OpenMed/multicare-articles huggingface dataset:
Co-occurrence of tethered cord syndrome and cervical spine instability in hypermobile Ehlers-Danlos syndrome
Authors: Cortney Gensemer, Victoria Daylor, Jared Nix, Russell A Norris, Sunil Patel
Journal: Front Neurol (2024)
Keywords: ehlers danlos syndrome, cervical instability, cranio-cervical junction, hypermobile ehlers danlos syndrome, hypermobility, occult tethered cord, tethered cord syndrome

The Ehlers-Danlos Syndromes (EDS) represent a group of hereditary connective tissue disorders, with the hypermobile subtype (hEDS) being the most prevalent. hEDS manifests with a diverse array of clinical symptoms and associated comorbidities spanning the musculoskeletal, neurological, gastrointestinal, cardiovascular, and immunological systems. hEDS patients may experience spinal neurological complications, including cervico-medullary symptoms arising from cranio-cervical and/or cervical instability/hypermobility, as well as tethered cord syndrome (TCS). TCS is often radiographically occult in nature, not always detectable on standard imaging and presents with lower back pain, balance issues, weakness in the lower extremities, sensory loss, and bowel or bladder dysfunction. Cervical instability due to ligament laxity can lead to headaches, vertigo, tinnitus, vision changes, syncope, radiculopathy, pain, and dysphagia. TCS and cervical instability not only share clinical features but can also co-occur in hEDS patients, posing challenges in diagnostics and clinical management. We present a review of the literature and a case study of a 20-year-old female with hEDS, who underwent surgical interventions for these conditions, highlighting the challenges in diagnosing and managing these complexities and underscoring the importance of tailored treatment strategies to improve patient outcomes.
Cine magnetic resonance imaging in evaluating retroperitoneal leiomyosarcoma arising from the inferior vena cava
Authors: Taisuke Tobe, Tomoaki Terakawa, Yoshiko Ueno, Keitaro Sofue, Takuto Hara, Junya Furukawa, Jun Teishima, Yuzo Nakano, Kenichi Harada, Masato Fujisawa
Journal: IJU Case Rep (2023)
Keywords: cine mri, inferior vena cava, leiomyosarcoma, retroperitoneal neoplasm, vascular neoplasm
MeSH terms: Case Reports

Introduction:
Leiomyosarcoma of the inferior vena cava is associated with poor prognosis. Complete resection is the only curative treatment. We present a patient with this disease in whom cine magnetic resonance imaging was valuable in selecting the surgical strategy and mitigating invasiveness.
Case presentation:
A 68-year-old woman presented with right-sided abdominal pain. Computed tomography revealed an 86 mm tumor in the right retroperitoneal space that extended into the inferior vena cava and reached superiorly to the right atrium. Percutaneous needle biopsy confirmed leiomyosarcoma. Cine magnetic resonance imaging demonstrated no adhesions between the tumor and the upper segment of inferior vena cava wall, nor with the right atrial wall, indicating resectability. Radical tumor resection was successfully performed without requiring thoracotomy.
Conclusion:
Cine magnetic resonance imaging appears to be useful in inferior vena cava leiomyosarcoma for evaluating adhesions between the tumor and vessel wall.
Partial response to trastuzumab deruxtecan (DS8201) following progression in HER2-amplified breast cancer with pulmonary metastases managed with disitamab vedotin (RC48): a comprehensive case report and literature review
Authors: Yanfang Lan, Jiahui Zhao, Fangrui Zhao, Juanjuan Li, Xiangpan Li
Journal: Front Oncol (2024)
Keywords: her2-amplified breast cancer, antibody-drug conjugate, disitamab vedotin, tislelizumab, trastuzumab deruxtecan
MeSH terms: Case Reports

Breast cancer remains one of the predominant malignancies worldwide. In the context of inoperable advanced or metastatic human epidermal growth factor receptor 2 (HER2)-positive breast cancer, systemic management primarily relies on HER2-targeting monoclonal antibodies. With the successful development of anti-HER2 antibody-drug conjugates (ADCs), these agents have been increasingly integrated into therapeutic regimens for metastatic breast cancer. Here, we present the case of a 42-year-old female patient with HER2-positive pulmonary metastatic breast cancer who underwent an extensive treatment protocol. This protocol included chemotherapy, radiation therapy, hormonal therapy, surgical intervention on the breast, and anti-HER2 therapies. The anti-HER2 therapies involved both singular and dual targeting strategies using trastuzumab and the ADC disitamab vedotin (RC48) over an 8-year period. After experiencing disease progression following HER2-targeted therapy with RC48, the patient achieved noticeable partial remission through a therapeutic regimen that combined trastuzumab deruxtecan (DS8201) and tislelizumab. The data suggest a promising role for DS8201 in managing advanced stages of HER2-amplified metastatic breast cancer, especially in cases that demonstrate progression after initial HER2-directed therapies using ADCs. Furthermore, its combination with anti-PD-1 agents enhances therapeutic efficacy by augmenting the anti-tumoral immune response.
Case report: eosinophilic myocarditis in hypereosinophilic syndrome: a journey to heart transplantation
Authors: Shriya Sharma, Smruti Desai, Juan Leoni, Smit Paghdar, Jose Ruiz, Rohan Goswami
Journal: Front Immunol (2024)
Keywords: heart failure, heart transplant, hypereosinophilia, myocarditis, restrictive cardiomyopathy
MeSH terms: Heart Transplantation / adverse effects, Hypereosinophilic Syndrome / complications, Hypereosinophilic Syndrome / diagnosis, Hypereosinophilic Syndrome / drug therapy, Myocarditis / diagnosis, Myocarditis / etiology, Myocarditis / therapy, Case Reports, Eosinophilia / diagnosis, Eosinophilia / etiology, Female, Heart Failure / etiology, Humans, Middle Aged

Introduction:
Hypereosinophilic Syndrome (HES) is a rare disorder characterized by persistent elevation of eosinophils, leading to multi-organ infiltration and damage. Eosinophilic Myocarditis (EM) is one of its severe complications contributing significantly to morbidity and mortality. Herein, we describe the diagnostic and therapeutic challenges of EM, emphasizing the significance of early recognition and multidisciplinary management.
Case presentation:
A 51-year-old female with a history of EM, heart failure, and peripheral eosinophilia presented with NYHA class 3b symptoms. Laboratory findings revealed elevated peripheral eosinophil count, NT-Pro BNP, and characteristic electrocardiogram abnormalities. Imaging studies confirmed biventricular thrombi and myocardial abnormalities consistent with EM. Treatment involved Solu-Medrol for HES and heparin for ventricular thrombi, leading to initial clinical improvement. However, refractory heart failure necessitated urgent heart transplantation.
Discussion:
EM, an under-recognized complication of HES, poses diagnostic and management challenges. Management includes standard heart failure treatments, steroids, and emerging therapies like Mepolizumab. Early diagnosis and aggressive management are pivotal for improving outcomes in this rare and potentially fatal condition.
Conclusion:
Advancements in the detection of complications, surgical management, and therapeutic options have improved outcomes in HES. Ongoing research is essential to further understand and address the diagnostic and therapeutic challenges of HES and EM.
Diagnosis of Acute Pulmonary Embolism on a Non-contrast CT Scan
Authors: Letizia Ebser, Emmanuel Coche
Journal: J Belg Soc Radiol (2023)
Keywords: acute pulmonary embolism, halo sign, non-contrast chest ct-scan
MeSH terms: Case Reports

Teaching Point: There are two important signs that could be seen on a non-contrast chest CT scan that can lead to the diagnosis of a pulmonary embolism: the hyperdense pulmonary artery sign and pulmonary infarction.
Treatment and Resolution of an Implant Periapical Lesion (IPL) with Guided Bone Regeneration
Authors: Carlo Sgarbanti, Frank Armando Mauro
Journal: Case Rep Dent (2023)
MeSH terms: Case Reports

Background:
Implant periapical lesion (IPL) is a rare condition that can affect dental implants. Several different approaches have been proposed for the treatment of this condition. Awareness and literature discussing this condition and possible treatment options have grown significantly in the last 25 years. Case Presentation. The present case report describes the treatment of an implant periapical lesion with a combined approach consisting of surgical lesion removal, mechanical instrumentation with titanium brush, detoxification with tetracycline, and guided bone regeneration (GBR) with demineralized allograft bone and cross-linked collagen membrane. The patient was followed up for 6 months postoperatively, showing complete resolution of the buccal fistula. No signs or symptoms of discomfort or pathology were reported.
Conclusions:
The case report presented a combined approach that can be successful in the surgical treatment of an IPL in which the implant stability is maintained.
Follicular adenoma with bizarre nuclei and wild-type P53 expression: A case report and literature review
Authors: Daniel Nguyen, Nyein Nyein Htun, Beverly Wang
Journal: Rare Tumors (2023)
Keywords: follicular thyroid adenoma, bizzare nuclei, p53 immunohistochemistry, thyroid nodules, thyroidectomy
MeSH terms: Case Reports

Introduction:
Thyroid cancer is the most common endocrine tumor in humans. Follicular adenoma/carcinoma is the second most common subtype. Multiple histological patterns have been identified. Follicular adenoma with bizarre nuclei is one of the patterns associated with p53 mutation and has an unclear clinical prognosis.
Case report:
A 74-year-old female presented with incidental findings of elevated TSH levels and normal thyroid markers. Ultrasound was performed and revealed multiple bilateral thyroid nodules measuring up to 1.9 cm. Fine needle aspiration was performed, and cytology showed one Bethesda category 5 nodule. Total thyroidectomy with neck dissection was performed, and the pathology showed follicular adenoma with bizarre nuclei. Based on the results of immunohistochemistry, the neoplastic cells exhibited staining for wild-type p53 and low levels of the proliferation index Ki-67.
Conclusions:
We report a rare case of thyroid follicular adenoma with bizarre nuclei. In contrast to previous reports of this tumor, our patient showed a p53 wild-type pattern using immunohistochemistry. More studies are needed to better understand the etiology and clinical prognosis of this tumor.
Bronchial Asthma With Scimitar Syndrome: A Case Report
Authors: Syed F Jamil, Elham H Alsalahi, Abaad A Alamri, Majd A Alsaman
Journal: Cureus (2024)
Keywords: chest infection, congenital pulmonary artery hypoplasia, dextrocardia, infantile scimitar syndrome, lung agenesis
MeSH terms: Case Reports

Scimitar syndrome is a rare congenital cardiopulmonary anomaly; it is also called venolobar syndrome, hypogenic lung syndrome, and Halasz syndrome. The syndrome is characterized by cardiac dextroposition, right lung and pulmonary artery hypoplasia as well as complete or partial anomalous pulmonary venous drainage of the right lung. We report a case of a 22-month-old full-term male child with a severe form of scimitar syndrome diagnosed at birth. The X-ray demonstrated dextrocardia and right lung hypoplasia, while the echocardiography clearly illustrated the scimitar vein. The patient had multiple ER visits and hospitalizations due to asthma exacerbation that was aggravated by recurrent respiratory tract infections; he responded well to asthma medications during his admissions yet compliance to his prophylactic asthma medications was poor at home.
Generalized Extension of Referred Trigeminal Pain due to Greater Occipital Nerve Entrapment
Authors: Jung-Woo Hyung, Byung-Chul Son
Journal: Case Rep Neurol Med (2023)
MeSH terms: Case Reports

We report a very rare case of referred pain caused by greater occipital nerve (GON) entrapment, inducing spontaneous pain in the whole body as well as in the trigeminal nerve region of the face and head. It has already been reported that entrapment of the GON can induce referred pain in the ipsilateral limb as well as the ipsilateral hemiface. A 42-year-old female patient presented with chronic pain in her gums, jaw angle, submandibular region, retro-auricular suboccipital, and temporo-occipital vertex that had been ongoing for four years. As the patient's head pain and facial pain became severe, severe spontaneous pain occurred in the arm, waist, and both lower extremities. This patient's pain in the occipital and neck, spontaneous pain in the face, jaw, and whole body improved with decompression of the GON. Anatomical basis of pain referral to the facial trigeminal area caused by chronic GON entrapment is convergence of nociceptive inflow from high cervical C1-C3 structures and trigeminal orofacial area in the dorsal horn of the cervical spinal cord from the C2 segment up to the medullary dorsal horn (MDH). The major afferent contribution among the suboccipital and high cervical structure is mediated by spinal root C2 that is peripherally represented by the GON. Chronic noxious input from GON entrapment can cause sensitization and hypersensitivity in second order neurons in the trigeminocervical complex (TCC) and MDH in the caudal trigeminal nucleus and high cervical cord. Generalized extension of referred pain due to GON entrapment is thought to involve two possible pathophysiologies. One is the possibility that generalized pain is caused by sensitization of third-order nociceptive neurons in the thalamus. Another speculation is that spontaneous pain may occur throughout the body due to dysfunction of the descending brain stem pain-modulating pathway by sensitization and hyperexcitation of the MDH and trigeminal brainstem sensory nuclear complex (TBSNC).
Unveiling the Journey: A Case Report of Managing an Impacted Central Incisor
Authors: Anjali Kathade, Rizwan Gilani, Ranjit Kamble, Shefali Singh, Aishwarya Atey
Journal: Cureus (2024)
Keywords: alignment, central incisors, impaction, supernumerary tooth, surgical exposure
MeSH terms: Case Reports

Although impaction of the maxillary permanent central incisor is uncommon in dentistry due to its significance to facial aesthetics which are challenging to treat. To abstain from the consequences related to aesthetic and functional occlusion, early detection of an impacted central incisor is imperative. This case report describes a male patient, aged 22 years, who had an impacted central incisor tooth in the maxillary anterior region. A surgery was performed to remove the impacted supernumerary tooth that was preventing the eruption of the central incisor. Using a combination of surgical exposure and orthodontic force, the impacted right maxillary central incisor was relocated to its proper occlusion in the dental arch.
Massive Gastrointestinal Bleeding Related to NSAID Use in a Patient with Ileorectal Anastomosis
Authors: Esere Nesiama, Letisha Mirembe, Kierra Weber, Sruthy Isaac, Deborah Trammell, Izi Obokhare
Journal: Case Rep Surg (2024)
MeSH terms: Case Reports

Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used to reduce pain and inflammation in over 30 million individuals daily. Gastrointestinal bleeding (GIB) associated with NSAID consumption has been well documented in gastric and duodenal bleeding; however, NSAID-associated GIB distal to the duodenum lacks extensive documentation. This report highlights small bowel occult bleeding related to NSAID use in a patient with a surgical history of robotic total colectomy with ileorectal anastomosis completed 1 year prior. In the case of bright red blood per rectum with associated NSAID use, we recommend NSAID cessation followed by an individualized treatment plan, such as upper/lower endoscopy and/or angioembolization.
Case report: Envafolimab causes local skin necrosis
Authors: Jing Jing Liu, Xiao Ya Xu, Huan Han, Tong Wang, Wei Zhang, Jing Cui, Maksim Semenov
Journal: Front Immunol (2024)
Keywords: pd-l1, adverse drug reaction, case report, envafolimab, humanized monoclonal antibody, skin necrosis, subcutaneous
MeSH terms: Antibodies, Monoclonal, Humanized, Carcinoma, Hepatocellular, Liver Neoplasms, Case Reports, Research Support, Non-U.S. Gov't, Adult, Disease Progression, Humans, Immunoglobulin G, Necrosis, envafolimab, Immunoglobulin G, Antibodies, Monoclonal, Humanized

Envafolimab is a Chinese domestic innovative fusion of a humanized single-domain programmed death-ligand 1 (PD-L1) antibody (dAb) and human immunoglobulin IgG1 crystalline fragment (Fc) developed for subcutaneous injections. It was granted conditional market authorization by the China National Medical Product Administration (NMPA) in December 2021. Envafolimab is used to treat adult patients with previously treated microsatellite instability-high (MSI-H) or deficient mismatch repair (dMMR) advanced solid tumors, including patients with advanced colorectal cancer disease progression who were previously administered fluorouracil, oxaliplatin, and irinotecan, as well as other patients with advanced solid tumors who experienced disease progression after receiving standard treatment and had no other alternative treatment options. However, the lack of post-marketing clinical trial data requires conducting more clinical studies on the safety and efficacy of envafolimab in order to provide scientific basis and a reference for future therapeutic applications. In this paper, we report a case of severe skin necrosis and bleeding in the area of injection after subcutaneous administration of envafolimab in a patient diagnosed with hepatocellular carcinoma. We discuss issues that must be considered before administration of a PD-L1 inhibitor subcutaneously, which could induce immune mechanisms leading to skin necrosis in the area of injection.
Case report: Targeted sequencing facilitates the diagnosis and management of rare multifocal pure ground-glass opacities with intrapulmonary metastasis
Authors: Yingshun Yang, Guotian Pei, Mingwei Li, Xiaoxue Ma, Shuai Wang, Xianjun Min, Shushi Meng, Jiayue Qin, Huina Wang, Jun Liu, Yuqing Huang
Journal: Front Oncol (2024)
Keywords: egfr tyrosine kinase inhibitors, case report, circulating tumor dna, intrapulmonary metastasis, multiple primary lung cancer, thoracoscopic surgery
MeSH terms: Case Reports

Introduction:
Treatments for multiple ground-glass opacities (GGOs) for which the detection rate is increasing are still controversial. Next-generation sequencing (NGS) may provide additional key evidence for differential diagnosis or optimal therapeutic schedules.
Case presentation:
We first reported a rare case in which more than 100 bilateral pulmonary GGOs (91.7% of the GGOs were pure GGOs) were diagnosed as both multiple primary lung cancer and intrapulmonary metastasis. We performed NGS with an 808-gene panel to assess both somatic and germline alterations in tissues and plasma. The patient (male) underwent three successive surgeries and received osimertinib adjuvant therapy due to signs of metastasis and multiple EGFR-mutated tumors. The patient had multiple pure GGOs, and eight tumors of four pathological subtypes were evaluated for the clonal relationship. Metastasis, including pure GGOs and atypical adenomatous hyperplasia, was found between two pairs of tumors. Circulating tumor DNA (ctDNA) monitoring of disease status may impact clinical decision-making.
Conclusions:
Surgery combined with targeted therapies remains a reasonable alternative strategy for treating patients with multifocal GGOs, and NGS is valuable for facilitating diagnostic workup and adjuvant therapy with targeted drugs through tissue and disease monitoring via ctDNA.
Understanding inequalities in the coverage of adolescent sexual and reproductive health services: a qualitative case study of the selected regions of Zambia
Authors: Margarate Nzala Munakampe, Alice Ngoma-Hazemba, Mutale Sampa, Choolwe N Jacobs
Journal: Front Reprod Health (2024)
Keywords: acceptability, accessibility, adolescents and young people, availability, human rights framework, quality, sexual and reproductive health

Introduction:
Despite substantial investment in improving healthcare among adolescents in low- and middle-income countries, barriers to access and utilization of services persist, especially to sexual and reproductive health (SRH) services. In response to adolescents' health service needs due to their vulnerability, interventions aimed at improving access and utilization of sexual and reproductive health services have been implemented in specific regions of Zambia. To highlight progress in the access and the overall delivery of services in Zambia, in the wake of a system-level funding mechanism, this paper aims to understand the accessibility, availability, acceptability and quality (AAAQ) of health services provided to young people.
Materials and methods:
In a qualitative case study, 48 discussions- 32 individual interviews with stakeholders and 16 focus group discussions, consisting of 128 male and female adolescents were conducted in six districts from Eastern, Southern and Muchinga provinces of Zambia. Interviews were audio-recorded, recordings transcribed verbatim, and transcripts were analysed using deductive thematic analysis, using the AAAQ framework and Atun's framework on integration, as a guide to reporting the findings.
Results:
We found that adolescents knew of and had access to common commodities and services- male condoms, health education and HIV counselling and testing. However, availability was affected by access-related barriers such as frequent stock-outs and insufficiently trained healthcare providers. In addition, accessibility was more restricted during the COVID-19 pandemic lockdown and compounded by the low acceptability of SRH service among adolescents across all contexts. This led to the use of alternatives such as herbal medicine and maintained common myths and misconceptions. The overall quality was marred by the lack of dedicated spaces for adolescent health services and the lack of information, education and communication (IEC) materials in some spaces.
Conclusion:
While it was noted that some services were available for adolescents in all the study sites, numerous barriers inhibited access to these services and had an impact on the quality-of-service provision. With the added restriction to SRH service asses for young people, due to the low acceptability of adolescent SRH service use, the overall integration of adolescent SRH interventions into routine service provision was low and can be improved by targeting contextual barriers and maintaining best practices.
Case report: Good response to CMOP regimen containing mitoxantrone hydrochloride liposome (PLM60) as induction chemotherapy in patients with angioimmunoblastic T-cell lymphoma
Authors: Lijie Liang, Ming Jiang
Journal: Front Oncol (2024)
Keywords: cmop, plm60, angioimmunoblastic t-cell lymphoma, case report, mitoxantrone hydrochloride liposome
MeSH terms: Case Reports

Angioimmunoblastic T-cell lymphoma (AITL) is a highly aggressive subtype of peripheral T-cell lymphoma. The current prognosis with the first-line standard of care remains unsatisfactory, necessitating the exploration of more effective treatment options. We reported 5 cases of AITL receiving CMOP (mitoxantrone hydrochloride liposome, cyclophosphamide, vincristine, and prednisone). Cases 1 and 2 initially received CHOP as first-line induction therapy but switched to CMOP due to inadequate efficacy and cardiac adverse events. Cases 3, 4, and 5 were newly diagnosed and received CMOP. All patients achieved complete remission with acceptable cardiotoxicities and hematologic toxicities. After study treatment discontinuation, Cases 1 and 3 underwent autologous stem cell transplantation, and Cases 4 and 5 received oral maintenance agents. At the last follow-up, 4 patients remained in remission and 1 (Case 2) exhibited tumor recurrence. CMOP showed promise as a potential treatment option for AITL patients. Further research is essential to identify its efficacy and safety.