OpenMed/multicare-articles huggingface dataset:
Case report: Gross persistent rectal prolapse. A case treated without mesh using deep retrorectal dissection/suturing
Authors: Go Miyano, Shunsuke Yamada, Hiroshi Murakami, Geoffrey J Lane, Atsuyuki Yamataka
Journal: Front Pediatr (2022)
Keywords: barium enema, laparoscopy, peritoneal reflection, rectal fixation, rectal prolapse
MeSH terms: Case Reports

A previously well 15-year-old male presented with a history of gross rectal prolapse (GRP) involving full-thickness rectal prolapse of increasing severity and incidence over 6 months that occurred with every bowel motion, varying from 10 to 40 cm. He denied constipation and passed a soft motion once daily, adeptly reducing his prolapsed rectum after each motion. This case illustrates technical challenges and planning for surgical intervention for optimal treatment in keeping with an FDA alert issued April, 2019 banning surgical mesh for pelvic organ prolapse. Preoperative fluoroscopic defecography confirmed rectal prolapse beginning with eversion of the anal verge identified on inspection. For surgery, general anesthesia was induced, he was placed in a Trendelenburg position, and four ports were inserted. The peritoneum was incised and blunt dissection used to expose the levator ani complex (LAC) taking care to prevent lateral nerve injury and preserve regional vascularity. Seven polypropylene sutures were used to fix the seromuscular posterior wall of the rectum to the median raphe of the LAC, the presacral fascia, and the periosteum of the sacral promontory. Operative time was 170 min. Postoperative recovery and progress were unremarkable. Currently, 5 years postoperatively, defecation is regular without recurrence of prolapse. For prolapse involving protrusion of the upper rectum without eversion of the anal verge, rectal fixation to the sacral promontory without further dissection beyond the peritoneal reflection is adequate, but when extensive prolapse is associated with eversion of the anal verge, more extensive blunt dissection from the peritoneal reflection to the LAC with multiple rectopexy sutures is valid for reducing risks for recurrence and eliminating mesh-related complications.
Case report: Treatment of metastatic dedifferentiated chondrosarcoma with pembrolizumab yields sustained complete response
Authors: Amisha Singh, Steven W Thorpe, Morgan Darrow, Janai R Carr-Ascher
Journal: Front Oncol (2022)
Keywords: case report, chondrosarcoma, dedifferentiated chondrosarcoma (ddcs), immunotherapy outcomes, pembrolizumab
MeSH terms: Case Reports

Dedifferentiated chondrosarcomas (DDCS) are aggressive tumors with poor outcomes. Treatment of localized DDCS is primarily surgical, though most patients present with unresectable or metastatic disease. Systemic treatment options for advanced DDCS are limited, and the benefits of chemotherapy in this patient population remain controversial. Among other systemic therapy options, there is emerging clinical evidence to support the use of immunotherapy in patients with advanced DDCS. However, studies regarding the efficacy of immunotherapy in advanced DDCS are limited. Here, we present the case of a patient with metastatic, programmed death-ligand 1 (PD-L1)-positive DDCS treated with pembrolizumab who showed a sustained complete response for 24 months after initiation of therapy. To our knowledge, this case represents one of few documented cases of metastatic chondrosarcoma with sustained response to immunotherapy. The impressive response seen with PD-L1 inhibition in our patient indicates that immunotherapy is a successful treatment option in a subset of DDCS patients, and further investigation is needed to identify potential responders to immunotherapy.
Treatment of ectopic mandibular second permanent molar with elastic separators
Authors: R Rajesh, V Naveen, S Amit, Kusai Baroudi, C Sampath Reddy, Srinivas Namineni
Journal: Case Rep Dent (2014)

Ectopic eruption is a developmental disturbance in which the tooth fails to follow its normal eruption pathway. Ectopic eruption of the second molar is relatively rare. This paper presents the case of thirteen-year-old male with an ectopic mandibular second permanent molar. The condition was corrected with surgical exposure and placement of elastic separators. This case report lays emphasis on the practice of basic methods to obtain acceptable results rather than extensive surgical or orthodontic corrections. It is advised that ectopic teeth should not be neglected especially when it concerns developing caries and malocclusion.
Intestinal obstruction due to small intestinal metastasis from primary Merkel cell carcinoma of the gluteal region
Authors: Juan Francisco Olivos-Gonzales, Elily Apumayta-Requena, Andrés Guevara-Jabiles, Mercedes Bravo-Taxa
Journal: Ecancermedicalscience (2022)
Keywords: merkel cells, carcinoma, intestinal obstruction, neoplasm, neoplasm recurrence, neoplastic metastasis
MeSH terms: Case Reports

Merkel cell carcinoma (MCC) is a rare neoplasm of unknown multifactorial origin first described in 1972. It occurs most often in older Caucasian males and is typically associated with sun-exposed areas of skin. However, cases have also been reported in other areas, such as the trunk and the gluteal region. Metastatic disease will occur in up to one-third of cases at onset or during the course of the disease, including metastases to the abdominal organs. We present the case of a 53-year-old male with a history of primary MCC of the right buttock and local resection surgery. Eighteen months later, he presented with a small bowel obstruction and had an emergency segmental bowel resection. Pathology examination with immunohistochemistry concluded that findings were consistent with metastatic MCC.
Aspirated Almond Masquerading as an Obstructing Endobronchial Mass Suspicious for Lung Cancer
Authors: Sreeja Biswas Roy, Mitchell D Ross, Nikhil Madan, Hesham Abdelrazek, Rebekah Edwards, Earle S Collum, Ross M Bremner, Vipul J Patel, Tanmay S Panchabhai
Journal: Case Rep Pulmonol (2018)
MeSH terms: Case Reports

Foreign body aspiration is relatively rare in adults compared to children. In adults with delayed presentation, a history of choking is often absent, resulting in delayed diagnosis and significant morbidity. Common presenting features in adults include nonresolving cough with or without fever, hemoptysis, or wheezing and may mimic infectious, inflammatory, or neoplastic disorders. We present a case of a 64-year-old man with 80-pack-year smoking history who had a nonresolving left lower lobe infiltrate on chest radiograph after treatment for community-acquired pneumonia. His insidious-onset symptoms included cough, decreased exercise tolerance, and localized wheezing. Computed tomography of the chest showed a left lower lobe consolidation, with narrowing of the bronchus. Flexible bronchoscopy revealed a fleshy endobronchial mass, prompting endobronchial needle aspiration and biopsies, all of which revealed acute inflammation on rapid onsite evaluation. After multiple biopsies, a white pearly object with a detached brown cover was revealed; the object was found to be an aspirated almond. The almond and its peel were retrieved. The patient acknowledged that he had frequently eaten almonds in the supine position while recovering from a previous injury. His symptoms completely resolved at 3-month follow up, and he has ceased smoking and no longer consumes food while supine.
Langerhans Cell Histiocytosis Manifests with Acute Severe Hypernatremia during Hospitalization
Authors: Kullaya Takkavatakarn, Hansamon Poparn, Pisut Katavetin
Journal: Case Rep Nephrol (2022)
MeSH terms: Case Reports

Central diabetes insipidus (DI) is characterized by a deficiency in arginine vasopressin (AVP), an antidiuretic hormone leading to excessive free water loss in the urine and hypernatremia. Central DI can be the first presentation of several occult diseases. However, patients with central DI who have functioning thirst mechanisms and access to water may initially exhibit normal sodium levels. We report a 57-year-old woman who was admitted to the hospital due to cholangitis. Her initial serum sodium was normal and she rapidly developed severe hypernatremia after fluid restriction. The results of the laboratory workup indicated DI, which dramatically responded to desmopressin. MRI showed an ill-defined faint hyper signal intensity in T1, T2/FLAIR lesions involving the bilateral hypothalamus. The histopathological findings confirmed the diagnosis of Langerhans cell histiocytosis (LCH) with multiorgan involvement. Serum sodium returned to normal after receiving desmopressin and water replacement therapy.
A case with mega cisterna magna renal and ear anomalies: is this a new syndrome?
Authors: Capan Konca, Bahar Caliskan, Mehmet Ali Tas
Journal: Case Rep Med (2013)

Background. Extrarenal pathologies may be associated with renal position and fusion anomalies. According to the literature, our patient is the first horseshoe kidney case that had mega cisterna magna, arachnodactyly, and mild mental retardation. Case Report. A 9-year-old boy admitted because of the myoclonic jerks. He had a dysmorphic face, low-set and cup-shaped ears, arachnodactyly, and mild mental retardation. The patient's laboratory findings were normal except for a mild leucocytosis and hypochromic microcytic anemia. His cerebrospinal fluid was cytologically and biochemically normal. Cranial MRI revealed 1.5 cm diametered mega cisterna magna in the retrocerebellar region. Although there were no significant epileptical discharges in the electroencephalography, there were slow wave discharges arising from the anterior regions of both hemispheres. Because he had stomachache, abdominal ultrasonography was performed, and horseshoe kidney was determined. Abdominal CT did not reveal any abnormalities except the horseshoe kidney. There were not any cardiac pathologies in echocardiography. He had normal 46XY karyotype and there were no repeated chromosomal derangements, but we could not evaluate for molecular and submicroscopic somatic changes. He was treated with valproic acid and myoclonic jerks did not repeat. Conclusion. We suggest that the presence of these novel findings may represent a newly recognized, separate syndrome.
Metastatic prostate cancer masquerading clinically and radiologically as a primary caecal carcinoma
Authors: Muhammad A Kabeer, Edward Lloyd-Davies, Giles Maskell, Rolf Hohle, Joseph Mathew
Journal: World J Surg Oncol (2007)
MeSH terms: Adenocarcinoma / secondary, Cecal Neoplasms / secondary, Cecal Neoplasms / therapy, Prostatic Neoplasms / pathology, Case Reports, Adenocarcinoma / complications, Adenocarcinoma / diagnosis, Adenocarcinoma / therapy, Aged, Biopsy, Needle, Cecal Neoplasms / complications, Cecal Neoplasms / diagnosis, Chemotherapy, Adjuvant, Colectomy / methods, Diagnosis, Differential, Follow-Up Studies, Gastrointestinal Hemorrhage / diagnosis, Gastrointestinal Hemorrhage / etiology, Humans, Immunohistochemistry, Male, Neoplasm Staging, Prostatectomy / methods, Prostatic Neoplasms / complications, Prostatic Neoplasms / diagnosis, Prostatic Neoplasms / therapy, Rectum, Risk Assessment, Tomography, X-Ray Computed, Treatment Outcome

Background:
Prostatic carcinoma is the second most common cause of cancer-related deaths in males in the West. Approximately 20% of patients present with metastatic disease. We describe the case of a patient with metastatic prostate cancer to the bowel presenting clinically and radiologically as a primary caecal cancer.
Case presentation:
A 72 year-old man presented with abdominal discomfort and a clinically palpable caecal mass and a firm nodule on his thigh, the latter behaving clinically and radiologically as a lipoma. Computed tomographic (CT) scan showed a luminally protuberant caecal mass with regional nodal involvement. The patient was being treated (Zoladex) for prostatic cancer diagnosed 6 years previously and was known to have bony metastases. On admission his PSA was 245.4 nmol/ml. The patient underwent a right hemicolectomy. Histology showed a poorly differentiated adenocarcinoma which was PSA positive, confirming metastatic prostatic adenocarcinoma to the caecum. The patient underwent adjuvant chemotherapy and is free from recurrence a year later.
Conclusion:
Metastasis of prostatic carcinoma to the bowel is a very rare occurrence and presents a challenging diagnosis. The diagnosis is supported by immunohistochemistry for PSA. The treatment for metastatic prostate cancer is mainly palliative.
Secondary HLH Case Report Highlighting Clinical Challenges
Authors: Riad El Fakih, Said Y Mohamed, Randa Alnounou, Ghada Elgohary
Journal: Case Rep Hematol (2018)
MeSH terms: Case Reports

A 19-year-old patient with relapsed acute myeloid leukemia (AML) developed severe and prolonged cytopenia and unexplained jaundice and fever after salvage chemotherapy. His workup revealed hemophagocytosis on the bone marrow biopsy. He was treated for HLH (hemophagocytic lymphohistiocytosis) secondary to AML and chemotherapy. The patient died on day 56 after starting his salvage chemotherapy. Unexpectedly, after his death, the microbiology laboratory reported positive mycobacterial growth from a bronchoalveolar lavage (BAL) sample taken during the workup of his fever. This case illustrates the difficulties in the diagnostic workup of HLH to identify triggers in a timely manner so that a targeted and specific therapy can be administered quickly, given the rapid and deadly evolution of the HLH process.
Placenta Accreta in a Woman with Childhood Uterine Irradiation: A Case Report and Literature Review
Authors: Nanayo Sasagasako, Hirohiko Tani, Yoshitsugu Chigusa, Shingo Io, Haruta Mogami, Junzo Hamanishi, Akihito Horie, Eiji Kondoh, Yukiyasu Sato, Masaki Mandai
Journal: Case Rep Obstet Gynecol (2019)
MeSH terms: Case Reports

The pregnancies of childhood cancer survivors who have received uterine irradiation are associated with a high risk of several obstetrical complications, including placenta accreta. The present case was a 26-year-old pregnant woman with a history of myelodysplastic syndrome treated with umbilical cord blood transplantation following chemotherapy and total body irradiation at the age of 10. Despite every possible measure to prevent preterm labor, uterine contractions became uncontrollable and a female infant weighing 892 g was vaginally delivered at 27+4 weeks of gestation. Under the postpartum ultrasonographic diagnosis of placenta accreta, we selected to leave the placenta in situ. Although emergency bilateral uterine artery embolization was required, complete resorption of the residual placenta was accomplished on the 115th day postpartum. Our experience highlighted the following points. (1) The expectant management of placenta accreta arising in an irradiated uterus may not only fulfill fertility preservation, but may also reduce possible risks associated with cesarean hysterectomy. (2) Due to extreme thinning of and a poor blood supply to the myometrium, reaching an antepartum diagnosis of placenta accreta in an irradiated uterus is difficult. (3) The recurrence of placenta accreta in subsequent pregnancies needs to be considered after successful preservation of the uterus.
Mycophenolic acid area under the curve recovery time following rifampicin withdrawal
Authors: V M Annapandian, D H Fleming, B S Mathew, G T John
Journal: Indian J Nephrol (2010)
Keywords: mycophenolate, interaction, renal transplantation, rifampicin
MeSH terms: Case Reports

Renal transplant patients prescribed mycophenolate mofetil (MMF) may require treatment for tuberculosis with a regimen including the tuberculocidal drug rifampicin. MMF is an ester prodrug which is rapidly hydrolysed to the active compound, mycophenolic acid (MPA). Therapeutic drug monitoring of mycophenolate involves the measurement of MPA area under the curve (MPA-AUC(0-12)). Rifampicin is known to increase the metabolism and decrease enterohepatic recirculation of mycophenolic acid, (MPA). When MPA is monitored after the discontinuation of rifampicin, an important factor is the time required for the MPA area under the curve to return to the pre-rifampicin value. At present this is not known. This report describes one such renal allograft patient, on long term MMF and prescribed rifampicin by a local physician. As expected there was a clinically significant decrease in MPA-AUC(0-12) Three weeks after rifampicin was discontinued the MPA-AUC(0-12) was still only 65% of the pre-rifampicin value and only 55% of the steady state MPA-AUC(0-12) measured six months later.
Durable Complete Response to Alectinib in a Lung Adenocarcinoma Patient With Brain Metastases and Low-Abundance EML4-ALK Variant in Liquid Biopsy: A Case Report
Authors: Yingying Zhu, Ran Jia, Yang W Shao, Liuqing Zhu, Qiuxiang Ou, Man Yu, Xue Wu, Yanbei Zhang
Journal: Front Oncol (2020)
Keywords: alk rearrangement, alectinib, brain metastases, liquid biopsy, lung adenocarcinoma
MeSH terms: Case Reports

EML4-ALK fusions are targetable oncogenic drivers in a subset of advanced non-small cell lung cancer (NSCLC) patients that can benefit from selected ALK inhibitors. Precise detection of ALK fusions may yield critical information for selection of appropriate therapy and hence improve patient survival. Analysis of circulating tumor DNA (ctDNA) in liquid biopsies using next generation sequencing (NGS) prior to or during treatment hold great promise for disease monitoring and treatment guidance of various cancers including NSCLC. Herein, we report a case of a 21-year-old advanced lung adenocarcinoma patient with a low abundance (0.03%) of EML4-ALK rearrangement identified in plasma ctDNA upon progression on two lines of chemotherapy that demonstrated long-term complete response to alectinib (>13 months) including metastatic brain tumors. Patient's clinical and pathologic characteristics, computerized tomography (CT) scans and brain magnetic resonance imaging (MRI) were reviewed retrospectively. Taken together, our report not only reinforces the translational utility of NGS-based genomic sequencing of liquid biopsy in guiding clinical practice, but also highlights the superior efficacy of alectinib than chemotherapy in ALK+ NSCLC with brain metastases, albeit at a low variant allele abundance.
Use of Purastat, a novel haemostatic matrix based on self-assembling peptides in the prevention of nasopharyngeal adhesion formation
Authors: Eugene Wong, Joyce Ho, Murray Smith, Niranjan Sritharan, Faruque Riffat, Mark C Smith
Journal: Int J Surg Case Rep (2020)
Keywords: adhesion, haemostasis, nasopharyngeal stenosis, purastat
MeSH terms: Case Reports

Introduction:
Purastat is a novel haemostatic agent that has recently been used effectively in nasal procedures, specifically in functional endoscopic endonasal surgery in the prevention of post-operative epistaxis while minimising adhesion formation. This study presents a case of successful application of Purastat following division of a nasopharyngeal/palatal stenosis following radiotherapy.
Presentation of case:
A 49-year-old male developed severe nasopharyngeal stenosis following concurrent chemoradiotherapy with curative intent a HPV positive base of tongue squamous cell carcinoma. Following treatment, while the patient experienced excellent metabolic response, he began to progressive nasal obstruction which he reported to be significantly affecting his quality of life. Following multidisciplinary team discussion, division of the stenosis was considered appropriate. Under general anaesthesia, the patient was positioned lying supine with the neck extended. A Boyle-Davis gag with lip and teeth protection was placed and a Y-suction catheter inserted to lift the palate from the posterior pharyngeal wall. Coblation using a PDW wand was used to divide the area of fibrosis bilaterally toward the superior tonsillar pillar until palatopharyngeus musculature was visible. Injection of 4 mg of Dexamethasone with a hypodermic needle was then performed followed by application of 4 ml of topical Purastat onto the raw surfaces after haemostasis was confirmed. The patient was discharged the same day on simple analgesia and instructions to avoid exertion for two weeks. He attended follow-up in the outpatient department two months later and reported persisting resolution of his nasal obstructive symptoms. No evidence of recurrence or residual adhesion tissue was noted.
Case Report: Use of reinforced buccal mucosa graft over gracilis muscle flap in management of post high intensity focused ultrasound (HIFU) rectourethral fistula
Authors: Shrikant Jai, Arvind Ganpule, Abhishek Singh, Mohankumar Vijaykumar, Vinod Bopaiah, Ravindra Sabnis, Mahesh Desai
Journal: F1000Res (2016)
Keywords: buccal mucosa graft, carcinoma prostate, complicated fistula, fistula, gracilis muslce flap, hifu, urethro–rectal fistula

High intensity focused ultrasound (HIFU) has come forward as alternative treatment for carcinoma of the prostate. Though minimally invasive,HIFUhas potential side effects. Urethrorectal fistula is one such rare side effect. Management of these fistulas has been described by Vanni et al. This case report describes points of technique that will help successful management of resilient rectourethral fistula. Urinary and faecal diversion in the form of suprapubic catheter and colostomy is vital. Adequate time between stoma formation, fistula closure and then finally stoma closure is needed. Lithotomy position and perineal approach gives best exposure to the fistula. The rectum should be dissected 2cm above the fistula; this aids in tension free closure of the rectal defect. Similarly buccal mucosal graft was used on the urethra to achieve tension free closure. A good vascular pedicle gracilis muscle flap is used to interpose between the two repairs. This not only provides a physical barrier but also provides a vascular bed for BMG uptake. Perfect haemostasis is essential, as any collection may become a site of infection thus compromising results. We strongly recommend rectourethral fistula be directly repaired with gracilis muscle flap with reinforced buccal mucosa graft without attempting any less invasive repairs because the "first chance is the best chance".
Extrapulmonary Sarcoidosis With Multi-Organ Involvement Presenting Primarily as Hypercalcemia
Authors: Inna Mikaella P Sta Maria, Julia Tullio, Vasudevan Mahalingam, Jamal Abukhaled, Vamshi Garlapaty
Journal: Cureus (2023)
Keywords: cutaneous sarcoidosis, extra pulmonary manifestations of sarcoidosis, hypercalcemia, multiorgan sarcoidosis, sarcoidosis
MeSH terms: Case Reports

Sarcoidosis is a highly variable disease. The majority of cases affect the lungs, but they can involve other organs as well. Extrapulmonary sarcoidosis is rare, and it can present in many ways. Therefore, the diagnosis can be challenging. We hereby present a case of a patient presenting with hypercalcemia and diagnosed with extrapulmonary sarcoidosis with multi-organ involvement. This article was previously presented as a meeting abstract at the MI-ACP 2022 Annual Scientific Meeting on October 14, 2022.
Rapid Acetabular Chondrolysis following Hemiarthroplasty of the Hip: A Poor Prognostic Sign
Authors: Abidemi Adenikinju, James D Slover, Kenneth A Egol
Journal: Case Rep Orthop (2019)
MeSH terms: Case Reports

Both hemiarthroplasty and total hip arthroplasty have been well described as effective methods of management for displaced femoral neck fractures in the elderly. Acetabular erosion is a common long-term complication of hemiarthroplasty. We present a case in which rapid acetabular erosion occurs within weeks of hemiarthroplasty, ultimately leading to an acetabular fracture and need for revision to total hip arthroplasty. Early and rapid acetabular erosion following hip hemiarthroplasty has not been well documented in current literature. It may lead to acetabular fracture and may be secondary to infectious causes. If encountered, an infection workup should be initiated.