OpenMed/multicare-articles huggingface dataset:
Intrinsic subtypes and therapeutic decision-making in hormone receptor-positive/HER2-negative metastatic breast cancer with visceral crisis: A case report
Authors: Francesco Schettini, Elia Seguí, Benedetta Conte, Esther Sanfeliu, Blanca Gonzalez-Farre, Pedro Jares, Sergi Vidal-Sicart, Sergi Ganau, Isaac Cebrecos, Fara Brasó-Maristany, Montserrat Muñoz, Aleix Prat, Maria Vidal
Journal: Front Oncol (2022)
Keywords: cdk4/6-inhibitors, her2-enriched, her2-negative, hormone receptor (hr), intrinsic subtype, metastatic breast cancer, ribociclib, visceral crisis
MeSH terms: Case Reports

Background:
CDK4/6 inhibitors (CDKi), namely, palbociclib, ribociclib, and abemaciclib, combined with either an aromatase inhibitor (AI) or fulvestrant are the standard first/second line for hormone receptor-positive(HR+)/HER2-negative(neg) metastatic breast cancer (MBC). However, the choice of one specific CDKi is arbitrary and based on the physician's experience with the drug, toxicity profile, and patient's preferences, whereas biomarkers for optimal patient selection have not been established so far. Moreover, upfront chemotherapy is still recommended in case of clinical presentation with visceral crisis, despite no evidence of superior benefit for chemotherapy regimens against CDKi-based regimens. Recent correlative biomarker analyses from pivotal trials of palbociclib and ribociclib showed that HR+/HER2-neg MBC might respond differently according to the molecular intrinsic subtype, with Luminal A and B tumors being sensitive to both CDKi, Basal-like being insensitive to endocrine therapy, irrespective of CDKi, and HER2-enriched tumors showing a benefit only with ribociclib-based therapy.
Clinical case:
We hereby present a paradigmatic clinical case of a woman affected by a relapsed HR+/HER2-neg MBC with bone and nodal lesions, presenting with a visceral crisis in the form of lymphangitis carcinomatosis and diagnosed with a molecularly HER2-enriched tumor, successfully treated with upfront ribociclib + fulvestrant. The patient experienced a complete symptomatic and radiologic remission of the lymphangitis with a partial response as best response, according to RECIST 1.1 criteria. The progression-free survival (PFS) was of 20 months, in line with the median PFS observed in the ribociclib + fulvestrant pivotal trial, where, however, patients with visceral crisis had been excluded.
Conclusions:
This clinical case confirms in the real-world setting that non-luminal subtypes can be found in HR+/HER2-neg disease and may have potential therapeutic implications in the metastatic setting. It also questions the recommendation of upfront chemotherapy in the case of a visceral crisis in the era of CDKi-based regimens. These issues merit further evaluation in prospective and larger studies.
Toothpick ingestion complicated by cecal perforation: case report and literature review
Authors: Andrea Lovece, Emanuele Asti, Andrea Sironi, Luigi Bonavina
Journal: World J Emerg Surg (2014)
Keywords: ingestion, perforation, peritonitis, toothpick
MeSH terms: Review

Background:
Diverticulitis and carcinoma represent the most common causes of colon perforation, but other causes, like ingestion of foreign bodies, should be taken into account.
Case presentation:
We report the case of a 64-year old man presenting in our Emergency Department with a 2 days history of right lower abdominal pain, nausea, vomiting and low grade fever. Physical examination evocated mild pain with positive rebound tenderness in the right lower abdominal quadrant, and positive right costovertebral angle tenderness. Routine blood tests, abdominal X-rays and CT scan were inconclusive for perforation. At explorative laparoscopy a cecal perforation with localized peritonitis was found, and a right colectomy was performed due to the suspicion of cancer. Histological examination confirmed the presence of a perforation caused by a piece of wood (toothpick) of 6 cm in length.
Conclusions:
Foreign body ingestion should be taken into account in the evaluation of acute abdominal pain. A detailed patient's history may be crucial for a correct diagnosis and treatment.
Subcutaneous Emphysema Caused by an Extraperitoneal Diverticulum Perforation: Description of Two Rare Cases and Review of the Literature
Authors: Gael Kuhn, Jean Bruno Lekeufack, Michael Chilcott, Zacharia Mbaidjol
Journal: Case Rep Surg (2018)
MeSH terms: Case Reports

The onset of colon diverticular disease is a frequent event, with a prevalence that increases with age. Amongst possible complications, free peritoneal perforation with abscess formation may occur. We herein describe two rare presentations of an extraperitoneal sigmoid diverticulum perforation. Our first patient, an 89-year-old female with no signs of distress, developed a subcutaneous abscess and emphysema in an incisional hernia following an appendectomy through a McBurney incision. The second patient, an 82-year-old female, was in general distress at the time of her admission and had a more advanced infection following the occurrence of a sigmoid perforation in a hernial sac. Complicated diverticulitis has a known course and evolution, but with an extraperitoneal presentation, this etiology is not expected. A computed tomography (CT) scan should be completed if the patient is hemodynamically stable, and wide debridement should be performed. Subcutaneous emphysema with an acute abdomen may be a sign of sigmoid perforation. Clinicians should keep this etiology in mind, regardless of the initial presentation.
Tug-of-War Injuries: A Case Report and Review of the Literature
Authors: Pranit N Chotai, Amr A Abdelgawad
Journal: Case Rep Orthop (2014)

We report a case of a 10-year-old boy presenting with radial nerve palsy due to injury during a tug-of-war game. Patient was managed nonoperatively and regained radial nerve function. Tug-of-war is a globally popular noncontact sport. Injuries during this game are inevitable and may range from simple sprains to life and limb threatening trauma. Combined hip and knee injuries and soft-tissue injuries involving the back are most frequent. Most injuries occur when tug-of-war was played in an informal setting and where the tug-of-war International Federation rules were less likely to be followed. Measures should be taken to increase the awareness about these safety rules and prevention of consequent injuries. Sports physicians, pediatricians, orthopedic surgeons, general physicians, and athletic trainers should be aware of potential injuries resulting from this game while caring for these athletes, so as to be well prepared for apt management of the injuries associated with TOW.
A Protracted Course of COVID19 Infection in a Metastatic Breast Cancer Patient During CDK4/6 Inhibitor Therapy
Authors: Albert Grinshpun, Irit Merlet, Hila Fruchtman, Dean Nachman
Journal: Front Oncol (2020)
Keywords: cdk4/6 inhibitors, covid19, metastatic breast cancer, palbociclib, pneumonia
MeSH terms: Case Reports

We describe the first case report of a patient with COVID19 infection and metastatic breast cancer, while on systemic therapy with a CDK4/6 inhibitor. The patient had unique disease course, characterized with delayed symptomatology. The case highlights novel findings and stress careful and extended follow-up during COVID19 infection in patients taking biologic therapies affecting the immune system.
Clinical Presentation and Management Strategies in Intraorbital Foreign Bodies
Authors: Samreen Khanam, Ayushi Agarwal, Ruchi Goel, Neha Rathie, Akash Raut, Shweta Raghav, Sumit Kumar, Mohit Chhabra, Sonam Singh, Sushil Kumar
Journal: Case Rep Ophthalmol Med (2021)
MeSH terms: Case Reports

The authors present a retrospective, observational case study of seven patients, who presented with retained Intra-Orbital Foreign Bodies (IOrbFBs) following penetrating orbital injury at a tertiary eye hospital over a period of one year. Cases were reviewed for epidemiological features, mechanism of injury, nature of foreign body, clinical features, imaging modality, associated complications, management outcomes, and the final prognosis. The mean age of presentation was 27.43 years. Amongst the seven patients, two were children (aged <10 years). The male : female ratio was 4 : 3. Of the seven retained IOrbFBs, two were plastic, two wooden, and three metallic in nature (one gunshot injury, one ball projectile (commonly referred to as BB) injury, and one with knife). Two out of seven had no light perception at presentation. The periocular location of the foreign bodies was inferior in 4 cases and medial in 3 cases. Computed Tomography scan confirmed the diagnosis in five cases and Magnetic Resonance Imaging (MRI) was diagnostic in one. Surgical intervention was done in five cases, and two cases were managed conservatively. The authors conclude that favourable outcome can be achieved even without surgical removal in cases of inert metallic/inorganic IOrbFBs. The properties of plastic FBs can frequently render them invisible on imaging, or they may mimic chronic inflammatory conditions like tuberculosis. Long-standing wooden IOrbFBs evade identification radiologically due to prolonged hydration. The ultimate choice of intervention must be individualised, weighing the risks of retention against the risk of iatrogenic damage.
Fatal atypical reversible posterior leukoencephalopathy syndrome: a case report
Authors: Stefanie Kristin Golombeck, Carsten Wessig, Camelia-Maria Monoranu, Ansgar Schütz, Laszlo Solymosi, Nico Melzer, Christoph Kleinschnitz
Journal: J Med Case Rep (2013)

Introduction:
Reversible posterior leukoencephalopathy syndrome - a reversible subacute global encephalopathy clinically presenting with headache, altered mental status, visual symptoms such as hemianopsia or cortical blindness, motor symptoms, and focal or generalized seizures - is characterized by a subcortical vasogenic edema symmetrically affecting posterior brain regions. Complete reversibility of both clinical signs and magnetic resonance imaging lesions is regarded as a defining feature of reversible posterior leukoencephalopathy syndrome. Reversible posterior leukoencephalopathy syndrome is almost exclusively seen in the setting of a predisposing clinical condition, such as pre-eclampsia, systemic infections, sepsis and shock, certain autoimmune diseases, various malignancies and cytotoxic chemotherapy, transplantation and concomitant immunosuppression (especially with calcineurin inhibitors) as well as episodes of abrupt hypertension. We describe for the first time clinical, radiological and histological findings in a case of reversible posterior leukoencephalopathy syndrome with an irreversible and fatal outcome occurring in the absence of any of the known predisposing clinical conditions except for a hypertensive episode.
Case presentation:
A 58-year-old Caucasian woman presented with a two-week history of subacute and progressive occipital headache, blurred vision and imbalance of gait and with no evidence for raised arterial blood pressure during the two weeks previous to admission. Her past medical history was unremarkable except for controlled arterial hypertension. Cerebral magnetic resonance imaging demonstrated cortical and subcortical lesions with combined vasogenic and cytotoxic edema atypical for both venous congestion and arterial infarction. Routine laboratory and cerebrospinal fluid parameters were normal. The diagnosis of reversible posterior leukoencephalopathy syndrome was established.Within hours after admission the patient showed a rapidly decreasing level of consciousness, extension and flexion synergisms, bilaterally extensor plantar responses and rapid cardiopulmonary decompensation requiring ventilatory and cardiocirculatory support. Follow-up cerebral imaging demonstrated widespread and confluent cytotoxic edematous lesions in different arterial territories, global cerebral swelling, and subsequent upper and lower brainstem herniation. Four days after admission, the patient was declared dead because of brain death.
Conclusion:
This case demonstrates that fulminant and fatal reversible posterior leukoencephalopathy syndrome may occur spontaneously, that is, in the absence of any of the known predisposing systemic conditions.
Oral Manifestations of Exudative Erythema Multiforme in a Patient with COVID-19
Authors: Zana Sllamniku Dalipi, Fatmir Dragidella, Donika Kastrati Dragidella
Journal: Case Rep Dent (2021)
MeSH terms: Case Reports

Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is a viral infection with multiorgan manifestations that may affect the oral mucosa. The full range of oral manifestations of COVID-19 are unknown, and there are limited reports describing the features of oral manifestations of COVID-19, including taste loss, oral lesions, and xerostomia. The aim of this study is to report a case of oral erythema multiforme (EM) manifesting as oral, lip, and skin lesions in a COVID-19 patient. The presence of oral lesions in the late stage of COVID-19 could be related to weak patient immunity or related therapies.
Outcome of Pantalar Fusion With Femoral Head Allograft in Avascular Necrosis of Talus
Authors: Thiru Karthikeyan Ramu, Mohd Yazid Bajuri, Muhammad Fathi Hayyun, Norliyana Mazli
Journal: Front Surg (2021)
Keywords: allograft, avascular necrosis, femoral head, hindfoot arthrodesis nail, talus
MeSH terms: Case Reports

Background: Avascular necrosis (AVN) of the talus is a challenging condition that is caused primarily by trauma. The severity of the talus fracture determines the risk of AVN. Severe osteonecrosis with the loss of talar integrity can be treated with arthrodesis and structural bone graft. Method: This study shows the experience of pantalar arthrodesis using hindfoot arthrodesis nail, screw fixation, and femoral head allograft in four patients. Result: All patients were satisfied in terms of pain and function after an average of 4 months postsurgery. Limb length discrepancy was <1 cm and hindfoot fusion was achieved by 3 months. The mean score for SF-36 physical function and AOFAS hindfoot score at a 2-year postpantalar arthrodesis was 88 and 80.8, respectively. Conclusion: Hindfoot ankle arthrodesis, with the usage of femoral head allograft, can be successfully used for the treatment of traumatic AVN of talus.
ST-Segment Elevation Myocardial Infarction Related to Potential Spontaneous Coronary Thrombosis in Pheochromocytoma Crisis
Authors: Fei Chen, Mingxia Zheng, Xi Li, Yong Peng, Mao Chen
Journal: Front Endocrinol (Lausanne) (2020)
Keywords: hypercoagulability, infarct-related coronary artery, myocardial infarction, pheochromocytoma, spontaneous coronary thrombosis
MeSH terms: Adrenal Gland Neoplasms / complications, Coronary Thrombosis / complications, Pheochromocytoma / complications, ST Elevation Myocardial Infarction / etiology, Case Reports, Research Support, Non-U.S. Gov't, Adrenal Gland Neoplasms / diagnosis, Adrenal Gland Neoplasms / metabolism, Aged, Catecholamines / adverse effects, Catecholamines / metabolism, Coronary Thrombosis / diagnosis, Electrocardiography, Humans, Hypertension / diagnosis, Hypertension / etiology, Male, Paraneoplastic Syndromes / complications, Paraneoplastic Syndromes / diagnosis, Paraneoplastic Syndromes / physiopathology, Pheochromocytoma / diagnosis, Pheochromocytoma / metabolism, ST Elevation Myocardial Infarction / diagnosis, Catecholamines

Pheochromocytoma crisis is a rare and possibly fatal emergency. Hypersecreted catecholamines may result in myocardial injury via its direct toxic effect on cardiomyocytes or mediating vasoconstriction which will reduce coronary blood flow in this special setting. Interestingly, several case studies have reported the occurrence of ST-segment elevation myocardial infarction in patients with pheochromocytoma crisis. However, no one found the angiographic evidence of occlusive thrombus in the infarct-related coronary artery. Additionally, pheochromocytoma can induce hypercoagulability and promote thrombosis, but spontaneous coronary thrombosis has never been reported in this condition. Here, we report an unusual case of pheochromocytoma crisis presenting with STEMI due to spontaneous coronary thrombosis.
Spontaneous 180-Degree Rotatory Dislocation of Rotating-Platform Total Knee Arthroplasty
Authors: Stephen Sierra, Chibuzo Akalonu, Kevin West, Matthew Blue, George Brindley
Journal: Case Rep Orthop (2019)
MeSH terms: Case Reports

Rotating-bearing total knee arthroplasty has been theorized to have some advantages in the kinematics and wear characteristics of total knee arthroplasty. A rare complication of rotating-bearing total knee arthroplasty is rotary dislocation, spinout, of the polyethylene component. When these dislocations occur, they typically result in a 90-degree dislocation in respect to the axial axis of the knee. This case is unique in that it presents a complete 180-degree polyethylene dislocation without trauma.
Vulval elephantiasis as a result of tubercular lymphadenitis: two case reports and a review of the literature
Authors: Chintamani, Jp Singh, Megha Tandon, Rohan Khandelwal, Tushar Aeron, Sidharth Jain, Nikhil Narayan, Rahul Bamal, Yashwant Kumar, S Srinivas, Sunita Saxena
Journal: J Med Case Rep (2010)

Introduction:
Elephantiasis as a result of chronic lymphedema is characterized by gross enlargement of the arms, legs or genitalia, and occurs due to a variety of obstructive diseases of the lymphatic system. Genital elephantiasis usually follows common filariasis and lymphogranuloma venereum. It may follow granuloma inguinale, carcinomas, lymph node dissection or irradiation and tuberculosis but this happens rarely. Vulval elephantiasis as a consequence of extensive lymph node destruction by tuberculosis is very rare. We present two very unusual cases of vulval elephantiasis due to tuberculous destruction of the inguinal lymph nodes.
Case presentation:
Two Indian women - one aged 40 years and the other aged 27 years, with progressively increasing vulval swellings over a period of five and four years respectively - presented to our hospital. In both cases, there was a significant history on presentation. Both women had previously taken a complete course of anti-tubercular treatment for generalized lymphadenopathy. The vulval swellings were extremely large: in the first case report, measuring 35 × 25 cm on the right side and 45 × 30 cm on the left side, weighing 20 lb and 16 lb respectively. Both cases were managed by surgical excision with reconstruction and the outcome was positive. Satisfactory results have been maintained during a follow-up period of six years in both cases.
Conclusions:
Elephantiasis of the female genitalia is unusual and it has rarely been reported following tuberculosis. We report two cases of vulval elephantiasis as a consequence of extensive lymph node destruction by tuberculosis, in order to highlight this very rare clinical scenario.
Laparoscopic attenuation of a congenital extrahepatic portosystemic shunt in a dog-a thin-film banding for splenophrenic shunt: A case report
Authors: Jiyoung Park, Kwangsik Jang, Hyun Min Jo, Se Eun Kim
Journal: Front Vet Sci (2022)
Keywords: computed tomography angiography, dog, extrahepatic portosystemic shunt, laparoscopic attenuation, thin film banding
MeSH terms: Case Reports

A 6-year-old castrated male Shih-Tzu dog weighing 6. 5 kg presented with chief complaints of pollakiuria and urine dribbling. He had a history of urolithiasis for 3 years, which was confirmed by the presence of ammonium urate in the urinary stone analysis, performed 2 years prior to the presentation. Blood examination showed high values of fasting ammonia, post-prandial bile acid, and low blood urea nitrogen. Microhepatica and urolithiasis were identified on plain radiography and ultrasonography. A computed tomography angiography demonstrated a shunting vessel, diameter up to 9.6 mm, originated from the splenic vein, and linked with the phrenic vein. A surgical attenuation with a thin-film banding was performed under laparoscopic visualization. Left triangular ligament was incised, and one stay suture was placed to the stomach to expose the vessel. The shunting vessel was dissected before it entered the diaphragm, and a thin-film band was applied around the vessel. The patient recovered uneventfully without post-attenuation neurologic signs. Portal vein diameter increased with time, and complete closure of the shunting vessel was identified on computed tomography angiography performed at 14 months after attenuation. The patient was doing well for 31 months after surgery without protein restriction. This is a report of laparoscopic attenuation for splenophrenic type of canine congenital extrahepatic portosystemic shunt with a favorable outcome using thin-film banding.
The psychiatric phenotype in triple X syndrome: new hypotheses illustrated in two cases
Authors: Maarten Otter, Constance T R M Schrander-Stumpel, Robert Didden, Leopold M G Curfs
Journal: Dev Neurorehabil (2012)
MeSH terms: Gene-Environment Interaction, Sex Chromosome Disorders of Sex Development / psychology, Case Reports, Adult, Autistic Disorder / genetics, Autistic Disorder / psychology, Chromosomes, Human, X / genetics, Developmental Disabilities / genetics, Developmental Disabilities / psychology, Humans, Intellectual Disability / genetics, Intellectual Disability / psychology, Middle Aged, Phenotype, Sex Chromosome Aberrations, Sex Chromosome Disorders of Sex Development / genetics, Sex Offenses / psychology, Trisomy / genetics, Triple X syndrome

Background:
Triple X syndrome (47,XXX or trisomy X) is a relatively frequent cytogenetic condition with a large variety of physical and behavioural phenotypes.
Method:
Two adult patients with a triple X karyotype are described.
Results:
Their karyotype was unknown until some years ago. What these patients have in common is that they were diagnosed with a broader autism phenotype, they were sexually abused, they suffer from psychotic illness and they show challenging behaviour, suicidality and a decline in occupational capacity.
Discussion:
These gene-environment interactions are discussed. Gene-environment interactions may explain the variety of behavioural and psychiatric phenotypes in triple X syndrome. Ongoing atypical development in adults is hypothesized.
Conclusions:
Gene-environment interactions and ongoing atypical development in adults should be taken into account in research concerning the psychiatric phenotype of developmental disorders, especially those involving triple X syndrome.
Retrieval of a separated instrument using Masserann technique
Authors: Arun Kulandaivelu Thirumalai, Mahalaxmi Sekar, Sumitha Mylswamy
Journal: J Conserv Dent (2008)
Keywords: instrument retrieval, masserann technique, instrument separation
MeSH terms: Case Reports

The fracture of endodontic instruments is a procedural problem creating a major obstacle to normal routine therapy. The separated instrument, particularly a broken file, leads to metallic obstruction in the root canal and impedes efficient cleaning and shaping. When an attempt to bypass such a fragment becomes difficult, it should be retrieved by mechanical devices. Masserann kit is one such device for orthograde removal of intracanal metallic obstructions. These clinical cases demonstrate the usage of Masserann technique in removal of separated instruments in anterior and also the posterior teeth.