OpenMed/multicare-articles huggingface dataset:
Revolutionizing tracheal reconstruction: innovations in vascularized composite allograft transplantation
Authors: Yiyuan Zhang, Shixiong Wei, Mingqian Li, Guoyue Lv
Journal: Front Bioeng Biotechnol (2024)
Keywords: allograft, re-vascularization, regeneration, tissue engineering, tracheal reconstruction
MeSH terms: Review

Tracheal defects, particularly those extending over long segments, present substantial challenges in reconstructive surgery due to complications in vascularization and integration with host tissues. Traditional methods, such as extended tracheostomies and alloplastic stents, often result in significant morbidity due to mucus plugging and mechanical erosion. Recent advances in vascularized composite allograft (VCA) transplantation have opened new avenues for effective tracheal reconstruction. This article reviews the evolution of tracheal reconstruction techniques, focusing on the shift from non-vascularized approaches to innovative revascularization methods that enhance graft integration and functionality. Key advancements include indirect revascularization techniques and the integration of regenerative medicine, which have shown promise in overcoming historical barriers to successful tracheal transplantation. Clinical case studies are presented to illustrate the complexities and outcomes of recent tracheal transplantation procedures, highlighting the potential for long-term success through the integration of advanced vascular engineering and immune modulation strategies. Furthermore, the role of chimerism in reducing graft rejection and the implications for future tracheal transplantation and tissue engineering efforts are discussed. This review underscores the transformative potential of VCA in tracheal reconstruction, paving the way for more reliable and effective treatments for extensive tracheal defects.
Case report: Diagnosis and surgical treatment of delayed traumatic diaphragmatic hernia with hepatothorax and enterothorax in a small dog
Authors: Bing Shao, Yiding Liu, Tiange Tai, Zhaoyang Liu, Tianyu Han, Yu Yang, Shanshan Fei, Shu Wang, Haibin Wang, Tiezhu Chen, Guangliang Shi
Journal: Front Vet Sci (2024)
Keywords: x-ray, case report, delayed diaphragmatic hernia, dog, ultrasound examination
MeSH terms: Case Reports

An 8-year-old castrated male teddy bear dog presented to our clinic with a persistent cough. The sick dog suffered from vehicular trauma 6 months prior to the visit and had imaging and exploratory laparotomy. Imaging and exploratory laparotomy at the time showed no significant damage. We performed contrast radiography (barium gavage) on the sick dog. Based on the results of a complete contrast radiography (barium gavage), tubular shadows in the thoracic cavity were identified as the small intestine and cecum, and delayed traumatic diaphragmatic hernia with hepatothorax and enterothorax was confirmed with radiographs. Accordingly, the sick dog underwent general anesthesia, manual ventilation and diaphragmatic herniorrhaphy by standard ventral midline abdominal approach. Postoperatively, the dog was given analgesia and antibacterial treatment, and the liver biochemical indexes were monitored to prevent endotoxin. Postoperative radiographs revealed clear contours of thoracic and abdominal organs. The dog moved, ate, and urinated normally within 10 days of the surgery. This case provides a reference for a complete barium meal imaging procedure that clearly shows the position of the organs in the thoracoabdominal cavity after the occurrence of a delayed traumatic diaphragmatic hernia. This paper provides a practical reference for the diagnosis of delayed traumatic diaphragmatic hernia with hepatothorax and enterothorax.
A case of pleural Mycobacterium tuberculosis infection with reversion of Quantiferon Gold Plus results from positive to negative
Authors: N Goire, M S Suchard, A Barling, R Fernando, L Dreyer, A A Mahony
Journal: Access Microbiol (2024)
Keywords: igra, mycobacterium tuberculosis, pcr, pleural tb, quantiferon gold, reversion
MeSH terms: Case Reports

Introduction. Mycobacterium tuberculosis (MTB) infections continue to have a high mortality and morbidity burden globally. Interferon-gamma release assays such as Quantiferon Gold Plus (QFG-Plus) aid in diagnosis of latent TB but diagnosis of pleural TB remains challenging. We present a case of active pleural MTB infection with reversion from positive to negative of IGRA result as well as negative Xpert MTB/RIF Ultra PCR result from tissues obtained from pleural biopsy. Case summary. A 52-year-old otherwise healthy male presented in August 2022 with a 2 week history of pleuritic chest pain associated with modest elevation in inflammatory markers. The patient had had a positive QFG-Plus result in 2018, however QFG-Plus during this admission was negative. Computed-tomography pulmonary angiogram and needle thoracocentesis showed an exudative left pleural effusion with predominant lymphocytes. The patient's symptoms failed to resolve with empiric antimicrobial therapy for community-acquired pneumonia. Broncho-alveolar lavage as well as biopsies of pleural tissues via video-assisted thoracoscopic surgery from the left lower lobe yielded negative results on routine microbiological culture as well as Xpert Ultra PCR. Growth of acid-fast bacilli was noted from mycobacterial cultures of pleural tissues which was identified as MTB. Conclusion. Despite significant technological advances, microbiological diagnosis of MTB infections remains challenging. We document QFG-Plus reversion during development from latent to active pleural TB. Decline in the ability of CD4+ and CD8+ T cells to produce interferon gamma in response to TB antigens (ESAT-6 and CFP-10) was likely associated with loss of host control of latent MTB. This case serves as a reminder that despite exhaustive testing with state-of-art diagnostic platforms, MTB infections can still elude discovery.
Case Report: Tracheal infiltration with wheezing revealing Hodgkin's disease
Authors: Selsabil Daboussi, Asma Saidane, Samira Mhamdi, Nouha Boubaker, Chaabane Mariem, Chiraz Aichaouia, Ghedira Hela, Fehmi Msadek, Moetemri Zied
Journal: F1000Res (2023)
Keywords: hodgkin’s disease, chemotherapy, trachea, wheezing
MeSH terms: Hodgkin Disease / complications, Hodgkin Disease / diagnosis, Hodgkin Disease / pathology, Respiratory Sounds / etiology, Case Reports, Adult, Female, Humans, Positron-Emission Tomography, Trachea / pathology, Tracheal Neoplasms / complications, Tracheal Neoplasms / diagnosis, Tracheal Neoplasms / pathology

Hodgkin's disease with an initial tracheobronchial involvement is not common. The symptoms might be misleading, resulting in a diagnosis delay. We report the case of a 38-year-old woman with a one-month history of wheezing associated with a dry cough. The physical examination revealed a good general state of health, bilateral wheezing and supra-clavicular lymphadenopathy. The adenopathy biopsy's histopathology revealed Hodgkin lymphoma. The whole body FDG-PET scan was an important tool to assess the diagnosis as well as for the staging. The patient was treated with chemotherapy. Another unusual aspect is the tracheobronchial metastasis confirmed by a bronchial biopsy. Thus, our patient was put on a second-line chemotherapy. She died one year after the initial diagnosis. To conclude, it is an atypical clinical presentation of an Hodgkin lymphoma with a tracheobronchial relapse. It should be considered in the differential diagnosis of asthma or a tracheal tumor.
Imaging findings of inflammatory myofibroblastic tumor of sigmoid colon: literature review and case report
Authors: Xianwen Hu, Wei Zhao, Ronghua Yu, Pan Wang
Journal: Front Med (Lausanne) (2024)
Keywords: 18f-fdg, ct, pet/ct, inflammatory myofibroblastic tumor, sigmoid colon
MeSH terms: Case Reports

Inflammatory myofibroblastic tumor (IMT) is an intermediate tumor composed of differentiated myofibroblastic spindle cells with inflammatory cell infiltration. It can occur in all parts of the body, with the lungs being the most common, while the tissues outside the lungs, including the sigmoid colon, are rare. Herein, we present a case of a 10-year-old girl with sigmoid IMT who presented to our hospital with abdominal pain. An abdominal computed tomography (CT) revealed a well-defined, slightly low-density mass in her lower abdomen that was not clearly demarcated from the sigmoid colon. The mass showed significant uneven enhancement on contrast-enhanced CT and increased fluorine-18 fluorodeoxyglucose (18F-FDG) uptake on positron emission tomography (PET). Moreover, a systematic review of the published literature on sigmoid IMT was conducted and its clinical and radiographic features were summarized to increase the understanding of this rare disease.
Transoesophageal echocardiography-guided balloon-assisted percutaneous closure of a large secundum atrial septal defect in a pregnant woman: a case report
Authors: Radityo Prakoso, Rina Ariani, Brian Mendel, Oktavia Lilyasari
Journal: Eur Heart J Case Rep (2024)
Keywords: atrial septal defect, balloon-assisted, case report, non-fluoroscopy, occluder, pregnant
MeSH terms: Case Reports

Background:
According to the 2018 European Society of Cardiology guidelines, atrial septal defect (ASD) closure can be performed during pregnancy but is rarely indicated. In this case, we demonstrate the viability of percutaneous balloon-assisted ASD closure without fluoroscopy in a pregnant woman.
Case summary:
A 23-year-old G3P2A0 woman who was 20 weeks pregnant had primary complaints of breathlessness [New York Heart Association functional class (NYHA fc) III and IV] for 1 week prior to admission. A transthoracic echocardiography showed a dilatation of the right atrium (RA), a dilated right ventricle, a dilated main pulmonary artery (28.1 mm), and an oval-shaped 22 × 33 mm-sized secundum ASD with a left-to-right shunt. Despite optimal pharmacological treatment, the NYHA fc persisted. Under transoesophageal echocardiography monitoring, we introduced a 40 mm Cera™ ASD Occluder (Lifetech, China) via the delivery sheath. The device was deployed in the usual position; however, despite numerous placement adjustments, the left atrium disc kept getting dislodged to the RA and could not engage correctly. Therefore, we decided to use a balloon-assisted approach using a sizing balloon of No. 34 mm. The device was successfully positioned, and a wiggle test was conducted to make sure that the device remained stable. The patient was able to give birth to the child normally several months later.
Discussion:
Despite the fact that pregnant women with ASD receive a very low dose of radiation, it is nevertheless recommended to avoid radiation because this demographic is particularly vulnerable to it. It is possible to treat a large ASD in pregnant women with a successful balloon-assisted approach.
A nonossifying fibroma of the femoral neck treated with curettage and dynamic hip screw with free fibular bone graft: a case report
Authors: Mohamad Al Masri, Hussain Muhammed, Ola Mahmoud Alrezej, Ameen Esa Alfrouh
Journal: Ann Med Surg (Lond) (2023)
Keywords: case report, free fibular bone graft, intracapsular neck of femur, nonossifying fibroma, pathologic fracture
MeSH terms: Case Reports

Introduction and importance:
Nonossifying fibroma (NOF) is a benign fibrogenic lesion that is related to dysfunctional ossification and one of the most common benign bone tumors in childhood with incidence rate of 30-40% of skeletally immature children.
Presentation of case:
A 25-year-old female with left hip pain for the past 2 months, which was treated conservatively, presented with severe pain in the hip. X-ray showed a pathologic fracture in the neck of the femur with underlying lesion. MRI showed an osteolytic lesion in neck of the femur. Curettage of the lesion was done with free fibular bone graft and stabilized by Dynamic Hip Screw and specimen sent to pathology. The pathology report consisted with NOF. No-weight bearing for 8 weeks with physical rehabilitation were ordered and six months later the patient had a full range of motion and healed fracture.
Clinical discussion\conclusion:
This study revealed that the surgical treatment with bone graft for pathologic femoral neck fracture and underlying NOF allowed a quick return to mobility and can be fixed sufficiently to achieve excellent postoperative recovery.
Case Report: Overcoming challenges in pancreatic cancer with liver metastases: a personalized therapeutic odyssey of TACE, ablation, and immunotherapy
Authors: Ying Zhu, Zhouyu Ning, Zhiqiang Meng
Journal: Front Immunol (2023)
Keywords: pd-1, pd-l1, immunotherapy therapy, microwave ablation, pancreatic cancer, transarterial chemoembolization (tace)
MeSH terms: Chemoembolization, Therapeutic / methods, Liver Neoplasms / secondary, Pancreatic Neoplasms / pathology, Pancreatic Neoplasms / therapy, Case Reports, Research Support, Non-U.S. Gov't, Female, Humans, Immunotherapy, Middle Aged, Positron Emission Tomography Computed Tomography, Programmed Cell Death 1 Receptor, Programmed Cell Death 1 Receptor

Pancreatic cancer represents a malignant neoplasm originating from pancreatic cells. The optimal approach to cancer treatment remains uncertain, lacking a definitive consensus. Here, we present a compelling case of a 49-year-old female with pancreatic head cancer with liver metastases, as identified by CT and confirmed by biopsy. PET-CT indicated widespread metastatic involvement. TACE therapy with gemcitabine and cisplatin was initiated, yielding a stable disease response. The patient's high PD-L1 expression prompted TACE-PD-1 monoclonal antibody combination therapy. Subsequent treatments, including ablation, sustained PD-1 immunotherapy, and consolidation TACE, culminated in a complete response, as evidenced by imaging and tumor marker dynamics. Our case underscores the potential of multifaceted strategies in managing aggressive pancreatic cancer.
Extra-axial primary meningeal pleomorphic xanthoastrocytoma: a case report
Authors: Emna Mili, Kais Maamri, Mohamed Amine Hadj Taieb, Mohamed Boukhit, Zohra Souei, Amine Trifa, Mohamed Maher Hadhri, Mehdi Darmoul
Journal: Pan Afr Med J (2024)
Keywords: glioma, case report, extra-axial, meningioma-like, pleomorphic xanthoastrocytoma
MeSH terms: Astrocytoma / diagnosis, Astrocytoma / pathology, Meningeal Neoplasms / diagnosis, Meningeal Neoplasms / pathology, Meningioma / diagnosis, Meningioma / pathology, Seizures / etiology, Case Reports, Diagnosis, Differential, Female, Humans, Intracranial Hypertension / diagnosis, Intracranial Hypertension / etiology, Young Adult

Pleomorphic xanthoastrocytoma (PXA) is a rare low-grade glial neoplasm of the central nervous system accounting for less than 1% of all astrocytomas. Similar to other gliomas, it can rarely arise from glial nests in the meninges, manifesting as an extra-axial mass mimicking a meningioma. Extra axial PXA is an extremely rare entity. Therefore, there are no standardized guidelines. In this article, we report the fourth case, so far, of a solitary primary extra-axial PXA mimicking a meningioma in a 23-year-old woman who presented with temporal seizures and features of raised intracranial pressure. Through this case, we tried to discuss all treatment options.
Case report: A highly active refractory myasthenia gravis with treatment of telitacicept combined with efgartigimod
Authors: Chaoyue Zhang, Yangtao Lin, Qianjin Kuang, Hongjin Li, Qilong Jiang, Xiaojun Yang
Journal: Front Immunol (2024)
Keywords: case report, efgartigimod, highly active, myasthenia gravis, refractory, telitacicept
MeSH terms: Myasthenia Gravis / diagnosis, Myasthenia Gravis / drug therapy, Case Reports, Adult, Drug Therapy, Combination, Female, Humans, Immunosuppressive Agents / administration & dosage, Immunosuppressive Agents / therapeutic use, Treatment Outcome, Immunosuppressive Agents

There is always a lack of effective treatment for highly active refractory generalized myasthenia gravis (GMG). Recently, telitacicept combined with efgartigimod significantly reduces circulating B cells, plasma cells, and immunoglobulin G, which brings promising therapeutic strategies. We report a case of a 37-year-old female patient with refractory GMG, whose condition got significant improvement and control with this latest treatment after multiple unsuccessful therapies of immunosuppressants. The new combination deserves further attention in the therapeutic application of myasthenia gravis.
A case of Magnusiomyces capitatus isolated during monitoring in an antimicrobial diagnostic stewardship context
Authors: Francesco Foglia, Giuseppe Greco, Carla Zannella, Annalisa Chianese, Annalisa Ambrosino, Alessandra Conzo, Giovanni Conzo, Anna De Filippis, Emiliana Finamore, Ludovico Docimo, Massimiliano Galdiero
Journal: IDCases (2024)
Keywords: antimicrobial diagnostic stewardship, magnusiomyces capitatus, surveillance, yeast infection
MeSH terms: Case Reports

Magnusiomyces capitatus (M. capitatus) is an emerging opportunistic yeast in the Mediterranean region typically isolated from immunocompromised patients, usually affected by blood malignancies. We reported a rare case of M. capitatus infection, isolated from a drainage fluid in a patient affected by lung cancer recovered in the University Hospital of Campania "Luigi Vanvitelli", Naples, Italy. The isolate was identified by phenotypic methods, i.e., Gram and Lactophenol cotton blue (LCB) staining, and matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) analysis. We identified M. capitatus on the third day from Sabouraud Dextrose Agar supplemented with chloramphenicol and gentamicin. Antifungal susceptibility test revealed that 5-fluorocytosine was the most active drug against M. capitatus, followed by itraconazole and voriconazole, micafungin, amphotericin B and fluconazole, posaconazole, anidulafungin, and caspofungin. Our data showed the importance of an early cultural and fast microbiology diagnosis based on the characteristic morphologic features observed in Gram-stained smears of blood culture positive bottles, and the validation via MALDI-TOF MS. This dual approach has significant impact in the clinical management of infectious diseases and antibiotic stewardship, by integrating sample processing, fluid handling, and detection for rapid bacterial diagnosis.
Anaphylactic Shock After Cervical Conization Hemostasis With a Packing Soaked in Monsel's Solution
Authors: Luís Pedro, Ana Gonçalves, Maria I Sousa, Sónia Duarte, Teresa Leal, Sandra Soares
Journal: Cureus (2024)
Keywords: anaphylaxis, cervical conization, monsel's solution, perioperative care, shock
MeSH terms: Case Reports

Anaphylactic shock is a life-threatening medical emergency, and its successful approach depends on early recognition and treatment. We present a case report of a 54-year-old female, with the American Society of Anesthesiology (ASA) Physical Status Classification III, admitted for cervical conization. She presented with known allergies to paracetamol, diclofenac, and nimesulide, and a history of nickel contact dermatitis, with no reports of complicated anesthesia. During conization, adrenaline was infiltrated in the cervix, and hemostasis was performed with packing soaked in Monsel's solution. The immediate postoperative period in the post-anesthesia care unit was uneventful, and no drugs were administered during this period. Three hours after discharge to the ward, the patient had progressive dyspnea with desaturation and maculopapular exanthema. Anesthesia medical emergency was activated. Upon arrival of the emergency team, the patient presented: marked edema of the lips and tongue, respiratory distress, SpO2 82% (under non-rebreathing high concentration oxygen mask), audible vesicular murmur but diminished in all lung fields (without bronchospasm), blood pressure of 60/40 mmHg, increased capillary refill time (4-5 seconds), Glasgow Coma Scale score of 14, as well as generalized maculopapular exanthema and eyelid edema. Gas analysis revealed the following: pH 7.36, pO2 150, pCO2 33, HCO3 22, and lactate 2.2 mmol/L. Anaphylactic shock was immediately diagnosed without an identified causative agent. Intramuscular adrenaline (0.5mg), endovenous hydrocortisone (200 mg), clemastine (2 mg), and profuse fluid therapy were administered. There was an initial slight improvement followed by subsequent worsening. Additional administration of 0.5 mg intramuscular adrenaline and endovenous methylprednisolone (125 mg) provided similar results. Considering that no other drugs were administered in the ward, the emergency team and the attending gynecologist assumed an association between nickel allergy and the chemical composition of Monsel's solute. Thus, it was decided to remove the packing soaked in Monsel's solute from the vaginal cavity and wash it with saline solution. After removing the packing and further administration of 0.5 mg intramuscular adrenaline, there was progressive improvement in the blood pressure and SpO2. Tryptase samples collected one hour later were increased (23.9 ug/L; normal: <11.4 ug/L). The patient was shifted to the intensive care unit for surveillance, from which she was discharged after 2 days, with scheduled immunoallergology consultation, which is waiting. This case highlights the importance of causative agent identification as a key point for anaphylactic shock resolution, as well as a multidisciplinary discussion among professionals.
Identification of a novel RPGR mutation associated with retinitis pigmentosa and primary ciliary dyskinesia in a Slovak family: a case report
Authors: Zuzana Kolkova, Peter Durdik, Veronika Holubekova, Anna Durdikova, Milos Jesenak, Peter Banovcin
Journal: Front Pediatr (2024)
Keywords: rpgr gene, x-linked inheritance, mutation, primary ciliary dyskinesia, retinitis pigmentosa
MeSH terms: Case Reports

Background:
The mutations in the RPGR (retinitis pigmentosa GTPase regulator) gene are the most common cause of X-linked retinitis pigmentosa (XLRP), a rare genetic disorder affecting the photoreceptor cells in the retina. Several reported cases identified this gene as a genetic link between retinitis pigmentosa (RP) and primary ciliary dyskinesia (PCD), characterised by impaired ciliary function predominantly in the respiratory tract. Since different mutations in the same gene can result in various clinical manifestations, it is important to describe a correlation between the gene variant and the observed phenotype.
Methods:
Two young brothers from a non-consanguineous Slovak family with diagnosed retinal dystrophy and recurrent respiratory infections were examined. Suspected PCD was diagnosed based on a PICADAR questionnaire, nasal nitric oxide analysis, transmission electron microscopy, high-speed video microscopy analysis, and genetic testing.
Results:
We identified a novel frameshift RPGR mutation NM_001034853: c.309_310insA, p.Glu104Argfs*12, resulting in a complex X-linked phenotype combining PCD and RP. In our patients, this mutation was associated with normal ultrastructure of respiratory cilia, reduced ciliary epithelium, more aciliary respiratory epithelium, shorter cilia, and uncoordinated beating with a frequency at a lower limit of normal beating, explaining the clinical manifestation of PCD in our patients.
Conclusion:
The identified novel pathogenic mutation in the RPGR gene expands the spectrum of genetic variants associated with the X-linked PCD phenotype overlapping with RP, highlighting the diversity of mutations contributing to the disorder. The described genotype-phenotype correlation can be useful in clinical practice to recognise a broader spectrum of PCD phenotypes as well as for future research focused on the genetic basis of PCD, gene interactions, the pathways implicated in PCD pathogenesis, and the role of RPGR protein for the proper functioning of cilia in various tissues throughout the body.