OpenMed/multicare-articles huggingface dataset:
Kidney Transplantation after Extended Multivisceral Resection for Pancreatic Ductal Adenocarcinoma
Authors: Hryhoriy Lapshyn, Louisa Bolm, Martin Nitschke, Andreas M Luebke, Jakob R Izbicki, Yogesh K Vashist, Tobias Keck, Ulrich F Wellner
Journal: Case Rep Transplant (2018)
MeSH terms: Case Reports

Long-term survival in patients with pancreatic ductal adenocarcinoma (PDAC) is limited. Consequently, solid organ transplantation in PDAC patients is usually not considered. This is the first case report of kidney transplantation (KT) in a 57-year-old female patient after extended multivisceral resection for PDAC of the distal pancreas who had developed end-stage renal disease (ESRD) due to toxic kidney damage by chemotherapy. 13,5 years after initial PDAC-operation and 3 years after KT the patient remains in a good general health condition with sufficient function of the kidney allograft without local tumor recurrence or distant metastasis.
An unusual "venous circle" of the internal mammary vein encountered during microvascular anastomosis and implications for practice
Authors: S Samaras, M A McKelvie, G Oni, C M Malata
Journal: Case Reports Plast Surg Hand Surg (2020)
Keywords: breast reconstruction, free tissue flaps, mammary arteries, microsurgery, regional anatomy
MeSH terms: Case Reports

The internal mammary vessels are commonly used for anastomosis in breast reconstruction. The anatomy when using the 2nd ICS has been shown to be predictable and hence preferentially used by the senior author. We present an unusual case of internal mammary vein bifurcation and immediate confluence forming a 'venous circle'.
Case Report: Successful treatment of severe pneumocystis carinii pneumonia in a case series of primary nephrotic syndrome after receiving anti-CD20 monoclonal antibody therapy
Authors: Lili Liu, Weihua Zheng, Ping Wang, Ying Wu, Guanghua Zhu, Rong Yang, Li Gu, Wenyan Huang, Yulin Kang
Journal: Front Pediatr (2023)
Keywords: metagenomic next-generation sequencing, pediatrics, pneumocystis carinii pneumonia, primary nephrotic syndrome, rituximab
MeSH terms: Case Reports

Rituximab is emerging as a new steroid sparing agent in children with difficult-to-treat nephrotic syndrome due to its ability of depleting CD20-positive B cells. Life-threatening adverse events such as pneumocystis carinii pneumonia may occur even though it seems to be well tolerated. Since rituximab is wildly used in immune-mediated diseases, it is important to manage its severe adverse events. To explore the importance of early diagnosis and treatment of pneumocystis carinii pneumonia in children with primary nephrotic syndrome (PNS) after receiving rituximab therapy, we retrospectively analyzed the clinical data of PNS patients younger than 18 years old with pneumocystis carinii pneumonia who were hospitalized in our center. Clinical features and laboratory test results were retrieved from the electronic medical records. Severe pneumocystis carinii pneumonia occurred in one child with steroid resistant nephrotic syndrome and two with steroid dependent nephrotic syndrome patients after rituximab treatment. These patients were diagnosed in time by metagenomic next-generation sequencing (mNGS) for pathogen detection. Fortunately, all three patients survived after antifungal treatment and achieved complete remission eventually. In conclusion, early diagnosis by using mNGS and timely antifungal treatment is the key to successful management of pneumocystis carinii pneumonia in children with difficult-to-treat PNS.
Corticospinal reorganization after locomotor training in a person with motor incomplete paraplegia
Authors: Nupur Hajela, Chaithanya K Mummidisetty, Andrew C Smith, Maria Knikou
Journal: Biomed Res Int (2013)
MeSH terms: Gait, Motor Cortex / physiopathology, Paraplegia / physiopathology, Paraplegia / therapy, Spinal Cord / physiopathology, Spinal Cord Injuries / physiopathology, Spinal Cord Injuries / therapy, Case Reports, Clinical Trial, Research Support, Non-U.S. Gov't, Evoked Potentials, Exercise Movement Techniques / methods, Female, Humans, Middle Aged, Nerve Net, Paraplegia / etiology, Spinal Cord Injuries / complications, Transcranial Magnetic Stimulation / methods, Transcutaneous Electric Nerve Stimulation / methods

Activity-dependent plasticity as a result of reorganization of neural circuits is a fundamental characteristic of the central nervous system that occurs simultaneously in multiple sites. In this study, we established the effects of subthreshold transcranial magnetic stimulation (TMS) over the primary motor cortex region on the tibialis anterior (TA) long-latency flexion reflex. Neurophysiological tests were conducted before and after robotic gait training in one person with a motor incomplete spinal cord injury (SCI) while at rest and during robotic-assisted stepping. The TA flexion reflex was evoked following nonnociceptive sural nerve stimulation and was conditioned by TMS at 0.9 TA motor evoked potential resting threshold at conditioning-test intervals that ranged from 70 to 130 ms. Subthreshold TMS induced a significant facilitation on the TA flexion reflex before training, which was reversed to depression after training with the subject seated at rest. During stepping, corticospinal facilitation of the flexion reflex at early and midstance phases before training was replaced with depression at early and midswing followed by facilitation at late swing after training. These results constitute the first neurophysiologic evidence that locomotor training reorganizes the cortical control of spinal interneuronal circuits that generate patterned motor activity, modifying spinal reflex function, in the chronic lesioned human spinal cord.
URGENT LIVER RETRANSPLANTATION DUE TO TRANSMISSION OF INTRAHEPATIC CHOLANGIOCARCINOMA BY DONOR: THE FIRST REPORT IN THE LITERATURE
Authors: Eduardo de Souza Martins Fernandes, Thays Ribeiro Rodrigues de Almeida, Raphael Rodrigues Correa, Eduardo Pinho Braga, Camila Liberato Girão, Leandro Savattone Pimentel, Ronaldo de Oliveira Andrade, Felipe Pedreira Tavares de Mello, Angela Cristina Gouvea Carvalho, Mariana Coelho Peres, Camila Tobias Queiroz, Samanta Teixeira Basto
Journal: Arq Bras Cir Dig (2023)
MeSH terms: Bile Duct Neoplasms / surgery, Cholangiocarcinoma / surgery, Cholangitis, Sclerosing / complications, Cholangitis, Sclerosing / surgery, Crohn Disease / complications, Hypertension, Portal / complications, Case Reports, Bile Ducts, Intrahepatic, Humans, Living Donors, Male, Middle Aged, Reoperation / adverse effects

Background:
Liver transplantation represents the best therapeutic modality in end-stage chronic liver disease, severe acute hepatitis, and selected cases of liver tumors.
Aims:
To describe a double retransplant in a male patient diagnosed with Crohn's disease and complicated with primary sclerosing cholangitis, severe portal hypertension, and cholangiocarcinoma diagnosed in the transplanted liver.
Methods:
A 48-year-old male patient diagnosed with Crohn's disease 25 years ago, complicated with primary sclerosing cholangitis and severe portal hypertension. He underwent a liver transplantation in 2018 due to secondary biliary cirrhosis. In 2021, a primary sclerosing cholangitis recurrence was diagnosed and a liver retransplantation was indicated. Recipient's hepatectomy was very difficult by reason of complex portal vein thrombosis requiring extensive thromboendovenectomy. Intraoperative ultrasound with liver doppler evaluation was performed. Two suspicious nodules were incidentally diagnosed in the donor's liver and immediately removed for anatomopathological evaluation.
Results:
After pathological confirmation of carcinoma, probable cholangiocarcinoma, at frozen section, the patient was re-listed as national priority and a new liver transplantation was performed within 24 hours. The patient was discharged after 2 weeks.
Conclusions:
The screening for neoplasms in donated organs should be part of our strict daily diagnostic arsenal. Moreover, we argue that, for the benefit of an adequate diagnosis and the feasibility of a safer procedure, the adoption of imaging tests routine for the liver donor is essential, allowing a reduction of the costs and some potential risks of liver transplant procedure.
Tibial Plasmablastic Lymphoma in a HIV-Negative Child: A Novel Extraoral Localisation
Authors: Ali Mala, Yameena Noman Khan, Akbar Ahmed, Naema Khayyam, Kanwal Aftab
Journal: Case Rep Hematol (2022)
MeSH terms: Case Reports

Plasmablastic lymphoma is an aggressive, high-grade non-Hodgkin lymphoma predominantly seen in HIV-infected individuals. Alongside a strong correlation with HIV, PBL can manifest in immunocompromised HIV-negative patients. A rare case of PBL in an immunocompetent and otherwise healthy child presented to Indus Hospital & Health Network (IHHN), Karachi, Pakistan. The patient had complaints of swelling and pain in the right leg and was referred from a city in Interior Sindh. Histopathological analysis revealed sheets and aggregates of neoplasm replacing bone marrow interspersed with sclerotic bony fragments. Large, monomorphic, multinucleated neoplastic cells containing abundant cytoplasm and scattered pleomorphic cells were also noted, leading to the diagnosis of tibial plasmablastic lymphoma. A FAB/LMB96 group C chemotherapy regimen for aggressive and high-risk cancer was administered with a marked improvement in clinical symptoms.
Cerebral relapse of metastatic gastrointestinal stromal tumor during treatment with imatinib mesylate: case report
Authors: Brett Hughes, Desmond Yip, David Goldstein, Paul Waring, Victoria Beshay, Guan Chong
Journal: BMC Cancer (2004)
MeSH terms: Antineoplastic Agents / therapeutic use, Brain Neoplasms / secondary, Gastrointestinal Stromal Tumors / drug therapy, Gastrointestinal Stromal Tumors / pathology, Piperazines / therapeutic use, Pyrimidines / therapeutic use, Case Reports, Benzamides, Humans, Imatinib Mesylate, Male, Middle Aged, Antineoplastic Agents, Benzamides, Piperazines, Pyrimidines, Imatinib Mesylate

Background:
The management of unresectable or metastatic gastrointestinal stromal tumors (GISTs) has previously been difficult as they are resistant to conventional chemotherapy and radiation. The development of imatinib mesylate has made a major impact on the management of advanced GISTs. It is apparent that there are sanctuary sites such as the central nervous system where imatinib does not achieve adequate concentrations. We describe the case of a man with metastatic GIST who experienced multiple cerebral relapses of disease while systemic disease progression appeared to be controlled by imatinib.
Case presentation:
A 47-year-old man presented in July 1999 with a jejunal GIST with multiple hepatic metastases. The jejunal primary was resected and after unsuccessful cytoreductive chemotherapy, the liver metastases were also resected in December 1999. The patient subsequently relapsed in August 2001 with symptomatic hepatic, subcutaneous gluteal, left choroidal and right ocular metastases all confirmed on CT and PET scanning. Biopsy confirmed recurrent GIST. MRI and lumbar puncture excluded central nervous system involvement. The patient was commenced on imatinib 400 mg bd in September 2001 through a clinical trial. The symptoms improved with objective PET and CT scan response until December 2002 when the patient developed a right-sided foot drop. MRI scan showed a left parasagittal tumor which was resected and confirmed histologically to be metastatic GIST. Imatinib was ceased pre-operatively due to the trial protocol but recommenced in February 2003 on a compassionate use program. The left parasagittal metastasis recurred and required subsequent re-excision in September 2003 and January 2004. Control of the systemic GIST was temporarily lost on reduction of the dose of imatinib (due to limited drug supply) but on increasing the dose back to 800 mg per day, systemic disease was stabilized for a period of time before generalised progression occurred.
Conclusion:
This case illustrates that the brain can be a sanctuary site to treatment of GISTs with imatinib. Maintaining dosing of imatinib in the face of isolated sites of disease progression is also important, as other metastatic sites may still be sensitive.
The Usefulness of Quantitative EEG and Advanced MR Techniques in the Monitoring and Long-Term Prognosis of Lance-Adams Syndrome
Authors: Aleksandra Szczepańska, Edyta Dziadkowiak, Joanna Bladowska, Lech Kipiński, Sławomir Budrewicz, Magdalena Koszewicz
Journal: Front Neurol (2019)
Keywords: lance-adams syndrome, mr spectroscopy, action myoclonus, chronic post-hypoxic myoclonus, quantitative eeg
MeSH terms: Case Reports

Objectives: Chronic post-hypoxic myoclonus, known as Lance-Adams syndrome (LAS), is a rare complication of successful cardiopulmonary resuscitation. It is characterized by intention myoclonus, cerebellar ataxia, and preserved intellect. The basis of the disease and its long-term prognosis remain unclear. Case report: The authors present a 53-year-old woman with a history of asthma bronchiale who suffered from myoclonus after hypoxic brain damage due to cardiac arrest. Advanced electrophysiological (quantitative EEG) and MR (MR spectroscopy) techniques were employed. Conclusions: Over long-term observation the results suggested permanent synaptic rearrangements of the neuronal networks due to brain plasticity in the patient after the brain hypoxia.
Successful Treatment of a Critically Ill COVID-19 Patient Using Continuous Renal Replacement Therapy With Enhanced Cytokine Removal and Tocilizumab: A Case Report
Authors: Thomas Tao-Min Huang, Ying-Chun Chien, Chih-Hsien Wang, Sui-Yuan Chang, Jann-Tay Wang, Song-Chou Hsieh, Yu-Chang Yeh, Shih-Chi Ku, Chong-Jen Yu, Bor-Luen Chiang, Shan-Chwen Chang, Ashita Tolwani
Journal: Front Med (Lausanne) (2021)
Keywords: covid-19, continuous renal replacement therapy, cytokine release syndrome, extracorporeal membrane oxygenation, tocilizumab
MeSH terms: Case Reports

The COVID-19 pandemic has caused multiple deaths worldwide. Since no specific therapies are currently available, treatment for critically ill patients with COVID-19 is supportive. The most severe patients need sustained life support for recovery. We herein describe the course of a critically ill COVID-19 patient with multi-organ failure, including acute respiratory failure, acute kidney injury, and fulminant cytokine release syndrome (CRS), who required mechanical ventilation and extracorporeal membrane oxygenation support. This patient with a predicted high mortality risk was successfully managed with a careful strategy of oxygenation, uremic toxin removal, hemodynamic support, and most importantly, cytokine-targeted intervention for CRS, including cytokine/endotoxin removal, anti-cytokine therapy, and immune modulation. Comprehensive cytokine data, CRS parameters, and biochemical data of extracorporeal removal were provided to strengthen the rationale of this strategy. In this report, we demonstrate that timely combined hemoperfusion with cytokine adsorptive capacity and anti-cytokine therapy can successfully treat COVID-19 patients with fulminant CRS. It also highlights the importance of implementing cytokine-targeted therapy for severe COVID-19 guided by the precise measurement of disease activity.
Spontaneous uterine perforation due to pyometra presenting as acute abdomen
Authors: Loabat Geranpayeh, Mohsen Fadaei-Araghi, Behnam Shakiba
Journal: Infect Dis Obstet Gynecol (2006)
MeSH terms: Abdomen, Acute / etiology, Peritonitis / etiology, Rupture, Spontaneous / complications, Uterine Diseases / complications, Uterine Perforation / complications, Case Reports, Female, Humans, Middle Aged, Rupture, Spontaneous / surgery, Suppuration / complications, Uterine Diseases / surgery, Uterine Perforation / surgery, Uterus / pathology, Uterus / surgery

Spontaneous perforation of the uterus is rare, its incidence being about 0.01%-0.05%. We report a rare case of diffuse peritonitis caused by spontaneously perforated pyometra. A 63-year-old woman with severe abdominal pain was admitted to our hospital. Laparotomy was performed because of the suspicion of gastrointestinal perforation with generalized peritonitis. At laparotomy, about 900 mL of pus was found in the peritoneal cavity. There were no abnormal findings in the alimentary tract, liver, or gallbladder. A total abdominal hysterectomy with bilateral salpingo-oophorectomy was performed. Pathological investigation of the surgical specimen revealed endometritis and myometritis of the uterus; but there was no evidence of malignancy, and the cervical canal was patent. Although spontaneously perforated pyometra is rare, a perforated pyometra should therefore also be considered when elderly women present with acute abdominal pain.
Cardiac Lipoma: An Uncharacteristically Large Intra-Atrial Mass Causing Symptoms
Authors: Fahad Syed Naseerullah, Hemangkumar Javaiya, Avinash Murthy
Journal: Case Rep Cardiol (2018)
MeSH terms: Case Reports

Primary tumours of the heart are often encountered in clinical practice. Different autopsy series estimate the incidence to be anywhere from 0.001% to 0.19%. Cardiac lipoma is a rare type of tumour of the heart and pericardium. It comprises approximately 10-19% of all cardiac tumours. We present a case of a large cardiac lipoma in a fifty-year-old female. She presented with sharp chest pains, palpitations, and dizziness. Acute coronary syndrome was ruled out. A transthoracic echocardiogram showed an abnormal, large, fixed right atrial mass. The mass was noted to be occupying most of the right atrium. It was excised due to its large size and persistent symptoms. On pathophysiology, the mass was definitively diagnosed to be an 80 mm × 70 mm cardiac lipoma. Postoperatively, the patient did well with resolution of her symptoms. This case provides evidence that even large, invasive, symptomatic cardiac lipomas can be successfully resected with good outcomes.
Mechanical Circulatory Support in Management of Cardiogenic Shock and Myxedema Coma
Authors: Jelena Z Arnautovic, Randi Connor-Schuler, Randy Ip
Journal: Case Rep Cardiol (2019)
MeSH terms: Case Reports

The cardiovascular system is a major target of thyroid hormone action and the two systems are closely interlinked. It can be greatly impacted even with subtle alterations in thyroid function. Caution is needed when implementing thyroid hormone replacement in patients with severe hypothyroidism, especially in the setting of ischemic coronary artery disease. If not properly treated, myxedema may ensue. Given the high mortality of myxedema coma, supportive care may not always suffice and patients may require more invasive interventions. We present a challenging case of a patient with overt hypothyroidism with concurrent acute coronary syndrome which subsequently lead to myxedema coma and cardiogenic shock. A transcaval approach for the delivery of an Impella 5.0 (Abiomed Inc., Danvers, MA) was utilized in supporting this patient. To our knowledge, this is the first reported case that describes the use of a mechanical circulatory support in treating myxedema-induced cardiovascular collapse.
GLM-based optimization of NGS data analysis: A case study of Roche 454, Ion Torrent PGM and Illumina NextSeq sequencing data
Authors: Sarah Sandmann, Aniek O de Graaf, Bert A van der Reijden, Joop H Jansen, Martin Dugas
Journal: PLoS One (2017)
MeSH terms: High-Throughput Nucleotide Sequencing / methods, Algorithms, Genes / genetics, High-Throughput Nucleotide Sequencing / instrumentation, Humans, Linear Models, Myelodysplastic Syndromes / genetics

Background:
There are various next-generation sequencing techniques, all of them striving to replace Sanger sequencing as the gold standard. However, false positive calls of single nucleotide variants and especially indels are a widely known problem of basically all sequencing platforms.
Methods:
We considered three common next-generation sequencers-Roche 454, Ion Torrent PGM and Illumina NextSeq-and applied standard as well as optimized variant calling pipelines. Optimization was achieved by combining information of 23 diverse parameters characterizing the reported variants and generating individually calibrated generalized linear models. Models were calibrated using amplicon-based targeted sequencing data (19 genes, 28,775 bp) from seven to 12 myelodysplastic syndrome patients. Evaluation of the optimized pipelines and platforms was performed using sequencing data from three additional myelodysplastic syndrome patients.
Results:
Using standard analysis methods, true mutations were missed and the obtained results contained many artifacts-no matter which platform was considered. Analysis of the parameters characterizing the true and false positive calls revealed significant platform- and variant specific differences. Application of optimized variant calling pipelines considerably improved results. 76% of all false positive single nucleotide variants and 97% of all false positive indels could be filtered out. Positive predictive values could be increased by factors of 1.07 to 1.27 in case of single nucleotide variant calling and by factors of 3.33 to 53.87 in case of indel calling. Application of the optimized variant calling pipelines leads to comparable results for all next-generation sequencing platforms analyzed. However, regarding clinical diagnostics it needs to be considered that even the optimized results still contained false positive as well as false negative calls.
Autoimmune Hemolytic Anemia in a Renal Transplant Patient Following Seasonal Influenza Vaccination
Authors: Imran Gani, George Hinnant, Rajan Kapoor, Natasha Savage
Journal: Case Rep Hematol (2019)
MeSH terms: Case Reports

Vaccines aim to prevent disease occurrence, its severity, and resultant complications. Our patient, a 58-year-old male, received seasonal influenza vaccination as part of routine health maintenance. Three days later, he presented with malaise, fever, and yellowish discoloration of eyes. His labs showed hyperbilirubinemia, anemia, elevated lactate dehydrogenase, and low haptoglobin, consistent with hemolytic anemia. Autoimmune hemolytic anemia has been associated with vaccine use and may result from phenomena of molecular mimicry and cross-reactivity with the possible role of vaccine adjuvants as well. An underlying structural defect of the red blood cell membrane may make them prone to hemolysis. The differential diagnosis and work-up of hemolytic anemia is extensive, as performed in our case. Management strategies for vaccine-induced hemolysis may involve supportive care, red blood cell transfusion, steroids, and intravenous immunoglobulin.
Heritage language and linguistic theory
Authors: Gregory Scontras, Zuzanna Fuchs, Maria Polinsky
Journal: Front Psychol (2015)
Keywords: experimental methods, heritage linguistics, morphosyntax, multilingualism, pragmatics, semantics, syntax
MeSH terms: Review

This paper discusses a common reality in many cases of multilingualism: heritage speakers, or unbalanced bilinguals, simultaneous or sequential, who shifted early in childhood from one language (their heritage language) to their dominant language (the language of their speech community). To demonstrate the relevance of heritage linguistics to the study of linguistic competence more broadly defined, we present a series of case studies on heritage linguistics, documenting some of the deficits and abilities typical of heritage speakers, together with the broader theoretical questions they inform. We consider the reorganization of morphosyntactic feature systems, the reanalysis of atypical argument structure, the attrition of the syntax of relativization, and the simplification of scope interpretations; these phenomena implicate diverging trajectories and outcomes in the development of heritage speakers. The case studies also have practical and methodological implications for the study of multilingualism. We conclude by discussing more general concepts central to linguistic inquiry, in particular, complexity and native speaker competence.