OpenMed/multicare-articles huggingface dataset:
Ureterocalyceal Fistula: A Rare Complication of Laparoscopic Partial Nephrectomy
Authors: Fayez T Hammad
Journal: Case Rep Urol (2020)
MeSH terms: Case Reports

Background:
Postoperative urinary leak is a well-documented complication following partial nephrectomy. It usually presents as persistent discharge from the retroperitoneal drain, nephrocutaneous fistula, urinary collection, systemic manifestations, or abdominal symptoms. Herein, we report for the first time on a case of urinary leak postlaparoscopic partial nephrectomy which did not heal and led to the formation of ureterocalyceal fistula. Case Presentation. A 41-year-old male presented with a coincidental renal mass at the inferiomedial aspect of the right kidney. He underwent laparoscopic partial nephrectomy. On the third postoperative day, he developed fever. CT scan showed minimal urine leak from the tumor site and a JJ stent was inserted. Due to severe bladder symptoms, the stent was removed and a perirenal drain was inserted and removed in few days. He did well initially but in two weeks, he started to develop urinary tract infections. Repeat CT scan showed ongoing urinary leak from the site of the previous surgery. Retrograde pyelography demonstrated a complete UPJ stenosis with an ureterocalyceal fistula. Trial for reanastomosis failed due to severe adhesions and small intrarenal pelvis. An ureterocalyceal anastomosis has to be performed to another calyx.
Conclusion:
We report for the first time on an ureterocalyceal fistula following laparoscopic partial nephrectomy. This complication might be prevented by a careful dissection of the area close to the ureter or by an insertion of a JJ stent for an adequate time if a ureteric injury is suspected.
Ptotic gall bladder with hepatic masses: a case report
Authors: Hasan Aydin, Z Banu Aydin, Baki Hekimoğlu, Ayşe Görmeli
Journal: Case Rep Radiol (2013)

Gall bladder (GB) may be found in a variety of abnormal positions. Most of them are due to arrested development of embryonic growth at different stages. A 63-year-old female patient was admitted to our radiology unit for magnetic resonance imaging (MRI) of the liver for the lesions identified in abdominal ultrasonography (US) and computed tomography (CT). MRI showed that there was a lobulated heterogenous mass in the left lobe of the liver and a smaller one in the right lobe of the liver with the same appearance. The inferior pole of the liver was located in the pelvic space, and the GB, which contained sludges and stones, was lying down to the upper pelvic space. Hepatic masses were considered to be hemangiomas, and GB was diagnosed as ptotic GB with luminal sludge and stones. In this case, especially, MR imaging helped the surgeon to plan a proper approach to the GB in abnormal localization.
Atrophy and other potential factors affecting long term deep brain stimulation response: a case series
Authors: Daniel Martinez-Ramirez, Takashi Morishita, Pamela R Zeilman, Zhongxing Peng-Chen, Kelly D Foote, Michael S Okun
Journal: PLoS One (2014)
MeSH terms: Brain / pathology, Deep Brain Stimulation, Case Reports, Research Support, Non-U.S. Gov't, Aged, Atrophy, Cerebral Ventricles / pathology, Electrodes, Female, Humans, Magnetic Resonance Imaging, Male, Middle Aged, Organ Size, Risk Factors, Time Factors, Treatment Outcome

Objective:
To describe three DBS cases which presented with new side effects or loss of benefit from stimulation after long-term follow-up and to discuss the potential contributing factors.
Methods:
A University of Florida (UF) database (INFORM) search was performed, identifying three patients, two Parkinson's disease (PD) and one Essential Tremor (ET), with an unexpected change in long-term programming thresholds as compared to initial evaluation. Clinical follow-up, programming, imaging studies, and lead measurements were reviewed. The UF Institutional Review Board (IRB) approved this study.
Results:
A substantial increase in the 3rd ventricular width (120%), Evans index (6%), ventricular index (5%), and cella media index (17%) was uncovered. A change in thresholds across lead contacts with a decrease in current densities as well as a relative lateral change of lead location was also observed. Hardware-related complications, lead migration, and impedance variability were not identified.
Conclusions:
Potential factors contributing to long-term side effects should be examined during a DBS troubleshooting assessment. Clinicians should be aware that in DBS therapy there is delivery of electricity to a changing brain, and atrophy may possibly affect DBS programming settings as part of long-term follow-up.
Case report: Dramatic response to alectinib in a lung adenosquamous carcinoma patient harbouring a novel CPE-ALK fusion
Authors: Yanyan Qin, Fei Li, Yuan Tan, Qianqian Duan, Qin Zhang
Journal: Front Oncol (2022)
Keywords: cpe-alk, ihc, ngs, alectinib, lung adenosquamous carcinoma
MeSH terms: Case Reports

Lung Adenosquamous carcinoma (ASC) is a rare histological subtype of lung cancer accounting for 0.4%-4% of all lung cancers. ASC is generally considered to be an aggressive cancer with poor prognosis. There is no specific standard treatment for ASC, and current treatment of ASC is relied on the guideline for non-small cell lung cancer (NSCLC). To date, only sporadic canonical EML4-ALK fusions have been reported in ASC patients, and the efficiency of ALK-TKI is still unclear in non-canonical ALK fusion positive ASC patients. Here we describe the case of a stage IV ASC patient harboring a novel CPE-ALK fusion detected via 74 genes panel analysis. Interestingly, the TP53 was wild-type and no another somatic mutation was found within 74 genes. In addition, immunohistochemical staining (IHC) also supports an oncogenic role for the CPE-ALK fusion. Based on these findings, the patient received alectinib 600 mg twice daily. After 4 months on treatment the patients achieved a radiological partial response (PR) and his symptoms were significantly relieved. Imaging showed that lesions of the patient were reduced, and the clinical evaluation was partial response (PR). To the best of our knowledge, this is the first report of a dramatic tumor response to alectinib in a patient with ASC harboring a CPE-ALK fusion. In addition, targeted NGS analysis may improve detection of ALK fusion in routine practice.
Multisystem cytomegalovirus end-organ disease in a patient with advanced HIV
Authors: Ruan Spies, Pierre Joubert, Dharshnee Chetty, Sipho Dlamini, Muhammed S Moosa
Journal: S Afr J Infect Dis (2022)
Keywords: aids, cmv, hiv, cytomegalovirus, end-organ disease, opportunistic infection

Cytomegalovirus (CMV) infection is common in people living with HIV, but multisystem CMV end-organ disease (EOD) is rare following the introduction of effective antiretroviral therapy. We present the case of a patient with advanced HIV and multisystem manifestations of CMV EOD.
Contributions:
This case report highlights the potential morbidity and mortality associated with CMV disease in patients with advanced HIV. Clinicians should be vigilant in considering CMV EOD in patients with advanced HIV and visual, neurological and gastointestinal symptoms.
Salvaging the Digit in Invasive Subungual Malignancies Using a Triple Technique under Awake Local Anesthesia
Authors: Samer Abdel Al, Mohamad K Abou Chaar, Ala'a Aldeen Alkhatib, Muhamad Al-Qawasmi, Mohammad Barham, Sameer Yaser, Samer Salah, Abed Al Raheem Suleiman, Wafa Asha
Journal: Case Rep Orthop (2021)
MeSH terms: Case Reports

Introduction:
Amputation for subungual malignancy (SUM) was thought to be the gold standard in preventing recurrence and metastasis. The rationale behind this aggressive treatment was never based on scientific evidence. Even though multiple recent studies supported more conservative management by illustrating successful results of the digit salvage technique, especially for "in situ" SUM, this salvage approach is not well supported for the more aggressive type of the "invasive" SUM; herein, we salvaged two cases of "invasive" SUM. Case Presentation. We present two cases of invasive SUM without radiographic evidence of intraosseous involvement, where we avoided digit amputation for both invasive subungual squamous cell carcinoma of the thumb and invasive subungual melanoma of the ring finger. Both were salvaged by using a triple technique under awake local anesthesia which included (I) radical excision of the nail bed unit including both eponychium and periosteum, (II) dorsal cortical bone shaving using a high-speed burr for the distal phalanx, and (III) flap coverage. Brunelli flap was used for the thumb in the first case, and V-Y plasty combined with proximal nail fold advancement flap was used for the ring finger in the second case. There was no evidence of local or distant recurrence, with a good functional outcome after 2.5 years in the first case and 2 years in the second.
Conclusion:
Ensuring complete resection with negative margins while preserving the functionality of the affected digit is considered to be the optimal challenge in treating "invasive" subungual malignancies. These two case reports contribute by reporting a successful digit salvage. The safety of this procedure could be confirmed by larger series and longer follow-up periods.
Adhesive Capsulitis in Eight Dogs: Diagnosis and Management
Authors: Brittany J Carr, Sherman O Canapp, Debra A Canapp, Lauri-Jo Gamble, David L Dycus
Journal: Front Vet Sci (2016)
Keywords: adhesive capsulitis, fibrous scar tissue, forelimb lameness, frozen shoulder, range of motion, synovitis

Objective:
To describe clinical and diagnostic findings as well as management of adhesive capsulitis in dogs.
Background:
Adhesive capsulitis, also known as frozen shoulder, is a syndrome defined by loss of range of motion of the shoulder and may be the end-stage manifestation of several primary conditions.
Evidentiary value:
This is a case series report of eight dogs with chronic forelimb lameness diagnosed with adhesive capsulitis.
Methods:
Medical records (June 1, 2010-September 1, 2015) including, physical examination findings, radiographic findings, magnetic resonance imaging (MRI) findings, arthroscopy findings, and treatment plans were reviewed.
Results:
All dogs presented with a chronic, grade III-VI/VI forelimb lameness. On orthopedic examination, all dogs had moderate to significant discomfort on shoulder extension and flexion and severe restriction of range of motion. Six of the eight dogs had evidence of bone remodeling and sclerosis in the affected shoulder on radiographs. Six of the dogs had an initial diagnostic ultrasound performed, which revealed evidence of fibrous scar tissue. Five dogs had MRI performed that revealed moderate shoulder effusion and enhancement of the synovial lining of the shoulder. Arthroscopy was performed in five of the eight patients. Three were noted to have significant contracture, adhesions, and fibrous scar tissue of the joint capsule. Severe inflammation was noted throughout the synovium of two patients. All eight patients tried conservative management consisting of oral medications and rehabilitation therapy. Five of the eight patients received extracorporeal shockwave therapy. Three patients received regenerative medicine treatment in the affected supraspinatus and shoulder. Regardless of the treatment elected, none of the dogs were reported to have significant improvement.
Conclusion:
Adhesive capsulitis is an uncommon cause of chronic forelimb lameness. Further investigation is needed to describe the etiology and pathogenesis of adhesive capsulitis in dogs to evaluate the effectiveness of both non-surgical and surgical treatment modalities, establish treatment protocols, and evaluate short- and long-term clinical outcome of patients.
Application:
Adhesive capsulitis should be considered in patients with chronic forelimb lameness and moderate to significant discomfort and restriction on shoulder range of motion.
Asymptomatic Pulmonary Artery Intimal Sarcoma with Chest Wall Metastasis as an Initial Manifestation: An Autopsy Case
Authors: Tomoo Kakimoto, Mamoru Sasaki, Shojiroh Morinaga, Robert Nakayama, Naoto Minematsu
Journal: Case Rep Med (2018)
MeSH terms: Case Reports

Pulmonary artery intimal sarcoma (PAIS) is a rare mesenchymal malignancy arising in the pulmonary trunk or proximal pulmonary artery and shows intraluminal growth. Clinical manifestations in PAIS are predominantly related to the pulmonary artery embolism, so cases with initial symptoms related to an extrapulmonary metastasis are unusual. The present report describes an 82-year-old man without any cardiopulmonary symptoms who was detected with an abnormal shadow on chest radiography during a routine health checkup. Contrast medium-enhanced chest computed tomography revealed an enhancing mass in the right pulmonary artery, pulmonary nodules, and a chest wall tumor corresponding to the abnormal shadow observed using chest radiography. A core needle biopsy for the chest wall tumor determined a pathological diagnosis of unclassified sarcoma. The patient was diagnosed with PAIS on the basis of clinical, radiological, and pathological correlations. He was scheduled to receive supportive care, but died of respiratory failure 1 year from the first visit. An autopsy revealed the pleomorphic sarcoma occupying the entire lumen of the right pulmonary artery with the only site of extrapulmonary metastasis in the chest wall. We should be aware of rare cases of asymptomatic PAIS found through routine health checkups.
Herpetic esophagitis in immunocompetent medical student
Authors: Andréia Vidica Marinho, Vinícius Mendes Bonfim, Luciana Rodrigues de Alencar, Sebastião Alves Pinto, João Alves de Araújo Filho
Journal: Case Rep Infect Dis (2014)

Esophagitis caused by herpes simplex virus (HSV) is often documented during periods of immunosuppression in patients infected with human immunodeficiency virus (HIV); it is rare in immunocompetent diagnosed patients. Case reports of herpetic esophagitis in students of health sciences are extremely rare. The disease presents with a clinical picture characterized by acute odynophagia and retrosternal pain without obvious causes and ulcers, evidenced endoscopically in the middistal esophagus. Diagnosis depends on endoscopy, biopsies for pathology studies, and immunohistochemistry techniques. The disease course is often benign; however, treatment with acyclovir speeds the disappearance of symptoms and limits the severity of infection. In this report, we present a case of herpetic esophagitis in an immunocompetent medical student, with reference to its clinical features, diagnosis, and treatment. The disease may have manifested as a result of emotional stress experienced by the patient.
Chronic purulent pericarditis: case report
Authors: Proches Vara, Diana Urassa, Boniface Temba, Kajiru Kilonzo, Alex Mremi, Adnan Sadiq, Furaha Lyamuya
Journal: Pan Afr Med J (2022)
Keywords: chronic pericarditis, tb pericarditis, case report, purulent pericarditis
MeSH terms: COVID-19 / complications, COVID-19 / diagnosis, Pericarditis / diagnosis, Pericarditis / etiology, Pericarditis / therapy, Case Reports, Adult, Ethambutol, Humans, Isoniazid, Male, Mediastinitis, Pericardium, Pyrazinamide, Rifampin, Sclerosis, Suppuration, Pyrazinamide, Ethambutol, Isoniazid, Rifampin, Mediastinal Fibrosis

Purulent pericarditis is an infection of the pericardial space that produces pus that is found on gross examination of the pericardial sac or on the tissue microscopy. In this case report, we will discuss a 31-year-old male who presented with a chief complaint of low-grade fevers, dry cough and difficulty breathing for about two weeks which preceded after removing of dental also two weeks prior. He was admitted and treated as COVID-19 in the isolation ward, he later developed cardiac tamponade and during pericardiocentesis thick pus was discharged. Pus culture and Gene Xpert tests were all negative. After his condition improved, the patient was transferred to the general ward with the pericardial window still discharging pus. Pericardiectomy was chosen as definitive management. The key takeaway in this report is that Empirical treatment with RHZE (rifampin, isoniazid, pyrazinamide, and ethambutol) in resource-limited settings is recommended due to difficulty in identifying the exact cause at a required moment.
Double-balloon endoscopy WAS effective in diagnosing small intestinal duplication: a case report
Authors: Yuji Nadatani, Toshio Watanabe, Takashi Sugawa, Shinpei Eguchi, Sunao Shimada, Koji Otani, Hirokazu Yamagami, Tetsuya Tanigawa, Masatsugu Shiba, Kazunari Tominaga, Yasuhiro Fujiwara, Tetsuo Arakawa
Journal: Springerplus (2016)
Keywords: double-balloon endoscopy, ileal duplication, small intestine

Introduction:
Ileal duplications are encountered infrequently in adults, because symptoms including abdominal pain, intussusception, hemorrhage, and perforation usually present in early childhood. In this report, we present an adult case of ileal duplication that was revealed by double-balloon endoscopy (DBE).
Case description:
A 73-year-old Japanese man presented with anemia and melena. Anal DBE detected the narrow opening of an extra lumen in the ileum about 100 cm proximal to the ileocecal valve. Enteroclysis via DBE showed a 5-cm-long ileal diverticulum-like structure at the mesenteric side of the ileum. No ectopic gastric mucosa was detected by technetium-99m pertechnetate scintigraphy. The final diagnosis was ileal duplication.
Discussion and evaluation:
This is the first report of tubular ileal duplication diagnosed by using DBE. The small intestinal duplication opening was not detected by using VCE and plane CT in this case, but was found by using DBE.
Conclusions:
The present case demonstrates that DBE was useful in the diagnosis of an adult small intestinal duplication that was not visualized by other modalities.
Case Report: Coexistence of Alzheimer-Type Neuropathology in Fragile X-Associated Tremor Ataxia Syndrome
Authors: Maria Jimena Salcedo-Arellano, Desiree Sanchez, Jun Yi Wang, Yingratana A McLennan, Courtney Jessica Clark, Pablo Juarez, Andrea Schneider, Flora Tassone, Randi J Hagerman, Verónica Martínez-Cerdeño
Journal: Front Neurosci (2021)
Keywords: apoe ε4 allele, alzheimer-type dementia, cgg expansion, fmr1 gene, fxtas, cognitive decline, neurodegeneration
MeSH terms: Case Reports

This case documents the co-occurrence of the fragile X-associated tremor ataxia syndrome (FXTAS) and Alzheimer-type neuropathology in a 71-year-old premutation carrier with 85 CGG repeats in the fragile X mental retardation 1 (FMR1) gene, in addition to an apolipoprotein E (APOE) ε4 allele. FXTAS and Alzheimer's Disease (AD) are late-onset neurodegenerative diseases that share overlapping cognitive deficits including processing speed, working memory and executive function. The prevalence of coexistent FXTAS-AD pathology remains unknown. The clinical picture in this case was marked with rapid cognitive decline between age 67 and 71 years in addition to remarkable MRI changes. Over the 16 months between the two clinical evaluations, the brain atrophied 4.12% while the lateral ventricles increased 26.4% and white matter hyperintensities (WMH) volume increased 15.6%. Other regions atrophied substantially faster than the whole brain included the thalamus (-6.28%), globus pallidus (-10.95%), hippocampus (-6.95%), and amygdala (-7.58%). A detailed postmortem assessment included an MRI with confluent WMH and evidence of cerebral microbleeds (CMB). The histopathological study demonstrated FXTAS inclusions in neurons and astrocytes, a widespread presence of phosphorylated tau protein and, amyloid β plaques in cortical areas and the hippocampus. CMBs were noticed in the precentral gyrus, middle temporal gyrus, visual cortex, and brainstem. There were high amounts of iron deposits in the globus pallidus and the putamen consistent with MRI findings. We hypothesize that coexistent FXTAS-AD neuropathology contributed to the steep decline in cognitive abilities.
Implications of anomalous pectoralis muscle in reconstructive breast surgery: the oblique pectoralis anterior
Authors: Katherine Marie Huber, Travis Guthrie Boyd, Amy R Quillo, Bradon J Wilhelmi
Journal: Eplasty (2012)

Introduction:
Many case reports have described anatomical variants of the pectoralis muscles. However, there is a paucity of published literature on the consequence of such presentations in reconstructive breast surgery.
Methods:
A 45-year-old female patient with breast cancer presented for left mastectomy and immediate reconstruction with tissue expander. During mastectomy, she was noted to have an extra muscle anterior to her pectoralis major muscle. This variant had not previously been described in the literature and was therefore named the oblique pectoralis anterior. After inspection of the aberrant musculature, the decision was made to release the inferolateral insertion of the accessory muscle with the inferior edge of pectoralis major. An adequate pocket for the expander was created.
Results:
After routine expansion and implant exchange, muscular coverage of the implant from pectoralis major and the oblique pectoralis anterior muscle approximated 70%. The patient was left with good symmetry and a cosmetic result, despite the challenges presented by her anomalous chest wall musculature.
Discussion:
Prior knowledge of the various anatomic aberrations described in the literature can prepare a surgeon to properly incorporate and utilize the variant anatomy, should it be encountered, to benefit the outcome of the operation.
Late presentation of iatrogenic dissection of right coronary cusp: A case report
Authors: Ali Eshraghi, Majid Jalalyazdi, Javad Ramezani, Mostafa Baburian
Journal: J Cardiovasc Thorac Res (2020)
Keywords: coronary angiography, coronary artery, dissection, iatrogenic
MeSH terms: Case Reports

Iatrogenic dissection of coronary arteries while performing catheter engagement, in general is not uncommon. However, we encountered a relatively rare case of iatrogenic right coronary cusp dissection.Here we report an iatrogenic coronary artery dissection after diagnostic angiography in a 54-year-oldwoman presented with exertional dyspnea and chest discomfort. In our case delayed progression of sub-intimal hematoma and subsequent compression of RCA ostium an SA node branch was the cause of SA node dysfunction and subsequent junctional rhythm and atrial fibrillation. To conclude it should be said that in catastrophic cases of iatrogenic coronary ostia dissection and ensuing aortic cusp involvement, stenting of entry point at coronary ostia is a logical decision with good result.