OpenMed/multicare-articles huggingface dataset:
A rare case of a giant arterio-venous fistula (AVF) following metastatic choriocarcinoma conditioning pulmonary embolism: multimodal transcatheter embolization using a simultaneous transarterial and transvenous approach
Authors: Massimo Venturini, Alice Bergamini, Anna Colarieti, Micaela Petrone, Paolo Marra, Emanuela Rabaiotti, Giorgia Mangili, Massimo Candiani, Alessandro Del Maschio, Francesco De Cobelli
Journal: CVIR Endovasc (2018)
Keywords: amplatzer vascular plug, arteriovenous fistula, choriocarcinoma metastases, embolic agents, embolization, pulmonary embolism

Background:
Choriocarcinoma is a highly malignant tumor but with a good prognosis due to the valid response to systemic chemotherapy. We present a case of a young woman affected by a giant pelvic arterio-venous fistula following a metastatic gestational choriocarcinoma, conditioning metrorrhagia and pulmonary embolism, successfully treated by multimodal transcatheter embolization, using a simultaneous transarterial and transvenous approach.
Case presentation:
In a young patient affected by choriocarcinoma and metrorrhagia, a computed tomography showed a giant arterio-venous fistula, pulmonary metastases and embolism. A transfemoral diagnostic arteriography showed a giant arterio-venous fistula sustained by right and left hypogastric arteries with early opacification of the right gonadal vein and of the inferior vena cava. A transarterial embolization of the distal branches of hypogastric arteries with poly-vinyl-alcohol particles, coils and Squid was performed. A transfemoral phlebography of the right gonadal vein showed multiple thrombi, responsible of the pulmonary embolism. An Amplatzer plug via trans-jugular was finally placed at the confluence of the gonadal vein in the vena cava, to reduce arterio-venous fistula out-flow and to occlude the vein, preventing further episodes of pulmonary embolism. Metrorrhagia progressively disappeared. A second transarterial embolization combined with a complete response to systemic chemotherapy determined arterio-venous fistula resolution.
Conclusions:
This was a very rare case of a giant pelvic arterio-venous fistula following choriocarcinoma in a patient symptomatic for metrorrhagia with an accidental finding of pulmonary embolism at computed tomography. A transcatheter embolization was successfully performed with different embolic materials, using a simultaneous transarterial and transvenous approach: the goal was not only to obtain metrorrhagia resolution but also to avoid a massive pulmonary embolism, a potential life threatening condition, in a young woman affected by a highly malignant tumor but with a good prognosis.
Case Report: Partial nephrectomy in primary renal sarcoma presenting as Wunderlich syndrome; a rare tumour with rare presentation managed atypically
Authors: Ramanitharan Manikandan, Ketan Mehra, Lalgudi Narayanan Dorairajan, Rajesh Nachiappa Ganesh, Sreerag K Sreenivasan, Rajeev Kumar
Journal: F1000Res (2019)
Keywords: partial nephrectomy, renal sarcoma, undifferentiated sarcoma, wunderlich syndrome
MeSH terms: Kidney Neoplasms / surgery, Nephrectomy, Sarcoma / surgery, Case Reports, Female, Humans, Kidney, Neoplasm Recurrence, Local, Young Adult

Spontaneous retroperitoneal haemorrhage also called Wunderlich Syndrome (WS) may be caused by various aetiologies. One of the most common causes is renal tumour. Renal sarcoma is a rare cause of WS, and renal sarcoma in itself is a rare entity. In the era of nephron-sparing surgery, optimum management of primary renal sarcoma remains a dilemma as there are limited number of cases available in the literature. Nevertheless, radical nephrectomy remains the recommended treatment, keeping in mind the aggressiveness of the tumour. We report a case of primary undifferentiated renal sarcoma, which presented as WS, and which was managed by partial nephrectomy.
Placenta Percreta and Uterine Rupture in the First Trimester of Pregnancy
Authors: Gabriel Ambrogi, Gilberto Ambrogi, Ailton Augustinho Marchi
Journal: Case Rep Obstet Gynecol (2018)
MeSH terms: Case Reports

Spontaneous uterine rupture in the first trimester of pregnancy is uncommon and difficult to diagnose. Although extremely rare, it is important to consider the occurrence of placenta percreta as differential diagnosis of acute hemorrhagic abdomen at the beginning of pregnancy. We describe below a case of uterine rupture in the first trimester of pregnancy related to placenta percreta.
Retinal artery occlusion following CoronaVac injection in a 45-year-old Filipino
Authors: Daniel Jose M Mendoza, David Francis F Chan, Ellen N Yu-Keh, Bryan Christopher W Sy
Journal: GMS Ophthalmol Cases (2023)
Keywords: covid-19 vaccine, coronavac, sars-cov-2, adverse effects, retinal arterial occlusion, retinal vasoocclusion
MeSH terms: Case Reports

Background:
While complex public health challenges and the emergence of variants have impeded responses to the COVID pandemic, vaccines continue to represent a crucial tool in mitigating the risk of morbidity and mortality. Safety issues weigh heavily upon both the utility and acceptability of every vaccine. Reports of sight-threatening events are scarce.
Case description:
We report the case of a hypertensive 45-year-old Filipino who noted unilateral (right eye) blurring of vision within 48 hours of his first dose of CoronaVac (Sinovac, China), an inactivated SARS-CoV-2/COVID-19 vaccine, with macular retinal arterial occlusion noted on day 21 post-inoculation. Further work-up revealed abnormal glycemic, metabolic, inflammatory, and bleeding parameters. Vision improved from counting fingers to 20/100 at week 6 with no interventions.
Conclusion:
A potential association between retinal vasoocclusion and inoculation with CoronaVac in our patient is supported by the temporal sequence of events, multiple mechanisms put forward in other cases, and reports of vascular adverse reactions in large country-level trials. It is mitigated by the profound infrequency of such events and the potentially substantial risk for ocular ischemic events imparted by the patient's baseline clinical background. Continued understanding of vaccine adverse reactions, however rare, is important not only for individual patient safety. This is helpful in ensuring the utility of current vaccines and in preserving the acceptability of vaccines through and beyond the current pandemic.
Application of metagenomic next-generation sequencing technique for diagnosing a specific case of necrotizing meningoencephalitis caused by human herpesvirus 2
Authors: Xin Li, Jing Li, Yawei Shi, Guode Wu, Manxia Wang, Ye Zhang, Han Xia
Journal: Open Life Sci (2022)
Keywords: case report, cerebrospinal fluid, human herpesvirus 2, metagenomic next-generation sequencing, necrotizing meningoencephalitis
MeSH terms: Case Reports

Reactivation of latent human herpesvirus 2 (HHV-2) can cause spontaneous recovering aseptic meningitis and recurrent meningitis in adults, but it rarely affects the brain parenchyma to cause encephalitis. Here, we report the case of a 37-year-old male patient admitted to our hospital due to fever with a progressive headache for 3 days and paroxysmal episodes of unconsciousness for 1 day. Brain magnetic resonance imaging (MRI) revealed viral meningoencephalitis. Then, metagenomics next-generation sequencing (mNGS) was applied, which detected 12,024 unique sequences of HHV-2 in cerebrospinal fluid (2022), indicating HHV-2 encephalitis. After antiviral treatment, the patient's symptoms improved, and he was discharged. During the 1-month follow-up, the patient recovered without any new symptoms, but a brain MRI revealed significant atrophy of the original foci. The patient was finally diagnosed with HHV-2 necrotizing meningoencephalitis, which is extremely rare. mNGS helped with the clinical diagnosis and strengthened our understanding of HHV-2 infections in the central nervous system.
'Strong clinging to objects': materiality and relationality in Melanie Klein's Observations after an Operation (1937)
Authors: Harriet Barratt
Journal: Wellcome Open Res (2021)
Keywords: klein, materiality, object relations, patient experience, phantasy, psychoanalysis, ‘anxiety-situations’

This article presents and analyses a set of notes written by the psychoanalyst Melanie Klein following an operation in 1937. The notes, entitled Observations after an Operation, act as a case study of the intersection of psychical, material and social relations as they play out in the immediate aftermath of surgical intervention. Using a close reading method, the article contextualises an analysis of Observations after an Operation by linking it to Klein's wider corpus of theoretical work. It deals in turn with the representation of anxiety mechanisms in the patient experience, drawing upon Klein's notes on the similarity with 'anxiety-situations' in early childhood; with Klein's changed relation with both external objects and their counterparts in the individual's mental landscape; with the role of sensation in phantasy, and the connection to bodily pain; with the doctor-patient relationship and the way this is perceived as being embodied in material objects, played out across two dreams experienced by Klein during her recovery; with the emphasis on illness as a form of mourning; and with the creative potential that the experience offers for a renewed structure of object relations. The article concludes that a greater attention to the role and representation of material objects, using psychoanalytic object relations theory as a starting point, can enhance how we collectively understand and assess the psychical impact of healthcare settings upon the patient. It also invites other scholars across the critical medical humanities to consult and analyse the newly available text upon which this article is based.
Case Report: Treatment Planning Study to Demonstrate Feasibility of Transthoracic Ultrasound Guidance to Facilitate Ventricular Tachycardia Ablation With Protons
Authors: Rosalind Perrin, Patrick Maguire, Adriano Garonna, Georg Weidlich, Shelley Bulling, Marie Fargier-Voiron, Cedric De Marco, Eleonora Rossi, Mario Ciocca, Viviana Vitolo, Alfredo Mirandola
Journal: Front Cardiovasc Med (2022)
Keywords: cardiac motion monitoring, protons, stereotactic radioablation, ultrasound, ventricular tachycardia
MeSH terms: Case Reports

Background:
Cardiac arrhythmias, such as ventricular tachycardia, are disruptions in the normal cardiac function that originate from problems in the electrical conduction of signals inside the heart. Recently, a non-invasive treatment option based on external photon or proton beam irradiation has been used to ablate the arrhythmogenic structures. Especially in proton therapy, based on its steep dose gradient, it is crucial to monitor the motion of the heart in order to ensure that the radiation dose is delivered to the correct location. Transthoracic ultrasound imaging has the potential to provide guidance during this treatment delivery. However, it has to be noted that the presence of an ultrasound probe on the chest of the patient introduces constraints on usable beam angles for both protons and photon treatments. This case report investigates the possibility to generate a clinically acceptable proton treatment plan while the ultrasound probe is present on the chest of the patient.
Case:
A treatment plan study was performed based on a 4D cardiac-gated computed tomography scan of a 55 year-old male patient suffering from refractory ventricular tachycardia who underwent cardiac radioablation. A proton therapy treatment plan was generated for the actual treatment target in presence of an ultrasound probe on the chest of this patient. The clinical acceptability of the generated plan was confirmed by evaluating standard target dose-volume metrics, dose to organs-at-risk and target dose conformity and homogeneity.
Conclusion:
The generation of a clinically acceptable proton therapy treatment plan for cardiac radioablation of ventricular tachycardia could be performed in the presence of an ultrasound probe on the chest of the patient. These results establish a basis and justification for continued research and product development for ultrasound-guided cardiac radioablation.
A case of multiple myeloma presenting as a distal renal tubular acidosis with extensive bilateral nephrolithiasis
Authors: Chathuranga Lakmal Fonseka, Sampath Rukshani Galappaththi, Jeewandarage Dhanushka Karunarathna, Dayakshi Dushyantha Kumarihami Abeyaratne, Nirmali Tissera
Journal: BMC Hematol (2016)
Keywords: distal renal tubular acidosis, multiple myeloma, nephrolithiasis
MeSH terms: Case Reports

Background:
At the time of diagnosis, Multiple Myeloma is commonly associated with renal impairment. Renal tubular acidosis without overt renal insufficiency is an uncommon disease presentation of myeloma. Among tubular acidosis types, isolated renal tubular acidosis is a very unusual presentation of multiple myeloma.
Case presentation:
We present a 55 years old female who presented with lower limb weakness due to persistent hypokalaemia caused by distal renal tubular acidosis. On further investigation of her anaemia with high erythrocyte sedimentation rate, we diagnosed IgG myeloma.
Conclusion:
Isolated distal renal tubular acidosis is a rare presentation of multiple myeloma. In the absence of hypercalciuria and demonstrable light chain excretion in urine, we assumed that the distal renal tubular acidosis could have been caused by monoclonal hypergammaglobulinaemic state of multiple myeloma.
Recurrent asymptomatic large pleural effusion due to endometriosis. A case report
Authors: Abdelrahman Elsayed, Mohamed Elmarasi, Abdulrahman Hamad, Mhd Baraa Habib
Journal: Respir Med Case Rep (2023)
Keywords: asymptomatic, catamenial, endometriosis, hemothorax, pleural effusion
MeSH terms: Case Reports

Pleural endometriosis is a rare manifestation of endometriosis that usually presents with catamenial symptoms, with or without complications. Here, we present a case of incidentally discovered pleural involvement of endometriosis in an asymptomatic young female. Pleurocentesis revealed bloody exudative pleural effusion with lymphocytic predominance. Thoracoscopy revealed inflamed parietal pleura, and the biopsy confirmed endometriotic involvement.
A Case of Myxoma Arising in the Buccal Mucosa
Authors: Masahiko Okubo, Yoshie Sano, Yosuke Fukushima, Taketo Tomoda, Shoichiro Kokabu, Tsuyoshi Sato
Journal: Case Rep Dent (2021)
MeSH terms: Case Reports

Myxomas arising in the oral and maxillofacial areas are extremely rare. This study reports a case of myxoma arising in the soft tissue beneath the buccal mucosa of an 86-year-old man.
Symptomatic isolated pleural effusion as an atypical presentation of ovarian hyperstimulation syndrome
Authors: Christine M Mullin, M Elizabeth Fino, Andrea Reh, Jamie A Grifo, Frederick Licciardi
Journal: Case Rep Obstet Gynecol (2011)
MeSH terms: Case Reports

Ovarian hyperstimulation syndrome (OHSS) presents in ~33% of ovarian stimulation cycles with clinical manifestations varying from mild to severe. Its pathogenesis is unknown. Pleural effusion is reported in ~10% of severe OHSS cases and is usually associated with marked ascites. The isolated finding of pleural effusions without ascites, as the main presenting symptom of OHSS is not frequently reported and its pathogenesis is also unknown. We describe two unusual cases of OHSS where dyspnea secondary to unilateral pleural effusion was the only presenting symptom. By reporting our experience, we would like to heighten physicians' awareness in detecting these cases early, as it is our belief that the incidence of pleural effusion in the absence of most commonly recognized risk factors for OHSS may be underestimated and may significantly compromise the health of the patient if treatment is not initiated in a reasonable amount of time.
Case Report of Foreign Body Stuck in Esophagus with Failure of Endoscopic Management in a Man with a History of Pica
Authors: Holly Mulinder, Allison Ammann, Yana Puckett, Sharmila Dissanaike
Journal: Case Rep Surg (2017)
MeSH terms: Case Reports

This is a case report of foreign body ingestion in a 55-year-old intellectually disabled man with a history of pica and previous removal of ten plastic gloves from his rectum four months prior to this presentation. The patient presented after ingesting plastic gloves which formed large, rigid esophageal and gastric bezoars that were not amenable to endoscopic removal. An exploratory laparotomy and gastrostomy was performed, and a 10 × 4.5 × 2 cm gastric bezoar consisting of rigid plastic gloves was removed without complication. Special considerations must be taken when considering the ingestion of nonfood items in the intellectually disabled population as these cases may not present classically with symptoms of a gastric bezoar.
Carbonic Anhydrase II Deficiency: A Rare Case of Severe Obstructive Sleep Apnea
Authors: Emanuela di Palmo, Marcella Gallucci, Elena Tronconi, Rosalba Bergamaschi, Salvatore Cazzato, Claudio La Scola, Giampaolo Ricci, Andrea Pession
Journal: Front Pediatr (2018)
Keywords: acidosis, adenotonsillectomy, carbonic anhydrase ii deficiency, continuous positive airway pressure, obstructive sleep apnea, osteopetrosis
MeSH terms: Case Reports

The term osteopetrosis describes a group of rare hereditary diseases of the skeleton, characterized by an increase in bone density, caused by a defect in the development or function of osteoclasts. It comprises a clinically and genetically heterogeneous conditions ranging from infantile onset life-threatening forms to mildest adult onset forms. "Malignant" osteopetrosis is characterized by bone fragility, short stature, compressive neuropathies, hypocalcaemia, pancytopaenia. The deficiency of carbonic anhydrase II causes a moderate form, presenting classically as a triad of osteopetrosis, renal tubular acidosis (RTA), and cerebral calcification. This condition leads to specific craniofacial dysmorphisms associated with upper airway obstruction that may result in obstructive sleep apnea. Herein we report a case of osteopetrosis with RTA associated with severe OSAS successfully treated with continuous positive airway pressure (CPAP).
Low Grade Islet but Marked Exocrine Pancreas Inflammation in an Adult with Autoimmune Pre-Diabetes
Authors: Hiroshi Nomoto, Tatyana Gurlo, Madeline Rosenberger, Mark D Girgis, Sarah Dry, Peter C Butler
Journal: Case Rep Endocrinol (2019)
MeSH terms: Case Reports

There is unexplained deficit in size and function of the exocrine pancreas in type 1 diabetes (T1D). We obtained pancreas from an individual with pre-T1D obtained at surgery and addressed the question, what is the relative inflammation in the exocrine and endocrine pancreas in pre-T1D in the absence of the potential confounding changes at autopsy or in brain dead organ donors. Pancreas was removed surgically from a 36 year woman for benign neuroendocrine tumors (NET). The patient had gestational diabetes at age 29 and has a 23 year old sister with T1D. Pre-operative fasting glucose of 109 mg/dl and HbA1C 5.8% revealed prediabetes with an anti-GAD 1,144 (5-250 U/ml) together with family history implying pre-T1D. There was patchy low grade immune infiltration in some, but not all, islets that met criteria for autoimmune insulitis. The exocrine pancreas showed more abundant inflammation with areas of chronic pancreatitis and acinar to ductal metaplasia, and with other areas of atrophy and fatty infiltration. In pre-T1D inflammation may be more prominent in the exocrine than the endocrine pancreas, calling into question the sequence of events and assumed islet centric basis of autoimmunity leading to T1D.
Familial pulmonary capillary hemangiomatosis early in life
Authors: Johannes Wirbelauer, Helge Hebestreit, Alexander Marx, Eugene J Mark, Christian P Speer
Journal: Case Rep Pulmonol (2011)
MeSH terms: Case Reports

Background. Pulmonary capillary hemangiomatosis (PCH) is a rare disease, especially in infancy. Four infants have been reported up to the age of 12 months. So far, no familial patients are observed at this age. Patients. We report three siblings, two female newborns and a foetus of 15-week gestation of unrelated, healthy parents suffering from histologically proven PCH. The first girl presented with increased O(2) requirements shortly after birth and patent ductus arteriosus (PDA). She subsequently developed progressive respiratory failure and pulmonary hypertension and died at the age of five months. The second girl presented with clinical signs of bronchial obstruction at the age of three months. The work-up showed a PDA-which was surgically closed-pulmonary hypertension, and bronchial wall instability with stenosis of the left main bronchus. Transient oxygen therapy was required with viral infections. The girl is now six years old and clinically stable without additional O(2) requirements. Failure to thrive during infancy and a somewhat delayed development may be the consequence of the disease itself but also could be attributed to repeated episodes of respiratory failure and a long-term systemic steroid therapy. The third pregnancy ended as spontaneous abortion. The foetus showed histological signs of PCH. Conclusion. Despite the differences in clinical course, the trias of PCH, PDA, and pulmonary hypertension in the two life born girls suggests a genetic background.
Simultaneous occurrence of medullary and papillary thyroid microcarcinomas: a case series and review of the literature
Authors: Zaina Adnan, Eldad Arad, James Dana, Yaakov Shendler, Elzbieta Baron
Journal: J Med Case Rep (2013)

Introduction:
Papillary thyroid microcarcinoma has been demonstrated to present in association with medullary thyroid carcinoma, however, medullary thyroid carcinoma and papillary thyroid carcinoma represent rare entities. In recent years this rarity has been increasingly observed. The pathogenesis is still controversial. Genetic analysis of RET proto-oncogenes in cases of simultaneous papillary thyroid carcinoma and medullary thyroid carcinoma has so far provided conflicting results; although it seems that germline mutations play a potential role in the development of both histological types.
Case presentations:
This paper describes four rare cases of simultaneous medullary thyroid carcinoma and papillary thyroid microcarcinoma with unique features:Case one was a 43-year-old Jewish woman, born in Israel, daughter of a Latvian immigrant mother and a father born in Israel. Case two was a 44-year-old Arab woman born in Israel. Case three was a 45-year-old Jewish woman, born in Israel, daughter of Moroccan immigrant parents and is unique for the presence of lymph node metastatic medullary thyroid carcinoma, and one lymph node with metastatic papillary carcinoma found in the same side. Case four was a 77-year-old Jewish woman, born in Iraq. These cases are unique in their composition of thyroid carcinoma, consisting of histologic features of medullary thyroid carcinoma, papillary thyroid microcarcinoma, and follicular thyroid adenoma. The four cases represent different ethnicity groups that live in north Israel, and case four is notable for the advanced age of the patient (77 years).
Conclusion:
These four cases add more data supporting the coincidental coexistence of papillary thyroid microcarcinoma and medullary thyroid carcinoma; our results may suggest that the simultaneous occurrence of medullary thyroid carcinoma and papillary thyroid microcarcinoma is generally a simple reflection of this coincidence. Endocrinologists and pathologists should be aware of this entity. The pathologist can play a pivotal role in identifying papillary thyroid microcarcinoma in concurrent existence with medullary thyroid carcinoma.