OpenMed/multicare-articles huggingface dataset:
Fluorescence-Guided Identification of the Thoracic Duct by VATS for Treatment of Postoperative Chylothorax: A Short Case Series
Authors: Francesco Londero, William Grossi, Massimo Vecchiato, Antonio Martino, Antonio Ziccarelli, Roberto Petri, Angelo Morelli
Journal: Front Surg (2022)
Keywords: vats, case series, chylothorax, indocyanine green, thoracic duct, thoracic surgery
MeSH terms: Case Reports

Background:
Chylothorax is a relatively rare complication after surgery of the mediastinum. The occurrence and the results of surgical treatment of this condition are difficult to foresee due to the wide heterogeneity in thoracic duct anatomy.
Case summary:
We report two cases of postoperative chylothorax treated with ligation by video-assisted thoracoscopic surgery (VATS). The first patient developed a massive left chylothorax shortly after discharge, following radical excision of a seminoma-involved left para-aortic lymphadenopathy. The second patient developed a high-output right chylothorax following VATS upper bilobectomy. In both cases, a surgical revision by VATS was performed. Inguinal injection of indocyanine green allowed an easy visualization of the lymphatic leakage point. In both cases, oral feeding was rapidly restarted after surgery. No recurrence of chylothorax was observed.
Conclusion:
The use of indocyanine green may greatly improve the identification of the thoracic duct during surgical ligation by VATS, with a favorable impact on the postoperative course and overall admission costs.
Infection with Clostridioides difficile ribotype 046 in a paediatric liver transplant patient
Authors: Hildenia B R Nogueira, Cecília L Costa, Conceição S Martins, Maria Luana G S Morais, Carlos Quesada-Gómez, Cibele B M Carvalho, Eliane de Oliveira Ferreira, Gerly Anne de Castro Brito
Journal: Access Microbiol (2021)
Keywords: clostridioides difficile infection, liver transplant, molecular characterisation, paediatric
MeSH terms: Case Reports

Clostridioides difficile causes nosocomial diarrhoea associated with antibiotic use and immunodeficiency. Although the number of paediatric C. difficile infections (CDIs) has increased worldwide, there are few studies on the molecular characterization of strains causing CDIs among children. We report the clinical features and strain molecular characterization of a CDI in a female child with a history of liver transplantation at 7 months of age. This is the first report of the 046 ribotype causing paediatric diarrhoea.
Axitinib Reverses Resistance to Anti-Programmed Cell Death-1 Therapy in a Patient With Renal Cell Carcinoma
Authors: Yonghao Yang, Hao Huang, Tiepeng Li, Quanli Gao, Yongping Song, Zibing Wang
Journal: Front Immunol (2021)
Keywords: pd-1, anti-angiogenic, axitinib, immunotherapy, low-dose, resistance
MeSH terms: Antibodies, Monoclonal, Humanized / therapeutic use, Antineoplastic Combined Chemotherapy Protocols / therapeutic use, Axitinib / therapeutic use, Carcinoma, Renal Cell / drug therapy, Drug Resistance, Neoplasm, Immune Checkpoint Inhibitors / therapeutic use, Kidney Neoplasms / drug therapy, Programmed Cell Death 1 Receptor / antagonists & inhibitors, Protein Kinase Inhibitors / therapeutic use, Case Reports, Research Support, Non-U.S. Gov't, Review, Antibodies, Monoclonal, Humanized / adverse effects, Antineoplastic Combined Chemotherapy Protocols / adverse effects, Carcinoma, Renal Cell / immunology, Carcinoma, Renal Cell / metabolism, Carcinoma, Renal Cell / secondary, Chemotherapy, Adjuvant, Female, Humans, Immune Checkpoint Inhibitors / adverse effects, Kidney Neoplasms / immunology, Kidney Neoplasms / metabolism, Kidney Neoplasms / pathology, Middle Aged, Programmed Cell Death 1 Receptor / metabolism, Treatment Outcome, Antibodies, Monoclonal, Humanized, Immune Checkpoint Inhibitors, PDCD1 protein, human, Programmed Cell Death 1 Receptor, Protein Kinase Inhibitors, sintilimab, Axitinib

Owing to broad and notable clinical anti-tumor activity, anti-programmed cell death-1 (PD-1)/anti-programmed cell death-ligand 1 (PD-L1) antibodies have been indicated for almost all types of cancer, and form a part of the current standard of care. However, a large proportion of patients do not respond to anti-PD-1/PD-L1 therapy (primary resistance), and responders often develop progressive disease (acquired resistance). The mechanisms of resistance are complex and largely unknown; therefore, overcoming resistance remains clinically challenging, and data on reversing anti-PD-1 resistance are scarce. Herein, we report the case of a 58-year-old woman with renal cell carcinoma associated with Xp11.2 translocation/transcription factor E3 gene fusion, who had already showed resistance to both anti-PD-1 monotherapy and standard-dose axitinib. However, she finally achieved a partial response with a continuous combination therapy comprising low-dose axitinib and anti-PD-1. We speculate that axitinib played a key role in reversing the primary resistance to anti-PD-1 therapy. Interestingly, we observed that the number of peripheral regulatory T cells increased after the standard-dose axitinib therapy, with accompanied tumor enlargement; however, after the dose was reduced, the number of regulatory T cells decreased gradually, and the tumor regressed. We also reviewed relevant literature, which supported the fact that low-dose axitinib might be more beneficial than standard-dose axitinib in assisting immunotherapy. Given that this is a single-case report, the immunomodulatory effect of axitinib requires further investigation.
Congenital hyperinsulinsim: case report and review of literature
Authors: Brahim El Hasbaoui, Abdelhkim Elyajouri, Rachid Abilkassem, Aomar Agadr
Journal: Pan Afr Med J (2020)
Keywords: congenital hyperinsulinism, gene mutations, insulin, neonatal hypoglycemia
MeSH terms: Congenital Hyperinsulinism / diagnosis, Seizures / etiology, Case Reports, Review, Congenital Hyperinsulinism / physiopathology, Diazoxide / administration & dosage, Fatal Outcome, Female, Humans, Infant, Newborn, Severity of Illness Index, Diazoxide

Neonatal hypoglycemia (NH) is one of the most common abnormalities encountered in the newborn. Hypoglycemia continues to be an important cause of morbidity in neonates and children. Prompt diagnosis and management of the underlying hypoglycemia disorder is critical for preventing brain damage and improving outcomes. Congenital hyperinsulinism (CHI) is the most common and severe cause of persistent hypoglycemia in neonates and children, it represents a group of clinically, genetically and morphologically heterogeneous disorders characterised by dysregulation of insulin secretion from pancreatic β-cells. It is extremely important to recognize this condition early and institute appropriate management to prevent significant brain injury leading to complications like epilepsy, cerebral palsy and neurological impairment. Histologically, CHI is divided mainly into two types focal and diffuse disease. The diffuse form is inherited in an autosomal recessive (or dominant) manner whereas the focal form is sporadic in inheritance and is localized to a small region of the pancreas. Recent discoveries of the genetic causes of CHI have improved our understanding of the pathophysiology, but its management is complex and requires the integration of clinical, biochemical, molecular, and imaging findings to establish the appropriate treatment according to the subtype. Here we present a case of sever congenital hyperinsulinism in a girl admitted for lethargy, irritability and general seizures accompanied with profound hypoglycemia, in spite of aggressive medical treatment, she died because of sever congenital hyperinsulinism diazoxide unresponsive.
A Sizable Aortic Root Paravalvular Mycotic Pseudoaneurysm
Authors: Ahmad Saeed Azhar, Noran M Abu-Ouf
Journal: Case Rep Cardiol (2016)

Mycotic aneurysm is an established condition first identified in 1885 by Sir William Osler. It is linked to malignant endocarditis. With prevalence of 0.7-2.6% of all cases of aortic aneurysms, it is associated with a significant rate of mortality and morbidity. Physicians should be highly cautious, as diagnosis and effective treatment for this condition are difficult. The following is a case report of a 13-year-old pediatric patient diagnosed with mycotic aneurysm. Before an adequate treatment plan could be developed and implemented, patient's status worsened swiftly and was ultimately terminal. This case is the sole instance of this condition evidenced in the last ten years in Saudi Arabia.
A Rare Cause of Hypovolemic Shock in Prepubertal Girl: Vaginal Leech Infestation
Authors: W Lahmini, M Bourrous, K Harou
Journal: Case Rep Obstet Gynecol (2019)
MeSH terms: Case Reports

Vaginal bleeding in girls is an alarming symptom for both parents and pediatricians. Serious underlying causes should be always evoked. Case Report. We describe here a 9-year-old girl who was admitted at our emergency department for vaginal bleeding and severe anemia. No history of trauma and no evidence of prior abuse were reported by the parents. Full Blood Count showed profound anemia (hemoglobin at 4 g/dl). The child was managed as a hypovolemic shock and resuscitated with intravenous fluids and urgent blood transfusion. Gynecologic examination found a live leech at the vulva and the extraction was facilitated by applying a saline solution. The child was clinically stable and discharged home the next day with ambulatory treatment. Conclusion. This case emphasizes that a through external genital exam with possible exam under anesthesia should be undertaken in all girls with unexplained vaginal bleeding and that in those living in rural areas without potable water, leech infection should be considered.
Complete lumbarization with calcified disc herniations at L5S1 and S1-2 levels treated with percutaneous endoscopic interlaminar discectomy: a case report and technique note
Authors: Hou Lisheng, Ge Feng, Zhang Dong, Gao Tianjun, Nan Shaokui, Bai Xuedong, He Qing
Journal: Front Surg (2023)
Keywords: castellvi classification, calcified disc herniation, complete lumbarization, lumbosacral transitional disc, lumbosacral transitional vertebra (lstv), misdiagnosis, percutaneous endoscopic interlaminar discectomy (peid)
MeSH terms: Case Reports

Objective:
This study aims to report a case of a patient with complete lumbarization (Castellvi-IB) who developed symptomatic calcified disc herniations at L5S1 and lumbarized S1-2 levels and achieved excellent neurological recovery following percutaneous endoscopic interlaminar discectomy (PEID).
Summary of background data:
In 1984, Castellvi et al. classified lumbosacral transitional vertebra (LSTV) into four types. They incorrectly classified I LSTV anomalies as only type I sacralization, not realizing type I lumbarization also belonged to type I LSTV, with the latter exhibiting a well-developed S1-2 disc (lumbosacral transitional disc, LSTD). Patients with type I lumbarization rarely develop calcified disc herniations concomitantly at L5S1 and LSTD levels. PEID has been developed to perform discectomy for neurological decompression at the lumbar region, especially at the lowest level where the higher iliac crest and/or widened transverse process exists.
Methods:
A 47-year-old male presented to our hospital complaining of an intractable left leg radiating pain for 3 weeks after suffering from chronic radiating pain for 4 years. His physical examination found hyperalgesia at the lateral side of the left calf, decreased dorsal flexion strength of the ankle (grade 4/5), and a positive sign of straight leg raising test at the left side (30°). The preoperational Lumbar JOA (Japanese Orthopaedic Association) score was 12. Image examinations including whole spinal radiograph, MRI, and CT confirmed complete lumbarization (Castellvi-IB) with calcified disc herniations at L5S1 and LSTD levels at the left side. PEID was carried out at two index levels to accomplish decompression via the left approach.
Results:
The patient's neurological function recovered quickly. One day postoperatively, he began to walk without discomfort. After 3 months, his muscle strength recovered to normal, and after 6 months, the residual dysesthesia at his posterolateral calf disappeared. The follow-up Lumbar JOA score was 26.
Conclusion:
Calcified lumbar disc herniation could develop at two distal levels concomitantly in the case of type I complete lumbarization. This anomaly might be misinterpreted as a normal lumbar sequence by only lumbar MRI. PEID may be an effective procedure to treat such calcified disc herniations in a single visit.
Thrombus Formation on the Tricuspid Valve After De Vega's Annuloplasty and Repair of Endocardial Cushion Defect
Authors: Süleyman Çağan Efe, Tuba Unkun, Servet Izci, Murat Cap, Ruken Bengi Bakal, Rezzan Deniz Acar, Cetin Geçmen, Emrah Erdoğan, Nihal Ozdemir
Journal: J Cardiovasc Thorac Res (2014)
Keywords: congenital heart defects, mass, tricuspid valve
MeSH terms: Case Reports

Endocardial cushion defect (ECD) can be partial (with two distinct valves) or complete (only one atrioventricular valve), and surgical therapy is usually required. The optimal surgical technique is controversial but De Vega's annuloplasty is widely performed. Tricuspid valve thrombosis are rarely seen after surgery. We present a 39-year-old male patient with tricuspid valve thrombosis after De Vega's annuloplasty without the use of a ring.
Complications of new medications
Authors: Carlos J Roldan, Linda Paniagua
Journal: West J Emerg Med (2015)
MeSH terms: Bisphosphonate-Associated Osteonecrosis of the Jaw / etiology, Bone Density Conservation Agents / adverse effects, Diphosphonates / adverse effects, Fractures, Spontaneous / etiology, Imidazoles / adverse effects, Mandibular Fractures / etiology, Case Reports, Aged, Bisphosphonate-Associated Osteonecrosis of the Jaw / diagnosis, Female, Fractures, Spontaneous / diagnosis, Humans, Mandibular Fractures / diagnosis, Zoledronic Acid, Bone Density Conservation Agents, Diphosphonates, Imidazoles, Zoledronic Acid

Numerous mandibular pathologies are diagnosed in the emergency department (ED). We present the case of a woman with severe right-sided mandibular pain who was found to have a pathological fracture and osteonecrosis of the jaw (ONJ). The etiology of ONJ was found to be associated to previous use of zoledronic acid to treat osteoporosis. The aim of this case report is to discuss the etiology, diagnosis and treatment of ONJ secondary to the use of zoledronic acid and to outline a clinical condition rarely seen in the ED whose incidence might rise with the increasing use of bisphosphonates.
Orbito-sinal foreign body with floor fracture: an unusual presentation
Authors: Narendra Patidar, Saket Agrawal, Rukmendra Pratap Singh, Prerana Phadnis
Journal: GMS Ophthalmol Cases (2020)
Keywords: floor fracture, fracture repair, orbito-sinal foreign body
MeSH terms: Case Reports

Wooden foreign bodies penetrating through the orbit into paranasal sinuses are rare. We report a case of a young male who complained of double vision, pain and redness after a fall from a tree. There was no external wound over periocular skin. The clinical and radiological examination was suggestive of an inferior orbito-sinal wooden foreign body with floor fracture, which was managed by surgical removal of the foreign body and orbital floor fracture repair using a silicon sheet in a single sitting.
Septic Embolic Stroke Followed by Hemorrhage and Brain Abscess in a Patient with Systemic Infections: A Case Report and Literature Review
Authors: Jama A Mohamud, Jingtao Wu, Ye Jing, Yu Wang
Journal: Case Rep Radiol (2018)
MeSH terms: Case Reports

We report a case of 50-year-old man with a severe acute ischemic stroke followed by intracerebral hemorrhage and brain abscess due to systemic infection. His initial intracranial radiographic findings were normal but three days later MRI scan of the brain revealed well-defined rounded cystic lesion on the T2-weighted and T1-weighted images in the right basal ganglia; the lesion presented an area of diffusion restriction on DWI; lately the lesion was confirmed to be an early stage of cerebral abscess. A week later the patient was noted to have worsening neurological status and left extremity weakness, and emergency brain CT scan revealed massive intracerebral hemorrhage in the right occipital lobe; he underwent intracranial hematoma evacuation surgery. The hematoma was removed successfully, and the systemic infections were treated with antibiotics.
Disease stabilization with pembrolizumab for metastatic acral melanoma in the setting of autoimmune bullous pemphigoid
Authors: Kristen M Beck, Joanna Dong, Larisa J Geskin, Vincent P Beltrani, Richard G Phelps, Richard D Carvajal, Gary Schwartz, Yvonne M Saenger, Robyn D Gartrell
Journal: J Immunother Cancer (2016)
Keywords: anti-pd1, autoimmunity, bullous pemphigoid, immune-related adverse events [iraes], immunotherapy, metastatic melanoma, pembrolizumab

Background:
To date, patients with pre-existing autoimmune conditions have been excluded from immunotherapy trials out of concern for severe autoimmune exacerbations.
Case presentation:
We describe the first case of a patient with metastatic cKIT mutated acral melanoma, brain metastasis, and pre-existing severe autoimmune bullous pemphigoid (BP) with stable and asymptomatic disease 10 months after treatment with pembrolizumab. The patient experienced severe BP exacerbation after therapy with ipilimumab requiring systemic immune suppression, but nonetheless pembrolizumab was administered on further disease progression.
Conclusions:
This case suggests that pembrolizumab may confer more benefit than risk even in patients with known severe autoimmune conditions who require intermittent systemic immunosuppression.
Successful peripheral blood stem cells collection in imatinib pretreated and nilotinib-treated chronic myeloid leukemia patient
Authors: Samuel Vokurka, Vladimir Koza, Daniel Lysak, Michal Karas, Pavel Dvorak, Pavel Jindra, Marcela Hrabetova, Vera Vozobulova
Journal: J Oncol (2010)
MeSH terms: Case Reports

We report a case of a successful mobilization and harvest of the peripheral blood stem cells (PBSCs) in imatinib-pretreated and nilotinib treated 52-year-old woman diagnosed with Philadelphia chromosome-positive and BCR-ABL (b2a2) positive chronic phase CML in 2/2002. She failed interferon-alfa and imatinib treatment. She achieved her first complete molecular remission after 16 months of nilotinib treatment and later on was mobilized with filgrastim at a dose of 10 ug/kg/day applied subcutaneously once daily. The total number of 2.98 x 10(6) CD34+ cells/kg was harvested on the fourth day of the mobilization. The autologous graft of the stem cells was cryopreserved and tested for the residual disease: the FISH revealed negative results and the RT-PCR was positive (BCR-ABL/ABL ratio 0,0017 in RQ-PCR). To our knowledge, this is the first report of successful PBSC harvest in a patient significantly pretreated with imatinib and nilotinib.
The first description of severe anemia associated with acute kidney injury and adult minimal change disease: a case report
Authors: Yimei Qian, Sushil K Mehandru, Nancy Gornish, Elliot Frank
Journal: J Med Case Rep (2009)

Introduction:
Acute kidney injury in the setting of adult minimal change disease is associated with proteinuria, hypertension and hyperlipidemia but anemia is usually absent. Renal biopsies exhibit foot process effacement as well as tubular interstitial inflammation, acute tubular necrosis or intratubular obstruction. We recently managed a patient with unique clinical and pathological features of minimal change disease, who presented with severe anemia and acute kidney injury, an association not previously reported in the literature.
Case presentation:
A 60-year-old Indian-American woman with a history of hypertension and diabetes mellitus for 10 years presented with progressive oliguria over 2 days. Laboratory data revealed severe hyperkalemia, azotemia, heavy proteinuria and progressively worsening anemia. Urine eosinophils were not seen. Emergent hemodialysis, erythropoietin and blood transfusion were initiated. Serologic tests for hepatitis B, hepatitis C, anti-nuclear antibodies, anti-glomerular basement membrane antibodies and anti-neutrophil cytoplasmic antibodies were negative. Complement levels (C3, C4 and CH50) were normal. Renal biopsy unexpectedly displayed 100% foot process effacement. A 24-hour urine collection detected 6.38 g of protein. Proteinuria and anemia resolved during six weeks of steroid therapy. Renal function recovered completely. No signs of relapse were observed at 8-month follow-up.
Conclusion:
Adult minimal change disease should be considered when a patient presents with proteinuria and severe acute kidney injury even when accompanied by severe anemia. This report adds to a growing body of literature suggesting that in addition to steroid therapy, prompt initiation of erythropoietin therapy may facilitate full recovery of renal function in acute kidney injury.
Case Report: A Case Series of Rare High-Type Anorectal Malformations With Perineal Fistula: Beware of Urethral Involvement
Authors: Lim Hui Jun, Anette Jacobsen, Rambha Rai
Journal: Front Surg (2021)
Keywords: anorectal malformation, pediatric surgery, posterior sagittal anoplasty, reconstruction, urethral involvement
MeSH terms: Case Reports

Anorectal malformations (ARMs) are one of the more common congenital anomalies encountered in pediatric surgery where the majority are diagnosed in the early neonatal period. The etiology of ARM remains uncertain and is likely to be multifactorial. A majority of ARMs result from abnormal development of the urorectal septum in early fetal life. There can be a broad range of presentation features varying from low anomalies with perineal fistula to high anomalies mandating intricate management. To develop a standardized system for comparison in follow-up studies, the Krickenbeck classification was introduced according to the type of fistula. According to the Krickenbeck classification of ARM, those with a rectoperineal fistula are classified as low-type ARM and are usually managed with a perineal anoplasty without colostomy. In this case series, we describe two rare cases of distinct high and intermediate ARM with rectoperineal fistulas, which were thought to be low-type ARM but were subsequently found to have urethral involvement. Our cases consisted of high and intermediate ARMs, which were successfully treated with posterior sagittal anorectoplasty as described. These cases exemplified rare variants of ARM where rectoperineal fistulas can be associated with high-type anomalies. Rare-variant ARM with rectopenile or rectoscrotal fistula can be associated with high-type anomalies in contrast to classical rectoperineal fistulas. A high index of suspicion should remain in cases with previous urinary tract infection despite normal imaging. Careful planning is also needed with consideration of possible need for urethral repair during anoplasty, which was needed in both our cases.