions:
The 2 patients hospitalized after exposure to chlorine gas at the leakage site showed a clinical course corresponding to RADS. All of the 209 non-hospitalized patients only complained of symptoms of the upper airways and mucous membrane irritation.
A 13 year-old boy with post-transplantation lymphoproliferative disorder presenting with obscure gastrointestinal bleeding: a case report
Authors: Edith Y Ho, Vijay George, Marjorie McCracken, James W Ostroff
Journal: F1000Res (2014)

One well recognized and potentially serious complication of chronic immunosuppression in organ transplant recipients is post-transplantation lymphoproliferative disorders (PTLD). This accounts for 20% of all malignancies in transplant recipients, which is four times higher than the general population (1,2). The diagnosis of PTLD is often difficult, due to various manifestations resulting in late diagnosis. We report an unusual presentation of PTLD in a pediatric patient where the diagnosis was achieved only after extensive investigation.
Metastatic giant basal cell carcinoma: a case report
Authors: Khadija Bellahammou, Asmaa Lakhdissi, Othman Akkar, Fadoua Rais, Benhmidou Naoual, Ibrahim Elghissassi, Hind M'rabti, Hassan Errihani
Journal: Pan Afr Med J (2016)
Keywords: giant basal cell carcinoma, metastasis, prognosis
MeSH terms: Carcinoma, Basal Cell / diagnosis, Lung Neoplasms / secondary, Skin Neoplasms / diagnosis, Case Reports, Aged, Antineoplastic Agents / therapeutic use, Carcinoma, Basal Cell / drug therapy, Carcinoma, Basal Cell / pathology, Fatal Outcome, Humans, Lung Neoplasms / pathology, Male, Neoplasm Metastasis, Skin Neoplasms / drug therapy, Skin Neoplasms / pathology, Antineoplastic Agents

Basal cell carcinoma is the most common skin cancer, characterised by a slow growing behavior, metastasis are extremely rare, and it occurs in less than 0, 1% of all cases. Giant basal cell carcinoma is a rare form of basal cell carcinoma, more aggressive and defined as a tumor measuring more than 5 cm at its largest diameter. Only 1% of all basal cell carcinoma develops to a giant basal cell carcinoma, resulting of patient's negligence. Giant basal cell carcinoma is associated with higher potential of metastasis and even death, compared to ordinary basal cell carcinoma. We report a case of giant basal cell carcinoma metastaticin lung occurring in a 79 years old male patient, with a fatal evolution after one course of systemic chemotherapy. Giant basal cell carcinoma is a very rare entity, early detection of these tumors could prevent metastasis occurrence and improve the prognosis of this malignancy.
Sporadic Multifocal Venous Malformations of the Head and Neck
Authors: Michael V Amato, Neha A Patel, Shirley Hu, Harry Pantelides
Journal: Case Rep Otolaryngol (2015)

Objective. To report a case of unusually widespread sporadic venous malformations of the head and neck associated with normal D-dimer levels and, due to the protean clinical manifestations and increased risk of coagulopathy of these lesions, to review their diagnosis and clinical management. Case Report. A 25-year-old man presented with a one-year history of intermittent right-sided neck swelling and tongue swelling. Physical exam revealed additional lesions present throughout the head and neck. There was no family history suggestive of heritable vascular malformations. Radiographic imaging demonstrated 15 lesions located in various tissue layers consistent with venous malformations. A coagulation screen showed a normal prothrombin time, activated partial thromboplastin time, international normalized ratio, D-dimer level, and fibrinogen level. It was determined that the patient was not at increased risk for intraoperative coagulopathy and preoperative heparin administration would not be necessary. The patient's buccal and tongue lesions were subsequently excised with no complications. The patient also underwent sclerotherapy evaluation for his neck mass. Conclusion. This case describes a unique presentation of sporadic multifocal venous malformations. It also emphasizes the importance of prompt diagnosis and workup when multiple venous malformations are present to prevent morbidity during surgical excision secondary to intravascular coagulopathy.
The Off-Label Use of a Lumen-Apposing Metal Stent (LAMS) for a Benign Colon Anastomotic Stricture Causing Recurrent Bowel Obstruction in a Patient with Keloids
Authors: Michael Coles, Pearl Uy, Victoria Madray, John Erikson Yap, Subbaramiah Sridhar
Journal: Case Rep Gastrointest Med (2021)
MeSH terms: Case Reports

Anastomotic strictures are a known complication of colorectal surgery. Despite a wide range of medical devices that have been deployed for this complication, outcomes remain challenging. Lumen-apposing metal stents (LAMSs) have recently emerged as a potentially superior therapeutic option. We herein report a patient with a past medical history of pT3, N0 adenocarcinoma of the colon with anastomotic stricture recurrence who underwent successful placement of an LAMS. We suggest that patients with a predisposition for keloid formation or fibrosis-prone anastomotic wound healing should be considered for LAMS deployment early in the treatment course.
Psychiatric manifestations of Kleefstra syndrome: a case report
Authors: Kazunari Yoshida, Daniel J Müller, Pushpal Desarkar
Journal: Front Psychiatry (2023)
Keywords: kleefstra syndrome, autism spectrum disorder, case report, intellectual disability, psychiatric manifestations
MeSH terms: Case Reports

Background:
Kleefstra syndrome is a rare genetic condition, which affects at least 1 in 120,000 individuals who have a neurodevelopmental disorder, characterized by the core clinical phenotype of intellectual disability, hypotonia, severe speech delay, and distinct facial characteristics with additional clinical features including sleep disturbance, overweight, psychiatric disorders, and autism spectrum disorder. To date, a limited number of case reports of Kleefstra syndrome with psychiatric manifestations have been reported.
Case presentation:
We reported a case of a 35-year-old male diagnosed with Kleefstra syndrome, who also had diagnoses of autism spectrum disorder and moderate to severe intellectual disability. He exhibited various psychiatric manifestations, including temporarily manic-like symptoms, excessive eating/overweight, addictive/gambling behaviors, inappropriate and unsafe internet use, sleep disturbance, rigid routines, and behaviors that challenged in the form of meltdowns. These symptoms were eventually relatively successfully managed with a combination of non-pharmacological and pharmacological treatments.
Conclusion:
To our knowledge, there is only a limited number of case reports that detail patients with Kleefstra syndrome exhibiting various psychiatric manifestations. Our report adds further knowledge to the paucity of literature and highlights the effectiveness of a combination of non-pharmacological and pharmacological treatments for behavioral/psychiatric difficulties in Kleefstra syndrome.
Case report: The feasibility of rTMS with intrathecal baclofen pump for the treatment of unresolved neuropathic pain following spinal cord injury
Authors: Stevie D Foglia, Ravjot S Rehsi, Claudia V Turco, Harsha Shanthanna, Aimee J Nelson
Journal: Front Rehabil Sci (2022)
Keywords: baclofen pump, intrathecal pump, neuropathic pain, rtms, repetitive transcranial magnetic simulation, spinal cord injury
MeSH terms: Case Reports

The main objective of this study was to assess the efficacy and safety of 10 Hz repetitive transcranial magnetic stimulation (rTMS) for the treatment of unresolved neuropathic pain in an individual with spinal cord injury and an intrathecal baclofen pump. A 62-year-old male presented with drug resistant neuropathic pain as a result of a complete spinal cord lesion at T8 level. Pain was classified into four types: pressure pain in the left foot, burning pain in buttocks, burning pain in sternum, and electrical attacks in the trunk. The treatment period involved 6 weeks of rTMS stimulation performed 5 days per week, a 6-week follow up period with no stimulation, and an 8-week top up session period which began 5-weeks after the end of the follow up period. 2004 pulses were delivered at 10Hz over the right-hand representation of the left primary motor cortex at 80% resting motor threshold during each session. Assessments were based on the numerical rating scale (NRS), neuropathic pain scale (NPS), Hamilton Depression and Anxiety rating scales. Following the treatment period there was a 30, 13, and 29% reduction in sternum, buttocks, and left foot pain respectively, as reported by the NRS. During this time, electrical attacks were abolished following the third week of treatment. These changes corresponded to a 38% decrease in NPS scores and a 65 and 25% reduction in anxiety and depressions scores respectively. The changes in sternum, buttocks, and left foot pain reported on the NRS persisted for 1 week following treatment. Top up sessions delivered 11 weeks after the end of the treatment period were unsuccessful in reducing pain to the level achieved during the treatment period. A 13% reduction in NPS was seen during these 8-weeks. Anxiety and depression scores decreased 78 and 67% respectively. The frequency of electrical attacks was zero during this time. rTMS stimulation delivered throughout this study did not cause any interference with the functioning of the intrathecal baclofen pump. This case study illustrates that rTMS may be effective at reducing drug resistant neuropathic pain with certain pain types exhibiting greater propensity for change.
Case Report: Schwannoma of the sigmoid colon: a case report of a rare colonic neoplasm and review of literature
Authors: Gangmi Kim, Sun Il Kim, Kang Young Lee
Journal: F1000Res (2019)
Keywords: colon, colectomy, colonic neoplasms, schwannoma
MeSH terms: Colonic Neoplasms / diagnosis, Colonic Neoplasms / therapy, Laparoscopy, Neurilemmoma / diagnosis, Neurilemmoma / therapy, Case Reports, Review, Aged, Colon, Sigmoid, Colonoscopy, Female, Humans

Background: Schwannomas are tumors originating in Schwann cells of the peripheral nerve system and uncommonly develop in the gastrointestinal tract. Sigmoid colon schwannomas are very rare and only 28 cases have been reported. This study aims to report a case of a sigmoid colon schwannoma and present a literature review. Case report: We report a case of a 66-year-old female with asymptomatic sigmoid colon schwannoma. The patient underwent a screening colonoscopy and about 4cm sized submucosal tumor was identified at the sigmoid colon. A colonoscopic biopsy was performed and the microscopic exam revealed an ulcerated lesion with a proliferation of fibroblast-like spindle cells beneath ulcer, which was insufficient for diagnosis. Abdominopelvic computerized tomography (CT) scan showed a well-defined, well-enhancing, round shaped and slightly heterogenous mass at the sigmoid colon. No distant metastasis was identified in abdominopelvic CT and chest CT scans. Carcinoembryonic antigen level was within a normal range (1.33ng/mL). The patient underwent laparoscopic anterior resection. Immunohistochemical staining of the resected specimen showed positivity for S-100 protein in tumor cells and schwannoma was diagnosed post-surgically. Surgical resection margins were free from tumor and no regional lymph node metastasis was reported. Conclusion: Colon schwannomas are rare diseases. Most cases of colon schwannomas are accidentally identified during screening colonoscopy. The tumors usually present as submucosal masses and colonoscopic biopsies are mostly non-diagnostic. Surgical resection is required, and definitive diagnosis is made by confirming S-100 positive tumor cells in immunohistochemical analysis. Most cases are benign; a few cases have been reported to be malignant. Surgical resection with free negative margins is the treatment of choice.