OpenMed/multicare-articles huggingface dataset:
Rescue of Immunotherapy-Refractory Metastatic Merkel Cell Carcinoma With Conventionally Fractionated Radiotherapy and Concurrent Pembrolizumab
Authors: Brooke C Bloom, Alexander Augustyn, Todd A Pezzi, Hari Menon, Lauren L Mayo, Shalin J Shah, David L Schwartz, Steven J Chmura, Faye M Johnson, James W Welsh, Stephen G Chun
Journal: Front Oncol (2019)
Keywords: merkel cell carcinoma, pd-1, pd-l1, abscopal, checkpoint, immunotherapy, radiation
MeSH terms: Case Reports

Merkel cell carcinoma has historically had dismal prognosis with limited cytotoxic chemotherapy options that provide durable control of metastatic disease. The advent of anti-programmed death protein (anti-PD1)/anti-programmed death-ligand 1 (anti-PD-L1) directed immunotherapy has shown initial promise in Merkel cell carcinoma and radiation might augment immune responses. We present a case report of a 70-year-old male who underwent resection of Merkel cell carcinoma of the right thigh with a close margin and positive right inguinal involvement. Due to high-risk features, the patient was treated with adjuvant radiation to the right groin and with systemic carboplatin/etoposide, but developed local failure requiring salvage surgical resection. The patient then developed metastatic disease with biopsy proven retroperitoneal involvement refractory to doxorubicin/cyclophosphamide chemotherapy. The patient was then transitioned to single-agent pembrolizumab with a partial response for 10 months until developing progressive disease involving the left inguinal and left external iliac nodal regions. The progressive left inguinal/pelvic disease was treated with conventionally fractionated intensity modulated radiation therapy to a dose of 45 Gy delivered in 25 fractions. Following radiation therapy, the patient had complete response of all sites of disease throughout the body on imaging by RECIST criteria including retroperitoneal and mediastinal disease outside the radiation field. At 20 months post-radiation, the patient remains on pembrolizumab without evidence of disease on imaging. Herein, we present a case of durable response of metastatic Merkel cell carcinoma treated with concurrent radiation and pembrolizumab, providing evidence that radiation might improve systemic responses to anti-PD1/PD-L1 directed immune therapy. Ongoing prospective trials evaluating the utility of radiation in conjunction with immunotherapy for Merkel cell carcinoma are anticipated to provide clarity on the frequency and durability of abscopal responses when radiation is combined with immune checkpoint inhibitors.
A Unique Presentation of Cutaneous Diffuse Large B-Cell Lymphoma
Authors: Mary Awad, Erik Holzwanger, Sandeep Jubbal
Journal: Case Rep Dermatol Med (2020)
MeSH terms: Case Reports

Cutaneous B-cell lymphomas (CBCL) are rare heterogeneous neoplastic diseases composing about 22.5% of all cutaneous lymphomas. These diseases can be divided into primary and secondary cutaneous variants with primary cutaneous B-cell lymphoma (PCBCL) divided into three distinct entities including primary cutaneous marginal zone lymphoma, primary cutaneous follicle center lymphoma, and primary cutaneous diffuse large B-cell lymphoma, leg type (PCDLBCL, LT). Secondary cutaneous diffuse large B-cell lymphoma (CDLBCL) and PCDLBCL, LT are more aggressive neoplasms compared to the aforementioned CBCL with survival rates of 37% and 50% after 5 years, respectively. CDLBCL can present as cutaneous or subcutaneous nodules, papular lesions, or indurated plaques. Here, we present a case of CDLBCL of an 88-year-old female that was mistaken for lower extremity cellulitis with phlegmon. Our patient failed two courses of antibiotic therapy as an outpatient and received a third as an inpatient before a cutaneous biopsy clinched the diagnosis.
Transcapsular Buttonholing of the Proximal Ulna as a Cause for Irreducible Pediatric Anterior Elbow Dislocation
Authors: Nick N Patel, Robert W Bruce
Journal: Case Rep Orthop (2018)
MeSH terms: Case Reports

Anterior elbow dislocations in the pediatric population represent rare and sometimes difficult injuries to manage. Associated olecranon fractures are even more uncommon with limited literature existing on the topic. We present the case of a six-year-old male with a traumatic transolecranon anterior elbow fracture dislocation in whom closed reduction was prevented by buttonholing of the proximal ulna through the anterior joint capsule. This case of pediatric anterior elbow fracture dislocation provides insight into an uncommon and challenging injury complex.
A Singleton Infant with Bilateral Renal Agenesis and Normal Pulmonary Function
Authors: Lovya George, Winston Manimtim, Jotishna Sharma
Journal: Case Rep Pediatr (2017)
MeSH terms: Case Reports

Bilateral renal agenesis leads to anhydramnios and other sequelae including pulmonary hypoplasia. There have been rare case reports of normal pulmonary function in the presence of bilateral renal agenesis in monoamniotic discordant twins, but this has never been reported in a singleton pregnancy. The few reported cases in twins have all been fatal in the neonatal period with no reported cases of survival beyond 2 months. We describe the first case of a singleton infant with bilateral renal agenesis who had normal pulmonary function and did well on peritoneal dialysis for 4 years while awaiting a renal transplant.
STA-MCA bypass following sphenoid wing meningioma resection: A case report
Authors: Anh Duc Nguyen, Tam Duc Le, Hung Manh Ngo, Hung Dinh Kieu
Journal: Int J Surg Case Rep (2019)
Keywords: case report, mca injury, sta-mca bypass, sphenoid wing meningioma

Introduction:
Sphenoid meningioma engulfed cerebral arteries has always been a challenge. To achieve a gross total resection, vessel sacrifice may be unavoidable.
Presentation of case:
A 22-year-old man with a history of head trauma a week ago complained of a headache for one week. On examination, he was alert, denied paralysis and cranial nerves palsies. Preoperative MRI showed a hypervascular left sphenoid wing meningioma embedding left internal carotid artery and proximal segment of the middle cerebral artery. In operation, a branch of the MCA was divided when dissecting the tumor. The MCA was clipped but was still difficult to dissect vessel ends in the Sylvian fissure. We decided to extend craniotomy and did superficial temporal artery to M4 segment of MCA bypass. Then, the patient was resuscitated in surgical high dependency unit for 3 days. Surgical outcome in one year postoperative was good with KPS 90 out of 100 points and no neurological deficits. On postoperative MRA, STA-MCA bypass shown acceptable flow.
Discussion:
There were a few cases of skull base tumors requiring vessel revascularization. Most of the revascularization cases were meningiomas. Saphenous vein graft (SVGs) was the most commonly reported graft, followed by radial artery graft (RAGs). In case of difficulty in dissecting the vessel ends due to the tumor infiltration, STA-MCA bypass was a safe and helpful choice, especially the collateral vessels were present and the need for blood flow augmentation was minimal.
Conclusion:
STA-MCA bypass was effective surgical management for MCA injury in sphenoid wing meningioma resection.
The Effect of Routine Management Combined with Case Management Model on Social Support, Self-Efficacy, Self-Management Ability, and Psychological Flexibility of AIDS Patients
Authors: Li Liu, Jing Zhou, Huan Xiao, Yanhe Luo, Yan Zeng, Li Fan, Chen Zheng
Journal: Comput Math Methods Med (2022)
MeSH terms: Acquired Immunodeficiency Syndrome / therapy, Self-Management, Retracted Publication, Case Management, Humans, Quality of Life / psychology, Self Efficacy, Social Support

Objective:
To explore the influence of conventional management combined with case management on social support and self-efficacy of AIDS patients.
Methods:
The clinical case data of 120 AIDS patients who were treated and nursed in our hospital from June 2019 to June 2021 were selected as the research objects and were divided into the control group and the observation group according to the digital table method, with 60 cases each. The control group implements routine management, and the observation group implements case-based nursing management on this basis and compares the effects of self-efficacy, self-management ability, nursing ability, social support, and psychological flexibility of the two groups of patients.
Results:
Before the intervention, the quality of life scores of the two groups was not statistically significant (P > 0.05). After the intervention, the physical function score, pain management score, and symptom response score of the observation group were significantly higher than those of the control group, and statistics showed that the difference was statistically significant (P < 0.05). Before the intervention, the self-management ability of the two groups of patients was not statistically significant (P > 0.05). After the intervention, the observation group's symptom management, emotional cognition management, social support and assistance, daily life management, disease knowledge management, and treatment compliance management were significantly higher than those of the control group. Statistics show that this difference is statistically significant (P < 0.05). Before the intervention, there was no significant difference in the nursing ability and psychological flexibility between the two groups of patients (P > 0.05). After the intervention, the observation group's health knowledge level, self-care skills, self-care responsibility, self-concept, and mental flexibility (resilience, strength, optimism) indicators were higher than the control group, while the depression mood disorder score was significantly lower than the control group; statistics showed that this difference was statistically significant (P < 0.05).
Conclusion:
Routine management combined with case-based nursing management can effectively improve the self-management ability and psychological flexibility of AIDS patients, improve patient care ability and self-efficacy, and provide certain reference value for effective management of AIDS patients.
The Relationship between Werner Syndrome and Sinonasal Malignant Melanoma: Two Sibling Cases of Werner Syndrome with Malignant Melanoma
Authors: Yoshinori Kadowaki, Satoru Kodama, Munehito Moriyama, Masashi Suzuki
Journal: Case Rep Otolaryngol (2017)
MeSH terms: Case Reports

Werner syndrome (WS) is an autosomal recessive disease characterized by premature aging. Malignant tumors such as thyroid carcinoma and malignant melanoma occur frequently in WS patients. We describe 2 siblings with WS who suffered from sinonasal malignant melanoma (MM). Both patients initially experienced nasal obstruction and recurrent nasal bleeding and died within 2 years of the diagnosis of MM. Otolaryngologists should recognize that WS patients have a high risk for head and neck malignant disease, particularly sinonasal MM, even if they are aged below the expected age range and undergo periodic examinations. Furthermore, it is important that WS patients are aware that a prompt nasal examination is indicated if they experience continuous nasal obstruction or recurrent nasal bleeding.
Median nerve neuropathy in the forearm due to recurrence of anterior wrist ganglion that originates from the scaphotrapezial joint: Case Report
Authors: Kiyoshi Okada, Junichi Miyake, Toshiyuki Kataoka, Hisao Moritomo, Tsuyoshi Murase, Hideki Yoshikawa
Journal: J Brachial Plex Peripher Nerve Inj (2012)
MeSH terms: Case Reports

Background:
Median nerve neuropathy caused by compression from a tumor in the forearm is rare. Cases with anterior wrist ganglion have high recurrence rates despite surgical treatment. Here, we report the recurrence of an anterior wrist ganglion that originated from the Scaphotrapezial joint due to incomplete resection and that caused median nerve neuropathy in the distal forearm.
Case presentation:
A 47-year-old right-handed housewife noted the appearance of soft swelling on the volar aspect of her left distal forearm, and local resection surgery was performed twice at another hospital. One year after the last surgery, the swelling reappeared and was associated with numbness and pain in the radial volar aspect of the hand. Magnetic resonance imaging revealed that the multicystic lesion originated from the Scaphotrapezial joint and had expanded beyond the wrist. Exploration of the left median nerve showed that it was compressed by a large ovoid cystic lesion at the distal forearm near the proximal end of the carpal tunnel. We resected the cystic lesion to the Scaphotrapezial joint. Her symptoms disappeared 1 week after surgery, and complications or recurrent symptoms were absent 13 months after surgery.
Conclusions:
A typical median nerve compression was caused by incomplete resection of an anterior wrist ganglion, which may have induced widening of the cyst. Cases with anterior wrist ganglion have high recurrence rates and require extra attention in their treatment.
Evidence of Authorship on Messages in Facilitated Communication: A Case Report Using Accelerometry
Authors: Patrick Faure, Thierry Legou, Bruno Gepner
Journal: Front Psychiatry (2021)
Keywords: accelerometry, authorship, autism spectrum disorder, coproduction, facilitated communication, motor disorders, physical support, validity
MeSH terms: Case Reports

Facilitated communication (FC) belongs to augmentative and alternative methods of communication. Currently, FC is very rarely and unofficially used with people suffering from verbal/communicative disorders or neurodevelopmental disorders such as intellectual deficiency or autism spectrum disorder (ASD). FC consists of physical support exerted by a facilitator at the hand/wrist/forearm/elbow of a patient/participant, aimed at helping him/her to point at pictures/words, and sometimes to type letters/words on a keyboard. Given most of (but not all) validation studies using control procedures failed to confirm that ASD participants themselves were authoring the messages via FC, this method has been massively disputed and rejected. However, firm and definitive conclusions for/against the validity of FC requires more robust demonstrations, particularly when considering the motor participation of both protagonists. We present here a case report investigating the motor contribution of both protagonists during a typing process using the non-invasive technique of accelerometry. A 17-year-old boy diagnosed with congenital deafness, ASD, and developmental delay, and his facilitator, were equipped with small accelerometers fixed on their index finger, aimed at transforming index acceleration along the three spatial axes into electric signals. Typing on a PC keyboard was performed under three support conditions: hand support, forearm support, elbow support, plus a solo-typing condition. Accelerometric signals and video data were recorded during four FC sessions. We measured and compared the typing speed, the number/percentage of acceleration peaks produced by the participant or by the facilitator first, and those of "signal under detection threshold" in the facilitator, the time offset between acceleration peaks of both protagonists, and the difference of the amount of acceleration between them, across the different support conditions. Results indicate that in the hand support, most of the time, acceleration motions of the participant's index finger preceded those of the facilitator's index finger. Then, the more distal the physical support (i.e., farer from the participant's hand), the slower the speed of typing, the higher the percentage of "signal under detection threshold" in the facilitator, the bigger the motor contribution from the participant. Altogether, in all the support conditions, the participant's authorship or, at least, co-authorship on the messages seems warranted. Finally, accelerometry seems relevant to objectivize authorship or co-authorship in FC and delineate various forms of FC.
Very Rare Liver Neoplasm: Lymphoepithelioma-Like ( LEL) Hepatocellular Carcinoma
Authors: Marcello Filotico, Valentina Moretti, Federica Floccari, Alessandro D'Amuri
Journal: Case Rep Pathol (2018)
MeSH terms: Case Reports

A case of lymphoepithelioma-like (LEL) hepatobiliary carcinoma is reported. To date, only 89 cases of this rare neoplasm have been reported, with both hepatocellular and cholangiocellular histotype. The case reported here could be classified as LEL mixed hepatobiliary carcinoma (Hepato-Cholangio), a histotype not reported so far in the LEL variant.
Antiphospholipid Antibody Induced by Nivolumab
Authors: Ahmed Aburahma, Nour Aljariri Alhesan, Farah Elounais, Emad Abu Sitta
Journal: Case Rep Hematol (2018)
MeSH terms: Case Reports

Nivolumab is a monoclonal antibody against the programmed death protein 1 and is used for patients with advanced melanoma. It is associated with potentially immune-related adverse events, including disorders of the skin, GI tract, and the thyroid; these disorders were successfully treated with prednisone and infliximab. Other immunotherapeutic agents were observed to induce the formation of antiphospholipid antibody (APA) including α-interferon and interleukin-2. We present a case of APA development after the third dose of nivolumab in a 71-year-old male with advanced melanoma. The APA was detected after finding a prolonged aPTT; the lupus anticoagulant assay tested positive. The patient was treated with prednisone but, unfortunately, he expired a few days later.
Malignant transformation of a phalangeal enchondroma into a recurrent grade II chondrosarcoma requiring successive transcarpal amputations: a case report
Authors: Ceyran Hamoudi, Benjamin Bouillet, Antoine Martins
Journal: Case Reports Plast Surg Hand Surg (2022)
Keywords: enchondroma, chondrosarcoma, hand, malignant transformation, posterior interosseous artery flap, small bone tumor, transcarpal amputation
MeSH terms: Case Reports

We report a case of malignant transformation of a phalangeal enchondroma into a grade II chondrosarcoma requiring two successive transcarpal amputations owing to recurrence. Soft tissue defects were repaired using single-stage reconstruction with a posterior interosseous artery flap. The 2-year follow-up assessment was satisfactory and no recurrence was observed.
Understanding the role of serological and clinical data on assessing the dynamic of malaria transmission: a case study of Bagamoyo district, Tanzania
Authors: Tunu Guntram Mwamlima, Solomon Mickson Mwakasungula, Catherine Gerald Mkindi, Mgeni Mohamed Tambwe, Sarah Senyoni Mswata, Stephen Gabriel Mbwambo, Michael Fred Mboya, Simon John Draper, Sarah Elizabeth Silk, Maxmillian Gideon Mpina, John-Mary Vianney, Ally Ibrahim Olotu
Journal: Pan Afr Med J (2022)
Keywords: plasmodium falciparum, total immunoglobulins (igg), anti-schizont antibodies, clinical malaria, infants, malaria transmission
MeSH terms: Malaria Vaccines, Malaria / epidemiology, Malaria, Falciparum / epidemiology, Antibodies, Protozoan, Cross-Sectional Studies, Humans, Immunoglobulin G, Infant, Plasmodium falciparum, Tanzania / epidemiology, Malaria Vaccines, Immunoglobulin G, Antibodies, Protozoan

Introduction:
naturally acquired blood-stage malaria antibodies and malaria clinical data have been reported to be useful in monitoring malaria change over time and as a marker of malaria exposure. This study assessed the total immunoglobulin G (IgG) levels to Plasmodium falciparum schizont among infants (5-17 months), estimated malaria incidence using routine health facility-based surveillance data and predicted trend relation between anti-schizont antibodies and malaria incidence in Bagamoyo.
Methods:
252 serum samples were used for assessment of total IgG by enzyme-linked immunosorbent assay and results were expressed in arbitrary units (AU). 147/252 samples were collected in 2021 during a blood-stage malaria vaccine trial [ClinicalTrials.gov NCT04318002], and 105/252 were archived samples of malaria vaccine trial conducted in 2012 [ClinicalTrials.gov NCT00866619]. Malaria incidence was calculated from outpatient clinic data of malaria rapid test or blood smear positive results retrieved from District-Health-Information-Software-2 (DHIS2) between 2013 and 2020. Cross-sectional data from both studies were analysed using STATA version 14.
Results:
this study demonstrated a decline in total anti-schizont IgG levels from 490.21AU in 2012 to 97.07AU in 2021 which was related to a fall in incidence from 58.25 cases/1000 person-year in 2013 to 14.28 cases/1000 person-year in 2020. We also observed a significant difference in incidence when comparing high and low malaria transmission areas and by gender. However, we did not observe differences when comparing total anti-schizont antibodies by gender and study year.
Conclusion:
total anti-schizont antibody levels appear to be an important serological marker of exposure for assessing the dynamic of malaria transmission in infants living in malaria-endemic regions.
Diagnostic and surgical management of primary central nervous system angioleiomyoma: A case report and literature review
Authors: Emanuele Rubiu, Emanuele La Corte, Giulio Bonomo, Francesco Restelli, Jacopo Falco, Elio Mazzapicchi, Morgan Broggi, Marco Paolo Schiariti, Bianca Pollo, Valentina Pinzi, Maria Grazia Bruzzone, Francesco Di Meco, Francesco Acerbi, Paolo Ferroli
Journal: Front Oncol (2022)
Keywords: cns, angiography, angioleiomyoma, fluorescein, intracranial, intraoperative confocal endomicroscopy, primitive
MeSH terms: Case Reports

Angioleiomyoma (ALM) is a benign smooth muscle neoplasm that mainly occurs in lower extremities subcutaneous tissue and generally affects middle-aged adults. This tumor histotype may rarely localize intracranially, although only a few cases have been described in the literature. We report a case of intracranial ALM, whose differential diagnosis has been particularly challenging, and firstly provide a comprehensive radiological and intra-operative evaluation of a such rare entity. This represents also the first report of the use of intraoperative confocal microscopy in ALM and the first documented short-term recurrence. At this regard, a scoping literature review has been conducted with the aim of presenting the major clinical and diagnostic features along with the proposed therapeutic strategies.
Surgical Approach in Management of Posttraumatic Diaphragmatic Hernia: Thoracotomy versus Laparotomy
Authors: Ahmed Shabhay, Pius Horumpende, Zarina Shabhay, Sjef G Van Baal, Ester Lazaro, Kondo Chilonga
Journal: Case Rep Surg (2020)
MeSH terms: Case Reports

Breach in diaphragmatic musculature permits abdominal viscera to herniate into the thoracic cavity. Time of presentation and associated injuries determines the surgical approach in management. This case report sets to highlight the challenges in clinical diagnosis, radiological interpretation, and surgical management approaches of posttraumatic diaphragmatic hernia. We report a case of a 43 years old male who was diagnosed with traumatic diaphragmatic hernia 6 months post blunt thoracoabdominal trauma due to motor traffic accident. He was initially diagnosed with haemothorax, drained with an underwater thoracostomy tube, and discharged. He continued to experience on and off chest pain worsening postfeeding, difficulty in breathing and abdominal pain for the next six months until his eventual diaphragmatic hernia diagnosis. He was scheduled for an elective thoracotomy. A left posterolateral thoracic over the 7th intercostal space incision was used. Intraoperatively, the stomach, left lobe of liver, part of transverse colon, small bowel, and omentum had herniated into the thoracic cavity adhering into thoracic viscera and wall. Adhesiolysis was done, and abdominal organs reduced into abdominal cavity. Rent was closed by interrupted Prolene sutures reinforced with a mesh. In patients with delayed presentation of diaphragmatic hernia post blunt thoracoabdominal injury without associated intra-abdominal visceral injury, we recommend the thoracic diaphragmatic repair approach as long-standing herniated bowels might adhere with thoracic cavity walls or viscera. In such cases, adhesiolysis and rent repair is easier through thoracotomy.