OpenMed/multicare-articles huggingface dataset:
Total arch replacement for aortic arch aneurysm with coexisting middle aortic syndrome
Authors: Zaiqiang Yu, Masahito Minakawa, Norihiro Kondo, Kazuyuki Daitoku, Ikuo Fukuda
Journal: Int J Surg Case Rep (2019)
Keywords: aortic arch aneurysm, axillary-femoral artery bypass, case report, middle aortic syndrome

Introduction:
Middle aortic syndrome (MAS) combined with thoracic aortic aneurysm (TAA) is a rare vascular disease. One stage open surgery to treat this condition, becomes a challenge for our cardiovascular surgery.
Presentation of case:
A 69-year-old man presented with a saccular type aortic arch aneurysm, shaggy aorta and severe atherosclerotic stenosis of the thoracoabdominal aorta with middle aortic syndrome and aberrant right subclavian artery, renovascular hypertension, renal dysfunction, and intermittent claudication of both legs. Total arch replacement procedure was performed under a cardiopulmonary bypass using aortic inflow from the right axillary artery and a femoro-femoral crossover bypass graft to avoid malperfusion of the lower body. Before weaning from the cardiopulmonary bypass, we established an extra-anatomical bypass from the ascending aortic graft to the femoro-femoral crossover bypass graft. 3D-CT showed patency of bypass graft without any sign of stenosis postoperative. The patient's postoperative course was uneventful and he was discharged from hospital with improvements in intermittent claudication, hypertension, and renal dysfunction.
Discussion:
Although open surgery including graft bypass for MAS is more invasive than endovascular treatment, it could be performed successfully to preventing from intraoperative complication or complications postoperatively.
Conclusion:
Combined operation of total arch replacement and a bypass from the ascending aorta to the bifemoral arteries is alternative for MAS combined with TAA.
Temporary airway stenting for giant anterior mediastinal tumor biopsy: Two case reports
Authors: Ryoichi Matsumoto, Masahiro Mitsuoka, Toshihiro Hashiguchi, Shintaro Yokoyama, Daigo Murakami, Koichi Yoshiyama, Tatsuya Nishi, Masaki Kashihara, Hirofumi Ono, Shinzo Takamori, Yoshito Akagi
Journal: Int J Surg Case Rep (2019)
Keywords: anterior mediastinal tumour, case report, central airway obstruction, temporary stenting

Introduction:
When the management of an anterior mediastinal tumor requires general anesthesia, airway narrowing and obstruction may occur secondary to muscle relaxation.
Presentation of cases:
Two men (ages, 15 and 36 years) presented with a giant anterior mediastinal tumor and central airway obstruction. We used Dumon stents to effectively secure the airway in both patients. After chemotherapy, stent removal was safely performed in each case because the tumor was substantially smaller.
Discussion:
Dumon stents effectively secured the airway. These stents were easily removed after chemotherapy without severe complications.
Conclusion:
Temporary stenting is useful in patients with a giant anterior mediastinal tumor who require general anesthesia.
Case Report: SAPHO Syndrome Mimicking Bone Metastases During Treatment With Pembrolizumab for Non-small Cell Lung Cancer
Authors: Yuko Kubo, Kimiteru Ito, Yutaka Fujiwara, Tatsuya Yoshida, Masahiko Kusumoto
Journal: Front Med (Lausanne) (2021)
Keywords: sapho syndrome, immune- related adverse event, immune-checkpoint inhibitors, non-small cell lung cancer, pembrolizumab
MeSH terms: Case Reports

A 69-year-old female with recurrent stage IV squamous cell lung carcinoma and metastatic abdominal lymph node but not bone metastases was being treated with pembrolizumab. Four months after starting the recurrent treatment, the tumour reduced in size but she began to complain of back pain and palmar rash. A bone scan showed uptake lesions in the left sternocostal joints and vertebrae, while spine magnetic resonance imaging (MRI) showed multiple lesions in the thoracic vertebrae. Her heterogeneous lesions, such as skin and multiple bone manifestations, were comprehensively diagnosed as SAPHO syndrome by different experts. Furthermore, the SAPHO syndrome was suspected to be an immune-related adverse event induced by pembrolizumab, and pembrolizumab withdrawal and prednisolone treatment were performed. Subsequently, her symptoms improved and the follow-up imaging findings showed that the bone lesions had almost disappeared. This case demonstrates that SAPHO syndrome mimicking bone metastases developed during treatment with pembrolizumab. SAPHO syndrome is rare and bone lesions related to the disease may be misdiagnosed as bone metastases. Therefore, it is important in the future for various physicians to have a better understanding of SAPHO syndrome and to consider the potential relationship between this disease and immunotherapy.
Intra-Abdominal Hemorrhage following Cardiopulmonary Resuscitation: A Report of Two Cases
Authors: Christos Koutserimpas, Argyrios Ioannidis, Petros Siaperas, Andreas Skarpas, Andreas Tellos, Georgios Velimezis, Ioannis Karanikas
Journal: Case Rep Emerg Med (2018)
MeSH terms: Case Reports

Cardiopulmonary resuscitation (CPR) represents an emergency procedure, consisting of chest compressions and artificial ventilation. Two rare cases of intra-abdominal bleeding following cardiac compressions are reported. The first case was a 29-year-old female with massive pulmonary embolism (PE). Following CPR due to cardiac arrest, she showed signs of intra-abdominal bleeding. A liver laceration was found and sutured. The patient passed away, due to massive PE. The second patient was a 62-year-old female, suffering from cardiac arrest due to drowning at sea. CPR was performed in situ. At presentation to the emergency department she showed signs of intra-abdominal bleeding. The origin of the hemorrhage was found to be vessels of the lesser curvature of the stomach, which were ligated. Regarding the first patient PE has already been described as a cause for liver lacerations in CPR due to stasis and liver enlargement. The second case is the first report of gastric vessel injury without gastric rupture/laceration and pneumoperitoneum. Complications of CPR should not represent a drawback to performing cardiac compressions. Parenchymatic injuries have been related to inappropriate technique of chest compressions during basic life support. Therefore, it is of utmost importance for the providers to refresh their knowledge of performing CPR.
Heterogeneous disease and intermittent treatment in metastatic colorectal cancer: A case report
Authors: Alfonso De Stefano, Nicoletta Zanaletti, Antonino Cassata, Lucrezia Silvestro, Anna Nappi, Rossana Casaretti, Carmela Romano, Francesca Foschini, Claudia Cardone, Marco Borrelli, Antonella Petrillo, Alfredo Budillon, Paolo Delrio, Antonio Avallone
Journal: Front Oncol (2023)
Keywords: braf, ras, anti-egfr, case report, intermittent strategy, precision medicine, resistance, tumor heterogeneity
MeSH terms: Case Reports

Background:
Metastatic colorectal cancer is one of the most common causes of cancer death worldwide. RAS and BRAF mutational analyses are strongly recommended before beginning chemotherapy in the metastatic setting for their predictive role for the efficacy of anti-EGFR monoclonal antibodies. In most of cases, mutational status coincides between primary tumor and metastases. In RAS and BRAF wild-type patients treated with anti-EGFRs, after an induction treatment period, recent evidence supports the role of a maintenance treatment with fluoropyrimidines and anti-EGFRs. However, skin toxicity is the most described and limiting side-effect of maintenance. Moreover, it is described that the continuous administration of these monoclonal antibodies leads to an acquired resistance to anti-EGFRs, with subsequent treatment failure. Intermittent strategy with chemotherapy plus anti-EGFR may help maintain treatment efficacy, delaying resistance.
Case presentation:
In this case report, we describe the case of a RAS-BRAF wild-type elderly patient undergoing first-line chemotherapy with FOLFOX + panitumumab, reporting response of disease on all metastatic sites except for a node. This node, surgically removed, revealed host BRAF V600 mutant clones. After surgery, patient continued chemotherapy with a stop-and-go strategy continuing to benefit from the same drugs after 4 years since diagnosis, and continuing to achieve response when on treatment, avoiding unacceptable anti-EGFR toxicity. This patient, still alive after 6 years since the diagnosis, represents the case of a good synergy between molecular profiling of disease, surgery, and intermittent treatment.
Mesothelioma in Familial Mediterranean Fever With Colchicine Intolerance: A Case Report and Literature Review
Authors: Rosa Talerico, Carmine Cardillo, Francesco De Vito, Francesca Schinzari, Manuel Soldato, Maria Cristina Giustiniani, Elena Verrecchia, Raffaele Manna
Journal: Front Immunol (2020)
Keywords: familial mediterranean fever (fmf), anakinra, canakinumab, colchicine, interleukin (il)-1b inhibition, malignant mesothelioma (mst), peritoneal recurrent inflammation
MeSH terms: Colchicine / therapeutic use, Familial Mediterranean Fever / diagnosis, Inflammation / diagnosis, Interleukin 1 Receptor Antagonist Protein / therapeutic use, Mesothelioma / diagnosis, Peritoneum / diagnostic imaging, Pyrin / genetics, Case Reports, Aged, Colchicine / adverse effects, Familial Mediterranean Fever / complications, Familial Mediterranean Fever / drug therapy, Homozygote, Humans, Inflammation / complications, Inflammation / drug therapy, Leukopenia, Male, Mesothelioma / complications, Mesothelioma / drug therapy, Peritoneum / pathology, Polymorphism, Genetic, Tomography, X-Ray Computed, Interleukin 1 Receptor Antagonist Protein, MEFV protein, human, Pyrin, Colchicine

A 65-year-old Italian physician affected by Familial Mediterranean fever (FMF) was hospitalized due to progressive abdominal enlargement, which had begun 6 months before admission. Physical examination revealed ascites and bilateral leg edema. Abdominal CT scan showed ascitic fluid and extensive multiple peritoneal implants; peritoneal CT-guided biopsy revealed an epithelial-type malignant mesothelioma. The patient's past medical history revealed recurrent episodes of abdominal pain and fever from the age of 2. Clinical diagnosis of FMF was suspected at the age of 25, while genetic analysis, performed at the age of 50, confirmed homozygosity for the M694I mutation in the MEFV gene. Treatment with the first line FMF drug colchicine was started and stopped several times because of worsened leukopenia. The patient in fact had a history of asymptomatic leukopenia/lymphopenia from an early age; the intake of colchicine aggravated his pre-existing problem until the definitive suspension of the drug. As for second-line drugs, canakinumab was first prescribed, but due to prescription issues, it was not possible to be administered. When he was given anakinra, there was a worsening of leukopenia leading to septic fever. Systematic literature review indicates that, in most cases, recurrent peritoneal inflammation results in benign peritoneal fibrosis or less commonly in encapsulating peritonitis. There are only a few reported cases of recurrent peritoneal inflammation progressing from FMF to peritoneal mesothelioma (MST). In such cases, intolerance to colchicine or its erratic intake may lead to long-term recurrent inflammation, which usually precedes the development of the tumor, while pre-existing leukopenia, as in our patient, could also be a factor promoting or accelerating the tumor progression. In conclusion, we suggest that in the presence of intolerance or resistance to colchicine, interleukin (IL)-1 inhibition could suppress peritoneal inflammation and prevent MSTs.
Cerebral aspergillosis after heart-lung transplantation in a child: Case report with 3-year follow-up and literature review
Authors: Huanwei Zhuang, Kun Xiang, Shuji Gong, Yangang Zhou, Jinlan Chen
Journal: Front Cardiovasc Med (2023)
Keywords: aspergillus, heart-lung transplantation, intracranial infection, metagenomic next-generation sequencing (mngs), voriconazole
MeSH terms: Case Reports

There are limited cases of heart-lung transplantation (HLT) in children worldwide owing to lack of donors, demanding surgical teamwork, and arduous post-operative management. Post-transplant management difficulties stem from the possible development of several post-operative complications, with infection being a common complication. Intracranial fungal infections are difficult to diagnose and prone to treatment delays because of their relatively insidious onset and atypical clinical presentation. Here, we present a case of a cerebral infection developed 3 months after HLT in a 10-year-old child, showing no positive results on conventional imaging or cerebrospinal fluid (CSF) examination and culture. On metagenomic next-generation sequencing of the cerebrospinal fluid, the causative organism was finally determined as Aspergillus. After administering 1-year anti-Aspergillus treatment, no recurrence of intracranial fungal infection was noted during the 3-year follow-up. This case illustrates the multifaceted diagnostic techniques for cerebral aspergillosis after HLT and shows the significance of dynamic monitoring of symptoms, such as headache, and of metagenomic sequencing results, trends in intracranial pressure and (1-3)-β-D-glucan levels for guiding diagnosis and treatment.
Implant therapy in patients with chronic periodontitis: A short follow-up with a successful outcome
Authors: Farhan Durrani, Akanksha Shukla, Himani Painuly
Journal: J Adv Periodontol Implant Dent (2019)
Keywords: bone loss, biological complications, dental implants, long-term survival, peri-implantitis, periodontitis, supportive periodontal therapy
MeSH terms: Case Reports

Chronic periodontitis is a progressive disease with loss of several teeth. Implant therapy in these patients can be a successful outcome as long as the tissues are kept healthy from a microbiologic viewpoint. Regular follow-up visits after complex reconstruction is the key for long-term success. In our report, recall visits were kept on short intervals for ten years. The results showed that implants were very good prosthetic replacements in chronic sufferers of the disease but regular followups are the gold standard.
Computed tomography angiography successfully used to diagnose postoperative systemic-pulmonary artery shunt narrowing
Authors: Kurt D Piggott, David G Nykanen, Susan Smith
Journal: Case Rep Cardiol (2011)
MeSH terms: Case Reports

In recent years, there has been a marked reduction in surgical mortality for many complex forms of congenital heart disease. Treatment or palliative strategies vary but may include systemic-pulmonary central or Blalock-Taussig shunt. These shunts can be complicated by overcirculation, infection, thrombosis, and thromboembolism. Many diagnostic modalities are available to aide in diagnosis of postoperative shunt complications including echocardiography and cardiac catheterization but these may be invasive, inconclusive, or difficult to obtain adequate images. Computed tomography angiography (CTA) has many attributes that make it potentially useful in the evaluation of congenital heart disease and postoperative shunt complications. We report one patient where CTA guided the post-operative algorithm and appropriately identified a shunt narrowing despite repeated echocardiograms showing a patent shunt. These findings along with clinical suspicion appropriately guided us toward cardiac catheterization. To our knowledge, this is the first paper where CTA appropriately suspected a shunt narrowing in the absence of echocardiographic confirmation.
A Case Series and Review of Bacillus Cereus Endocarditis from India
Authors: Anusha Gopinathan, Anil Kumar, Amitabh C Sen, Srisruthy Sudha, Praveen Varma, Sunil Gs, Malini Eapen, Kavitha R Dinesh
Journal: Open Microbiol J (2018)
Keywords: bacillus species, bacteremia, endocarditis, gram positive bacilli, infant, valvular heart disease
MeSH terms: Case Reports

Introduction:
Bacillus cereus is a gram positive bacilli found commonly in the soil and environment. It is a bacteria rarely associated with endocarditis.
Case history:
Intravenous drug abuse, presence of valvular defects, pacemakers, immunodeficiency are some of the known risk factors for B.cereus endocarditis. We present here a case series of two patients with B.cereus endocarditis along with a review of the literature.
Conclusion:
This is the first report of B.cereus endocarditis from India to the best of our knowledge.
Severe periodontal disease associated with long-term treatment with intravenous immunoglobulin
Authors: Jôice Dias Corrêa, Amanda Leal Rocha, Lidiane Cristina Machado Costa, Denise Travassos, Wagner Henriques Castro, Gustavo Pompermaier Garlet, Rodrigo Santiago Gomez, Antônio Lúcio Teixeira, Tarcília Aparecida Silva
Journal: Case Rep Dent (2014)

Intravenous immunoglobulin (IVIG) is used in the treatment of neuropathy. This case report presents, for the first time, a patient with severe periodontal destruction after chronic therapy with IVIG. The patient reported having extracted his maxillary anterior teeth himself due to high mobility. Clinical examination and radiographic images show a generalized and severe periodontitis. No significant alterations in genetic or microbiological features were observed. The present case suggests that periodontal disease aggravation could be considered a new adverse effect of IVIG therapy. Postulated mechanisms are immune complexes formation, complement activation, and a direct effect in osteoclasts. In conclusion, it is important that patients that will receive IVIG treatment underwent dental evaluation.
Reoperation as a result of raised intracranial pressure associated with cyst formation in tumor cavity after intracranial tumor resection: a report of two cases
Authors: Jinlu Yu, Wenji Xiong, Limei Qu, Haiyan Huang
Journal: Case Rep Med (2010)
MeSH terms: Case Reports

Reoperation as a result of increased intracranial pressure (ICP) associated with cyst formation in an intracranial tumor resection cavity is a rare clinical condition. We report two cases of reoperation as a result of raised ICP associated with cyst formation in the tumor resection cavity, one arising after glioma resection and the other after meningioma resection. In both cases, a "valve"-like structure was noted intraoperatively in the roof region of the tumor resection cavity. Surgical resection of the "valve"-like structure led to slow regression over several months after the reoperation rather than to immediate disappearance of the cyst. Both cases illustrate that the "valve"-like structure formed in the roof region of the tumor resection cavity may be responsible for cyst formation. Surgical resection of it provides good long-term outcomes in such patients though short-term outcomes are unsatisfactory; we speculate that if the resection of the cortical tissue around the "valve"-like structure is enough wide, its return may be avoided.
A Case of a Persistent Postoperative Infection Caused by Multidrug-Resistant Kluyvera ascorbata in the Oral and Maxillofacial Region
Authors: Si-Hai Zou, Lu-Ying Zhu, Yong Li, Fu-Gui Zhang
Journal: Case Rep Infect Dis (2019)
MeSH terms: Case Reports

Introduction:

Kluyvera ascorbata infection is rare, but it has been extensively studied because of its potential to cause a wide range of infections and its ability to transfer the gene encoding for CTX-M-type extended spectrum β-lactamases (ESBLs) to other Enterobacteriaceae.
Case presentation:
The authors report a case of a 61-year-old Chinese male with a persistent postoperative infection caused by a multidrug-resistant ESBL-producing K. ascorbata. Following antimicrobial susceptibility testing, he was aggressively treated with gentamicin and levofloxacin with a favorable outcome.
Conclusion:
To our knowledge, this is the first case report of a persistent postoperative infection caused by a multidrug-resistant K. ascorbata in the oral and maxillofacial region. The authors suggest that K. ascorbata infection warrants prompt identification and aggressive antibiotic management, given that ESBL-producing K. ascorbata is resistant to penicillins and first-generation to third-generation cephalosporins.
Giant Perineal Solitary Fibrous Tumor: A Rare Case Report
Authors: Petronio Augusto de Souza Melo, Ana Maria Yoshino Bonifaci, Fabio da Silva Crochik, Claudio Bovolenta Murta, Joaquim Francisco de Almeida Claro, Joao Padua Manzano
Journal: Case Rep Urol (2017)
MeSH terms: Case Reports

Background. Solitary fibrous tumor (SFT) is a fibroblastic mesenchymal tumor that was initially described from the pleura but currently arises at almost every anatomic site. It is usually benign, and surgical resection is curative. SFT involving the perineum is extremely rare. This is the third case report of a perineal SFT in the literature. Case Presentation. We reported an uncommon case of a 64-year-old man presenting with a huge perineal mass that started growing 3 years before his arrival in our service. He was asymptomatic. A contrast-enhanced CT scan revealed a heterogeneous well-circumscribed perineal mass with soft-tissue density. Invasion of the surrounding organs, distal metastasis, and lymph node swelling were absent. The complete resection of mass was done successfully. The specimen was a 23.0 × 14.0 × 8.0 cm encapsulated tumor. Mass weight was 1,170 g. After pathological analysis, we confirmed that the mass was a solitary fibrous tumor. The diagnosis was based on clinical findings and histological morphology and immunohistochemistry study. Conclusion. SFTs are usually indolent tumors with a favorable prognosis. The perineal location is extremely rare. Complete resection of the mass is the treatment of choice.
Upper Tract Urothelial Carcinoma in the Genetically Predisposed Patient: Role of Urinary Markers in Predicting Recurrence
Authors: Wei Phin Tan, Nahom Tecle, Patrick Whelan, Andrea Strong, Leslie A Deane
Journal: J Endourol Case Rep (2016)
Keywords: cxbladder, fish assay, urine cytology, urothelial cancer
MeSH terms: Case Reports

Background: Upper tract urothelial carcinoma (UTUC) is an uncommon disease that is diagnosed clinically by the selective use of urine cytology, urine biomarkers, and imaging of the upper tract. We present a case of a patient with Lynch syndrome and high-grade UTUC that was diagnosed by an abnormal Cxbladder assay, prompting further endoscopic examination. Case Presentation: A 59-year-old Caucasian female with a history of endometrial cancer and bladder cancer with Lynch syndrome presented for evaluation of recurrent urothelial carcinoma. Her previous bladder tumors have been T1 high grade and Ta high grade and have been treated with resection and multiple cycles of intravesical Bacillus Calmette-Guerin (BCG) therapy. She had also undergone a robotic left distal ureterectomy and psoas hitch for a high-grade distal ureteral tumor. Surveillance cystoscopy 7 months after revealed a biopsy-confirmed bladder tumor, which was resected, and she was started on maintenance BCG therapy. At presentation, follow-up urine cytology and UroVysion studies were negative. Cxbladder test was also initially negative. However, during close clinical monitoring, the Cxbladder test became positive. Cystoscopy was once more performed, which was unremarkable. Bilateral ureteroscopy was performed, revealing high-grade upper tract renal papillary carcinoma (UTUC) in the left renal pelvis. The patient declined a nephroureterectomy. She was treated with two sessions of holmium laser ablation of the left renal pelvis tumor and underwent 6 weekly courses of BCG + interferon instilled into her left renal pelvis using a 5F open-ended catheter. Repeat urine cytology, UroVysion, and Cxbladder tests were negative after completion of upper tract BCG therapy. Conclusion: Cxbladder test may be useful and an adjunct to urine cytology and the UroVysion FISH assay to evaluate patients at high risk for recurrent UTUC.