OpenMed/multicare-articles huggingface dataset:
An early complication in the donor site of the medial sural artery perforator flap: necrosis of the medial head of gastrocnemius
Authors: Hui-Ju Tsou, Chih-Peng Tu, Yu-Fan Chen, Wen-Teng Yao
Journal: Case Reports Plast Surg Hand Surg (2019)
Keywords: msap flap, early donor site complication, medial head of gastrocnemius
MeSH terms: Case Reports

The relatively new medial sural artery perforator flap is increasingly being used for reconstruction. However, muscle necrosis of the medial head of gastrocnemius after MSAP flap harvest is a previously unnoticed early complication of the donor site. We present two cases of MSAP flap reconstruction that developed this early complication.
Resistant ovary syndrome: Pathogenesis and management strategies
Authors: Zhenni Mu, Sinan Shen, Lei Lei
Journal: Front Med (Lausanne) (2022)
Keywords: etiology, infertility, management strategies, pathogenesis, resistant ovary syndrome
MeSH terms: Review

Resistant ovary syndrome (ROS) is a rare and difficult gynecological endocrine disorder that poses a serious risk to women's reproductive health. The clinical features are normal sex characteristics, regular female karyotype, and usual ovarian reserve, but elevated endogenous gonadotropin levels and low estrogen levels with primary or secondary amenorrhea. Although there have been many case reports of the disease over the past 50 years, the pathogenesis of the disease is still poorly understood, and there are still no effective clinical management strategies. In this review, we have collected all the current reports on ROS and summarized the pathogenesis and treatment strategies for this disease, intending to provide some clinical references for the management and treatment of this group of patients and provide the foothold for future studies.
Successful Treatment of a Patient With Brain Metastasis From Ovarian Cancer With BRCA Wild Type Using Niraparib: A Case Report and Review of the Literature
Authors: Zhenhua Zhang, Muying Xu, Abbas Sakandar, Xiuju Du, Huailin He, Wenfeng He, Dan Li, Qinglian Wen
Journal: Front Oncol (2022)
Keywords: parp inhibitors, brain metastases, case report, monotherapy, niraparib, ovarian carcinoma, survival
MeSH terms: Case Reports

Background:
Brain metastases from ovarian cancer are extremely rare and have a very poor prognosis. A multimodal approach (surgery combined with radiotherapy and chemotherapy) yields the best results in reducing neurological symptoms and prolonging survival. Unfortunately, not every patient receives a complete multimodal treatment due to their individual factors. Poly(ADP-ribose) polymerase (PARP) inhibitors have emerged as a maintenance treatment option for recurrent ovarian cancer. Using PARPi may prolong the overall survival in patients with brain metastases and recurrent ovarian cancer.
Case presentation:
We report a case of a female patient with advanced ovarian cancer without any germline or somatic BRCA mutation. After 21 months, after reduction surgery and adjuvant chemotherapy, she was diagnosed with brain metastasis. Due to her physical fitness and economic situation, she did not receive any radiotherapy or chemotherapy but only received surgical debulking of the brain metastasis and niraparib maintenance treatment. Up to now, she has achieved a good treatment response, and the PFS is 29 months.
Conclusion:
Based on the response of our patient, PARP inhibitors as a single agent can probably be considered in patients with brain metastasis from ovarian cancer without BRCA mutation who cannot tolerate radiotherapy and chemotherapy.
Jaundice Caused by Hyperemesis Gravidarum
Authors: Angsupat Pornchai, Patarapong Kamalaporn, Chutintorn Sriphrapradang
Journal: Ochsner J (2022)
Keywords: hyperemesis gravidarum, liver diseases, pregnancy, pregnancy complications, thyrotoxicosis
MeSH terms: Case Reports

Background: Hyperemesis gravidarum is characterized by intractable vomiting and associated with weight loss exceeding 5% of prepregnancy body weight, dehydration, and ketosis. Hyperemesis gravidarum occurs during the first trimester and typically resolves by 16 to 20 weeks of gestation. Approximately half of all hospitalized females with hyperemesis gravidarum have a mild elevation in liver enzymes; however, jaundice and hepatic synthetic dysfunction are uncommon. Case Report: A 22-year-old gravida 1 para 0 in her ninth week with a singleton gestation was hospitalized with persistent nausea, vomiting, weight loss of 11% of her prepregnancy body weight, dehydration, hypokalemia, and jaundice. Liver function tests showed hyperbilirubinemia of 7.1 mg/dL and alanine aminotransferase levels high as 676 U/L. Other hepatobiliary diseases were excluded. Thyroid function tests revealed thyrotoxicosis. Gestational thyrotoxicosis is often associated with hyperemesis gravidarum because of their shared pathophysiology of high human chorionic gonadotropin levels during the first trimester. After supportive management including hydration, correction of electrolyte disturbance, vitamin supplementation, and antiemetic treatment, the patient's symptoms resolved. Liver and thyroid dysfunction returned to normal after resolution of vomiting. The patient delivered a healthy child at 38 weeks' gestation. Conclusion: Elevation of aminotransferase and bilirubin levels may occur in patients with hyperemesis gravidarum. Although jaundice and highly elevated liver enzymes have been reported, investigations to exclude preexisting and concurrent liver diseases are required. Management of hyperemesis gravidarum is supportive, and outcomes are generally favorable.
Hematometrocolpos following Low Transverse Cesarean Delivery Complicated by Uterine Dehiscence
Authors: Lauryn C Gabby, Katherine E McDaniel, Brian J Gordon, Laila A Al-Marayati
Journal: Case Rep Obstet Gynecol (2021)
MeSH terms: Case Reports

Background:
Hematometrocolpos is a rare complication following procedures performed on the female genital tract. While usually seen in adolescents with congenital anomalies including imperforate hymen and vaginal stenosis, it has also been described following obstetric vaginal lacerations. The incidence following cesarean delivery is unknown.
Case:
This is a 43-year-old multigravida who underwent a low transverse cesarean delivery complicated by uterine dehiscence, as well as cervical and vaginal lacerations. The repair resulted in lower genital tract obstruction. She presented seven months afterwards with severe abdominopelvic pain and secondary amenorrhea, which resolved after vaginal dilation and excision of the vaginal scar.
Conclusion:
Systematic inspection of the upper vagina should be undertaken following complicated cesarean delivery with vaginal extension. Hematometrocolpos after cesarean delivery should be managed similar to a transverse vaginal septum.
Encapsulating Peritoneal Sclerosis - A rare and serious complication of peritoneal dialysis: Case series
Authors: O Mihalache, C Bugă, H Doran, E Catrina, F Bobircă, T Pătrașcu
Journal: J Med Life (2014)
Keywords: chronic kidney disease, encapsulated peritoneal sclerosis, peritoneal dialysis
MeSH terms: Peritoneal Dialysis / adverse effects, Peritoneal Fibrosis / etiology, Case Reports, Adult, Aged, Female, Humans, Intraoperative Care, Male, Middle Aged, Peritoneal Fibrosis / surgery, Retrospective Studies

Introduction:
Encapsulating peritoneal sclerosis is a pathological entity mainly associated with peritoneal dialysis (PD). The clinical syndrome is characterized by various degrees of intestinal obstruction due to thickening, sclerosis and calcification of peritoneum resulting in the encapsulation and cocooning of the bowel. It is a rare but potentially devastating complication associated with a considerable morbidity and mortality.
Materials and methods:
Cases of encapsulating peritoneal sclerosis (EPS), diagnosed in the Surgical Clinic of "Cantacuzino" Hospital, between 2007 and 2014 were retrospectively reviewed. During this interval, 432 surgical interventions related to peritoneal dialysis were performed: 306 peritoneal access interventions and 124 complications, of which 15 patients with EPS.
Results:
In all but two cases, the EPS diagnostic was established at the time of the surgical intervention addressed to other complication or pathology. Moreover, in 2 of the 15 patients the diagnostic was established approximately 5 months after PD was discontinued, and, in one of these patients at the time of the extraction of the dialysis catheter. 12 of 15 patients were diabetic. Most patients had a history of multiple peritonitis episodes. All the patients required the passing from peritoneal dialysis to hemodialysis. There were 4 deaths (26,6%) of which one was around two months from the diagnosis.
Conclusions:
The timely diagnosis of the condition and the appropriate phase-specific treatment is of utmost importance in EPS. In advanced stages, the surgical intervention performed by a well-trained team could achieve good long-term results.
Long response duration to pembrolizumab in metastatic, castration-resistant prostate cancer with microsatellite instability-high and neuroendocrine differentiation: A case report
Authors: Tsukasa Yoshida, Hiroshi Yaegashi, Ren Toriumi, Suguru Kadomoto, Hiroaki Iwamoto, Kouji Izumi, Yoshifumi Kadono, Hiroko Ikeda, Atsushi Mizokami
Journal: Front Oncol (2022)
Keywords: immune checkpoint inhibitor (ici), metastatic castration-resistant prostate cancer (mcrpc), microsatellite instability-high (msi-high), neuroendocrine differentiation (ned), pembrolizumab
MeSH terms: Case Reports

Background:
The detection of microsatellite instability in urologic cancers is rare, especially in metastatic, castration-resistant prostate cancer with neuroendocrine differentiation.
Case presentation:
This is a case of a 66-year-old Asian male patient with prostate adenocarcinoma who had metastases at initial presentation. Despite combined androgen deprivation therapy, his prostate-specific antigen (PSA) progressively increased, and prostate re-biopsy revealed small cell carcinoma. He was treated with platinum-based systemic chemotherapy, and his tumor markers, including PSA, remained negative; however, his local symptoms worsened. Subsequently, microsatellite instability-high was detected, and pembrolizumab was administered resulting in complete remission with the resolution of symptoms and continued therapeutic effect for more than 14 months.
Conclusion:
Microsatellite instability testing should be considered, despite its low detection rate, because the response to pembrolizumab in metastatic, castration-resistant prostate cancer with detectable microsatellite instability is associated with a prolonged duration of response.
Intensity Modulated High Dose Rate (HDR) Brachytherapy Using Patient Specific 3D Metal Printed Applicators: Proof of Concept
Authors: James J Sohn, Mitchell Polizzi, Sang-Won Kang, Woo-Hyeong Ko, Yong-Hyun Cho, Keun-Yong Eom, Jin-Beom Chung
Journal: Front Oncol (2022)
Keywords: 3d metal printing, hdr brachytherapy, imbt, patient-specific, tandem applicator

Purpose:
In high-dose-rate (HDR) brachytherapy, an anisotropic dose distribution may be desirable for achieving a higher therapeutic index, particularly when the anatomy imposes challenges. Several methods to deliver intensity-modulated brachytherapy (IMBT) have been proposed in the literature, however practical implementation is lacking due to issues of increased delivery times and complicated delivery mechanisms. This study presents the novel approach of designing a patient-specific inner shape of an applicator with 3D metal printing for IMBT using an inverse plan optimization model.
Methods:
The 3D printed patient-specific HDR applicator has an external shape that resembles the conventional brachytherapy applicator. However, at each dwell position of the HDR source, the shielding walls in the interior are divided into six equiangular sections with varying thicknesses. We developed a mathematical model to simultaneously optimize the shielding thicknesses and dwell times according to the patient's anatomical information to achieve the best possible target coverage. The model, which is a bi-convex optimization problem, is solved using alternating minimization. Finally, the applicator design parameters were input into 3D modeling software and saved in a 3D printable file. The applicator has been tested with both a digital phantom and a simulated clinical cervical cancer patient.
Results:
The proposed approach showed substantial improvements in the target coverage over the conventional method. For the phantom case, 99.18% of the target was covered by the prescribed dose using the proposed method, compared to only 58.32% coverage achieved by the conventional method. For the clinical case, the proposed method increased the coverage of the target from 56.21% to 99.92%. In each case, both methods satisfied the treatment constraints for neighboring OARs.
Conclusion:
The study simulates the concept of the IMBT with inverse planning using the 3D printed applicator design. The non-isotropic dose map can be produced with optimized shielding patterns and tailored to individual patient's anatomy, to plan a more conformal plan.
Duplication of the NPHP1 gene in patients with autism spectrum disorder and normal intellectual ability: a case series
Authors: Yuka Yasuda, Ryota Hashimoto, Ryoko Fukai, Nobuhiko Okamoto, Yoko Hiraki, Hidenaga Yamamori, Michiko Fujimoto, Kazutaka Ohi, Masako Taniike, Ikuko Mohri, Mitsuko Nakashima, Yoshinori Tsurusaki, Hirotomo Saitsu, Naomichi Matsumoto, Noriko Miyake, Masatoshi Takeda
Journal: Ann Gen Psychiatry (2014)
Keywords: autism spectrum disorder, copy-number variants, duplication, intelligence, nephronophthisis 1 gene
MeSH terms: Case Reports

Autism spectrum disorder is a neurodevelopmental disorder characterized by impairments in social interactions, reduced verbal communication abilities, stereotyped repetitive behaviors, and restricted interests. It is a complex condition caused by genetic and environmental factors; the high heritability of this disorder supports the presence of a significant genetic contribution. Many studies have suggested that copy-number variants contribute to the etiology of autism spectrum disorder. Recently, copy-number variants of the nephronophthisis 1 gene have been reported in patients with autism spectrum disorder. To the best of our knowledge, only six autism spectrum disorder cases with duplications of the nephronophthisis 1 gene have been reported. These patients exhibited intellectual dysfunction, including verbal dysfunction in one patient, below-average verbal intellectual ability in one patient, and intellectual disability in four patients. In this study, we identified nephronophthisis 1 duplications in two unrelated Japanese patients with autism spectrum disorder using a high-resolution single-nucleotide polymorphism array. This report is the first to describe a nephronophthisis 1 duplication in an autism spectrum disorder patient with an average verbal intelligence quotient and an average performance intelligence quotient. However, the second autism spectrum disorder patient with a nephronophthisis 1 duplication had a below-average performance intelligence quotient. Neither patient exhibited physical dysfunction, motor developmental delay, or neurological abnormalities. This study supports the clinical observation of nephronophthisis 1 duplication in autism spectrum disorder cases and might contribute to our understanding of the clinical phenotype that arises from this duplication.
Peripartum Severe Acute Pancreatitis with Rare Complications: Case Report and Review of Literature
Authors: Syed Muhammad Ali, Nissar Ahmed Shaikh, Zia Aftab, Ejaz Latif, Muhammad Sameer, Muhammad Burhan Khan, Mohannad Al-Tarakji
Journal: Case Rep Surg (2020)
MeSH terms: Case Reports

Peripartum pancreatitis is a rare clinical condition that occurs usually in the third trimester of pregnancy. Pancreatitis is usually secondary to gallstones, and it can lead to life-threatening and rare complications. We report a case of necrotizing postpartum pancreatitis that developed abdominal compartment syndrome (ACS) in early course, posterior reversible encephalopathy syndrome (PRES), and splanchnic and extrasplanchnic thrombosis later on. Case. 31-year-old female, one week after delivery, presented to the emergency department with abdominal pain, nausea and vomiting, tenderness in the epigastrium, and raised pancreatic enzymes. Ultrasound (USG) showed bulky pancreas with gallstones. She was diagnosed as having acute biliary pancreatitis and started to be hydrated and was supplemented with analgesia. Her condition deteriorated on the 2nd day, and she was shifted to the surgical intensive care unit (SICU) where she developed abdominal compartment syndrome (ACS), respiratory distress, and acute kidney injury, requiring endotracheal intubation and ventilation. Computerized tomography (CT) showed pancreatic necrosis with multiple fluid collections and significant left-sided pleural effusion. Percutaneous drainage of pleural effusion was done, and she was stabilized to be weaned off from mechanical ventilation. On day 15, she underwent USG-guided drainage of the pancreatic collection and ERCP (endoscopic retrograde cholangiopancreatography) on day 19. Post-ERCP, she had tonic colonic convulsions which were treated with benzodiazepines and phenytoin. It was diagnosed by imaging studies as posterior reversible encephalopathy syndrome (PRES). Her abdomen was still distended and tender; CT showed a significant pseudocyst with splanchnic and extrasplanchnic thrombosis. She had laparotomy, gastrocystostomy, and cholecystectomy on day 28th. She made uncomplicated recovery and discharged in good health. Conclusion. Peripartum pancreatitis can be complicated by ACS, PRES, and splanchnic and extrasplanchnic thrombosis.
Clinical, Imaging and Histopathology of Angioleiomyoma of the Buccal Cheek
Authors: Mohammad Jafarian, Fatemeh Mashhadi Abbas, Mitra Ghazizadeh Ahsaie, Homeira Saebnoori
Journal: Case Rep Dent (2021)
MeSH terms: Case Reports

Angioleiomyoma is a benign neoplasia originating from vascular smooth muscle and very uncommon in the oral cavity. In this report, we present a rare case of angioleiomyoma in oral cavity in a 46-year-old female buccal cheek and discuss the clinical, histological, and immunohistochemical characteristics. As the treatment of choice is the complete excision, the lesion was excised under local anesthesia with no further complications. In addition, a brief update on other reported cases of angiomyoma in the oral cavity is further discussed.
De Novo CD5 Negative Blastic Mantle Cell Lymphoma Presented with Massive Bone Marrow Necrosis without Adenopathy or Organomegaly
Authors: Ghaleb Elyamany, Ali Matar Alzahrani, Eman Al Mussaed, Hassan Aljasem, Sultan Alotaibi, Hatem Elghezal
Journal: Case Rep Hematol (2015)

The recent World Health Organization (WHO) classification defines mantle cell lymphoma (MCL) as a distinct entity characterized by a unique immunophenotype and a molecular hallmark of chromosomal translocation t(11;14)(q13;q32). We report an unusual case of an advanced stage of CD5 negative MCL with a blastoid variant with a massive bone marrow (BM) necrosis as an initial presenting feature, with no adenopathy or hepatosplenomegaly. The pathologic features showed blastoid variant of MCL and flow cytometry showed that the tumor cells were CD5-, CD19+, CD20+, FMC-7+, CD23-, and lambda light chain restricted. Chromosomal analysis, using karyotype and fluorescent in situ hybridization (FISH), demonstrated karyotypic abnormalities in addition to the t(11;14). Our case study may be reported as a unique case of CD5- blastic MCL with unusual presentation and findings which made the diagnosis of MCL difficult.
Neoadjuvant nivolumab and cabozantinib in advanced renal cell carcinoma in a horseshoe kidney - how to achieve a safe and radical resection? a case report and review of the literature
Authors: Anezka Zemankova, Hana Studentova, Andrea Kopova, Tomas Tichy, Vladimir Student, Bohuslav Melichar
Journal: Front Oncol (2023)
Keywords: cabozantinib, case report, complete response, horseshoe kidney, immunotherapy, neoadjuvant, nivolumab, renal carcinoma
MeSH terms: Case Reports

Introduction:
Neoadjuvant nivolumab and cabozantinib in locally advanced renal cell carcinoma in a horseshoe kidney is a novel therapeutic approach in the preoperative setting.
Methods:
We report a case of a 52-year old male who presented with a large inoperable tumor of the horseshoe kidney and achieved major partial radiologic response after neoadjuvant therapy with nivolumab and cabozantinib leading to radical resection of the tumor. The patient remains tumor free on the subsequent follow-up and his renal function is only mildly decreased. The systemic treatment was complicated by hepatotoxicity leading to early nivolumab withdrawal.
Results:
Currently, the combination therapy based on immune checkpoint inhibitors and tyrosine kinase inhibitors represents the treatment of choice in treatment-naïve patients with metastatic renal cell carcinoma in any prognostic group. The neoadjuvant treatment approach is being tested in prospective clinical trials and results are eagerly awaited. Renal cell carcinoma in a horseshoe kidney is an uncommon finding that is always challenging. Additionally, management guidance in this patient population is lacking. In some patients neoadjuvant therapy could be the only way to preserve kidney function. The initial treatment strategy should be individualized to patient needs aiming at the radical resection of the primary tumor as the only chance of getting the tumor under control in the long term.
Conclusion:
Herein, we highlight the feasibility of neoadjuvant systemic therapy with nivolumab and cabozantinib allowing the subsequent performance of radical tumor resection with negative margins in a patient with advanced renal cell carcinoma in a horseshoe kidney, removing the primary tumor while sparing the patient from lifelong dialysis.
Giant Squamous Cell Papilloma of the Eyelid-Diagnostic and Therapeutic Challenges
Authors: Attila Vass, Gábor Vass, Erika Gabriella Kis, Levente Kuthi, Judit Oláh, Tibor Hortobágyi, Edit Tóth-Molnár
Journal: Case Rep Ophthalmol Med (2019)
MeSH terms: Case Reports

Squamous cell papilloma (SCP) is generally a human papillomavirus (HPV) induced exophytic or endophytic proliferation on the surface of the skin, oral cavity, larynx, esophagus, cervix, vagina, and anal canal. The endophytic type SCP can cause differential diagnostic difficulties with keratoacanthoma, inverted follicular keratosis, and squamous cell carcinoma; however, these lesions are not associated with HPV infection. The authors present a female patient who noticed an extremely rapidly growing tumor destructing the left lower eyelid. The histological analysis of the biopsy sample revealed a virus-induced squamoproliferative lesion. The eyelid affected was completely removed, and the histological examination resulted in a HPV induced endophytic squamous cell papilloma. The tarsus and the conjunctiva were replaced by a chondromucosal graft harvested from the nasal septum, while the skin defect could be closed directly. Restoration of the eyelid function has been achieved with satisfying functional and cosmetic results.