OpenMed/multicare-articles huggingface dataset:
Case Report: A case report of dry tap during ventriculostomy
Authors: Sunil Munakomi, Binod Bhattarai
Journal: F1000Res (2015)
Keywords: dry tap, management, pneumocephalus

Pneumocephalus following ventriculoperitoneal (VP) shunt insertion is an exceptionally rare occurrence. We report such an event after attempting ventricular puncture (ventriculostomy) for VP shunt insertion and then discuss the management of the same. Dry tap can lead to multiple attempts for ventriculostomy with the associated added risks of complications, as well as complicating the subsequent management. In addition, there is an increased risk of tension pneumocephalus, seizure and shunt failure due to a blockage by air bubbles. Our patient presented with features of raised intracranial pressure two months following craniotomy and evacuation of traumatic subdural hematoma. External ventricular puncture revealed egress of CSF under pressure. Upon attempting VP shunting for post-traumatic hydrocephalus, we experienced dry tap during ventricular puncture that complicated further management. We placed the proximal shunt in the presumed location of the foramen of Monro of ipsilateral frontal horn of lateral ventricle and did not remove the external ventricular drain. Post-operative CT scan revealed pneumoventriculi as the cause for the dry tap during ventricular puncture. Patient was managed with 100% oxygen. He showed gradual improvement and was later discharged. This case shows that variations in the procedure, including head down positioning, adequate cruciate dural incision prior to cortex puncture, and avoiding excessive egress of CSF can help to prevent such complications.
Not All Acute Abdomen Cases in Early Pregnancy Are Ectopic; Expect the Unexpected: Renal Angiomyolipoma Causing Massive Retroperitoneal Haemorrhage
Authors: Muhammad Asim Rana, Ahmed F Mady, Nagesh Jakaraddi, Shahzad A Mumtaz, Habib Ahmad, Kamal Naser
Journal: Case Rep Crit Care (2016)

Retroperitoneal haemorrhage (or retroperitoneal haematoma) refers to an accumulation of blood found in the retroperitoneal space. It is a rare clinical entity with variable aetiology including anticoagulation, ruptured aortic aneurysm, acute pancreatitis, malignancy, and bleeding from renal aneurysm. Diagnosis of retroperitoneal bleed is sometimes missed or delayed as presentation is often nonspecific. Multislice CT and arteriography are important for diagnosis. There is no consensus about the best management plan for patients with retroperitoneal haematoma. Stable patients can be managed with fluid resuscitation, correction of coagulopathy if any, and blood transfusion. Endovascular options involving selective intra-arterial embolisation or stent-grafts are clearly getting more and more popularity. Open repair is usually reserved for cases when there is failure of conservative or endovascular measures to control the bleeding or expertise is unavailable and in cases where the patient is unstable. Mortality of patients with retroperitoneal haematoma remains high if appropriate and timely measures are not taken. Haemorrhage from a benign renal tumour is a rarer entity which is described in this case report which emphasizes that physicians should have a wide index of suspicion when dealing with patients presenting with significant groin, flank, abdominal, or back pain, or haemodynamic instability of unclear cause. Our patient presented with features of acute abdomen and, being pregnant, was thought of having a ruptured ectopic pregnancy.
Case Report: A 91-Year-Old Patient With Non-Small Cell Lung Cancer Harboring MET Y1003S Point Mutation
Authors: Beili Gao, Ran Zeng
Journal: Front Med (Lausanne) (2022)
Keywords: met y1003 mutation, case report, crizotinib, next-generation sequencing, non-small cell lung cancer
MeSH terms: Case Reports

Background:
The Y1003S point mutation in exon 14 of mesenchymal-epithelial transition (MET) is a rare mutation that can lead to oncogenic transformation. Few data are available on the characteristics of this mutation. This report presents an elderly patient with non-small cell lung cancer (NSCLC) and a Y1003S mutation in MET detected by next-generation sequencing (NGS).
Case report:
In October 2020, a 91-year-old male was admitted to the Department of Respiratory and Critical Care Medicine, Ruijin Hospital because of an increased carcinoembryonic antigen. Imaging revealed highly suspicious lesions in the right upper lobe of the lung, right apex, and left upper lobe with traction of the adjacent pleura. The patient was histologically confirmed as having adenocarcinoma and the MET Y1003S mutation was detected by the NGS subsequently. After evaluation, the patient started crizotinib treatment in December 2020. In the first assessment of tumor response, a chest CT scan in January 2021 showed a partial response. The patient experienced a pulmonary embolism and an abnormal liver function during the treatment and recovered after symptomatic treatment. He maintained a partial response in the last available assessment in July 2021, with the right upper lung lesion being 26 × 9 mm.
Conclusion:
The MET Y1003S mutation was detected in this case, and the patient achieved a partial response using crizotinib. This case highlighted the role of NGS in detecting a rare mutation. Successful remission of complications in such an elderly patient necessitates careful and timely management.
Atypical Presentation of Takotsubo Cardiomyopathy in an Elderly Woman
Authors: Priya Arunachalam, Nina Manian, Lamees Ibrahim El Nihum, Saleem Toro, John M Buergler
Journal: Methodist Debakey Cardiovasc J (2022)
Keywords: takotsubo cardiomyopathy, apical ballooning syndrome, cardiac tamponade, hemodynamic instability, pericardial effusion
MeSH terms: Cardiac Tamponade / diagnostic imaging, Cardiac Tamponade / etiology, Cardiac Tamponade / therapy, Pericardial Effusion / diagnostic imaging, Pericardial Effusion / etiology, Pericardial Effusion / therapy, Takotsubo Cardiomyopathy / diagnostic imaging, Takotsubo Cardiomyopathy / therapy, Case Reports, Review, Aged, Aged, 80 and over, Female, Humans

We describe an 83-year-old woman who presented to the emergency department with extreme thirst. Diagnostic testing revealed Takotsubo cardiomyopathy. Following symptomatic improvement and discharge, she returned to the emergency department with exudative pericardial effusion and elevated intrapericardial pressures. This case illustrates the importance of close follow-up of Takotsubo patients in whom complications such as pericardial effusion may lead to cardiac tamponade and hemodynamic instability if not managed properly.
Secondary ureteral perforation by invasive amebiasis in a patient with acquired immunodeficiency syndrome: a case report
Authors: Ming-Yin Yu, Chi-Cheng Chen, Cheng-Mao Ho, Hsi-Chin Wu, Chao-Hsiang Chang, Yung-Hsiang Chen, Wen-Chi Chen
Journal: Case Rep Nephrol (2011)

Ureteral perforation is a rare complication of abdominal infection, especially in a patient with human immunodeficiency virus (HIV) infection. We reported a case of ureteral perforation caused by a secondary amebiasis in a patient with acquired immunodeficiency syndrome (AIDS). Following bowel perforation and immunocompromised conditions, secondary right ureteral perforation was not easily to be treated well. He was treated with percutaneous drainage initially. Definite and successful treatment by a Boari flap was delayed until his underling disease was under control.
Aneurysms of Pancreaticoduodenal Artery due to Median Arcuate Ligament Syndrome, Treated by Open Surgery and Laparoscopic Surgery
Authors: Satoshi Tokuda, Shunsuke Sakuraba, Hajime Orita, Mutsumi Sakurada, Tomoyuki Kushida, Hiroshi Maekawa, Koichi Sato
Journal: Case Rep Surg (2019)
MeSH terms: Case Reports

Introduction:
There are many possible causes of an abdominal visceral aneurysm, including the obstruction of the celiac artery by the median arcuate ligament (MAL). We report two cases of an aneurysm of the pancreaticoduodenal artery due to MAL syndrome that we treated surgically.
Case presentation:
Case 1: a 66-year-old Japanese woman was diagnosed with a rupture of an aneurysm of the inferior pancreaticoduodenal artery. Because of the difficulty of endovascular therapy, we performed an emergency operation. We chose an abdominal operation, and the postoperative course was uneventful. Case 2: a 75-year-old Japanese man presented at our hospital with acute abdominal pain, nausea, and cold sweat. Our experience of treating MAL syndrome in case 1 enabled us to diagnose the disease accurately. We chose laparoscopic surgery, and the postoperative course was uneventful.
Discussion:
There are several treatment choices for an aneurysm of the pancreaticoduodenal artery due to MAL syndrome. We have performed only a release of the MAL for treatment, but it is difficult to conclude whether only releasing the MAL is enough to ensure a positive long-term prognosis. Regular follow-up is needed in such cases.
Conclusion:
Laparoscopic surgery can be considered one of the options for MAL syndrome.
Case report of old anterior dislocation of the shoulder joint and review of the literature
Authors: Weiming Guo, Ming Hui, Yuan Yang, Teng Wan, Guang-Gui Zeng, Peiguan Huang, Xiaoxu Wang, Mingjun Qiu
Journal: Front Surg (2022)
Keywords: anterior shoulder dislocation, arthroscopy, case, surgery, traumatic
MeSH terms: Case Reports

Background:
Dislocation of the shoulder joint is the most common type of joint dislocation. It is rare to be in a persistent dislocation that has not been reset. Successful arthroscopic treatment of the obsolete shoulder is relatively uncommon.
Case report:
We report a rare case of persistent anterior dislocation of the old shoulder joint in a 30-year-old female patient. The patient underwent an emergency shoulder dislocation at a local hospital after a traumatic injury and re-dislocated persistently after surgery. 26 days later, she was admitted to our department for treatment, mainly because of joint deformity and limitation of motion. We adopted arthroscopic release and repositioning surgery. The patient was followed up for 1 year after surgery. Functional recovery was satisfactory.
Conclusion:
The state of obsolete shoulder dislocation rarely occurs after shoulder dislocation and the prognosis of the patient is good after complete arthroscopic release and repositioning. It provides a reference for clinical arthroscopic treatment of old shoulder dislocations.
Case report: Clinical characteristics and treatment of secondary osteoporosis induced by X-linked congenital adrenal dysplasia
Authors: Xiaohui Tao, Tian Xu, Li Liu, Xiaoyun Lin, Zhenlin Zhang, Hua Yue
Journal: Front Endocrinol (Lausanne) (2022)
Keywords: nr0b1 gene, x-linked congenital adrenocortical hypoplasia, efficacy of treatment, gene mutation, secondary osteoporosis
MeSH terms: Bone Diseases / drug therapy, Femoral Fractures / drug therapy, Osteoporosis / etiology, Osteoporosis / genetics, Case Reports, Research Support, Non-U.S. Gov't, Diphosphonates / therapeutic use, Humans, Mutation, Vitamin K, Diphosphonates, Vitamin K

Objective:
To summarize the clinical features and bone complications in a patient from a large family with X-linked congenital adrenocortical hypoplasia (AHC) and evaluate the efficacy of different treatment regimens on the prognosis of secondary osteoporosis caused by AHC at a 5-year follow-up.
Methods:
A large family with AHC was recruited, and the causative gene mutation was identified by Sanger sequencing in the proband. Clinical features as well as radiological examinations and laboratory indices of osteoporosis secondary to AHC were analyzed in this study. Meanwhile, the proband was treated with classical antiresorptive drugs (bisphosphonates) for 2 years and switched to a vitamin K2 analogue for another 3 years, during which the efficacy of the drugs was evaluated.
Results:
The proband was identified as carrying a homozygous insertion mutation (p. Thr193GlyfsX13) in the NR0B1 (nuclear receptor subfamily 0, group B, member 1) gene, resulting in a premature stop codon due to a frameshift mutation. During treatment and follow-up, the proband did not respond well to bisphosphonate and developed atypical femoral fractures. Vitamin K2 improved clinical symptoms. In terms of bone mineral density (BMD), there is no evidence of any effect of vitamin K2 on the neck of femur, though some minor effects on spinal BMD cannot be excluded.
Conclusions:
Secondary osteoporosis induced by AHC deserves clinical attention. Unlike in primary osteoporosis, the curative effect of bisphosphonates was unsatisfactory and was more likely to cause atypical femoral fractures in long-term treatment. It is suggested that bone anabolic drugs may be better alternatives.
Autoimmune thyroid disease with fluctuating thyroid function
Authors: Ali S Alzahrani, Saleh Aldasouqi, Suzan Abdel Salam, Ali Sultan
Journal: PLoS Med (2005)
MeSH terms: Hashimoto Disease / complications, Case Reports, Adult, Female, Graves Disease / etiology, Humans, Iodine Radioisotopes / therapeutic use, Thyroxine / therapeutic use, Time Factors, Iodine Radioisotopes, Thyroxine

The authors describe the case of a woman with autoimmune thyroid disease, who presented with hypothyroidism but went on to develop hyperthyroidism.
Case Report: Persisting Lymphopenia During Neuropsychiatric Tumefactive Multiple Sclerosis Rebound Upon Fingolimod Withdrawal
Authors: Valeria Koska, Moritz Förster, Katja Brouzou, Ercan Arat, Philipp Albrecht, Orhan Aktas, Patrick Küry, Sven G Meuth, David Kremer
Journal: Front Neurol (2021)
Keywords: fingolimod, lymphopenia, multiple sclerosis, neuropsychiatric, rebound, tumefactive
MeSH terms: Case Reports

Fingolimod (FTY) is a disease modifying therapy for relapsing remitting multiple sclerosis (RRMS) which can lead to severe lymphopenia requiring therapy discontinuation in order to avoid adverse events. However, this can result in severe disease reactivation occasionally presenting with tumefactive demyelinating lesions (TDLs). TDLs, which are thought to originate from a massive re-entry of activated lymphocytes into the central nervous system, are larger than 2 cm in diameter and may feature mass effect, perifocal edema, and gadolinium enhancement. In these cases, it can be challenging to exclude important differential diagnoses for TDLs such as progressive multifocal leukoencephalopathy (PML) or other opportunistic infections. Here, we present the case of a 26-year-old female patient who suffered a massive rebound with TDLs following FTY discontinuation with primarily neuropsychiatric symptoms despite persisting lymphopenia. Two cycles of seven plasmaphereses each were necessary to achieve remission and ocrelizumab was used for long-term stabilization.
Successful Administration of Recombinant Human Soluble Thrombomodulin α (Recomodulin) for Disseminated Intravascular Coagulation during Induction Chemotherapy in an Elderly Patient with Acute Monoblastic Leukemia Involving the t(9;11)(p22;q23) MLL/AF9 Translocation
Authors: Kazutaka Takagi, Toshiki Tasaki, Takahiro Yamauchi, Hiromichi Iwasaki, Takanori Ueda
Journal: Case Rep Hematol (2011)
MeSH terms: Case Reports

Patients with acute myelogenous leukemia complicate with disseminated intravascular coagulation (DIC), not only at the time of the initially leukemia diagnosis, but also during induction chemotherapy. In Japan, recently, a recombinant human soluble thrombomodulin alpha (Recomodulin) has been introduced as a new type of anti-DIC agent for clinical use in patients with hematological cancer or infectious disease. We describe a 67-year-old female case in which 25,600 units of Recomodulin for 6 days were successfully administered for both initially complicating and therapy-induced DIC without any troubles of bleeding in an acute monoblastic leukemia (AML-M5a) patient with the MLL gene translocation. Furthermore, the levels of DIC biomarkers recovered rapidly after the Recomodulin treatment. Our case suggests that DIC control using Recomodulin is one of the crucial support-therapies during remission induction chemotherapy in patients with acute leukemia of which type tends to complicate extramedullary or extranodal infiltration having potential to onset DIC.
Genomic Surveillance Enables the Identification of Co-infections With Multiple SARS-CoV-2 Lineages in Equatorial Guinea
Authors: Salome Hosch, Maxmillian Mpina, Elizabeth Nyakurungu, Nelson Silochi Borico, Teodora Mikumu Alogo Obama, Maria Carmen Ovona, Philipp Wagner, Sarah E Rubin, Ulrich Vickos, Diosdado Vicente Nsue Milang, Mitoha Ondo'o Ayekaba, Wonder P Phiri, Claudia A Daubenberger, Tobias Schindler
Journal: Front Public Health (2022)
Keywords: central-africa, sars-cov-2, co-infection, genomic surveillance, variant of concern
MeSH terms: COVID-19, Coinfection / epidemiology, Case Reports, Research Support, Non-U.S. Gov't, Equatorial Guinea, Genomics, Humans, Male, SARS-CoV-2, SARS-CoV-2 variants

COVID-19 disease caused by SARS-CoV-2 represents an ongoing global public health emergency. Rapid identification of emergence, evolution, and spread of SARS-CoV-2 variants of concern (VOC) would enable timely and tailored responses by public health decision-making bodies. Yet, global disparities in current SARS-CoV-2 genomic surveillance activities reveal serious geographical gaps. Here, we discuss the experiences and lessons learned from the SARS-CoV-2 monitoring and surveillance program at the Public Health Laboratory on Bioko Island, Equatorial Guinea that was implemented as part of the national COVID-19 response and monitoring activities. We report how three distinct SARS-CoV-2 variants have dominated the epidemiological situation in Equatorial Guinea since March 2020. In addition, a case of co-infection of two SARS-CoV-2 VOC, Beta and Delta, in a clinically asymptomatic and fully COVID-19 vaccinated man living in Equatorial Guinea is presented. To our knowledge, this is the first report of a person co-infected with Beta and Delta VOC globally. Rapid identification of co-infections is relevant since these might provide an opportunity for genetic recombination resulting in emergence of novel SARS-CoV-2 lineages with enhanced transmission or immune evasion potential.
Compassionate use of ruxolitinib in acute and chronic graft versus host disease refractory both to corticosteroids and extracorporeal photopheresis
Authors: Mauricio Sarmiento Maldonado, Pablo Ramírez Villanueva, Pablo Bertín Cortes-Monroy, Veronica Jara Arias, Katherine Soto Donoso, Pablo Uribe Gonzalez, Mauricio Ocqueteau Tachini, Jose Antonio Perez-Simón
Journal: Exp Hematol Oncol (2017)
Keywords: corticoid refractoriness, extracorporeal photopheresis, graft versus host disease, ruxolitinib
MeSH terms: Case Reports

Background:
Ruxolitinib is a potent inhibitor of JAK1/2 with proven efficacy in myelofibrosis. In recent years, research in graft versus host disease (GVHD) has revealed the role of activation of JAK pathways in alloreactive lymphocytes. Some reports have shown significant responses in refractory GVHD patients.
Cases presentation:
In this report we present our experience in 8 patients with acute or chronic GVHD with refractoriness to steroids and extracorporeal photopheresis treated with ruxolitinib. Three patients had acute GVHD (1 pulmonary, 2 cutaneous, 1 multi-systemic) and 5 had chronic GVHD (3 cutaneous); 85% obtained an overall response and 50% a complete response with a tolerable toxicity profile.
Conclusions:
In our series, Ruxolitinib was very active as a rescue therapy for patients with acute or chronic GVHD refractory to standard treatment.
Primary Klebsiella pneumoniae Osteomyelitis with Bacteremia and Sepsis in a Patient with Cirrhosis
Authors: Akshay Khatri, Naga Sasidhar Kanaparthy, Bright Jebaraj Selvaraj, Eunna Cho, Marc Y El Khoury
Journal: Case Rep Infect Dis (2018)
MeSH terms: Case Reports

Osteomyelitis is commonly caused by Staphylococci, Streptococci, Escherichia coli, and anaerobes. There have been cases of rare organisms like Klebsiella pneumoniae (Kp) being initially overlooked as causes of osteomyelitis. We report a case of an elderly cirrhotic adult male transferred for further management of liver failure, who was subsequently diagnosed with Kp osteomyelitis and sepsis. He had a history of blunt leg trauma, and MRI of the leg revealed osteomyelitis, with a negative workup for other sources of infection. Kp osteomyelitis is reported in less than 100 cases, mainly in pediatric and sickle-cell patients. There are no pathognomonic imaging findings. Lesions may be metastatic, with rapid widespread destruction and exuberant periosteal reaction. Kp is a rare, under recognized cause of osteomyelitis in immune-suppressed adults. Given its pathogenicity, early identification is critical.
Reconstruction giant cell tumor of the right proximal humerus Campanacci 3 with pedicle and rod system: A case report
Authors: Yogi Prabowo, Irsan Abubakar
Journal: Int J Surg Case Rep (2018)
Keywords: campanacci 3, giant cell, pedicle screw, reconstruction, rod system, wide excision

Introduction:
Giant Cell tumors (GCT) are benign tumors with potential for aggressive behavior and capacity to metastasize. Although considered to be benign tumors of bone, GCT has a relatively high recurrence rate. Tumor often extends to the articular subchondral bone or even abuts the cartilage. The joint and/or its capsule are rarely invaded. Surgical resection is the universal standard of care for the treatment of bone GCT. The key ensuring an adequate surgical treatment with complete removal of tumor is by obtaining adequate exposure of the lesion.
Presentation of case:
We reported a case of 24-years-old male with Giant cell tumor (GCT) of the right proximal humerus. Patient presented with chief complaint of pain on the right shoulder and had a history of fell on the right elbow. Radiographic examination showed a primary bone tumor of the proximal humerus. MRI provided excellent depiction in suggesting the diagnosis of cutaneous GCT Campanacci 3, which was later, affirmed by biopsy. Patient underwent successful wide excision and reconstruction. The limb salvage procedure consisted of shoulder resection type 1B and reconstruction with pedicle screw and rod system. During 5 days post-operative period, there was no major event observed. Patient could do shoulder flexion forward 0-30, shoulder extension 0-20, elbow extension - Flexion, wrist flexion extension, and fingers flexion.
Discussion:
GCT of bone typically shown as an epiphyseal, eccentric, expansive lytic lesion with a 'soap-bubble appearance'. MRI is useful to assess extracortical spread and intramedullary extension. Surgery is the treatment of choice. Curettage is usually combined with cementing or bone grafting. Hemi-articular and total elbow allografts have been used for reconstruction of the defects following tumor excision, but the complication rates are high, and these techniques are reserved as salvage procedures following failed total elbow arthroplasty.
Conclusion:
Wide resection and total elbow arthroplasty enables good functional outcome and lower risk for recurrence. Pedicle and rod system for shoulder reconstruction is a viable option, as it provides good pain relief and functional improvement with lower complication rates.