OpenMed/multicare-articles huggingface dataset:
Ectopic ACTH Secretion in a Child With Metastatic Ewing's Sarcoma: A Case Report
Authors: Valentina Di Ruscio, Giada Del Baldo, Maria Debora De Pasquale, Rita De Vito, Evelina Miele, Giovanna Stefania Colafati, Annalisa Deodati, Maria Antonietta De Ioris, Assunta Tornesello, Giuseppe Maria Milano, Angela Mastronuzzi
Journal: Front Oncol (2020)
Keywords: acth, cushing syndrome, ewing's sarcoma, paraneoplastic syndrome, pediatric oncology
MeSH terms: Case Reports

Ectopic ACTH syndrome is rare in pediatric age. Sarcomas that cause Ectopic ACTH Syndrome (EAS) are even more uncommon. Currently, only three cases of EAS caused by Ewing' sarcoma have been reported. We detail a 10-year-old boy with Cushing's syndrome symptoms caused by ectopic ACTH production by a metastatic Ewing's sarcoma of the right ischio-pubic and ileo-pubic branches. The rapid appearance of cushingoid symptoms, with significant weight gain, acne, hirsutism, and hypercortisolism were implications of ectopic ACTH production as paraneoplastic Cushing's Syndrome. The very high levels of ACTH and non-suppression at the high dose dexamethasone test confirmed the clinical suspicion. We underline the possibility EAS was caused by an ACTH-secreting tumor, including soft tissue sarcomas.
A New Anesthetic, Remimazolam, Is Useful in the Management of Anesthesia in Patients with Liver Cirrhosis
Authors: Anna Onoda, Yasuyuki Suzuki
Journal: Case Rep Anesthesiol (2022)
MeSH terms: Case Reports

Background:
Management of general anesthesia in patients with liver cirrhosis is challenging because it is difficult to maintain the circulation and concentration of anesthetics within a safe range. Unlike many other anesthetics, which are metabolized by cytochrome P450 enzymes, remimazolam is metabolized by carboxylesterase. In a liver cirrhosis model, cytochrome P450 activity is suppressed by approximately 30%; however, carboxylesterase activity is maintained at approximately 60%. Also, remimazolam is less likely to inhibit circulation. A 77-year-old woman was scheduled to undergo laparoscopic cholecystectomy. The patient was diagnosed with Child-Pugh B liver cirrhosis due to type C viral hepatitis. General anesthesia with remimazolam stabilized the intraoperative circulation and resulted in rapid postoperative awakening.
Conclusion:
We report a case in which a patient with Child-Pugh B cirrhosis was safely managed under general anesthesia using remimazolam during laparoscopic cholecystectomy.
Coronary subclavian steal syndrome unamenable to angioplasty successfully managed with subclavian-subclavian bypass
Authors: Saad Tariq, Swosty Tuladhar, Edward Wingfield, Honesto Poblete
Journal: Case Rep Vasc Med (2012)
MeSH terms: Case Reports

Purpose. Coronary-subclavian steal syndrome (CSSS) is defined as a reversal of flow in a previously constructed internal mammary artery (IMA) coronary conduit, producing myocardial ischemia. We present a case of CSSS which could not be ameliorated with endovascular therapy and necessitated a subclavian-subclavian bypass. Case Report. 80-year-old Caucasian male with history of CABG presented with syncope. He had absent left-sided radial pulse with blood pressure being 60/40 on left arm and 130/80 on the right. He underwent cardiac catheterization for NSTEMI which showed patent left internal mammary artery graft to left anterior descending coronary artery with retrograde flow, and diagnosis of coronary subclavian steal syndrome was made. Complete occlusion of proximal left subclavian artery was identified. Percutaneous angioplasty failed because of calcified plaque causing 100% occlusion. Carotid doppler showed bilateral carotid artery disease. He finally underwent subclavian-subclavian bypass which resolved his condition. Conclusion. Subclavian-subclavian bypass is a successful alternative to carotid-subclavian bypass for management of CSSS especially with concomitant critical carotid artery atherosclerotic disease.
Hepatectomy and pneumectomy combined with targeted therapy for primary hepatic neuroendocrine carcinoma: Case report and review of the literature
Authors: Keyu Huang, Zhujing Lan, Weitao Chen, Jianyong Zhang, Jilong Wang, Hai Zhu, Banghao Xu, Ling Zhang, Tingting Lu, Ya Guo, Zhang Wen
Journal: Front Surg (2022)
Keywords: case report, gene sequencing, liver, neuroendocrine carcinoma, targeted therapy
MeSH terms: Case Reports

Primary hepatic neuroendocrine carcinoma (PHNEC) manifests as a rare type of liver tumor. PHNEC is not specifically clinical or radiographical and is often misdiagnosed and mistreated. Here, we present a case report of PHNEC in a 50-year-old woman who was admitted to our department with concealed pain in the right upper abdomen. The initial diagnosis was a probable hepatic space-occupying lesion with tumor bleeding. The patient was subjected to a partial right hemihepatectomy, cholecystectomy, partial resection of the lower lobe of the right lung, partial resection of the diaphragm, and resection of the right perirenal fat sac to alleviate her symptoms. After surgery, gene sequencing was performed to determine the possible cause of the condition. However, five months after discharge, the patient was hospitalized again because of retroperitoneal and peritoneal multiple metastases. Nine months after surgery, the patient died. This case is likely to aid in furthering our understanding of PHNEC to improve the future diagnosis and treatment of this disease.
Combined Orthodontic and Surgical Approach in the Correction of a Class III Skeletal Malocclusion with Mandibular Prognathism and Vertical Maxillary Excess Using Bimaxillary Osteotomy
Authors: George Jose Cherackal, Eapen Thomas, Akhilesh Prathap
Journal: Case Rep Dent (2013)

For patients whose orthodontic problems are so severe that neither growth modification nor camouflage offers a solution, surgery to realign the jaws or reposition dentoalveolar segments is the only possible treatment. Surgery is not a substitute for orthodontics in these patients. Instead, it must be properly coordinated with orthodontics and other dental treatments to achieve good overall results. Dramatic progress in recent years has made it possible for combined surgical orthodontic treatment to be carried out successfully for patients with a severe dentofacial problem of any type. This case report provides an overview of the current treatment methodology in managing a combination of asymmetrical mandibular prognathism and vertical maxillary excess.
Comparison of impact and cost-effectiveness of rotavirus supplementary and routine immunization in a complex humanitarian emergency, Somali case study
Authors: Lisa M Gargano, Jacqueline E Tate, Umesh D Parashar, Saad B Omer, Susan T Cookson
Journal: Confl Health (2015)
Keywords: cost-effectiveness, humanitarian emergency, rotavirus vaccine, routine immunization, somalia

Background:
A humanitarian emergency involves a complete breakdown of authority that often disrupts routine health care delivery, including immunization. Diarrheal diseases are a principal cause of morbidity and mortality among children during humanitarian emergencies. The objective of this study was to assess if vaccination against rotavirus, the most common cause of severe diarrhea among children, either as an addition to routine immunization program (RI) or supplemental immunization activity (SIA) would be cost-effective during a humanitarian emergency to decrease diarrhea morbidity and mortality, using Somalia as a case study.
Methods:
An impact and cost-effectiveness analysis was performed comparing no vaccine; two-dose rotavirus SIA and two-dose of RI for the 424,592 births in the 2012 Somali cohort. The main summary measure was the incremental cost per disability-adjusted life-year (DALY) averted. Univariate sensitivity analysis examined the extent to which the uncertainty in the variables affected estimates.
Results:
If introduced in Somalia, a full-series rotavirus RI and SIA would save 908 and 359 lives, respectively, and save US$63,793 and US$25,246 in direct medical costs, respectively. The cost of a RI strategy would be US$309,458. Because of the high operational costs, a SIA strategy would cost US$715,713. US$5.30 per DALY would be averted for RI and US$37.62 per DALY averted for SIA. Variables that most substantially influenced the cost-effectiveness for both RI and SIA were vaccine program costs, mortality rate, and vaccine effectiveness against death.
Conclusions:
Based on our model, rotavirus vaccination appears to be a cost-effective intervention as either RI or SIA, as defined by the World Health Organization as one to three times the per capita Gross Domestic Product (Somalia $112 in 2011). RI would have greater health impact and is more cost effective than SIA, assuming feasibility of reaching the target population. However, given the lack of infrastructure, whether RI is realistic in this setting remains unanswered, and alternative approaches like SIA should be further examined.
Beware of Rattling Underfoot: Cystic Artery Pseudoaneurysm in Acute Cholecystitis With a Cholecystostomy
Authors: Umasankar Mathuram Thiyagarajan, Amirtha Ponnuswamy, Andrew Hindmarsh
Journal: Cureus (2023)
Keywords: cholecystitis, cholecystostomy, gallstones, gastrointestinal bleeding, pseudoaneurysm
MeSH terms: Case Reports

Cystic artery pseudoaneurysm (CAP) is a very rare complication of acute cholecystitis. The pathogenesis of CAP in the context of cholecystitis is unknown but is possibly related to the inflammatory process in the vicinity of the cystic artery, leading to weakness in the wall of the artery. Though CAP has been reported in the literature, our patient had a unique presentation in the presence of a cholecystostomy catheter in situ. There were no risk factors for CAP in our patient including usage of anticoagulants, trauma, or surgical procedures. Fortunately, the blood-stained fluid in the cholecystostomy catheter effluent alerted the clinical team to a possible vascular complication in the background of ongoing cholecystitis. This finding should serve as a warning sign to alert clinicians to the possibility of CAP-beware of rattling underfoot.
Systemic inflammatory response syndrome following laparoscopic repair of diaphragmatic injury: A case report
Authors: Philip Umman
Journal: J Minim Access Surg (2010)
Keywords: diaphragmatic injury, laparoscopic repair, systemic inflammatory response syndrome, tension pneumothorax
MeSH terms: Case Reports

Trauma is a major cause of morbidity and mortality in the younger age group. Though diagnostic laparoscopy has been attempted in trauma earlier, with the advance in minimal access techniques, there is an increasing attempt at advancing the indications for laparoscopy in the setting of trauma. Though there are reports and studies on the successful use of laparoscopy in the setting of abdominal trauma, it is essential to remember that laparoscopy in trauma is associated with risks inherent in the procedure itself and also with higher incidence of missed injuries if used as a diagnostic tool.
Refractory Auto-Immune Thrombotic Thrombocytopenic Pupura Successfully Treated With Caplacizumab
Authors: Chloé Mellaza, Nicolas Henry, Pierre-Marie Fayolle, Satar Mortaza, Jean-François Subra, Agnès Veyradier, Paul Coppo, Jean-François Augusto
Journal: Front Med (Lausanne) (2020)
Keywords: caplacizumab, case report, platelet, refractor, thrombotic thrombocitopenic purpura
MeSH terms: Case Reports

Thrombotic thrombocytopenic purpura (TTP) is a rare thrombotic microangiopathy characterized by mechanical hemolytic anemia, profound thrombocytopenia, and neurological manifestations. Acquired auto-immune TTP, the most prevalent cause of TTP, is induced by the presence of inhibitory anti-ADAMTS13 auto-antibodies. Modern treatment of acquired TTP relies on plasma exchange, rituximab, and steroids. Caplacizumab (Cablivi®), a humanized single-variable domain immunoglobulin that targets the A1 domain of the ultra-large von Willebrand factor, inhibits the interaction between ultra-large vWFand platelets. In two clinical trials, caplacizumab, in addition to conventional treatment, shortened the delay to platelet count normalization in comparison to conventional treatment plus placebo, without increasing significantly hemorrhagic complications. Moreover, caplacizumab was associated with reduced occurrence of a secondary endpoint associating death, TTP recurrence, and major thromboembolic events. Here, we report the off-label use of caplacizumab in a 68-year-old patient with confirmed acquired TTP, severe thrombocytopenia, and generalized tonic-clonic seizures requiring mechanical ventilation and admission in the intensive care unit. Conventional treatment was rapidly started. Despite the intensification of plasma exchange treatment with twice-daily sessions, steroid continuation, and a second rituximab infusion on day 6, thrombotic microangiopathy worsened with thrombocytopenia at 21 g/L on day 8 from admission. We also considered using caplacizumab, which we could obtain and start on day 12 from admission, as it was available under a temporary authorization use in France. As soon as 12 h after caplacizumab initiation, we observed a significant increase of platelet count and improvement of other hemolytic parameters. We observed resolution of encephalopathy and complete recovery of motor paralysis, allowing us to stop mechanical ventilation on day 14. Caplacizumab was maintained for 128 days until day 139 from initial admission. The patient is going well 10 months after initial admission, without any neurological sequelae, and TTP did not relapse. To the best of our knowledge, this is the first reported use of caplacizumab in such a condition. This case report suggests that caplacizumab use may help to reduce the rate of refractory TTP episodes.
Giant cell tumor of the temporal bone--a case report
Authors: S Balaji Pai, R M Lalitha, Kavitha Prasad, Saraswathi G Rao, K Harish
Journal: BMC Ear Nose Throat Disord (2005)

Background:
Giant cell tumor is a benign but locally aggressive bone neoplasm which uncommonly involves the skull. The petrous portion of the temporal bone forms a rare location for this tumor.
Case presentation:
The authors report a case of a large giant cell tumor involving the petrous and squamous portions of the temporal bone in a 26 year old male patient. He presented with right side severe hearing loss and facial paresis. Radical excision of the tumor was achieved but facial palsy could not be avoided.
Conclusion:
Radical excision of skull base giant cell tumor may be hazardous but if achieved is the optimal treatment and may be curative.
A Case of Pneumothorax after Treatment with Lenvatinib for Anaplastic Thyroid Cancer with Lung Metastasis
Authors: Haruhiko Yamazaki, Hiroyuki Iwasaki, Toshinari Yamashita, Tatsuya Yoshida, Nobuyasu Suganuma, Takashi Yamanaka, Katsuhiko Masudo, Hirotaka Nakayama, Kaori Kohagura, Yasushi Rino, Munetaka Masuda
Journal: Case Rep Endocrinol (2018)
MeSH terms: Case Reports

A 63-year-old man was diagnosed with multiple lung metastases from anaplastic thyroid cancer and received lenvatinib. Follow-up computed tomography on day 34 of lenvatinib treatment showed pneumothorax. The pneumothorax was temporarily improved with chest drainage. However, pleurodesis was performed to treat a relapse of the pneumothorax. Pneumothorax during chemotherapy for a malignant tumor is considered a relatively rare complication. This case is the first documentation that pneumothorax may develop during lenvatinib treatment. The possible development of pneumothorax should be considered when lenvatinib is used in patients with lung metastasis.
Hepatocellular Carcinoma in a 24-Year-Old Female with Beckwith-Wiedemann Syndrome: A Case Report and Review of the Literature
Authors: Carolyn G Ahlers, Quoc-Huy Trinh, Martin Montenovo
Journal: Case Rep Genet (2020)
MeSH terms: Case Reports

In this report, the case of a 24-year-old female with Beckwith-Wiedemann Syndrome (BWS) who was diagnosed with well-differentiated hepatocellular carcinoma (HCC) is described. While BWS has been associated with childhood embryonal tumors, most commonly Wilms tumors and hepatoblastomas, this is the first case report to describe HCC in an adult with BWS. Although HCC typically occurs in elderly adults or those with underlying liver disease, in this case, we show that HCC can occur in a young adult with BWS without any underlying liver disease.
Ultrasonographic manifestations and the effective diagnosis of epididymal leiomyosarcoma: Case report and systematic literature review
Authors: Ruixiao Song, Jing Xi, Honglei Shi, Zhixin Xue, Huifang Li, Xiaolong Yu
Journal: Front Oncol (2023)
Keywords: antidiastole, diagnosis, epididymis, leiomyosarcoma, ultrasonographic
MeSH terms: Case Reports

Background:
Epididymal leiomyosarcoma is an extremely rare tumor. In this study, we describe the sonographic features of this uncommon tumor.
Methods:
A case of epididymal leiomyosarcoma diagnosed at our institute was retrospectively analyzed. Ultrasonic images, noted clinical manifestations, treatment procedures, and pathology results were collected for this patient. The same information was collected from a systematic literature search on epididymal leiomyosarcoma, including the PUBMED, Web of Science and Google Scholar databases.
Results:
The literature search resulted in 12 articles; we were able to extract data from 13 cases of epididymal leiomyosarcomatosis. The median patient age was 66 (35-78) years, and the average tumor diameter was 2-7 cm. All patients had unilateral epididymal involvement. The lesions were all solid, irregular-shaped in almost half of the cases, featured clear borders in six cases, and had unclear borders in four cases. The internal echogenicity was heterogeneous in the majority of lesions: six cases were hypoechoic (7/11) and three cases moderately echoic (3/10). Information on blood flow within the mass was provided in four cases, but all were noted with significant vascularity. Surrounding tissue invasion was discussed in 11 cases, with 4 featuring peripheral invasion or metastasis.
Conclusion:
Epididymal Leiomyosarcoma demonstrates sonographic characteristics common to many malignant tumors, such as increased density, irregular shape, heterogeneous internal echogenicity, and hypervascular. Ultrasonography is helpful to differentiate benign epididymal lesions, and can provide some reference for clinical diagnosis and treatment. However, compared with other malignant tumors of the epididymis, it has no characteristic sonographic features,and pathological confirmation is required.
Subacute Thyroiditis Associated with COVID-19
Authors: Eugenia Campos-Barrera, Teresa Alvarez-Cisneros, Mario Davalos-Fuentes
Journal: Case Rep Endocrinol (2020)
MeSH terms: Case Reports

Subacute thyroiditis is a self-limiting inflammatory disorder, characterized by neck pain or discomfort, a tender diffuse goiter, and sometimes a transient episode of hyperthyroidism followed by euthyroidism and sometimes hypothyroidism. There is usually a normalization of thyroid function within a few weeks. Subacute thyroiditis has a higher incidence in summer and has been linked to a viral or bacterial upper respiratory postinfection inflammatory response. We hereby describe the case of a previously healthy 37-year-old female presenting with subacute thyroiditis associated with a very mild presentation of COVID-19. As most patients with SARS-Cov-2 are asymptomatic, we suggest to rule out SARS-Cov-2 infection in patients presenting with symptoms suggesting SAT.
Case report: Metastatic metaplastic breast cancer with choriocarinomatous features: Targeting the choriocarcinoma component for cure
Authors: Krisha K Mehta, Rosa Nouvini, Jingxuan Liu, Yi Wang, Alison Stopeck
Journal: Front Oncol (2023)
Keywords: breast cancer with choriocarcinomatous features, chemotherapy, choriocarcinoma, long term remission, metaplastic breast cancer, methrotrexate
MeSH terms: Case Reports

Breast cancer with choriocarcinomatous features (BCCF) is a rare and aggressive breast cancer. BCCF carries a poor prognosis and there is unfortunately scant literature to guide treatment beyond surgical resection with most patients receiving standard regimens for breast cancer. In our case, we present a 42-year-old female with an initial hCG of 2,324 and two suspicious lesions of the right breast. On biopsy, each lesion had distinct histopathology with the larger lesion diagnosed as BCCF and the smaller lesion being an invasive ER/PR positive ductal carcinoma. The diagnosis of BCCF rather than metastatic choriocarcinoma was confirmed using DNA typing. Salvage chemotherapy targeting choriocarcinoma resulted in marked clinical and biomarker success including normalization of the hCG. After recurrent brain metastases were diagnosed, high dose chemotherapy with methotrexate was administered resulting in long term remission.
Differential Diagnosis and Management of Incomplete Locked-In Syndrome after Traumatic Brain Injury
Authors: Lauren Surdyke, Jennifer Fernandez, Hannah Foster, Pamela Spigel
Journal: Case Rep Neurol Med (2017)
MeSH terms: Case Reports

Locked-in syndrome (LIS) is a rare diagnosis in which patients present with quadriplegia, lower cranial nerve paralysis, and mutism. It is clinically difficult to differentiate from other similarly presenting diagnoses with no standard approach for assessing such poorly responsive patients. The purpose of this case is to highlight the clinical differential diagnosis process and outcomes of a patient with LIS during acute inpatient rehabilitation. A 32-year-old female was admitted following traumatic brain injury. She presented with quadriplegia and mutism but was awake and aroused based on eye gaze communication. The rehabilitation team was able to diagnose incomplete LIS based on knowledge of neuroanatomy and clinical reasoning. Establishing this diagnosis allowed for an individualized treatment plan that focused on communication, coping, family training, and discharge planning. The patient was ultimately able to discharge home with a single caregiver, improving her quality of life. Continued evidence highlights the benefits of intensive comprehensive therapy for those with acquired brain injury such as LIS, but access is still limited for those with a seemingly poor prognosis. Access to a multidisciplinary, specialized team provides opportunity for continued assessment and individualized treatment as the patient attains more medical stability, improving long-term management.
Transabdominal Laparoscopic Repair of Amyand's Hernia: A Case Report
Authors: Bachir Elias, Elie Chelala, Jean-Louis Allé
Journal: Case Rep Surg (2011)
MeSH terms: Case Reports

The occurrence of appendicitis within an inguinal hernia, known as Amyand's hernia, is a rare condition. Laparoscopic approach to this type of hernia is not widely used, and there is little data comparing it to the open surgery approach. This article presents a case of Amyand's hernia treated successfully by laparoscopy via a transabdominal approach supported by a short review of literature on this rare condition.
Maltoma veiled in the lung-a rare case of pulmonary and gastric maltoma
Authors: Adeel Nasrullah, Ayla Gordon, Anam Javed, Usman Tariq, Atif Raja, Ahmad Alhajhusain
Journal: Respir Med Case Rep (2021)
Keywords: extranodal marginal zone lymphoma, lymphoma, pulmonary maltoma
MeSH terms: Case Reports

Mucosa associated lymphoid tissue (MALT) is a type of B-cell lymphoma that is commonly observed in the gastrointestinal site, most frequently occurring in the stomach. However, the incidence of this type of lymphoma in the respiratory tract is very uncommon. We report a case of this rare clinical entity in a patient who presented with non-symptomatology and was diagnosed with pulmonary MALT lymphoma (pMALToma).