OpenMed/multicare-articles huggingface dataset:
Isolated posterior malleolus fracture: a rare injury mechanism
Authors: Sancar Serbest, Uğur Tiftikçi, Haci Bayram Tosun, Engin Kesgin, Metin Karataş
Journal: Pan Afr Med J (2015)
Keywords: ankle, ankle sprain, ottawa ankle rules, fracture, isolated, posterior malleolar fractures
MeSH terms: Ankle Injuries / diagnosis, Tibial Fractures / diagnosis, Case Reports, Accidents, Traffic, Adult, Bone Screws, Delayed Diagnosis, Diagnostic Errors, Emergencies, False Negative Reactions, Female, Fracture Fixation, Internal, Humans, Physical Examination, Soft Tissue Injuries / diagnosis, Symptom Assessment, Tibial Fractures / surgery, Tomography, X-Ray Computed

Sprain of the ankle is undoubtedly a common injury during athletic activity, and the sprain can be also associated with fracture of the ankle. Isolated posterior malleolus fracture is a very rare condition, which is usually missed. Here, we are presenting a 37 years old female patient, who suffered injury secondary pressing on brake pedal during collision in a traffic accident. Clinical evaluation is based on Ottawa Ankle Rules and a fracture is diagnosed; patient is started on daily activities at postoperative Week 8. This study aims to emphasize that Ottawa Ankle Rules are usually efficient for evaluating fractures of ankle, but clinicians should always make a detailed physical examination.
A case of early pulmonary embolism following blunt trauma to chest and a long bone fracture: a case report
Authors: Yalini Thivaharan, Asurappulige Dayapala, Muthulingam Thanushan
Journal: Egypt J Forensic Sci (2023)
Keywords: chest trauma, de novo thrombi, deep vein thrombosis, early pulmonary embolism, long bone fracture
MeSH terms: Case Reports

Background:
After substantial trauma, pulmonary embolism (PE) carries a high risk of morbidity and mortality. Early post-traumatic PE in the absence of deep vein thrombosis (DVT) is a distinct entity that might be connected to rare mechanisms or unidentified biochemical processes.
Case presentation:
A driver of a car was presented with worsening chest pain and shortness of breath (SOB) following a road traffic accident in which he suffered an impact on the chest against the steering wheel and a closed fracture of the right femur. Radiological investigations revealed a pulmonary embolism in the left posterior segment pulmonary artery, without evidence of internal chest injuries or DVT within 12 h from the incident. D-dimer, troponin I, and creatinine kinase were elevated without evidence of myocardial infarction or myocardial injury. Other parameters were within the normal range.
Conclusions:
Possibilities of early PE in the absence of detectable DVT could be due to hyper-coagulability states, clots from the lower extremity completely getting detached and embolizing to the pulmonary circulation, screening errors, and "de novo" thrombi in the pulmonary circulation. Chest trauma is an identified risk factor for early or late pulmonary embolism. Action of the post-traumatic adrenergic response causing vascular endothelial inflammation and the synthesis of circulating adhesion molecules leading to localized thrombosis have also been suggested as causes for this phenomenon. A greater understanding of rare risk factors for early PE and the possibility of rare complications of chest trauma is useful in detecting and treating them in time, reducing morbidity and mortality.
20p12.3 deletion is rare cause of syndromic cleft palate: case report and review of literature
Authors: Saadia Amasdl, Abdelhafid Natiq, Aziza Sbiti, Maria Zerkaoui, Jaber Lyahyai, Saaid Amzazi, Thomas Liehr, Abdelaziz Sefiani
Journal: BMC Res Notes (2016)
MeSH terms: Chromosome Deletion, Chromosomes, Human, Pair 20 / genetics, Cleft Palate / genetics, Case Reports, Review, Child, Preschool, Chromosome Banding, Humans, In Situ Hybridization, Fluorescence, Infant, Infant, Newborn, Karyotyping, Male

Background:
Orofacial cleft (OFC) is one of the most common congenital malformations with a global incidence of approximately 1/700 live births. Clinically, OFCs can be syndromic or non-syndromic.
Case presentation:
A 5 years old boy admitted for genetic evaluation because of psychomotor delay, failure to thrive, dysmorphic features and cleft palate. Conventional cytogenetic showed a notably short p arm of one chromosome 20. FISH analysis identified the derivative chromosome 20 as a de novo 20p12.3 deletion.
Conclusion:
We present in this paper a Moroccan patient with syndromic cleft palate caused by a de novo 20p12.3 deletion, and we highlight the interest of FISH in the diagnosis confirmation of chromosomal rearrangement. In practice, 20p12.3 deletion should be considered as an etiological diagnosis in the case of syndromic cleft palate.
The Effects of NBF Gingival Gel Application in the Treatment of the Erosive Lichen Planus: Case Report
Authors: Mirjana Popovska, Jasmin Fidovski, Sonja Mindova, Katerina Dirjanska, Stevica Ristoska, Emilija Stefanovska, Vera Radojkova-Nikolovska, Kristina Mitic, Biljana Rusevska
Journal: Open Access Maced J Med Sci (2016)
Keywords: nbf gingival gel, erosive lichen planus, therapy, topical treatment

The therapy of erosive lichen planus (ELP) has been particular problem in the treatment of oral lesions. This case of ELP in male patient 29 years old was treated with topic application of the NBF gingival gel, three times a day after meal, previously rinsed with Clorhexidine gluconate 0.12%. After 5 days of treatment, initial improvements were recorded, and after two weeks of application of the NBF gingival gel we observed significant improvement. Clinical monitoring after the fifth day showed mild epithelialization of the eroded mucosa, yet still present erythematous base of the lesion. After the second week the erythema area was significantly reduced and the eroded surfaces of the mucosa were minimal, measured less than 0.5 mm. After the third week there were no erosions to detect on the oral mucosa, yet still present vague redness, which completely pulled after the fourth week. Treatment ended after the fifth week when the topical application of the NBF gingival gel was terminated, and therapy was done, and clinically achieved effects remained stable even after the third month of the treatment. Topic application of the NBF gingival gel with ELP patients showed positive clinical effects in relatively short time period.
Isolated Pulmonary Hydatid Cyst: A Rare Presentation in a Young Maasai Boy from Northern Tanzania
Authors: Jay Lodhia, Ayesiga Herman, Rune Philemon, Adnan Sadiq, Deborah Mchaile, Kondo Chilonga
Journal: Case Rep Surg (2019)
MeSH terms: Case Reports

Introduction:
Hydatidosis is a parasitic manifestation caused by Echinococcus granulosus. It is characterized by cystic lesions in the liver and lungs. Diagnosis is based on typical history and radiological measures.
Case presentation:
A four-year-old boy presented with a one-year history of dry cough and difficulty in breathing which was of gradual progression. Computed tomography of the chest revealed a large 11.7 cm × 8.6 cm × 11.0 cm cyst in the right hemithorax. The patient underwent thoracotomy and recovered well post procedure.
Conclusion:
This case report highlights that large hydatid cysts can be surgically removed with good outcome and the importance of realizing that the disease is a burden to the public health and is much neglected.
Textiloma, migration of retained long gauze from abdominal cavity to intestine
Authors: Hojjat Molaei Govarjin, Mohsen Talebianfar, Farinaz Fattahi, Mohammad Esmaeil Akbari
Journal: J Res Med Sci (2010)
Keywords: foreign body, gossypiboma, retained surgical towel, surgical error
MeSH terms: Case Reports

Retaining of gauzes and surgical sponges in the abdomen is one of the most frequent medical errors usually manifesting as abscess or abdominocutaneus fistulas with no definite symptoms during lifetime. Here, we introduce a 35 year old woman with symptoms and signs of partial bowel obstruction and enterocutaneous fistulas caused by migration of retained gauze from abdominal cavity to terminal ileum, 9 months after cesarean section. This is called "Textiloma". There are several reports of gossypiboma worldwide but migration of retained gauze into intestine causing an enterocutaneous fistula is rare.
Reduction of orbital inflammation following decompression for thyroid-related orbitopathy
Authors: Sang-Rog Oh, Jonathan D Tung, Ayelet Priel, Leah Levi, David B Granet, Bobby S Korn, Don O Kikkawa
Journal: Biomed Res Int (2013)
MeSH terms: Decompression, Surgical, Inflammation / surgery, Orbit / pathology, Orbital Diseases / surgery, Thyroid Gland / pathology, Case Reports, Research Support, Non-U.S. Gov't, Female, Humans, Inflammation / complications, Male, Middle Aged, Orbital Diseases / complications, Postoperative Care, Preoperative Care

Purpose:
Thyroid-related orbitopathy (TRO) is associated with inflammation, expansion of orbital fat, enlargement of extraocular muscles, and optic neuropathy (ON). We examined the effects of orbital decompression on the inflammatory and congestive signs of TRO in patients who underwent emergent orbital decompression.
Methods:
This retrospective, consecutive study included patients with ON from TRO who underwent orbital decompression. Pre- and postoperative orbital inflammatory signs in the operated and nonoperated, contralateral eyes were graded with the 10-item clinical activity score (CAS).
Results:
Thirty-one orbits were included. Postoperatively, 22 patients and 29 orbits had resolution of ON while the remaining 2 patients had improvement in visual acuity. Mean preoperative CAS was 9.5 ± 0.4. At 12 months, postoperative CAS was 2.1 ± 0.6 (P < 0.01) in the operated eye and 3.2 ± 0.5 (P < 0.05) in the nonoperated, contralateral eye.
Conclusion:
In our series, 94% of orbits had resolution of ON. There was also a statistically significant postoperative reduction in the CAS in both the operated and nonoperated, contralateral eyes. This phenomenon may be due to lowered venous congestion, decreased intraorbital pressure, and diminution in inflammatory factors.
Disseminated Kaposi sarcoma presenting in unusual locations: A case report
Authors: Adziambei Mudau, Nonjabulo Z Makhanya, Farhana E Suleman
Journal: SA J Radiol (2017)
MeSH terms: Case Reports

Kaposi sarcoma (KS) is the most common malignancy associated with HIV infection. It usually affects the skin, the gastrointestinal tract and the lungs. It is generally described in the setting of CD4 counts < 150 cells/mm3 - 200 cells/mm3. We describe a case of recurrence of KS with a rare presentation of breast and musculoskeletal involvement in the setting of a CD4 count of 374 cell/mm3 and an undetectable viral load. The patient was on highly active antiretroviral therapy for 5 years at the time of the second presentation.
Tumors Sharply Increased after Ceasing Pazopanib Therapy for a Patient with Advanced Uterine Leiomyosarcoma: Experience of Tumor Flare
Authors: Terumi Tanigawa, Shintaro Morisaki, Hisanobu Fukuda, Shuichiro Yoshimura, Hisayoshi Nakajima, Kohei Kotera
Journal: Case Rep Obstet Gynecol (2017)
MeSH terms: Case Reports

Pazopanib has activity in patients with soft-tissue sarcoma. We report an advanced uterine leiomyosarcoma case that suddenly worsened after cessation of pazopanib therapy. A 47-year-old woman had a primary uterine leiomyosarcoma tumor and multiple lung metastases, which progressed during her initial treatment. In subsequent treatment with pazopanib for 3 months, the sum of her tumor diameters after cessation sharply increased for two weeks. Symptoms such as dyspnea suddenly worsened also. She died of the disease one month after cessation of pazopanib therapy. Given the poor prognosis of recurrent uterine leiomyosarcoma and the rapid tumor enlargement after ending pazopanib therapy, control of this disease is especially important. Therefore, the decision to discontinue pazopanib therapy requires careful consideration.
Disseminated Coccidioidomycosis Presenting as Septic Shock with Multiorgan Failure
Authors: Olufemi Aduroja, Jerome Okudo, Angelica Padilla
Journal: Case Rep Infect Dis (2021)
MeSH terms: Case Reports

Coccidioidomycosis is a fungal infection caused by Coccidioides immitis and Coccidioides posadasii. While infections are usually mild, severe disease occurs in immunocompromised patients. Dissemination is associated with severe morbidity and mortality. Because of the tendency of this disease to imitate many diseases, diagnosis may be difficult on presentation. We present a case of disseminated coccidioidomycosis in a patient who was initially managed as miliary tuberculosis. In endemic areas, coccidioidomycosis is one of the two top differentials for miliary micronodular distribution on chest imaging. The patient was a recently diagnosed HIV positive patient and presented to the hospital with multiorgan failure, septic shock, and acute respiratory distress syndrome. He rapidly deteriorated and died within three days of presentation at the emergency department.
Long-lasting benefit on multimodal treatment combining osimertinib and stereotaxic radiotherapy for metastatic non-small cell lung cancer with the EGFR exon 20 insertion 773-774 HVdelinsLM: a case report
Authors: Aurélie Louvet, Natasha Honoré, Anne-France Dekairelle, Cédric Van Marcke, Jean-Charles Goeminne
Journal: Front Oncol (2023)
Keywords: egfr, exon 20, multimodal, non-small cell lung cancer, osimertinib, stereotaxic radiotherapy, tyrosine kinase inhibitor
MeSH terms: Case Reports

A non-small-cell-lung-cancer patient with cerebral metastasis presenting an atypical exon 20 mutation in the EGFR gene had a long-lasting tumor cotrol on mulimodal treatment with osimertinib and stereotaxic radiotherapy on oligoprogressing lesions. Most exon-20 mutations are resistant to first, second and third generation EGFR-directed TKI. This case was discussed on our molecular tumour board. As the more specific exon-20 targeted therapies were not yet available and as sporadic short responses on the third generation EGFR-directed TKI, osimertinib had been described, the patient started osimertinib. She had a prolonged tumoral response on Osimertinib. The patient is still asymptomatic up to 32 months after initiating the medication. This case confirms that not all exon20 EGFR mutations are equal to osimertinib and that the localization of the exon 20 insertion mutation is probably important to consider when treating EGFR mutated NSCLC. The long-term clinical benefit can be maintained through stereotactic radiotherapy on focal progressive lesions.
Successful Treatment for Adult Precursor B-Cell Lymphoblastic Lymphoma Involving Central Nervous System Monitored by 18F-Fluorodeoxyglucose PET/CT Imaging
Authors: Xiang Shi, Weiyan Zhou, Mengqiao Xu, Tao Hua, Yihui Guan
Journal: Front Oncol (2020)
Keywords: pet/ct, philadelphia chromosome, fluorodeoxyglucose (fdg), imatinib, precursor b-cell lymphoblastic lymphoma
MeSH terms: Case Reports

Precursor B-cell lymphoblastic lymphoma (PBLL) is a rare subtype of non-Hodgkin lymphoma originating from B-cell precursors. PBLL, as a solitary mass lesion affecting the central nervous system without leukemic disease at presentation, is quite uncommon. Here we report a rare PBLL case with Philadelphia chromosome positivity. The 44-year-old male presented a solitary bulky mass primarily involving the left frontotemporal lobes and extended into the infratemporal fossa. Pretreatment PET/CT imaging showed avid 18F-fluorodeoxyglucose (18F-FDG) uptake of the lesion. By aggressive chemotherapy and imatinib maintenance treatment, the patient achieved and remained in complete remission on another two consecutive PET/CT imaging follow-ups.
Primary renal embryonal rhabdomyosarcoma in adults: a case report and review of the literature
Authors: Rafik Nabil Fanous, Erik K Mayer, Justin Vale, Josephine Lloyd, Marjorie M Walker
Journal: Case Rep Oncol Med (2012)

Adult renal rhabdomyosarcoma is a rare subtype of renal sarcoma. We present a case of a renal mass treated with radical nephrectomy that subsequently was shown to be renal rhabdomyosarcoma. We discuss the clinical presentation, imaging findings, and histology for this case and review the available literature.
Use of Cerebrospinal Fluid Biomarkers in Diagnosis and Monitoring of Rheumatoid Meningitis
Authors: Mette Scheller Nissen, Anna Christine Nilsson, Jonatan Forsberg, Jesper Milthers, Martin Wirenfeldt, Christian Bonde, Keld-Erik Byg, Torkell Ellingsen, Morten Blaabjerg
Journal: Front Neurol (2019)
Keywords: cxcl13, anti-ccp, biomarker, inflammation, rheumatoid meningitis
MeSH terms: Case Reports

Rheumatoid meningitis is a rare extra-articular manifestation of rheumatoid arthritis, often with non-specific symptoms. In most cases brain MRI shows a patchy lepto- and pachymeningeal enhancement, but the diagnosis currently relies on examination of a meningeal biopsy with presence of plasma cells and rheumatoid noduli. Presence of IgM rheumatic factor (RF) has been found in several cases and recently four cases have shown high titer anti-cyclic citrullinated peptide (anti-CCP) in CSF, suggesting this as a potential marker for rheumatoid meningitis. We present a 62 year-old woman with sero-positive (IgM RF and anti-CCP) rheumatoid arthritis, presenting with headache and gait impairment. Brain MRI revealed the classical patchy meningeal enhancement and the diagnosis of rheumatoid meningitis was confirmed by neuropathological examination of a meningeal biopsy. Analysis of the CSF revealed positive IgM RF (92.7 IU/mL) and strongly positive anti-CCP (19,600 IU/mL) and CXCL-13 (>500 ng/L). After treatment with high-dose steroid and Rituximab the clinical symptoms resolved. A 6 month follow-up analysis of CSF showed a dramatic decrease in all these markers with negative IgM RF and a decrease in both anti-CCP (64 IU/mL) and CXCL-13 (<10 ng/L). Our case further underlines the potential use of CSF anti-CCP and IgM RF in the diagnosis of RM and the use of these markers and CXCL-13 in evaluation of treatment response. A case review of 48 cases of rheumatoid meningitis published since 2010, including, symptoms, serum, and CSF findings, treatment, and outcome is provided.
Epileptic Phenotype and Cannabidiol Efficacy in a Williams-Beuren Syndrome Patient With Atypical Deletion: A Case Report
Authors: Antonio G Nicotera, Maria Spanò, Alice Decio, Giulia Valentini, Maria Saia, Gabriella Di Rosa
Journal: Front Neurol (2021)
Keywords: williams-beuren syndrome, antiepileptic drugs, cannabidiol, neurogenetics, pharmacoresistant epilepsy
MeSH terms: Case Reports

Epilepsy is a rare clinical manifestation in Williams-Beuren syndrome patients. However, some studies report the presence of infantile spasms and epilepsy in patients carrying larger deletions. Herein, we describe a 13-year-old female affected by Williams-Beuren syndrome and pharmacoresistant epilepsy reporting a de novo large heterozygous 7q11.21q21 deletion (19.4 Mb) also including the YWHAG gene. Studies indicate that cannabidiol is effective as adjunctive therapy for seizures associated with tuberous sclerosis complex, and it is under investigation also in focal cortical dysplasia. When treated with cannabidiol, our patient showed a significant reduction in seizure frequency and intensity, and improved motor and social skills. We hypothesized that CBD could exert a gene/disease-specific effect.
Case Report: Cord blood-derived natural killer cells as new potential immunotherapy drug for solid tumor: a case study for endometrial cancer
Authors: Yongxu Mu, Jiabei Tong, Yujun Wang, Yuxiao Yang, Xiaoyun Wu
Journal: Front Immunol (2023)
Keywords: advanced malignancies, cord blood (cb) donor, endometrial cancer, immunotherapy, natural killer
MeSH terms: Endometrial Neoplasms / therapy, Fetal Blood, Case Reports, Research Support, Non-U.S. Gov't, Cytokines / pharmacology, Female, Humans, Immunotherapy / methods, Killer Cells, Natural, Middle Aged, Quality of Life, Cytokines

Adoptive transfer of natural killer (NK) cells represents a viable treatment method for patients with advanced malignancies. Our team previously developed a simple, safe, and cost-effective method for obtaining high yields of pure and functional NK cells from cord blood (CB) without the need for cell sorting, feeder cells, or multiple cytokines. We present the case of a 52-year-old female patient diagnosed with poorly differentiated stage IVB (T3N2M1) endometrial cancer, who exhibited leukemoid reaction and pretreatment thrombocytosis as paraneoplastic syndromes. The patient received two courses of CB-derived NK (CB-NK) cell immunotherapy between March and September 2022, due to her extremely low NK cell activity. Two available CB units matched at 8/10 HLA with KIR-mismatch were chosen, and we were able to produce NK cells with high yield (>1.0×1010 NK cells), purity (>90%), and function (>80%) from CB without cell sorting, feeder cells, or multiple cytokines. These cells were then adoptively transferred to the patient. No adverse effects or graft-versus-host disease were observed after infusion of CB-NK cells. Our clinical experience supports the efficacy of CB-NK cell treatment in increasing NK cell activity, depleting tumor activity, improving quality of life, and reducing the size of abdominal and pelvic masses with the disappearance of multiple lymph node metastases through the regulation of systemic antitumor immunity. Remarkably, the white blood cell and platelet counts decreased to normal levels after CB-NK cell immunotherapy. This clinical work suggests that CB-NK cell immunotherapy holds promise as a therapeutic approach for endometrial cancer.
Paediatric hypopituitarism: a case report and management challenges in a resource poor setting
Authors: Isaac Oludare Oluwayemi, Oladele Simeon Olatunya, Ezra Olatunde Ogundare, Adebukola Bidemi Ajite, Adefunke Olarinre Babatola, Adewuyi Temidayo Adeniyi, Akinwumi Kolawole Komolafe
Journal: Pan Afr Med J (2020)
Keywords: hypopituitarism, adolescent, challenges, developing country, management
MeSH terms: Growth Disorders / etiology, Hormone Replacement Therapy / methods, Hypopituitarism / diagnosis, Case Reports, Adolescent, Body Height, Body Weight, Growth Disorders / drug therapy, Hormone Replacement Therapy / economics, Humans, Hypopituitarism / complications, Hypopituitarism / drug therapy, Male, Nigeria, Twins

Hypopituitarism, a deficiency of one or more of the hormones produced by the pituitary gland, is a rare disorder. It can be congenital or acquired. Case report on childhood hypopituitarism is rare in Nigeria. We present a 15-year-old boy, second of a set of twins, who presented with short stature and delayed puberty. Subtle difference in stature, was noticed on review of their childhood pictures by 2 years of age though disparity in stature became obvious to the parents at 6 years of age and it became embarrassing at 15 years of age when parents decided to seek medical attention. He was a product of term gestation with birth weight of 3.2kg; there was no history suggestive of birth trauma. Developmental milestone in the first two years of life was essentially normal like his unaffected twin brother. At presentation both height and weight were below 3rd percentile for age, he had a low blood pressure of 80/50mmHg, infantile male external genitalia with testicular volume of 2ml, bone age of 7 years, very low serum testosterone, growth hormone, adrenocorticotropic hormone, thyroxine, follicle stimulating hormone, leutenizing hormone, Cortisol and high thyroid stimulating hormone. He achieved remarkable improvement in physical activity, height, weight and hormonal profile within the first 7 months of hormone replacement therapy but could not sustain therapy because of financial constraint. Paediatric hypopituitarism is a rare and treatable disorder. Early presentation, diagnosis and appropriate hormone replacement therapy at affordable price is essential for survival and good prognosis.