OpenMed/multicare-articles huggingface dataset:
De Garengeot's Hernia: Two Case Reports with Correct Preoperative Identification of the Vermiform Appendix in the Hernia
Authors: Zhaosheng Jin, Muhammad Rafiz Imtiaz, Henry Nnajiuba, Suzette Samlalsingh, Akinyede Ojo
Journal: Case Rep Surg (2016)

We present two cases of incarcerated de Garengeot's hernia. This anatomical phenomenon is thought to occur in as few as 0.5% of femoral hernia cases and is a rare cause of acute appendicitis. Risk factors include a long pelvic appendix, abnormal embryological bowel rotation, and a large mobile caecum. In earlier reports operative treatment invariably involves simultaneous appendicectomy and femoral hernia repair. Both patients were correctly diagnosed preoperatively with computed tomography (CT). Both had open femoral hernia repair, one with appendectomy and one with the appendix left in situ. Both patients recovered without complications. Routine diagnostic imaging modalities such as ultrasonography and standard CT have previously shown little success in identifying de Garengeot's hernia preoperatively. We believe this to be the first documented case of CT with concurrent oral and intravenous contrast being used to confidently and correctly diagnose de Garengeot's hernia prior to surgery. We hope that this case report adds to the growing literature on this condition, which will ultimately allow for more detailed case-control studies and systematic reviews in order to establish gold-standard diagnostic studies and optimal surgical management in future.
Colovesical Fistula: An Uncommon Cause of Hematuria and Rectal Bleeding
Authors: Jeffrey K Than, Greg S Cohen
Journal: Case Rep Gastrointest Med (2022)
MeSH terms: Case Reports

Colovesical fistula is an infrequent complication of diverticular disease that presents with pneumaturia, fecaluria, dysuria and, rarely, hematuria or hematochezia. Here we present a case of concurrent hematuria and rectal bleeding arising from a diverticular bleed traversing a previously undiagnosed colovesical fistula. Other causes of colovesical fistula include Crohn's disease, radiation, and malignancy, though it is most commonly caused by complicated diverticulitis as in this case. Computed tomography (CT) imaging, cystoscopy, and gastrograffin enema have been described as high-yield diagnostic tests. Interestingly, colonoscopy is only successful in diagnosing colovesical fistula in approximately 55% of cases. Management often requires surgical intervention, as in this case, given limited success with conservative management. Colovesical fistula should be considered in patients presenting with fecaluria, pneumaturia, and dysuria as well as in cases of hematuria.
Case Report: Cadonilimab-related toxic epidermal necrolysis-like reactions successfully treated with supplemental Adalimumab
Authors: Peng-Yu Chen, Zi-Yun Li, Sui-Qing Cai
Journal: Front Immunol (2023)
Keywords: adalimumab, cadonilimab/ak104, case report, immune checkpoint inhibitor, immune-related adverse events, toxic epidermal necrolysis
MeSH terms: Carcinoma, Hepatocellular / drug therapy, Chemoembolization, Therapeutic, Liver Neoplasms, Stevens-Johnson Syndrome / diagnosis, Stevens-Johnson Syndrome / drug therapy, Stevens-Johnson Syndrome / etiology, Case Reports, Research Support, Non-U.S. Gov't, Adalimumab / adverse effects, Humans, Adalimumab

Cadonilimab is the first bi-specific antibody approved for certain malignancies in June 2022, which has a modified Fc structure to reduce immune-related adverse events. To date, no reports have described Cadonilimab-related toxic epidermal necrolysis (TEN). Here, we report the first case of TEN-like reactions occurring during the treatment of hepatocellular carcinoma with Cadonilimab in combination with Lenvatinib and transarterial chemoembolization, successfully treated with supplemental Adalimumab. We confirmed Cadonilimab as the culprit and observed significant improvement in the patient's condition following Adalimumab treatment. The case emphasizes the potential risk of Cadonilimab inducing TEN, and suggests that supplemental Adalimumab could be a favorable option for treating refractory Cadonilimab-related TEN.
Amebic Encephalitis in a Patient with Chronic Lymphocytic Leukemia on Ibrutinib Therapy
Authors: Ensi Voshtina, Huiya Huang, Renju Raj, Ehab Atallah
Journal: Case Rep Hematol (2018)
MeSH terms: Case Reports

Chronic lymphocytic leukemia (CLL) is the most common type of leukemia in Western countries. A common first-line therapy offered to qualifying patients includes ibrutinib, an oral covalent inhibitor of Bruton's tyrosine kinase. Treatment of CLL with ibrutinib therapy is generally well tolerated; however, serious opportunistic infections are being reported in patients treated with ibrutinib. In this report, we present a patient with CLL on ibrutinib therapy who developed rapidly declining neurological status concerning for the central nervous system (CNS) process related to his immunocompromised status. Despite multiple testing modalities, no evidence was found to explain the acute changes the patient was experiencing, and he had no improvement with common antimicrobial coverage. The patient ultimately expired, and autopsy of the brain revealed granulomatous amebic encephalitis due to opportunistic infection by Acanthamoeba species. As evidenced by this case, ibrutinib therapy, despite being generally well tolerated, has the potential to predispose patients to opportunistic infections like amebic encephalitis. Amebic encephalitis is a highly lethal CNS infection, and it is important for clinicians to recognize early on the potential for infection in patients on ibrutinib therapy presenting with CNS symptoms.
Mexiletine and False Positive Urine Drug Screen for Amphetamine: A Case Review
Authors: Sumit Sohal, Mina Sous, Gauri Pethe, Shanmugha V Padmanabhan, Rajesh Akbari, Shahriar Dadkhah
Journal: Case Rep Med (2021)
MeSH terms: Case Reports

Advanced heart failure patients commonly suffer from ventricular arrhythmias which can be managed by antiarrhythmic drugs like mexiletine. These ventricular arrhythmias can be complicated by illicit drug use which alter outcomes and can potentially impact the patient-physician relationship through countertransference. However, mexiletine can lead to false positive urine drug screen testing for amphetamine, and these false-positive urine drug screen test results can affect the decision-making process. Health care providers should be aware of this fact and should either use confirmatory testing or look for confounding compounds in patients who deny using illicit substances and have a positive urine drug screen. Our patient is 64 years old who arrived at the emergency department after experiencing a shock by his intracardiac defibrillator. The patient tested positive for amphetamine on his urine drug screen and was later ruled out by confirmatory quantitative testing.
A view on EGFR-targeted therapies from the oncogene-addiction perspective
Authors: Rolando Perez, Tania Crombet, Joel de Leon, Ernesto Moreno
Journal: Front Pharmacol (2013)
Keywords: egfr, cetuximab, combination therapy, erlotinib, nimotuzumab, oncogene addiction, targeted therapy

Tumor cell growth and survival can often be impaired by inactivating a single oncogen- a phenomenon that has been called as "oncogene addiction." It is in such scenarios that molecular targeted therapies may succeed. among known oncogenes, the epidermal growth factor receptor (EGFR) has become the target of different cancer therapies. So far, however, the clinical benefit from EGFR-targeted therapies has been rather limited. a critical review of the large amount of clinical data obtained with anti-EGFR agents, carried out from the perspective of the oncogene addiction concept, may help to understand the causes of the unsatisfactory results. In this article we intend to do such an exercise taking as basis for the analysis a few case studies of anti-EGFR agents that are currently in the clinic. There, the "EGFR addiction" phenomenon becomes apparent in high-responder patients. We further discuss how the concept of oncogene addiction needs to be interpreted on the light of emerging experimental evidences and ideas; in particular, that EGFR addiction may reflect the interconnection of several cellular pathways. In this regard we set forth several hypotheses; namely, that requirement of higher glucose uptake by hypoxic tumor cells may reinforce EGFR addiction; and that chronic use of EGFR-targeted antibodies in EGFR-addicted tumors would induce stable disease by reversing the malignant phenotype of cancer stem cells and also by sustaining an anti-tumor T cell response. Finally, we discuss possible reasons for the failure of certain combinatorial therapies involving anti-EGFR agents, arguing that some of these agents might produce either a negative or a positive trans-modulation effect on other oncogenes. It becomes evident that we need operational definitions of EGFR addiction in order to determine which patient populations may benefit from treatment with anti-EGFR drugs, and to improve the design of these therapies.
DiGeorge Syndrome Presenting as Hypocalcaemia-Induced Seizures in Adulthood
Authors: Adrian Zammit, Deborah Grech Marguerat, Josephine Psaila, Alexander Attard
Journal: Case Rep Med (2013)

Introduction. DiGeorge syndrome is a developmental defect commonly caused by a microdeletion on the long arm of chromosome 22 or less frequently by a deletion of the short arm of chromosome 10. Case report. We report a case of a gentleman with mild dysmorphic features who presented with hypocalcaemia-induced seizures and an associated thyroid mass with a background of learning difficulties and abnormal immune function. Discussion. DiGeorge syndrome was initially described in 1967 by Angelo DiGeorge. The majority of cases are due to a novel mutation. The resulting learning difficulties, congenital heart disease, palatal abnormalities, hypoplasia/aplasia of the parathyroid and thymus glands, and immune deficiency generally lead to diagnosis in childhood. Presentation in adulthood is rare but must be borne in mind when dealing with cases of hypocalcaemia even in the absence of florid phenotypic features. A link with malignant disease has also been reported and should lead to prompt investigation of concerning masses.
A case report of REM sleep behavior disorder, Behcet's disease, Sjogren's syndrome and cognitive dysfunction
Authors: Fulong Xiao, Jun Zhang, Waner Wang, Xuehua Wang, Wei Zhang, Liyue Xu, Fang Han
Journal: BMC Rheumatol (2018)
Keywords: behcet’s disease, rem sleep behavior disorder, sjogren’s syndrome
MeSH terms: Case Reports

Background:
Behcet's disease and Sjogren's syndrome is an autoimmune disorder from which many systems of the body can suffer. Here we reported a patient with a history of Behcet's disease and Sjogren's syndrome in which REM sleep behavior disorder (RBD) was then detected by polysomnographic (PSG) monitoring.
Case presentation:
A 68-year-old male patient with a history of Behcet's disease and Sjogren's syndrome was diagnosed with RBD by clinical examination and video-PSG, and he also underwent a multiple sleep latency test and cerebral magnetic resonance imaging. The patient had a history of Behcet's disease for 20 years and Sjogren's syndrome for 2 years. The cerebral magnetic resonance imaging also suggested cerebral demyelination and mild cortical atrophy, with cognitive dysfunction by a score of 28 on the mini-mental state examination (MMSE) and a score of 22 on the Montreal cognitive assessment (MoCA).
Conclusion:
RBD is common in the elderly population and is significantly related to α-synucleinopathy. Combining the decline in neuro-cognition and mild cortical atrophy, presentation of RBD in this patient could indicate an underlying α-synucleinopathy neurodegenerative disorder in the future. Considering the role of inflammation in the pathogenesis of α-synucleinopathy and a common shared HLA allelic genes in RBD and Sjogren's syndrome, it is suggested that a physiological process which is related to neuroinflammation may be involved in the pathogenesis of RBD.
An unusual presentation of a papillary thyroid carcinoma in the struma ovarii in a 10 year-old girl: A case report
Authors: Manouchehr Iranparvar Alamdari, Afshin Habibzadeh, Hossein Pakrouy, Parastoo Chaichi, Sharareh Sheidaei
Journal: Int J Surg Case Rep (2018)
Keywords: papillary thyroid cancer, struma ovarii, thyroidectomy

Introduction:
Struma ovarii is an ovarian tumor with thyroid tissue as its predominant component. It usually occurs in older women and presents with abdominal mass, pain and abnormal bleeding. Most patients are euthyroid, but some reports have noted thyrotoxicosis originating from the malignant struma ovarii.
Presentation of case:
A 10 year-old girl presented with tachycardia, normal thyroid exam and thyrotoxicosis. Thyroid scan showed no uptake with increased uptake in right ovary indicative of struma ovarii. The patient underwent oophorectomy and thyroidectomy, Pathology showed papillary thyroid carcinoma limited to the struma ovarii. Following TSH suppressive therapy and treatment with I131, she is totally symptom free.
Discussion:
Struma ovarii should be a possible diagnosis in any female patient with thyrotoxicosis manifestations with normal thyroid scan and examination.
Anesthetic management for cesarean section in a patient with uncorrected double-outlet right ventricle
Authors: Juan Gu, Yunxia Cai, Bin Liu, Sheng Lv
Journal: Springerplus (2016)
Keywords: anesthesia, cesarean section, double-outlet right ventricle (dorv)

Background:
We describe the anesthetic management for cesarean section in a pregnant woman with uncorrected double-outlet right ventricle. The anesthetic method, treatment of complications and lessons are discussed.
Case presentation:
A 28-year-old woman visited our emergency room for progressive dyspnea and recurrent hemoptysis at 30 weeks' gestation. Her New York Heart Association functional class was III-IV. Echocardiography indicated that she had congenital heart disease of double-outlet right ventricle. She hadn't received any treatment. The obstetrician decided to terminate the pregnancy by cesarean section. We chose epidural anesthesia and pumped phenylephrine at the same time to minimize hemodynamic fluctuation. Just in the process of changing position to supine position with uterus displaced to the left, the patient coughed badly and complained about dyspnea. At the same time, the oxygen saturation decreased quickly. The symptoms were ameliorated soon by treating as heart failure. But the symptoms reappeared after oxytocin administration. At the end of surgery, the baby was sent to the Neonatal Intensive Care Unit for premature birth. The mother recovered successfully and discharged 7 days later.
Discussion and evaluation:
Double-outlet right ventricle is a seldom disease and pregnancy with uncorrected double-outlet right ventricle is rare. In this case, the patient belonged to the type of ventricular septal defect characterized by subaortic ventricular septal defect without pulmonary stenosis. Most of the aorta arises from the right ventricle, the volume of venous blood was injected from the right ventricle into the aorta, which decided the oxygen saturations. Compared to general anesthesia, epidural anesthesia reduces venous return and alleviates the cardiac burden. So, we pumped phenylephrine along with epidural anesthesia in case of critical cyanosis following significant blood pressure decrease. In the process of anesthesia, dyspnea, cough and cyanosis attacked the patient for two times. The most probable reason was heart failure which induced by the sudden increasing of returned blood. As a result of severe cough, pulmonary artery pressure increased rapidly. Then a great amount of venous blood was injected into the aorta and cyanosis became more serious as well as oxygen saturation declined quickly.
Conclusion:
Epidural anesthesia with continuous phenylephrine infusion is a preferable choice for parturient women with uncorrected double-outlet right ventricle for cesarean section. It is not the optimal choice for this type of patients to lie on the left. The dose of oxytocin should be reduced to avoid potential cardiovascular complications.
Transforaminal blood patch for the treatment of chronic headache from intracranial hypotension: a case report and review
Authors: Kirk Bowden, Adam Wuollet, Amol Patwardhan, Theodore J Price, John Lawall, Jeffery Annabi, Steven Barker, Emil Annabi
Journal: Anesthesiol Res Pract (2012)

This case report describes the successful treatment of chronic headache from intracranial hypotension with bilateral transforaminal (TF) lumbar epidural blood patches (EBPs). The patient is a 65-year-old male with chronic postural headaches. He had not had a headache-free day in more than 13 years. Conservative treatment and several interlaminar epidural blood patches were previously unsuccessful. A transforaminal EBP was performed under fluoroscopic guidance. Resolution of the headache occurred within 5 minutes of the procedure. After three months without a headache the patient had a return of the postural headache. A second transforaminal EBP was performed again with almost immediate resolution. The patient remains headache-free almost six months from the time of first TF blood patch. This is the first published report of the use of transforaminal epidural blood patches for the successful treatment of a headache lasting longer than 3 months.
Intracranial tuberculomas or neurocysticercosis: differentiated by cervical lymph node pathology
Authors: Sevda Diker, Derlen Özgeç Ruso, Nesil Bayraktar, Uğurcan Balyemez
Journal: Egypt J Neurol Psychiatr Neurosurg (2022)
Keywords: magnetic resonance imaging, neurocysticercosis, seizure, tuberculoma
MeSH terms: Case Reports

Background:
Diagnosis of tuberculomas can be difficult in the absence of pulmonary involvement due to numerable mimics.
Case report:
We report an immunocompetent 20-year-old female patient, who was admitted with new-onset generalized seizure. Cranial magnetic resonance imaging (MRI) revealed multiple ring-enhancing lesions. There was no reported systemic symptom such as weight loss, fever or night sweating. Polymerase chain reaction for SARS-COV-2 was negative. Computed tomography of thorax was normal. With an initial diagnosis of neurocysticercosis, she was treated with albendazole for one month. Follow-up cranial MRI showed no improvement. On follow-up visit, an enlarged cervical lymph node was recognized. Biopsy of the lymph node led to the diagnosis of tuberculosis. Two months after the onset of anti-tuberculosis therapy, follow-up cranial MRI showed near-complete resolution.
Conclusion:
Investigation of any involvement of disease other than the central nervous system can enable accurate and timely diagnosis of tuberculomas in the absence of pulmonary involvement.
Full median sternotomy approach for treatment of upper thoracic vertebral tuberculosis in a developing country: case report and short literature review
Authors: Isaac Okyere, Anthony Lamina, Benedict Owusu
Journal: Pan Afr Med J (2017)
Keywords: osteomyelitis, cervicothoracic junction, laminectomy, median sternotomy
MeSH terms: Osteomyelitis / surgery, Sternotomy / methods, Tuberculosis, Spinal / surgery, Case Reports, Review, Ghana, Humans, Male, Spinal Cord Compression, Spinal Fusion, Thoracic Vertebrae, Young Adult

Direct anterior approach to the cervicothoracic spine (C7-T4) poses a technical challenge in neurosurgery, due to the presence of important neurovascular structures anterior to the cervicothoracic junction (CTJ). Median Sternotomy approach is a surgical option that allows for direct anterior exposure of the lower cervical and upper thoracic vertebrae. We report the first case from Ghana, West Africa of a young man who developed post-tuberculosis osteomyelitis of upper thoracic (T1-2) vertebrae with cord compression after spinal tuberculosis in childhood. He underwent a full median Sternotomy for Anterior Decompression and Fusion of C7-T2 with autologous iliac crest bone graft. We detail our operative procedure and review the relevant literature.
Terpene-Enriched CBD oil for treating autism-derived symptoms unresponsive to pure CBD: Case report
Authors: Noa Raz, Iso Heller, Titti Lombardi, Giorgio Marino, Elyad M Davidson, Aharon M Eyal
Journal: Front Pharmacol (2022)
Keywords: agitation, autism, case report, cbd, terpene-enriched, terpenes, treatment efficacy
MeSH terms: Case Reports

Cannabidiol (CBD) rich products are successfully used in some countries for treating symptoms associated with autism spectrum disorder (ASD). Yet, CBD provides insufficient intervention in some individuals, or for some characterizing symptoms of ASD, raising the need for improved compositions. The current study presents a case wherein pure CBD was sufficient for treating ASD during childhood and early adolescence. However, it became insufficient during puberty accompanied by increased hyperactivity, agitation, and frequent severe aggressive behavior. Increasing the CBD dose did not result in significant improvement. Enriching the pure CBD with a carefully selected blend of anxiolytic and calming terpenes, resulted in gradual elimination of those aggressive events. Importantly, this was achieved with a significantly reduced CBD dose, being less than one-half the amount used when treating with pure CBD. This case demonstrates a strong improvement in efficacy due to terpene enrichment, where pure CBD was not sufficient. Combined with terpenes' high safety index and the ease with which they can be incorporated into cannabinoid-containing products, terpene-enriched CBD products may provide a preferred approach for treating ASD and related conditions. The careful selection of terpenes to be added enables maximizing the efficacy and tailoring the composition to particular and changing needs of ASD subjects, e.g., at different times of the day (daytime vs nighttime products).
Clomiphene Associated Inferior STEMI in a Young Female due to Right Coronary Artery Dissection
Authors: Feras Husain Abuzeyad, Eltigani Seedahmed Ibnaouf, Mudhaffar Al Farras
Journal: Case Rep Emerg Med (2017)
MeSH terms: Case Reports

Nonatherosclerotic spontaneous coronary artery dissection (NA-SCAD) is an uncommon cause of myocardial infarction. It most commonly affects females in the perimenopausal age. NA-SCAD has been associated with many predisposing factors including pregnancy and hormonal therapy for both contraception and ovulation induction. The presented case is a previously healthy 41-year-old woman diagnosed with inferior ST-elevation myocardial infarction due to right descending coronary artery dissection associated with recent use of clomiphene monotherapy for ovulation induction (a previously fertile woman), which was not previously reported. Learning Objectives. Emergency physicians (EPs) should be aware about NA-SCAD as a cause of acute coronary syndrome (ACS) especially in perimenopausal women even with no risk factors. NA-SCAD occurs more commonly in the postpartum period and in females following hormonal therapy. Here, clomiphene monotherapy was reported as a possible contributing factor to NA-SCAD. Guidelines for NA-SCAD management are not up to date, and EPs should avoid some interference before the final diagnosis of the cause of myocardial infarction.