OpenMed/multicare-articles huggingface dataset:
Catheter-Related Right Atrial Endocarditis in a Dialysis Patient
Authors: Maria Inês Ribeiro, Francisco D'Orey, João Prosil Sampaio, João Grade Santos, Vera Pereira
Journal: Cureus (2024)
Keywords: chronic kidney disease, echocardiogram (echo), hemodialysis access, infective endocarditis, right atrial mass, transoesophageal echo
MeSH terms: Case Reports

Hemodialysis catheters are frequently used for vascular access in end-stage chronic kidney disease patients lacking mature arteriovenous fistula. The incidence of infective endocarditis in hemodialysis patients is higher than in the general population and is associated with severe and potentially life-threatening complications. A high index of suspicion is imperative for early diagnosis and timely intervention to enhance the prognosis of this high-mortality condition. Imaging studies, like transthoracic and transesophageal echocardiography, are crucial for prompt diagnosis. We present a case of a 36-year-old woman undergoing hemodialysis, whose prolonged use of a permanent catheter led to the development of infective endocarditis complicated with septic pulmonary embolism. Our case report presents an example of right atrial endocarditis with a poor outcome due to delayed diagnosis.
Reconstruction of Gingival Mask around CAD-CAM Bar and Ball Attachment in Implant-Retained Overdenture
Authors: Samira Naybandi Atashi, Somayeh Zeighami
Journal: Case Rep Dent (2024)
MeSH terms: Case Reports

Gingival mask is a copy of the peri-implant tissue, which plays an important role in the fabrication of an optimal restoration. Losing the gingival mask is a clinical problem that complicates the process of restoration fabrication. Herein, a simple precise technique is described step by step to solve this problem in the patient with CAD/CAM milled bar and ball attachment treatment plan for a maxillary and a mandibular implant-supported overdenture, without the need to repeat the entire clinical and laboratory procedures.
Effective control of postoperative recurrence of pregnancy-related gastric cancer using anti-PD-1 as a monotherapy: a case report
Authors: Xu Liu, Xiaoqi Li, Chunchao Zhu, Linhua Ji
Journal: Front Oncol (2024)
Keywords: anti-pd-1, immunotherapy, monotherapy, pregnancy-related gastric cancer, tumor recurrence
MeSH terms: Case Reports

Pregnancy-related gastric cancer is characterized by a refractory nature and poor prognosis; few gastric cancer cases during pregnancy achieved acceptable outcomes by using anti-PD-1 as a monotherapy. A 32-year-old pregnant female patient was admitted to the emergency department of the obstetrics and gynecology department and eventually diagnosed with gastric cancer. Radical surgery for gastric cancer was conducted after the termination of pregnancy. At 1-year postoperative follow-up, tumor recurrence was revealed. This patient has achieved a decrease in tumor burden after receiving anti-PD-1 as a monotherapy. This case documents tumor response to PD-1 monotherapy in pregnancy-related gastric cancer and highlights the potential for future use in specific clinical scenarios.
Unraveling the Enigma of Managing a Large Periapical Lesion: A Case Report
Authors: Mrinal Nadgouda, Aditya Patel, Manoj Chandak, Anuja Ikhar, Swayangprabha Sarangi
Journal: Cureus (2024)
Keywords: apicoectomy, miniplate, odontogenic tumor, screw, surgical endodontics
MeSH terms: Case Reports

This case report documents the diagnosis and successful management of a substantial periapical lesion located in the lower left region of the jaw. The patient presented with clinical symptoms indicative of periapical pathology, and radiographic examination revealed an extensive radiolucent lesion. The chosen treatment approach involved endodontic intervention coupled with surgical decompression, leading to the resolution of the lesion and restoration of oral health. This case underscores the significance of an accurate diagnosis and a multidisciplinary treatment approach in addressing large periapical lesions.
The Clue is in the Eyes. A Case Report of Internuclear Ophthalmoplegia
Authors: Cooper Nickels, Christy Keyes, Caroline Astemborski, Haley Fulton
Journal: J Educ Teach Emerg Med (2024)

The chief complaint of vertiginous symptoms can be daunting, and the differential is quite long. Approximately 15% of patients presenting to the emergency department (ED) with dizziness have a dangerous underlying cause.1 We present a case of a 40-year-old female with a sudden onset of what she describes as vertigo, in the setting of intermittent diplopia. The patient was found to have a left medial rectus palsy consistent with a left internuclear ophthalmoplegia. Internuclear ophthalmoplegia (INO) is an abnormal gaze that is characterized by the weakness or inability to adduct the affected eye. This occurs secondary to a lesion in the brain affecting the medial longitudinal fasciculus (MLF) most commonly in the pons; however, this pathway can also be affected in the midbrain.2 The diagnosis in our patient was confirmed after an MRI revealed an acute infarct of the left dorsal pons involving the medial longitudinal fasciculus, resulting in the observed left INO. The patient was admitted to the hospitalist service with neurology consultation for further stroke workup. Ultimately, the stroke was deemed cryptogenic in etiology with hyperlipidemia and obesity as the patient's risk factors. She was discharged home after three days in the hospital on daily aspirin and high-intensity statin. Upon six-month follow up she had near resolution of her symptoms.
Topics:
Internuclear Ophthalmoplegia, INO, Vertigo, Stroke, Neurology.
Giant Patent Ductus Arteriosus Aneurysm Compressing the Esophagus
Authors: Soichiro Henmi, Chikashi Nakai, So Izumi, Yutaka Nakashima, Takuro Tsukube
Journal: Ann Vasc Dis (2023)
Keywords: aneurysm, patent ductus arteriosus, total arch replacement
MeSH terms: Case Reports

It is extremely rare to observe aneurysmal changes in patients with patent ductus arteriosus (PDA), especially in adults. If left untreated, a PDA aneurysm can increase the risk of life-threatening complications, including rupture, dissection, esophageal fistula, and infection. Following is a description of successful surgical repair in a 55-year-old man with PDA aneurysm compressing the esophagus. Histologically, the aneurysmal wall showed mild thickening of the intima and media with hyperplastic smooth muscle cells, but no destructive changes were observed.
Benign Paroxysmal Positional Vertigo After Joint Replacement Surgeries: Case Series
Authors: Khalid Bashir, Abdulla Yousuf, Talha Shahzad, Keebat Khan, Zeenat Khuda Bakhsh
Journal: Cureus (2024)
Keywords: anesthesia, bppv, dix-hallpike test, epley maneuver, hip replacement, joint replacement, knee replacement, postoperative complications, vertigo
MeSH terms: Case Reports

Benign paroxysmal positional vertigo (BPPV) is characterized by brief episodes of vertigo triggered by changes in head position caused by the displacement of otoliths from the utricle to the semicircular canals, particularly the posterior canal. This study explored the potential link between BPPV, the patient's preexisting conditions, and surgery-related factors including surgical positioning, duration of the procedure, exposure to vibratory forces, and anesthesia effects. This report presents two cases of BPPV following major joint replacement surgery. The first case involved a 65-year-old male with a history of diet-controlled diabetes who had undergone right-sided total hip replacement. The second case was that of a 60-year-old female with a history of osteoporosis managed with bisphosphonate therapy and left-sided knee replacement. Both patients developed vertigo symptoms one day postoperatively and were diagnosed with BPPV. In both cases, the Dix-Hallpike test confirmed the right-sided posterior canal BPPV diagnosis, and the patients were successfully treated using the Epley maneuver. Notably, there was no recurrence of vertigo at the four-week follow-up. These cases highlight the importance of considering BPPV in patients presenting with vertigo symptoms after joint replacement surgery, especially in the presence of comorbidities like diabetes and osteoporosis which possibly increase susceptibility to BPPV. This article presents two cases of benign paroxysmal positional vertigo (BPPV) following non-otologic surgery. It explores the pathophysiological mechanism underlying BPPV after such surgeries and also discusses the diagnosis and treatment approaches. This underscores the need for prompt diagnosis and treatment of BPPV to improve postoperative outcomes.
Immunohistochemistry combined with NGS to assist the differential diagnosis of multiple primary lung cancer with lymph node metastasis: a case report
Authors: Chang Liu, Shuai Zhang, Hong Yang, Yu Bai, Yanru Shen, Yi Ren
Journal: Front Oncol (2023)
Keywords: immunohistochemistry, lymph node metastasis, multiple primary lung cancers, next-generation sequencing, osimertinib
MeSH terms: Case Reports

In recent years, the incidence of synchronous multiple primary lung cancers (MPLCs) has gradually increased. Surgery is the preferred treatment for these patients. There are great differences in the driving genes between individual tumors in patients with MPLC, and tumors with targeted mutations do not represent other tumors, which challenges the selection of targeted therapies for patients with MPLC. Driving mutations in each lesion after surgery are crucial for establishing accurate pathological staging and subsequent treatment strategies. There are some mutated genes in the lymph nodes of postoperative metastatic MPLCs, and the tumor cell count/DNA concentration is low, which limits the next-generation sequencing (NGS) detection effect. A combination with immunohistochemistry to determine the source of metastasis may be a better choice. This study reports a rare case of lung cancer with double primary adenocarcinomas of the lung combined with 10 groups of lymph node metastases. The source of metastasis was identified using immunohistochemistry combined with NGS to guide postoperative adjuvant treatment. We hope that this case report can provide new ideas for the identification of MPLCs and assist in their diagnosis and individualized treatment. In addition, the combination specific immunohistochemistry and NGS seems to be an effective identification method. This approach can provide clinical benefits; however, this still requires further exploration through studies with large sample sizes.
Endovascular management of aortic aneurysm with severe neck angulation and/or iliac artery tortuosity using multiple stiff wire technique: a case series
Authors: Taofan Taofan, Suko Adiarto, Iwan Dakota, Suci Indriani, Jonathan Edbert Afandy, Achmad Hafiedz Azis Kartamihardja, Sung-Gwon Kang, Renan Sukmawan
Journal: F1000Res (2024)
Keywords: evar, tevar, artery tortuosity, multiple stiff wire technique, neck angulation
MeSH terms: Aortic Aneurysm, Endovascular Procedures, Catheters, Humans, Iliac Artery / surgery, Research

Background:
Suitable aortic neck is one of the essential components for thoracic endovascular aortic repair (TEVAR) and endovascular aortic repair (EVAR). Advanced techniques were developed to adjust and compromise the aneurysm neck angulation but with adding additional devices and complexity to the procedure. We proposed a simple technique to modify severe neck angulation and/or iliac artery tortuosity by using the multiple stiff wire (MSW) technique.
Method:
Two femoral accesses were required for the MSW technique. A guidewire with a support catheter was inserted through the right and left femoral arteries and positioned in the abdominal or thoracic aorta. Wire exchanges were done with extra stiff wire in both femoral accesses. It can be considered to add multiple stiff wires to align the torturous neck / iliac artery. Delivery of the stent graft main body can be done via one of the accesses.
Result:
Six patients with different aortic pathology were admitted to our hospital. Four patients undergo EVAR procedure and two patients undergo TEVAR procedure. All patients had aortic neck angulation problems with one patient having iliac artery tortuosity. MSW technique was performed on the patients with good results. Follow-up CTA after 3 months revealed a good stent position without stent migration and no endoleak was found in all but one patient.
Conclusion:
MSW technique is a simple and effective technique to modify aortic neck/iliac artery angulation in TEVAR or EVAR procedure.
Disitamab Vedotin (RC48) for HER2-positive advanced breast cancer: a case report and literature review
Authors: Yang Li, Jingjiao Zhang, Zhengang Cai, Xue Gao, Lina Zhang, Zhi Lu, Xiaojie Wang, Peiyao Yu, Jia Li, Fengqi Fang
Journal: Front Oncol (2023)
Keywords: disitamab vedotin (rc48), advanced breast cancer, case report, human epidermal growth factor receptor 2, targeted therapy, tumor resistance
MeSH terms: Case Reports

Background/aim:
Human epidermal growth factor receptor 2 (HER2)-positive breast cancer is associated with a higher risk of metastasis and poorer overall survival (OS) due to HER2 gene overexpression/amplification. Although anti-HER2 targeted therapy has shown survival benefits in HER2-positive advanced breast cancer (ABC) patients, long-term treatment often leads to drug resistance, complicating further treatment options. RC48, an antibody-drug conjugate (ADC), combines the benefits of antibody targeting with the cytotoxic effects of a small molecule drug.
Case report:
We present a case involving a female patient with HER2-positive ABC who developed drug resistance and disease progression following multi-line anti-HER2 targeted therapy. In this instance, RC48 exhibited anti-tumor activity in an ABC patient resistant to HER2-targeted therapy. After eight treatment cycles with 120 mg of RC48, the tumor size decreased and stabilized.
Conclusion:
This case report underscores the potential clinical value of RC48 as a promising treatment alternative for patients resistant to HER2 targeted therapies.
Non-Epstein-Barr Virus Sinonasal Undifferentiated Carcinoma Presenting as Diplopia and Rhinorrhea
Authors: Syeda Q Kaifee, Yawar Haq, Birkaran Sadhar
Journal: Cureus (2024)
Keywords: cerebrospinal fluid rhinorrhea, ebv, ebv-assocaited carcinoma, head and neck cancer, horizontal diplopia, intracranial mass lesion, nasopharyngeal carcinoma, orbit malignancy, sinonasal undifferentiated carcinoma, snuc
MeSH terms: Case Reports

Sinonasal undifferentiated carcinoma (SNUC) is an extremely rare and highly aggressive malignant neoplasm of the nasal cavity and/or paranasal sinuses. SNUC is clinicopathologically distinctive from other tumors but is difficult to study due to its low incidence. There is also very little consensus about the etiology of SNUC, including its association with Epstein-Barr virus (EBV). Treatment modalities include surgery, chemotherapy, and radiation depending on the stage and grading. Herein, we discuss a patient who presented to the emergency department with chronic rhinorrhea and various ophthalmologic symptoms such as flashes, floaters, and diplopia. The patient was later diagnosed with SNUC in the setting of negative serological testing for EBV in addition to his previously concomitant history of bladder cancer. The purpose of this case report is to contribute to the broader literature of SNUC and the specifics surrounding the diagnostic modalities utilized, management, and outcome of non-EBV sinonasal undifferentiated carcinoma in a patient with atypical symptomatology.
Laparoscopic management of intestinal obstruction in a young adult with a virgin abdomen: Unusual presentation of combined vitellointestinal duct remnants: A clinical case report
Authors: Mohannad Al-Tarakji, Mohamed Almogtaba, Yaseen Al-Hashimy, Omar S Moustafa, Mona S Shehata, Raed M Al-Zoubi, Mohamed Said Ghali
Journal: Clin Case Rep (2024)
Keywords: abdomen, case report, intestinal obstruction, laparoscopic, management, remnants, vitelline duct
MeSH terms: Case Reports

Key clinical message:
In an 18-year-old, Meckel's diverticulum and a rare vitellointestinal fibrous band caused bowel obstruction. Clinicians should be vigilant for such anomalies, especially in young adults with virgin abdomens, as potential sources of intestinal obstruction.
Abstract:
In this case report, we highlight the rarity of vitellointestinal or omphalomesenteric duct anomalies causing intestinal obstruction in the adult population. The patient, an 18-year-old male, presented to the emergency department with a two-day history of abdominal pain and vomiting. Physical examination revealed mild distension of his virgin abdomen with generalized tenderness. Abdominal X-ray displayed dilated small bowel loops, and a computed tomography scan indicated features consistent with closed-loop bowel obstruction. Diagnostic laparoscopy confirmed a vitellointestinal duct remnant as the cause of the small intestinal obstruction, involving a combined Meckel's diverticulum and vitellointestinal fibrous band. In early fetal development, the vitellointestinal duct communicates between the midgut and the yolk sac, expected to disappear during fetal growth. Failure to obliterate can lead to issues such as intestinal blockage, primarily observed in children, making occurrences in adults, as in this case, infrequent with only a few documented instances. Despite its uncommon occurrence in young adults, healthcare providers should consider the vitellointestinal duct anomalous remnant as a potential source of intestinal obstruction, particularly in individuals with a virgin abdomen. Early detection of intestinal obstruction is imperative for patient survival, facilitating prompt management and minimizing the risk of serious morbidities, ultimately contributing to a better patient outcome.
Nocardia otitidiscaviarum causing pulmonary nocardiosis: a case report and its review of the literature
Authors: Saumya Srivastava, Arghadip Samaddar, Salman Khan, Vibhor Tak, Gopal Krishna Bohra, Deepak Sharma, Arnab Ghosh, Vijaya Lakshmi Nag
Journal: Access Microbiol (2024)
Keywords: maldi tof ms, nocardia otitidiscaviarum, ziehl-neelsen, ziehl-neelsen staining, pleural nocardiosis, pulmonary nocardiosis
MeSH terms: Case Reports

Background:
Infections caused by Nocardia spp. can occur in immunocompromised as well as immunocompetent individuals. Although nocardiosis is rare, it is being increasingly recognized owing to the rise in occurrence rate over the years. The documentation of pleural involvement in nocardiosis is rare in India.
Case:
We report a case of pulmonary nocardiosis in an immunocompromised individual caused by Nocardia otitidiscaviarum.
Discussion:
Pulmonary nocardiosis caused by Nocardia otitidiscaviarum may go unnoticed without clinical suspicion. Correct and timely identification is the key to proper patient management.
Conclusion:
Coordination between clinicians and microbiologists is necessary for early diagnosis and appropriate management of nocardiosis.
Diagnosis of contralateral rare pulmonary cavity metastasis after lung squamous cell carcinoma surgery by electromagnetic navigation: one case report and review of the literature
Authors: Zhengjun Li, Xiaoge Wang, Chang Liu, Yi Ren
Journal: Front Med (Lausanne) (2024)
Keywords: case report, electromagnetic navigation, lung cancer, lung cancer associated with cystic airspaces, squamous cell carcinoma
MeSH terms: Case Reports

Background:
Lung cancer associated with cystic airspaces is a rare disease, and a rare imaging performance of non-small cell lung cancer. Due to the lack of conventional diagnosis methods, it is difficult to rely on imaging diagnosis. Therefore, the definitive diagnosis of these neoplastic lesions remains challenging.
Case presentation:
We summarize the follow-up and diagnosis of a rare cystic airspaces lung metastatic carcinoma in an elderly man with annular density shadow in the right inferior lobe 2 years after surgery for squamous cell carcinoma in the left inferior lobe.
Results:
During the follow-up of the patient, after the lesion of the lower lobe of the right lung was enlarged, the structural and imaging characteristics were identified, and a special method was selected, namely biopsy of the lesion under the electromagnetic navigation bronchoscope, for clear diagnosis and subsequent treatment.
Conclusion:
For pulmonary cystic airspaces, it is important to correctly identify their imaging features. Because of the possibility of malignancy, it is essential to stop the radiological study in time and to acquire the pathological diagnosis by an appropriate method.
Central pontine myelinolysis: a rare finding in hyperosmolar hyperglycemia
Authors: Hui-Ling Qu, Xiao-Yu Sun, Ying-Jie Dai
Journal: Front Neurol (2023)
Keywords: blood glucose, central pontine myelinolysis, hyperosmolar, hyponatremia, osmotic demyelination syndrome
MeSH terms: Case Reports

Central pontine myelinolysis (CPM) is a heterogeneous nervous system disease of pontine demyelination, usually caused by rapid correction of hyponatremia. In the present study, we report a unique case of a 46-year-old man with a hyperglycemic state complicated with CPM. MRI demonstrated a high signal on T2 and symmetric restricted diffusion in the pontine. In conclusion, the clinical case described confirmed that the hyperosmolar state inherent in hyperglycemia was a likely cause of CPM.
A Case of Syphilis Suspected Preoperatively as a Case of Tongue Cancer
Authors: Shigeru Kondo, Ryuhei Okada, Yosuke Ariizumi, Takashi Kurita, Hiroshi Shintaku, Takahiro Asakage
Journal: Case Rep Otolaryngol (2023)
MeSH terms: Case Reports

Syphilis is a sexually transmitted disease caused by Treponema pallidum (TP). We report a case of syphilis that was initially suspected as tongue cancer. An 86-year-old man consulted a neighborhood clinic with an approximately one-month history of pain in the right tongue. The result of scraping cytology of the tongue performed at the clinic was classified as class V, squamous cell carcinoma, and the patient was referred to our hospital. Physical examination revealed a mass on the right side of the tongue and a firm cervical mass. Biopsy revealed no evidence of malignancy; however, the imaging findings led to the suspicion of tongue cancer and lymph node metastasis. The results of blood examination revealed that the patient had syphilis, but since the patient showed few other symptoms, we decided to treat the infection after the planned surgery. We performed right partial glossectomy and neck dissection; however, the postoperative histopathology revealed no evidence of malignancy but nonspecific inflammatory changes with TP spirochetes. The incidence of syphilis has increased dramatically around the world, including Japan, during the last 20 years, and it no longer remains a rare disease. Therefore, syphilis should be included in the differential diagnosis of oral or cervical masses.