OpenMed/multicare-articles huggingface dataset:
Case report: Complex left-carina resection: three-year single-center experience
Authors: Simone Tombelli, Domenico Viggiano, Ottavia Salimbene, Marco Trigiani, Luca Voltolini, Alessandro Gonfiotti
Journal: Front Oncol (2024)
Keywords: carina, carinal pneumonectomy, complex tracheobronchial resection, tracheal sleeve pneumonectomy, tracheobronchial angle
MeSH terms: Case Reports

Carinal and tracheobronchial angle tumors have long been a contraindication for surgical removal; the technique of tracheal sleeve pneumonectomy makes it possible to approach this malignancy but still represents a surgical challenge. Left sleeve pneumonectomy is less common compared with right sleeve pneumonectomy and represents a minority component in the literature's case series due to the complexity of the anatomy. In addition, there is no standard for treatment strategy, and it must be assessed on a case-by-case basis. From 2020 to 2023, we performed three left tracheal sleeve pneumonectomies and one neocarina reconstruction surgery for benign lesions without lung resections. All cases were performed without cardiovascular support such as cardiopulmonary bypass and via median sternotomy. With a median length of stay of 21.5 days (between 14 days and 40 days), all patients were transferred to a physiotherapeutic rehabilitation facility for functional reactivation, where they received physiotherapeutic respiratory therapy given the slow functional recovery. The recorded 30-day mortality was 0. There is no standardized approach for left-sided sleeve pneumonectomy, and it is still a surgical challenge due to intraoperative and postoperative difficulties.
Regorafenib-related erythrocytosis in metastatic extra-gastrointestinal stromal tumor: a case report
Authors: Elena Fassi, Vito Amoroso, Deborah Cosentini, Vittorio Ferrari, Marta Laganà, Alfredo Berruti, Pierluigi di Mauro
Journal: Front Oncol (2024)
Keywords: egist, tkis, erythrocytosis, polycythemia, regorafenib
MeSH terms: Case Reports

Introduction:
Regorafenib is an oral multi-targeted tyrosine kinase inhibitor (TKI) indicated for the treatment of various tumor types, including metastatic gastrointestinal stromal tumors (GIST), as a third-line systemic therapy. Erythrocytosis, which is characterized by an increase in erythrocyte count, hemoglobin, and hematocrit levels, has been described as a side effect of some antiangiogenic TKIs but has never been associated with regorafenib administration.
Case presentation:
An extra-GIST was diagnosed in a 58-year-old woman after she underwent surgery to remove a pelvic mass. Three years later, systemic therapy with imatinib was started due to pelvic disease recurrence. However, after six months, due to disease progression, we prescribed sunitinib, which the patient received for four years. Regorafenib was initiated in June 2019, and after six months, we noted an increase in the erythrocytes' count and hemoglobin (Hb) levels. Given that the patient had clinical benefit and hematocrit was within normal range, we only monitored the blood cell count and continued to give regorafenib at the same dose. The drug was then stopped for over six weeks due to hospitalization for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, and Hb levels returned to normal. Therefore, we decided to restart regorafenib at a lower dose. However, Hb levels rose again in conjunction with increased hematocrit, resulting in the need for multiple phlebotomies. We attempted to restart regorafenib every other day, but it was unsuccessful, so we stopped it permanently in May 2023, and all values returned to normal.
Conclusion:
Regorafenib may cause secondary erythrocytosis that could not be dose-related, as this case report suggests. Secondary erythrocytosis might be a marker of TKI efficacy, given the patient's prolonged clinical benefit during regorafenib treatment (48 months). In patients receiving regorafenib, monitoring blood count as well as any symptoms associated with erythrocytosis may be suggested.
Case report: Ipilimumab and nivolumab in metastatic adrenocortical cancer with high tumor mutational burden
Authors: Rebekka Mispelbaum, Tessa Hattenhauer, Franz-Georg Bauernfeind, Jan-Frederic Lau, Peter Brossart, Annkristin Heine
Journal: Front Oncol (2024)
Keywords: adrenocortical cancer, high mutational burden, immunotherapy, ipilimumab, nivolumab
MeSH terms: Case Reports

In the setting of metastatic adrenocortical cancer, there are limited therapy options such as mitotane and platinum-based chemotherapy with only low response rates. Ipilimumab and nivolumab are approved for several solid cancer types. Tumor mutational burden is one established marker to predict treatment success of immunotherapy and has been associated with improved response rates to immune checkpoint inhibitors. We here present the case of a 68-year-old woman with metastatic adrenocortical cancer and high tumor mutational burden treated with ipilimumab and nivolumab in a fourth-line setting. She showed a stable disease for at least 48 weeks, which is significantly longer than the treatment response to mitotane or platinum-based chemotherapy. To the best of our knowledge, this is the first successful use of a long-term two-drug immunotherapy (48 weeks) in a patient with metastatic adrenocortical cancer and high mutational burden. Ipilimumab and nivolumab should be considered as a new therapy option in this patient group.
Brachial Plexus Rupture: A Neglected Trauma, Is There Any Hope?
Authors: Ibtissam El Ouali, Mohamed Jiddane, Firdaous Touarsa
Journal: J Belg Soc Radiol (2024)
Keywords: brachial plexus, mri, trauma
MeSH terms: Case Reports

Teaching point: Magnetic resonance imaging (MRI) has significantly improved the evaluation of brachial plexus injuries, offering new possibilities for microsurgical repair and contributing to the functional prognosis.
Case report: Anxiety and depression as initial symptoms in a patient with acute hypoxia and patent foramen ovale
Authors: Xiaoyan Zhai, Ronghong Jiao, Aihua Ni, Xueyi Wang
Journal: Front Psychiatry (2023)
Keywords: agitated, anxiety, depression, hypoxia, patent foramen ovale, right-to-left shunt
MeSH terms: Case Reports

The prevalence of patent foramen ovale (PFO) is 15-35% among adults. The role of right-to-left shunting through the PFO, anxiety, depression, and hypoxemia in the systemic circulation remains poorly understood. Herein, we present the case of a 52-year-old woman with no heart or lung disease, who was admitted due to anxiety for 5 months and had symptom exacerbation with dizziness for 4 days and presented with cyanosis. She was noted to have acute hypoxemia, with an oxygen saturation of 94.48% on room air, and arterial blood gas showed an oxygen tension of 65.64 mmHg. Agitated saline contrast echocardiography showed right-to-left shunting due to PFO. Arteriovenous fistula, pneumonia, pulmonary embolism, pulmonary hypertension, congestion peripheral cyanosis, ischemic peripheral cyanosis, and methemoglobin were excluded. Additionally, the patient improved by taking Paroxetine, Oxazepam, and Olanzapine. Her oxygen tension returned to 90.42 mmHg, and her symptoms resolved. In the case of severe anxiety and depression, right-to-left shunting through the PFO may cause acute systemic hypoxemia via a flow-driven mechanism, occasionally manifesting as cyanosis. When anxiety improved, hypoxia also improved. Thus, the treatment of anxiety and depression seems effective in improving hypoxemia. Notably, this is a rare report, and we hope to draw the attention of psychosomatic specialists, psychiatrists, and clinicians to seek the relationship between anxiety appearing as acute stress and PFO. This may be a new therapeutic method for treating severe anxiety disorder.
Incidental Finding of Thyroid Tuberculosis by Operation for Graves' Disease: A Rare Case Presentation
Authors: Zineb El Azime, Samira Handa, Ghita Bourkadi, Hayat Aynaou, Houda Salhi, Hanan El Ouahabi
Journal: Case Rep Endocrinol (2024)
MeSH terms: Case Reports

Thyroid tuberculosis is a rare form of extrapulmonary tuberculosis, even in endemic countries such as Morocco; its precise incidence is not well-defined. The clinical presentation of thyroid tuberculosis can vary, often being asymptomatic. Consequently, the diagnosis may be overlooked or delayed. Intriguingly, thyroid tuberculosis can manifest alongside thyrotoxicosis due to Graves' disease, an exceptional association. This article reports a distinctive case of thyroid tuberculosis coexisting with Graves' disease, one of the autoimmune thyroid diseases. A 33-year-old female presented symptoms consistent with hyperthyroidism and bilateral exophthalmos. She was subsequently diagnosed with Graves' disease. Despite initially managed medically, recurrences of the disease led to definitive treatment by total thyroidectomy. Histopathological examination revealed concurrent presence of thyroid tuberculosis.
The Spontaneous Resolution of Trauma-Induced Uterine Arteriovenous Malformation
Authors: Laurence Stolzenberg, Alixandra Ryan, Paul J Hannon
Journal: Cureus (2024)
Keywords: arterial ablation, dilation and curettage, interventional radiology, radiology, uterine avm
MeSH terms: Case Reports

This paper will describe the case of a woman who presented with a rare condition called uterine arteriovenous malformation (AVM). A uterine AVM represents a connection between veins and arteries in the uterus. Clinicians should always consider this condition for a woman of childbearing age who presents with unexplained vaginal bleeding. In this particular case, a woman had an AVM diagnosed two months following a miscarriage, and a dilation and curettage (D&C), for retained products of conception. This patient presented to the emergency department in apparent distress, although physical examination and initial laboratory values revealed no hemodynamic instability. Ultrasonographic study, followed by an MRI, confirmed the presence of a uterine AVM. Following a consultation with obstetrics and gynecology, she was ultimately referred to an interventional radiologist for a minimally invasive uterine artery embolization. On the day of the procedure, following vascular access, angiography revealed the AVM had spontaneously self-resolved in the interval. In this paper, we will further discuss the possible utility of a repeat ultrasonographic study to reconfirm AVM prior to any surgical procedure, as well as discuss some confounding factors including the use of medroxyprogesterone acetate injections for birth control prior to the formation of the AVM.
Atypical Mycobacterial Infection Mimicking Psoriasis in an Elderly Patient: Diagnostic Challenges and Management
Authors: Muhammad Arshad, Aakash Kumar, Muaz Shafique Ur Rehman, Piere R Tito Rodriguez, Giustino Varrassi
Journal: Cureus (2024)
Keywords: arthritis, infection, mycobacterial, psoriasis, rheumatoid arthriitis
MeSH terms: Case Reports

Atypical mycobacterial infections can have diverse clinical presentations, frequently resulting in diagnostic challenges. This study examines an uncommon atypical mycobacterial disease in an older patient, initially misidentified as psoriasis, emphasizing the difficulties in diagnosing and managing the condition. A 70-year-old male patient arrived at the dermatology department at National Hospital and Medical Centre, Lahore, with a persistent, dry, red rash mainly affecting his arms and legs. The patient had a medical background of diabetes mellitus and hypertension. Initial clinical diagnosis suggested psoriasis based on the appearance and patient's age. The patient was started on conventional psoriatic therapies. However, there was only a slight improvement, which led to the need for additional inquiry. Skin biopsies were conducted, uncovering the presence of granulomatous inflammation. Following cultures and polymerase chain reaction (PCR) tests, the presence of atypical mycobacteria was established. Subsequent laboratory tests eliminated the possibility of tuberculosis (TB) and other prevalent diseases. The conclusive diagnosis was an unusual mycobacterial infection, which posed a challenge due to its clinical similarity to psoriasis. The patient was treated with antibiotics appropriate to the mycobacterial species discovered. The duration of the treatment spanned six months, resulting in a notable amelioration of the skin lesions. The patient is being closely observed for any potential reoccurrence. This case highlights the significance of including atypical mycobacterial infection as a possible diagnosis for persistent dermatological problems, particularly in persons with impaired immune systems. It emphasizes the need for biopsy and culture in unusual situations of suspected psoriasis. This instance also demonstrates the intricacies associated with managing older patients with multiple concurrent medical issues. Unusual mycobacterial infections can imitate conventional skin disorders such as psoriasis, presenting considerable difficulties in diagnosis. Having a strong suspicion and doing relevant laboratory tests are essential for achieving an accurate diagnosis and efficient treatment.
Case report: Retroperitoneal solid pseudopapillary neoplasm associated with multiple hepatic metastases
Authors: Lin Chen, Mengchen Yuan, Meng Wang, Chenglong Luo, Mengyu Gao, Qingbo Huang, Zhenqian Li, Zhigang Zhou
Journal: Front Oncol (2024)
Keywords: abdominal neoplasm, extrapancreatic, hepatic metastasis, retroperitoneal neoplasm, solid pseudopapillary neoplasm
MeSH terms: Case Reports

Solid pseudopapillary neoplasm (SPN) is a rare tumor mostly occurring in the pancreas. They are low-grade malignant tumors of the exocrine pancreas that occasionally metastasize, usually to the liver or peritoneum. Additionally, multiple metastases of extrapancreatic SPN to the liver are extremely rare and have been reported before. This study presents a case of a 13-year-old male patient with retroperitoneal SPN and multiple hepatic metastases. The patient presented with abdominal trauma and underwent enhanced CT, which revealed upper pancreatic occupancy and three hypodense foci in the right lobe of the liver. Moreover, increased spleen size was noted. The patient's serum tumor marker CA125 was increased to 39.00 U/mL (N < 35.0 U/mL), and circulating tumor cells were elevated to 10.2 FU/3 mL (N < 8.7 FU/3 mL). The patient underwent retroperitoneal occupancy resection and splenectomy, followed by resection of liver metastases 7 months after the surgery. Furthermore, multiple liver metastases from retroperitoneal SPN were confirmed postoperatively. The patient recovered for 1 year without tumor recurrence. This case emphasizes the importance of evaluating serum tumor markers and medical imaging in young patients as well as the fact that surgery appears to be the preferred treatment option for multiple metastases in SPN.
Becoming first time father of premature newborn during the first wave of the pandemic: a case study approach
Authors: Romuald Jean-Dit-Pannel, Chloé Dubroca, Flora Koliouli
Journal: Front Psychol (2024)
Keywords: covid-19, experienced separations, experiential approach, first-time fathers, moments of connection, prematurity, qualitative study

Introduction:
The aim of this paper is to delve into the emotional and psychological challenges that fathers face as they navigate the complexities of having a preterm infant in the NICU and in an unprecedented sanitary context.
Methods:
We used three data collection methods such as interviews (narrative and the Clinical Interview for Parents of High-risk Infants- CLIP) and the Edinburgh Postnatal Depression Scale (EPDS) to gain a comprehensive understanding of the cases.
Results:
The following analysis explores two individuals' personal experiences of becoming a first-time father during the first wave of the COVID-19 pandemic through a close examination of two superordinate themes: "A series of separations through the experienced COVID- 19 restrictions" and "Moments of connection." The transition to fatherhood is essentially with a medicalized form of connection with their newborn and the perceived paternal identity. In terms of temporality, these fathers experienced a combination of concerns about their infants' long-term development and COVID-19 health concerns. Furthermore, they showed indications of phobic or hypochondriac tendencies using a psychoanalytic framework, along with an increased risk of postpartum depression.
Phage therapy: a revolutionary shift in the management of bacterial infections, pioneering new horizons in clinical practice, and reimagining the arsenal against microbial pathogens
Authors: Subhash Lal Karn, Mayank Gangwar, Rajesh Kumar, Satyanam Kumar Bhartiya, Gopal Nath
Journal: Front Med (Lausanne) (2023)
Keywords: bacteriophage, immune response, preclinical and clinical trials, treatment challenges, veterinary medicine
MeSH terms: Review

The recent approval of experimental phage therapies by the FDA and other regulatory bodies with expanded access in cases in the United States and other nations caught the attention of the media and the general public, generating enthusiasm for phage therapy. It started to alter the situation so that more medical professionals are willing to use phage therapies with conventional antibiotics. However, more study is required to fully comprehend phage therapy's potential advantages and restrictions, which is still a relatively new field in medicine. It shows promise, nevertheless, as a secure and prosperous substitute for antibiotics when treating bacterial illnesses in animals and humans. Because of their uniqueness, phage disinfection is excellent for ready-to-eat (RTE) foods like milk, vegetables, and meat products. The traditional farm-to-fork method can be used throughout the food chain to employ bacteriophages to prevent food infections at all production stages. Phage therapy improves clinical outcomes in animal models and lowers bacterial burdens in numerous preclinical investigations. The potential of phage resistance and the need to make sure that enough phages are delivered to the infection site are obstacles to employing phages in vivo. However, according to preclinical studies, phages appear to be a promising alternative to antibiotics for treating bacterial infections in vivo. Phage therapy used with compassion (a profound understanding of and empathy for another's suffering) has recently grown with many case reports of supposedly treated patients and clinical trials. This review summarizes the knowledge on the uses of phages in various fields, such as the food industry, preclinical research, and clinical settings. It also includes a list of FDA-approved bacteriophage-based products, commercial phage products, and a global list of companies that use phages for therapeutic purposes.
Diffuse Large B-Cell Lymphoma, Not Otherwise Specified (DLBCL NOS) Presenting as Multiple Subcutaneous Nodules: An Unusual Cutaneous Presentation of Systemic Disease
Authors: Nika Tavberidze, Daniel D Bennett, Daniel R Matson
Journal: Case Rep Pathol (2023)
MeSH terms: Case Reports

Diffuse large B-cell lymphoma, not otherwise specified (DLBCL NOS) is the most common lymphoid malignancy in the Western world and classically presents as a rapidly enlarging nodal or extranodal mass. Cutaneous involvement by systemic DLBCL NOS is an infrequent clinical presentation, encountered in only 1.5-3.5% of cases, while disseminated cutaneous disease with multiple subcutaneous nodules at the time of diagnosis is unusual and can present a diagnostic challenge. The differential diagnosis when encountering a high-grade B-cell malignancy at a cutaneous site is broad and includes primary cutaneous follicle center lymphoma (PCFCL), primary cutaneous diffuse large B-cell lymphoma, leg type (PCDLBCL-LT), high-grade B-cell lymphoma with MYC and BCL2 rearrangements (HGBCL-MYC/BCL2), and other potential entities which must all be carefully considered before rendering a final diagnosis. In this report, we describe the case of a 69-year-old man who was seen at our hospital due to generalized weakness and was found to have multiple subcutaneous nodules representing disseminated DLBCL NOS. The case was complicated by concurrent monoclonal B-cell lymphocytosis involving the bone marrow.
Microendoscopic Ultrasound-Guided Percutaneous Tracheostomy (MUGPT): A Case Series Describing a Novel Technique for Performing Percutaneous Tracheostomy
Authors: Mayyas M Msheik, Amro F Khalili, Mustapha A Nahle, Chakib M Ayoub, Yara M Al Ghabour, Hachem Y Abdul-Kader, Marwan S Rizk
Journal: Case Rep Crit Care (2023)
MeSH terms: Case Reports

A percutaneous tracheostomy is a common surgical procedure done in intensive care. Several different techniques have been described. Recently, the addition of bronchoscopy or ultrasound has been advocated to decrease the risks and complications associated with the procedure; however, both aids used alone, bronchoscopy or ultrasound, have some drawbacks and pitfalls. In this manuscript, we describe a new technique implementing a new technology, Microendoscopy coupled with ultrasound to perform percutaneous dilation tracheostomy MUGPT. MUGPT relies on dual real-time feedback microendoscopy and ultrasound to perform percutaneous dilation tracheostomy. This technique helps reduce the risk of bleeding, airway loss, tracheal wall injury, tracheal ring fracture, damage to adjacent structures, pneumothorax, pneumomediastinum, subcutaneous emphysema, false placement, hypoxia, carbon dioxide retention bronchospasm, cardiac dysrhythmias, and cost reduction. Methods. This is a case series of 6 patients who underwent single-step percutaneous dilation tracheostomy using the MUGPT technique. All the patients were in ICU and were candidates for tracheostomy. Intraoperative data collection, vital signs, oxygen saturation, and end-tidal CO2 were measured. No postoperative or intraoperative complications were documented. Conclusion. Microendoscopic ultrasound-guided percutaneous tracheostomy (MUGPT) is a promising technique with minimal complications. It is a procedure that can be performed and taught easily to Junior physicians and is a lifesaver in difficult cases.