OpenMed/multicare-articles huggingface dataset:
Multiple spontaneous small bowel perforations due to clozapine-Case report
Authors: A Rodrigues, A Duarte, A Marques, M Magalhães, R Camarneiro, R Silva, Á Ferreira, I Dionísio, L Val Flores, M Brito E Melo
Journal: Int J Surg Case Rep (2018)
Keywords: antipsychotic drugs, case report, clozapine, small bowel perforation

Introduction:
Spontaneous free perforation of the small bowel is unusual. There are many causes of spontaneous small bowel free perforation such as: immune-mediated or inflammatory, infections, drugs and biological agents, congenital, metabolic, vascular and neoplasm. A severe adverse effect of antipsychotic drugs is intestinal ischemia, which could lead to perforation.
Case presentation:
The authors report the clinical case of a 42-year-old schizophrenic patient, smoker, medicated with clozapine 600 mg per day, admitted to the emergency room with diffuse abdominal pain. On physical examination the patient presented abdominal rebound tenderness and peritoneal sign with raised inflammation markers and the abdominal tomography revealed pneumoperitoneum. An emergency laparotomy revealed multiple jejunal and ileal perforations. The patient was subject to small bowel resection complicated with anastomosis dehiscence, respiratory tract infection and intra-abdominal abscess. Histologic specimens showed nonspecific inflammatory findings with ischemia. The main infectious, inflammatory, congenital, auto-immune and vascular causes of spontaneous perforations were excluded.
Discussion:
Spontaneous free perforation of the small bowel is uncommon. An intestinal ischemia might be a rare adverse effect of antipsychotics. However, only colon perforations due to ischemic colitis are described in the literature. While diagnosis of the precise cause might be challenging, and after excluding other causes, these perforations may be attributed to an adverse effect of clozapine.
Conclusion:
The cause was attributed to clozapine as the other etiologies were excluded. The clozapine's reintroduction is controversial. In this case the clozapine dose was reduced successfully.
Endovascular treatment of a right pulmonary sequestration supplied by an aneurysmal aberrant artery originating from the abdominal aorta
Authors: Leopoldo Marine, Jose Ignacio Torrealba, Francisco Valdes, Renato Mertens, Francisco Vargas, Michel Bergoeing, Daniel Vallejos
Journal: J Vasc Bras (2022)
Keywords: bronchopulmonary sequestration, embolization, endovascular procedures, therapeutic
MeSH terms: Case Reports

Endovascular embolization of arteries feeding pulmonary sequestrations is a growing therapeutic option. A 51-year-old woman with chest pain and hemoptysis was admitted. During hospitalization she presented 150 mL hemoptysis, hypotension, and hematocrit fell to 23.3%. Contrast-enhanced computed tomography confirmed a pulmonary sequestration irrigated by an aneurysmal artery from the abdominal aorta. The patient underwent endovascular coil embolization of the artery feeding the aneurysm and an Amplatzer device was deployed in the proximal third of the sequestration artery. Subsequent contrast-enhanced computed tomography confirmed complete thrombosis of the aberrant artery feeding the aneurysm and absence of irrigation of the pulmonary sequestration. At 56 months follow-up the patient remains asymptomatic, tomography showed involution of the sequestration and complete thrombosis of the aberrant artery. The challenges presented by the different treatment alternatives are discussed.
Hereditary Angioedema with Normal C1 Esterase Inhibitor Refractory to Long-Term Prophylaxis: A Case Report
Authors: Gavin Cobb, Celina C Bernabe
Journal: Cureus (2023)
Keywords: allergy and immunology, angioedema, c1 esterase inhibitor, covid 19 vaccine, hae, hae type iii, hae with normal c1 inhibitor, hereditary angioedema, hereditary angioedema without normal c1 inhibitor
MeSH terms: Case Reports

Hereditary angioedema (HAE) was classically thought to be related to a deficiency in the C1 esterase inhibitor (C1-INH). However, HAE with a normal C1 esterase inhibitor (HAE nC1-INH) is a rare disease that has been recently characterized. In this case, we describe a woman with a 21-year history of angioedema who, in the last two years, has experienced severe exacerbations that led to the formal diagnosis of HAE nC1-INH. The patient has been treated with current HAE long-term prophylaxis (LTP) and on-demand therapies but is still experiencing severe, frequent attacks. Our case describes the timeline of this patient's presentation and provides valuable insight into the presentation and management of HAE nC1-INH.
An Unusual Cause of Dyspnea and Thoracic Pressure
Authors: Claire Chakkalakal, Rezo Jorbenadze, Meinrad Gawaz
Journal: Case Rep Cardiol (2019)
MeSH terms: Case Reports

There is a high prevalence of hepatic cysts in the general population. Simple cysts are most of the times asymptomatic and are usually detected incidentally on ultrasonography, computed tomography, or magnetic resonance imaging. Symptoms may range from abdominal discomfort and pain, early satiety, dyspepsia, nausea, and vomiting to jaundice and portal hypertension due to obstruction of adjacent structures. Complications include spontaneous hemorrhage, infection, thrombosis, and atrophy of surrounding hepatic tissue. We present a unique case of a middle-aged patient with acute onset of dyspnea and thoracic pressure due to compression of the right ventricle by a large hepatic cyst.
Reconstruction intramedullary nailing for a failed subtrochanteric Seinsheimer type IIB fracture: a case report
Authors: Fei Wang, Tianfeng Liu, Shoujin Guo, Lei Wu, Peiwang Xin
Journal: Front Surg (2023)
Keywords: seinsheimer type iib fracture, fail, femoral reconstruction intramedullary needle, nail off, subtrochanteric fracture of femur
MeSH terms: Case Reports

Introduction:
A case of subtrochanteric Seinsheimer II B fracture was retrospectively analyzed to determine the causes of failure and the possible problems with femoral reconstruction intramedullary nailing.
Methods:
This study focused on a case of an elderly patient with Seinsheimer type IIB fracture treated with minimally invasive femoral reconstruction intramedullary nailing. By retrospectively analyzing the intraoperative and postoperative course, we can identify the reasons that may lead to the surgical failure in order to avoid similar problems in the future.
Result:
It was observed that the nail was dislodged after surgery, and the broken end was displaced again. Through our analysis and research, we believe that non-anatomical reduction, deviation of needle insertion point, improper selection of surgical methods, mechanical and biomechanical effects, doctor-patient communication and non-die-cutting cooperation, and non-compliance with doctor's orders may be related to the success of surgery.
Conclusion:
Femoral reconstruction intramedullary nailing is used for the treatment of subtrochanteric Seinsheimer II B fractures; however, non-anatomical reduction, choice of needle insertion point, inappropriate choice of surgical method, mechanical and biomechanical effects, doctor-patient communication and cooperation without die-cutting, and non-compliance with doctor's advice may result in surgical failure. According to the analysis of individuals, under the premise of an accurate needle entry point, minimally invasive closed reduction PFNA or open reduction of broken ends and intramedullary nail ligation for femoral reconstruction can be used in Seinsheimer type IIB fractures. It can effectively avoid the instability of reduction and the insufficiency of the biomechanics caused by osteoporosis.
Case Report: How whole-genome sequencing-based cell-free DNA prenatal testing can help identify a marker mhromosome
Authors: Pascale Kleinfinger, Marie Brechard, Armelle Luscan, Detlef Trost, Aicha Boughalem, Mylene Valduga, Stéphane Serero Dr, Jean-Marc Costa, Laurence Lohmann
Journal: Front Genet (2022)
Keywords: array, case report, fish, noninvasive prenatal testing, supernumerary marker chromosome
MeSH terms: Case Reports

A supernumerary marker chromosome (SMC) is a structurally abnormal chromosome that cannot be characterized by conventional banding cytogenetics. Marker chromosomes are present in 0.075% of prenatal cases. They are associated with variable phenotypes, ranging from normal to severely abnormal, and the prognosis is largely dependent on the results of further cytogenomic analysis. Here, we report the identification and characterization of a marker chromosome following prenatal screening in a 39-year-old pregnant patient. The patient had a normal first trimester ultrasound but was high-risk for fetal chromosome anomalies based on the results of maternal serum parameters. Chorionic villus sampling was performed, and analysis of chorionic villi revealed the presence of two identical marker chromosomes. In the interest of a rapid identification of the markers, we performed noninvasive prenatal testing (NIPT) together with chorionic villus sampling. A pericentromeric 29 Mb duplication of chromosome 20: dup (20) (p13q11.21) was identified and thereafter confirmed by targeted metaphasic FISH. Whole-genome sequencing-based NIPT was instrumental in rapid characterization of the SMCs and allowed us to obviate the need for multiple expensive and time-consuming FISH analyses.
Metachronous anal canal and prostate cancers with simultaneous definitive therapy: a case report and review of the literature
Authors: Edward F Miles, Laura L Jacimore, John W Nelson
Journal: Case Rep Oncol Med (2011)
MeSH terms: Case Reports

Anal canal cancer is rare, accounting for only 1.3% of all gastrointestinal tract malignancies. Prostate cancer incidence is much higher and accounts for 27.6% of all malignancies in men. Treatment guidelines for anal cancer involve radiotherapy to the primary site and draining lymphatics while treatment for prostate cancer can also include pelvic radiotherapy. The literature is silent on the optimum course of action when these two malignancies are found synchronously or metachronously. Herein, we report a case of a patient diagnosed with intermediate risk prostate cancer who, prior to definitive therapy for this first malignancy, was also diagnosed with anal canal cancer. We conclude that a simultaneous approach with radiation therapy and chemotherapy with subsequent boost to the prostate is recommended. Screening for synchronous prostate cancer in male anal canal cancer patients is probably indicated and may preclude suboptimal treatment for a second occult primary.
105 Inappropriate ICD Shocks in a Patient with Dilated Cardiomyopathy and Broca's Aphasia
Authors: Christian Georgi, Michael Neuß, Viviane Möller, Martin Seifert, Christian Butter
Journal: Case Rep Cardiol (2019)
MeSH terms: Case Reports

With a growing number of ICD recipients, device complications are seen more frequently in the clinical setting and outpatient departments. Among the most severe are ICD infections and inappropriate therapies caused by oversensing of atrial tachycardias or lead fracture. We report on a 76-year-old female patient with dilative cardiomyopathy and Broca's aphasia after stroke, who experienced 105 consecutive inappropriate ICD shocks due to cluster missensing of her fractured ICD lead. The diagnosis was complicated and delayed by patient's aphasia emphasizing the need for intensified remote monitoring along with regular in-person visits, especially in people with intellectual or communication disabilities.
Fumarate hydratase-deficient renal cell carcinoma in extended remission with bevacizumab and erlotinib
Authors: Shubham Tomar, Lakhan Kashyap, Akhil Kapoor
Journal: Ecancermedicalscience (2022)
Keywords: fh gene mutation, bevacizumab and erlotinib therapy, hereditary leiomyoma and renal cell carcinoma
MeSH terms: Case Reports

Hereditary leiomyomatosis and renal cell carcinoma (HLRCC) is an autosomal dominant syndrome associated with fumarate hydratase (FH) gene mutation leading to defective DNA double-strand break repair mechanism. Although these tumours have an aggressive presentation, they respond well to targeted therapy with fewer adverse effects. Here we present a case of a 42-year-old female having isolated renal cell carcinoma, papillary type 2, carrying a mutation in the FH gene without cutaneous and uterine involvement. Her tumour responded well to erlotinib and bevacizumab combination and she was on treatment for 23 months. This report adds to the current literature and can help to define treatment protocols for HLRCC.
Total Intracorporeal Robot Kidney Autotransplantation: Case Report and Description of Surgical Technique
Authors: Charles Van Praet, Edward Lambert, Liesbeth Desender, Benjamin Van Parys, Caroline Vanpeteghem, Karel Decaestecker
Journal: Front Surg (2020)
Keywords: case report, kidney autotransplantation, kidney transplantation, minimal-invasive surgery, robotic surgery, robotics
MeSH terms: Case Reports

Introduction and Objectives: Kidney autotransplantation can be performed in patients with complex renal or ureteral pathology not suitable for in situ reconstruction, such as renal vasculature anomalies, patients with proximal or long complex ureteral strictures, or complex oncological cases. Robot-assisted surgery allows for a high-quality vascular and ureteral anastomosis and faster patient recovery. Robot-assisted kidney autotransplantation (RAKAT) is performed in two phases: nephrectomy and pelvic transplantation. In-between, extraction of the kidney allows for vascular reconstruction or kidney modification on the bench and safe cold ischemia can be established. If no bench reconstruction is needed, total intracorporeal RAKAT (tiRAKAT) is feasible. One case report in Europe has been described; however, to our knowledge no surgical video is available. Methods: A 58 year-old woman suffered from right mid- and distal ureteral stenosis following pelvic radiotherapy 10 years prior for cervical cancer. A JJ stent was placed, but she suffered from recurrent urinary tract infections, and ultimately a nephrostomy was placed. Renogram demonstrated 43% relative right kidney function. As her bladder volume was low following radiotherapy, no Boari flap was possible and the patient refused life-long nephrostomy or nephrectomy. Therefore, tiRAKAT was performed using the DaVinci Xi system. Results: We describe our surgical technique including a video. Surgical time (skin-to-skin) was 5 h and 45 min. Warm ischemia time was 4 min, cold ischemia 55 min, and rewarming ischemia 15 min. The abdominal catheter and bladder catheter were removed on the first and second postoperative day, respectively. The JJ stent was removed after 4 weeks. The patient suffered from pulmonary embolism on the second postoperative day, for which therapeutic low molecular weight heparin was started. No further complications occurred during the first 90 postoperative days. After 7 months, overall kidney function remained stable, right kidney function dropped non-significantly from 27 to 25.2 mL/min (-6.7%) on renal scintigraphy. Conclusion: We demonstrated feasibility and, for the first time, a surgical video of tiRAKAT highlighting patient positioning, trocar placement, and intracorporeal cold ischemia technique.
Delayed Management of an Orbital Floor Blow-out Fracture
Authors: Aida Pidro, Nina Jovanovic, Emina Kadribašic, Nedim Barucija, Nedim Leto, Alon Kahana
Journal: Beyoglu Eye J (2021)
Keywords: enophthalmos, hypoglobus, orbital fracture, transconjunctival approach
MeSH terms: Case Reports

A bony fracture in the orbital floor, the most common site, can lead to tissue herniation, enophthalmos, hypoglobus, or strabismic diplopia. Several surgical approaches for repair have been described in the literature. This report is a description of an illustrative case and a brief summary of the literature related to the transconjunctival approach to orbital floor fracture repair as performed by ophthalmologists. A 19-year-old female patient had fallen from a 5-meter-high fence and sustained panfacial fractures, including both orbits and the surrounding sinuses. An acute repair was performed by a maxillofacial team to stabilize the facial structure . Following neurosurgical stabilization, she was referred to ophthalmology with pronounced hypoglobus and enophthalmos, diplopia, relative afferent pupillary defect, and a slightly pale right optic nerve head. Surgery was performed under general anesthesia using the transconjunctival approach and an alloplastic implant. This approach was effective, providing excellent exposure while reducing the risks of lower eyelid retraction and surgical scars associated with the transcutaneous approach.
Cancer During Pregnancy: How to Handle the Bioethical Dilemmas?-A Scoping Review With Paradigmatic Cases-Based Analysis
Authors: Diogo Alpuim Costa, José Guilherme Nobre, Susana Baptista de Almeida, Marisa Horta Ferreira, Inês Gonçalves, Sofia Braga, Diogo Pais
Journal: Front Oncol (2020)
Keywords: cancer, carcinoma, ethical, ethics, gestation, neoplasm, pregnancy, pregnant
MeSH terms: Review

Ethical issues that arise during the care of a pregnant woman with cancer are challenging to physicians, policymakers, lawyers, and the bioethics community. The main purpose of this scoping review is to summarize existing literature regarding the bioethical dilemmas when a conflict arises in the maternal-fetus dyad, like the one related to cancer and pregnancy outcomes. Moreover, we illustrate the decision-making process of real-life case reports. Published data were searched through the PubMed and Google Scholar databases, as well as in grey literature, using appropriate controlled keywords in English and Portuguese. After identification, screening, eligibility and data extraction from the articles, a total of 50 was selected. There are several established ethical frameworks for conflict resolution and decision-making. Pragmatic theoretical approaches include case-based analysis, the ethics of care, feminist theory, and traditional ethical principlism that scrutinizes the framework of autonomy, justice, beneficence, and non-maleficence. In addition, society and practitioner values could mediate this complex ethical interplay. The physician must balance autonomy and beneficence-based obligations to the pregnant woman with cancer, along with beneficence-based obligations to the fetus. Ethical challenges have received less attention in the literature, particularly before the third trimester of pregnancy. Best, unbiased and balanced information must be granted both to the patient and to the family, regarding the benefits and harms for the woman herself as well as for the fetal outcome. Based on a previously validated method for analyzing and working up clinical ethical problems, we suggest an adaptation of an algorithm for biomedical decision-making in cancer during pregnancy, including recommendations that can facilitate counseling and help reduce the suffering of the patient and her family.
Multiple Myeloma, Misdiagnosed As Somatic Symptom Disorder: A Case Report
Authors: Jiashu Yao, Danmei Lv, Wei Chen
Journal: Front Psychiatry (2018)
Keywords: case report, misdiagnosis, multiple myeloma, somatic symptom and related disorders, somatic symptom disorder
MeSH terms: Case Reports

Here we report on a case of a 57-year-old woman with pain and discomfort in multiple sites of upper body who was diagnosed as somatic symptom disorder after completing a partial examinations of relevant parts which turned out to be negative. Finished imageological examinations of all painful parts, she was eventually diagnosed with multiple myeloma after 6-month being misdiagnosed as somatic symptom disorder. This case highlights the importance of completing imageological examinations of all the painful parts of the patient to exclude the possibility of multiple myeloma especially when symptoms are associated with objective signs and treatment has been ineffective; and it is as well as significant to notice characteristics of symptoms and to pay excessive attention directed toward the symptoms in the diagnosis of somatic symptom disorder.
Traumatic aortic injury: Computed tomography angiography imaging and findings revisited in patients surviving major thoracic aorta injuries
Authors: Richard Edwards, Nausheen Khan
Journal: SA J Radiol (2021)
Keywords: tai, computed tomography angiography, major chest trauma, thoracic aortic injuries, traumatic aortic injury
MeSH terms: Case Reports

Blunt chest trauma related acute thoracic aortic injury (TAI) is a life-threatening condition that requires prompt diagnosis and appropriate management because of high mortality. Computed tomography angiography (CTA) is the imaging of choice for evaluation of patients with major chest trauma findings suspicious of TAI on chest radiography. This case series describes the CTA findings in four high-velocity incident survivors with associated TAIs, discusses the injury type and treatment, and reviews the literature.
Pneumatization within a maxillary sinus graft: a case report
Authors: Viviane Rozeira Crivellaro, João César Zielak, Tatiana Miranda Deliberador, Naylin Danyele de Oliveira, Felipe Rychuv Santos, Carmen Lucia Mueller Storrer
Journal: Int J Implant Dent (2016)
Keywords: angiogenesis, bone graft vascularization, maxillary sinus, pneumatization

Rehabilitation of edentulous posterior maxilla with implant-supported prostheses frequently presents a challenge to dentists. This is due to insufficient bone within the region, in addition to other limiting factors such as anatomical pneumatization of the maxillary sinus. Thus, grafting of the maxillary sinus is a common procedure used to counteract these problems. Regardless of the type of biomaterial used, the success of the procedure is dependent on the formation of high-quality bone. Therefore, vascularization is a key factor for successful grafting and for the long-term maintenance of the treatment. This paper reports a clinical case of bone graft pneumatization and attempts to elucidate its potential etiology.
Management of Acute Posterior Multifocal Placoid Pigment Epitheliopathy (APMPPE): Insights from Multimodal Imaging with OCTA
Authors: Mariana A Oliveira, Jorge Simão, Amélia Martins, Cláudia Farinha
Journal: Case Rep Ophthalmol Med (2020)
MeSH terms: Case Reports

A 28-year-old man presented to the emergency room with blurred vision in the right eye for two days. He reported a preceding flu-like illness one week earlier. His best-corrected visual acuity (BCVA) was 20/40 in the right eye and 20/25 in the left eye. There was no anterior chamber inflammation or vitritis in either eye. He presented multiple yellowish-white placoid lesions in the posterior pole, some involving the foveal area, bilaterally. General examination and systemic investigation were unremarkable. Multimodal evaluation with fluorescein angiography, indocyanine green angiography, and spectral domain and optical coherence tomography angiography (OCTA) were consistent with the diagnosis of acute posterior multifocal placoid pigment epitheliopathy. Due to centromacular involvement with decreased BCVA, treatment with oral methylprednisolone was started after infectious causes were ruled out. After two weeks, the patient presented functional and anatomical improvement. OCTA showed partial reperfusion of the choriocapillaris in the affected areas, in both eyes.