OpenMed/multicare-articles huggingface dataset:
Case report: A novel perspective on the treatment of primary tracheal small cell carcinoma: a patient's experience with immuno-combined EP therapy and literature review
Authors: Yu Chen, Hongbin Zhu, Danping Wang, Yalan Ye, Jianrong Gao
Journal: Front Immunol (2024)
Keywords: adebrelimab, etoposide-platinum regimen, immune-combined therapy, optimal treatment strategy, tracheal small cell carcinoma
MeSH terms: Carcinoma, Small Cell / drug therapy, Lung Neoplasms / pathology, Small Cell Lung Carcinoma / drug therapy, Review, Case Reports, Antineoplastic Combined Chemotherapy Protocols / therapeutic use, Etoposide / therapeutic use, Humans, Etoposide

Tracheal small cell carcinoma (SCC) is a rare malignancy, for which the optimal treatment strategy has yet to be determined. Currently, treatment largely aligns with the therapeutic guidelines established for small cell lung cancer, although numerous unresolved issues remain. This paper details a case study of a patient with Stage IIIB primary tracheal SCC, who was treated with an immune-combined etoposide-platinum(EP) regimen. This treatment offers valuable insights into innovative approaches for managing such malignancies. Furthermore, the study includes a comprehensive literature review to better contextualize the findings. The patient, admitted on May 2, 2023, had been experiencing persistent symptoms of airway discomfort for 15 days. A bronchoscopy performed on May 4 revealed tracheal SCC, classified as T4N2M0, IIIB. Following the CAPSTONE-1 study's methodology, the patient underwent six cycles of PD-L1(adebrelimab) combined with EP therapy, leading to significant relief of symptoms and the eventual disappearance of the tracheal mass.
Preventing Shift from Pneumocephalus During Deep Brain Stimulation Surgery: Don't Give Up the 'Fork in the Brain'
Authors: Alfonso Enrique Martinez-Nunez, Joshua K Wong, Justin D Hilliard, Kelly D Foote, Michael S Okun
Journal: Tremor Other Hyperkinet Mov (N Y) (2024)
Keywords: deep brain stimulation, brain shift, intra-operative, microelectrode recording, pneumocephalus
MeSH terms: Deep Brain Stimulation / adverse effects, Pneumocephalus / diagnostic imaging, Pneumocephalus / etiology, Pneumocephalus / therapy, Case Reports, Brain / diagnostic imaging, Brain / surgery, Globus Pallidus / diagnostic imaging, Globus Pallidus / surgery, Humans, Movement

Clinical vignette:
We present the case of a patient who developed intra-operative pneumocephalus during left globus pallidus internus deep brain stimulation (DBS) placement for Parkinson's disease (PD). Microelectrode recording (MER) revealed that we were anterior and lateral to the intended target.
Clinical dilemma:
Clinically, we suspected brain shift from pneumocephalus. Removal of the guide-tube for readjustment of the brain target would have resulted in the introduction of movement resulting from brain shift and from displacement from the planned trajectory.
Clinical solution:
We elected to leave the guide-tube cannula in place and to pass the final DBS lead into a channel that was located posterior-medially from the center microelectrode pass.
Gap in knowledge:
Surgical techniques which can be employed to minimize brain shift in the operating room setting are critical for reduction in variation of the final DBS lead placement. Pneumocephalus after dural opening is one potential cause of brain shift. The recognition that the removal of a guide-tube cannula could worsen brain shift creates an opportunity for an intraoperative team to maintain the advantage of the 'fork' in the brain provided by the initial procedure's requirement of guide-tube placement.
Case Report: Supramalleolar osteotomy to preserve joint function and delay the development of Charcot neuroarthropathy of the ankle
Authors: Baozhou Zhang, Wenjing Li, Ying Li, Hui Du, Yong Wu
Journal: Front Surg (2023)
Keywords: charcot arthritis, charcot neuroarthropathy, ankle function, quality of life, supramalleolar osteotomy
MeSH terms: Case Reports

Background:
Charcot neuroarthropathy (CN) is a severe disease that primarily affects the foot and ankle. Conservative treatment with total contact casts is suitable for early stages, but surgery is necessary for complications such as ulceration, malalignment, infection, or severe pain. The ankle instability caused by excessive axial load may require arthrodesis. However, preserving joint function in young patient can significantly enhance the quality of life.
Case report:
A 33-year-old woman underwent open reduction and internal fixation after the right tibia and fibula fractures following a fall while walking. She developed severe pain and deformity in her right ankle after full weightbearing. After further evaluation, she was diagnosed with Charcot neuroarthropathy (CN) of the right ankle. The patient declined arthrodesis and opted for a supramalleolar osteotomy (SMO) instead 18 months after the initial surgery. The SMO procedure involved correcting the hindfoot malalignment through osteotomy and fixation. Although she experienced skin necrosis, the patient eventually achieved satisfactory outcomes with improvements in pain, deformity, and functionality of the ankle. Radiographic measurements showed positive realignment, and the patient reported a significant improvement in her quality of life at the final follow-up.
Conclusions:
The SMO procedure could potentially be considered as an option to preserve ankle function and delay the disease development of CN for young patients. The restored foot stability and hindfoot alignment can help improve patients' quality of life.
Insulinoma Presenting as Seizures: Challenges of Managing a Rare Disease in a Resource-challenged Setting
Authors: David O Soyoye, Segun A Atolani, Tajudin A Adetunji, Olusegun I Alatise
Journal: JCEM Case Rep (2023)
Keywords: hypoglycemia, insulinomas, neuroendocrine tumors, obesity, seizures
MeSH terms: Case Reports

Insulinomas are functioning pancreatic neuroendocrine tumors (NETs). They secrete insulin, and hence, present with hypoglycemia. We report a case of insulinoma in a 16-year-old girl presenting as seizures. She was initially managed at a private clinic and later commenced on carbamazepine when convulsion persisted. Convulsions were generalized, associated with dizziness and altered sensorium, often preceded by hunger and physical exertion, but relieved by the intake of carbonated drinks and fruit juice. She was referred to the neurology clinic when seizures persisted, despite the use of anticonvulsant. She was later referred to the endocrine clinic on suspicion of insulinoma when her random blood glucose (BG) was found to be low during an episode of convulsion. She was moderately obese but other examination findings were normal. She had a 72-hour prolonged fast, which was terminated when hypoglycemia (BG = 2.2 mmol/L) ensued after 12 hours, with elevated serum insulin and C-peptide. Abdominal magnetic resonance imaging scan showed a pancreatic tumor suggestive of insulinoma. She subsequently had distal pancreatectomy performed with complete resolution of symptoms. Unusual presentation of insulinoma may delay diagnosis, resulting in wastage of resources with increased morbidities and mortality.
Reduced Fatigue Symptoms in the Post-COVID Syndrome With Amifampridine: A Collective Casuistry With Double-Blind Discontinuation Trials
Authors: Thomas Boehmeke
Journal: Cureus (2024)
Keywords: amifampridine, bell score, fatigue, post-covid syndrome, sars-cov-2
MeSH terms: Case Reports

After a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, approximately 10-20% of patients are affected by the post-COVID syndrome (PCS). This condition leads to a variety of functional complaints, including symptoms of fatigue. To date, there is still no adequate treatment option. Five patients are presented, including the self-observation of one of the authors, in whom the administration of amifampridine as an "off-label use" led to a normalization of the unphysiologically increased need for sleep with a simultaneous increase in the Bell score. This effect was confirmed in a double-blind discontinuation trial (the medication was discontinued on a trial basis) in two of the patients. The five patients, who were previously unable to lead a normal life due to their fatigue symptoms, were able to return to everyday life after treatment with amifampridine. This offers hope to millions of affected patients.
Persistent, Poorly Responsive Immune Thrombocytopenia Secondary to Asymptomatic COVID-19 Infection in a Child
Authors: Chamila Mettananda, Senani Williams
Journal: Case Rep Infect Dis (2023)
MeSH terms: Case Reports

Immune thrombocytopenic purpura (ITP) secondary to asymptomatic COVID-19 infection, especially in children, is not reported. Furthermore, persistent, treatment-resistant ITP secondary to COVID-19 is not reported. We report a previously healthy 14-year-old Asian boy who developed secondary ITP following an asymptomatic COVID-19 infection and is having a relapsing and remitting cause with poor response to immunosuppressants even after 21 months following the diagnosis. This case emphasizes the importance of testing for COVID-19 in newly diagnosed ITP patients and the need for follow-up platelet counts in patients who recover from COVID-19 as it may follow into developing secondary ITP yet being asymptomatic until you present with a bleeding complication of ITP. The poor response to standard immunosuppression warrants more understanding of the pathophysiology of persistently low platelets following COVID-19 infection. Long-term sequelae of the disease highlight the importance of getting vaccinated for COVID-19 despite COVID-19 being no longer a global emergency.
Spongiform leukoencephalopathy unveiled in an autopsy of a drug abuser
Authors: Hemlata Jangir, Govinda Balmuchu, Jhansi Lakshmi Mylapalli, Arulselvi Subramanian, Sanjeev Lalwani
Journal: Autops Case Rep (2024)
Keywords: forensic toxicology, leukoencephalopathy, progressive multifocal, psychoses, substance-induced
MeSH terms: Case Reports

Toxic leukoencephalopathy (TLE) is a rare neurological debilitating and fatal condition. It has been previously associated with exposure to leukotoxic offenders such as chemotherapy, cranial radiation, certain drugs, and environmental factors. Currently, it is a commoner white matter syndrome resulting from increased substance abuse, classically by inhaled heroin and other opioids. Herein, we report a case of fatal TLE unveiled in an autopsy of a drug abuser. A 24-year-old male was found dead on the roadside. A day before, he was located in a state of delirium. In this case, the autopsy findings and histopathology characteristics of cerebral cortex involvement particularly directed to speculate the heroine as the principal offender.
The enigma of a subluxated globe
Authors: Pratheeba Devi Nivean, T S Mohammed Sayee, Sonam Nisar, Nivean Madhivanan
Journal: GMS Ophthalmol Cases (2024)
Keywords: lateral tarsorrhaphy, medical emergency, shallow orbits, spontaneous globe subluxation
MeSH terms: Case Reports

Spontaneous globe subluxation (SGS) is an uncommon condition wherein the equator of the globe protrudes anteriorly beyond the eyelid aperture causing severe lagophthalmos, proptosis and exposure keratopathy. SGS can lead to an emotional disturbance leading to anxiety and fear, thereby affecting one's quality of life. The patients might often be able to reduce the globe on their own, but permanent measures must be taken to prevent recurrence and vision-threatening sequelae of SGS. We present this case due to its rarity and to highlight the importance of a simple, cost-effective and cosmetically acceptable bilateral tarsorrhaphy in management of SGS.
Two Cases of Splanchnic Nerve Block With Epidural Anesthesia in Patients Unable to Maintain Prone Position Due to Pancreatic Pain
Authors: Shunya Sekiguchi, Yusuke Ishida, Mikiko Tomino, Kiyoshige Ohseto
Journal: Palliat Med Rep (2023)
Keywords: epidural anesthesia, pancreatic cancer, prone position, splanchnic nerve block
MeSH terms: Case Reports

Splanchnic nerve block is considered to be effective for abdominal visceral pain, and is performed for the purpose of controlling abdominal pain and back pain caused by upper abdominal cancer. The patients in this case report were candidates for splanchnic nerve block owing to cancer-associated pain. However, because they could not assume the prone position that is required for the block owing to their pain, combined epidural anesthesia was used, resulting in successful implementation of the splanchnic nerve block. Patients who are candidates for splanchnic nerve block often have advanced cancer, and it is hence often difficult to secure and maintain the position required for the procedure owing to their severe pain. The two patients presented here suggest the possibility that epidural anesthesia might be useful as an adjunct in such cases.
Lung cavitation to pneumothorax: A case report of the multilayered respiratory challenges in oncology patients
Authors: Nathaniel Grabill, Mena Louis, Cindy Idowu, Clifton Hastings, Hardeep Singh
Journal: Int J Surg Case Rep (2024)
Keywords: chemotherapy-induced complications, community-acquired pneumonia, empyema differential, leiomyosarcoma, lung cavitation, multidisciplinary management, pneumothorax, pseudomonas aeruginosa, regorafenib, sepsis, surgical risk management, thoracotomy
MeSH terms: Case Reports

Introduction:
The management of patients with complex oncological histories poses unique challenges, particularly when they are on targeted chemotherapy agents known for specific side effects. This case report illuminates the multifaceted complexities encountered in such scenarios, with a focus on the rare complications associated with targeted therapies.
Case presentation:
We present a 50-year-old male with an extensive oncological background, including childhood retinoblastoma and radiation-induced leiomyosarcoma. Recently diagnosed with skull base osteosarcoma, he was undergoing treatment with Regorafenib. Admitted with sepsis due to Pseudomonas aeruginosa-induced community-acquired pneumonia, his clinical course was complicated by lung cavitation leading to a spontaneous pneumothorax. This report highlights the absence of empyema, a crucial differential in the diagnosis.
Discussion:
This case unravels the intricate interplay between targeted chemotherapy, concurrent medications like prednisone, and their potential to cause severe complications such as pneumonia and pneumothorax. It delves into the mechanisms by which Regorafenib can lead to lung cavitation and abscess formation, a rare but significant risk. The importance of a multidisciplinary approach for prompt diagnosis and treatment, including surgical intervention, is highlighted. The pathology of the surgically resected lobe revealed metastatic high-grade leiomyosarcoma, adding another layer of complexity to the case.
Conclusion:
This case serves as a cautionary tale highlighting the need for vigilant monitoring of patients on targeted chemotherapy agents, especially those with complex medical histories. It highlights the importance of considering potential drug-related complications and the rationale behind therapeutic choices, including antibiotic selection and surgical decision-making, in the management of acute medical conditions in these patients.
Reactive Granulomatous Dermatitis in a Child with Acute Lymphoblastic Leukemia
Authors: Hannah C Tolson, Mariana McCune, Miranda Yousif, David DiCaudo, Elizabeth Dupuy
Journal: Case Rep Dermatol Med (2023)
MeSH terms: Case Reports

Reactive granulomatous dermatitis (RGD) is an umbrella term to describe a reaction pattern characterized by skin-colored to erythematous papules, plaques, and nodules although other morphologies have been described. RGD has rarely been reported in children, and in this report, we present the case of a 3-year-old girl with acute lymphoblastic leukemia (ALL) who presented with firm, tender nodules, and ulcerated plaques on her extremities. Histopathologic examination showed foci of dense granulomatous inflammatory infiltrates composed of histiocytes, neutrophils, and multinucleate giant cells. The constellation of clinical symptoms, negative infectious workup, and histopathology support the diagnosis of RGD.
Multiple dentigerous cysts in a patient showing features of Gorlin-Goltz syndrome: A case report
Authors: Mohammad H Al-Shayyab, Ra'ed Hisham Aldweik, Mohammad Alzyoud, Aya Qteish
Journal: Int J Surg Case Rep (2024)
Keywords: case report, dentigerous cyst, gorlin-goltz syndrome, third molar
MeSH terms: Case Reports

Introduction and importance:
The association between Dentigerous cysts (DCs) and Gorlin-Goltz syndrome (GGS) was claimed theoretically in a very few reports, with very few clinical foundations. The aim of this report was to present a unique case of multiple DCs in the mandible in a patient showing features of GGS.
Case presentation:
A 63-year-old male patient presented with multiple cyst-like lesions in the mandible associated with some clinical and radiological features of GGS, and that raised the suspension of odontogenic keratocyst (OKC). The patient underwent marsupialization and enucleation of these cysts, and the histopathological examination confirmed the diagnosis of DCs.
Clinical discussion:
In this report, the patient presented with symptoms related to multiple unilocular radiolucent lesions found in the mandible and the clinical and radiological features were highly suggestive of OKCs associated with GGS. However, the perioperative findings raised the suspicion of DCs, which was confirmed by histopathology. Interestingly, GGS is an inherited autosomal dominant disorder arising from mutations in the patched tumor suppressor gene (PTCH). Previous studies showed this gene alteration in DCs; this can possibly be implicated in the pathogenesis of the association found in this report.
Conclusion:
This report presented a case of bilateral DC in the mandible in a patient showing features of GGS. Therefore, this report verified the very rare association between DC and GGS. This may help dentists and physicians in reaching an accurate and early diagnosis of GGS.
Angiographic and Clinical Impact of Novel Revascularization for Occluded Femoropopliteal Prosthetic Bypass Graft: A Combination of Surgical Thrombectomy and Drug-Coated Balloon Angioplasty
Authors: Tatsuro Takei, Takashi Kajiya, Keisuke Yamamoto, Junichiro Takaoka, Yoshihiko Atsuchi, Nobuhiko Atsuchi
Journal: Case Rep Vasc Med (2023)
MeSH terms: Case Reports

Background:
Previous reports have revealed various endovascular intervention techniques for prosthetic femoropopliteal bypass occlusion (PFPBO); however, treatment for PFPBO remains challenging for most interventionalists and vascular surgeons because the procedure is complicated. Most of the reported techniques involve device implantation. In the present study, we performed a combination of surgical graft thrombectomy and drug-coated balloon angioplasty for PFPBO without implanting any additional devices. Furthermore, we determined the favorable long-term results of this treatment using follow-up angiography. Case Presentation. A 77-year-old man with a history of chronic kidney disease and coronary artery disease presented to our clinic with rest pain on his left leg. Seven years prior to the current consult, he underwent femoropopliteal bypass (FPB) surgery using a prosthetic graft due to in-stent occlusion of the left superficial femoral artery (SFA). Four years after surgery, a duplex ultrasound scan revealed stenosis of the proximal anastomosis site; hence, medical therapy was continued. On the current consult, diagnostic angiography revealed occlusion of the FPB and infrapopliteal vessels. In the first attempt at recanalization, the guidewire was unable to pass through the occluded SFA. Therefore, another technique was performed to revascularize the FPBO and infrapopliteal vessels. We obtained an angiography of the left leg after inserting the guiding sheath via the right common femoral artery (CFA). First, surgical thrombectomy using a Fogarty catheter via the exposed left CFA was performed. Following endovascular therapy via the right CFA, we performed drug-coated balloon angioplasty for anastomotic stenosis and recanalized occlusive infrapopliteal vessels. Restenosis was not observed on follow-up angiograms. On further follow-up angiography, there was notable regression of the residual stenosis at the proximal anastomosis of the prosthetic graft.
Conclusion:
This novel revascularization strategy may be a viable treatment option for PFPBO.
Esophageal Liposarcoma: A rare tumor
Authors: Ameet Kumar, M Saqib Qamar Ishaqi, Mehak Ali Baig, Rafeah Khan
Journal: Pak J Med Sci (2024)
Keywords: esophageal liposarcoma, lipomatous tumors
MeSH terms: Case Reports

Esophageal liposarcoma is a rare type of tumor. This case report documents the presentation, diagnosis, and management of a 74-year-old male with a medical history including diabetes mellitus, asthma, and hypertension. The patient's primary complaint was dysphagia, accompanied by regurgitation and substantial weight loss over a six-month period. Diagnostic evaluation revealed a sizable esophageal liposarcoma, which was successfully resected through surgery. Follow-up assessments demonstrated the absence of residual mass. Esophageal liposarcomas, though rare, should be considered in patients presenting with dysphagia or chest discomfort. Surgical resection is the mainstay of treatment, with the recommendation for extended postoperative surveillance given the limited available data regarding long-term prognosis.
Acute Leukaemia following Dengue Infection in Nepalese Patients: A Report of Two Cases
Authors: Anushka Agrawal, Pratik Lamichhane, Rituraj Baral, Sabin Thapaliya
Journal: Case Rep Hematol (2024)
MeSH terms: Case Reports

Dengue is a mosquito-borne, acute febrile illness caused by dengue viruses. The association between hematological malignancies and dengue infection is obscure, and the literature on this occurrence is also limited. We report two cases of acute leukaemia following dengue infection in a recent outbreak in Nepal. Our case reports suggest a possible association of acute leukaemia with dengue infection. The relationship should be explored further with observational studies.
Management of Refractory Post-operative Osteomyelitis and Discitis: A Case Report
Authors: Chase A DeLong, Malek Bashti, Long Di, Sumedh S Shah, Emade Jaman, Gregory W Basil
Journal: Cureus (2024)
Keywords: extreme lateral interbody fusion, management, post-operative discitis, post-operative osteomyelitis, refractory discitis, refractory osteomyelitis, xlif
MeSH terms: Case Reports

Vertebral osteomyelitis/discitis is a relatively rare disease but is a known potential complication of spinal surgical intervention. In general, the first-line treatment for this condition is targeted antibiotic therapy with surgical intervention only utilized in refractory cases with evidence of extensive damage, structural instability, or abscess formation. However, surgical best practices have not been established for osteomyelitis, including indications for anterior lateral interbody fusion (ALIF), posterior lateral interbody fusion (PLIF), or direct lateral interbody fusion (DLIF). This case provides a discussion of the indications that led to a direct lateral approach in the setting of refractory osteomyelitis/discitis, supporting factors that led to its success, and the efficacy of utilizing intraoperative neuromonitoring in cases of infection.