OpenMed/multicare-articles huggingface dataset:
Mixed Neuroendocrine Carcinoma and Hepatocellular Carcinoma: A Case Report and Literature Review
Authors: Jianwei Lan, Deliang Guo, Xian Qin, Baiyang Chen, Quanyan Liu
Journal: Front Surg (2021)
Keywords: hcc, case reports, heterogeneous malignancies, neuroendocrine tumor, primary hepatic neuroendocrine tumor
MeSH terms: Case Reports

Background: Neuroendocrine tumors are heterogeneous malignancies that originate from the neuroendocrine system. Previous studies show that this cancer type mainly localizes in the gastrointestinal tract and often metastasizes to the liver. Primary liver neuroendocrine tumors are very rare and primary hepatic neuroendocrine tumors (PHNET) with concurrent hepatocellular carcinoma (HCC) are extremely rare. To the best of our knowledge, only few PHNET cases have been identified, making their diagnosis difficult. Here, we report the biggest ever reported and "deceiving" lesion of a mixed neuroendocrine-non-neuroendocrine neoplasm in the liver, aiming to raise awareness and improve treatment of the disease. Case Presentation: Here, we report a preoperative misdiagnosed case that presented with hepatocellular carcinoma clinical features and no extrahepatic tumors. Postoperative pathology confirmed that it was a mixed neuroendocrine-non-neuroendocrine neoplasm. The patient was then referred for etoposide and cisplatin-based chemotherapy. No disease recurrence was observed at the 6-month follow-up. Conclusion: We report a very rare and easily misdiagnosed case and we speculate that there were "undifferentiated cells" undergoing neuroendocrine and hepatocellular carcinoma differentiation, during which some hepatocellular carcinoma cells express neuroendocrine features. We recommend proper surgery and postoperative platinum-based chemotherapy in the management of this disease.
Pulmonary artery stenosis caused by a large aortic arch pseudoaneurysm detected 10 years after a minor trauma
Authors: Jalal Zamani, Kamran Aghasadeghi, Khalil Zarrabi, Alireza Abdi Ardekani, Abdolali Zolghadrasli
Journal: J Cardiovasc Thorac Res (2016)
Keywords: aortic arch pseudoaneurysm, blunt chest trauma, pulmonary artery compression
MeSH terms: Case Reports

Pseudoaneurysm of aorta is a rare condition usually seen after aortic surgeries or serious accidents. Here we report a 60 years old man without any previous medical condition who presented with non-specific symptoms and underwent different investigations for more than 1 year, until the presence of a continuous murmur raised suspicion toward his cardiovascular system. In echocardiographic and computed tomography (CT) angiographic studies a large pseudoaneurysm of aortic arch with compression effect on pulmonary artery was detected. At this stage he remembered having suffered a minor trauma 10 years ago. He finally underwent operation and his aortic wall was repaired successfully with a patch. This case highlights the importance of thorough history taking and physical examination in patients irrespective of symptoms and high index of suspicion to detect this life-threatening condition.
Recurrent parathyromatosis in a patient with concomitant MEN1 and CASR gene alterations: Clinical management of a case report and literature review
Authors: Giulia Sapuppo, Maria Ausilia Giusti, Demetrio Aricò, Romilda Masucci, Martina Tavarelli, Marco Russo, Gabriella Pellegriti
Journal: Front Endocrinol (Lausanne) (2023)
Keywords: casr alterations, men 1 syndrome, case report, parathyromatosis, somatostatin analogues (ssas)
MeSH terms: Hyperparathyroidism / pathology, Osteoporosis / pathology, Case Reports, Review, Adult, Calcium, Female, Humans, Neoplasm Recurrence, Local / pathology, Parathyroid Glands / diagnostic imaging, Parathyroid Glands / pathology, Receptors, Calcium-Sensing / genetics, Calcium, CASR protein, human, Receptors, Calcium-Sensing

Introduction:
Parathyromatosis is a rare cause of primitive hyperparathyroidism characterized by the presence of numerous parathyroid tissue foci in the neck/mediastinum, due to hyperplasia of parathyroid embryologic residues (primary-form) or to local parathyroid tissue implantation (secondary-form). 63 cases have been described in the literature. In our patient parathyromatosis was due to a combination of two mutations.
Case report:
A 36-years-old woman was diagnosed with osteoporosis secondary to primary hyperparathyroidism. Subsequent right parathyroidectomy showed a parathyroid adenoma. The follow-up was negative but after 10 years she had a relapse. The genetic screening showed a rare intronic mutation of the MEN1 gene and a heterozygous mutation never described in exon 8 of the CASR gene, coding for the calcium receptor. Calcemia and PTH increased over the years with the onset of nephrocalcinosis and the worsening of osteoporosis despite the therapy with Cinacalcet, bisphosphonates and Vitamin D. She had therefore two additional surgical procedures (parathyroid tissue without malignancy). At follow-up she showed elevated levels of PTH (>1000 pg/ml) and calcium (11.2 mg/dl) and CT scans multiple subcentimetric nodules in the neck/upper mediastinum. Since the 68Ga-DOTATATE showed an increased uptake in the neck/mediastinum, lanreotide was added. After two months there was a significant biochemical response but, unfortunately, after six months, the patient showed a new worsening.
Conclusions:
a rare case of parathyromatosis due to a combination of two genetic alterations never described. The main issues concern the diagnosis and the radical treatment. Somatostatin analogues may have a useful role in both diagnosis and therapy.
High-Frequency and Low-Intensity Patterned Transcranial Magnetic Stimulation over Left Dorsolateral Prefrontal Cortex as Treatment for Major Depressive Disorder: A Report of 3 Cases
Authors: Lizbeth Castillo-Aguilar, Alma E Ríos-Ponce, Edson Albano de Mendonca, Gabriel Villafuerte
Journal: Case Rep Psychiatry (2021)
MeSH terms: Case Reports

Current transcranial magnetic stimulation devices apply intense (near 1 tesla) repetitive magnetic pulses over a specific area of the skull at relatively lower frequencies (1-50 Hz). Nevertheless, different studies have shown that very small magnetic fields, at higher frequencies (50-1000 Hz.), produce therapeutic effects in major depressive disorder. We report the application of high-frequency and low-intensity patterned magnetic pulses over the left prefrontal dorsolateral cortex in three subjects diagnosed with clinical major depressive disorder. All three patients showed sharp changes in their self-reports as well as in the standardized clinical assessment. Hypothesized mechanisms of action of this new variant of magnetic stimulation are discussed.
IBUPROFEN-INDUCED ASEPTIC MENINGITIS: A CASE REPORT
Authors: Sofia Alexandra Pereira Pires, Ana Pereira Lemos, Ester Preciosa Maio Nunes Pereira, Paulo Alexandre da Silva Vilar Maia, João Patrício de Sousa E Alvim Bismarck do Agro
Journal: Rev Paul Pediatr (2019)
MeSH terms: Anti-Inflammatory Agents, Non-Steroidal / adverse effects, Ibuprofen / adverse effects, Meningitis, Aseptic / chemically induced, Case Reports, Adolescent, Diagnosis, Differential, Drug Hypersensitivity, Fever, Headache, Humans, Male, Meningitis, Aseptic / diagnosis, Treatment Outcome, Vomiting, Anti-Inflammatory Agents, Non-Steroidal, Ibuprofen

Objective:
To report a case of a male adolescent with the diagnosis of ibuprofen-induced meningitis. We discuss themain causes of drug-induced aseptic meningitis (DIAM) and highlight the importance of early recognition of DIAM, sothat the offending drug can be withdrawn, and recurrences prevented. Only few DIAM cases have been reported in pediatric age.
Case description:
A healthy 15-year-old boy presented to the emergency department with headache, nausea, dizziness, fever, conjunctival hyperemia and blurred vision 30 minutes after ibuprofen-intake. During his stay, he developed emesis and neck stiffness. Cerebrospinal ﬂuid analysis excluded infectious causes, and DIAM was considered. He totally recovered after drug withdrawal.
Comments:
DIAM is a rare entity, that should be considered in the differential diagnosis of an aseptic meningitis. The major causative agents are nonsteroidal anti-inflammatory drugs, particularly ibuprofen. Suspicion is made by the chronologic link between drug intake and the beginning of symptoms, but infectious causes should always be ruled out.
Abnormal Thyroid Function Laboratory Results Caused by Selective Serotonin Reuptake Inhibitor (SSRI) Antidepressant Treatment
Authors: Huijuan Liao, David S Rosenthal, Salini C Kumar
Journal: Case Rep Psychiatry (2023)
MeSH terms: Case Reports

Mental health issues, especially depressive disorders, are major burdens to the health care systems. This has been more pronounced since the onset of the COVID-19 pandemic. Selective serotonin reuptake inhibitors (SSRIs) are often prescribed for depression. Uncommonly appreciated, however, are the adverse effects these agents may have on thyroid function laboratory test results as well as the clinical thyroidal functional status of such patients, which may lead to erroneous diagnoses and inappropriate treatments. We report on a depressed woman who developed abnormal thyroid biochemical laboratory reports during fluoxetine therapy. After changing to the serotonin and norepinephrine reuptake inhibitor (SNRI) venlafaxine, the thyroid laboratory reports were normalized. In light of this, we wish to alert treating clinicians to this potential significant adverse effect.
Acute Abdomen due to Primary Omental Torsion and Infarction
Authors: S Occhionorelli, M Zese, L Cappellari, R Stano, G Vasquez
Journal: Case Rep Surg (2014)

Background. Torsion of greater omentum is a quite uncommon cause of acute abdomen. It can be primary or secondary but in both cases omentum twists upon itself and causes omental segmentary or diffuse necrosis. Symptoms are unspecific and preoperative diagnosis is difficult. The widespread and increasing use of computer tomography (CT) in differential diagnosis of acute abdomen can be useful for making a specific diagnosis. Objectives. This work aims to describe primary omental torsion in order to help avoid misdiagnosis, especially with acute appendicitis, which is eventually based solely on a physical examination. Case Report. We present a case of primary omental torsion in a young man and discuss contemporary methods in diagnosis and management of the condition. Conclusions. When a right diagnosis has been posed, possible treatments for omental torsion and necrosis are two: conservative or surgical. Conservative treatment had been rarely carried out because of frequent and important sequelae just like abdominal abscesses. Nowadays, surgical treatment, laparoscopic or laparotomic, is preferred because it is a safe method in diagnosis and management of this condition.
Clinical and Radiographic Success of Selective Caries Removal to Firm Dentin in Primary Teeth: 18-Month Follow-Up
Authors: Tássia Carina Stafuzza, Luciana Lourenço Ribeiro Vitor, Daniela Rios, Thiago Cruvinel Silva, Maria Aparecida Andrade Moreira Machado, Thais Marchini Oliveira
Journal: Case Rep Dent (2018)
MeSH terms: Case Reports

The selective caries removal is increasingly spreading in daily clinical practice because this minimally invasive technique treats deep carious lesion and decreases the risk of pulp exposure. This case report was aimed at describing the selective removal to firm dentin on the primary mandibular left first molar of a girl aged 7 years and 6 months. The Mineral Trioxide Aggregate (MTA Angelus™) was used as liner, and the tooth was definitively restored with resin-modified glass ionomer cement (Vitremer™). The clinical and radiographic following-up was performed at 6, 12, and 18 months after treatment. The treatment showed satisfactory results after 18-month following-up, suggesting that this minimally invasive approach for carious lesion removal can replace the total removal, when properly indicated. Notwithstanding, further randomized clinical trials with longer following-up periods are still necessary.
Secondary Hemophagocytic Lymphohistiocytosis: A Challenging Diagnosis in a Patient with Autoimmune Hepatitis
Authors: Colin Casault, Juan G Posadas-Calleja
Journal: Case Rep Crit Care (2019)
MeSH terms: Case Reports

Background:
We describe a case of secondary Hemophagocytic Lymphohistiocytosis (HLH) from autoimmune hepatitis mimicking severe sepsis in a man admitted to the intensive care unit.
Case presentation:
A 34-year-old Pakistani male with a prior history of biopsy-proven autoimmune hepatitis presented to a regional hospital with severe fever, cytopenias, hyperferritinemia, hypertriglyceridemia, splenomegaly, and a bone marrow biopsy showing hemophagocytosis. After ruling out mimicking conditions, a diagnosis of HLH was made using the HLH-2004 diagnostic criteria. He was treated with dexamethasone and etoposide, without bone marrow transplantation (BMT) due to poor functional status. At one-year after follow-up, he had returned to his baseline functional status without recurrence.
Conclusion:
We describe a rare case of secondary HLH in the setting of autoimmune hepatitis. Broadly, this case report educates clinicians to consider this potentially missed diagnosis. This case also informs clinicians that treatment of secondary HLH with BMT may not be necessary for the management of secondary HLH due to autoimmune hepatitis. Finally, it provides a detailed description of the natural history of a single patient with secondary HLH due to autoimmune hepatitis.
Corrective osteotomy of distal radius malunion after IIIB open fracture: Palmar approach - Case report
Authors: Cen Bytyqi, Hasime Qorraj, Arber Tolaj, Rrahman Hajdari
Journal: Int J Surg Case Rep (2019)
Keywords: case report, corrective osteotomy, malunion, open fracture type iiib

Background:
Despite the fact that distal radius fractures are the most common, open fractures are relatively uncommon. The aim of this study is to present the case with severe malunion of extra-articular left distal radius after open fracture grade IIIB (Gustillo). The treatment was done with open correctuve osteotomy and ostosynthesis with volar low profile plate.
Case presentation:
A 32-years old man was admitted to our departement because of severely malunited left distal radius extra-articular metaphyseal fracture after treatment of an open fracture. He was primary treated in a Regional Hospital with irrigation, debridement, antimicrobial cover, and immediate skeletal management through fixation with Kirschner's wires. No external fixator was used. He developed volar metaphyseal angulation after loss of primary reduction of K-wires fixation; therefore it required corrective surgical treatment. Because of malunion, open corrective osteotomy and bone grafting of distal radius with volar plating were done. Follow-up 20 months after surgery show deformity correction of radial volar inclination, height, and restitution of distal radioulnar joint.
Conclusion:
This case report offers an informative overview on this uncommon case of distal radius open fracture malunion treated successfully with volar approach corrective osteotomy. Corrective surgery is the primary therapy of choice in the this case. This method have shown to be safe and effective in treatment of distal radius malunion with volar angulation.
Transverse myelitis masquerading as cauda equina syndrome, stroke and cervical myelopathy
Authors: Sally Shin Jie Chan, Arun-Kumar Kaliya-Perumal, Quan You Yeo, Jacob Yoong Leong Oh
Journal: Biomedicine (Taipei) (2020)
Keywords: compressive myelopathy, corticosteroids, neurological disorder, spinal cord compression, transverse myelitis
MeSH terms: Case Reports

Transverse myelitis is an uncommon but well-defined neurological syndrome. However, a high index of suspicion is needed to diagnose this condition, especially when it occurs in concomitance with preexisting spinal canal stenosis. We report our patient, a 48 year old male, who initially presented to our spine clinic with acute onset unilateral lower limb weakness associated with urinary retention, which was suspected to be cauda equina syndrome due to a prolapsed intervertebral disc. However, initial magnetic resonance (MR) imaging showed only mild spinal canal stenosis from L2-L5 and C3- C6 levels; thus, the possibility of cauda equina syndrome was ruled out. A few days later, patient developed ipsilateral upper limb weakness giving an impression of hemiparesis due to stroke. However, imaging of brain returned normal. There was still a dilemma whether symptoms could be due to cervical myelopathy as there was mild cervical cord compression with early myelomalacia changes, but the findings were subtle to come to a definite conclusion. Subsequently, patient desaturated and required ventilatory support. Repeat MR imaging of the cervical spine revealed T2 hyperintensities spanning multiple levels in the cervical cord which highlighted the possibility of transverse myelitis and the diagnosis was clinched after a CSF analysis. Despite the debilitating effects, patient responded well to corticosteroid therapy and gradually recovered. This case is reported to highlight the diagnostic dilemma and the rapid progression of transverse myelitis that demands timely medical intervention to avoid permanent disabilities.
Case report: The effective response to pembrolizumab in combination with bevacizumab in the treatment of a recurrent glioblastoma with multiple extracranial metastases
Authors: Gang Yang, Yu Fang, Ming Zhou, Wei Li, Dapeng Dong, Jing Chen, Yong Da, Kunpeng Wang, Xinru Li, Xiaoyan Zhang, Tonghui Ma, Ge Shen
Journal: Front Oncol (2022)
Keywords: bevacizumab, case report, combined treatment, extracranial metastases glioblastoma, pembrolizumab
MeSH terms: Case Reports

Multiple extracranial metastases of recurrent glioblastoma are rare and often indicate a very poor prognosis. The main conventional treatments are chemotherapy, radiotherapy, chemoradiotherapy or antiangiogenic therapy. Median overall survival is 2.3 to 6 months after the detection of extracranial metastases, and to date, there is no effective treatment for these patients. Herein, we report a recurrent glioblastoma patient with lung metastasis treated with a combination therapy containing bevacizumab and pembrolizumab due to overexpression of PD-L1 and the absence of driver mutations. The progression-free survival was 11 months from lung metastases to bone metastases. This combination treatment was further used as maintenance therapy for another 11 months after bone metastasis and secondary dorsal metastasis because there was no suitable treatment alternative. The overall survival was 27 months after lung metastases, which is much longer than previously reported cases. To our knowledge, this was the first effective use of bevacizumab plus pembrolizumab in a glioblastoma patient with extracranial metastases. Furthermore, this was the first time that bevacizumab plus pembrolizumab was used as a maintenance treatment in glioblastoma, with 11 months of response. Importantly, we showed that such combination therapy may be a novel and effective therapy for glioblastoma patients with extracranial metastases.
Mycobacteriumabscessus-associated vertebral osteomyelitis in an immunocompetent patient: a rare case report and literature review
Authors: Muhammad Z Moral, Khusboo Desai, Abdul R Arain, Robert E O'Leary, Stefanos F Haddad, James P Lawrence
Journal: Spinal Cord Ser Cases (2019)
Keywords: bacterial infection, infection
MeSH terms: Mycobacterium Infections, Nontuberculous / pathology, Osteomyelitis / microbiology, Spinal Diseases / microbiology, Case Reports, Review, Aged, 80 and over, Anti-Bacterial Agents / therapeutic use, Debridement / methods, Drug Therapy, Combination / methods, Humans, Male, Mycobacterium Infections, Nontuberculous / therapy, Osteomyelitis / therapy, Spinal Diseases / therapy, Spine, Anti-Bacterial Agents

Introduction:
Vertebral osteomyelitis (VO) is an uncommon infection with Staphylococcus aureus as the most commonly implicated organism. VO caused by nontuberculous mycobacteria (NTM) such as Mycobacteriumabscessus (M. abscesscus) is exceedingly rare with only eight cases reported in literature.
Case presentation:
We report a rare case of an 82-year-old male with a remote history of trauma who was diagnosed with NTM vertebral osteomyelitis. The patient initially underwent a vertebroplasty of T12 and kyphoplasty of L1 for pathologic compression fractures. Subsequent cultures revealed M. abscessus. The patient further underwent an anterior T12-L2 corpectomy and debridement with instrumented fusion, as well as a posterior T9-L4 instrumentation and fusion. He received multi-agent antibiotic therapy; however, was ultimately unable to tolerate the aggressive treatment regimen and his prolonged postoperative course.
Discussion:
Nontuberculous mycobacteria vertebral osteomyelitis is exceedingly rare. NTM vertebral osteomyelitis is challenging to treat. Surgical management plays a limited role in early VO, but is the mainstay treatment in chronic VO. Early recognition of the condition and shared patient management with multidisciplinary teams is key to successfully treating cases of NTM VO.
The circle of security parenting and parental conflict: a single case study
Authors: Chiara Pazzagli, Loredana Laghezza, Francesca Manaresi, Claudia Mazzeschi, Bert Powell
Journal: Front Psychol (2014)
Keywords: attachment based intervention, circle of security parenting, parental conflict, pre-school age, secure base, single case study, support to parenting

The Circle of Security Parenting (COS-P) is an early attachment based intervention that can be used with groups, dyads, and individuals. Created in the USA and now used in many countries, COS-P is a visually based approach that demonstrates its central principles through videos of parent/child interactions. The core purpose of the COS-P is to provide an opportunity for caregivers to reflect on their child's needs and on the challenges each parent faces in meeting those needs. Even though there is a wide range of clinical settings in which child/parent attachment is an important component of assessment there is limited empirical data on when and how attachment based interventions are appropriate for specific clinical profiles and contexts. The aim of this paper is to present a clinical application of COS-P in order to explore and reflect on some specific therapeutic tasks where it works and on some clinical indicators and contexts appropriate for its application. A single case study of a father, "M." (43 years old) in conflict for the custody of his 5 years old daughter is reported. The Adult Attachment Projective Picture System (AAP), the Parenting Stress Index, the Strengths and Difficulties Questionnaire, and the Parental Alliance Measure, were administered pre- and post-intervention. The clinical significance analysis method revealed that numerous changes occurred in the father. The AAP showed improvements in the level of agency of self. M. made gains in his capacity to use internal resources and to increase his agency of self. M. was classified as recovered in his perception of the child's functioning and as improved in his parenting stress and parenting alliance with the mother. Considerations on specific contexts and clinical indicators for the application of COS-P are proposed.