OpenMed/multicare-articles huggingface dataset:
EGFR p.V774M/p.L833V compound mutations in lung adenocarcinoma responded well to almonertinib: a case report
Authors: Hai Pan, Linlin Zhang, Fanlu Meng, Shasha Guan, Diansheng Zhong
Journal: Front Oncol (2023)
Keywords: egfr, v774m/l833v, almonertinib, compound mutation, lung adenocarcinoma
MeSH terms: Case Reports

Background:
There are about 10-15% of uncommon EGFR mutations found in NSCLC patients, and their sensitivity to EGFR TKIs still lack sufficient clinical evidence, especially for rare compound mutations. Almonertinib is the third generation of EGFR-TKI that has demonstrated excellent efficacy in classical mutations, however, effects in rare mutations have also been rarely reported.
Case presentation:
In this case report, we present a patient with advanced lung adenocarcinoma with a rare EGFR p.V774M/p.L833V compound mutations, who achieved long-lasting and stable disease control after first-line Almonertinib targeted therapy. This case report could provide more information for therapeutic strategy selecting of NSCLC patients harboring rare EGFR mutations.
Conclusion:
We report for the first time the long-lasting and stable disease control with Almonertinib for EGFR p.V774M/p.L833V compound mutations treatment, hoping to provide more clinical case references for the treatment of rare compound mutations.
Lactobacillus Endocarditis-Associated Glomerulonephritis Complicated by anti-Coagulant Nephropathy and Renal Amyloidosis
Authors: Mitchell Moosavi, Jonathan E Zuckerman
Journal: Case Rep Pathol (2019)
MeSH terms: Case Reports

Kidney injury is a well-known sequelae of infectious endocarditis. Various types of kidney injury can be seen, including endocarditis-associated glomerulonephritis, and may affect nearly half of the patients with infectious endocarditis. Lactobacillus species are an infrequently documented cause of endocarditis. We present a case of Lactobacillus endocarditis-associated glomerulonephritis in a patient with a complex medical history including Lactobacillus infection of an artificial heart valve. To our knowledge, this is the first reported case of development of endocarditis-associated glomerulonephritis secondary to Lactobacillus species organisms. Furthermore, the patient's renal biopsy revealed several frequently overlooked concomitant findings including anti-coagulant nephropathy and renal amyloidosis.
Orthotopic Liver Transplantation in a Patient with Acutely Decompensated Liver Disease and Personal History of Malignant Hyperthermia
Authors: Elizabeth A Townsend, Manuchehr Habibi, Molly Groose, Thomas McDowell
Journal: Case Rep Anesthesiol (2022)
MeSH terms: Case Reports

Introduction:
Orthotopic liver transplants are characterized by sudden changes in hemodynamics, intraoperative hemorrhage, metabolic and electrolyte derangements, and arrhythmias. Many of these features are also hallmarks of malignant hyperthermia episodes and make differentiation difficult intraoperatively. Additionally, the treatment for malignant hyperthermia, dantrolene, can cause hepatotoxicity in already damaged native livers and newly reperfused organ allografts. Thus, it is imperative to avoid a triggering anesthetic in these patients. Here we report on a successful total intravenous anesthetic in a malignant hyperthermia susceptible individual undergoing an orthotopic liver transplant for acutely decompensated end-stage liver disease. Case Presentation. A 49-year-old male with a past medical history significant for malignant hyperthermia episodes as a child was admitted with decompensated alcoholic cirrhosis. He underwent uneventful total intravenous general anesthesia with propofol and sufentanil continuous infusions for an orthotopic liver transplant. He required minimal vasoactive agents to maintain a mean arterial blood pressure >65 mmHg and was extubated on postoperative day 1.
Conclusions:
Total intravenous anesthesia is necessary for patients with a personal history of malignant hyperthermia. However, this type of general anesthesia is difficult in the setting of fluctuating hemodynamics, hemorrhage, and changes in drug metabolism and clearance during the anhepatic and reperfusion phases of an orthotopic liver transplant. Propofol and sufentanil continuous infusions provided stable hemodynamics and an excellent plane of anesthesia throughout the case and should be considered in other individuals undergoing this procedure who require a total intravenous anesthetic.
Entrapment of a metal foreign body in the heart during surgical procedure: A case report and literature review
Authors: Fei Wang, Ting Li, Xinwei Yuan, Jiang Hu
Journal: Front Surg (2022)
Keywords: complication, foreign body migration, multidisciplinary collaboration, orthopedic surgery, vascular complication
MeSH terms: Case Reports

A rongeur had been used to remove thin bones in both orthopedic surgery and neurosurgery, featured with a tip holding and cutting bone effectively while protecting the underlying instruments. The authors describe a case of a 40-year-old man who proceeded with the second lumbar vertebrae osteotomy and presented to be ankylosing spondylitis with kyphosis and limited mobility for 10 years. During the surgery, we found that the rongeur tip was missing. C-arm fluoroscopy showed the high-density body just in front of the vertebral body intraoperatively. However, the CT scan showed the foreign body migrated to the right auricle of the heart postoperatively. This case is unique in that there was no exact vessel injury detected intraoperatively. There were few reports about the surgical instrument migrating to the heart. Our case showed the rare experience of the function of multidisciplinary collaboration in the migration of foreign bodies in the cervical spinal canal.
Crisis Averted: Clinical T1b Renal Mass with Concurrent Arteriovenous Malformation and Renal Vein Thrombus
Authors: David Zekan, Kareem Wasef, Zachary Werner, Robert Grammer, Cara Lombard, Adam Luchey, Ali Hajiran
Journal: Case Rep Urol (2022)
MeSH terms: Case Reports

Arteriovenous malformations (AVMs) secondary to renal-cell carcinoma (RCC) are well-described in the literature. Independently, renal vein and inferior vena cava tumor thrombi can be detected in locally-advanced RCC. A 67-year-old gentleman presented with a cT1b renal mass detected on workup for elevated creatinine. Multiphase CT imaging obtained for partial nephrectomy surgical-planning revealed an initially-missed renal cortical AVM. This drastically changed the plan for intervention, including use of an open approach with AVM embolization by interventional radiology prior and avoidance of a nephron-sparing approach. Final pathology confirmed the AVM and a subclinical renal vein thrombus masked by arterial flow on CT imaging, making this the first concurrent case described in the literature. Herein, we describe avoidance of catastrophic intraoperative hemorrhage by careful review of preoperative imaging and provide a literature review of imaging modalities for both renal surgical-planning and detection of tumor thrombi in RCC.
Sunburn as a Cause of Unexpected Neutrophilia in a Healthy Pregnant Woman
Authors: Robert Harper
Journal: Case Rep Obstet Gynecol (2018)
MeSH terms: Case Reports

Background:
Neutrophilia has a broad differential diagnosis and represents a systemic response to an infection or other inflammatory pathologies.
Case:
A 31-year-old woman, Gravida 3, Para 2 at 28 weeks of gestation, presented to the day assessment unit following routine blood tests that showed an unexpected marked neutrophilia. The underlying cause of the neutrophilia was sunburn. The sunburn recovered and her neutrophil count spontaneously normalised.
Conclusion:
Clinicians can add sunburn to the broad differential diagnosis of neutrophilia.
Inner experience in the scanner: can high fidelity apprehensions of inner experience be integrated with fMRI?
Authors: Simone Kühn, Charles Fernyhough, Benjamin Alderson-Day, Russell T Hurlburt
Journal: Front Psychol (2014)
Keywords: descriptive experience sampling, fmri, inner experience, inner hearing, inner speaking, inner speech, introspection, mind wandering

To provide full accounts of human experience and behavior, research in cognitive neuroscience must be linked to inner experience, but introspective reports of inner experience have often been found to be unreliable. The present case study aimed at providing proof of principle that introspection using one method, descriptive experience sampling (DES), can be reliably integrated with fMRI. A participant was trained in the DES method, followed by nine sessions of sampling within an MRI scanner. During moments where the DES interview revealed ongoing inner speaking, fMRI data reliably showed activation in classic speech processing areas including left inferior frontal gyrus. Further, the fMRI data validated the participant's DES observations of the experiential distinction between inner speaking and innerly hearing her own voice. These results highlight the precision and validity of the DES method as a technique of exploring inner experience and the utility of combining such methods with fMRI.
Lung cancer with skin and breast metastasis: a case report and literature review
Authors: Bikash Bhattarai, Marie Frances Schmidt, Meenakshi Ghosh, Abhisekh Sinha Ray, Saveena Manhas, Vikram Oke, Chidozie Charles Agu, Md Rawshan Basunia, Danilo Enriquez, Joseph Quist, Catherine Bianchi, Ravi Hans, Saroj Kandel
Journal: Case Rep Pulmonol (2015)

Lung cancer is one of the most common cancers in America. Frequent sites of metastasis include the Hilar lymph nodes, adrenal glands, liver, brain, and bone. The following case report is of a primary lung cancer with metastases to the breast and skin. Case. A 48-year-old African American male with a past medical history of poorly differentiated left breast cancer status after modified radical mastectomy (MRM), chronic obstructive pulmonary disease, and smoking (20 pack-years) presents to the ER with progressive shortness of breath on exertion, upper back pain, and weight loss for 2 months in duration. On physical examination he is found to have a MRM scar on his left breast and a left periumbilical cutaneous mass. Chest X-ray and chest CT reveal a right upper lobe mass and biopsies from the breast, lung, and the periumbilical mass indicate a poorly differentiated carcinoma of unclear etiology; all tumor markers are negative. The patient is male and a chronic smoker; therefore the diagnosis is made as lung carcinoma with metastases to the breast and skin. Conclusion. A high index of suspicion for cutaneous metastases should be cast when investigating cutaneous pathologies in patients at risk for primary lung malignancy.
HSV-Encephalitis Reactivation after Cervical Spine Surgery
Authors: Joshua E Heller, Geoffrey Stricsek, Lauren Thaete
Journal: Case Rep Surg (2019)
MeSH terms: Case Reports

Background:
Herpes simplex virus encephalitis (HSVE) is a viral neurological disorder that occurs when the herpes simplex virus (HSV) enters the brain. The disorder is characterized by the inflammation of the brain and a significant decline in mental status. HSVE reactivation after neurosurgery, although rare, can cause severe neurological deterioration. The high morbidity rate among untreated patients necessitates prompt diagnosis and management.
Case description:
We report a case of a 78-year-old woman with no known prior history of HSVE and declining mental status eleven days after a posterior C3-T1 decompression and instrumented fusion following resection of an intradural extramedullary tumor, confirmed to be meningioma on final pathology. Reactivation of HSV-1 encephalitis was suspected to be the underlying cause of her symptoms, though MRI scans of the brain for HSVE were negative. The patient reacted positively to a 21-day treatment of acyclovir and was discharged with a neurological status comparable to her preoperative baseline. This case contributes to the literature in that it is the first reported instance of HSVE reactivation after intradural cervical spinal surgery with negative MRI findings.
Conclusion:
We recommend utilizing multiple tests, including PCR, EEG, and MRI, for postoperative neurosurgery patients that have decreased mental status in order to quickly and correctly diagnose/treat patients who are HSVE positive. Clinicians should consider the possibility of receiving false-negative results from PCR, CSF, EEG, or MRI tests before terminating treatment for HSVE reactivation.
Mixed Germ Cell Tumor of Testis with Isolated Scapular Metastasis: A Case Report and Review of the Literature
Authors: Dipti Rani Samanta, Chaitali Bose, Roopesh Krishnappa, Saumyaranjan Mishra, Sulagna Mohanty, Ashish Upadhyay, Surendra Nath Senapati
Journal: Case Rep Urol (2015)

Bone metastasis is a rare entity in germ cell tumor of testis and is a poor prognostic site. It is usually associated with synchronous metastasis at other sites. Till now very few cases of isolated bone metastasis of germ cell tumor of testis have been reported but none have reported scapular metastasis. We are reporting a case of nonseminomatous germ cell tumor of right testis that was operated eight months ago and now presented with isolated scapular metastasis. Histopathology of the scapular tissue revealed rhabdomyosarcoma or poorly differentiated synovial sarcoma. Immunohistochemistry with serum markers concluded it to be metastatic germ cell tumor. To the best of our knowledge this is the first reported case of scapular metastasis of testicular germ cell tumor. This case is being reported here due to dilemmatic way of presentation and also to emphasize that histopathology may sometimes misguide and immunohistochemistry is necessary in such cases.
Case Report: A Rare Case of Coexisting of Autoimmune Polyglandular Syndrome Type 3 and Isolated Gonadotropin-Releasing Hormone Deficiency
Authors: Qiuhui Jiang, Ting Wu, Yuxian Zhang, Shunhua Wang, Liying Wang, Weijuan Su, Mingzhu Lin, Xuejun Li
Journal: Front Immunol (2021)
Keywords: gnrh stimulation test, graves’ disease, autoimmune polyglandular syndrome type 3, isolated gonadotropin-releasing hormone deficiency, secondary amenorrhea, type 1 diabetes mellitus
MeSH terms: Gonadotropin-Releasing Hormone / deficiency, Graves Disease / complications, Hypothalamic Diseases / complications, Latent Autoimmune Diabetes in Adults / complications, Polyendocrinopathies, Autoimmune / complications, Case Reports, Adult, Amenorrhea / diagnosis, Amenorrhea / etiology, Biomarkers / blood, Female, Gonadotropin-Releasing Hormone / blood, Graves Disease / blood, Graves Disease / diagnosis, Graves Disease / drug therapy, Humans, Hypothalamic Diseases / blood, Hypothalamic Diseases / diagnosis, Hypothalamic Diseases / drug therapy, Latent Autoimmune Diabetes in Adults / blood, Latent Autoimmune Diabetes in Adults / diagnosis, Latent Autoimmune Diabetes in Adults / drug therapy, Polyendocrinopathies, Autoimmune / blood, Polyendocrinopathies, Autoimmune / diagnosis, Polyendocrinopathies, Autoimmune / drug therapy, Biomarkers, Gonadotropin-Releasing Hormone

APS (autoimmune polyglandular syndrome) is defined as the coexistence of at least two kinds of endocrine autoimmune diseases. APS type 3 comprises autoimmune thyroid diseases and other autoimmune diseases but does not involve autoimmune Addison's disease. So far, APS-3 combined with isolated gonadotropin-releasing hormone (GnRH) reduction caused by the suspected autoimmune hypothalamic disease has not been reported. We recently received a 43-year-old woman with a one-year history of Graves' disease (GD) and a four-month history of type 1 diabetes presented with hyperthyroidism and hyperglycemia. After the GnRH stimulation test, she was diagnosed with secondary amenorrhea attributed to suspected autoimmune Hypothalamitis and APS type 3 associated with Graves' disease and Latent Autoimmune Diabetes (LADA). According to this case, the hypothalamus cannot be spared from the general autoimmune process. It is recommended to carry out the GnRH stimulation test when encountering APS patients combined with secondary amenorrhea.
Giant Intrapericardial Myxoma Adjacent to the Left Main Coronary Artery
Authors: Piotr Nikodem Rudziński, Barbara Lubiszewska, Jacek Różański, Ilona Michałowska, Mariusz Kruk, Cezary Kepka, Karolina Kryczka, Andrzej Kurowski, Wieslawa Grajkowska, Maciej Pronicki, Marcin Demkow
Journal: Front Oncol (2018)
Keywords: cardiac tumor, coronaries, intrapericardial mass, intrapericardial tumor, myxoma
MeSH terms: Case Reports

A 62-years-old woman was admitted to the hospital because of chronic cough, expectoration of thick mucus, hoarseness and tightness in the precordial area. Computed Tomography (CT) examination revealed the presence of a giant intrapericardial tumor with the dimensions of 80 × 38 × 32 mm. It was located anteriorly and laterally to the left atrium, posteriorly to the pulmonary trunk and the ascending aorta. This hypodense change modeled the left atrium without evidence of invasion. CT coronary angiography and 3-dimensional reconstruction were applied to enable precise planning of cardiac surgery. CT evaluation confirmed that it is possible to remove the tumor without damage to the adjacent left main coronary artery. The patient underwent cardiac surgery with sternotomy and cardiopulmonary bypass. A cohesive, smooth, vascularized tumor pedunculated to the left atrial epicardium was visualized. The location and dimensions corresponded to those determined by CT scan examination. The entire tumor was successfully dissected together with adjacent adipose and fibrous tissue. Histological evaluation revealed the presence of myxoid cells, blood vessels, degenerative changes, and microcalcifications embedded in profuse hyalinized stroma. Those histological features enabled identification of the intrapericardial tumor as a myxoma. Follow-up CT examination did not demonstrate any signs of recurrence of the myxoma. According to our knowledge, a myxoma located inside the pericardial sac has never been described before.
Clinically silent indolent T-cell leukemia
Authors: Clément Janot, Joffrey Feriel, Claire Borie, Edouard Lefevre, Annelise Bennaceur-Griscelli, Ali G Turhan, Cédric Aumont
Journal: Clin Case Rep (2018)
Keywords: cellular hematology, t‐cell leukemia, t‐cell prolymphocytic leukemia, indolent, lymphoid neoplasms
MeSH terms: Case Reports

The clinically silent, symptom-free T-cell prolymphocytic leukemia case that we report here confirms the major interest of the analysis of the blood smear as usual care of any emergent lymphocytosis. It also brings out the issue of the monitoring and follow-up of this uncommon presentation.
Metastatic Malignant Paraganglioma Presenting as a Neck Mass Treated with Radiolabeled Somatostatin Analog
Authors: Waqas Jehangir, Alexander Karabachev, Jackie Tsao, Christopher J Anker, Sree Susmitha Garapati, Janusz K Kikut, Hibba Tul Rehman
Journal: Case Rep Oncol Med (2021)
MeSH terms: Case Reports

Paragangliomas are rare neuroendocrine tumors that arise from chromaffin-containing tissue. Surgical resection and/or radiation are used for locoregional disease, and reduction of tumor burden with systemic therapy is reserved for metastatic disease. Iobenguane I-131, somatostatin analog (octreotide), and Sunitinib are noncytotoxic options for treatment, while cyclophosphamide, vincristine, and dacarbazine (CVD) and temozolomide are often used as initial chemotherapy options as studies have shown that they offer some tumor response. However, there are no randomized clinical trials demonstrating prolonged survival with the use of chemotherapeutics in metastatic cases. Investigation of alternative therapies that provide survival benefit is thus necessary. We present a case of a 69-year-old female with metastatic malignant paraganglioma presenting as a left parapharyngeal neck mass, which metastasized after surgery, requiring radiation therapy for bony metastasis who was treated with a radioisotope somatostatin analog for disease progression.
Transcatheter closure of atrial septal defect in a patient with cor triatriatum sinister and atrial septal defect
Authors: Wasana Hongkan, Kriangsak Thongchaiprasit, Kritvikrom Durongpisitkul
Journal: Case Rep Cardiol (2011)
MeSH terms: Case Reports

Cor triatriatum sinister is a rare congenital heart disease and rarely found in adults. The authors describe an asymptomatic 20-year old man presenting with heart murmur by check up. Transthoracic and transesophageal echocardiogram demonstrate atrial septal defect (ASD) secundum 26 mm and cor triatriatum sinister with 20 mm of fenestration. Transcatheter closure of ASD using Occlutech Figulla(R) device was successfully performed without complications. Echocardiogram post procedure demonstrate good position of device without obstruction of blood flow, no residual shunt and residual 12 mm of fenestration of cor triatriatum.
Systematic Observation of an Expert Driver's Gaze Strategy-An On-Road Case Study
Authors: Otto Lappi, Paavo Rinkkala, Jami Pekkanen
Journal: Front Psychol (2017)
Keywords: driving, expertise, eye movements, eye tracking, fixation classification, gaze coding, naturalistic tasks, observational instruments

In this paper we present and qualitatively analyze an expert driver's gaze behavior in natural driving on a real road, with no specific experimental task or instruction. Previous eye tracking research on naturalistic tasks has revealed recurring patterns of gaze behavior that are surprisingly regular and repeatable. Lappi (2016) identified in the literature seven "qualitative laws of gaze behavior in the wild": recurring patterns that tend to go together, the more so the more naturalistic the setting, all of them expected in extended sequences of fully naturalistic behavior. However, no study to date has observed all in a single experiment. Here, we wanted to do just that: present observations supporting all the "laws" in a single behavioral sequence by a single subject. We discuss the laws in terms of unresolved issues in driver modeling and open challenges for experimental and theoretical development.
A Novel Surgical Approach for the Management of Cloacal Exstrophy with a Giant Omphalocele
Authors: Caitlin A Smith, Jeffrey R Avansino, Paul Merguerian, Victoria Lane, Marc Levitt
Journal: European J Pediatr Surg Rep (2021)
Keywords: anorectal malformation, bladder exstrophy, cloacal exstrophy
MeSH terms: Case Reports

Cloacal exstrophy is a rare malformation that presents as a lower midline abdominal wall defect which affects the gastrointestinal and genitourinary systems. The components of cloacal exstrophy characteristically include omphalocele, exstrophy of perineal structures, and imperforate anus. Most of these patients also have renal anomalies such as pelvic kidney, fused kidneys, or solitary kidneys. This congenital condition can also be associated with spinal issues, such as spinal dysraphism. When combined with spinal defects, it is referred to as the omphalocele, exstrophy, imperforate anus, and spinal defects (OEIS) complex, and is one of the most challenging surgical conditions to manage. Here, we present a unique case of a low-birth-weight patient with OEIS and a liver containing giant omphalocele and the novel surgical technique used to manage her cloacal exstrophy whereby the cecal plate was not separated from the bladder halves, but rather left for an autoaugment, and the ileum was connected to the hindgut.