OpenMed/multicare-articles huggingface dataset:
Orthodontic Management of a Rare Incidence Bilateral Maxillary Canine-First Premolar Transposition Using Fixed Appliance
Authors: Samer Mereani, Amjad Alotaibi, Ahmed Bokhari
Journal: Case Rep Dent (2022)
MeSH terms: Case Reports

Objective:
A change in the location of two permanent teeth within the same quadrant of the dental arch is known as tooth transposition. This article illustrates the nonextraction treatment of a bilaterally complete transposition between maxillary canines and first premolars, using fixed mechanics. Material and Method. Upper and lower preadjusted, edgewise, fixed appliances with MBT prescription (0.022″ × 0.028″ slot size brackets) were used for the treatment. After providing room for the canine teeth, the piggyback technique was used to bring the right canine to the arch in the position of the first premolar. In the final phase of treatment, both the upper and lower arches had 0.019 × 0.025 stainless steel wire with Class II elastic 4 oz on the right and left sides.
Result:
It showed that the maxillary first premolars and canines were favorably aligned into transposed position. The upper right and left premolars occluded with the lower canines in Class I relationship and good intercuspation as well as skeletal and molar Class I relationships were maintained with a pleasant facial profile.
Conclusion:
The early diagnosis plays a significant role as much as considering esthetics and function factors in deciding which treatment strategy should be followed. The key to a successful and stable result is substantial treatment planning and careful orthodontic management.
Rechallenge of denosumab in advanced giant cell tumor of the bone after atypical femur fracture: A case report and review of literature
Authors: Vincenzo Nasca, Anna Maria Frezza, Carlo Morosi, Ciriaco Buonomenna, Antonina Parafioriti, Giorgio Zappalà, Federica Bini, Paolo Giovanni Casali, Mattia Loppini, Silvia Stacchiotti
Journal: Front Oncol (2022)
Keywords: atypical femur fracture, bone tumor, denosumab, giant cell tumor of bone, sarcoma
MeSH terms: Case Reports

Giant cell tumor of the bone (GCTB) is a locally aggressive neoplasm where surgery is often curative. However, it can rarely give rise to distant metastases. Currently, the only available active therapeutic option for unresectable GCTB is denosumab, an anti-RANKL monoclonal antibody that dampens the aggressive osteolysis typically seen in this disease. For advanced/metastatic GCTB, denosumab should be continued lifelong, and although it is usually well tolerated, important questions may arise about the long-term safety of this drug. In fact, uncommon but severe toxicities can occur and eventually lead to denosumab discontinuation, such as atypical fracture of the femur (AFF). The optimal management of treatment-related AFF is a matter of debate, and to date, it is unknown whether reintroduction of denosumab at disease progression is a clinically feasible option, as no reports have been provided so far. Hereinafter, we present a case of a patient with metastatic GCTB who suffered from AFF after several years of denosumab; we describe the clinical features, orthopedic treatment, and oncological outcomes, finally providing the first evidence that denosumab rechallenge after AFF occurrence may be a safe and viable option at GCTB progression.
Neuroblastoma of the elderly, an oncologist's nightmare: case presentation, literature review and SEER database analysis
Authors: Elisa Rogowitz, Hani M Babiker, Mohammed Kanaan, Rebecca A Millius, Q Scott Ringenberg, Maria Bishop
Journal: Exp Hematol Oncol (2014)
Keywords: adult, neuroblastoma, siadh, thymus
MeSH terms: Case Reports

Neuroblastoma is considered a pediatric malignancy as over 95% of cases are diagnosed in patients ≤10 years old. This cancer is extremely rare in elderly patients. We conducted a Surveillance, Epidemiology, and End Results (SEER) database analysis in the USA between 1973-2007 that revealed only 35 elderly patients (>60 years of age) with neuroblastoma of whom only 2 patients had primary mediastinal neuroblastoma. There is a paucity of treatment and survival outcomes data for the elderly owing to the rarity of neuroblastoma in this population. Currently there are no standard guidelines or protocols for treatment of adult neuroblastoma. We report a rare and challenging case of an 86-year old patient presenting with mediastinal neuroblastoma and syndrome of inappropriate antidiuretic hormone secretion (SIADH) successfully treated with resection. Herein, we also provide a review of the literature and updated survival data on neuroblastoma based on results of our SEER database review.
Impressive Performance: New Disposable Digital Ureteroscope Allows for Extreme Lower Pole Access and Use of 365 μm Holmium Laser Fiber
Authors: Raymond J Leveillee, Emily Fell Kelly
Journal: J Endourol Case Rep (2016)
MeSH terms: Case Reports

Background:
Since the development of the first flexible ureteroscope, in 1964, technological advances in image quality, flexibility, and deflection have led to the development of the first single-use digital flexible ureteroscope, LithoVue™ (Boston Scientific, Marlborough, MA). With respect to reusable fiber-optic and now digital ureteroscopes, there is an initial capital cost of several thousand dollars (USD) as well as, controversy regarding durability, the cost of repairs and the burdensome reprocessing steps of ureteroscopy. The single-use LithoVue eliminates the need for costly repairs, the occurrence of unpredictable performance, and procedural delays. Renal stones located in the lower pole of the kidney can be extremely challenging as extreme deflections of greater than 160° are difficult to maintain and are often further compromised when using stone treatment tools, such as laser fibers and baskets. This case describes an initial use of the LithoVue digital disposable ureteroscope in the effective treatment of lower pole calculi using a 365 μm holmium laser fiber.
Case report:
A 35-year-old female, with a medical history significant for chronic bacteriuria, and recurrent symptomatic culture proven urinary tract infections, underwent localization studies. Retrograde ureteropyelography demonstrated two calcifications adjoining, measuring a total of 1.4 cm, overlying the left renal shadow. Urine aspirated yielded clinically significant, >100,000, Escherichia coli and Streptococcus anginosus bacteriuria, which was felt to be originating from the left lower calix. This case used the newly FDA-approved LithoVue flexible disposable ureteroscope. The two stones were seen using the ureteroscope passed through an ureteral access sheath in the lower pole calix. A 365 μm holmium laser fiber was inserted into the ureteroscope and advanced toward the stones. There was no loss of deflection as the ureteroscope performed reproducibly. The laser was used for more than 4000 pulses at 15 W, producing mucoid debris and fragments. A 1.9F nitinol basket was, then, used to extract the fragments, and the patient was rendered stone free. Treatment success was confirmed by plain abdominal film obtained 1 week after stent removal.
Conclusion:
The LithoVue system single-use digital flexible ureteroscope provides an economical advantage over both reusable digital and fiber-optic ureteroscopes. The LithoVue system uses the enhanced image resolution of the digital complementary metal oxide semiconductor imager, similar to other reusable digital ureteroscopes, while maintaining the small ureteroscope size of a flexible fiber-optic ureteroscope, allowing for consistent and effective lower pole access. Deflection characteristics are maintained even when thicker laser fibers are passed through the working channel.
Case report: Application of metagenomic next-generation sequencing in the diagnosis of visceral leishmaniasis and its treatment evaluation
Authors: Qiuping Liang, Xiaogong Liang, Dengwei Hong, Yuan Fang, Lanlan Tang, Jiao Mu, Xiaoli Tan, Feng Chen
Journal: Front Med (Lausanne) (2023)
Keywords: leishmania, case, mngs, treatment efficacy, visceral leishmaniasis
MeSH terms: Case Reports

Visceral leishmaniasis is a vector-borne infection by the Leishmania spp., a parasite. Although the overall incidence of visceral leishmaniasis is low, the disease still occurs frequently in some high-risk areas. In our study, two patients were admitted to the hospital with an unprovoked and recurrent high fever, and the condition was not improved after antibiotics administration. Meanwhile, bone marrow aspiration smears failed to find out any pathogen. Finally, Leishmania-specific nucleic acid sequences were successfully detected in the peripheral blood of two patients through metagenomic next-generation sequencing (mNGS), which was further confirmed by bone marrow smear microscopy and antibody tests. After targeted treatment for visceral leishmaniasis in the patients, mNGS reported a decrease in the reads number of Leishmania sequence. The results indicate the feasibility of mNGS in detecting Leishmania spp. in peripheral blood samples. Its therapeutic effect evaluation may be achieved through a comparative analysis of the number of reads before and after the treatment.
Case Report: Prostate Adenocarcinoma With Mucinous Features of Normal-Level Serum PSA, Atypical Imaging, Biopsy-Negative, and Peculiar Urethrocystoscopic Manifestation
Authors: Yao Zhang, Hua Shen, Kai Liao, Weili Wu, Jiuming Li, Hongbo Yu, Hongfei Wu, Zengjun Wang
Journal: Front Oncol (2020)
Keywords: mri, psa, mucinous adenocarcinoma, needle biopsy, prostate cancer, transurethral resection of the prostate, urethrocystoscopic manifestation
MeSH terms: Case Reports

Background:
Mucinous tumors of the prostate are seen as rare morphological variants of prostate carcinoma. Misdiagnosis and missed diagnosis are frequent clinically, especially when the clinical performance appears atypical. Furthermore, there has not been reported about the urethrocystoscopic performance of mucinous adenocarcinoma growing into the prostatic urethra so far.
Case presentation:
The current case report describes a 48-year old Asian male who was hospitalized because of intermittent gross hematuria for more than two months. The patient was diagnosed as prostatic space occupying lesions and an examination of needle biopsy was conducted on him, which did not indicate a definite malignancy. Transurethral plasma kinetic resection of the prostate (TUPKP) was performed for the patient, but the postoperative pathology revealed prostatic adenocarcinoma with mucinous features. Specifically, two cord-like neoplasms, extending to the bladder neck, were found through urethrocystoscopy in the prostatic urethra, both of which grew pedicles. The pedicles were situated on the right side of the parenchyma of the prostate. Finally, the patient underwent radical prostatectomy three weeks later.
Conclusion:
Here, we reported a case that prostatic adenocarcinoma with mucinous features was diagnosed after TUPKP. The patient had normal serum prostate-specific antigen levels with atypical images and negative biopsy result. This report lays stress on the vigilance of clinicians in prostate mucinous adenocarcinoma and makes a description of its peculiar urethrocystoscopic manifestation, typical imaging, and unique growth pattern for the first time.
Diagnostic Challenges of Pneumocystis Pneumonia during the COVID-19 Pandemic: A Case of a Young Patient with Ground Glass Opacities and Pulmonary Embolism on Chest CT
Authors: William Lim, Maham Suhail, Keith Diaz
Journal: Case Rep Infect Dis (2021)
MeSH terms: Case Reports

The coronavirus disease 2019 (COVID-19) pandemic is wreaking havoc across the globe. This pandemic has given rise to a mindset where physicians tend to neglect other causes of pneumonia, especially if the patient presents with signs and symptoms commonly associated with COVID-19. Herein, we report a case of a young man presenting to the emergency department with common clinical, radiological, and laboratory features of COVID-19 pneumonia such as shortness of breath, hypoxia, pulmonary embolism, elevated D-dimer, and bilateral ground glass opacities on computed tomography of the chest but was later diagnosed with Pneumocystis pneumonia that was treated with appropriate antibiotics and corticosteroids. This case highlights the importance of performing a thorough clinical history and differentiating the clinical and radiological features of COVID-19 pneumonia from pneumonia of other etiologies.
Flow cytometry as a diagnostic tool in the early diagnosis of aggressive lymphomas mimicking life-threatening infection
Authors: Nikolaos J Tsagarakis, Nektaria A Kentrou, Georgios Kakiopoulos, Georgios Androutsos, Athanasios Galanopoulos, Christos Michaelidis, Dimitra Rontogianni, Apostolos Tolis, Stavroula Chini, Georgios Gortzolidis, Konstantinos A Papadimitriou, Dimitra Skoumi, Konstantina Tzanetou, Georgios Paterakis
Journal: Case Rep Med (2011)
MeSH terms: Case Reports

Aggressive lymphomas can present with symptoms mimicking life-threatening infection. Flow cytometry (FC) is usually recommended for the classification and staging of lymphomas in patients with organomegaly and atypical cells in effusions and blood, after the exclusion of other possible diagnoses. FC may also have a place in the initial diagnostic investigation of aggressive lymphoma. Three cases are presented here of highly aggressive lymphomas in young adults, which presented with the clinical picture of fever of unknown origin (FUO) in patients severely ill. All followed a life-threatening clinical course, and two developed the hemophagocytic syndrome (HPS), but microbiological, immunological, and morphological evaluation and immunohistochemistry (IHC) failed to substantiate an early diagnosis. FC was the technique that provided conclusive diagnostic evidence of lymphoma, subsequently verified by IHC. Our experience with these three cases highlights the potential role of FC as an adjunct methodology in the initial assessment of possible highly aggressive lymphoma presenting with the signs and symptoms of life-threatening infection, although the definitive diagnosis should be established by biopsy. In such cases, FC can contribute to the diagnosis of lymphoma, independently of the presence of HPS.
Primary pituitary tuberculosis
Authors: Tarun Kumar, Jitendra Singh Nigam, Iffat Jamal, Vikas Chandra Jha
Journal: Autops Case Rep (2020)
Keywords: adenoma, granuloma, pituitary gland, tuberculosis
MeSH terms: Case Reports

Tuberculosis is an infectious disease that involves any organ. However, the primary pituitary tuberculosis is an extremely rare disease. Intracranial tuberculomas account for 0.15-5% of intracranial space-occupying lesions, of which, pituitary as the primary site is unusual, and easily misdiagnosed as pituitary adenoma. In this setting, the late diagnosis can result in permanent endocrine dysfunction. We report the case of a 50-year-old woman who presented to the neurosurgery outpatient department with complaints of progressively increasing headache and diminished vision over the last year. On the clinical examination, the patient was conscious and oriented. The routine hematological and biochemical workup showed an increased erythrocyte sedimentation rate (ESR) and increased prolactin levels. The radiological working diagnosis was consistent with pituitary macroadenoma. No other radiological and/or clinical clue that could elicit the suspicion of pulmonary or extrapulmonary lesions of tuberculosis was found. The transsphenoidal endonasal tumor excision was done. The histopathology showed numerous epithelioid cell granulomas, Langhans giant cells along with scant necrosis. Ziehl Neelsen staining demonstrated acid-fast bacilli, and the final diagnosis of pituitary tuberculoma was made. We report this rare case of pituitary lesion that may be included in the differential diagnosis of sellar lesions to avoid unnecessary surgical interventions, especially in regions where the disease is endemic.
Extensive Mucocutaneous Verruca Vulgaris in a Nonimmunocompromised Patient
Authors: Vela D Desai, Rajeev Sharma, Durgesh N Bailoor
Journal: Int J Clin Pediatr Dent (2011)
Keywords: human papilloma virus, verruca vulgaris, warts
MeSH terms: Case Reports

Papilloma virus infections of the oral cavity have been long recognized with various clinical expressions characterized as verruca vulgaris, Heck's disease, multiple papilloma and condyloma acuminata. In this paper, we are highlighting a case of verruca vulgaris involving the oral cavity with extensive skin lesions in a nonimmunocompromised 9-year-old boy. Different treatment modalities are discussed in this article.
Case Report: Omicron BA.2 Subvariant of SARS-CoV-2 Outcompetes BA.1 in Two Co-infection Cases
Authors: Marija Gjorgjievska, Sanja Mehandziska, Aleksandra Stajkovska, Slavica Pecioska-Dokuzovska, Anica Dimovska, Idriz Durmish, Sara Ismail, Teodora Pavlovska, Antonija Stojchevska, Haris Amedi, Jasna Andonova, Marija Nikolovska, Sara Velickovikj, Zan Mitrev, Ivan Kungulovski, Goran Kungulovski
Journal: Front Genet (2022)
Keywords: covid-19, sars- cov2, co-infection, next-generation sequencing, omicron
MeSH terms: Case Reports

Trends from around the world suggest that the omicron BA.2 subvariant is increasing in proportion to the original BA.1 subvariant. Here we report two cases of co-infection with omicron BA.1 and omicron BA.2 in co-exposed individuals. In both individuals, genome sequencing and/or S-gene specific PCR identified omicron BA.1 at early time-points, which was replaced by omicron BA.2 at later time-points of the infection. The timeline of our data supports the proposition that BA.2 outcompetes BA.1 in a real-life scenario, and in time becomes the dominant variant in the upper respiratory tract of the host.
Can Met-PET/CT Predict Sporadic Multiglandular Hyperparathyroidism? Report of a Case and Review of the Literature
Authors: Andreas Hillenbrand, Johannes Lemke, Doris Henne-Bruns, Ambros J Beer, Vikas Prasad
Journal: Case Rep Endocrinol (2019)
MeSH terms: Case Reports

Background:
Primary hyperparathyroidism (pHPT) is a common endocrine disorder of the parathyroid glands. In most cases pHPT is caused by single gland disease, but about 10% of patients suffer from sporadic multiglandular disease (MGD). Patients with MGD, especially with ectopic parathyroid adenomas, have an increased risk for persistence/recurrence after surgery. Normally, sporadic MGD cannot be diagnosed preoperatively by parathyroid scintigraphy. We analyzed the potential of positron emission tomography/computed tomography (Met-PET/CT) to predict MGD.
Methods and case presentation:
We reviewed the literature, if preoperative Met-PET/CT could predict MGD in patients with pHPT. Further, we present a 71-year-old female with ectopic MGD. Preoperative localization via Met-PET/CT showed MGD with two areas suspected to be enlarged parathyroid glands (left lateral to the thyroid lobe and posterior mediastinum). Both diagnostic findings were extirpated and parathormone dropped into normal levels.
Results:
We identified four additional manuscripts, referring to MGD and Met-PET/CT with divergent results. Preoperative localization diagnostics using Met-PET/CT may not necessarily identify MGD. In most cases, Met-PET/CT localized only one adenoma and localizes larger adenomas more reliably than smaller adenomas.
Conclusion:
Identifying patients at risk of MGD preoperatively remains challenging. We found MET-PET/CT seems to predict MGD in patients with large size and high weight PTH adenomas. For ectopic parathyroid adenomas, accurate preoperative localization is the key to successful surgical removal. Met-PET/CT appears to have great potential in soft-tissue analysis of complex anatomical regions and can predict ectopic parathyroid adenomas.
Successful eculizumab treatment of recurrent postpartum atypical hemolytic uremic syndrome after kidney transplantation
Authors: Katherine Garlo, Doug Dressel, Marizela Savic, John Vella
Journal: Clin Nephrol Case Stud (2015)
Keywords: complement, eculizumab, hemolytic uremic syndrome, kidney transplant, postpartum
MeSH terms: Case Reports

Postpartum atypical hemolytic uremic syndrome (aHUS) is a rare disorder associated with poor maternal and fetal outcomes. We describe a case of severe postpartum aHUS with recurrence in a kidney allograft after a second pregnancy. The patient had initially presented age 28 years with aHUS that developed after her first delivery. In spite of treatment with plasma exchange, she developed end-stage renal disease (ESRD) requiring years of hemodialysis before receiving a kidney transplant from a living unrelated donor. Two years later, she became pregnant again and at 26 weeks gestation she presented to our hospital with hypertension and proteinuria. Within 48 hours of delivery she developed hemolytic anemia, thrombocytopenia, and oliguric acute kidney injury (AKI) culminating in the need for dialysis. There was no response to therapeutic plasma exchange (TPE). However, treatment with eculizumab led to prompt, successful resolution of hemolysis, thrombocytopenia, and AKI. Three months after therapy was stopped, her disease relapsed causing renal failure again requiring dialysis. At that time, an allograft biopsy revealed severe thrombotic microangiopathy (TMA). Eculizumab was resumed without plasma exchange leading to resolution of aHUS and return of kidney function. Now, her baby is nearly 2 years old. She remains on maintenance eculizumab therapy 1,200 mg every 2 weeks without dialysis. She has excellent renal function with creatinine of 1.2 mg/dL, eGFR 52 mL/min/1.73 m, and proteinuria 0.35 g/day. She will likely be on eculizumab for the remainder of her life.
Change of Anesthesia Management for a Patient Undergoing CABG by an Incidental Finding of a Genetic Variant Associated with Malignant Hyperthermia
Authors: Trey B Creech, Li Zhang
Journal: Case Rep Anesthesiol (2019)
MeSH terms: Case Reports

Malignant hyperthermia (MH) is a rare life-threatening hypermetabolic muscular disorder with a high mortality rate. Three genes, RYR1, CACNA1S, and STAC3, have been associated with MH susceptibility. Multiple genetic variants have been identified in these three genes. Some of those variants were pathogenic, but many others are yet to be tested. Such uncertainty can make it challenging for anesthesia providers as there is currently no anesthesia guideline for each genetic variant in patients who have neither clinical nor family history of MH. With the increasing popularity of whole exome sequencing, anesthesia providers will likely face such challenges more often as many patients may have genetic variations of unknown clinical significance in their RYR1, CACNA1S, or STAC3 genes. Here we describe change of anesthesia management for a patient who had an incidental finding of a genetic variant in RYR1 gene undergoing an elective coronary artery bypass surgery.