OpenMed/multicare-articles huggingface dataset:
Duodenal gastrointestinal stromal tumors appear similar to pancreatic neuroendocrine tumors: A case report
Authors: Yurie Futo, Shin Saito, Hideyo Miyato, Ai Sadatomo, Yuki Kaneko, Yoshihiko Kono, Daisuke Matsubara, Hisanaga Horie, Alan Kawarai Lefor, Naohiro Sata
Journal: Int J Surg Case Rep (2018)
Keywords: case report, duodenal gastrointestinal stromal tumor, gastrointestinal bleeding, pancreatic neuroendocrine tumor

Introduction:
Duodenal gastrointestinal tumors (GISTs) are rare. Duodenal GISTs and pancreatic neuroendocrine tumors (NETs) may appear similar on imaging studies. GISTs arising from the second or third portions of duodenum may be incorrectly diagnosed as pancreatic NETs.
Presentation of case:
The patient is a 79-year-old man who was referred to our hospital with a history of tarry stools and loss of consciousness. Urgent upper digestive tract endoscopy revealed a bleeding submucosal duodenal lesion, which was controlled using endoscopic clips. Enhanced computed tomography scan showed a hyper-vascular mass 50 mm in diameter, at the pancreatic uncus. The patient underwent a pylorus-preserving pancreaticoduodenectomy. Histologically, the tumor was composed of spindle-shaped cells immunohistochemically positive for c-kit and CD34, and the lesion diagnosed as a duodenal GIST.
Discussion:
Duodenal GISTs often present with gastrointestinal bleeding, which can necessitate emergency surgery. Surgical resection with regional lymph node dissection is the optimal treatment for pancreatic NETs. In contrast, GISTs are generally treated with a minimal resection and without lymph node dissection. Thus, establishing the diagnosis is important in the management of these tumors. Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) is effective to establish the diagnosis of these lesions.
Conclusion:
A tumor located in the pancreatic head or mesenteric side of the duodenum cannot always be diagnosed based on imaging, and is ideally diagnosed histologically to guide the extent of resection. While EUS-FNA can establish the diagnosis, the complications of this procedure must be considered.
Bilateral Ovarian Serous Borderline Tumor with Non-Invasive Endometrial Implants
Authors: Melissa Bou Malham, Jordy Mehawej, Andreas Filippaios, Christina Kushnir, Paulette Mhawech-Fauceglia
Journal: Case Rep Obstet Gynecol (2023)
MeSH terms: Case Reports

Herein, we are presenting a case of a 33-year-old woman who presented to the emergency department complaining of persistent lower abdominal pain of one-day duration. Physical examination revealed abdominal tenderness with right lower quadrant rebound tenderness. Computed tomography abdomen/pelvis showed a 6 cm possible necrotic mass of the left ovary with moderate amount of complex ascites. A laparoscopic left oophorectomy with bilateral salpingectomy, right ovarian biopsy, and appendectomy were performed without complications. The cut surface of the left ovary showed a 9.7 cm × 8 cm × 4 cm ovarian mass, and the cut surface revealed multiple gray-tan friable papillary excrescence. Microscopic evaluation showed findings consistent with left and right ovarian serous borderline tumor (SBT). Subsequently, a tumor staging was conducted with total laparoscopic hysterectomy, pelvic and periaortic lymph node dissection, and omentectomy. The endometrium sections showed several small foci of SBT within the endometrial stroma, consistent with non-invasive implants of the endometrium. The omentum and lymph nodes were all negative for malignancy. SBTs associated with endometrial implants are very rare with only one case reported in the literature. Their existence can cause diagnostic challenges, and they should be acknowledged for early diagnosis and to plan for patient's treatment and outcome.
A Case of Organic Acidemia: Are Physicians Aware Enough?
Authors: Taskina Mosleh, Sanjoy Kumer Dey, Md Abdul Mannan
Journal: Euroasian J Hepatogastroenterol (2016)
Keywords: fatal prognosis, inborn error of metabolism, organic academia
MeSH terms: Case Reports

Diversity of clinical presentation of inborn errors of metabolism (IEM) gives a diagnostic challenge to the practicing physicians. In recent years there have been dramatic advances in the diagnosis and treatment of these fatal diseases, which shows improved prognosis of many of these conditions. The need for screening for IEM arises out of the fact that most cases take to irreversible effects as time progresses. Here, the main challenge is to recognize the early signs and symptoms that are also common to sick infants with other diseases. We describe a 32-day-old female infant who was finally diagnosed as a case of IEM (organic acidemia).The baby had a history of multiple neonatal intensive care unit admission. She died during her last hospital admission. The purpose of our case presentation is to provide clues to the true nature of the disease and to make physicians aware about the possibility of IEM.
How to cite this article:
Mosleh T, Dey SK, Mannan MA. A Case of Organic Acidemia: Are Physicians Aware Enough? Euroasian J Hepato-Gastroenterol 2016;6(1):89-90.
Perforative peritonitis confused with peritoneal dialysis-related peritonitis: Report of three cases
Authors: Ryosuke Arata, Masataka Banshodani, Masahiro Yamashita, Sadanori Shintaku, Misaki Moriishi, Hideki Kawanishi
Journal: Int J Surg Case Rep (2020)
Keywords: case series, gastrointestinal perforation, peritoneal dialysis, refractory peritonitis

Introduction:
Perforative peritonitis in patients on peritoneal dialysis (PD) is a serious adverse event associated with significant mortality. The signs and symptoms of perforative peritonitis in patients on PD are often confused with those of PD-related peritonitis; therefore, early diagnosis is often difficult.
Presentation of cases:
In all three cases, antibiotic therapy was started for peritonitis. Although contrast-enhanced computed tomography (CT) was not performed, perforative peritonitis was suspected due to severe cloudiness of PD effluents, and emergency surgeries were performed 8, 5, and 6 days after therapy onset in cases 1, 2, and 3, respectively. In case 1, the ileum was perforated owing to ischemia, and partial ileal resection and divided ileostomy were performed. The patient died 18 days postoperatively. In case 2, partial ileal resection and divided ileostomy were performed for an incarcerated obturator hernia and perforated ileum. The patient was transferred for hemodialysis (HD) and discharged 117 days postoperatively. In case 3, lavage drainage was performed for peritonitis because of mesenteric penetration of a sigmoid colon diverticulum. The patient was then transferred for HD, and colostomy was subsequently performed. He was discharged 159 days postoperatively.
Discussion:
Early diagnosis between PD-related peritonitis and perforative peritonitis is often difficult since the washing effect of the peritoneal dialysate might relieve peritoneal irritation.
Conclusion:
In PD patients with refractory peritonitis, it is necessary to keep in mind the possibility of perforative peritonitis, and the differential diagnosis should be performed using contrast-enhanced CT within at least 5 days after antibiotic therapy.
Isolated Persistent Left Superior Vena Cava Revealed by an Associated Asthma
Authors: I Bachouch, N Belloumi, M Attia, F Chermiti Ben Abdallah, S Hantous Zannad, S Fenniche
Journal: Case Rep Vasc Med (2021)
MeSH terms: Case Reports

Background:
Persistent left superior vena cava (PLSVC) is a rare anomaly of the thoracic venous system. Case Report. We present a case of a patient with isolated asymptomatic PLSVC, who was diagnosed because of dyspnea revealing an associated asthma. An 18-year-old male patient complained of paroxystic sibilant dyspnea. He did not have any anomaly in physical examination. The chest X-ray revealed cardiomegaly with a widening of lower mediastinum. The electrocardiogram does not show any anomaly. Echocardiography showed the PLSVC. The thoracic contrast computed tomography of the chest showed ecstasies of the right cardiac cavities and a double superior vena cava. The patient did not have similar family cases. Respiratory functional explorations led to the diagnosis of an associated asthma. Currently, he is followed up periodically. Asthma was improved with inhaled corticosteroid treatment.
Conclusion:
PLSVC is rare but can have important clinical implications. Associated severe cardiac malformations must be systematically sought.
PyramidalExplorer: A New Interactive Tool to Explore Morpho-Functional Relations of Human Pyramidal Neurons
Authors: Pablo Toharia, Oscar D Robles, Isabel Fernaud-Espinosa, Julia Makarova, Sergio E Galindo, Angel Rodriguez, Luis Pastor, Oscar Herreras, Javier DeFelipe, Ruth Benavides-Piccione
Journal: Front Neuroanat (2016)
Keywords: 3d reconstructions, cerebral cortex, dendritic spines, functional models, visual analysis

This work presents PyramidalExplorer, a new tool to interactively explore and reveal the detailed organization of the microanatomy of pyramidal neurons with functionally related models. It consists of a set of functionalities that allow possible regional differences in the pyramidal cell architecture to be interactively discovered by combining quantitative morphological information about the structure of the cell with implemented functional models. The key contribution of this tool is the morpho-functional oriented design that allows the user to navigate within the 3D dataset, filter and perform Content-Based Retrieval operations. As a case study, we present a human pyramidal neuron with over 9000 dendritic spines in its apical and basal dendritic trees. Using PyramidalExplorer, we were able to find unexpected differential morphological attributes of dendritic spines in particular compartments of the neuron, revealing new aspects of the morpho-functional organization of the pyramidal neuron.
Pulmonary tuberculosis complicating post patent ductus arteriosus ligation recovery: a case report
Authors: Uchenna Chinweokwu Onubogu, Martha Elizabeth Okorie
Journal: Pan Afr Med J (2023)
Keywords: patent ductus arteriosus, case report, children, comorbidity, tuberculosis
MeSH terms: Ductus Arteriosus, Patent / surgery, Heart Failure, Case Reports, Adult, Child, Female, Humans, Infant, Infant, Newborn, Ligation

Patent ductus arteriosus beyond the early neonatal period presents with failure to thrive, congestive cardiac failure, and recurrent pneumonia which is similar to the presentation of pulmonary tuberculosis. Both clinical conditions can coexist with significant adverse outcomes if not properly treated. This is a case of a 9-month-old female who had a hemodynamically significant patent ductus arteriosus (PDA). She had a surgical ligation of the PDA, and postoperative recovery was stalled by pulmonary tuberculosis which was initially missed as her post-operative symptoms were thought to have been from a post-op complication. She however progressively worsened till the diagnosis of pulmonary tuberculosis (PTB) was mading a suggestive chest X-ray finding. She was treated for PTB and made remarkable improvement with the resolution of the respiratory symptoms and adequate weight gain. A child with a symptomatic congenital cardiac defect in a TB endemic area can still have pulmonary tuberculosis which should not be missed. Also, the diagnosis of TB in children can be challenging due to laboratory tests that could have relatively poor yield when compared to adults. Hence, to avoid missing the diagnosis, a combination of clinical, laboratory, and regional epidemiology correlation is essential.
Gigantism in a McCune-Albright's syndrome with calcified GH-releasing pituitary adenoma: Case report and literature review
Authors: Miguel Vega-Arroyo, Martha Lilia Tena-Suck, Celia Teresa de Jesús Álvarez-Gamiño, Citlaltepetl Salinas-Lara, Juan Luis Gómez-Amador
Journal: Int J Surg Case Rep (2018)
Keywords: adenoma, calcification, gigantism, mas, mccune-albright’s, pituitary

Background:
McCune-Albright's syndrome (MAS) is a rare disorder that is characterized by café-au-lait macules, fibrous dysplasia of the skull and endocrinopathies like excessive secretion of growth hormone by a hyper-functional pituitary adenoma (PA).
Case:
We describe the case of a 43-year-old male with history of Gigantism in 1990 secondary to a GH-secreting pituitary macroadenoma that was treated via microscopic transsphenoidal surgery at that time. He was reported as asymptomatic for 26 years until he developed headache and right temporal hemianopia with left amaurosis. Also ptosis and proptosis was found caused by a re-growth of the tumor on the follow up MRI. A second surgical procedure was performed via a dorsolateral craniotomy. Gross total resection was also achieved with a Neuropathology report of a pituitary adenoma tissue accompanied by extended dystrophic calcification and bone formation.
Conclusion:
This is a rare case of MAS. Gigantism within the context of a pituitary calcification raises special diagnostic and therapeutic challenges. The cause of the excessive secretion of GH in MAS is not well understood concluding that it seems to be a different etiology of patients with Acromegaly and Gigantism in non-MAS patients.
Prenatal Sonographic Image of Sirenomelia with Anencephaly and Craniorachischisis Totalis
Authors: Takako Sugiura, Yuka Sato, Naoyuki Nakanami, Kiyomi Tsukimori
Journal: Case Rep Obstet Gynecol (2018)
MeSH terms: Case Reports

Sirenomelia is a rare congenital malformation characterized by varying degrees of fusion of the lower extremities. It is commonly associated with severe urogenital and gastrointestinal malformations; however, the association of sirenomelia with anencephaly and rachischisis totalis is extremely rare. To our knowledge, the prenatal sonographic images of this association have not been previously published. Here, we present prenatal sonographic images of this association, detected during the 17th week of gestation through combined two-dimensional, four-dimensional, and color Doppler ultrasound. Two-dimensional ultrasound images showed anencephaly, spina bifida, and possible fusion of the lower limbs. Three-dimensional HDlive rendering images confirmed the final diagnosis of sirenomelia with anencephaly and rachischisis totalis. The patient opted to undergo medical termination of pregnancy and delivered a fetus with fused lower limbs, anencephaly, and rachischisis totalis confirming the in utero imaging findings. Awareness of these rare associations will help avoid misdiagnoses and facilitate prenatal counselling. This case highlights the importance of a thorough ultrasound examination.
Two-stage hepatectomy and associated liver partition and portal vein ligation for staged hepatectomy (ALPPS) in treating liver metastases of rectal cancer: a case report
Authors: Yusuke Ome, Kazuyuki Kawamoto, Tae Bum Park, Tadashi Ito, Keizo Ogasahara
Journal: Springerplus (2015)
Keywords: alpps, associated liver partition and portal vein ligation, colorectal cancer, liver metastasis, two-stage hepatectomy

Introduction:
An innovative approach, called associated liver partition and portal vein ligation for staged hepatectomy(ALPPS), has made possible a marked increase in future liver remnant (FLR) volume over a short period of time, thus permitting extended hepatectomy.
Case description:
This report describes ALPPS in a 63-year-old male patient with rectal cancer and synchronous multiple liver metastases. The primary lesion was resected, followed by chemotherapy. We had planned to completely resect the metastases in both liver lobes, but CT volumetry revealed a very small FLR (364 ml, 29% of the total liver volume, 0.61% of total body weight). His indocyanine green retention rate at 15 minutes was 12.7%. Because of the risk of tumor progression in the interim, we performed ALPPS. During the first stage, the tumor in segment 3 was resected, the right lobe was mobilized, the liver was partitioned, and the right portal vein was ligated. The right hepatic artery, duct and vein were secured with vessel loops. CT on postoperative day 6 showed sufficient FLR increase (from 364 ml to 573 ml, or from 0.61% to 0.96% of total body weight) and ICGR15 improvement to 3.4%. The second stage of ALPPS was on postoperative day 7, completing resection of the metastases. The patient recovered well and was discharged 21 days after the second step.
Discussion and evaluation:
The ALPPS approach has many advantages, but it lacks evidence of long-term results. Considering the high mortality and morbidity rates of ALPPS, it is essential to evaluate its risks and benefits in individual patients and determine the strict criteria for this surgical method.
Conclusions:
ALPPS procedure rapidly increases FLR, permitting extended hepatectomy for patients with initially insufficient FLR.
Intraluminal Apple as a Rare Cause of Small Bowel Obstruction
Authors: Koichi Inukai, Akihiro Usui, Motohiko Yamada, Koji Amano, Nobutaka Mukai, Yusuke Tsunetoshi, Yasuki Nakata, Junichiro Yokota
Journal: Case Rep Gastrointest Med (2018)
MeSH terms: Case Reports

Small bowel obstruction due to ingested foreign bodies is rare in adults. A 48-year-old male visited our hospital with abdominal pain and vomiting. Computed tomography revealed intestinal obstruction by a 3 × 4 cm apple-shaped foreign body. Emergency surgery was performed to clear the obstruction which, upon inspection, was caused by a sexual toy made of rubber. Flexible rubber products that are ingested should be carefully followed after they pass thorough the pylorus. For obstructions related to sexual behavior, the patient's sense of shame often delays the process of seeking medical attention, thereby making preoperative diagnosis difficult.
Brunner's Gland Hyperplasia in a Patient after Roux-Y Gastric Bypass: An Important Pitfall in GLP-1 Receptor Imaging
Authors: Matthias Hepprich, Kwadwo Antwi, Beatrice Waser, Jean Claude Reubi, Damian Wild, Emanuel R Christ
Journal: Case Rep Endocrinol (2020)
MeSH terms: Case Reports

Severe cases of postprandial hypoglycaemia after bariatric surgery can be a diagnostic and therapeutic challenge. The diagnostic role of 68Ga-DOTA-Exendin-4 PET/CT in postbariatric hypoglycaemia for further treatment decisions is unclear. We present a case of a 50-year-old woman with frequent and severe postprandial hypoglycaemic (≤2.5 mmol/L) episodes starting three years after Roux-Y gastric bypass. Despite strict dietary adherence and several medical therapies, the patient remained severely affected, and 68Ga-DOTA-Exendin-4 PET/CT was performed to exclude atypical presentation of an insulinoma or nesidioblastosis. No pancreatic abnormalities were found, but intensive tracer accumulation in the first and second part of the duodenum was detected, which proved to be hyperplastic Brunner's glands on histology and were strongly positive for the glucagon-like peptide-1 receptor. This case provides histopathological verification that duodenal 68Ga-DOTA-Exendin-4 uptake is caused by uptake in Brunner's glands and points to a potential relationship between bariatric surgery and Brunner's glands.
Intralesional antibiotic injection using 41G needle for the management of subretinal abscess in endogenous endophthalmitis
Authors: Pradeep Venkatesh, Shreys Temkar, Koushik Tripathy, Rohan Chawla
Journal: Int J Retina Vitreous (2016)
MeSH terms: Case Reports

Background:
Presence of subretinal abscess in endogenous endophthalmitis indicates a more severe form of infection. Available reports indicate variable response to standard treatment with systemic, intravitreal pharmacotherapy and vitreous surgery. There are no reports citing the possible role of intralesional antibiotic therapy in managing subretinal abscess.
Case presentation:
A 30 year old lady presented with features of endogenous endophthalmitis and subretinal abscess. Presenting vision was finger counting close to face. Despite prompt initiation of systemic antibiotics and intravitreal injection, no response was noted. 25G pars plana vitrectomy was performed along with injection of vancomycin directly into the subretinal abscess, using a 41G needle. Postoperative course was uneventful and the abscess showed signs of rapid resolution. Visual acuity improved to 6/24.
Conclusion:
Intralesional pharmacotherapy may be safe and effective in the treatment of subretinal abscess associated with endogenous endophthalmitis.
Use of adrenaline continuous infusion to treat hypotension during general anaesthesia in a cow and a calf
Authors: Laura Gómez Fernández, María Chie Niimura Del Barrio, Claire Loughran
Journal: Ir Vet J (2020)
Keywords: adrenaline, epinephrine, anaesthesia, bovine, infusion
MeSH terms: Case Reports

Background:
Hypotension is one of the most common complications observed during inhalation anaesthesia in veterinary patients. Treatment of hypotension in cattle is more challenging than in other species, owing to the limited number of drugs licensed in food producing animals. The use of adrenaline as an infusion to support blood pressure has not been described previously in bovines.
Case presentation:
A cow and a calf presented to University College Dublin Veterinary Hospital for bilateral mandibular fracture repair and bladder rupture repair respectively, developed severe anaesthetic related hypotension unresponsive to conventional treatments. In both cases an adrenaline infusion was started and slowly increased to effect, with infusion rates ranging from 0.01 to 0.25 μg/kg/min. Blood pressure increased as the adrenaline infusion rate increased, but clinically significant improvements in blood pressure were only observed with infusion rates exceeding 0.05 μg/kg/min. The side effect observed with adrenaline infusion was an increase in plasma lactate levels in both cases. Both animals were euthanised due to non-anaesthetic related complications.
Conclusions:
Maintenance of normotension is important during bovine anaesthesia to prevent the development of post-anaesthetic complications. In the cases described here, adrenaline was effective as an additional treatment of anaesthetic related hypotension. Further research is required to establish the recommended infusion rates, cardiovascular effects and possible side effects of adrenaline infusion administration as a treatment for hypotension in bovines.
A case with significant proteinuria caused by secreted protein from urothelial carcinoma
Authors: Masanori Sakakima, Yoshihide Fujigaki, Hideo Yasuda, Akashi Togawa, Tomoyuki Fujikura, Atsushi Otsuka, Seiichiro Ozono, Akira Hishida
Journal: Case Rep Nephrol (2011)
MeSH terms: Case Reports

58-year-old female was admitted to our hospital complaining isolated proteinuria of 1.7 g/day. Abdominal echography showed right-sided unilateral hydronephrosis, and computed tomography pointed out a tumor of the right renal pelvis, suggesting cancer of renal pelvis. The right nephroureterectomy was carried out. Pathological diagnosis was urothelial carcinoma. Renal tissue revealed no apparent glomerulopathy with tubular atrophy, interstitial fibrosis, and mildly-to-moderately interstitial mononuclear cell infiltration. Immunofluorescence study showed no deposition of immunoreactanct, and electron microscopy showed almost normal glomerulus without electron dense deposit. Proteinuria disappeared within 6 days after the operation. Moderate amount of proteinuria in our patient was probably caused by secreted protein from urothelial carcinoma. This condition is rare but should be taken into account in patients with even moderate amount of proteinuria.