OpenMed/multicare-articles huggingface dataset:
Extraabdominal fibromatosis in retroperitoneal space
Authors: Akira Kikkawa, Akira Kido, Tsukasa Kumai, Toru Hoshida
Journal: World J Surg Oncol (2004)

Background:
Fibromatosis or desmoid tumor covers a broad spectrum of benign fibrous tissue proliferations. It is characterized by infiltrative growth and a tendency towards recurrence; however, unlike sarcoma, it never metastasizes.
Case presentation:
We report on a case of extraabdominal fibromatosis originating from the retroperitoneal space in a 43-year-old woman. Seven years earlier she had undergone ureterolysis and ureteroureterostomy for ureteral obstruction. Computed tomography revealed a tumor between the iliocostalis and the psoas muscle. Histopathological evaluation revealed uniform proliferation of spindle cells, with a moderate amount of collagen fibers, suggesting extraabdominal fibromatosis (desmoid tumor). The tumor was surgically resected, and since then, the patient has remained asymptomatic without any restrictions of daily living activities and without any signs of tumor recurrence during the two-year follow-up.
Conclusions:
Complete resection is the treatment of choice. Adjuvant therapy using non steroidal anti-inflammatory agents, tamoxifen, interferon, anti-neoplastic agents, and radiotherapy, either alone or in combination finds application for unresectable or recurrent cases.
Umbilical cord coiling: case report and review of literature
Authors: Rajendra Kumar Diwakar, Meena M Naik, Monika M Jindal
Journal: BJR Case Rep (2016)

Sonographic evaluation of the umbilical cord coiling can be performed during routine foetal anatomic survey in the second trimester of pregnancy. Umbilical coiling index can be determined by dividing 1 by the intercoil distance in centimetres. Umbilical coiling index has been reported to be around 0.21 + 0.07 (standard deviation) coils per centimetre. Abnormal coiling in its two forms, hypercoiling and hypocoiling, have been reported to be more frequent in gestational diabetes and pre-eclampsia.
The use of innovative approaches to strengthen health system resilience during the COVID-19 pandemic: case studies from selected Commonwealth countries
Authors: Janneth Mghamba, Emily Gilmour, Layne Robinson, Azma Simba, Albert Tuyishime, Anand Persaud, Charles Mwansambo, Lakshmi Somatunga, Solomon Werema, Witness Mchwampaka, Vida Makundi, Kakulu Remedius, Fidelis Ronjiono, Beatrice Mutayoba, Theophile Dushime, Edison Rwagasore, Baptiste Byiringiro, Sylvere Mugumya, Claude Muvunyi, Frank Anthony, Narine Singh, Joseph Tsung-Shu Wu, Simeon Yosefe, Queen Dube, Nimdinu Mayakaduwa, Rangana Wadugedara
Journal: Front Public Health (2023)
Keywords: covid-19 response, commonwealth, best practices, digital innovations, health system resilience, multisectoral engagement
MeSH terms: COVID-19 / epidemiology, COVID-19 / prevention & control, Health Status, Humans, Investments, Malawi, Pandemics / prevention & control

This article is part of the Research Topic 'Health Systems Recovery in the Context of COVID-19 and Protracted Conflict'. The COVID-19 pandemic has exposed the vulnerabilities and limitations of many health systems and underscored the need for strengthening health system resilience to make and sustain progress toward Universal Health Coverage (UHC), global health security and healthier populations in tandem. In response to the COVID-19 pandemic, Commonwealth countries have been practicing a combination of innovative integrated approaches and actions to build health systems resilience. This includes utilizing digital tools, improvements in all-hazard emergency risk management, developing multisectoral partnerships, strengthening surveillance and community engagement. These interventions have been instrumental in strengthening national COVID-19 responses and can contribute to the evidence-base for increasing country investment into health systems resilience, particularly as we look toward COVID-19 recovery. This paper gives perspectives of five Commonwealth countries and their overall responses to the pandemic, highlighting practical firsthand experiences in the field. The countries included in this paper are Guyana, Malawi, Rwanda, Sri Lanka, and Tanzania. Given the diversity within the Commonwealth both in terms of geographical location and state of development, this publication can serve as a useful reference for countries as they prepare their health systems to better absorb the shocks that may emerge in future emergencies.
Split skin grafting for leg ulcers complicating rheumatoid arthritis
Authors: Reena Rai, M Aruchamy, Chakravarthi R Srinivas
Journal: J Cutan Aesthet Surg (2008)
Keywords: cyclophosphamide, leg ulcer, rheumatoid arthritis, skin grafting
MeSH terms: Case Reports

Leg ulcers as a complication of rheumatoid arthritis are difficult to heal. We present a case responding to treatment with cyclophosphamide and split skin grafting.
Case Report: Durable Response to the Combination of Brigatinib and Cetuximab Plus Icotinib in a NSCLC Patient Harboring EGFR L858R-T790M-cis-G796S and L718Q Resistance Mutations Following Progression With Osimertinib
Authors: Yubo Wang, Rui Han, Mengxiao Zhu, Tingting He, Yong He
Journal: Front Oncol (2022)
Keywords: nsclc, t790m-cis-g796s, brigatinib, cetuximab, osimertinib resistance
MeSH terms: Case Reports

The efficacy of osimertinib is severely limited by the emergence of EGFR C797S, which is detected in either the cis or trans position with T790M when osimertinib is used as a second-line treatment, and which is largely identified in combination with an EGFR 19 deletion. The EGFR T790M-cis-G796S mutation, which also occurs in exon 20 as C797S, participates in osimertinib resistance. To date, limited data for overcoming this resistance mutation have been reported. Here, we report data for an advanced NSCLC patient who developed EGFR L858R-T790M-cis-G796S and EGFR L718Q resistance co-mutations following progression with osimertinib. Such a case has rarely been reported, and under chemotherapy guidelines for this situation, no other effective treatment is recommended. The patient in our case experienced remarkable clinical improvement and good tolerance to the combination target therapy of brigatinib and cetuximab plus icotinib. At the time of our patient's last follow-up and prior to publication, our patient had reached more than 9 months of progression-free survival (PFS) and felt very well. Our finding provides clinical evidence that the combined target therapy of brigatinib and cetuximab may potentially be an effective treatment strategy for patients with an acquired EGFR T790M-cis-G796S resistance mutation following osimertinib treatment.
Challenges of Diagnosing Severe Ehrlichiosis in Orthotopic Liver Transplant Recipients
Authors: Melissa Parkinson, Spandana Vuyyuru, Jay Patel, Chinelo Animalu
Journal: Case Rep Transplant (2021)
MeSH terms: Case Reports

In recent solid organ transplant recipients, acute febrile illness is usually a source of grave concern and a diagnostic dilemma, especially if no response is noted after initiation of broad antimicrobial therapy. Human Monocytic Ehrlichiosis (HME) is a tick-borne illness caused by Ehrlichia chaffeensis and is not considered an opportunistic infection in immunocompromised patients such as solid organ transplant patients. Ehrlichiosis in immunocompromised patients can be life-threatening, and a strong index of suspicion is needed, especially in patients who live in endemic areas, for proper treatment initiation with doxycycline. We report a case of a 40-year-old male who received an orthotopic liver transplant six months earlier secondary to primary sclerosing cholangitis, on chronic immunosuppressive medication, who presented with complaints of sudden onset fever associated with nausea, vomiting, and diarrhea. Initial extensive infectious workup was negative and no response to empiric antimicrobials. There was suspicion for ehrlichiosis prompting empiric doxycycline use. Subsequently, E. chaffeensis polymerase chain reaction (PCR) was positive, and the antibiotic regimen was de-escalated to only doxycycline with complete resolution of his symptoms and progressive improvement in previously abnormal biochemical indices.
A Mistaken Diagnosis of Secondary Glioblastoma as Parasitosis
Authors: Chenxi Liu, Wenlong Xu, Pan Liu, Yukui Wei
Journal: Front Neurol (2019)
Keywords: fdg-pet, fet-pet, brain neoplasm, mistaken diagnosis, multi-parametric mri, parasitosis, secondary glioblastoma
MeSH terms: Case Reports

Background: Glioblastoma is a malignant brain tumor with poor prognosis requiring early diagnosis. Secondary glioblastoma refers to cases that progressed from low-grade glioma. Evidence shows that timely resection correlates with increased survival. Case presentation: We describe a case of a patient with secondary glioblastoma who was mistakenly diagnosed with Angiostrongylus cantonensis infection until 7 years after disease onset. The patient presented with non-specific clinical manifestations at disease onset. A conventional magnetic resonance imaging (MRI) in the primary survey provided insufficient information, and thus failed to identify the malignancy. During follow-up, unfortunately, clinicians were misled by the patient's raw food diet, a positive serum parasite antibody and a result of low glucose metabolism on Fluorodeoxyglucose-positron emission tomography-computed tomography (FDG-PET-CT). The patient was diagnosed with parasitosis. However, his condition kept getting worse under antiparasitic treatment. Preoperative magnetic resonance spectroscopy (MRS) and diffusion tensor imaging (DTI) failed to reverse the mistaken impression. Final diagnosis was confirmed until intraoperative and postoperative pathological findings indicated glioblastoma. Conclusion: We ascribe the incorrect diagnosis to insufficient understanding on imaging manifestations of brain neoplasm as well as clinical features of parasitosis. Thus, we review the MRI, FDG-PET-CT, MRS, and DTI data of this case according to the timeline, refer to relevant studies, and point out the pitfalls. With a long course of slowly progressing, this was a rare case of secondary glioblastoma with the absence of isocitrate dehydrogenase 1 (IDH1) gene mutation.
Upper extremity deep vein thrombosis in a 25 year old apparently healthy man
Authors: Fitsum Girma
Journal: Pan Afr Med J (2010)
Keywords: deep vein thrombosis, paget-schroetter syndrome, axillary vein, subclavian vein
MeSH terms: Anticoagulants / therapeutic use, Heparin, Low-Molecular-Weight / therapeutic use, Upper Extremity Deep Vein Thrombosis / diagnostic imaging, Upper Extremity Deep Vein Thrombosis / drug therapy, Warfarin / therapeutic use, Case Reports, Arm / blood supply, Blood Coagulation Tests, Humans, Male, Subclavian Vein / diagnostic imaging, Treatment Outcome, Ultrasonography, Doppler, Anticoagulants, Heparin, Low-Molecular-Weight, Warfarin

This case of upper extremity deep vein thrombosis is selected for case report as it is a rare form of deep vein thrombosis without a very well established treatment modality and prognosis. The objective of this study was to report the outcome of a 25 years old male patient with idiopathic upper extremity deep vein thrombosis treated conservatively with low molecular weight heparin (LMWH) and oral warfarin. The data sources used were patient interview, laboratory and radiology investigation results and patient charts. The patient had no apparent recurrence or complication for 3 years except the presence of occasional dull pain over the affected left upper extremity.
Increased Sensitivity to Serotonin Syndrome in Cerebral Palsy
Authors: Adam Schindzielorz
Journal: Case Rep Psychiatry (2022)
MeSH terms: Case Reports

Serotonin syndrome is characterized by symptoms of neuromuscular and autonomic excitation and altered mental status. It is most often drug induced with antidepressants being the main precipitants. However, other classes have been implicated as well including antipsychotics, antiemetic and pain medications, and lithium. The syndrome is typically induced by the combination of two or more serotonergic agents; however, there have been instances of serotonin syndrome occurring while a patient is on a single medication. The literature is limited regarding the study of risk factors associated with the production of serotonin syndrome while on only monotherapy or otherwise atypically causative agents. One such risk factor may be underlying neuromuscular pathology. This study is the first case series to our knowledge reporting two separate cases of serotonin syndrome being induced in patients with cerebral palsy as an underlying common factor.
The autopsy is not dead: ongoing relevance of the autopsy
Authors: Alexia Vignau, Clara Milikowski
Journal: Autops Case Rep (2023)
Keywords: b cell lymphoma, clear cell carcinoma of ovary, guillain-barré syndrome, hypercoagulability
MeSH terms: Case Reports

Background:
Autopsy requests have been trending downward for a variety of factors. There are differences between pre- and postmortem diagnoses. Autopsies remain a tool for education, public health research, quality control, and closure for families.
Objective:
We report two cases that illustrate the utility of autopsy for uncovering contributing factors in the death of these patients and highlight their ongoing importance.
Design:
Clinical and autopsy investigation of two individuals and illustration of the importance of autopsy findings which, had they been diagnosed premortem, could have changed the outcome. Cases were evaluated using the Goldman criteria for discrepancies between premortem clinical diagnoses and postmortem autopsy findings.
Results:
In the first case, the patient had been previously admitted due to a non-ST elevation myocardial infarction months before the fatal event. The autopsy showed an undiagnosed clear cell carcinoma of the ovary. She expired due to a massive myocardial infarction secondary to neoplasm induced hypercoagulable state. The degree of pre-mortem/postmortem diagnostic discrepancy makes this a Goldman Class I error.In the second case, the patient presented to the emergency department with symptoms of Guillain-Barré Syndrome (GBS), for which he was treated. Abdominal masses were discovered; however, the patient decompensated before workup was completed. A high-grade B-cell lymphoma was confirmed but would not have altered the outcome, making this a Goldman class II error.
Conclusions:
The autopsy remains a relevant and necessary tool for physicians and society. It assists in the establishment of diagnoses, measurement of treatment quality, the providence of public health metrics, and closure to the survivors.
When is a GIST not a GIST? A case report of synchronous metastatic gastrointestinal stromal tumor and fibromatosis
Authors: Chee Khoon Lee, Alison Hadley, Keshani Desilva, Gareth Smith, David Goldstein
Journal: World J Surg Oncol (2009)
MeSH terms: Fibroma / diagnosis, Gastrointestinal Stromal Tumors / diagnosis, Case Reports, Diagnosis, Differential, Fibroma / surgery, Gastrointestinal Stromal Tumors / surgery, Humans, Immunoenzyme Techniques, Male, Middle Aged, Positron-Emission Tomography, Proto-Oncogene Proteins c-kit / metabolism, Tomography, X-Ray Computed, Proto-Oncogene Proteins c-kit

Background:
A number of non-malignant diseases that share similar morphological features as gastrointestinal stromal tumor (GIST) have been reported. Co-existence of GIST with these other diseases is rarely recognized or reported.
Case presentation:
We report a case of a 62 year-old man with long-term stable control of metastatic GIST with systemic therapy, presented with an apparent intra-abdominal progression but not supported by imaging with positron emission tomography. Subsequent resection of the intra-abdominal tumor identified a non-malignant fibroid.
Conclusion:
Differentiating localized progression of GIST from other diseases has important prognostic and therapeutic implications. The potential for co-existence of non-malignant soft tissue neoplasm should always be considered.
A case of isolated elevated copper levels during pregnancy
Authors: Latoya R Walker, Meghan Rattigan, Joseph Canterino
Journal: J Pregnancy (2011)
MeSH terms: Copper / blood, Pregnancy Complications / prevention & control, Pregnancy, High-Risk / blood, Zinc / therapeutic use, Case Reports, Adult, Female, Humans, Infant, Newborn, Male, Pregnancy, Pregnancy Complications / blood, Secondary Prevention, Copper, Zinc

Introduction:
Outside of Wilson's Disease, abnormal copper metabolism is a rare condition. In pregnancy, excess copper levels can be associated with intrauterine growth restriction, preeclampsia and neurological disease.
Case report:
A 32 year old Gravida 4 para 2012 with an obstetrical history complicated by elevated copper levels presented for routine prenatal care. Her children had elevated copper levels at birth, with her firstborn child being diagnosed with autism and suffering three myocardial infarctions and being treated for elevated copper levels. During her prior pregnancies, she declined treatment for her elevated copper levels. During this pregnancy, she had declined chelation therapy and instead choose zinc therapy. She delivered a healthy infant with normal copper levels.
Conclusion:
Alterations in copper metabolism are rare, the consequences in pregnancy can be devastating. While isolated elevations of copper in pregnancy is exceedingly rare, it is treated the same as Wilson's disease. The goal is to prevent fetal growth restricting and neurological sequelae in the newborn and preeclampsia in the mother. Counseling, along with treatment options and timely delivery can greatly improve neonatal and maternal outcome.
Hyperthyroidism in a complete molar pregnancy with a mature cystic ovarian teratoma
Authors: Bryce C Simes, Alozie A Mbanaso, Carlos A Zapata, Chukwuma M Okoroji
Journal: Thyroid Res (2018)
Keywords: beta-carboxy-terminal peptide (b-ctp), beta-human chorionic gonadotropin (b-hcg), complete molar pregnancy, hydatidiform mole, hyperthyroidism, mature cystic ovarian teratoma
MeSH terms: Case Reports

Background:
The hallmark of gestational trophoblastic disease is the production of human chorionic gonadotropin (hCG) due to the hyperproliferation of extraembryonic trophoblast cells. Previous studies show hCG has thyrotropic action due to its structural similarity with thyroid stimulating hormone (TSH) molecules. Germ cell tumors represent 15-20% of all ovarian tumors and can be malignant or benign.
Case presentation:
We present a case of a 53-year old African American female with a history of hyperthyroidism secondary to a complete hydatidiform mole and an associated finding of a mature cystic ovarian teratoma. She presented with nausea, vomiting, nervousness, weight gain, abdominal pain and a b-hCG of greater than 450,000mIU/mL. A total abdominal hysterectomy with bilateral salpingo-oophorectomy was performed and curative for her symptoms. Lung nodules were noted with slight increases in b-hCG levels in the months following the surgery. Propranolol and methimazole were used to treat the acute hyperthyroid symptoms.
Conclusion:
This case presents the rare occurrence of a complete hydatidiform mole causing hyperthyroidism and an associated finding of a mature cystic teratoma. It also highlights the importance of monitoring b-hCG levels following a complete molar pregnancy due to an increased risk of choriocarcinoma.
Cecal Volvulus following a Right Nephrectomy for Wilms' Tumor: Should We Need to Close the Lateral Peritoneum?
Authors: Mauricio Gonzalez-Urquijo, Christian Ovalle-Chao, Eduardo Flores-Villalba, Ulises de Jesus Garza-Luna, Jose Humberto Velazco-De La Garza, Ulises Garza-Serna
Journal: European J Pediatr Surg Rep (2018)
Keywords: wilms' tumor, cecal volvulus, lateral peritoneum, nephrectomy
MeSH terms: Case Reports

Wilms' tumor (WT) accounts for 90% of all pediatric renal malignant tumors. The most common postoperative complication based on the National Wilms' Tumor Study is small bowel obstruction. We report on a 2-year-old girl with postoperative bowel obstruction following a right nephrectomy for WT. The patient was reintervened 48 hours after surgery and a cecal volvulus was found. Here, we will describe possible causes of this postoperative complication and discuss management.
Gastric cancer in the setting of persistently elevated human chorionic gonadotropin: a case report
Authors: Latoya R Walker, Brian Erler
Journal: Case Rep Obstet Gynecol (2011)
MeSH terms: Case Reports

A 35-year-old woman presented to the emergency room for the evaluation of failed surgical and medical management of a suspected ectopic pregnancy. When imaging studies were performed, she had lymphadenopathy and diffuse sclerosis of the osseous framework. Multiple biopsies were performed and revealed poorly differentiated metastatic carcinoma with signet ring features. Esophagogastroduodenoscopy confirmed the findings of a Stage IV gastric adenocarcinoma. Signs and symptoms of gastric carcinoma are vague. However, to our knowledge, an elevation in human chorionic gonadotropin (hCG) is not an associated finding. Persistence of hCG has many causes from abnormal pregnancy to menopause and other forms of cancer.
Inflammatory Fibroid Polyp: An Unusual Cause of Abdominal Pain in the Upper Gastrointestinal Tract a Case Report
Authors: Huan Wang, Tiejun Zhou, Cuiwei Zhang, Hao Li, Muhan Lü
Journal: Open Med (Wars) (2020)
Keywords: endoscopy, immunocytochemistry, pathology, vanek’s tumor

Inflammatory fibroid polyps (IFPs) tend to occur in the gastrointestinal tract, and they are rare and benign neoplasms. In general, IFPs often come from epithelial tissue. The gastric antrum is the most common location. Endoscopic ultrasound (EUS) often shows a predominantly hypoechoic mass with well-defined borders originating from the submucosal area. Here, we report the case of a 46-year-old woman with abdominal pain who underwent computed tomography (CT), endoscopic ultrasound and endoscopic submucosal dissection (ESD) of resected specimens; the diagnosis was ultimately an inflammatory fibroid polyp. She is currently in clinical remission.
Diabetes insipidus as a complication of Wegener's granulomatosis and its treatment with biologic agents
Authors: Joanna Rosalind Cunnington, Ramesh Jois, Ivan Zammit, David Scott, John Isaacs
Journal: Int J Rheumatol (2009)
MeSH terms: Case Reports

Wegener's granulomatosis of the pituitary gland resulting in diabetes insipidus is a rare complication of the disease. Standard treatment for Wegener's granulomatosis involves a combination of prednisolone and cylophosphamide, however biologic agents are now being used in refractory cases. We report three cases of patients with diabetes insipidus as a complication of Wegener's granulomatosis who were treated with biologic agents. All three cases showed clinical response to treatment with biologic agents including rituximab and alemtuzumab and two cases demonstrated improvement in pituitary gland abnormalities by MRI. Clinicians should be aware that diabetes insipidus can present as a complication of Wegener's granulomatosis and that biologic therapies may be effective in refractory cases.