OpenMed/multicare-articles huggingface dataset:
Mini-ALPPS-based multidisciplinary treatment leading to long-term survival in a patient with a large HCC: A case report
Authors: Gao-Min Liu, Yao-Min Zhang
Journal: Front Surg (2023)
Keywords: hcc, tace, long-term survival, mini-alpps, salvage
MeSH terms: Case Reports

Background:
The future liver remnant (FLR) induced by stage I associated liver partition and portal vein ligation for staged hepatectomy (ALPPS) in hepatocellular carcinoma (HCC) might be limited due to liver fibrosis/cirrhosis or incomplete liver parenchymal transection.
Case presentation:
A 51-year-old male with hepatitis B liver fibrosis was diagnosed with a large HCC (13.5 cm × 12.5 cm × 13.8 cm). The FLR of the patient was insufficient to permit one-stage tumor resection. Therefore, the two-stage ALPPS surgery was planned. Stage I ALPPS was performed with incomplete liver parenchymal transection due to bleeding (which is why we called it Mini-ALPPS). On postoperative day (POD) 18, CT revealed that the FLR hypertrophy was poor. The FLR/standard liver volume (SLV) had only increased from 22.00% to 34.63%. Salvage transhepatic arterial chemoembolization (TACE) was performed on POD 22 days to control possible tumor progression during the waiting period and to further facilitate FLR growth. About 16 days later, a CT reassessment of FLR revealed a 42.5% FLR/SLV. A right hepatectomy was then uneventfully performed. Although HCC recurred after 586 days, the patient survived for more than 1,920 days after stage II ALPPS.
Discussion:
Damage control during a difficult conventional stage I ALPPS was important. TACE during the interstage and postoperative periods of this Mini-ALPPS was safe and beneficial. A multidisciplinary based on Mini-ALPPS treatment could provide patients long-term survival; however, Mini-ALPPS should not be selected as the primary solution for such patients today, as some other minimally invasive and effective strategies are available.
Long-term Survival after Resection of HER2+ Infiltrating Ductal Carcinoma Metastasis to the Brainstem
Authors: Al-Wala Awad, Hasan A Zaidi, Al-Homam Awad, Robert Spetzler
Journal: Cureus (2016)
Keywords: brainstem, breast cancer, ductal carcinoma, her2+, metastasis, trastuzumab
MeSH terms: Case Reports

The central nervous system is a common site of metastatic spread from neoplasms in distant organs, including breast, bone, and lung. The decision to surgically treat these metastatic lesions is often challenging, especially in the setting of systemic disease or when eloquent brain regions are involved. Treating metastatic disease in the brainstem can be technically difficult, and in many institutions, considered a contraindication to surgical intervention, given the relatively high risk of new postoperative neurological deficits. Herein, we report a case of metastatic ductal carcinoma of the breast with spread to the pontine-medullary junction that was treated with aggressive surgical resection and chronic hormonal therapy. After surgical excision of the brainstem lesion, the patient remained asymptomatic and was maintained on trastuzumab therapy over a 10-year follow-up period, with no radiographic or clinical evidence of recurrent disease. To our knowledge, this is the first report of a patient treated for a solitary metastasis to the brainstem with long-term survival.
Perioperative Anaphylaxis to Chlorhexidine during Surgery and Septoplasty
Authors: Ana Paula Teixeira de Abreu, Leonardo Ramos Ribeiro de Oliveira, Ana Flavia Teixeira de Abreu, Evandro Ribeiro de Oliveira, Michele Santos de Melo Ireno, Fernando Monteiro Aarestrup, Matheus Fonseca Aarestrup, Paula Fonseca Aarestrup
Journal: Case Rep Otolaryngol (2017)
MeSH terms: Case Reports

Chlorhexidine is an antiseptic and disinfectant used in surgical and clinical practice since 1954 and is available in aqueous or alcoholic solutions 0.5%-4.0% and has a broad-spectrum activity. Despite their widespread use, allergic reactions with chlorhexidine are rarely reported. We describe a case of anaphylaxis with chlorhexidine during a septoplasty, turbinectomy, and maxillary sinusectomy. The patient presented with periorbital edema, hives, hypotension, and wheezing. Immediately after the diagnosis of anaphylaxis promethazine, hydrocortisone, and epinephrine were administered with immediate clinical improvement. This case highlights the importance of assessing whether there is a previous clinical history of hypersensitivity to chlorhexidine in patients who will undergo surgical procedures.
Case Report: Young Adults With Breast Cancer: A Case Series of Fertility Preservation Management and Literature Review
Authors: Mohd Faizal Ahmad, Yodo Sugishita, Yuki Suzuki-Takahashi, Shino Sawada, Hideyuki Iwahata, Eriko Shiraishi, Seido Takae, Yuki Horage-Okutsu, Nao Suzuki
Journal: Front Med (Lausanne) (2021)
Keywords: breast cancer, cryopreservation, fertility preservation, oncofertility, young adult
MeSH terms: Case Reports

Breast cancer comprised at least 21.8% of the overall cancer among young adult (YA) women and became the leading cancer in this group in Japan, with 50% adolescent and YAs being diagnosed and 15-44-year-old women showing excellent 5-year survival. Surgical-chemoradiation therapy often results in excellent survivorship with an increased incidence of treatment-induced subfertility. Therefore, adding fertility preservation (FP) to the primary cancer treatment is necessary. Herein, we reported a series of cases of YA women with breast cancer who opted for FP, where their option was tailored accordingly. To date, the selection of oocytes, embryos and ovarian tissue is widely available as an FP treatment. PGT could reduce the risk of BRCA mutation transmission amongst BRCA carriers before pregnancy planning. Otherwise, gonadotropin-releasing hormone analog has no gonadoprotective effect and thus should not be considered as an FP option.
Do Not Miss the Tumor: A Novel Presentation of Osteosarcoma
Authors: Michael DePalma, Sachin Gupta, Jie Nguyen, Divya Talwar, Alexandre Arkader, Lawrence Wells
Journal: Case Rep Pediatr (2021)
MeSH terms: Case Reports

Antalgic gait is a common clinical presentation among pediatric patients and can have many different etiologies, with rare life-threatening etiologies including primary bone malignancies. Osteosarcoma is the most common primary malignancy of bone in pediatric and adolescent patients. The incidence rate of osteosarcoma has been reported as high as 5 to 7 per million among patients 19 years old or younger with males slightly more affected than females and African-Americans more than other racial groups. This report describes the case of a five-year-old African-American female who presented with an antalgic gait secondary to osteosarcoma in the left distal femur and follows her through treatment. In this case, the age is atypical as the peak incidence for osteosarcoma is around 16 years of age and is postulated to coincide with growth spurts. Osteosarcoma can have a range of presentations making it difficult to diagnose, which can cause delays in treatment and potential poor patient outcomes. Due to this, such a diagnosis must be included in the differential for patients presenting with antalgic gait. Because primary-care physicians and pediatricians may be the first medical providers to encounter patients with osteosarcoma, it is imperative that such clinicians are familiar with the signs and symptoms associated with osteosarcomas in order to reduce the risk of metastasis and disease progression and prevent treatment delays. Additionally, we believe these clinicians should have a low threshold to refer patients to orthopedists or oncologic specialists in the cases of persistent pain or inconsistencies with history, physical exam, and diagnostic studies. Finally, direct communication and discussion between radiologists and referring clinicians helps decrease delays in diagnosing of osteosarcoma and other life-threatening conditions.
Antiretroviral activity of 5-azacytidine during treatment of a HTLV-1 positive myelodysplastic syndrome with autoimmune manifestations
Authors: Panagiotis T Diamantopoulos, Maria Michael, Olga Benopoulou, Efthymia Bazanis, George Tzeletas, John Meletis, George Vayopoulos, Nora-Athina Viniou
Journal: Virol J (2012)
MeSH terms: Anti-Retroviral Agents / administration & dosage, Antimetabolites, Antineoplastic / administration & dosage, Autoimmune Diseases / drug therapy, Azacitidine / administration & dosage, HTLV-I Infections / drug therapy, Human T-lymphotropic virus 1 / drug effects, Myelodysplastic Syndromes / drug therapy, Case Reports, Human T-lymphotropic virus 1 / genetics, Human T-lymphotropic virus 1 / isolation & purification, Humans, Male, Middle Aged, Polymerase Chain Reaction, Treatment Outcome, Anti-Retroviral Agents, Antimetabolites, Antineoplastic, Azacitidine

Myelodysplastic syndromes (MDS) are often accompanied by autoimmune phenomena. The underlying mechanisms for these associations remain uncertain, although T cell activation seems to be important. Human T-lymphotropic virus (HTLV-1) has been detected in patients with myelodysplastic syndromes, mostly in regions of the world which are endemic for the virus, and where association of HTLV-1 with rheumatological manifestation is not rare. We present here the case of a 58 year old man who presented with cytopenias, leukocytoclastic vasculitis of the skin and glomerulopathy, and was diagnosed as MDS (refractory anemia with excess blasts - RAEB 1). The patient also tested positive for HTLV-1 by PCR. After 8 monthly cycles of 5-azacytidine he achieved a complete hematologic remission. Following treatment, a second PCR for HTLV-1 was carried out and found to be negative. This is the first report in the literature of a HTLV-1-positive MDS with severe autoimmune manifestations, which was treated with the hypomethylating factor 5-azacitidine, achieving cytogenetic remission with concomitant resolution of the autoimmune manifestations, as well as HTLV-1-PCR negativity. HTLV-1-PCR negativity may be due to either immune mediated clearance of the virus, or a potential antiretroviral effect of 5-azacytidine. 5-azacytidine is known for its antiretroviral effects, although there is no proof of its activity against HTLV-1 infection in vivo.
Atypical presentation of traumatic aortic injury
Authors: Andrew Fu Wah Ho, Tallie Wei-Lin Chua, Puneet Seth, Kenneth Boon Kiat Tan, Sohil Pothiawala
Journal: Case Rep Emerg Med (2014)

Background. Blunt thoracic aorta injury (BAI) is second only to head injury as cause of mortality in blunt trauma. While most patients do not survive till arrival at the hospital, for the remainder, prompt diagnosis and treatment greatly improve outcomes. We report an atypical presentation of BAI, highlighting the diagnostic challenges of this condition in the emergency department. Case Presentation. A previously well 25-year-old male presented 15 hours after injury hemodynamically stable with delirium. There were no signs or symptoms suggestive of BAI. Sonography showed small bilateral pleural effusions. Chest radiograph showed a normal mediastinum. Eventually, CT demonstrated a contained distal aortic arch disruption. The patient underwent percutaneous endovascular thoracic aortic repair and recovered well. Conclusion. This catastrophic lesion may present with few reliable signs and symptoms; hence, a high index of suspicion is crucial for early diagnosis and definitive surgical management. This paper discusses the diagnostic utility of clinical features, injury mechanism, and radiographic modalities. Consideration of mechanism of injury, clinical features, and chest radiograph findings should prompt advanced chest imaging.
Juvenile dermatomyositis and nephrotic syndrome: A case report and a mini literature review
Authors: Weiran Zhou, Linlin Dong, Xuemei Liu, Chunhua Dong, Hongxia Zhang
Journal: Front Pediatr (2023)
Keywords: adalimumab, anti-nxp2, case report, juvenile dermatomyositis, nephrotic syndrome
MeSH terms: Case Reports

Background:
Renal involvement is rarely reported in juvenile dermatomyositis and may be caused by the toxic effects of myoglobinuria or an autoimmune reaction. We report a case of dermatomyositis and nephrotic syndrome in a child to explore the association between juvenile dermatomyositis and renal involvement.
Case presentation:
An 8-year-old girl with skin rash, edema, proximal muscle weakness predominantly involving the lower extremities, low-grade fever, and foamy urine was admitted to our hospital. Her laboratory tests met the criteria of nephrotic syndrome. She had elevated creatine kinase and lactate dehydrogenase and was diagnosed with juvenile dermatomyositis after electromyography and muscle MRI. Anti-NXP2 antibodies were positive. Her proteinuria was relieved soon after treatment with prednisone and methotrexate, but her muscle strength progressively decreased. The disease was relieved after pulse methylprednisolone treatment and mycophenolate mofetil, but recurred after drug reduction with mild proteinuria. Adalimumab was used for treatment and helped reduce the doses of glucocorticoid and mycophenolate mofetil.
Conclusion:
Juvenile dermatomyositis may be one of the rare causes of nephrotic syndrome. The mechanism involved in JDM combined with renal injury may be multifactorial. Autoantibodies may play important roles in both muscle and renal damage.
Solid Pseudopapillary Tumor of the Pancreas in a 50-Year-Old Man: A Case Report and Review of the Literature
Authors: Xie Hongjian, Li Dujuan, Xue Shuang, Zhao Yuewu, Kong Lingfei
Journal: Case Rep Pancreat Cancer (2016)
Keywords: pancreatic neoplasm, pancreatic tumor, solid pseudopapillary tumor
MeSH terms: Case Reports

Background: A solid pseudopapillary tumor (SPT) of the pancreas is a rare neoplasm with low malignancy, constituting about 2% of pancreatic tumors, which mainly occurs in young women. Case Presentation: We herein report a case of a small SPT arising from the head of the pancreas in an asymptomatic 50-year-old man. This patient was admitted to our department at Henan Provincial People's Hospital for the evaluation of a pancreatic mass and a pancreatic resection was performed. Histology revealed the lesion to be an SPT of the pancreas, with the characteristic pseudopapilla formation, central degeneration, and capsule formation. The tumor was positive for vimentin, CD10, α1-antichymotrypsin, α1-antitrypsin, β-catenin, neuron-specific enolase, synaptophysin, and progesterone receptor. Conclusion: We diagnosed an SPT in the patient based on these histological findings and immunophenotype.
Uterine Carcinosarcoma with Alpha-Fetoprotein-Producing Hepatoid Component: A Case Report and Literature Review
Authors: Joshua J X Li, Jacqueline H S Lee, Vicky T C Chan, Mei-Yung Yu
Journal: Case Rep Pathol (2018)
MeSH terms: Case Reports

A 67-year-old woman presented with postmenopausal vaginal bleeding. Full body imaging demonstrated an intrauterine mass with deep myometrial invasion but no nodal or other metastatic disease. Uterine curettage was performed. Histologically, the tumor was an endometrioid adenocarcinoma with sarcomatous element and a hepatoid component, the latter was immunohistochemically positive for alpha-fetoprotein, HepPar-1, and arginase-1. The patient underwent total abdominal hysterectomy and bilateral salpingo-oophorectomy. Serum alpha-fetoprotein level decreased from 31896 ug/l preoperatively to 2063 ug/l postoperatively. Eight weeks later, a rise in serum alpha-fetoprotein was detected, and a biopsy-proven vaginal recurrence was diagnosed. Palliative chemotherapy led to tumor shrinkage and a concurrent decrease in the serum alpha-fetoprotein level. A rise in serum alpha-fetoprotein, refractory to second-line chemotherapy, was accompanied by subsequent development of ureteric obstruction, ascites, and radiological evidence of peritoneal metastases. This is an unusual case of uterine carcinosarcoma with an alpha-fetoprotein-producing hepatoid adenocarcinoma component. Serum alpha-fetoprotein level corresponds to disease recurrence and progression.
Superior vena cava thrombosis and dilated cardiomyopathy as initial presentations of Behcet's disease
Authors: Ahmed M Elzanaty, Mohammed T Awad, Ashu Acharaya, Ebrahim Sabbagh, Eman Elsheikh, Moshrik AbdAlamir
Journal: Thromb J (2020)
Keywords: behcet’s disease, dilated cardiomyopathy, svc thrombosis
MeSH terms: Case Reports

Background:
Bechet's disease (BD) is a relatively rare disease that causes recurrent oral and genital ulcers in addition to a variety of systemic manifestations. Concomitant superior-vena-cava (SVC) thrombosis and cardiac involvement with dilated cardiomyopathy (DCM) as initial presentations for BD is considered rare.
Case presentation:
A 32-year-old-man presenting with intractable headaches and dyspnea. He was later diagnosed with SVC thrombosis and DCM. A diagnosis of BD was made after detailed history-taking.
Conclusions:
Cardiovascular manifisations can be the initial presentation of BD. We aim to highlight the importance of early clinical recognition of BD as a cause of DCM and SVC thrombosis.
Bilateral mandibular premolar dens invaginations: a case report
Authors: Richard Holliday, Emma Beecroft
Journal: Case Rep Dent (2012)

Dens invaginations are a rare developmental defect most commonly affecting maxillary lateral incisors, with very few reported cases in mandibular teeth. We describe a rare case of bilateral first mandibular premolar dens invaginations type I, where apparently health teeth presented with periapical pathology.
Case report: Incidence and prognostic value of brain MRI lesions and elevated cerebrospinal fluid protein in children with Guillain-Barré syndrome
Authors: Francesco Pizzo, Alessandra Di Nora, Alessia Di Mari, Giuseppe Costanza, Elisabetta Testa, Marianna Strazzieri, Filippo Greco, Tiziana Timpanaro, Antonio Basile, Giuseppe Belfiore, Andrea Giugno, Roberta Rocca, Martino Ruggieri, Agata Fiumara, Piero Pavone
Journal: Front Neurol (2022)
Keywords: csf, guillain–barré syndrome, mri, childhood, clinical outcome, neurology-clinical
MeSH terms: Case Reports

Background:
Guillain-Barrè syndrome (GBS) is an acute immune-mediated disorder affecting peripheral nerves and nerve roots with a variable clinical course and outcome. Epidemiologic analyses have revealed that the incidence of the syndrome increases linearly among the age. The clinical diagnosis of GBS is based on the family history, physical and neurological examination, electrodiagnostic exams, and cerebrospinal fluid analysis with the classical presence of albumin-cytologic dissociation. Prognosis is associated with the severity of clinical signs and the type of peripheral nerves involved.
Methods:
This study aims to clarify which clinical features can be used for prognostic purposes. We evaluated the correlation between (1) brain MRI lesions and grade of disability; (2) brain MRI lesions and elevated cerebrospinal fluid (CSF) protein; and (3) increased levels of CSF protein and grade of disability. Statistical analysis extracted from these data indicated a good correlation to be a prognostic indicator in children affected by GBS. We found little evidence regarding laboratory tests, imaging, and prognosis. We enrolled 12 continuous patients who met the Brighton criteria for GBS in this retrospective study. Each patient was clinically evaluated at the time of disease onset to assess the GBS disability score and after 2 weeks.
Results:
We estimated Pearson's correlation index to evaluate the possible correlation between MRI and disability and CSF protein levels and disability. The correlation coefficient was 0.92 and 0.85, respectively. In addition, we developed a graph to see the trend of the disability values, proteins in the CSF, and damage assessed with MRI in the 12 patients. It seems that these parameters have a parallel trend and a good correlation in each patient. Finally, we calculated the correlation between MRI and CSF protein values, with an r-value of 0.87. The values suggest a correlation among the MRI score, CSF protein, and prognosis.
Conclusion:
The MRI and CSF laboratory parameters can be important tools for the clinician not only for diagnosis but also to evaluate the possible worsening of general conditions or the need to prepare measures to support life parameters. Patients who need ventilatory support could be established early from patients who have less severe GBS and can begin rehabilitation earlier. We suggest MRI should be performed routinely in children with GBS to be able to estimate the evolution of the clinical condition.
HIV-Associated Vacuolar Myelopathy and HIV-Associated Dementia as the Initial Manifestation of HIV/AIDS
Authors: Natalia Wuliji, Matthew J Mandell, Jason M Lunt, Adam Merando
Journal: Case Rep Infect Dis (2019)
MeSH terms: Case Reports

HIV-associated vacuolar myelopathy (HIV-VM) is the most common cause of spinal disease in HIV/AIDS. HIV-VM causes progressive spastic paraparesis, sensory ataxia, and autonomic dysfunction. It is a progressive myelopathy that shares features with subacute combined degeneration seen in vitamin B12 deficiency as well as other neurological diseases and can occur synchronously with HIV-associated dementia (HAD). Here, we describe a rare case in which a patient's initial presentation of HIV/AIDS was both HIV-VM and HAD. A fifty-three-year-old man presented with a six-month history of numerous falls due to progressive gait instability with associated memory loss, tremor, urinary retention, and impotence. His exam was significant for hyperreflexia and weakness in bilateral lower extremities, upgoing plantar reflex, dysmetria, and ataxic gait. MRI-brain was notable for nonspecific volume loss and diffusely increased T2 signal throughout the supratentorial white matter. Lumbar puncture showed isolated lymphocytic pleocytosis with all other CSF testing unremarkable. He ultimately tested positive for HIV-1, with a CD4 count of 157 cells/mm3 and a viral load of 874,000 copies/mL. He was diagnosed with HIV-VM and HAD which improved after several months of antiretroviral therapy. This case highlights the importance of considering HIV testing in a patient with a sensory neuropathy and/or progressive cognitive impairment.
Isolated internal iliac artery aneurysm causing rectal necrosis due to compression early after endovascular repair: A case report
Authors: Toru Imagami, Satoru Takayama, Taku Hattori, Ryohei Matsui, Hisanori Kani, Akimitsu Tanaka, Satoshi Kurokawa
Journal: Int J Surg Case Rep (2019)
Keywords: endovascular repair, isolated internal iliac artery aneurysm, rectal necrosis, residual aneurysm

Introduction:
Recently, endovascular repair has become the first-line treatment for internal iliac artery aneurysm (IIAA). However, rectal necrosis due to the compression of the residual IIAA early after endovascular repair is rare.
Presentation of case:
We present a rare case of a huge, isolated left IIAA that severely compressed the rectum and ureter. The patient underwent emergency endovascular repair; however, rectal necrosis occurred 10 days later because the repair failed to shrink the size of the aneurismal sac.
Discussion:
We hypothesize that the compression of the residual IIAA caused rectal necrosis. During open surgery, endovascular repair disrupted blood flow within the IIAA, which probably allowed for aneurysm dissection and residual hematoma removal.
Conclusion:
Endovascular repair alone could not immediately release compression on the surrounding organs; however, open surgical removal of aneurysms after successful endovascular repair may be a useful option for IIAAs with compression of surrounding organs.