OpenMed/multicare-articles huggingface dataset:
Colouterine and Jejunouterine Fistula Secondary to Chronic Diverticulitis
Authors: Ilias Galanis, Georgios Floros, Christophoros Theodoropoulos, Myriam Metaxa, Panagiotis Theodoropoulos, Panagiotis Tsintavis, Dimitrios Bartziotas, Georgios Giannos, Georgios Stylianidis, Georgios Papadopoulos
Journal: Case Rep Gastrointest Med (2021)
MeSH terms: Case Reports

Fistulae between the colon or the small intestine and the uterus are extremely rare as the uterus is a thick, muscular organ. Here, we present the case of a 74-year-old female presenting to our surgical department because of fecal vaginal discharge for the past few months, which proved to be caused by a combined colouterine and jejunouterine fistula due to chronic diverticulitis. Total abdominal hysterectomy with bilateral oophorectomy with en bloc resection of part of the jejunum and the sigmoid colon and primary anastomoses were performed. This case represents an unusual type of diverticulitis complication and aims to point out the diagnostic and therapeutic issues of such a rare medical condition.
Laparoscopic intrapancreatic accessory splenectomy: A case report of recurrent immune thrombocytopenia in a 33 years old male patient after 6 years of splenectomy
Authors: Abdullah AlShammari, Dana Kalagi, Talal Hijji, Mohammad Aburahmah
Journal: Int J Surg Case Rep (2019)
Keywords: accessory spleen, idiopatic thrombocytopenic purpura, laparoscopy, splenectomy

Introduction:
Intra-pancreatic Accessory Spleen (IPAS) is a rare benign abnormality of splenic embryology that should be considered in any patient with recurrence of immune thrombocytopenia (ITP). The case demonstrates that remission could be achieved if an IPAS is correctly identified and safely removed.
Case presentation:
We report a 33-years-old male patient who presented with chronic ITP relapsed 3 years post initial splenectomy. The patient presented with severe thrombocytopenia requiring steroids and intravenous immunoglobulin (IVIG).
Discussion:
IPAS can be identified using enhanced CT scan along with Tc-99m sulfur colloid scintigraphy. Our patient underwent CT scan of abdomen and pelvis and was found to have an IPAS originating from the tail of the pancreas which was subsequently removed laparoscopically. The patient was then tapered off steroids and was followed up regularly and found to have acceptable platelet levels and no symptoms for 30 months post-surgery.
Conclusion:
The diagnosis of IPAS can be non-invasively made by an experienced radiologist with the recent advancement of medical imaging. Recognizing IPAS as a possible cause of ITP recurrence, and using minimally invasive approach can be performed safely and lead satisfactory outcomes.
Right Ventricular Perforation with the Body of Swan-Ganz Catheter during Lung Transplantation by ECMO Support: A Case Report
Authors: Alireza Jahangirifard, Zargham Hossein Ahmadi, Ali Khalili, Abolghasem Daneshvar Kakhaki, Kambiz Sheikhy
Journal: Tanaffos (2017)
Keywords: extracorporeal membrane oxygenation (ecmo), lung transplantation, perforation, right ventricle
MeSH terms: Case Reports

A 46-year-old woman with a 12-year history of lymphangiomyomatosis (LAM) was admitted for lung transplantation in January 2017. We decided to apply veno-arterial extracorporeal membrane oxygenation (ECMO) to manage arrhythmia and hypotension during lung transplantation, since it was not controllable with inotropic drugs. After transplanting the right (first) lung and at the time of left pneumonectomy, the body of the Swan-Ganz catheter was suddenly observed to be protruding from the right ventricular (RV) wall. The catheter was found folded at part of its body and ran out 0.5 cm from the RV. The protruding part of the catheter was inserted before the perforated part of the cardiac muscle was repaired in order to control the bleeding. ECMO was used throughout the rest of the procedure and the patient was transferred to the intensive care unit (ICU) in good condition before being weaned from the ventilator after 16 hours. It seems that gentle manipulation, concurrent use of transesophageal echocardiography (TEE), insertion of the appropriate length of the catheter into the heart chambers, and a softer material in the structure of the catheters would be helpful to prevent these kinds of potentially fatal complications.
Large Cholesterol Granuloma of the Middle Ear Eroding into the Middle Cranial Fossa
Authors: Tessei Kuruma, Tohru Tanigawa, Yasue Uchida, Ogawa Tetsuya, Hiromi Ueda
Journal: Case Rep Otolaryngol (2017)
MeSH terms: Case Reports

Background:
Cholesterol granuloma of the middle ear is extremely rare in comparison to cholesterol granuloma of the petrous apex but sometimes shows an aggressive course.
Case report:
We report herein a case involving a large, aggressive cholesterol granuloma of the middle ear that eroded the middle cranial fossa. A 64-year-old woman presented with pain in the left ear and hearing loss. Cholesterol granuloma was finally diagnosed from diffusion-weighted imaging, and cortical mastoidectomy was performed with canal wall down tympanoplasty type III. Recovery was uneventful recovery and the patient well at the 3-year follow-up.
Conclusion:
This case demonstrates the rare but clinically important pathology of aggressive cholesterol granuloma of the middle ear.
Perioperative Management of a Patient with Hemophilia C and Allergy to Fresh Frozen Plasma
Authors: Sara Kianian, Giacomo Scorsese, Eric Zabirowicz, Jeremy Poppers
Journal: Case Rep Anesthesiol (2023)
MeSH terms: Case Reports

Hemophilia C is a rare bleeding disorder characterized by a deficiency in clotting factor XI (fXI) and has no standard of care for preoperative optimization before cardiac surgery. Normalization of fXI levels in patients with hemophilia C can be achieved with fresh frozen plasma (FFP), which sometimes results in allergic reactions. We present a case of a patient with hemophilia C requiring coronary artery bypass grafting surgery who developed an allergic reaction to FFP. Our report underscores the balance between thrombosis and bleeding risks when devising a perioperative plan for patients with hemophilia C.
A Pregnant Woman with Spina Bifida: Need for a Multidisciplinary Labor Plan
Authors: Mary Angela O'Neal
Journal: Front Med (Lausanne) (2017)
Keywords: complications, labor, neuraxial anesthesia, pregnancy, spina bifida
MeSH terms: Case Reports

Women with spina bifida present both obstetrical and anesthesia challenges. They are more likely to require a caesarian delivery and traditionally neuraxial anesthesia has been avoided due to concerns of worsening neurologic disability. The case of a pregnant woman with a history of a surgically corrected lipomeningocele and tethered cord is presented to illustrate the need for a comprehensive labor plan.
Regeneration of Cartilage in Human Knee Osteoarthritis with Autologous Adipose Tissue-Derived Stem Cells and Autologous Extracellular Matrix
Authors: Jaewoo Pak, Jung Hun Lee, Kwang Seung Park, Byeong Chul Jeong, Sang Hee Lee
Journal: Biores Open Access (2016)
Keywords: adipose tissue-derived stem cells, extracellular matrix, human cartilage regeneration, osteoarthritis

This clinical case series demonstrates that percutaneous injections of autologous adipose tissue-derived stem cells (ADSCs) and homogenized extracellular matrix (ECM) in the form of adipose stromal vascular fraction (SVF), along with hyaluronic acid (HA) and platelet-rich plasma (PRP) activated by calcium chloride, could regenerate cartilage-like tissue in human knee osteoarthritis (OA) patients. Autologous lipoaspirates were obtained from adipose tissue of the abdominal origin. Afterward, the lipoaspirates were minced to homogenize the ECM. These homogenized lipoaspirates were then mixed with collagenase and incubated. The resulting mixture of ADSCs and ECM in the form of SVF was injected, along with HA and PRP activated by calcium chloride, into knees of three Korean patients with OA. The same affected knees were reinjected weekly with additional PRP activated by calcium chloride for 3 weeks. Pretreatment and post-treatment magnetic resonance imaging (MRI) data, functional rating index, range of motion (ROM), and pain score data were then analyzed. All patients' MRI data showed cartilage-like tissue regeneration. Along with MRI evidence, the measured physical therapy outcomes in terms of ROM, subjective pain, and functional status were all improved. This study demonstrates that percutaneous injection of ADSCs with ECM contained in autologous adipose SVF, in conjunction with HA and PRP activated by calcium chloride, is a safe and potentially effective minimally invasive therapy for OA of human knees.
Large Strangulated Spigelian Hernia: Management of an Uncommon Presentation of Abdominal Hernias in Central Uganda
Authors: Wasingya Lucien, Franck Katembo Sikakulya, Kisembo Peter, Atwijukire Vincent
Journal: Case Rep Surg (2019)
MeSH terms: Case Reports

Background:
Spigelian hernia is an uncommon presentation of abdominal hernias with 0.1-2%. We report a case of a large strangulated Spigelian hernia, an uncommon presentation of abdominal hernias, and its management in a health facility in Central Uganda.
Case presentation:
A 76-year-old female presented with a 2-day history of colicky abdominal pain, bilious vomiting, and abdominal distension. On abdominal ultrasound scan, an abdominal wall defect measuring 4.45 cm with herniated bowel loops in the left anterior abdominal region with mild fluid collection in the hernia sac was seen. Conservative management for intestinal obstruction which included putting the patient on nil per os, NG tube decompression, and soapy enema was instituted, and surgery was done on the second day of admission. Intraoperatively, using a Rutherford-Morrison incision, we found a large defect at the Spigelian aponeurosis, with an inflamed sac protruding. The Spigelian hernia was repaired with a mesh under layers. The patient recovered uneventfully and was discharged 10 days after surgery.
Conclusion:
Clinicians and especially general surgeons might be aware of this rare condition in most of the anterior abdominal swellings. Strangulation is the commonest complication of Spigelian hernia, and surgical management remains the mainstay of its treatment.
Biochemical and Clinical Features of Insulinoma in a Patient with Turner Syndrome
Authors: Darius A Schneider, M Zare, F Behnia, M Matesan, T Tylee
Journal: Case Rep Endocrinol (2019)
MeSH terms: Case Reports

Turner syndrome (TS), i.e., mosaic or nonmosaic states with only one normal X chromosome in females, is characterized by a wide spectrum of somatic, hormonal, and metabolic features. Here we report an unusual case of recurrent hypoglycemia in a 53-year-old woman with TS. Biochemical work-up following a 72h fast revealed detectable, inappropriate for low glucose insulin levels and elevated proinsulin and beta-hydroxybutyrate (BOHB) levels. MR and multiphase CT showed a solid 2.5 cm pancreatic tail mass with absent uptake in the 111In-pentetreotide (Octreoscan) scan. Subsequent hepatic vein blood sampling after intra-arterial calcium stimulation showed sharp increase in insulin and modest increase in proinsulin levels. The patient underwent excision of the mass with resolution of symptoms. Histopathologic examination confirmed the neuroendocrine etiology of the tumor. This is, to our knowledge, the third report of TS and concomitant insulinoma. Impaired counterregulatory response to hypoglycemia in patients with TS may result in symptomatic hypoglycemia with only mild insulin elevation and elevated proinsulin in setting of hypoglycemia may be the only indication of insulinoma in these patients. BOHB levels should not be used for ruling out EHH in patients with TS.
SEM Analysis and Management of Fracture Dental Implant
Authors: Archana Singh, Ankita Singh, Rajul Vivek, T P Chaturvedi, Pankaj Chauhan, Shruti Gupta
Journal: Case Rep Dent (2013)

Implant fracture is one of the important biomechanical complications which can present with a considerable problem to the patient as well as the dental surgeon. The aim of this case report is to describe the management of a case of fractured endosseous dental implant in premolar region and microscopic evaluation of the fractured implant segment using scanning electron microscopy. In most of such cases, complete removal of the fractured implant has been a preferred treatment option. In the present case, fractured implant segment was successfully removed and rehabilitated immediately with larger diameter implant. It was found that retrieved fracture segment had a diameter of 3.3 mm, and SEM analysis shows fatigue fractures which may be the result of excessive overloading and use of small diameter implant which enhances fatigue failure.
Global Transcriptional Analysis Reveals the Complex Relationship between Tea Quality, Leaf Senescence and the Responses to Cold-Drought Combined Stress in Camellia sinensis
Authors: Chao Zheng, Yu Wang, Zhaotang Ding, Lei Zhao
Journal: Front Plant Sci (2016)
Keywords: camellia sinensis, rna-seq, cold-drought combined stress, leaf senescence, tea quality

In field conditions, especially in arid and semi-arid areas, tea plants are often simultaneously exposed to various abiotic stresses such as cold and drought, which have profound effects on leaf senescence process and tea quality. However, most studies of gene expression in stress responses focus on a single inciting agent, and the confounding effect of multiple stresses on crop quality and leaf senescence remain unearthed. Here, global transcriptome profiles of tea leaves under separately cold and drought stress were compared with their combination using RNA-Seq technology. This revealed that tea plants shared a large overlap in unigenes displayed "similar" (26%) expression pattern and avoid antagonistic responses (lowest level of "prioritized" mode: 0%) to exhibit very congruent responses to co-occurring cold and drought stress; 31.5% differential expressed genes and 38% of the transcriptome changes in response to combined stresses were unpredictable from cold or drought single-case studies. We also identified 319 candidate genes for enhancing plant resistance to combined stress. We then investigated the combined effect of cold and drought on tea quality and leaf senescence. Our results showed that drought-induced leaf senescence were severely delayed by (i) modulation of a number of senescence-associated genes and cold responsive genes, (ii) enhancement of antioxidant capacity, (iii) attenuation of lipid degradation, (iv) maintenance of cell wall and photosynthetic system, (v) alteration of senescence-induced sugar effect/sensitivity, as well as (vi) regulation of secondary metabolism pathways that significantly influence the quality of tea during combined stress. Therefore, care should be taken when utilizing a set of stresses to try and maximize leaf longevity and tea quality.
Therapeutic Potential of a Vasopressin V2 Receptor Antagonist for Calcium Channel Blocker-Associated Edema with Vasospastic Angina
Authors: Kojiro Toda, Masashi Fujino, Kota Murai, Teruo Noguchi
Journal: Case Rep Cardiol (2022)
MeSH terms: Case Reports

Calcium channel blocker- (CCB-) associated peripheral edema does not resolve without CCB discontinuation or dose reduction. However, renin-angiotensin system (RAS) inhibitors have been reported to be effective for CCB-associated edema. We report a case of vasospastic angina with refractory CCB-associated edema. A 78-year-old man had refractory edema induced by a CCB. It was successfully treated with tolvaptan, an active vasopressin V2 receptor antagonist. The aim of this case report is to understand the mechanism and treatment of CCB-associated peripheral edema and how tolvaptan affects peripheral edema.
Bilateral Basal Ganglion Hemorrhage after Severe Olanzapine Intoxication
Authors: Kerstin Schweyer, Bastian Fatke, Kornelia Kreiser, Christian Rabe, Christian Seifert, Benno Ikenberg
Journal: Case Rep Psychiatry (2020)
MeSH terms: Case Reports

Olanzapine is a second-generation antipsychotic drug which is generally considered safe with well therapeutic antipsychotic effects. We describe a patient suffering from bilateral intracerebral hemorrhage after severe olanzapine intoxication without underlying thrombocytopenia, arterial hypertension, or vascular malformation as cause of intracerebral hemorrhage. This raises the possibility of a direct side effect of high-dose olanzapine intake. So far, intracranial hemorrhage after olanzapine intoxication in such constellation has not been reported before. Given the high number of its prescription rates, our finding of intracranial hemorrhage after olanzapine intoxication is of high clinical relevance.
A Rare Case of Small Bowel Obstruction in a Patient with Endosalpingiosis, Fitz-Hugh-Curtis Syndrome, and Chlamydia trachomatis Pelvic Inflammatory Disease
Authors: Zhi Kiat Sia, Jodie Trautman, Takako Eva Yabe, James Wykes
Journal: Case Rep Surg (2022)
MeSH terms: Case Reports

A 19-year-old female has multiple presentations to emergency department with recurrent abdominal pain. During her third presentation, the radiological features were suggestive of high-grade small bowel obstruction in a virgin abdomen. A diagnostic laparoscopy has been performed. The intraoperative findings include a band adhesion between omentum and small bowel mesentery, and perihepatic adhesions consistent with Fitz-Hugh-Curtis syndrome. The histopathology from a biopsy of the macular lesions of the abdominal wall showed endosalpingiosis. The postoperative high vaginal swab was positive for Chlamydia trachomatis. The underlying cause of her small bowel obstruction could be due to pelvic inflammatory disease, Fitz-Hugh-Curtis syndrome, or endosalpingiosis. We aimed to create awareness amongst readers that small bowel obstruction in young female patients with no prior abdominal surgery is possible and often difficult to diagnose immediately.
Case Report: Longitudinal monitoring of clonal evolution by circulating tumor DNA for resistance to anti-EGFR antibody in a case of metastatic colorectal cancer
Authors: Tamotsu Sagawa, Yasushi Sato, Masahiro Hirakawa, Kyoko Hamaguchi, Fumito Tamura, Hiroyuki Nagashima, Koshi Fujikawa, Koichi Okamoto, Yutaka Kawano, Masahiro Sogabe, Hiroshi Miyamoto, Tetsuji Takayama
Journal: Front Oncol (2023)
Keywords: anti-egfr antibody, clonal evolution, ctdna, metastatic colorectal cancer, resistance
MeSH terms: Case Reports

Background:
Treatment with anti-EGFR antibody has been shown to prolong survival in patients with RAS wild-type metastatic colorectal cancer (mCRC). However, even patients who initially respond to anti-EGFR antibody therapy, almost without exception, develop resistance to the therapy and then fail to respond. Secondary mutations in the mitogen-activated protein (MAPK) signaling pathway (mainly in NRAS and BRAF) have been implicated in anti-EGFR resistance. However, the process by which resistant clones develop during therapy has not been elucidated, and considerable intrapatient and interpatient heterogeneity exists. Circulating tumor DNA (ctDNA) testing has recently allowed the noninvasive detection of heterogeneous molecular alterations that underlie the evolution of resistance to anti-EGFR. In this report, we describe our observation of genomic alterations in KRAS and NRAS in a patient with acquired resistance to anti-EGFR antibody drugs by tracking clonal evolution using serial ctDNA anaylsis.
Case presentation:
A 54-year-old woman was initially diagnosed with sigmoid colon cancer with multiple liver metastases. After receiving first-line mFOLFOX + cetuximab, second-line FOLFIRI + ramucirumab, third-line trifluridine/tipiracil + bevacizumab, fourth-line regorafenib, and fifth-line CAPOX + bevacizumab, she was rechallenged with CPT-11 + cetuximab. The best response to anti-EGFR rechallenge therapy was a partial response. RAS in the ctDNA was assessed during treatment. The RAS status changed from wild type to mutant type, back to wild type, and again to mutant type (NRAS/KRAS codon 61) during the course of treatment.
Conclusion:
In this report, tracking of ctDNA allowed us to describe clonal evolution in a case in which we observed genomic alterations in KRAS and NRAS in a patient who acquired resistance to anti-EGFR antibody drugs during treatment. It is reasonable to consider repeat molecular interrogation during progression in patients with mCRC by using ctDNA analysis, which could help to identify patients who may benefit from a rechallenge strategy.
A novel compound heterozygous variant in ALPK3 induced hypertrophic cardiomyopathy: a case report
Authors: Tiange Li, Yuxi Jin, Rui Liu, Yimin Hua, Kaiyu Zhou, Shuhua Luo, Yifei Li, Donghui Zhang
Journal: Front Cardiovasc Med (2023)
Keywords: alpk3, case report, hypertrophic cardiomyopathy, novel variant, whole-exome sequencing
MeSH terms: Case Reports

Background:
Malignant hypertrophic cardiomyopathy (HCM) phenotypes have potential risks of severe heart failure, fatal arrhythmia, and sudden cardiac death. Therefore, it is critical to predict the clinical outcomes of these patients. It was reported recently that the alpha kinase 3 (ALPK3) gene was involved in the occurrence of HCM. Herein we reported a girl with HCM, while whole-exome sequencing found novel compound heterozygous variants in ALPK3 gene, which identified a potential association.
Case presentation:
We reported a 14-year-girl who suffered from clinical manifestations of cardiac failure, with sudden cardiac arrest before admission. The heartbeat recovered after cardiopulmonary resuscitation, though she remained unconscious without spontaneous breath. The patient stayed comatose when she was admitted. Physical examination indicated enlargement of the heart boundary. Laboratory results revealed a significant increment of myocardial markers, while imaging demonstrated hypertrophy of the left heart and interventricular septum. Whole-exome sequencing (WES) identified a compound heterozygous variant in ALPK3 gene consisting of c.3907_3922del and c.2200A>T, which was inherited from her parents. Both variants (p.G1303Lfs*28 and p.R734*) were disease-causing evaluated by MutationTaster (probability 1.000). The crystal structure of the complete amino acid sequence is predicted and evaluated by AlphaFold and SWISS-MODEL software (July, 2022), which revealed three domains. Moreover, both variants resulted in a wide protein-truncating variant and damaged protein function. Thus, a novel compound heterozygous variant in ALPK3 associated with HCM was diagnosed.
Conclusion:
We described a young patient with ALPK3-associated HCM who experienced sudden cardiac arrest. Through WES, we identified a compound heterozygous variant in the ALPK3 gene, c.3907_3922del and c.2200A>T, which were inherited from the patient's parents and resulted in a truncated protein, indirectly causing the symptoms of HCM. In addition, WES provided clues in evaluating potential risks of gene variants on fatal clinical outcomes, and the nonsense and frameshift variants of ALPK3 were related to adverse clinical outcomes in HCM patients, which required implantable cardioverter defibrillator (ICD) timely.