OpenMed/multicare-articles huggingface dataset:
A dilemma of a case of Zenker diverticulum; leak or Acinetobacter baumannii?! A case report
Authors: Abdulwahid M Salih, Twana M Ameen, Safeen O Mahmood, Fahmi H Kakamad, Bahman L Fathulla, Tomas M Mikael, Imad J Habibullah, Shvan H Mohammed, Rawezh Q Salih, Suhaib H Kakamad
Journal: Int J Surg Case Rep (2020)
Keywords: acinetobacter baumannii, leak, zenker’s diverticulum
MeSH terms: Case Reports

Introduction:
Zenker's diverticulum is an acquired mucosal pulsion of the upper esophagus. The aim of this paper is to report a case of Zenker's diverticulum with a complicated postoperative course including infection by Acinetobacter baumannii causing diagnostic as well as management dilemma.
Case report:
A 43-year-old male complained from dysphagia for three months. Barium swallow revealed Zenker's diverticulum. Under general anesthesia, the small Zenker's diverticulum was ligated and myotomy was done. He developed erythematous swelling at the site of the operation. The patient was taken to the operation theater. The esophagus was tested, no trace of leak was found. The patient developed cardiac arrest. He was admitted to the intensive care unit and remained there for twenty eight days. Bronchial wash culture showed Acinetobacter baumannii. The patient was on antibiotic, supportive treatment and enteral feeding through nasogastric tube. After recovery he was extubated and barium swallow was done which was normal and showed no signs of leak. Three months after the operation, the patient was completely normal.
Discussion:
This case had a positive culture for Acinetobacter baumannii. It is commonly accounted for nosocomial infections. It has been documented as a serious threat worldwide because of the emerging prevalence of multidrug resistant. However, an inadequate understanding of A. baumannii pathophysiology and ecosystem confines the progress of alternative therapeutic policies. In the current case, it was not clear either leak or Acinetobacter baumannii was the cause of deterioration.
Conclusion:
Both esophageal leak and infection with Acinetobacter baumannii are fulminant debilitating conditions that could be managed with conservative strategies.
Osteogenesis imperfecta Type IV: a newly identified variant at position c.560 (G > T; p.Gly187Val) in the COL1A2 gene
Authors: Akin Usta, Dilay Karademir, Eylem Sen, Selcuk Yazici, Ertan Adali, Erkan Erdem, Meric Karacan
Journal: Pan Afr Med J (2017)
Keywords: col1a2 gene, osteogenesis ιmprefecta, malecular analysis, skeletal dysplasia
MeSH terms: Collagen Type I / genetics, Diphosphonates / administration & dosage, Femur / abnormalities, Osteogenesis Imperfecta / genetics, Case Reports, Adult, Exons, Female, Follow-Up Studies, Humans, Infant, Newborn, Mutation, Osteogenesis Imperfecta / drug therapy, Pregnancy, Collagen Type I, Diphosphonates, Osteogenesis Imperfecta, Type IV

Osteogenesis imperfecta is a clinically heterogenous disease caused by defective collagen syntesis associated with a mutation in the COL1A1 or COL1A2 genes. In this report, we present a case of osteogenesis imperfecta (OI) type IV, seen in a female fetus with incurved femurs at 18 weeks of gestation. Molecular analysis of the newborn revealed a novel mutation at position c.560 (c.560 G > T) of the exon 12 in the COL1A2 gene; which lead to the glycine modification with valine (p.Gly187Val) at codon 187. The pregnancy follow-up was uneventful. After delivery, the newborn underwent biphosponat therapy and no fracture was detected until 1 year old.
Surgical resection of retrohepatic inferior vena cava leiomyosarcoma without vascular reconstruction: case report
Authors: Ian Freire Castro, Paulo Henrique Silva Nunes, Ana Camila Xavier Lopes, Mariana Coelho Lima, Régis Ponte Conrado, Renato Mazon Lima Verde Leal, Annya Costa Araújo de Macedo Goes, Marcelo Leite Vieira Costa
Journal: J Vasc Bras (2023)
Keywords: leiomyosarcoma, retroperitoneal neoplasms, sarcoma, vascular surgical procedures, vena cava inferior
MeSH terms: Case Reports

Inferior vena cava leiomyosarcoma (IVCL) is a rare malignant mesenchymal tumor. Surgical treatment is a challenge because it must combine free surgical margins with vascular reconstruction, using prosthetic or autologous grafts, primary suture, or simple ligation without vein reconstruction. The ligation option is possible thanks to the slow growth of the tumor, allowing collateral venous circulation to develop. We present a case of an IVCL treated with radical resection without vascular reconstruction. The patient was a 48-year-old female with abdominal pain in the right upper quadrant, asthenia, and postprandial dyspeptic symptoms. Abdominal tomography revealed a mass with an expansive formation located in the infrahepatic segment of the inferior vena cava and reduced vessel lumen. During surgery, vein clamping did not provoke hemodynamic repercussions, suggesting sufficient collateral circulation formation. It was decided to perform a radical resection of the entire portion of the retrohepatic vena cava and ligate the vena cava without vascular reconstruction. The patient recovered without complications.
Hemophagocytic Lymphohistiocytosis Secondary to Chronic Lymphocytic Leukemia Progression
Authors: Nina Jancar, Filipa Sousa Gonçalves, José Fragoso Duro, Patrício Aguiar, Catarina Jacinto Correia
Journal: Cureus (2023)
Keywords: b-cell chronic lymphocytic leukemia (b-cll), fever, hemophagocytic lymphohistiocytosis (hlh), hepatomegaly, septic shock
MeSH terms: Case Reports

Hemophagocytic lymphohistiocytosis (HLH) is an acute, rare systemic hyperinflammatory disorder caused by a dysregulated immune cell function and massive cytokine release, often leading to multiple organ involvement and failure. Fever, hepatosplenomegaly, cytopenia, elevated liver enzymes, hypertriglyceridemia, and hyperferritinemia are the hallmarks of the disease. Its primary (genetic) form is typically observed in pediatric patients and its secondary, acquired form is seen in adult patients with an underlying autoimmune, malignant, or infectious disease. It is not frequently reported in patients with chronic lymphocytic leukemia (CLL) without an infectious or pharmacological trigger. We present a case of a 71-year-old patient with hemophagocytic lymphohistiocytosis due to the progression of chronic lymphocytic leukemia.
Ultrasonic Features of Uncommon Congenital Heterotopic Colon and Pancreas in the Neck: An Extremely Rare Case Report
Authors: Yingli Wei, Zhihao Pan, Xiaoling Kang, Cuiqing Huang, Dan Chen
Journal: Front Pediatr (2021)
Keywords: case report, color doppler flow imaging, congenital heterotopic colon, cyst, heterotopic pancreas, ultrasound
MeSH terms: Case Reports

Congenital heterotopic colon and pancreas localized to the neck has not been reported. Herein, we describe an extremely uncommon case of congenital heterotopic colon and pancreas aberrantly presented within a cyst on the neck, and the thickened wall of the cyst on ultrasound may represent an important ultrasonic feature.
Cross-leg as salvage procedure after free flaps transfer failure: a case report
Authors: F Contedini, L Negosanti, E Fabbri, V Pinto, B Tavaniello, R Sgarzani, R Cipriani
Journal: Case Rep Orthop (2012)
MeSH terms: Case Reports

Posttraumatic wounds of the lower leg with soft tissue defects and exposed fractures are a reconstructive challenge due to the scarce availability of local tissues and recipient vessels. Even when a free tissue transfer can be performed the risk of failure remains considerable. When a free flap is contraindicated or after a free flap failure, the cross-leg flap is still nowadays a possible option. We report a case of a male with a severe posttraumatic wound of the lower leg with exposed tibia fracture firstly treated with two consecutive latissimus dorsi muscular free flaps, failed for vascular thrombosis; the coverage was then achieved with a cross-leg flap with acceptable results.
Primary cardiac angiosarcoma
Authors: Dhatri Kodali, Kala Seetharaman
Journal: Sarcoma (2006)
MeSH terms: Case Reports

Primary cardiac sarcoma is a rare clinical entity, with an incidence of 0.0001% in collected autopsy series. The majority of the literature describes a uniformly dismal prognosis with a median survival of only 6 months for these aggressive tumors. Standard surgery, adjuvant chemotherapy, and radiotherapy have been consistently unsuccessful. Early heart transplantation and novel radiation therapy approaches may offer a survival benefit in nonmetastatic tumors, but up to 80% of the patients present with systemic metastasis at diagnosis. Though several chemotherapeutic regimens have been tried, the role of chemotherapy is not well established and outcome data available is minimal. Liposomal doxorubicin (PLD) has been shown to be useful in the treatment of soft tissue sarcomas, and our case supports its use in cardiac angiosarcoma.
Gastric duplication cyst with a red flag presentation: a case report
Authors: Dinesh Alagoo, Harivinthan Sellappan, Jayaprihyan Jayasilan, Nornazirah Azizan, Firdaus Hayati
Journal: Pan Afr Med J (2021)
Keywords: duplication cysts, case report, gastrointestinal bleeding, hypergastrinaemia
MeSH terms: Cysts / diagnosis, Gastrointestinal Hemorrhage / etiology, Stomach / abnormalities, Case Reports, Adult, Cysts / congenital, Cysts / surgery, Endoscopy, Gastrointestinal, Female, Gastrointestinal Hemorrhage / diagnosis, Gastrointestinal Neoplasms / diagnosis, Gastrointestinal Stromal Tumors / diagnosis, Humans, Stomach / surgery

Gastric duplication cyst (GDC) is a rare congenital malformation of the gastrointestinal (GI) tract. Despite being benign in the entity, its complications vary from an asymptomatic abdominal mass to fulminant or massive GI bleeding. A 28-year-old lady presented with unexplained GI haemorrhage, in which the upper endoscopy showed a classic feature of GI stromal tumour. The preoperative diagnosis was also confirmed by the computed tomography. She subsequently underwent surgical resection and the final histopathology was consistent with a benign entity of GDC.
Type 1 diabetes recurrence after SARS-CoV-2 infection in a subject with pancreas transplantation
Authors: Valentina Popolla, Alessandro Rizzi, Linda Tartaglione, Alfredo Pontecorvi, Dario Pitocco
Journal: Endocrinol Diabetes Metab (2023)
MeSH terms: COVID-19, Diabetes Mellitus, Type 1 / complications, Diabetes Mellitus, Type 1 / diagnosis, Hyperglycemia / etiology, Pancreas Transplantation / adverse effects, Case Reports, Female, Humans, Insulin, Insulin, Regular, Human, Middle Aged, Pandemics, SARS-CoV-2, Insulin, Insulin, Regular, Human

Background:
During COVID-19 pandemic, several studies have demonstrated a strong link between SARS-CoV-2 infection and diabetes mellitus. Hyperglycaemia is a frequent event during the infection, also in patients without a history of diabetes. Furthermore, several cases of diabetic ketoacidosis during COVID-19 disease have been described. No data are available about the effects of SARS-CoV-2 infection on glycaemic control in pancreas transplant patients.
Case presentation:
A 45-year-old woman affected by type 1 diabetes mellitus was treated with kidney-pancreas transplantation in 2015, 6 years before COVID-19 infection. After transplantation, insulin therapy was stopped with a good glycaemic control during the following years.After SARS-CoV-2 infection, she developed severe hyperglycaemia requiring insulin therapy again. During the acute phase of the infection, the detection of antibodies against islet cells (ICA) and against glutamic acid decarboxylase (GAD) was found positive.
Conclusions:
The onset of hyperglycaemia after SARS-CoV-2 infection might be the result of a direct virus-induced toxicity or the effect of a virus-mediated activation of autoimmunity.
Successful management of a gastric sleeve leak with an endoscopic stent
Authors: Albin Abraham, Kaleem Rizvon, Jaspreet Singh, Ghulam Siddiqui, Apsara Prasad, Sadat Rashid, Magdalene Vardaros, Vikas Garg, Krishnaiyer Subramani, Paul Mustacchia
Journal: Case Rep Gastrointest Med (2012)
MeSH terms: Case Reports

Laparoscopic sleeve gastrectomy has been a recently developed technique for treating morbid obesity. Gagner and Patterson performed the first laparoscopic sleeve gastrectomy as part of a duodenal switch procedure at Mount Sinai Hospital in New York in 1999. Since then many surgeons and institutions have adopted this technique. One of the most dreaded complications of sleeve gastrectomy is a leak along the staple line. We present the case of a 23-year-old female with gastric sleeve leak managed successfully with a fully covered wall flex stent. Our aim is to examine the incidence, causes, classification, and presentation of gastric sleeve leaks and to evaluate the use of endoscopic stents in its management.
Island Posterior Thigh Flap Revisited in Covering Extensive Sacral Wounds: Our Experience with Two Patients
Authors: F Nangole Wanjala, Ajujo Martin
Journal: Case Rep Surg (2017)
MeSH terms: Case Reports

Deep sacral wounds are best covered by flaps. Posterior thigh flaps have routinely been used to cover such wounds. The flap can however be modified as an island flap. Two patients with extensive sacral wounds were managed with island posterior thigh flaps. Both patients were admitted secondary to road traffic accident with subsequent soft tissue loss of the sacral area. The sacral defects in both patients were approximately 17 cm by 23 cm in dimensions. Unilateral island posterior thigh flap was raised and used to cover the wounds. Postoperatively both patients did well; the donor site and recipient sites healed without any complications. Island posterior thigh flap is thus an option in covering extensive defects of the sacral area. The flap is reliable and easy to raise and has minimal donor site morbidity. By raising it as an island flap the dog ear defect is avoided and the flap is able to be tunneled under the gluteal muscle. This maneuver enables the flap to be advanced further allowing it to cover more distal and extensive defects.
Have we got the optimal treatment for refractory Kawasaki disease in very young infants? A case report and literature review
Authors: Robert Lersch, Guido Mandilaras, Meike Schrader, Felicitas Anselmino, Nikolaus A Haas, André Jakob
Journal: Front Pediatr (2023)
Keywords: kawasaki disease, coronary artery aneurysm, inflammation, tumor-necrosis-factor-alpha inhibitor, young infant
MeSH terms: Case Reports

A small group of patients with Kawasaki disease (KD) demonstrates resistance to standard therapy, putting them at high risk for an unfavorable prognosis, especially regarding coronary artery aneurysms. Although adding corticosteroids to first-line i.v. immunoglobulins (IVIGs) is considered beneficial, and despite timely treatment initiation, very young infants, in particular, can present an unfavorable clinical course. We report on a 3-month-old boy with a clinically severe KD phenotype involving the early development of giant coronary artery aneurysms. Because of his poor response to the first course of IVIG and prednisolone, we administered infliximab. His clinical condition improved after that, and his temperature dropped. Inflammatory markers however did not recover completely, and he remained subfebrile. In addition, as the coronary artery dimensions deteriorated, a second IVIG course was administered and prednisolone continued at the initial dosage. Although fever and routine inflammatory parameters normalized, close follow-up investigations revealed both still increasing coronary artery dimensions and renewed rise in inflammatory parameters, necessitating two more infliximab administrations in addition to continuous prednisolone. Because of the coronary artery dimensions (left anterior descending artery, 4.9 mm, Z-score 11.1; right coronary artery 5.8 mm, Z-score 15.5), dual platelet inhibitory therapy with ASA and later clopidogrel combined with low-molecular heparin was indicated. Four weeks after his initial KD diagnosis, we detected no renewed increase in inflammatory markers; at that time, we observed a slight reduction in coronary dimensions. In summary, despite timely guideline-fulfilling therapy, the prolonged clinical course of this very young infant with KD entailing the development of giant coronary artery aneurysms makes us question whether this age group may benefit from early, even more intense therapy.
Case report: A rare Salter-Harris V metaphyseal fatigue fracture of the knee in an adolescent patient with obesity
Authors: Chao Gao, Ling Le Feng, Jiang Hua Zheng, Jin Cao, Hua Jing Sun
Journal: Front Pediatr (2023)
Keywords: salter v fracture, fatigue fracture, metaphysis, obese adolescent, operative treatment
MeSH terms: Case Reports

Stress fractures are rare, occurring in 1.5/100,000 high school athletes. High impact, repetitive loading participation in woman's sports, and being a white athlete have been identified as risk factors for stress fractures. Mostly treated conservatively, they are more common in the tibia (33%). Stress fractures requiring surgery, which are extremely rare, have been reported in the scaphoid, fifth metatarsal, and neck of femur. Herein, a 16-year-old adolescent patient with obesity presented with atypical knee pain after prolonged exercise. Advanced imaging revealed a stress fracture of the left tibia with a Salter-Harris type V fracture and varus deformity of the knee. We initially managed the fatigue fracture conservatively, followed by surgical correction of the varus deformity in the knee joint. The patient made a satisfactory recovery with equal limb length and no evidence of claudication. This is the first case of a proximal tibial metaphyseal stress fracture requiring surgery. The clinical manifestations of proximal tibial metaphyseal stress fractures and potential treatment strategies and the use of magnetic resonance for tibial stress fractures have been discussed. Understanding the location of unusual stress fractures can improve early diagnostic efficiency and reduce complication rates, healthcare costs, and recovery time.
Identification of two near-identical novel HIV-1 unique recombinant forms (CRF01_AE/B) among men who have sex with men in baoding, hebei, China
Authors: Binbin Zhang, Sisi Chen, Juan Meng, Miaomiao Su, Weiguang Fan, Weina An, Xinli Lu
Journal: Front Genet (2023)
Keywords: hiv, msm, baoding, near full-length genome, unique recombination forms
MeSH terms: Case Reports

Men who have sex with men (MSM) are the most frequent infection route of the human immunodeficiency virus (HIV) in Baoding, China, creating chances for the occurrence of unique recombinant forms (URFs) of the virus, i.e., recombination of different subtypes caused by co-circulation of multiple subtypes. In this report, two near-identical URFs (BDD002A and BDD069A) isolated from MSM in Baoding were identified. Phylogenetic tree analysis based on nearly full-length genomes (NFLGs) revealed that the two URFs formed a distinct monophyletic cluster with a bootstrap value of 100%. Recombinant breakpoints analysis identified that the NFLGs of BDD002A and BDD069A were both composed of CRF01_AE and subtype B, with six subtype B mosaic segments inserted into the CRF01_AE backbone. The CRF01_AE segments of the URFs clustered closely with the CRF01_AE reference sequences, and the B subregions clustered with the B reference sequences. The recombinant breakpoints of the two URFs were almost identical. These results suggest that effective interventions are urgently needed to prevent the formation of complex HIV-1 recombinant forms in Baoding, China.
Case Report: An extremely rare occurrence of recurrent inguinal low-grade fibromyxoid sarcoma involving the scrotum
Authors: Samy Chitayat, Rodrigo Barros, José Genilson Ribeiro, Heleno Augusto Moreira Silva, Flávio Rondinelli Sá, Bruno de Souza Bianch Reis, Angelo Maurilio Fosse Junior
Journal: F1000Res (2020)
Keywords: low-grade fibromyxoid sarcoma, sarcoma, scrotum sarcoma
MeSH terms: Fibrosarcoma / surgery, Scrotum / pathology, Soft Tissue Neoplasms / surgery, Case Reports, Adult, Fibrosarcoma / pathology, Humans, Male, Scrotum / surgery, Soft Tissue Neoplasms / pathology

Low-grade fibromyxoid sarcoma (LGFMS) is a rare sarcoma subtype. The most common tumor locations are the deep soft tissue of extremities or trunks. We report a rare case of recurrent LGFMS in the inguinal region involving the scrotum and both testicles. A 38-year-old male patient reported a history of multiple nodular lesions in the left inguinal region accompanied by local inflammation. The patient was submitted for local resection of the lesion at our institution, with histopathological diagnosis of LGFMS. He missed his follow-up, returning with a large bulge in the left inguinal region involving the scrotum with signs of tissue necrosis and local purulent discharge. Surgical exploration was performed and the patient underwent tumor resection in the left inguinal region and the entire scrotum, with bilateral orchiectomy, with the margins enlarged to the right inguinal region and proximal surface of the penis. Local reconstruction was performed with a left fascia lata tensor muscle flap and ipsilateral thigh coverage using partial skin graft. On microscopic examination, the tumor showed spindle cells arranged in bundles, with abundant collagen and myxoid stroma with interspersed prominent vessels. The immunohistochemical study carried out showed immunoreactivity with Ki67 (<5%), immunonegativity with desmin and S100, confirming the diagnosis of LGFMS. Postoperative recovery was good and no recurrence was seen after two years. The patient is in good health, realizing multidisciplinary outpatient follow-up and performing continuous testosterone replacement. Surgical resection with negative margins for localized disease remains the standard treatment for LGFMS.
Right Atrial Thrombus in Transient in a COVID-19 Patient: Clinical Echocardiographic Features-Case Report and Literature Review
Authors: Cheikh A Abool Maaly, Jassim Al Suwaidi, Mohamad Yahya Khatib, Hakam Alzaeem
Journal: SN Compr Clin Med (2020)
Keywords: covid-19, pulmonary embolism, right atrial thrombus, right heart failure

A 54-year-old male is admitted with COVID-19 pneumonia and received prophylactic anticoagulation. On day 8, the patient rapidly deteriorated requiring urgent endotracheal intubation. Transthoracic echocardiography revealed large right atrial thrombus in transient, resulting in pulmonary embolism and severe RV failure; fibrinolytic therapy was not effective and the patient passed away.
Plexiform Neurofibroma of the Posterior Tibial Nerve Misdiagnosed as Proximal Tarsal Tunnel Syndrome: A Case Report
Authors: Sang Hyun Nam, Jung Yeon Kim, Jaeki Ahn, Yongbum Park
Journal: Surg J (N Y) (2018)
Keywords: tinel's sign, neurofibroma, tarsal tunnel syndrome
MeSH terms: Case Reports

Plexiform neurofibromas of the foot are rare, benign tumors of the peripheral nerves. Diagnosis can be challenging if they present with symptoms mimicking other peripheral nerve pathologies. Tarsal tunnel syndrome is an entrapment syndrome of the entire tibial nerve behind the medial malleolus and under the flexor retinaculum. The clinical presentation typically includes posteromedial pain, positive Tinel's sign, and neurogenic signs, including both the sensation of numbness and the actual hypoesthesia and clawing of the toes. Here, we report the case of a 59-year-old female patient with plexiform neurofibroma with symptoms similar to those of tarsal tunnel syndrome. The plexiform neurofibroma was surgically excised and the nerve function was partially preserved.