OpenMed/multicare-articles huggingface dataset:
Large esophageal schwannoma: En-bloc resection with primary closure by esophagoplasty
Authors: Jad A Degheili, Pierre Sfeir, Ibrahim Khalifeh, Ali H Hallal
Journal: Int J Surg Case Rep (2019)
Keywords: esophagoplasty, esophagotomy, esophagus, gastrointestinal stromal tumor, schwannoma, submucosal tumor

Background:
Gastrointestinal schwannomas are submucosal tumors accounting for 2-7% of mesenchymal gastro-intestinal neoplasms; the stomach being the most common site. Esophageal schwannomas are more frequent in women, and are usually located in the upper to mid portion. Dysphagia is the main presenting symptom. A definitive diagnosis requires confirmation by histopathological and immunohistochemical studies.
Case presentation:
A 50-year-old healthy lady, presented with gradual increasing onset of dyspnea, with minimal dysphagia to solid food, over a period of several years. Enhanced CT scan of the chest revealed a well-defined soft tissue mass arising from the proximal third of the esophagus, measuring 7.8 × 5.4 x 10.5 cm. Esophagogastric endoscopy with ultrasonography showed an elevated, smooth surface lesion, arising from the submucosal layer of the esophagus, with a hypervascular mucosa. Enucleation of this large tumor, with preservation of the overlying mucosa, was difficult to accomplish due to its large size. Making use of a dilated proximal esophageal segment, total en-bloc excision of the mass rendered a 15 cm esophagotomy gap, which was easily closed, in two layers, without affecting the overall caliber thus achieving a good esophagoplasty result. Histologically, abundance of spindle-shaped cells with positive S-100 proteins, confirmed the diagnosis of esophageal schwannoma.
Conclusion:
Variations in mesenchymal gastrointestinal tumors is vast, rendering diagnosis by radiology alone difficult. As such, characteristic histologic and immunostaining features are cornerstones in precise diagnosis of esophageal schwannomas. Despite being rare in incidence, symptomatic esophageal schwannoma lesions can be excised entirely, with low rate of recurrence and favorable overall outcomes.
Assessment of Neuromuscular Function in Patients With Prior Cosmetic Procedures: A Case Report
Authors: Nicole K Le, Daniel Liauw, Sabrina Z Siddiqui, Kevin M Donohue
Journal: Eplasty (2019)
Keywords: cisatracurium besylate (nimbex), facial nerve, neuromuscular blockade, onabotulinum toxin a (botox), train-of-four peripheral nerve stimulation
MeSH terms: Case Reports

Objective: The use of Botulinum toxin type A (Botox) for cosmetic procedures has become so prevalent that many patients do not always consider it to be a past surgical procedure, and it goes excluded from the medical record. Without the knowledge of prior Botox use, interpretation of facial nerve train-of-four testing may be inaccurate. Methods: We describe a 61-year-old woman with a history of multiple cosmetic procedures whose postoperative course was complicated by multiorgan system failure, requiring neuromuscular blockade while on mechanical ventilatory support. Results: Gauged by facial nerve stimulation, adequate neuromuscular blockade was assumed. However, patient-ventilator dyssynchrony motivated the decision to move the peripheral nerve stimulator to the ulnar nerve, where muscle twitches were observed. This indicated inadequate paralysis. Conclusions: This case report highlights the importance of monitoring neuromuscular function with ulnar nerve testing in patients with a history of cosmetic Botox procedures.
Radiology examination as a diagnostic aid in presentations with wide differential diagnoses: Case report of new Hodgkin's lymphoma on a background of poorly controlled HIV
Authors: Rachel Hubbard, Jalpa Kotecha, Thomas Nash, Yu Jin Lee, Nasir Khan, Farhat Kazmi
Journal: SA J Radiol (2017)
MeSH terms: Case Reports

Hodgkin's lymphoma and disseminated Mycobacterium avium complex (MAC) infection share similar clinical features; both may affect human immunodeficiency virus (HIV)-positive individuals. We discuss a patient with poorly controlled HIV-infection presenting with chest sepsis, dyspnoea and weight loss. Whilst the initial working diagnosis was that of MAC infection, pathology results had not met diagnostic criteria. Lymph node biopsy instead revealed classical Hodgkin's lymphoma. We discuss the role of radiological examination in cases of diagnostic uncertainty.
Eyelid Retraction in Isolated Unilateral Congenital Blepharoptosis
Authors: Michael S Salman, Ian H Clark
Journal: Front Neurol (2017)
Keywords: blepharoptosis, congenital, isolated, levator palpebrae superioris, lid retraction in downgaze, static eyelid
MeSH terms: Case Reports

Isolated unilateral congenital ptosis is encountered relatively infrequently in clinical practice. It typically consists of a unilateral droopy eyelid, weak levator palpebrae superioris muscle function, lid lag, and an absent upper lid crease with no other abnormalities on examination. We present a four-and-a-half-year-old girl with isolated and mild unilateral congenital ptosis who unexpectedly demonstrated a static upper eyelid on downgaze in conjunction with a well-formed upper lid skin crease. We attribute this uncommon sign in congenital ptosis to stiffness and presumed fibrosis of the levator muscle. Examining the function of the eyelids in all directions of gaze is important in patients with abnormalities of lid position, since additional useful information can be gleaned about the status of the levator muscle including, aberrant regeneration or fibrosis.
Ablation of advanced tongue cancer and mobile tongue reconstruction by using a sensitive anterolateral thigh and vastus lateralis muscle free flap
Authors: Tuhar, D Zamfirescu, C Gheorghiță, D Slăvescu, A Frunză, I Lascăr
Journal: J Med Life (2015)
Keywords: anterolateral thigh flap, free flap, tongue reconstruction
MeSH terms: Free Tissue Flaps, Plastic Surgery Procedures, Quadriceps Muscle / surgery, Thigh / surgery, Tongue Neoplasms / surgery, Case Reports, Aged, Humans, Intraoperative Care, Male, Middle Aged, Postoperative Care

Background:
Successful tongue reconstruction after total glossectomy for advanced tongue or base of tongue cancer should restore swallowing, speech function, and cosmesis.
Methods:
The anterior lateral thigh flap sensitive myocutaneous (ALTF) with vastus lateralis muscle was used to reconstruct the oral defect in a patient undergoing total glossectomy with laryngeal preservation for T4 tongue cancer.
Results:
Good functional outcomes, measured by independent feeding, speech and swallowing, were achieved.
Conclusions:
The anterolateral thigh myocutaneous flap for total tongue reconstruction creates a free neotongue tip with an adequate volume, producing acceptable swallowing function and cosmesis. The reconstruction with free flaps is a feasible method of restoring the functional outcomes in speech and deglutition among patients who undergo total glossectomy with laryngeal preservation.
Urinary bladder hemangioma -a rare urinary bladder tumor in a child
Authors: Shubhangi Jibhkate, Vandana Sanklecha, Arvind Valand
Journal: APSP J Case Rep (2015)
Keywords: cystectomy, hemangioma, stem cells, urinary bladder
MeSH terms: Case Reports

Urinary bladder hemangiomas are rare, accounting for 0.6% of the urinary bladder tumors. Hemangioma is considered arising from embryonic stem cells of an angioblastic lineage. A 3-year old boy presented with hematuria. He had past operative history of excision of extensive lymphatic malformation involving retroperitoneum, pelvis and upper thigh. Computed tomography scan of abdomen and pelvis with contrast revealed a large soft tissue mass arising from the dome of the bladder. Partial cystectomy was done. Histopathology confirmed the mass as cavernous hemangioma of urinary bladder.
BiSpectral Index (BIS) monitoring may detect critical hypotension before automated non-invasive blood pressure (NIBP) measurement during general anaesthesia; a case report
Authors: Matthew M J Smith
Journal: F1000Res (2014)

A patient undergoing general anaesthesia for neurosurgery exhibited an unexpected sudden decrease in the BiSpectral Index (BIS) value to near-zero. This prompted the detection of profound hypotension using non-invasive blood pressure (NIBP) measurement and expedited urgent assessment and treatment, with the patient making a full recovery. Widely regarded as a 'depth of anaesthesia' monitor, this case demonstrates the potential extra clinical benefit BIS may have in the detection of critical incidents such as anaphylaxis during general anaesthesia.
Gallbladder carcinosarcoma with two heterologous components: a case report
Authors: El Mehdi Tiabi, Achraf Miry, Anas Haloui, Mohammed Bouziane, Imane Skiker, Nassira Karich, Amal Bennani
Journal: Pan Afr Med J (2022)
Keywords: carcinosarcoma, case report, gallbladder, multidisciplinary therapy
MeSH terms: Carcinosarcoma / diagnosis, Carcinosarcoma / pathology, Carcinosarcoma / therapy, Gallbladder Neoplasms / diagnostic imaging, Gallbladder Neoplasms / pathology, Case Reports, Aged, Cholecystectomy, Humans, Male, Tomography, X-Ray Computed

Carcinosarcoma of the gallbladder is a rare cancer characterized by presence of a carcinomatous and a sarcomatous component. In our work, we report the case of a 66-year-old male patient, presenting with isolated abdominal pain evolving for more than 6 months. contrast-enhanced computed tomography enabled identification of a gallbladder mass, invading liver, duodenum and abdominal wall. A cholecystectomy, extended to liver, duodenum and abdominal wall was performed. The final diagnosis of gallbladder carcinosarcoma was obtained by pathological assessment. Gallbladder carcinosarcoma has a poor prognosis. Since it is rare, no established chemotherapy or radiation protocols exist. Further studies about case series are needed to establish better therapeutic protocols. Gallbladder carcinosarcoma is a rare cancer with a rapid progression making therapeutic decisions difficult. All these factors contribute to the poor prognosis of this cancer.
Giant Coronary Sinus Complicated by Spontaneous Thrombosis
Authors: Otito Ojukwu, Salma Zook, Neal Kleiman, Gerald Lawrie, Mahwash Kassi
Journal: Methodist Debakey Cardiovasc J (2022)
Keywords: coronary sinus thrombosis, echocardiogram, fistula, mitral regurgitation, unroofed coronary sinus
MeSH terms: Coronary Sinus / diagnostic imaging, Coronary Thrombosis / complications, Coronary Thrombosis / diagnostic imaging, Coronary Vessel Anomalies / complications, Sinus Thrombosis, Intracranial / complications, Case Reports, Cardiac Catheterization, Humans

Spontaneous coronary sinus thrombosis (CST) is an extremely rare occurrence. Most cases are iatrogenic and related to right heart instrumentation, due to either central line placement or electrophysiology procedures such as pacemaker insertion that causes direct damage to the endothelial lining. The course can be insidious and may result in a fatal outcome. Diagnosis of CST is challenging, and the syndrome often goes unrecognized. However, in the current era of multimodality imaging, it is possible that this condition will be recognized in more patients. Herein, we present a patient with spontaneous coronary sinus thrombosis that was diagnosed using multimodality imaging and thereafter successfully managed.
Acquired von Willebrand Disease Secondary to Clear Cell Renal Cell Carcinoma
Authors: Brian Odom, Iyad Khourdaji, Victoria Golas, Richard Zekman, Bradley Rosenberg
Journal: J Endourol Case Rep (2018)
Keywords: acquired von willebrand disease, clear cell carcinoma, laparoscopic nephrectomy, nephrectomy, renal cell carcinoma, von willebrand disease

Background: Acquired von Willebrand disease (AvWD) is a rare and often underdiagnosed disease that typically is associated with lymphoproliferative, cardiovascular disease, and myeloproliferative disease. It is challenging to diagnose as it requires a hemostatic challenge to present itself. Case Presentation: This is a 46-year-old male with a history of multiple sclerosis complicated by neurogenic bladder who presented with intermittent gross painless hematuria. He underwent a gross hematuria workup. Cystoscopy demonstrated active bleeding from the right ureteral orifice. CT Urogram showed a filling defect in the right renal pelvis and endophytic 3 cm solid, enhancing left kidney mass. The patient underwent diagnostic cystourethroscopy, bilateral retrograde pyelogram demonstrating no filling defects bilaterally. Right ureteropyeloscopy demonstrated diffuse patchy erythema of the infrarenal collecting system with biopsies obtained. His postoperative course was complicated by gross hematuria requiring cystoscopy which demonstrated no upper tract bleeding and small pulsatile bleeding vessel in the bladder requiring cauterization. Hematology was consulted to rule out bleeding diathesis with workup demonstrating a von Willebrand deficiency (vWD). He had no family history of vWD and an AvWD was suspected. Hematologic workup was consistent with AvWD, type 2B vWD also known as a platelet-type von Willebrand disease. Renal pelvis biopsies were negative for pathology. Further investigation of the left renal mass confirmed a biopsy-proven clear cell renal cell carcinoma (ccRCC). He underwent a laparoscopic left radical nephrectomy with final pathology demonstrating pT1 ccRCC with negative margins. Postoperatively his repeat laboratories demonstrated normal factor VIII activity, ristocetin cofactor, and vWF antigen with normalized activated partial thromboplastin time. Follow-up imaging demonstrated no further evidence of disease supporting the hypothesis of a paraneoplastic syndrome from his ccRCC that caused an AvWD. Conclusion: This is the first case report to our knowledge of a paraneoplastic AvWD secondary to ccRCC. This should be on your differential when there is abnormal bleeding in the setting of renal masses.
Application of modified subtotal resection of adenomyosis combined with LNG-IUS and GnRH-a sequential therapy in severe adenomyosis: A case series
Authors: Zhenyue Qin, Zhiyong Dong, Huimin Tang, Shoufeng Zhang, Huihui Wang, Mingyue Bao, Weiwei Wei, Ruxia Shi, Jiming Chen, Bairong Xia
Journal: Front Surg (2022)
Keywords: dysmenorrhea, gonadotropin-releasing hormone agonist, levonorgestrel intrauterine delivery system, severe adenomyosis, subtotal resection of adenomyosis

Background and objective:
Adenomyosis focus resection has always been the main surgical method for patients with uterine preservation, but its curative effect and surgical method are still controversial. We improved this method on the basis of the "double-flap method" and combined it with the levonorgestrel intrauterine delivery system (LNG-IUS) and gonadotropin-releasing hormone agonist (GnRH-a) sequential treatment to determine the clinical effect and feasibility of this scheme in the treatment of severe adenomyosis.
Methods:
This is a retrospective review. A total of 64 patients with severe adenomyosis were treated in the Department of Gynecology of Changzhou Second People's Hospital, which is affiliated to Nanjing Medical University, from December 2017 to September 2021. The transabdominal approach and laparoscopic approach were adopted for the purposes of treatment in this study. Hence, the patients were subdivided into the transabdominal approach subgroup and the laparoscopic approach subgroup. The hemoglobin, visual analog score (VAS) score, menstruation score, and other indices of each patient before and after treatment were observed, recorded, and analyzed.
Results:
All 64 patients underwent the operation successfully. After the completion of sequential treatment, the CA125 decreased significantly 1 month after the operation, the average uterine volume significantly reduced, the hemoglobin value increased to a certain extent 3 months after the operation, and the menstrual score and dysmenorrhea during the first menstruation were significantly lower than they were before the operation. After the treatment, the therapeutic results of the transabdominal approach subgroup and endoscopic approach subgroup were compared on the basis of the observed indices, and no significant difference was observed (P > 0.05). Only one patient had a downward movement of the LNG-IUS, and the vaginal ultrasound showed that the upper end of the LNG-IUS was approximately 1.5 cm from the bottom of the uterine cavity. The average follow-up period was 24.02 ± 11.77 months, and no lesion progression was found in any patients.
Conclusion:
For patients suffering from severe adenomyosis who have no pregnancy plans and require uterine preservation, transabdominal or laparoscopic subtotal resection of the focus of adenomyosis, combined with the LNG-IUS + GnRH-a sequential treatment, may be a safe and effective alternative when conservative treatments such as drugs fail.
An Extremely Rapid Case of Pneumonitis with the Use of Nivolumab for Pancreatic Adenocarcinoma
Authors: Rubens Barros Costa, Al Benson, Vahid Yaghmai, Ricardo L B Costa, Haijun Zhou, Amir Behdad, Jason B Kaplan, Maureen Sadim, Sarah Talamantes, Aparna Kalyan
Journal: Case Rep Oncol Med (2018)
MeSH terms: Case Reports

Pancreatic cancer is the fourth most common cancer death in the United States despite comprising a small percentage of the total number of cancer cases. The estimated 5-year overall survival (OS) for patients with distant metastatic disease is approximately 3%. New treatment options are an unmet need and remain an area of active investigation. A 53-year-old male with metastatic pancreatic cancer presented to the hospital with acute-on-chronic respiratory failure approximately 24 hours after receiving a novel therapeutic combination. Chest imaging showed marked changes as concerning for pneumonitis. Infectious workup was negative. The patient had initial clinical improvement after receiving initial intravenous steroids and oxygen support but eventually deteriorated later opting for supportive measures only. With infection ruled out, drug-induced pneumonitis was felt to be the likely cause of the radiologic and clinical changes. The rapidity of onset of symptoms is the aspect being highlighted in this case.
Case Report: Detection of Double ROS1 Translocations, SDC4-ROS1 and ROS1-GK, in a Lung Adenocarcinoma Patient and Response to Crizotinib
Authors: Long Xu, Xiaoxia Chen, Hong Huo, Yongye Liu, Xiaodan Yang, Dejian Gu, Mingming Yuan, Min Zhang, Rongrong Chen, Jiayin Wang, Zhendong Zheng
Journal: Front Med (Lausanne) (2021)
Keywords: crizotinib, double ros1 fusion, lung adenocarcinoma, next-generation sequencing, novel ros1 fusion
MeSH terms: Case Reports

ROS1 rearrangement, identified in ~2% of non-small cell lung cancer (NSCLC), has defined a distinctive molecular subtype. Patients with ROS1 fusion have been shown to be highly sensitive to treatment with crizotinib. However, the efficacy of crizotinib in NSCLC patients with double ROS1 fusions remains to be elucidated. Here, we report a 40-year-old male diagnosed with stage IIIA lung adenocarcinoma. Two ROS1 fusions [SDC4-ROS1 (EX2:EX32) and ROS1-GK (EX31:EX13)] were detected simultaneously in tumor tissue of this patient by next-generation sequencing. Crizotinib was administered, and the patient showed a partial response in lung lesions. Nevertheless, a brain lesion was found at 8 months after treatment. The slightly short duration of response may be related to the presence of ROS1-GK rearrangement. This case proved that patients with SDC4-ROS1 and ROS1-GK fusions may be sensitive to crizotinib, but short progression-free survival of this case showed that the presence of ROS1-GK rearrangement may affect the efficacy of crizotinib. A large-scale investigation on the efficacy of ROS1 inhibitors in patients with complex ROS1 fusions should be conducted in the future.
Modification of the therapist's facial expressions using virtual reality technology during the treatment of social anxiety disorder: a case series
Authors: Toshiro Horigome, Shigeo Yoshida, Tomohiro Tanikawa, Masaru Mimura, Taishiro Kishimoto
Journal: Front Psychol (2023)
Keywords: exposure therapy, facial expressions, fear of negative evaluation, social anxiety disorder, virtual reality

Exposure therapy is a mainstream of treatment for social anxiety disorder (SAD). However, effort and time are required to recreate interpersonal situations that produce moderate anxiety. On the other hand, virtual reality exposure therapy can easily control anxiety-inducing conditions and allow for graduated exposure. However, artificial intelligence and animations that speak as naturally as actual humans are not yet practical, adding to the limitations of these treatments. The authors propose the use of a virtual reality technology that can transform facial expressions into smiling or sad faces in real time and display them on a monitor, potentially solving the above-mentioned problems associated with virtual reality animations. This feasibility study was conducted to determine whether this system can be safely applied to the treatment of SAD patients. A total of four SAD patients received 16 exposure therapy sessions led by an experienced therapist over a monitor; throughout the sessions, the facial expressions of the therapist were modified using software to display expressions ranging from smiling to sad on the monitor that was being viewed by the patient. Client satisfaction, treatment alliance, and symptom assessments were then conducted. Although one patient dropped out of the study, treatment satisfaction and treatment alliance were scored high in all the cases. In two of the four cases, the improvement in symptoms was sustained over time. Exposure therapy in which the interviewer's facial expressions are modified to induce appropriate levels of anxiety in the patient can be safely used for the treatment of SAD patients and may be effective for some patients.
Case report: Transcatheter tricuspid valve intervention using K-Clip™ system after prior Kay's annuloplasty
Authors: Shengjun Wu, Xiaoyi Dai, Lingshan Liu, Shuai Yuan, Peng Teng, Yiming Ni
Journal: Front Cardiovasc Med (2023)
Keywords: k-clip™, annuloplasty, transcatheter, tricuspid regurgitation, tricuspid valve
MeSH terms: Case Reports

The K-Clip™ system is emerging as an alternative to correct tricuspid regurgitation (TR) for patients with high surgical risk. However, patients with recurrent severe tricuspid regurgitation after prior Kay's annuloplasty are not generally deemed to be candidates for K-Clip™ implantation. Herein, we report a case of a 63-year-old woman with recurrent symptomatic torrential tricuspid regurgitation 5 years after double valve replacement with Kay's annuloplasty of the tricuspid valve. The K-Clip™ was successfully implanted, and the severity of tricuspid regurgitation and dimensions of tricuspid annulus achieved significant reduction. In conclusion, K-Clip™ can still be feasible and effective for patients with prior Kay's annuloplasty. However, indications become more rigorous, and evaluation should be more comprehensive.
New Horizon of Intervention in Congenital Heart Disease: AFR in a Complex Cyanotic Patient
Authors: Zahra Khajali, Homa Ghaderian, Ata Firoozi, Zahra Hosseini, Maryam Aliramezany
Journal: Case Rep Cardiol (2020)
MeSH terms: Case Reports

Double-inlet left ventricle (DILV) is the commonest form of the anatomic univentricular heart which has different ventriculoarterial connection; generally, the most prevalent type is DILV with the hypoplastic right ventricle on the left side. The disease is associated with several heart defects, and the treatment method is different based on the anatomy of the heart, but treatment methods are almost always palliative. In this paper, we described one adult patient with DILV and severe left AV (atrioventricular valve) stenosis who is managed with a novel palliative intervention; it means AFR (atrial flow regulator) device implantation for the first time.