OpenMed/multicare-articles huggingface dataset:
Case Report: Exacerbation of varices following atezolizumab plus bevacizumab treatment of hepatocellular carcinoma: A case series and literature review
Authors: Hiroyuki Suzuki, Hideki Iwamoto, Shigeo Shimose, Takashi Niizeki, Tomotake Shirono, Yu Noda, Naoki Kamachi, Taizo Yamaguchi, Masahito Nakano, Ryoko Kuromatsu, Hironori Koga, Takumi Kawaguchi
Journal: Front Oncol (2022)
Keywords: atezolizumab, bevacizumab, gastrointestinal hemorrhage, hepatocellular carcinoma, portal hypertension, varices
MeSH terms: Case Reports

Recently, a combined regimen of atezolizumab and bevacizumab (AB) treatment has been approved as a first-line treatment in patients with advanced hepatocellular carcinoma (HCC), contributing to prolonged survival. However, we often encounter cases where treatment must be discontinued due to the occurrence of adverse events. One of these events, which is often fatal, is gastrointestinal bleeding. To clarify the clinical effects of gastrointestinal bleeding after AB treatment, we evaluated patients with HCC who were treated with AB at our institution. Of the 105 patients, five treated with AB developed gastrointestinal bleeding, necessitating treatment discontinuation. Additionally, we encountered two cases where exacerbation of varicose veins was observed, and AB therapy could be continued by preventive treatment of varices. In conclusion, an appropriate follow-up is required during treatment with AB to prevent possible exacerbation of varicose veins.
The need for a complete dental autopsy of unidentified edentulous human remains
Authors: Emilio Nuzzolese, Mario Torreggianti
Journal: Forensic Sci Res (2021)
Keywords: forensic sciences, dental autopsy, edentulous, forensic odontology, identification, missing person
MeSH terms: Case Reports

In December 2017, a decomposed unidentified body was found near the river Tronto in Teramo, Italy. The corpse was found without any identifying documents or specific personal belongings, except for a packet of cigarettes. The medical examiner determined a gastric perforation from the intake of hydrochloric acid to be the cause of death. A jar of muriatic acid found near the body led to suicide being considered the manner of death. The Penal Court in Teramo appointed two forensic odontologists to complete the postmortem assessment and collect dental data for personal identification. The corpse was found wearing a complete set of upper and lower dentures. The dental autopsy and 42 periapical X-ray images helped generate a biological profile of a man totally edentulous with upper and lower dentures, as well as an osteosynthesis with two plates and screws in the left ascending ramus of the mandible. In March 2018, the sister of a missing person reported the disappearance of her brother, and a presumptive identification was performed through visual recognition of the decomposed body. The sister confirmed the presence of two dentures and the location of the maxillo-facial surgery for the treatment of the fractured mandible. A complete dental autopsy was able to establish his identity without any DNA comparison needed. This case highlights the importance of performing a complete dental autopsy inclusive of dental radiographs, and its value in the identification of all unknown human remains even when totally edentulous. A complete dental autopsy should be performed in all cases of human identification.KeypointsDespite a corpse being edentulous, a complete dental autopsy can still be useful.Dental radiographs, such as bitewings, periapical images, panoramic radiographs, and CT scans, are recommended in all identification autopsies.
Periprosthetic Fracture through a Unicortical Tracking Pin Site after Computer Navigated Total Knee Replacement
Authors: Matt Blue, Christian Douthit, Joel Dennison, Cyrus Caroom, Mark Jenkins
Journal: Case Rep Orthop (2018)
MeSH terms: Case Reports

A rare complication from computer-navigated total knee arthroplasty is a fracture through the insertion site of a tracking pin. These pins are inserted across the femoral and tibial shafts either bicortically, transcortically, or unicortically and have a reported fracture incidence of 1.38%, with all published cases occurring after bicortical pin placement. In this case, a 60-year-old female suffered a femoral shaft fracture through a unicortically inserted computer navigation tracking pin 6 weeks after total knee arthroplasty. Her fracture was successfully fixated with an intramedullary nail with retention of the knee prosthesis. This case is important as it records the risk for a postoperative fracture through a unicortically inserted computer navigation pin.
Pancreatic Paraganglioma: A Case Report
Authors: Sumant Tumuluru, Vincent Mellnick, Maria Doyle, Bella Goyal
Journal: Case Rep Pancreat Cancer (2016)
Keywords: extra-adrenal, pancreas, paraganglioma
MeSH terms: Case Reports

Background: Paraganglionic neoplasms that originate in the adrenal medullas are referred to as pheochromocytomas, but if they arise from other paraganglia scattered throughout the body, they are referred to as paragangliomas. Pancreatic paragangliomas are an extremely rare entity as only 20 cases have been reported in the literature. They tend to be nonfunctional and typically occur in the fourth to fifth decade of life without a gender predilection. We describe in this study a case of a pancreatic paraganglioma and its CT appearance. Case Presentation: A 62-year-old woman undergoing presurgical evaluation for an olfactory groove meningioma resection was incidentally found to have a pancreatic mass. Multiple fine needle aspirations of the mass through endoscopic ultrasound yielded only atypical epithelial cells. The mass demonstrated avid enhancement on serial CTs with mild interval growth over a period of 5 years. No lymphadenopathy was ever found. The patient's complete blood count, complete metabolic panel, and plasma carcinoembryonic antigen levels were all within normal limits. Urine catecholamine metabolite levels were never checked as the patient demonstrated no symptoms of catecholamine excess. The patient underwent a laparoscopic distal pancreatectomy and splenectomy, and the mass was eventually diagnosed as a pancreatic paraganglioma through pathology. While the patient tolerated the surgery well, she did require a biliary sphincterotomy and placement of a pancreatic duct stent postoperatively for treatment of a pancreatic duct leak, which completely resolved. She showed no evidence of disease recurrence on multiple subsequent CTs and continues to do well. Conclusion: Pancreatic paragangliomas are usually incidentally discovered and typically demonstrate avid homogenous enhancement on contrast-enhanced CT or MR. Aggressive surgical resection is necessary to maximize the chances of disease-free survival. Pancreatic paragangliomas are similar histologically, whether benign or malignant, to paragangliomas that occur anywhere else in the body, with ∼70% in the abdomen and 30% in the chest.
The Daily Consumption of Cola Can Determine Hypocalcemia: A Case Report of Postsurgical Hypoparathyroidism-Related Hypocalcemia Refractory to Supplemental Therapy with High Doses of Oral Calcium
Authors: Valentina Guarnotta, Serena Riela, Marina Massaro, Sebastiano Bonventre, Angela Inviati, Alessandro Ciresi, Giuseppe Pizzolanti, Salvatore Benvenga, Carla Giordano
Journal: Front Endocrinol (Lausanne) (2017)
Keywords: calcium absorption, cola, hyperphosphatemia, hypocalcemia, hypoparathyroidism
MeSH terms: Case Reports

The consumption of soft drinks is a crucial factor in determining persistent hypocalcemia. The aim of the study is to evaluate the biochemical mechanisms inducing hypocalcemia in a female patient with usual high consumption of cola drink and persistent hypocalcemia, who failed to respond to high doses of calcium and calcitriol supplementation. At baseline and after pentagastrin injection, gastric secretion (Gs) and duodenal secretion (Ds) samples were collected and calcium and total phosphorus (Ptot) concentrations were evaluated. At the same time, blood calcium, Ptot, sodium, potassium, chloride, magnesium concentrations, and vitamin D were sampled. After intake of cola (1 L) over 180 min, Gs and Ds and blood were collected and characterized in order to analyze the amount of calcium and Ptot or sodium, potassium, magnesium, and chloride ions, respectively. A strong pH decrease was observed after cola intake with an increase in phosphorus concentration. Consequently, a decrease in calcium concentration in Gs and Ds was observed. A decrease in calcium concentration was also observed in blood. In conclusion, we confirm that in patients with postsurgical hypoparathyroidism, the intake of large amounts of cola containing high amounts of phosphoric acid reduces calcium absorption efficiency despite the high doses of calcium therapy.
MRI Findings of Early-Stage Hyperacute Hemorrhage Causing Extramedullary Compression of the Cervical Spinal Cord in a Dog with Suspected Steroid-Responsive Meningitis-Arteritis
Authors: Adriano Wang-Leandro, Enrice-Ina Huenerfauth, Katharina Heissl, Andrea Tipold
Journal: Front Vet Sci (2017)
Keywords: bleeding, canine, immune-mediated vasculitis, magnetic resonance imaging, signal intensity, steroid-responsive meningitis-arteritis, subarachnoid hematoma, tetraparesis
MeSH terms: Case Reports

A 9-month-old female Weimaraner was presented to the emergency service due to episodes of fever and neck pain. Physical examination revealed a stiff neck posture and elevated body temperature. Shortly after clinical examination was performed, the dog developed peracute onset of non-ambulatory tetraparesis compatible with a C1-C5 spinal cord (SC) lesion. Immediately thereafter (<1 h), MRI of the cervical SC was performed with a 3-T scanner. A left ventrolateral intradural-extramedullary SC compression caused by a round-shaped structure at the level of C3--C4 was evidenced. The structure was iso- to slightly hyperintense in T1-weighted (T1W) sequences compared to SC parenchyma and hyperintense in T2-weighted, gradient echo, and fluid-attenuated inversion recovery. Moreover, the structure showed a strong homogeneous contrast uptake in T1W sequences. Cerebrospinal fluid (CSF) analysis revealed a mixed pleocytosis, as well as elevated protein and erythrocyte count. Early-stage hyperacute extramedullary hemorrhage was suspected due to immune mediated vasculitis. The dog was maintained under general anesthesia and artificial ventilation for 24 h and long-term therapy with corticosteroids and physiotherapy was initiated. Eight weeks after initial presentation, the dog was ambulatory, slightly tetraparetic. Follow-up MRI showed a regression of the round-shaped structure and pleocytosis was not evident in CSF analysis. This report describes an early-stage hyperacute extramedullary hemorrhage, a condition rarely recorded in dogs even in experimental settings.
Acute respiratory distress in patient with laryngeal schwannoma
Authors: Laura Mannarini, Patrizia Morbini, Giulia Bertino, Omar Gatti, Marco Benazzo
Journal: Case Rep Med (2012)
MeSH terms: Case Reports

Schwannoma is a neurogenic benign tumour arising from the proliferation of Schwann cells present in the peripheral nerve sheath of myelinated nerves. This proliferation can hypothetically appear in every anatomic region of the human body, but the nerve sheath tumors rarely occur within the larynx. In this paper the authors discuss the case of a 74-year-old female who presented to Emergency Unit (EU) for an important acute respiratory distress. Airway flexible endoscopy revealed a bulky mass of the aryepiglottic fold measuring 3.5 cm in diameter. The patient underwent tracheotomy and a single-step surgical excision treatment of the mass which was recognized as a schwannoma at pathological examination. Tracheotomy was closed 2 weeks postoperatively. After 18 months of followup, the patient is alive and free of disease and her voice had improved markedly.
Massive Hematometra due to Congenital Cervicovaginal Agenesis in an Adolescent Girl Treated by Hysterectomy: A Case Report
Authors: Turki Gasim, Fathia E Al Jama
Journal: Case Rep Obstet Gynecol (2013)

A case of massive hematometra with a bicornuate uterus in a 14-year-old mentally handicapped girl complicated by vaginal agenesis and absent cervix is presented. She was managed by abdominal hysterectomy and right salpingo-oophorectomy that included the ovarian cystadenoma. The left ovary was conserved. This treatment was considered appropriate for this patient.
The Rare Occurrence of a Left Atrial Thrombus in a Dog
Authors: Sven Otto, Robert Höpfner
Journal: Case Rep Vet Med (2020)
MeSH terms: Case Reports

Intracardiac thrombi are rare in dogs. If they occur, they are mostly seen in the right atrium while only two case reports describing a mural left atrial thrombus in dogs are available. This case report describes a 14-year-old mixed-breed bitch that was presented at the clinic because of dyspnoea. The dog suffered from alopecia for about three years and displayed polyuria and polydipsia for a number of months. Clinical examination revealed intensified inspiratory and expiratory respiratory sounds and various heart sounds. Chest X-ray showed cardiomegaly (VHS 11) and a mixed bronchoalveolar lung pattern of the caudal lung. A transthoracic echocardiography was performed and showed a moderate mitral regurgitation, a highly dilated left atrium, a low-grade pulmonary insufficiency, and a minimal aortic and tricuspid insufficiency. Additionally, a free-floating ball thrombus was found in the left atrium. Hyperadrenocorticism was indicated by an ACTH stimulation test. The previous medical therapy of the referring veterinarian consisted of benazepril and furosemide and was complemented by clopidogrel. The pet owners declined any further clinical diagnostics and therapy. The dog died 19 days later. This is the first reported case of a dog with a free-floating left atrial thrombus. Specific therapeutic strategies for intracardiac thrombi in the dog are currently not available, and therefore, every patient should be treated individually.
Behcet's Disease With Cerebral Artery Infarction Caused by Cerebral Arteritis as an Early Symptom Only With Elevated Interleukin-8
Authors: Hao Yin, Yun Song, Meimei Zheng, Ju Han, Jiyou Tang
Journal: Front Neurol (2019)
Keywords: behcet's disease, il-8, cerebral arteritis, cerebral infarction, neuro-behcet's disease
MeSH terms: Case Reports

Background: Behcet's disease (BD) is multi-systemic vasculitis, which generally is repeated oral and genital ulcerations as well as ocular and skin lesions. Today, the pathogenesis of BD remains mostly unknown. It is also suggested that the disease is probably related to autoinflammatory and autoimmune disorders, and innate immunity damages were perceived as key in its pathologic process. Only 5% of BD patients have neurological involvement, and it usually occurs in 4-6 years after the initial symptoms. Early onset of neurological impairment makes it difficult to diagnose and treat definitely. Case Presentation: A 38-year-old man was admitted to our hospital with numbness and weakness of the left extremities. Diffusion magnetic resonance imaging (MRI) revealed focal infarction in the posterior limb of the internal capsule. Skin pathology suggested small vessel vasculitis, and high-resolution MRI revealed intracranial arteritis. The patient had a negative skin pathery test and then developed a scar at the venous puncture site at the early stage of disease. Laboratory examination showed that interleukin 8 (IL-8) increased. The patient was treated with an immunosuppressive agent including mycophenolate mofetil, hydroxychloroquine, and colchicine. All symptoms were alleviated after half a year's treatment. There was neither stroke nor recurrence of oral ulcer thereafter. Conclusion: This case demonstrates that neurological involvement might be an early symptom of BD. IL-8 could act as a novel target for the treatment of BD theoretically and probably play a key role in disease recovery.
Intima sarcoma of the pulmonary artery mimicking takayasu disease
Authors: C Belge, I Renckens, R Van Puijenbroek, W Wuyts, B Meyns, M Delcroix
Journal: Case Rep Vasc Med (2011)
MeSH terms: Case Reports

Pulmonary artery intima sarcoma is an uncommon but fatal tumor, which often masquerades chronic thromboembolic pulmonary hypertension (CTEPH) and in the present case Takayasu arteritis. Pulmonary arterial pressure is mildly elevated in the presence of extensive proximal lesions. A parenchyma thin-walled cavitary lesion may be a sign of pulmonary extravasation of the tumor.
Concurrent arterial and venous thrombosis in a patient with catastrophic antiphospholipid syndrome
Authors: Muhammad Shoaib Khan, Muhammad Ishaq, Marek Siorek, Robert Biederman
Journal: Caspian J Intern Med (2021)
Keywords: antiphospholipid syndrome, catastrophic antiphospholipid antibody syndrome, disseminated intravascular coagulation, heparin induced thrombocytopenia, thrombotic microangiopathies
MeSH terms: Case Reports

Background:
Antiphospholipid syndrome (APS) is marked by arterial, venous, or small vessel thrombosis. There have been few reported cases on APS presenting as thrombosis simultaneously involving large arteries and venous side of the blood circulation. CAPS can easily be confused with DIC, HIT, and other TMA. Anticoagulants remain the mainstay of treatment for CAPS, whereas in DIC and TMA, anticoagulants have no role.
Case presentation:
A 43-year-old male presented to our facility with a chief complaint of right foot pain, calf cramps, and shortness of breath. The patient's right dorsal pedal artery was not palpable. CT angiogram showed bilateral pulmonary emboli (fig.1), emboli within the right saphenofemoral artery (SFA), and popliteal artery (PA). Digital subtraction angiogram showed occlusive thrombi in SFA and in the PA. Thrombolysis was performed by an intra-arterial catheter-directed tissue plasminogen activator. Agitated saline bubble study showed no evidence of atrial shunting. The patient was noted to have thrombocytopenia, hypofibrinogenemia, high serum D-Dimer and normal activated partial thromboplastin time (APTT). The patient tested positive for anticardiolipin (aCL) antibodies and lupus anticoagulant (LA). After 12 weeks, aCL antibodies and LA testing were suggestive of APS.
Conclusion:
Simultaneous thrombosis in large arteries and veins is a very unusual presentation for the APS. The patients should be started on anticoagulants immediately as the mortality rate associated with CAPS is high and the key to management is initiating anticoagulants expeditiously.
Waldenström Macroglobulinemia and Cerebral Venous Thrombosis: From Diagnosis to Complication
Authors: Paulo Zoé Costa, Pedro Chorão, Andreia Póvoa, Pedro Vieira, Heidy Cabrera, Orlando Mendes, Céu Evangelista
Journal: Case Rep Med (2019)
MeSH terms: Case Reports

Waldenström macroglobulinemia (WM) is a type of non-Hodgkin lymphoma in which cancer cells produce large amounts of an abnormal protein that can cause hyperviscosity syndrome (HVS). A 43-year-old woman with WM, who developed seizures, had a head computed tomography scan that showed signs of cerebral venous thrombosis (CVT). Nevertheless, the value of immunoglobulin M was lower than 50 g/L, and evaluation of serum viscosity was not performed. Moreover, there was no history of bleeding, and the eye funduscopy was normal. These findings lead to think of causes of CVT other than HVS in a patient with WM.
Hiding in Plain Sight: A Case of Perinephric Abscess Diagnosed by POCUS
Authors: David Haughey, Tai Truong
Journal: POCUS J (2020)
Keywords: kidney, perinephric abscess, renal, urinoma
MeSH terms: Case Reports

An 87 year old male with obstructive uropathy was initially diagnosed with acute kidney injury (AKI), a new renal mass and hydronephrosis. When transferred to a facility with a hospital medicine POCUS program, the renal mass was correctly identified as a perinephric abscess, which was percutaneously drained leading to resolution of AKI and the underlying infection. Renal POCUS is readily taught via brief educational interventions and empowers providers to identify common (hydronephrosis) and uncommon (perinephric abscess) renal pathology at the bedside.
Recurrent Pericarditis: A Rare Adverse Effect of Mesalamine
Authors: Pratul Karki, Ariya Kunwar, Nitish Sharma, Megha Dogra
Journal: Cureus (2023)
Keywords: atypical chest pain, chest pain, dyspnea, inspiratory dyspnea, mesalamine, recurrent pericarditis
MeSH terms: Case Reports

Inflammation of the myocardium (myocarditis), pericardium (pericarditis), or both (myopericarditis) is a rare but potentially lethal side effect of mesalamine, a drug widely used in the treatment of inflammatory bowel disease (IBD). A 64-year-old female with a history of ulcerative colitis on mesalamine presented with dyspnea and chest pain. The patient was found to have mild to moderate pericardial effusion with signs of pericarditis. Further workup revealed positive rheumatoid factor, antineutrophil cytoplasmic autoantibody, cytoplasmic (c-ANCA), and antinuclear antibodies (ANA), raising suspicion for rheumatoid-associated pericarditis. She was discharged with a prednisone taper and an outpatient rheumatology follow-up. However, the patient presented again in three months with similar complaints and was found to have recurrent pericarditis. On this admission, mesalamine-induced pericarditis was considered in the differential diagnosis, and it was stopped on discharge. On a three-month follow-up, the patient showed complete resolution. Mesalamine-induced pericarditis is a rare side effect of this drug, and prompt recognition and appropriate intervention are important to prevent the progression of the inflammation and avoid adverse cardiovascular outcomes. The association of IBD with extra-intestinal cardiac manifestations can delay early diagnosis and treatment.
Two Cases of Iatrogenic Lumbar Foraminal Disc Herniations
Authors: Ryota Taniguchi, Osamu Kawano, Takeshi Maeda, Yasuharu Nakajima, Yuichiro Morishita
Journal: Case Rep Orthop (2021)
MeSH terms: Case Reports

Objective:
We report two cases of iatrogenic deterioration of lumbar foraminal disc herniations following lumbar disc injections. Summary of Background Data. Complications associated with discography were reported. However, only a few reports have thus far referred to the iatrogenic deterioration of lumbar foraminal disc herniations.
Cases:
60-year-old and 74-year-old men were treated with MR images of L4-5 foraminal disc herniations without fragment in the spinal canal. The patients underwent discography and disc block for its diagnosis and treatment. After disc injections, both patients complained of deterioration of L4 radiculopathy.
Results:
On disco-CT or reexamined MR images after disc injections, herniated fragment was migrated from neural foramen to cranial central spinal canal with was not shown in previous MR images. The herniated fragments were extirpated by means of osteoplastic laminoplasty or transforaminal lumbar interbody fusion with facetectomy. The herniated fragments were migrated from neural foramen to cranial central spinal canal.
Conclusions:
The injection of liquid medicine into the nucleus led the intradiscal pressure increased, and the disc fragment might prolapsed through the raptured region of annulus fibrosus and migrated to cranial central spinal canal by anatomical reason. The disc injection may have a risk for deterioration of foraminal disc herniation. Our report is instructive for the management of discography for the diagnosis of foraminal disc herniations.