OpenMed/multicare-articles huggingface dataset:
First Use of GORE TAG Thoracic Endograft with Active Control System in Traumatic Aortic Rupture
Authors: Fotios Eforakopoulos, Ioanna Akrida, Petros Zampakis, Konstantinos Katsanos, Panagiotis Papadopoulos, Efstratios Koletsis
Journal: Case Rep Surg (2020)
MeSH terms: Case Reports

Patients after a high-velocity motor vehicle collision with rapid deceleration are at a significant risk of blunt aortic injury, a life-threatening condition that usually occurs in the aortic isthmus. Aortic transection is the second leading cause of death behind head injury for individuals aged 4 to 34. During the last two decades, there has been a shift from open towards the endovascular repair. Significant progress has been made recently in terms of the design of both the stent graft and the delivery system. We herein present the case of a female patient under dual antiplatelet therapy for coronary artery disease, with type IV blunt aortic injury (rupture) that was successfully repaired with Conformable Thoracic Endograft with Active Control System. This new device provides an intermediate deployment step at 50% and optional angulation control of the proximal part of the stent graft. These improvements are beneficial providing accurate device placement and maximum seal length in anatomies where the distal, as well as a proximal landing zone, is critical.
Case Report: Prenatal Diagnosis and Treatment of Fetal Autoimmune-Associated First-Degree Atrioventricular Block: First Report From China
Authors: Changqing Tang, Haiyan Yu, Shuran Shao, Yimin Hua, Maoli Chen, Qi Zhu, Yifei Li, Kaiyu Zhou, Chuan Wang
Journal: Front Cardiovasc Med (2021)
Keywords: autoimmune disease, diagnosis, fetal atrioventricular block, fetus, first-degree atrioventricular block, treatment
MeSH terms: Case Reports

Background: The rapid progression from fetal first-degree atrioventricular block (AVB) to third-degree AVB had been reported. However, how to define fetal first-degree AVB with proper technique and the necessity of the treatment in utero for fetal autoimmune-associated first-degree AVB are still controversial. Purpose: To explore the diagnosis and the effect of treatment for fetal first-degree AVB. Cases Presentation: Four pregnant women with positive autoantibodies anti-SSA/Ro were admitted into our hospital with complaints of rapid prolonged atrioventricular (AV) intervals of their fetuses. Fetal AV intervals were re-measured by tissue Doppler imaging (TDI) from the onset of atrial contraction to ventricular systole (Aa-Sa), which were 170 ms (case 1-twin A), 160 ms (case 1-twin B), 163 ms (case 2) and 172 ms (case 3) and 170 ms (case 4), respectively. The histories of medication usage or infection during gestation were denied. Amniotic fluid genetic screenings and virological tests were negative in all cases. No structural cardiac disorders were found and the cardiovascular profile scores were 10 for each fetus. Oral dexamethasone (initial dose of 4.5 mg daily) and hydroxychloroquine (200 mg bid) plus weekly follow-up surveillance were suggested. The dosage of dexamethasone was adjusted according to the changes of the AV intervals and fetal development of biparietal diameters (BPD) and femur lengths (FL). All fetal AV intervals were controlled well. Maternal and fetal adverse effects were noted as diabetes in 1 mother and growth retardation in all fetuses. All fetuses were delivered via cesarean section at 35+4, 37, 38, and 37+1 gestational weeks, with 10 scores of Apgar score. Postnatally, positive anti-SSA/Ro was found in all neonates. However, there were no clinical or laboratory evidence of neonatal lupus syndrome. No abnormal signs were found on postnatal electrocardiogram and echocardiography for all neonates. With a follow-up of 8-53 months, there was no progression of disease and all infants demonstrated normal physical, mental, and motor development. Conclusion: Prenatal treatment for fetal autoimmune-associated first-degree AVB could be an alternative. Strict surveillance and timely adjustment of the treatment according to the conditions of the mother and the fetus are indicated. Further studies are necessary to prove our concept.
Spider Angioma Number and Location as Potential Prognostic Indicators in Chronic Liver Disease: A Case Report
Authors: Kristy Terp, Guillermo Izquierdo-Pretel
Journal: Cureus (2023)
Keywords: chronic liver disease, location, number, prognosis, spider angioma
MeSH terms: Case Reports

Spider angiomas (SAs) are a well-known physical exam feature found in patients with chronic liver disease. While SAs are thought to correspond with a higher risk of mortality in chronic liver disease (CLD) patients, only few studies have been done to assess the number and location of SAs as prognostic indicators. We present a case of a 64-year-old patient with decompensated CLD who was found to have three SAs on physical exam. The patient presented to the inpatient service at a community hospital in Miami, Florida. He had experienced previous esophageal varices banding, had a Model for End-Stage Liver Disease (MELD) score of 31, and needed large-volume paracentesis due to significant ascites. It was determined that he had a very poor prognosis and was in need of a liver transplant. We suggest that more research is necessary to determine if there is a prognostic importance to the number and location of SAs in patients with CLD, as earlier interventions could potentially lead to improvements in outcomes through this physical exam finding.
Successful Treatment of Unresectable Advanced Melanoma by Administration of Nivolumab With Ipilimumab Before Primary Tumor Resection
Authors: Taku Fujimura, Yumi Kambayashi, Yota Sato, Kayo Tanita, Ryo Amagai, Akira Hashimoto, Takanori Hidaka, Setsuya Aiba
Journal: Front Med (Lausanne) (2019)
Keywords: t cell expansion, advanced melanoma, ipilimumab, nivolumab, pre-surgical administration
MeSH terms: Case Reports

Ipilimumab, in combination with nivolumab, is one of the promising drugs that enhance the anti-tumor immune response of patients with advanced melanoma. Since the co-administration of nivolumab with ipilimumab in the neoadjuvant setting expands melanoma-reactive T cells at the primary site of melanoma and has a high rate of histological complete response, the pre-surgical administration of this combination could be the optimal therapy for unresectable advanced melanoma. In this report, a case of unresectable advanced melanoma treated successfully with administration of nivolumab with ipilimumab before primary tumor resection is presented. In addition, CD8+ T cells increased among the tumor-infiltrating lymphocytes that were surrounding melanoma cells and caspase 3+ cells. The present case suggests that pre-surgical administration of nivolumab with ipilimumab could be the optimal therapy for the treatment of unresectable advanced melanoma.
Lipedema in a male patient: report of a rare case - management and review of the literature
Authors: Mattis Bertlich, Mark Jakob, Ines Bertlich, Reggy Schift, Randolf Bertlich
Journal: GMS Interdiscip Plast Reconstr Surg DGPW (2021)
Keywords: lipedema, liposuction, tumescence liposuction
MeSH terms: Case Reports

Objective: Lipedema is a relatively common yet debilitating and often misdiagnosed lipodystrophy that mainly affects females. Very little is known about the etiology and pathophysiology of the disease. However, due to its high preference for female patients, hormonal factors may contribute to the pathogenesis. Case: A 62-year-old male patient presented to the authors with painful swelling of the thighs. The patient had been treated elsewhere for lymphedema with subsequent disease progression. Lipedema stage IV was confirmed by clinical examination and ultrasound. The patient underwent three sessions of tumescence liposuction which was well tolerated. Later on, the patient reported great improvement in terms of complaints as well as disfigurement. Conclusion: The etiology and pathophysiology of lipedema remain unclear. However, the case at hand shows that lipedema may, albeit rare, also present in male patients. Moreover, we show that liposuction is efficient and safe in treating lipedema even in atypical cases.
Sudden, Painless Incontinence following Extracorporeal Shock Wave Lithotripsy: A Case Report
Authors: Fatih Akbulut, Alpaslan Akbas, Dilek Sahin
Journal: Case Rep Urol (2013)

Urinary incontinence is a stent-related complication; however, total incontinence is not often seen in emergency departments. We report a patient who presented with a sudden, painless, and total urinary incontinence after extracorporeal shock wave lithotripsy. This is the first case of total incontinence due to migrated ureteral double J stent through the external urethral sphincter into the urethra following extracorporeal shock wave lithotripsy.
Normalization of lymphocyte count after high ablative dose of I-131 in a patient with chronic lymphoid leukemia and secondary papillary carcinoma of the thyroid. Case report
Authors: Anneliese Rosmarie Gertrud Fischer Thom, Nelson Hamerschlak, Verônica Goes Teles, Akemi Osawa, Fabio Pires de Souza Santos, Denise da Cunha Pasqualin, Jairo Wagner, Lilian Yuri Itaya Yamaga, Marcelo Livorsi da Cunha, Guilherme de Carvalho Campos Neto, Marcelo Buarque de Gusmão Funari
Journal: Einstein (Sao Paulo) (2014)
MeSH terms: Carcinoma / radiotherapy, Carcinoma / secondary, Laser Therapy / methods, Leukemia, Lymphocytic, Chronic, B-Cell / radiotherapy, Thyroid Neoplasms / radiotherapy, Thyroid Neoplasms / secondary, Case Reports, Aged, Biopsy, Fine-Needle, Carcinoma / diagnostic imaging, Carcinoma / surgery, Carcinoma, Papillary, Dose-Response Relationship, Radiation, Humans, Iodine Radioisotopes / therapeutic use, Leukemia, Lymphocytic, Chronic, B-Cell / complications, Lymph Nodes / pathology, Lymphocyte Count, Male, Thyroid Cancer, Papillary, Thyroid Neoplasms / diagnostic imaging, Thyroid Neoplasms / surgery, Thyroidectomy / methods, Time Factors, Tomography, Emission-Computed, Single-Photon, Treatment Outcome, Iodine Radioisotopes

The authors report the case of a 70-year-old male patient with chronic lymphoid leukemia who presented subsequently a papillary carcinoma of the thyroid with metastases to regional lymph nodes. The patient was treated with surgical thyroidectomy with regional and cervical lymph node excision and radioiodine therapy (I-131). The protocolar control scintigraphy 4 days after the radioactive dose showed I-131 uptake in both axillae and even in the inguinal regions. PET/CT showed faint FDG-F-18 uptake in one lymph node of the left axilla. An ultrasound guided fine needle biopsy of this lymph node identified by I-131 SPECT/CT and FDG-F-18 PET/CT revealed lymphoma cells and was negative for thyroid tissue and thyroglobulin content. The sequential blood counts done routinely after radiation treatment showed a marked fall until return to normal values of leucocytes and lymphocytes (absolute and relative), which were still normal in the last control 19 months after the radioiodine administration. Chest computed tomography showed a decrease in size of axillary and para-aortic lymph nodes. By immunohistochemistry, cells of the lymphoid B lineage decreased from 52% before radioiodine therapy to 5% after the procedure. The authors speculate about a possible sodium iodide symporter expression by the cells of this lymphoma, similar to some other non-thyroid tumors, such as breast cancer cells.
Co-occurrence of Anti-N-Methyl-D-Aspartate Receptor Encephalitis and Anti-myelin Oligodendrocyte Glycoprotein Inflammatory Demyelinating Diseases: A Clinical Phenomenon to Be Taken Seriously
Authors: Yijun Ren, Xiqian Chen, Qiang He, Renchun Wang, Wei Lu
Journal: Front Neurol (2019)
Keywords: n-methyl-d-aspartate (nmda), autoimmune encephalitis, demyelinating diseases, immunotherapy, myelin oligodendrocyte glycoprotein (mog)

Background: Anti-N-methyl-D-aspartate receptor (NMDAR) immunoglobulin G antibodies which exist on myelin sheaths, composed of oligodendrocytes, especially target GluN1 subunits and are highly characteristic of anti-NMDAR encephalitis which is a newly recognized autoimmune encephalitis (AE) characterized by psychiatric symptoms, behavioral abnormalities, seizures, cognitive impairment and other clinical symptoms. Myelin oligodendrocyte glycoprotein (MOG) is a type of protein which is expressed on the surface of oligodendrocytes and myelin in the central nervous system. Anti-MOG antibodies cause demyelination. In some rare reported cases, these two types of antibodies have been found to co-exist, but the underlying mechanisms remain unknown. Case presentation: Here we report cases of 4 inpatients (median age 31.5 years, age range 27-43 years) from The Second Xiangya Hospital of Central South University between March 2018 and April 2019. Two of the cases were first diagnosed as anti-NMDAR encephalitis and had developed visual impairments in the course of the dosage reduction during corticosteroid therapy. They were found at the time, to have anti-MOG antibody-positive CSF and/or serum. Another patient was diagnosed with anti-MOG inflammatory demyelinating diseases (IDDs) when he tested double positive for both anti-NMDAR and anti-MOG antibodies early in the course of his illness. Over the course of the dosage reduction during corticosteroid therapy, his symptoms deteriorated; however, anti-MOG antibody levels elevated while anti-NDMAR antibody levels remained low. The other patient had initially developed psychiatric symptoms and limb weakness. She was also double positive for anti-NMDAR and anti-MOG antibodies early in the course of her illness. However, over the course of the dosage reduction during corticosteroid therapy, her symptoms worsened and levels of both antibodies elevated. Conclusion: Anti-NMDAR and anti-MOG antibodies may coexist in rare cases. In addition, anti-NMDAR encephalitis and anti-MOG inflammatory demyelinating diseases may occur either simultaneously or in succession. Thus, when a patient is diagnosed with either of these two diseases, but exhibits symptoms of the other disease, the possibility of co-occurrence with both these diseases should be considered and the appropriate antibodies should be accurately detected to enable prompt selection of appropriate treatments by the physicians.
Genetic Tracing of Clonal Expansion and Progression of Pancreatic Ductal Adenocarcinoma: A Case Report and Multi-Region Sequencing Analysis
Authors: Shion Tachibana, Yusuke Mizukami, Yusuke Ono, Yuya Sugiyama, Tetsuhiro Okada, Arisa Kitazaki, Junpei Sasajima, Motoya Tominaga, Jun Sakamoto, Keisuke Kimura, Yuko Omori, Toru Furukawa, Taichi Kimura, Shinya Tanaka, Kazuo Nagashima, Hidenori Karasaki, Tomoyuki Ohta, Toshikatsu Okumura
Journal: Front Oncol (2020)
Keywords: kras, clonal evolution, multi-region sequencing, pancreatic cancer, premalignant field defect
MeSH terms: Case Reports

Pancreatobiliary tumors frequently contain multiple malignant and precancerous lesions; however, the origin of the driver mutations and the mechanisms that underlie the generation of distinct clones within an organ field remain unclear. Herein, we describe a 76-year-old male suffering from moderately differentiated adenocarcinomas of the pancreas that primarily involved the distal bile duct and multiple "dispersing" invasive lesions in the pancreatic head. The patient underwent pylorus-preserving pancreaticoduodenectomy with superior mesenteric vein resection, and targeted sequencing of 18 genes associated with pancreatic tumorigenesis and immunohistochemical analysis of RNF43 and ARID1A were performed on each tumor compartment, including the invasive and non-invasive areas. Multi-region sequencing revealed shared KRAS and TGFBR1 mutations in all invasive foci, including those involving the distal bile duct. Distinct KRAS variants were found to be present in other non-continuous and non-invasive lesions in the pancreas. Intraductal lesions with KRAS G12D and RNF43 V50R mutations were evident in the main pancreatic duct. This appeared to be a founder clone, given that the mutation profile was common to the invasive foci as well as the additional high-grade dysplasia harboring ARID1A mutations, thereby suggesting a clonal branch-off during tumor evolution. In addition, we also observed independent intraductal papillary mucinous neoplasms with KRAS G12V and GNAS R201H mutations. Our theory, learned from this patient, was that lesions skipped dissemination and wide-spread movement potentially through the pancreatic ductal system as a process of pancreatic cancer development.
Mistrial or Misdiagnosis: The Importance of Autopsy and Histopathological Examination in Cases of Sudden Infant Bronchiolitis-Related Death
Authors: Giuseppe Bertozzi, Francesca Maglietta, Benedetta Baldari, Livia Besi, Alessandra Torsello, Cira Rosaria Tiziana Di Gioia, Francesco Sessa, Mariarosaria Aromatario, Luigi Cipolloni
Journal: Front Pediatr (2020)
Keywords: acute viral bronchiolitis, autopsy, immunohistochemistry, sudden infant death, sudden unexpected infant deaths (suids)
MeSH terms: Case Reports

Pediatrics, among all the branches of medicine, is a sector not particularly affected by a high number of claims. Nevertheless, the economic value of the compensation is significantly high, for example, in cases of children who suffered multiple disabilities following perinatal lesions with a long life expectancy. In Italy, most of the claims for compensation concern surgical pathologies and infections. Among these latter, the dominant role is taken by respiratory tract infections. In this context, the purpose of this manuscript is to present a case series of infant deaths in different emergency-related facilities (ambulances, emergency rooms) denounced by relatives. Following these complaints, the autopsy was performed, and subsequent histological examinations revealed the presence of typical and pathognomonic histological findings of acute viral bronchiolitis, whose morphological appearance is poorly reported in the literature. The analysis of these cases made it possible to highlight the following conclusions: the main problems in diagnosing sudden death causes, especially in childhood, are the rapidity of death and the scarce correlation between the preexistent diseases and of the cause of death itself. For all these reasons, the autopsy, either clinical or medicolegal, is mandatory in cases of sudden unexpected infant death to manage claim requests because only the histological examinations performed on samples collected during the autopsy can reveal the real cause of death.
Hydatid disease simulating acute abdomen: a case report and brief review of the literature
Authors: Georgios Lianos, Georgios Baltogiannis, Avrilios Lazaros, Konstantinos Vlachos
Journal: Case Rep Gastrointest Med (2012)

Introduction. Hydatid disease is caused by the tapeworm Echinococcus granulosus and is still a matter of public health in many regions of the world, where it is an endemic parasitic disease. Although the liver is the most involved organ, hydatidosis can be found anywhere in the human body. Rare forms of location may lead to diagnostic and therapeutic dilemmas. Case Report. Herein we report a rare case of acute abdominal pain and progressively increasing abdominal distension due to abdominal and multiple splenic echinococcosis in a 72-year-old Caucasian male. We also provide a brief review of the literature. Conclusion. Although hydatid disease is found most often in the liver and lungs, rarely any organ of the body can be involved by this zoonosis. Though rare, the possibility of unusual location of echinococcosis must always be considered by the operating surgeon, when dealing with diffuse abdominal pain in endemic areas, because any misinterpretation may result in unfavorable outcomes.
High Frequency of Cell-in-Cell Formation in Heterogeneous Human Breast Cancer Tissue in a Patient With Poor Prognosis: A Case Report and Literature Review
Authors: Banzhan Ruan, Zubiao Niu, Xiaoyi Jiang, Zhuo Li, Yanhong Tai, Hongyan Huang, Qiang Sun
Journal: Front Oncol (2019)
Keywords: breast cancer, cell cannibalism, cell-in-cell formation, entosis, heterogeneity, poor prognosis
MeSH terms: Case Reports

Cell cannibalism is a unique pathological phenomenon that has been observed at low frequency in a variety of human tumor samples (<0.5%), including breast cancer. Cannibalistic cells typically form cell-in-cell (CIC) structures characterized by enclosure of one cell or more by another, mediating a novel type of cell death "entosis," which was proposed as the type IV cell death. A large number of CIC structures are generally associated with malignant transformation and progression, and they are believed to be primed by and form among heterogeneous cells. However, there is currently no in vivo evidence from human tumor samples. In this case report, covering a 37-year-old female breast cancer patient, we observed considerable heterogeneity and proliferative activity (>70% Ki-67 positivity) in her breast cancer cells, accompanied by high frequency of CIC formation (~6%) and poor prognosis. We consider this a typical example of cell cannibalism, supporting a role of heterogeneity in cell-in-cell formation and malignant progression. It may serve as a pretest basis for further investigations of cell-in-cell biology and breast cancer treatment.
Early Failure of Total Ankle Arthroplasty in a Patient with Ipsilateral Varus Knee Deformity
Authors: Taehyeon Kim, Su Chan Lee, Chang Hyun Nam, Suengryol Ryu, Hye Sun Ahn, Ji-Hoon Baek
Journal: Case Rep Orthop (2021)
MeSH terms: Case Reports

Multiple risk factors such as age, body mass index (BMI), preoperative diagnosis, smoking, diabetes mellitus, malalignment of an implant, and presence of ipsilateral hindfoot fusion have been shown to contribute to failure of total ankle arthroplasty (TAA). However, the exact causes of TAA failure remain uncertain, and various causes can lead to a need for revision surgery. We report a case of early aseptic loosening of the implant following TAA in a patient with severe varus deformity of the ipsilateral knee.
Chiari Malformation and Attention Deficit Hyperactivity Disorder
Authors: Anaïs DuBow, Aurélie Mourot, Smadar Valérie Tourjman
Journal: Case Rep Med (2020)
MeSH terms: Case Reports

Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental condition characterized by inattention, hyperactivity, and impulsivity. Chiari malformations (CM), first described approximately a hundred years ago, refer to a spectrum of hindbrain malformations characterized by cerebellar herniation through the foramen magnum. We present the case of a 28-year-old woman with ADHD and concurrent Chiari malformation type I (CM-I) that was diagnosed by CT scan. There is growing evidence supporting the role of the cerebellum and its associated structures in the pathophysiology of ADHD. Thus, a cerebellar malformation such as CM may impact neurological circuitry in a manner favoring the development of a neuropsychiatric disorder such as ADHD. Our case highlights the need for further studies pertaining to the role of the cerebellum in the pathophysiology of ADHD and the importance of considering the presence of CM when evaluating a patient with ADHD.