OpenMed/multicare-articles huggingface dataset:
Small bowel adenocarcinoma of the jejunum detected by double contrast enhanced ultrasound: a case report of a novel ultrasound modality
Authors: Shuang Wu, Huizhen Yu, Ying Liu, Hong Zhou, Yang Zhou
Journal: Front Oncol (2024)
Keywords: small bowel, adenocarcinoma, double contrast, jejunum, ultrasound
MeSH terms: Case Reports

Background:
Small Bowel Adenocarcinoma (SBA) is rare, occult and life-threatening malignancy in digestive system. Given low incidence and nonspecific symptoms, SBA is frequently detected in later stages. Double contrast enhanced ultrasound (DCEUS) is an innovative imaging technique applied to visualize the gastrointestinal tract, merging intravenous contrast-enhanced ultrasound with oral contrast-enhanced ultrasound. In this case, DCEUS was utilized and successfully detected an SBA of the jejunum.
Case presentation:
A Chinese woman, aged 64, sought consultation in the gastroenterology department at our hospital, reporting symptoms of abdominal pain. Three months before entering the hospital, she underwent gastroscopy and colonoscopy which suggested chronic gastritis, and she was treated with oral drugs. However, her symptoms were not relieved, and even worsened. To further investigate, DCEUS was performed. The oral contrast agent dilated the luminal space of the upper gastrointestinal tract, resolving the hindrance caused by gas in the gastrointestinal tract and creating an acoustic window for scanning. Through this acoustic window, oral agent contrast-enhanced ultrasound (OA-CEUS) revealed a localized thickening of jejunal intestinal wall measuring 4x3 cm. Following intravenous injection of ultrasound contrast agent, the jejunal lesion exhibited faster enhancement and heterogeneous hyper-enhancement. Finally, the patient underwent jejunal tumor resection. Pathological examination revealed a jejunal adenocarcinoma.
Conclusion:
The timely diagnosis of SBA can be challenging. DCEUS may have the potential to contribute to diagnosis and detailed evaluation of SBA, particularly in cases involving jejunum. Further researches are needed to fully explore the benefits of DCEUS in the standard diagnostic approach for small bowel diseases.
Case Report: Heart aneurysm of unknown origin in a two-year-old child diagnosed in the course of Multisystem Inflammatory Syndrome in Children
Authors: Dominika Mystkowska, Michal Galeczka, Wojciech Tarala, Pawel Banaszak, Joanna Sliwka, Szymon Pawlak, Roland Fiszer
Journal: Front Cardiovasc Med (2024)
Keywords: covid-19, multisystem inflammatory syndrome in children, sars-cov-2 virus, cardiac surgery, heart aneurysm
MeSH terms: Case Reports

We present a case of a 22-month-old boy with a hypokinetic and thin-walled aneurysm of the left ventricle apex. The lesion was diagnosed during routine echocardiography examination in the course of MIS-C, and its occurrence due to MIS-C is plausible. Cardiac magnetic resonance imaging revealed an akinetic aneurysm of the LV apex with a full-wall ischemic scar. Aortography confirmed a normal course of coronary arteries, with adequate perfusion of essential branches and no evidence of stenosis or aneurysms. The boy underwent consultation with the heart team and was deemed eligible for surgery. The aneurysm was excised up to the margin of healthy tissues, and both the surgery and the periprocedural period were uneventful. Determining the origin of the aneurysm is challenging. The most probable etiology appears to be a congenital lesion. Another consideration is an ischemic lesion that may have resulted from impaired coronary circulation during the complicated course of MIS-C. It is possible that this disturbance resolved spontaneously before aortography was performed. Additionally, a complication of pericarditis cannot be entirely ruled out.
Clinical utility of intraoperative direct wave monitoring in patients with pre-operative motor deficits: Case series
Authors: Shyam Duvuru, Vivek Sanker, Maneeth Mylavarapu, Sejal Lund, Rahul Jena, Tirth Dave
Journal: Int J Surg Case Rep (2024)
Keywords: d wave, emg, ionm, intraoperative neuromonitoring, mep, ssep, spine surgery

Introduction and importance:
D-wave (Direct waves) are Motor Evoked Potentials (MEPs) generated by a single transcranial stimulation and captured by attaching an epidural recording electrode caudal to the vulnerable area. Intraoperative neurophysiologic monitoring (IONM) is widely used in neurosurgery to recognize important neurological structures but can be challenging in the pediatric population due to incomplete neural development.
Case presentation:
Case 1: A 48-year-old female presented to the outpatient department with complaints of difficulty walking for the past six months, numbness and weakness in bilateral lower limbs with recurrent falls for the past 1 month. Case 2: A 12-year-old boy presented to the emergency room with a history of inability to use both upper and lower limbs on the right side with tremulousness.
Clinical discussion:
Magnetic resonance imaging (MRI) Spine in the first case revealed a D9-D10 calcified meningioma with significant spinal cord compression. In the second case, MRI Spine showed C1-C2 Intramedullary Space Occupying Lesion (SOL) and was planned for C1-C2 laminectomy with midline myelotomy. The first case was planned for microsurgical excision of the lesion under IONM guidance. The procedure went smoothly. Microsurgical gross total resection (GTR) of the intramedullary SOL under IONM Guidance was done for the second case. Postoperatively, the first patient showed no neurological compromise or complications. In the second case, following surgery, the child recovered gradually from surgery.
Conclusion:
This case series demonstrates the successful surgical management of two cases of spinal cord tumors through an IONM-guided surgery and the effective use of D waves in such challenging cases.
Clinical T1a Renal Cell Carcinoma with Solitary Diaphragmatic Metastasis in a Patient with von Hippel-Lindau Disease
Authors: Tadataka Hirai, Mayu Uka, Toshihiro Iguchi, Kazuya Yasui, Takahiro Kawabata, Noriyuki Umakoshi, Koji Tomita, Yusuke Matsui, Yasuyuki Kobayashi, Motoo Araki, Takao Hiraki
Journal: J Kidney Cancer VHL (2024)
Keywords: carcinoma, diaphragm, renal cell, von hippel-lindau disease
MeSH terms: Case Reports

We report the case of a 38-year-old man with two von Hippel-Lindau disease-associated T1a renal cell carcinomas (RCCs) (<2 cm in diameter) which developed into a 2.5-cm solitary diaphragmatic metastatic tumor. After diagnosis using percutaneous biopsy, the diaphragmatic metastasis and two RCCs were treated by laparoscopic resection and percutaneous cryoablation, respectively. One year after treatment, the patient survived without local recurrence or distant metastasis. This report describes a rare case of RCC metastasis in VHL disease and its treatment.
Adult diffuse hepatic hemangiomatosis lesion occupying the entire abdominal and pelvic cavities: a case report
Authors: Ya-Nan Ge, Yan Shao, Shu-Chen Dong, Xing-Bin Ma, Wei Wang
Journal: Front Med (Lausanne) (2024)
Keywords: kasabach-merritt syndrome, diffuse hepatic hemangiomatosis, giant cavernous hemangioma, imaging features, multimodality evaluation
MeSH terms: Case Reports

Introduction:
Adult diffuse hepatic hemangiomatosis (DHH) is an extremely rare disease. Consequently, its characteristics are poorly understood. Herein, we report a case of adult DHH involving both liver lobes but without extrahepatic involvement. To the best of our knowledge, this the largest reported adult DHH to date.
Case presentation:
A 51-year-old man was admitted due to abdominal distension and dyspnea. Physical examination revealed marked liver enlargement. Color Doppler, plain and contrast-enhanced computed tomography, and contrast-enhanced magnetic resonance imaging revealed a hepatic lesion sized 35.1 × 32.1 × 14.1 cm occupying nearly the entire abdominal and pelvic cavities. Diagnosis was established by liver puncture biopsy. The patient exhibited clinical signs of portal hypertension and hypersplenism, but remains free of serious DHH-related complications. He is followed up regularly, with proactive evaluation for future liver transplantation.
Conclusion:
This case will contribute to the current knowledge on the clinical and imaging features of this rare entity.
Endovascular treatment of epidural arteriovenous fistula associated with sacral arteriovenous malformation: case report
Authors: Ahmad Sulaiman Alwahdy
Journal: Front Neurol (2024)
Keywords: arteriovenous fistula, arteriovenous malformation, embolization, endovascular, epidural, spinal
MeSH terms: Case Reports

Spinal epidural arteriovenous fistulas with sacral arteriovenous malformation (AVM) are a rare type of spinal arteriovenous fistulas. There are two varieties of spinal epidural arteriovenous fistulas (SEDAVFs), with type 1 involving intradural venous drainage and type 2 not involving intradural venous drainage. We present a case of transarterial embolization for type 1 SEDAVFs with sacral AVM. Within 8 months, a 14-year-old boy presented with progressively weaker lower extremities and bladder-bowel dysfunction. Magnetic resonance imaging (MRI) of the whole spine revealed thoracic spinal cord congestion, a single dilated flow void running from the lumbosacral area to the conus medullaris, and continuing cranial draining up to the C5 level via the perimedullary vein. Filling of the venous sac through a preferential feeder after embolizing the AVM nidus was performed. After 3 months, the clinical follow-up showed improvement of motoric function, although mild. Endovascular treatment for SEDAVF type 1 might have achieved total obliteration without any procedural complications. Nevertheless, it can be very challenging due to multiple feeders and the presence of an AVM nidus like in this case. However, the most difficult thing in fistula cases is establishing the diagnosis and finding the fistula point. Early treatment is required, due to the fact that longstanding lesions could cause irreversible damage.
Clinical symptoms, pathogenesis and postoperative course of non-specific constrictive pericarditis with dumbbell-shaped heart
Authors: Feridoun Sabzi, Reza Faraji, Saeed Khoshnood
Journal: GMS Hyg Infect Control (2024)
Keywords: constrictive pericarditis, tuberculosis
MeSH terms: Case Reports

Non-specific chronic constrictive pericarditis is a rare and debilitating chronic infection in developed countries and its rapid diagnosis and treatment has not affected its outcome and complication. A 15-year-old male, well nourished, negative HIV test, and without a history of previous pulmonary tuberculosis, was admitted to our hospital for exertional dyspnea (New York Heart Association, NYHA, functional class II). Our patient had had no pulmonary tuberculosis during childhood, had received anti-tuberculosis treatment, and was referred to our center for further surgical pericardiectomy.
Primary pure large cell neuroendocrine carcinoma of the urinary bladder: a case report and literature review
Authors: Zhenpeng Sun, Xin Liang, Changcun Zhang, Shizhang Song, Jiangang Gao
Journal: Front Oncol (2024)
Keywords: bladder cancer, large cell neuroendocrine carcinomas, prognosis, radical cystectomy, toripalimab
MeSH terms: Case Reports

Background:
The large cell neuroendocrine carcinoma (LCNEC) of the urinary bladder is a rare malignancy. With its high aggressiveness and poor prognosis, the disease is often accompanied by metastasis or recurrence. The lack of specific clinical manifestations and imaging features causes considerable challenges for clinical diagnosis and treatment.
Case presentation:
We report a case of LCNEC of the urinary bladder. The patient was a 79-year-old male admitted to our hospital with recurrent episodes of asymptomatic gross hematuria. Based on the computed tomography (CT) scan findings, our patient presented with a bladder mass displaying invasion into the serosal layer, suggestive of muscle involvement and indicative of malignancy. The patient received a radical cystectomy, and the postoperative pathology confirmed primary, pure LCNEC of the urinary bladder. We gave him 16 cycles of toripalimab immunotherapy. As of follow-up, the patient was alive, and periodic CT reexamination showed no evidence of recurrence.
Conclusions:
We reviewed domestic and foreign literature and found no explicit treatment protocols exist for the disease. Surgical resection combined with chemotherapy were the most common treatments. Herein, we reported the first case of primary, pure LCNEC of the urinary bladder treated by radical cystectomy combined with pure immunotherapy, achieving sustained remission, which provides a new idea for the immunotherapy and integrative treatment of the disease.
Ovarian hydatid cyst: an uncommon site of presentation
Authors: Kaushlendra Kumar, Ariba Zaidi, Nuzhat Husain
Journal: Autops Case Rep (2023)
Keywords: echinococcosis, ovarian cysts, ovarian neoplasms
MeSH terms: Case Reports

Hydatid cyst is a parasitic infestation caused by Echinococcus larvae. Hydatid cyst of the ovary is a highly unusual presentation. Herein, we present a case of a young woman who complained of episodic lower abdominal pain. Ultrasound of the abdomen revealed a multi-cystic left adnexal mass measuring 86 mm x 67 mm. A possibility of ovarian cystic neoplasm was suggested. Unilateral salpingo-oophorectomy was performed. On histopathological examination, a cyst measuring 8.0 x 5.5 x 4.5 cm was found, replacing the entire ovary. The cyst cavity was filled with serous fluid and multiple pearly white membranous structures, giving a multiloculated appearance. Microscopic examination showed a cyst lined by a lamellar membrane containing protoscolices and hooklets. Hydatid disease is a zoonotic ailment caused by tapeworms (Echinococcus granulosus or, less commonly, Echinococcus multilocularis). The definitive hosts are carnivores. Humans are the accidental intermediate hosts. The hydatid cyst commonly affects the liver and the lungs. The primary hydatid cyst of the ovary is quite rare, with few case reports in the literature. In most cases, symptoms are vague, and the lesion is misdiagnosed as benign or malignant ovarian cystic neoplasm on clinical and radiological examination. Ovarian hydatid cyst is treated by surgery with ovarian cystectomy as the gold standard. The possibility of a hydatid cyst should be kept under differential diagnoses while evaluating the cystic diseases of the ovary.
The impact of mental health stigma in a young Malaysian lady with recurrent suicidal ideations and moribund presentations to the Emergency Department: a case report
Authors: Chiara Francine Petrus, Hajar Mohd Salleh Sahimi, Marhani Midin, Jane Tze Yn Lim
Journal: Front Psychiatry (2023)
Keywords: emergency department, mental health, stigma, suicide, suicide-related behavior
MeSH terms: Case Reports

Introduction:
Mental health stigma (MHS) has been a pervasive social issue and a significant barrier to treatment seeking behavior. The treatment pathways and outcomes for people with mental illness, specifically those with recurrent suicidal ideations and attempts have been influenced by how MHS was experienced in clinical practice.
Methods:
We reported a case of a young lady diagnosed with bipolar II disorder, obsessive-compulsive disorder and borderline personality disorder who had recurrent visits to various emergency departments (ED) of tertiary hospitals in Malaysia for suicidality; each time presenting with increased mortality risk and escalating near-lethal outcomes. Among the multiple ED visits after her alleged overdoses of psychotropic medications, thrice she was near-unconscious and had to be intubated for airway protection, subsequently requiring ventilatory support and ICU care. These near-lethal presentations in ED were due to her delays in seeking treatment for fear of re-experiencing the stigmatizing environment among healthcare staff and professionals in the ED.
Discussion:
The impact of MHS is detrimental. Effective interventions at various levels in the clinical setting is of utmost importance to prevent the negative consequences of suicidality against MHS.
Gas Density Within the Pancreas: A Case of Emphysematous Pancreatitis
Authors: Laurens Hutsebaut, Elyn Van Snick, Bart Claikens
Journal: J Belg Soc Radiol (2023)
Keywords: computed tomography, emphysematous pancreatitis, gas density, necrotizing infection, pancreatitis
MeSH terms: Case Reports

Teaching Point: Computed tomography is the imaging modality of choice to detect the presence of gas within or around the pancreas in emphysematous pancreatitis.
A Muscle Energy Techniques-Based Physiotherapeutic Intervention Protocol for Managing Nightstick Fracture: A Case Report
Authors: Aditi P Ambekar, Mitushi Deshmukh, Vaishnavi M Thakre, Pooja S Ladkhedkar, Palak R Ahuja
Journal: Cureus (2024)
Keywords: fracture, malunion, motion, pronation, radius, supination, ulna
MeSH terms: Case Reports

Distal ulna and radius fractures are the most frequent upper extremity fractures seen in emergency rooms. The axis of rotation for forearm pronation and supination runs through the radial head (proximal) and the ulnar fovea (distal). Throughout pronation and supination, the radius can rotate relative to the ulna, thanks to the way its head articulates with it. The ulna remains relatively stable during these movements. However, in cases of fractures of these bones, surgery to repair the radius is usually the best course of action for a distal ulna fracture. Most distal ulna fractures heal successfully with only conservative treatment once the radius is stabilized. To achieve the best results, medical personnel must take into account patient characteristics including age, level of activity, and aspirations. The majority of distal ulna injuries do not require surgery, but there are several circumstances where it is necessary. In therapeutic practice, muscle energy techniques (METs) are comparatively painless methods for restoring a restricted spectrum of motion. Malunion, reduced grasp, and other significant problems might result from a lack of understanding of this illness. The 48-year-old patient in the present study was reported to have sustained injuries to his left forearm in a road traffic accident (RTA) as he fell from his bike and slid during a traffic collision. X-ray imaging of the left forearm revealed an isolated ulnar shaft fracture. METs, isometric contractions, and active concentric and eccentric movements were all part of the physiotherapy intervention protocol to produce an active range of motion in the upper extremity. In this particular case, the specified physiotherapy management was found to be effective.
A Long-Term Survivor of Trisomy 18
Authors: Anusha Garg, Trudy C Wu
Journal: Cureus (2024)
Keywords: genetics, pediatrics, quality-of-life, trisomy 18, trisomy 18 syndrome
MeSH terms: Case Reports

Trisomy 18 is known for its severe prognosis, with most affected infants not surviving beyond a week, but this report sheds light on a remarkable case of a two-and-a-half-year-old girl born with Trisomy 18 who has thrived due to specialized medical care. Despite a complex medical profile, including congenital heart defects and hepatoblastoma, this patient underwent successful treatments, including multiple surgeries and chemotherapy. This case report showcases how modern medical advancements and multidisciplinary care can defy the historically grim prognosis associated with Trisomy 18, providing hope for improved outcomes and a better quality of life (QOL) for affected individuals and their families.
Activity of apremilast in a patient with severe pemphigus vulgaris: case report
Authors: Cheyenne Delvaux, Gérôme Bohelay, Ishaï-Yaacov Sitbon, Isaac Soued, Marina Alexandre, Joël Cucherousset, Laurent Gilardin, Antoine Diep, Frédéric Caux, Christelle Le Roux-Villet
Journal: Front Immunol (2024)
Keywords: apremilast, auto-immune bullous disease, keratinocytes, pemphigus vulgaris, phosphodiesterase 4 inhibitor
MeSH terms: Pemphigus / diagnosis, Pemphigus / drug therapy, Thalidomide / analogs & derivatives, Thalidomide / therapeutic use, Case Reports, Aged, Anti-Inflammatory Agents, Non-Steroidal / therapeutic use, Female, Humans, Phosphodiesterase 4 Inhibitors / therapeutic use, Treatment Outcome, apremilast, Thalidomide, Anti-Inflammatory Agents, Non-Steroidal, Phosphodiesterase 4 Inhibitors

Introduction:
Although the treatment for pemphigus vulgaris (PV) has been revolutionized by the use of rituximab combined with corticosteroids, new effective therapies with a better safety profile are needed.
Observation:
A 67-year-old woman was diagnosed with severe mucosal PV, which was initially misdiagnosed as atypical Behçet's disease. Following an unsuccessful colchicine treatment, significant improvement was observed upon the introduction of apremilast: reduced pain, fewer lesions, and a stabilized weight. The discontinuation of apremilast led to a rapid relapse. Retrospective analysis through anti-Dsg3 ELISA indicated a gradual decrease in antibody levels during the apremilast treatment.
Discussion:
Apremilast, a phosphodiesterase 4 inhibitor approved for psoriasis and Behçet's disease's related oral ulcers treatment, demonstrated its efficacy in this PV case. This is the second case report highlighting the effectiveness of apremilast for PV treatment. Apremilast's ability to upregulate cyclic adenosine monophosphate (cAMP) levels appears to contribute to the stabilization of keratinocyte adhesion.
Conclusion:
Apremilast may be a promising therapeutic option for the treatment of pemphigus, with an innovative mechanism of action, no induced immunosuppression, and good tolerance. It could be a good alternative to steroids, in the treatment regimen of steroids combined with rituximab.
Iron quantification in basal ganglia using quantitative susceptibility mapping in a patient with ALS: a case report and literature review
Authors: Sadegh Ghaderi, Seyed Amir Hossein Batouli, Sana Mohammadi, Farzad Fatehi
Journal: Front Neurosci (2023)
Keywords: als, mri, qsm, basal ganglia, iron
MeSH terms: Case Reports

Background:
Quantitative susceptibility mapping (QSM) is a magnetic resonance imaging (MRI) technique that can measure the magnetic susceptibility of tissues, which can reflect their iron content. QSM has been used to detect iron accumulation in cortical and subcortical brain regions. However, its application in subcortical regions such as the basal ganglia, particularly the putamen, is rare in patients with amyotrophic lateral sclerosis (ALS).
Case presentation and literature review:
We present the case of a 40-year-old male patient with ALS who underwent an MRI for QSM. We compared his QSM images with those of a control subject and performed a quantitative analysis of the magnetic susceptibility values in the putamen regions. We also reviewed the literature on previous QSM studies in ALS and summarized their methods and findings. Our QSM analysis revealed increased magnetic susceptibility values in the bilateral putamen of the ALS patient compared to controls, indicating iron overload. This finding is consistent with previous studies reporting iron dysregulation in subcortical nuclei in ALS. We also discussed the QSM processing techniques used in our study and in the literature, highlighting their advantages and limitations.
Conclusion:
This case report demonstrates the potential of QSM as a sensitive MRI biomarker for evaluating iron levels in subcortical regions of ALS patients. QSM can provide quantitative information on iron deposition patterns in both motor and extra-motor areas of ALS patients, which may help understand the pathophysiology of ALS and monitor disease progression. Further studies with larger samples are needed to validate these results and explore the clinical implications of QSM in ALS.