OpenMed/multicare-articles huggingface dataset:
Oral Intravascular Papillary Endothelial Hyperplasia Associated with an Organizing Thrombus: Case Report and Immunohistochemical Analysis
Authors: Darcy Fernandes, Daphine Caxias Travassos, Túlio Morandin Ferrisse, Elaine Maria Sgavioli Massucato, Cláudia Maria Navarro, Mirian Aparecida Onofre, Jorge Esquiche León, Andreia Bufalino
Journal: Case Rep Pathol (2016)

Intravascular papillary endothelial hyperplasia (IPEH) is a benign lesion of the skin and mucosa of vascular origin characterized by reactive proliferation of endothelial cells. A 76-year-old woman was referred presenting a painless nodule on the lip. Intraoral examination revealed bluish submucosal nodular proliferation, measuring 10 × 5 × 5 mm, affecting the lower labial mucosa. The lesion had a firm consistency and it was not fixed to the adjacent tissues. The main differential diagnoses were mucocele/mucus retention cyst, sialolith, or salivary gland neoplasia. An incisional biopsy was performed and during the intraoperative procedure an encapsulated red-bluish nodular mass was observed. Microscopic analysis revealed papillary endothelial proliferation in the center of the lesion and fibrin admixed with inflammatory cells in organization peripherally. There was no nuclear atypia, mitotic figures, or necrosis. The endothelial cells were CD34 positive, with low Ki-67 proliferation index (4%). α-SMA highlighted the vessel walls, whereas negativity for D2-40 excluded lymphatic origin. Final diagnosis was IPEH associated with an organizing thrombus. Dentists should be aware about this rare benign vascular lesion, whose final diagnosis is achieved only after histopathology analysis. Surgical removal is the treatment of choice and no recurrence is expected.
Total parenteral nutrition-induced Wernicke's encephalopathy after oncologic gastrointestinal surgery
Authors: Piergiorgio Fedeli, Richard Justin Davies, Roberto Cirocchi, Georgi Popivanov, Paolo Bruzzone, Michela Giustozzi
Journal: Open Med (Wars) (2020)
Keywords: wernicke’s encephalopathy, malpractice, parenteral nutrition
MeSH terms: Case Reports

Carl Wernicke described the disease bearing his name in 1881 and reported three cases characterized by the presence of mental confusion, ataxia, and ophthalmoplegia. Wernicke's disease is mainly observed in alcoholic patients, due to decreased vitamin intake as a consequence of an unbalanced diet, and a reduction of absorption due to the effects of alcohol. Likewise, inadequate vitamin intake is prevalent in older patients. Wernicke's encephalopathy due to inappropriate total parenteral nutrition (TPN) occurs infrequently; recently, there is an increase in the literature concerning Wernicke's encephalopathy in patients after general and bariatric surgeries. We present two cases of Wernicke's encephalopathy after oncologic gastrointestinal surgery by failure to administer vitamin B1 during TPN; to our knowledge, these are the first two cases of Wernicke's encephalopathy after colorectal surgery for cancer. In our opinion, timely diagnosis and treatment are mandatory to avoid nonfunctional recovery and consequent malpractice legal actions as well as an increase in the health-care costs correlated with the prolonged hospital stay and with the nonfunctional recovery.
Class II Correction with Microimplant Supported Molar Distalization: A Report of Two Cases
Authors: Zouhair Skaf, Fidèle Nabbout
Journal: Case Rep Dent (2022)
MeSH terms: Case Reports

Introduction:
Orthodontic treatment of class II malocclusion with conventional treatment modalities can be challenging for the clinician. The use of microimplants to obtain absolute anchorage has become very popular in recent years especially in noncompliant patients. Microimplants are convenient, save time, and produce good treatment results with no need for patient cooperation. A special approach for class II correction with microimplant supported molar distalization has been developed by the authors and is illustrated through two clinical cases. Description. For each clinical case, 0.022" preadjusted brackets were bonded on both arches except on the maxillary first and second premolars with bands on the first and second molars. After leveling and alignment, a 0.017" × 0.025" stainless steel wire was fitted on the upper arch, and two microimplants were placed bilaterally between the maxillary second premolar and the first molar. Open coil springs were inserted in the upper archwire on both sides and compressed via a steel ligature on sliding hooks to the microimplants pushing distally simultaneously the first and second maxillary molars. En-masse retraction of the maxillary anterior teeth was then carried out on a 0.019" × 0.025" stainless steel closing loop archwire while the posterior segment was anchored to the microimplant with a steel ligature to the first premolar.
Results:
Class I canine and molar relationship were achieved, and an ideal occlusion was established. Both ANB and FMA angles decreased by 1° due to the counterclockwise rotation effect of the maxillomandibular complex. Skeletal and dental results remained stable three years later.
Conclusion:
Maxillary molar distalization using coils and buccal microimplants can be regarded as an effective technique in a relatively short time and might be considered a breakthrough in the treatment of class II malocclusions. Microimplants enable the clinician to perform a nonextraction treatment in noncompliant patients who would alternatively be treated only with extractions.
Perforated Meckel's diverticulitis complicating active Crohn's ileitis: a case report
Authors: Frank Schwenter, Pascal Gervaz, Philippe de Saussure, Thomas McKee, Philippe Morel
Journal: J Med Case Rep (2009)

Introduction:
In Crohn's disease, the extension of active terminal ileitis into a Meckel's diverticulum is possible, but usually has no impact on clinical decision-making. We describe an original surgical approach in a young woman presenting with a combination of perforated Meckel's diverticulitis and active Crohn's ileitis.
Case presentation:
We report the case of a 22-year-old woman with Crohn's disease, who was admitted for abdominal pain, fever and diarrhoea. CT scan demonstrated active inflammation of the terminal ileum, as well as a fluid collection in the right iliac fossa, suggesting intestinal perforation. Laparoscopy was performed and revealed, in addition to extensive ileitis, a 3 x 3 cm abscess in connection with perforated Meckel's diverticulitis. It was therefore possible to avoid ileocaecal resection by only performing Meckel's diverticulectomy; pathological examination of the surgical specimen revealed the presence of transmural inflammation with granulomas and perforation of the diverticulum at its extremity.
Conclusion:
Crohn's disease of the ileum may be responsible for Meckel's diverticulitis and cause perforation which, in this case, proved to be a blessing in disguise and spared the patient an extensive small bowel resection.
Bilateral tuberculous psoas abscess
Authors: Mouhcine Miloudi, Lamiae Arsalane, Anas Kharrab, Youssef El Kamouni, Said Zouhair
Journal: Access Microbiol (2020)
Keywords: psoas abscess, spondylodiscitis, tuberculosis
MeSH terms: Case Reports

The unilateral psoas abscess is a rare disease that is often caused by common germs, including Staphylococcus aureus . Tuberculous origin and bilateral involvement are even rarer, especially in developed countries. It may be primary or secondary to a neighbourhood focus. We report a case of bilateral tuberculous abscess of psoas in an immunocompetent patient secondary to spondylodiscitis.
A rare case report of multifocal para-aortic and para-vesical paragangliomas
Authors: San-Chao Xiong, Xing-Peng Di, Meng-Ni Zhang, Kan Wu, Xiang Li
Journal: Front Endocrinol (Lausanne) (2022)
Keywords: mibg, case report, catecholamine, paraganglioma, surgery
MeSH terms: Adrenal Gland Neoplasms, Paraganglioma / diagnostic imaging, Paraganglioma / surgery, Pheochromocytoma, Case Reports, Research Support, Non-U.S. Gov't, 3-Iodobenzylguanidine, Adult, Catecholamines, Humans, Male, Catecholamines, 3-Iodobenzylguanidine

Background:
Paragangliomas (PGLs) are uncommon tumors of uncertain malignant potential. Multifocal paragangliomas are scarcely reported in the literature.
Case summary:
A 25-year-old male patient was reported for the first time with multifocal para-aortic and para-vesical PGLs. The diagnosis was identified by blood catecholamine tests and enhanced CT scan and MIBG scintigraphy. A resection surgery was performed for treatment and the immunochemistry test of the tumors presented the features of PGL.
Conclusion:
A case of multifocal para-aortic and para-vesical PGLs confirmed by the catecholamine test, enhanced CT, and MIBG scintigraphy is presented. The cooperation of experienced surgeons, anesthesiologists, and endocrinologists was critical in treatment.
Unexpected Leiomyosarcoma 4 Years after Laparoscopic Removal of the Uterus Using Morcellation
Authors: J R Prins, M W Van Oven, J M Helder-Woolderink
Journal: Case Rep Obstet Gynecol (2015)

Background. Laparoscopic hysterectomies are increasingly popular; a morcellation device is often used. Although there are some clear benefits, morcellation of tissue does have potential risks. Case Presentation. In this case report we present a 55-year-old woman with an abdominal tumour 4 years after a laparoscopic hysterectomy using a morcellation device. Postoperative histological analysis, compromised by morcellated tissue, showed benign myoma. Because of the benign tumour no follow-up was performed. The patient presented now with an abdominal tumour, and she was scheduled for surgical removal of the tumour. During abdominal surgery the tumour appeared malignant and biopsies were taken. Histological analysis showed leiomyosarcoma, and the patient was referred to a third care centre for further treatment. The patient recovered quickly after abdominal removal of the tumour; however, after 7 months the patient had complaints and a CT scan showed a large intra-abdominal tumour with possible lung metastasis. The patient received palliative chemotherapy and died after 10 months. Conclusion. This case shows that although unexpected after a hysterectomy, a leiomyosarcoma has to be considered in case of a suspect tumour in the lower abdomen.
Teratoma with malignant transformation: a case report with pathological, cytogenetic, and immunohistochemistry analysis
Authors: Jue Wang, Syed A Jaffar Kazmi
Journal: Sarcoma (2011)
MeSH terms: Case Reports

Background. Teratoma with malignant transformation (TMT) is rare and most commonly encountered in adult patient with germ cell tumor (GCT). Method. We report a rare case of testicular teratoma with metastatic TMT/embryonal rhabdomyosarcoma (ERMS). A 44-year-old man underwent right orchiectomy which revealed a malignant teratoma, he subsequently had right pneumonectomy with two pulmonary masses containing a high-grade embryonal rhabdomyosarcoma. The patient developed liver metastasis three months after initial diagnosis. He was treated with a chemotherapy regimen with vincristine, dactinomycin, and cyclophosphamide (VAC) alternating with vincristine and irinotecan (VI) with complete resolution of his liver lesion. The tumors were examined with a battery of cytogenetic, immunohistochemical, and molecular assays. Results. The malignant cells were immunohistochemically positive for desmin, myogenin, and MyoD1. Molecular cytogenetics of embryonal rhabdomyosarcoma tissue revealed the presence of i(12p). The tumor expressed high level of TOPO2A, TOPO1, MRP1, MGMT, BCRP, ERCC1, RRM1, and TS. Conclusion. The activity of topoisomerase inhibitors and the potential usefulness of topoisomerase expression as biomarkers should be further tested in aprospective study.
Ranolazine Induced Bradycardia, Renal Failure, and Hyperkalemia: A BRASH Syndrome Variant
Authors: Syed Arsalan Akhter Zaidi, Danial Shaikh, Muhammad Saad, Timothy J Vittorio
Journal: Case Rep Med (2019)
MeSH terms: Case Reports

Ranolazine is a well-known antianginal drug, that was first licensed for use in the United States in 2006. It was objectively shown to improve exercise capacity and to lengthen the time to symptom onset in patients with coronary artery disease. The most commonly reported side effects of ranolazine include dizziness, headache, constipation, and nausea. Here, we describe a case of bradycardia, hyperkalemia, and acute renal injury in the setting of ranolazine use. Our patient is an 88-year-old female who presented with abdominal pain, nausea, and vomiting. Her medical comorbidities included hypertension, diabetes, CAD, heart failure with preserved ejection fraction, paroxysmal atrial fibrillation, hypothyroidism, and a history of cerebrovascular accident without any residual deficits. Her prescription regimen included amlodipine, furosemide, isosorbide mononitrate, levothyroxine, metformin, omeprazole, and ranolazine. Physical examination was remarkable for bradycardia and decreased breath sounds in the left lower lung field. Laboratory studies were significant for a serum potassium level of 6.8 mEq/L and a serum creatinine level of 1.6 mg/dL. She was given insulin with dextrose, sodium polystyrene, and calcium gluconate in addition to fluids. Her bradycardia and renal function worsened over the next 24 hours. Ranolazine was discontinued. Metabolic derangements were treated appropriately. After 48 hours from presentation, potassium and renal function returned to baseline and her heart rate improved to a range of 60-100 bpm. She was discharged with an outpatient cardiology follow-up. Ranolazine treatment was not continued upon discharge. In summary, our case illustrates an association between ranolazine and renal failure induced hyperkalemia, leading to conduction delays in the myocardium. Though further studies are warranted, we suspect that this is a variant of the recently described BRASH syndrome. We propose that in cases such as ours, along with treatment of the hyperkalemia, medication review and removal of any offending agent should be considered.
Acute intrathoracic gastric volvulus with retrograde gastric intussusception: A case report of a rare surgical emergency with review of the literature
Authors: Giovambattista Caruso, Sebastiano Caramma, Angelo Zappalà, Domenico Zerbo, Giuseppe Evola, Carlo Reina, Giuseppe Angelo Reina
Journal: Int J Surg Case Rep (2020)
Keywords: case report, emergent surgery, gastric volvulus, gastrogastric intussusception, subtotal gastrectomy, upside-down stomach
MeSH terms: Case Reports

Introduction:
The gastric volvulus is a rare condition in which the stomach, or part of it, rotates on its axis, for over 180°, constituting a surgical emergency. Even more rare is gastro-gastric intussusception. A delay in their diagnosis and treatment can have fatal consequences PRESENTATION OF CASE: An 82-year-old woman was admitted to the Surgery Unit with a two-day history of abdominal pain associated at first with coffee vomiting and, subsequently, with unproductive retching and oligoanuria. Physical examination showed severe dehydration, fever, at the abdominal level, palpation caused a marked tenderness of all quadrants, with signs of peritonism. Laboratory test showed showed neutrophilic hyperleukocytosis and high C reactive protein level. Abdominal computed tomography revealed an acute intrathoracic gastric volvulus and a gastrogastric intussuception. The patient was submitted to exploratory laparotomy, subtotal gastrectomy with Roux en Y anastomosis and simple plastic of the esophageal hiatus. At the end of the surgery, however, the patient died of your septic shock.
Discussion:
The traditional treatment for a patient with acute gastric volvulus is an immediate surgical intervention to derotate the stomach and prevent vascular insufficiency. In the presence of necrosis or gastric perforation, resection should be performed. The few cases of gastrogastric intussusception described in the literature have been treated with sub-total gastrectomy and gastro-jejunal anastomosis. Any delay in diagnosis and treatment can prove fatal.
Conclusion:
Intrathoracic Gastric Volvulus and, even more, retrograde gastrointestinal intussusception are very rare pathologies, difficult to diagnose.
Dental aspect of distal tubular renal acidosis with genu valgum secondary to rickets: a case report
Authors: Rakesh N Bahadure, Nilima Thosar, Ritika Kriplani, Sudhindra Baliga, Punit Fulzele
Journal: Case Rep Dent (2012)
MeSH terms: Case Reports

Distal renal tubular acidosis is a disease that occurs when the kidneys do not remove acid properly into the urine, leaving the blood too acidic (called acidosis). Distal renal tubular acidosis (type I RTA) is caused by a defect in the kidney tubes that causes acid to build up in the bloodstream. It ultimately results rickets which include chronic skeletal pain, in skeletal deformities, skeletal fractures. Rickets is among the most frequent childhood diseases in many developing countries. Dental problems in rickets include delayed eruption of permanent teeth, premature fall of deciduous teeth, defects in structure of teeth, enamel defects in permanent teeth (hypoplastic), pulp defects, intraglobular dentine, and caries tooth. Herewith, reported a case of distal tubular renal acidosis with genu valgum secondary to rickets, with pain and extraoral swelling associated with right and left mandibular 1st permanent molars. Teeth were infected with pulp without being involved with caries. Radiographically cracks in enamel and dentin were observed. Pulp revascularization with 46 and root canal treatment was done for 36 with followup of 1 year.
Perinephric Hematoma and Hemorrhagic Shock as a Rare Presentation for an Acutely Obstructive Ureteral Stone with Forniceal Rupture: A Case Report
Authors: Firas G Petros, Debra L Zynger, Geoffrey N Box, Ketul K Shah
Journal: J Endourol Case Rep (2016)
MeSH terms: Case Reports

Background:
Spontaneous perinephric hematoma (SPH) secondary to a forniceal rupture as the first presenting sign for an obstructive ureteral stone in a patient without history of urolithiasis has not been described previously.
Case presentation:
We report a 70-year-old Caucasian male patient who presented to our emergency room with fever, altered mental status, and left flank pain. He had a temperature of 103.3°F, tachycardia, but stable blood pressure. He had left flank tenderness. A computed tomography scan of the abdomen/pelvis with intravenous contrast revealed an intracapsular hematoma (13.3 × 10.0 × 6.4 cm) with an active bleeding and a 1.1 cm left proximal ureteral stone. The patient became quickly hemodynamically unstable and was taken for emergent exploratory laparotomy and left nephrectomy. An active bleeding was encountered secondary to a (2.4 × 2.0 cm) lateral capsular defect in the kidney.
Conclusion:
Hemorrhagic/septic shock as a presenting sign for an obstructive ureteral stone may require an emergent nephrectomy in a hemodynamically unstable patient.
Case Report: Clinical Management of a Patient With Metastatic Non-Small Cell Lung Cancer Newly Receiving Immune Checkpoint Inhibition During Symptomatic COVID-19
Authors: Sibylle C Mellinghoff, Kanika Vanshylla, Christine Dahlke, Marylyn M Addo, Oliver A Cornely, Florian Klein, Thorsten Persigehl, Jan Rybniker, Henning Gruell, Paul J Bröckelmann
Journal: Front Immunol (2021)
Keywords: covid-19, nsclc, sars-cov-2, anti-pd1, immune checkpoint, immunotherapy, pneumonitis
MeSH terms: Adrenal Cortex Hormones / therapeutic use, COVID-19 Drug Treatment, Carcinoma, Non-Small-Cell Lung / drug therapy, Immune Checkpoint Inhibitors / therapeutic use, Lung Neoplasms / drug therapy, SARS-CoV-2 / drug effects, Case Reports, Research Support, Non-U.S. Gov't, Adult, CD8-Positive T-Lymphocytes / drug effects, CD8-Positive T-Lymphocytes / immunology, CD8-Positive T-Lymphocytes / virology, COVID-19 / complications, COVID-19 / immunology, COVID-19 Vaccines / administration & dosage, COVID-19 Vaccines / immunology, Carcinoma, Non-Small-Cell Lung / complications, Carcinoma, Non-Small-Cell Lung / immunology, Humans, Immunity, Humoral / drug effects, Immunity, Humoral / immunology, Lung Neoplasms / complications, Lung Neoplasms / immunology, Male, Neoplasm Metastasis, Pneumonia / immunology, Pneumonia / prevention & control, Pneumonia / virology, SARS-CoV-2 / immunology, Adrenal Cortex Hormones, COVID-19 Vaccines, Immune Checkpoint Inhibitors

Effects of initiation of programmed-death-protein 1 (PD1) blockade during active SARS-CoV-2 infection on antiviral immunity, COVID-19 course, and underlying malignancy are unclear. We report on the management of a male in his early 40s presenting with highly symptomatic metastatic lung cancer and active COVID-19 pneumonia. After treatment initiation with pembrolizumab, carboplatin, and pemetrexed, the respiratory situation initially worsened and high-dose corticosteroids were initiated due to suspected pneumonitis. After improvement and SARS-CoV-2 clearance, anti-cancer treatment was resumed without pembrolizumab. Immunological analyses with comparison to otherwise healthy SARS-CoV-2-infected ambulatory patients revealed a strong humoral immune response with higher levels of SARS-CoV-2-reactive IgG and neutralizing serum activity. Additionally, sustained increase of Tfh as well as activated CD4+ and CD8+ T cells was observed. Sequential CT scans showed regression of tumor lesions and marked improvement of the pulmonary situation, with no signs of pneumonitis after pembrolizumab re-challenge as maintenance. At the latest follow-up, the patient is ambulatory and in ongoing partial remission on pembrolizumab. In conclusion, anti-PD1 initiation during active COVID-19 pneumonia was feasible and cellular and humoral immune responses to SARS-CoV-2 appeared enhanced in our hospitalized patient. However, distinguishing COVID-19-associated changes from anti-PD1-associated immune-related pneumonitis posed a considerable clinical, radiographic, and immunologic challenge.
The Successful Implementation of a Modified Pediatric Acute Lymphoblastic Leukemia Protocol to Treat an Elderly Patient With T-cell Lymphoblastic Leukemia: A Case Report
Authors: Ibraheem H Motabi, Yara A Alsaif, Mohammed K Bin Shuayl, Faisal M Farwana, Abdulaziz T Alhassan, Faisal A Alsaif
Journal: Cureus (2023)
Keywords: acute lymphoblastic leukemia (all), adult t-cell leukemia-lymphoma (atll), children's oncology group, hematological malignancies, t-cell leukemia, treatment of all
MeSH terms: Case Reports

Acute lymphoblastic leukemia (ALL) is a group of hematological malignancies most commonly seen in pediatrics. The disease process localizes in lymphoid organs, the central nervous system, the mediastinum, and bone marrow (BM). The clinical features of T-cell acute lymphoblastic leukemia (T-ALL) in adults include evidence of generalized lymphadenopathy, hepatosplenomegaly, immunosuppression, and hypercalcemia. There is limited research on the efficacy of using modified pediatric treatment regimens in the elderly over the age of 60 with ALL; this case report aims to illustrate the successful treatment of a 67-year-old male patient diagnosed with T-ALL, using a modified Children's Oncology Group (COG) protocol. Through this, it has been shown to be an effective, safe, and efficacious treatment option for our patient.