OpenMed/multicare-articles huggingface dataset:
Spinal cord infarction following epidural and general anesthesia: a case report
Authors: Kaori Kobayashi, Noriko Narimatsu, Takafumi Oyoshi, Takashi Ikeda, Toshimitsu Tohya
Journal: JA Clin Rep (2017)
Keywords: epidural anesthesia, magnetic resonance imaging, spinal cord infarction

Background:
Epidural anesthesia is widely used for postoperative analgesia and rarely causes permanent neurological complications. We report a case of paraplegia following abdominal surgery under combined epidural/general anesthesia.
Case presentation:
A 75-year-old woman underwent a scheduled abdominal total hysterectomy and bilateral salpingo-oophorectomy for suspected endometrial cancer. In the operating room, an epidural catheter was inserted at T11/12 while the patient was conscious. The needle entered smoothly, with no observed bleeding, paresthesia, or pain, and general anesthesia was induced. During surgery, 4 mL of 0.25% levobupivacaine and 0.1 mg of fentanyl were administered via the epidural catheter, and a solution of 2.5 μg/mL fentanyl and 0.2% levobupivacaine was continuously infused at 4 mL/h for postoperative analgesia. The patient promptly regained consciousness and could move her bilateral lower extremities without difficulty upon leaving the operating room. During the first postoperative night, she complained of an absence of sensation and weakness in the lower extremities. By the morning of the second postoperative day, she had developed paralysis and sensory losses associated with touch, temperature, pinprick, and vibration below T5. The epidural infusion was stopped. Magnetic resonance imaging (MRI) revealed a hyperintense area of the thoracic cord from T8 to T11, and spinal cord infarction was suspected. Ossification of the yellow spinal ligaments between T11 and T12, resulting in thoracic canal stenosis and thoracic spinal cord compression, were observed. Notably, the epidural catheter was inserted at the same site where the thoracic canal stenosis was present.
Conclusions:
Permanent neurological complications of epidural anesthesia are rare. Studies of neurological complications after epidural/spinal anesthesia have noted the possibility of spinal anomalies, such as lumbar stenosis, in relation to neurological complications after epidural/spinal anesthesia. In this case, the onset of spinal cord infarction may have occurred coincidentally with catheter insertion into the site of existing spinal stenosis. Therefore, it is important to evaluate lower extremity symptoms and consider spinal disease before administering epidural anesthesia. Spinal cord infarction may be prevented by preoperatively identifying spinal lesions using computed tomography or MRI in cases of suspected spinal disease.
Left paraduodenal hernia: A rare cause of acute abdomen
Authors: Karim Ibn Majdoub Hassani, Younes Aggouri, Said Ait Laalim, Imane Toughrai, Khalid Mazaz
Journal: Pan Afr Med J (2014)
Keywords: paraduodenal hernia, acute abdomen, left
MeSH terms: Abdomen, Acute / etiology, Duodenal Diseases / complications, Hernia / complications, Case Reports, Abdomen, Acute / diagnosis, Abdomen, Acute / surgery, Duodenal Diseases / diagnosis, Duodenal Diseases / surgery, Hernia / diagnosis, Herniorrhaphy, Humans, Intraoperative Period, Male, Middle Aged

Paraduodenal hernia is a rare congenital anomaly that arises from an error of rotation of the midgut. The duodenum and the small intestine become trapped in a sac which is lined by the peritoneum, behind the mesentery of the colon, either to the right or left of the midline. It is therfore a rare and potentially life-threatening condition that can cause intestinal obstruction progressing to strangulation and perforation. We report a case of a 55-year-old patient presenting a left paraduodenal hernia diagnosed intraoperatively after being operated on in the emergency setting for acute abdomen. The small bowel was twisted upon its mesentery and was entrapped in a large left paraduodenal space. Fortunately, once the bowel was reduced from the paraduodenal space, the blood flow was reestablished and the small bowel resumed a proper functioning. The mouth of the sac was obliterated by suture opposition to the posterior wall. The patient's subsequent hospital course was uneventful, and he was discharged in satisfactory condition 4 days postoperatively.
Necrotizing sialometaplasia of palate: a case report
Authors: N G Garcia, D T Oliveira, S E S Faustino, A L R Azevedo
Journal: Case Rep Pathol (2012)

Background. Necrotizing sialometaplasia (NS) is an uncommon benign reactive necrotizing inflammatory process involving minor salivary gland that often mimics malignancy both clinically and histopathologically. Case Report. We report the case of a healthy 26-year-old man with a painless swelling in the hard palate near the middle raphe, asymptomatic, well limited, and raised edges. The patient was submitted to incisional biopsy and histopathological examination. The histological diagnosis was necrotizing sialometaplasia. Discussion. The clinical and histological similarity between this entity and a malignant lesion implies a risk of unnecessary or mistreatment. Therefore, clinicians and pathologists should be aware of this lesion as to avoid errors in the diagnosis and treatment of this benign pathologic condition.
KRAS G12 isoforms exert influence over up-front treatments: A retrospective, multicenter, Italian analysis of the impact of first-line immune checkpoint inhibitors in an NSCLC real-life population
Authors: Sara Fancelli, Enrico Caliman, Francesca Mazzoni, Luca Paglialunga, Marta Rita Gatta Michelet, Daniele Lavacchi, Rossana Berardi, Giulia Mentrasti, Giulio Metro, Ilaria Birocchi, Angelo Delmonte, Ilaria Priano, Camilla Eva Comin, Francesca Castiglione, Caterina Bartoli, Luca Voltolini, Serena Pillozzi, Lorenzo Antonuzzo
Journal: Front Oncol (2022)
Keywords: kras g12 isoforms, kras mutations, pd-l1, immune check-point inhibitors, treatment responses

Background:
KRAS is commonly mutated in non-small cell lung cancer (NSCLC); however, the prognostic and predictive impact of each G12 substitution has not been fully elucidated. The approval of specific G12C inhibitors has modified the idea of KRAS "undruggability", and although the first-line standard consists of immune checkpoint inhibitors (ICIs) with or without chemotherapy, as suggested at ASCO 2022, the outcome in KRAS-mutated population is still controversial.
Methods:
We retrospectively described the clinical and pathological characteristics of a homogeneous G12 mutated cohort of 219 patients treated in four Italian oncologic units. We evaluated the outcome (PFS at 18 months and OS at 30 months) of those who underwent standard first-line treatment according to PD-L1 status, focusing on differences across single mutations.
Results:
In the study population, 47.9% of patients harbor the KRAS G12C mutation; 20.5%, G12V; 17.4%, G12D; and 8.2%, G12A. Smoking was a common behavior of patients harboring transversions and transition mutations. PD-L1 expression does not show particular distribution in the case series, although we recorded a prevalence of PD-L1 <1% in G12V (51.4%) compared to G12A (26.7%). ICIs alone was the clinician's choice in 32.7% of patients, and the chemo-immune combination in 17.3% of patients. We described the independent prognostic role of young age (p = 0.007), female gender (p = 0.016), and an ICI-based regimen (p = 0.034) regardless of mutations. Overall, our data confirm the worst prognostic value of G12V mutation apart from treatment choice unlike the other major mutations (C, D, and A) that showed a favorable trend in PFS.
Conclusions:
KRAS G12 mutations are confirmed to have different characteristics, and the outcome is influenced by ICI first-line regimen. This study provides valuable information for further analysis in the future.
Monkeypox Virus Infection in 18-Year-Old Woman after Sexual Intercourse, France, September 2022
Authors: Alexandre Vallée, Audrey Chatelain, Marie Carbonnel, Catherine Racowsky, Erwan Fourn, David Zucman, Jean-Marc Ayoubi
Journal: Emerg Infect Dis (2023)
Keywords: france, monkeypox, genital, outbreak, prevention, sexually transmitted infections, vaccine, viruses, women
MeSH terms: Coitus, Monkeypox / diagnosis, Monkeypox / epidemiology, Case Reports, Letter, Adolescent, Female, France / epidemiology, Humans, Monkeypox virus / genetics, Sexual Behavior

A monkeypox virus outbreak has spread worldwide since April 2022. We report a young woman in France positive for monkeypox virus transmitted through oral and vaginal sex. Ulceronecrotic lesions developed intravaginally and around her vulva. Health professionals should become familiar with all aspects of infection from this virus, including possible vertical transmission.
Intraoral Sebaceous Carcinoma: Case Report of a Rare Tumor Emphasizing the Histopathological Differential Diagnosis
Authors: Manveen Kaur Jawanda, R V Subramanyam, Harshaminder Grewal, Chitra Anandani, Ravi Narula
Journal: Case Rep Dent (2018)
MeSH terms: Case Reports

Background:
Sebaceous carcinoma (SC) is an uncommon cutaneous malignancy, usually occurring predominantly in the eyelids and only occasionally involving the oral cavity. Sebaceous carcinoma (SC) is a rare malignancy. Only 10 cases of sebaceous carcinoma of the oral cavity have been reported so far.
Case presentation:
A 40-year-old female presented with a mass on the left side of the middle third of the face. Radiographic findings were inconclusive. Resection of the mass was consistent with the diagnosis of primary sebaceous carcinoma.
Conclusion:
Intraoral sebaceous carcinoma is uncommon. Due to its varied clinical appearance and presence of a diverse histopathologic appearance, the diagnosis is quite often confounding and elusive. Hence, it is imperative to familiarize oneself about various aspects of this rare tumor for earlier diagnosis, to improve the chances of patient's survival.
Castleman Disease in a Patient with Common Variable Immunodeficiency
Authors: Luisa Ricciardi, Fabiana Furci, Antonio Ieni, Antonio Macrì
Journal: Case Reports Immunol (2019)
MeSH terms: Case Reports

Common variable immunodeficiency (CVID) is a primary immunodeficiency due to a disorder of the adaptive immune system which causes hypogammaglobulinemia and therefore an increased susceptibility to infection; noninfectious, inflammatory conditions including systemic autoimmunity and lymphoproliferative complications are also commonly associated with CVID. Castleman disease (CD) is a systemic disease clinically characterized by diffuse lymphadenopathy, splenomegaly, anemia, and systemic inflammatory symptoms. This makes CD a great mimicker of more common benign and malignant masses in the neck, chest, abdomen, and pelvis. A novel case of primary immunodeficiency (CVID) in a middle-aged woman, who developed multicentric CD (MDC) with splenomegaly, is described. The authors suggest that the onset of MCD and of the correlated splenomegaly was due to incorrect management of the hypogammaglobulinemia as immunoglobulin G (IgG) levels were not kept within normal ranges. Correct management of the hypogammaglobulinemia allowed splenectomy to be performed without any infectious surgical complications. MCD is reported for the first time in association with an adult case of CVID. The above reported case highlights the need for a timely correct diagnosis and treatment of CVID to avoid complications, which could cause recourse to splenectomy, such as in our case or development of malignancies.
Hyaluronic Acid Injections as Nonsurgical Alternative in case of Delayed Diagnosis of Malar Arch Fracture: Case Report and Literature Review
Authors: Raffaele Rauso, Giorgio Lo Giudice, Nicola Zerbinati, Gianpaolo Tartaro
Journal: Case Rep Surg (2019)
MeSH terms: Case Reports

Background:
In this article, we describe a nonsurgical approach based on hyaluronic acid filler injection to restore the facial features of a delayed diagnosis of malar fracture. We analyze the differences between surgical and nonsurgical solution: in case of early detection, the surgical approach is the gold standard of treatment. However, in cases of delayed facial fracture diagnosis without functional impairment, nonsurgical procedures could be considered an alternative tool as we show in the present case report.
Aims:
The aim of this study is to underline the importance of a complete aesthetic restoration in patients treated for noncosmetic purposes.
Patients/methods:
We present a case of a 26-year-old male patient with a delayed diagnosis of malar fracture without functional impairment that was treated with hyaluronic acid (HA) filler injections.
Results:
The patient was followed up for 1 year showing stable results for the first 8 months; at the 12-month follow-up, a touch-up was suggested due to partial resorption of the filler.
Conclusion:
This is the first case describing a facial fracture treated with HA injections for only recontouring purposes. We assess that nonsurgical cosmetic procedures could be considered a "new" tool in the process of facial rehabilitation but only when functional problems are not associated with facial trauma.
The surgery of intra-orbital hydatid cyst: a case report and literature review
Authors: Kamal Chtira, Lamia Benantar, Houssaine Aitlhaj, Hasna Abdourafiq, Yassine Elallouchi, Khalid Aniba
Journal: Pan Afr Med J (2019)
Keywords: child, hydatid cyst, orbit, proptosis, surgery
MeSH terms: Echinococcosis / diagnosis, Eye Infections, Parasitic / diagnosis, Orbital Diseases / diagnosis, Case Reports, Review, Blindness / parasitology, Child, Preschool, Echinococcosis / parasitology, Echinococcosis / surgery, Exophthalmos / parasitology, Eye Infections, Parasitic / parasitology, Eye Infections, Parasitic / surgery, Female, Humans, Orbital Diseases / parasitology, Orbital Diseases / surgery, Visual Acuity

Intra-orbital hydatid cyst is a very rare pathological entity that affects children and the young adults; it is secondary to the development in the orbit of the echinococcus granulosis tapeworm. Its frequency does not exceed 1% of all cases of hydatid disease. Clinical presentation of intra-orbital hydatid cyst is dominated by proptosis and a decrease in visual acuity, complete surgical excision is difficult, evolution is generally better when the treatment is early before the installation of irreversible optic atrophy. We report one case of a 3 years old girl operated for right intra-orbital hydatid cyst who presented with proptosis and blindness. Complete removal was difficult and puncture of the cyst was performed followed by excision of its membrane with good post-operative results. We also discuss the different epidemiological, clinical, radiological and therapeutic aspects of intra-orbital hydatid cyst and a review of literature of this rare pathology.
Suicidality and Illness Course Worsening in a Male Patient with Bipolar Disorder during Tamoxifen Treatment for ER+/HER2+ Breast Cancer
Authors: Claudia Carmassi, Francesco Pardini, Valerio Dell'Oste, Annalisa Cordone, Virginia Pedrinelli, Marly Simoncini, Liliana Dell'Osso
Journal: Case Rep Psychiatry (2021)
MeSH terms: Case Reports

Purpose:
Tamoxifen is a selective estrogenic receptor modulator (SERM) drug. In addition to its common use in breast cancer ER+, Tamoxifen has been object of growing interest in psychiatry as antimanic drug. At the same time, clinical concerns about Tamoxifen's depressogenic effect have been repeatedly raised even without reaching univocal conclusions. We discuss the case of a 45-year-old-male with a diagnosis of Bipolar Disorder type II, treated with Tamoxifen as relapse prevention treatment after surgery for a ER+/HER2+ breast cancer. The patient required two psychiatric admissions in a few-month time span since he showed a progressive worsening of both depressive and anxiety symptoms, with the onset of delusional ideas of hopelessness and failure up to suicidal thoughts. The clinical picture showed poor response to treatment trials based on various associations of mood-stabilising, antidepressants, and antipsychotic drugs. During the second hospitalization, after a multidisciplinary evaluation, the oncologists agreed on Tamoxifen discontinuation upon the severity of the psychiatric condition. The patient underwent a close oncological and psychiatric follow-up during the following 12 months.
Methods:
Psychiatric assessments included the Montgomery-Asberg Depression Rating Scale (MADRS), the Hamilton Depression Scale (HAM-D), the Columbia Suicide Severity Rating Scale (C-SSRS), and the Quality of Life Enjoyment and Satisfaction Questionnaire Short Form (Q-LES-Q-SF). All questionnaires were administered at the time of the second hospitalization and in a one-year follow-up.
Results:
Suicidal ideation fully remitted and depressive symptoms markedly and rapidly improved in the aftermath of Tamoxifen discontinuation. The symptomatological improvement remained stable across one-year follow-up.
Conclusions:
Male patients with a mood disorder history constitute a high-risk group as to Tamoxifen psychiatric side effects. The onset or worsening of depressive symptoms or suicidality should be carefully addressed and promptly treated, and clinicians should be encouraged to consider the possibility of discontinue or reduce Tamoxifen therapy after a multidisciplinary evaluation.
Metastatic Merkel Cell Carcinoma Masquerading as Multiple Immune-Related Adverse Events
Authors: Farees Saqlain, Sophia Z Shalhout, Kevin S Emerick, Tomas G Neilan, Tatyana Sharova, David Michael Miller
Journal: Case Rep Dermatol Med (2020)
MeSH terms: Case Reports

Merkel cell carcinoma is a rare cutaneous neuroendocrine carcinoma with a high rate of regional and distant metastasis and mortality. Here, we report a novel case of Merkel cell carcinoma which presented as a primary lesion to the left cheek with regional lymph node involvement and was treated with pembrolizumab and radiation. Widely metastatic disease eventually revealed on autopsy clinically mimicked immune-related organ insult leading to management with immunosuppressants. The patient also had a biopsy-confirmed immune-related cutaneous adverse event during admission. The case highlights a rare circumstance in which disease progression masqueraded as multiple immune-related end-organ adverse events. Contribution of on-target anti-PD-1 toxicity remains a possibility.
A novel proximal 3q29 chromosome microdeletion in a Chinese patient with Chiari malformation type II and Sprengel's deformity
Authors: Shuai Guo, Xue-Feng Fan, Jie-Yuan Jin, Liang-Liang Fan, Lei Zeng, Zheng-Bing Zhou, Rong Xiang, Ju-Yu Tang
Journal: Mol Cytogenet (2018)
Keywords: 3q29 microdeletion, acap2, chiari malformation, sprengel’s deformity, xxylt1
MeSH terms: Case Reports

Background:
Chiari malformation type II (CM-II) is mainly characterized by elongation and descent of the cerebellum through the foramen magnum into the spinal canal. Moreover, CM-II is uniquely associated with myelomeningocele. Sprengel's deformity refers to the malposition of the scapula, i.e. scapular elevation which is sometimes accompanied with scapula dysplasia. Although few familial cases of CM-II and Sprengel's deformity have been previously reported, both of these defects are considered to be sporadic, thus the exact etiology and causative genes have largely remained unknown.
Case presentation:
The patient was diagnosed with CM-II accompanied with Sprengel's deformity. Further genetic investigation revealed a novel 666 kb microdeletion located in 3q29 (chr3:194,532,035-195,198,585; Hg19). Subsequently, genes within the affected region were summarized, and XXYLT1 and ACAP2 were identified as the candidate genes.
Conclusion:
We reported a case of a patient with CM-II and Sprengel's deformity harboring a microdeletion in 3q29. This case highlights the importance of 3q29 in early neural and skeletal development, as well as expands the phenotype spectrum of this rare disorder.
Injecting drug use via femoral vein puncture: preliminary findings of a point-of-care ultrasound service for opioid-dependent groin injectors in treatment
Authors: Richard Senbanjo, Tracey Tipping, Neil Hunt, John Strang
Journal: Harm Reduct J (2012)

Background:
Within the UK, injecting in the femoral vein (FV), often called 'groin injecting', is a serious cause of risk and harm. This study aimed to use ultrasound scanning as a means to engage groin injectors (GIs), examine their femoral injecting sites and assess their venous health, with the intention of developing improved responses.
Methods:
Between September 2006 and March 2009, GIs attending a network of community drug treatment centres in South East England were invited to attend an ultrasound 'health-check' clinic. This paper provides a narrative account of the scanning procedure and operation of the service, with descriptive statistical analysis of GIs who attended. The analysis uses a structured, specially-developed clinical data set that incorporates a categorisation for the severity of FV damage. Case studies using ultrasound images and a link to a video are provided to illustrate the range of presentations encountered and the categorisations used for severity.
Results:
A total of 160 groin scans (76 bilateral and 8 unilateral) were performed in 84 GIs. The majority were men (69.0%) and the mean age of the sample was 36.8 years. The mean duration of drug use and injecting drug use was 19.7 years and 13.8 years, respectively. FV damage at the injecting site in the right groin was graded as minimal in 20 patients (25%), moderate in 27 (33.8%), severe in 16 (20.0%) and very-severe in 17 (21.3%). Corresponding figures for left FV were 24 (30.0%), 22 (27.5%), 18 (22.5%) and 16 (20.0%). Wide variation was observed in the time to the development of these grades of FV damage.
Conclusions:
Modern, portable ultrasound scanners make it possible to examine the venous health of GIs in community treatment settings. Ultrasound scanning identified extensive FV damage, much hitherto-unrecognised in this population. These findings should further alert clinicians, policy-makers and patients to the urgent need for effective harm reduction responses to GI behaviour. Images of damaged FV in this paper might prove to be a useful resource for discussions about GI risks.
Primary and subsequent secondary aorto-enteric fistulae in the setting of chronic Q fever
Authors: Dana Tabbara, Adam Frankel, Iain Thomson
Journal: J Surg Case Rep (2023)
Keywords: evar, q fever, aorto-enteric fistula
MeSH terms: Case Reports

We report the case of an 80-year-old male with stage three kidney disease, who survived a primary aorto-enteric fistula (AEF) in the setting of chronic Q fever after presenting with melena and syncope. His initial surgical treatment included endovascular aortic repair. Type 2 endoleak was present post-operatively. Six months later, he was diagnosed with a secondary AEF after syncope and large volume hematemesis. He was definitively treated with an open explant of his stent, repair of the duodenum and bilateral axillofemoral bypass. Two years later, he remains active and independent on life-long antibiotics.