OpenMed/multicare-articles huggingface dataset:
Acellular dermis (SureDerm®) use for managing pulsatile tinnitus: a long-term follow-up of a novel surgical technique
Authors: Joshua Agilinko, Sara Katharine Drever, Winston Kin Wai Low, Muhammad Shakeel, Akhtar Hussain
Journal: GMS Interdiscip Plast Reconstr Surg DGPW (2021)
MeSH terms: Case Reports

Introduction: Pulsatile tinnitus (PT) can be very distressing for the patient. An identifiable abnormality is rarely detected. Dural AV malformation is responsible for arterial PT. Venous PT has rarely been attributed to an obvious abnormality on venogram. Dehiscent high jugular bulb or sigmoid sinus have been thought to be potential cause for venous PT. Ligation of internal jugular vein (IJV) has been advocated as a definitive surgical treatment. To our knowledge the use of acellular dermal matrix for treatment of venous PT has not been reported previously. Objectives: To share our experience of a successful treatment of PT using acellular dermis. Methodology: Case report and literature review. Case description: A 23-year-old Caucasian female presented with right-sided PT of 9 months duration. All clinical and audiological investigations were normal. MRI brain and internal auditory canals was normal but the CT scan showed a high right jugular bulb. It also showed dehiscence of the right sigmoid plate with herniation of sigmoid sinus into the mastoid. She underwent transmastoid correction of dehiscent sigmoid sinus and jugular bulb. Acellular dermis was used for extra luminal packing of mastoid cavity and hypotympanum. The patient made a good post-operative recovery and reported resolution of tinnitus on recovering from anaesthesia. The patient was discharged home the following day. There were no sequelae from surgery. The patient has remained symptom-free 11 years following her treatment. Conclusion: The surgical goal of dehiscent sigmoid sinus correction can be accomplished with acellular dermis packing. Traditionally ligation of the IJV or rigid correction of herniated sinus has been recommended; however, we have demonstrated that a relatively thick pliable acellular dermis is more than adequate to correct herniation of the sigmoid venous sinus.
Subretinal fluid application to close a refractory full thickness macular hole
Authors: Carsten H Meyer, Robert Borny, Nicole Horchi
Journal: Int J Retina Vitreous (2017)
MeSH terms: Case Reports

Background:
To close a refractory full thickness macular hole (FTMH) by adjacent subretinal fluid application to release the elastic retina from the retinal pigment epithelium (RPE).
Case presentation:
A 83 years old patient presented an old FTMH with a diameter of 1444 μm. After confirming intraoperatively the complete release of the epiretinal membrane around the FTMH, we installed 3 small subretinal blebs around the hole, to release the adjacent retina from the RPE. The mobilized retina was gently moved towards the macular center. A silicone oil tamponade was installed to secure a proper healing and observation of the FTMH. The closure of the 1444 μm FTMH was seen on indirect ophthalmoscopy and confirmed by OCT 5 days after surgery by restoring the retinal architecture. A late reopening was not apparent at the postoperative observations. Visual acuity improved from hand motion to 20/200 at 4 weeks postoperative.
Conclusion:
Although FTMH develop by epiretinal tangential traction, large FTMH may persist even after complete release of its epiretinal traction. Subretinal fluid application may release the flexible retina from the RPE to achieve a relocation at the central fovea facilitating an anatomical closure of the macular hole.
Case Report: Re-Treatment With Lu-DOTATATE in Neuroendocrine Tumors
Authors: Elena María Vida Navas, Alberto Martínez Lorca, Aintzane Sancho Gutiérrez, Lucia Sanz Gómez, Teresa Navarro Martínez, Enrique Grande Pulido, Alfredo Carrato Mena, Pablo Gajate Borau
Journal: Front Endocrinol (Lausanne) (2021)
Keywords: lu-dotatate, case report, neuroendocrine neoplasms, neuroendocrine tumors, peptide receptor radionuclide therapy
MeSH terms: Bone Neoplasms / radiotherapy, Neuroendocrine Tumors / radiotherapy, Octreotide / analogs & derivatives, Organometallic Compounds / therapeutic use, Radiopharmaceuticals / therapeutic use, Rectal Neoplasms / radiotherapy, Case Reports, Adult, Antineoplastic Agents / therapeutic use, Bone Neoplasms / diagnostic imaging, Bone Neoplasms / drug therapy, Bone Neoplasms / secondary, Everolimus / therapeutic use, Humans, Magnetic Resonance Imaging, Male, Neuroendocrine Tumors / diagnostic imaging, Neuroendocrine Tumors / drug therapy, Neuroendocrine Tumors / secondary, Octreotide / therapeutic use, Rectal Neoplasms / diagnostic imaging, Rectal Neoplasms / drug therapy, Rectal Neoplasms / pathology, Retreatment, Sunitinib / therapeutic use, Tomography, X-Ray Computed, Antineoplastic Agents, Organometallic Compounds, Radiopharmaceuticals, Everolimus, lutetium Lu 177 dotatate, Octreotide, Sunitinib

Peptide receptor radionuclide therapy (PRRT) is an established treatment in advanced neuroendocrine tumors (NETs), which overexpressed somatostatin receptors. However, after progression there are a limited number of available treatments. We want to share a case report about a patient with a NET re-treated with 177Lu-DOTATATE and a literature review about salvage treatment with PRRT. We present a 26-year-old man who started with pelvic pain and after a biopsy of a retro-rectal mass observed in a magnetic resonance was diagnosed with an advanced neuroendocrine tumour. After progression to lanreotide, everolimus and sunitinib, treatment with 177Lu-DOTATATE was initiated, achieving an excellent response with a progression free survival (PFS) of 38 months. At the time of progression, re-treatment with 177Lu-DOTATATE was decided, showing a new partial response, which is currently stable after 15 months. The patient had not presented significant treatment-related toxicity. Although there are no randomized phase III trials or a consensus about the number or dose of cycles, there is evidence about the efficacy and low toxicity of salvage treatment with 177Lu-DOTATATE in NETs. Median progression-free survival ranges from 6 to 22 months. Toxicity is mostly hematologic (anemia and neutropenia), 4-7% grade 3/4.
Cancer of Unknown Primary in Adolescents and Young Adults: Clinicopathological Features, Prognostic Factors and Survival Outcomes
Authors: Kanwal Raghav, Hemendra Mhadgut, Jennifer L McQuade, Xiudong Lei, Alicia Ross, Aurelio Matamoros, Huamin Wang, Michael J Overman, Gauri R Varadhachary
Journal: PLoS One (2016)
MeSH terms: Neoplasms, Unknown Primary / pathology, Case Reports, Research Support, Non-U.S. Gov't, Adolescent, Adult, Female, Humans, Kaplan-Meier Estimate, Male, Models, Statistical, Multivariate Analysis, Prognosis, Reproducibility of Results, Survival Analysis, Young Adult

Background:
Cancer in adolescents and young adults (AYAs) (15-39 years) is increasingly recognized as a distinct clinical and biological entity. Cancer of unknown primary (CUP), a disease traditionally presenting in older adults with a median age of 65 years, poses several challenges when diagnosed in AYA patients. This study describes clinicopathological features, outcomes and challenges in caring for AYA-CUP patients.
Methods:
A retrospective review of 47 AYAs diagnosed with CUP at MD Anderson Cancer Center (6/2006-6/2013) was performed. Patients with favorable CUP subsets treated as per site-specific recommendations were excluded. Demographics, imaging, pathology and treatment data was collected using a prospectively maintained CUP database. Kaplan-Meier product limit method and log-rank test were used to estimate and compare overall survival. The cox-proportional model was used for multivariate analyses.
Results:
Median age was 35 years (range 19-39). All patients underwent comprehensive workup. Adenocarcinoma was the predominant histology (70%). A median of 9 immunostains (range 2-29) were performed. The most common putative primary was biliary tract based on clinicopathological parameters as well as gene profiling. Patients presented with a median of 2 metastatic sites [lymph node (60%), lung (47%), liver (38%) and bone (34%)]. Most commonly used systemic chemotherapies included gemcitabine, fluorouracil, taxanes and platinum agents. Median overall survival for the entire cohort was 10.0 (95% confidence interval (CI): 6.7-15.4) months. On multivariate analyses, elevated lactate dehydrogenase (Hazard ratio (HR) 3.66; 95%CI 1.52-8.82; P = 0.004), ≥3 metastatic sites (HR 5.34; 95%CI 1.19-23.9; P = 0.029), and tissue of origin not tested (HR 3.4; 95%CI 1.44-8.06; P = 0.005) were associated with poor overall survival. Culine's CUP prognostic model (lactate dehydrogenase, performance status, liver metastases) was validated in this cohort (median overall survival: good-risk 25.2 months vs. poor-risk 6.1 months).
Conclusions:
AYA-CUP is associated with a poor prognosis. In the current "-omics" era collaborative research efforts towards understanding tumor biology and therapeutic targets in AYA-CUP is an unmet need, necessary for improving outcomes in young CUP patients.
Use of Cephalic Vein for Venous Anastomosis in Head and Neck Reconstruction: A Case Series
Authors: Mohammad Fazlur Rahman, Muhammad Asif Ahsan, Safdar Ali Shaikh, Muhammad Ubaid Khan, Sami Ullah
Journal: Eplasty (2020)
Keywords: cephalic vein, free flaps, head and neck, recipient, venous anastomosis

Purpose: To describe the use of the cephalic vein as a recipient vessel for venous outflow in head and neck reconstruction. The cephalic vein is used as a vessel in cases where there is a paucity of veins in the neck. This may be due to previous surgery, previous radiation therapy, or advanced cancer. The cephalic vein may also be used to salvage a failing free flap. Methods: It is a retrospective review of 230 free flaps that had been used in head and neck reconstruction performed from July 2014 to July 2018 by a single surgeon. Results: There were 6 patients in whom the cephalic vein was used as a recipient vessel. The cephalic vein was used in 2 cases where a tumor was involved with the internal jugular vein, in 1 case where a previous neck dissection had been done, in 1 case where internal jugular vein had iatrogenic damage, and in 2 cases a salvage procedure was done. In all cases, the cephalic vein was rotated above the clavicle. The cephalic vein easily reached the free flap vein and had a good caliber. There were no failures in any of the patients. Conclusion: The cephalic vein is a good option for venous anastomoses in patients in whom there is a paucity of recipient vessels in the neck.
Posterior Mediastinal Epithelioid Angiosarcoma Arising in Schwannoma: A Case Report and Review of the Literature
Authors: Yingming Xiang, Liping Yan, Xia Lin, Xiangyan Zhang, Fangbiao Zhang, Zhijun Wu
Journal: Front Surg (2021)
Keywords: angiosarcoma, mediastinum, schwannoma, surgery, thoracoscopic
MeSH terms: Case Reports

Epithelioid angiosarcoma arising in schwannoma is an extremely rare mesenchymal tumor that accounts for only 1 to 2% of all sarcomas. This type of tumor occurs in all parts of the body, most often in the skin and soft tissues and rarely in the mediastinum. The present study describes the case of an asymptomatic, 58-year-old male who presented with epithelioid angiosarcoma in the posterior mediastinum during a physical examination. Enhanced computed tomography of the chest revealed a 3.5 × 3.1-cm mass in the posterior mediastinum. Thoracoscopic mediastinal mass resection was performed under general anesthesia due to the possibility that the tumor was malignant. Pathological examination revealed the presence of angiosarcoma and schwannoma components. Immunohistochemical staining for cluster of differentiation (CD) 31, CD34, early growth response (EGR), vimentin, Sry-related HMG box (SOX)-10 and S-100 was strongly positive. The patient recovered and was discharged on postoperative day 5. Two months postsurgery, the patient returned for evaluation, and no evidence of tumor recurrence was observed.
Pulmonary arterial hypertension in an 80-year-old man with long-term use of cyclophosphamide
Authors: Takatoshi Suzuki, Ichizo Tsujino, Wataru Harabayashi, Hideki Shima, Junichi Nakamura, Takahiro Sato, Masaru Suzuki, Yukari Takeda, Satohi Konno
Journal: Respir Med Case Rep (2023)
Keywords: cyclophosphamide, primary macroglobulinemia, pulmonary arterial hypertension
MeSH terms: Case Reports

An 80-year-old man diagnosed with primary macroglobulinemia 7 years earlier had been treated with cyclophosphamide, following which he developed dyspnea on exertion. Cyclophosphamide was discontinued. The patient's dyspnea, however, failed to improve. Right heart catheterization (RHC) revealed precapillary pulmonary hypertension (PH). He was transferred to our institution for further examination. Prior use of cyclophosphamide was the patient's only risk factor for PH, and cyclophosphamide use was considered as a possible cause of PH in this case. He was treated with tadalafil and dyspnea gradually improved. A follow-up RHC exhibited improvement in mean pulmonary arterial pressure and pulmonary vascular resistance.
The Integration of a Dual-Wavelength Super Pulsed Diode Laser for Consistent Tissue Ablation in the Esthetic Zone: A Case Series
Authors: Nur Hafizah Kamar Affendi, Rohana Ahmad, Farhad Vahidi, Mohd Zulkifli Hassan, Siti Nadia Rahimi
Journal: Case Rep Dent (2020)
MeSH terms: Case Reports

Introduction:
A diode laser is one of the universally compact accepted laser systems used fundamentally for soft tissue applications. Most diode laser devices have a single wavelength of either 810 nm for superior coagulation or 980 nm for tissue ablation. In these case series, the use of dual wavelengths (810 nm and 980 nm) in combination with super pulsing has provided a cleaner cut (no charring) with faster healing that eases the placement of the final restoration in the esthetic zone. Case Description. The present case series describe four cases in the esthetic zone that achieved hemostasis ablation without collateral damage to enhance gingival balance of definitive restoration. The gingivoplasty and gingivectomy modes are used to achieve efficient tissue ablation. Although there is no specific mode indicated in the FDA laser requirement for gingival depigmentation, the procedure could be safely performed with the dual-wavelength diode laser.
Result:
All four patients revealed a good esthetic outcome and reported no pain postoperatively. Healing was uneventful, and definitive restoration was delivered within two to four weeks postoperatively.
Conclusion:
Within the limitation of these case series, the dual-wavelength super pulsed diode laser has the capacity to deliver peak powers resulting in efficient cutting and less tissue charring and also as an alternative tool for removal of gingival pigmentation. Prospective clinical research with larger sample size is needed for conclusive results.
Detection of a Left Superior Vena Cava during a Pacemaker Implantation in Cotonou
Authors: A Sonou, M Hounkponou, L Codjo, P M Adjagba, C Houehanou, H Dohou, S Assani, Y Tchabi, M Houenassi
Journal: Case Rep Cardiol (2017)
MeSH terms: Case Reports

Persistent left superior vena cava (LSVC) is a rare congenital anomaly. Its prevalence in the general population is 0.1 to 0.5%. LSVC is 5 times rarer when accompanied by an absence of the right superior vena cava (RSVC). We present the case of a 54-year-old man who carries a persistent LSVC without RSVC. Clinically, this patient presented a regular bradycardia at 40 per minute associated with a heart failure syndrome. The electrocardiogram diagnosed a complete atrioventricular block and transthoracic echocardiography showed dilated left heart cavities and a left ventricular ejection fraction of 50%. During the procedure of pacemaker implantation, the probe followed an unusual LSVC-coronary sinus-right atrium path and it was not easy to pass through the tricuspid orifice. We propose a review of the literature on this subject, focusing on the clinical implications of this malformation in cardiac stimulation and in other areas of cardiology.
A rare case of primary inverted papilloma of the middle ear
Authors: Mehdi Hasnaoui, Mohamed Masmoudi, Nouha Ben Abdeljelil, Nouha Ben Hmida, Nabil Driss
Journal: Pan Afr Med J (2019)
Keywords: inverted papilloma, middle ear, surgery
MeSH terms: Ear Neoplasms / diagnosis, Papilloma, Inverted / diagnosis, Tympanoplasty / methods, Case Reports, Ear Neoplasms / pathology, Ear Neoplasms / surgery, Ear, Middle / pathology, Ear, Middle / surgery, Hearing Loss / etiology, Humans, Male, Middle Aged, Neoplasm Recurrence, Local, Otoscopy / methods, Papilloma, Inverted / pathology, Papilloma, Inverted / surgery, Tinnitus / etiology, Tomography, X-Ray Computed

Inverted papilloma (IP) of the middle ear as a primary lesion or as an extension of a sinonasal papilloma, is extremely rare. Only 23 cases of primary inverted papilloma of the middle ear have been reported in the literature. They are locally aggressive tumours, with a high rate of recurrence and associated malignancy. We present a rare case of a 59-year-old man presenting with unilateral otorrhoea, tinnitus, and hearing loss. Otoscopy revealed posterior perforation filled by irregular budding neoformation. The temporal CT scan showed tissue filling the tympanic cavity as well as the mastoid antrum without bone lysis. The patient underwent limited tympanoplasty. An intraoperative biopsy of polypoid tissue filling the tymapanic cavity was made and histopathology showed an IP. A recurrence occurred 4 months after surgery. We performed open tympanoplasty allowing complete resection of the lesions, with no recurrence after a follow-up of 30 months.
Late onset epilepsia partialis continua in a middle-aged patient with huge arachnoid cyst
Authors: Mohammad Javad Nasr, Amir Hossein Zohrevand, Ali Alizadeh Khatir
Journal: Caspian J Intern Med (2021)
Keywords: arachnoid cyst, epilepsia partialis continua, spastic cerebral palsy
MeSH terms: Case Reports

Background:
Arachnoid cysts are congenital or acquired cerebrospinal fluid (CSF) filled intra arachnoidal lesions, included 1% of all infantile intracranial masses and were discovered incidentally in MRI or CT-scan. The vast majority of these lesions are generally asymptomatic but some patients with arachnoid cyst have headache, dizziness, seizure (or epilepsy), vestibular symptoms and cognitive impairment.
Case presentation:
We present a case of a 43-year-old woman who has late onset epilepsia partialis continua and had right spastic cerebral palsy due to huge arachnoid cyst. Surprisingly without any history of seizure, her first seizure presents with sustained seizures (epilepsia partialis continua) and occur in the middle age for the first time.
Conclusion:
Most arachnoid cysts are asymptomatic and may not produce any symptoms throughout life. In our case, the late onset epilepsia partialis continua in the 5th decade of life with probably a large arachnoid cyst without any history of seizure before that is unusual. Conservative approaches usually made for the management of arachnoid cysts as patients with these cysts usually maintain the vital neurological functions.
Dilemmas and limitations interpreting carbohydrate antigen 19-9 elevation after curative pancreatic surgery: A case report
Authors: Grace Gold, Su Kah Goh, Christopher Christophi, Vijayaragavan Muralidharan
Journal: Int J Surg Case Rep (2019)
Keywords: ca19-9, case report, general surgery, hepatopancreatobiliary surgery, pancreatic cancer, tumour marker

Introduction:
Serum carbohydrate antigen 19-9 (CA19-9) is routinely used in the management of pancreatic cancer for diagnosis, prognostication and surveillance purposes despite its low specificity.
Case presentation:
This case report demonstrates the challenges of interpreting elevated serum CA19.9 levels in a patient with pancreatic cancer. We performed a Whipple's procedure in an otherwise fit 78-year-old man for pancreatic adenocarcinoma. One year after surgery, he presented with a non-malignant anastomotic stricture that was associated with an elevated serum CA19-9. Subsequently, he presented with biliary sepsis secondary to an infected liver cyst. CA19-9 in the cyst fluid and serum were elevated. On both of these occasions, serum CA19-9 normalised without any clinical or radiological evidence of recurrence.
Discussion:
Despite sound clinical acumen and investigations, it may be hard to differentiate cancer recurrence from benign aetiologies. Benign conditions may cause elevation of CA19-9, even in the setting of previous malignancy. Persistently high CA19-9 level post-decompression raises suspicion of malignancy.
Conclusion:
This case serves as a reminder for clinicians that non-specific increases in CA19-9 after curative surgery is not uncommon. We recommend careful interpretation of CA19-9 levels in combination with clinical history, physical examination and radiological investigations.
Aneurysms of the P2P Segment of Posterior Cerebral Artery: Case Report and Surgical Steps
Authors: Paulo Aguiar, Luana Gatto, Maick Neves, Carlos Martins, Fabio Nakasone, Gustavo Isolan
Journal: Case Rep Med (2014)

The posterior cerebral artery (PCA) is divided into 4 segments: precommunicating segment (P1), postcommunicating segment (P2), quadrigeminal segment (P3), and calcarine segment (P4). Small aneurysms are more prevalent than large aneurysms in patients with ruptured aneurysms. P2 and P3 aneurysms are usually managed by the subtemporal approach. This is a case report of rupture saccular aneurysm of posterior cerebral artery on P2P segment. The authors show the surgical steps of these rare aneurysms with an illustrative case.
Nanofilled composite restorations with different adhesives strategies: clinical cases
Authors: Luana Dutra de Carvalho, Renata Gondo Machado, Guilherme Carpena Lopes, Mauro Caldeira de Andrada
Journal: Case Rep Dent (2012)
MeSH terms: Case Reports

The esthetic procedures with composites are widely applied, both to posterior and anterior teeth to restore caries cavities, to replace failed restorations, or to make cosmetic procedures. The materials selected to each case may make the difference in the clinical result. This paper presents two clinical cases made with a nanofilled composite resin system used in different bond strategies. In the first, a wide posterior class I restoration, the self-etching strategy was used. The second, an esthetic anterior restoration, was made using the prior etching with phosphoric acid and a hydrophobic adhesive.
Neurobrucellosis presenting as an intra-medullary spinal cord abscess
Authors: Girish V Vajramani, Mahantesh B Nagmoti, Chidanand S Patil
Journal: Ann Clin Microbiol Antimicrob (2005)
MeSH terms: Abscess / etiology, Brucella melitensis / isolation & purification, Brucellosis / etiology, Spinal Cord Diseases / etiology, Case Reports, Abscess / drug therapy, Adult, Brucellosis / drug therapy, Female, Humans

Background:
Of the diverse presentation of neurobrucellosis, intra-medullary spinal cord abscess is extremely rare. Only four other cases have been reported so far. We present a case of spinal cord intra-medullary abscess due to Brucella melitensis.
Case presentation:
A forty-year-old female presented with progressive weakness of both lower limb with urinary incontinence of 6 months duration. She was febrile. Neurological examination revealed flaccid areflexic paraplegia with T10 below sensory impairment including perianal region. An intramedullary mass was diagnosed on Magnetic Resonance Image (MRI) scan extending from T12 to L2. At surgery, a large abscess was encountered at the conus medullaris, from which Brucella melitensis was grown on culture. She was started on streptomycin and doxycycline for 1 month, followed by rifampicin and doxycycline for 1 month. At 2-year follow-up, she had recovered only partially and continued to have impaired bladder function.
Conclusion:
Neurobrucellosis, if not treated early, can result in severe neurological morbidity and sequelae, which may be irreversible. Hence it is important to consider the possibility of neurobrucellosis in endemic region and treat aggressively.