OpenMed/multicare-articles huggingface dataset:
Successful reimplantation of extruded bone segment in lower limb open fractures: case report and literature review
Authors: Xiongke Hu, Qian Tan, Guanghui Zhu, Kun Liu
Journal: Front Pediatr (2024)
Keywords: bone extrusion, ethylene, femoral fracture, open fracture, reimplantation

Objective:
The aim of this study is to summarize and demonstrate the different sterilization methods and surgical techniques for open fractures with impacted bone segments in the lower limbs.
Methods:
A retrospective analysis was conducted on the clinical characteristics, treatment methods, and outcomes of a case involving a 10.5 cm extruded segment of the femur in a 9-year-old male with a right femoral comminuted fracture treated at our center. Additionally, a retrospective review and summary were conducted on all reported cases of open fractures with impacted bone segments in the lower limbs.
Results:
Our center treated a 9-year and 11-month-old male child who presented with a Gustilo type IIIB open fracture of the femur along with a large segment of the femur being ejected as a result of a car accident. The child was resuscitated to correct hypovolemic shock, underwent emergency wound debridement, and had Ilizarov external fixation of the femur. The ejected femur segment was sterilized using ethylene oxide and re-implanted four days after the injury. A literature review showed that out of the cases of open fractures with impacted bone segments in the lower limbs, there were 14 cases involving the femur and 5 cases involving the tibia. Among them, sterilization was performed using povidone-iodine in 6 cases, high-pressure steam sterilization in 3 cases, and other methods including gamma-ray irradiation and soaking in antibacterial solution were used in the remaining cases. In terms of surgical methods, 7 cases were fixed with locking plates, 3 cases were fixed with external fixation devices, 1 case was immobilized in a cast, 1 case was fixed with an intramedullary rod, and 4 cases involved a combination of external fixation and internal fixation. The average time for re-implantation was 7.6 days after the injury. There were no serious complications such as infection or non-union observed in any of the cases during follow-up.
Conclusion:
Ethylene oxide can be considered a reliable choice for the reimplantation of displaced bone segments in open fractures after sterilization.
Null-Cell Ectopic Pituitary Adenoma of the Nasal Cavity
Authors: Nicholas Figaro, Jibran Juman, Ashton Ramsundar, Fidel Rampersad, Melanie Johncilla, Solaiman Juman
Journal: Case Rep Otolaryngol (2023)
MeSH terms: Case Reports

An ectopic pituitary adenoma (EPA) is an uncommon type of pituitary adenoma, accounting for only 2% of all pituitary adenomas. EPAs are benign tumors that can occur anywhere along the migratory embryonic path of the pituitary gland and have no relationship to intrasellar elements. They are usually hormonally active and have a minor female predominance. The clinical features of EPAs are highly dependent on its hormonal activity, anatomical location, and its local mass effect. Appropriate radiological imaging is essential for the evaluation of EPAs. Imaging investigations show a normal pituitary gland and sellar turcica, provide details on the size of the tumor, its margins, and extent, and help with surgical planning. The criteria for diagnosing an ectopic pituitary adenoma depend on detailed histopathological examination. EPA management should be individualized. We present a case of a 71-year-old male who presented with a 9-month history of left nasal obstruction, purulent nasal discharge, and intermittent anterior epistaxis. The patient was being managed by his general practitioner for chronic rhinosinusitis but failure of his symptoms to resolve prompted a visit to the otorhinolaryngologist. The patient was diagnosed with a null-cell ectopic pituitary adenoma through histological analysis of a biopsy specimen that showed adenohypophyseal cells without cell-type-specific differentiation. The patient subsequently underwent an endoscopic endonasal excision and had an uneventful hospital stay.
Unilateral severe gynecomastia in a 14 year-old adolescent with neurofibromatosis type 1 undergoing endoscopic mastectomy: a case report
Authors: Fangjian Shang, Bo Xi, Duojun Qiu, Xin Chen, Yifang Wang, Meng He, Bo Liu, Zengren Zhao
Journal: Front Med (Lausanne) (2024)
Keywords: nf-1, adolescent, endoscopy, gynecomastia, mastectomy
MeSH terms: Case Reports

Gynecomastia can be caused by neurofibromas but has rarely been reported. The present case report describes the clinical appearance, diagnosis, and therapy of a rare combination of a 14 year-old adolescent male unilateral severe gynecomastia with NF-1 neurofibromatosis. In this particular case, we successfully performed minimally invasive surgery using endoscopic mastectomy, which not only resulted in a satisfactory appearance but also confirmed the presence of neurofibroma type 1 by detecting typical immunohistochemical indicators associated with the disease. Additionally, we analyzed the gene responsible for the disease, c.1431del: p. F477Lfs*21, based on the patient's family history.
Case Report: Iatrogenic trauma of the bladder due to long-term unidentified intrauterine device malposition inside the bladder with rectovesical fistula
Authors: Ahmad Agil, Tjahjodjati Tjahjodjati, Nur Atik, Dedi Rachmadi, Tengku Tania Zahrina
Journal: F1000Res (2024)
Keywords: cystoscopy, iatrogenic bladder trauma, intrauterine device, vesicolithiasis
MeSH terms: Fistula, Intrauterine Devices / adverse effects, Case Reports, Female, Humans, Iatrogenic Disease, Urinary Bladder

According to reports, there are 1.9-3.6 incidences of IUD migration and uterine perforation for every 1000 IUD insertions. It is important to note that bladder perforation caused by a misplaced IUD is uncommon and is thought to happen most frequently during insertion. Here, we describe a patient who presented with symptoms related to the malposition of IUD inside the bladder. It is feasible to draw the conclusion that the cystoscopy technique should be taken into consideration as a suitable therapy option for such injuries in this organ. When a problem cannot be effectively treated by cystoscopy alone, laparotomy should be considered.
Navigating the Landscape of Herniated Discs: A Rare Case of Herniated Disc Regression
Authors: Ilko Ilyov, Edvin Vasvi, Petar-Preslav Petrov, Vladislav Velchev, Plamen Penchev
Journal: Cureus (2024)
Keywords: clinical case report, compressive myelopathy, herniated disc, mri, progressive myelopathy
MeSH terms: Case Reports

A herniated disc is a condition in which the nucleus pulposus is displaced from the intervertebral space. It usually leads to back pain, thus being the most common reason for it. Patients often describe the first symptoms of a herniated disc as extreme and decisive pain. Unlike the usual mechanical back pain, a herniated disc is often related to a stinging or burning sensation that often spreads to the lower extremities and proves to be continuous at lower temperatures. We present a case of a 58-year-old male patient who visited the Acibadem City Clinic with complaints of pain initially starting from his hip, which in time extended to his left leg (L5 radiculopathy) and a few days later to his right leg (L5 radiculopathy). Before visiting the clinic, he had been treated in Germany with physiotherapy and supplements, which had proved ineffective. After an MRI, which revealed an L4-L5 herniated disc, he underwent conservative treatment with nonsteroidal anti-inflammatory drugs (NSAIDs) and proton pump inhibitors (PPIs) for 14 days in addition to Medrol 4mg tablets (3x1 per day for 10 days). On the third day of the treatment, 60% of the symptoms had subsided. Seven months later, he came in for a scheduled checkup, and 95% of the symptoms were gone. A controlled MRI was done, and the herniated disc had completely vanished. We hope that this type of research will benefit medical professionals, patients, researchers, doctors, and students, among others. Such cases also contribute to the quality of care for such patients and help set regulated factual guidelines regarding their treatment as a whole.
Case Report: Acute cerebral infarction caused by left atrial and right ventricular myxoma received emergency operation
Authors: Chengbin Tang, Xianglong Gao, Tao Chen, Jun Shao, Tao Zhu, Xucai Zheng, Chuanli Ren
Journal: Front Cardiovasc Med (2024)
Keywords: cardiac tumors, case report, emergency operation, myxomas, neurologic symptoms
MeSH terms: Case Reports

Cardiac myxoma is a rare etiology of ischemic stroke, especially in young people. We report a case of multiple myxomas in left atrium and right ventricle inducing acute cerebral infarction. No significant abnormalities were detected in the patient's preoperative laboratory examination. Following emergency surgery, the patient's prognosis was satisfactory, providing valuable empirical insight for the surgical management of acute cerebral infarction in individuals diagnosed with cardiac myxoma. Our objective is to heighten awareness regarding the evaluation and treatment of patients with acute cerebral infarction subsequent to early diagnosis of cardiac myxoma.
Primary familial brain calcification presenting with parkinsonism and motor complications caused by a novel SLC20A2 variant: a case report
Authors: Dandan Sun, Yu Wang, Jiawei Wang, Shijing Wang, Ling Zhu, Kun Xia, Yunyun Zhang, Xun Wang
Journal: Front Neurol (2024)
Keywords: fahr’s disease, slc20a2 gene, levodopa-induced dyskinesia, motor fluctuation, parkinsonism, primary familial brain calcification
MeSH terms: Case Reports

Primary familial brain calcification (PFBC), also known as Fahr's disease, is a central nervous system calcium deposition disorder with symmetrical basal ganglia calcification. Most PFBC cases are caused by SLC20A2 gene variant. We report a Chinese female patient with PFBC and dopamine-responsive parkinsonism who had motor fluctuations and dyskinesia and recovered effectively after symptomatic medication adjustment. A novel heterozygous missense variant was found by whole-exome sequencing and proven harmful by family validation and genetic analysis. This example expands the phenotype of SLC20A2-associated PFBC patients and shows the clinical efficacy of dopaminergic replacement treatment.
Case report: A sustained survival benefit of third-line immunotherapy for refractory thymic carcinoma
Authors: Mi Meng, Bo Yu, Jie Luo, Yuju Bai, Lin Li, Shicheng Chen, Sisi He, Hu Ma
Journal: Front Oncol (2024)
Keywords: anti-pd-1, case report, sintilimab, therapeutic option, thymic carcinoma(tc)
MeSH terms: Case Reports

Thymic carcinoma (TC) is an uncommon type of thymic epithelial tumors. Patients with relapsed or refractory TCs have a poor prognosis. Immune checkpoint inhibitor monotherapy can be applied as a second-line treatment for such cases. This study reported a TC patient who did not respond to conventional chemotherapy and radiotherapy but achieved prolonged partial remission lasting 17 months following the third-line treatment with anti-programmed cell death-1 inhibitor sintilimab. This patient did not experience any serious side effects associated with sintilimab treatment. The above results demonstrated that sintilimab could be a feasible therapeutic option for refractory TC patients.
3D laparoscopic treatment of bladder cancer with pelvic multi-organ invasion: a case report and literature review
Authors: Zheng Chen, Kaifeng Deng, Luping Sun, Lijun Qu, Xinhui Chao, Jingmin Rao, Caimmei Hong, Yumin Zhuo, Zhichao Lin, Caiyong Lai
Journal: Front Oncol (2023)
Keywords: 3d laparoscopy-assisted treatment, ileal conduit, muscle-invasive bladder cancer, pelvic lymph node dissection, radical cystectomy
MeSH terms: Case Reports

Introduction:
Radical cystectomy with dissection of pelvic lymph nodes and urethral diversion is the standard surgical treatment for muscle-invasive non-metastatic bladder cancer. In rare cases where patients with bladder cancer without distant metastasis have pelvic multi-organ invasion, the cancer compresses or invades the ureter and, in severe cases, leads to bilateral upper urinary tract obstruction and renal damage. The treatment recommended by guidelines often cannot improve the patients' clinical symptoms immediately, and patients cannot complete the treatment owing to severe side effects, resulting in poor survival benefits.
Case presentation:
A 69-year-old woman with facial edema was treated at the First Affiliated Hospital of Jinan University. The serum creatinine and potassium values were 1244 umol/L and 5.86 mmol/L, respectively. Pelvic magnetic resonance and abdominal computed tomography revealed that the bladder tumor had infiltrated the uterus, anterior vaginal wall, rectum, right ureter, right fallopian tube, and right ovary and metastasized to multiple pelvic lymph nodes. Tumor invasion of the right ureter resulted in severe hydronephrosis of the right kidney and loss of function and obstructive symptoms in the left kidney. Four days later, the patient's creatinine level decreased to 98 u mol/L, the general condition significantly improved, and the patient and family members strongly desired surgical treatment of the tumor. Through a comprehensive preoperative discussion, possible intraoperative and postoperative complications were evaluated. Right nephrectomy, right ureterectomy, total pelvic organ resection, extended pelvic lymph node dissection, and bowel and urinary diversion were conducted under 3D laparoscopy-assisted treatment. The patient was followed-up for 1.5 years and showed good tumor control, self-care, and mental status.
Conclusion:
Minimally invasive surgery is a curative option for patients with bladder cancer with pelvic multi-organ invasion without distant metastasis. Surgeons should strictly control the indications for surgery and warn patients about the occurrence of related post-surgical complications.
Coagulopathy Induced by Antibiotics Usage and Bowel Obstruction With Colon Cancer: Report of a Rare Case
Authors: Sho Fujiwara, Ryujiro Akaishi, Tomoki Yokosawa, Hiroshi Suzuki, Toru Hoshida
Journal: Cureus (2024)
Keywords: antibiotics awareness, coagulopathy, postoperative ileus, prolonged fasting, vitamin k deficiency
MeSH terms: Case Reports

This case report presents a rare occurrence of coagulopathy induced by antibiotics in a woman in her 90s with chronic bowel obstruction and massive colon cancer. The patient developed vitamin K deficiency-related coagulopathy following antibiotic administration, resulting in bleeding complications. Despite initial consideration of disseminated intravascular coagulation, further investigations revealed antibiotic-induced vitamin K deficiency. Prompt discontinuation of antibiotics and IV vitamin K2 administration led to the resolution of coagulopathy. The case emphasizes the importance of cautious antibiotic use in patients with chronic bowel obstruction and prolonged fasting. The protein induced by vitamin K absence-II (PIVKA-II) proved valuable in diagnosing vitamin K deficiency. The learning points include the potential for coagulopathy with antibiotics in prolonged bowel obstruction and the utility of PIVKA-II in assessing vitamin K deficiency. Healthcare providers should exercise caution when administering antibiotics in similar clinical scenarios.
Toddler with giant omental cyst, profound anemia, and shock: case report and review of the literature
Authors: Fengchun Cheng, Xueling Xing, Xiaoming Liu, Shuai Sun, Zhaona Lv, Xiaoliang Xu, Tingliang Fu, Lei Geng
Journal: Front Med (Lausanne) (2023)
Keywords: case report, complication, hemorrhage, omental cyst, pediatric, shock
MeSH terms: Case Reports

Giant greater omental cysts with associated massive hemorrhage are rare. We encountered a 16-month-old boy with a four-day history of acute abdominal pain, distension, and paleness. Physical examination revealed a blood pressure of 74/27 mmHg. No well-defined masses were observed on abdominal palpation. The hemoglobin level on admission was 24 g/L. After initial resuscitation and blood transfusion, a computed tomography (CT) scan was performed, revealing a giant cystic mass with an intracystic hemorrhage. The diagnosis was confirmed via exploratory laparotomy, and the cyst, with the attached partial omentum was removed. Pathological findings revealed a simple cyst originating from the greater omentum. The patient recovered uneventfully and remained well during the two-year follow-up period. We reviewed the literature published over the last 27 years on cases of omental cysts to evaluate demographic characteristics, clinical presentations, complications, diagnostic tool options, and surgical approaches.
Pilomatricoma presenting as a giant cutaneous horn in an 8-year-old child: A case report and literature review
Authors: Madeleine Crawford, Jincheng Shi, Archan Kakadekar, Ashley Sutherland
Journal: SAGE Open Med Case Rep (2024)
Keywords: perforating pilomatricoma, cutaneous horn, pediatric pilomatricoma, pilomatricomal horn
MeSH terms: Case Reports

Pilomatricoma is an uncommon benign adnexal tumor of childhood. We report a case of pilomatricoma presenting as a large, recurrent painful cutaneous horn on the neck of an 8-year-old boy treated with surgical excision. On histopathology, classical features of pilomatricoma along with transepidermal elimination and perforation were shown. We propose that perforating pilomatricoma and pilomatrical horn represent equivalent clinical and pathological entities. The diagnosis of perforating pilomatricoma should be considered in pediatric patients presenting with a cutaneous horn.
Successful therapy using high-dose furmonertinib for non-small cell lung cancer with leptomeningeal metastasis: a case report and literature review
Authors: Ting Chen, Jie Chen, De-Sheng Liu, Yan-Ling Shu, Mao-Yue Fu, Hai-Jun Gou, Kai-Jian Lei, Yu-Ming Jia
Journal: Front Oncol (2023)
Keywords: egfr, nsclc, furmonertinib, leptomeningeal metastasis, target therapy
MeSH terms: Case Reports

Background:
Lung cancer is the second most common form of malignant tumor and has the highest mortality rate worldwide. Among its subtypes, lung adenocarcinoma is the most prevalent. Leptomeningeal metastasis (LM) is rare and is characterized by a dismal prognosis, with overall survival periods typically spanning 4 to 6 weeks without treatment. However, in specific cases, survival can be extended to 4 to 6 months with appropriate therapy. The recent approval of third-generation tyrosine kinase inhibitors (TKIs), such as osimertinib, aumolertinib, and furmonertinib, has introduced promising treatment options for individuals with non-small cell lung cancer (NSCLC) who develop LM after developing resistance to first- and second-generation TKIs. These third-generation TKIs exhibit an enhanced ability to penetrate the blood-brain barrier (BBB), opening up new avenues for managing this challenging condition.
Case summary:
We report the case of a 48-year-old Chinese man diagnosed with advanced NSCLC harboring an epidermal growth factor receptor (EGFR) mutation. Following a pulmonary lobectomy and postoperative adjuvant therapy with gefitinib, the patient was diagnosed with LM, which was confirmed by his neurologic symptoms, cerebrospinal fluid cytologic analysis, and cranial enhancement magnetic resonance imaging. Subsequently, he received oral treatment in the form of 160 mg of furmonertinib daily. After 5 days of furmonertinib therapy, the patient recovered from lethargy, with an obvious improvement in cognitive function. Follow-up visits revealed a 6-month survival period following the LM diagnosis. Patients with NSCLC and LM typically present with severe symptoms, and the efficacy of systemic treatment, intrathecal chemotherapy, and radiotherapy remains unsatisfactory. We hope that this specific case provide valuable insights into the management of patients with EGFR mutation-associated NSCLC with LM.
Conclusion:
Furmonertinib, a third-generation EGFR TKI with notable BBB penetration, shows promise in LM control and the rapid alleviation of intracranial symptoms. Further investigations into appropriate dosage and toxicity management are imperative.
Disitamab vedotin (RC48) long-term regimen in a post-nephroureterectomy patient with metastases: a case report
Authors: Weiping Li, Suoshi Jing, Bo Zhao, Wei Jiang, Bin Zhang
Journal: Front Oncol (2024)
Keywords: gc, disitamab vedotin (rc48), immunotherapy, metastasis, upper tract urothelial carcinoma
MeSH terms: Case Reports

Background:
For patients with metastatic upper tract urothelial carcinoma (UTUC), the preferred first-line treatment is platinum-based chemotherapy. Immunotherapy can be considered a subsequent treatment if the chemotherapy is ineffective or the disease progresses. However, how should treatment be administered if immunotherapy is useless and the patient cannot take chemotherapy? Especially in patients who have metastasized after radical nephroureterectomy (RNU).
Case presentation:
A 68-year-old woman was admitted to the hospital due to left flank pain for two weeks and was diagnosed with metastatic UTUC after RNU. The patient underwent systemic chemotherapy with gemcitabine and cisplatin (GC), as well as reduced-dose GC, but developed myelosuppression. Immunotherapy was ineffective, so Disitamab vedotin (RC48) was chosen.
Results:
Disitamab vedotin (RC48) monotherapy was administered for 13 cycles, during which thyroid function remained normal, the patient responded well to the treatment, and the disease was controlled well. In the subsequent two years of follow-up, there was no disease recurrence.
Conclusion:
The long-term treatment regimen with RC48 is feasible for metastatic UTUC after RNU, and RC48 monotherapy is suitable as first-line therapy for selected patients.
Newly diagnosed AIDS patient with cerebellar JC virus
Authors: Sergio Alvarez-Mulett, Eli Sepkowitz, Douglas Sepkowitz
Journal: IDCases (2023)
Keywords: cerebellum, immune reconstitution, jc virus
MeSH terms: Case Reports

We present a case of a 57-year-old man with newly diagnosed acquired immunodeficiency syndrome (AIDS) infection who initially sought care for progressive dysarthria and gait instability. Neuroimaging and CSF studies revealed a diagnosis of progressive multifocal leukoencephalopathy (PML). Although the patient's human immunodeficiency virus (HIV) decreased considerably in response to anti-retroviral therapy, he continued to deteriorate clinically. Ultimately, the central nervous system (CNS) lesions, which were once centered in the cerebellum, became expansile throughout his posterior fossa. There are few reported cases of cerebellar PML in patients with AIDS.
3D-Printed Temporary Wing Bride as a Temporary Restoration in the Posterior
Authors: Richard Mosch, Maurice Hatzky, Patricia Hatzky, Constantin von See
Journal: Case Rep Dent (2024)
MeSH terms: Case Reports

The fear of a missing tooth often leads to postponing the visit at the dentist. While extraction itself is a major stressful experience for the patient, the presence of visible gaps or missing teeth inside or outside the aesthetic zone is a deal breaker for a lot of patients. Bridging the time spent until inserting any final restoration with a provisional enables the patients to still take part in everyday life. This case report shows a new approach for a fixed dental provisional in the anterior region using a printed wing bridge approach to replace an extracted tooth. The provisional was prefabricated, and extraction and integration of the provisional could be placed in a single visit. The chosen approach shows the integrability of 3D printing in everyday practice providing immediate economical and aesthetic treatment.