OpenMed/multicare-articles huggingface dataset:
Zolpidem for the Treatment of Dystonia
Authors: Stephanie Patricia J Badillo, Roland Dominic G Jamora
Journal: Front Neurol (2019)
Keywords: dystonia, movement disorders, systematic review, treatment, zolpidem
MeSH terms: Systematic Review

Background and Purpose: There are recent reports of zolpidem being effective for the treatment of a variety of movement disorders, due to its action on the gamma-aminobutyric acid A receptors in the thalamus, subthalamic nucleus, and globus pallidus, hence facilitating inhibitory pathways in the basal ganglia motor loop. Its beneficial effects have been described for Parkinson's disease and other related disorders. The objective of this study was to assess the therapeutic effects of zolpidem for various types of dystonia. Methods: We conducted a literature search using MEDLINE via PubMed, Cochrane Library, EMBASE, Scopus, and Google Scholar. Results: There were no randomized controlled trials. The literature included 6 case reports, 4 case series, and 1 non-randomized, non-controlled interventional trial. Overall, 49 adult participants (range 1-34 participants) with a mean age of 49.5 years were treated. Regardless of the dystonia subtype, a single dose of zolpidem at 10 mg causes improvement of symptoms for a mean duration of 3.4 h until patient returns to baseline. The main adverse effect noted was drowsiness, which was dose-dependent. Conclusion: While the current available literature suggests that zolpidem may be an effective pharmacologic option for treating dystonia, however the quality of evidence remains limited. Larger sample size, methodological consistency, and randomized controlled trials with long-term patient follow-ups are necessary to come up with definitive conclusion.
Case Report: Echinocandin-Resistance Candida glabrata FKS Mutants From Patient Following Radical Cystoprostatectomy Due to Muscle-Invasive Bladder Cancer
Authors: Maria Szymankiewicz, Krzysztof Kamecki, Sylwia Jarzynka, Anna Koryszewska-Bagińska, Gabriela Olędzka, Tomasz Nowikiewicz
Journal: Front Oncol (2021)
Keywords: candida glabarta, fks mutation, antifungal resistance, bladder cancer cystoprostatectomy, echinocandins
MeSH terms: Case Reports

Invasive Candida glabrata infections are not common complications after radical cystoprostatectomy. Furthermore, resistance to echinocandins arising during the course of a patient's treatment is rarely recognised. We described a case of development of echinocandin resistance in a patient with muscle-invasive bladder cancer (pT2b N0 M0, high grade) diagnosis, subjected to radical cystoprostatectomy and exposed to echinocandins. A male patient with a previous surgical history after a traffic accident, who was operated on due to bladder cancer, underwent an episode of candidemia and mixed postoperative wound and urinary tract infection caused by C. glabrata and extended spectrum β-lactamase (ESBL)-producing Escherichia coli during hospital treatment. The patient was started on caspofungin. Repeat blood cultures showed clearance of the bloodstream infection; however, infection persisted at the surgical site. Resistance to echinocandins developed within 2 months from the day of initiation of therapy with caspofungin in the C. glabrata strain obtained from the surgical site. The isolates sequentially obtained during the patient's treatment demonstrated resistance to echinocandins due to the mutation in hotspot 1 FKS2. Although resistance to echinocandins is relatively rare, it should be considered in oncological patients with increased complexity of treatment and intestinal surgery.
Rectal foreign body of a shattered glass bottle; Case report of unexpected late post-operative hemorrhage managed transanally
Authors: Elliot Klein, Moshe Bressler, Shmuel Nadler, Michelle Shayowitz, Seth Lapin
Journal: Int J Surg Case Rep (2020)
Keywords: case report, clipping, colonoscopy, exploratory laparotomy, foreign body, rectal perforation
MeSH terms: Case Reports

Introduction:
Retained rectal foreign bodies are commonly implicated in patients engaging in erotic behavior. The foreign bodies vary widely, however, penetrating rectal wounds are uncommon and often complicate the retrieval of the object. The rich vascular bed of the rectal mucosa provides additional bleeding complications.
Presentation of case:
A 55-year-old male presented with active bleeding after intentional insertion of a glass bottle into the rectum which shattered. Partial retrieval via proctoscopy was followed by an exploratory laparotomy with a diverting colostomy, mucous fistula, and presacral drainage. Postoperative course was complicated by severe hematochezia. Colonoscopy was performed in the operating room found actively bleeding ulcers at sites of previously lacerated mucosa; one pulsating, protruding, vessel was visible. Clips were placed over the vessel with cessation of bleeding. Barium enema at three months follow revealed no leaks allowing for reversal of the colostomy.
Discussion:
This case of operative retrieval of a rectal foreign body is unique because it displays deviation from commonly used algorithms are periodically needed to optimize patient recover.
Conclusion:
The utilization of minimally-invasive colonoscopy prior to additional surgical intervention in post-operative rectal bleeding following a rectal foreign body retrieval may improvie patient recovery time, functionality, and long-term outcomes.
Clear cell adenocarcinoma of the colon: a case report and review of the literature
Authors: Christian Daniel Barrera-Maldonado, Isidoro Wiener, Sue Sim
Journal: Case Rep Oncol Med (2014)

Clear cell adenocarcinoma of the colon has been described scarcely in the literature. It affects elderly men more commonly than women and usually appears in the left side of the colon. A Hispanic 41-year-old female came to the emergency room with abdominal pain, vomiting, and distension. Physical exam revealed generalized tenderness without peritoneal signs. Laboratory data was unremarkable. A CT scan showed an apple-core lesion in the distal colon. A flexible sigmoidoscopy revealed an obstructive mass that made further evaluation impossible. Exploratory surgery revealed a hard mass obstructing the descending colon, which was resected. Histopathology analysis with immunohistochemistry staining was positive for cytokeratin 20, cytokeratin 10, CDX2, and villin, while it was negative for cytokeratin 7, RCC, vimentin, and CD31. These results confirmed the clear cell variant of the adenocarcinoma. Clear cell adenocarcinomas usually arise from the kidneys and Müllerian organs. Immunohistochemistry is crucial for establishing the origin of these neoplastic cells. A cytokeratin 20+/7- with positive CDX2 is highly specific and sensitive for intestinal neoplastic origin. The main treatment has been surgery alone with moderately good results. More research and information about this malignancy is needed, especially in regard to prognosis and in order to provide the best treatment option.
ACE Inhibitor-Induced Angioedema following Cervical Spine Surgery
Authors: Faris Hannoodi, Hussam Sabbagh
Journal: Case Rep Cardiol (2017)
MeSH terms: Case Reports

Angioedema is a well-known side effect of angiotensin converting enzyme inhibitors (ACEi). However, ACE inhibitors induced angioedema after cervical surgery is a rare condition. They result in increased levels of circulating bradykinins. Rare cases of angioedema following local trauma in patients using ACE inhibitors have been published. We present such a case. A 54-year-old Caucasian female with a history significant for hypertension, controlled with lisinopril, was admitted for routine cervical spine surgery. She has severe degenerative cervical disc disease and was admitted to the hospital for an elective cervical diskectomy. The patient failed weaning off the ventilator on multiple attempts postoperatively. There were no observed symptoms of an allergic reaction. A CT scan of the neck showed extensive soft tissue edema at the level of the arytenoids. Dexamethasone was given to reduce the edema without successful resolution. On review of her medications, it was found that the patient was resumed on lisinopril following the procedure. It was subsequently discontinued. By the following day the patient had a positive leak around the ET tube cuff and patient was successfully extubated.
Recurrent Hydatidiform Moles: A Clinical Challenge-A Case Report and an Update on Management and Therapeutical Strategies
Authors: S Riccio, F Galanti, M Scudo, L Di Troia, M G Ferrillo, F Manzara, P Ianiri, F A Battaglia
Journal: Case Rep Obstet Gynecol (2023)
MeSH terms: Case Reports

Hydatidiform mole, complete or partial (CHM/PHM), is the most common type of gestational trophoblastic disease (GTD), which is characterized by excessive trophoblastic proliferation and abnormal embryonic development. Some patients present with sporadic or familiar recurrent hydatidiform moles (RHMs), which are characterized by two or more episodes of the disease. A healthy 36-year-old woman was admitted to the Obstetrics and Gynecology Unit of Santa Maria Goretti Hospital, Latina, because of RHMs at 6 weeks of amenorrhea, with an obstetrical anamnesis of RHMs. We performed uterine dilatation and curettage with suction evacuation. The histological examination confirmed the diagnosis of PHM. The clinical follow-up was conducted according to recent guidelines on the diagnosis and management of GTD. After the return to the baseline values of the beta-human chorionic gonadotropin hormone, a combined oral contraceptive therapy was proposed, and the patient was invited to undergo in vitro fertilization (IVF) techniques, specifically oocyte donation, to reduce the possibility of similar future cases of RHMs. Although some etiopathogenetic mechanisms involved in RHMs are still unknown, all patients of childbearing age who are affected by this syndrome should be properly treated and directed towards a correct clinical path as IVF, to have a successful and safe pregnancy.
Case report: Metastatic pancreatic neuroendocrine tumour associated with portal vein thrombosis; successful management with subsequent pregnancies
Authors: Lívia Sira, Noémi Zsíros, László Bidiga, Sándor Barna, Zsolt Kanyári, Edit B Nagy, Nicolas Guillaume, Damian Wild, Katalin Rázsó, Szilvia Andó, István Balogh, Endre V Nagy, Zoltán Balogh
Journal: Front Endocrinol (Lausanne) (2023)
Keywords: complete remission, metastatic pancreatic neuroendocrine tumour, pregnancy, splanchnic vein thrombosis, thrombocytosis
MeSH terms: Adenoma, Islet Cell, Liver Neoplasms / secondary, Liver Neoplasms / therapy, Neoplasms, Second Primary, Neuroectodermal Tumors, Primitive / complications, Neuroendocrine Tumors / complications, Neuroendocrine Tumors / pathology, Neuroendocrine Tumors / therapy, Pancreatic Neoplasms / complications, Pancreatic Neoplasms / diagnosis, Pancreatic Neoplasms / therapy, Thrombosis, Case Reports, Female, Humans, Portal Vein, Pregnancy, Somatostatin, Somatostatin, Non functioning pancreatic endocrine tumor

Background:
Splanchnic vein thrombosis due to co-existing metastatic pancreatic neuroendocrine tumour (pNET) and JAK2V617F mutation is a rare condition.
Case report:
Here we present a case of a young woman with complete remission of a non-functioning grade 2 pNET with unresectable liver metastases, coexisting with JAK2V617F mutation. Splenectomy and distal pancreatectomy were performed. Neither surgical removal, nor radiofrequency ablation of the liver metastases was possible. Therefore, somatostatin analogue (SSA) and enoxaparine were started. Peptide receptor radionuclide therapy (PRRT) was given in 3 cycles 6-8 weeks apart. Genetic testing revealed no multiple endocrine neoplasia type 1 (MEN-1) gene mutations. After shared decision making with the patient, she gave birth to two healthy children, currently 2 and 4 years old. On pregnancy confirmation, SSA treatment was interrupted and resumed after each delivery. Ten years after the diagnosis of pNET, no tumour is detectable by MRI or somatostatin receptor scintigraphy. PRRT followed by continuous SSA therapy, interrupted only during pregnancies, resulted in complete remission and enabled the patient to complete two successful pregnancies.
Schwannoma of the stomach: a case report
Authors: Aminder Singh, Ankur Mittal, Bhavna Garg, Neena Sood
Journal: J Med Case Rep (2016)
MeSH terms: Endoscopy, Gastrointestinal / methods, Gastrectomy, Neurilemmoma / diagnosis, Stomach Neoplasms / diagnosis, Case Reports, Aged, Humans, Immunohistochemistry, Male, Neurilemmoma / surgery, Stomach Neoplasms / surgery, Tomography, X-Ray Computed, Treatment Outcome

Background:
Schwannomas, also known as neurilemmomas, are benign slow-growing neoplasms originating from a Schwann cell sheath. These neoplasms are rare among the mesenchymal tumors of the gastrointestinal tract. In the stomach, Schwannomas only represent 0.2 % of all gastric tumors; this makes the presentation of a schwannoma in the stomach of a man in his seventh decade unusual. This case report highlights the rarity of a schwannoma at the greater curvature of the stomach because only a few cases have been reported in the literature. This case describes the importance of including gastric schwannomas in the differential diagnosis when preoperative assessment reveals a submucosal gastric mass with gastrointestinal stromal tumor as a leading differential diagnosis because of its common occurrence at this site.
Case presentation:
A 72-year-old man of Indian origin presented with a painless abdominal mass with nonspecific gastrointestinal upset. An endoscopy showed a submucosal lesion in his stomach measuring 4 × 3 × 2 cm. Histology revealed a benign spindle cell tumor. Immunohistochemistry confirmed the diagnosis of gastric schwannoma. He is on regular follow-up and doing well.
Conclusions:
It should be remembered that a schwannoma can present as a mass lesion in the stomach and mimic gastrointestinal stromal tumor. Patients should undergo an endoscopy and a biopsy of the lesion should be done. Many patients do not undergo endoscopy which can delay diagnosis and management. As these tumors have an excellent prognosis, surgical removal is sufficient treatment. Surgeons, radiologists, pathologists and gastroenterologists must be aware of this entity.
Identifying population segments for effective intervention design and targeting using unsupervised machine learning: an end-to-end guide
Authors: Elisabeth Engl, Peter Smittenaar, Sema K Sgaier
Journal: Gates Open Res (2019)
Keywords: psycho-behavioral segmentation, behavioral science, cluster analysis, global health and development, targeted intervention design, human heterogeneity, machine learning, unsupervised learning

One-size-fits-all interventions that aim to change behavior are a missed opportunity to improve human health and well-being, as they do not target the different reasons that drive people's choices and behaviors. Psycho-behavioral segmentation is an approach to uncover such differences and enable the design of targeted interventions, but is rarely implemented at scale in global development. In part, this may be due to the many choices program designers and data scientists face, and the lack of available guidance through the process. Effective segmentation encompasses conceptualization and selection of the dimensions to segment on, which often requires the design of suitable qualitative and quantitative primary research. The choice of algorithm and its parameters also profoundly shape the resulting output and how useful the results are in the field. Analytical outputs are not self-explanatory and need to be subjectively evaluated and described. Finally, segments can be prioritized and targeted with matching interventions via appropriate channels. Here, we provide an end-to-end overview of all the stages from planning, designing field-based research, analyzing, and implementing a psycho-behavioral segmentation solution. We illustrate the choices and critical steps along the way, and discuss a case study of segmentation for voluntary medical male circumcision that implemented the method described here. Though our examples mostly draw on health interventions in the developing world, the principles in this approach can be used in any context where understanding human heterogeneity in driving behavior change is valuable.
Hypotension, Syncope, and Fever in Systemic Mastocytosis without Skin Infiltration and Rapid Response to Corticosteroid and Cyclosporin: A Case Report
Authors: Didem Ozdemir, Selcuk Dagdelen, Tomris Erbas, Kemal Agbaht, Songul Serefhanoglu, Salih Aksu, Sibel Ersoy-Evans
Journal: Case Rep Med (2010)
MeSH terms: Case Reports

Mast cell disorders are defined by an abnormal accumulation of tissue mast cells in one or more organ systems. In systemic mastocytosis, at least one extracutaneous organ is involved by definition. Although, systemic mastocytosis usually represents with skin lesion called urticaria pigmentosa, in a small proportion, there is extracutaneous involvement without skin infiltration. Other manifestations are flushing, tachycardia, dyspepsia, diarrhea, hypotension, syncope, and rarely fever. Various medications have been used but there is not a definite cure for systemic mastocytosis. The principles of treatment include control of symptoms with measures aimed to decrease mast cell activation. We describe a case of systemic mastocytosis presenting with hypotension, syncope attacks, fever, and local flushing. In bone marrow biopsy, increased mast cell infiltration was demonstrated. She had no skin infiltration. A good clinicopathological response was obtained acutely with combination therapy of glucocorticoid and cyclosporine.
Serous borderline tumor of the fallopian tube presented as hematosalpinx: a case report
Authors: Maja Krasevic, Teodora Stankovic, Oleg Petrovic, Neda Smiljan-Severinski
Journal: BMC Cancer (2005)
MeSH terms: Cystadenoma, Serous / diagnosis, Fallopian Tube Diseases / diagnosis, Fallopian Tube Neoplasms / diagnosis, Case Reports, Adult, Cell Cycle, Cystadenoma, Serous / therapy, DNA, Neoplasm / metabolism, Diagnosis, Differential, Fallopian Tube Neoplasms / therapy, Female, Humans, S Phase, Treatment Outcome, DNA, Neoplasm

Background:
Compared with their ovarian counterparts, serous borderline tumors of the fallopian tube are uncommon, with limited experience about their clinical behaviour. We present a case of serous borderline tumor of the fallopian tube with unusual presentation and summarise all the published cases to date.
Case presentation:
A case of serous borderline tumor of the fallopian tube in a 34-year old patient is presented, incidentally found during routine gynecologic examination. At laparoscopy the tumor was unusually presented as hematosalpinx and was treated by salpingectomy. Cell-cycle analysis of the tumor tissue revealed a diploid DNA content and a low S-phase fraction. There was no evidence of the disease during the follow-up period of 4.6 years.
Conclusion:
The current case and review of the literature suggest salpingectomy as the optimal treatment for patients with serous borderline tumor of the fallopian tube.
Metastatic carcinoma of unknown primary presenting as jugular venous thrombosis
Authors: Prince Cheriyan Modayil, Sathyan Panthakalam, David C Howlett
Journal: Case Rep Med (2009)
MeSH terms: Case Reports

Jugular venous thrombosis is unusual and is associated with central venous catheterisation, intravenous drug abuse and head and neck sepsis. It is rarely associated with malignancy. We report a case of metastatic carcinoma of unknown primary in a forty year old female which presented with jugular venous thrombosis. The discussion includes investigation and treatment options for this condition.
Management of worsening aortic dilation and insufficiency in a 20-week pregnant woman: a case report
Authors: Amy Shah, Johanna Schwarzenberger, Dorina Gui, Richard Hong, Angela Chen
Journal: Case Rep Obstet Gynecol (2011)
MeSH terms: Case Reports

Preexisting aortic disease can worsen during pregnancy as physiologic hemodynamic changes evolve. At a large academic institution, a patient with a remote history of vasculitis presented with a second trimester pregnancy with increasing aortic dilatation and aortic insufficiency. Extensive obstetric discussions encompassed maternal cardiac risks from continuing the pregnancy and fetal risks from maternal cardiac intervention. This patient desired termination of pregnancy to avoid further complications and to expedite surgical aortic repair.
Hydroxychloroquine overcomes cabergoline resistance in a patient with Lactotroph Pituitary neuroendocrine tumor: a case report
Authors: Shaojian Lin, Changxi Han, Xiaohui Lou, Zhe Bao Wu
Journal: Front Endocrinol (Lausanne) (2022)
Keywords: cabergoline, case report, hydroxychloroquine, novel therapy, resistant lactotroph pituitary neuroendocrine tumors
MeSH terms: Lactotrophs / pathology, Neuroendocrine Tumors / complications, Neuroendocrine Tumors / drug therapy, Neuroendocrine Tumors / surgery, Pituitary Neoplasms / complications, Pituitary Neoplasms / drug therapy, Pituitary Neoplasms / surgery, Prolactinoma / complications, Prolactinoma / drug therapy, Prolactinoma / pathology, Case Reports, Research Support, Non-U.S. Gov't, Adult, Cabergoline / therapeutic use, Ergolines / therapeutic use, Humans, Hydroxychloroquine / therapeutic use, Male, Prolactin, Young Adult, Ergolines, Hydroxychloroquine, Prolactin, Cabergoline

Objective:
A 22-year-old man complaining erectile dysfunction underwent transsphenoidal surgery for a 2.7 cm sellar mass with total resection and was confirmed at pathology to have a lactotroph pituitary neuroendocrine tumor (PiNET). Postoperatively, the patient's PRL remained at high level and therefore accepted high-dose dopamine receptor agonist (DA) therapy. After over 3 months of bromocriptine (BRC) (15mg/day) and over 3 years of cabergoline (CAB) (3mg/week) therapy, the patient's prolactin (PRL) never achieved long-term normalization. He was diagnosed with DA-resistant lactotroph PitNET.
Method:
In this study, the patient was given hydroxychloroquine (HCQ) (200 mg/d) and CAB (3 mg/w) in combination for four months. His PRL level was tested by blood test every month.
Results:
Taking the combination therapy of HCQ and CAB, the patient's uncontrolled PRL level was normalized within one month and was maintained at the normal level thereafter. Pituitary magnetic resonance imaging (MRI) images with enhancement showed no recurrence. The patient also regained normal sexual function.
Discussion:
This is the first report on the combination of HCQ with CAB for the effective treatment of DA-resistant lactotroph pituitary neuroendocrine tumor in a patient, which might provide a novel treatment strategy for clinical management.