OpenMed/multicare-articles huggingface dataset:
Anti-leucine-rich glioma-inactivated 1 encephalitis revealed by a manic episode: insights from frontal lobe dysfunction in neuropsychiatry through neuropsychology and metabolic imaging. A case report
Authors: Federica Porpiglia, Maxime Guillaume, Evangeline Bliaux, Dimitri Psimaras, Pierre Decazes, Olivier Guillin, Maud Rothärmel, Alexandre Morin
Journal: Front Psychiatry (2023)
Keywords: fdg-pet, anti-lgi1 encephalitis, autoimmune manic syndrome, behavior, limbic encephalitis
MeSH terms: Case Reports

Background:
Anti-leucine-rich glioma-inactivated 1 (LGI1) encephalitis is a limbic encephalitis that rarely presents as an isolated psychiatric syndrome.
Case presentation:
A 70-year-old patient first presented with behavioral disorder including hyperactivity, euphoria, with disinhibition and accelerated speech associated with severe insomnia and cognitive disorder. A manic episode was diagnosed and he received various psychotropic medications with no improvement. Invesitgations were negative (MRI showed T2 aspecific hyperintensities with no hyperintensities in limbic regions and EEG was normal). He was transferred to a nursing home, with a diagnosis of neurodegenerative condition. Later, he was referred to our unit for further investigations. A cerebral 18F-FDG-PET revealed an association of frontal hypometabolism and temporal and striatum hypermetabolism and CSF analysis revealed slightly increased white blood cell counts. Plasmatic anti-LGI1 antibodies were detected. The patient was treated with intra-venous immunoglobulin (IvIg) but showed no improvement. Second-line treatment (a combination of rituximab and cyclophosmphamide) was then administered for a year, leading to an improvement of neuropsychiatric symptoms and normalization of metabolic impairment on 18F-FDG-PET.
Conclusion:
In this report, we describe a novel case of a patient withanti-LGI1 encephalitis with a predominant long-term psychiatric presentation. An atypical presentation (such as atypical psychiatric symptoms, neurocognitive disorder, and hyponatremia) should prompt further investigations such as CSF analysis, considering that MRI and EEG may be normal. FDG-PET might be of interest but few data are available in the literature. Early treatment of anti-LGI1 encephalitis is crucial for overall prognosis and may delay the development of dementia in some cases.
An Unusual Case of Ascending Pancreatitis with Mediastinal Involvement: A Case Report with CT and MRI Findings
Authors: Ernesto Di Cesare, Alessandra Di Sibio, Antonio Gennarelli, Valentina Felli, Valentina Vellucci, Ines Casazza, Carlo Masciocchi
Journal: Case Rep Radiol (2014)

Fluid collections are common findings of pancreatitis and spread, more often, along preferential drainage pathways in the abdomen. In some rare cases, fluid collections may spread towards extra-abdominal sites like the mediastinum leading to the formation of mediastinal collections. We present the case of a 52-years-old man with pain in the right upper quadrant of the abdomen and mid-epigastrium lasting for some hours. Laboratory tests suggested a diagnosis of pancreatitis. CT and subsequent MRI revealed changes consistent with acute exacerbation on chronic pancreatitis spreading to the mediastinum and to the greater omentum. The patient received medical treatment and reported gradual improvement in his laboratory results and CT findings.
Case Report: Recombinant Human Endostatin Plus Chemotherapy for Epidermal Growth Factor Receptor-Negative Miliary Lung Adenocarcinoma
Authors: Jian Zhu, Ya Xu, Wen-Cai Huang, Tao Ji, Guo-Ping Ai, Yan-Hong Gao
Journal: Front Oncol (2022)
Keywords: anti-angiogenic therapy, immunotherapy, lung adenocarcinoma, miliary metastasis, recombinant human endostatin
MeSH terms: Case Reports

Except for the traditional chemotherapy, few treatments strategy about miliary intrapulmonary carcinomatosis (MIPC) have been reported in the existing literature. In this report, we primarily discussed the possible etiology and the potentially effective treatment options for a patient with MIPC who benefited from combined treatment. A nonsmoking woman was diagnosed with MIPC at an advanced stage. Gene detection showed an EGFR negative status. She accepted first-line chemotherapy with pemetrexed and cisplatin, and the tumor progressed. Next, PD-1 inhibitors plus pemetrexed and cisplatin were administered, and the tumor remained uncontrolled. After two cycles of recombinant human endostatin plus second-line chemotherapy, the numerous pulmonary nodules had all nearly completely disappeared, while an accentuated decrease in the primary tumor volume was observed. Moreover, biochemical markers, including the patient's tumor markers, also trended toward normal. This report describes the first case of a MIPC patient who significantly responded to antiangiogenic therapy combined with chemotherapy. Anti-angiogenic therapy may be a possible strategy for the EGFR-negative lung adenocarcinoma population.
Pelvic actinomycosis presenting as a malignant pelvic mass: a case report
Authors: Arife Simsek, Asiye Perek, Ibrahim Ethem Cakcak, Ali Vedat Durgun
Journal: J Med Case Rep (2011)

Introduction:
Pelvic actinomycosis constitutes 3% of all human actinomycosis infections. It is usually insidious, and is often mistaken for other conditions such as diverticulitis, abscesses, inflammatory bowel disease and malignant tumors, presenting a diagnostic challenge pre-operatively; it is identified post-operatively in most cases. Here we present a case that presented as pelvic malignancy and was diagnosed as pelvic actinomycosis post-operatively.
Case presentation:
A 48-year-old Caucasian Turkish woman presented to our clinic with a three-month history of abdominal pain, weight loss and difficulty in defecation. She had used an intra-uterine device for 16 years, however it had recently been removed. The rectosigmoidoscopy revealed narrowing of the lumen at 12 cm due to a mass lesion either in the wall or due to an extrinsic lesion that prevented the passage of the endoscope. On examination, there was no gynecological pathology. Magnetic resonance imaging showed a mass, measuring 5.5 × 4 cm attached to the rectum posterior to the uterus. The ureter on that side was dilated. Surgically there was a pelvic mass adhered to the rectum and uterine adnexes, measuring 10 × 12 cm. It originated from uterine adnexes, particularly ones from the left side and formed a conglomerated mass with the uterus and nearby organs; the left ureter was also dilated due to the pelvic mass. Because of concomitant tubal abscess formation and difficulty in dissection planes, total abdominal hysterectomy and bilateral salphingo-oophorectomy was performed (our patient was 48 years old and had completed her childbearing period). The cytology revealed inflammatory cells with aggregates of Actinomyces. Penicillin therapy was given for six months without any complication.
Conclusions:
Pelvic actinomycosis should always be considered in patients with a pelvic mass especially in ones using intra-uterine devices, and who have a history of appendectomy, tonsillectomy or dental infection. Surgeons should be aware of this infection in order to avoid excessive surgical procedures.
45,X/46,XY Mosaicism and Normozoospermia in a Patient with Male Phenotype
Authors: Shathmigha Ketheeswaran, Birgit Alsbjerg, Preben Christensen, Claus Højbjerg Gravholt, Peter Humaidan
Journal: Case Rep Med (2019)
MeSH terms: Case Reports

The phenotypic spectrum of 45,X/46,XY mosaic males varies greatly. Previous reports have only described cases with either oligozoospermia, growth retardation, or elevated gonadotropins. However, the present case presented with normozoospermia, and normal height, sperm DNA fragmentation index (DFI), and gonadotropins. The male and his spouse were referred to The Fertility Clinic, Skive Regional Hospital, due to 2 years of infertility. After failure of several attempts of assisted reproductive treatment (ART), the male underwent genetic analysis. Conventional karyotyping in peripheral lymphocytes yielded a low-grade 45,X/46,XY mosaicism, confirmed by fluorescence in situ hybridization (FISH) showing 6% 45,X cells. A FISH test performed on interphase nuclei from buccal mucosal cells yielded one cell with only one X-signal (0.6%), explaining the normal phenotype of the patient, but not the infertility. FISH test for sperm aneuploidy showed normal range parameters, except for a 10-fold elevated gonosomal nullisomy rate (2.1%). Hence, germinal mosaicism may be an explanation of the infertility of the case. Increased sex nullisomy levels may reflect an aberrant testicular environment compromising fertility even though sperm euploidy rates and other sperm parameters do not preclude a successful treatment with ART. Based on these results, the couple decided to use donor semen for their subsequent intrauterine insemination treatment and obtained a successful pregnancy.
Bacterial Endocarditis of Anatomically Normal Native Pulmonic Valve with No Predisposing Risk Factors: Case Report and Review
Authors: Muhannad Antoun, John Deel, Dermot Halpin, Fadi Al-Akhrass
Journal: Case Rep Infect Dis (2020)
MeSH terms: Case Reports

Right-sided native valve infective endocarditis (IE) includes tricuspid valve (TV) and pulmonic valve (PV). It represents 10% of all cases. However, it is more common in persons who inject drugs or in presence of cardiac implantable electronic device (CIED). Pulmonic valve endocarditis is a rare infection and represents ∼1% of all cases. Our case represents a patient with large pulmonic valve vegetation with no known common risk factors for right-sided IE.
Acquired Hemophilia A Presenting as Massive Postoperative Bleeding in a Patient with Oral Squamous Cell Carcinoma
Authors: Susumu Oba, Mitsuhiko Nakahira, Yasunao Kogashiwa, Yasuhiro Ebihara, Masashi Sugasawa
Journal: Case Rep Otolaryngol (2020)
MeSH terms: Case Reports

Acquired hemophilia A (AHA) is an extremely rare and serious bleeding disorder caused by autoantibodies against coagulation factor VIII (FVIII). Approximately, 10% of patients with AHA have an underlying malignancy. We report on a 46-year-old man with AHA and advanced oral cancer who presented with massive bleeding after surgery. Preoperative blood coagulation tests showed no abnormalities. He underwent radical tumor resection followed by reconstruction using a free rectus abdominal musculocutaneous flap. Massive subcutaneous hemorrhage developed in his neck and abdomen on the first postoperative day. The hemorrhage remained uncontrolled, despite embolization of the responsible vessels. Subsequent laboratory data showed prolonged activated partial thromboplastin time and decreased FVIII levels. On the basis of his clinical course and the presence of the FVIII inhibitor, we speculated that the patient suffered from AHA. We administered recombinant activated factor VII and prednisolone, after which the spontaneous bleeding stopped and the subcutaneous hemorrhage resolved. A review of the literature identified only three previous documented cases of AHA associated with head and neck cancer. This case indicates that AHA should not be ruled out in patients with uncontrolled postoperative bleeding, while attempting to ensure bleeding control and preventing potentially catastrophic fatal consequences.
Case Report: Pulmonary tuberculosis and raised transaminases without pre-existing liver disease- Do we need to modify the antitubercular therapy?
Authors: Sanjeev Gautam, Keshav Raj Sigdel, Sudeep Adhikari, Buddha Basnyat, Buddhi Paudyal, Jiwan Poudel, Ujjwol Risal
Journal: Wellcome Open Res (2020)
Keywords: liver friendly regimen, standard att, transaminitis, tuberculosis
MeSH terms: Case Reports

We report a case of an adult female with pulmonary tuberculosis who had biochemical evidence of liver injury during the presentation manifested as raised transaminases, but without clinically obvious pre-existing liver disease nor a history of hepatotoxic drug use. This is a fairly common scenario seen in tuberculosis endemic areas; however, this is an under reported condition in the literature and guidelines for its management has not been established. Many clinicians including the authors have treated such cases with modified liver friendly regimens in fear of increasing the hepatotoxicity with standard antitubercular drugs. However, the modified regimens may not be optimal in treating the underlying tuberculosis. In this report, we gave full dose standard drugs, and the liver injury resolved as evidenced by normalization of transaminases. Further research is required in this regard, but the presence of transaminitis with no obvious common underlying etiology may not warrant a modification of standard antitubercular regimen.
Percutaneous Thrombin Injection for Treatment of a Hepatic Arterial Pseudoaneurysm after the Placement of a Transjugular Intrahepatic Portosystemic Shunt
Authors: Daniel C Oppenheimer, Luann Jones, Ashwani Sharma
Journal: J Clin Imaging Sci (2019)
Keywords: hepatic artery pseudoaneurysm, portal hypertension, transjugular intrahepatic portosystemic shunt
MeSH terms: Case Reports

Transjugular intrahepatic portosystemic shunt (TIPS) is a widely accepted option for treating the complications of portal hypertension. The procedure involves creating a communication between the portal and hepatic venous systems using imaging guidance, thereby diverting the portal venous flow and reducing the portosystemic gradient. However, as with any procedure, TIPS insertion is not without potential complications. We present a case of a 37-year-old female who developed a hepatic artery pseudoaneurysm following the placement of a TIPS which was successfully treated with percutaneous thrombin injection.
Idiopathic Hypertrophic Pyloric Stenosis with Complete Ladd's Band: A Rare Association
Authors: Ahmed M Abo Elyazeed, Mohamed M Shalaby, Mohamed M Awad, AbdelMotaleb M Effat, Ahmed E Abdella, Sherif Mohamed Shehata
Journal: European J Pediatr Surg Rep (2019)
Keywords: ladd's band, ladd's procedure, laparoscopic exploration, laparoscopic pyloromyotomy, malrotation, postoperatively, vomiting
MeSH terms: Case Reports

A male infant aged 45 days presented with projectile nonbilious vomiting for 2 weeks. Ultrasound showed picture of idiopathic hypertrophic pyloric stenosis. Laparoscopic pyloromyotomy was done, but postoperative vomiting that was mainly nonbilious continued without improvement. After 4 days of persistent vomiting, laparoscopic exploration was done and complete pyloromyotomy was confirmed and malrotation with complete Ladd's band was found, then case converted to open laparotomy and Ladd's procedure was done. Postoperatively, vomiting stopped completely and baby began gradual feeding till reaching full feed. Despite that the presentation of concurrent Idiopathic Hypertrophic Pyloric Stenosis with malrotation is extremely rare; a formal laparoscopic abdominal exploration should be done as the first step before proceeding to pyloromyotomy.
Radiofrequency wire 'power wire' recanalization of calcified chronically occluded inferior vena cava
Authors: Abhijit Salaskar, Michael Ferra, Harish Narayanan, Rishi Sood, Daniel Scher, Albert Chun, Anthony Venbrux, Shawn Sarin
Journal: CVIR Endovasc (2018)
Keywords: ivc, inferior vena cava, inferior vena cava occlusion, inferior vena cava recanalization, power wire, radiofrequency wire

Background:
Radiofrequency (RF) wire recanalization of short segments of central venous obstruction has been considered safe; however its use for recanalization of long segments of inferior vena cava (IVC) has not been reported.
Case presentation:
A 55-year-old female with recurrent massive hematemesis was found to have systemic venous upper esophageal varices on endoscopy and an extensive chronic IVC occlusion on CT. Using both a percutaneous transhepatic and transfemoral approach IVC recanalization was performed. A snare was advanced to the cavo-atrial junction via transhepatic venous access. From the groin utilizing RF wire steerable guide sheaths, endovascular reconstruction of the IVC was performed. Post recanalization venography demonstrated patent stented IVC and marked decrease in the intraabdominal-pelvic collaterals. No recurrence of hematemesis was noted. After 6 months, patient remained asymptomatic and had functioning right femoral arteriovenous hemodialysis graft.
Conclusions:
Using appropriate techniques, Power wire recanalization of long occlusive segments of IVC can be safe and effective.
Male breast cancer originating in an accessory mammary gland in the axilla: a case report
Authors: Jun Yamamura, Norikazu Masuda, Yoshinori Kodama, Hiroyuki Yasojima, Makiko Mizutani, Keiko Kuriyama, Masayuki Mano, Shoji Nakamori, Mitsugu Sekimoto
Journal: Case Rep Med (2012)

Carcinoma of an accessory mammary gland is an extremely rare tumor. A 61-year-old male patient presented with a hard mass measuring 85 mm × 51 mm in the left axilla. Incisional biopsy histopathologically showed an adenocarcinoma compatible with breast carcinoma originating in an accessory mammary gland. Systemic examinations revealed no evidence of malignant or occult primary lesion in the bilateral mammary glands or in other organs. Neoadjuvant chemotherapy was performed for the locally advanced axillary tumor and reduced the tumor to 55 mm in size, and, then, he could undergo complete resection with a negative surgical margin in combination with reconstructive surgery to fill the resulting skin defect with a local flap of the latissimus dorsi muscle. The patient has presented with no metastatic lesion in four years since the operation. This unusual case shows that neoadjuvant chemotherapy is an effective and tolerated therapy for advanced accessory breast cancer in the axilla.
Recurrent Incisional Hernia Repair-An Overview
Authors: Ferdinand Köckerling
Journal: Front Surg (2019)
Keywords: component separation technique, laparoscopic ipom, open ipom, recurrent incisional hernia, sublay
MeSH terms: Review

Introduction: Recurrent incisional hernias with a rate of around 20% account for a relatively large proportion of all incisional hernias. It is difficult to issue any binding recommendations on optimum treatment in view of the relatively few studies available on this topic. This review now aims to collate the data available on recurrent incisional hernia. Material and Methods: A systematic search of the available literature was performed in January 2019 using Medline, PubMed, Scopus, Embase, Springer Link, and the Cochrane Library, as well as a search of relevant journals and reference lists. For the present analysis, 47 publications were identified as relevant. Results: There are mainly case series available on the treatment of recurrent incisional hernia. Eight evaluable case series and two prospective comparative studies report on treatment of between 27 and 85 recurrent hernias. After primary open repair of incisional hernia and defect sizes of < 8-10 cm, the recurrence operation can be performed in laparoscopic technique provided the surgeon has sufficient experience in that procedure. That also applies to multiple recurrences after exclusively open repair. There are no evaluable data on a repeat laparoscopic approach after minimally invasive repair of primary incisional hernia. Such an approach should only be chosen by very experienced laparoscopic surgeons and based on a well-founded indication. Further data are urgently needed on treatment of recurrent incisional hernia. Conclusion: Very little data are available on the treatment of recurrent incisional hernia. Based on the tailored approach concept, a laparoscopic approach undertaken by an experienced laparoscopic surgeon can be recommended for recurrent hernias after primary open repair and for defects of up to 8-10 cm.
Case Report: Functional and Symptomatic Improvement With Cariprazine in Various Psychiatric Patients: A Case Series
Authors: Tommaso Vannucchi, Costanza Taddeucci, Lorenzo Tatini
Journal: Front Psychiatry (2022)
Keywords: antipsychotic, bipolar disorder, cariprazine, cocaine-seeking relapse, drug abuse, partial agonist, schizophrenia
MeSH terms: Case Reports

Cariprazine is a third-generation antipsychotic medication approved for the treatment of schizophrenia and bipolar disorder, with unique pharmacodynamic and pharmacokinetic properties. In this case series, the functional and symptomatic improvement of three patients who had been diagnosed with different psychiatric disorders and who exhibited various symptoms from psychotic to mood symptoms is described. The first case is about a young male patient with bipolar disorder and cocaine abuse who managed to become abstinent from cariprazine. The second and third cases describe patients with psychosis suffering from positive, cognitive and mood symptoms who were non-adherent to previous medication. In both cases, cariprazine was well-tolerated and effective in alleviating symptoms, thus improving their everyday functioning as well. In the discussion, the associations between symptom domains and the receptor profile of cariprazine are also highlighted, providing an explanation of the observed effects. It is concluded that cariprazine is a good treatment option for patients with symptoms of psychosis and addiction; is well-tolerated without the induction of side effects such as weight gain or sedation; and is appropriate for patients who have problems with adherence.
Unusual cause of a painful right testicle in a 16-year-old man: a case report
Authors: Khalid N Shehzad, Amjid A Riaz
Journal: J Med Case Rep (2011)

Introduction:
Urgent surgical exploration of the scrotum of a child or teenager who presents with a painful and swollen testicle is paramount if testicular torsion is not to be missed. It is extremely rare for a non-scrotal pathology to present with acute scrotal signs. Here we present such a rare case and emphasize the importance of being aware of this potential clinical pitfall.
Case presentation:
A 16-year-old Caucasian man presented as a surgical emergency with a five to six hour history of a painful, red, and swollen right hemiscrotum. He also complained of vague lower abdominal pain, vomiting, and watery diarrhea. He had a temperature of 38.5°C and a tender, red, and swollen right hemiscrotum. The right testicle appeared elevated. He was mildly tender in his central and upper abdomen and less so in the lower abdomen. No convincing localizing abdominal signs were noted. He had an increased white cell count (15 × 109/L) and C-reactive protein (CRP; 300 mg/L). Urgent right hemiscrotal exploration revealed about 5 ml of pus in the tunica vaginalis and a normal testicle. A right iliac fossa incision identified the cause: a perforated retrocecal appendix. Appendectomy was performed, and both the abdomen and scrotum washed copiously with saline before closure. The patient made an uneventful recovery.
Conclusion:
Acute appendicitis presenting with scrotal signs due to a patent processus vaginalis is an extremely rare clinical entity. To date, fewer than five such cases have been reported in the medical literature. It is, therefore, extremely important to be aware of this unusual clinical scenario, as only a high index of suspicion will enable prompt, successful management of both the appendicitis and the scrotal abscess.