OpenMed/multicare-articles huggingface dataset:
Unusual Case of Urethrorectal Fistula in Adolescence in a Patient with a History of Congenital Anorectal Malformation
Authors: Constantinos Nastos, Ira Sotirova, Athanasios Papatsoris, Andreas Skolarikos, Ioannis Papaconstantinou, Athanasios Dellis
Journal: J Endourol Case Rep (2016)
MeSH terms: Case Reports

Background:
Urethrorectal fistula is a rare and debilitating condition. Spontaneous closure is rarely effective, and appropriate management regarding timing of repair and surgical approach remains controversial.
Case presentation:
We present a case of an 18-year-old male found to have a urethrorectal fistula after diagnostic work up for unejaculation. The patient gradually developed recurrent urinary tract infections and urine and semen leak from his rectum. He had a medical history of an anorectal reconstruction in the second postnatal day due to an anorectal malformation. Imaging with a rectal endoscopic ultrasound scan revealed a suprasphincteric urethrorectal fistula that was further confirmed with semirigid urethrocystoscopy and placement of a nitinol guidewire through the urethral fistula orifice. Its anal orifice was 3 cm above the anal verge at the 12th hour of the rectum. The fistula orifice on the rectum was identified with a transanal approach and the fistula was managed with the performance of an advancement mucosal flap and bladder catheterization. The patient developed a recurrence with this approach and finally underwent fistula ligation and reconstruction using a scrotal flap. The patient has not had a recurrence of the fistula during his follow-up.
Conclusion:
This is an unusual case of iatrogenic urethrorectal fistula as it presented in adolescence many years from the initial operation of anorectal reconstruction and with unusual symptoms.
Imaging of Accidental Contamination by Fluorine-18 Solution: A Quick Troubleshooting Procedure
Authors: Kalevi Kairemo, Aki Kangasmäki
Journal: Asia Ocean J Nucl Med Biol (2016)
Keywords: f-18, quantitative gamma imaging, radio fluorine uptake, radiopharmaceutical preparation, skin contamination
MeSH terms: Case Reports

To the best of our knowledge, imaging of accidental exposure to radioactive fluorine-18 (F-18) due to liquid spill has not been described earlier in the scientific literature. The short half-life of F-18 (t½=110 min), current radiation safety requirements, and Good Manufacturing Practice (GMP) regulations on radiopharmaceuticals have restrained the occurrence of these incidents. The possibility of investigating this type of incidents by gamma and positron imaging is also quite limited. Additionally, a quick and precise analysis of radiochemical contamination is cumbersome and sometimes challenging if the spills of radioactive materials are low in activity. Herein, we report a case of accidental F-18 contamination in a service person during a routine cyclotron maintenance procedure. During target replacement, liquid F-18 was spilled on the person responsible for the maintenance. The activities of spills were immediately measured using contamination detectors, and the photon spectrum of contaminated clothes was assessed through gamma spectroscopy. Despite protective clothing, some skin areas were contaminated, which were then thoroughly washed. Later on, these areas were imaged, using positron emission tomography (PET), and a gamma camera (including spectroscopy). Two contaminated skin areas were located on the hand (9.7 and 14.7 cm2, respectively), which showed very low activities (19.0 and 22.8 kBq respectively at the time of incident). Based on the photon spectra, F-18 was confirmed as the main present radionuclide. PET imaging demonstrated the shape of these contaminated hot spots. However, the measured activities were very low due to the use of protective clothing. With prompt action and use of proper equipments at the time of incident, minimal radionuclide activities and their locations could be thoroughly analyzed. The cumulative skin doses of the contaminated regions were calculated at 1.52 and 2.00 mSv, respectively. In the follow-up, no skin changes were observed in the contaminated areas.
Focal Intramucosal Adenocarcinoma Occurring in Gastric Hyperplastic Polyps Treated with Endoscopic Mucosal Resection
Authors: Jéssica Alférez-Andía, Harold Benites-Goñi, Fernando Palacios-Salas
Journal: Case Rep Gastrointest Med (2018)
MeSH terms: Case Reports

Hyperplastic polyps are the most frequent benign epithelial gastric polyps. Although they are considered nonneoplastic, some cases have been reported with focal adenocarcinoma. We present the case of a 59-year-old woman with a sessile lesion of 15 mm on the distal gastric body associated with an extensive atrophic gastritis. Magnifying endoscopy with Fuji Intelligent Color Enhancement (FICE) revealed an irregular microsurface pattern at the apex, suggesting malignancy. A mucosectomy was performed. The histopathology revealed that the base corresponded to a hyperplastic polyp, where a tubular adenoma with high-grade dysplasia was established, with focal well-differentiated intramucosal tubular adenocarcinoma.
Occult Perforation of the Esophagus during Removal of an Enteral Feeding Tube: A Case Report and Literature Review
Authors: Mohammad Alabdallat, Gustav Strandvik, Ibrahim Afifi, Ruben Peralta, Ashok Parchani, Ayman El-Menyar, Sandro Rizoli, Hassan Al-Thani
Journal: Case Rep Surg (2023)
MeSH terms: Case Reports

Background. The use of oral or nasal route for enteral feeding is a standard practice in intensive care patients with a safe profile in general. However, complications associated with the insertion of a nasogastric (NGT) or orogastric tube (OGT) are common in the medical literature compared to the removal of such tubes. Case presentation. We presented a 38-year-old male who was involved in a motor-vehicle collision and found with low Glasgow Coma Scale outside his vehicle. He had polytrauma and was intubated-and commenced on enteral feeding via an OGT. Esophageal bezoar developed within a few days around the feeding tube, resulting in significant force being required to remove it, which was complicated by esophageal perforation. The esophageal injury was treated conservatively with uneventful recovery. Discussion and conclusions. Although limited case reports of esophageal enteral feeding bezoar formation do exist in the literature, we believe that this is the first case report of esophageal perforation due to the forceful removal of a wedged OGT secondary to esophageal bezoar formation. Morbidity associated with OGT/NGT is not common and may require a high index of suspicion to be identified. This is especially true if resistance is appreciated while removing the NGT/OGT. Gastroenterology consultation is recommended as early as possible to detect and manage any complications, however, their role was very limited in such stable case. In addition, early computed tomography (CT) can be considered for timely recognition of esophageal perforation. Non-operative management may be considered in stable patients, especially if the leak is in the cervical portion of the esophagus. Finally, prevention is better than cure, so being diligent in confirming NGT/OGT position, both radiologically and by measuring the tube length at the nostril/mouth, is the key to avoid misplacement and complication. This case raises the awareness of physician for such preventable iatrogenic event.
Ultrasound Diagnosis of a Retained Migrated Foreign Body Following Penetrating Injury to The Upper Thigh in a Child: A Case Report Demonstrating an Underused Indication for Diagnostic Ultrasound
Authors: Alexander Sheeka, Richard Jenkins, Sufi Sadigh, Nicholas Alexander, Afshin Alavi
Journal: POCUS J (2022)
Keywords: delayed diagnosis, emergency ultrasound, penetrating trauma, retained foreign body
MeSH terms: Case Reports

We present a case of delayed diagnosis of retained glass foreign body in the inguinal region of a child using ultrasonography following penetrating trauma to the upper thigh. The foreign body had traversed significantly by the time of diagnosis, from the medial upper thigh to the inguinal region at the level of the inguinal ligament. Ultrasound can be an effective initial imaging modality for the diagnosis of foreign bodies in children, allowing the potential to reduce ionizing radiation exposure.
A Novel Cause of Biliary Peritonitis after Endoscopic Retrograde Cholangiopancreatography: Case Report and Literature Review
Authors: Andrija Karačić, Paula Batur, Domagoj Štritof, Taro Fukui, Branko Bakula, Inka Kekez
Journal: Case Rep Gastrointest Med (2021)
MeSH terms: Case Reports

Background:
Endoscopic retrograde cholangiopancreatography (ERCP) can lead to several complications such as duodenal or bile duct perforation. The incidence of pneumoperitoneum post-ERCP is rarely seen (<1%) and is associated with perforations of the duodenum or common bile duct in therapeutic ERCP after sphincterotomy. In this case, we disclose a novel cause of biliary peritonitis after ERCP. Case Presentation. A 65-year-old man presented with abdominal pain and distended abdomen after uneventful ERCP with sphincterotomy. An abdominal computed tomography (CT) was performed whose finding indicated duodenal perforation. The patient was rushed to an emergency laparotomy where only a rupture of an otherwise normal subcapsular intrahepatic bile duct was found. The surrounding liver parenchyma was healthy. The cause of this condition was probably post-ERCP pneumobilia and the increase of pressure in the biliary tract.
Conclusions:
This is the first case in literature describing the rupture of a subcapsular healthy bile duct as cause of biliary peritonitis after ERCP. This case also suggests that in the management of post-ERCP complications, the cooperation of radiologists and surgeons is vital for the patient's wellbeing.
[Vocal fold paralysis in children: diagnostic and management from a case report]
Authors: Romualdo Suzano Louzeiro Tiago, Sandra Jager Patrocínio, Patricya Santos Figueiredo dos Anjos, Juparethan Trento Ribeiro, Fábio Marangoni Gil, Flávia Villin Denunci
Journal: Braz J Otorhinolaryngol (2005)
MeSH terms: Heart Defects, Congenital / surgery, Vocal Cord Paralysis / diagnosis, Case Reports, English Abstract, Child, Ductus Arteriosus, Patent / complications, Ductus Arteriosus, Patent / surgery, Dyspnea / etiology, Female, Humans, Infant, Newborn, Infant, Premature, Laryngoscopy, Perioperative Care, Postoperative Care, Respiratory Sounds / etiology, Vocal Cord Paralysis / etiology

Vocal fold paralysis accounts for 10% of the larynx congenital abnormality, being the second most common cause of laryngeal stridor in childhood. As to unilateral vocal fold paralysis, the main cause is left-sided iatrogenic injury to the recurrent laryngeal nerve, secondary to surgery to correct the patent ductus arteriosus. In this study we reviewed the literature, reporting a case of a child who, after having undergone surgery to close the patent ductus arteriosus, evolved with breathing difficulty and dysphonia. We suggest that flexible fiberoptic laryngoscopy is carried out pre- and post surgery in children for whom heart surgery to correct congenital abnormalities is indicated, thus allowing for early diagnosis of vocal fold paralysis and the selection of the best management approach.
Case report: Recurrent lung infections following treatment with pralsetinib for an elderly patient with RET-fusion positive NSCLC
Authors: Li An, Pengzhi Chen, Junfeng Wang, Xuebing Qin, Tingting Liu, Yanhong Gao, Peng Wang, Dong Zhang, Xiangqun Fang, Zhijian Zhang
Journal: Front Oncol (2022)
Keywords: ret-fusion, cryptococcal pneumonia, lung cancer, pralsetinib, pulmonary abscess
MeSH terms: Case Reports

Patients with RET fusions represent 1-2% of all cases of non-small cell lung cancer (NSCLC), the majority of whom are younger, and are extremely rare in the elderly. As a selective RET inhibitor, pralsetinib has been shown to be efficacious and well-tolerated in patients with RET-fusion NSCLC. Nevertheless, there are currently insufficient data available for assessing the activity and safety of pralsetinib in elderly patients with NSCLC. Herein, we report an 81-year-old NSCLC patient with KIF5B-RET fusion, who achieved stable disease for more than 9 months at a low-dose of pralsetinib as second-line therapy. Of particular note, during pralsetinb therapy, his clinical course was complicated by cryptococcal pneumonia and staphylococcus aureus lung abscess. Our study demonstrates that pralsetinib is an effective therapeutic option that provides survival benefits for elderly NSCLC patients harboring RET fusion. However, during pralsetinb therapy, treating physicians should maintain particular vigilance for the increased risk of infection, especially in elderly patients.
Safety and efficacy of rituximab treatment for vasculitis in hepatitis B virus-associated type II cryoglobulinemia: a case report
Authors: Florian Pasquet, François Combarnous, Brigitte Macgregor, Brigitte Coppere, Christelle Mausservey, Jacques Ninet, Arnaud Hot
Journal: J Med Case Rep (2012)

Introduction:
Systemic B-cell depletion and clinical remission of the systemic effects of cryoglobulins have already been achieved using rituximab in hepatitis C virus-positive immunocompetent patients. Conversely, to the best of our knowledge there are no reports in the literature regarding the use of rituximab in hepatitis B virus-associated cryoglobulinemia.
Case presentation:
We report here the case of a 60-year-old Caucasian man who presented with hepatitis B virus-associated type II cryoglobulinemia with severe multisystem disease, including membranoproliferative glomerulonephritis with acute renal failure. The vasculitis was refractory to conventional and antiviral therapy but rituximab use led to a fall in cryoglobulin levels and disease control. The B-cell depletion was safe and efficient to induce a complete remission of the disease.
Conclusion:
Our case highlights the benefit and the efficacy of rituximab in association with antiviral therapy in small vessel vasculitis related to hepatitis B virus-associated mixed cryoglobulinemia.
Institutionalizing provider-initiated HIV testing and counselling for children: an observational case study from Zambia
Authors: Jane N Mutanga, Juliette Raymond, Megan S Towle, Simon Mutembo, Robert Captain Fubisha, Frank Lule, Lulu Muhe
Journal: PLoS One (2012)
MeSH terms: Counseling / statistics & numerical data, HIV Infections / diagnosis, Mass Screening / statistics & numerical data, Nurses, Research Support, Non-U.S. Gov't, Anti-HIV Agents / therapeutic use, Epidemics, HIV Infections / epidemiology, HIV Infections / therapy, Health Services Accessibility, Humans, Infant, Infant, Newborn, Molecular Diagnostic Techniques, Polymerase Chain Reaction, Quality Improvement, Zambia / epidemiology, Anti-HIV Agents

Background:
Provider-initiated testing and counselling (PITC) is a priority strategy for increasing access for HIV-exposed children to prevention measures, and infected children to treatment and care interventions. This article examines efforts to scale-up paediatric PITC at a second-level hospital located in Zambia's Southern Province, and serving a catchment area of 1.2 million people.
Methods and principal findings:
Our retrospective case study examined best practices and enabling factors for rapid institutionalization of PITC in Livingstone General Hospital. Methods included clinical observations, key informant interviews with programme management, and a desk review of hospital management information systems (HMIS) uptake data following the introduction of PITC. After PITC roll-out, the hospital experienced considerably higher testing uptake. In a 36-month period following PITC institutionalization, of total inpatient children eligible for PITC (n = 5074), 98.5% of children were counselled, and 98.2% were tested. Of children tested (n = 4983), 15.5% were determined HIV-infected; 77.6% of these results were determined by DNA polymerase chain reaction (PCR) testing in children under the age of 18 months. Of children identified as HIV-infected in the hospital's inpatient and outpatient departments (n = 1342), 99.3% were enrolled in HIV care, including initiation on co-trimoxazole prophylaxis. A number of good operational practices and enabling factors in the Livingstone General Hospital experience can inform rapid PITC institutionalization for inpatient and outpatient children. These include the placement of full-time nurse counsellors at key areas of paediatric intake, who interface with patients immediately and conduct testing and counselling. They are reinforced through task-shifting to peer counsellors in the wards. Nurse counsellor capacity to draw specimen for DNA PCR for children under 18 months has significantly enhanced early infant diagnosis. The hospital's bolstered antiretroviral supply chain, package of on-site HIV services, and follow-up care for children and families improved the continuum of service uptake.
Conclusions and significance:
The clinical impact and operational experience emphasizes that institutional PITC is a feasible strategy for increasing access to paediatric HIV care, particularly in generalized epidemic settings.
Rare Presentation of Small Bowel Obstruction Secondary to Intestinal Leiomyoma in a Patient with Crohn's Disease
Authors: Benjamin J Behers, Brett M Behers, Ryan C Perez, Kabir Grewal, Joe Cyriac, Joanne Makar, Russell W Novak
Journal: Case Rep Surg (2023)
MeSH terms: Case Reports

Small bowel obstructions (SBOs) are surgical emergencies that can occur with mechanical blockage of the intestinal lumen. These blockages are most commonly caused by adhesions or hernias, but can also result from intestinal neoplasms. This case report documents the rare occurrence of SBO due to a submucosal leiomyoma. This case was complicated by the patient's longstanding history of Crohn's disease, which has a considerable overlap in symptomatology with SBOs. This may have resulted in a delay in the patient's diagnosis. Leiomyomas should always be considered as a potential, albeit rare, cause of SBO.
Early Onset Prosthetic Joint Infection and Bacteremia due to Campylobacter fetus Subspecies fetus
Authors: Igor Dumic, Mohan Sengodan, Joni J Franson, Diego Zea, Poornima Ramanan
Journal: Case Rep Infect Dis (2017)
MeSH terms: Case Reports

Campylobacter fetus is a zoonotic pathogen that occasionally causes serious, relapsing, invasive disease, especially in immunocompromised hosts. We report a case of relapsing C. fetus diarrheal illness in a 75-year-old woman which resulted in secondary bacteremia and seeding of the left knee prosthetic joint. Patient responded favorably to debridement and retention of prosthesis in addition to six weeks of meropenem followed by chronic oral doxycycline suppressive therapy.
Multiple stage tissue expansion for reconstruction of scalp nevocellular nevus in pediatric age group
Authors: Hiba AlBurshaid, Yasir Ali Alshehri, Lamya AlAbdulrahman, Reem AlJehani, Hussein Fadaak
Journal: GMS Interdiscip Plast Reconstr Surg DGPW (2019)
MeSH terms: Case Reports

Aim: To present a rare case of giant congenital nevocellular nevus in a 7-year-old girl's scalp and to highlight our management steps and outcomes. Case description: An otherwise healthy 7-year-old girl presented to plastic surgery clinic with a giant congenital nevus (GCN) that covered almost her entire scalp that was treated successfully with tissue expander three times over a period of 14 months. A total of 34 cm width of skin, which comprised 78% of the patient's scalp, was removed. The patient was reassessed five years later with a great cosmetic outcome represented by a remarkable hair growth and near normal scalp appearance. Conclusion: Giant scalp nevocellular nevi in pediatric age group can be treated completely with tissue expanders more than twice to achieve near normal outcomes.
A 66-Year-Old Female with Apical Hypertrophic Cardiomyopathy Presenting with Hypertensive Crises and Type 2 Myocardial Infarction and a Normal Coronary Angiogram
Authors: Vineet Meghrajani, Karan Wats, Abhinav Saxena, Bilal Malik
Journal: Case Rep Cardiol (2018)
MeSH terms: Case Reports

A 66-year-old female presented to the emergency room with an episode of chest pain that lasted for a few minutes before resolving spontaneously. Electrocardiogram showed a left bundle branch block, left ventricular hypertrophy, and T wave inversions in the lateral leads. Initial cardiac troponin level was 0.15 ng/ml, with levels of 4 ng/ml and 9 ng/ml obtained 6 and 12 hours later, respectively. The peak blood pressure recorded was 195/43 mmHg. Echocardiogram with DEFINITY showed a small left ventricular cavity with apical hypertrophy, and coronary angiogram showed no stenotic or occluding lesions in the coronary arteries. The patient was admitted for a type 2 myocardial infarction with hypertensive crises. She was diagnosed with having apical hypertrophic cardiomyopathy, which is a variant of hypertrophic cardiomyopathy (HCM) in which the hypertrophy predominantly involves the apex of the left ventricle resulting in midventricular obstruction, as opposed to the left ventricular outflow tract obstruction seen in HCM. Patients with apical HCM may present with angina, heart failure, myocardial infarction, syncope, or arrhythmias and are typically managed with medications like verapamil and beta-blockers for those who have symptoms and antiarrhythmic agents like amiodarone and procainamide for treatment of atrial fibrillation and ventricular arrhythmias. An implantable cardioverter defibrillator (ICD) is recommended for high-risk HCM patients with a history of previous cardiac arrest or sustained episodes of ventricular tachycardia, syncope, and a family history of sudden death.
Improvement in Frailty in a Patient With Severe Chronic Obstructive Pulmonary Disease After Ninjin'yoeito Therapy: A Case Report
Authors: Hirai Kuniaki, Tanaka Akihiko, Homma Tetsuya, Mikuni Hatsuko, Kawahara Tomoko, Ohta Shin, Kusumoto Sojiro, Yamamoto Mayumi, Yamaguchi Fumihiro, Suzuki Shintaro, Ohnishi Tsukasa, Sagara Hironori
Journal: Front Nutr (2018)
Keywords: kampo medicine, ninjin'yoeito therapy, anorexia, chronic obstructive pulmonary disease, frailty
MeSH terms: Case Reports

Frailty is a poor prognostic factor in patients with chronic obstructive pulmonary disease (COPD). Although various studies have assessed the effects of conventional treatment with bronchodilators, nutritional support, and pulmonary rehabilitation for frailty in patients with COPD, none have addressed the effects of traditional Japanese medicine (Kampo medicine). Herein, we report the successful management of frailty using Ninjin'yoeito therapy in a 76-year-old patient with COPD. Despite being prescribed multiple bronchodilators, nutritional supplement therapy, patient education, and pulmonary rehabilitation, the patient exhibited unintentional weight loss, low energy, and low physical activity. Ninjin'yoeito was prescribed and these subjective symptoms began to improve 1 month after treatment initiation. In 6 months, the patient reported no frailty, had increased muscle mass, and had achieved an almost normal healthy state. Ninjin'yoeito has been associated with both physical effects, such as improvement in overall physical strength and appetite, and reduction in fatigue, and psychological effects, such as greater motivation and reduction of depression and anxiety symptoms. Physicians have usually treated COPD primarily with organ-specific treatments, such as bronchodilators; however, addressing both the physiological and psychological vulnerability has been difficult. This case report illustrates the potential usefulness of Ninjin'yoeito treatment for frailty in patients with COPD.