OpenMed/multicare-articles huggingface dataset:
Cathodal tDCS Over Motor Cortex Does Not Improve Tourette Syndrome: Lessons Learned From a Case Series
Authors: Nora Behler, Bianka Leitner, Eva Mezger, Elif Weidinger, Richard Musil, Bernhard Blum, Beatrice Kirsch, Linda Wulf, Lisa Löhrs, Christine Winter, Frank Padberg, Ulrich Palm
Journal: Front Behav Neurosci (2018)
Keywords: gts, ocd, obsessive compulsive disorder, supplementary motor areas, tdcs, tourette syndrome, transcranial direct current stimulation

Introduction: Current pathophysiological hypotheses of Gilles de la Tourette Syndrome (GTS) refer to temporally abnormal neuronal activation in cortico-striato-thalamo-cortical (CSTC) networks. Modifying cortical activity by non-invasive brain-stimulation appears to be a new treatment option in GTS. Background: Previous studies suggested therapeutic effects of cathodal transcranial direct current stimulation (tDCS) to pre-supplementary motor areas (SMA), however, treatment modalities concerning electrode placement, current intensity and stimulation-rate have not been systematically explored. Aim of this study was to assess efficacy of an alternative stimulation regime on GTS symptoms in a pilot study. To test a treatment protocol with tDCS twice a day, we administered 10 sessions over 5 days of bilateral cathodal tDCS (30 min, 2 mA) over the pre-SMA in three patients with severe GTS. Tic severity as well as obsessive-compulsive (OC) symptoms and affective scales were rated before and after tDCS treatment. Discussion: Only one out of three patients showed a 34.5% reduction in tic severity. The two other patients showed an increase in tic severity. All patients showed a mild increase in positive affect and a reduction in negative affect, OC symptom changes were heterogeneous. Our results do not support earlier findings of extensive therapeutic effects of cathodal tDCS on tics in patients with GTS and show that prediction of stimulation effects on a targeted brain area remains inaccurate. Concluding Remarks: Future research will have to focus on the determination of most effective stimulation modes regarding site, polarity and frequency of tDCS in GTS patients.
Clinical Complete Remission of An Advanced Gastric Adenocarcinoma After Camrelizumab Plus Chemotherapy Followed by Camrelizumab Plus Capecitabine: A Case Report
Authors: Jieheng Lin, Jianying Yang, Wenping Wang, Xiaotong Lin, Yang Cao
Journal: Front Oncol (2021)
Keywords: advanced gastric adenocarcinoma, camrelizumab, chemotherapy, clinical complete response (ccr), peritoneal metastasis
MeSH terms: Case Reports

We report a rare case of PDL1-negative advanced gastric adenocarcinoma that improved significantly after camrelizumab plus chemotherapy followed by camrelizumab plus capecitabine as first-line therapy. A 65-year-old woman was diagnosed with a gastric adenocarcinoma in 2017 via contrast-enhanced computed tomography (CT) and endoscopic biopsy. She stabilised after preoperative neoadjuvant chemotherapy, surgery, and postoperative adjuvant chemotherapy. In September 2019, positron emission tomography (PET)/CT re-examination suggested a peritoneal metastasis and multiple lymph node metastases. She then received six cycles of camrelizumab plus chemotherapy. PET/CT indicated that the metastatic foci had disappeared and that she had achieved a clinical complete response(CCR). She was followed-up with camrelizumab plus capecitabine (maintenance therapy). At the time of writing, her progression-free survival is more than 14 months and her quality of life is good. Thus, camrelizumab plus chemotherapy is a useful first-line treatment for HER2- and PD-L1-negative advanced gastric adenocarcinoma.
Early Gastric Cancer: A Demonstrative Case Report
Authors: Sebahat Basyigit, Bora Aktas, Metin Küçükazman, Hülya Demirkaynak Simsek, Gulçin Güler Simsek, Ayse Kefeli, Abdullah Özgür Yeniova, Yasar Nazligül
Journal: Euroasian J Hepatogastroenterol (2014)
Keywords: early gastric cancer, endoscopy, gastroenterology
MeSH terms: Case Reports

With early detection of gastric cancer, mortality from gastric cancer has decreased. Endoscopists should be more suspicious about these lesions because these can be easily neglected. We reported a case which has endoscopic appearance of benign lesion but possessed malignant histological features. How to cite this article: Basyigit S, Aktas B, Küçükazman M, Simsek HD, Simsek GG, Kefeli A, Yeniova AÖ, Nazligul Y. Early Gastric Cancer: A Demonstrative Case Report. Euroasian J Hepato-Gastroenterol 2014;4(1):61.
Treatment and Postinterventional Management of a Fusiform Intracranial Aneurysm in a Professional Soccer Player: A Case Report
Authors: Manina Maja Etter, Leo Bonati, Ioannis Tsogkas, Gregor Hutter, Kristine Blackham, Raphael Guzman, Marios-Nikos Psychogios
Journal: Front Neurol (2022)
Keywords: case report, dual antiplatelet therapy, endovascular treatment, intracranial aneurysms, professional athletes
MeSH terms: Case Reports

Introduction:
While intracranial aneurysms are common lesions affecting between 1 and 5% of the general population, the prevalence in professional athletes remains unknown. The result is uncertainty and lack of guidelines on appropriate treatment of these patients.
Case presentation:
A 29-year-old professional soccer player presented in our hospital with an incidentally found intracranial aneurysm. After detailed depiction of the aneurysm and interdisciplinary discussion, endovascular treatment using a flow diverter was chosen to be the best treatment modality. Postinterventional medication consisted of dual antiplatelet therapy with aspirin and clopidogrel. The main challenge in managing the case of our patient was the combination of the dual antiplatelet treatment regime with his professional career in a contact sport.
Conclusion:
Due to lack of literature or similar reports regarding the management of professional athletes with intracranial aneurysms, the optimal treatment strategy remains unclear. Even though decisions should be made dynamically and case-adapted to each situation, developing a registry could help provide guidance and new ideas for similar cases in the future.
Spontaneous Coronary Artery Dissection: A Rare Manifestation of Alport Syndrome
Authors: Amornpol Anuwatworn, Prince Sethi, Kelly Steffen, Orvar Jonsson, Marian Petrasko
Journal: Case Rep Cardiol (2017)
MeSH terms: Case Reports

Alport syndrome (AS) is a genetic disorder due to inheritance of genetic mutations which lead to production of abnormal type IV collagen. AS has been associated with renal, auditory, and ocular diseases due to the presence of abnormal alpha chains of type IV collagen in the glomerulus, cochlea, cornea, lens, and retina. The resulting disorder includes hereditary nephritis, corneal opacities, anterior lenticonus, fleck retinopathy, temporal retinal thinning, and sensorineural deafness. Aortic and aortic valve pathologies have been described as extrarenal manifestations of AS in multiple case reports. One case report described intramural hematoma of the coronary artery. We report the first case of true spontaneous coronary artery dissection (SCAD) with an intimal flap as a very rare manifestation of AS. The patient is a 36-year-old female with history of AS with chronic kidney disease, hypertension, and obesity who presented to the emergency room with acute onset of substernal chest pain radiating to her neck and arms. Troponin was elevated, and ECG showed transient 1 mm ST-segment elevation in the inferior leads. Subsequent coronary angiography revealed localized dissection of the left circumflex artery. Percutaneous coronary angioplasty was performed and her symptoms improved. This case illustrates that SCAD may be a manifestation of AS patients with chest pain.
Nasopalatine Duct Cyst with Impacted Inverted Mesiodens: A Rare Case Report and Literature Review
Authors: Shamimul Hasan, Deepika Bablani Popli, Syed Ansar Ahmad, Keya Sircar, Shahnaz Mansoori, Kirti Dua
Journal: Case Rep Dent (2022)
MeSH terms: Case Reports

Nasopalatine duct cyst (NPDC) is a non-odontogenic, developmental epithelial cyst that accounts for 1% of maxillary cysts. It often arises due to the spontaneous proliferation of the epithelial tissue remnants, although trauma, bacterial infection, and mucous retention may also trigger the proliferation. Owing to its slow-growing, asymptomatic nature, the cyst is often discovered as an accidental finding during routine clinical and radiographic examinations. However, the majority of cases present as a tiny, asymptomatic swelling just posterior to the palatine papillae. Radiographically, it appears as a well-defined oval or round radiolucency in the maxillary anterior teeth region and should be differentially diagnosed with inflammatory periapical lesions and a wide incisive foramen. A pulp vitality test is essential to rule out lesions of endodontic origin. Microscopically, NPDCs display a mixed pattern of the epithelial lining and exhibit neurovascular bundles (small to medium-sized nerves, arteries, and veins), and minor salivary glands in the cystic connective tissue, a distinctive feature facilitating a confirmatory diagnosis. Enucleation and marsupialization remain the treatment of choice. NPDC associated with impacted mesiodens is an extremely uncommon entity. A comprehensive literature search carried out on the PubMed and Google Scholar search engines revealed only three cases of NPDC with impacted mesiodens to date. The purpose of this study is to report an extremely rare case of NPDC associated with an impacted inverted mesiodens in a 19-year-old male patient who presented with an asymptomatic swelling in the maxillary anterior teeth region. To the best of our knowledge, this is only the fourth reported case of NPDC with impacted mesiodens.
Mucinous Cystadenoma: A Rare Hepatic Tumor in a Child
Authors: Danielle A Ferraguti, Molly McGetrick, Ivan Zendejas, David Hernandez-Gonzalo, Regino Gonzalez-Peralta
Journal: Front Pediatr (2017)
Keywords: children, liver mass, liver tumors, mucinous cystadenoma, pediatrics
MeSH terms: Case Reports

Mucinous cystadenomas (MCAs) of the liver (also called hepatic biliary cystadenomas) are rare tumors that comprise about 5% of cystic masses of the liver in adults. These slow-growing lesions most commonly occur in middle-aged individuals, with a female sex predominance. Herein, we present a MCA in a 6-year-old male, one of only very few such cases described in the pediatric literature to date. Although MCAs are generally considered benign lesions, malignant transformation rarely occurs. The recurrence rate is high when partial cyst excision is performed. Therefore, complete surgical cyst resection with clinical follow-up, including imaging, is warranted.
Myocarditis, hepatitis, and pancreatitis in a patient with coxsackievirus A4 infection: a case report
Authors: Nobuhiro Akuzawa, Naoyuki Harada, Takashi Hatori, Kunihiko Imai, Yonosuke Kitahara, Shinji Sakurai, Masahiko Kurabayashi
Journal: Virol J (2014)
MeSH terms: Coxsackievirus Infections / diagnosis, Coxsackievirus Infections / pathology, Enterovirus / isolation & purification, Hepatitis, Viral, Human / etiology, Myocarditis / etiology, Pancreatitis / etiology, Case Reports, Research Support, Non-U.S. Gov't, Coxsackievirus Infections / virology, Enterovirus / classification, Hepatitis, Viral, Human / complications, Hepatitis, Viral, Human / pathology, Humans, Immunocompromised Host, Male, Middle Aged, Myocarditis / complications, Myocarditis / pathology, Pancreatitis / complications, Pancreatitis / pathology, Rectal Neoplasms / complications, Rectal Neoplasms / diagnosis

Viral myocarditis presents with various symptoms, including fatal arrhythmia and cardiogenic shock, and may develop chronic myocarditis and dilated cardiomyopathy in some patients. We report here a case of viral myocarditis with liver dysfunction and pancreatitis. A 63-year-old man was admitted to our hospital with dyspnea. The initial investigation showed pulmonary congestion, complete atrioventricular block, left ventricular dysfunction, elevated serum troponin I, and elevated liver enzyme levels. He developed pancreatitis five days after admission. Further investigation revealed a high antibody titer against coxsackievirus A4. The patient's left ventricular dysfunction, pancreatitis, and liver dysfunction had resolved by day 14, but his troponin I levels remained high, and an endomyocardial biopsy showed T-lymphocyte infiltration of the myocardium, confirming acute myocarditis. The patient underwent radical low anterior resection five weeks after admission for advanced rectal cancer found incidentally. His serum troponin I and plasma brain natriuretic peptide levels normalized six months after admission. He has now been followed-up for two years, and his left ventricular ejection fraction is stable.This is the first report of an adult with myocarditis and pancreatitis attributed to coxsackievirus A4. Combined myocarditis and pancreatitis arising from coxsackievirus infection is rare. This patient's clinical course suggests that changes in his immune response associated with his rectal cancer contributed to the amelioration of his viral myocarditis.
A case report of adrenocorticotropic hormone to treat recurrent focal segmental glomerular sclerosis post-transplantation and biomarker monitoring
Authors: Siddiq Anwar, Derek S Larson, Nima Naimi, Muhammad Ashraf, Nancy Culiberk, Helen Liapis, Changli Wei, Jochen Reiser, Daniel C Brennan
Journal: Front Med (Lausanne) (2015)
Keywords: acute kidney injury, albumin permeability factor, angiotensin 1 receptor antibody, podocyte, recurrent focal segmental glomerular sclerosis, soluble urokinase plasminogen activator receptor

Background:
Recurrent focal segmental glomerular sclerosis (rFSGS) in renal transplant recipients (RTR) is difficult to predict and treat. Early rFSGS is likely from circulating factors and preformed antibodies.
Methods:
We present the case of a 23-year-old white man who presented with rFSGS and acute renal failure, requiring dialysis 9-months after a 1-haplotype matched living-related transplant. We retrospectively analyzed serum samples from various clinical stages for rFSGS biomarkers: serum glomerular albumin permeability (Palb), soluble urokinase-type plasminogen activator receptor (suPAR) serum level with suPAR-β3 integrin signaling on human podocytes, and angiotensin II type I receptor-antibody (AT1R-Ab) titer.
Results:
All biomarkers were abnormal at 1-year pre-transplant prior to initiation of dialysis and at the time of transplant. After initiation of hemodialysis, β3 integrin activity on human podocytes, in response to patient serum, as well as AT1R-Ab were further elevated. At the time of biopsy-proven recurrence, all biomarkers were abnormally high. One week after therapy with aborted plasmapheresis (secondary to intolerance), and high dose steroids, the Palb and suPAR-β3 integrin activity remained significantly positive. After 12-weeks of treatment with high-dose steroids, rituximab, and galactose, the patient remained hemodialysis-dependent. Three-months after his initial presentation, we commenced adrenocorticotropic hormone (ACTH, Acthar(®) Gel), 80 units subcutaneously twice weekly. Four-weeks later, he was able to discontinue dialysis. After 8-months of maintenance ACTH therapy, his serum creatinine stabilized at 1.79 mg/dL with <1 g of proteinuria.
Conclusion:
ACTH therapy was associated with improvement in renal function within 4 weeks. The use of rFSGS biomarkers may aid in predicting development of rFSGS.
Subarachnoid fluid lactate and paraplegia after descending aorta aneurysmectomy: two compared case reports
Authors: Enrico Giustiniano, Silvia Eleonora Malossini, Francesco Pellegrino, Franco Cancellieri
Journal: Case Rep Anesthesiol (2013)

We report a comparison of two cases regarding subjects who underwent thoracoabdominal aorta aneurysmectomy. During the procedure we monitored cerebrospinal fluid lactate concentration. One patient experienced postoperative paraplegia and his cerebrospinal fluid lactate concentration was much higher than that in the other case, whose postoperative outcome was uneventful. Consequently we consider that monitoring the lactate concentration in cerebrospinal fluid during thoracic aorta surgical procedures may be a helpful tool to predict the ischemic spine-cord injury allowing for trying to recover it precociously.
Case Report: Primary Hyperparathyroidism due to Posterior Mediastinal Parathyroid Adenoma With One-Year Follow-Up
Authors: Yi Shao, Qingdong Zeng, Bin Lv, Xu Chen, Lei Sheng
Journal: Front Surg (2022)
Keywords: ectopic parathyroid adenoma, posterior superior mediastinum, primary hyperparathyroidism, thoracic surgery, vitamin d deficiency
MeSH terms: Case Reports

Ectopic parathyroid adenoma, though rare, is one of the causes of persistent hyperparathyroidism and recurrence of hyperparathyroidism. Ectopic parathyroid glands can be seen in thymus, thyroid, and mediastinum. However, ectopic parathyroid adenoma occurred in the posterior superior mediastinum is extremely rare. Here, we report a case of primary hyperparathyroidism caused by ectopic parathyroid adenoma located in the posterior superior mediastinum. Serum parathyroid hormone, calcium, and vitamin D levels of the patient was followed up for one year.
Pulmonary Langerhans Cell Histiocytosis and Diabetes Insipidus in a Young Smoker
Authors: K Earlam, C A Souza, R Glikstein, M M Gomes, S Pakhalé
Journal: Can Respir J (2016)
MeSH terms: Histiocytosis, Langerhans-Cell / diagnostic imaging, Case Reports, Diabetes Insipidus / complications, Histiocytosis, Langerhans-Cell / complications, Histiocytosis, Langerhans-Cell / pathology, Humans, Lung / pathology, Magnetic Resonance Imaging, Male, Smoking / adverse effects, Tomography, X-Ray Computed, Young Adult

Langerhans cell histiocytosis is characterized by the abnormal nodular proliferation of histiocytes in various organ systems. Pulmonary involvement seen in young adults is nearly always seen in the context of past or current cigarette smoking. Although it tends to be a single-system disease, extrapulmonary manifestations involving the skin, bone, and hypothalamic-pituitary-axis are possible. High resolution CT (HRCT) of the thorax findings includes centrilobular nodules and cysts that are bizarre in shape, variable in size, and thin-walled. Often the diagnosis can be made based on the appropriate clinical presentation and typical imaging findings. Treatment includes smoking cessation and the potential use of glucocorticoids or cytotoxic agents depending on the severity of disease and multisystem involvement.
Endovascular pharmacomechanical thrombolysis-a novel treatment for circumaortic left renal vein and inferior vena cava thrombosis in a paediatric patient with relapsing nephrotic syndrome
Authors: Manraj Kanwal Singh Heran, Tyler Michael Coupal, Janis Dionne
Journal: BJR Case Rep (2017)
MeSH terms: Case Reports

While venous thromboembolism (VTE) in children with nephrotic syndrome (NS) remains an uncommon clinical entity, it represents one of the disease's most severe and potentially fatal complications. As such, clinicians and radiologists must maintain a high level of suspicion for VTE and low threshold for performing diagnostic imaging studies in children with NS, thereby ensuring prompt diagnosis and early management initiation. Despite the recent advances and development of image-guided endovascular procedures, there remains a marked paucity of literature describing the use of endovascular intervention for the treatment of acute VTE in NS, and a clear consensus on the gold standard for management has yet to be fully elucidated. Moreover, given the relative rarity of this complication in children as opposed to adults, no prior report has been made in which a paediatric patient has undergone endovascular intervention for acute VTE in the setting of NS. This report will outline the use of endovascular pharmacomechanical thrombolysis and thrombectomy as a novel treatment option for acute circumaortic left renal vein and inferior vena cava thrombosis in a paediatric patient with relapsing NS.
Clinical Impact of Genomic Information in Pediatric Leukemia
Authors: Emilie Lalonde, Gerald Wertheim, Marilyn M Li
Journal: Front Pediatr (2017)
Keywords: diagnosis, genomic profiling, pediatric leukemia, prognosis, therapy

Pediatric leukemia remains a significant contributor to childhood lethality rates. However, recent development of new technologies including next-generation sequencing (NGS) has increased our understanding of the biological and genetic underpinnings of leukemia, resulting in novel diagnostic and treatment paradigms. The most prevalent pediatric leukemias include B-cell acute lymphoblastic leukemia (B-ALL) and acute myeloid leukemia (AML). These leukemias are highly heterogeneous, both clinically and genetically. There are multiple genetic subgroups defined by the World Health Organization, each with distinct clinical management. Clinical laboratories have started adopting genomic testing strategies to include high-throughput sequencing assays which, together with conventional cytogenetic techniques, enable optimal patient care. This review summarizes genetic and genomic techniques used in clinical laboratories to support management of pediatric leukemia, highlighting technical, biological, and clinical advances. We illustrate clinical utilities of comprehensive genomic evaluation of leukemia genomes through clinical case examples, which includes the interrogations of hundreds of genes and multiple mutation mechanisms using NGS technologies. Finally, we provide a future perspective on clinical genomics and precision medicine.
Total knee arthroplasty for Ochronosis induced knee arthropathy. Case report
Authors: Mohamed Al Ateeq Al Dosari, Aissam Elmhiregh, Safa Abulhail, Elhadi Babikir, Shamsi Abdul Hameed
Journal: Int J Surg Case Rep (2020)
Keywords: alkaptunurea, black bone disease, homogentisic acid, ochronosis, total knee arthroplasty
MeSH terms: Case Reports

Introduction:
Alkaptunurea is a rare metabolic disorder with autosomal recessive genetic pattern in transmission, it is characterized by accumulation of hemogenistic acid in the tissues due to deficiency of homogentisate 1,2 dioxygenase activity. Characteristically, affected patient will have dark urine and blackish discoloration of connective tissue, especially cartilage and bone and hence it is known as black bone disease.
Presentation of the case:
The reported case is for 49 years old gentleman, known to have hypertension, hypothyroidism and Alkaptunurea. He presented to our facility with long standing bilateral knee pain (more in the left) with difficulty in doing daily activities. He presented to our tertiary facility after failure of previous treatment measures. The patient underwent uncomplicated Robotic assisted total knee arthroplasty that resulted in significant improvement of his pain and function.
Conclusion:
Knee arthroplasty is a reliable and reproducible modality in treating Ochronotic knee arthropathy and it would result in pain reduction and better function of patients with such condition.