OpenMed/multicare-articles huggingface dataset:
The will of young minors in the terminal stage of sickness: A case report
Authors: Piergiorgio Fedeli, Sergio Giorgetti, Nunzia Cannovo
Journal: Open Med (Wars) (2020)
Keywords: children, informed consent, neuroblastoma, palliative sedation

Introduction:
In Italy, both parents have parental responsibility, so they have the power to give or withhold consent to medical procedures on their children.
Methods:
The present work reports the case of a 5-year-old boy diagnosed with neuroblastoma in the right adrenal loggia, who underwent several chemotherapy treatments that prolonged his life until the age of 10. Informed consent for treatments was requested exclusively of the parents, without taking into consideration the minor's will, not even when he asked for increased pain relief medication instead of other palliative treatments.
Results:
The authors thought it interesting to examine the case in the light of new Italian legislation on informed consent and to verify whether it promotes greater participation of minors in healthcare choices, given that the issue of acquisition of informed consent is becoming increasingly broad and complex.
Conclusion:
The case examined here indicates that current Italian legislation, even including the modifications introduced, does not allow for concrete and active participation of minors, especially those under the age of 12, in the discussion of choices about their health, not even in choices regarding the end of life, and not even when the minor manifests a mature capacity for discernment.
Gallbladder non-Hodgkin's lymphoma: Case report
Authors: Fei Gao, Haichao Zhao, Xidong Chen, Xiushan Dong, Tao Liu, Xifeng Fu
Journal: Int J Surg Case Rep (2019)
Keywords: bile duct disappearance syndrome, case report, extrahepatic biliary non-hodgkin’s lymphoma, hematopoietic syndrome

Introduction:
Extrahepatic biliary non-Hodgkin's lymphoma (EBNHL) is rare, with a prevalence of 0.6% of malignant biliary tumors. Primary biliary non-Hodgkin's lymphoma accounts for 0.4% of extranodal non-Hodgkin's lymphoma (NHL), accounting for approximately 0.016% of all NHL cases. The patient presented with typical bile duct disappearance syndrome. The late performance is a bloodthirsty syndrome.
Presentation of case:
This patient was admitted to the hospital with "intermittent fever, abdominal pain for 19 days". The relevant laboratory tests showed severe infection. The patients were treated according to abdominal infection, and then laparoscopic cholecystectomy was performed. After the operation, the patient's condition did not relieve and further deteriorated. Postoperative patient performance was not based on preoperative estimates, and surgery did not achieve the desired results. Postoperative pathological diagnosis confirmed gallbladder non-Hodgkin's lymphoma. The patient eventually died.
Discussion:
Non-calculus inflammation occurs more frequently in the gallbladder. Non-calculus infections are generally caused by bile stasis and ischemia, resulting in bacterial reproduction and reduced blood supply, and gangrene and perforation of the gallbladder are more likely to occur. This patient is also diagnosed and treated according to this idea. The development after surgery completely exceeded our expectations. Gallbladder non-Hodgkin's lymphoma is very rare, and this case also includes hemophagocytic syndrome and bile duct disappearance syndrome, which is rare.
Conclusion:
Malignant lymphoma of the extrahepatic biliary system is extremely rare, and its clinical manifestations are easily misdiagnosed. At the same time, non-calculous cholecystitis with fever, jaundice and hepatosplenomegaly should be considered.
Lymphoepithelioma-like carcinoma of the salivary gland: is radiotherapy alone adequate?
Authors: Orit Kaidar-Person, Abraham Kuten, Salem Billan
Journal: Case Rep Otolaryngol (2011)
MeSH terms: Case Reports

Introduction. Lymphoepithelioma-like carcinoma (LELC) of the salivary gland is a rare tumor. Currently, surgery with or without radiotherapy is the recommended treatment for all salivary gland carcinomas. However, in contrast to other high-grade salivary gland carcinomas, LELCs are considered radiosensitive. There are only a few published reports of radiotherapy alone for the treatment of salivary gland LELC. Case. We present two cases of LELC of the salivary gland. One was treated with surgery and postoperative radiotherapy, and the other was given a single cycle of chemotherapy and then radiotherapy. Currently, both patients have no evidence of disease. Conclusion. Radiotherapy as a single modality should be reevaluated. The role of systemic chemotherapy to gain systemic control should be addressed due to noteworthy metastatic disease.
A Rare Case of Colonic Triplication with Associated Imperforate Anus in a Newborn Male
Authors: Elise McKenna, Christina Ho, Andrea Badillo, Gustavo Villalona, Marc A Levitt
Journal: European J Pediatr Surg Rep (2022)
Keywords: anorectal malformation, colonic duplication, colonic triplication, imperforate anus, rectovesical fistula
MeSH terms: Case Reports

We present a case of a newborn male with imperforate anus who was found to have colonic triplication with a high rectovesical fistula. The case is presented with a focus on surgical strategies for the management of this rare malformation.
Patient-derived tumor organoids for personalized medicine in a patient with rare hepatocellular carcinoma with neuroendocrine differentiation: a case report
Authors: Marie-Anne Meier, Sandro Nuciforo, Mairene Coto-Llerena, John Gallon, Matthias S Matter, Caner Ercan, Jürg Vosbeck, Luigi M Terracciano, Savas D Soysal, Daniel Boll, Otto Kollmar, Raphaël Delaloye, Salvatore Piscuoglio, Markus H Heim
Journal: Commun Med (Lond) (2022)
Keywords: hepatocellular carcinoma

Background:
Hepatocellular carcinoma with neuroendocrine differentiation (HCC-NED) is a very rare subtype of primary liver cancer. Treatment allocation in these patients therefore remains a challenge.
Methods:
We report the case of a 74-year-old man with a HCC-NED. The tumor was surgically removed in curative intent. Histopathological work-up revealed poorly differentiated hepatocellular carcinoma (Edmondson-Steiner grade IV) with diffuse expression of neuroendocrine markers synaptophysin and chromogranin. Three months after resection, multifocal recurrence of the HCC-NED was observed. In the meantime, tumor organoids have been generated from the resected HCC-NED and extensively characterized. Sensitivity to a number of drugs approved for the treatment of HCC or neuroendocrine carcinomas was tested in vitro.
Results:
Based on the results of the in vitro drug screening, etoposide and carboplatin are used as first line palliative combination treatment. With genomic analysis revealing a NTRK1-mutation of unknown significance (kinase domain) and tumor organoids found to be sensitive to entrectinib, a pan-TRK inhibitor, the patient was treated with entrectinib as second line therapy. After only two weeks, treatment is discontinued due to deterioration of the patient's general condition.
Conclusion:
The rapid establishment of patient-derived tumor organoids allows in vitro drug testing and thereby personalized treatment choices, however clinical translation remains a challenge. To the best of our knowledge, this report provides a first proof-of-principle for using organoids for personalized medicine in this rare subtype of primary liver cancer.
The Role of NMP22 and CSTB Levels in Predicting Postoperative Recurrence of Bladder Cancer
Authors: Changkun Huang, Xiaolin Ai, Liping Hu, Da Ren
Journal: J Immunol Res (2022)
MeSH terms: Carcinoma, Transitional Cell / diagnosis, Carcinoma, Transitional Cell / pathology, Carcinoma, Transitional Cell / surgery, Cystatin B, Nuclear Proteins, Urinary Bladder Neoplasms / diagnosis, Urinary Bladder Neoplasms / surgery, Biomarkers, Tumor, Humans, Neoplasm Recurrence, Local / diagnosis, Sensitivity and Specificity, Transcription Factors, Biomarkers, Tumor, Nuclear Proteins, Transcription Factors, nuclear matrix protein 22, Cystatin B

Objective:
To investigate the value of preoperative urinary nuclear matrix protein 22 (NMP22) and Cystatin B (CSTB) expressions in evaluating the postoperative recurrence of bladder cancer.
Methods:
The clinical case data of 102 patients with bladder cancer who underwent surgical treatment from January 2017 to January 2022 were collected, and the patients were divided into a recurrence group (n = 54) and nonrecurrence group (n = 48) according to whether the patients recurred after surgery, and the preoperative NMP22 and CSTB expression levels between the two groups were compared. Receiver operating curve (ROC) was used to analyze the evaluation value of preoperative NMP22 and CSTB expression in patients with bladder cancer postoperative recurrence. Logistic multivariate regression method was used to analyze the correlation between preoperative NMP22 and CSTB expression and postoperative bladder cancer recurrence. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of NMP22 and CSTB single detection and combined detection were evaluated for postoperative recurrence of bladder cancer.
Results:
The preoperative expression levels of NMP22 and CSTB in the recurrence group were significantly higher than those in the nonrecurrence group (P < 0.05). The results of ROC curve analysis showed that the AUC of preoperative NMP22 and CSTB expression levels to assess postoperative recurrence of bladder cancer was 0.696 and 0.659, respectively (P < 0.05). Logistic multivariate regression analysis showed that preoperative NMP22 and CSTB overexpression was an independent risk factor for postoperative recurrence of bladder cancer (OR = 1.042, 2.307, P < 0.05). The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of preoperative NMP22 combined with CSTB in evaluating bladder cancer recurrence after surgery were higher than those of preoperative NMP22 and CSTB alone, and the differences were statistically significant (P < 0.05).
Conclusion:
Preoperative NMP22 and CSTB conveying is hardly interrelated to postoperative recurrence of bladder carcinoma and has certain appraisal worth for postoperative recurrence of bladder carcinoma, and the combined testing of the two has a taller appraisal worth. NMP22 combined with CSTB detection will help to detect postoperative recurrence of bladder cancer and formulate effective treatment measures in time.
Polyarteritis nodosa with bilateral asynchronous testicular necrosis: a case report
Authors: Nicholas J Toepfer, Nektarios I Lountzis, Joseph C Ugoeke, Tammie C Ferringer
Journal: Case Rep Urol (2011)
MeSH terms: Case Reports

Polyarteritis nodosa (PAN) is a systemic vasculitis which may result in thrombosis or aneurysm formation in any organ of the body. We report a case polyarteritis nodosa (PAN) resulting in bilateral asynchronous testicular necrosis. A 55-year-old male developed acute onset of left testicular pain resulting in a left orchiectomy and right orchidopexy for an ischemic left testicle without evidence of torsion. Three weeks later, the patient developed acute right-sided scrotal pain, and surgical exploration revealed a right necrotic testicle resulting in a right orchiectomy. Pathologic evaluations demonstrated benign testes with acute interstitial hemorrhage and focal atrophy. The patient also experienced abdominal skin necrosis, penile pain and swelling, and temporary loss of vision. This is a unique case of PAN and the only case of asynchronous testicular necrosis in the medical literature.
How do case presentation teaching methods affect learning outcomes?--SNAPPS and the One-Minute preceptor
Authors: Masayasu Seki, Junji Otaki, Raoul Breugelmans, Takayuki Komoda, Shizuko Nagata-Kobayashi, Yu Akaishi, Jun Hiramoto, Iwao Ohno, Yoshimi Harada, Yoji Hirayama, Miki Izumi
Journal: BMC Med Educ (2016)
MeSH terms: Education, Medical, Graduate / methods, Educational Measurement, Internship and Residency / methods, Patient Simulation, Preceptorship / methods, Teaching / methods, Comparative Study, Adult, Ambulatory Care / methods, Clinical Clerkship, Clinical Competence, Female, Hospitals, University, Humans, Japan, Learning / physiology, Male, Physician-Patient Relations, Risk Assessment

Background:
Various techniques have been developed to enable preceptors to teach residents effectively in outpatient settings to promote active learning, including SNAPPS and the One-Minute Preceptor (OMP). This study aimed to ascertain the differences between SNAPPS and the OMP in case presentation content and learner evaluation when used to teach residents about case presentation.
Methods:
From 2011 to 2013, participants were 71 junior clinical residents employed in two hospitals for clinical training. They were randomly allocated to two groups, one using SNAPPS and the other the OMP. From recorded discussions, the "differential diagnoses", "questions and uncertainties", "treatment plans", and "learning issues" were counted. Also, a self-evaluation form was distributed at the end of the study to evaluate the residents' satisfaction with the case presentation.
Results:
Members of the SNAPPS group used significantly more meaning units related to questions and uncertainties compared with those of the OMP group (P < 0.001). Self-evaluation sheets revealed that members of the SNAPPS group had significantly higher positive responses than those of the OMP group in terms of the following evaluations: "It was easy to bring up questions and uncertainties" (P = 0.046), "It was easy to present the case efficiently" (P = 0.002), "It was easy to present the case in the sequence given" (P = 0.029), and "I was able to give an in-depth case presentation" (P = 0.005).
Conclusions:
SNAPPS may induce more meaning units related to questions and uncertainties and give more satisfaction to residents than the OMP.
Case report: Utility, complications, and short-term outcomes in three dogs managed with percutaneous pigtail cystostomy catheters for urethral obstruction
Authors: Yanshan Er, Meghan E Fick, Erin Long Mays
Journal: Front Vet Sci (2023)
Keywords: catheter, cystostomy, diversion, obstruction, pigtail, urinary
MeSH terms: Case Reports

Objective:
This study aimed to describe the utility, complications, and short-term outcomes of three dogs managed with percutaneous pigtail cystostomy catheters placed in the emergency room (ER).
Case summary:
Three dogs were presented separately to the ER for unalleviated mechanical urethral obstruction secondary to urolithiasis and urethral neoplasia. Retrograde urinary catheterization and urohydropulsion were not successful after multiple attempts. Percutaneous pigtail cystostomy catheters were placed under sedation to achieve temporary urinary diversion, and were successful in two of the three dogs. Complications encountered include mild abdominal effusion, unsuccessful placement resulting in hemorrhagic abdominal effusion, steatitis, abdominal pain, and kinking of the catheter. The two dogs diagnosed with urolithiasis were discharged from the hospital, and the dog diagnosed with urethral neoplasia was humanely euthanized due to poor prognosis.
New or unique information provided:
When successful, the placement of pigtail cystostomy catheters allowed for temporary urinary diversion until definitive treatment could be performed and were well tolerated. Short-term outcomes were good. Complications arising from this procedure were common and increased morbidity. The risk of unsuccessful catheter placement may be increased when the procedure is performed in an over conditioned patient or by an inexperienced operator. Careful case selection and risk-benefit analysis should be considered before attempting this procedure. Further studies are necessary to evaluate the ideal technique, incidence of complications, and outcomes of this procedure.
Solitary fibrous tumor with IGF-II-induced non-islet cell tumor hypoglycemia: a case report and molecular characterization by next-generation sequencing
Authors: Helvijs Niedra, Ilze Konrade, Raitis Peculis, Sergejs Isajevs, Rihards Saksis, Roberts Skapars, Armands Sivins, Beate Elizabete Daukste, Dace Mezaka, Vita Rovite
Journal: Front Oncol (2023)
Keywords: igf-ii, rna sequencing, non-islet cell tumor hypoglycemia, solitary fibrous tumor, whole genome sequencing
MeSH terms: Case Reports

Background:
Non-islet cell tumor-induced hypoglycemia (NICTH) is a rare, life-threatening medical condition caused by excessive insulin-like growth factor II (IGF-II) secretion from tumors of most commonly mesenchymal origin. Using next-generation sequencing, we have characterized the genome and transcriptome of the resected IGF-II-secreting solitary fibrous tumor from a patient with severe hypoglycemia accompanied by hypoglycemia unawareness.
Case presentation:
A 69-year-old male patient presenting with abdominal discomfort was examined using computer tomography, revealing a large lesion at the lesser pelvis extending above the umbilicus. As no bone and lymph node metastases were detected, the patient was scheduled for laparotomy. Before surgery, the patient presented with symptoms of severe hypoglycemia. Suppressed C-peptide levels and subsequent hypokalemia indicated a possible case of NICTH. The patient was treated with methylprednisolone (8 mg) to assess hypoglycemia. After the surgery, mild hypoglycemia was present for the postoperative period, and no radiological recurrences were observed 3 and 12 months after discharge. Histopathological examination results were consistent with the diagnosis of malignant solitary fibrous tumor (SFT). Overexpression of IGF-II was confirmed by both immunohistochemistry and RNA sequencing. Further NGS analysis revealed an SFT characteristic alteration-NAB2-STAT6 fusion. Additionally, three deleterious missense variants were detected in oncogenes BIRC6, KIT, and POLQ, and one homozygous in-frame deletion in the RBM10 tumor suppressor gene.
Conclusion:
While the NAB2-STAT6 fusions are well characterized, the mutational landscape of SFTs remains understudied. This study reports the importance of NGS to characterize SFTs as we detected four coding variants in genes (BIRC6, KIT, POLQ, and RBM10) associated with tumorigenesis that could potentially contribute to the overall pathogenesis of SFT.
Hyperammonemia After Lung Transplantation: Systematic Review and a Mini Case Series
Authors: Amir Y Kamel, Amir M Emtiazjoo, Lauren Adkins, Abbas Shahmohammadi, Hassan Alnuaimat, Andres Pelaez, Tiago Machuca, Mauricio Pipkin, Hyun-Wook Lee, I David Weiner, Satish Chandrashekaran
Journal: Transpl Int (2022)
Keywords: ammonia, ammonia scavengers, glutamine synthetase, hyperammonemia, lung transplantation, mollicutes, urea cycle
MeSH terms: Hyperammonemia / etiology, Hyperammonemia / therapy, Lung Transplantation / adverse effects, Review, Systematic Review, Ammonia, Cohort Studies, Humans, Retrospective Studies, Ammonia

Background: Hyperammonemia after lung transplantation (HALT) is a rare but serious complication with high mortality. This systematic review delineates possible etiologies of HALT and highlights successful strategies used to manage this fatal complication. Methods: Seven biomedical databases and grey literature sources were searched using keywords relevant to hyperammonemia and lung transplantation for publications between 1995 and 2020. Additionally, we retrospectively analyzed HALT cases managed at our institution between January 2016 and August 2018. Results: The systematic review resulted in 18 studies with 40 individual cases. The mean peak ammonia level was 769 μmol/L at a mean of 14.1 days post-transplant. The mortality due to HALT was 57.5%. In our cohort of 120 lung transplants performed, four cases of HALT were identified. The mean peak ammonia level was 180.5 μmol/L at a mean of 11 days after transplantation. HALT in all four patients was successfully treated using a multimodal approach with an overall mortality of 25%. Conclusion: The incidence of HALT (3.3%) in our institution is comparable to prior reports. Nonetheless, ammonia levels in our cohort were not as high as previously reported and peaked earlier. We attributed these significant differences to early recognition and prompt institution of multimodal treatment approach.
A case of valproate induced hyperammonemic encephalopathy
Authors: Surjit Tarafdar, Mark Slee, Faisal Ameer, Matt Doogue
Journal: Case Rep Med (2011)
MeSH terms: Case Reports

A 36-years-old man on phenytoin, levetiracetam, and sodium valproate presented with acute confusion. Routine investigations including serum valproate and phenytoin concentration were normal. His serum ammonia concentration was raised. His valproate was held and 2 days later he recovered with concordant normalisation of serum ammonia concentration. Urea acid cycle disorder was ruled out, and a diagnosis of valproate induced hyperammonemic encephalopathy (VHE) was made. Asymptomatic hyperammonemia occurs in 15-50% of valproate-treated patients, and while the true incidence of VHE is not known, it is a recognized complication of sodium valproate treatment. VHE typically presents acutely with impaired consciousness, lethargy, and vomiting. Valproate concentrations may be in the therapeutic range, and liver function tests are typically "normal." Treatment for VHE consists of ceasing valproate and providing supportive care. Some have advocated carnitine replacement.
Coccydynia Treated with Dorsal Root Ganglion Stimulation
Authors: Nicholas L Giordano, Noud van Helmond, Kenneth B Chapman
Journal: Case Rep Anesthesiol (2018)
MeSH terms: Case Reports

Coccydynia can be difficult to resolve with conventional treatment options. Dorsal root ganglion (DRG) stimulation has recently emerged as a treatment for chronic pain, but its application has not been described in the context of coccydynia. We used DRG stimulation treatment in a patient suffering from intractable coccyx pain. At long-term follow-up, the patient experienced a decrease in pain intensity and improvement in function, without any complications. DRG stimulation may be a treatment modality for coccydynia refractory to other approaches.